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Aortic Surveillance Program: An Interdisciplinary and Standardized Approach to Comprehensive Imaging and Monitoring of Aortic Dissections

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INTRODUCTION

Patients who survive initial acute aortic events require frequent and detailed life-long surveillance to prevent future complications.  This presents numerous logistical challenges for both the cardiovascular imaging and surgical care teams involved.  The complexities of aortic anatomy and disease progression make it difficult to capture accurate and precise measurements on subsequent CT scan without standardized training or a systematic workflow, which can result in measurement errors and inconsistent monitoring of the aorta between scans.  Additionally, traditional radiology reports are not particularly well-suited to capture and efficiently communicate important morphological changes and degeneration over time.

 

PURPOSE

Cardiovascular Surgery (CVS) and the 3D and Quantitative Imaging Laboratory (3DQ Lab) collaborated in creating an interdisciplinary aortic surveillance program with the goal of standardizing and systematically capturing aortic measurements over time; coordinating between the different points of care to ensure thorough and timely processing of CT scans (including those obtained at outside institutions); and displaying key morphological changes in an easy-to-read comprehensive and dynamic report, accessible to the clinical staff at each patient’s clinical appointment.

 

METHODS

An aortic surveillance protocol was developed to capture standardized, orthogonal measurements of the major and minor diameters at eleven key landmarks along with other obvious point of interest.  To ensure proper localization and 3D orientation of landmarks on subsequent scans, the most recent study is used as a point of reference.  A web-based interface (Weblog) allows the clinical staff to communicate a patient’s scanning and clinical appointments; this allows the 3D Lab to process prior scans from outside institutions and prioritize the new scan so that measurements are recorded by the time of the patient’s same-day appointment.  The measurements are incorporated into a concise and dynamic longitudinal report consisting of data tables and a scaled aortic schematic, accessible to the clinical staff at the clinical appointment via Weblog.

 

RESULTS

The surveillance program was implemented over a period of eight weeks, requiring approximately 60 hours for Weblog development and 10 training hours per technologist.  The protocol guarantees comprehensive monitoring of the aorta at each scan, not only at obvious points of concern.  Weblog has streamlined coordination between the care team such that CT images are now processed within approximately 2 hours of acquisition.  The comprehensive graph has allowed for efficient evaluation of the aorta; the color-coded schematic makes it easy to contrast between measurements at different scan dates, highlighting areas of rapid aortic changes.  The reports have also facilitated communication between surgeons and patients regarding future treatment plans.  Approximately 300 cases have been processed to-date.

 

CONCLUSION

Close collaboration between CVS and CVI has generated an interdisciplinary and dedicated program for the surveillance of chronic and complex aortic diseases.  Standardized protocols and a systematic workflow help improve the accuracy and precision of measurements, while Weblog facilitates interdepartmental coordination.  The non-traditional report extracts and highlights the key aortic changes in morphology over time, allowing for quicker medical decision making and more effective communication with patients at the point of care.  Ultimately we hope that this program improves overall management of chronic aortic diseases.

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