Patent Publication Number: US-2022218302-A1

Title: Passive-ultrasound-sensor-based initialization for image-based device segmentation

Description:
BACKGROUND OF THE INVENTION 
     An ultrasound tracking technology estimates the position of a passive ultrasound sensor (e.g., PZT, PVDF, copolymer or other piezoelectric material) in the field of view (FOV) of a diagnostic ultrasound B-mode image by analyzing the signal received by the passive ultrasound sensor as imaging beams from an ultrasound probe sweep the field of view. A passive ultrasound sensor is an acoustic pressure sensor, and such a passive ultrasound sensor may be used to determine a location of an interventional medical device to which it is attached. Time-of-flight measurements provide the axial/radial distance of the passive ultrasound sensor from an imaging array of the ultrasound probe, while amplitude measurements and knowledge of the direct beam firing sequence provide the lateral/angular position of the passive ultrasound sensor. 
       FIG. 1  illustrates a known system for tracking an interventional medical device using a passive ultrasound sensor. In  FIG. 1 , an ultrasound probe  102  emits an imaging beam  103  that sweeps across a passive ultrasound sensor  104  on a tip of an interventional medical device  105 . An image of tissue  107  is fed back by the ultrasound probe  102 . A location of the passive ultrasound sensor  104  on the tip of the interventional medical device  105  is provided as a tip location  108  upon determination by a signal processing algorithm. The tip location  108  is overlaid on the image of tissue  107  as an overlay image  109 . The image of tissue  107 , the tip location  108 , and the overlay image  109  are all displayed on a display  100 . 
     The known technology for passive ultrasound sensors provides the location of the passive ultrasound sensor  104  but not the shape of the interventional medical device  105 . In many clinical situations, such as for example cardiac and vascular interventions, it may be advantageous to determine the shape of the interventional medical device  105 . 
     SUMMARY OF THE INVENTION 
     It is an object of the invention to at least partly provide this shape. 
     According to an aspect of the present disclosure, a controller for determining a shape of an interventional medical device in an interventional medical procedure based on a location of the interventional medical device includes a memory that stores instructions and a processor that executes the instructions. When executed by the processor, the instructions cause a system that includes the controller to implement a process that includes obtaining the location of the interventional medical device and obtaining imagery of a volume that includes the interventional medical device. The process implemented when the processor executes the instructions also includes applying, based on the location of a point on the interventional medical device, image processing to the imagery to identify the interventional medical device including the shape of the interventional medical device. The process implemented when the processor executes the instructions further includes segmenting the interventional medical device to obtain a segmented representation of the interventional medical device. The segmented representation of the interventional medical device is overlaid on the imagery. 
     According to another aspect of the present disclosure, a tangible non-transitory computer readable storage medium stores a computer program. When executed by a processor, the computer program causes a system that includes the tangible non-transitory computer readable storage medium to perform a process for determining a shape of an interventional medical device in an interventional medical procedure based on a location of the interventional medical device. The process performed when the processor executes the computer program from the tangible non-transitory computer readable storage medium includes obtaining the location of at least one point on the interventional medical device and obtaining imagery of a volume that includes the interventional medical device. The process performed when the computer program is executed by a processor also includes applying, based on the location of the interventional medical device, image processing to the imagery to identify the interventional medical device including the shape of the interventional medical device. The process performed when the computer program is executed by a processor further includes segmenting the interventional medical device to obtain a segmented representation of the interventional medical device. The segmented representation of the interventional medical device is overlaid on the imagery. 
     According to yet another aspect of the present disclosure, a system for determining a shape of an interventional medical device in an interventional medical procedure based on a location of a passive ultrasound sensor located using an ultrasound imaging probe includes an ultrasound imaging probe, a passive ultrasound sensor, and a controller. The ultrasound imaging probe emits beams during the interventional medical procedure. The passive ultrasound sensor is fixed to the interventional medical device during the interventional medical procedure. The controller includes a memory that stores instructions and a processor that executes the instructions. When executed by the processor, the instructions cause the system to implement a process that includes obtaining the location of the passive ultrasound sensor based on emission of a beam from the ultrasound imaging probe and obtaining imagery of a volume that includes the interventional medical device and the passive ultrasound sensor. The process implemented when the processor executes the instructions also includes applying, based on the location of the passive ultrasound sensor, image processing to the imagery to identify the interventional medical device including the shape of the interventional medical device and location of the interventional medical device. The process implemented when the processor executes the instructions further includes segmenting the interventional medical device to obtain a segmented representation of the interventional medical device. The segmented representation of the interventional medical device is overlaid on the imagery together with the location of the passive ultrasound sensor. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The example embodiments are best understood from the following detailed description when read with the accompanying drawing figures. It is emphasized that the various features are not necessarily drawn to scale. In fact, the dimensions may be arbitrarily increased or decreased for clarity of discussion. Wherever applicable and practical, like reference numerals refer to like elements. 
         FIG. 1  illustrates a known system for tracking an interventional medical device using a passive ultrasound sensor. 
         FIG. 2  illustrates a system for passive-ultrasound-sensor-based initialization for image-based device segmentation, in accordance with a representative embodiment. 
         FIG. 3  illustrates a process for passive-ultrasound-sensor-based initialization for image-based device segmentation, in accordance with a representative embodiment. 
         FIG. 4  illustrates a visualization progression for passive-ultrasound-sensor-based initialization for image-based device segmentation, in accordance with a representative embodiment, in accordance with a representative embodiment. 
