Comparison of calibrated and uncalibrated arterial pressure-based cardiac output monitors during orthotopic liver transplantation

Arterial pressure-based cardiac output monitors (APCOs) are increasingly used as alternatives to thermodilution. Validation of these evolving technologies in high-risk surgery is still ongoing. In liver transplantation, FloTrac-Vigileo (Edwards Lifesciences) has limited correlation with thermodilution, whereas LiDCO Plus (LiDCO Ltd.) has not been tested intraoperatively. Our goal was to directly compare the 2 proprietary APCO algorithms as alternatives to pulmonary artery catheter thermodilution in orthotopic liver transplantation (OLT). The cardiac index (CI) was measured simultaneously in 20 OLT patients at prospectively defined surgical landmarks with the LiDCO Plus monitor (CI(L)) and the FloTrac-Vigileo monitor (CI(V)). LiDCO Plus was calibrated according to the manufacturer's instructions. FloTrac-Vigileo did not require calibration. The reference CI was derived from pulmonary artery catheter intermittent thermodilution (CI(TD)). CI(V)-CI(TD) bias ranged from -1.38 (95% confidence interval = -2.02 to -0.75 L/minute/m(2), P = 0.02) to -2.51 L/minute/m(2) (95% confidence interval = -3.36 to -1.65 L/minute/m(2), P < 0.001), and CI(L)-CI(TD) bias ranged from -0.65 (95% confidence interval = -1.29 to -0.01 L/minute/m(2), P = 0.047) to -1.48 L/minute/m(2) (95% confidence interval = -2.37 to -0.60 L/minute/m(2), P < 0.01). For both APCOs, bias to CI(TD) was correlated with the systemic vascular resistance index, with a stronger dependence for FloTrac-Vigileo. The capability of the APCOs for tracking changes in CI(TD) was assessed with a 4-quadrant plot for directional changes and with receiver operating characteristic curves for specificity and sensitivity. The performance of both APCOs was poor in detecting increases and fair in detecting decreases in CI(TD). In conclusion, the calibrated and uncalibrated APCOs perform differently during OLT. Although the calibrated APCO is less influenced by changes in the systemic vascular resistance, neither device can be used interchangeably with thermodilution to monitor cardiac output during liver transplantation.

Comparison of non-calibrated pulse-contour analysis with continuous thermodilution for cardiac output assessment in patients with induced hypothermia after cardiac arrest

Induced mild hypothermia after cardiac arrest interferes with clinical assessment of the cardiovascular status of patients. In this situation, non-invasive cardiac output measurement could be useful. Unfortunately, arterial pulse contour is altered by temperature, and the performance of devices using arterial blood pressure contour analysis to derive cardiac output may be insufficient.

Augmenting the effective field of view of optical tracking cameras--a way to overcome difficulties during intraoperative camera alignment

An Internet survey demonstrated the existence of problems related to intraoperative tracking camera set-up and alignment. It is hypothesized that these problems are a result of the limited field of view of today's optoelectronic camera systems, which is usually insufficiently large to keep the entire site of surgical action in view during an intervention. A method is proposed to augment a camera's field of view by actively controlling camera orientation, enabling it to track instruments as they are used intraoperatively. In an experimental study, an increase of almost 300% was found in the effective volume in which instruments could be tracked.

Reconstruction of patient-specific 3D bone surface from 2D calibrated fluoroscopic images and point distribution model

Reconstruction of patient-specific 3D bone surface from 2D calibrated fluoroscopic images and a point distribution model is discussed. We present a 2D/3D reconstruction scheme combining statistical extrapolation and regularized shape deformation with an iterative image-to-model correspondence establishing algorithm, and show its application to reconstruct the surface of proximal femur. The image-to-model correspondence is established using a non-rigid 2D point matching process, which iteratively uses a symmetric injective nearest-neighbor mapping operator and 2D thin-plate splines based deformation to find a fraction of best matched 2D point pairs between features detected from the fluoroscopic images and those extracted from the 3D model. The obtained 2D point pairs are then used to set up a set of 3D point pairs such that we turn a 2D/3D reconstruction problem to a 3D/3D one. We designed and conducted experiments on 11 cadaveric femurs to validate the present reconstruction scheme. An average mean reconstruction error of 1.2 mm was found when two fluoroscopic images were used for each bone. It decreased to 1.0 mm when three fluoroscopic images were used.

Automatic extraction of femur contours from calibrated fluoroscopic images

Automatic identification and extraction of bone contours from X-ray images is an essential first step task for further medical image analysis. In this paper we propose a 3D statistical model based framework for the proximal femur contour extraction from calibrated X-ray images. The automatic initialization is solved by an estimation of Bayesian network algorithm to fit a multiple component geometrical model to the X-ray data. The contour extraction is accomplished by a non-rigid 2D/3D registration between a 3D statistical model and the X-ray images, in which bone contours are extracted by a graphical model based Bayesian inference. Preliminary experiments on clinical data sets verified its validity

Precise pose recovery of distal locking holes from single calibrated fluoroscopic image via a novel variable decomposition approach

This paper presents a novel variable decomposition approach for pose recovery of the distal locking holes using single calibrated fluoroscopic image. The problem is formulated as a model-based optimal fitting process, where the control variables are decomposed into two sets: (a) the angle between the nail axis and its projection on the imaging plane, and (b) the translation and rotation of the geometrical model of the distal locking hole around the nail axis. By using an iterative algorithm to find the optimal values of the latter set of variables for any given value of the former variable, we reduce the multiple-dimensional model-based optimal fitting problem to a one-dimensional search along a finite interval. We report the results of our in vitro experiments, which demonstrate that the accuracy of our approach is adequate for successful distal locking of intramedullary nails.