X-Ray/Intravascular Imaging Colocation Method And System

Abstract

In the present invention, a method and associated system is provided that produces a new sequence of combined X-ray/fluoro images obtained in synchrony with intravascular dataset/images. This synchronization is based on the time tags recorded at the acquisition of one dataset of the X-ray/fluoroscopic images and the intravascular images/datasets and the cardiac cycle correspondence between the combined X-ray/fluoro datasets/images. The combined X-ray/fluoro and intravascular sensor images provided in the method for each position of intravascular measurement/slice along the blood vessel allows the physician the ability to determine the planned position of the treatment, e.g., a stent, in the X-ray/fluoro images based on the intravascular images, and allows an accurate assessment of the target/lesion location in the X-ray/fluoro images during treatment.

Claims

1. A method for producing enhanced X-ray images of a blood vessel/myocardium, the method comprising the steps of: obtaining a first set of X-ray images of the blood vessel/myocardium over a single cardiac cycle; obtaining a second set of X-ray images of the blood vessel/myocardium over a number of cardiac cycles; synchronizing the second set of X-ray images and the first set of X-ray images with regard to the portion of the cardiac cycle at which each image was obtained; and overlaying one of the first set of X-ray images with a synchronized one of the second set of X-ray images to produce a combined X-ray image.

2. The method of claim 1 further comprising the step of injecting a contrast agent into the blood vessel/myocardium prior to obtaining the first set of X-ray images.

3. A method for producing enhanced X-ray images of a blood vessel/myocardium, the method comprising the steps of: obtaining a first set of X-ray images of the blood vessel/myocardium over a single cardiac cycle; obtaining a second set of X-ray images of the blood vessel/myocardium over a number of cardiac cycles; obtaining a set of intravascular images of the blood vessel/myocardium concurrently with obtaining the second set of X-ray images; synchronizing the set of intravascular images and the second set of X-ray images with regard to the time each of the set of intravascular images and each of the second set of X-ray images was obtained; and overlaying one of the first set of X-ray images with a corresponding one of the second set of X-ray images to produce a combined X-ray image.

4. The method of claim 3 further comprising the step of injecting a contrast agent into the blood vessel/myocardium prior to obtaining the first set of X-ray images.

5. The method of claim 4, wherein the step of obtaining the first set of X-ray images provides clear images of the structure of the blood vessels/myocardium; and wherein the step of obtaining the second set of X-ray images provides clear images of a location of a catheter tip of an intravenous catheter within the blood vessels/myocardium and utilized to obtain the set of intravascular images.

6. The method of claim 3 further comprising the steps of: selecting one of the set of intravascular images for review after obtaining the set of intravascular images; reviewing the second set of X-ray images to determine the one of the second set of X-ray images obtained at the same time as the selected one of the set of intravascular images.

7. The method of claim 6 further comprising the steps of: recording a first ECG signal for the single cardiac cycle concurrently with obtaining the first set of X-ray images; and recording a second ECG signal for the number of cardiac cycles concurrently with obtaining the second set of X-ray images.

8. The method of claim 7 further comprising the steps of: reviewing the first ECG signal to determine a first point in the single cardiac cycle at which one of the first set of X-ray images was obtained; reviewing the second ECG signal to determine a second point within the number of cardiac cycles that the one of the second set of X-ray images obtained at the same time as the selected one of the set of intravascular images was obtained, wherein the second point closely corresponds to the first point in their respective positions within the respective cardiac cycles; and overlaying the one of the first set of X-ray images taken at the first point with the one of the second set of X-ray images taken at the second point to form the combined X-ray image.

9. The method of claim 8, wherein the step of overlaying the one of the first set of X-ray images with the one of the second set of X-ray images comprises processing at least one of the one of the first set of X-ray images or the one of the second set of X-ray images.

10. The method of claim 9, wherein the step of processing at least one of the one of the first set of X-ray images or the one of the second set of X-ray images comprises applying an image processing filter to the one of the second set of X-ray images that enhances curvilinear structures.

11. The method of claim 9, wherein the step of processing at least one of the one of the first set of X-ray images or the one of the second set of X-ray images comprises distorting the one of the second set of X-ray images in a known manner to compensate for motion of the blood vessels/myocardium induced by respiration.