         FIG. 5  illustrates another process for passive-ultrasound-sensor-based initialization for image-based device segmentation, in accordance with a representative embodiment. 
         FIG. 6  illustrates another process for passive-ultrasound-sensor-based initialization for image-based device segmentation, in accordance with a representative embodiment. 
         FIG. 7  illustrates a set of 2-dimensional or X-plane images used for optimizing a view for passive-ultrasound-sensor-based initialization for image-based device segmentation, in accordance with a representative embodiment. 
         FIG. 8  illustrates a visualization of a mesh of an interventional medical device overlaid in an ultrasound volume in passive-ultrasound-sensor-based initialization for image-based device segmentation, in accordance with a representative embodiment. 
     
    
    
     DETAILED DESCRIPTION OF THE EMBODIMENTS 
     In the following detailed description, for purposes of explanation and not limitation, representative embodiments disclosing specific details are set forth in order to provide a thorough understanding of an embodiment according to the present teachings. Descriptions of known systems, devices, materials, methods of operation and methods of manufacture may be omitted so as to avoid obscuring the description of the representative embodiments. Nonetheless, systems, devices, materials and methods that are within the purview of one of ordinary skill in the art are within the scope of the present teachings and may be used in accordance with the representative embodiments. It is to be understood that the terminology used herein is for purposes of describing particular embodiments only and is not intended to be limiting. The defined terms are in addition to the technical and scientific meanings of the defined terms as commonly understood and accepted in the technical field of the present teachings. 
     It will be understood that, although the terms first, second, third etc. may be used herein to describe various elements or components, these elements or components should not be limited by these terms. These terms are only used to distinguish one element or component from another element or component. Thus, a first element or component discussed below could be termed a second element or component without departing from the teachings of the inventive concept. 
     The terminology used herein is for purposes of describing particular embodiments only and is not intended to be limiting. As used in the specification and appended claims, the singular forms of terms ‘a’, ‘an’ and ‘the’ are intended to include both singular and plural forms, unless the context clearly dictates otherwise. Additionally, the terms “comprises”, and/or “comprising,” and/or similar terms when used in this specification, specify the presence of stated features, elements, and/or components, but do not preclude the presence or addition of one or more other features, elements, components, and/or groups thereof. As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items. 
     Unless otherwise noted, when an element or component is said to be “connected to”, “coupled to”, or “adjacent to” another element or component, it will be understood that the element or component can be directly connected or coupled to the other element or component, or intervening elements or components may be present. That is, these and similar terms encompass cases where one or more intermediate elements or components may be employed to connect two elements or components. However, when an element or component is said to be “directly connected” to another element or component, this encompasses only cases where the two elements or components are connected to each other without any intermediate or intervening elements or components. 
     In view of the foregoing, the present disclosure, through one or more of its various aspects, embodiments and/or specific features or sub-components, is thus intended to bring out one or more of the advantages as specifically noted below. For purposes of explanation and not limitation, example embodiments disclosing specific details are set forth in order to provide a thorough understanding of an embodiment according to the present teachings. However, other embodiments consistent with the present disclosure that depart from specific details disclosed herein remain within the scope of the appended claims. Moreover, descriptions of well-known apparatuses and methods may be omitted so as to not obscure the description of the example embodiments. Such methods and apparatuses are within the scope of the present disclosure. 
     As described herein, the shape of the interventional medical device (e.g., a wire) can be obtained readily using the location of the passive ultrasound sensor. The shape can be quantified using the system that identifies the location of the passive ultrasound sensor. The location of the passive ultrasound sensor can be used to initialize image processing algorithms that use, for example, spatial filtering or cross correlation with a known shape, to determine the shape of the device. Once the shape of the interventional medical device is determined, a mesh of the interventional medical device can be generated and overlaid to enhance visualization. 
       FIG. 2  illustrates a system for passive-ultrasound-sensor-based initialization for image-based device segmentation, in accordance with a representative embodiment. 
     In  FIG. 2 , an ultrasound system  200  includes an ultrasound imaging probe  210 , a controller  220 , a console  290 , an interventional medical device  201  and a passive ultrasound sensor S 1 . As a caveat, the ultrasound system  200  is representative of a system that includes a controller  220  used to obtain a location of an interventional medical device and imagery of a volume that include the interventional medical device. However, other types of location and imaging systems may be used to perform features described herein, and still fall within the spirit and scope of the present disclosure. Similarly, the ultrasound system  200  is representative of a system that includes a controller  220  for applying image processing to the imagery based on the location of the interventional medical device  201 , and for segmenting the interventional medical device to obtain a segmented representation of the interventional medical device  201 . However, other types of imaging systems may be used to perform these features described herein, and still fall within the spirit and scope of the present disclosure. Thus, a system as described herein does not have to be an ultrasound system. 
     The controller  220  includes a memory  221  that stores instructions and a processor  222  that executes the instructions. As another caveat, a controller  220  as described herein may be distributed among multiple devices that each include a combination of memory and processor to perform one or more characteristic functions attributed to the controller  220  herein. 
     The console  290  includes a memory  291  that stores instructions and a processor  292  that executes the instructions. The console  290  also includes a monitor  295  and a touch panel  296 . The memory  291  and the processor  292  may be considered a sensor unit that determines the location of the passive ultrasound sensor S 1  and provides the location of the passive ultrasound sensor S 1  to the controller  220 . Alternatively, another combination of a memory and a processor (not shown) may be used to receive the voltage readings from the passive ultrasound sensor S 1  and the timing of beams from the ultrasound imaging probe  210  and determine the location of the passive ultrasound sensor S 1  to provide to the controller  220 . 
