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arxiv: 2604.22497 · v1 · submitted 2026-04-24 · 💻 cs.HC · cs.NA· math.NA

Catheter Monitoring in Intelligent Endovascular Navigation Systems: Interactive Simulations and Mixed Reality for Enhanced Navigational Awareness

Veronica Ruozzi , Giovanni Battista Regazzo , Maria Chiara Palumbo , Wim-Alexander Beckers , Mouloud Ourak , Xiu Zhang , Francesca Perico , Alessandro Caimi
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Emmanuel Vander Poorten Emiliano Votta
This is my paper

Pith reviewed 2026-05-08 10:35 UTC · model grok-4.3

classification 💻 cs.HC cs.NAmath.NA
keywords endovascular navigationmixed realityfinite element modelingcatheter monitoringfiber bragg gratingbiomechanical simulationvascular deformationreal-time visualization
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The pith

Integrating real-time sensor data with finite element simulations and mixed reality enables continuous monitoring of catheter-vessel interactions during endovascular navigation.

A machine-rendered reading of the paper's core claim, the machinery that carries it, and where it could break.

The paper develops a framework that feeds live catheter position and shape readings from sensors into an interactive finite element model of the blood vessels, then streams the resulting deformations to a mixed reality headset. This produces a visual display of how the catheter presses against and bends the vessel walls as the operator advances the device. A reader would care because current navigation relies on limited imaging that does not show these mechanical interactions in real time, so added awareness could help avoid vessel damage. The in-vitro tests on a silicone replica confirm the system runs at interactive speeds with displacement errors under a few millimeters.

Core claim

The study demonstrates the feasibility of integrating interactive biomechanical simulation with real-time sensor data to enable continuous monitoring of catheter-vessel interactions, with mixed reality visualization serving as a user interface to support operator decision-making. In-vitro validation on a sensorized catheter advanced through a silicone replica showed simulated time exceeding real time by 12 percent initially and 45 percent in tortuous sections, stable rendering at 35-40 frames per second, and median relative displacement errors remaining below 1 mm and 2.33 mm respectively.

What carries the argument

Finite element model of the venous pathway with Lagrange multiplier contact formulation, driven by Fiber Bragg Grating and electromagnetic sensor read-outs and rendered in mixed reality.

If this is right

  • Operators receive visual cues on vessel deformation that are unavailable from standard fluoroscopy alone.
  • The simulation updates fast enough to remain interactive even through complex vessel paths.
  • Accuracy sufficient for monitoring is achieved when validated against stereo-camera ground truth.
  • Mixed reality serves as a stable interface at 35-40 frames per second for decision support.

Where Pith is reading between the lines

These are editorial extensions of the paper, not claims the author makes directly.

  • The same sensor-to-simulation pipeline could be adapted to monitor other flexible instruments such as guidewires or endoscopes.
  • Future versions might incorporate predictive elements to warn of impending high-stress contacts before they occur.
  • If deployed in the operating room, the system could reduce reliance on repeated contrast injections for vessel visualization.

Load-bearing premise

The finite element model and silicone replica accurately represent real vessel mechanical behavior and real-time sensor data can be streamed without significant lag or error in clinical settings.

What would settle it

A clinical trial that directly measures actual vessel wall displacements during live procedures and finds the system's predictions deviate by more than a few millimeters or introduces noticeable display lag that affects navigation accuracy.

Figures

Figures reproduced from arXiv: 2604.22497 by Alessandro Caimi, Emiliano Votta, Emmanuel Vander Poorten, Francesca Perico, Giovanni Battista Regazzo, Maria Chiara Palumbo, Mouloud Ourak, Veronica Ruozzi, Wim-Alexander Beckers, Xiu Zhang.

