PURPOSE During endovascular aneurysm repair (EVAR) procedures, medical instruments are guided with two-dimensional (2D) fluoroscopy and conventional digital subtraction angiography. However, this requires X-ray exposure and contrast agent is used, and the depth information is missing. To overcome these drawbacks, a three-dimensional (3D) guidance approach based on tracking systems is introduced and evaluated. METHODS A multicore fiber with fiber Bragg gratings for shape sensing and three electromagnetic (EM) sensors for locating the shape were integrated into a stentgraft system. A model for obtaining the located shape of the first 38 cm of the stentgraft system with two EM sensors is introduced and compared with a method based on three EM sensors. Both methods were evaluated with a vessel phantom containing a 3D-printed vessel made of silicone and agar-agar simulating the surrounding tissue. RESULTS The evaluation of the guidance methods resulted in average errors from 1.35 to 2.43 mm and maximum errors from 3.04 to 6.30 mm using three EM sensors, and average errors from 1.57 to 2.64 mm and maximum errors from 2.79 to 6.27 mm using two EM sensors. Moreover, the videos made from the continuous measurements showed that a real-time guidance is possible with both approaches. CONCLUSION The results showed that an accurate real-time guidance with two and three EM sensors is possible and that two EM sensors are already sufficient. Thus, the introduced 3D guidance method is promising to use it as navigation tool in EVAR procedures. Future work will focus on developing a method with less EM sensors and a detailed latency evaluation of the guidance method.

中文翻译：

---

三维引导，包括用于血管内动脉瘤修复的支架移植系统的形状传感。

目的 在血管内动脉瘤修复 (EVAR) 手术中，医疗器械通过二维 (2D) 透视和传统数字减影血管造影进行引导。然而，这需要X射线曝光并使用造影剂，并且深度信息丢失。为了克服这些缺点，引入并评估了基于跟踪系统的三维（3D）制导方法。方法将具有用于形状传感的光纤布拉格光栅和用于定位形状的三个电磁（EM）传感器的多芯光纤集成到支架移植物系统中。介绍了一种使用两个电磁传感器获得覆膜支架系统前 38 cm 定位形状的模型，并与基于三个电磁传感器的方法进行了比较。这两种方法均使用容器模型进行评估，该模型包含由硅胶和琼脂制成的 3D 打印容器，模拟周围组织。结果 制导方法的评估结果显示，使用三个 EM 传感器时，平均误差为 1.35 至 2.43 mm，最大误差为 3.04 至 6.30 mm；使用两个 EM 传感器时，平均误差为 1.57 至 2.64 mm，最大误差为 2.79 至 6.27 mm。此外，连续测量制作的视频表明，这两种方法都可以实现实时指导。结论 结果表明，使用两个和三个电磁传感器进行精确的实时引导是可能的，并且两个电磁传感器已经足够。因此，引入的 3D 制导方法有望用作 EVAR 程序中的导航工具。未来的工作将集中于开发一种使用较少电磁传感器的方法以及对制导方法进行详细的延迟评估。