# US 10,319,091 B2 · Providing image support to a practitioner > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 10,319,091 B2 - Document ID: US10319091B2 - Status: Granted - Kind: B2 - Application number: 15/368,670 - Filed: 2016-12-04 - Published: 2017-06-08 - Granted: 2019-06-11 - Earliest claimed: 2015-12-04 - Assignees: Siemens Healthcare GmbH - Applicants: Thomas Hoffmann; Martin Skalej - Inventors: Thomas Hoffmann; Martin Skalej - Web page: https://patentgrep.com/patent/US10319091B2 ## CPC - G06T 7/0012: {Biomedical image inspection} - A61B 6/4441: {the rigid structure being a C-arm or U-arm} - A61B 6/461: {Displaying means of special interest} - A61B 6/487: {involving fluoroscopy} - A61B 6/504: {for diagnosis of blood vessels, e.g. by angiography} - A61B 6/5235: {combining images from the same or different ionising radiation imaging techniques, e.g. PET and CT} - A61B 6/5252: {removing objects from field of view, e.g. removing patient table from a CT image} - G06T 7/11: Region-based segmentation - G06T 7/60: Analysis of geometric attributes - G06T 2207/10021: Stereoscopic video; Stereoscopic image sequence - G06T 2207/10064: Fluorescence image - G06T 2207/30101: Blood vessel; Artery; Vein; Vascular - G06T 2211/404: Angiography - G06T: IMAGE DATA PROCESSING OR GENERATION, IN GENERAL - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract A three-dimensional subtraction angiography image data set including a target region of the patient is acquired. A region of interest is selected. An imaging geometry is defined for monitoring the intervention using an X-ray device. The image-obscuring blood vessels that superimpose the region of interest in the imaging geometry and imaging zones that show fractions of the image-obscuring blood vessels in the imaging geometry are determined. Path information relating to the image-obscuring blood vessels is defined. The information relating to the path is input into a two-dimensional forward projection data set. A fluoroscopic image is acquired in the imaging geometry. Pixels showing the image-obscuring blood vessels in the fluoroscopic image are determined using the path information and image intensity information from the fluoroscopic image. A masked image of the image-obscuring blood vessels is subtracted. The fluoroscopic image that has been modified is displayed. ## Claims ### Claim 1 A method for providing image support to a practitioner in an interventional treatment of a target area in a patient, the method comprising: acquiring a three-dimensional (3D) subtraction angiography image data set including a target region of the patient that includes the target area; selecting a region of interest in the 3D subtraction angiography image data set, the region including the target area; defining an imaging geometry that implements a projection direction for acquiring two-dimensional (2D) fluoroscopic images for monitoring the intervention using an X-ray device; determining image-obscuring blood vessels that superimpose the region of interest in the imaging geometry, and determining imaging zones that show fractions of the image-obscuring blood vessels in the imaging geometry without superimposition by other blood vessels by forward projection of the 3D subtraction angiography image data set in the projection direction; defining path information relating to the image-obscuring blood vessels at least in a zone around the region of interest and in the imaging zones, and inputting the path information into a 2D forward projection data set; acquiring a fluoroscopic image in the imaging geometry; determining pixels that show the image-obscuring blood vessels in the fluoroscopic image using the information relating to the path, and determining image intensity information from intensities measured on pixels in the fluoroscopic image; modifying the fluoroscopic image, the modifying comprising subtracting a masked image of the image-obscuring blood vessels acquired by the path information in the region of interest and the image intensity information from the fluoroscopic image in the region of interest; and displaying the modified fluoroscopic image. ### Claim 2 (depends on 1) The method of claim 1, wherein acquiring the 3D subtraction angiography image data set ensues with the same X-ray device as the fluoroscopic image in the patient, the patient not being moved between the acquiring of the 3D subtraction angiography image data set and the acquiring of the fluoroscopic image, or a coordinate system of the X-ray device is or becomes registered with the subtraction angiography data set in order to acquire the fluoroscopic images. ### Claim 3 (depends on 1) The method of claim 1, wherein before the determining of the image-obscuring blood vessels in the pixels showing the imaging zones, a fine registration of the 2D forward projection data set and of the fluoroscopic image ensues based on at least the path of the image-obscuring blood vessels in the region of interest described by the information relating to the path. ### Claim 4 (depends on 1) The method of claim 1, wherein the path information includes at least a center line, an extent, or the center line and the extent of the image-obscuring blood vessels, an extent of the image-obscuring blood vessels that is to be considered when generating the masked image in the fluoroscopic image is determined at least in the region of interest, or a combination thereof. ### Claim 5 (depends on 1) The method of claim 1, wherein when there is a change in the imaging geometry during fluoroscopic image monitoring, the method further comprises providing a fresh definition of the 2D forward projection data set using the new imaging geometry, and subsequently using the forward projection data set to correct fluoroscopic images of the new imaging geometry. ### Claim 6 (depends on 1) The method of claim 1, wherein an intensity of the imaging of the image-obscuring blood vessels in the masked image is acquired by interpolation or extrapolation between or from intensities measured on the pixels in the imaging zones. ### Claim 7 (depends on 6) The method of claim 6, wherein through the interpolation or extrapolation, an intensity trajectory is defined along the center line of the image-obscuring blood