Project details

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Diagnostic performance of new virtual reality techniques in the catheterization lab to identify coronary artery disease

Keywords:
imaging Virtual Reality Catheterization lab

Researchers:
Prof. dr. P. van der Harst
Drs. R. van Dijk
Drs. D. Ties
dr. E. Lipsic

Nature of the research:
Cardiac imaging with virtual reality techniques

Fields of study:
radiology cardiology

Background / introduction
Patients who have chest pain and who are suspected of having coronary artery disease (CAD) are referred to the catheterization lab to undergo invasive coronary angiography (ICA). In the cath lab, special X-ray images of the coronary artery tree are acquired. These images are visually assessed to determine the presence and severity of coronary atherosclerotic plaques. In case uncertainty exists about the consequences of plaque for the blood flow to the myocardium visually, drop in coronary blood pressure can be measured using fractional flow reserve (FFR). However, the introduction of an invasive pressure wire and induction of maximal blood flow during FFR is associated with patient discomfort, risk of complications and high costs. Despite the reasonable diagnostic performance of current imaging and measurement techniques used in the cath lab, there is an ongoing battle to improve diagnostic accuracy and safety of the ICA and FFR procedure.

Recently developed imaging techniques offer the opportunity to reconstruct a 3D coronary vessel from X-ray images in the cath lab by using virtual reality techniques. These 3D reconstructions can be used to estimate the severity of coronary stenosis caused by atherosclerotic plaque. Clinical care for patients that undergo ICA in the cath lab can be improved by using these virtual reality techniques, since these techniques can replace invasive FFR procedures. This will lead to a reduction in patient discomfort, complication rate and procedural costs. Several virtual reality techniques are applied to acquire 3D reconstructions. Further research regarding diagnostic performance and potential clinical implementations of the varying virtual reality techniques is warranted in order to improve clinical care in the cath lab.
Research question / problem definition
To study and compare the diagnostic performance of different virtual reality techniques against wire-based FFR for the detection of coronary artery disease.
Workplan
As a student on this project, you will be an important part of the research team, since you will acquire 3D reconstructions of coronary vessels using the latest virtual reality techniques. You will be able to attend the catheterization procedures in the cardiac cath lab of the UMCG, that is equipped with latest imaging techniques, including virtual reality techniques.

You will learn how to evaluate X-ray images acquired during ICA and how to operate virtual reality techniques to acquire a 3D reconstruction of the vessel. You will perform virtual analysis on coronary X-ray images of approximately 100 patients who underwent FFR. Diagnostic performance of these virtual reality techniques will be compared against wire-based FFR.

Furthermore, you will be able to expand your research skills by gaining knowledge on statistical analysis (in SPSS or STATA) and data collection (in RedCap, an online database builder). In case of satisfactory performance, the project can be extended to larger sample sizes and other cardiac imaging techniques within our research group.
References
(1) Ties D, van Dijk R, Pundziute G, Lipsic E, Vonck TE, van den Heuvel AFM, et al. Computational quantitative flow ratio to assess functional severity of coronary artery stenosis. Int J Cardiol. 2018;271:36–41.
(2) Fearon WF, Achenbach S, Engstrom T, Assali A, Shlofmitz R, Jeremias A, et al. Accuracy of Fractional Flow Reserve Derived From Coronary Angiography. Circulation. 2019;139(4):477–84.
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