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.
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 7.5MHz 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 0.11mm 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 180Mbps), accurate, and an intelligent, web-based clinical tool for multi-center clinical trials and routine telemedicine clinical care.
Department of Radiology, University of Cagliari, Italy.
Luca
L
Saba
Department of Electrical Engineering, NIT Raipur, Chhattisgarh, India.
Sumit K
SK
Banchhor
Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA.
Harman S
HS
Suri
Department of Electrical Engineering, NIT Raipur, Chhattisgarh, India.
Narendra D
ND
Londhe
Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
Tadashi
T
Araki
Cardiovascular Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Nobutaka
N
Ikeda
Department of Radiology and Ultrasound, Zagreb, Croatia.
Klaudija
K
Viskovic
CorVasc Vascular Laboratory, 8433 Harcourt Rd #100, Indianapolis, IN, USA.
Shoaib
S
Shafique
UC Davis Vascular Centre, University of California, Davis, CA, USA.
John R
JR
Laird
Brain and Mind Research Institute, Weill Cornell Medical College, NY, USA.
Ajay
A
Gupta
Vascular Screening and Diagnostic Centre, London, England; Vascular Diagnostic Centre, University of Cyprus, Nicosia, Cyprus.
Andrew
A
Nicolaides
Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA; Point-of-Care Devices, Global Biomedical Technologies, Inc., Roseville, CA, USA; Department of Electrical Engineering, University of Idaho (Affl.), ID, USA. Electronic address: Jasjit.Suri@atheropoint.com.
Jasjit S
JS
Suri
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059168:Carotid Intima-Media Thickness; D000067917:Cloud Computing; D001330:Electronic Data Processing / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D018570:Risk Assessment; D020521:Stroke / Q000000981:diagnostic imaging* / Q000503:physiopathology
Atherosclerosis; Automated; Carotid; Cloud; Pharmaceutical trails; Precision of merit; ROC; Routine; Stroke; Telemedicine; Ultrasound; Web-based; cIMT; reliable