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Gordon LB, Basso S, Maestranzi J, Aikawa E, Clift CL, Cammardella AG, Danesi TH, del Nido PJ, Edelman ER, Hamdy A, Hegde SM, Kleinman ME, Maschietto N, Mehra MR, Mukundan S, Musumeci F, Russo M, Rybicki FJ, Shah PB, Suarez WA, Tuminelli K, Zaleski K, Prakash A, Gerhard-Herman M. Intervention for critical aortic stenosis in Hutchinson-Gilford progeria syndrome. Front Cardiovasc Med 2024; 11:1356010. [PMID: 38725831 PMCID: PMC11079313 DOI: 10.3389/fcvm.2024.1356010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Hutchinson-Gilford Progeria Syndrome (HGPS) is an ultra-rare genetic premature aging disease that is historically fatal in teenage years, secondary to severe accelerated atherosclerosis. The only approved treatment is the farnesyltransferase inhibitor lonafarnib, which improves vascular structure and function, extending average untreated lifespan of 14.5 years by 4.3 years (30%). With this longer lifespan, calcific aortic stenosis (AS) was identified as an emerging critical risk factor for cardiac death in older patients. Intervention to relieve critical AS has the potential for immediate improvement in healthspan and lifespan. However, HGPS patient-device size mismatch, pervasive peripheral arterial disease, skin and bone abnormalities, and lifelong failure to thrive present unique challenges to intervention. An international group of experts in HGPS, pediatric and adult cardiology, cardiac surgery, and pediatric critical care convened to identify strategies for successful treatment. Candidate procedures were evaluated by in-depth examination of 4 cases that typify HGPS clinical pathology. Modified transcatheter aortic valve replacement (TAVR) and left ventricular Apico-Aortic Conduit (AAC) placement were deemed high risk but viable options. Two cases received TAVR and 2 received AAC post-summit. Three were successful and 1 patient died perioperatively due to cardiovascular disease severity, highlighting the importance of intervention timing and comparative risk stratification. These breakthrough interventions for treating critical aortic stenosis in HGPS patients could rewrite the current clinical perspective on disease course by greatly improving late-stage quality of life and increasing lifespan. Expanding worldwide medical and surgical competency for this ultra-rare disease through expert information-sharing could have high impact on treatment success.
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Affiliation(s)
- Leslie B. Gordon
- Division of Genetics, Department of Pediatrics, Hasbro Children's Hospital and Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
- The Progeria Research Foundation, Peabody, MA, United States
| | - Sammy Basso
- The Progeria Research Foundation, Peabody, MA, United States
- Associazione Italiana Progeria Sammy Basso, Tezze sul Brenta, Vicenza
- CNR - National Research Council of Italy, Institute of Molecular Genetics Luigi Luca Cavalli-Sforza,Unit 9 of Bologna, Bologna, Italy
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Elena Aikawa
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States
| | - Cassandra L. Clift
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States
| | | | - Tommaso Hinna Danesi
- Department of Surgery, Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Pedro J. del Nido
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Elazer R. Edelman
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Abeer Hamdy
- Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Sheila M. Hegde
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Monica E. Kleinman
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Nicola Maschietto
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Mandeep R. Mehra
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Srinivasan Mukundan
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States
- Department of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Francesco Musumeci
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Roma, Italy
| | - Marco Russo
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Roma, Italy
| | - Frank J. Rybicki
- Department of Radiology, University of Arizona - Phoenix, Phoenix, AZ, United States
| | - Pinak Bipin Shah
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States
| | - William A. Suarez
- Division of Pediatric Cardiology, Department of Pediatrics, University of Toledo Medical Center, Toledo, OH, United States
| | | | - Katherine Zaleski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ashwin Prakash
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Marie Gerhard-Herman
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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Lee J, Chadalavada SC, Ghodadra A, Ali A, Arribas EM, Chepelev L, Ionita CN, Ravi P, Ryan JR, Santiago L, Wake N, Sheikh AM, Rybicki FJ, Ballard DH. Clinical situations for which 3D Printing is considered an appropriate representation or extension of data contained in a medical imaging examination: vascular conditions. 3D Print Med 2023; 9:34. [PMID: 38032479 PMCID: PMC10688120 DOI: 10.1186/s41205-023-00196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Medical three-dimensional (3D) printing has demonstrated utility and value in anatomic models for vascular conditions. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (3DPSIG) provides appropriateness recommendations for vascular 3D printing indications. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with vascular indications. Each study was vetted by the authors and strength of evidence was assessed according to published appropriateness ratings. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for the following areas: aneurysm, dissection, extremity vascular disease, other arterial diseases, acute venous thromboembolic disease, venous disorders, lymphedema, congenital vascular malformations, vascular trauma, vascular tumors, visceral vasculature for surgical planning, dialysis access, vascular research/development and modeling, and other vasculopathy. Recommendations are provided in accordance with strength of evidence of publications corresponding to each vascular condition combined with expert opinion from members of the 3DPSIG. CONCLUSION This consensus appropriateness ratings document, created by the members of the 3DPSIG, provides an updated reference for clinical standards of 3D printing for the care of patients with vascular conditions.
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Affiliation(s)
- Joonhyuk Lee
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | - Anish Ghodadra
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | - Elsa M Arribas
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leonid Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Justin R Ryan
- Webster Foundation 3D Innovations Lab, Rady Children's Hospital, San Diego, CA, USA
- Department of Neurological Surgery, University of California San Diego Health, San Diego, CA, USA
| | - Lumarie Santiago
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Adnan M Sheikh
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Arizona - Phoenix, Phoenix, AZ, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Ali A, Morris JM, Decker SJ, Huang YH, Wake N, Rybicki FJ, Ballard DH. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: neurosurgical and otolaryngologic conditions. 3D Print Med 2023; 9:33. [PMID: 38008795 PMCID: PMC10680204 DOI: 10.1186/s41205-023-00192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Medical three dimensional (3D) printing is performed for neurosurgical and otolaryngologic conditions, but without evidence-based guidance on clinical appropriateness. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness recommendations for neurologic 3D printing conditions. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with neurologic and otolaryngologic conditions. Each study was vetted by the authors and strength of evidence was assessed according to published guidelines. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for diseases of the calvaria and skull base, brain tumors and cerebrovascular disease. Recommendations are provided in accordance with strength of evidence of publications corresponding to each neurologic condition combined with expert opinion from members of the 3D printing SIG. CONCLUSIONS This consensus guidance document, created by the members of the 3D printing SIG, provides a reference for clinical standards of 3D printing for neurologic conditions.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | | | - Summer J Decker
- Division of Imaging Research and Applied Anatomy, Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Yu-Hui Huang
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Ravi P, Rybicki FJ. Proper Registration of Image Sets to Ensure Quality of 3D Printed Anatomic Models. Radiographics 2023; 43:e230177. [PMID: 37616170 DOI: 10.1148/rg.230177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Prashanth Ravi
- Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, PO Box 670761, Cincinnati, OH 45267-0761
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, PO Box 670761, Cincinnati, OH 45267-0761
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Sriwastwa A, Ravi P, Emmert A, Chokshi S, Kondor S, Dhal K, Patel P, Chepelev LL, Rybicki FJ, Gupta R. Generative AI for medical 3D printing: a comparison of ChatGPT outputs to reference standard education. 3D Print Med 2023; 9:21. [PMID: 37525019 PMCID: PMC10391950 DOI: 10.1186/s41205-023-00186-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023] Open
Affiliation(s)
- Aakanksha Sriwastwa
- Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, OH, 45219, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, OH, 45219, USA
| | - Andrew Emmert
- Department of Orthopedics and Sports Medicine, University of Cincinnati, Cincinnati, OH, 45209, USA
| | - Shivum Chokshi
- Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, OH, 45219, USA
| | - Shayne Kondor
- Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, OH, 45219, USA
| | - Kashish Dhal
- Department of Mechanical and Aerospace Engineering, University of Texas, Arlington, TX, 76010, USA
| | - Parimal Patel
- Department of Mechanical and Aerospace Engineering, University of Texas, Arlington, TX, 76010, USA
| | - Leonid L Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, M5G 2N2, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, OH, 45219, USA.
- Department of Biomedical Engineering, University of Cincinnati, College of Engineering and Applied Sciences, Cincinnati, OH, 45219, USA.
| | - Rajul Gupta
- Department of Orthopedics and Sports Medicine, University of Cincinnati, Cincinnati, OH, 45209, USA
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Tonneau M, Phan K, Manem VSK, Low-Kam C, Dutil F, Kazandjian S, Vanderweyen D, Panasci J, Malo J, Coulombe F, Gagné A, Elkrief A, Belkaïd W, Di Jorio L, Orain M, Bouchard N, Muanza T, Rybicki FJ, Kafi K, Huntsman D, Joubert P, Chandelier F, Routy B. Generalization optimizing machine learning to improve CT scan radiomics and assess immune checkpoint inhibitors' response in non-small cell lung cancer: a multicenter cohort study. Front Oncol 2023; 13:1196414. [PMID: 37546399 PMCID: PMC10400292 DOI: 10.3389/fonc.2023.1196414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/28/2023] [Indexed: 08/08/2023] Open
Abstract
Background Recent developments in artificial intelligence suggest that radiomics may represent a promising non-invasive biomarker to predict response to immune checkpoint inhibitors (ICIs). Nevertheless, validation of radiomics algorithms in independent cohorts remains a challenge due to variations in image acquisition and reconstruction. Using radiomics, we investigated the importance of scan normalization as part of a broader machine learning framework to enable model external generalizability to predict ICI response in non-small cell lung cancer (NSCLC) patients across different centers. Methods Radiomics features were extracted and compared from 642 advanced NSCLC patients on pre-ICI scans using established open-source PyRadiomics and a proprietary DeepRadiomics deep learning technology. The population was separated into two groups: a discovery cohort of 512 NSCLC patients from three academic centers and a validation cohort that included 130 NSCLC patients from a fourth center. We harmonized images to account for variations in reconstruction kernel, slice thicknesses, and device manufacturers. Multivariable models, evaluated using cross-validation, were used to estimate the predictive value of clinical variables, PD-L1 expression, and PyRadiomics or DeepRadiomics for progression-free survival at 6 months (PFS-6). Results The best prognostic factor for PFS-6, excluding radiomics features, was obtained with the combination of Clinical + PD-L1 expression (AUC = 0.66 in the discovery and 0.62 in the validation cohort). Without image harmonization, combining Clinical + PyRadiomics or DeepRadiomics delivered an AUC = 0.69 and 0.69, respectively, in the discovery cohort, but dropped to 0.57 and 0.52, in the validation cohort. This lack of generalizability was consistent with observations in principal component analysis clustered by CT scan parameters. Subsequently, image harmonization eliminated these clusters. The combination of Clinical + DeepRadiomics reached an AUC = 0.67 and 0.63 in the discovery and validation cohort, respectively. Conversely, the combination of Clinical + PyRadiomics failed generalizability validations, with AUC = 0.66 and 0.59. Conclusion We demonstrated that a risk prediction model combining Clinical + DeepRadiomics was generalizable following CT scan harmonization and machine learning generalization methods. These results had similar performances to routine oncology practice using Clinical + PD-L1. This study supports the strong potential of radiomics as a future non-invasive strategy to predict ICI response in advanced NSCLC.
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Affiliation(s)
- Marion Tonneau
- Department of Cancer Research, Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, QC, Canada
- Université de Médecine, Lille, France
| | - Kim Phan
- Imagia Canexia Health, Montreal, QC, Canada
| | - Venkata S. K. Manem
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Québec City, QC, Canada
- Department of Mathematics and Computer Science, University of Quebec at Trois-Rivières, Trois-Rivières, QC, Canada
| | | | | | - Suzanne Kazandjian
- Department of Medical Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - Davy Vanderweyen
- Department of Radiology, Centre Hospitalier de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Justin Panasci
- Department of Medical Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - Julie Malo
- Department of Cancer Research, Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, QC, Canada
| | - François Coulombe
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Québec City, QC, Canada
| | - Andréanne Gagné
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Québec City, QC, Canada
| | - Arielle Elkrief
- Department of Cancer Research, Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, QC, Canada
- Hemato-Oncology Division, Centre Hospitalier de l’université de Montreal, Montreal, QC, Canada
| | - Wiam Belkaïd
- Department of Cancer Research, Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, QC, Canada
| | | | - Michele Orain
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Québec City, QC, Canada
| | - Nicole Bouchard
- Department of Oncology, Centre Hospitalier de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Thierry Muanza
- Department of Medical Oncology, Jewish General Hospital, Montreal, QC, Canada
- Department of Radiation Oncology, Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
| | | | - Kam Kafi
- Imagia Canexia Health, Montreal, QC, Canada
| | | | - Philippe Joubert
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Québec City, QC, Canada
- Department of Pathology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | | | - Bertrand Routy
- Department of Cancer Research, Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, QC, Canada
- Hemato-Oncology Division, Centre Hospitalier de l’université de Montreal, Montreal, QC, Canada
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Patel P, Dhal K, Gupta R, Tappa K, Rybicki FJ, Ravi P. Medical 3D Printing Using Desktop Inverted Vat Photopolymerization: Background, Clinical Applications, and Challenges. Bioengineering (Basel) 2023; 10:782. [PMID: 37508810 PMCID: PMC10376892 DOI: 10.3390/bioengineering10070782] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Medical 3D printing is a complex, highly interdisciplinary, and revolutionary technology that is positively transforming the care of patients. The technology is being increasingly adopted at the Point of Care (PoC) as a consequence of the strong value offered to medical practitioners. One of the key technologies within the medical 3D printing portfolio enabling this transition is desktop inverted Vat Photopolymerization (VP) owing to its accessibility, high quality, and versatility of materials. Several reports in the peer-reviewed literature have detailed the medical impact of 3D printing technologies as a whole. This review focuses on the multitude of clinical applications of desktop inverted VP 3D printing which have grown substantially in the last decade. The principles, advantages, and challenges of this technology are reviewed from a medical standpoint. This review serves as a primer for the continually growing exciting applications of desktop-inverted VP 3D printing in healthcare.
