Clinical evaluation of respiratory motion compensation for anatomical roadmap guided cardiac electrophysiology procedures

X-ray fluoroscopically guided cardiac electrophysiological procedures are routinely carried out for diagnosis and treatment of cardiac arrhythmias. X-ray images have poor soft tissue contrast and, for this reason, overlay of static 3-D roadmaps derived from preprocedural volumetric data can be used to add anatomical information. However, the registration between the 3-D roadmap and the 2-D X-ray image can be compromised by patient respiratory motion. Three methods were designed and evaluated to correct for respiratory motion using features in the 2-D X-ray images. The first method is based on tracking either the diaphragm or the heart border using the image intensity in a region of interest. The second method detects the tracheal bifurcation using the generalized Hough transform and a 3-D model derived from 3-D preoperative volumetric data. The third method is based on tracking the coronary sinus (CS) catheter. This method uses blob detection to find all possible catheter electrodes in the X-ray image. A cost function is applied to select one CS catheter from all catheter-like objects. All three methods were applied to X-ray images from 18 patients undergoing radiofrequency ablation for the treatment of atrial fibrillation. The 2-D target registration errors (TRE) at the pulmonary veins were calculated to validate the methods. A TRE of 1.6 mm ± 0.8 mm was achieved for the diaphragm tracking; 1.7 mm ± 0.9 mm for heart border tracking, 1.9 mm ± 1.0 mm for trachea tracking, and 1.8 mm ± 0.9 mm for CS catheter tracking. We present a comprehensive comparison between the techniques in terms of robustness, as computed by tracking errors, and accuracy, as computed by TRE using two independent approaches.     

Registration and tracking to integrate X-ray and MR images in an XMR facility

We describe a registration and tracking technique to integrate cardiac X-ray images and cardiac magnetic resonance (MR) images acquired from a combined X-ray and MR interventional suite (XMR). Optical tracking is used to determine the transformation matrices relating MR image coordinates and X-ray image coordinates. Calibration of X-ray projection geometry and tracking of the X-ray C-arm and table enable three-dimensional (3-D) reconstruction of vessel centerlines and catheters from bi-plane X-ray views. We can, therefore, combine single X-ray projection images with registered projection MR images from a volume acquisition, and we can also display 3-D reconstructions of catheters within a 3-D or multi-slice MR volume. Registration errors were assessed using phantom experiments. Errors in the combined projection images (two-dimensional target registration error--TRE) were found to be 2.4 to 4.2 mm, and the errors in the integrated volume representation (3-D TRE) were found to be 4.6 to 5.1 mm. These errors are clinically acceptable for alignment of images of the great vessels and the chambers of the heart. Results are shown for two patients. The first involves overlay of a catheter used for invasive pressure measurements on an MR volume that provides anatomical context. The second involves overlay of invasive electrode catheters (including a basket catheter) on a tagged MR volume in order to relate electrophysiology to myocardial motion in a patient with an arrhythmia. Visual assessment of these results suggests the errors were of a similar magnitude to those obtained in the phantom measurements.     

Three-dimensional motion tracking of coronary arteries in biplane cineangiograms

A three-dimensional (3-D) method for tracking the coronary arteries through a temporal sequence of biplane X-ray angiography images is presented. A 3-D centerline model of the coronary vasculature is reconstructed from a biplane image pair at one time frame, and its motion is tracked using a coarse-to-fine hierarchy of motion models. Three-dimensional constraints on the length of the arteries and on the spatial regularity of the motion field are used to overcome limitations of classical two-dimensional vessel tracking methods, such as tracking vessels through projective occlusions. This algorithm was clinically validated in five patients by tracking the motion of the left coronary tree over one cardiac cycle. The root mean square reprojection errors were found to be submillimeter in 93% (54/58) of the image pairs. The performance of the tracking algorithm was quantified in three dimensions using a deforming vascular phantom. RMS 3-D distance errors were computed between centerline models tracked in the X-ray images and gold-standard centerline models of the phantom generated from a gated 3-D magnetic resonance image acquisition. The mean error was 0.69 (+/- 0.06) mm over eight temporal phases and four different biplane orientations.     

