INVIA Coronary Flow Reserve Training

Coronary flow reserve or CFR quantification is an important tool in evaluating the health of a patient's heart. Here in Via, it's our mission to improve patient care and by developing for DM Patsy Fr. We're moving in that direction. This video describes CFR who benefits from it the importance of the acquisition and how to utilize 40M in your diagnosis. Traditional myocardial perfusion imaging, or MPI normalizes the tracer distribution to the region of the left ventricle with the highest uptake. This method assumes the tissue in that region is healthy relative to the surrounding area. Impatience with the entire myocardium is compromised or unhealthy. There's a potential for misdiagnosis, an underestimation of the true extent of disease. With the quantification of CF, our cardiac professionals now have the ability to assess blood flow more accurately. How it's all about timing. See if our looks at the rate of absolute myocardial blood flow and the change in the rate of blood flow from stress to rest. The tracer is tracked from the moment of injection as it passes through the heart and during the right ventricle passing through the left ventricle and then taken up by the ventricular tissue. Traditional pet MPI is limited and then it starts the evaluation of flow, typically at the two minute mark. Once the tracer has cleared the left ventricle and entered the tissue. These first 2 minutes are important because it is at this time that the scanner is able to track the rate of the tracer and therefore the blood flow as it makes its first pass through the chambers of the heart. Higher speeds indicate a better flow and a healthier heart. Once the tracer has made its first pass and absorbed into the ventricular myocardium, the pet detectors are no longer able to measure rate. Not all scanners are capable of tracking tracer rate during those first 2 minutes, since that measurement requires high resolution, high sensitivity pet imaging systems. See if our quantification has been shown to check balance this kimia as well as coronary artery disease. At an earlier stage. See if R is also used to measure improvements in blood flow after procedures such as stenting or bypass grafting have been performed. In patients undergoing drug therapy, see if are can help evaluate effectiveness of medical treatment earlier. Enabling physicians to adjust if needed. Patients are most often referred for Patsy Fr if they have known macro or micro vascular disease or a history of heart attacks. A patients referred for standard SPECT or PET imaging may also benefit from Patsy of our studies, especially patients with an intermediate risk or above, and those who cannot exercise. When a patient has the option for Patsy Fr versus standard Pat imaging, it is in their best interest. Optiv hezi Fr valuation. This was decisively shown by a study published in circulation in which 2783 patients referred for standard Pat imaging were re evaluated with the addition of ceafar quantification. 17% of the patients who originally classified as intermediate risk were reclassified to high risk and 34% were reclassified to low risk after see if our imaging was performed. See if our quantification significantly improves patient risk assessment over standard pet analysis. PET scanners are currently required for CFR quantification and review. GE, Siemens and positron manufacture scanners validated for such acquisitions, acquiring high Resolution image data in list mode. List mode image data acquisitions are capable of creating dynamic static and gated datasets from the same acquisition. It's dynamic image series created from the time of injection until the end of imaging that is required for quantitative flow calculations. Either of two pet radiopharmaceuticals are typically used rubidium 82, using a 6 minute dynamic acquisition protocol. Or a 6 to 10 minute dynamic acquisition protocol using ammonia. Image acquisition begins with EKG heart monitors being attached to the patient. The patient undergoes two brief CT scans prior to tracer injection for positioning an attenuation correction. The patient's heart is centered in the scanner, and the technologist begins the PET scan. Simultaneously, the patient is injected with the pet tracer. Rubidium 82. A description of the rest Stress Rubidium protocol follows. Approximately 3 minutes after the six minute rest Rubidium acquisition completes the first dose of Rubidium has decayed to less than 1% of the initially injected activity. The patient is then injected with a pharmacologic stress are in this case ready Denison. The technologist begins the stress scan approximately one minute after The Reg adenosine injection with the simultaneous injection of a second dose of rubidium. The stress scan, like the rest, can last 6 minutes. Once the scan is completed, the patient's heart rate is monitored for a few additional minutes. Note that the image data used for CF are quantification begins from the moment of injection. The first 2 minutes of data for both stress an rescans is critical to be captured correctly for the accurate quantification of blood flow. As with all acquisitions, it is important that the patient lie completely still to ensure consistent flow from the injection site into the heart. Using the reconstruction software on the acquisition workstation, the technologist first create static and EKG gated stress and rest image datasets. He then bins the data into rest and stress dynamic datasets. Binning means the list mode data is reconstructed into a series of frames or images beginning with the time of injection until the end of the acquisition. Typically, these frames are approximately 10 second duration for the first minute or two and then become progressively longer until the end of the acquisition, creating several 3D image volumes which are defined as a dynamic datasets. The dynamic datasets allow 40 M to assess the points in time when the trees are transitive, the right and left ventricles, as well as when it refused into the heart wall of the left ventricle. At this point, the technology