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. 

David M. Axelrod, M.D., clinical associate professor in pediatrics (cardiology) at Stanford School of Medicine, explains how Stanford developed the Virtual Heart to help parents, patients and new physicians understand complex congenital heart anatomy and repairs. He said virtual reality (VR) will be a quantum leap in cardiovascular care, education and research.

He spoke at the 2019 Cardiology AI-Med conference. 

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6 Key Health Information Technology Trends at HIMSS 2019
 

Anthony Chang, M.D., chief artificial intelligence officer, Children’s Hospital of Orange County (CHOC), and founder, AIMed, explains the basic principles of artificial intelligence (AI) in medicine. He outlines some basic AI definitions, potential programming biases and use cases. He also explains the need for the Cardiology AI-Med conference, which held its inaugural meeting in June 2019 in Chicago.

Related AI Content:

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VIDEO: Artificial Intelligence Applications for Cardiology — Interview with Anthony Chang, M.D.

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Technology Report: Artificial Intelligence 

This is a walk through of the primary structural heart hybrid cath lab at Henry Ford Hospital in Detroit, Mich. It is the hospital's newest lab and is centered around a Philips Azurion angiography system, which is a low dose imaging system that significantly reduces dose exposure compared to previous generation systems. As seen in the video, the lab is also equipped with a vascular access ultrasound system, transesophageal echo (TEE) system, an Abiomed Impella console, a large number of storage cabinets, surgical lighting for cases that convert over to open surgery or for transapical TAVR access, movable radiation shielding and ample space to accommodate surgical equipment and extra staff involved in structural heart procedures. There also is an electrosurgical cutter unit in the lab, which Henry Ford operators use to perform transcaval access TAVR procedures for patients who have anatomical challenges to the femoral access route. 

Watch the related VIDEO: Overview of the Henry Ford Hospital Structural Heart Program

Find more Henry Ford videos and news.

This is an example of how the heart's left atrial appendage (LAA) can be evaluated for thrombus and possible transcatheter occlusion using a new cardiac ultrasound lighting technology called TrueVue. It is a movable virtual light source that can interact with the echocardiography images to show photorealistic, virtual surgical views of the cardiac anatomy. The light source can be moved anywhere in the image, including behind structures to backlight them. The technology is offered on the Philips Healthcare Epiq CVx cardiovascular ultrasound system. It was shown for the first time in the U.S. at the American Society of Echocardiography (ASE) 2018 meeting.

See another VIDEO example of the photo-realistic lighting technology showing a transcatheter ASD closure with two Amplatzer occluders.

Alex Haak, Ph.D., clinical scientist at Philips Health Systems North America, is based at the University of Colorado Hospital, to work directly with physicians in the cath lab to gather immediate feedback and improve next generation fusion imaging technologies used for structural heart interventions. Philips worked with the University of Colorado to develop the EchoNavigator, which fuses 3-D anatomical imaging, live transesophageal echo (TEE) and live fluoroscopy in the cath lab to help guide structural heart procedures. Haak is permanently based at the hospital to help trouble shoot and tweak the new EchoNavigator and other interventional guidance technologies being alpha-tested there prior to final commercialization.

Additional videos and coverage of the University of Colorado Hospital

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.

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. 

Related Cardiac Sarcoidosis Content:

ASNC and SNMMI Release Joint Document on Diagnosis, Treatment of Cardiac Sarcoidosis

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Recent Advances in Cardiac Nuclear Imaging Technology

This is a virtual heart with the same electrophysiology characteristics as the real patient being developed to help optimize cardiac resynchronization therapy (CRT) lead placement. CRT currently has a 30 percent nonresponder rate, which is mainly due to the placement of leads. This model allows virtual placement of the leads In various locations to test response prior to the implantation procedure. The green dot shows the location of the virtual lead. It was unveiled at the Healthcare Information Management and Systems Society (HIMSS) 2019 annual meeting in February by Siemens. This "digital twin" technology is in development and will be able to create virtual, digital organs from a patient’s ECG, MRI scan and other clinical data. Siemens said the technology also might have applications for testing virtual ablations strategies to save procedure time when the patient is in the EP lab. 

Read more about the digital twin technology.

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

Find news and videos from HIMSS 2019.

This is an example of an arterial venous malformation (AVM) in the brain imaged on a Canon Alphenix Alpha angiography system. It shjows a contrast injection highlighting the vessels, which have been color coded to show the position of the veins and arteries involved in this vascular defect. 

Read more about advances in angiography imaging systems. 

