Detection of Bjork-Shiley convexo-concave heart valve outlet strut single leg separations: Consensus image acquisition and interpretation using two different cineradiographic imaging technologies

Kenneth D. Hopper, Ian Gilchrist, J. Richard Landis, A. Russell Localio, Ronald Wilson, Walter Pae, Allen Kunselman, James W. Griffith, William S. Pierce, Paul S. Potok, Thomas R. TenHave

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Conventional cineradiology has been used clinically to detect partially broken outlet struts (single leg separations, SLSs) in normally functioning Bjork-Shiley convexo-concave (C/C) heart valves. The value of radiographic screening has, however, been debated in the medical literature. This study uses the same radiographic technique in sheep implanted with known-status C/C valves in combination with a newly developed geometric image magnification radiography system. This study was designed to test whether sensitivity and specificity of radiographic screening of C/C valves in detecting SLSs could be improved through the combination of readers and imaging modalities. Methods: Twenty-one sheep with mitral C/C valves were studied on both systems. Five were used for extensive scanning training. When operators were expert on both systems, 16 blinded study valves (4 intact and 12 with outlet strut SLSs) were scanned twice on both systems, first on a modified conventional and then a prototype geometric image magnification (Feinfocus(TM)) cineradiographic system by two expert physicians working together. Results: Among the 32 scanned valves, the two combined expert physicians were required to evaluate 40 intact legs and 24 with an SLS. For all SLS valves, the conventional and Feinfocus systems separately detected 50 (12/24) and 54% (13/24), respectively. When the two systems were combined, the final consensus score was correct in 67% (16/24) of all SLS valves. Conclusions: Combined modality, paired expert physicians detected 67% of all SLSs. The Feinfocus system might be best reserved for those patients in whom the Siemens screening study demonstrates in minimally suspicious (grade 2) or suspicious (grade 3) appearance of a C/C valve outlet strut leg.

Original languageEnglish (US)
Pages (from-to)96-101
Number of pages6
JournalCardiology
Volume91
Issue number2
DOIs
StatePublished - Aug 17 1999

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Heart Valves
Leg
Technology
Physicians
Sheep
Expert Systems
Radiography
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Hopper, Kenneth D. ; Gilchrist, Ian ; Landis, J. Richard ; Localio, A. Russell ; Wilson, Ronald ; Pae, Walter ; Kunselman, Allen ; Griffith, James W. ; Pierce, William S. ; Potok, Paul S. ; TenHave, Thomas R. / Detection of Bjork-Shiley convexo-concave heart valve outlet strut single leg separations : Consensus image acquisition and interpretation using two different cineradiographic imaging technologies. In: Cardiology. 1999 ; Vol. 91, No. 2. pp. 96-101.
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title = "Detection of Bjork-Shiley convexo-concave heart valve outlet strut single leg separations: Consensus image acquisition and interpretation using two different cineradiographic imaging technologies",
abstract = "Background: Conventional cineradiology has been used clinically to detect partially broken outlet struts (single leg separations, SLSs) in normally functioning Bjork-Shiley convexo-concave (C/C) heart valves. The value of radiographic screening has, however, been debated in the medical literature. This study uses the same radiographic technique in sheep implanted with known-status C/C valves in combination with a newly developed geometric image magnification radiography system. This study was designed to test whether sensitivity and specificity of radiographic screening of C/C valves in detecting SLSs could be improved through the combination of readers and imaging modalities. Methods: Twenty-one sheep with mitral C/C valves were studied on both systems. Five were used for extensive scanning training. When operators were expert on both systems, 16 blinded study valves (4 intact and 12 with outlet strut SLSs) were scanned twice on both systems, first on a modified conventional and then a prototype geometric image magnification (Feinfocus(TM)) cineradiographic system by two expert physicians working together. Results: Among the 32 scanned valves, the two combined expert physicians were required to evaluate 40 intact legs and 24 with an SLS. For all SLS valves, the conventional and Feinfocus systems separately detected 50 (12/24) and 54{\%} (13/24), respectively. When the two systems were combined, the final consensus score was correct in 67{\%} (16/24) of all SLS valves. Conclusions: Combined modality, paired expert physicians detected 67{\%} of all SLSs. The Feinfocus system might be best reserved for those patients in whom the Siemens screening study demonstrates in minimally suspicious (grade 2) or suspicious (grade 3) appearance of a C/C valve outlet strut leg.",
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Detection of Bjork-Shiley convexo-concave heart valve outlet strut single leg separations : Consensus image acquisition and interpretation using two different cineradiographic imaging technologies. / Hopper, Kenneth D.; Gilchrist, Ian; Landis, J. Richard; Localio, A. Russell; Wilson, Ronald; Pae, Walter; Kunselman, Allen; Griffith, James W.; Pierce, William S.; Potok, Paul S.; TenHave, Thomas R.

