We have built new asymmetric stents for minimally invasive endovascular treatment of cerebral aneurysms. Each asymmetric stent consists of a commercial stent with a micro-welded circular mesh patch. The blood flow modification in aneurysm-vessel phantoms due to these stents was evaluated using x-ray angiographic analysis. However, the density difference between the radiographic contrast and the blood gives rise to a gravity effect, which was evaluated using an initial optical dye-dilution experiment. For the radiographic evaluations, curved-vessel phantoms instead of simple straight side-wall aneurysm phantoms were used in the characterization of meshes/stents. Six phantoms (one untreated, one treated with a commercial stent, and four treated with different asymmetric stents) with similar morphologies were used for comparison. We calculated time-density curves of the aneurysm region and then calculated the peak value (Pk) and washout rate (1/τ) after analytical curve fitting. Flow patterns in the angiograms showed reduction of vortex flow and slow washout in the dense mesh patch treated aneurysms. The meshes reduced Pk down to 21% and 1/τ down to 12% of the values for the untreated case. In summary, new asymmetric stents were constructed and their evaluation demonstrates that they may be useful in the endovascular treatment of aneurysms.
New neuro-interventional devices such as stents require high spatial-resolution image guidance to enable accurate localization both along the vessel axis as well as in a preferred rotational orientation around the axis. A new high-resolution angiographic detector has been designed with capability for micro-angiography at rates exceeding the 5 fps of our current detector and, additionally, with noise low enough and gain high enough for fluoroscopy. Although the performance requirements are demanding and the detector must fit within practical clinical space constraints, image guidance is only needed within a approximately 5 cm region of interest at the site of the intervention. To achieve the design goals, the new detector is being assembled from available components which include a CsI(Tl) phosphor module coupled to a fiber-optic taper assembly with a two stage light image intensifier and a mirror between the output of the fiber taper and the input to a conventional high performance optical CCD camera. Resulting acquisition modes include 50-micron effective pixels at up to 30 fps with the capability to adjust sensitivity for both fluoroscopy and angiography. Estimates of signal at the various stages of detection are made with quantum accounting diagrams (QAD).
Minimally invasive image-guided interventions require very high image resolution and quality, specifically over regions-of-interest (ROI) crucial to the procedure. An ROI high quality image allows limited patient radiation deposition while permitting rapid frame transfer rates. Considering current developments in direct conversion Flat Panel Detectors (FPD), advantages of such an imager for ROI angiography were investigated. The performance of an amorphous-selenium based FPD was simulated to evaluate improvements in MTF and DQE under various angiographic imaging conditions. The detector envisioned incorporates the smallest pixel size of 70 mm, reported to date, and a photoconductor thickness of 1000 mm to permit angiography. The MTF of the FPD is calculated to be 60% at the Nyquist frequency of 7.1 lp/mm compared to 6% for a previously reported CsI(Tl)-based ROI CCD camera. The DQE(0) of the FPD at 0.7 mR and 70 kVp is 74% while for the CCD camera is 70%. At 7.1 lp/mm, the FPD's DQE is 26% while for the CCD camera it is 12%. Images of an undeployed stent with 70 mm pixel mammography FPD prototype, compare favorably with images acquired with the CCD camera. Thus a practical direct flat-panel ROI detector with both improved performance and physical size is proposed.
A new high spatial resolution micro-angiographic camera will enable routine viewing within a region of interest of detailed vascular structure unable to be seen with current full field of view (FOV) angiographic detectors. Such details include perforator vessels, vessel contractility or compliance, and condition and location of 50 micron or smaller stent wires. Although the basic CsI(Tl) phosphor-optical taper-CCD design of the new ROI micro-angiographic camera is essentially the same as that of the pre-clinical prototype, many of the physical parameters are much improved. The FOV is 5 cm X 5 cm vs. the previous 1 cm X 1 cm; the phosphor thickness is 350 - 400 micron vs. the previous 100 micron; the taper ratio is now 1.8 rather than 3.0 (2.8X improvement in light collection). The pixel size is either 25 or 50 micron. Additionally, detector noise may now be carefully considered in the camera design as may mechanical supporting mechanisms, methods to synchronize image acquisition with exposure and the effects of other physical factors such as exposure parameters, tube loading, focal spot size and geometric unsharpness. It is expected that this new capability should allow improved treatments and further development of smaller interventional devices and catheter delivery systems.
The x-ray flat-panel detector (FPD) will be a key component of the coming generation of x-ray imaging systems. FPD systems applicable to both fluoroscopy and radiography especially, will be the prime candidate to replace current image intensifier x-ray (IIXR-TV) systems. Nevertheless, IIXR-TV systems which have recently been improved by the addition of CCD cameras, have established themselves over time by offering good image quality which in most cases clinicians appear to be satisfied with. It will thus take a substantial improvement in image quality combined with a new ease of use due to reduced physical size for new FPDs to replace those systems that have evolved over many decades. Our group has been developing a selenium-based FPD which has superior spatial resolution characteristics. The purpose of this research is to elucidate the FPD's potential to replace IIXR-TV systems by offering improved image quality. Detailed measurements of physical characteristics were made and extensive in vivo animal studies were conducted. It can be concluded that the FPD's demonstrated superior image quality appears to have the potential to improve clinical performance.