An example of Siemens' photo-realistic Cinematic image reconstruction. This image is from a CTA exam from a Siemens Force CT scanner. 

Vendors who offer this realistic type of CT image rendering say it is not used for diagnostics. However, the technology can be helpful when explaining things to the patient and their family, educating physicians and staff, and for surgeons, since it offers a realistic view of the anatomy that is easier for most people to understand who are not familiar with cardiac anatomy as it appears in traditional CT multiplanar reconstruction (MPR) images. 

This example of software was demonstrated on the expo floor at the 2019 Society of Cardiovascular Computed Tomography (SCCT) meeting. 

Find more news and videos from the SCCT meeting

This is an example of an automated calcium scoring software to speed review of coronary artery calcium (CAC) scoring cardiac computed tomography (CT) scans. This advanced visualization software from Ziosoft uses artificial intelligence to segment the coronary vessels, identify valves and the aorta and then color code tag the calcium deposits and quantify the amount of calcified plaque in each vessel. It tallies the score into a table and computes an overall Agatston risk score. This risk score correlates to that patient's risk for a heart attack in the future. The software notes calcium in the heart outside the coronaries in valve leaflets and the aorta, but excludes this data. This type of automation is now offered by most advanced visualization and CT system vendors. This automation can save a large amount of post-processing time and make it easier for hospitals to offer low-cost CAC CT screening programs. 

CAC scans can be used to determine if a patient needs to go on statin therapy. An Agatston score of zero means the patient has no risk of coronary disease. 

Calcium in arteries is a marker for damage caused by vessel wall inflammation from atherosclerosis. Calcium can form from previously ruptured necrotic, lipid core plaques, also referred to as vulnerable plaques. These are the types of plaque responsible for heart attacks. When the core of these plaques rupture, the blood reacts to the exposed core similar to a wound and begins to clot, forming a thrombus in the vessel, which can block the blood flow. When the vessel heals over time it calcifies, leaving behind an easily identifiable marker on CT imaging. 

This example of software was demonstrated on the expo floor at the 2019 Society of Cardiovascular Computed Tomography (SCCT) meeting. 

Related CT Calcium Scorining Content:

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

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.

Nate Bachman, graduate research assistant in the Human Cardiovascular Physiology Lab of the Dept. of Health and Exercise Science at Colorado State University, describes how he and fellow researchers used multiple types of cardiac imaging to evaluate the cardiovascular health of athletes who compete in endurance events lasting six hours or more, and what the results may suggest for future screening.

Andrew Choi, M.D., FACC, FSCCT, co-director, cardiac CT and MRI, assistant professor of medicine and radiology, George Washington University, Division of Cardiology, Washington, D.C., explains the role of social media to extend the reach of cardiovascular research from peer review journals. He spoke on this topic in multiple sessions at the Society of Cardiovascular Computed Tomography (SCCT) 2019 meeting.

Find more SCCT news and videos

Joao Cavalcante, M.D., FSCCT, director of structural heart CT and cardiac MRI, Minneapolis Heart Institute, discusses transcatheter mitral valve replacement (TMVR) imaging requirements at the Society of Cardiovascular Computed Tomography (SCCT) 2019 meeting. SCCT held its first TMVR planning hands-on workshop, which he was involved in. TMVR is expanding with currently FDA cleared valve-in-valve (VIV) and valve-in-ring (VIR) procedures.

Related TMVR Content:

Interventional Imagers: The Conductors of the Heart Team Orchestra

VIDEO: The Importance of the Neo-LVOT in Transcatheter Mitral Valve Replacement  — Interview with Dee Dee Wang, M.D.

VIDEO: Transcatheter Structural Heart Procedure Navigation Technology Advances  — Interview with Stephen Little, M.D.

Recent Advances in Transcatheter Valve Technology

Abbott Begins Tendyne Transcatheter Mitral Valve U.S. Pivotal Trial

VIDEO: The Essentials of CT Transcatheter Valve Imaging — Interview with Jonathon Leipsic, M.D.,

New LAMPOON Technique Reduces LVOT Obstruction in Transcatheter Mitral Valve Replacement

Find more SCCT news and videos

Ron Blankstein, M.D., director of cardiac computed tomography, Brigham and Women's Hospital, and associate professor of medicine and radiology, Harvard Medical School, and current SCCT president, offers an overview of the recent trends in cardiac CT and some of the new highlights at the Society of Cardiovascular Computed Tomography (SCCT) 2019 meeting. The  said key topics included integration of artificial intelligence into CT systems, the integration of CT calcium scoring into the 2018 American Heart Association (AHA) cholesterol management guidelines, structural heart assessments for transcatheter valve and left atrial appendage (LAA) occlusion, and partner sessions with TCT and HRS that explain the roll of CT in interventional cardiology and electrophysiology.