     Using the ultrasound system  200  or other embodiments consistent with the description herein, a shape of an interventional medical device  201  can be quantified by locating the tip of the interventional medical device  201  (or another location on the interventional medical device  201 ) using a passive ultrasound sensor S 1 . The tip of the interventional medical device  201  is located using the passive ultrasound sensor S 1  in either a two-dimensional or a three-dimensional ultrasound space. Afterwards, image processing techniques, such as spatial filtering, are applied to the ultrasound image to enhance structures that are potentially identifiable as the body of the interventional medical device  201 . The interventional medical device  201  may be segmented and overlaid on the image based on the most prominent device-like structures that appear near the known location of the passive ultrasound sensor S 1 . 
     A processor  222  or a processor  292  for a controller is tangible and non-transitory. As used herein, the term “non-transitory” is to be interpreted not as an eternal characteristic of a state, but as a characteristic of a state that will last for a period. The term “non-transitory” specifically disavows fleeting characteristics such as characteristics of a carrier wave or signal or other forms that exist only transitorily in any place at any time. A processor is an article of manufacture and/or a machine component. A processor  222  for a controller  220  is configured to execute software instructions to perform functions as described in the various embodiments herein. A processor  22  for a controller  220  may be a general-purpose processor or may be part of an application specific integrated circuit (ASIC). A processor  222  for a controller may also be a microprocessor, a microcomputer, a processor chip, a controller, a microcontroller, a digital signal processor (DSP), a state machine, or a programmable logic device. A processor  222  for a controller may also be a logical circuit, including a programmable gate array (PGA) such as a field programmable gate array (FPGA), or another type of circuit that includes discrete gate and/or transistor logic. A processor  222  for a controller may be a central processing unit (CPU), a graphics processing unit (GPU), or both. Additionally, any processor described herein may include multiple processors, parallel processors, or both. Multiple processors may be included in, or coupled to, a single device or multiple devices. A “processor” as used herein encompasses an electronic component which is able to execute a program or machine executable instruction. References to the computing device comprising “a processor” should be interpreted as possibly containing more than one processor or processing core. The processor may for instance be a multi-core processor. A processor may also refer to a collection of processors within a single computer system or distributed amongst multiple computer systems. The term computing device should also be interpreted to possibly refer to a collection or network of computing devices each including a processor or processors. Many programs have instructions performed by multiple processors that may be within the same computing device or which may even be distributed across multiple computing devices. 
     Memories such as the memory  221  or the memory  291  described herein are tangible storage mediums that can store data and executable instructions and are non-transitory during the time instructions are stored therein. As used herein, the term “non-transitory” is to be interpreted not as an eternal characteristic of a state, but as a characteristic of a state that will last for a period. The term “non-transitory” specifically disavows fleeting characteristics such as characteristics of a carrier wave or signal or other forms that exist only transitorily in any place at any time. A memory described herein is an article of manufacture and/or machine component. Memories described herein are computer-readable mediums from which data and executable instructions can be read by a computer. Memories as described herein may be random access memory (RAM), read only memory (ROM), flash memory, electrically programmable read only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), registers, a hard disk, a removable disk, tape, compact disk read only memory (CD-ROM), digital versatile disk (DVD), floppy disk, blu-ray disk, or any other form of storage medium known in the art. Memories may be volatile or non-volatile, secure and/or encrypted, unsecure and/or unencrypted. “Memory” is an example of a computer-readable storage medium. Computer memory is any memory which is directly accessible to a processor. Examples of computer memory include, but are not limited to RAM memory, registers, and register files. References to “computer memory” or “memory” should be interpreted as possibly being multiple memories. The memory may for instance be multiple memories within the same computer system. The memory may also be multiple memories distributed amongst multiple computer systems or computing devices. 
     For convenience, reference to features of the ultrasound system  200  will be used throughout the present disclosure in and for other embodiments for the sake of consistency. However, as noted above the ultrasound system  200  is only an example of a system that may perform the functions and functionality described herein. 
       FIG. 3  illustrates a process for passive-ultrasound-sensor-based initialization for image-based device segmentation, in accordance with a representative embodiment. 
     At S 310 , the process of  FIG. 3  begins by emitting a beam from an ultrasound imaging probe. For example, the ultrasound imaging probe  210  in  FIG. 2  may emit the beam as part of a sequence of beams at S 310 . 
     Next, at S 320 , the process of  FIG. 3  proceeds to obtaining a location of a passive ultrasound sensor S 1  location in an ultrasound volume. The location of the passive ultrasound sensor S 1  may be determined in a predetermined three-dimensional coordinate system with an origin set for the ultrasound imagery. Registration may be performed to align the three-dimensional coordinate system for the ultrasound imagery with other three-dimensional coordinate systems, such as for the interventional medical device  201  including for imagery from the viewpoint of the interventional medical device when the interventional medical device  201  is an imaging device such as an endoscope. Registration may be performed by aligning landmarks in imagery in two different underlying coordinate systems in order to import one coordinate system to the other by image transformation. Registration may also be performed to align 2D or 3D ultrasound imagery to a 2D or projection imaging space, for example by identifying common landmarks in each imaging space or identifying the pose of the ultrasound transducer in another imaging space. 
     At S 330 , the process of  FIG. 3  next includes obtaining imagery of the ultrasound volume that includes the interventional medical device  201  and the passive ultrasound sensor S 1 . The imagery may be ultrasound imagery resulting from the ultrasound beams emitted by the ultrasound imaging probe  210  during the interventional medical procedure. 
