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 #
5R01EB002873-08
Application #
8704369
Study Section
Biomedical Imaging Technology Study Section (BMIT)
Program Officer
Krosnick, Steven
Project Start
2003-09-20
Project End
2016-07-31
Budget Start
2014-08-01
Budget End
2015-07-31
Support Year
8
Fiscal Year
2014
Total Cost
$598,337
Indirect Cost
$178,332
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; Setlur Nagesh, Swetadri Vasan; Ionita, Ciprian N et al. (2016) Stent retriever thrombectomy with the Cover accessory device versus proximal protection with a balloon guide catheter: in vitro stroke model comparison. J Neurointerv Surg 8:413-7
Rana, V K; Rudin, S; Bednarek, D R (2016) A tracking system to calculate patient skin dose in real-time during neurointerventional procedures using a biplane x-ray imaging system. Med Phys 43:5131
Mokin, Maxim; Kan, Peter; Sivakanthan, Sananthan et al. (2016) Endovascular therapy of wake-up strokes in the modern era of stent retriever thrombectomy. J Neurointerv Surg 8:240-3
Brouillard, Adam M; Sun, Xingwen; Siddiqui, Adnan H et al. (2016) The Use of Flow Diversion for the Treatment of Intracranial Aneurysms: Expansion of Indications. Cureus 8:e472
Russ, M; Singh, V; Loughran, B et al. (2015) New Family of Generalized Metrics for Comparative Imaging System Evaluation. Proc SPIE Int Soc Opt Eng 9412:
Shakir, Hakeem J; Diletti, Sara M; Hart, Alexandra M et al. (2015) Carotid body tumor imitator: An interesting case of Castleman's disease. Surg Neurol Int 6:181
Munich, Stephan A; Cress, Marshall C; Rangel-Castilla, Leonardo et al. (2015) Importance of repeat angiography in the diagnosis of iatrogenic anterior cerebral artery territory pseudoaneurysm following endoscopic sinus surgery. BMJ Case Rep 2015:
Wood, Rachel P; Khobragade, Parag; Ying, Leslie et al. (2015) Initial testing of a 3D printed perfusion phantom using digital subtraction angiography. Proc SPIE Int Soc Opt Eng 9417:
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, Vijay K; Rudin, Stephen; Bednarek, Daniel R (2015) A Real-Time Skin Dose Tracking System for Biplane Neuro-Interventional Procedures. Proc SPIE Int Soc Opt Eng 9412:

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