In Vivo Assessment of Optimal Viewing Angles From X-Ray Coronary Angiography

OBJECTIVES: To propose and validate a novel approach to determine the optimal angiographic viewing angles for a selected coronary (target) segment from X-ray coronary angiography, without the need to reconstruct the entire coronary tree in three-dimensions (3D), such that subsequent interventions are carried out from the best view.

METHODS: The approach starts with standard quantitative coronary angiography (QCA) of the target vessel in two angiographic views. Next, the target vessel is reconstructed in 3D, and in a very simple and intuitive manner, the possible overlap of the target vessel and other vessel segments can be assessed, resulting in the best view with minimum foreshortening and overlap. A retrospective study including 67 patients was set up for the validation. The overlap prediction result was compared with the true overlap on the available angiographic views (TEST views). The foreshortening for the views proposed by the new approach software viewing angle (SVA) and the views used during the stent deployment software viewing angle (EVA) were compared. Two experienced interventional cardiologists visually evaluated the success of SVA with respect to EVA. The evaluation results were graded into five values ranging from -2 to 2.

RESULTS: The overlap prediction algorithm successfully predicted the overlap condition for all 235 TEST views. EVA was associated with more foreshortening than SVA (8.9%±8.2% vs. 1.6%±1.5%, p<0.001). The average evaluated point for the success of SVA was 0.94±0.80

(p <0.001), indicating that the evaluators were in favor of the optimal views determined by the proposed approach versus the views used during the actual intervention.

CONCLUSIONS: The proposed approach is able to accurately and quickly determine the optimal viewing angles for the online support of coronary interventions.

PMID: 21550911

Posted in Radiography and tagged , , , , .

3 Comments

  1. See post from March 13th:
    Potential role of three-dimensional rotational angiography and C-arm CT for valvular repair and implantation.
    Schwartz JG, Neubauer AM, Fagan TE, Noordhoek NJ, Grass M, Carroll JD.
    Int J Cardiovasc Imaging. 2011 Mar 11.
    PMID: 21394614

    And:
    Fusion of 3D QCA and IVUS/OCT.
    Tu S, Holm NR, Koning G, Huang Z, Reiber JH.
    Int J Cardiovasc Imaging. 2011 Feb;27(2):197-207. Epub 2011 Jan 25.
    PMID: 21264684 [PubMed - in process]

    AND:
    Note: Link is in Chinese
    中华放射学杂志2011年2月第45卷第2期  
    Chin J Radiol,February 2011,Vol.45,No.2
    一种从冠状动脉X线造影生成最佳投照角度的新方法
    涂圣贤 魏向龙 宋旭东 郝培远 黄铮 
    Koning, Gerhard; Reiber, JohanHC

    check also:

    International Journal of Cardiovascular Imaging
    Volume 27, Number 2 / February 2011

    QCA, IVUS and OCT in Interventional Cardiology – 2011
    Guest Editors: Hiram G. Bezerra, R.A. Costa and H.M. Garcia-Garcia

    153-154
    EDITORIAL NOTE
    Introduction to QCA, IVUS and OCT in interventional cardiology
    Johan H. C. Reiber
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    155-156
    EDITORIAL
    QCA editorial
    Ricardo A. Costa and Johan H. C. Reiber
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    157-165
    ORIGINAL PAPER
    Novel QCA methodologies and angiographic scores
    Vivian G. Ng and Alexandra J. Lansky
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    ORIGINAL PAPER
    Dedicated bifurcation analysis: basic principles
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    175-180
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    Quantitative coronary analysis in the Nordic Bifurcation studies
    Niels R. Holm, Helle Højdahl, Jens F. Lassen, Leif Thuesen and Michael Maeng
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    181-188
    ORIGINAL PAPER
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    Carlos Collet, Ricardo A. Costa and Alexandre Abizaid
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    189-196
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    Ricardo A. Costa, Marco A. Costa and Issam D. Moussa
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    ORIGINAL PAPER
    Fusion of 3D QCA and IVUS/OCT
    Shengxian Tu, Niels R. Holm, Gerhard Koning, Zheng Huang and Johan H. C. Reiber
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    209-214
    EDITORIAL
    Ultrasound and light: friend or foe? On the role of intravascular ultrasound in the era of optical coherence tomography
    Jennifer Huisman, Marc Hartmann and Clemens von Birgelen
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    215-224
    ORIGINAL PAPER
    IVUS-based imaging modalities for tissue characterization: similarities and differences
    Hector M. Garcìa-Garcìa, Bill D. Gogas, Patrick W. Serruys and Nico Bruining
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    225-237
    ORIGINAL PAPER
    Assessment of coronary atherosclerosis by IVUS and IVUS-based imaging modalities: progression and regression studies, tissue composition and beyond
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    249
    EDITORIAL
    OCT section
    Hiram Grando Bezerra and Marco A. Costa
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    251-258
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    F. Prati, M. W. Jenkins, A. Di Giorgio and A. M. Rollins
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    REVIEW
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    299-308
    ORIGINAL PAPER
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    Gregory T. Stefano, Hiram G. Bezerra, Guilherme Attizzani, Daniel Chamié and Emile Mehanna, et al.
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  2. Paul,

    Do interventionalists really have such trouble at determining angles without the assistance of an algorithm like the one proposed? The authors describe: “In 89.6% of target vessels the proposed approach was able to determine the optimal viewing angles with less than 3% foreshortening and without overlap with major coronary branches which could influence the visibility of the target vessel. On the other hand, the experienced interventionalists were able to select a view with less than 3% foreshortening in only 28.4% target vessels and with more than 10% foreshortening in 38.8% target vessels. ”

    What do you think?

  3. Check also:

    In vivo assessment of bifurcation optimal viewing angles and bifurcation angles by three-dimensional (3D) quantitative coronary angiography.
    Tu S, Jing J, Holm NR, Onsea K, Zhang T, Adriaenssens T, Dubois C, Desmet W, Thuesen L, Chen Y, Reiber JHC.
    Int J Cardiovasc Imaging. Epub Ahead of Print, DOI: 10.1007/s10554-011-9996-x.
    Open Accessed, Available at: http://www.springerlink.com/content/r46831731544567w/

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