Accurate cloud-based smart IMT measurement, its validation and stroke risk stratification in carotid ultrasound

A web-based point-of-care tool for multicenter clinical trial

Luca Saba, Sumit K. Banchhor, Harman S. Suri, Narendra D. Londhe, Tadashi Araki, Nobutaka Ikeda, Klaudija Viskovic, Shoaib Shafique, John R. Laird, Ajay Gupta, Andrew Nicolaides, Jasjit S. Suri

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

This study presents AtheroCloud™ - a novel cloud-based smart carotid intima-media thickness (cIMT) measurement tool using B-mode ultrasound for stroke/cardiovascular risk assessment and its stratification. This is an anytime-anywhere clinical tool for routine screening and multi-center clinical trials. In this pilot study, the physician can upload ultrasound scans in one of the following formats (DICOM, JPEG, BMP, PNG, GIF or TIFF) directly into the proprietary cloud of AtheroPoint from the local server of the physician's office. They can then run the intelligent and automated AtheroCloud™ cIMT measurements in point-of-care settings in less than five seconds per image, while saving the vascular reports in the cloud. We statistically benchmark AtheroCloud™ cIMT readings against sonographer (a registered vascular technologist) readings and manual measurements derived from the tracings of the radiologist.One hundred patients (75 M/25 F, mean age: 68±11 years), IRB approved, Toho University, Japan, consisted of Left/Right common carotid artery (CCA) artery (200 ultrasound scans), (Toshiba, Tokyo, Japan) were collected using a 7.5 MHz transducer. The measured cIMTs for L/R carotid were as follows (in mm): (i) AtheroCloud™ (0.87±0.20, 0.77±0.20); (ii) sonographer (0.97±0.26, 0.89±0.29) and (iii) manual (0.90±0.20, 0.79±0.20), respectively. The coefficient of correlation (CC) between sonographer and manual for L/R cIMT was 0.74 (P<0.0001) and 0.65 (P<0.0001), while, between AtheroCloud™ and manual was 0.96 (P<0.0001) and 0.97 (P<0.0001), respectively. We observed that 91.15% of the population in AtheroCloud™ had a mean cIMT error less than 0.11 mm compared to sonographer's 68.31%. The area under curve for receiving operating characteristics was 0.99 for AtheroCloud™ against 0.81 for sonographer. Our Framingham Risk Score stratified the population into three bins as follows: 39% in low-risk, 70.66% in medium-risk and 10.66% in high-risk bins. Statistical tests were performed to demonstrate consistency, reliability and accuracy of the results. The proposed AtheroCloud™ system is completely reliable, automated, fast (3-5 seconds depending upon the image size having an internet speed of 180 Mbps), accurate, and an intelligent, web-based clinical tool for multi-center clinical trials and routine telemedicine clinical care.

Original languageEnglish (US)
Pages (from-to)217-234
Number of pages18
JournalComputers in Biology and Medicine
Volume75
DOIs
StatePublished - Aug 1 2016

Fingerprint

Point-of-Care Systems
Carotid Intima-Media Thickness
Multicenter Studies
Ultrasonics
Stroke
Clinical Trials
Thickness measurement
Bins
Blood Vessels
Reading
Digital Imaging and Communications in Medicine (DICOM)
Japan
Telemedicine
Statistical tests
Benchmarking
Physicians' Offices
Risk assessment
Tokyo
Research Ethics Committees
Common Carotid Artery

Keywords

  • Atherosclerosis
  • Automated
  • Carotid
  • CIMT
  • Cloud
  • Pharmaceutical trails
  • Precision of merit
  • Reliable
  • ROC
  • Routine
  • Stroke
  • Telemedicine
  • Ultrasound
  • Web-based

ASJC Scopus subject areas

  • Computer Science Applications
  • Health Informatics

Cite this

Accurate cloud-based smart IMT measurement, its validation and stroke risk stratification in carotid ultrasound : A web-based point-of-care tool for multicenter clinical trial. / Saba, Luca; Banchhor, Sumit K.; Suri, Harman S.; Londhe, Narendra D.; Araki, Tadashi; Ikeda, Nobutaka; Viskovic, Klaudija; Shafique, Shoaib; Laird, John R.; Gupta, Ajay; Nicolaides, Andrew; Suri, Jasjit S.

In: Computers in Biology and Medicine, Vol. 75, 01.08.2016, p. 217-234.

