Imaging-based biomechanical assessment of abdominal aortic aneurysms for improved progression risk prediction

利奇博士是一名职业生涯早期的内科科学家，曾接受过放射学和计算机方面的专业培训。 生物力学，他寻求在退伍军人管理局医疗保健系统内继续发展他的职业生涯。利奇医生的 长期的职业目标是利用他所有的临床和研究知识和专业知识来 全面帮助患者和临床医生最大限度地增进福祉，预防和减轻痛苦 通过改善对血管疾病的理解、诊断和风险分层。要实现 为此，利奇博士寻求额外的指导培训，以进一步发展他在两个关键方面的知识和专长 方法：1)提高他在基于成像的血管疾病分析方面的科学技能 解剖特征，包括成分分析、生物力学和提取的生物特征 来自先进的成像，以及2)在临床放射学和血管成像研究领域的领先地位。 从病人和医疗保健两方面改善腹主动脉瘤(AAA)的管理 系统水平需要新的能力来区分将保持稳定和临床的动脉瘤 从那些会迅速逐渐扩大甚至可能破裂的地方静止下来。要做到这一点，我们必须迈出 除了目前的AAA监测模式，它只涉及测量动脉瘤的大小， 并找到评估其他易于快速进展的AAA特征的方法。利奇博士是完美的 由于他的先进，他致力于开发强大的AAA评估新方法 科学培训和熟悉AAA病的复杂性、临床处理和 目前成像评估的不足之处和未来发展的令人印象深刻的可能性。 在这项应用中，利奇博士的目标是将他在血管放射学和技术方面的临床专业知识结合起来 以影像为基础的血管生物力学分析的专业知识，以执行必要的开发 这将使更多针对患者的几何和生物力学AAA分析(目标1和2)成为可能， AAA的多参数和多时间点评估，并将在假设驱动的研究中达到顶峰 AAA的特征及其与动脉瘤进展的关系(目标3)。这项工作的中心是细心 基于MRI的先进方法与事实上标准的基于CT的方法的测试和基准比较 AAA评估，以确定复杂性与精确度和广度之间的适当平衡 可得性和成本。]]利奇博士对这些进步的追求需要与 退伍军人管理局的放射科医生和影像研究人员、血管外科医生和计算机科学家组成的社区，以及 为利奇博士提供了一个自然的机会来扩大他在那个社区的领导力。 拟议的研究和职业发展计划有望显著提高我们的能力 根据患者的具体情况全面评估AAA的进展风险，并为利奇医生准备 在血管成像和血管研究领域发挥领导作用。以促进科学研究的成功 在建议的培训和培训方面，利奇博士组建了一支由导师和顾问组成的非凡团队 他们本身就是血管成像(霍普、塞隆纳)、图像处理和 计算分析(Mitouras)，[和心血管外科(Gasper，Tseng)]]。利奇博士的训练计划 由直接指导的经验、正式的课程和研讨会以及来自 顾问。这项提案的研究和培训部分将共同装备和建立Dr Leach 作为一名有能力的独立调查员，能够在年末提交功绩审查申请 CDA时期。[[利奇博士致力于推进退伍军人和其他血管疾病患者的护理， 通过拟议的研究和培训，他将在退伍军人管理局建立一个研究计划，以实现这一目标。]]

Dr Leach is an early career physician-scientist with specialty training in radiology and computational biomechanics, who seeks to continue developing his career within the VA health care system. Dr Leach’s long-term career goal is to use all of his clinical and research knowledge and expertise to comprehensively help patients and clinicians maximize wellbeing and prevent and alleviate suffering through improved understanding, diagnosis, and risk stratification of vascular diseases. To achieve this, Dr Leach seeks additional mentored training to further develop his knowledge and expertise in two key ways: 1) advancement of his scientific skills in imaging-based analysis of vascular disease that steps beyond anatomic characterization, to include compositional analysis, biomechanics, and biological features extracted from advanced imaging, and 2) leadership in clinical radiology and the vascular imaging research community. Improving management of abdominal aortic aneurysms (AAA) at both the patient and health care system levels necessitates new capabilities to distinguish aneurysms that will remain stable and clinically quiescent from those that will rapidly progressively enlarge and possibly rupture. To do this, we must step beyond the present paradigm of AAA surveillance, which involves no more than measuring the aneurysm size, and find ways to assess other AAA features that predispose to rapid progression. Dr Leach is perfectly positioned to pursue development of powerful new methods of AAA assessment, owing to his advanced scientific training and intimate familiarity with the complexity of AAA disease, its clinical management, and the simultaneous shortcomings of current imaging evaluation and impressive possibilities for future development. In this application, Dr Leach aims to combine his clinical expertise in vascular radiology and technical expertise in imaging-based biomechanical analysis of blood vessels to perform the necessary developments that will permit increasingly patient-specific geometric and biomechanical AAA analysis (Aims 1 and 2), multiparametric and multi-timepoint evaluation of AAA, and will culminate in a hypothesis-driven investigation of AAA features and their associations with aneurysm progression (Aim 3). [[Central to this work is careful testing and benchmarking of advanced MRI-based methods against the de facto standard CT-based methods of AAA assessment, to determine the appropriate balance between sophistication and precision and wide availability and cost.]] Dr Leach’s pursuit of these advancements necessitates close interaction with the community of radiologists and imaging researchers, vascular surgeons, and computer scientists at the VA, and provides a natural opportunity for Dr Leach to expand his leadership within that community. The proposed research and career development plan is expected to meaningfully advance our ability to comprehensively assess the progression risk of AAAs on a patient-specific basis and prepare Dr Leach for leadership roles in the vascular imaging and vascular research domains. To facilitate success in the scientific and training aspects of the proposal, Dr Leach has assembled an exceptional team of mentors and advisors who are themselves respected leaders in vascular imaging (Hope, Saloner), image processing and computational analysis (Mitsouras), [[and cardiovascular surgery (Gasper, Tseng)]]. Dr Leach’s training plan consists of directly mentored experiences, formal coursework and workshops, and structured counseling from advisors. The research and training components of this proposal will collectively equip and establish Dr Leach as a capable independent investigator well-positioned to submit a Merit Review application in the later years of the CDA period. [[Dr Leach is committed to advancing the care of veterans and others with vascular disease, and through the proposed research and training, he will build a research program at the VA toward this goal.]]