Robert Quaife, M.D., director of advanced cardiac imaging, University of Colorado Hospital, explains why advanced imaging techniques are required to tackle complex transcatheter procedures and structural heart interventions. The University of Colorado Hospital helped develop the Philips EchoNavigator live image fusion technology, and this video offers an overview of how it came to be and where the technology is going.

Watch the related VIDEO: Evolution of Transcatheter Mitral Valve Repair at the University of Colorado, which shows examples of the navigation technology is use during a MitraClip procedure. 

VIDEO: Overview of University of Colorado Structural Heart Program — Interview with John Carroll, M.D., Robert Quaife, M.D., and James Chen, Ph.D.

Highlighting Innovation at the University of Colorado Hospital Cardiology Program

Additional videos and coverage of the University of Colorado Hospital

Interview with John Messenger, M.D., FACC, FSCAI, director of the cardiac cath labs and director of the cardiovascular ICU/stepdown unit, and Kevin Rogers, M.D., director of vascular medicine at the University of Colorado Hospital. They explain the trend toward more complex procedures, including chronic total occlusions (CTOs) and complex high-risk indicated procedure (CHIP) patients. They explain how they minimize X-ray and contrast dose during these longer procedures, the tools they use to perform the procedures and offer advice for centers expanding into complex PCI.

Watch a VIDEO walk through of this cath lab at the University of Colorado Hospital.

VIDEO: Overview of University of Colorado Structural Heart Program — Interview with John Carroll, M.D., Robert Quaife, M.D., and James Chen, Ph.D.

Highlighting Innovation at the University of Colorado Hospital Cardiology Program

Find more content from the University of Colorado Hospital.

This is the newest cardiac cath lab at the University of Colorado Hospital in Aurora, Colorado. Construction was completed in June 2018. It is centered around a Philips Azurion Clarity IQ angiography system, which was chosen because its low X-ray dose imaging and guidance technologies that enable more complex, longer procedures. The room is use for the most involved complex percutaneous coronary interventions (PCI), including chronic total occlusions (CTOs) and complex high-risk indicated procedures (CHIP) patients. It is also used for transcatheter aortic valve replacement (TAVR), septal occluder procedures, transcatheter LAA closures and alcohol ablations.

The room is equipped for radial access procedures, which is used in a little more than 50 percent of cases at the hospital. It is also equipped with an Impella hemodynamic support system, wires and microcatheters for CTOs, and a SonoSite point of care ultrasound console for vascular access needle guidance.

See a 360 Degree View During a CTO Case in this room

Watch the VIDEO: The Evolution of Complex PCI at University of Colorado, which speaks with two of the operators who use this room.

Find more content from the University of Colorado Hospital.

This is a walk around of the new Spectrum Dynamics Veriton SPECT-CT nuclear imaging system introduced at the 2018 Radiological Society of North America (RSNA) meeting.

This is a walk around of an innovative new SPECT-CT nuclear imaging system shown at the Radiological Society Of North America (RSNA) 2018 meeting this week. It's CT system with comes in 16, 64 or 128 slice configurations. It has 12 SPECT detector robotic arms that automatically move toward the patient and use a sensor to stop a few millimeters from the skin to optimize photon counts and SPECT image quality. It also uses more sensitive CZT digital detectors, which allows either faster scan times, or use of only half the radiotracer dose of analog detector scans.

Read the article “Nuclear Imaging Moves Toward Digital Detector Technology.” 

Read the article "Spectrum Dynamics Sues GE for Theft, Misappropriation of Trade Secrets and Unfair Competition."

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.
 

Anton S. Becker, M.D., radiology resident at the University Hospital of Zurich, Switzerland, discusses the long-term risks of cyberattacks on medical imaging data at the 2018 Radiological Society of North America (RSNA) annual meeting.

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

Matthew Budoff, M.D., professor of medicine, David Geffen School of Medicine, UCLA, spoke at the 2018 American Heart Association (AHA) meeting on the new AHA guidelines for cholesterol, including the use of computed tomography (CT) calcium scoring scans to assess patient risk. Budoff has been involved in several of the coronary artery calcium (CAC) trials that supported the new recommendation.

Related CT Calcium Scorining Content:

VIDEO: New Cholesterol Guidelines Support CT Calcium Scoring for Risk Assessment — Interview with Matthew Budoff, M.D.

CT Calcium Scoring Becoming a Key Risk Factor Assessment

ACC and AHA Release Updated Cholesterol Guidelines for 2018

VIDEO: CT Calcium Scoring to Screen For Who Should Take Statins — Interview with Matthew Budoff, M.D.

VIDEO: The History of CT Calcium Scoring — Interview with Arthur Agatston, M.D.