DE102007052123A1 - Fusion image producing method, involves making registration of two-dimensional and three-dimensional image acquisition together in dependence of center line determined for acquisitions in context of production of fusion image - Google Patents

Abstract

The method involves three-dimensionally providing a center line (4) for a two-dimensional image acquisition and a three-dimensional image acquisition for a section of a blood vessel. A registration of the image acquisitions is made together in dependence of the center line determined for the image acquisitions in context of production of a fusion image. The center line is determined for two-dimensional image acquisition under the use of a magnetic positioning system for a medical instrument guided into the blood vessel.

Description

The The invention relates to a method for creating a fusion image from at least one two-dimensional and at least one three-dimensional on at least one blood vessel related medical Image capture and an associated medical Facility.

Image capture, the blood vessels in the body of one Patients show, for example, in the treatment of total occlusions of Vessels, so-called "chronic total occlusions "(CTOs) significant. In the case of such total occlusions of vessels, it is difficult to do this reopen minimally invasively by means of a catheter. For this are experienced Cardiologists required, and even for this one such intervention can by no means be regarded as unproblematic.

The Use of a system for locating the catheter to eliminate the Closure offers such support a clear support, since it is possible with such a system is, not only the location of the catheter, but also the orientation, So to capture the direction in which the catheter points, and this optionally in a live fluoro image, that while treatment is recorded. This offers the possibility the catheter during the treatment within the closed vessel without perforating the vessel. For such a leadership successfully performed can, must however, information about the course of the vessel is present, in the case of total occlusion in the two-dimensional X-ray angiogram not included. The missing information can be, for example from a three-dimensional image data set from computed tomography be won.

For this have to the vessel profile obtained from the computed tomography image or superimposed the corresponding image with the two-dimensional live fluoro image become. Problematic with such a fusion or overlay is the registration of the two pictures taken with very high Accuracy, taking in the described intervention for treatment from vascular occlusions one Accuracy in the submillimeter range is required. The registration is particularly problematic because the two images with different modalities were created.

Known In this context, it is only three-dimensional projections Image data sets to register with regard to two-dimensional images, so one Perform 2D / 3D registration (cf. for example, P. Penney, "Registration of Tomographic Images to X-ray Projections for Use in Image Guided Interventions " Dissertation, University of London, 1999).

Of the Invention is therefore the object of a method for creating a fusion image of at least one two-dimensional and at least a three-dimensional on at least one blood vessel related medical imaging, which improves in this regard is.

to solution This object is such a method is provided in which for the two-dimensional image acquisition and the three-dimensional image acquisition at least one centerline at least for a section at least a blood vessel three-dimensional is determined and depending the at least one for determined the two-dimensional and three-dimensional image acquisition Center line in the context of creating the fusion image a registration the two-dimensional and the three-dimensional image recording with each other is made.

The at least one two-dimensional and the at least one three-dimensional Image acquisition are thus merged into a fusion image by in both shots or for both recordings determined at least one centerline of a vessel will and for This center line is a registration. So it will be, for example for one certain section of a particular vessel such a midline generated or calculated, this generation for both to be merged image recordings carried out becomes. It is thus both in or for the two-dimensional recording as well as in or for defines the three-dimensional image data set such a center line or to these records determined, by means of a comparison or comparison of this center line in the different image recordings or image data sets the Image fusion can take place. Of course, the image fusion to be performed by other merger procedures not included in the calculation or calculation Centerline based, supported become. The determination of the centerline can be done with the three-dimensional Images are based solely on image data; but in addition can Also, more data can be used, especially in the two-dimensional Image recordings, around the centerline three-dimensional, ie with their spatial Coordinates, specify.

The use of such a centerline offers the advantage that this missing information can be supplemented in a comparatively simple manner, in particular in the case of treatment of a total occlusion of a vessel, ie if the information about the course of the vessel in the two-dimensional fluoroscopic image is completely missing for example, a targeted navigation of a catheter to allow the opening of the closed vessel cuttings.

