Hi, everyone. Good morning. Um Happy to be here. Um So I'm gonna talk about the future of Coronary CT A um a little bit different in the sense that I'm, I'm not gonna use cases, but I'm actually going to use a software platform that um Santeria is probably going to move forward with and hopefully have available in the next year. Um And I think this is um really interesting and novel platform. Um And so I will show you some stuff here as we move forward with Coronary CT A, the, the our scanners have gotten uh so good at this point that this has really become the preferred modality of, of noninvasive assessment for coronary artery disease um in, in select patients. But um in a vast majority of them, these are some images from a photon counting CT. Um This is kind of the highest generation scanner um that's available and you can see these are volume rendered images, but these are beautiful images of coronary arteries. Um and the detail here um is very impressive. And so you can see that as we move forward, our ability to kind of quantify um and look at coronary arteries is is rapidly changing. So I want to highlight a program here, this is called clearly it's a program we've partnered with and we hopefully have available in the next year. Um But I want to highlight the process and kind of what this means for imager and general cardiologists going forward. Um So, you know, we do a coronary CT A uh of a patient for whatever the indication is. Um And that data will automatically get sent uh to this company. Now, this is not a necessarily a clearly ad um There are other companies that do this. The two main big players in the field are clearly in heart flow. Um And they offer kind of detailed of coronary assessment, but I'll show you this because this is who uh we've partnered with. Um So our scans get sent to uh clearly and then right away, they get preprocess and, and um put into an A I algorithm and this has been vetted through thousands and thousands of studies. Um And then there's also some manual tech input on the other end to essentially outline coronary arteries, trace plaques, calcified plaques, noncalcified plaques, and you can see these uh setups here. Now, this allows oversight as well. So, um from the imagers perspective, I can go through this, I can say, I don't agree where this coronary artery is outlined. Uh I don't agree that it called this plaque or not. And so I can change this and there can be oversight but um with uh deep learning and, and multiple iterations of A I, this has become pretty darn good. Um And so this is the data analysis um and input portion, then you look here's another portion here. This is these are um straight reformatted images of the coronary arteries. And you can see from every angle so 100 and 80 degrees here, 0 22.5 and so on and so forth. You can see that the vessel wall is outlined. Um The plaques are outlined the uh and they're, they're color coded based on whether they're calcified, noncalcified or low density noncalcified plaque. And again, all of this or the vast majority of this is actually A I based. So we move forward and this is actually the analysis that you would get um uh back on the patient if you're the the reader essentially. And so you get this um overview kind of like you would do in the Cath lab where you can say, hey to your patient, you know, we found a lesion here and it was this tight. Um but this is color coded and it essentially gives you a color coding of vessel stenosis. But then anything also outlined in that kind of reddish halo, you see there actually means that the vessel is ischemic. Um And so what does that mean we've gotten into this era now where we, you know, we had CT as an, an atomic definition. Um And so, yes, we could say there's a stenosis that's 30 degrees or 50 degrees or uh or uh percent, sorry, 70% or so, generally, we think anything above 70% is, is significant. But what does that mean? And in the last I'd say 10 years or so, we've started to use um flow, he dynam flo flow hemodynamic assessment of CT um to say that these would either correlate with FFR positive or FFR negative lesions. And so this is CTFFR essentially. Um So this, this can now be a functional and an, an atomic test all in one. So that's, that's kind of a gold standard in my mind um or is going to probably become a gold standard in my mind. So if we move forward and we click on that L ad lesion, um what we would get is something like this. Now, interestingly, there's a lot of information here and I think that was one of our biggest concerns at the beginning is how much information do we need? Um And how much does the patient get and what does this mean? Um But I think from the, from the basic perspective, it's actually nice to have all this information. I'll show you why. Um So here we're in the proximal ID and you can see it tells you how many severe stenosis, there are, how many moderate stenosis there are. Um how much uh plaque volume. There is how that's divided into calcified and noncalcified plaque. Um Is there positive remodeling of the vessel which we think is potentially um a harbinger of bad things, maybe a higher risk uh plaque. And then what the uh Luminal stenosis is whether that's by diameter or area. And you can see you can actually go all up and down this vessel with different degrees and I'll show you a video of that in a second. But so this is all from the centerpiece, you can see at the um top corner there, this is that overall screen that we start with. Then we move to atherosclerosis again, calcified lesions, noncalcified lesions, how much of each, how much in each segment, proximal segment, midsegment distal segment. Um and it's all done for you essentially. So we move on to stenosis. Here's a nice chart here. Anything in red is severe. Anything in uh that orange is yellow color, there is moderate and then anything below is mild, you can click on those lesions. So for example, uh on the uh