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AlZAIEM AL-AZHARI UNIVERSITY

FACULTY OF POST GRADUATE STUDIESFACULTY OF RADIOLOGIC SCIENCES & MEDICAL

IMAGINGMEDICAL DIAGNOCTIC ULTRASOUND(MS.C)BATCH(9)

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ULTRASOUND FUSION

HOAIDA MOHAMMAD HASSAN WALAA ISMAIL MUSA SUPERVISOR,Dr. AHMED ABD. ALRAHEEM

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CONTENTS

DefinitionHistory

EquipmentsTechniqueClinical applications

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Definition :

The term is used when multiple patient`simages are registered and overlaid or mergedto provide additional information.

Fused images may be created from multiple images from the same imaging modality. Fused images may also combine function with

anatomical reference . (1)

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What we mean by ultrasound fusion

images-fusion between ultrasound andvarious visualization modes ( MagneticResonance Imaging MRI , Computedtomography CT , Positron emissiontomography PET ) to give more accurate imagein real-time targeting tumors .(1)

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Different imaging modalities

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Why we use different methods of

imaging ?Different methods reveal different featuresAccessibility and PortabilityRepeated exposure and safetyPatient acceptability

Cost Effectiveness (2)

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Different methods reveal different features

Plane-film X-ray maps the totalattenuation of X-rays , Good for bone

structure in accidents.

X-ray CT measures the X-ray attenuationcoefficient of the body at each point .True 3-D images. (2)

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Different methods reveal different features (cont.)

MRI maps the distribution andenvironment of water molecules inthe bod y.

PET maps the distribution of

radioactively labeled compounds . (2)

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Accessibility and Portability

Ultrasound MRI .(2)

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Repeated exposure and safety

Different modalities of imaging use different types of radiation(e.g., MRI uses radio waves, PET uses gamma rays), whichhave different characteristics. At all times, we should pickthe least invasive method.(2)

As Low As Reasonably Practicable

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Patient acceptability

Different types of scan entail different degrees ofpatient discomfort. Some might require an injectionof a contrast agent. The scanning environment is alsoimportant . (2)

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Cost Effectiveness

Always pick the simplest solution for your problem

Ultrasound X-ray CT MRI PET

20k - 100k 500k - 1M 2M - 4M >5M (2)

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Ultrasound fusion with CT &MR

Fusion system can simultaneously show

both ultrasound imaging with previous magnetic

resonance (MR) and CT study. The basic concept ofimaging fusion depends on the idea that an MR/CTstudy creates a 3D data set that represents the

patients anatomy. The 3D data set can be stored inany convenient imaging network location .

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US is the real-time modality, that allows touse a feature called Volume Navigation tovirtually project the patients previous

statics MR/CT data into the space where theclinician is performing a live, real-time,ultrasound. As the operator scans, the

ultrasound system shows both the real-timeultrasound and the corresponding slicethrough the previous MR/CT 3D data .

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How does Fusion work?

Fusion Imaging is similar to NavigationTechnology (1)

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Image Fusion

Traffic + topography =

Real time + anatomy = (1)

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Equipment

TransmitterSensor

Position sensing electronic unit (1)

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Transmitter creates a magnetic field about30 cubic inches from the face of theTransmitter . (1)

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Sensors 2 probe sensors are a fixed distance

apart. If field distortion is present, this can varyand the environment issue can be reported tothe user, alerting them to a problem that cantbe seen. (1)

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Data Registration

Registration procedure is needed toperform fusion imaging correctly . It isachieved by defining common anatomical

planes . First the transducer is placed parallelto MRI or CT volume data axial slice; secondthe common anatomical landmark such asportal vein bifurcation , are identified in thereal time ultrasound image and the MR or CTimage ; and third , these points are marked oneach image . (4)

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Structure Mapping

After the suitable registration of the ultrasoundimage and the CT or MRI image , ultrasoundscanning can be viewed simultaneously with the

corresponding multiplanar reconstruction slicefrom the preaquired volumetric CT or MRI data inreal time . The global positioning system (GPS)tool, can visually track the marked position duringscanning (4) .

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Viewing Options

Side by Side Fused display Overlay Fused display (1)

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Cont .

However, interventional treatment is easier toperform under ultrasound-guidance, while theexposure to increased doses of radiation isalso avoided. Thus, real-time virtualsonography combines the imaging advantagesof both techniques. (5)

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Interventional applications :Ultrasound suffers from a relatively narrow

FOV . MR/CT, by contrast, has an optimalcontrast resolution and a wide FOV but lacksreal time.

Furthermore ,Ultrasound is well suited for

many interventional procedures because of itsreal-time imaging & portability. (6)

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Cont.

Tracking sensors are also incorporated intosome interventional devices such as introducersand ablation needles, enabling the display ofneedle location as an overlay on live ultrasoundimages . This can be useful for overcomingdifficulties in visualizing needles duringultrasound-guided procedures . Such devices may

allow procedures to be completed more quicklyand with fewer placement attempts, particularlyfor more complex cases . (7)

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Tracking Needle

Sensor

Stylet (18G)

Sheathuter diameter,

18G ProcedureNeedles.

Assembled (1)

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Examples of Clinical Applications

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Figure a subtle lesion located at the dome of the liver

was difficult to identify by ultrasound alone. Byfusing CT and ultrasound images and locating thelesion on CT further evaluation can be done. (8)

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US CFM /MRI Overlay - PV Thrombosis (1)

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Liver biopsy in patient with suspected primary

pancreatic neoplasm. Cirrhosis made lesions morechallenging to see on US compared to CT. NeedleTracking allowed for successful biopsy under US

guidance . (1)

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Radiofrequency ablation of a liver massguided by ultrasound imaging in the CTsuite. (3)

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Cont,

5-

http://www.ncbi.nlm.nih.gov/pubmed/21218083date 25/3/2013 5:55 pm

6-http//www.intechopen.com/books/current_topics_in_ionizing_radiation_research/ultrasound_image_fusion_a_new_strategy_to_reduce_xray_exposure_during_image_guided_pain_therapies_

date 25/3/2013 5:55 pm

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Cont,

7-http://www.sciencedirect.com/science/article/pii/S2211968X12001064

date 23/3/2013 1:45 pm8-

http://www.gesignalpulse.com/signalpulse/spring2009pg=3#pg68

date 23/3/2013 1:45 pm

http://www.sciencedirect.com/science/article/pii/S2211968X12001064http://www.sciencedirect.com/science/article/pii/S2211968X12001064http://www.gesignalpulse.com/signalpulse/spring2009pg=3http://www.gesignalpulse.com/signalpulse/spring2009pg=3http://www.gesignalpulse.com/signalpulse/spring2009pg=3http://www.gesignalpulse.com/signalpulse/spring2009pg=3http://www.gesignalpulse.com/signalpulse/spring2009pg=3http://www.gesignalpulse.com/signalpulse/spring2009pg=3http://www.gesignalpulse.com/signalpulse/spring2009pg=3http://www.gesignalpulse.com/signalpulse/spring2009pg=3http://www.gesignalpulse.com/signalpulse/spring2009pg=3http://www.sciencedirect.com/science/article/pii/S2211968X12001064http://www.sciencedirect.com/science/article/pii/S2211968X12001064http://www.sciencedirect.com/science/article/pii/S2211968X12001064http://www.sciencedirect.com/science/article/pii/S2211968X12001064http://www.sciencedirect.com/science/article/pii/S2211968X12001064