Of course it is the method of image fusion using centerlines not on image acquisition related to an intervention at Vascular total occlusions limited, but The method can generally be a fusion of three-dimensional Images with two-dimensional images with a very high accuracy enable, So come in the widest variety of applications to the sentence.

background the method according to the invention is it that it is z. B. already known, with magnetic positioning systems or similar locating systems have a centerline for one still accessible vessel section take. Are such positioning or positioning systems in X-ray systems integrated, so can in this way three-dimensional, ie in terms of fixed in space, a center line is generated or determined, with the associated Two-dimensional fluoro image is registered and this is properly superimposed. In addition, you can as described from the three-dimensional images corresponding Center lines are obtained, which then with the two-dimensional Image to be assigned center line.

Accordingly, as medical imaging such as X-ray based image acquisition fused, in particular two-dimensional fluoroscopy images and three-dimensional computed tomography scans.

in the Application of the total closures of vessels can such a two-dimensional X-ray angiogram be superimposed with the three-dimensional data of a computed tomography image data set, so the corresponding required information about the course of the vessel to obtain.

there of course the registration is done that way Be that not just a single midline proximal to one Vascular closure for registration it is also used in sections for the ent speaking vessel respectively a midline over certain routes are determined and used for registration.

As well It is in principle conceivable that centerlines not only for a vessel, but in addition also for a for example, adjacent other vessel determined and for image fusion be used. However, the prerequisite is that, in particular for the two-dimensional image such a generation of a centerline in another vessel or a further vessel section at all possible is, so z. B. a location functionality for the centerline determination, for example, by a (further) medical tool or an implant with locating device or the like, is given.

At least a midline, especially for the two-dimensional image capture, as pictured using a location system for at least one in the context of a medical intervention in the Blood vessel introduced medical Instrument be determined.

It So, for example, an X-ray system with an associated Location system or integrated location system can be used with that, under support through appropriate software, determining a centerline in a two-dimensional image recording is possible. In this case can the three-dimensional centerline, for example, from computed tomography images be calculated. Of course but it is also possible that both or more centerlines using appropriate location systems or supported by them be determined. For example, already in the computed tomography recording a Catheters have been introduced with locating means.

At least a centerline can be made using at least one magnetic Location system to be determined. Of course locating systems can also be used where different locating principles or types of Position determination can be used in combination or in the different Locating devices are integrated.

Furthermore At least one may be determined using a location system Centerline for recorded an image recording with the image capture and, where appropriate be merged with this. So for example a magnetic positioning system integrated into an X-ray system, so can use this positioning system to create a centerline in the three-dimensional space, ie with the associated three-dimensional coordinates, be generated already with one or the two-dimensional Pictures of the X-ray system is registered. This centerline can be on demand or on demand fused by an operator with the two-dimensional image capture being represented.

For at least one intervention accompanying, especially in the context of the treatment of a complete vascular occlusion, created image capture, in particular for at least one live image acquisition, at least one centerline can be determined using a location system. The center line can thus be created with the aid of a location system for such image recordings, which were created as part of an intervention, for example a treatment of a vascular total occlusion. These may preferably be two-dimensional live fluoro images. Using the location system, in particular a magnetic locating system, determined centerline can then be the registration with the three-dimensional image data set for determining the vessel course in the "missing" section, ie the area of the total closure, which is not recognizable in the two-dimensional fluoroscopic image done.

At least one for at least one image taken during the intervention to create a certain midline can change one or the angulation and / or a Bildaufnah meposition of an associated image recording system automatically carried become. So if the shooting angle or angle of a for example, X-ray based Image acquisition system (eg by rotation of a C-arm to a to the axis of the central jet vertical axis) changed, so is for then at a different angle or from another position created images the center line automatically carried, without that a user input or a user action, for example, in the sense of initiating a new determination the location of the midline would be required.

By the automatic entrainment is always correct with, for example, the two-dimensional Fluoro image registered centerline before overlaying with the three-dimensional image data set with high accuracy easy way to enable based on the specific centerline.

in the Frame of registration of two-dimensional and three-dimensional Image recording or the (respectively) multiple image shots with each other can depend on at least one common image content at least one excellent Point of the at least one center line, in particular a starting point, To be defined. This point can then be the starting point or a comparison point for form the image registration. Accordingly, it is expediently around a point in the underlying anatomy, So z. For example, a point that refers to certain peculiarities of vascular anatomy or the shape, structure, etc. of the vessel goes back. In this way can as mentioned a starting point for a centerline. However, it is also conceivable a centerline based on its endpoint or midpoint or another excellent point used for registration be defined or this in the context of the registration is used.