Markerless real-time 3-D target region tracking by motion backprojection from projection images

Accurate and fast localization of a predefined target region inside the patient is an important component of many image-guided therapy procedures. This problem is commonly solved by registration of intraoperative 2-D projection images to 3-D preoperative images. If the patient is not fixed during the intervention, the 2-D image acquisition is repeated several times during the procedure, and the registration problem can be cast instead as a 3-D tracking problem. To solve the 3-D problem, we propose in this paper to apply 2-D region tracking to first recover the components of the transformation that are in-plane to the projections. The 2-D motion estimates of all projections are backprojected into 3-D space, where they are then combined into a consistent estimate of the 3-D motion. We compare this method to intensity-based 2-D to 3-D registration and a combination of 2-D motion backprojection followed by a 2-D to 3-D registration stage. Using clinical data with a fiducial marker-based gold-standard transformation, we show that our method is capable of accurately tracking vertebral targets in 3-D from 2-D motion measured in X-ray projection images. Using a standard tracking algorithm (hyperplane tracking), tracking is achieved at video frame rates but fails relatively often (32% of all frames tracked with target registration error (TRE) better than 1.2 mm, 82% of all frames tracked with TRE better than 2.4 mm). With intensity-based 2-D to 2-D image registration using normalized mutual information (NMI) and pattern intensity (PI), accuracy and robustness are substantially improved. NMI tracked 82% of all frames in our data with TRE better than 1.2 mm and 96% of all frames with TRE better than 2.4 mm. This comes at the cost of a reduced frame rate, 1.7 s average processing time per frame and projection device. Results using PI were slightly more accurate, but required on average 5.4 s time per frame. These results are still substantially faster than 2-D to 3-D registration. We conclude that motion backprojection from 2-D motion tracking is an accurate and efficient method for tracking 3-D target motion, but tracking 2-D motion accurately and robustly remains a challenge.     

Surgical navigation by autostereoscopic image overlay of integral videography

This paper describes an autostereoscopic image overlay technique that is integrated into a surgical navigation system to superimpose a real three-dimensional (3-D) image onto the patient via a half-silvered mirror. The images are created by employing a modified version of integral videography (IV), which is an animated extension of integral photography. IV records and reproduces 3-D images using a microconvex lens array and flat display; it can display geometrically accurate 3-D autostereoscopic images and reproduce motion parallax without the need for special devices. The use of semitransparent display devices makes it appear that the 3-D image is inside the patient's body. This is the first report of applying an autostereoscopic display with an image overlay system in surgical navigation. Experiments demonstrated that the fast IV rendering technique and patient-image registration method produce an average registration accuracy of 1.13 mm. Experiments using a target in phantom agar showed that the system can guide a needle toward a target with an average error of 2.6 mm. Improvement in the quality of the IV display will make this system practical and its use will increase surgical accuracy and reduce invasiveness.     

A robust 3-D IVUS transducer tracking using single-plane cineangiography

During an intravascular ultrasound (IVUS) intervention, a catheter with an ultrasound transducer is introduced in the body through a blood vessel, and then, pulled back to image a sequence of vessel cross sections. Unfortunately, there is no 3-D information about the position and orientation of these cross-section planes, which makes them less informative. To position the IVUS images in space, some researchers have proposed complex stereoscopic procedures relying on biplane angiography to get two X-ray image sequences of the IVUS transducer trajectory along the catheter. To simplify this procedure, we and others have elaborated algorithms to recover the transducer 3-D trajectory with only a single view X-ray image sequence. In this paper, we present an improved method that provides both automated 2-D and 3-D transducer tracking based on pullback speed as a priori information. The proposed algorithm is robust to erratic pullback speed and is more accurate than the previous single-plane 3-D tracking methods.     

An augmented reality system for patient-specific guidance of cardiac catheter ablation procedures

We present a system to assist in the treatment of cardiac arrhythmias by catheter ablation. A patient-specific three-dimensional (3-D) anatomical model, constructed from magnetic resonance images, is merged with fluoroscopic images in an augmented reality environment that enables the transfer of electrocardiography (ECG) measurements and cardiac activation times onto the model. Accurate mapping is realized through the combination of: a new calibration technique, adapted to catheter guided treatments; a visual matching registration technique, allowing the electrophysiologist to align the model with contrast-enhanced images; and the use of virtual catheters, which enable the annotation of multiple ECG measurements on the model. These annotations can be visualized by color coding on the patient model. We provide an accuracy analysis of each of these components independently. Based on simulation and experiments, we determined a segmentation error of 0.6 mm, a calibration error in the order of 1 mm and a target registration error of 1.04 +/- 0.45 mm. The system provides a 3-D visualization of the cardiac activation pattern which may facilitate and improve diagnosis and treatment of the arrhytmia. Because of its low cost and similar advantages we believe our approach can compete with existing commercial solutions, which rely on dedicated hardware and costly catheters. We provide qualitative results of the first clinical use of the system in 11 ablation procedures.     

