Three-Dimensional Computed Tomography in the Cardiac Catheterization Laboratory

Objectives: To establish the feasibility of fusion of a 3-dimensional computed tomography (3D CT) dataset to the routine fluoroscopic image in the cardiac catheterization laboratory. Background: Routine fluoroscopic imaging in the cardiac catheterization laboratory often does not provide adequate anatomic detail for structural cardiac interventions. The modern C-arm is capable of acquiring CT-like 3D images (Syngo DynaCT), and the overlay of CT-acquired details on the fluoroscopic image may be useful. The feasibility of this new technology has not yet been reported. Methods: Three patients (presenting with three different clinical indications) were selected, all of whom had previously undergone contrast-enhanced chest CT. Anatomic details of interest were marked on the preprocedural CT, and the CT was registered to a DynaCT acquired in the catheterization laboratory. The CT:CT registration was then fused to the "real-time" fluoroscopic image. Results: Fusion of the CT to the fluoroscopic image was successful in these three patients and provided a substantial degree of anatomic guidance for catheter and device manipulation. Conclusions: We have demonstrated the ability to delineate cardiovascular structures of interest on the "real-time" fluoroscopic image using CT fusion. Future studies should address whether this technology can reduce overall contrast administration and radiation dose. (C) 2011 Wiley-Liss, Inc.