Research output: Contribution to journalArticle

Saba, L, Banchhor, SK, Suri, HS, Londhe, ND, Araki, T, Ikeda, N, Viskovic, K, Shafique, S, Laird, JR, Gupta, A, Nicolaides, A & Suri, JS 2016, 'Accurate cloud-based smart IMT measurement, its validation and stroke risk stratification in carotid ultrasound: A web-based point-of-care tool for multicenter clinical trial', Computers in Biology and Medicine, vol. 75, pp. 217-234. https://doi.org/10.1016/j.compbiomed.2016.06.010
Saba, Luca ; Banchhor, Sumit K. ; Suri, Harman S. ; Londhe, Narendra D. ; Araki, Tadashi ; Ikeda, Nobutaka ; Viskovic, Klaudija ; Shafique, Shoaib ; Laird, John R. ; Gupta, Ajay ; Nicolaides, Andrew ; Suri, Jasjit S. / Accurate cloud-based smart IMT measurement, its validation and stroke risk stratification in carotid ultrasound : A web-based point-of-care tool for multicenter clinical trial. In: Computers in Biology and Medicine. 2016 ; Vol. 75. pp. 217-234.
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abstract = "This study presents AtheroCloud™ - a novel cloud-based smart carotid intima-media thickness (cIMT) measurement tool using B-mode ultrasound for stroke/cardiovascular risk assessment and its stratification. This is an anytime-anywhere clinical tool for routine screening and multi-center clinical trials. In this pilot study, the physician can upload ultrasound scans in one of the following formats (DICOM, JPEG, BMP, PNG, GIF or TIFF) directly into the proprietary cloud of AtheroPoint from the local server of the physician's office. They can then run the intelligent and automated AtheroCloud™ cIMT measurements in point-of-care settings in less than five seconds per image, while saving the vascular reports in the cloud. We statistically benchmark AtheroCloud™ cIMT readings against sonographer (a registered vascular technologist) readings and manual measurements derived from the tracings of the radiologist.One hundred patients (75 M/25 F, mean age: 68±11 years), IRB approved, Toho University, Japan, consisted of Left/Right common carotid artery (CCA) artery (200 ultrasound scans), (Toshiba, Tokyo, Japan) were collected using a 7.5 MHz transducer. The measured cIMTs for L/R carotid were as follows (in mm): (i) AtheroCloud™ (0.87±0.20, 0.77±0.20); (ii) sonographer (0.97±0.26, 0.89±0.29) and (iii) manual (0.90±0.20, 0.79±0.20), respectively. The coefficient of correlation (CC) between sonographer and manual for L/R cIMT was 0.74 (P<0.0001) and 0.65 (P<0.0001), while, between AtheroCloud™ and manual was 0.96 (P<0.0001) and 0.97 (P<0.0001), respectively. We observed that 91.15{\%} of the population in AtheroCloud™ had a mean cIMT error less than 0.11 mm compared to sonographer's 68.31{\%}. The area under curve for receiving operating characteristics was 0.99 for AtheroCloud™ against 0.81 for sonographer. Our Framingham Risk Score stratified the population into three bins as follows: 39{\%} in low-risk, 70.66{\%} in medium-risk and 10.66{\%} in high-risk bins. Statistical tests were performed to demonstrate consistency, reliability and accuracy of the results. The proposed AtheroCloud™ system is completely reliable, automated, fast (3-5 seconds depending upon the image size having an internet speed of 180 Mbps), accurate, and an intelligent, web-based clinical tool for multi-center clinical trials and routine telemedicine clinical care.",
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T1 - Accurate cloud-based smart IMT measurement, its validation and stroke risk stratification in carotid ultrasound

T2 - A web-based point-of-care tool for multicenter clinical trial

AU - Saba, Luca

AU - Banchhor, Sumit K.

AU - Suri, Harman S.

AU - Londhe, Narendra D.

AU - Araki, Tadashi

AU - Ikeda, Nobutaka

AU - Viskovic, Klaudija

AU - Shafique, Shoaib

AU - Laird, John R.

AU - Gupta, Ajay

AU - Nicolaides, Andrew

AU - Suri, Jasjit S.