3-D/2-D registration by integrating 2-D information in 3-D

In image-guided therapy, high-quality preoperative images serve for planning and simulation, and intraoperatively as "background", onto which models of surgical instruments or radiation beams are projected. The link between a preoperative image and intraoperative physical space of the patient is established by image-to-patient registration. In this paper, we present a novel 3-D/2-D registration method. First, a 3-D image is reconstructed from a few 2-D X-ray images and next, the preoperative 3-D image is brought into the best possible spatial correspondence with the reconstructed image by optimizing a similarity measure (SM). Because the quality of the reconstructed image is generally low, we introduce a novel SM, which is able to cope with low image quality as well as with different imaging modalities. The novel 3-D/2-D registration method has been evaluated and compared to the gradient-based method (GBM) using standardized evaluation methodology and publicly available 3-D computed tomography (CT), 3-D rotational X-ray (3DRX), and magnetic resonance (MR) and 2-D X-ray images of two spine phantoms, for which gold standard registrations were known. For each of the 3DRX, CT, or MR images and each set of X-ray images, 1600 registrations were performed from starting positions, defined as the mean target registration error (mTRE), randomly generated and uniformly distributed in the interval of 0-20 mm around the gold standard. The capture range was defined as the distance from gold standard for which the final TRE was less than 2 mm in at least 95% of all cases. In terms of success rate, as the function of initial misalignment and capture range the proposed method outperformed the GBM. TREs of the novel method and the GBM were approximately the same. For the registration of 3DRX and CT images to X-ray images as few as 2-3 X-ray views were sufficient to obtain approximately 0.4 mm TREs, 7-9 mm capture range, and 80%-90% of successful registrations. To obtain similar results for MR to X-ray registrations, an image, reconstructed from at least 11 X-ray images was required. Reconstructions from more than 11 images had no effect on the registration results.     

Phase-based multidimensional volume registration

We present a method for accurate image registration and motion compensation in multidimensional signals, such as two-dimensional (2-D) X-ray images and three-dimensional (3-D) computed tomography/magnetic resonance imaging volumes. The method is based on phase from quadrature filters, which makes it robust to noise and temporal intensity variations. The method is equally applicable to signals of two, three or higher number of dimensions. We use parametric models, e.g., affine models, finite elements or local affine models with global regularization. Experimental results show high accuracy for 2-D and 3-D motion compensation.     

3-D/2-D registration of CT and MR to X-ray images

A crucial part of image-guided therapy is registration of preoperative and intraoperative images, by which the precise position and orientation of the patient's anatomy is determined in three dimensions. This paper presents a novel approach to register three-dimensional (3-D) computed tomography (CT) or magnetic resonance (MR) images to one or more two-dimensional (2-D) X-ray images. The registration is based solely on the information present in 2-D and 3-D images. It does not require fiducial markers, intraoperative X-ray image segmentation, or timely construction of digitally reconstructed radiographs. The originality of the approach is in using normals to bone surfaces, preoperatively defined in 3-D MR or CT data, and gradients of intraoperative X-ray images at locations defined by the X-ray source and 3-D surface points. The registration is concerned with finding the rigid transformation of a CT or MR volume, which provides the best match between surface normals and back projected gradients, considering their amplitudes and orientations. We have thoroughly validated our registration method by using MR, CT, and X-ray images of a cadaveric lumbar spine phantom for which "gold standard" registration was established by means of fiducial markers, and its accuracy assessed by target registration error. Volumes of interest, containing single vertebrae L1-L5, were registered to different pairs of X-ray images from different starting positions, chosen randomly and uniformly around the "gold standard" position. CT/X-ray (MR/ X-ray) registration, which is fast, was successful in more than 91% (82% except for L1) of trials if started from the "gold standard" translated or rotated for less than 6 mm or 17 degrees (3 mm or 8.6 degrees), respectively. Root-mean-square target registration errors were below 0.5 mm for the CT to X-ray registration and below 1.4 mm for MR to X-ray registration.     

