therapy to facilitate breath-holding), acquisition parameters (compromise between
spatial and temporal resolution), and injection parameters. This innovation includes
post-processing techniques that have been introduced by radiologists on site. At first,
CT manufacturers have developed fast, reliable reconstruction software packages,
providing 2D and 3D images in any plane, but the extensive clinical experience of
the CCN radiologists required new tools to extract all the information contained in
this ECG gate, multiphase volume acquisition. With a 64-row detector CT, any
cardiac examination represented a set of 2700 images and the radiologists of CCN
developed a new workflow in order to cope with this amount of data, while
managing the accuracy of the potential CAD assessment.
14 Consequently, they
initiated a rigorous multiphase review protocol: (1) morphologic and kinetic study
of left ventricular wall and cardiac valves, (2) selection of diastolic and systolic
phases for function analysis, (3) selection of the best phases for the right coronary
artery and for the left coronary system.
Medical users accumulate through their clinical experience tacit knowledge. The
medical device manufacturer or medical software companies possibly capture and
codify to bring patient-centric solutions. This transfer process involves numerous
interactions between clinical users and software engineering team from heterogeneous organizations.
Innovation of that kind contributes in healthcare to some possible paradigm shift:
the CT cardiac imaging enables coronary investigation and a search for myocardial
lesions in a single outpatient visit, when its noninvasive dimension and its
“protocolization” expand the number of patients who may benefit from this technique.
15 In turn, this new clinical solution being introduced, clinical practitioners
face the difficulty of fixing the right indications for its use in specific clinical
situations. Prescription of the new examination will depend on not only its clinical
relevance but also its freedom from risk, its cost, and the availability of equipment.
For some clinical indications, it is complementary to traditional techniques,
16 while
in others it can replace them as shown in Fig. 2.
Our field study shows that CT cardiac angiography (measured by occurrence of
this term in medical publications) rapidly gained acceptance, from 2006 and still
growing with the recent advances such as CT perfusion imaging and fractional flow
reserve CT (FFR-CT), as portrayed in Fig. 3.
14 Ibid.
15 We find protocol examples in a public website dedicated to the Medical Radiology Industry, Aunt
Minnie, in a subsection named Cardiac Imaging Community, accessed from http://www.
auntminnie.com/ on June 8, 2009.
16 For instance, balloon angioplasty is a surgical procedure in which a small balloon is inserted and
inflated to open narrowed or blocked blood vessels of the heart (coronary arteries). A coronary stent
is a semiflexible tube left in place to hold open the previously clogged artery.
110
J. Galbrun
spatial and temporal resolution), and injection parameters. This innovation includes
post-processing techniques that have been introduced by radiologists on site. At first,
CT manufacturers have developed fast, reliable reconstruction software packages,
providing 2D and 3D images in any plane, but the extensive clinical experience of
the CCN radiologists required new tools to extract all the information contained in
this ECG gate, multiphase volume acquisition. With a 64-row detector CT, any
cardiac examination represented a set of 2700 images and the radiologists of CCN
developed a new workflow in order to cope with this amount of data, while
managing the accuracy of the potential CAD assessment.
14 Consequently, they
initiated a rigorous multiphase review protocol: (1) morphologic and kinetic study
of left ventricular wall and cardiac valves, (2) selection of diastolic and systolic
phases for function analysis, (3) selection of the best phases for the right coronary
artery and for the left coronary system.
Medical users accumulate through their clinical experience tacit knowledge. The
medical device manufacturer or medical software companies possibly capture and
codify to bring patient-centric solutions. This transfer process involves numerous
interactions between clinical users and software engineering team from heterogeneous organizations.
Innovation of that kind contributes in healthcare to some possible paradigm shift:
the CT cardiac imaging enables coronary investigation and a search for myocardial
lesions in a single outpatient visit, when its noninvasive dimension and its
“protocolization” expand the number of patients who may benefit from this technique.
15 In turn, this new clinical solution being introduced, clinical practitioners
face the difficulty of fixing the right indications for its use in specific clinical
situations. Prescription of the new examination will depend on not only its clinical
relevance but also its freedom from risk, its cost, and the availability of equipment.
For some clinical indications, it is complementary to traditional techniques,
16 while
in others it can replace them as shown in Fig. 2.
Our field study shows that CT cardiac angiography (measured by occurrence of
this term in medical publications) rapidly gained acceptance, from 2006 and still
growing with the recent advances such as CT perfusion imaging and fractional flow
reserve CT (FFR-CT), as portrayed in Fig. 3.
14 Ibid.
15 We find protocol examples in a public website dedicated to the Medical Radiology Industry, Aunt
Minnie, in a subsection named Cardiac Imaging Community, accessed from http://www.
auntminnie.com/ on June 8, 2009.
16 For instance, balloon angioplasty is a surgical procedure in which a small balloon is inserted and
inflated to open narrowed or blocked blood vessels of the heart (coronary arteries). A coronary stent
is a semiflexible tube left in place to hold open the previously clogged artery.
110
J. Galbrun