# Presentation: 154994

##  THE DATA EXPLOSION:HOW CAN WE ACHIEVEINTEROPERABILITY F.David Rollo M.D., PhD., FACC, FACNPChief Medical OfficerPhilips Medical Systems

##  DIAGNOSTIC IMAGING ISSUES     

***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         

***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 ***
***    ***
***   ****** ***

##  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)******  ***
***    ***
***    ***
***   ****** ***

## LACK OF STANDARDIZATIONDevice 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******   ***
***  ***
***    ***
***    ***
***   ****** ***

## 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)***
***     ***

##     IMPROVED DECISIONS FOR THERAPY        

***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 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 ***
***    ***
***   ****** ***

## PATIENT STUDY 

**PATIENT STUDY**

**76 yr old white male post prostatectomy in 1998 & recent increased PSA**

## PATIENT STUDY 

**Original CT                 Transformed                      Fused  **
**                                  ****attenuation map        CT & SPECT image**

**           ****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**

**PATIENT STUDY**

**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 **

## 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 ***
***    ***
***   ****** ***