Endovascular image-guided interventions (EIGIs)

Citation

Rudin, S., Bednarek, D. R., & Hoffmann, K. R. (2007). Endovascular image-guided interventions (EIGIs). Medical Physics, 34(12), 4602–4618. https://doi.org/10.1118/1.2821702

Keywords

  • Endovascular Image-Guided Interventions (EIGIs)
  • High-Resolution Detectors
  • Region of Interest Computed Tomography (ROI-CT)
  • Dose Tracking Systems
  • Interventional Devices
  • Quantitative Treatment Planning
  • Medical Physicist Role
  • Minimally Invasive
  • Fluoroscopy
  • Cone-Beam Computed Tomography (CBCT)
  • Computational Fluid Dynamics (CFD)

Brief

This article outlines six predictions for the future of endovascular image-guided interventions (EIGIs), including improvements in imaging, devices, treatment planning, and the role of medical physicists.

Summary

This article discusses the future of endovascular image-guided interventions (EIGIs), a minimally invasive approach to treating vascular diseases and cancer. The authors predict six major changes in the field within 7–10 years:

  • Improved Imaging: Higher-resolution, lower-noise, real-time imaging systems, especially for the region of interest (ROI) near the intervention site. This will be achieved through advancements in flat panel detectors (FPDs), such as the use of avalanche gain materials and new detector designs like the high-sensitivity microangiographic fluoroscope (HSMAF) and the solid-state x-ray image intensifier (SSXII).
  • High-Resolution 3D Imaging: High-resolution cone-beam computed tomography (CBCT) will be available for the ROI, enabling 3D roadmapping and automated catheter or guidewire tip superimposition. This will be achieved by combining ROI data with lower-resolution full-field-of-view CT images to reduce artifacts.
  • Precise Dose Monitoring: There will be improved accounting of patient dose distribution during EIGI, including techniques to minimize the total dose and deterministic effects. Real-time dose tracking systems will be implemented to calculate and display cumulative entrance skin dose distribution and dose rate.
  • Advanced Devices: Endovascular devices will become more refined, patient-specific, biocompatible, and complex, incorporating remotely actuated active components like shape memory alloys, micromachines, microfluidics, and microelectronics. This will be facilitated by advances in high-resolution imaging for precise device deployment.
  • Extensive Treatment Planning: Treatment planning for EIGIs will become more comprehensive, employing simulations to verify device selection, delivery, and to predict blood flow before, during, and after the intervention. These simulations will leverage 3D morphological information from imaging, computational fluid dynamic (CFD) calculations, and sophisticated models of the human vasculature.
  • Active Role of Medical Physicists: Medical physicists will assume a more prominent role in individual EIGI procedures and training. They will assist in device selection, delivery system optimization, and interpretation of CFD results. This expanded role will necessitate new training programs and certifications in EIGI physics for medical physicists.

The authors believe these advancements will lead to safer and more effective EIGI procedures, with medical physicists playing a crucial role in this progress.

Origin: https://aapm.onlinelibrary.wiley.com/doi/full/10.1118/1.2821702

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