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Affiliation(s)
- Parimal Patel
- Department of Mechanical & Aerospace Engineering, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Kashish Dhal
- Department of Mechanical & Aerospace Engineering, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Rajul Gupta
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Karthik Tappa
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati, Cincinnati, OH 45219, USA
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Chen D, Ganapathy A, Abraham N, Marquis KM, Bishop GL, Rybicki FJ, Hoegger MJ, Ballard DH. 3D printing exposure and perception in radiology residency: survey results of radiology chief residents. 3D Print Med 2023; 9:13. [PMID: 37103761 PMCID: PMC10133904 DOI: 10.1186/s41205-023-00173-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/24/2023] [Indexed: 04/28/2023] Open
Abstract
RATIONALE AND OBJECTIVES The purpose of this study is to summarize a survey of radiology chief residents focused on 3D printing in radiology. MATERIALS AND METHODS An online survey was distributed to chief residents in North American radiology residencies by subgroups of the Association of University Radiologists. The survey included a subset of questions focused on the clinical use of 3D printing and perceptions of the role of 3D printing and radiology. Respondents were asked to define the role of 3D printing at their institution and asked about the potential role of clinical 3D printing in radiology and radiology residencies. RESULTS 152 individual responses from 90 programs were provided, with a 46% overall program response rate (n = 90/194 radiology residencies). Most programs had 3D printing at their institution (60%; n = 54/90 programs). Among the institutions that perform 3D printing, 33% (n = 18/54) have structured opportunities for resident contribution. Most residents (60%; n = 91/152 respondents) feel they would benefit from 3D printing exposure or educational material. 56% of residents (n = 84/151) believed clinical 3D printing should be centered in radiology departments. 22% of residents (n = 34/151) believed it would increase communication and improve relationships between radiology and surgery colleagues. A minority (5%; 7/151) believe 3D printing is too costly, time-consuming, or outside a radiologist's scope of practice. CONCLUSIONS A majority of surveyed chief residents in accredited radiology residencies believe they would benefit from exposure to 3D printing in residency. 3D printing education and integration would be a valuable addition to current radiology residency program curricula.
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Affiliation(s)
- David Chen
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Aravinda Ganapathy
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Nihil Abraham
- Department of Internal Medicine, University of California-Riverside School of Medicine, Riverside, CA, USA
| | - Kaitlin M Marquis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Grace L Bishop
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mark J Hoegger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
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Arribas EM, Kelil T, Santiago L, Ali A, Chadalavada SC, Chepelev L, Ghodadra A, Ionita CN, Lee J, Ravi P, Ryan JR, Sheikh AM, Rybicki FJ, Ballard DH. Radiological Society of North America (RSNA) 3D Printing Special Interest Group (SIG) clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: breast conditions. 3D Print Med 2023; 9:8. [PMID: 36952139 PMCID: PMC10037829 DOI: 10.1186/s41205-023-00171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023] Open
Abstract
The use of medical 3D printing has expanded dramatically for breast diseases. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides updated appropriateness criteria for breast 3D printing in various clinical scenarios. Evidence-based appropriateness criteria are provided for the following clinical scenarios: benign breast lesions and high-risk breast lesions, breast cancer, breast reconstruction, and breast radiation (treatment planning and radiation delivery).
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Affiliation(s)
- Elsa M Arribas
- Division of Diagnostic Imaging, Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Tatiana Kelil
- Department of Radiology, University of California, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA
| | - Lumarie Santiago
- Division of Diagnostic Imaging, Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Arafat Ali
- Diagnostic Radiology, Henry Ford Medical Group, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | | | - Leonid Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Anish Ghodadra
- UPMC Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Ciprian N Ionita
- Department of Biomedical Engineering, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, University at Buffalo School of Engineering and Applied Sciences, 8052 Clinical Translational Research Center, 875 Ellicott Street, Buffalo, NY, 14203, USA
| | - Joonhyuk Lee
- University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Justin R Ryan
- 3D Innovations Lab, Rady Children's Hospital, San Diego, CA, USA
| | - Adnan M Sheikh
- Department of Medical Imaging, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, K1H 8L6, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University, St Louis, MO, USA
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10
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Maroules CD, Rybicki FJ, Ghoshhajra BB, Batlle JC, Branch K, Chinnaiyan K, Hamilton-Craig C, Hoffmann U, Litt H, Meyersohn N, Shaw LJ, Villines TC, Cury RC. 2022 use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: An expert consensus document of the Society of cardiovascular computed tomography (SCCT): Endorsed by the American College of Radiology (ACR) and North American Society for cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2023; 17:146-163. [PMID: 36253281 DOI: 10.1016/j.jcct.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
Coronary computed tomography angiography (CTA) improves the quality of care for patients presenting with acute chest pain (ACP) to the emergency department (ED), particularly in patients with low to intermediate likelihood of acute coronary syndrome (ACS). The Society of Cardiovascular Computed Tomography Guidelines Committee was formed to develop recommendations for acquiring, interpreting, and reporting of coronary CTA to ensure appropriate, safe, and efficient use of this modality. Because of the increasing use of coronary CTA testing for the evaluation of ACP patients, the Committee has been charged with the development of the present document to assist physicians and technologists. These recommendations were produced as an educational tool for practitioners evaluating acute chest pain patients in the ED, in the interest of developing systematic standards of practice for coronary CTA based on the best available data or broad expert consensus. Due to the highly variable nature of medical care, approaches to patient selection, preparation, protocol selection, interpretation or reporting that differs from these guidelines may represent an appropriate variation based on a legitimate assessment of an individual patient's needs.
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Affiliation(s)
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Juan C Batlle
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
| | - Kelley Branch
- Department of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nandini Meyersohn
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Todd C Villines
- Department of Cardiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ricardo C Cury
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
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11
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Ravi P, Burch MB, Farahani S, Chepelev LL, Yang D, Ali A, Joyce JR, Lawera N, Stringer J, Morris JM, Ballard DH, Wang KC, Mahoney MC, Kondor S, Rybicki FJ. Utility and Costs During the Initial Year of 3D Printing in an Academic Hospital. J Am Coll Radiol 2023; 20:193-204. [PMID: 35988585 DOI: 10.1016/j.jacr.2022.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There is a paucity of utility and cost data regarding the launch of 3D printing in a hospital. The objective of this project is to benchmark utility and costs for radiology-based in-hospital 3D printing of anatomic models in a single, adult academic hospital. METHODS All consecutive patients for whom 3D printed anatomic models were requested during the first year of operation were included. All 3D printing activities were documented by the 3D printing faculty and referring specialists. For patients who underwent a procedure informed by 3D printing, clinical utility was determined by the specialist who requested the model. A new metric for utility termed Anatomic Model Utility Points with range 0 (lowest utility) to 500 (highest utility) was derived from the specialist answers to Likert statements. Costs expressed in United States dollars were tallied from all 3D printing human resources and overhead. Total costs, focused costs, and outsourced costs were estimated. The specialist estimated the procedure room time saved from the 3D printed model. The time saved was converted to dollars using hospital procedure room costs. RESULTS The 78 patients referred for 3D printed anatomic models included 11 clinical indications. For the 68 patients who had a procedure, the anatomic model utility points had an overall mean (SD) of 312 (57) per patient (range, 200-450 points). The total operation cost was $213,450. The total cost, focused costs, and outsourced costs were $2,737, $2,180, and $2,467 per model, respectively. Estimated procedure time saved had a mean (SD) of 29.9 (12.1) min (range, 0-60 min). The hospital procedure room cost per minute was $97 (theoretical $2,900 per patient saved with model). DISCUSSION Utility and cost benchmarks for anatomic models 3D printed in a hospital can inform health care budgets. Realizing pecuniary benefit from the procedure time saved requires future research.
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Affiliation(s)
- Prashanth Ravi
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Michael B Burch
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Shayan Farahani
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Leonid L Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | | | - Arafat Ali
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Jennifer R Joyce
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Nathan Lawera
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Jimmy Stringer
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | | | - David H Ballard
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St Louis, Missouri
| | - Kenneth C Wang
- Department of Radiology, University of Maryland, Baltimore, Maryland; and Department of Radiology, Baltimore VA Medical Center, Baltimore, Maryland; and Co-Chair, ACR 3D Printing Registry Governance Committee
| | - Mary C Mahoney
- Chair, Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shayne Kondor
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Frank J Rybicki
- Vice Chair of Operations & Quality, Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio; and Co-Chair, ACR 3D Printing Registry Governance Committee.
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12
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Cury RC, Leipsic J, Abbara S, Achenbach S, Berman D, Bittencourt M, Budoff M, Chinnaiyan K, Choi AD, Ghoshhajra B, Jacobs J, Koweek L, Lesser J, Maroules C, Rubin GD, Rybicki FJ, Shaw LJ, Williams MC, Williamson E, White CS, Villines TC, Blankstein R. CAD-RADS™ 2.0 - 2022 Coronary Artery Disease-Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR), and the North America Society of Cardiovascular Imaging (NASCI). JACC Cardiovasc Imaging 2022; 15:1974-2001. [PMID: 36115815 DOI: 10.1016/j.jcmg.2022.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/10/2022] [Accepted: 07/02/2022] [Indexed: 12/14/2022]
Abstract
Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developments in cardiac CT, including data from recent clinical trials and new clinical guidelines. The updated CAD-RADS classification will follow an established framework of stenosis, plaque burden, and modifiers, which will include assessment of lesion-specific ischemia using CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), when performed. Similar to the method used in the original CAD-RADS version, the determinant for stenosis severity classification will be the most severe coronary artery luminal stenosis on a per-patient basis, ranging from CAD-RADS 0 (zero) for absence of any plaque or stenosis to CAD-RADS 5 indicating the presence of at least one totally occluded coronary artery. Given the increasing data supporting the prognostic relevance of coronary plaque burden, this document will provide various methods to estimate and report total plaque burden. The addition of P1 to P4 descriptors are used to denote increasing categories of plaque burden. The main goal of CAD-RADS, which should always be interpreted together with the impression found in the report, remains to facilitate communication of test results with referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will continue to provide a framework of standardization that may benefit education, research, peer-review, artificial intelligence development, clinical trial design, population health and quality assurance with the ultimate goal of improving patient care.
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Affiliation(s)
- Ricardo C Cury
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, Florida, USA.
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Suhny Abbara
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Stephan Achenbach
- Friedrich-Alexander-Universität, Department of Cardiology, Erlangen, Germany
| | - Daniel Berman
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Marcio Bittencourt
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew Budoff
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | | | - Andrew D Choi
- The George Washington University School of Medicine, Washington, DC, USA
| | - Brian Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jill Jacobs
- NYU Langone Medical Center, New York, New York, USA
| | - Lynne Koweek
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - John Lesser
- Division of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | | | - Geoffrey D Rubin
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Leslee J Shaw
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Eric Williamson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Todd C Villines
- Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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13
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Cury RC, Leipsic J, Abbara S, Achenbach S, Berman D, Bittencourt M, Budoff M, Chinnaiyan K, Choi AD, Ghoshhajra B, Jacobs J, Koweek L, Lesser J, Maroules C, Rubin GD, Rybicki FJ, Shaw LJ, Williams MC, Williamson E, White CS, Villines TC, Blankstein R. CAD-RADS™ 2.0 - 2022 Coronary Artery Disease - Reporting and Data System.: An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR) and the North America Society of Cardiovascular Imaging (NASCI). J Am Coll Radiol 2022; 19:1185-1212. [PMID: 36436841 DOI: 10.1016/j.jacr.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developments in Cardiac CT, including data from recent clinical trials and new clinical guidelines. The updated CAD-RADS classification will follow an established framework of stenosis, plaque burden, and modifiers, which will include assessment of lesion-specific ischemia using CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), when performed. Similar to the method used in the original CAD-RADS version, the determinant for stenosis severity classification will be the most severe coronary artery luminal stenosis on a per-patient basis, ranging from CAD-RADS 0 (zero) for absence of any plaque or stenosis to CAD-RADS 5 indicating the presence of at least one totally occluded coronary artery. Given the increasing data supporting the prognostic relevance of coronary plaque burden, this document will provide various methods to estimate and report total plaque burden. The addition of P1 to P4 descriptors are used to denote increasing categories of plaque burden. The main goal of CAD-RADS, which should always be interpreted together with the impression found in the report, remains to facilitate communication of test results with referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will continue to provide a framework of standardization that may benefit education, research, peer-review, artificial intelligence development, clinical trial design, population health and quality assurance with the ultimate goal of improving patient care.
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Affiliation(s)
- Ricardo C Cury
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, 8900 N Kendall Drive, Miami FL, 33176, USA.