Especially can be an excellent point depending on a vessel branch be defined, in particular depending on a respect an area of intervention of the proximal branch of the vessel.

Possibly may be a starting point of a centerline at the location of a bifurcation of the vessel in one concerning the proximal region of the intervention area. For example, a well recognizable bifurcation or branch of a larger vessel used to set the starting point of the center line. This bifurcation is, for example, in advance of a total closure, the distance to the intervention area with regard to the straight In this area required accuracy of fusion should not be too big.

Of course, for the respective centerlines also several excellent points, for example a start and an end point or the like.

The Fusion picture may be at least a vascular occlusion, in particular a complete one Vascular occlusion, preferably in cardiology, to be created.

Just at full Vascular occlusions exists namely the problem that in the two - dimensional X - ray angiogram the vascular course in the Area of the closure can not be reconstructed, so that Here, the creation of a fusion image with a three-dimensional Image data set is of particular advantage.

Of course they are but also other applications conceivable. Generally speaking with the inventive method a fusion of three-dimensional images with two-dimensional images in very different application areas with a very high Accuracy done.

The actual image fusion or the determination of centerlines can for example, with the help of a corresponding control and / or Processing device, if necessary fully automatic, performed.

The Fusion picture can be considered in the case of taking pictures of the heart at least one heart-phase-related information is created, especially considering a cardiac output based on an electrocardiogram Information.

So For example, when treating a vascular occlusion to be registered in the area of the heart, taking into account the phase information of the heart, for example in that each is corrected for the heart movement, or also in such a way that in each case shots fused for the same heart phase whereby the creation of the fusion image will facilitate the use of the Angiography image originally missing section for the Navigation of a catheter or other medical instrument by means of magnetic guidance devices or other principles of navigation. Basis for this is that the vessel in the three-dimensional image, so for example in the computed tomography recording, Also visible at the point where the vascular occlusion is present.

According to the invention centerlines for many Sections of a blood vessel and / or for many Blood vessels determined become. In this case, the registration can be done using a Variety of information to be performed with even greater accuracy.

The Determination of such center lines, for example for two-dimensional X-ray angiography recordings using the data of a positioning system is very simple and perform quickly, so that the use of multiple centerlines for multiple Vessels or Vessel sections to increase of merger accuracy.

Of Furthermore, the invention relates to a medical device, in particular to carry out a method as described above, with at least one Image recording means for producing at least one two-dimensional image and at least one three-dimensional relative to at least one blood vessel medical imaging and with means that are three-dimensional Determining at least one centerline for at least one Section of at least one blood vessel for two-dimensional image acquisition and the three-dimensional image recording and depending on the at least one for the two-dimensional and three-dimensional image acquisition specific midline as part of creating a fusion image from the two-dimensional and the three-dimensional image acquisition for registration of the two-dimensional and the three-dimensional image recording are formed with each other.

The Medical device thus comprises, on the one hand, imaging means, So for example, a computed tomography device and separately or integrated an x-ray system for generating X-ray angiographic images as 2D images, in particular as (intervention accompanying) 2D live fluoro images. Of Further, one or more are in the medical facility Means integrated to determine midlines for blood vessels. In these Means may be, for example, a control and / or Processing device, so a computer system, act, the data a magnetic device also integrated into the medical device or on a different principle based location system retrieves or supplied gets and uses this to determine the midline. Furthermore, funds are available to take into account the specific Center line registration of the two-dimensional or three-dimensional Take pictures together. This can also be done from the side the control and / or processing device take place, the already the determination of the midline from the CT scans or made the two-dimensional recordings.

So With the help of the medical device can merge three-dimensional Pictures with two-dimensional pictures very fast and with a high one Accuracy done. In particular, so will the required accuracy in the submillimeter range for a precise one Intervention on the patient allows.

there are the inventively generated or certain centerlines in relation to the course of the vessel transversal sectional images each points through their three-dimensional Position in the room are determined.

Further Advantages, features and details of the invention will be apparent from the following embodiments as well as from the drawings. Showing:

1 a two-dimensional Angiographieaufnahme to illustrate the creation of a fusion image according to the invention,

2 a sketch for carrying out a method according to the invention and

3 a medical device according to the invention.

