Abstract
Obtaining reliable axillary vein access is a critical first step of a successful Cardiac Implantable Electronic Device (CIED) implantation. To support puncture-site selection, clinicians rely on Venography, which visualizes the vein with an iodinated contrast agent. However, Venography X-ray imaging is invasive, nephrotoxic, and not always feasi
ble. In its absence, access is performed blindly using external anatomical landmarks, which carries the risk of pneumothorax, arterial puncture, and brachial plexus injury. In this study, we investigate how much of the puncture-relevant information that Venography provides can be recovered from a non-contrast X-ray alone. A dataset of 95 patient cases was assembled, each with paired non-contrast and contrast sequences, as well as clinician-validated puncture-region boxes. A U-Net was trained to reconstruct the axillary vein from the mean of the non-contrast sequence. In a frozen 30-patient test set, the puncture point derived from the predicted vein fell inside the Venography-informed puncture region in 93.3% of patients, including all 17 patients in which the blind landmark puncture could have missed it, and reduced the mean distance to 3.79 mm, against 6.88 mm for a population atlas prior and 9.44 mm for the blind landmark. These retrospective results suggest that non contrast X-ray images contain puncture-relevant, patient-specific information to approximate Venography-informed puncture guidance and motivate contrast-free guidance as a direction for prospective investigation.
Links to Paper and Supplementary Materials
Main Paper (Open Access Version): https://papers.miccai.org/miccai-2026-sat/paper/COLAS_018.pdf
SharedIt Link: Not yet available
SpringerLink (DOI): Not yet available
Supplementary Material: Not Submitted
Link to Open Review
Open Review Page: https://openreview.net/forum?id=8a1CyLrA2H
BibTex
@InProceedings{SpaEva_Puncture_MICCAISAT2026,
author = { Spatharis, Evangelos AND Falasconi, Giulio AND Penela, Diego AND Latini, Alessia Chiara AND Saglietto, Andrea AND Soto-Iglesias, David AND Berruezo, Antonio AND Camara, Oscar AND Camps, Julia},
title = { { Puncture Guidance from Non-Contrast X-Ray for Cardiac Pacemaker Implantation } },
booktitle = {Medical Image Computing and Computer Assisted Intervention -- MICCAI 2026 Workshops and Challenges},
year = {2026},
publisher = {Springer Nature Switzerland},
volume = {LNCS pending},
month = {pending},
page = {pending}
}