Our overall goal in this project is to vastly improve patient care in the practice of image guided neurovascular diagnosis and interventions by providing vastly improved images with minimal increased radiation effective dose. The basic concept is that for many diagnoses and for most interventions, the best image is needed only over the region of interest around the pathology, hence a detector far superior in image quality to standard x-ray image intensifiers or flat panels but small in field of view could provide this improvement in diagnosis and image guidance, hence greatly improving the intervention itself. While we have accomplished in the previous funded period the specific aims of constructing such a detector and testing it in phantoms and animals, we have only recently introduced this Micro-Angiographic Fluoroscope (MAF) to guide human interventions. The MAF has had some outstanding initial results including major positive impacts on some of the interventions leading to improved patient procedures at substantially reduced effective doses. Our goals for continuing the MAF project fall into two broad groupings: I) developing further improvements in the detector system technology and II) doing continued human testing as each development is implemented, so that at the conclusion of this renewed project we will have enough results to justify the final translation of our research into manufactured medical systems that provide the new standard of care in image guided endovascular interventions. Although we believe the basic ROI imaging concepts being developed here may be applicable to all endovascular procedures including cardio and peripheral vascular diagnoses and interventions and to pediatric studies, to maintain project focus, we emphasize neurovascular applications. We will improve the detector system technology by: optimally selecting and evaluating components such as CsI thickness and type;implementing and evaluating spatial as well as temporal noise reduction filtering in real-time as well as studying methods of reducing patient vessel motion image degradation;improving the detector construction for stability and compactness;studying ROI CBCT, bi-plane MAFs, and automatic dose and other objective parameter tracking;and studying ways to increase the field of view. We will do human testing and evaluate the impact of the MAF technology on various neurovascular applications such as on aneurysm coiling, stent and distal protection device placement, determination and treatment of arterio- venous malformation niduses, flow and flow modifying devices, visualizing (hence preserving) small but very important perforator vessels, guiding of thrombolysis and deployment of clot removal devices for acute stroke, better determining morphology of complex pathology, and tracking the MAF dose, usage time and other objective operating parameters, as well as calculating the changes in effective dose for MAF use. We will correlate MAF use and these procedural parameters to standard patient outcome metrics.

Public Health Relevance

This project will vastly improve patient care in the practice of image guided neurovascular diagnosis and interventions by providing vastly improved images with minimal increased radiation effective dose. At the conclusion of this renewed project we will have enough results to justify the final translation of our research into manufactured medical systems that provide the new standard of care in image guided endovascular interventions. Although the current project focuses on neurovascular applications, the basic ROI imaging concepts being developed here should be applicable to all endovascular procedures including cardio and peripheral vascular diagnoses and interventions and to pediatric procedures.

Agency
National Institute of Health (NIH)
Institute
National Institute of Biomedical Imaging and Bioengineering (NIBIB)
Type
Research Project (R01)
Project #
5R01EB002873-07
Application #
8526457
Study Section
Biomedical Imaging Technology Study Section (BMIT)
Program Officer
Krosnick, Steven
Project Start
2003-09-20
Project End
2016-07-31
Budget Start
2013-08-01
Budget End
2014-07-31
Support Year
7
Fiscal Year
2013
Total Cost
$595,362
Indirect Cost
$169,959
Name
State University of New York at Buffalo
Department
Radiation-Diagnostic/Oncology
Type
Schools of Medicine
DUNS #
038633251
City
Buffalo
State
NY
Country
United States
Zip Code
14260
Mokin, Maxim; Ionita, Ciprian N; Nagesh, Swetadri Vasan Setlur et al. (2015) Primary stentriever versus combined stentriever plus aspiration thrombectomy approaches: in vitro stroke model comparison. J Neurointerv Surg 7:453-7
Rana, R; Loughran, B; Swetadri Vasan, S N et al. (2014) Workflow for the use of a high-resolution image detector in endovascular interventional procedures. Proc SPIE Int Soc Opt Eng 9033:90335S
Singh, V; Jain, A; Bednarek, D R et al. (2014) Relative object detectability (ROD): a new metric for comparing x-ray image detector performance for a specified object of interest. Proc SPIE Int Soc Opt Eng 9033:90335I
Singh, V; Jain, A; Bednarek, D R et al. (2014) Limitations of anti-scatter grids when used with high resolution image detectors. Proc SPIE Int Soc Opt Eng 9033:903362
Turk 3rd, A S; Martin, R H; Fiorella, D et al. (2014) Flow diversion versus traditional endovascular coiling therapy: design of the prospective LARGE aneurysm randomized trial. AJNR Am J Neuroradiol 35:1341-5
Rana, Vijay K; Rudin, Stephen; Bednarek, Daniel R (2014) Improved-Resolution, Real-Time Skin-Dose Mapping for Interventional Fluoroscopic Procedures. Proc SPIE Int Soc Opt Eng 9033:
Ionita, Ciprian N; Mokin, Maxim; Varble, Nicole et al. (2014) Challenges and limitations of patient-specific vascular phantom fabrication using 3D Polyjet printing. Proc SPIE Int Soc Opt Eng 9038:90380M
Loughran, Brendan; Swetadri Vasan, S N; Singh, Vivek et al. (2014) Detector system comparison using relative CNR for specific imaging tasks related to neuro-endovascular image-guided interventions (neuro-EIGIs). Proc SPIE Int Soc Opt Eng 9033:903321
Ionita, Ciprian N; Garcia, Victor L; Bednarek, Daniel R et al. (2014) Effect of injection technique on temporal parametric imaging derived from digital subtraction angiography in patient specific phantoms. Proc SPIE Int Soc Opt Eng 9038:90380L
Jain, Amit; Panse, A; Bednarek, Daniel R et al. (2014) Focal spot measurements using a digital flat panel detector. Proc SPIE Int Soc Opt Eng 9033:

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