     At S 340 , the process of  FIG. 3  includes applying image processing to the imagery based on the location of the passive ultrasound sensor S 1  to identify the interventional medical device  201  including the shape of the interventional medical device  201  and the location of the interventional medical device  201 , using constraints. The image processing at S 340  may be applied based on a location of a point on the interventional medical device  201  or based on a location of at least one point on the interventional medical device  201 . The constraints used at S 340  may include one or more of characteristics of pixel intensity, of relative pixel location, of predetermined shape(s), and/or of dimensional characteristic(s). As an example, pixel intensity of pixels corresponding to locations of the interventional medical device  201  may be higher than for pixel intensity of pixels corresponding to anatomical features of the subject of the interventional medical procedure. As another example, the search may be limited to pixels within a predetermined range measured in distance, pixels or something else, from the pixels corresponding to the location of the passive ultrasound sensor S 1 . The image processing may involve filtering the pixels to eliminate pixels based on predetermined characteristics, so that the remaining elements of the original image better show the interventional medical device  201 . That is, elements of the device shape (i.e., of the interventional medical device  201 ) remain after the filtering. The image processing therefore intentionally discards representations of shapes such as anatomical features, but not necessarily based on the shape insofar as the discarding may be based on the pixel intensity or pixel location and so on. 
     In other examples, the characteristics used for the image filtering may include a predetermined shape selected from, for example, a library of predetermined shapes corresponding to different interventional medical devices with different shapes. In another example, the characteristics used for the image filtering may include a dimensional characteristic of a predetermined shape, such as a minimum or maximum length, width, height, diameter, radius, cross-sectional area, curvature, and so on. For example, a wire as the interventional medical device  201  may have a very small cross-section, and the search for the wire may look for an end with an area or diameter less than a threshold corresponding to the very small cross-section. 
     At S 350 , the process of  FIG. 3  next includes reconstructing and segmenting a reconstruction of a shape of an interventional medical device  201  or a predetermined shape of the interventional medical derive to obtain a segmented representation of the interventional medical device  201 . The predetermined device shape may be used as a predetermined constraint so that the predetermined device shape is used as a candidate for the shape of the interventional medical device  201 . The elements of the device shape (i.e., of the interventional medical device  201 ) remaining after filtering may be used for reconstructing the device shape. Segmentation is a representation of the surface of structures such as anatomical features and/or interventional medical devices such as the interventional medical device  201  and consists for example of a set of points in three-dimensional (3-D) coordinates on the surfaces of the structure, and triangular plane segments defined by connecting neighboring groups of three points, such that the entire structure is covered by a mesh of non-intersecting triangular planes. A three-dimensional model of the structure is obtained by segmenting. Segmenting as described herein for S 350  and similar operations in other embodiments may involve performing segmentation on an interventional medical device  201 , anatomy structures, and/or other structures present in a three-dimensional ultrasound volume. 
     At S 360 , the process of  FIG. 3  includes overlaying the segmented representation of the interventional medical device  201  on imagery together with the location of the passive ultrasound sensor S 1 . 
     The process of  FIG. 3  and the features of other embodiments herein can be used for many types of interventional procedures. For example, in structural heart repair, the use of the features herein can be used to check to ensure the correct shape/path during deployment of an interventional medical device  201 . Additionally or alternatively, the use of the features herein can be used to detect whether the interventional medical device  201  has left a desired path during invasive procedures such as septal punctures. For example, a reference marker can be placed at the location of the target anatomy. As an additional or alternative use of the features described herein for structural heart repair, a shape of a mitral valve or other implant may be quantified in three dimensions during structural heart repair. 
       FIG. 4  illustrates a visualization progression for passive-ultrasound-sensor-based initialization for image-based device segmentation, in accordance with a representative embodiment, in accordance with a representative embodiment. 
     In visualization A, the progression of  FIG. 4  shows an interventional medical device  201  tip location. 
     At visualization B, the progression of  FIG. 4  shows the effects or results of image processing. In  FIG. 4 , the effect is much reduced detail of the overall imagery, but much greater detail of the interventional medical device  201 . 
     At visualization C, the progression of  FIG. 4  shows the interventional medical device  201  overlaid on the original image. That is, the interventional medical device  201  identified and highlighted in visualization B may be overlaid in visualization C. Of course, the visualization of the interventional medical device  201  from visualization B may be augmented such as by filling in missing pixels in order to entirely populate the full expected shape according to a model retrieved from a library of models. Therefore, the image processing used to reduce the detail of the overall imagery for visualization B may also include augmenting to enhance the detail of the interventional medical device. 
     In  FIG. 4 , the shape of the interventional medical device  201  is obtained from image processing that is initialized based on the location of the passive ultrasound sensor S 1 . The tip or other location of the interventional medical device  201  is located in the 3D volume using tracking of the passive ultrasound sensor S 1 . Image processing techniques are applied to, in the embodiment of  FIG. 4 , make tube-like structures appear more clearly. The highest intensity tube-like structure near the location of the passive ultrasound sensor S 1  may be assumed to be the body of the interventional medical device  201 , which is then overlaid on the original image. 