Application of sonomicrometry and multidimensional scaling tocardiac catheter tracking

This paper describes a technique for tracking the three-dimensional (3-D) position of a cardiac catheter using sonomicrometry and the mathematical method of multidimensional scaling (MDS). Sonomicrometry is used to measure the distances between ultrasonic transceivers. MDS is then used to calculate the 3-D coordinates of the ultrasonic transceiver locations, including the catheter tip, from the measured distances. Feasibility of catheter tracking was initially studied using simulated data from a geometric model in which the actual coordinates of all transceivers were known. The method was then shown to be feasible in vivo by tracking a catheter-mounted piezoelectric transducer using seven reference crystals sewn to the epicardial surface of a sheep heart. Simulation results indicate that a catheter can be tracked with a root-mean-square (rms) error of 1.51±0.05 mm and an average-distance error of e=1.06±0.27 mm using 12 reference points. In vivo results showed acceptable stress values (G<0.05) for 95% of the data samples with an average-distance error of e=0.52±0.66 mm. These simulation and experimental results show that sonomicrometry and MDS can be used to accurately localize the 3-D position and track the motion of a catheter tip within the heart     

Guide wire reconstruction and visualization in 3DRA using monoplane fluoroscopic imaging

A method has been developed that, based on the guide wire position in monoplane fluoroscopic images, visualizes the approximate guide wire position in the three-dimensional (3-D) vasculature, that is obtained prior to the intervention with 3-D rotational X-ray angiography (3DRA). The method assumes the position of the guide wire in the fluoroscopic images is known. A two-dimensional feature image is determined from the 3DRA data. In this feature image, the guide wire position is determined in a two-step approach: a mincost algorithm is used to determine a suitable position for the guide wire, and subsequently a snake optimization technique is applied to move the guide wire to a better position. The resulting guide wire can then be visualized in 3-D in combination with the 3DRA dataset. The reconstruction accuracy of the method has been evaluated using a 3DRA image of a vascular phantom filled with contrast, and monoplane fluoroscopic images of the same phantom without contrast and with a guide wire inserted. The evaluation has been performed for different projection angles, and with different parameters for the method. The final result does not appear to be very sensitive to the parameters of the method. The average mean error of the estimated 3-D guide wire position is 1.5 mm, and the average tip distance is 2.3 mm. The effect of inaccurate C-arm geometry information is also investigated. Small errors in geometry information (up to 1 degrees) will slightly decrease the 3-D reconstruction accuracies, with an error of at most 1 mm. The feasibility of this approach on clinical data is demonstrated.     

Registration of three-dimensional cardiac catheter models to single-plane fluoroscopic images

Transvenous cardiac procedures require accurate positioning of catheters within the geometrically complex cavities of the heart. Recently, nonfluoroscopic catheter tracking technologies have been developed to quantitate the (degrees-of-freedom) three-dimensional positions of intracardiac catheters. This paper presents a projection-Procrustes method to register an animated three-dimensional (3-D) model of multiple intracardiac catheters with a single-plane fluoroscopic image. Applying the computed transformation to the catheter coordinates enables the animated 3-D model of the catheters to be viewed from the same perspective as the fluoroscopic image. Mathematical simulations show that the computed transformation parameters are sensitive to both the position errors in the 3-D catheter coordinates and to the spatial distribution of the catheter-mounted transducers. Simulations with a realistic geometric model of three catheters with four transducers per catheter showed an angular error of 1.91 degrees +/- 0.27 degree for 3-D catheter position errors of 2.0 mm. An in vitro experiment demonstrated the feasibility of the method using a water tank phantom of three catheters and fluoroscopic images taken over an 80 degrees range. The mean angular error was 0.61 degree +/- 0.48 degree. The results of this study indicate that the projection-Procrustes method is a useful tool for registering 3-D catheter tracking models to single-plane fluoroscopic images.     

