Real-time registration of 3D echo to X-ray fluoroscopy based on cascading classifiers and image registration

YingLiang Ma, R. James Houston, Ansab Fazili, Aruna V. Arujuna, Kawal S Rhode

    Research output: Contribution to journalArticlepeer-review

    3 Citations (Scopus)
    107 Downloads (Pure)


    Three-dimensional (3D) transesophageal echocardiography (TEE) is one of the most significant advances in cardiac imaging. Although TEE provides real-time 3D visualization of heart tissues and blood vessels and has no ionizing radiation, X-ray fluoroscopy still dominates in guidance of cardiac interventions due to TEE having a limited field of view and poor visualization of surgical instruments. Therefore, fusing 3D echo with live X-ray images can provide a better guidance solution. This paper proposes a novel framework for image fusion by detecting the pose of the TEE probe in X-ray images in real-time. The framework does not require any manual initialization. Instead it uses a cascade classifier to compute the position and in-plane rotation angle of the TEE probe. The remaining degrees of freedom are determined by fast marching against a template library. The proposed framework is validated on phantoms and patient data. The target registration error for the phantom was 2.1 mm. In addition, 10 patient datasets, seven of which were acquired from cardiac electrophysiology procedures and three from trans-catheter aortic valve implantation procedures, were used to test the clinical feasibility as well as accuracy. A mean registration error of 2.6 mm was achieved, which is well within typical clinical requirements.

    Original languageEnglish
    Article number055019
    JournalPhysics in Medicine and Biology
    Issue number5
    Publication statusPublished - 25 Feb 2021

    Bibliographical note

    This is the Accepted Manuscript version of an article accepted for publication in Physics in Medicine and Biology. IOP Publishing Ltd is not responsible for any errors or omissions in this version of the manuscript or any version derived from it. The Version of Record is available online at 10.1088/1361-6560/abe420


    • 3d ultrasound
    • Cardiac interventional guidance
    • Echo probe tracking
    • Image fusion
    • X-ray fluoroscopy

    ASJC Scopus subject areas

    • Radiological and Ultrasound Technology
    • Radiology Nuclear Medicine and imaging


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