     In an embodiment, a process that involves the progression of  FIG. 4  may be used for an image processing algorithm applied in a three-dimensional volume to locate and enhance the visualization of the interventional medical device  201 . The two-dimensional imaging plane from an ultrasound imaging probe  210  may be used to sweep the three-dimensional space that includes the interventional medical device  201 . The resultant imagery may be analyzed subsequently to obtain a three-dimensional volumetric model of the space and/or the interventional medical device  201  in the space. The three-dimensional volumetric model of the space and/or the interventional medical device  201  may then be segmented. As an example, an initial two-dimensional plane may be set so that it includes a passive ultrasound sensor, and then the two-dimensional plane is incrementally rotated to roughly pivot around the passive ultrasound sensor. Two-dimensional image processing such as filtering and clustering may be performed on each frame in the rotational sweep to identify portions of the interventional medical device  201 . The view of the interventional medical device  201  in each plane may be analyzed to determine which plane from the sweep provides the best display of the device, such as the longest section of the device, or shows the most distal portion near the passive ultrasound sensor. The segmentation of the interventional medical device is then displayed. 
       FIG. 5  illustrates another process for passive-ultrasound-sensor-based initialization for image-based device segmentation, in accordance with a representative embodiment. 
     At S 510 , the process of  FIG. 5  starts with obtaining a location of a passive ultrasound sensor S 1  in an ultrasound volume. 
     At S 520 , the process of  FIG. 5  next includes setting filter constraints and searching the constraints. That is, a search for the interventional medical device  201  in imagery may start at the location of the passive ultrasound sensor S 1 . A search for the constraints may be a search for regions in the imagery that satisfy predetermined constraints. A region that satisfied predetermined constraints may be within a specified radius or distance from the passive ultrasound sensor and may include characteristics such one or more pixels with a pixel intensity higher than a predetermined threshold. In an example, the predetermined constraints may be for a particular shape that is part of the shape of the interventional medical device  201 , such as a corner or set of corners, one or more angles in the profile of the interventional medical device  201  that would appear in ultrasound imagery, and other types of constraints. The constraints may be predetermined constraints, and may vary based on the type of interventional medical device  201 , the type of surgery, and characteristics of the subject of the interventional medical procedure including anatomical characteristics 
     At S 530 , the process of  FIG. 5  next moves to applying a filter to the ultrasound volume using the filter constraints. A process performed by a controller  220  or the ultrasound system  200  that includes the controller  220  may include filtering the imagery from an ultrasound imaging system to eliminate representations of a subject of the interventional medical procedure. For example, filtering may be performed to eliminate representations of tissue, bone and other anatomical features of the subject of the interventional medical procedure, since the object sought in the image processing is the interventional medical device  201 . 
     At S 540 , the process of  FIG. 5  includes searching for regions of maximum intensity surrounding the location of the passive ultrasound sensor and identifying points with the maximum intensity. The maximum intensity may be a pixel intensity above a predetermined threshold, or a relative intensity greater than a predetermined threshold of intensities of nearby pixels. 
     At S 550 , the process of  FIG. 5  next includes connecting neighboring points. The neighboring points may be for pixels with intensities over a threshold and within a predetermined distance from the location of the passive ultrasound sensor S 1 . 
     At S 560 , the process of  FIG. 5  ends with overlaying the shape of the interventional medical device  201  on the ultrasound imagery. The overlaid interventional medical device  201  is a representation of the interventional medical device  201 , and may be superimposed on the ultrasound imagery, and highlighted such as by a highlighted outline. 
     The process of  FIG. 5  and other embodiments herein can be used for many types of interventional procedures. For example, in peripheral vascular interventions the features herein can be used for monitoring shape of an interventional medical device  201  such as a wire during stenosis or occlusion crossings to detect buckling of the interventional medical device  201 . Additionally or alternatively, the features herein can be used to detect progression of an interventional medical device  201  such as a wire with respect to the vessel to check if the interventional medical device  201  has exited the vessel wall. 
       FIG. 6  illustrates another process for passive-ultrasound-sensor-based initialization for image-based device segmentation, in accordance with a representative embodiment. 
     The process of  FIG. 6  starts at S 610  with obtaining a location of a passive ultrasound sensor in an ultrasound volume. 
     Next, at S 620  the process of  FIG. 6  includes setting filter constraints and identifying an interventional medical device  201  model. The filter constraints may be predetermined constraints or may be constraints that are dynamically set for each different interventional medical procedure. The filter constraints may be applied in order to identify regions that satisfy predetermined constraints, so that the image processing to be performed is only performed at the identified regions or at least starts at the identified regions. 
     At S 630 , the process of  FIG. 6  next includes fixing a tip of an identified interventional medical device  201  model to a location of the passive ultrasound sensor in the ultrasound volume. 
     At S 640 , the process of  FIG. 6  includes determining an interventional medical device  201  optimal angle relative to a location of the passive ultrasound sensor S 1  in the ultrasound volume. The angle may be used to pose the interventional medical device  201  starting from the location ultrasound sensor S 1  and aligned in the direction of the angle from the passive ultrasound sensor S 1 . 
     At S 650 , the process of  FIG. 6  concludes with overlaying the shape of the interventional medical device  201  on the ultrasound surgery. For example, a mesh resulting from segmenting a shape of a predetermined structure as the interventional medical device  201  may be aligned based on the process at S 640 , and then placed so that the representation of the corner or other extremity of the interventional medical device  201  overlaps the representation of the passive ultrasound sensor S 1  in or on the passive ultrasound imagery. 
       FIG. 7  illustrates a set of 2-dimensional or X-plane images used for optimizing a view for passive-ultrasound-sensor-based initialization for image-based device segmentation, in accordance with a representative embodiment. 
