Novel WEB Decision Support System for cardiac image interpretation and reporting

描述(申请人提供)：今天的心脏影像领域要求诊断医生掌握一个不断扩大的知识库(KB)，而掌握这些知识、将其应用于特定任务和报销的时间正在稳步缩短。这些限制构成了一个严重的医疗问题，不可避免地导致医生的差错。因此，需要新的工具来帮助医生及时地将全面的、最新的客观知识和可用的患者数据应用于特定的临床问题。我们快速通道建议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的工具来改善对心脏病患者的护理，并降低心脏图像解释的成本，该工具箱提供决策支持，以提高检测冠心病(CHD)的准确性。具体地说，我们提出了一个基于Web的系统，在该系统中，采集的心电门控心肌灌注SPECT(MPS)原始图像被上传到自动重建和分析中，以提取心肌灌注和功能的局部定量参数。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)，该系统不断更新最新的科学/临床知识，以得出对患者心脏状态的印象。DSS得出的这些结论和每个结论的理由被用来自动生成基于网络的结构化报告，供诊断医生轻松审查、学习理由，并修改和/或批准CHD的诊断和预后的最佳准确性。具体地说，我们建议：1)开发一种新型的左心室(LV)定量算法，自动提取左室局部血流参数和用于诊断冠心病的功能；2)开发LV专家(LVX)决策支持系统；3)使用.Net平台设计和实现LV量化和DSS算法，以便它们可以集成到我们的Syntermed基础设施中，部署在网络上和/或用作传统的独立工作站。在第一阶段，我们将开发一个原则证明系统，其中分析来自MPS研究的左心室血流灌注信息，并解释DSS以自动生成报告和医生审查。在第二阶段，该系统将：a)扩展到包括心肌功能、缺血、生存能力和临床风险因素的量化和决策支持系统；b)扩展到包括一种持续更新LVX知识库的方法；c)自动连接部署在.Net上的所有重建、处理、量化、解释和报告应用程序；d)网络上的数据库和电子商务会计能力。使用这一过程，我们期望确认我们的主要假设，即使用我们的决策支持的诊断人员将比没有该系统帮助的相同诊断人员提供更快、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，包括：1)向主要仪器制造商发放许可证；2)向使用个人电脑工作站的客户直接销售；3)使用现有的Syntermed Live网络按网络访问费收费。 与公共卫生相关：医生被要求掌握不断扩大的知识库，并考虑到越来越多的针对患者的临床信息，而可用于掌握这些知识库并将其应用于具体任务的时间正在稳步减少。主要解释核心脏病学研究的心脏病诊断师[Fye04]也越来越缺乏，越来越多的老年“婴儿潮一代”成为患者[Kni02]。这个项目是开发软件工具，将使用来自医学文献和领域专家的最新相关临床和成像知识，并使其在网上可供医生支持他们的医疗决策，以便他们可以做出更快和更准确的诊断，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.