Novel WEB Decision Support System for cardiac image interpretation and reporting

描述（由申请人提供）：当今的心脏成像领域要求诊断医生掌握不断扩大的知识库（KB），而掌握这些知识、将其应用于特定任务和报销的时间却在稳步缩短。这些限制造成了严重的医疗保健问题，不可避免地导致医生的错误。因此，需要新的工具来帮助医生及时应用全面的、最新的客观知识和可用的患者数据来解决特定的临床问题。我们快速通道提案的长期目标是通过为可通过网络访问的心脏工具箱开发新工具来改善心脏病患者的护理并降低心脏图像判读的成本，该工具箱提供决策支持以提高检测冠心病 (CHD) 的准确性。具体来说，我们提出了一个基于 WEB 的系统，其中上传获取的心电门控心肌灌注 SPECT (MPS) 原始图像，进行自动重建和分析，以提取心肌灌注和功能的区域定量参数。这些参数被转换为异常的确定性因素，并提交给成像决策支持系统（DSS），该系统根据最新的科学/临床知识不断更新，以获得对患者心脏状态的印象。 DSS 得出的这些结论以及每个结论的理由用于自动生成基于网络的结构化报告，以便诊断医生轻松审查、从理由中学习，并修改和/或批准 CHD 诊断和预后的最佳准确性。具体来说，我们建议：1）开发一种新型左心室（LV）定量算法，自动提取左心室区域灌注参数和用于诊断冠心病的功能； 2) 开发 LV 专家 (LVX) DSS，3) 使用 .net 平台设计和实施 LV 量化和 DSS 算法，以便将它们集成到我们的 Syntermed 基础设施中并通过网络部署和/或用作传统的独立工作站。在第一阶段，我们将开发一个原理验证系统，对来自 MPS 研究的 LV 灌注信息进行分析，并对 DSS 进行解释，以用于自动报告生成和医生审查。在第二阶段，该系统将：a) 扩展到包括心肌功能、缺血、活力和临床风险因素的量化和 DSS，b) 扩展到包括持续更新 LVX 知识库的方法，c) 自动链接所有重建、处理、量化、解释和报告应用程序，d) 部署在具有数据库和电子商务会计功能的 .net 网络上。通过这个过程，我们希望证实我们的主要假设，即使用我们的决策支持的诊断医生将比没有该系统帮助的相同诊断医生提供更快、更准确的 CHD 诊断和预后。该系统将利用 Syntermed 的其他 Emory 软件的成功战略进行商业化，具体方式为：1) 向主要仪器制造商授权，2) 直接销售给使用 PC 工作站的客户，3) 使用现有的 Syntermed Live 网络按 WEB 访问收费。 公共卫生相关性：医生需要掌握不断扩大的知识库，并考虑到越来越多的患者特定临床信息，而掌握该知识库并将其应用于特定任务的时间却在稳步缩短。主要解释核心脏病学研究的心脏诊断医生 [Fye04] 也越来越短缺，而成为患者的老龄化“婴儿潮一代”的数量也不断增加 [Kni02]。该项目旨在开发软件工具，使用来自医学文献和领域专家的最新相关临床和影像知识，并使其可以通过网络提供给医生来支持他们的医疗决策，以便他们能够做出更快、更准确的诊断，避免误诊和患者管理不善。

DESCRIPTION (provided by applicant): Today's cardiac imaging field requires diagnosticians to master an ever-expanding knowledge base (KB) while the time to master this knowledge, apply it to specific tasks and reimbursement are steadily shrinking. These constraints pose a serious healthcare problem that inevitably leads to physician's errors. Thus new tools are required to assist physicians to timely apply comprehensive, up-to-date objective knowledge and the available patient data to specific clinical problems. The long-term objective of our Fast-Track proposal is to improve the care of cardiac patients and reduce the cost of cardiac image interpretation by developing new tools for a WEB-accessible cardiac toolbox that provides decision support to increase the accuracy of detecting coronary heart disease (CHD). Specifically, we propose a WEB-based system where acquired ECG-gated myocardial perfusion SPECT (MPS) raw images are uploaded to be automatically reconstructed and analyzed to extract regional quantitative parameters of myocardial perfusion and function. These parameters are converted to certainty factors of abnormality and submitted to an imaging decision support system (DSS) that is continuously updated with the latest scientific/clinical knowledge to reach an impression of the patient's heart status. These conclusions reached by the DSS and justifications for each conclusion are used to automatically generate a web-based structured report for the diagnostician to easily review, learn from the justifications, and either modify and/or approve for optimal accuracy of the diagnosis and prognosis of CHD. Specifically we propose to: 1) develop a novel left ventricular (LV) quantitative algorithm that automatically extracts parameters of left LV regional perfusion and function used to diagnose CHD; 2) develop the LV expert (LVX) DSS and 3) design and implement the LV quantification and DSS algorithms using the .net platform so that they can be integrated into our Syntermed infrastructure and deployed over the web and/or used as conventional stand- alone work-stations. In Phase I we will develop a proof-of-principle system where LV perfusion information from MPS studies is analyzed and DSS interpreted for automatic report generation and physician review. In Phase II, the system will be: a) extended to include quantification and DSS of myocardial function, ischemia, viability and clinical risk factors, b) extended to include a methodology to continuously update LVX's KB, c) automated to link all the reconstruction, processing, quantification, interpretation, and reporting applications, and d) deployed in .net on the web with database and eCommerce accounting capability. Using this process we expect to confirm our primary hypothesis that diagnosticians using our decision support will provide a faster, more accurate diagnosis and prognosis of CHD than those provided by the same diagnosticians without the aid of this system. The system will be commercialized using Syntermed's successful strategy of other Emory software through: 1) licensing to major instrumentation manufacturers, 2) direct sales to clients that use PC workstations and 3) per WEB-access fee using the existing Syntermed Live network. PUBLIC HEALTH RELEVANCE: Physicians are required to master an ever-expanding knowledge base and take into account an ever increasing amount of patient-specific clinical information while time available to master this knowledge base and apply it to specific tasks is steadily shrinking. There is also an increasing shortage of cardiac diagnosticians [Fye04] who primarily interpret nuclear cardiology studies and an ever increasing number of aging "Baby Boomers" who are becoming patients [Kni02]. This project is to develop software tools that will use the latest pertinent clinical and imaging knowledge from the medical literature and domain experts and make it WEB-available to physicians to support their medical decisions so they can make faster and more accurate diagnosis and avoid misdiagnosis and patient mismanagement.