In: Cardiology, Vol. 91, No. 2, 17.08.1999, p. 96-101.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Detection of Bjork-Shiley convexo-concave heart valve outlet strut single leg separations

T2 - Consensus image acquisition and interpretation using two different cineradiographic imaging technologies

AU - Hopper, Kenneth D.

AU - Gilchrist, Ian

AU - Landis, J. Richard

AU - Localio, A. Russell

AU - Wilson, Ronald

AU - Pae, Walter

AU - Kunselman, Allen

AU - Griffith, James W.

AU - Pierce, William S.

AU - Potok, Paul S.

AU - TenHave, Thomas R.

PY - 1999/8/17

Y1 - 1999/8/17

N2 - Background: Conventional cineradiology has been used clinically to detect partially broken outlet struts (single leg separations, SLSs) in normally functioning Bjork-Shiley convexo-concave (C/C) heart valves. The value of radiographic screening has, however, been debated in the medical literature. This study uses the same radiographic technique in sheep implanted with known-status C/C valves in combination with a newly developed geometric image magnification radiography system. This study was designed to test whether sensitivity and specificity of radiographic screening of C/C valves in detecting SLSs could be improved through the combination of readers and imaging modalities. Methods: Twenty-one sheep with mitral C/C valves were studied on both systems. Five were used for extensive scanning training. When operators were expert on both systems, 16 blinded study valves (4 intact and 12 with outlet strut SLSs) were scanned twice on both systems, first on a modified conventional and then a prototype geometric image magnification (Feinfocus(TM)) cineradiographic system by two expert physicians working together. Results: Among the 32 scanned valves, the two combined expert physicians were required to evaluate 40 intact legs and 24 with an SLS. For all SLS valves, the conventional and Feinfocus systems separately detected 50 (12/24) and 54% (13/24), respectively. When the two systems were combined, the final consensus score was correct in 67% (16/24) of all SLS valves. Conclusions: Combined modality, paired expert physicians detected 67% of all SLSs. The Feinfocus system might be best reserved for those patients in whom the Siemens screening study demonstrates in minimally suspicious (grade 2) or suspicious (grade 3) appearance of a C/C valve outlet strut leg.

AB - Background: Conventional cineradiology has been used clinically to detect partially broken outlet struts (single leg separations, SLSs) in normally functioning Bjork-Shiley convexo-concave (C/C) heart valves. The value of radiographic screening has, however, been debated in the medical literature. This study uses the same radiographic technique in sheep implanted with known-status C/C valves in combination with a newly developed geometric image magnification radiography system. This study was designed to test whether sensitivity and specificity of radiographic screening of C/C valves in detecting SLSs could be improved through the combination of readers and imaging modalities. Methods: Twenty-one sheep with mitral C/C valves were studied on both systems. Five were used for extensive scanning training. When operators were expert on both systems, 16 blinded study valves (4 intact and 12 with outlet strut SLSs) were scanned twice on both systems, first on a modified conventional and then a prototype geometric image magnification (Feinfocus(TM)) cineradiographic system by two expert physicians working together. Results: Among the 32 scanned valves, the two combined expert physicians were required to evaluate 40 intact legs and 24 with an SLS. For all SLS valves, the conventional and Feinfocus systems separately detected 50 (12/24) and 54% (13/24), respectively. When the two systems were combined, the final consensus score was correct in 67% (16/24) of all SLS valves. Conclusions: Combined modality, paired expert physicians detected 67% of all SLSs. The Feinfocus system might be best reserved for those patients in whom the Siemens screening study demonstrates in minimally suspicious (grade 2) or suspicious (grade 3) appearance of a C/C valve outlet strut leg.

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