Goal 4: Develop Workforce and Resources

Training for radiologist researchers for effective translational research

Critical Challenge

Submitted by (@str0001)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

As targeted therapy and molecular mechanisms of disease are emerging, a mechanism to improve the ability of radiologists to perform translational research is crucial. Such knowledge is essential for collaborative multidisciplinary research that ultimately leads to imaging as disease-specific diagnostic and therapeutic tools to combat pulmonary and cardiovascular disease.

Feasibility and challenges of addressing this CQ or CC :

Knowledge in the molecular mechanisms of disease and the potential for imaging technology to advance via targeted imaging agents, positron emission tomography (PET), functional MR methods, PET/computer tomography, and PET/MR is increasing. The radiologist has in depth expertise within imaging technology, performance of studies, and diagnostic abilities of imaging techniques. A program directed towards developing imagers towards translational imaging research will include in-depth education and training in lung physiology, pulmonary disease mechanisms, multimodality imaging bridging CT, PET/CT, MR and PET/MR, and the molecular techniques. With such knowledge and training, radiologists will be prepared to serve as principal investigators and collaborators in multidisciplinary teams. An understanding of imaging technologies and their capabilities, the clinical challenges, and molecular techniques will enable imagers to provide innovative solutions to diagnostic dilemmas in pulmonary and cardiovascular disease.

Name of idea submitter and other team members who worked on this idea : Society of Thoracic Radiology

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5 up votes
6 down votes
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Goal 2: Reduce Human Disease

Support for Cardiothoracic Surgery and Pediatric Heart Clinical Trial Networks

Continued and expanded support for the Cardiothoracic Surgical Trials Network (CTSN) and Pediatric Heart Network (PHN) is essential as both design, conduct, and analyze multiple, collaborative clinical trials that evaluate surgical interventions, and related management approaches for the treatment of cardiovascular disease. To date both networks have reported on and developed a portfolio of studies which need continued ...more »

Submitted by (@meaton)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

The work and support provided to date have allowed for the creation of an infrastructure for both the CTSN and PHN. Each network is now providing valuable results to the cardiothoracic surgery specialty which will allow an increase in quality patient care in the years and decades to come. The continued support is essential for the success of these networks as any reduction will limit the resources available for site participation and ultimately results. Due to the existing infrastructure for each network, the financial burden associated with de-funding and then restarting the networks in future years would be at least triple the financial commitment currently in place.

Feasibility and challenges of addressing this CQ or CC :

Conducting multi-center clinical trials is a substantial financial commitment but a vital part for the future of the cardiothoracic surgery specialty.

Name of idea submitter and other team members who worked on this idea : Matt E.

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108 net votes
151 up votes
43 down votes
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Goal 2: Reduce Human Disease

Development of non-contrast alternatives in cardiac magnetic resonance imaging

Critical Challenge

Submitted by (@str0001)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Late gadolinium-enhancement cardiac magnetic resonance imaging (MR) plays a crucial role in the evaluation of patients with suspected myocardial scar tissue. Alternative methods to contrast-enhanced MR however are in need, given the number of patients who have concomitant compromised renal function and concern for nephrogenic systemic fibrosis. Noncontrast MR techniques such as diffusion-weighted imaging would complement and eventually replace gadolinium administration thus impacting the evaluation of those with suspected and confirmed infiltrative cardiac processes and systemic diseases.

Feasibility and challenges of addressing this CQ or CC :

Late gadolinium enhancement technique characterizes enhancement patterns of heart disease, identifies areas amenable to ablation, and aids in decisions pertaining to workup and therapy. The underlying mechanism of Brownian motion/diffusion in the expanded extracellular space makes diffusion weighted imaging a potential gadolinium-saving modality. Diffusion MR, applied primarily in the brain and abdominal imaging, is underutilized in the heart given respiratory and cardiac motion. A need exists to further develop and apply noncontrast MR techniques towards cardiovascular applications. Such methods are promising noncontrast alternatives to characterize patients with myocardial disease, determine those with differing prognoses, and direct appropriate therapies to subgroups.

