medical imaging question.

[William Gaatjes]

I am watching house and very often i see them guiding a tube like device through large aorta and large veins all the way inside the brain.
But they have this imaging system were they can see where they are inside the brain and it has a resolution high enough to actually see the veins.
Am i duped here and is this still science fiction or do such medical imaging systems actually exist ?

I know there exist a real time x ray imaging system that allows for to see the tissues while moving them around.
I had seen a youtube video about it once that explained how a woman had serious pain but was diagnosed as a fake because stationary imaging did not show any issues.
With that device i had seen on youtube, they could see that one of her vertebra in her neck slipped against the spinal cord causing her pain when she moved her head. This was something of a 30fps xray imaging system.

Or does House use a fluoroscope ?

 

[adamantine.me]

You can't diagnose pain as fake, because you can't measure pain. You also cannot deny that you might be missing the real cause of the pain.

But what you're describing sounds like a fiber optic camera, and I'm not sure you can just jam that inside the brain. You could post a link to a vid/pic

 

[Ken g6]

Or does House use a fluoroscope ?

Very likely. Digital fluoroscopes use a lot less radiation than the old analog ones did.

Not sure if you're referring to fluoroscopy with a dye injection or with an intravenous catheter up from the leg, or both. It's all pretty common.

 

[William Gaatjes]

You can't diagnose pain as fake, because you can't measure pain. You also cannot deny that you might be missing the real cause of the pain.

But what you're describing sounds like a fiber optic camera, and I'm not sure you can just jam that inside the brain. You could post a link to a vid/pic

It happened. It was a news story. She was dismissed and insurance companies would not accept the bills. Even prominent doctors did not believe her. Until she met a doctor who had contacts who developed such an imaging system. When the xray video footage was shown to other prominent doctors, they immediately understood what her problem was. The slipping disc between her vertebra. It could move.

I will make a screenshot of the house episode.

 

[William Gaatjes]

Very likely. Digital fluoroscopes use a lot less radiation than the old analog ones did.

Not sure if you're referring to fluoroscopy with a dye injection or with an intravenous catheter up from the leg, or both. It's all pretty common.

Here are the screenshots :

 

[William Gaatjes]

I should note, that the new story was about a woman who had been in a car accident. She was rear-ended , i think but i am not sure. It was years ago.
Anyway, one disc could move when she moved her head and it would press against her spinal cord. Giving her huge debilitating head aches and other pain symptoms.
After they found the issue, some relatively minor surgery was needed to solve her problem. And, if they had not found it and she would have had another car accident or had fallen the wrong way, she could have been paralyzed.

But besides this intermezzo, you guys know if this really exists ?

 

[Ken g6]

So, something like this?

 

[William Gaatjes]

So, something like this?

I guess. It is fluoroscopy then ?. I feel more confident in medical science every day.

Now if only the work pressure could be relieved on doctors and surgeons, in order to reduce the mistakes.

 

[brianmanahan]

I am watching house and very often i see them guiding a tube like device through large aorta and large veins all the way inside the brain.
But they have this imaging system were they can see where they are inside the brain and it has a resolution high enough to actually see the veins.
Am i duped here and is this still science fiction or do such medical imaging systems actually exist ?

that sounds similar to the device used for the "wada test", but that is just for delivering chemicals which put 1/2 of your brain to sleep instead of taking pictures.

 

[Artdeco]

The problem is seeing anything, there are intravascular ultrasound systems that give you a cross section of the surrounding veins or arteries, looks like a picture of a solar eclipse, really cool to work with, http://www.lorvenheart.com/proIVU.html. fluoroscopy is mostly used, and contrast injected in the veins and arteries.

I worked in Interventional Radiology for 5 years, we have a ton of toys.

Not aware of any useful cameras that were used outside of R&D at the present time. You'd have to flush the vein/artery with saline or use CO2 because blood is opaque, and you couldn't see anything.

Cerebral angiogram using fluro, I assisted with a gazillion of these http://youtu.be/OmXDrHnt2iw

This kind of stuff is a big part of the future of surgery.

 

[William Gaatjes]

Aha, it must be angiography ? ^_^

https://en.wikipedia.org/wiki/Angiography

 

[William Gaatjes]

With the advances in science, there is a lot more possible i see :

https://en.wikipedia.org/wiki/Magnetic_resonance_angiography

https://en.wikipedia.org/wiki/Computed_tomography_angiography

Thanks y'all.

 

[Artdeco]

We did a lot of CT guided procedures too, lots more radiation though.

 

[Linux23]

well i had an svt ablasion done. worst mistake in my life.

 

[William Gaatjes]

well i had an svt ablasion done. worst mistake in my life.

Why ?