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Suhny Abbara
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Stephan Achenbach
- Friedrich-Alexander-Universität, Department of Cardiology, Erlangen, Germany
| | | | | | - Matthew Budoff
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | - Andrew D Choi
- The George Washington University School of Medicine, Washington, DC, USA
| | - Brian Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jill Jacobs
- NYU Langone Medical Center, New York, NY, USA
| | - Lynne Koweek
- Department of Radiology, Duke University, Durham, NC, USA
| | - John Lesser
- Division of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA
| | | | - Geoffrey D Rubin
- Department of Medical Imaging, University of Arizona, Tucson, AZ, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Leslee J Shaw
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Todd C Villines
- Division of Cardiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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14
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Kirsch J, Wu CC, Bolen MA, Henry TS, Rajiah PS, Brown RKJ, Galizia MS, Lee E, Rajesh F, Raptis CA, Rybicki FJ, Sams CM, Verde F, Villines TC, Wolf SJ, Yu J, Donnelly EF, Abbara S. ACR Appropriateness Criteria® Suspected Pulmonary Embolism: 2022 Update. J Am Coll Radiol 2022; 19:S488-S501. [PMID: 36436972 DOI: 10.1016/j.jacr.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Pulmonary embolism (PE) remains a common and important clinical condition that cannot be accurately diagnosed on the basis of signs, symptoms, and history alone. The diagnosis of PE has been facilitated by technical advancements and multidetector CT pulmonary angiography, which is the major diagnostic modality currently used. Ventilation and perfusion scans remain largely accurate and useful in certain settings. MR angiography can be useful in some clinical scenarios and lower-extremity ultrasound can substitute by demonstrating deep vein thrombosis; however, if negative, further studies to exclude PE are indicated. In all cases, correlation with the clinical status, particularly with risk factors, improves not only the accuracy of diagnostic imaging but also overall utilization. Other diagnostic tests have limited roles. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Carol C Wu
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Travis S Henry
- Panel Chair, Division Chief of Cardiothoracic Imaging, Duke University, Durham, North Carolina; Co-Director, ACR Education Center HRCT Course; Chair
| | | | - Richard K J Brown
- Vice Chair of Clinical Operations, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Elizabeth Lee
- University of Michigan Health System, Ann Arbor, Michigan; Director M1Radiology Education University of Michigan Medical School; Associated Program Director Diagnostic Radiology Michigan Medicine; Director of Residency Education Cardiothoracic Division Michigan
| | - Fnu Rajesh
- MetroHealth Medical Center, Cleveland, Ohio; Primary care physician
| | | | | | | | - Franco Verde
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Todd C Villines
- University of Virginia Health System, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Stephen J Wolf
- Denver Health, Denver, Colorado; American College of Emergency Physicians; Director of Service for Emergency Medicine, Denver Health Medical Center, Denver Colorado; Co-Chair, American College of Emergency Physicians Clinical Policies Committee
| | - Jeannie Yu
- Deputy Chief of Medicine, VA Medical Center, University of California-Irvine, Irvine, California; Society for Cardiovascular Magnetic Resonance
| | - Edwin F Donnelly
- Specialty Chair, Ohio State University Wexner Medical Center, Columbus, Ohio; Ohio State University Medical Center: Chief of Thoracic Radiology, Interim Vice Chair of Academic Affairs, Department of Radiology
| | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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15
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Cury RC, Leipsic J, Abbara S, Achenbach S, Berman D, Bittencourt M, Budoff M, Chinnaiyan K, Choi AD, Ghoshhajra B, Jacobs J, Koweek L, Lesser J, Maroules C, Rubin GD, Rybicki FJ, Shaw LJ, Williams MC, Williamson E, White CS, Villines TC, Blankstein R. CAD-RADS™ 2.0 - 2022 Coronary Artery Disease-Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR), and the North America Society of Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2022; 16:536-557. [PMID: 35864070 DOI: 10.1016/j.jcct.2022.07.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/10/2022] [Accepted: 07/02/2022] [Indexed: 12/14/2022]
Abstract
Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developments in Cardiac CT, including data from recent clinical trials and new clinical guidelines. The updated CAD-RADS classification will follow an established framework of stenosis, plaque burden, and modifiers, which will include assessment of lesion-specific ischemia using CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), when performed. Similar to the method used in the original CAD-RADS version, the determinant for stenosis severity classification will be the most severe coronary artery luminal stenosis on a per-patient basis, ranging from CAD-RADS 0 (zero) for absence of any plaque or stenosis to CAD-RADS 5 indicating the presence of at least one totally occluded coronary artery. Given the increasing data supporting the prognostic relevance of coronary plaque burden, this document will provide various methods to estimate and report total plaque burden. The addition of P1 to P4 descriptors are used to denote increasing categories of plaque burden. The main goal of CAD-RADS, which should always be interpreted together with the impression found in the report, remains to facilitate communication of test results with referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will continue to provide a framework of standardization that may benefit education, research, peer-review, artificial intelligence development, clinical trial design, population health and quality assurance with the ultimate goal of improving patient care.
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Affiliation(s)
- Ricardo C Cury
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami FL, USA.
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Suhny Abbara
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Stephan Achenbach
- Friedrich-Alexander-Universität, Department of Cardiology, Erlangen, Germany
| | | | | | - Matthew Budoff
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | - Andrew D Choi
- The George Washington University School of Medicine, Washington, DC, USA
| | - Brian Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jill Jacobs
- NYU Langone Medical Center, New York, NY, USA
| | - Lynne Koweek
- Department of Radiology, Duke University, Durham, NC, USA
| | - John Lesser
- Division of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA
| | | | - Geoffrey D Rubin
- Department of Medical Imaging, University of Arizona, Tucson, AZ, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Leslee J Shaw
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Todd C Villines
- Division of Cardiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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16
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Cury RC, Leipsic J, Abbara S, Achenbach S, Berman D, Bittencourt M, Budoff M, Chinnaiyan K, Choi AD, Ghoshhajra B, Jacobs J, Koweek L, Lesser J, Maroules C, Rubin GD, Rybicki FJ, Shaw LJ, Williams MC, Williamson E, White CS, Villines TC, Blankstein R. CAD-RADS™ 2.0 - 2022 Coronary Artery Disease - Reporting and Data System An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR) and the North America Society of Cardiovascular Imaging (NASCI). Radiol Cardiothorac Imaging 2022; 4:e220183. [PMID: 36339062 PMCID: PMC9627235 DOI: 10.1148/ryct.220183] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/10/2022] [Accepted: 07/02/2022] [Indexed: 06/16/2023]
Abstract
Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developments in Cardiac CT, including data from recent clinical trials and new clinical guidelines. The updated CAD-RADS classification will follow an established framework of stenosis, plaque burden, and modifiers, which will include assessment of lesion-specific ischemia using CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), when performed. Similar to the method used in the original CAD-RADS version, the determinant for stenosis severity classification will be the most severe coronary artery luminal stenosis on a per-patient basis, ranging from CAD-RADS 0 (zero) for absence of any plaque or stenosis to CAD-RADS 5 indicating the presence of at least one totally occluded coronary artery. Given the increasing data supporting the prognostic relevance of coronary plaque burden, this document will provide various methods to estimate and report total plaque burden. The addition of P1 to P4 descriptors are used to denote increasing categories of plaque burden. The main goal of CAD-RADS, which should always be interpreted together with the impression found in the report, remains to facilitate communication of test results with referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will continue to provide a framework of standardization that may benefit education, research, peer-review, artificial intelligence development, clinical trial design, population health and quality assurance with the ultimate goal of improving patient care. Keywords: Coronary Artery Disease, Coronary CTA, CAD-RADS, Reporting and Data System, Stenosis Severity, Report Standardization Terminology, Plaque Burden, Ischemia Supplemental material is available for this article. This article is published synchronously in Radiology: Cardiothoracic Imaging, Journal of Cardiovascular Computed Tomography, JACC: Cardiovascular Imaging, Journal of the American College of Radiology, and International Journal for Cardiovascular Imaging. © 2022 Society of Cardiovascular Computed Tomography. Published by RSNA with permission.
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Affiliation(s)
- Ricardo C. Cury
- Miami Cardiac and Vascular Institute and Baptist Health of South
Florida, 8900 N Kendall Drive, Miami FL, 33176, USA
| | | | - Suhny Abbara
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX,
USA
| | - Stephan Achenbach
- Friedrich-Alexander-Universität, Department of Cardiology,
Ulmenweg 18, 90154, Erlangen, Germany
| | | | | | | | | | - Andrew D. Choi
- The George Washington University School of Medicine, USA
| | | | - Jill Jacobs
- NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016,
USA
| | | | - John Lesser
- Division of Cardiology, Minneapolis Heart Institute, USA
| | | | | | - Frank J. Rybicki
- Department of Radiology, University of Cincinnati College of
Medicine, USA
| | | | | | | | | | - Todd C. Villines
- Division of Cardiology, University of Virginia Health System,
USA
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School,
USA
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17
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Yao J, Chepelev L, Nisha Y, Sathiadoss P, Rybicki FJ, Sheikh AM. Evaluation of a deep learning method for the automated detection of supraspinatus tears on MRI. Skeletal Radiol 2022; 51:1765-1775. [PMID: 35190850 DOI: 10.1007/s00256-022-04008-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate if deep learning is a feasible approach for automated detection of supraspinatus tears on MRI. MATERIALS AND METHODS A total of 200 shoulder MRI studies performed between 2015 and 2019 were retrospectively obtained from our institutional database using a balanced random sampling of studies containing a full-thickness tear, partial-thickness tear, or intact supraspinatus tendon. A 3-stage pipeline was developed comprised of a slice selection network based on a pre-trained residual neural network (ResNet); a segmentation network based on an encoder-decoder network (U-Net); and a custom multi-input convolutional neural network (CNN) classifier. Binary reference labels were created following review of radiologist reports and images by a radiology fellow and consensus validation by two musculoskeletal radiologists. Twenty percent of the data was reserved as a holdout test set with the remaining 80% used for training and optimization under a fivefold cross-validation strategy. Classification and segmentation accuracy were evaluated using area under the receiver operating characteristic curve (AUROC) and Dice similarity coefficient, respectively. Baseline characteristics in correctly versus incorrectly classified cases were compared using independent sample t-test and chi-squared. RESULTS Test sensitivity and specificity of the classifier at the optimal Youden's index were 85.0% (95% CI: 62.1-96.8%) and 85.0% (95% CI: 62.1-96.8%), respectively. AUROC was 0.943 (95% CI: 0.820-0.991). Dice segmentation accuracy was 0.814 (95% CI: 0.805-0.826). There was no significant difference in AUROC between 1.5 T and 3.0 T studies. Sub-analysis showed superior sensitivity on full-thickness (100%) versus partial-thickness (72.5%) subgroups. DATA CONCLUSION Deep learning is a feasible approach to detect supraspinatus tears on MRI.
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Affiliation(s)
- Jason Yao
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada.
| | - Leonid Chepelev
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada
| | - Yashmin Nisha
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada
| | - Paul Sathiadoss
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, 234 Goodman Street, Box 670761, Cincinnati, OH, 45267-0761, USA
| | - Adnan M Sheikh
- Department of Radiology, The University of British Columbia Faculty of Medicine, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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Ravi P, Chepelev LL, Stichweh GV, Jones BS, Rybicki FJ. Medical 3D Printing Dimensional Accuracy for Multi-pathological Anatomical Models 3D Printed Using Material Extrusion. J Digit Imaging 2022; 35:613-622. [PMID: 35237891 PMCID: PMC9156585 DOI: 10.1007/s10278-022-00614-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 12/15/2022] Open
Abstract
Medical 3D printing of anatomical models is being increasingly applied in healthcare facilities. The accuracy of such 3D-printed anatomical models is an important aspect of their overall quality control. The purpose of this research was to test whether the accuracy of a variety of anatomical models 3D printed using Material Extrusion (MEX) lies within a reasonable tolerance level, defined as less than 1-mm dimensional error. Six medical models spanning across anatomical regions (musculoskeletal, neurological, abdominal, cardiovascular) and sizes (model volumes ranging from ~ 4 to 203 cc) were chosen for the primary study. Three measurement landing blocks were strategically designed within each of the six medical models to allow high-resolution caliper measurements. An 8-cc reference cube was printed as the 7th model in the primary study. In the secondary study, the effect of model rotation and scale was assessed using two of the models from the first study. All models were 3D printed using an Ultimaker 3 printer in triplicates. All absolute measurement errors were found to be less than 1 mm with a maximum error of 0.89 mm. The maximum relative error was 2.78%. The average absolute error was 0.26 mm, and the average relative error was 0.71% in the primary study, and the results were similar in the secondary study with an average absolute error of 0.30 mm and an average relative error of 0.60%. The relative errors demonstrated certain patterns in the data, which were explained based on the mechanics of MEX 3D printing. Results indicate that the MEX process, when carefully assessed on a case-by-case basis, could be suitable for the 3D printing of multi-pathological anatomical models for surgical planning if an accuracy level of 1 mm is deemed sufficient for the application.
