Improving image integration: Comparison on intra cardiac echocardiography guided surface registration with landmarks registration

In cardiac ablation, image integration can simplify the procedure, reduce complications and minimize radiation exposure. To achieve these results, the accuracy of the image integration process is crucial. In the present study, we compared ICE (intra-cardiac echocardiography)-guided landmarks registration with a new technique of ICE-guided localized surface registration. Twenty patients underwent registration by means of landmarks collected under ICE guidance (Group A). Twenty matched patients underwent the new localized ICE-guided surface registration, which involves collecting a single landmark in the inferior portion of the LIPV (left inferior pulmonary vein) and some surface points in the posterior area of the left PV antrum and around the antrum of the right PVs (Group B). In group A, the mean landmark error was 4.62 plusmn 1.65 mm and the mean ablation-point error was 3.00 plusmn 0.99 mm. In group B, the mean error between ECHO-guided surface points and MRI/CT surface was 1.73 plusmn 0.29 mm. The quality of the final alignment was validated by means of ICE in both groups. Mathematical results combined with ICE-guided validation revealed that ICE-guided surface registration appears to offer better performance than landmarks registration.