Find more SCCT news and videos

This is an example of a cardiac echocardiography exam performed using an iPhone and the Butterfly IQ ultrasound transducer and app. The company is exhibiting at the American Society Of Echocardiography (ASE) 2019 meeting. This is the first “ultrasound system on a chip.” The Butterfly IQ ultrasound system consists of a transducer that connects to an iPhone or iPad to record ultrasound exams. The system has 18 different applications for specialized images, including cardiac imaging, vascular, lung, abdominal and others. The apps allow for quantification and offers many of the features of larger cart-based systems. The company is working on incorporating artificial intelligence technologies to automate some processes, such as auto ejection fractions.

This technology was picked as one of the big ultrasound advances in the VIDEO: 4 Recent Advances in Echocardiography Technology and in the VIDEO: Editor's Choice of the Most Innovative New Technology at RSNA 2018.

Federico Asch, M.D., FASE, director of cardiac imaging research and director of the cardiovascular imaging lab, MedStar Health Research Institute, Washington, D.C., spoke about the cardiovascular impact of chagas disease and the symptoms that should be considered for patients who are from, or visited, South or Central America. He spoke on the topic at the 2019 American Society Of Echocardiography (ASE) meeting.

Chagas, also called trypanosomiasis, is a tropical parasitic disease caused by the protist Trypanosoma cruzi. It is spread through the bite of the triatominae insect, which is also known as the "kissing bug." Link to the Center for Disease Control (CDC) page on Chagas.

Asch served as the co-chair of the group that created the guidelines to image Chagas disease.

Read the guidelines at "Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease: A Report from the American Society of Echocardiography in Collaboration With the InterAmerican Association of Echocardiography (ECOSIAC) and the Cardiovascular Imaging Department of the Brazilian Society of Cardiology (DIC-SBC).

Find more news and video from ASE 2019

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.

Related Cardio-oncology Content:

VIDEO: Echocardiography Strain Fundamentals Made Easy 

Strain Imaging Improves Cardiac Surveillance of Certain Breast Cancer Patients

Assessing Cardiotoxicity Due to Cancer Therapy

VIDEO: Assessing Cardiotoxicity Response With Cardio-Oncology Echo Imaging — interview with Federico Asch, M.D.

New Echo Protocol Aids Monitoring Children’s Heart Abnormalities Due to Chemotherapy

Strain Imaging Improves Cardiac Surveillance of Certain Breast Cancer Patients

VIDEO: Characterization of Cardiac Structural Changes and Function Following Radiation Therapy

Study Demonstrates Strain Imaging Utility With Contrast-Echo Studies

VIDEO: Echocardiography Strain Fundamentals Made Easy 

Strain Imaging Improves Cardiac Surveillance of Certain Breast Cancer Patients

Automation Enhances, Streamlines Echocardiography

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.

VIDEO: ACC Efforts to Advance Evidence-based Implementation of AI in Cardiovascular Care — Interview with John Rumsfeld, M.D.

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

PODCAST: Fitting Artificial Intelligence Into Cardiology — Interview with Anthony Chang, M.D.

VIDEO: How Hospitals Should Prepare for Artificial Intelligence Implementation — Interview with Paul Chang, M.D.

Technology Report: Artificial Intelligence 

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.  

This is a sample of the 3-D printed hearts and coronary anatomy models created from patient CT scans to enable anatomical assessment, device sizing and plan which devices to use and navigation for complex structural heart cases at Henry Ford Hospital, Detroit, Mich. These hearts are in the office of Dee Dee Wang, M.D., director of structural heart imaging, at Henry Ford. She is in charge of a robust 3-D printing program to aid the structural heart program, which surpassed its 1,000th patient printed heart earlier in 2019. 

Realted Content With Wang:

VIDEO: Applications in Cardiology for 3-D Printing and Computer Aided Design

VIDEO: The Importance of the Neo-LVOT in Transcatheter Mitral Valve Replacement

Interventional Imagers: The Conductors of the Heart Team Orchestra

Additional articles and videos on Henry Ford Hospital 

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.

Related Content:

VIDEO: What to Look for in PACS Workflow Efficiency

6 Key Health Information Technology Trends at HIMSS 2019

The Building Blocks of Enterprise Imaging

Technology Report: Enterprise Imaging

Find more RSNA 2018 coverage.

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

This video offers an overview of the Watchman left atrial appendage (LAA) occluder system, including information of its design, implantation and clinical data supporting its use. Catheter-based LAA occlusion is used to seal off the LAA in the heart, which is the source of most stroke-causing clots in patients with atrial fibrillation (Afib). The device be used in place of anticoagulation therapy for stroke prevention. 

Related LAA Occlusion Content:

VIDEO: New Data on LAA Occlusion From the PREVAIL and PROTECT Trials — Interview with Vivek Reddy, M.D.

Occluding the Left Atrial Appendage (LAA)

VIDEO: Comparison Between Watchman vs. Amulet LAA Occluders — Interview with Ashish Pershad, M.D.

Device-related Thrombus After Watchman LAA Closure Occurs in Small Number of Patients

Closure of Left Atrial Appendage During Heart Surgery Protects the Brain

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.