AN INNOVATIVE ULTRASOUND-BASED PROSPECTIVE-GATING TECHNIQUE FOR CARDIAC COMPUTED

描述(由申请人提供)：这份K-23提案描述了一个多学科、跨领域的职业发展计划，该计划将使首席研究员、心胸和腹部放射科医生和电气工程师成为心血管成像领域富有成效的独立翻译研究员。这项研究的目的是融合计算机断层扫描(CT)和实时超声(US)的独特能力，提供门控信号，以获得冠状动脉的无运动CT图像。PI假设US可以直接评估心脏机械运动，并且在确定一个心动周期内的相对心脏运动方面将比ECG更可靠。US提供的实时数据类似于心电图仪。冠状动脉疾病是一个重要的国家医疗保健问题，目前对冠状动脉疾病的评估基于以下两种方法：(1)导管冠状动脉造影术(CCA)，其非常昂贵且具有侵入性，且有已知的重大并发症；(2)CT冠状动脉造影术(CTCA)，其目前的形式要么是辐射密集型的，要么是由于运动伪影而不可靠的。在目标1中，PI将评估超声门控与心电门控在确定相对心脏静止方面的相对价值。在目标2中，PI将评估美国派生的门控参数相对于心电门控在从回溯性门控CT扫描生成无运动CTCA方面的有效性。对于目标3，PI将启动基于数字信号处理和现场可编程门阵列技术的原型硬件的设计和仿真，为CTCA提供最佳、预期的实时触发。构建硬件的基本原理是，心脏CT预期触发的严格时间分辨率要求要求US对大量数据进行实时分析；这不能通过软件实时完成。所提出的基于机械信号的门控方法是CTCA的一种范式转换，可能导致一种经济、低辐射、快速、非侵入性和可靠的冠状动脉评估技术。这一发展最重要的意义将是减少诊断的、侵入性的、显示“正常”动脉的颈动脉及其相关并发症的数量，从而显著节省医疗成本。更广泛地说，这种基于美国的门控技术的潜在影响是，它可以直接应用于其他诊断问题，包括正电子发射断层扫描-CT的呼吸门控和放射治疗。拟议的K23奖学金利用了PI结合工程学和医学的背景，以及由世界知名科学家和内科科学家组成的精心挑选的多元化导师/咨询委员会。职业发展计划有三个主要组成部分：技术部分、翻译部分和临床部分。技术部分涉及开发一种基于硬件的触发技术，该技术将在一位生物医学成像领域的顶尖科学家和一位具有广泛学术和工业经验的工程学教授的指导下进行。佐治亚理工学院电气和计算机工程系以及生物医学工程系将提供图像/信号处理和硬件设计方面的其他重点教学指导。翻译部分包括由埃默里大学临床研究理学硕士项目提供的教学部分，以及由北美放射学会提供的成像临床试验研讨会。最后，将在埃默里大学放射科和心脏科的国际公认的心血管成像先驱的指导下，进行涉及收集和分析US、CG和CT数据的临床研究部分。该计划将在一个处于医学成像、心脏病学和生物医学工程前沿的环境中进行，拥有广泛的临床、教育和研究资源。

DESCRIPTION (provided by applicant): This K-23 proposal describes a multidisciplinary, cross-cutting career development program, which will enable the Principal Investigator, a Cardiothoracic and Abdominal Radiologist, and an Electrical Engineer, to become a productive independent translational researcher in cardiovascular imaging. The objective of the proposed research is to merge the unique capabilities of computed tomography (CT) and real-time ultrasound (US) to provide a gating signal in order to obtain motion-free CT images of coronary arteries. The PI hypothesizes that US, which provides real-time data similar to electrocardiography (ECG), can directly evaluate cardiac mechanical motion and would be more reliable than ECG at determining relative cardiac akinesia within a cardiac cycle. Coronary artery disease is a significant national healthcare issue, and the evaluation of coronary artery disease is currently based on either (1) catheter coronary angiography (CCA), which is very expensive and invasive with known significant complications or (2) CT coronary angiography (CTCA), which, in its current forms, is either radiation-intensive or unreliable due to motion artifacts. In Aim 1, the PI will evaluate US-gating relative to ECG-gating in determining relative cardiac quiescence. In Aim 2, the PI will evaluate the efficacy of US-derived gating parameters relative to ECG-gating in generating motion-free CTCA from retrospectively-gated CT scans. For Aim 3, the PI will initiate the design and simulation of prototype hardware based on Digital Signal Processing and Field Programmable Gate Array technologies to provide an optimal, prospective real-time trigger for CTCA. The rationale for building hardware is that the stringent temporal resolution requirements for prospective triggering of cardiac CT dictate that the US analysis be performed in real-time on a large volume of data; this cannot be accomplished by software in real-time. The proposed method of gating based on mechanical signals is a paradigm-shift for CTCA and could result in an economical, low-radiation, rapid, non-invasive and reliable technique for evaluating coronary arteries. The most important implication of this development will be a reduction in the number of diagnostic, invasive CCAs that reveal "normal" arteries, and their associated complications, resulting in dramatic healthcare cost savings. More broadly, the potential impact of this US-based gating technique is that it can be applied directly to other diagnostic problems including respiratory gating for positron-emission tomography-CT and radiation therapy. The proposed K23 scholarship takes advantage of the PI's background combining engineering and medicine and the carefully selected, diverse mentorship/advisory committee which is comprised of world- renowned scientists, and physician-scientists. The career development program has three major components: a technical component, a translational component and a clinical component. The technical component involves the development of a hardware-based triggering technique which will be performed under the mentorship of a leading scientist in biomedical imaging and an engineering professor with extensive academic and industrial experience. Additional focused didactic instruction in image/signal processing and hardware design will be obtained from the Electrical and Computer Engineering and the Biomedical Engineering Departments of the Georgia Institute of Technology. The translational component involves a didactic component, provided by Emory University's Master of Science in Clinical Research program and an Imaging Clinical Trials workshop offered by the Radiological Society of North America. Finally, a clinical research component that involves gathering and analyzing US, ECG and CT data will be performed under the mentorship of internationally recognized pioneers in cardiovascular imaging from the Departments of Radiology and Cardiology at Emory University. The program would take place in an environment which is at the cutting edge of medical imaging, cardiology, and biomedical engineering, with extensive clinical, educational and research resources.