Figure 1
Figure 1. Figure 1: Schematic overview of the proposed framework. An Initialization step pre￾processes vessel (A) and catheter (B) models and instantiates the interactive simulation. A Registration step aligns sensor ({EM}) and anatomical ({CT}) frames (C). During Runtime, the interactive simulation continuously updates the mixed reality visualization (D). The method integrates four components: (i) an fiber Bragg grating (FBG… view at source ↗
Figure 2
Figure 2. Figure 2: Experimental setup for integrating and testing the framework. A robotic driver inserted the sensorized catheter into a silicone phantom replicating the vessel anatomy. Two high-speed cameras tracked surface-marker displacements on the phantom wall, while the corresponding FEM nodes were identified by applying the transformation CTTEM to the point cloud acquired at rest using the EM probe. The setup ( view at source ↗
Figure 3
Figure 3. Figure 3: A 7.4 mm catheter (A) housed a multi-core FBG fiber and two EM sensors within its central lumen (B). The sensor-based reconstructed catheter centerline, expressed in the {EM} reference frame as cEM(x, t), was uniformly discretized into 78 points. Each point served as the center of a rigid sphere, and consecutive points were connected by cylinders of 7.4 mm diameter, producing a piecewise-continuous geometr… view at source ↗
Figure 4
Figure 4. Figure 4: Interactive FEM performance: simulated time (TCP U ) vs. physical time (TP HY S) for three repeated tests. Three latency phases were identified: startup, low-latency (slope 1.12), and high-latency (slope 1.45). The deformed vein lumen, color-coded by dis￾placement magnitude, is shown at specific time-points. The low variability in the initial lag suggests that startup latency is a fixed delay from system i… view at source ↗
Figure 5
Figure 5. Figure 5: A) Ground-truth marker configurations (pEXP ) overlaid on the undeformed vessel (light gray) at three representative time-points; each is annotated with the 95th percentile of the displacement magnitude (∥u∥95). B) Corresponding FEM configurations at the same time-points, shown with a displacement colormap and overlaid on the undeformed vessel. The ∥u∥95 computed over the marker-covered region is reported.… view at source ↗
read the original abstract

Purpose: Developing and testing a framework that integrates real-time catheter shape reconstruction, interactive simulations, and mixed reality visualization to enable accurate monitoring of catheter-vessel interactions during endovascular navigation. Methods: A finite element model (FEM) of the venous pathway from the right femoral vein to the inferior vena cava was generated from computed tomography data and implemented into an interactive simulation. Catheter motion was imposed as boundary condition, and catheter-vessel contact was modeled with a Lagrange multiplier formulation to compute vessel deformation. The framework was tested in-vitro using a sensorized catheter with Fiber Bragg Grating and electromagnetic sensors as it was advanced through a silicone replica of the vascular anatomy. Real-time sensor read-outs fed the simulation, and the updated catheter and vessel geometries were streamed to Hololens 2. The performance and accuracy of FEM-computed vessel wall displacement were validated against experimental ground-truth obtained via stereo frames triangulation. Results: The simulated time exceeded the real temporal extent by 12% during initial navigation and by 45% when the catheter reached the most tortuous portion. Hololens 2 rendering remained stable at 35-40 frames per second. The median relative displacement error between FEM-computed and ground-truth vessel wall displacements remained below 1 mm and 2.33 mm for these two phases, respectively. Conclusion: The study demonstrates the feasibility of integrating interactive biomechanical simulation with real-time sensor data to enable continuous monitoring of catheter-vessel interactions, with mixed reality visualization serving as a user interface to support operator decision-making.

Editorial analysis

A structured set of objections, weighed in public.

Desk editor's note, referee report, simulated authors' rebuttal, and a circularity audit. Tearing a paper down is the easy half of reading it; the pith above is the substance, this is the friction.

Referee Report

2 major / 1 minor

Summary. The manuscript presents a framework integrating real-time catheter shape reconstruction from FBG and EM sensors, an interactive FEM simulation of catheter-vessel contact (using Lagrange multipliers for deformation), and mixed-reality visualization streamed to Hololens 2. In-vitro validation in a silicone replica of the venous pathway reports median relative displacement errors below 1 mm (initial phase) and 2.33 mm (tortuous phase) against stereo-triangulation ground truth, with simulation times exceeding real temporal extent by 12% and 45% respectively, while Hololens rendering holds at 35-40 fps.