In the 1 is a two-dimensional Angiographieaufnahmen 1 to illustrate the creation of a fusion image according to the invention. The angiography recording 1 shows a vessel structure 2 , which is a vascular structure in the heart. It lies in the area 3 a complete vascular occlusion, thus an area in which the vasoregrape in the Angiographieaufnahme 1 , which is a two-dimensional image, can not be recognized.

Especially the missing information over the course of the vessel in the area of the complete vascular occlusion 3 To obtain a registration with a three-dimensional image data set, which was recorded as part of a computed tomography, is now performed.

In order to be able to perform this fusion or registration, in the two-dimensional Angiographieaufnahme 1 a midline 4 of a vessel. The determination of the midline 4 is made in the present case using a magnetic locating system. This magnetic location system is integrated into the X-ray system and makes it possible to quickly and easily create a three-dimensional centerline, ie the center line 4 , to obtain. This midline 4 is with the angiography recording 1 is registered and is automatically carried along with a change in the angulation of the system and correctly superimposed on the image.

As starting point 5 the middle line 4 a proximal proximal branch of the vessel is used. The orientation information for the medical instrument, here the catheter for the removal of the vascular occlusion 3 , is present, by the arrow 6 indicated.

With Help of the fusion images thus created can be the missing information about the Obtained vessel course are at the same time due to the very high accuracy of Procedure the security for the patient in such interventions are significantly increased can.

The 2 shows a sketch for performing a method according to the invention, wherein on the one hand a two-dimensional image recording 7 On the other hand, a three-dimensional image recording 8th available. In the two-dimensional image recording 7 is a vessel structure 9 to recognize the vessel structure 10 that in the three-dimensional image capture 8th is shown corresponds. In the two-dimensional image recording 7 However, the vessel is in the range of a total occlusion, here in the area 11 not to be seen.

In order to be able to follow the course of the vessel by means of an image fusion, according to the invention a centerline indicated here by dashed lines 12 determined, this determination is three-dimensional, so that the centerline 12 or the individual points of the centerline 12 each three-dimensional coordinates are assigned in space.

As starting point 13 the centerline 12 used for registration, a vascular branch is used. The orientation of the catheter to remove the vascular occlusion is indicated by the arrow 14 indicated.

Also to the three-dimensional image acquisition 8th becomes a corresponding centerline 15 determined, which is also known with its three-dimensional coordinates and thus the center line of the two-dimensional image acquisition 7 equivalent. Also this centerline 15 has a corresponding starting point 16 at the point of the vessel branch on.

The two pictures 7 . 8th are registered with each other to the fusion image 17 in which in turn the centerline 18 represents is. The starting point is here with 20 designated.

Furthermore, the fusion image contains 17 an information regarding the orientation of the medical instrument, indicated here by the arrow 19 that from the two-dimensional recording 7 comes. In contrast to the two-dimensional image acquisition 7 However, due to the information from the three-dimensional image acquisition 8th It is also possible to detect the course of the vessel in the area of the total occlusion, so that the intervention can be carried out with reliable image accompaniment. Thanks to the fusion method according to the invention, there is sub-millimeter accuracy in the fused image, so that the method can be carried out with significantly higher safety and thus a correspondingly reduced risk of vessel perforation or other complications compared to previous methods.

In the 3 is finally a medical device according to the invention 21 shown via a computed tomography device 22 for recording three-dimensional computed tomography images and an angiography device 23 for the creation of two-dimensional angiographic images.

There is also a catheter system 24 provided, the catheter of which is for treatment in the vascular system of the patient 25 is magnetically locatable, so that accordingly a magnetic locating system for the catheter system 24 or the angiography device 23 is provided.

The control of the image acquisition operation and the image processing or fusion takes place via a control and processing device 26 with a computing component 27 and an image display means 28 , About the control and processing device 26 the control of the image recording operation and then the generation or determination of the desired center lines to one or more vessels shown in the image recordings or to specific vessel sections. Furthermore, by the control and processing device 26 in the present case a fully automated fusion of two-dimensional onal images of the angiography device 23 as well as the three-dimensional images of the computed tomography device 22 performed.

