Virtual medicine: Utilization of the advanced cardiac imaging patient avatar for procedural planning and facilitation

Abstract

Advances in imaging technology have led to a paradigm shift from planning of cardiovascular procedures and surgeries requiring the actual patient in a "brick and mortar" hospital to utilization of the digitalized patient in the virtual hospital. Cardiovascular computed tomographic angiography (CCTA) and cardiovascular magnetic resonance (CMR) digitalized 3-D patient representation of individual patient anatomy and physiology serves as an avatar allowing for virtual delineation of the most optimal approaches to cardiovascular procedures and surgeries prior to actual hospitalization. Pre-hospitalization reconstruction and analysis of anatomy and pathophysiology previously only accessible during the actual procedure could potentially limit the intrinsic risks related to time in the operating room, cardiac procedural laboratory and overall hospital environment. Although applications are specific to areas of cardiovascular specialty focus, there are unifying themes related to the utilization of technologies. The virtual patient avatar computer can also be used for procedural planning, computational modeling of anatomy, simulation of predicted therapeutic result, printing of 3-D models, and augmentation of real time procedural performance. Examples of the above techniques are at various stages of development for application to the spectrum of cardiovascular disease processes, including percutaneous, surgical and hybrid minimally invasive interventions. A multidisciplinary approach within medicine and engineering is necessary for creation of robust algorithms for maximal utilization of the virtual patient avatar in the digital medical center. Utilization of the virtual advanced cardiac imaging patient avatar will play an important role in the virtual health care system. Although there has been a rapid proliferation of early data, advanced imaging applications require further assessment and validation of accuracy, reproducibility, standardization, safety, efficacy, quality, cost effectiveness, and overall value to medical care.

3D printing of the aortic annulus based on cardiovascular computed tomography: Preliminary experience in pre-procedural planning for aortic valve sizing

“…A life-size, patientspecific model, not only gives haptic feedback to the surgeon or interventional cardiologist but also permits decision-making on device choice and appropriate size, a possibility to simulate the implant, as in the operating theater, evaluating the best operative approach and the more accurate positioning of the implant. It may also be a great tool to improve the physician-patient communication during the explanation of the procedure (20).…”

Latest Developments in Adapting Deep Learning for Assessing TAVR Procedures and Outcomes

“…Moreover, CT is widely used for accurate 3D reconstruction of major heart valves and arteries [21][22][23]. Recently, cardiac computed tomography angiography (CCTA), together with cardiac MRI, have been utilized to generate high-fidelity virtual simulations for cardiovascular procedures, which can help optimize the approaches for surgery before hospitalization [24]. Multidetector CT along with transthoracic/transoesophageal echocardiography plays a key role in the pre-operative assessment of suitability for TAVR in measuring the size of aortic annuals, assessing the amount of calcification in the aortic root, and predicting the angle of deployment.…”

Cardiovascular Computed Tomographic Angiography as a Virtual Patient Avatar for Individualized Surgical Planning of Complex Anomalous Coronary Artery Anatomy

“…Cardiovascular computed tomographic angiography (CCTA) 3-D thoracic reconstruction can serve as a “virtual patient avatar” providing a surgeon’s plane of view to complex individual anatomy in the context of cardiovascular and thoracic structure. 1 – 3 The utility of these techniques in surgical approach to complex congenital anomalous coronary artery anatomy is demonstrated in a middle-aged male with recurrent exertional chest pain, non-ST segment elevation myocardial infarction, and exertional syncope. The CCTA images showed absence of the left main coronary artery and a single coronary artery ostium arising from the right aortic sinus of Valsalva which trifurcated.…”