Sharon Mulvagh, M.D., FASE, FACC, FRCPC, professor of medicine, division of cardiology, Dalhousie University, Halifax, Nova Scotia, Canada, and professor emeritus, Mayo Clinic, explains the latest updates to guidelines for the use of cardiovascular ultrasound enhancing imaging agents. She spoke to DAIC at the 2019 American Society of Echocardiography (ASE) meeting.

The changes include a new term for contrast so the agents are not confused with safety issues regarding gadolinium, iodine-based contrast or radioactive nuclear radiotracers. She gives an overview of the 2018 guidelines that are based on a large level of clinical study evidence. Previously, the ASE issued a statement rather than a guideline, because the more clinical evidence was needed for more a more conclusive set of guidelines. 

Read the full guidelines: Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update.

Find more news and videos from ASE 2019.

Marielle Scherrer-Crosbie, M.D., Ph.D., director of echocardiography at the Hospital of the University of Pennsylvania, and chair of the 2019 American Society Of Echocardiography (ASE) sessions, explains how cardiac ultrasound strain imaging is being used and where the technology is at the ASE 2019 meeting.  She is an expert in echo strain, which is gaining wider usage in echocardiography, especially for cardio-oncology assessments. She spoke at the 2019 American Society of Echocardiography (ASE) meeting.

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Find more ASE 2019 coverage

Judy Hung, M.D., director of echocardiography, Division of Cardiology, Massachusetts General Hospital, Boston, explains some of the changes in recent guidelines for cardiac ultrasound assessments of aortic and mitral valves. She spoke at the 2019 American Society of Echocardiography (ASE) meeting.

Links to ASE guidelines:

   • Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation

   • Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography

Find more ASE 2019 coverage

Thomas Porter, M.D., FASE, the Theordore F. Hubbard Distinguished Chair of Cardiology and a professor of medicine at the University of Nebraska Medical Center, explains a new study on how cardiac ultrasound imaging combined with bubble contrast was able to break down blood clots and restore blood flow to blocked vessels in STEMI heart attack patients. He gave an update on this new potential therapeutic direction for ultrasound at the 2019 American Society Of Echocardiography (ASE) meeting.

The Brazilian study used this approach in about 100 ST-elevated myocardial infarction (STEMI) patients and was recently published in the Journal of the American College of Cardiology (JACC). Porter said about 50 percent of patients had their ST resolved by the time they made it to the cath lab for percutaneous coronary intervention (PCI). Two more studies in Amsterdam and Pittsburgh are now starting to see if this technique can be used while transporting patients in an ambulance to further improve heart attack outcomes and to reduce infarct size.

Porter also explains recent research that shows ultrasound pulses promote ATP and nitric acid production, which have a lasting beneficial effect on small vessel perfusion in the area treated and down stream for hours after the use of the transducer. 

Watch the VIDEO: Therapeutic Applications for Contrast Ultrasound — another  interview with Porter. 

Sanjaya Gupta, M.D., electrophysiologist, St. Luke's Mid America Heart Institute, and assistant professor, University of Missouri–Kansas City School of Medicine, explains how his center developed an artificial intelligence (AI) application to automatically risk stratify atrial fibrillation (AFib) patients. The Epic-based app stratifies patients into those who should be placed on anticoagulation and those who are candidates for left atrial appendage (LAA) occlusion. He spoke at the 2019 AI-Med Cardiology conference. 

His center hopes to develop similar guidelines based AI apps for other types of cardiac risk scoring. Gupta said he is looking for other centers to partner with to co-develop and test these AI apps.    

Related Cardiology AI Content:

VIDEO: Overview of Artificial Intelligence and its Use in Cardiology — Interview with Anthony Chang, M.D.

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John Rumsfeld, M.D., Ph.D., FACC, American College Cardiology (ACC) chief innovation officer, and professor of medicine at the University of Colorado School of Medicine, explains how the ACC is working with artificial intelligence (AI) vendors to directly impact cardiac care. He said there is a tremendous amount of investment in and hype surrounding AI in healthcare, but to date there has been very little of this has translated in to changes in the way cardiology care is delivered. He outlines several areas to successfully apply AI to improve cardiovascular care and outcomes. He also discussed the current ACC efforts to advance evidence-based implementation of AI in cardiac care including applications for the NCDR.

He spoke at the 2019 Cardiology AI-Med conference. 

Watch the related VIDEO: Overview of Artificial Intelligence and its Use in Cardiology, an interview with Anthony Chang, M.D., chief artificial intelligence officer, Children’s Hospital of Orange County (CHOC), and founder of AIMed.  