shifts over to the processing workstation and launches the reconstructed datasets into 40 M to begin the 40 amp. At see of our review. Beginning on the MI processing screen, the technologist verifies the orientation LV surface is and the results that 40 M auto processed for all reconstructed datasets. The technologist can now process the study for CF are using the reserve screen. First, he confirms that the ventricular tissue boundaries are properly sized and ensures that the perfusion images captured through the short axis horizontal long axis and vertical long axis volumes by using the contours tool. He then quantified the data using the selected algorithm with a left click of the process tool. Here we use the automated factor analysis algorithm. Additional processing methods are available within 40 M including the region of interest method. The technologist then click save to complete his workflow. When the physician launches the patient, the technologist modifications, if any, automatically display. The reserve screen is worth of position focuses. Is CF our evaluation. On this screen he first performs quality assurance by reviewing the time activity curves to verify that the auto processing correctly identified RV and LV bloodpool curves and tissue curves. The RV curve in blue should peak somewhat higher than the Green LV curve peaks, which indicates the tracer activity in the RV was greater as it made its first pass through the right ventricle last. So by the time it passed through the left ventricle. The RV curve peak should also display to the left of the LV curve peak to indicate that the tracer entered the RV at a point in time prior to when entered the LV. The next step in the physician's qualitative analysis is to review the factor assignments or blood pool in the three main areas of the heart. When using the factor analysis algorithm. By clicking the QA images tool, fortium updates the orthogonal displays to show the auto processed, RV LV and tissue factor assignment. The physician should ensure the RV and LV bloodpool are accurately identified and that the tissue viewport accurately displays the myocardial uptake. The physician continues the Pepsi Fr workflow with the interpretation of the relative MPI findings using standard poor map analysis. He then compares the polar map results with the absolute myocardial blood flow and the coronary flow reserve quantification. On the reserve screen, the relative results display in the leftmost column of polar Maps. Stress rest in the reverse ability of any defects, as would appear in a non see of our acquisition. The physician continues the Pepsi Fr workflow with the interpretation of the relative NPI findings using standard polar map analysis. The next two columns of polar Maps contain the comparative myocardial blood flow and coronary flow reserve information. Blood flow and see if our values display in three different formats for interpretation. Color coded 17 segment polar Maps, numeric 17 segment polar Maps and in the upper right screen a table of global and regional blood flow and see if our results. The flow polar Maps and the associated values display the absolute myocardial blood flow calculations at stress and at rest and are calculated from the blood and tissue time activity curves. The blood flow results are reported in milliliters per minute per gram of left ventricular tissue. Higher flow values at stress than at rest tell the physician that the rate of blood flow has increased. The heart may be able to pump blood to the entire body in response to a higher workload. The segmental and global CF. Our values are calculated by dividing the stress blood flow quantification by the rest. The higher the value, the greater the reserved capacity to respond to increased workloads. The physician also checks for areas of the heart exhibiting normal tracer uptake in the standard polar Maps, but with decreased blood flow and CF are estimations. For this patient, the physician notes that the absolute blood flow does show signs of improvement from rest to stress, indicating more blood is supplying the body at stress. Most physicians agree normal myocardial blood flow at stress should range from 2 to 4 milliliters per minute per gram, while normal rest flow should fall between 0.5 and one. While those patients global stress flow value of 1.9 and global rust flow value of 0.9 are near or within the normal range, appan closer examination of the regions of the heart, the physician notes the Lady and Elks regional values present some outside of that normal range. The physician then reviews the CF are polar mapping table, which display the ratio of absolute blood flow at stress to that at rest. In this case, the CF our global value of 2.1. Again, Bridge is the edge of that normal range for assessing patient risk. See if our calculations above 2 generally indicate a healthy heart. With the knowledge of the regional findings from the absolute blood flows, the physician then examines the lead in Elks regional values and notes that these areas may be cause for concern. Comparing traditional MPI findings with the CFR results, the physician notes that while the perfusion findings alone appear to indicate only one defect consistent with single vessel disease, the CF our findings indicate more extensive multivessel disease showing decreased reserve and flow in both the Ellie D&LC Ax vascular territories. Upon further examination of this patient during a coronary angiography procedure before DM, see if our results are validated as the angiography shows a significant occlusion in the distal left main artery. The physician saves any changes and creates a report, exporting relevant information to his packs or EMR. See if our technology has resulted in recent improvement in noninvasive molecular imaging leading to better patient care through more informed diagnosis. 40 M is leading the way by providing accurate, reproducible ceafar quantification within a streamlined, comprehensive workflow powered by University of Michigan technology.

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