One of the biggest medical challenges of the last century has been refining invasive cardiac diagnostic and therapeutic techniques. Like all great discoveries, the development of cardiac catheterization has actually been a series of events—many of which were by chance and each of which contributed to the history of this exciting field.
Catheterization is a procedure by which a long, thin tube (a catheter) is inserted into a tiny incision, entering anatomical structures without being excessively invasive for diagnostic or therapeutic purposes. Catheterization dates back to Egypt, around the year 3000 B.C.E. But it was not until 400 B.C.E., in the time of Hippocrates that the functioning of the heart was first documented1. The term “catheterization” was coined by Claude Bernard, a French physiologist whose work in 1844 led to a series of discoveries, each more interesting than the last.
In one of his experiments, Bernard successfully measured the temperature of the ventricles by inserting a long thermometer via the carotid artery. A series of physiological discoveries ensued (Chauveau and Marey, 1868: Measuring Systolic and Diastolic Pressure; Fick, 1870: Formula for Calculating Cardiac Output, etc.). The last notable discovery of the 19th century was no doubt Röntgen’s 1895 discovery of X-rays, which played a central role in the development of catheterization. In 1956, the Nobel Prize for Medicine was awarded to Cournand, Richards and Forssmann in recognition of their respective works on cardiac catheterization—all of which was documented with X-rays. Without radiography, it would have been very difficult for this scientific contribution to become widely known and accepted.Developing imaging techniques to support catheterization is still a relevant topic today. Medical imaging is one of the top 11 medical milestones of the last millennium, according to the millennium edition of the prestigious New England Journal of Medecine2. Images are still essential indeveloping new techniques for safer percutaneous interventions. Catheterization technologies are continually being developed and evolving. Minimally invasive interventions—especially in cardiology but also in other fields known for traditional surgical procedures, such as orthopedics—are becoming increasingly popular within the medical field. Because they require such small incisions, these interventions are more appealing than traditional surgery, but they require some very specialized tools. Since the advent of the digital era, we have seen a boom in software programs that can help specialists navigate complex vascular structures. The fundamental problem, however, is that 2D images cannot allow for the proper characterization of complex 3D vascular structures. Real-time 3D imaging adapted for medical interventions is more effective in guiding catheterization procedures, but developing these techniques is very challenging. Advancements in imaging have helped pave the way for more precise and robust modelling of the complex structures that make up the human body. One day, they may help clinicians in daily decision-making or even during surgery, in which case the proposed technologies must not only be precise and robust, but information must also be displayed in real time.
People have always been fascinated by the prospect of travelling inside the human body, and that’s precisely the premise of Fantastic Voyage. Will this old science-fiction dream become a reality in the next millennium?
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Luc Duong is a professor in the Software Engineering and IT Department at ÉTS, and researcher at the CHU Research Center. His research focuses on medical imaging, computer vision, algorithms and artificial intelligence.
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