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Affiliation(s)
- Prashanth Ravi
- Department of Radiology, University of Cincinnati College of Medicine, 234 Goodman St, Cincinnati, OH, 45219, USA.
| | - Leonid L Chepelev
- Department of Radiology, Stanford University, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Gabrielle V Stichweh
- 1819 Innovation Hub Makerspace, University of Cincinnati, 2900 Reading Rd, Cincinnati, OH, 45206, USA
| | - Benjamin S Jones
- 1819 Innovation Hub Makerspace, University of Cincinnati, 2900 Reading Rd, Cincinnati, OH, 45206, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, 234 Goodman St, Cincinnati, OH, 45219, USA
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Blankstein R, Shaw LJ, Gulati M, Atalay MK, Bax J, Calnon DA, Dyke CK, Ferencik M, Heitner JF, Henry TD, Hung J, Knuuti J, Lindner JR, Phillips LM, Raman SV, Rao SV, Rybicki FJ, Saraste A, Stainback RF, Thompson RC, Williamson E, Nieman K, Tremmel JA, Woodard PK, Di Carli MF, Chandrashekhar YS. Implications of the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Chest Pain Guideline for Cardiovascular Imaging: A Multisociety Viewpoint. JACC Cardiovasc Imaging 2022; 15:912-926. [PMID: 35512960 DOI: 10.1016/j.jcmg.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Leslee J Shaw
- Departments of Medicine (Cardiology) and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Martha Gulati
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Michael K Atalay
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Jeroen Bax
- Heart Center, Turku University Hospital, Turku, Finland; Leiden University Medical Centre, Leiden, the Netherlands
| | - Dennis A Calnon
- Ohio Health Heart & Vascular Physicians, Columbus, Ohio, USA
| | | | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio, USA
| | - Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Juhani Knuuti
- Heart Center, Turku University Hospital, Turku, Finland
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Subha V Raman
- Indiana University CV Institute and Krannert CV Research Center, Indianapolis, Indiana, USA
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Frank J Rybicki
- University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Antti Saraste
- Heart Center, Turku University Hospital, Turku, Finland; Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Raymond F Stainback
- Texas Heart Institute and Baylor College of Medicine, Division of Cardiology, Houston, Texas, USA
| | - Randall C Thompson
- St. Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | - Koen Nieman
- Stanford University, Palo Alto, California, USA
| | | | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Rakhra KS, Chepelev L, McInnes MDF, Schieda N, Rybicki FJ. A Metrics-Based Research Salary Award System and Its 9-Year Impact on Publication Productivity. Acad Radiol 2022; 29:728-735. [PMID: 32807606 DOI: 10.1016/j.acra.2020.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/18/2020] [Accepted: 06/26/2020] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES Although metrics-based systems may incentivize academic output, no prior studies have evaluated the impact on publication metrics in academic radiology. This study presents a metrics-based system of awarding research protected time, and retrospectively evaluates its 9-year impact on publication productivity and impact factor. MATERIALS AND METHODS Based on a metrics-based algorithm to award department funded Research Protected Time (RPT), metrics pre-RPT (2003-2009) and during the RPT period (2010-2018) from an academic radiology department were retrospectively analyzed to test the hypothesis that the RPT program resulted in higher publication productivity and journal impact factor at the departmental level and for faculty members receiving the award. Comparison was made between (1) pre-RPT and RPT periods and (2) during the RPT period, between RPT and non-RPT faculty members, for annual publication productivity normalized to faculty count (Student's t test) and median impact factor (Wilcoxon rank sum test). RESULTS For the evaluation period of 2003-2018, 724 unique publications were identified: 15% (107/724) pre-RPT period and 85% (617/724) RPT period. Normalized annual publication productivity was higher during the RPT period compared to the Pre-RPT period (1.2 vs. 0.3, p = 0.002), and within the RPT period, higher among faculty who received RPT vs. non-RPT faculty (3.5 vs. 0.4, p = 0.002). Median impact factor was higher during the RPT period compared to pre-RPT period (2.843 vs. 2.322, p = 0.044), and within the RPT period, higher in RPT vs. non-RPT faculty (3.016 vs. 2.346, p < 0.001). CONCLUSION The implementation of a metrics-based system of funded, research protected time, was associated with increased publication productivity and increased impact factor.
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Affiliation(s)
- Kawan S Rakhra
- Department of Radiology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Leonid Chepelev
- Department of Radiology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Matthew D F McInnes
- Department of Radiology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Rybicki FJ. The impact of regulation, reimbursement, and research on the value of 3D printing and other 3D procedures in medicine. 3D Print Med 2022; 8:6. [PMID: 35102462 PMCID: PMC8805272 DOI: 10.1186/s41205-022-00132-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Affiliation(s)
- Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Abstract
Editor's Note.-Articles in the RadioGraphics Update section provide current knowledge to supplement or update information found in full-length articles previously published in RadioGraphics. Authors of the previously published article provide a brief synopsis that emphasizes important new information such as technological advances, revised imaging protocols, new clinical guidelines involving imaging, or updated classification schemes. Articles in this section are published solely online and are linked to the original article.
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Affiliation(s)
- Dimitrios Mitsouras
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (D.M.); Radiology Service, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (D.M.); Department of Radiology: 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, Montefiore Medical Center, Bronx, NY (N.W.); Department of Radiology, NYU Langone Health, New York, NY (N.W.); and Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219 (F.J.R.)
| | - Peter C Liacouras
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (D.M.); Radiology Service, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (D.M.); Department of Radiology: 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, Montefiore Medical Center, Bronx, NY (N.W.); Department of Radiology, NYU Langone Health, New York, NY (N.W.); and Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219 (F.J.R.)
| | - Nicole Wake
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (D.M.); Radiology Service, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (D.M.); Department of Radiology: 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, Montefiore Medical Center, Bronx, NY (N.W.); Department of Radiology, NYU Langone Health, New York, NY (N.W.); and Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219 (F.J.R.)
| | - Frank J Rybicki
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (D.M.); Radiology Service, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (D.M.); Department of Radiology: 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, Montefiore Medical Center, Bronx, NY (N.W.); Department of Radiology, NYU Langone Health, New York, NY (N.W.); and Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219 (F.J.R.)
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Dewey M, Rochitte CE, Ostovaneh MR, Chen MY, George RT, Niinuma H, Kitagawa K, Laham R, Kofoed K, Nomura C, Sakuma H, Yoshioka K, Mehra VC, Jinzaki M, Kuribayashi S, Laule M, Paul N, Scholte AJ, Cerci R, Hoe J, Tan SY, Rybicki FJ, Matheson MB, Vavere AL, Arai AE, Miller JM, Cox C, Brinker J, Clouse ME, Di Carli M, Lima JAC, Arbab-Zadeh A. Prognostic value of noninvasive combined anatomic/functional assessment by cardiac CT in patients with suspected coronary artery disease - Comparison with invasive coronary angiography and nuclear myocardial perfusion imaging for the five-year-follow up of the CORE320 multicenter study. J Cardiovasc Comput Tomogr 2021; 15:485-491. [PMID: 34024757 DOI: 10.1016/j.jcct.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/19/2021] [Accepted: 04/21/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few data exist on long-term outcome in patients undergoing combined coronary CT angiography (CTA) and myocardial CT perfusion imaging (CTP) as well as invasive coronary angiography (ICA) and single photon emission tomography (SPECT). METHODS At 16 centers, 381 patients were followed for major adverse cardiac events (MACE) for the CORE320 study. All patients underwent coronary CTA, CTP, and SPECT before ICA within 60 days. Prognostic performance according binary results (normal/abnormal) was assessed by 5-year major cardiovascular events (MACE) free survival and area under the receiver-operating-characteristic curve (AUC). RESULTS Follow up beyond 2-years was available in 323 patients. MACE-free survival rate was greater among patients with normal combined CTA-CTP findings compared to ICA-SPECT: 85 vs. 80% (95% confidence interval [CI] for difference 0.1, 11.3) though event-free survival time was similar (4.54 vs. 4.37 years, 95% CI for difference: -0.03, 0.36). Abnormal results by combined CTA-CTP was associated with 3.83 years event-free survival vs. 3.66 years after abnormal combined ICA-SPECT (95% CI for difference: -0.05, 0.39). Predicting MACE by AUC also was similar: 65 vs. 65 (difference 0.1; 95% CI -4.6, 4.9). When MACE was restricted to cardiovascular death, myocardial infarction, or stroke, AUC for CTA-CTP was 71 vs. 60 by ICA-SPECT (difference 11.2; 95% CI -1.0, 19.7). CONCLUSIONS Combined CTA-CTP evaluation yields at least equal 5-year prognostic information as combined ICA-SPECT assessment in patients presenting with suspected coronary artery disease. Noninvasive cardiac CT assessment may eliminate the need for diagnostic cardiac catheterization in many patients. CLINICAL TRIAL REGISTRATION NCT00934037.
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Affiliation(s)
- Marc Dewey
- Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany
| | - Carlos E Rochitte
- InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil
| | - Mohammad R Ostovaneh
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Marcus Y Chen
- Cardiology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Richard T George
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Hiroyuki Niinuma
- Memorial Heart Center, Iwate Medical University, Morioka, Japan; Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Roger Laham
- Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass, USA
| | - Klaus Kofoed
- Department of Cardiology, Rigs Hospitalet, University of Copenhagen, Denmark
| | - Cesar Nomura
- Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | | | - Vishal C Mehra
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | | | | | - Michael Laule
- Department of Medicine/Cardiology, Charité Medical School-Humboldt, Berlin, Germany
| | - Narinder Paul
- Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rodrigo Cerci
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - John Hoe
- Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore
| | - Swee Yaw Tan
- Department of Cardiology, National Heart Centre, Singapore
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, OH, USA
| | - Matthew B Matheson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L Vavere
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Andrew E Arai
- Cardiology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Julie M Miller
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeffrey Brinker
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Melvin E Clouse
- Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass, USA
| | - Marcelo Di Carli
- Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - João A C Lima
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA
| | - Armin Arbab-Zadeh
- Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA.
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Ravi P, Chepelev L, Lawera N, Haque KMA, Chen VCP, Ali A, Rybicki FJ. A systematic evaluation of medical 3D printing accuracy of multi-pathological anatomical models for surgical planning manufactured in elastic and rigid material using desktop inverted vat photopolymerization. Med Phys 2021; 48:3223-3233. [PMID: 33733499 DOI: 10.1002/mp.14850] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/12/2021] [Accepted: 03/12/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The dimensional accuracy of three-dimensional (3D) printed anatomical models is essential to correctly understand spatial relationships and enable safe presurgical planning. Most recent accuracy studies focused on 3D printing of a single pathology for surgical planning. This study evaluated the accuracy of medical models across multiple pathologies, using desktop inverted vat photopolymerization (VP) to 3D print anatomic models using both rigid and elastic materials. METHODS In the primary study, we 3D printed seven models (six anatomic models and one reference cube) with volumes ranging from ~2 to ~209 cc. The anatomic models spanned multiple pathologies (neurological, cardiovascular, abdominal, musculoskeletal). Two solid measurement landing blocks were strategically created around the pathology to allow high-resolution measurement using a digital micrometer and/or caliper. The physical measurements were compared to the designed dimensions, and further analysis was conducted regarding the observed patterns in accuracy. All of the models were printed in three resins: Elastic, Clear, and Grey Pro in the primary experiments. A full factorial block experimental design was employed and a total of 42 models were 3D printed in 21 print runs. In the secondary study, we 3D printed two of the anatomic models in triplicates selected from the previous six to evaluate the effect of 0.1 mm vs 0.05 mm layer height on the accuracy. RESULTS In the primary experiment, all dimensional errors were less than 1 mm. The average dimensional error across the 42 models was 0.238 ± 0.219 mm and the relative error was 1.10 ± 1.13%. Results from the secondary experiments were similar with an average dimensional error of 0.252 ± 0.213 mm and relative error of 1.52% ± 1.28% across 18 models. There was a statistically significant difference in the relative errors between the Elastic resin and Clear resin groups. We explained this difference by evaluating inverted VP 3D printing peel forces. There was a significant difference between the Solid and Hollow group of models. There was a significant difference between measurement landing blocks oriented Horizontally and Vertically. In the secondary experiments, there was no difference in accuracy between the 0.10 and 0.05 mm layer heights. CONCLUSIONS The maximum measured error was less than 1 mm across all models, and the mean error was less than 0.26mm. Therefore, inverted VP 3D printing technology is suitable for medical 3D printing if 1 mm is considered the cutoff for clinical use cases. The 0.1 mm layer height is suitable for 3D printing accurate anatomical models for presurgical planning in a majority of cases. Elastic models, models oriented horizontally, and models that are hollow tend to have relatively higher deviation as seen from experimental results and mathematical model predictions. While clinically insignificant using a 1 mm cutoff, further research is needed to better understand the complex physical interactions in VP 3D printing which influence model accuracy.
