Pulmonary Veins Mapping Preablation Planning for CT

Purpose

 Document pulmonary veins and anatomy for ablation planning

Tag(s)

 

Panel

 Cardiac

TOUCH-AI ID

 TAI-04180017

Originator

 David Wymer

Panel Chair

 Carlo De Cecco

Panel Reviewers

 Cardiac Panel

License

 Creative Commons 4.0

Status  Public Commenting

Clinical Implementation


Value Proposition

Automate the pulmonary vein measurements and pertinent cardiac anatomy to save the radiologist time from manually measuring.

Narrative(s)

A patient presents with atrial fibrillation (afib) and needs an ablation procedure based on clinical needs and/or failure of medical control.

Workflow Description

A patient receives pre-afib ablation contrast-enhanced CT (CE-CT) and triggers the algorithm. The algorithm retrieves input from imagery and electronic health record data such as age, gender, and symptom chronicity. The algorithm executes and measures pulmonary veins at the insertion to the left atrium. The algorithm then evaluates for atrial appendage thrombus and measures left atrial size, thickness of atrial septum, and left ventricular size. After evaluating for mitral and aortic valve calcification, the algorithm measures the proximity of vein ostia to the esophagus and aorta. The algorithm returns all measurements, along with the degree of valvular calcifications, positive and negative atrial thrombus, and esophagus and aorta proximity to vein ostia. The algorithm suggests the likelihood of chronic afib due to a non-atrial cause (mitral/aortic stenosis/regurgitation).

Considerations for Dataset Development


Procedures(s): CE-CT Heart

Sex at Birth: {Male, Female}

 

Age (years): [0,90]

 

Afib Chronicity: varied frequencies

 

Frailty Index: varied

 

Comorbidities: {heart failure, pulmonary artery hypertension}

Technical Specifications


Inputs

DICOM Study

Procedure

CE-CT Heart

Data Type

DICOM

Modality

CT

Body Region

Chest

Anatomic Focus

Heart

 

Primary Outputs

Pulmonary Vein Diameter

RadElement ID

RDE281 

Definition

Diameter of pulmonary vein (mm)

Data Type

Categorical

Value Set

 

Units

mm

 

Interatrial Septal Thickness

RadElement ID

RDE282 

Definition

Interatrial septal thickness (mm)

Data Type

Numeric

Value Set

 

Units

mm

 

Presence of Atrial Thrombus

RadElement ID

RDE283 

Definition

Determine the presence of atrial thrombus

Data Type

Categorical

Value Set

0 – Unknown

1 – Present

2 –Absent

Units

N/A

 

Presence of Valvular Calcifications

RadElement ID

RDE284 

Definition

Determine the presence of valvular calcifications

Data Type

Categorical

Value Set

0 – Unknown

1 – Present

2 –Absent

Units

N/A

 

Vein Ostia Proximity to Esophagus

RadElement ID

RDE285 

Definition

Measure the distance between the vein ostia and esophagus(cm)

Data Type

Numeric

Value Set

 

Units

cm

 

Vein Ostia Proximity to Aorta

RadElement ID

RDE286

Definition

Measure the distance between the vein ostia and aorta (cm)

Data Type

Numeric

Value Set

 

Units

cm

Secondary Outputs 

Likelihood of Ablation Success

RadElement ID

RDE287 

Definition

Estimate the probability of ablation success

Data Type

Numeric

Value Set

[0,1]

Units

% likelihood of success

Public Commenting


Use cases are meant to be a primary vehicle for distributing clinical information to the developer community. They pinpoint precise scenarios within radiology workflows where potential automation could add noticeable value and establish standards for interpreting and passing corresponding common data elements. Implementing effective standards requires the perspective from all stakeholders. So to that end, we encourage your feedback on use cases.

To submit comments, please email DSIUseCases@acr.org with the use case title(s) and relevant comments by January 1, 2019. If more convenient, you may also download this use case and comment directly on the PDF. Just attach the PDF copy on the email.