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A Period of Refinement

Johan HC Reiber of Leiden University Medical Center, George Heyrich of St Mary’s Medical Center, US, and Anton van Weert of Bio-Imaging Technologies, The Netherlands, map out quantitative coronary angiography in clinical studies

Quantitative coronary arteriography (QCA) is an important tool for studying the effects of coronary interventions in the catheterisation laboratory in an accurate and reproducible manner. Nowadays, peer-reviewed publications on relevant interventional trials are only accepted if the vascular interpretations are presented in quantitative terms, whereby the degree of restenosis, and the so-called late lumen loss, are the most relevant parameters.

Important technical developments in the catheterisation arena over the past 15 years have included the digitisation of the catheterisation laboratories, whereby the conventional 35mm cinefilm was replaced by the digital CD. Furthermore, the image data is now stored in digitial imaging and communications in medicine (DICOM) format. This greatly simplifies the transfer of the image data on digital copies to other physicians and the imaging core laboratories (ICLs), where they can be analysed without any loss of information.

In the last few years, an increasing number of cardiovascular X-ray imaging systems have been equipped with flat-panel detectors, replacing the conventional vacuum tube image intensifier in combination with a CCD camera. There are a number of major advantages to these flat-panel detectors, which include the ability to preserve significantly more of the original digital signal and the absolute absence of spatial distortions, thereby providing superior image quality and enabling further image enhancement. In clinical practice, this means improved visibility of vessels, lesions, stents and guidewires, even at reduced X-ray dose levels.

The great advantage of a QCA analysis is that the sizes of the selected coronary segments can be determined from the coronary arterial arteriograms in a standardised manner according to standard operating procedures (SOPs) with robust and automated contour detection techniques. A typical example of a QCA analysis in a circumflex artery is given in Figure 1.


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Professor Hans Reiber is Director of the Division of Image Processing (LKEB), Department of Radiology, at the Leiden University Medical Center (LUMC). He received his MSc EE-degree from the Delft University of Technology in 1971 and his PhD in 1975 from Stanford University, US. In 1977, he founded the LKEB and has continued its work from 1990 at the LUMC, The Netherlands. His research interests include knowledge-guided image processing and its clinical applications. He is a member of the Scientific Advisory Board of Bio-Imaging Technologies, Inc.

George Heyrich is board certified in internal medicine, cardiovascular disease and interventional cardiology. He currently has a private practice, Mercer Bucks Cardiology, in Yardley and Lawrenceville, US. He received his BA in Biology with a minor in Economics from Franklin and Marshall College in Lancaster, Pennsylvania. He received his MD from Georgetown University School of Medicine in Washington DC. George has served as Assistant Clinical Professor of Medicine at the University of Pennsylvania, Director of the Cardiac Catheterization Laboratory, Capital Health Systems, Mercer Medical Center, Trenton; and he serves on St Mary’s Institutional Review Board. He is a Fellow of the American College of Physicians.

Dr Anton van Weert studied Medicinal Chemistry and Molecular Genetics at the University of Leiden. Following the completion of his degree in 1992, he went on to obtain a PhD in Cell Biology in 1996 at the Faculty of Medicine of the University Medical Centre of Utrecht. The same year, Anton started his career at the Phase I Pharmacology Unit of Kendle International Inc, as a Clinical Research Scientist. In 1998, Anton joined Heart Core as the Managing Director. He is currently Senior Director Scientific Services at Bio-Imaging Technologies Inc

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Professor Hans Reiber
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George Heyrich
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Dr Anton van Weert
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