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Affiliation(s)
- Prashanth Ravi
- Department of Radiology, University of Cincinnati College of Medicine, 234 Goodman St, Cincinnati, OH, 45219, USA
| | - Leonid Chepelev
- Department of Radiology, Stanford University, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Nathan Lawera
- Department of Radiology, University of Cincinnati College of Medicine, 234 Goodman St, Cincinnati, OH, 45219, USA
| | - Khan Md Ariful Haque
- Department of Industrial, Manufacturing and Systems Engineering, University of Texas at Arlington, 500 West First St, Arlington, TX, 76019, USA
| | - Victoria C P Chen
- Department of Industrial, Manufacturing and Systems Engineering, University of Texas at Arlington, 500 West First St, Arlington, TX, 76019, USA
| | - Arafat Ali
- Department of Radiology, University of Cincinnati College of Medicine, 234 Goodman St, Cincinnati, OH, 45219, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, 234 Goodman St, Cincinnati, OH, 45219, USA
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Adham S, Rybicki FJ, Mahoney MC, Yong-Hing CJ, Khosa F. Analysis of Gender Disparity in US and Canadian Radiology Residency Programs. Curr Probl Diagn Radiol 2021; 51:21-24. [PMID: 33775505 DOI: 10.1067/j.cpradiol.2021.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/03/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Equity, diversity, and inclusion in academic radiology are a work in progress and although the gender gap has decreased, there remains a paucity of studies examining female representation among radiology trainees over the past decade. OBJECTIVE The aim of our undertaking was to evaluate gender parity in United States (US) and Canadian radiology residency programs and to suggest future directions to improve female representation MATERIALS AND METHODS: Retrospective analysis of publicly available data on radiology residents from the US and Canada was performed from 2007to 2019. Data on diagnostic radiology residents was collected from the Accreditation Council for Graduate Medical Education for the US and the Canadian Post M.D. Education Registry for Canada. Statistical tests including regression and ANOVA were used to study the gender proportions from 2007to 2019. RESULTS There has been little progress in bridging the gender gap in the last 12 years. The proportion of female residents pursuing radiology has remained at an average of 26.74% (n = 1,238of 4,629) in US programs and 31.78% (n = 28 of88) in Canadian programs. The average change in the percentage of female residents was 0.0% per year (P = 0.0) for US programs and -2.9% per year (P = 0.3) for Canadian programs. DISCUSSION Despite a higher proportion of females in North American medical schools, gender disparity persists among radiology residents. More research is needed to identify barriers limiting female representation and improve gender parity across North American radiology programs.
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Affiliation(s)
- Sami Adham
- McMaster University Michael G. DeGroote School of Medicine, Hamilton, ON; Canada..
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, OH
| | - Mary C Mahoney
- Department of Radiology, University of Cincinnati, Cincinnati, OH
| | - Charlotte J Yong-Hing
- Department of Cancer, University of British Columbia, BC Cancer - Vancouver, Vancouver, BC; Canada
| | - Faisal Khosa
- Department of Radiology, University of British Columbia, Vancouver, BC; Canada
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Vagal A, Mahoney M, Anderson JL, Allen B, Hudepohl J, Chadalavada S, Choe KA, Kapur S, Gaskill-Shipley M, Makramalla A, Brown A, Braley S, England E, Scheler J, Udstuen G, Rybicki FJ. Recover Wisely From COVID-19: Responsible Resumption of Nonurgent Radiology Services. Acad Radiol 2020; 27:1343-1352. [PMID: 32933802 PMCID: PMC7416732 DOI: 10.1016/j.acra.2020.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 01/17/2023]
Abstract
Rationale and Objectives Following state and institutional guidelines, our Radiology department launched the “Recover Wisely” for all nonurgent radiology care on May 4, 2020. Our objective is to report our practice implementation and experience of COVID-19 recovery during the resumption of routine imaging at a tertiary academic medical center. Materials and Methods We used the SQUIRE 2.0 guidelines for this practice implementation. Recover Wisely focused on a data driven, strategic rescheduling and redesigning patient flow process. We used scheduling simulations and meticulous monitoring and control of outpatient medical imaging volumes to achieve a linear restoration to our pre-COVID imaging studies. We had a tiered plan to address the backlog of rescheduled patients with gradual opening of our imaging facilities, while maintaining broad communication with our patients and referring clinicians. Results Recover Wisely followed our anticipated linear modeling. Considering the last 10 weeks in the recovery, outpatient growth was linear with an increase of approximately 172 cases per week, (R2 =0.97). We achieved an overall recovery of 102% in week 10, as compared to average weekly pre-COVID outpatient volumes. The modalities recovered as follows in outpatient volumes: CT (113%), MRI (101%), nuclear medicine including PET (138%), mammograms (97%), ultrasound (99%) and interventional radiology (106%). When compared to identical 2019 calendar weeks (May 4, 2020–July 10, 2020), the total 2020 radiology volume was 11% reduced from the 2019 volume. The reduction in total weighted relative value units was 8% in this time period, as compared to 2019. Conclusion Our department utilized a data-driven, team approach based on our guiding principles to “Recover Wisely.” We created and implemented a methodology that achieved a linear increase in outpatient studies over a 10-week recovery period.
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Ali A, Ballard DH, Althobaity W, Christensen A, Geritano M, Ho M, Liacouras P, Matsumoto J, Morris J, Ryan J, Shorti R, Wake N, Rybicki FJ, Sheikh A. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: adult cardiac conditions. 3D Print Med 2020; 6:24. [PMID: 32965536 PMCID: PMC7510265 DOI: 10.1186/s41205-020-00078-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Medical 3D printing as a component of care for adults with cardiovascular diseases has expanded dramatically. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness criteria for adult cardiac 3D printing indications. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with a number of adult cardiac indications, physiologic, and pathologic processes. Each study was vetted by the authors and graded according to published guidelines. RESULTS Evidence-based appropriateness guidelines are provided for the following areas in adult cardiac care; cardiac fundamentals, perioperative and intraoperative care, coronary disease and ischemic heart disease, complications of myocardial infarction, valve disease, cardiac arrhythmias, cardiac neoplasm, cardiac transplant and mechanical circulatory support, heart failure, preventative cardiology, cardiac and pericardial disease and cardiac trauma. CONCLUSIONS Adoption of common clinical standards regarding appropriate use, information and material management, and quality control are needed to ensure the greatest possible clinical benefit from 3D printing. This consensus guideline document, created by the members of the RSNA 3D printing Special Interest Group, will provide a reference for clinical standards of 3D printing for adult cardiac indications.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Waleed Althobaity
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Michelle Ho
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Jane Matsumoto
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Justin Ryan
- Rady Children's Hospital, San Diego, CA, USA
| | - Rami Shorti
- Intermountain Healthcare, South Jordan, UT, USA
| | - Nicole Wake
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Ballard DH, Mills P, Duszak R, Weisman JA, Rybicki FJ, Woodard PK. Medical 3D Printing Cost-Savings in Orthopedic and Maxillofacial Surgery: Cost Analysis of Operating Room Time Saved with 3D Printed Anatomic Models and Surgical Guides. Acad Radiol 2020; 27:1103-1113. [PMID: 31542197 DOI: 10.1016/j.acra.2019.08.011] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVE Three-dimensional (3D) printed anatomic models and surgical guides have been shown to reduce operative time. The purpose of this study was to generate an economic analysis of the cost-saving potential of 3D printed anatomic models and surgical guides in orthopedic and maxillofacial surgical applications. MATERIALS AND METHODS A targeted literature search identified operating room cost-per-minute and studies that quantified time saved using 3D printed constructs. Studies that reported operative time differences due to 3D printed anatomic models or surgical guides were reviewed and cataloged. A mean of $62 per operating room minute (range of $22-$133 per minute) was used as the reference standard for operating room time cost. Different financial scenarios were modeled with the provided cost-per-minute of operating room time (using high, mean, and low values) and mean time saved using 3D printed constructs. RESULTS Seven studies using 3D printed anatomic models in surgical care demonstrated a mean 62 minutes ($3720/case saved from reduced time) of time saved, and 25 studies of 3D printed surgical guides demonstrated a mean 23 minutes time saved ($1488/case saved from reduced time). An estimated 63 models or guides per year (or 1.2/week) were predicted to be the minimum number to breakeven and account for annual fixed costs. CONCLUSION Based on the literature-based financial analyses, medical 3D printing appears to reduce operating room costs secondary to shortening procedure times. While resource-intensive, 3D printed constructs used in patients' operative care provides considerable downstream value to health systems.
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Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110.
| | | | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffery A Weisman
- University of Illinois at Chicago Occupational Medicine, Chicago, Illinois
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
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Podgorsak AR, Sommer KN, Reddy A, Iyer V, Wilson MF, Rybicki FJ, Mitsouras D, Sharma U, Fujimoto S, Kumamaru KK, Angel E, Ionita CN. Initial evaluation of a convolutional neural network used for noninvasive assessment of coronary artery disease severity from coronary computed tomography angiography data. Med Phys 2020; 47:3996-4004. [DOI: 10.1002/mp.14339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alexander R. Podgorsak
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Kelsey N. Sommer
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Abhinay Reddy
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Vijay Iyer
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Michael F. Wilson
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Frank J. Rybicki
- Department of Radiology University of Cincinnati 234 Goodman Street Cincinnati OH USA
| | - Dimitrios Mitsouras
- San Francisco Department of Radiology and Biomedical Imaging University of California 505 Parnassus Avenue San Francisco CA 94143USA
| | - Umesh Sharma
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Shinchiro Fujimoto
- Department of Cardiovascular Medicine Juntendo University 3‐1‐3 Hongo, Bunkyo‐ku Tokyo Japan
| | - Kanako K. Kumamaru
- Department of Radiology Juntendo University 3‐1‐3 Hongo, Bunkyo‐ku Tokyo Japan
| | - Erin Angel
- Canon Medical Systems USA, Inc. 2441 Michelle Drive Tustin CA 92780USA
| | - Ciprian N. Ionita
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
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Abstract
Editor's Note.-Articles in the RadioGraphics Update section provide current knowledge to supplement or update information found in full-length articles previously published in RadioGraphics. Authors of the previously published article provide a brief synopsis that emphasizes important new information such as technological advances, revised imaging protocols, new clinical guidelines involving imaging, or updated classification schemes. Articles in this section are published solely online and are linked to the original article.
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Affiliation(s)
- Dimitrios Mitsouras
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (D.M.); Radiology Service, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (D.M.); Department of Radiology: 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, Montefiore Medical Center, Bronx, NY (N.W.); Department of Radiology, NYU Langone Health, New York, NY (N.W.); and Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219 (F.J.R.)
| | - Peter C Liacouras
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (D.M.); Radiology Service, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (D.M.); Department of Radiology: 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, Montefiore Medical Center, Bronx, NY (N.W.); Department of Radiology, NYU Langone Health, New York, NY (N.W.); and Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219 (F.J.R.)
| | - Nicole Wake
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (D.M.); Radiology Service, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (D.M.); Department of Radiology: 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, Montefiore Medical Center, Bronx, NY (N.W.); Department of Radiology, NYU Langone Health, New York, NY (N.W.); and Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219 (F.J.R.)
| | - Frank J Rybicki
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (D.M.); Radiology Service, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (D.M.); Department of Radiology: 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, Montefiore Medical Center, Bronx, NY (N.W.); Department of Radiology, NYU Langone Health, New York, NY (N.W.); and Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219 (F.J.R.)
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Vagal A, Mahoney M, Allen B, Kapur S, Udstuen G, Wang L, Braley S, Makramalla A, Chadalavada S, Choe KA, Scheler J, Brown A, England E, Hudepohl J, Rybicki FJ. Rescheduling Nonurgent Care in Radiology: Implementation During the Coronavirus Disease 2019 (COVID-19) Pandemic. J Am Coll Radiol 2020; 17:882-889. [PMID: 32473108 PMCID: PMC7236746 DOI: 10.1016/j.jacr.2020.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To meet hospital preparedness for the coronavirus disease 2019 pandemic, the Centers for Disease Control and Prevention and ACR recommended delay of all nonemergent tests and elective procedures. The purpose of this article is to report our experience for rescheduling nonemergent imaging and procedures during the pandemic at our tertiary academic institution. METHODS We rescheduled the nonemergent imaging and procedures in our hospitals and outpatient centers from March 16 to May 4, 2020. We created a tiered priority system to reschedule patients for whom imaging could be delayed with minimal clinical impact. The radiologists performed detailed chart reviews for decision making. We conducted daily virtual huddles with discussion of rescheduling strategies and issue tracking. RESULTS Using a snapshot during the rescheduling period, there was a 53.4% decrease in imaging volume during the period of March 16 to April 15, 2020, compared with the same time period in 2019. The total number of imaging studies decreased from 38,369 in 2019 to 17,891 in 2020 during this period. Although we saw the largest reduction in outpatient imaging (72.3%), there was also a significant decrease in inpatient (40.5%) and emergency department (48.9%) imaging volumes. DISCUSSION The use of multiple communication channels was critical in relaying the information to all our stakeholders, patients, referring physicians, and the radiology workforce. Teamwork, quick adoption, and adaptation of changing strategies was important given the fluidity of the situation.
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Affiliation(s)
- Achala Vagal
- Vice Chair Research, Department of Radiology, University of Cincinnati, Cincinnati, Ohio.
| | - Mary Mahoney
- Department Chair, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Becky Allen
- Enterprise Director of Imaging, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Sangita Kapur
- Section Chief, Chest, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Gavin Udstuen
- Director, Outpatient Imaging, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Lily Wang
- Neuroradiology Fellowship Director, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Susan Braley
- Section Chief, Musculoskeletal, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Abouelmagd Makramalla
- Section Chief, Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Seetharam Chadalavada
- Vice Chair of Informatics, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Kyuran A Choe
- University of Cincinnati and University of Cincinnati Physicians, Inc, Cincinnati, Ohio
| | - Jennifer Scheler
- Section Chief, Nuclear medicine, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Ann Brown
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Eric England
- Vice Chair, Education, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Joseph Hudepohl
- Executive Business Director, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Frank J Rybicki
- Vice Chair of Operations, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
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Ballard DH, Wake N, Witowski J, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D Printing Special Interest Group (SIG) clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: abdominal, hepatobiliary, and gastrointestinal conditions. 3D Print Med 2020; 6:13. [PMID: 32514795 PMCID: PMC7278118 DOI: 10.1186/s41205-020-00065-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/23/2020] [Indexed: 02/06/2023] Open
Abstract
Background Medical 3D printing has demonstrated value in anatomic models for abdominal, hepatobiliary, and gastrointestinal conditions. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness criteria for abdominal, hepatobiliary, and gastrointestinal 3D printing indications. Methods A literature search was conducted to identify all relevant articles using 3D printing technology associated with a number of abdominal pathologic processes. Each included study was graded according to published guidelines. Results Evidence-based appropriateness guidelines are provided for the following areas: intra-hepatic masses, hilar cholangiocarcinoma, biliary stenosis, biliary stones, gallbladder pathology, pancreatic cancer, pancreatitis, splenic disease, gastric pathology, small bowel pathology, colorectal cancer, perianal fistula, visceral trauma, hernia, abdominal sarcoma, abdominal wall masses, and intra-abdominal fluid collections. Conclusion This document provides initial appropriate use criteria for medical 3D printing in abdominal, hepatobiliary, and gastrointestinal conditions.
