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1 New Approaches to Systolic Function: 4D Roberto M Lang, MD Conflict of Interests Philips Medical Imaging Research Grants Speakers bureau Advisory bureau Tomtec Research Grants Epsilon Research Grants 1
2 Eur Heart J Cardiovasc Imaging Mar;16(3): J Am Soc Echocardiogr 2015;28:1 39 Chamber Quantification 2
3 Why is 3D More Accurate? long axis (cm) A4C * 7 2D 3D Mor-AviV, LangRMetal., Circulation : Limitations to the Implementation of 3D Echocardiography in the Laboratory Time-consuming Requires training in 3DE analysis Accuracy varies with expertise Reproducibility varies among individuals and institutions 3
4 Slide 6 2 change to text, limitations and Wendy Tsang, 6/25/2013
5 Artificial Intelligence Type of artificial intelligence (AI) that provides computers with the ability to learn without being explicitly programmed. Real-Time Automated 3D TTE Left Heart Chamber Quantification using an Adaptive Analytics Algorithm Tsang W, Salgo IS, Medvedofsky D, Takeuchi M, Prater D, Weinert L, Yamat M, Mor-Avi V, Patel AR, Lang RM: J Am Coll Cardiol Cardiovasc Img 2016; 9:
6 Real-Time Automated Transthoracic Three- Dimensional Echocardiographic Left Heart Chamber Heart Quantification Model Overview using an Adaptive Analytics Algorithm Generic Model Final Model Tsang w, Lang RM. JACC Imaging (in press) Library of ~1000 Images Local Adaptation Adjustments for: variations in dropout acoustic clutter ventricular shape dataset orientation Real-Time Automated Transthoracic Three- Dimensional Echocardiographic Left Heart Chamber Quantification using an Adaptive Analytics Algorithm Dilated Banana Sigmoid Septum Normal Tsang w, Lang RM. JACC Imaging (in press) 5
7 Real-Time Automated Transthoracic Three-Dimensional Echocardiographic Left Heart HeartModel A.I. Chamber Quantification using an Adaptive Analytics Algorithm Algorithm Align & Orient Model Adjust Local Borders Automatically Corrects Foreshortening Avoids Geometric Assumptions 15 Initial fully automated model Global/regional corrections LV Focused Views Final model 4 chamber 2 chamber 3 chamber LA Focused Views 6
8 EDV ESV EF LAV r=0.99 r=0.99 r=0.94 r=0.99 Bias: 8 ml LOA: ± 24 ml Bias: 6 ml LOA: ± 24 ml Bias: 1% LOA: ± 10 % Bias: 10 ml LOA: ± 12 ml Eur Heart J Cardiovasc Imaging 2017 Fully Automated Cardiac Chamber Quantification 7
9 Fully Automated Cardiac Chamber Quantification LV Shape: Regional Curvature Salgo, Tsang, Lang et al. JASE 2011: 25(1):80 8 8
10 Curvature: the amount by which a geometric object deviates from being flat. r 1 k1 R 1 1 k2 R 2 R 1 k=1/r LV Shape Analysis Salgo I, Tsang W, Lang RM et al., J Am Soc Echocardiogr 2011: 25(1):80-8 9
11 Salgo, Tsang, Lang et al. JASE 2011: 25(1):
12 RV Volumes and EF <45 RV EDV/BSA, Men 61.3± RV EDV/BSA, Women 53± RV ESV/BSA, Men 27± RV ESV/BSA, Women 22±
13 RV Shape: Regional Curvature 0.6 R Normalized Curvature k n Curvature < 0 Curvature > 0 Curvature = 0 Convexity Concavity Normal 1.5 Free wall surface Indexed Curvature 0.5 Septal wall surface Indexed Curvature
14 Artificial Intelligence Fusion Imaging 3D Printing Virtual Reality Holography Valve Pathology N Figure Mitral Degenerative 2 A, B Cleft 1 C Perforation 1 D Stenosis 1 Bi leaflet 2 E Degenerative 1 F Device lead Tricuspid interference 1 G Quadricuspid 1 Malcoaptation 1 Vegetation 1 Aortic Perforation 1 Malcoaptation 1 Pulmonary Fibroelastoma 1 H Quadricuspid 1 I LAA LAA Aorta Aorta Right ventricular perspective D A Perforation Devicelead Right ventricular perspective 2 1 Flail P2 Bileaflet Right atrial perspective Fibroelastoma Aorta G H I C F 13
15 3/14/2018 New Rendering Algorithms 14
16 FUSION IMAGING Fusion Imaging Fluoroscopic anatomy 15
17 FUSION IMAGING FUSION IMAGING Strain Imaging Perfusion Imaging Maffessanti F, Patel AR, Patel MB, Walter JJ, Mediratta A, Medvedofsky D, Kachenoura N, Lang RM, Mor Avi V.. Eur Heart J Cardiovasc Imaging Jul 26. pii: jew147. [Epub ahead of print] PMID:
18 3D Printing Virtual Reality Computer-generated simulation of a threedimensional image that can be interacted with by a person using special electronic equipment (helmet with a screen inside or gloves fitted with sensors. 17
19 Stenotic Bioprosthetic MV From LA From LV Virtual Reality 18
20 Virtual Reality 19
21 Virtual Reality Nobel Prize Laureate
22 3D Holography: Photographic technique that records the light scattered from an object, and then presents it in a way that appears 3D RealView Imaging Ltd. All rights reserved. 21
23 Virtual Surgery on a computer? Promises and Perspectives 3D Chamber Quantification, LV &RV Shape and Image Fusion Where have we been? Where are we going? Feasible Improved accuracy Improved reproducibility Mechanistic insights Improved temporal and spatial resolution Improved integration into clinical practice Automation Establish outcome measures/guidelines Decreased costs 22
24 23
Conflict of Interests
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