12. The method of claim 9, wherein the step of processing at least one of the one of the first set of X-ray images or the one of the second set of X-ray images comprises the steps of: combining the first set of X-ray images to form a small video loop covering the single cardiac cycle overlaying each of the second set of X-ray images with the one of the first set of X-ray images corresponding to their respective positions within the respective cardiac cycles to form a video of the sequence of multiple cardiac cycles covered by the second set of X-ray images.

13. The method of claim 8, wherein the step overlaying the one of the first set of X-ray images taken at the first point with the one of the second set of X-ray images taken at the second point comprises overlaying the entire first set of X-ray images with the entire second set of X-ray images.

14. The method of claim 8 further comprising the step of displaying the combined X-ray image in conjunction with the selected one of the set of intravascular images.

15. The method of claim 14 wherein the step of displaying the combined X-ray image in conjunction with the selected one of the set of intravascular images comprises displaying the combined X-ray image, the selected one of the set of intravascular images and a stacked roadmap image combining all of the set of intravascular images.

16. The method of claim 8, wherein the step overlaying the one of the first set of X-ray images taken at the first point with the one of the second set of X-ray images taken at the second point comprises overlaying the one of the first set of X-ray images taken at the first point with each of the second set of X-ray images to form a number of combined X-ray images.

17. The method of claim 1, wherein the step overlaying the one of the first set of X-ray images with the one of the second set of X-ray images comprises overlaying the one of the first set of X-ray images with each of the second set of X-ray images to form a number of combined X-ray images.

18. An imaging system for performing the method of claim 1.

19. An imaging system for performing the method of claim 3.

20. An imaging system for performing the method of claim 6.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0034] The drawings illustrate the best mode presently contemplated of carrying out the disclosure. In the drawings:

[0035] FIG. 1 is a block diagram of an multimodal imaging system according to one exemplary embodiment of the invention.

[0036] FIG. 2 is a schematic view of an X-ray/fluoro imaging system of the imaging system and associated recorded cardiac cycle images obtained by the X-ray/fluoro imaging system operated according to a first step of an exemplary embodiment of the invention.

[0037] FIG. 3 is a schematic view of an X-ray/fluoro imaging system and associated recorded cardiac cycle images obtained by the X-ray/fluoro imaging system and an intravascular imaging system and associated intravascular images obtained by the intravascular imaging system operated according to a second step of an exemplary embodiment of the invention.

[0038] FIG. 4 is a schematic view of the combination of recorded cardiac cycle images obtained by the X-ray/fluoro imaging system and intravascular images obtained by the intravascular imaging system operated according to a third step of an exemplary embodiment of the invention.

DETAILED DESCRIPTION OF THE DRAWINGS

[0039] In the following detailed description, reference is made to the accompanying drawings that form a part hereof, and in which is shown by way of illustration specific embodiments, which may be practiced. These embodiments are described in sufficient detail to enable those skilled in the art to practice the embodiments, and it is to be understood that other embodiments may be utilized and that logical, mechanical, electrical and other changes may be made without departing from the scope of the embodiments. The following detailed description is, therefore, not to he taken in a limiting sense.

[0040] Exemplary embodiments of the invention relate to a method for displaying synchronized X-ray/fluoro images obtained with and without simultaneous intravascular imaging in order to readily locate and display the position of a catheter utilized in the intravascular imaging within the X-ray/fluoro images.

[0041] In the exemplary embodiment of the invention illustrated in FIG. 1, a multimodal imaging system 10 is shown that includes an X-ray/fluoro imaging system 12 and an intravascular imaging system 14. The systems 12 and 14 can be any suitable imaging systems, with one example for the X-ray/fluoro system 12 being an angiographic or X-ray/fluoro/ECG device 13, which can also be separate X-ray/fluoro and ECG devices, such as the IGS 520 sold by GE Healthcare, and one example of the intravascular imaging system 14 being and intravascular ultrasound (IVUS) device 15, such as those manufactured and sold by Volcano under the name Eagle Eye IVUS, by Acist under the name HD IVUS or by Boston Scientific under the name Opticross Coronary Imaging catheter

[0042] As shown in in FIG. 1, the X-ray/fluoro/ECG device 13 is operably connected to a database 16 within which the X-ray/fluoro datasets or images 24, 28 and ECG recordings 17,27 (FIGS. 2 and 3) are stored, and the IVUS device 15 is operably connected to a database 18 in which the IVUS images 30 (FIGS. 3 and 4) are stored. Each of the databases 16 and 18 is further operably connected to a suitable computer or processing unit 20, which is also optionally operably connected to the devices 12,13 and 14,15, and to a display 22 for displaying the various images 24, 28 and 30, which can be formed on or separate from the devices 12,13 and 14,15.

