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 Medical Imaging, 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 Mean 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 noise 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