Name of idea submitter and other team members who worked on this idea : Society of Thoracic Radiology

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3 net votes
6 up votes
3 down votes
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Goal 3: Advance Translational Research

Comprehensive Assessment of Cardiovascular Physiology: Imaging of Structure, Function and Blood Flow

The development of cardiovascular disease is associated with changes in structure, function and blood flow within a complex and highly interconnected system. Current diagnostic tools focus on individual elements of the cardiovascular system and/or relatively simple parameters which do not reflect the true underlying pathophysiology. A novel multi-modular and multi-parametric approach based on new and promising imaging ...more »

Submitted by (@mmarkl)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

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1 net vote
1 up votes
0 down votes
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Goal 3: Advance Translational Research

Applying Imaging in Chronic Lung Diseases

How can chest CT or other imaging tools be optimally used to characterize expression and progression of chronic lung disease?

Submitted by (@jdc000)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Chest CT scans provide anatomical information on disease pattern and severity that cannot be readily obtained otherwise. These imaging studies could be essential in reclassifying chronic lung diseases more effectively and in assessing disease progression more accurately.

Feasibility and challenges of addressing this CQ or CC :

The increasing use of chest CT scans for lung cancer screening will provide a large number of imaging studies that could transform pulmonary research in multiple chronic lung diseases. However, the images will need to be appropriately collected and analyzed.

Name of idea submitter and other team members who worked on this idea : Ed Silverman, James Crapo and COPDGene Executive Committee

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33 net votes
47 up votes
14 down votes
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Goal 2: Reduce Human Disease

Imaging indicators of metabolic syndrome and cardiopulmonary disease

Critical Challenge

Submitted by (@str0001)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Obesity and metabolic syndrome affect a large portion of the population and affects multiple organ systems. Identifying obesity phenotypes by imaging will impact the significant healthcare issue presented by MetS and could provide a reliable, non-invasive index of disease severity, guide prevention and intervention response.

Feasibility and challenges of addressing this CQ or CC :

Metabolic syndrome, abnormal metabolism, may be potentially linked to obesity and cardiopulmonary disease. Theories exist but are in need of clarification. The relationship between metabolic syndrome and multiple other diseases including chronic obstructive lung disease, coronary atherosclerosis, and obesity warrants further investigation and can be elucidated through imaging. Advances in computed tomography (CT) and magnetic resonance imaging (MR) enable assessment of the cardiopulmonary manifestations, with promising MR techniques to complement high-resolution imaging data achievable with chest CT and coronary CT angiography. Assessment of CT and MR techniques in combination with three-dimensional quantitative analysis of manifestations of metabolic syndrome such as fat deposits derived from different adipocytes (white fat versus brown fat) such as in the subcutaneous, visceral, epicardial, and perivascular regions is feasible with current technology and may enable differentiation of those with varying risks of cardiovascular and pulmonary disease. The association of imaging parameters, metabolic syndrome, and associated diseases are in need of investigation, and knowledge gained may prove crucial for identifying those at risk for metabolic syndrome and at higher risk for complications in the large population of our country affected by obesity.

Name of idea submitter and other team members who worked on this idea : Society of Thoracic Radiology

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6 net votes
10 up votes
4 down votes
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Goal 2: Reduce Human Disease

Noninvasive biomarkers for characterizing cardiovascular disease

Critical Challenge

Submitted by (@str0001)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Phenotypical characterization of cardiovascular disease with computed tomography (CT) and magnetic resonance imaging (MR) to individualize targeted therapies for coronary artery and myocardial disease. Coronary artery disease is a major cause of patient death in the United States. Nonischemic myocardial disease includes entities with clinically heterogeneous presentations and is thus challenging to manage.