[0043] Looking now at FIGS. 2-4, the method includes a sequence of image acquisition steps that utilizes the X-ray/fluoro/ECG device 13 in Step 1. In Step 1, as illustrated in FIG. 2, the X-ray/fluoro/ECG device 13 is used to perform a record or segmented acquisition of a first set of X-ray/fluoro images 24 over an ECG recording of a single cardiac cycle 17, i.e., a first recorded ECG signal, of the patient (not shown), such as in an Acquisition Mode for the device 13. The sequence of the images 24 over the cardiac cycle 17 in this step are obtained after the injection of a contrast agent into the patient in order to more clearly illustrate the structure of the blood vessels/myocardium 26 represented within the images 24. In addition, as these images 24 are obtained, they are identified/tagged by the time or position within the cardiac cycle 17 in which they were obtained and stored within the database 16. The process used in this initial step to identify the images 24 is similar to the process utilized in producing cine or movie images of the blood vessels/myocardium 26 by using known ECG tracing techniques to take the images 24 at different stages of the ECG recorded cardiac cycle 17, which may then be looped in order to illustrate the motion of the blood vessels/myocardium 26 over the recorded cycle 17 to identify any issues from the images 24. The segmented acquisition sequence of the images 24 taken in this step can be enhanced as desired using the device 13 and/or the computer 20 connected to the database 16, such as into an acquired sequence, where the images 24 are processed to white the contrast that was injected, or a roadmap/photo obtained by processing of the individual images 24 of the injected. Further, the computer 20 can identify the X-ray/fluoro images 24 as the overlay images to be utilized in the following steps of the overall method.

[0044] Referring now to FIG. 3, after the X-ray/fluoro images 24 have been obtained and stored, in Step 2 the X-ray/fluoro/ECG device 13 is utilized to obtain a second set of X-ray/fluoro images 28 of the blood vessels/myocardium 26 over a number N of ECG recorded cardiac cycles 27, i.e., a second recorded ECG signal, where N>1, such as in a FluoroStore mode for the device 13. These X-ray/fluoro images 28 are stored in database 16, or alternatively in a separate database (not shown) and are taken without any injected contrast agent present in the blood vessels/myocardium 26 such that the location of an intravascular catheter 32 operably connected to the IVUS device 15 within the blood vessels/myocardium 26 can be shown in the X-ray/fluoro images 28. However, with the lack of contrast agent, the structure of the blood vessel/myocardium 26 is not shown at all in the X-ray/fluoro images 28.

[0045] Concurrently, a set of IVUS images 30 are obtained of the blood vessel/myocardium 26 using the IVUS device 15 during the pullback of the intravascular catheter 32 including a sensor 33 at a catheter tip 34, that is positioned within the blood vessels/myocardium 26 and connected to the IVUS device 15. The images 30 illustrate slices of the blood vessel/myocardium 26 that are oriented perpendicular to the catheter tip 34. The pullback of the IVUS catheter 32 provides individual slices/images 30 of the blood vessels/myocardium 26 at each point along the blood vessels/myocardium 26 where the images 30 are obtained. Also, these slices/images 30 from the sensor 33 can be stacked/combined by the computer 20 to form a three-dimensional representation/roadmap image 35 of the blood vessel/myocardium 26, as shown in FIGS. 3 and 4, which can be shown along with the selected slice(s) 30.

[0046] Over the time period of Step 2 in which the second set of X-ray/fluoro images 28 and the set of IVUS images 30 are obtained, the images 28,30 are linked or time tagged/synced with one another as they are obtained in a known manner, such as by using the computer 20 or other suitable device(s) (not shown) in order to provide a registration between the images 28,30 that are taken at the same time during this step of the method. In addition, as they are obtained, the images 28,30 are subsequently stored within the databases 16,18 associated with the respective devices 13,15 that obtained the images 28,30. Further, the second set of X-ray/fluoro images 28 is also recorded within the database 16 with an identification of the segment/portion of the individual cardiac cycle 17 within the sequence of cycles 27 at which each particular image 28 was obtained, in order to enable the computer 20 to relate the images 28 to an image 24 taken of the blood vessel/myocardium 26 over the single cycle 17 that is identical or at least closely related in time to the segment/portion of the cycle 17 at which the image 28 was taken.

