Grid Databases for Shared Image Analysis in the MammoGrid Project

The MammoGrid project aims to prove that Grid infrastructures can be used for collaborative clinical analysis of database-resident but geographically distributed medical images. This requires: a) the provision of a clinician-facing front-end workstation and b) the ability to service real-world clinician queries across a distributed and federated database. The MammoGrid project will prove the viability of the Grid by harnessing its power to enable radiologists from geographically dispersed hospitals to share standardized mammograms, to compare diagnoses (with and without computer aided detection of tumours) and to perform sophisticated epidemiological studies across national boundaries. This paper outlines the approach taken in MammoGrid to seamlessly connect radiologist workstations across a Grid using an "information infrastructure" and a DICOM-compliant object model residing in multiple distributed data stores in Italy and the UKComment: 10 pages, 5 figure

Standardized measurement of coronary inflammation using cardiovascular computed tomography: integration in clinical care as a prognostic medical device

Aims: Coronary computed tomography angiography (CCTA) is a first-line modality in the investigation of suspected coronary artery disease (CAD). Mapping of perivascular fat attenuation index (FAI) on routine CCTA enables the non-invasive detection of coronary artery inflammation by quantifying spatial changes in perivascular fat composition. We now report the performance of a new medical device, CaRi-Heart®, which integrates standardized FAI mapping together with clinical risk factors and plaque metrics to provide individualized cardiovascular risk prediction. Methods and results: The study included 3912 consecutive patients undergoing CCTA as part of clinical care in the USA (n = 2040) and Europe (n = 1872). These cohorts were used to generate age-specific nomograms and percentile curves as reference maps for the standardized interpretation of FAI. The first output of CaRi-Heart® is the FAI-Score of each coronary artery, which provides a measure of coronary inflammation adjusted for technical, biological, and anatomical characteristics. FAI-Score is then incorporated into a risk prediction algorithm together with clinical risk factors and CCTA-derived coronary plaque metrics to generate the CaRi-Heart® Risk that predicts the likelihood of a fatal cardiac event at 8 years. CaRi-Heart® Risk was trained in the US population and its performance was validated externally in the European population. It improved risk discrimination over a clinical risk factor-based model [Δ(C-statistic) of 0.085, P = 0.01 in the US Cohort and 0.149, P < 0.001 in the European cohort] and had a consistent net clinical benefit on decision curve analysis above a baseline traditional risk factor-based model across the spectrum of cardiac risk. Conclusion: Mapping of perivascular FAI on CCTA enables the non-invasive detection of coronary artery inflammation by quantifying spatial changes in perivascular fat composition. We now report the performance of a new medical device, CaRi-Heart®, which allows standardized measurement of coronary inflammation by calculating the FAI-Score of each coronary artery. The CaRi-Heart® device provides a reliable prediction of the patient's absolute risk for a fatal cardiac event by incorporating traditional cardiovascular risk factors along with comprehensive CCTA coronary plaque and perivascular adipose tissue phenotyping. This integration advances the prognostic utility of CCTA for individual patients and paves the way for its use as a dual diagnostic and prognostic tool among patients referred for CCTA

Resolving clinicians queries across a grid infrastructure

F. Estrella (1) , C. del Frate (2) , T. Hauer (1), R. McClatchey (1) , M. Odeh (1) , D. Rogulin (1) , S. R. Amendolia (3), D. Schottlander (4) , T. Solomonides (1) , R. Warren(5