Calibration-free device sizing using an inverse geometry x-ray system.

PURPOSE: Quantitative coronary angiography (QCA) can be used to support device size selection for cardiovascular interventions. The accuracy of QCA measurements using conventional x-ray fluoroscopy depends on proper calibration using a reference object and avoiding vessel foreshortening. The authors have developed a novel interventional device sizing method using the inverse geometry scanning-beam digital x-ray (SBDX) fluoroscopy system. The proposed method can measure the diameter and length of vessel segments without imaging a reference object and when vessels appear foreshortened.
METHODS: SBDX creates multiple tomosynthetic x-ray images corresponding to planes through the patient volume. The structures that lie in the plane are in focus and the features above and below the plane are blurred. Three-dimensional localization of the vessel edges was performed by examining the degree of blurring at each image plane. A 3D vessel centerline was created and used to determine vessel magnification and angulation relative to the image planes. Diameter measurements were performed using a model-based method and length measurements were calculated from the 3D centerline. Phantom validation was performed by measuring the diameter and length of vessel segments with nominal diameters ranging from 0.5 to 2.8 mm and nominal lengths of 42 mm. The phantoms were imaged at a range of positions between the source and the detector (+/- 16 cm relative to isocenter) and with a range of foreshortening angles (0 degrees-75 degrees).
RESULTS: Changes in vessel phantom position created magnifications ranging from 87% to 118% relative to isocenter magnification. Average diameter errors were less than 0.15 mm. Average length measurements were within 1% (0.3 mm) of the true length. No trends were observed between measurement accuracy and magnification. Changes in vessel phantom orientation resulted in decreased apparent length down to 28% of the original nonforeshortened length. Average diameter errors were less than 0.25 mm across all vessel angulations; errors were less than 0.1 mm for smaller diameter vessels and low to moderate vessel angles. Diameter errors increased with true diameter and vessel angle relative to the image plane. Average length measurement errors were also within 1% (0.3 mm) for each angulation.
CONCLUSIONS: Tomosynthetic imaging with SBDX can accurately measure dimensions of vessels in various magnifications and angulations without calibration. This method may be more accurate and convenient than conventional QCA techniques.