I had to look it up to find out what that means :
http://www.heart.org/HEARTORG/Condi...rhythmias_UCM_301991_Article.jsp#.Vq5pB-Z3CUk

This nonsurgical procedure is used to treat some types of rapid heart beating, such as atrial fibrillation, atrial flutter and atrial tachycardia. It's most often used to treat supraventricular tachyarrhythmias. These are rapid, uncoordinated heartbeats starting in the heart's upper chambers (atria) or middle region (AV node or the very beginning portion of the heart's electrical system).

How is radiofrequency ablation done?
A physician guides a catheter with an electrode at its tip to the area of heart muscle where the damaged site is located. Then a mild, painless radiofrequency energy (similar to microwave heat) is transmitted to the site of the pathway. Heart muscle cells in a very small area (about 1/5 of an inch) die and stop conducting the extra impulses that caused the rapid heartbeats.

How effective and safe is this procedure?
Radiofrequency ablation has a success rate of over 90 percent, a low risk of complications and the patient can resume normal activities in a few days. It causes little or no discomfort and is done under mild sedation with local anesthesia. For these reasons, it's now widely used and is the preferred treatment for many types of rapid heartbeats.
TRANSCATHETER ABLATION

Radiofrequency ablation that is done through a catheter to the targeted site is a transcatheter approach. Newer advances now permit therapeutic ablations using a transcatheter approach. In this technique, an electrode catheter inserted through a blood vessel during electrophysiologic studies is used to perform targeted electrocautery in the heart. A patient may be cured of tachycardia through ablative therapy, so antiarrhythmic medication is no longer needed. Transcatheter ablation is rapidly becoming the treatment of choice for many supraventricular tachycardias.

That is an idea to kill off unwanted cells. A low to medium energy RF signal to burn the cells. I guess that it must be a signal the several hundreds of Megahertz range.
What went wrong ?

 

[Mark R]

Here are the screenshots :

That's a fairly standard procedure known as cerebral angiography. Caption is wrong though; the catheter is way below the optic chiasm.

The equipment shown is pretty out-dated now. Resolution is much better these days, my latest machine has a roughly 0.2 mm resolution; so you can with reasonably confidence manipulate a microcatheter (ultra-small diameter tube, typically 0.5 mm outer-diameter) into a suitable position, to for example, block a diseased artery which is at risk of bleeding.

CT and MR angiography is pretty good; the resolution isn't there, but it's close (the latest CT can get about 0.5 x 0.5 x 0.5 mm resolution), although it is less selective.

With conventional angiography, you advance the catheter (tube) to the artery of interest, and inject dye into a single artery; you can then do a cine X-ray capture, so you see the rate of flow of the dye, and you see only one artery.

With CT angiography, you inject into an arm vein, the dye mixes with the blood in the heart and all the arteries fill at the same time. You get the advantage of full 3D voxel data, instead of just flat images (although modern angiography equipment can also do CT-like 3D capture, by rotating the equipment).

The latest CT equipment can now do cine volumetric acquisition - so you can do a 512 x 512 x 640 volume at 2 Hz. This way you can actually see the rate of flow of dye, see where there are regions of delay, etc. There is an issue that the radiation dose can be excessive with this technique; the amount of data produced is also rather overwhelming (about 10-20 GB for a study) which leads to even top-end workstations lagging out and struggling, not to mention the amount of time it takes to read a study with 20k images in it.

Used to do loads of cerebral angiograms, but I've packed them in, as I find 3D CT/MR angiography and 4D CT angiography to be adequate these days. Angiography can be reserved for actually treating an abnormality.

 

[William Gaatjes]

Thank you, Mark R. Very interesting read.
One question, the software, does it run on just x86 processors or has it specialized cores to do the math ? Or are cuda or manthle libraries used ?

 

[DigDog]

that's an endoscopy? yeah it's real.

 

[Mark R]

Thank you, Mark R. Very interesting read.
One question, the software, does it run on just x86 processors or has it specialized cores to do the math ? Or are cuda or manthle libraries used ?

The software runs on regular servers, although there may be some CUDA processing. I don't really know, the software is supplied as a "black-box" server which you are not supposed to touch; so I don't know the actual hardware specification.

I've knocked up my own software which just uses direct3D shaders to do the processing, and on my radeon 280x it runs about the same speed as the very expensive servers; so I would guess that they are using some kind of GPU processing.

 

[Artdeco]

that's an endoscopy? yeah it's real.

No, endoscopy is the GI tract, we're talking about veins and arteries.

 

[Artdeco]

that sounds similar to the device used for the "wada test", but that is just for delivering chemicals which put 1/2 of your brain to sleep instead of taking pictures.

Exactly, I've assisted with a ton of them, we do use fluoroscopy to get the catheter(s) in the right place. Patients tell me it's a crazy experience.