title: Free and open-source software application for the evaluation of coronary computed tomography angiography images.
abstract: BACKGROUND
  The standardization of images used in Medicine in 1993 was performed using the DICOM (Digital Imaging and Communications in Medicine) standard. Several tests use this standard and it is increasingly necessary to design software applications capable of handling this type of image; however, these software applications are not usually free and open-source, and this fact hinders their adjustment to most diverse interests.
  
  
  OBJECTIVE
  To develop and validate a free and open-source software application capable of handling DICOM coronary computed tomography angiography images.
  
  
  METHODS
  We developed and tested the ImageLab software in the evaluation of 100 tests randomly selected from a database. We carried out 600 tests divided between two observers using ImageLab and another software sold with Philips Brilliance computed tomography appliances in the evaluation of coronary lesions and plaques around the left main coronary artery (LMCA) and the anterior descending artery (ADA). To evaluate intraobserver, interobserver and intersoftware agreements, we used simple and kappa statistics agreements.
  
  
  RESULTS
  The agreements observed between software applications were generally classified as substantial or almost perfect in most comparisons.
  
  
  CONCLUSIONS
  The ImageLab software agreed with the Philips software in the evaluation of coronary computed tomography angiography tests, especially in patients without lesions, with lesions < 50% in the LMCA and < 70% in the ADA. The agreement for lesions > 70% in the ADA was lower, but this is also observed when the anatomical reference standard is used.
authors.affiliation: Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil. marcelohadlich@cardiol.br
authors.forename: Marcelo Souza
authors.initials: MS
authors.lastname: Hadlich
authors.forename: Gláucia Maria Moraes
authors.initials: GM
authors.lastname: Oliveira
authors.forename: Raúl A
authors.initials: RA
authors.lastname: Feijóo
authors.forename: Clerio F
authors.initials: CF
authors.lastname: Azevedo
authors.forename: Bernardo Rangel
authors.initials: BR
authors.lastname: Tura
authors.forename: Paulo Gustavo Portela
authors.initials: PG
authors.lastname: Ziemer
authors.forename: Pablo Javier
authors.initials: PJ
authors.lastname: Blanco
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pina
authors.forename: Márcio
authors.initials: M
authors.lastname: Meira
authors.forename: Nelson Albuquerque de
authors.initials: NA
authors.lastname: Souza e Silva
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012016:Reference Values; D015203:Reproducibility of Results; D012984:Software; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D055815:Young Adult