Three-dimensional guide-wire reconstruction from biplane image sequences for integrated display in 3-D vasculature

Using three-dimensional rotational X-ray angiography (3DRA), three-dimensional (3-D) information of the vasculature can be obtained prior to endovascular interventions. However, during interventions, the radiologist has to rely on fluoroscopy images to manipulate the guide wire. In order to take full advantage of the 3-D information from 3DRA data during endovascular interventions, a method is presented that yields an integrated display of the position of the guide wire and vasculature in 3-D. The method relies on an automated method that tracks the guide wire simultaneously in biplane fluoroscopy images. Based on the calibrated geometry of the C-arm, the 3-D guide-wire position is determined and visualized in the 3-D coordinate system of the vasculature. The method is evaluated in an intracranial anthropomorphic vascular phantom. The influence of the angle between projections, distortion correction of the projection images, and accuracy of geometry knowledge on the accuracy of 3-D guide-wire reconstruction from biplane images is determined. If the calibrated geometry information is used and the images are corrected for distortion, a mean distance to the reference standard of 0.42 mm and a tip distance of 0.65 mm is found, which means that accurate guide-wire reconstruction from biplane images can be performed.     

Volume registration using needle paths and point landmarks for evaluation of interventional MRI treatments

We created a method for three-dimensional (3-D) registration of medical images (e.g., magnetic resonance imaging (MRI) or computed tomography) to images of physical tissue sections or to other medical images and evaluated its accuracy. Our method proved valuable for evaluation of animal model experiments on interventional-MRI guided thermal ablation and on a new localized drug delivery system. The method computes an optimum set of rigid body registration parameters by minimization of the Euclidean distances between automatically chosen correspondence points, along manually selected fiducial needle paths, and optional point landmarks, using the iterative closest point algorithm. For numerically simulated experiments, using two needle paths over a range of needle orientations, mean voxel displacement errors depended mostly on needle localization error when the angle between needles was at least 20 degrees. For parameters typical of our in vivo experiments, the mean voxel displacement error was < 0.35 mm. In addition, we determined that the distance objective function was a useful diagnostic for predicting registration quality. To evaluate the registration quality of physical specimens, we computed the misregistration for a needle not considered during the optimization procedure. We registered an ex vivo sheep brain MR volume with another MR volume and tissue section photographs, using various combinations of needle and point landmarks. Mean registration error was always < or = 0.54 mm for MR-to-MR registrations and < or = 0.52 mm for MR to tissue section registrations. We also applied the method to correlate MR volumes of radio-frequency induced thermal ablation lesions with actual tissue destruction. In this case, in vivo rabbit thigh volumes were registered to photographs of ex vivo tissue sections using two needle paths. Mean registration errors were between 0.7 and 1.36 mm over all rabbits, the largest error less than two MR voxel widths. We conclude that our method provides sufficient spatial correspondence to facilitate comparison of 3-D image data with data from gross pathology tissue sections and histology.     

US-fluoroscopy registration for transcatheter aortic valve implantation

Transcatheter aortic valve implantation is a minimally invasive alternative to open-heart surgery for aortic stenosis in which a stent-based bioprosthetic valve is delivered into the heart on a catheter. Limited visualization during this procedure can lead to severe complications. Improved visualization can be provided by live registration of transesophageal echo (TEE) and fluoroscopy images intraoperatively. Since the TEE probe is always visible in the fluoroscopy image, it is possible to track it using fiducial-based single-perspective pose estimation. In this study, inherent probe tracking performance was assessed, and TEE to fluoroscopy registration accuracy and robustness were evaluated. Results demonstrated probe tracking errors of below 0.6 mm and 0.2°, a 2-D RMS registration error of 1.5 mm, and a tracking failure rate of below 1%. In addition to providing live registration and better accuracy and robustness compared to existing TEE probe tracking methods, this system is designed to be suitable for clinical use. It is fully automatic, requires no additional operating room hardware, does not require intraoperative calibration, maintains existing procedure and imaging workflow without modification, and can be implemented in all cardiac centers at extremely low cost.     

Three-dimensional (3-D) reconstruction of the spine from a single X-ray image and prior vertebra models

The lateral bending test is routinely used by clinicians for the preoperative assessment of spinal mobility. The evaluation of bending motion is usually based on the qualitative analysis of a two-dimensional (2-D) antero-posterior X-ray image. The aim of this paper is to introduce a novel three-dimensional (3-D) reconstruction technique that is a prerequisite for the quantitative 3-D analysis of lateral bending motion. An algorithm was developed for the 3-D reconstruction of the spine from a single X-ray image. The X-ray is calibrated using a small calibration object and an explicit calibration algorithm. The information contained in the single X-ray is completed by registering a priori 3-D geometric models of individual vertebrae. Part of the error yielded by the 3-D/2-D registration is corrected by a vertebral alignment constraint that aims to minimize intervertebral dislocations. Three-dimensional models of 15 different scoliosis patients, obtained from a standard stereo-radiographic 3-D reconstruction, were used in simulation and validation experiments. Experimental results show that the new method is robust and accurate. With pessimistic levels of simulated noise, the average root mean square reconstruction error is 2.89 mm, which is appropriate for common clinical applications.     

