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DIAGNOSTIC IMAGING ISSUES

THE DATA EXPLOSION: HOW CAN WE ACHIEVE INTEROPERABILITY F.David Rollo M.D., PhD., FACC, FACNP Chief Medical Officer Philips Medical Systems. MedPac report - Escalating utilization of diagnostic imaging - Diagnostic imaging a major cause of increase in healthcare costs

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DIAGNOSTIC IMAGING ISSUES

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  1. THE DATA EXPLOSION:HOW CAN WE ACHIEVEINTEROPERABILITYF.David Rollo M.D., PhD., FACC, FACNPChief Medical OfficerPhilips Medical Systems

  2. MedPac report - Escalating utilization of diagnostic imaging - Diagnostic imaging a major cause of increase in healthcare costs - No evidence diagnostic imaging improves clinical outcomes - Major cause for increased utilization due to lack of standardization: protocols, training and certification - No evidence diagnostic imaging reduces or eliminates unnecessary or inappropriate procedures - Increased utilization also related to new operating venues: - Physician offices - Stand alone clinics - Shared services DIAGNOSTIC IMAGING ISSUES

  3. MedPac report - Escalating utilization of diagnostic imaging - Diagnostic imaging a major cause of increase in healthcare costs - No evidence diagnostic imaging improves clinical outcomes - Major cause for increased utilization due to lack of standardization: protocols, training and certification - No evidence diagnostic imaging reduces or eliminates unnecessary or inappropriate procedures - Increased utilization also related to new operating venues: - Physician offices - Stand alone clinics - Shared services FOCUS ON INTEROPERABILITY

  4. INTEROPERABILITY ISSUES • Lack of standardization examples: • Acquisition protocols • Clinical validation of post acquisition • processing (Reconstruction) • Guidelines for applying post acquisition • processing • Recommendations on how to optimize image • quality and diagnostic content for devices which • vary in performance • - Between manufacturers • - New vs older technology (Same vendor)

  5. LACK OF STANDARDIZATIONDevice Examples • PET: • - Variations in patient preparation protocols • - Variations in acquisition/processing: 2D/2D; 2D,3D; 3D,3D • - Device design and performance variation • 7 different detector types • 8 different reconstruction alternatives • Spatial resolution variance: 4.5-6.9 mm • NEC variance: 30-80 kcps@ clinical dose • MRI • - Variations in acquisition protocol • - Variations in post acquisition processing • - Device design and performance variation • Open vs closed design • O.25- 7T field strength • Fixed vs variable magnets

  6. GOAL FOR INTEROPERABILITY Consistency in image quality and reproducibility of diagnostic content resulting in: - Increased diagnostic accuracy - Increased confidence in physicians interpretation - Improved decisions regarding most appropriate therapy, WITH, Repeatability of diagnostic decisions for most appropriate therapy independent of the geographical location, vendor or site for service ( access to care)

  7. GOAL: Clinically validate the impact of AC on MPI in terms of: sensitivity/specificity; confidence in interpretation; and appropriateness of referrals to cardiac cath STUDY DESIGN: -250 patients from 3 facilities with MPI with and without AC and cardiac cath results - 10 experienced physicians participated in blinded study to score AC and non AC images in random order for presence of ischemia (1-5), confidence in interpretation and recommendations for cath RESULTS: Sensitivity/ Specificity with and w/o AC:92%, 84%: 88%,82% Confidence with and w/o AC: 89% ,37% Cardiac cath referral with and w/o AC: 8%, 32% ASNC GUIDELINE: All MPI studies should utilize AC IMPROVED DECISIONS FOR THERAPY

  8. IMPROVED IMAGE QUALITY AND DIAGNOSTIC CONTENT • GOAL: Collaborate with MI Pharma to improve image quality and diagnostic content through development of optimized reconstruction software • STUDY DESIGN: • Pharma provided 10 raw data image sets • Device manufacturer developed software optimized for target specific imaging which included :OSEM-3D Recon, Resolution Recovery, Scatter Correction, CT AC and CT for anatomical localization • RESULTS: • System Spatial resolution improved from 8 mm to 5mm • Improved accuracy of lesion detection allows SPECT/CT data to be exported to RTP for IMRT therapy vs Brachytherapy

  9. PATIENT STUDY 76 yr old white male post prostatectomy in 1998 & recent increased PSA Slice #55 ~12,573 counts/slice

  10. PATIENT STUDY 3D FBP OS-EM, 2 it. OS-EM, 3 it. OS-EM, 5 it. w/o correction w/ CDR correction w/ CDR, attenuation w/ CDR, attenuation Butterworth, n=8, fc=0.15/p correction correction & scatter correction 76 yr old white male post prostatectomy in 1998 & recent increased PSA SPECT images show asymmetric radiotracer focus at the left common iliac suspicious for lymph node involvement Original CT Transformed Fused attenuation map CT & SPECT image Slice #55 ~12,573 counts/slice

  11. RECCOMENDATIONS FOR IMPROVED INTEROPERABILITY ACROSS MODALITIES • Cross license clinically validated software solutions to all vendors to standardize protocols and to optimize image quality and diagnostic content for all devices at all points of care • Establish NIH/NCIF data base for all modalities and require that all new reconstruction software be clinically validated and certified in terms of diagnostic accuracy for intended applications • Encourage Professional Medical Societies to establish guidelines for: • - clinical indications for performing studies • - recommended acquisition and processing protocols • - training and certification requirements for staff • - accreditation requirements for facility

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