Feasibility and challenges of addressing this CQ or CC :

Currently CT and MR technology allows dynamic evaluation of the perfusion and contractility of the heart. Quantitative measures of disease burden, such as atherosclerotic plaque composition and myocardial texture imaging biomarkers (such as T1 mapping, activation mapping, flow pattern analysis, delayed myocardial enhancement), are possible. Positron emission tomography (PET)/MR, which combines metabolic with functional evaluation, is currently available and facilitates the development of targeted molecular-imaging techniques. Metrics derived from these techniques may serve to stratify patients noninvasively and direct appropriate therapies. Such imaging methods address noninvasive evaluation of cardiovascular disease, including ischemic heart disease but also myocardial diseases that include secondary and infiltrative cardiomyopathies, hypertrophic cardiomyopathy, and organ rejection in the scenario of transplantation.

Name of idea submitter and other team members who worked on this idea : Society of Thoracic Radiology

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8 net votes
11 up votes
3 down votes
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Goal 2: Reduce Human Disease

Short comprehensive cardiac MR imaging in post-chemotherapy cancer patients

Critical Challenge

Submitted by (@str0001)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Cardiovascular disease and cancer are frequently identified in the same patient. Both diseases are highly prevalent in the United States population, and cancer or its therapies can result in cardiovascular disease. Early diagnosis and prediction of cardiovascular disease in patients to undergo therapy will identify patients at higher risk for cardiac dysfunction and enable earlier diagnosis of subclinical cardiac dysfunction.

Feasibility and challenges of addressing this CQ or CC :

Cardiovascular magnetic resonance imaging (MR) is a powerful imaging modality for evaluating the heart function. Specifically, MR techniques allow for quantifying regional heart function, e.g. strain and strain rate, and may provide earlier markers of cardiovascular disease development than global measures of heart function, e.g. left ventricular ejection fraction, as estimated by echocardiography. Early identification of subclinical heart failure of post-chemotherapy cancer patients will allow for early and on-time chemotherapy change and personalized treatment.

Name of idea submitter and other team members who worked on this idea : Society of Thoracic Radiology

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3 net votes
6 up votes
3 down votes
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Goal 2: Reduce Human Disease

Quantitative imaging biomarkers for chronic lung disease

Critical Challenge

Submitted by (@str0001)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Methods for stratifying patients with diffuse lung disease are crucial for predicting their clinical course and directing appropriate therapies accordingly. Currently imaging markers for prognostic stratification are limited, due to observer variability in characterizing the type and degree of computed tomography (CT) abnormalities. A reproducible method for categorizing varying diffuse lung diseases on CT imaging is needed, particularly in combination with other biomarkers in a multidisciplinary approach. With lung cancer screening, the characterization and stratification of patients with varying COPD phenotypes and interstitial lung disease are essential to aid in management of the large number of patients who currently satisfy criteria for CT lung cancer screening.

Feasibility and challenges of addressing this CQ or CC :

Currently the classification of diffuse lung disease on CT is based upon visual evaluation and qualitative or semi-quantitative evaluation of CT data. Diffuse lung disease manifests with varying CT findings and distribution within the lung. Computer-assisted tools for quantifying airways and parenchymal disease have been developed. More-sophisticated quantitative computer image-analysis methods, such as those that address three-dimensional spatial orientation, are possible given advances in computer capabilities yet remain in need of further development. Advances in magnetic resonance imaging (MR) technology, positron emission tomography (PET), and PET/MR will increase the ability to characterize diffuse lung disease quantitatively. The ability of such technology to differentiate subtypes within more frequently occurring and clinically-significant diffuse lung disease is feasible. Such tools would impact a large population, particularly given the potential need to phenotype emphysema and smoking-related interstitial pneumonias in those undergoing CT screening.

Name of idea submitter and other team members who worked on this idea : Society of Thoracic Radiology

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7 net votes
9 up votes
2 down votes
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Goal 3: Advance Translational Research

Translation of novel computed tomography technologies

Computed tomography and related x-ray imaging techniques are mainstays of cardiovascular imaging and treatment. Novel technologies are emerging for CT that promise further improvements for cardiovascular disease, such as spectral CT, phase contrast CT or nanoparticle contrast agents. However, many challenges remain for their translation to patients.