[0047] Referring now to FIG. 4, with the X-ray/fluoro images 24,28 of the blood vessels/myocardium 26 stored and synced with the portions of the ECG recorded cardiac cycle 17 at which they were obtained, and the X-ray/fluoro images 28 additionally synced with the IVUS images 30 based on the acquisition time t.sub.i at which they were obtained, the computer 20 can conduct an analysis of the images 24,28,30 in order to provide a combined X-ray/fluoro image 40 on the display 22 in association with a selected IVUS image/slice 30 in Step 3. This combined image 40 is a combination of the X-ray/fluoro image 28 taken at the acquisition time t.sub.i corresponding to each IVUS image/slice 30 and the X-ray/fluoro image 24 taken at the point of the ECG recorded cardiac cycle 17 closest in time to the point in the ECG recorded cycle 17 in the sequence of cycles 27 at which the X-ray/fluoro image 28 was obtained.

[0048] In performing the analysis on and blending of the images 24,28,30 to produce the combined images 32 in Step 3, when the physician initiates a review of the images 24,28,30 by selecting a particular slice or IVUS image 30 for review, the computer 22 determines the acquisition time t.sub.i during Step 2 at which the selected image 30 was obtained, as stored in conjunction with the selected slice 30 in database 18. As a result of the time sync/registration performed by the computer 20 for the X-ray/fluoro images 28 and IVUS images 30 obtained in Step 2, the computer 20 can locate the particular X-ray/fluoro image 28 in the database 16 obtained at the same acquisition time t.sub.i of Step 2 for the selected IVUS slice 30.

[0049] In addition, once the X-ray/fluoro image 28 associated with the selected IVUS image 30 has been determined using the time synchronization/registration between the images 28,30, in Step 3 the computer 20 can additionally determine the point 36 in the particular ECG recorded cardiac cycle 17 of the sequence of cycles 27 covered in Step 2 at which the X-ray/fluoro image 28 was obtained. This can he one using the acquisition time t.sub.i and locating the particular cycle 17 and point 36 within that cycle 17 corresponding to the acquisition time t.sub.i. The computer 20 then locates the X-ray/fluoro image 24 taken at the point 38 of the ECG recorded single cycle 17 covered in Step 1 corresponding as closely in time as possible to the point of the cycle 17 at which the X-ray/fluoro image 28 was obtained.

[0050] Once the X-ray/fluoro images 24 and 28 are located that correspond with regard to one another based on the points 36,38 of the individual ECG recorded cardiac cycles 17 in Step 1 and Step 2, the X-ray/fluoro images 24,28 can be overlaid on one another on the display 22, or in any other suitable manner, by the computer 20 in Step 3. IN a specific exemplary embodiment, the process performed in Step 3 to combine the X-ray images 24 and 28 is performed without any algorithms required in the prior art to accommodate for the significant errors that can occur as a result of the motion of the vessel in the images. In doing so, the contrast defining the structure of the blood vessels/myocardium 26 provided by the agent injected for the image 24 is superimposed on the image 28 illustrating/highlighting the position of the tip 34 of the IVUS catheter 32 on the display 22. Thus, the combined image 40 formed by overlaying X-ray/fluoro image 24 on X-ray/fluoro image 28, or vice versa, provides both a clear view of the structure of the blood vessels/myocardium 26 and the position of the catheter tip 34 and catheter 32 within the blood vessels/myocardium 26. In doing so, the computer 20 can additionally process the image 40 to enhance the representation of the catheter tip 34 in the combined image 40, while also clearly illustrating the vessel 26 from the injected image 24 of Step 1.

[0051] After the analysis and processing has been completed, the combined image 32 can be presented along with the selected IVUS image 30 to provide additional information to the physician regarding the internal structures of the blood vessels/myocardium 26. The different images provided on the display 22, namely the IVUS image/slice 30, the stacked slices/roadmap 35 and the combined X-ray/fluoro image 40, thus enable the physician to assess the position of the intravascular probe with respect to the vessel. Further, the array if images 30,35,40 allow the physician to better assess the target-lesion location within the blood vessels/myocardium 26 and to display the planned location of placement for the stent used to treat the lesion.

