Towards 3D Path Planning from a Single 2D Fluoroscopic Image for Robot Assisted Fenestrated Endovascular Aortic Repair

The current standard of intra-operative navigation during Fenestrated Endovascular Aortic Repair (FEVAR) calls for the need of 3D alignments between inserted devices and aortic branches. The navigation commonly via 2D fluoroscopic images, lacks anatomical information, resulting in longer operation hours and radiation exposure. In this paper, a skeleton instantiation framework of Abdominal Aortic Aneurysm (AAA) from a single 2D fluoroscopic image is introduced for real-time 3D robotic path planning. A graph matching method is proposed to establish the correspondences between the 3D preoperative and 2D intra-operative AAA skeletons, and then the two skeletons are registered by skeleton deformation and regularization in respect to skeleton length and smoothness. Furthermore, deep learning was used to segment 3D preoperative AAA from Computed Tomography (CT) scans to facilitate the framework automation. Simulation, phantom and patient AAA data sets have been used to validate the proposed framework. 3D distance error of 2mm was achieved in the phantom setup. Performance advantages were also achieved in terms of accuracy, robustness and time-efficiency.