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Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA.
| | - Nicole Wake
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jan Witowski
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Krakow, Poland
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Sommer KN, Shepard LM, Mitsouras D, Iyer V, Angel E, Wilson MF, Rybicki FJ, Kumamaru KK, Sharma UC, Reddy A, Fujimoto S, Ionita CN. Patient-specific 3D-printed coronary models based on coronary computed tomography angiography volumes to investigate flow conditions in coronary artery disease. Biomed Phys Eng Express 2020; 6:045007. [PMID: 33444268 DOI: 10.1088/2057-1976/ab8f6e] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND 3D printed patient-specific coronary models have the ability to enable repeatable benchtop experiments under controlled blood flow conditions. This approach can be applied to CT-derived patient geometries to emulate coronary flow and related parameters such as Fractional Flow Reserve (FFR). METHODS This study uses 3D printing to compare such benchtop FFR results with a non-invasive CT-FFR research software algorithm and catheter based invasive FFR (I-FFR) measurements. Fifty-two patients with a clinical indication for I-FFR underwent a research Coronary CT Angiography (CCTA) prior to catheterization. CT images were used to measure CT-FFR and to generate patient-specific 3D printed models of the aortic root and three main coronary arteries. Each patient-specific model was connected to a programmable pulsatile pump and benchtop FFR (B-FFR) was derived from pressures measured proximal and distal to coronary stenosis using pressure transducers. B-FFR was measured for two coronary outflow rates ('normal', 250 ml min-1; and 'hyperemic', 500 ml min-1) by adjusting the model's distal coronary resistance. RESULTS Pearson correlations and ROC AUC were calculated using invasive I-FFR as reference. The Pearson correlation factor of CT-FFR and B-FFR-500 was 0.75 and 0.71, respectively. Areas under the ROCs for CT-FFR and B-FFR-500 were 0.80 (95%CI: 0.70-0.87) and 0.81 (95%CI: 0.64-0.91) respectively. CONCLUSION Benchtop flow simulations with 3D printed models provide the capability to measure pressure changes at any location in the model, for ultimately emulating the FFR at several simulated physiological blood flow conditions. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/show/NCT03149042.
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Affiliation(s)
- Kelsey N Sommer
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228, United States of America. Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, United States of America
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Kishi S, Magalhães TA, Cerci RJ, Zimmermann E, Matheson MB, Vavere A, Tanami Y, Kitslaar PH, George RT, Brinker J, Miller JM, Clouse ME, Lemos PA, Niinuma H, Reiber JHC, Kofoed KF, Rochitte CE, Rybicki FJ, Di Carli MF, Cox C, Lima JAC, Arbab-Zadeh A. Comparative effectiveness of coronary artery stenosis and atherosclerotic plaque burden assessment for predicting 30-day revascularization and 2-year major adverse cardiac events. Int J Cardiovasc Imaging 2020; 36:2365-2375. [DOI: 10.1007/s10554-020-01851-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/10/2020] [Indexed: 11/30/2022]
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Tino R, Moore R, Antoline S, Ravi P, Wake N, Ionita CN, Morris JM, Decker SJ, Sheikh A, Rybicki FJ, Chepelev LL. COVID-19 and the role of 3D printing in medicine. 3D Print Med 2020; 6:11. [PMID: 32337613 PMCID: PMC7183817 DOI: 10.1186/s41205-020-00064-7] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Rance Tino
- Centre for Additive Manufacture, Royal Melbourne Institute of Technology, School of Engineering, 58 Cardigan St, Carlton, Melbourne, VIC, 3001, Australia.,Department of Physical Sciences, Victorian Comprehensive Cancer Centre, Peter MacCallum Cancer Centre, Level B1/305 Grattan St, Melbourne, VIC, 3000, Australia
| | - Ryan Moore
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2003, Cincinnati, OH, 45229-3039, USA
| | - Sam Antoline
- Department of Mechanical and Materials Engineering, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, OH, 45219, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati College of Medicine, 234 Goodman Street, Cincinnati, OH, 45267, USA
| | - Nicole Wake
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Ciprian N Ionita
- Department of Biomedical Engineering, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, University at Buffalo School of Engineering and Applied Sciences, 8052 Clinical Translational Research Center, 875 Ellicott Street, Buffalo, NY, 14203, USA
| | - Jonathan M Morris
- Anatomic Modeling Lab, Department of Radiology, Division of Neuroradiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Summer J Decker
- Department of Radiology, USF Health Morsani College of Medicine, Tampa, FL, 33606, USA
| | - Adnan Sheikh
- Department of Radiology, University of Ottawa School of Medicine, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH, 45219, USA.
| | - Leonid L Chepelev
- Department of Radiology, University of Ottawa School of Medicine, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
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Romero C, Rybicki FJ. Patient-Friendly Summary of the ACR Appropriateness Criteria: Abdominal Aortic Aneurysm Follow-up (Without Repair). J Am Coll Radiol 2020; 17:e13. [DOI: 10.1016/j.jacr.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 10/24/2022]
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Abdellatif W, Ding J, Jalal S, Nguyen T, Khorshed D, Rybicki FJ, Ali IT, McInnes MDF, Khan NA, Shah S, Khosa F. Lack of Gender Disparity Among Administrative Leaders of Canadian Health Authorities. J Womens Health (Larchmt) 2020; 29:1469-1474. [PMID: 32091966 DOI: 10.1089/jwh.2019.7852] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Gender distribution within the managing bodies of the Canadian health authorities has not been studied despite their integral role in the health care system. The purpose of this study is to quantify gender differences and to craft a geographic gender analysis of such distribution. Methods: Retrospective data collection of all Canadian health authorities at the provincial, territorial, regional, and first nations levels was conducted. The dependent variable was gender, and other covariates, where applicable, included province/territory, region, leadership position, education (PhD or Master's), honorary degree, and primary occupation. Any member within the executive managing body or board of directors of a Canadian health authority was included, unless their gender could not be determined, in which case they were excluded. Results: Quantitative analysis of the 67 health authorities revealed 1346 individuals with identifiable gender (710 women; 636 men). Thematic distribution showed no significant difference in the gender distribution by provinces/territories (chi square = 14.248; p = 0.28), by leadership position (chi square = 1.88; p = 0.75), by education (chi square = 1.85; p = 0.17), or by primary occupation (chi square = 1.53; p = 0.46). Conclusion: The overall number of females exceeded that of males and there were no gender disparities. Critical analysis of probable causes was discussed. Further studies should be conducted to examine the policies and programs within the Canadian health authorities that successfully tackle the retention, recruitment, and promotion of females.
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Affiliation(s)
- Waleed Abdellatif
- Radiology Department, University of British Columbia/Vancouver General Hospital, Vancouver, Canada
| | - Jeffrey Ding
- Faculty of Science, University of British Columbia, Vancouver, Canada
| | - Sabeena Jalal
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | - Tribesty Nguyen
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Frank J Rybicki
- Department of Radiology, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Ismail Tawakol Ali
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | - Nadia A Khan
- Department of Medicine, University of British Columbia Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada
| | - Samad Shah
- Department of Clinical Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Faisal Khosa
- Radiology Department, University of British Columbia/Vancouver General Hospital, Vancouver, Canada
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Walpot J, Juneau D, Massalha S, Dwivedi G, Rybicki FJ, Chow BJW, Inácio JR. Left Ventricular Mid-Diastolic Wall Thickness: Normal Values for Coronary CT Angiography. Radiol Cardiothorac Imaging 2019; 1:e190034. [PMID: 33778527 DOI: 10.1148/ryct.2019190034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 07/23/2019] [Accepted: 09/04/2019] [Indexed: 11/11/2022]
Abstract
Purpose To generate normal reference values for left ventricular mid-diastolic wall thickness (LV-MDWT) measured by using CT angiography. Materials and Methods LV-MDWT was measured in 2383 consecutive patients, without structural heart disease, undergoing prospective electrocardiographically (ECG) triggered mid-diastolic coronary CT angiography. LV-MDWT was manually measured on automatically segmented short-axis images according to the American Heart Association's 17-segment model. Commercially available automatic software was used to calculate the left ventricular (LV) mass. Results Among the 2383 patients, average LV-MDWT was 7.24 mm ± 1.86 (standard deviation [SD]), with the basal anteroseptal segment being the thickest wall (8.71 mm ± 2.19) and the apical inferior segment being the thinnest wall (5.9 mm ± 1.58; P < .001). Over all LV segments, the maximum upper limit, as defined as 2 SD above the mean, was 13.6 mm for men (LV1) and 11.2 mm for women. For men, only the basal anterior segment was above 13 mm. There was a significant difference in average LV-MDWT between women and men with 6.47 mm ± 1.07 and 7.90 mm ± 1.24, respectively (P < .001). Significant differences in LV-MDWT were found in the subgroups aged less than 65 years and greater than or equal to 65 years (P < .001). There was a strong correlation between LV-MDWT and LV mass (P < .001). Conclusion Normal sex- and age-specific reference ranges for LV-MDWT in prospective ECG-triggered mid-diastolic coronary CT angiography have been provided. These benchmarks may expand the diagnostic and prognostic roles of CT angiography, beyond its role in the identification of coronary artery disease.© RSNA, 2019.
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Affiliation(s)
- Jeroen Walpot
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada (J.W., S.M., B.J.W.C.); Service de Médecine Nucléaire, Centre Hospitalier de l'Université de Montréal, Montréal, Canada (D.J.); Harry Perkins Institute of Medical Research, University of Western Australia, Nedlands, Australia (G.D.); and Department of Radiology, University of Ottawa, The Ottawa Hospital, Medical Imaging and The Ottawa Hospital Research Institute, 501 Smyth Rd, Office M1466B, Mailbox 232, Ottawa, ON, Canada K1H 8L6 (F.J.R., J.R.I.)
| | - Daniel Juneau
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada (J.W., S.M., B.J.W.C.); Service de Médecine Nucléaire, Centre Hospitalier de l'Université de Montréal, Montréal, Canada (D.J.); Harry Perkins Institute of Medical Research, University of Western Australia, Nedlands, Australia (G.D.); and Department of Radiology, University of Ottawa, The Ottawa Hospital, Medical Imaging and The Ottawa Hospital Research Institute, 501 Smyth Rd, Office M1466B, Mailbox 232, Ottawa, ON, Canada K1H 8L6 (F.J.R., J.R.I.)
| | - Samia Massalha
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada (J.W., S.M., B.J.W.C.); Service de Médecine Nucléaire, Centre Hospitalier de l'Université de Montréal, Montréal, Canada (D.J.); Harry Perkins Institute of Medical Research, University of Western Australia, Nedlands, Australia (G.D.); and Department of Radiology, University of Ottawa, The Ottawa Hospital, Medical Imaging and The Ottawa Hospital Research Institute, 501 Smyth Rd, Office M1466B, Mailbox 232, Ottawa, ON, Canada K1H 8L6 (F.J.R., J.R.I.)
| | - Girish Dwivedi
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada (J.W., S.M., B.J.W.C.); Service de Médecine Nucléaire, Centre Hospitalier de l'Université de Montréal, Montréal, Canada (D.J.); Harry Perkins Institute of Medical Research, University of Western Australia, Nedlands, Australia (G.D.); and Department of Radiology, University of Ottawa, The Ottawa Hospital, Medical Imaging and The Ottawa Hospital Research Institute, 501 Smyth Rd, Office M1466B, Mailbox 232, Ottawa, ON, Canada K1H 8L6 (F.J.R., J.R.I.)
| | - Frank J Rybicki
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada (J.W., S.M., B.J.W.C.); Service de Médecine Nucléaire, Centre Hospitalier de l'Université de Montréal, Montréal, Canada (D.J.); Harry Perkins Institute of Medical Research, University of Western Australia, Nedlands, Australia (G.D.); and Department of Radiology, University of Ottawa, The Ottawa Hospital, Medical Imaging and The Ottawa Hospital Research Institute, 501 Smyth Rd, Office M1466B, Mailbox 232, Ottawa, ON, Canada K1H 8L6 (F.J.R., J.R.I.)
| | - Benjamin J W Chow
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada (J.W., S.M., B.J.W.C.); Service de Médecine Nucléaire, Centre Hospitalier de l'Université de Montréal, Montréal, Canada (D.J.); Harry Perkins Institute of Medical Research, University of Western Australia, Nedlands, Australia (G.D.); and Department of Radiology, University of Ottawa, The Ottawa Hospital, Medical Imaging and The Ottawa Hospital Research Institute, 501 Smyth Rd, Office M1466B, Mailbox 232, Ottawa, ON, Canada K1H 8L6 (F.J.R., J.R.I.)
| | - João R Inácio
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada (J.W., S.M., B.J.W.C.); Service de Médecine Nucléaire, Centre Hospitalier de l'Université de Montréal, Montréal, Canada (D.J.); Harry Perkins Institute of Medical Research, University of Western Australia, Nedlands, Australia (G.D.); and Department of Radiology, University of Ottawa, The Ottawa Hospital, Medical Imaging and The Ottawa Hospital Research Institute, 501 Smyth Rd, Office M1466B, Mailbox 232, Ottawa, ON, Canada K1H 8L6 (F.J.R., J.R.I.)
