A sample image of the interior of a skull, as it might appear using EchoPixel.

Credit: Courtesy, EchoPixel

With New 3-D Technology, Doctors Can Step Inside The Human Brain

July 7, 2017

A cerebral aneurysm diagnosis opens up a world of frightening possibilities. If the weakened artery in the brain leaks or ruptures, a patient could die or suffer serious disability. To determine the best course of treatment, surgeons turn to neuroradiologists for the most detailed images possible. 

At Lahey Hospital in Burlington, radiologists are exploring a new technique that lets doctors step right inside the brain, with the help of 3-D technology.

Three dimensional scans of the brain and other organs are not new. Dr. Sup Choi, the director of interventional neuroradiology at Lahey, says the technology is nearly 20 years old.  

“About 17, 18 years ago, the first so-called rotational angiogram was developed. You take a series of images by X-ray machine rotating around 180 degrees. They acquire 120 spot images and reconstruct this as a three-dimensional image of the blood vessels,” he says.

This is now mainstream technology we all take for granted -- think of the 360 views some online retailers provide for everything from cars to grills, or how easy it is to move around and change perspective in video games.  

Choi pulls up one of those models, showing the brain’s blood vessels on his computer. He explains that these images are still limited, because they are flat pictures.

“We are still looking at a computer screen,” he says. ”The visualization itself is still 2-D.” There’s still a wall between the doctor and what he is examining.

The new system Choi is using is called EchoPixel, and it removes this wall and allows the doctor to step inside the image. in order to use it, you need to don a set of 3-D glasses, just as you would to watch the new Transformers movie. 

As a demonstration, Choi pulls up the angiogram we had just looked at on the ordinary computer screen. It now appears floating in front of us, over a grid that gives us a sense of space and perspective. Choi wields a light pen that emits a virtual beam of light. He pokes the arteries and veins, moving and manipulating them. 

The blood vessels in the brain are as gnarled and complicated as a root system. Choi says the shape of a damaged blood vessel is unique, and damages can be complicated. The shape of the damage can determine proper treatment: sometimes leaks are plugged with an injection of glue, or stents, or debris, like tiny platinum coils.  

The scans Choi shows me in 3 dimensions reveal a fistula, which is a hole in an artery.

“You can see this is about a one millimeter sized vessel. And then it drains into this abnormal vein directly,” he says, taking us deeper in to the image with his magic pen.  He’s able to change the colors of the individual blood vessels, distinguishing artery from vein. He then zooms in, separating and moving the blood vessels, as if performing surgery in midair. 

Choi says in this case they repaired the damage with an injection of glue, and he shows me follow-up scans, where we can see the glue sealing the hole. 

“This case was a very complex problem. But this is a fantastic way of looking at the results,” Choi says.

Other hospitals across the country have been trying out the EchoPixel technology for organs like the heart and colon, where giving surgeons a 3-D head start can prove vital. Lahey is the first hospital to try it out for the brain, and Choi says that so far, he’s “delighted” with that decision.

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