Of course, the fusion of the images or the image acquisition operation and the determination of the center lines alternatively or in other embodiments, operator-based or at least under confirmation of individual processing steps by an operator. For this purpose, a correspondingly modified software should be provided, wherein the operator input via appropriate tools such as a computer mouse or keyboard or the like, the control and processing device 26 are assigned, can take place.

As a general rule is an easy and fast way to use Centerlines Fusion of three-dimensional images with two-dimensional images, especially with regard to an intervention-accompanying Real-time representation of a vessel course, possible.

Claims (13)

Method for creating a fusion image ( 17 ) of at least one two-dimensional and at least one three-dimensional ( 7 . 8th ) on at least one blood vessel related medical image recording, characterized in that for the two-dimensional image recording ( 7 ) and three-dimensional image acquisition ( 8th ) at least one midline ( 4 . 12 . 15 . 18 ) is determined three-dimensionally, at least for a section of at least one blood vessel, and as a function of the at least one for the two-dimensional and three-dimensional image acquisition ( 7 . 8th ) certain centerline ( 4 . 12 . 15 . 18 ) in the context of the preparation of the fusion image ( 17 ) Registration of two-dimensional and three-dimensional image acquisition ( 7 . 8th ) is made with each other. Method according to claim 1, characterized in that as medical image recordings ( 7 . 8th ) X-ray-based image recordings are fused, in particular two-dimensional fluoroscopy images and three-dimensional computed tomography images. Method according to one of the preceding claims, characterized in that at least one center line ( 4 . 12 . 15 . 18 ), in particular for two-dimensional image acquisition, using a location system for at least one medical instrument introduced into the blood vessel as part of a medical intervention. Method according to claim 3, characterized in that at least one center line ( 4 . 12 . 15 . 18 ) is determined using at least one magnetic locating system. Method according to one of claims 3 or 4, characterized in that at least one center line determined using a locating system ( 4 . 12 . 15 . 18 ) is registered for an image acquisition with the image recording and possibly fused with this. Method according to one of claims 3 to 5, characterized in that for at least one intervention accompanying created image capture ( 7 . 8th ), in particular for at least one live image recording, at least one center line ( 4 . 12 . 15 . 18 ) is determined using a location system. A method according to claim 6, characterized in that at least one image taken for at least one intervention accompanying ( 7 . 8th ) certain centerline ( 4 . 12 . 15 . 18 ) is automatically carried on a change of an angulation and / or an image pickup position of an associated image acquisition system. Method according to one of the preceding claims, characterized in that in the context of the registration of the two-dimensional and the three-dimensional image recording ( 7 . 8th ) in dependence on at least one common image content at least one excellent point of the at least one center line, in particular a starting point ( 13 . 16 . 20 ). Method according to claim 8, characterized in that that at least one excellent point depending on a vessel branch is defined, in particular depending on one with respect to a Intervention area proximal branch of the vessel. Method according to one of the preceding claims, characterized in that the fusion image ( 17 ) in the context of an interventional treatment of at least one vascular occlusion, in particular a complete vascular occlusion, preferably in cardiology. Method according to one of the preceding claims, characterized in that the fusion image ( 17 ) is created in the case of image recordings of the heart, taking into account at least heart-phase-related information, in particular taking into account a cardiac-phase-related information determined on the basis of an electrocardiogram. Method according to one of the preceding claims, characterized in that center lines ( 4 . 12 . 15 . 18 ) for several sections of a blood vessel and / or for several blood vessels. Medical facilities ( 21 ), in particular for carrying out a method according to one of the preceding claims, having at least one image acquisition means for producing at least one two-dimensional and at least one three-dimensional medical image recording () relating to at least one blood vessel ( 7 . 8th ) and means for the three-dimensional determination of at least one center line ( 4 . 12 . 15 . 18 ) at least for a portion of at least one blood vessel for two-dimensional image acquisition ( 7 ) and three-dimensional image acquisition ( 8th ) and in dependence on the at least one for the two-dimensional and three-dimensional image recording ( 7 . 8th ) certain centerline ( 4 . 12 . 15 . 18 ) in the context of the preparation of a merger picture ( 17 ) from two-dimensional and three-dimensional image acquisition ( 7 . 8th ) for registration of two-dimensional and three-dimensional image acquisition ( 7 . 8th ) are formed with each other.