# US 12,213,825 B2 · Augmented fluoroscopy with digital subtraction imaging > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 12,213,825 B2 - Document ID: US12213825B2 - Status: Granted - Kind: B2 - Application number: 17/733,772 - Filed: 2022-04-29 - Published: 2022-08-18 - Granted: 2025-02-04 - Earliest claimed: 2018-04-17 - Assignees: The Board of Trustees of the Leland Stanford Junior University; Pulmera, Inc. - Applicants: The Board of Trustees of the Leland Stanford Junior University - Inventors: Bryan I. Hartley; Harmeet Bedi; Rene Vargas-Voracek; Norbert J. Pelc - Web page: https://patentgrep.com/patent/US12213825B2 ## CPC - A61B 6/487: {involving fluoroscopy} - A61B 6/022: {Stereoscopic imaging} - A61B 6/0492: {using markers or indicia for aiding patient positioning} - A61B 6/4441: {the rigid structure being a C-arm or U-arm} - A61B 6/469: {for selecting a region of interest [ROI]} - A61B 6/481: {involving the use of contrast agents} - A61B 6/50: specially adapted for specific body parts; specially adapted for specific clinical applications - A61B 6/5217: {extracting a diagnostic or physiological parameter from medical diagnostic data} - A61B 6/5235: {combining images from the same or different ionising radiation imaging techniques, e.g. PET and CT} - A61B 90/39: {Markers, e.g. radio-opaque or breast lesions markers} - G06T 5/50: using two or more images, e.g. averaging or subtraction - G06T 7/0014: {using an image reference approach} - A61B 2090/3966: {Radiopaque markers visible in an X-ray image} - G06T 2207/10016: Video; Image sequence - G06T 2207/10121: Fluoroscopy - G06T 2207/30064: Lung nodule - G06T 2207/30208: Marker matrix - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) - G06T: IMAGE DATA PROCESSING OR GENERATION, IN GENERAL ## Abstract A method of x-ray fluoroscopy images a region of interest at distinct first and second imaging projection angles using digital subtraction x-ray fluoroscopic imaging with a fiducial marker board positioned in a field of view containing the region of interest to produce first and second sets of images. Image segmentation information is determined to identify an anatomical feature in the region of interest imaged in the first set of images and the second set of images. The region of interest is then imaged using x-ray fluoroscopic imaging, again with the fiducial marker board positioned in a third field of view containing the region of interest, but without digital subtraction, to produce a third set of images. A virtual image of the anatomical feature is projected onto the third set of images, computed from the image segmentation information and from a predetermined geometric relationship of markers within the fiducial marker board. ## Claims ### Claim 1 A method of x-ray fluoroscopy comprising: imaging a region of interest at a first imaging projection angle using digital subtraction x-ray fluoroscopic imaging with a fiducial marker board positioned in a first field of view containing the region of interest to produce a first set of images; wherein the region of interest is a lung; wherein imaging the region of interest at the first imaging projection angle using digital subtraction x-ray fluoroscopic imaging comprises performing bronchoscopy with air pressure inflation of the lung near the pulmonary nodule during the digital subtraction x-ray fluoroscopic imaging; imaging the region of interest at a second imaging projection angle using digital subtraction x-ray fluoroscopic imaging with the fiducial marker board positioned in a second field of view containing the region of interest to produce a second set of images; wherein imaging the region of interest at the second imaging projection angle using digital subtraction x-ray fluoroscopic imaging comprises performing bronchoscopy with air pressure inflation of the lung near the pulmonary nodule during the digital subtraction x-ray fluoroscopic imaging: determining image segmentation information to identify an anatomical feature in the region of interest imaged in the first set of images and the second set of images; wherein the anatomical feature is a pulmonary nodule; imaging the region of interest using x-ray fluoroscopic imaging with the fiducial marker board positioned in a third field of view containing the region of interest to produce a third set of images; projecting a virtual image of the anatomical feature onto the third set of images, where the virtual image is computed from the image segmentation information to identify the anatomical feature in the region of interest, from images of the fiducial marker board, and from a predetermined geometric relationship of markers within the fiducial marker board. ### Claim 2 (depends on 1) The method of claim 1 wherein performing bronchoscopy with air pressure inflation of the lung near the pulmonary nodule is performed using a catheter with an expandable occluding device disposed at a distal end, air pumps, and air valves. ### Claim 3 (depends on 1) The method of claim 1 wherein performing bronchoscopy with air pressure inflation of the lung near the pulmonary nodule comprises expanding an occluding device disposed at a distal end of a catheter to occlude an airway segment and inflating the airway segment. ### Claim 4 (depends on 1) The method of claim 1 wherein the fiducial marker board comprises multiple rows of radio-dense markers embedded within a board with a predetermined geometric arrangement. ### Claim 5 (depends on 1) The method of claim 1 wherein imaging the region of interest at the first imaging projection angle using digital subtraction x-ray fluoroscopic imaging is performed using a fluoroscopic x-ray C-arm device; wherein imaging the region of interest at the second imaging projection angle using digital subtraction x-ray fluoroscopic imaging is performed using the fluoroscopic x-ray C-arm device; and wherein the method further comprises rotating the fluoroscopic x-ray C-arm device between imaging the region of interest at the first imaging projection angle and imaging the region of interest at the second imaging projection angle. ### Claim 6 (depends on 1) The method of claim 1 wherein determining the image segmentation information is performed automatically using digital image processing.