Health Engineering to Facilitate Cardiac Interventions

The first time I went into an operating room at the Hôpital Sainte-Justine, I was impressed by the number of cardiologists and other clinical practitioners involved in “fixing” a tiny artery, measuring only millimeters, in a baby that was a few months old.  At that time, I had just completed my Master’s in software engineering, at the ÉTS, and I was doing a research internship with the team of Professor Luc Duong. I was still torn between looking for a job and enrolling in a Ph.D. program. After my first visit to Sainte-Justine, however, I knew I wanted to do a Ph.D. in Professor Duong’s team, at the Interventional Imaging Lab.

Figure 1 Percutaneous Coronary Intervention

My job is to propose X-ray segmentation and registration techniques, which will help guide the surgeons during percutaneous coronary interventions. A percutaneous procedure is a form of surgery used to repair or diagnose a disease. Unlike open heart surgery, this procedure involves passing a catheter (a tube of a few millimeters in diameter) in an artery (e.g., femoral artery) and navigating it through the arterial structure of the patient until the “diseased” area is reached. The only way to guide the surgeon manipulating the catheter is to provide X-rays, taken in real time, which can show in a few seconds the inside of the patient’s chest, enabling the surgeon to visualize the catheter and the blood vessel surrounding it. However, X-rays do not provide all the required information. This is where our research team hopes to intervene.

Figure 2 Extraction of the coronary arteries (red) from a 2D X-ray

My first research objective is to find a solution to automatically detect and extract the structures of interest (i.e. arteries and other blood vessels) from the rest of the image. Such a solution would then serve to make an image registration of the patient’s structure, acquired in 3D (before the operation), and according to the image viewed in real-time (2D radiographic sequence). This would also provide a better presentation of X-rays during percutaneous interventions.

A Ph.D. is a long journey that has its ups and downs (otherwise it would not be a good challenge). What motivates me the most is to be working on a specific problem, on one side, with a multidisciplinary team of engineers and professors of the ÉTS and, on the other, with surgeons and other clinical practitioners. Also, I still think of my first visit to the operating room where I saw three cardiologists observing the same X-ray in order to place the catheter into the patient’s heart. I told myself then: “If I could help them just a little in their work, I would be the happiest of Ph.D. students! ”