Purpose:
The dynamic evolution of cardiac multimodal imaging is based on the increasing clinical interest on the use of different and complementary data to evaluate cardiac diseases. This is supported by the development of technologies related to single or hybrid imaging devices. The increasing use of combined imaging for diagnosis and clinical decision requires to choose an appropriate diagnostic path combining, step by step, invasive and/or noninvasive tests.
The costrisk-benefits balance represents the key element of multimodal path definition. The purpose of this work is to present a new web-based educational tool (EduCAD) directed to young cardiologists for training in the appropriate use of multimodal imaging technology for diagnosis of ischemic heart
disease, thus promoting the culture of multimodal imaging for cardiac diseases assessment.
The main proposal is to allow user to choose among different validated clinical cases and to build up for each case an optimal imaging diagnostic pathway on the basis of clinical evidence and appropriateness criteria for the use of noninvasive and invasive tests. The final user’s conclusion and diagnostic imaging pathway is compared to the opinion of expert specialists.
EduCAD website offers several clinical cases accurately selected from the EVINCI study (European Project: Evaluation of INtegrated Cardiac Imaging for the Detection, Characterization and Monitoring of Ischemic Heart Disease, 7th FWP, reference number 222915) population in order to train the user in relevant pathological conditions.
Methods:
The web-based educational software has been developed using Adobe Flash technology (Adobe Systems incorporated, San Jose, California) and included into a dedicated
website. Further project information and useful instructions to the best use of the educational tool are also added to the site. Each clinical case provided by the EduCAD tool is composed by both stress imaging and anatomical imaging.
In the first case, PET or SPECT, for myocardial perfusion evaluation, and MR or ECHO for the assessment of myocardial wall motion are provided. Generally both CTA and ICA anatomical tests, used to estimate the degree of coronary artery stenosis, are supplied. This could be useful to compare noninvasive test with the invasive one that represents the gold standard in anatomic evaluation. For each involved modality, the educational software has been implemented in order to show standard views images, normally used in clinical assessment. EduCAD expert’s opinion is given for each modality as well as for diagnostic and therapeutic conclusions.
Starting from the evaluation of pre and post stress-ECG CAD probability, the user may choose to start his diagnostic investigation. At each step the user can choose between available imaging modalities, in order to acquire new data with the purpose to give his final opinion on the evaluated clinical case.
Two educational constraints limit the player to include at most one stress imaging and not to choose other tests after the selection of the ICA invasive modality. At each step of the pathway, the user is asked to give his modality evaluation and optionally to compare it with the expert’s opinion. At the end, the user must give his final diagnosis and related therapy.
Moreover, at this stage, a general comment on the clinical case and on the suggested pathway is provided by the expert specialists. If needed the users will be able to review and/or replay the clinical case making a more accurate analysis.
Results: The first release of the EduCAD educational tool was tested using 10 clinical cases select from the EVINCI study. The involved young and expert cardiologists gave a good opinion about the developed tool.
Conclusion:
The proposed educational tool has been developed with the purpose to train youngcardiologists in the use of multimodal imaging. This goal has been pursued considering both the
accuracy of clinical diagnosis and therapy and the appropriateness of multimodal imaging pathway used to reach the final decision. Moreover, the developed educational tool has the potential to train in the evaluation of hybrid images resulting from the integration and fusion of different modalities.
In a more advanced idea the user will be allowed to connect directly with a dedicated imaging server and access the raw imaging data performing his own reconstruction and analysis before giving his interpretation.
In the next project scenario the new clinical cases will be validated and selected by a dedicated scientific committee and new technological solutions will be considered.