Perspectives in Medicine (2012) 1, 8081

Bartels E, Bartels S, Poppert H (Editors):

New Trends in Neurosonology and Cerebral Hemodynamics an Update.
Perspectives in Medicine (2012) 1, 8081

journal homepage: www.elsevier.com/locate/permed

Ultrasound fusion imaging

Jeffrey Stoll

Siemens Ultrasound, Mountain View, CA, USA

KEYWORDS Summary Condent interpretation of image data is critical for the success of complex cases.
By enabling the simultaneous live navigation of reference series, such as CT, MRI and PET, side-
Fusion;
by-side with live ultrasound, fusion imaging enables the physician to directly correlate anatomy
CT;
between modalities. This display facilitates interpretation of ultrasound and communication of
MRI;
ndings.
Biopsy;
2012 Elsevier GmbH. Open access under CC BY-NC-ND license.
Workow

Ultrasound fusion is an emerging technique in the eld of
abdominal imaging with translation possibilities to neuro-
radiology. This technique involves the co-registered display
of live ultrasound with a reference series from another
modality, such as CT, MRI or PET [1,2]. As the ultrasound
exam is performed the fusion system continuously generates
reformatted planes from the reference series matching the
oblique imaging planes of the ultrasound transducer. The
reformatted planes are displayed either as an overlay or
side-by-side with the live ultrasound (Figs. 1 and 2). This
display enhances interpretation of ultrasound by enabling a
direct comparison with the reference images from the same
view angle.
The combined use of different modalities for denitive
diagnosis is common. Ultrasound, for instance, is useful to
assess indeterminate lesions identied in CT or MRI. A con-
dent diagnosis can be made if a clear correlation can be
made between ultrasound and the preceding series. How-
ever, if a physician is not condent that ultrasound has
found the correct lesion, the case may be further referred to
another modality with increased time, cost and potentially
mixed results. Fusion imaging enables greater condence
in establishing a clear correlation between modalities by
E-mail addresses: jeffrey.stoll@siemens.com,
jeff.stoll@gmail.com
visualizing the same anatomy from the same view angle.
Ultrasound is also useful for guiding biopsies for denitive
diagnosis. Once again, clear correlation with CT or MRI is
required to condently target a specic lesion. Fusion imag-
ing also has potential as a training tool, similarly allowing
trainees to better understand ultrasound in the context of
CT or MRI.
Fusion imaging makes use of a tracking system to
localize ultrasound transducers and other devices rela-
tive to the patient. Optical and electromagnetic systems
are available, the latter being most commonly used. Var-
ious software tools are also used to bring the reference
series into alignment with the tracking system for fusion
display [36]. Research into these tools has been ongo-
ing for approximately 20 years. Clinical implementation
of fusion imaging has suffered, however, due to the time
required to achieve adequate alignment using traditional
methods. Recent advancements in automatic image analysis
may potentially reduce this time greatly.
Tracking sensors are also incorporated into some inter-
ventional devices such as introducers and ablation needles,
enabling the display of needle location as an overlay on
live ultrasound images (Fig. 2). This display can be use-
ful for overcoming difculties in visualizing needles during
ultrasound-guided procedures [7]. Such devices may allow
procedures to be completed more quickly and with fewer
placement attempts, particularly for more complex cases
(Fig. 3).

2211-968X 2012 Elsevier GmbH. Open access under CC BY-NC-ND license.

http://dx.doi.org/10.1016/j.permed.2012.05.004
Ultrasound fusion imaging 81

Figure 1 Ultrasound (right) fused with a contrast CT of the Figure 3 Needle spatial tracking data overlaid graphically on
liver (left). The ultrasound image is taken from an oblique plane live ultrasound images. The colors indicate parts of the needle
showing the hepatic vasculature. The same vasculature is visu- behind and in front of the ultrasound image. The display enables
alized in the same anatomical plane from the CT. the physician to orient the needle with respect to the image.

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