Autonomous Guidewire Navigation in Dynamic Environments

Cardiovascular disease treatment involves the challenging task of navigating guidewires and catheters through the vascular anatomy. This often results in prolonged proce- dures where both the patient and clinician are subjected to X-ray radiation. As a potential solution, Deep Reinforcement Learning methods have demonstrated potential in learning this task, paving the way for automated catheter navigation during robotic interventions. However, current works show a limited ability to generalize to unseen and/or deforming anatomies. In this paper, we extend our previous reinforcement learning approach in two main areas: we improve the training strategy to learn a control of the device even when the vascular anatomy is deforming and we propose a method to estimate the motion of the anatomy from single view fluoroscopy images. The combination of these two contributions makes it possible to automatically navigate across a moving vascular anatomy under fluoroscopic imaging, even without injecting a contrast agent. We validate our method on two scenarios: a simulated beating heart and a liver subjected to breathing motion. Our approach leads to an average success rate of 95% in reaching random targets within these anatomies. Our framework is also computationally efficient, enabling the training of our controller to be completed in about 6 hours.