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

Leach博士是一位早期职业医生兼科学家，接受过放射学和计算机科学方面的专业培训。 生物力学，谁寻求继续发展他的职业生涯中VA医疗保健系统。Leach医生 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， 全面帮助患者和临床医生最大限度地提高福祉，预防和减轻痛苦 通过提高对血管疾病的理解、诊断和风险分层。实现 为此，利奇博士寻求额外的指导培训，以进一步发展他的知识和专业知识，在两个关键 方法：1）他在血管疾病的基于成像的分析方面的科学技能的进步， 解剖表征，包括成分分析、生物力学和提取的生物特征 从先进的成像，和2）在临床放射学和血管成像研究界的领导地位。 改善患者和医疗保健部门对腹主动脉瘤（AAA）的管理 系统水平需要新的能力来区分动脉瘤， 从那些将迅速逐渐扩大和可能破裂的静止。为此，我们必须 除了目前AAA监测的范例，其仅涉及测量动脉瘤大小， 并找到评估其他易导致快速进展的AAA特征的方法。利奇博士完全可以 定位于追求强大的AAA评估新方法的发展，由于他先进的 科学的培训和熟悉AAA疾病的复杂性，其临床管理， 目前的成像评估和未来发展的可能性令人印象深刻的同时缺点。 在这项应用中，Leach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联合收割机结合起来， 专门知识在血管的成像为基础的生物力学分析，以执行必要的发展 这将允许越来越多的患者特异性几何和生物力学AAA分析（目标1和2）， AAA的多参数和多时间点评价，并将以假设驱动的研究为高潮 AAA特征及其与动脉瘤进展的相关性（目标3）。这项工作的核心是仔细 对基于MRI的先进方法与基于CT的实际标准方法进行测试和基准测试 AAA评估，以确定复杂性和精确性之间的适当平衡， 价格和成本]。Leach博士对这些进步的追求需要与 VA的放射科医生和成像研究人员、血管外科医生和计算机科学家社区，以及 为利奇博士提供了一个自然的机会，以扩大他在该社区的领导。 拟议的研究和职业发展计划预计将有意义地提高我们的能力， 在患者特定的基础上全面评估AAA的进展风险，并为Leach博士做好准备， 在血管成像和血管研究领域的领导作用。为了在科学上取得成功， 和培训方面的建议，利奇博士已经组建了一个特殊的导师和顾问团队 他们本身就是血管成像（Hope，Saloner），图像处理和 计算分析（Mitsouras），[[and cardiovascular surgery（Gasper，Tseng）]。Leach博士的培训计划 包括直接指导的经验，正式的课程和研讨会，以及结构化的咨询， 顾问。该提案的研究和培训部分将共同装备和建立利奇博士 作为一名有能力的独立调查员，有能力在2012年的后几年提交Merit Review申请。 CDA时期。[[Dr利奇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，他将在退伍军人事务部建立一个研究计划，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.]]