Submitted by (@davidcormode)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Spectral and phase contrast CT promise enhanced diagnoses of cardiovascular disease due to their improved soft tissue contrast and increased sensitivity towards contrast agents. Novel contrast agents are starting to allow molecular imaging with CT. These technologies could allow sophisticated characterization of atherosclerotic plaque and other diseases. This would provide enhanced diagnoses, tailored treatments and monitoring of response to therapies.

Feasibility and challenges of addressing this CQ or CC :

Improvements and innovations need to be made in beam filtration, detector systems, electronics and image reconstruction algorithms to allow clinical versions of spectral and phase contrast CT systems to be developed that have similar performance in terms of speed and radiation dose of current clinical systems. Investments need to be made in the development of novel, targeted nanoparticle contrast agent materials and studying their safety prior to clinical trials. While these are very significant challenges, with innovative approaches it should be possible to overcome these problems.

Name of idea submitter and other team members who worked on this idea : Cormode

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-7 net votes
4 up votes
11 down votes
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Goal 2: Reduce Human Disease

Functional pulmonary imaging with noninvasive imaging techniques

Critical Challenge

Submitted by (@str0001)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Pulmonary dynamics are altered with diffuse lung disease. Pulmonary function testing is a mainstay for evaluating patients with diffuse lung disease. However, ability to assess alterations of local lung mechanics and physiology may elucidate those patients with varying outcomes and mechanisms of disease. Such local analysis is possible with imaging such as MR and quantitative computed tomography (CT).

Feasibility and challenges of addressing this CQ or CC :

Dynamic magnetic resonance imaging (MR) techniques are available that are capable of evaluating the oxygen delivery and blood flow to regional areas of the lung and measurement of pressures in the heart and vasculature. Additionally, advanced dual-energy CT techniques enable assessment of blood volume within the lungs. Such techniques can be applied to pulmonary vascular and pulmonary parenchymal disease and combinations of the two. For example, an understanding of the cardiopulmonary interaction and phenotyping of pulmonary hypertension is needed. A need exists to determine if advanced CT technology and MR can identify patients with the emerging phenotypes of combined pulmonary hypertension, in which the degree of pulmonary hypertension is greater than expected from cardiac and pulmonary causes. MR can potentially serve as early predictors of these phenotypes, given MR’s ability to evaluate the parenchyma, the pulmonary vasculature, and heart, and in combination with other biomarkers determine appropriate therapy.

Name of idea submitter and other team members who worked on this idea : Society of Thoracic Radiology

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3 net votes
6 up votes
3 down votes
Active

Goal 3: Advance Translational Research

Translation of novel computed tomography technologies

Computed tomography and related x-ray imaging techniques are mainstays of cardiovascular imaging and treatment. Novel technologies are emerging for CT that promise further improvements for cardiovascular disease, such as spectral CT, phase contrast CT or nanoparticle contrast agents. However, many challenges remain for their translation to patients.

Submitted by (@davidcormode)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Spectral and phase contrast CT promise enhanced diagnoses of cardiovascular disease due to their improved soft tissue contrast and increased sensitivity towards contrast agents. Novel contrast agents are starting to allow molecular imaging with CT. These technologies could allow sophisticated characterization of atherosclerotic plaque and other diseases. This would provide enhanced diagnoses, tailored treatments and monitoring of response to therapies.

Feasibility and challenges of addressing this CQ or CC :

Improvements and innovations need to be made in beam filtration, detector systems, electronics and image reconstruction algorithms to allow clinical versions of spectral and phase contrast CT systems to be developed that have similar performance in terms of speed and radiation dose of current clinical systems. Investments need to be made in the development of novel, targeted nanoparticle contrast agent materials and studying their safety prior to clinical trials. While these are very significant challenges, with innovative approaches it should be possible to overcome these problems.

Name of idea submitter and other team members who worked on this idea : Cormode

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-9 net votes
3 up votes
12 down votes
Active