Towards active image guidance: Tracking of a fiducial in the thorax during respiration under X-ray fluoroscopy

A central purpose of image-guidance is to assist the interventionalist with feedback of geometric performance in the direction of therapy delivery. Tradeoffs exist between accuracy, precision and the constraints imposed by parameters used in the generation of images. A framework that uses geometric performance as feedback to control these parameters can balance such tradeoffs in order to maintain the requisite localization precision for a given clinical procedure. We refer to this principle as Active Image-Guidance (AIG). This framework requires estimates of the uncertainty in the estimated location of the object of interest. In this study, a simple fiducial marker detected under X-ray fluoroscopy is considered and it is shown that a relation exists between the applied imaging dose and the uncertainty in localization for a given observer. A robust estimator of the location of a fiducial in the thorax during respiration under X-ray fluoroscopy is demonstrated using a particle filter based approach that outputs estimates of the location and the associated spatial uncertainty. This approach gives an rmse of 1.3mm and the uncertainty estimates are found to be correlated with the error in the estimates. Furthermore, the particle filtering approach is employed to output location estimates and the associated uncertainty not only at instances of pulsed exposure but also between exposures. Such a system has applications in image-guided interventions (surgery, radiotherapy, interventional radiology) where there are latencies between the moment of imaging and the act of intervention.