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FUSION EUS IMAGING: IS IT READY FOR PRIME TIME?

Alina Liliana Constantin 1, Lucian Gruionu 2, Anca Udristoiu 2, Nicoleta Podina (Sandu) 1, Elena-Codruta Gheorghe 2, Catalin Copaescu 1, Gabriel Gruionu 3, Adrian Săftoiu 4

Affiliations

1 Ponderas Academic Hospital, Bucharest, Romania

2 INCESA, University of Craiova, Craiova, Romania

3 University of Medicine and Pharmacy Craiova, Craiova, Romania

4 Elias Emergency University Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

Summary

AI Generated

A second-generation endoscopic ultrasound fusion imaging system using electromagnetic navigation was tested in a porcine model to co-register real-time EUS images with pre-procedure CT cross-sections.

The system used electromagnetic 6 degrees of freedom positioning sensors placed on the model and within a catheter in the endoscope working channel to enable real-time fusion of live EUS images with pre-procedure CT
Testing was performed on a porcine model with simulated structures including gallbladder and pseudocyst to replicate interventional procedures such as EUS-guided fine needle aspiration or drainage
The system displayed both EUS image and corresponding CT cross-section in real-time, with small registration errors overcome by allowing the operator to adjust catheter tip angle during the procedure
The stated purpose of incorporating image fusion into pancreatico-biliary pathology includes improving the EUS learning curve, enhancing accuracy of preoperative tumor resectability assessment, and increasing safety of therapeutic EUS procedures

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Endoscopic ultrasound (EUS) fusion imaging with cross sectional imaging (CT or MR) has been proposed as a method for co-registration of structures visible through different imaging techniques, with localization and tracking of the position of biopsy tools or therapeutic devices. Although initially developed for transabdominal [1] or endorectal [2] applications, the method seams feasible also for EUS [3], as tested with an initial prototype system [4]. The aim of our paper was to report on the testing of a second generation EUS fusion imaging based on electromagnetic (EM) navigation.

Aims & Methods

The equipment used consisted of Hitachi Noblus US system, Pentax linear scope, Custom made model and Aurora NDI magnetic-navigation. In order to create a porcine model we used an artificial “esophagus” and a porcine stomach. Beyond that, we attached to the model “gallbladder filled with stones” and a “pseudocyst“ with the aim of simulating interventional procedures such as EUS-guided fine needle aspiration / biopsy (EUS-FNA/B) or EUS-guided pseudocyst / gallbladder drainage. Additionally, one EM 6 degrees of freedom (DOF) positioning sensor was placed on the “patient“ chest and scanned by CT. Furthermore, the 3D rendering of the model and registration with the pre-procedure data using the sensor have been performed.The last step was placing a catheter with an EM 6DOF sensor mounted inside, in the working channel of the endoscope close to the distal tip in order to fuse live EUS images with the pre-procedure CT.

Results

The system displayed in real-time both EUS image and corresponding CT cross-section. Small registrations errors due to the differences between the pre-operative data and real model anatomy at the procedure time occurred but they have been overcome. Thus, the rotation correction between EUS scan and corresponding CT cross section can be done by the doctor during endoscopic procedure operating a special designed catheter handle and adjusting the angle of the catheter tip inside the endoscope.

Conclusion

The purpose of incorporating image fusion into pancreatico-biliary pathology is to boost the quality of diagnostic and therapeutic strategies not only by improving and speeding up the learning curve of EUS, but also by enhancing the accuracy of preoperative assessment regarding tumor resectability or by increasing the safety of therapeutic EUS procedures.

References

1. Ewertsen C, Săftoiu A, Gruionu LG, Karstrup S, Nielsen MB. Real-time image fusion involving diagnostic ultrasound. AJR Am J Roentgenol 2013; 200(3): W249-55.
2. Ignee A, Dong Y, Schuessler G, Baum U, Dietrich CF. Endorectal fusion imaging: A description of a new technique. Endosc Ultrasound 2017; 6(4): 241-244.
3. Singh BS, Cazacu IM, Deza CA, Rigaud BS, Saftoiu A, Gruionu G, Guionu L, Brock KK, Koay EJ, Herman JM, Bhutani MS. Image Fusion Involving Real-Time Transabdominal or Endoscopic Ultrasound for Gastrointestinal Malignancies: Review of Current and Future Applications. Diagnostics (Basel). 2022 Dec 19;12(12):3218.
4. Gruionu LG, Saftoiu A, Gruionu G. A novel fusion imaging system for endoscopic ultrasound. Endosc Ultrasound 2016; 5(1): 35-42.

Disclosure

Funding: IDEAR project
Relationship with industry: None

Conference

UEG Week Copenhagen 2023

Topics

Pancreas

Submission format

Abstract

Session

PP 08 Pancreas (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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SHP2 REGULATES CAF ACTIVITY AND ADAPTIVE STROMAL REMODELING DURING VERTICAL RAS PATHWAY INHIBITION IN PANCREATIC CANCER

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