MRI catheter guidance and steering of vascular procedures with a reduced heating risk.

Bringing diagnostic or therapeutic devices to a target tissue via vascular inserted catheters has been the mainstay of interventional radiology, vascular surgery, and interventional cardiology since the 1930s (1). Catheter technology has dramatically improved over time, a result of using novel mechanical engineering and materials science, leading to a variety of application-specific kits. There are, however, three issues that limit catheter applications and affect procedure duration, outcomes, and the number and severity of complications (2). The first issue is visualization of catheter position and orientation. The second is visualization of tissues that surround the catheter during various stages of the procedure. The third issue is improved catheter steering, because catheters are manipulated by hand motion occurring at large (1.2–1.6 m) distances from the catheter distal tip. For catheter position and orientation visualization, the classic imaging modality of X-ray fluoroscopy, has many advantages, such as a high-temporal update and a strong contrast-to-noise ratio (CNR) between catheters and the vascular background (2). There are also a number of disadvantages: shadowing effects when multiple catheters are in proximity; interference from obstructing highly absorptive tissues, such as bones; the availability of projection views only, lacking depth localization; and a radiation dose to both patient and clinician. In addition, during navigation in small vessels, if the surrounding vascular bed is not well seen, repeated ionic-contrast injection is required. Finally, the interventional staff wears heavy lead aprons, which contributes to a high incidence of back pain. The early 1990s saw the introduction of non–X-ray based techniques to track catheter position. The most widely used navigational tools are based on electromagnetic (EM) methods. These can either be magnetic (3,4) or electrical (5). Using these systems significantly reduced the radiation dose during navigation and treatment and dramatically improved the three-dimensional (3D) visualization of catheter shape and its spatial localization.

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