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Cai T, Zhang L, Yang N, Kumamaru KK, Rybicki FJ, Cai T, Liao KP. EXTraction of EMR numerical data: an efficient and generalizable tool to EXTEND clinical research. BMC Med Inform Decis Mak 2019; 19:226. [PMID: 31730484 PMCID: PMC6858776 DOI: 10.1186/s12911-019-0970-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 11/06/2019] [Indexed: 11/12/2022] Open
Abstract
Background Electronic medical records (EMR) contain numerical data important for clinical outcomes research, such as vital signs and cardiac ejection fractions (EF), which tend to be embedded in narrative clinical notes. In current practice, this data is often manually extracted for use in research studies. However, due to the large volume of notes in datasets, manually extracting numerical data often becomes infeasible. The objective of this study is to develop and validate a natural language processing (NLP) tool that can efficiently extract numerical clinical data from narrative notes. Results To validate the accuracy of the tool EXTraction of EMR Numerical Data (EXTEND), we developed a reference standard by manually extracting vital signs from 285 notes, EF values from 300 notes, glycated hemoglobin (HbA1C), and serum creatinine from 890 notes. For each parameter of interest, we calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and F1 score of EXTEND using two metrics. (1) completion of data extraction, and (2) accuracy of data extraction compared to the actual values in the note verified by chart review. At the note level, extraction by EXTEND was considered correct only if it accurately detected and extracted all values of interest in a note. Using manually-annotated labels as the gold standard, the note-level accuracy of EXTEND in capturing the numerical vital sign values, EF, HbA1C and creatinine ranged from 0.88 to 0.95 for sensitivity, 0.95 to 1.0 for specificity, 0.95 to 1.0 for PPV, 0.89 to 0.99 for NPV, and 0.92 to 0.96 in F1 scores. Compared to the actual value level, the sensitivity, PPV, and F1 score of EXTEND ranged from 0.91 to 0.95, 0.95 to 1.0 and 0.95 to 0.96. Conclusions EXTEND is an efficient, flexible tool that uses knowledge-based rules to extract clinical numerical parameters with high accuracy. By increasing dictionary terms and developing new rules, the usage of EXTEND can easily be expanded to extract additional numerical data important in clinical outcomes research.
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Affiliation(s)
- Tianrun Cai
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, 6016BB, 60 Fenwood Road, Boston, 02115, USA. .,Harvard Medical School, Boston, MA, USA.
| | | | - Nicole Yang
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, 6016BB, 60 Fenwood Road, Boston, 02115, USA
| | - Kanako K Kumamaru
- Department of Radiology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Frank J Rybicki
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Tianxi Cai
- Harvard Medical School, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Katherine P Liao
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, 6016BB, 60 Fenwood Road, Boston, 02115, USA.,Harvard Medical School, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA
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Romero C, Rybicki FJ. Patient-Friendly Summary of the ACR Appropriateness Criteria: Thoracic Aorta Interventional Planning and Follow-Up. J Am Coll Radiol 2019; 17:e3. [PMID: 31536715 DOI: 10.1016/j.jacr.2019.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 08/27/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Celena Romero
- ECRI Institute, Lehigh Carbon Community College, Cincinnati, Ohio
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio.
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Alshahrani AM, Mahmood H, Wells GA, Hossain A, Rybicki FJ, Achenbach S, Al-Mallah MH, Andreini D, Bax JJ, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei E, Marques H, Pontone G, Raff G, Rubinshtein R, Shaw LJ, Villines TC, Lin FY, Min JK, Chow BJ. Point of Care Clinical Risk Score to Improve the Negative Diagnostic Utility of an Agatston Score of Zero: Averting the Need for Coronary Computed Tomography Angiography. Circ Cardiovasc Imaging 2019; 12:e008737. [PMID: 31526300 DOI: 10.1161/circimaging.118.008737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary artery calcification is a marker of underlying atherosclerotic vascular disease. The absence of coronary artery calcification is associated with a low prevalence of obstructive coronary artery disease (CAD), but it cannot be ruled out completely. We sought to develop a clinical tool that can be added to Agatston score of zero to rule out obstructive CAD with high accuracy. METHODS We developed a clinical score retrospectively from a cohort of 4903 consecutive patients with an Agatston score of zero. Patients with prior diagnosis of CAD, coronary percutaneous coronary intervention, or surgical revascularization were excluded. Obstructive CAD was defined as any epicardial vessel diameter narrowing of ≥50%. The score was validated using an external cohort of 4290 patients with an Agatston score of zero from a multinational registry. RESULTS The score consisted of 7 variables: age, sex, typical chest pain, dyslipidemia, hypertension, family history, and diabetes mellitus. The model was robust with an area under the curve of 0.70 (95% CI, 0.65-0.76) in the derivation cohort and 0.69 (95% CI, 0.65-0.72) in the validation cohort. Patients were divided into 3 risk groups based on the score: low (≤6), intermediate (7-13), and high (≥14). Patients who score ≤6 have a negative likelihood ratio of 0.42 for obstructive CAD, whereas those who score ≥14 have a positive likelihood ratio of >5.5 for obstructive CAD. The outcome was ruled out in >98% of patients with a score ≤6 in the validation cohort. CONCLUSIONS We developed a score that may be used to identify the likelihood of obstructive CAD in patients with an Agatston score of zero, which may be used to direct the need for additional testing. However, the results of this retrospective analysis are hypothesis generating and before clinical implementation should be validated in a trial with a prospectively collected data.
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Affiliation(s)
- Ali M Alshahrani
- Department of Medicine-Cardiology (A.M.A., H. Mahmood, B.J.C.), University of Ottawa Heart Institute, Canada.,Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Riyadh, Saudi Arabia (A.M.A.)
| | - Hamza Mahmood
- Department of Medicine-Cardiology (A.M.A., H. Mahmood, B.J.C.), University of Ottawa Heart Institute, Canada
| | - George A Wells
- Cardiovascular Research Method Center (G.A.W., A.H.), University of Ottawa Heart Institute, Canada
| | - Alomgir Hossain
- Cardiovascular Research Method Center (G.A.W., A.H.), University of Ottawa Heart Institute, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa Hospital Research Institute, Canada (F.J.R., B.J.C.)
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (M.H.A.-M.)
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, Milan, Italy (D.A., G.P.)
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, the Netherlands (J.J.B.)
| | - Daniel S Berman
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B.)
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.)
| | - Filippo Cademartiri
- Department of Radiology, Cardiovascular Imaging Center, Naples, Italy (F.C.)
| | | | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.)
| | | | - Ricardo C Cury
- Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.)
| | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Austria (G.F.)
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Germany (M.H.)
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-UniversitätMünchen, Munich, Germany (J.H.)
| | | | - Yong-Jin Kim
- Seoul National University Hospital, South Korea (Y.-J.K.)
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.A.L.)
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy (E.M.)
| | - Hugo Marques
- Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal (H. Marques)
| | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, Milan, Italy (D.A., G.P.)
| | - Gilbert Raff
- William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.)
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (R.R.)
| | - Leslee J Shaw
- Department of Radiology (L.J.S.), New York-Presbyterian Hospital and the Weill Cornell Medical College
| | - Todd C Villines
- Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.).,Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.)
| | - Fay Y Lin
- Department of Radiology (F.Y.L., J.K.M.), New York-Presbyterian Hospital and the Weill Cornell Medical College
| | - James K Min
- Department of Radiology (F.Y.L., J.K.M.), New York-Presbyterian Hospital and the Weill Cornell Medical College
| | - Benjamin J Chow
- Department of Medicine-Cardiology (A.M.A., H. Mahmood, B.J.C.), University of Ottawa Heart Institute, Canada.,Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa Hospital Research Institute, Canada (F.J.R., B.J.C.)
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Yates L, Rybicki FJ. Patient-Friendly Summary of the ACR Appropriateness Criteria: Suspected Lower Extremity Deep Vein Thrombosis. J Am Coll Radiol 2019; 16:e37. [DOI: 10.1016/j.jacr.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
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Kumamaru KK, Angel E, Sommer KN, Iyer V, Wilson MF, Agrawal N, Bhardwaj A, Kattel SB, Kondziela S, Malhotra S, Manion C, Pogorzelski K, Ramanan T, Sawant AC, Suplicki MM, Waheed S, Fujimoto S, Sharma UC, Rybicki FJ, Ionita CN. Inter- and Intraoperator Variability in Measurement of On-Site CT-derived Fractional Flow Reserve Based on Structural and Fluid Analysis: A Comprehensive Analysis. Radiol Cardiothorac Imaging 2019; 1:e180012. [PMID: 33778507 DOI: 10.1148/ryct.2019180012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/17/2019] [Accepted: 06/24/2019] [Indexed: 11/11/2022]
Abstract
Purpose To measure the inter- and intraobserver variability among operators of varying expertise in conducting CT-derived fractional flow reserve (CT FFR) measurements on-site by using structural and fluid analysis and to evaluate differences in reproducibility between two different training methods for end users. Materials and Methods This retrospective analysis of the prospectively enrolled cohort included 22 symptomatic patients who underwent both 320-detector row coronary CT angiography and catheter-derived fractional flow reserve (FFR) within 90 days. Thirteen operators of varying expertise were assigned to one of two training arms: arm 1, on-site training by a specialist in CT FFR technology; arm 2, self-training through use of written materials. After the training, all 13 operators reviewed the CT data and measured CT FFR in 24 vessels in 22 patients. Inter- and intraoperator variability and agreements between CT FFR and catheter-derived FFR measurements were evaluated. Results The overall intraclass correlation coefficient (ICC) among operators was 0.71 (95% confidence interval: 0.58, 0.83) with a mean absolute difference (± standard deviation) of 0.027 ± 0.022. The operators in arm 2 showed greater interoperator differences than those in arm 1 (0.031 ± 0.024 vs 0.023 ± 0.018; P = .024). Among operators who recalculated CT FFR, the mean CT FFR value did not significantly differ between the first and second calculations (ICC, 0.66; 95% confidence interval: 0.46, 0.87), with the medical specialists producing the lowest intraoperator variability (0.053 ± 0.060). The overall correlation coefficient between CT FFR and catheter FFR was r = 0.61, with a mean absolute difference of 0.096 ± 0.089. Conclusion Good reproducibility of CT FFR values calculated on-site on the basis of structural and fluid analysis was observed among operators of varying expertise. Face-to-face training sessions may cause less variability.© RSNA, 2019Supplemental material is available for this article.
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Affiliation(s)
- Kanako K Kumamaru
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Erin Angel
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Kelsey N Sommer
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Vijay Iyer
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Michael F Wilson
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Nikhil Agrawal
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Aishwarya Bhardwaj
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Sharma B Kattel
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Sandra Kondziela
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Saurabh Malhotra
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Christopher Manion
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Katherine Pogorzelski
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Tharmathai Ramanan
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Abhishek C Sawant
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Mary M Suplicki
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Sameer Waheed
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Shinichiro Fujimoto
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Umesh C Sharma
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Frank J Rybicki
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
| | - Ciprian N Ionita
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.)
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Haase R, Schlattmann P, Gueret P, Andreini D, Pontone G, Alkadhi H, Hausleiter J, Garcia MJ, Leschka S, Meijboom WB, Zimmermann E, Gerber B, Schoepf UJ, Shabestari AA, Nørgaard BL, Meijs MFL, Sato A, Ovrehus KA, Diederichsen ACP, Jenkins SMM, Knuuti J, Hamdan A, Halvorsen BA, Mendoza-Rodriguez V, Rochitte CE, Rixe J, Wan YL, Langer C, Bettencourt N, Martuscelli E, Ghostine S, Buechel RR, Nikolaou K, Mickley H, Yang L, Zhang Z, Chen MY, Halon DA, Rief M, Sun K, Hirt-Moch B, Niinuma H, Marcus RP, Muraglia S, Jakamy R, Chow BJ, Kaufmann PA, Tardif JC, Nomura C, Kofoed KF, Laissy JP, Arbab-Zadeh A, Kitagawa K, Laham R, Jinzaki M, Hoe J, Rybicki FJ, Scholte A, Paul N, Tan SY, Yoshioka K, Röhle R, Schuetz GM, Schueler S, Coenen MH, Wieske V, Achenbach S, Budoff MJ, Laule M, Newby DE, Dewey M. Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data. BMJ 2019; 365:l1945. [PMID: 31189617 PMCID: PMC6561308 DOI: 10.1136/bmj.l1945] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. DESIGN Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. DATA SOURCES Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. RESULTS Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% v 86.5%, P=0.002) and specificity (84.4% v 72.6%, P<0.001). The area under the receiver-operating-characteristic curve for CTA was 0.897 (0.889 to 0.906), and the diagnostic performance of CTA was slightly lower in women than in with men (area under the curve 0.874 (0.858 to 0.890) v 0.907 (0.897 to 0.916), P<0.001). The diagnostic performance of CTA was slightly lower in patients older than 75 (0.864 (0.834 to 0.894), P=0.018 v all other age groups) and was not significantly influenced by angina pectoris type (typical angina 0.895 (0.873 to 0.917), atypical angina 0.898 (0.884 to 0.913), non-anginal chest pain 0.884 (0.870 to 0.899), other chest discomfort 0.915 (0.897 to 0.934)). CONCLUSIONS In a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42012002780.