Significance. If the performance limitations can be resolved, the work offers a promising approach to enhancing navigational awareness in endovascular procedures through continuous biomechanical feedback and MR interfaces. Strengths include the use of independent experimental ground truth (avoiding circularity) and demonstration of stable MR rendering in a controlled phantom setting.

major comments (2)
  1. [Abstract/Results] Abstract and Results: The reported simulation times exceeding real temporal extent by 12% initially and 45% in the tortuous portion indicate that the Lagrange-multiplier contact FEM cannot process imposed boundary conditions (catheter motion from sensors) at real advancement rates. This directly undermines the central claim of 'real-time sensor data' integration and 'interactive' simulation for continuous monitoring, as geometry updates lag and the MR visualization cannot reflect live interactions without delay.
  2. [Methods] Methods: No details are provided on finite element model parameters (e.g., material properties, mesh density or convergence criteria), time integration scheme, or statistical analysis of the displacement errors. These omissions are load-bearing for assessing whether the median errors below 1 mm and 2.33 mm robustly support the accuracy claims against ground truth.
minor comments (1)
  1. [Conclusion] The conclusion should qualify the 'real-time' and 'feasibility' statements to align with the performance metrics (time exceedance) reported in the results.

Simulated Author's Rebuttal

2 responses · 0 unresolved

We thank the referee for the constructive and detailed review. The comments identify key areas where our presentation of performance limitations and methodological details requires clarification and expansion. We address each point below and have prepared revisions accordingly.

read point-by-point responses

  1. Referee: [Abstract/Results] Abstract and Results: The reported simulation times exceeding real temporal extent by 12% initially and 45% in the tortuous portion indicate that the Lagrange-multiplier contact FEM cannot process imposed boundary conditions (catheter motion from sensors) at real advancement rates. This directly undermines the central claim of 'real-time sensor data' integration and 'interactive' simulation for continuous monitoring, as geometry updates lag and the MR visualization cannot reflect live interactions without delay.

    Authors: We agree that the reported simulation times indicate the FEM component does not run at strict real-time rates, particularly in the tortuous phase. This is a substantive limitation of the current implementation. In the revised manuscript we will update the abstract, results, and discussion sections to qualify the terminology: sensor acquisition and shape reconstruction occur in real time, while the full FEM update may lag behind catheter advancement speed. We will retain the demonstration of interactive MR visualization (stable at 35-40 fps) and add a paragraph discussing computational bottlenecks and planned optimizations such as model reduction or GPU acceleration. These changes preserve the feasibility claim while accurately reflecting the performance data. revision: yes

  2. Referee: [Methods] Methods: No details are provided on finite element model parameters (e.g., material properties, mesh density or convergence criteria), time integration scheme, or statistical analysis of the displacement errors. These omissions are load-bearing for assessing whether the median errors below 1 mm and 2.33 mm robustly support the accuracy claims against ground truth.

    Authors: We acknowledge that the original Methods section omitted these essential parameters, limiting reproducibility and evaluation of the error metrics. The revised manuscript will add a dedicated subsection specifying the vessel constitutive model (hyperelastic properties drawn from literature and CT-derived geometry), mesh resolution (element count, type, and average size), convergence tolerances, time-integration scheme (implicit method with adaptive stepping), and the statistical procedures used to compute median and interquartile-range displacement errors relative to the stereo-triangulation ground truth. These additions directly address the referee's concern and strengthen the accuracy claims. revision: yes

Circularity Check

0 steps flagged

No circularity: external validation against independent stereo ground-truth

full rationale

The paper applies standard finite-element methods (Lagrange-multiplier contact) to boundary conditions taken directly from FBG/EM sensor read-outs on a physical silicone replica; vessel-wall displacements are then compared to separate stereo-triangulation measurements. No result is obtained by fitting a parameter to a subset of the target data and then re-labeling it a prediction, no self-citation supplies a uniqueness theorem or ansatz that the present work merely renames, and the reported time-lag and error figures are empirical outcomes rather than tautological re-statements of the input model. The validation chain therefore remains externally grounded.

Axiom & Free-Parameter Ledger

0 free parameters · 1 axioms · 0 invented entities

Based on abstract only; no explicit free parameters, axioms, or invented entities are detailed beyond standard FEM contact modeling. The Lagrange multiplier formulation for contact is invoked as a standard domain assumption for computing deformation.

axioms (1)
  • domain assumption Lagrange multiplier formulation models catheter-vessel contact to compute vessel deformation
    Used within the finite element model as described in the methods summary.

pith-pipeline@v0.9.0 · 5627 in / 1250 out tokens · 55162 ms · 2026-05-08T10:35:58.067572+00:00 · methodology

discussion (0)

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