[0052] In other exemplary embodiments of the invention, in processing/combining the X-ray/fluoro images 24,28 from Steps 1 and 2 to form the combined image 40, with or without inclusion of any corresponding IVUS images 30, there are different optional processes that may be used to enhance the image 40 as presented, which are as follows: [0053] Process the X-ray/fluoro image 28 to make the probe more visible in this image 28. This processing can take the form of, for example, displaying the image in an inverted video, or applying an image processing filter to the image 28 that enhances curvilinear structures. Another strategy may be to use color within the images 24,28 and represent the X-ray/fluoro images 24,28 along different color ramps. [0054] Distort the X-ray/fluoro image 28 in a known manner to compensate for motion induced by the respiration of the patient. [0055] One record frame/image 24 from Step 1 (with or without ECG recordal for registration purposes) can be combined/fused with the all of the X-ray/fluoro images 28 from Step 2 (taken with or without ECG recordal for registration purposes). [0056] The entire set of X-ray images 24 from Step 1 (with ECG recordal for registration purposes) can be combined with the entire set of X-ray/fluoro images 28 obtained in Step 2 with ECG recordal for registration purposes.

[0057] In still another exemplary embodiment of the invention, the X-ray/fluoro images 24 from Step 1 can be combined in Step 3 to form a small video loop covering the cardiac cycle 17. The different X-ray/fluoro images 28 taken in Step 2 are then combined with the corresponding image 24 from Step 1 based on the ECG recordal of the cardiac cycles 17,27 corresponding to the images 24,28 for registration purposes. After combination of the images 28 with the corresponding images 24 in the video, the video can be looped to cover the sequence 27 of multiple cardiac cycles 17 covered within the images 28 obtained in Step 2. In this method, the correspondence between the images 24,28 of Step 1 and Step 2 is defined by considering the images 24 and 28 which are the closest in time during their respective cardiac cycles 17. The position in the cardiac cycle 17 is commonly identified by analyzing the ECG tracings based on well-known algorithms and/or ECG triggered segmented imaging, which can be used to correlate the individual images 24 and 28 with one another.

[0058] In still other exemplary embodiments of the invention, it is contemplated that the combined X-ray/fluoro images 40 can be utilized in conjunction with other intravascular imaging modalities/devices 14, such as OCT, and/or with other intravascular sensors 33, such as a blood pressure sensor. Additionally, the images 28 of Step 2 can be obtained with contrast material injected into the blood vessels/myocardium 26 with additional features present in the system 10 in order to effectively highlight the catheter tip 34 in the resulting X-ray/fluoro images 28 taken during the pullback of the sensor 33/tip 34 in Step 2. In one exemplary embodiment of this variation, a navigation system (not shown) with an antenna/sensor 33 in the catheter tip 34 can be utilized to identify the position of the tip 34 in the images 28 and the combined images 40. Also, to reduce the dosage during the image acquisitions, the frame rate for the X-ray/fluoro images 28 may be very low with collimation during the sensor pullback acquisitions.

[0059] To perform the above exemplary embodiments of the method, any suitable system 10 can be utilized that is similar to those discussed previously. In addition, the method can be performed on the system 10 by integrate all the elements/functions of the method in a single software application hosted on suitable imaging equipment such as, for example, an angiographic unit 12,13. The method can additionally be performed utilizing an open interface (not shown) between the respective imaging devices 12, 14 utilized in the system 10.

[0060] In still another alternative exemplary embodiment for the implementation of the method, the method can be compiled as an application capable of being stored on and performed or run by the angiographic unit 12,13 to produce the combined X-ray image(s) 40. Correspondingly, a protocol that is openly available on the network (not shown) to which the devices 12,14 are operably connected can be utilized to indicate in conjunction with the display of the image 40 the time tag of the currently displayed combined image 40. This time tag can then be used by the intravascular equipment/device 14 to display the information/image 32 that was collected at this time tag. Additionally, the protocol can be used in reverse as well, with a display of the proper combined x-ray image 40 resulting from the time tag provided to the angiographic unit 12,13 by the intravascular equipment 14.

[0061] The written description uses examples to disclose the invention, including the best mode, and also to enable any person skilled in the art to practice the invention, including making and using any devices or systems and performing any incorporated methods. The patentable scope of the invention is defined by the claims, and may include other examples that occur to those skilled in the art. Such other examples are intended to be within the scope of the claims if they have structural elements that do not differ from the literal language of the claims, or if they include equivalent structural elements with insubstantial differences from the literal language of the claims.