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Affiliation(s)
- Robert Haase
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Pascal Gueret
- Department of Cardiology, Henri Mondor Hospital, University Paris Est Créteil, Créteil, France
| | - Daniele Andreini
- Department of Cardiology and Radiology, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | | | - Hatem Alkadhi
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mario J Garcia
- Department of Cardiology, Montefiore, University Hospital for the Albert Einstein College of Medicine, NY, USA
| | - Sebastian Leschka
- Department of Radiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Willem B Meijboom
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Bernhard Gerber
- Department of Cardiology, Clinique Universitaire St Luc, Institut de Recherche Clinique et Expérimentale, Brussels, Belgium
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Abbas A Shabestari
- Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus Universtity Hostipal, Aarhus, Denmark
| | - Matthijs F L Meijs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Axel C P Diederichsen
- Department of Cardiology, Glasgow Royal Infirmary and Stobhill Hospital, Glasgow, UK
| | - Shona M M Jenkins
- Department of Cardiology, Glasgow Royal Infirmary and Stobhill Hospital, Glasgow, UK
| | - Juhani Knuuti
- Turku University Hospital and University of Turku, Turku, Finland
| | - Ashraf Hamdan
- Department of Cardiovascular Imaging, Department of Cardiology, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Carlos E Rochitte
- Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil
| | - Johannes Rixe
- Department of Cardiology, Kerckhoff Heart Centre, Bad Nauheim, Germany
| | - Yung Liang Wan
- Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Chang Gung Memorial Hospital at Linkou, Taoyaun City, Taiwan
| | - Christoph Langer
- Heart and Diabetes Center NRW in Bad Oeynhausen, University Clinic of the Ruhr-University Bochum, Bochum, Germany
| | - Nuno Bettencourt
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Eugenio Martuscelli
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Said Ghostine
- Department of Cardiology, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lin Yang
- Department of Radiology, Beijing Anzhen Hospital, Beijing, China
| | - Zhaqoi Zhang
- Department of Radiology, Beijing Anzhen Hospital, Beijing, China
| | - Marcus Y Chen
- National Heart and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - David A Halon
- Cardiovascular Clinical Research Unit, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Matthias Rief
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Kai Sun
- Department of Radiology, Baotou Central Hospital, Inner Mongolia Province, China
| | - Beatrice Hirt-Moch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | - Roy P Marcus
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Réda Jakamy
- Department of Cardiology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Benjamin J Chow
- University of Ottawa, Heart Institute, Ottawa, Ontario, Canada
| | - Philipp A Kaufmann
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | | | - Klaus F Kofoed
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jean-Pierre Laissy
- Department of Diagnostic Imaging and Interventional Radiology, Bichat University Hospital, Paris, France
| | - Armin Arbab-Zadeh
- Division of Cardiology, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA
| | | | - Roger Laham
- BIDMC/Harvard Medical School, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | | | - John Hoe
- Department of Radiology, Mount Elizabeth Hospital, Singapore
| | - Frank J Rybicki
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Arthur Scholte
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Narinder Paul
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Swee Y Tan
- National Heart Centre, Singapore, Singapore
| | | | - Robert Röhle
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Georg M Schuetz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sabine Schueler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Maria H Coenen
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Viktoria Wieske
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Michael Laule
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - David E Newby
- British Heart Foundation, University of Edinburgh, Edinburgh, UK
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Rybicki FJ. Introduction to the JACR Appropriateness Criteria May 2019 Supplement. J Am Coll Radiol 2019; 16:S1. [DOI: 10.1016/j.jacr.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 10/26/2022]
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Rybicki FJ, Lalani T. Patient-Friendly Summary of the ACR Appropriateness Criteria: Staging of Pancreatic Ductal Adenocarcinoma. J Am Coll Radiol 2019; 16:e15. [PMID: 30947954 DOI: 10.1016/j.jacr.2018.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 11/15/2022]
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Jaremko JL, Azar M, Bromwich R, Lum A, Alicia Cheong LH, Gibert M, Laviolette F, Gray B, Reinhold C, Cicero M, Chong J, Shaw J, Rybicki FJ, Hurrell C, Lee E, Tang A. Canadian Association of Radiologists White Paper on Ethical and Legal Issues Related to Artificial Intelligence in Radiology. Can Assoc Radiol J 2019; 70:107-118. [PMID: 30962048 DOI: 10.1016/j.carj.2019.03.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 02/26/2019] [Accepted: 03/02/2019] [Indexed: 01/01/2023] Open
Abstract
Artificial intelligence (AI) software that analyzes medical images is becoming increasingly prevalent. Unlike earlier generations of AI software, which relied on expert knowledge to identify imaging features, machine learning approaches automatically learn to recognize these features. However, the promise of accurate personalized medicine can only be fulfilled with access to large quantities of medical data from patients. This data could be used for purposes such as predicting disease, diagnosis, treatment optimization, and prognostication. Radiology is positioned to lead development and implementation of AI algorithms and to manage the associated ethical and legal challenges. This white paper from the Canadian Association of Radiologists provides a framework for study of the legal and ethical issues related to AI in medical imaging, related to patient data (privacy, confidentiality, ownership, and sharing); algorithms (levels of autonomy, liability, and jurisprudence); practice (best practices and current legal framework); and finally, opportunities in AI from the perspective of a universal health care system.
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Affiliation(s)
- Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Marleine Azar
- Department of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Rebecca Bromwich
- Department of Law and Legal Studies, Carleton University, Ottawa, Canada
| | - Andrea Lum
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | | | - Martin Gibert
- Centre de recherche en éthique, Université de Montréal, Montréal, Quebec, Canada
| | | | - Bruce Gray
- Department of Medical Imaging, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | | | - Jaron Chong
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - James Shaw
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Frank J Rybicki
- Department of Radiology, The University of Ottawa Faculty of Medicine and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Imagia Cybernetics, Montreal, Quebec, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Emil Lee
- Canadian Association of Radiologists, Ottawa, Ontario, Canada; Department of Radiology, Valley Medical Imaging, Langley, British Columbia, Canada; Department of Medical Imaging, Fraser Health Authority, British Columbia, Canada
| | - An Tang
- Department of Radiology, Radio-oncology, and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada.
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Minhas A, Dewey M, Vavere AL, Tanami Y, Ostovaneh MR, Laule M, Rochitte CE, Niinuma H, Kofoed KF, Geleijns J, Hoe J, Chen MY, Kitagawa K, Nomura C, Clouse ME, Rybicki FJ, Tan SY, Paul N, Matheson M, Cox C, Rief M, Maier P, Feger S, Plotkin M, Schönenberger E. Patient Preferences for Coronary CT Angiography with Stress Perfusion, SPECT, or Invasive Coronary Angiography. Radiology 2019; 291:340-348. [PMID: 30888934 DOI: 10.1148/radiol.2019181409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Patient preference is pivotal for widespread adoption of tests in clinical practice. Patient preferences for invasive versus other noninvasive tests for coronary artery disease are not known. Purpose To compare patient acceptance and preferences for noninvasive and invasive cardiac imaging in North and South America, Asia, and Europe. Materials and Methods This was a prospective 16-center trial in 381 study participants undergoing coronary CT angiography with stress perfusion, SPECT, and invasive coronary angiography (ICA). Patient preferences were collected by using a previously validated questionnaire translated into eight languages. Responses were converted to ordinal scales and were modeled with generalized linear mixed models. Results In patients in whom at least one test was associated with pain, CT and SPECT showed reduced median pain levels, reported on 0-100 visual analog scales, from 20 for ICA (interquartile range [IQR], 4-50) to 6 for CT (IQR, 0-27.5) and 5 for SPECT (IQR, 0-25) (P < .001). Patients from Asia reported significantly more pain than patients from other continents for ICA (median, 25; IQR, 10-50; P = .01), CT (median, 10; IQR, 0-30; P = .02), and SPECT (median, 7; IQR, 0-28; P = .03). Satisfaction with preparation differed by continent and test (P = .01), with patients from Asia reporting generally lower ratings. Patients from North America had greater percentages of "very high" or "high" satisfaction than patients from other continents for ICA (96% vs 82%, respectively; P < .001) and SPECT (95% vs 79%, respectively; P = .04) but not for CT (89% vs 86%, respectively; P = .70). Among all patients, CT was preferred by 54% of patients, compared with 18% for SPECT and 28% for ICA (P < .001). Conclusion For cardiac imaging, patients generally favored CT angiography with stress perfusion, while study participants from Asia generally reported lowest satisfaction. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Woodard and Nguyen in this issue.
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Affiliation(s)
- Anum Minhas
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Marc Dewey
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Andrea L Vavere
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Yutaka Tanami
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Mohammad R Ostovaneh
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Michael Laule
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Carlos E Rochitte
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Hiroyuki Niinuma
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Klaus F Kofoed
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Jacob Geleijns
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - John Hoe
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Marcus Y Chen
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Kakuya Kitagawa
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Cesar Nomura
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Melvin E Clouse
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Frank J Rybicki
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Swee Yaw Tan
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Narinder Paul
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Matthew Matheson
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Christopher Cox
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Matthias Rief
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Pia Maier
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Sarah Feger
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Michail Plotkin
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
| | - Eva Schönenberger
- From the Department of Cardiology, Johns Hopkins Hospital and Health System, Baltimore, Md (A.M., A.L.V., M.R.O., M.M., C.C., P.M.); Departments of Radiology (M.D., M.L., M.R., S.F., M.P.) and Anesthesiology (E.S.), Charité-Universitätsmedizin Berlin, Humboldt-Universität and Freie Universität zu Berlin, Schumannstr 20/21, Berlin 10117, Germany; Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T.); Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); Department of Medicine, Division of Cardiology, St Luke's International Hospital, Tokyo, Japan (H.N.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.G.); Department of Radiology, Mount Elizabeth Hospital, Singapore (J.H.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil (C.N.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (M.E.C.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Canada (F.J.R.); Department of Cardiology, National Heart Center Singapore, Singapore (S.Y.T.); and Department of Radiology, Toronto General Hospital, Toronto, Canada (N.P.)
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Shepard LM, Sommer KN, Angel E, Iyer V, Wilson MF, Rybicki FJ, Mitsouras D, Molloi S, Ionita CN. Initial evaluation of three-dimensionally printed patient-specific coronary phantoms for CT-FFR software validation. J Med Imaging (Bellingham) 2019; 6:021603. [PMID: 30891468 DOI: 10.1117/1.jmi.6.2.021603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/19/2019] [Indexed: 12/17/2022] Open
Abstract
We developed three-dimensionally (3D) printed patient-specific coronary phantoms that are capable of sustaining physiological flow and pressure conditions. We assessed the accuracy of these phantoms from coronary CT acquisition, benchtop experimentation, and CT-FFR software. Five patients with coronary artery disease underwent 320-detector row coronary CT angiography (CCTA) (Aquilion ONE, Canon Medical Systems) and a catheter lab procedure to measure fractional flow reserve (FFR). The aortic root and three main coronary arteries were segmented (Vitrea, Vital Images) and 3D printed (Eden 260V, Stratasys). Phantoms were connected into a pulsatile flow loop, which replicated physiological flow and pressure gradients. Contrast was introduced and the phantoms were scanned using the same CT scanner model and CCTA protocol as used for the patients. Image data from the phantoms were input to a CT-FFR research software (Canon Medical Systems) and compared to those derived from the clinical data, along with comparisons between image measurements and benchtop FFR results. Phantom diameter measurements were within 1 mm on average compared to patient measurements. Patient and phantom CT-FFR results had an absolute mean difference of 4.34% and Pearson correlation of 0.95. We have demonstrated the capabilities of 3D printed patient-specific phantoms in a diagnostic software.
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Affiliation(s)
- Lauren M Shepard
- University at Buffalo, University Department of Biomedical Engineering, Buffalo, New York, United States.,Canon Stroke and Vascular Research Center, Buffalo, New York, United States
| | - Kelsey N Sommer
- University at Buffalo, University Department of Biomedical Engineering, Buffalo, New York, United States.,Canon Stroke and Vascular Research Center, Buffalo, New York, United States
| | - Erin Angel
- Canon Medical Systems USA, Tustin, California, United States
| | - Vijay Iyer
- University at Buffalo Medicine, Interventional Cardiology, UBMD, Buffalo, New York, United States
| | - Michael F Wilson
- University at Buffalo Medicine, Interventional Cardiology, UBMD, Buffalo, New York, United States
| | - Frank J Rybicki
- University of Ottawa, Ottawa Hospital Research Institute and the Department of Radiology, Ottawa, Canada
| | - Dimitrios Mitsouras
- University of Ottawa, Ottawa Hospital Research Institute and the Department of Radiology, Ottawa, Canada
| | - Sabee Molloi
- University of California Irvine, University Department of Radiological Sciences, Irvine, California, United States
| | - Ciprian N Ionita
- University at Buffalo, University Department of Biomedical Engineering, Buffalo, New York, United States.,Canon Stroke and Vascular Research Center, Buffalo, New York, United States.,University at Buffalo, University Department of Neurosurgery, Buffalo, New York, United States
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