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N2 - This study presents AtheroCloud™ - a novel cloud-based smart carotid intima-media thickness (cIMT) measurement tool using B-mode ultrasound for stroke/cardiovascular risk assessment and its stratification. This is an anytime-anywhere clinical tool for routine screening and multi-center clinical trials. In this pilot study, the physician can upload ultrasound scans in one of the following formats (DICOM, JPEG, BMP, PNG, GIF or TIFF) directly into the proprietary cloud of AtheroPoint from the local server of the physician's office. They can then run the intelligent and automated AtheroCloud™ cIMT measurements in point-of-care settings in less than five seconds per image, while saving the vascular reports in the cloud. We statistically benchmark AtheroCloud™ cIMT readings against sonographer (a registered vascular technologist) readings and manual measurements derived from the tracings of the radiologist.One hundred patients (75 M/25 F, mean age: 68±11 years), IRB approved, Toho University, Japan, consisted of Left/Right common carotid artery (CCA) artery (200 ultrasound scans), (Toshiba, Tokyo, Japan) were collected using a 7.5 MHz transducer. The measured cIMTs for L/R carotid were as follows (in mm): (i) AtheroCloud™ (0.87±0.20, 0.77±0.20); (ii) sonographer (0.97±0.26, 0.89±0.29) and (iii) manual (0.90±0.20, 0.79±0.20), respectively. The coefficient of correlation (CC) between sonographer and manual for L/R cIMT was 0.74 (P<0.0001) and 0.65 (P<0.0001), while, between AtheroCloud™ and manual was 0.96 (P<0.0001) and 0.97 (P<0.0001), respectively. We observed that 91.15% of the population in AtheroCloud™ had a mean cIMT error less than 0.11 mm compared to sonographer's 68.31%. The area under curve for receiving operating characteristics was 0.99 for AtheroCloud™ against 0.81 for sonographer. Our Framingham Risk Score stratified the population into three bins as follows: 39% in low-risk, 70.66% in medium-risk and 10.66% in high-risk bins. Statistical tests were performed to demonstrate consistency, reliability and accuracy of the results. The proposed AtheroCloud™ system is completely reliable, automated, fast (3-5 seconds depending upon the image size having an internet speed of 180 Mbps), accurate, and an intelligent, web-based clinical tool for multi-center clinical trials and routine telemedicine clinical care.

AB - This study presents AtheroCloud™ - a novel cloud-based smart carotid intima-media thickness (cIMT) measurement tool using B-mode ultrasound for stroke/cardiovascular risk assessment and its stratification. This is an anytime-anywhere clinical tool for routine screening and multi-center clinical trials. In this pilot study, the physician can upload ultrasound scans in one of the following formats (DICOM, JPEG, BMP, PNG, GIF or TIFF) directly into the proprietary cloud of AtheroPoint from the local server of the physician's office. They can then run the intelligent and automated AtheroCloud™ cIMT measurements in point-of-care settings in less than five seconds per image, while saving the vascular reports in the cloud. We statistically benchmark AtheroCloud™ cIMT readings against sonographer (a registered vascular technologist) readings and manual measurements derived from the tracings of the radiologist.One hundred patients (75 M/25 F, mean age: 68±11 years), IRB approved, Toho University, Japan, consisted of Left/Right common carotid artery (CCA) artery (200 ultrasound scans), (Toshiba, Tokyo, Japan) were collected using a 7.5 MHz transducer. The measured cIMTs for L/R carotid were as follows (in mm): (i) AtheroCloud™ (0.87±0.20, 0.77±0.20); (ii) sonographer (0.97±0.26, 0.89±0.29) and (iii) manual (0.90±0.20, 0.79±0.20), respectively. The coefficient of correlation (CC) between sonographer and manual for L/R cIMT was 0.74 (P<0.0001) and 0.65 (P<0.0001), while, between AtheroCloud™ and manual was 0.96 (P<0.0001) and 0.97 (P<0.0001), respectively. We observed that 91.15% of the population in AtheroCloud™ had a mean cIMT error less than 0.11 mm compared to sonographer's 68.31%. The area under curve for receiving operating characteristics was 0.99 for AtheroCloud™ against 0.81 for sonographer. Our Framingham Risk Score stratified the population into three bins as follows: 39% in low-risk, 70.66% in medium-risk and 10.66% in high-risk bins. Statistical tests were performed to demonstrate consistency, reliability and accuracy of the results. The proposed AtheroCloud™ system is completely reliable, automated, fast (3-5 seconds depending upon the image size having an internet speed of 180 Mbps), accurate, and an intelligent, web-based clinical tool for multi-center clinical trials and routine telemedicine clinical care.

KW - Atherosclerosis

KW - Automated

KW - Carotid

KW - CIMT

KW - Cloud

KW - Pharmaceutical trails

KW - Precision of merit

KW - Reliable

KW - ROC

KW - Routine

KW - Stroke

KW - Telemedicine

KW - Ultrasound

KW - Web-based

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