Multi-angled simultaneous biplane High-Speed Angiography (HSA) of patient-specific 3D-printed aneurysm phantoms using 1000 fps CdTe Photon-Counting Detectors (PCD's).

1000 fps HSA enables visualization of flow details, which may be important in accurately guiding interventional procedures; however, single-plane imaging may lack clear visualization of vessel geometry and flow detail. The previously presented high-speed orthogonal biplane imaging may overcome these limitations but may still result in foreshortening of vessel morphology. In certain morphologies, acquiring two non-orthogonal biplane projections at multiple angles can provide better flow detail rather than a standard orthogonal biplane acquisition. Flow studies of aneurysm models were performed, where simultaneous biplane acquisitions at various angles separating the two detector views allowed for better evaluation of morphology and flow. 3D-printed, patient-specific internal carotid artery aneurysm models were imaged with various non-orthogonal angles between the two high-speed photon-counting detectors (7.5 cm x 5 cm FOV) to provide frame-correlated simultaneous 1000-fps image sequences. Fluid dynamics were visualized in multi-angled planes of each model using automated injections of iodine contrast media. The resulting dual simultaneous frame-correlated 1000-fps acquisitions from multiple planes of each aneurysm model provided improved visualization of complex aneurysm geometries and flow streamlines. Multi-angled biplane acquisitions with frame correlation allows for further understanding of aneurysm morphology and flow details: additionally, the ability to recover fluid dynamics at depth enables accurate analysis of 3D flow streamlines, and it is expected that multiple-planar views will enable better volumetric flow visualization and quantification. Such better visualization has the potential to improve interventional procedures.

Comparison of pulsatile flow dynamics before and after endovascular intervention in 3D-printed patient-specific internal carotid artery aneurysm models using 1000 fps photon-counting detectors for Simultaneous Biplane High Speed Angiography (SB-HSA).

A significant challenge regarding the treatment of aneurysms is the variability in morphology and analysis of abnormal flow. With conventional DSA, low frame rates limit the flow information available to clinicians at the time of the vascular intervention. With 1000 fps High-Speed Angiography (HSA), high frame rates enable flow details to be better resolved for endovascular interventional guidance. The purpose of this work is to demonstrate how 1000 fps biplane-HSA can be used to differentiate flow features, such as vortex formation and endoleaks, amongst patient-specific internal carotid artery aneurysm phantoms pre- and post-endovascular intervention using an in-vitro flow setup. The aneurysm phantoms were attached to a flow loop configured to a carotid waveform, with automated injections of contrast media. Simultaneous Biplane High-Speed Angiographic (SB- HSA) acquisitions were obtained at 1000 fps using two photon-counting detectors with the respective aneurysm and inflow/ outflow vasculature in the FOV. After x-rays were turned on, the detector acquisitions occurred simultaneously, during which iodine contrast was injected at a continuous rate. A pipeline stent was then deployed to divert flow from the aneurysm, and image sequences were once again acquired using the same parameters. Optical Flow, an algorithm that calculates velocity based on spatial-temporal intensity changes between pixels, was used to derive velocity distributions from HSA image sequences. Both the image sequences and velocity distributions indicate detailed changes in flow features amongst the aneurysms before and after deployment of the interventional device. SB-HSA can provide detailed flow analysis, including streamline and velocity changes, which may be beneficial for interventional guidance.

Determining 3D Distributions of Pulsatile Blood Flow Using Orthogonal Simultaneous Biplane High-Speed Angiography (SB-HSA) with 1000 fps CdTe Photon Counting Detectors for 3D X-ray Particle Image Velocimetry (3D-XPIV) compared to Results Using Computational Fluid Dynamics (CFD).

3D hemodynamic distributions are useful for the diagnosis and treatment of aneurysms. Detailed blood-flow patterns and derived velocity maps can be obtained using 1000 fps High Speed Angiography (HSA). The novel orthogonal Simultaneous Biplane High-Speed Angiography (SB-HSA) system enables flow information to be quantified in multiple planes, and with additional components of flow at depth, accurate 3D flow distributions are available. Computational Fluid Dynamics (CFD) is the current standard for derivation of volumetric flow distributions, but obtaining solution convergence is computationally expensive and time intensive. More importantly, matching in-vivo boundary conditions is non-trivial. Therefore, an experimentally derived 3D flow distribution method could offer realistic results with less computation time. Using SB-HSA image sequences, 3D X-Ray Particle Image Velocimetry (3D-XPIV) was explored as a new method for assessing 3D flow. 3D-XPIV was demonstrated using an in-vitro setup, where a patient-specific internal carotid artery aneurysm model was attached to a flow loop, and an automated injection of iodinated microspheres was used as a flow tracer. Two 1000 fps photon-counting detectors were placed orthogonally with the aneurysm model in the FOV of both planes. Frame-synchronization of the two detectors made correlation of single-particle velocity components at a given timepoint possible. With frame-rates of 1000 fps, small particle displacements between frames resolved realistic time varying flow, where accurate velocity distributions depended on near-instantaneous velocities. 3D-XPIV velocity distributions were compared to CFD velocity distributions, where the simulation boundary conditions matched the in-vitro setup. Results showed similar velocity distributions between CFD and 3D-XPIV.