Optimal C-arm angulation during transcatheter aortic valve replacement: Accuracy of a rotational C-arm computed tomography based three dimensional heart model

Figure 1 Mesh topology of the rotational C-arm computed tomography model for transcatheter aortic valve replacement (left), extended topology model with rings for diameter measurements (blue), prolonged descending aorta and left ventricle.

Figure 2 Definition of C-arm coordinate system and illustration of angular displacement between two position vectors each representing a C-arm projection view.

Figure 3 Interobserver variability of rotational C-arm computed tomography-based view planning. Using Monte-Carlo methods the cumulative distribution function of the angular deviation between two operator-defined C-arm configurations was computed; from this distribution function the expected angular deviation is derived to be the value of the distribution function at 95% confidence level.

Figure 4 Line of perpendicularity curve for the aortic valve annulus of a sample patient. The solid line represents the line of perpendicularity curve derived from the RCT model; optimal views following the right-cusp rule are given for two operators and the RCT model. RCT: Rotational C-arm computed tomography.

Figure 5 Bland-Altman plot relating aortic annulus diameter measurements done by a medical expert to rotational C-arm computed tomography-model-based measurements. RCT: Rotational C-arm computed tomography.

Figure 6 Model-based view planning and interventional overlay with Philips HeartNavigator software.