vessels that has been acquired as part of the path information. ### Claim 8 (depends on 7) The method of claim 7, wherein a function that is parameterizable according to the extent is used in the masked image towards an edge of the image-obscuring blood vessels to describe a decrease in an attenuation described by the intensity. ### Claim 9 (depends on 6) The method of claim 6, wherein superimposition-free segments of the image-obscuring blood vessels are selected as imaging zones in the projection direction as close as possible to the region of interest. ### Claim 10 (depends on 4) The method of claim 4, wherein the extent of the image-obscuring blood vessels that is to be considered when generating the masked image in the fluoroscopic image is determined at least in the region of interest in the context of the fine registration. ### Claim 11 An X-ray device comprising: a controller configured to: acquire a three-dimensional (3D) subtraction angiography image data set including a target region of a patient that includes a target area; select a region of interest in the 3D subtraction angiography image data set, the region of interest including the target area; define an imaging geometry that implements a projection direction for acquiring two-dimensional (2D) fluoroscopic images for monitoring the intervention using an X-ray device; determine image-obscuring blood vessels that superimpose the region of interest in the imaging geometry, and determining imaging zones that show fractions of the image-obscuring blood vessels in the imaging geometry without superimposition by other blood vessels by forward projection of the 3D subtraction angiography image data set in the projection direction; define path information relating to the image-obscuring blood vessels at least in a zone around the region of interest and in the imaging zones, and inputting the path information into a 2D forward projection data set; acquire a fluoroscopic image in the imaging geometry; determine pixels that show the image-obscuring blood vessels in the fluoroscopic image using the information relating to the path, and determining image intensity information from intensities measured on pixels in the fluoroscopic image; modify the fluoroscopic image, the modifying comprising subtracting a masked image of the image-obscuring blood vessels acquired by the path information in the region of interest and the image intensity information from the fluoroscopic image in the region of interest; and display the modified fluoroscopic image. ### Claim 12 In a non-transitory computer-readable storage medium that stores instructions executable by a computer to provide image support to a practitioner in an interventional treatment of a target area in a patient, the instructions comprising: acquiring a three-dimensional (3D) subtraction angiography image data set including a target region of the patient that includes the target area; selecting a region of interest in the 3D subtraction angiography image data set, the region including the target area; defining an imaging geometry that implements a projection direction for acquiring two-dimensional (2D) fluoroscopic images for monitoring the intervention using an X-ray device; determining image-obscuring blood vessels that superimpose the region of interest in the imaging geometry, and determining imaging zones that show fractions of the image-obscuring blood vessels in the imaging geometry without superimposition by other blood vessels by forward projection of the 3D subtraction angiography image data set in the projection direction; defining path information relating to the image-obscuring blood vessels at least in a zone around the region of interest and in the imaging zones, and inputting the path information into a 2D forward projection data set; acquiring a fluoroscopic image in the imaging geometry; determining pixels that show the image-obscuring blood vessels in the fluoroscopic image using the information relating to the path, and determining image intensity information from intensities measured on pixels in the fluoroscopic image; modifying the fluoroscopic image, the modifying comprising subtracting a masked image of the image-obscuring blood vessels acquired by the path information in the region of interest and the image intensity information from the fluoroscopic image in the region of interest; and displaying the modified fluoroscopic image. ### Claim 13 (depends on 12) The non-transitory computer-readable storage medium of claim 12, wherein acquiring the 3D subtraction angiography image data set ensues with the same X-ray device as the fluoroscopic image in the patient, the patient not being moved between the acquiring of the 3D subtraction angiography image data set and the acquiring of the fluoroscopic image, or a coordinate system of the X-ray device is or becomes registered with the subtraction angiography data set in order to acquire the fluoroscopic images. ### Claim 14 (depends on 12) The non-transitory computer-readable storage medium of claim 12, wherein before the determining of the image-obscuring blood vessels in the pixels showing the imaging zones, a fine registration of the 2D forward projection data set and of the fluoroscopic image ensues based on at least the path of the image-obscuring blood vessels in the region of interest described by the information relating to the path. ### Claim 15 (depends on 12) The non-transitory computer-readable storage medium of claim 12, wherein the path information includes at least a center line, an extent, or the center line and the extent of the image-obscuring blood vessels, an extent of the image-obscuring blood vessels that is to be considered when generating the masked image in the fluoroscopic image is determined at least in the region of interest, or a combination thereof. ### Claim 16 (depends on 12) The non-transitory computer-readable storage medium of claim 12, wherein when there is a change in the imaging geometry during fluoroscopic image monitoring, the instructions further comprise providing a fresh definition of the 2D forward projection data set using the new imaging geometry, and subsequently using the forward projection data set to correct fluoroscopic images of the new imaging geometry.