Future of Echocardiography: Unlocking the Power of Volume Imaging


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Join Dr. Dinesh Thavendiranathan of the University of Toronto for a discussion on 3D volume echocardiography in the left heart. Hear how volume echocardiography enables the acquisition of an entire volume of the heart in a single full cardiac cycle and facilitates faster and more accurate analysis via full automation of endocardial contours. Also learn about workflow improvements, more reproducible echo exams and ways to save costs

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Future of Echocardiography: Unlocking the Power of Volume Imaging

  1. 1. Sponsored by Future of Echocardiography Unlocking the Power of Volume Imaging Dinesh Thavendiranathan, MD Cardiologist University of Toronto, Canada
  2. 2. Sponsored by Evolution of Volume Imaging 1. Multiple 2D images of the heart – sort in sequence to create 3D datasets 2. Stitched acquisition: Acquire small sub volumes, store in post processing to generate a full 3D volume. – Require: Good ECG gaiting; regular heart rhythm
  3. 3. Sponsored by Gated Imaging Gating depends on the RR intervals:  Volume segmented into small pieces  Small pieces of volumes obtained in each part of interval  Volumes stitched together = full volume Limitations of stitched acquisition  Irregularity in data  artifacts  Single volume is a combination of multiple different heart beats.
  4. 4. Sponsored by Volume Imaging Obtainentirevolumeoftheheartinasinglefullcardiaccycle Benefits:  No stitching artifacts  Subsequent datasets from multiple continuous or contiguous heart beats
  5. 5. Sponsored by Workflow Previously, post-processing…  Was done offline  Directlyonthemachinefromwhichthedataareacquired.  Is time consuming and sometimes inaccurate Now,wehavesinglebeatfullvolumeimagingwhichbringbenefits:  No stitching artifact  Automationtodetectendocardialcontour improvesthespeedandaccuracytoa previouslymanualprocess  Efficient workflow for sonographers
  6. 6. Sponsored by Workflow & Volume Imaging More attractive and more practical Creates datasets free of artifacts when imaging patients that are sick - arrhythmias or difficulty breath-holding Enables best volume for analysis
  7. 7. Sponsored by Economic and Cost Savings with Volume Echo Cardiac MRI  Cost is higher  Wait time is longer  Takes longer to get a volume dataset Echo more widely available Echo  More widely available  Offers multiple volumetric datasets to analyze vs. cardiac MRI with a single volume dataset, depending on measurements
  8. 8. Sponsored by Benefits of 3D Echo vs. 2D Echo: Diagnosis and Prognosis 3D makes a difference in accurate and reproducible ventricular volumes and ejection fraction Assists in decision-making:  For patients with ischemic heart disease and mitral regurgitation  When changes in ejection fraction and volume over time has an impact on clinical decision – ie surgery
  9. 9. Sponsored by Benefits of 3D Echo vs. 2D Echo: Diagnosis and Prognosis Today, many labs are using 2D methods vs. 3D methods 3D echo should be our standard for ventricular volume and function assessment and post processing Oncology patient population – small changes in ejection fraction to determine changes in chemotherapy Patients with valve disease – volume and function assessment and valves
  10. 10. Sponsored by Reproducibility of 3D Echo Interobserver variability: Measurement of the same dataset by two different people Intraobserver variability: Measurement of the same twice by the same person Test re-test variability: Imaging the person twice, with no change in physiology and comparing the accuracy of the two measurements
  11. 11. Sponsored by Reproducibility of 3D Echo Reproducibility markers very important, better with 3D echo vs. 2D echo Longitudinal reproducibility: 3D echo function over multiple time points over a year 3D echo superior in interobserver, intraobserver, test re-test and longitudinal variability
  12. 12. Sponsored by Reproducibility of 3D Echo What differentiates 3D echo? Post-processing method! Greatest benefit to automated volume technique: Removes observer variability – learned algorithms detect endocardial borders and endocardium
  13. 13. Sponsored by Volume Echo vs. Cardiac MRI Differences in contrast noise ratio and signal to noise ratio Benefits of cardiac MRI: Superior contrast to noise ratio  differentiates blood pool from the endocardium; draw endocardial contours accurately and reproducibly Benefits of 3D echo: Automated methods to measure the endocardium border and endocardial contours in an accurate and reproducible manner Looking at reproducibility: Automated 3D echo and cardiac MRI are quite comparable now vs. older 3D methods
  14. 14. Sponsored by 3D Echo Single Beat Full Volume Acquisition Benefit  Hemodynamic Data In the Past:  DependedonpulsewaveDopplertomeasuremitralinflow,stroke volumesandaorticoutflowstrokevolumes  Calculate mitral regurgitation volume and regurgitative fraction  With 2D echo we’ve had to make several assumptions: - Geometry of mitral inflow orifice as well as the left ventricular outflow tract - Pulse wave Doppler: Measure mitral inflow and aortic outflow in sample volume
  15. 15. Sponsored by 3D Echo Single Beat Acquisition Benefit  Hemodynamic Data Today:  Color Doppler volume imaging measures stroke volumes, velocities intrinsic in data set  Studies show 3D full volume single heart beat echo with color Doppler measure stroke volume of aortic and mitral valves is better than 2D echocardiography  Applied in patients with mitral regurgitation where it matters for the quantification of regurgitation volume and regurgitation fraction  Hemodynamic data provides useful information
  16. 16. Sponsored by Benefits of Hemodynamic Data into the Future  Mitral valve regurgitation: Quantification of aortic regurgitation, more accurate quantification of aortic stenosis and mitral stenosis  Implication in the quantification of QP/QS in cases when shunts present – more accurate measure right and left stroke volume and calculate shunt fraction  Stroke volume measurements have had limitations – now with 3D data and 3D color Doppler we may be able to measure stroke volumes better and use that as a marker of severity of underline cardiovascular disease
  17. 17. Sponsored by Benefits of Hemodynamic Data into the Future  Understand the ventricular hemodynamics better  past: used vortex flows in the ventricle as a marker of ventricular function and changes in ventricular geometry – depend on single, 2D plane  With 3D dataset and real time volume color doppler data, it may help us to understand intraventricular hemodynamics better
  18. 18. Sponsored by Single Beat Full Volume Acquisitions: Changed the Balance Between Qualitative and Quantitative Echo Due to limitations of quantification  Depended on qualitative measures for mitral regurgitation, aortic regurgitation, other valve of the disease quantification and left ventricular function quantification Automated and accurate methods of quantifying volumes function regurgitation fraction will help us move towards quantification rather than just use qualitative methods to access disease severity
  19. 19. Sponsored by Looking Forward Single beat full volume data acquisition and automation have really helped us move forward with 3D echo Future: Single image acquisition for comprehensive echocardiography study  Expand volume dataset to cover the whole heart with real-time color Doppler  we may be able to get a single dataset acquisition of left and right ventricle; or whole volume of heart to use for post-processing and assessment of right left ventricular function and valvular disease severity
  20. 20. Sponsored by Looking Forward Future: Atrial volume and atrial function for disease severity and prediction  Full volume 3D dataset could make a difference in the acquisition of left atrial and right atrial volumes  Real-time volume dataset over multiple consecutive heart beats  potentially use volume to measure atrial function parameters add to data to use in either clinical decision-making or prognosticating
  21. 21. Sponsored by Future of Echocardiography Unlocking the Power of Volume Imaging Dinesh Thavendiranathan, MD Cardiologist University of Toronto, Canada For more information, visit: http://usa.healthcare.siemens.com/ultrasound