University of Twente Student Theses


Preoperative planning and intraoperative image fusion improvement during endovascular aneurysm repair

Smorenburg, S.P.M. (2019) Preoperative planning and intraoperative image fusion improvement during endovascular aneurysm repair.

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Abstract:Objective: To improve endovascular aneurysm repair (EVAR) preoperative planning by evaluating automated and manual 3D sizing measurements in two software programs and to improve automated image fusion registration Methods: A total of 40 patients with abdominal aortic aneurysms (AAA) treated with EVAR were retrospectively studied. Two study phases were defined. Phase one comprised EVAR preoperative planning and phase two comprised EVAR intraoperative image fusion of preoperative CTA and live fluoroscopy. During phase one, 30 patients were measured on aortoiliac diameters and lengths with two software programs following a standardized measuring protocol consisting of 23 measurements per patient. Three investigators were defined: two vascular surgeons with over ten years surgery and sizing experience and one technical physician. Absolute measurements (mm) and interclass correlation coefficients (ICC) were obtained and inter-observer variability was calculated. Also the measurements were timed. During phase two, 10 patients were evaluated with automated fusion software. An automated fusion prototype was developed with Philips (Best, the Netherlands). Preoperative computed tomography angiography (CTA) was fused with live fluoroscopy with the registration algorithm. Bone mismatch (mm) and vascular mismatch was measured (mm) and the registrations were timed. Results: For phase one, 1380 measurements were performed. ICC values of 0.95 or higher were reached for all manual measurements. The automated measurements resulted in lower ICC. For phase two, seven of the ten patients were fused fully automatically and three patients needed manual adjustment. A submillimetre bony mismatch was reached and a vascular mismatch of >5 mm. Conclusions: During preoperative planning, manual measurements have an almost perfect agreement when measured in two different software programs. Automated measurement agreement is lower. Additionally, automated fusion was successful with a submillimetre bony mismatch.
Item Type:Essay (Master)
Amsterdam UMC, Amsterdam, Netherlands
Philips, Best, Netherlands
Faculty:TNW: Science and Technology
Subject:02 science and culture in general, 30 exact sciences in general, 33 physics, 44 medicine, 50 technical science in general
Programme:Technical Medicine MSc (60033)
Awards:Best Vascular Poster Awards European Society for Cardiovascular and Vascular Surgery 2019 Congress - Groningen
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