     As shown in  FIG. 7 , five different 2-dimensional or X-plane images are labelled A, B, C, D and E, and each shows a view in which the interventional medical device  201  varies due to the differing viewpoints. The most complete view is that of 2-dimensional or X-plane image “C”, which corresponds to the view with the greatest amount of detail of the interventional medical device  201 . 
     In the embodiment of  FIG. 7 , imagery from two-dimensional or X-plane views can be viewed to see which provides the best detail of the interventional medical device  201 . The imagery from  FIG. 7  may be obtained before or after segmentation of the interventional medical device  201 , and then used for example to identify or confirm the best placement, orientation and pose of the interventional medical device  201  on the underlying three-dimensional ultrasound volume. As an example consistent with an example described in the context of  FIG. 4 , an initial two-dimensional plane may be set so that it includes a passive ultrasound sensor, and then the two-dimensional plane is incrementally rotated to roughly pivot around the passive ultrasound sensor. In embodiments where location is determined by a mechanism other than passive ultrasound sensors, the location of a point on an interventional medical device  201  may still be used as the starting point of the sweep. Two-dimensional image processing such as filtering and clustering may be performed on each frame in the rotational sweep to identify portions of the interventional medical device  201 . The view of the interventional medical device  201  in each plane can be analyzed to determine which plane from the sweep provides the best display of the device, such as the longest section of the device, or shows the most distal portion near the passive ultrasound sensor. The segmentation of the interventional medical device is then displayed. 
       FIG. 8  illustrates a visualization of a mesh of an interventional medical device  201  overlaid in an ultrasound volume in passive-ultrasound-sensor-based initialization for image-based device segmentation, in accordance with a representative embodiment. 
     In the embodiment of  FIG. 8 , the interventional medical device  201  may be a SHD device which is segmented into a mesh and overlaid in a 3-dimensional ultrasound volume. The shape of the interventional medical device  201  is known, and may be rigid, and can be fit to the ultrasound imagery of the 3-dimensional ultrasound volume. The location of the passive ultrasound sensor is used to initialize the search volume so as to identify the proper orientation, pose and overall placement of the interventional medical device  201  in  FIG. 8 . 
     As an example for the embodiment of  FIG. 8 , the interventional medical device  201  may be rigid, such as in the case of a transeptal puncture needle or mitral repair device. Image processing techniques can be used to search for the specific shape of the device in the region near the passive ultrasound sensor. The mesh of the known device can then be overlaid on the two-dimensional or three-dimensional ultrasound image as shown in  FIG. 8 . The overlaid mesh of the known device may be superimposed on the ultrasound imagery, and highlighted such as by color, brightness, or other visual characteristics to make the superimposed mesh distinctive in the combined image. 
     Accordingly, passive-ultrasound-sensor-based initialization for image-based device segmentation enables identification of an interventional medical device  201  in ultrasound imagery, and placement of a model of the interventional medical device  201  in or on the ultrasound imagery. The passive-ultrasound-sensor based initialization for image-based segmentation can be used in myriad ways such as to ensure that an interventional medical device  201  is being deployed in a correct pose and along a correct path, such as to detect irregular an path during an interventional medical procedure (e.g., septal puncture or chronic total occlusion crossing), and/or to quantify an interventional medical device  201  in three-dimensions during an interventional medical procedure. 
     Although passive-ultrasound-sensor-based initialization for image-based device segmentation has been described with reference to several exemplary embodiments, it is understood that the words that have been used are words of description and illustration, rather than words of limitation. Changes may be made within the purview of the appended claims, as presently stated and as amended, without departing from the scope and spirit of passive-ultrasound-sensor-based initialization for image-based device segmentation in its aspects. Although passive-ultrasound-sensor-based initialization for image-based device segmentation has been described with reference to particular means, materials and embodiments, passive-ultrasound-sensor-based initialization for image-based device segmentation is not intended to be limited to the particulars disclosed; rather passive-ultrasound-sensor-based initialization for image-based device segmentation extends to all functionally equivalent structures, methods, and uses such as are within the scope of the appended claims. 
     For example, examples above describe use of features herein for structural heart repair or peripheral vascular intervention. Other practical applications of the features herein may include detecting bending of an interventional medical device  201  such as a needle during a deep tissue biopsy. Other practical applications of the features herein may include providing a reliable in-body two-dimensional projection fiducial for registration between ultrasound and/to X-ray. 
     The following Examples are provided: 
     Example 1 
     A controller ( 220 ) for determining a shape of an interventional medical device ( 201 ) in an interventional medical procedure based on a location of the interventional medical device ( 201 ), comprising: 
     a memory ( 221 ) that stores instructions, and 
     a processor ( 222 ) that executes the instructions, wherein, when executed by the processor, the instructions cause a system that includes the controller ( 220 ) to implement a process that includes: 
     obtaining (S 320 ) the location of a point on the interventional medical device ( 201 ); 
     obtaining (S 330 ) imagery of a volume that includes the interventional medical device ( 201 ); 
     applying (S 340 ), based on the location of the interventional medical device, image processing to the imagery to identify the interventional medical device including the shape of the interventional medical device; and 
     segmenting (S 350 ) the interventional medical device to obtain a segmented representation of the interventional medical device, wherein the segmented representation of the interventional medical device is overlaid (S 360 ) on the imagery. 