A demonstration of how to calculate the neo-left ventricular outflow tract (neo-LVOT) on CT imaging for a transcatheter mitral valve replacement using Circle Imaging's advanced visualization software. The demonstration looks at the use of an Edward's Sapien valve being implanted for a mitral valve-in-valve procedure. The overhang of the Sapien can block the LVOT blood flow, which can be catastrophic for the patient. So, assessment of the neo-LVOT in a simulation of the implant is required prior to the procedure to find the ideal landing zone and assess if the patient's anatomy is compatible with this technique.  

Watch the related VIDEO: The Importance of the Neo-LVOT in Transcatheter Mitral Valve Replacement — an interview with Dee Dee Wang, M.D., director of structural heart imaging, Henry Ford Hospital. 

This clip was recorded on the expo floor at the 2018 Society of Cardiovascular Computed Tomography (SCCT).

This is an example of a carotid artery reporting module from Change Healthcare at 2018 Radiological Society of North America (RSNA) annual meeting. It shows how the PACS can bring in ultrasound imaging of the carotid artery and the graphical report can be modified to match the patient anatomy. The text and modifications made to the vessel tree convert into text to help auto-fill fields in the written report to help speed workflow. The vessel tree is similar to cath lab reporting systems that use a similar model of the coronaries that can be modified and helps auto complete the cath report.

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Find more RSNA 2018 coverage.

Paul Chang, M.D., professor of radiology, vice chair of radiology informatics and medical director for enterprise imaging, University of Chicago, explains some of the issues with artificial intelligence (AI) and how hospitals can better prepare for its eventual implementation across the field medicine. A key takeaway is that hospitals need an infrastructure and roadway for AI and deep-learning algorithms to operate. Chang said most health systems will not invest directly in AI, but will invest in analytics, which Chang said uses much of the same infrastructure required by AI.

Chang spoke on this topic at an AIMed breakfast briefing seminar in Chicago April 9, 2019. Listen to a webcast of this hour and 15 minute talk.

William Pinsky, M.D., a pediatric cardiologist and CEO of the Educational Commission for Foreign Medical Graduates (ECFMG), and Mandeep Mehra, M.D., medical director of the Brigham and Women’s Hospital (BWH) Heart and Vascular Center and professor of medicine at Harvard Medical School, explain the U.S. doctor shortage and how foreign doctors help fill the gap.

According to 2017 data provided by the Association of American Medical Colleges (AAMC), 40 percent of interventional cardiologists, 30 percent of cardiovascular disease specialists, and 26 percent of pediatric cardiologists in the United States are international medical graduates (IMGs). However, as the physician shortage continues to impact primary care doctors, psychiatrists, OB/GYNs, among others, the U.S. also expects to see a shortage of cardiologists within the next 10 years, according to a spotlight cardiology study issued by the professional services firm PYA, which specialized in healthcare consulting.

The interview was shot at the American College of Cardiology (ACC) 2019 meeting.

Raza Alvi, M.D., a research fellow in radiology at Massachusetts General Hospital, has been involved in a study of a positron-emission tomography (PET) FDG radiotracer agent to image sarcoidosis. The inflammatory disease affects multiple organs and usually include abnormal masses or nodules (granulomas) consisting of inflamed tissues that can form in the heart. Alvi presented on this topic at American College of Cardiology (ACC) 2019 meeting. 

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Christine Albert, M.D., MPH, director of the Center for Arrhythmia Prevention at Brigham and Women’s Hospital, and professor of medicine at Harvard Medical School, spoke at the American College of Cardiology (ACC) 2019 meeting, and also with ITN/DAIC Contributing Editor Greg Freiherr. In her interview, she focused on two key electrophysiology trends with the use of the Apple Watch to detect atrial fibrillation (AF) and the results of the CABANA Trial, which showed ablation is as effective as drug therapy in treating AF, with a significant reduction in death or cardiovascular hospitalization.

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Augmented reality (AR) and virtual reality (VR) are starting to be adopted for physician training, patient education about their planned procedures, treatment planning and it is expected to be used as a procedure guidance tool in the near future. This example of AR displayed at the Healthcare Information Management and Systems Society (HIMSS) 2019 meetingwas among the most innovative because it allows users to "feel" the 3-D hologram of the heart. Developed by the company SoftServe., the “Touch My Heart” work-in-progress technology allows anyone wearing an AR headset to see and interact with the heart and get a touch sensation when they reach into the virtual tissue. A pad below the image is composed of dozens of ultrasound transducers that emit sound waves in the shape of the heart so users feel touch sensations when interacting with the virtual tissue.

Read the article "Virtual Reality Boosts Revenues and Patient Understanding,"

Look through a photo gallery of other new technologies at HIMSS19. 

Find news and videos from HIMSS 2019.

