Kinetic imaging as a Marcell Gyano MD novel analysis of X-ray angiography

CIRSE 16/09/2017 Copenhagen Disclosures

I have the following potential conflicts of interest to report:

I received travel support from Semmelweis University I am employed by and receiving honoraria from Kinepict Health Ltd. as a researcher First ideas

Motion Based X-Ray Imaging Modality Krisztian Szigeti; Domokos Mathe; Szabolcs Osvath IEEE Transactions on , 2014, Volume: 33, Issue: 10 Theoretical background of kinetic imaging

Kinetic image possibly better than Deviation DSA

A t Novel statistical t analysis of intensity e deviation in motion n intensity image series u a t Big deviation causes i small mean intensity o change n Time DSA: mean intensity Mask - mask Does the kinetic image show the same vasculature as DSA? • Fractal Dimension - Box Counting (Minkowski-Bouligand Dimension)

KIN DSA KIN-DSA Results

• Fractal dimension measurements:

• 10 image pairs of lower limb angiography • The fractal dimensions of the segmented images were compared with paired t-test

• No significant differences were found (p = 0,3112) Which image would the physicist choose?

Raw sumDSA Postprocessed sumDSA Raw kinetic picture Signal to ratio (SNR)

Signal = intensity difference

Noise = field deviation

- Raw sumDSA (rsDSA): calculated from all the pictures in the angiography series

- Siemens post-processed sumDSA (ssDSA): rsDSA + Pixel Shift and other image quality enhancers (Siemens Artis zee with Pure, Siemens Syngo workstation - 2016)

- Kinetic image (KIN): calculated from all the pictures SNR results

42x3 lower limb angiography series, 1903 measuring point

Confidence interval rsDSA (x) ssDSA (x) < 2,5% 1,33794 0,78216 > 97,5% 7,68235 5,53260 median 3,26257 2,28070

x: multiplier value of the SNR of KIN image compared to the SNR measured in rsDSA or ssDSA images Which image would choose the physicians?

ssDSA KIN Visual questionnaire

• 260 lower limb angiography image pairs with 3 questions • Which picture is more detailed? • In which picture do the structures more distinct? • Which picture is more useful diagnostically?

• Sum: 1215 answer from 5 specialist (vascular surgeons, interventional radiologist) Questionnaire result

Kin vs ssDSA (1215 answers)

Mean 95% Confidence Question 1. 65,35% 62,67-68,03% Question 2. 56,79% 54,00-59,58% Question 3. 56,37% 53,59-59,17%

Agreement between the answers

%agree % st.dev. Kappa Kappa p Question 1. 75,8 14,1 0,0968 < 0,0001 Question 2. 74,16 14,22 0,1263 < 0,0001 Question 3. 74,07 14,24 0,1265 < 0,0001 Conclusion

• Kinetic imaging provides:

- better SNR than DSA - better contrast enhancement than DSA - better diagnostically image quality as DSA Dose efficiency

• Better SNR ➤ ’gold standard’ image quality with less signal

• Less signal ➤ less X-ray and/or contrast agent dose

Prospective aims:

• validate kinetic imaging technology in a multicenter clinical study • significant reduction of radiation and contrast agent dose Thank you for your attention