Semiautomatic 3-D image registration as applied to interventional MRI liver cancer treatment

We evaluated semiautomatic, voxel-based registration methods for a new application, the assessment and optimization of interventional magnetic resonance imaging (I-MRI) guided thermal ablation of liver cancer. The abdominal images acquired on a low-field-strength, open I-MRI system contain noise, motion artifacts, and tissue deformation. Dissimilar images can be obtained as a result of different MRI acquisition techniques and/or changes induced by treatments. These features challenge a registration algorithm. We evaluated one manual and four automated methods on clinical images acquired before treatment, immediately following treatment, and during several follow-up studies. Images were T2-weighted, T1-weighted Gd-DTPA enhanced, T1-weighted, and short-inversion-time inversion recovery (STIR). Registration accuracy was estimated from distances between anatomical landmarks. Mutual information gave better results than entropy, correlation, and variance of gray-scale ratio. Preprocessing steps such as masking and an initialization method that used two-dimensional (2-D) registration to obtain initial transformation estimates were crucial. With proper preprocessing, automatic registration was successful with all image pairs having reasonable image quality. A registration accuracy of approximately equal to 3 mm was achieved with both manual and mutual information methods. Despite motion and deformation in the liver, mutual information registration is sufficiently accurate and robust for useful applications in I-MRI thermal ablation therapy.     

Prospective motion correction of X-ray images for coronary interventions

A method for prospective motion correction of X-ray imaging of the heart is presented. A 3D + t coronary model is reconstructed from a biplane coronary angiogram obtained during free breathing. The deformation field is parameterized by cardiac and respiratory phase, which enables the estimation of the state of the arteries at any phase of the cardiac-respiratory cycle. The motion of the three-dimensional (3-D) coronary model is projected onto the image planes and used to compute a dewarping function for motion correcting the images. The use of a 3-D coronary model facilitates motion correction of images acquired with the X-ray system at arbitrary orientations. The performance of the algorithm was measured by tracking the motion of selected left coronary landmarks using a template matching cross-correlation. In three patients, we motion corrected the same images used to construct their 3D + t coronary model. In this best case scenario, the algorithm reduced the motion of the landmarks by 84%-85%, from mean RMS displacements of 12.8-14.6 pixels to 2.1-2.2 pixels. Prospective motion correction was tested in five patients by building the coronary model from one dataset, and correcting a second dataset. The patient's cardiac and respiratory phase are monitored and used to calculate the appropriate correction parameters. The results showed a 48%-63% reduction in the motion of the landmarks, from a mean RMS displacement of 11.5-13.6 pixels to 4.4-7.1 pixels.     

Three-dimensional trajectory assessment of an IVUS transducer from single-plane cineangiograms: a phantom study

The recovery of the three-dimensional (3-D) path of the transducer used during an intravascular ultrasound (IVUS) examination is of primary importance to assess the exact 3-D shape of the vessel under study. Traditionally, the reconstruction is done by simply stacking the images during the pullback, or more recently using biplane angiography to recover the vessel curvature. In this paper, we explain, how single-plane angiography can be used with two projection models, to perform this task. Two types of projection geometry are analyzed: weak-perspective and full-perspective. In weak-perspective projection geometry, the catheter path can be reconstructed without prior transducer depth information. With full-perspective projection geometry, precise depth location of reference points are needed in order to minimize the error of the recovered transducer angle of incidence. The transducer angulation reconstruction is based on the foreshortening effect as seen from the X-ray images. By comparing the measured to the true transducer length, we are able to get its incidence angle. The transducer trajectory is reconstructed by stitching together the different estimated angulations obtained from each image in a cineangiogram sequence. The method is described and validated on two helical vessel phantoms, giving on average a reconstructed path that is less than 2 mm distant from the true path when using full-perspective projection.