     Example 2 
     The controller ( 220 ) of Example 1, wherein the process implemented by the system further comprises: 
     obtaining (S 320 ) a location of a passive ultrasound sensor based on emission of a beam from an ultrasound imaging probe, wherein the location of the interventional medical device corresponds to the location of the passive ultrasound sensor; and 
     starting (S 340 ) a search for the interventional medical device in the imagery at the location of the passive ultrasound sensor and searching for regions in the imagery that satisfy predetermined constraints, to apply the image processing to the imagery, 
     wherein the segmented representation of the interventional medical device is overlaid on the imagery together with the location of the passive ultrasound sensor. 
     Example 3 
     The controller ( 220 ) of Example 2, wherein the process implemented by the system further comprises: 
     applying (S 340 ) the predetermined constraints to the imagery to isolate regions in the imagery that potentially qualify as including a portion of the shape of the interventional medical device, 
     wherein the predetermined constraints include characteristics of pixel intensity, and pixel location relative to the location of the passive ultrasound sensor. 
     Example 4 
     The controller ( 220 ) of Example 2, wherein the process implemented by the system further comprises: 
     applying (S 340 ) the predetermined constraints to the imagery to isolate regions in the imagery that potentially qualify as including a portion of the shape of the interventional medical device, 
     wherein the predetermined constraints include at least one predetermined shape used as a candidate for the shape of the interventional medical device. 
     Example 5 
     The controller ( 220 ) of Example 2, wherein the process implemented by the system further comprises: 
     applying (S 340 ) the predetermined constraints to the imagery to isolate regions in the imagery that potentially qualify as including a portion of the shape of the interventional medical device, 
     wherein the predetermined constraints include at least one dimensional characteristic of a predetermined shape. 
     Example 6 
     The controller ( 220 ) of Example 1, wherein the process implemented by the system further comprises: 
     filtering (S 340 ) the imagery to eliminate representations of a subject of the interventional medical procedure in which the interventional medical device is inserted, wherein elements of the shape of the interventional medical device remain in the imagery after the filtering, and 
     reconstructing (S 350 ) the shape of the interventional medical device based on the elements of the shape of the interventional medical device remaining in the imagery after the filtering to obtain a reconstruction of the shape of the interventional medical device. 
     Example 7 
     The controller ( 220 ) of Example 6, wherein the segmenting is performed on the reconstruction of the shape of the interventional medical device, and the segmented representation of the interventional medical device comprises a segmented representation of the reconstruction of the shape of the interventional medical device. 
     Example 8 
     The controller ( 220 ) of Example 1, wherein the segmenting is performed on a predetermined shape based on the image processing, and the segmented representation of the interventional medical device comprises a segmented representation of the predetermined shape of the interventional medical device so that the segmented representation of the predetermined shape is overlaid on the imagery. 
     Example 9 
     A tangible non-transitory computer readable storage medium that stores a computer program, the computer program, when executed by a processor, causing a system that includes the tangible non-transitory computer readable storage medium to perform a process for determining a shape of an interventional medical device in an interventional medical procedure based on a location of the interventional medical device, the process performed when the processor ( 222 ) executes the computer program from the tangible non-transitory computer readable storage medium comprising: 
     obtaining (S 320 ) the location of the interventional medical device; 
     obtaining (S 330 ) imagery of a volume that includes the interventional medical device; 
     applying (S 340 ), based on a location of at least one point on the interventional medical device, image processing to the imagery to identify the interventional medical device including the shape of the interventional medical device; and 
     segmenting (S 350 ) the interventional medical device to obtain a segmented representation of the interventional medical device, wherein the segmented representation of the interventional medical device is overlaid (S 360 ) on the imagery. 
     Example 10 
     The tangible non-transitory computer readable storage medium of Example 9, wherein the process implemented by the system further comprises: 
     starting (S 340 ) a search for the interventional medical device in the imagery at the location of a passive ultrasound sensor and searching for regions in the imagery that satisfy predetermined constraints, to apply the image processing to the imagery. 
     Example 11 
     The tangible non-transitory computer readable storage medium of Example 10, wherein the process implemented by the system further comprises: 
     obtaining (S 320 ) a location of a passive ultrasound sensor based on emission of a beam from an ultrasound imaging probe, wherein the location of the interventional medical device corresponds to the location of the passive ultrasound sensor; and 
     applying (S 340 ) the predetermined constraints to the imagery to isolate regions in the imagery that potentially qualify as including a portion of the shape of the interventional medical device, 
     wherein the predetermined constraints include characteristics of pixel intensity, and pixel location relative to the location of the passive ultrasound sensor, 
     wherein the segmented representation of the interventional medical device is overlaid on the imagery together with the location of the passive ultrasound sensor. 
     Example 12 
     The tangible non-transitory computer readable storage medium of Example 10, wherein the process implemented by the system further comprises: 
     applying (S 340 ) the predetermined constraints to the imagery to isolate regions in the imagery that potentially qualify as including a portion of the shape of the interventional medical device, 
     wherein the predetermined constraints include at least one predetermined shape used as a candidate for the shape of the interventional medical device. 
     Example 13 
     The tangible non-transitory computer readable storage medium of Example 10, wherein the process implemented by the system further comprises: 
     applying (S 340 ) the predetermined constraints to the imagery to isolate regions in the imagery that potentially qualify as including a portion of the shape of the interventional medical device, 
     wherein the predetermined constraints include at least one dimensional characteristic of a predetermined shape. 
     Example 14 
     The tangible non-transitory computer readable storage medium of Example 9, wherein the process implemented by the system further comprises: 
     filtering (S 340 ) the imagery to eliminate representations of a subject of the interventional medical procedure in which the interventional medical device is inserted, wherein elements of the shape remain in the imagery after the filtering, and 
     reconstructing (S 350 ) the shape of the interventional medical device based on the elements of the shape of the interventional medical device remaining in the imagery after the filtering to obtain a reconstruction of the shape of the interventional medical device. 
