Download El presente proyecto coordinado aborda el problema de la

ANEURISM@: Computational Image Analysis and Personalised Hemodynamic Simulation
for Supporting Diagnosis of Cerebral Aneurysms and Planning of Minimally Invasive
Endovascular Interventions
This project deals with the problem of predicting the risk of rupture of brain aneurysms. Its objective is the integration, within a computational framework, of multimodal information acquired from different modern medical
imaging modalities. This will provide the specialists with the opportunity of making more informed decisions about the
appropriateness of a particular treatment, as well as the tools needed for planning minimally invasive surgery. With
such aim, computer vision and advanced techniques for image analysis, and fluid dynamics simulation will be
used. Three-dimensional rotational angiography (3DRA) will be the imaging modality mainly used. From these images, personalised anatomical models will be obtained. To this end, implicit deformable models for surface evolution
will be considered, as they allow dealing with segmentation problems with variable topology. These geometrical
models can later be used as the basis to define a space of morphological features where the aneurysms will be
uniquely described in a complete but compact way. In this framework, we will use shape indexes available in the
literature and introduce new ones, focusing on those that are invariant under similarity transformations. Moreover,
we will also develop methods based upon medical images to determine in vivo and non-invasively the blood flow
inside the aneurysms and in the adjacent vessels, as well as to estimate their elastic properties. By combining
image-based anatomical models and boundary conditions into the framework of simulation studies, the information
needed for analysing the role of the hemodynamics in the natural history and evolution of brain aneurysms will be
available. Similarly, in order to improve the planning of minimally invasive surgery and the design of endovascular
devices, we will also study the effect of such devices on the blood flow by means of simulation studies. To accomplish the abovementioned goals, the use of registration techniques will play a fundamental role in merging multimodal information. One of the key objectives of this project is to establish the relevance of the different morphological and hemodynamic features of aneurysms, as predictors of aneurysm rupture. Furthermore, we will
develop an annotated electronic data base which will be used as a reference in future decision making processes
and will facilitate case-based reasoning strategies. Finally, we pretend to create a pilot multidisciplinary laboratory
for advanced diagnosis and surgical planning where all the image analysis and numerical simulations will be
carried out in order to provide support to neurosurgeons or interventionist neuroradiologists in the operating room. As
managing this support system will necessarily require from computing infrastructures and highly qualified staff,
providing service to a single hospital could be economically implausible. For this reason, it is foreseen that the laboratory for planning and diagnosis will be installed outside the hospital and will potentially provide service to the whole
metropolitan area of Barcelona. Nevertheless, in this project we only intend to build a pilot demo for Barcelona Clinic
Hospital and Catalonia General Hospital. It is also worth noting that this project is highly interdisciplinary and
international and includes the participation of the following external collaborators: School of Computational Sciences
from George Mason University (USA), Inova Fairfax Hospital (USA), Valencia Clinic Hospital (E), Geneva University
Hospital (CH), and Philips Medical Systems Nederland BV (NL). Our collaborators are internationally recognised
scientists and their contributions to the project with data and/or clinic and scientific expertise will be crucial for the
development of our research.
CardioSync: Modelling, Analysis and Simulation Platform for Cardiac Resynchronization
Therapy Planning and Candidate Recruiting
The project CardioSync aims to develop an application software interface that through a series of analysis,
modeling and simulation tools will allow evaluating the cardiac function, through the study of its electrical and
mechanical properties. The necessary data will be provided by dynamic studies of the heart provided by state-ofthe-art image acquisition equipments. These include non-invasive and non-ionizing modalities, such us magnetic
resonance imaging (MRI), three-dimensional ultrasound (3DUS), and electroanatomic mapping systems
(EAM). To carry out the modeling and run simulations, algorithms will be developed based on electromechanical
models of the heart.
The CardioSync environment will be focused on the clinical field of cardiac resynchronization therapy (CRT).
This technique tries to improve the ventricular function by means of resynchronization of contraction patterns, using
implantable resynchronization devices (IRD). In the last few years, the CRT has generated great clinical interest
due to the success in patient candidates to cardiac transplant, which were not answering to the rest of the therapies. Nevertheless, it is an invasive, costly and ineffectively administered technique, and since nowadays, almost one third of intervened patients do not respond to the treatment.
In concrete, CardioSync will provide tools of great utility, in three main applications: CRT planning, quantitative
evaluation of CRT results and optimal patient selection.
Among the above mentioned objectives, the construction of electromechanical models of the heart is stressed.
These models will be specific to every patient and derived from the aforementioned image modalities, using advanced tools of image analysis, like statistical model-based segmentation, non-rigid image and surface registration,
among others. Due to the complexity of the considered geometries, the modeling and the simulations will be carried
out using the method of the finite elements, in order to spatially discretise the problem. To guarantee the specificity of
the model to every patient, parameter estimation techniques will be explored in order to elucidate from the information provided by the images, the physical parameters (electrical and mechanical) of the patient. In addition, the
system will be provided with mechanisms of 3D visualization and fusion of anatomical and functional information.
Although the quantitative analysis tools will be expressly orientated to the CRT, we foresee their utility in arrhythmia
ablation procedures, using the electromechanical model for simulating these scenarios.
In order to effectively handle the big volume of produced information and the computational burden of some
algorithms, it will be necessary to exhaustively distribute and parallelize computation tasks. TO this aim, the solutions
provided by Grid computing will be available, as well as the latest technology for intensive computation, 3D
rendering and visualization
The Centre Cardiovascular Saint Jordi (CCSJ) is the applicant of the proposal. A multidisciplinary team of excellence including both, clinical and private centers, will also participate: CETIR-Jordi (CET) MR Center, Hospital
Clinic Provincial (HCPB) of Barcelona, Hospital San Carlos (HSCM) of Madrid. Universities and companies of the
information technologies sector will also participate: University Pompeu Fabra (UPF) of Barcelona by means of a
research group specialized in medical image analysis, University of Girona (UDG) with a specialized group in computational fluid mechanics who will coordinate the tasks of numerical simulation, GridSystems S.A. (GS) a company
specialized in GRID solutions with headquarters in Palma de Mallorca, and Silicon Graphics S.A. (SGI) that will
contribute with their experience in hardware architectures in both, high performance computing and graphical advanced visualization. Finally, as a external observer of the proposal, Philips Ibérica S.A. (PIB) will give technical
support to their products and image acquisition machinery.
The roles of the partners will be as follows. UPF and the UDG will be in charged of developing the scientific and
technical aspects through the joint work of postdoctoral investigators, PhD students and scientific developers. GS
and SGI will offer support to the distribution and parallelization of the necessary calculation, both for the development
of the tools, and for the graphical user interface. The clinical centers will provide the studies to construct the volunteers and patient database necessary for the research, development and evaluation of the proposed algorithms. The
clinical specialists will follow the development of the project through the provision of requirements and specifications,
contribution of information, and permanent feedback in the different phases of developing. HCPB and HSCM, as
clinical research public centers, will contribute to increase the experience of the private centers, in the use of new
imaging technologies that they already have, in designing new clinical protocols, and in the analysis of the results.
Finally, PIB, who will participate as external observer of the project, has committed to contribute with confidential
technical information of their equipment and software tools, as well as technical support for them.
To conclude, we intend to stress that the transference of technology, which not only will be directed to the
coordinating company, but also to the public hospitals, will come from several places and will be of interdisciplinary nature.