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Definition History Equipments Technique Clinical applications

The term is used when multiple patient`s images are registered and overlaid or merged to provide additional information. Fused images may be created from multiple images from the same imaging modality. Fused images may also combine function with anatomical reference . (1)

What we mean by ultrasound fusion

images-fusion between ultrasound and

various visualization modes ( Magnetic Resonance Imaging MRI , Computed tomography CT , Positron emission tomography PET ) to give more accurate image in real-time targeting tumors .(1)

Different imaging modalities

Why we use different methods of imaging ?

Different methods reveal different features Accessibility and Portability Repeated exposure and safety Patient acceptability Cost Effectiveness (2)

Different methods reveal different features

Plane-film X-ray maps the total attenuation of X-rays , Good for bone structure in accidents.

X-ray CT measures the X-ray attenuation coefficient of the body at each point. True 3-D images. (2)

Different methods reveal different features (cont.)

MRI maps the distribution and environment of water molecules in the body.
PET maps the distribution of radioactively labeled compounds. (2)

Accessibility and Portability


MRI .(2)

Repeated exposure and safety

As Low As Reasonably Practicable
Different modalities of imaging use different types of radiation (e.g., MRI uses radio waves, PET uses gamma rays), which have different characteristics. At all times, we should pick the least invasive method.(2)

Patient acceptability
Different types of scan entail different degrees of patient discomfort. Some might require an injection of a contrast agent. The scanning environment is also important . (2)

Cost Effectiveness
Always pick the simplest solution for your problem

Ultrasound 20k - 100k

X-ray CT 500k - 1M

MRI 2M - 4M

PET >5M (2)

Ultrasound fusion with CT &MR

Fusion system can simultaneously show both ultrasound imaging with previous magnetic resonance (MR) and CT study. The basic concept of imaging fusion depends on the idea that an MR/CT study creates a 3D data set that represents the patients anatomy. The 3D data set can be stored in any convenient imaging network location .

US is the real-time modality, that allows to use a feature called Volume Navigation to virtually project the patients previous statics MR/CT data into the space where the clinician is performing a live, real-time, ultrasound. As the operator scans, the ultrasound system shows both the real-time ultrasound and the corresponding slice through the previous MR/CT 3D data .

How does Fusion work?

Fusion Imaging is similar to Navigation Technology (1)

Image Fusion


topography =

Real time



Ultraguide (est. 1996, Haifa, Israel) the first system that used magnetically tracked ultrasound transducers and biopsy instruments . However, the clinical benefit of the technology over traditional fixed biopsy guides was never clearly demonstrated . The ultrasound vendor Biosound Esaote (Genoa, Italy) uses magnetic tracking as well, of both the ultrasound transducer and, optionally, an ablation electrode (Crocetti et al., 2008). The pre-operative CT data is integrated before the ablation procedure using manual registration . (3)

How to mix images together?

The first task is to estimate the parameters that relates homologous points in the two studies (data registration). The second task is to apply the resultant transformation to map structures or features of interest from one study to another (structure mapping) or to directly combine grayscale data from the two studies (data fusion) . (3)

Transmitter Sensor Position sensing electronic unit (1)

Transmitter creates a magnetic field about 30 cubic inches from the face of the Transmitter . (1)

Sensors 2 probe sensors are a fixed distance apart. If field distortion is present, this can vary and the environment issue can be reported to the user, alerting them to a problem that cant be seen. (1)

Position Sensing Electronics Unit drives transmitter, receives signal from sensors and generates position location of sensors in the coordinate space of the transmitter . (1)

Fusion system is composed of a position sensing unit , a magnetic field transmitter , and two sensors connected to a transducer bracket . The transmitter is placed on a stand so that the area being scanned is within the range of the transmitter . Because a position sensor is attached to the transducer , the fusion feature allowed us to import previously acquired CT or MRI DICOM data and to register ultrasound images with the acquired volumetric CT or MRI DICOM data .(4)

MR Image- Axial Plane (1)

Transducer orientation: Axial

Data Registration
Registration procedure is needed to perform fusion imaging correctly . It is achieved by defining common anatomical planes . First the transducer is placed parallel to MRI or CT volume data axial slice; second the common anatomical landmark such as portal vein bifurcation , are identified in the real time ultrasound image and the MR or CT image ; and third , these points are marked on each image . (4)

Structure Mapping
After the suitable registration of the ultrasound image and the CT or MRI image , ultrasound scanning can be viewed simultaneously with the corresponding multiplanar reconstruction slice from the preaquired volumetric CT or MRI data in real time . The global positioning system (GPS) tool, can visually track the marked position during scanning (4) .

Viewing Options

Side by Side Fused display

Overlay Fused display (1)

Diagnostic applications :
ultrasound exams cannot always identify isoechoic tumors . In addition, in ultrasound examinations, there are a few dead angles and it is difficult to examine the whole liver, especially in obese patients. Nodules that are poorly identified on ultrasound are clearly visible on CT/MR. (5)

However, interventional treatment is easier to perform under ultrasound-guidance, while the exposure to increased doses of radiation is also avoided. Thus, real-time virtual sonography combines the imaging advantages of both techniques. (5)

Interventional applications :
Ultrasound suffers from a relatively narrow FOV . MR/CT, by contrast, has an optimal contrast resolution and a wide FOV but lacks real time. Furthermore ,Ultrasound is well suited for many interventional procedures because of its real-time imaging & portability. (6)

The fusion of CT/MRI and US allows using ColorDoppler or CEUS superimposed with CT/MRI. Fusing the images from different modalities could help to avoid multiple exposures to ionizing radiations, improving costs, and quality . (6)

Tracking sensors are also incorporated into some interventional devices such as introducers and ablation needles, enabling the display of needle location as an overlay on live ultrasound images . This can be useful for overcoming difficulties in visualizing needles during ultrasound-guided procedures . Such devices may allow procedures to be completed more quickly and with fewer placement attempts, particularly for more complex cases . (7)

Tracking Needle
Sensor Stylet (18G)

Sheath outer diameter, 18G Procedure Needles.

Assembled (1)

Examples of Clinical Applications

Figure a subtle lesion located at the dome of the liver was difficult to identify by ultrasound alone. By fusing CT and ultrasound images and locating the lesion on CT further evaluation can be done. (8)

US CFM /MRI Overlay - PV Thrombosis (1)

Figure 3 Needle spatial tracking data overlaid graphically on live ultrasound images. The colors indicate parts of the needle behind and in front of the ultrasound image. The display enables the physician to orient the needle . (7)

Liver biopsy in patient with suspected primary pancreatic neoplasm. Cirrhosis made lesions more challenging to see on US compared to CT. Needle Tracking allowed for successful biopsy under US

guidance. (1)

Radiofrequency ablation of a liver mass guided by ultrasound imaging in the CT suite. (3)

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