     Example 15 
     The tangible non-transitory computer readable storage medium of Example 14, 
     wherein the segmenting is performed on the reconstruction of the shape of the shape of the interventional medical device, and the segmented representation of the interventional medical device comprises a segmented representation of the reconstruction of the shape of the interventional medical device. 
     Example 16 
     The tangible non-transitory computer readable storage medium of Example 9, 
     wherein the segmenting is performed on a predetermined shape based on the image processing, and the segmented representation of the interventional medical device comprises a segmented representation of the predetermined shape of the interventional medical device so that the segmented representation of the predetermined shape is overlaid on the imagery. 
     Example 17 
     A system ( 200 ) for determining a shape of an interventional medical device ( 201 ) in an interventional medical procedure based on a location of a passive ultrasound sensor (S 1 ) located using an ultrasound imaging probe ( 210 ), comprising: 
     an ultrasound imaging probe ( 210 ) that emits beams during the interventional medical procedure; 
     a passive ultrasound sensor (S 1 ) fixed to the interventional medical device ( 201 ) during the interventional medical procedure; and 
     a controller ( 220 ) comprising a memory ( 221 ) that stores instructions and a processor ( 222 ) that executes the instructions, wherein, when executed by the processor ( 222 ), the instructions cause the system to implement a process that includes: 
     obtaining (S 320 ) the location of the passive ultrasound sensor based on emission of a beam from the ultrasound imaging probe; 
     obtaining (S 330 ) imagery of a volume that includes the interventional medical device and the passive ultrasound sensor; 
     applying (S 340 ), based on the location of the passive ultrasound sensor, image processing to the imagery to identify the interventional medical device including the shape of the interventional medical device and location of the interventional medical device; and 
     segmenting (S 350 ) the interventional medical device to obtain a segmented representation of the interventional medical device, wherein the segmented representation of the interventional medical device is overlaid (S 360 ) on the imagery together with the location of the passive ultrasound sensor. 
     Example 18 
     The system of Example 17, further comprising: 
     a sensor unit ( 291 / 292 ) that determines the location of the passive ultrasound sensor and provides the location of the passive ultrasound sensor to the controller ( 220 ); and 
     a display ( 295 ) that displays the segmented representation of the interventional medical device based on the segmenting by the controller ( 220 ) and that displays the location of the passive ultrasound sensor determined by the sensor unit. 
     Example 19 
     The system of Example 17, wherein the process implemented by the system further comprises: 
     starting (S 340 ) a search for the interventional medical device in the imagery at the location of the passive ultrasound sensor and searching for regions in the imagery that satisfy predetermined constraints, to apply the image processing to the imagery. 
     Example 20 
     The system of Example 17, wherein the process implemented by the system further comprises: 
     filtering (S 340 ) the imagery to eliminate representations of a subject of the interventional medical procedure in which the interventional medical device is inserted, wherein elements of the shape remain in the imagery after the filtering, and 
     reconstructing (S 350 ) the shape based on the elements of the shape remaining in the imagery after the filtering to obtain a reconstruction of the shape of the interventional medical device. 
     The illustrations of the embodiments described herein are intended to provide a general understanding of the structure of the various embodiments. The illustrations are not intended to serve as a complete description of all of the elements and features of the disclosure described herein. Many other embodiments may be apparent to those of skill in the art upon reviewing the disclosure. Other embodiments may be utilized and derived from the disclosure, such that structural and logical substitutions and changes may be made without departing from the scope of the disclosure. Additionally, the illustrations are merely representational and may not be drawn to scale. Certain proportions within the illustrations may be exaggerated, while other proportions may be minimized. Accordingly, the disclosure and the figures are to be regarded as illustrative rather than restrictive. 
     One or more embodiments of the disclosure may be referred to herein, individually and/or collectively, by the term “invention” merely for convenience and without intending to voluntarily limit the scope of this application to any particular invention or inventive concept. Moreover, although specific embodiments have been illustrated and described herein, it should be appreciated that any subsequent arrangement designed to achieve the same or similar purpose may be substituted for the specific embodiments shown. This disclosure is intended to cover any and all subsequent adaptations or variations of various embodiments. Combinations of the above embodiments, and other embodiments not specifically described herein, will be apparent to those of skill in the art upon reviewing the description. 
     The Abstract of the Disclosure is provided to comply with 37 C.F.R. § 1.72(b) and is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. In addition, in the foregoing Detailed Description, various features may be grouped together or described in a single embodiment for the purpose of streamlining the disclosure. This disclosure is not to be interpreted as reflecting an intention that the claimed embodiments require more features than are expressly recited in each claim. Rather, as the following claims reflect, inventive subject matter may be directed to less than all of the features of any of the disclosed embodiments. Thus, the following claims are incorporated into the Detailed Description, with each claim standing on its own as defining separately claimed subject matter. 
     The preceding description of the disclosed embodiments is provided to enable any person skilled in the art to practice the concepts described in the present disclosure. As such, the above disclosed subject matter is to be considered illustrative, and not restrictive, and the appended claims are intended to cover all such modifications, enhancements, and other embodiments which fall within the true spirit and scope of the present disclosure. Thus, to the maximum extent allowed by law, the scope of the present disclosure is to be determined by the broadest permissible interpretation of the following claims and their equivalents and shall not be restricted or limited by the foregoing detailed description.