  Augmenting X-ray imaging with 3D roadmap to improve guidance is a common
strategy. Such approaches benefit from automated analysis of the X-ray images,
such as the automatic detection and tracking of instruments. In this paper, we
propose a real-time method to segment the catheter and guidewire in 2D X-ray
fluoroscopic sequences. The method is based on deep convolutional neural
networks. The network takes as input the current image and the three previous
ones, and segments the catheter and guidewire in the current image.
Subsequently, a centerline model of the catheter is constructed from the
segmented image. A small set of annotated data combined with data augmentation
is used to train the network. We trained the method on images from 182 X-ray
sequences from 23 different interventions. On a testing set with images of 55
X-ray sequences from 5 other interventions, a median centerline distance error
of 0.2 mm and a median tip distance error of 0.9 mm was obtained. The
segmentation of the instruments in 2D X-ray sequences is performed in a
real-time fully-automatic manner.