Anthony Chang, M.D., chief intelligence and innovation officer, Children's Hospital of Orange County (CHOC), and medical director of the Sharon Disney Lund Medical Intelligence and Innovation Institute. He is expert in artificial intelligence (AI). He spoke in several sessions at Healthcare Information and Management Systems Society (HIMSS) 2019 meeting on the integration of AI in healthcare. 

He said AI will play a big roll in imaging assessments of adult congenital heart disease to help relieve the burden on the small number of congenital cardiologists. 

Chang also explained there is a tsunami of data about to wash over healthcare as wearable devices begin to be integrated into patient care. AI will play a key role in sorting through all this data by monitoring the information to identify trends or disease markers and alert clinicians and the patient.

He was a keynote speaker at HIMSS19 with his session "Synergies Between Man and Machine — Future AI apps can be directed to help mitigate physician burnout by decreasing the EHR burden, improving medical education, and automating quality improvement."

Chang is head of the artificial intelligence organization AIMed, which hosts educational sessions and an annual meeting on AI applications in medicine.

Listen to Chang in the PODCAST: Fitting Artificial Intelligence Into Cardiology.
 

Read the article 6 Key Health Information Technology Trends at HIMSS 2019.

Look through a photo gallery of other new technologies at HIMSS19. 

Find news and videos from HIMSS 2019.

How wearable devices will play a role in healthcare was a big topic at the Healthcare Information Management and Systems Society (HIMSS) 2019 meeting. The biggest question is how to attached the data from consumer devices into a usable format for clinicians that interfaces with the electronic medical record (EMR). A good example of how wearables are being integrated in clinical care was demonstrated by the company Datos. It offers software that can integrate data from a wide variety of wearable devices from several makers into a mobile app, It can transfer the information to an EMR. The app also offers two way communication between the patient and the doctor’s office. It can prompt patients with a list of things they need to do each day to reach physician specified goals and displays analytics on a patient’s health data, including charts and graphs.

The system is used by Sheba Medical Center in Israel for a remote cardiac rehabilitation program. It now remotely monitors hundreds of patients and does not require them to come to the hospital for sessions, which has helped increase patient satisfaction and aided in increasing physical activity compliance. Watch the VIDEO: Use of Wearable Medical Devices for Cardiac Rehabilitation — an interview with Robert Klempfner, M.D., director of the Cardiovascular Prevention Institute, Sheba Medical Center.
 

Look through a photo gallery of other new technologies at HIMSS19. 

Find news and videos from HIMSS 2019.

Steve Holloway, principal analyst and company director for the healthcare market research firm Signify Research, explains the key trends he is seeing in enterprise imaging systems. He spoke to ITN at the 2019 Healthcare Information Management and Systems Society at (HIMSS) conference.  

Additional HIMSS 2019 coverage.

Look through a photo gallery of new technologies highlighted at HIMSS 2019.

Watch the RSNA 2018 VIDEO: Technology Report — Enterprise Imaging

DAIC Editor Dave Fornell takes a tour of some of the most interesting new medical imaging technologies displayed on the expo floor at the 2018 Radiological Society of North America (RSNA) meeting. The video includes new technologies for fetal ultrasound, CT, MRI, mobile DR X-ray, a new generation of fluoroscopy systems, MRI contrast mapping to better identify tumors, and a new technique to create moving X-ray images from standard digital radiography (DR) imaging.

Watch the related VIDEO: Editor’s Choice of the Most Innovative New Artificial Intelligence Technologies at RSNA 2018. This includes a tour of some of the recently FDA-cleared AI technologies for medical imaging at RSNA 2018. 

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Echocardiography Trends at ASE 2019

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This is a quick walk around of a GE Healthcare Image Guided System (IGS) angiography system cath lab room display at the 2018 Radiological Society of North America (RSNA) meeting.

Read the related article "Recently Introduced Angiography Imaging Technology."

Watch the related VIDEO: Technologies and Techniques to Reduce Radiation Dose in the Cardiac Cath Lab.
 

This is an example of the FDA-cleared OpenSight augmented reality (AR) system for surgical planning from NovaRad at the Radiological Society Of North America (RSNA) 2018 meeting. It uses a HoloLens headset to register an overlay of the patient’s MR or CT scan in the patient. The operator can use hand movements to slice through and manipulate the images.

The vendor gained an FDA indication for AR to be used in surgical planning in 2018. NovaRad is working with the FDA for a second indication for use of the AR in the operating room during procedures.

This video is jerky, slightly misaligned and the hand movements did not always respond because itwas shot with an iPhone inside the visor. The image quality and hand movements are much better when actually wearing it on your head and aligned for the specific user.

Read more about this technology