left side of the screen here, we we clicked on the um severe stenosis and it brings up that image again and you can surf the entire vessel and look at what the computer is reading for you. And you see there's a 71% stenosis there in the proximal led, which is uh you know, potentially a problem. You see how small that lumen is when you're looking in cross section. Um And again, this is all done without me having to manipulate screens and look at CTS and say, you know, it looks like this lesion is a problem. Let me reconstruct it in three, you know, in three dimensions and see what that looks like it's all done. So we move on to the ischemia assessment and you'll see the video on the right uh sorry on the left, this is uh me surfing through the vessel, you see it gets really tight there where that stenosis is and you can see all the way down. So we'll let that run for a second and then you can see I can actually go through the angles um to just make sure that we're looking at it from all angles here. So I think we'd all agree that's a tight lesion, but nice that you can kind of comprehensively uh assess that it also, you know, the, the some of the newer stuff too is not just is the vessel tight and is there ischemia. But then, then the question is, can you plan for PC I or can you plan for an intervention? Um So you'll see there, there's measures of lesion length there. Um There's measures of minimal Luminal diameter, there's reference vessel diameters. And so this all becomes actually, you know, pretty interesting and probably a way that you can match this with your interventional imaging in terms of um you know IVIS or OCT when you're planning for stents. So we move forward here. The software will actually suggest ac ad rads. Um category C AD R DS is what we use to essentially classify coronary artery disease. Going from N being a non diagnostic study. Um zero being no plaque or Luminal stenosis. One being mild or minimal stenosis, sorry, two mild stenosis, three moderate for A is any severe stenosis for B is what we typically think about as revascularized uh or treatable coronary disease in the chronic setting. So left main disease or three vessel disease. Um and then five being a CTO or chronic total occlusion, there are modifiers down there. You see NSGV and so um you have stents, grafts, uh vulnerable plaques and there are markers within the CTS that we look for. Uh that we think are plaques that are potentially more prone to rupture where the data stands on that in terms of intervening. Um I don't think we're quite there yet, but I think we have an idea of what is a vulnerable plaque and what tends to lead to heart attacks. We just don't know that treating those upfront uh makes a difference right now. So then we come to this, this is a busy slide. But I think uh as I mentioned before, there's a lot of data here and that was one of our big concerns upfront. Um I think this is actually really nice though because you can see you can actually export this to a PDF, you can export it right to Excel. And so all of this data which is uh per segment data, volume of plaque, uh calcified, noncalcified low density, uh all of that is available for you at the click of a button. And so when you start talking about how do we actually study these things? Um and what do they mean going forward when all of this is put through an A I system? Um th this is really powerful data. Um you know, you talk about big data and I think this is a, a potential spot for it. Um This is where we start to learn what is, what do coronary lesions mean. And um how do we move forward in treating them? The other really nice thing here too. Uh at least from an efficiency standpoint is that it will generate a report for you. Um So this is a report I didn't touch this, it came with it. Uh After that study being sent to it gives you a summary of the C AD R DS uh overall C AD R ad score. Um And this can be completely edited. So you see it's by vessel on the uh on one side of the screen and then the summary on the other side of the screen, you can send this to, you know, a pack system um and report it, you can edit it, you can also pre template it. So if we say, you know, as a Centa group, we actually don't like that. The, you know, plaque volume is in there. We'd like something else that can be done too for every study. And so this is really nice um from an efficiency standpoint. Um The other really awesome thing about this too and I looked at this last night is it, it generates a PDF that's about 25 pages um but easily readable for a patient. Um And it's, it, it takes you through all of coronary artery disease. So at, at a really nice learning level takes you through um what is coronary artery disease? What is my cardiac CT scan mean? What does it mean if I have calcified plaque or noncalcified plaque? Um What happens when people take statins? What are those? What does that look like in terms of what that does to uh my disease and how does that modify my disease? And then it really sets the groundwork to have a nice discussion with your physician about um you know, what it makes sense to do going forward in terms of either treatment or intervention and then what it provides to the actual provider on the other side is a nice chart here. So a little less um uh busy in my mind kind of gives you a breakdown by vessel, gives you a breakdown by severity of stenosis and ischemia and then actually provides you a a vessel interpretation. I I just provided the ischemic vessels there, the right coronary uh and the led um but kind of shows the referring as well like, hey, this is what we were looking at and you can look at it too and here's the disease in your patient. Um and also something nice that they could potentially show the patient um in a visit where they say look, you know, you actually have disease and, and this is why it's worth treating. Um So I will stop there. Um This is a really exciting software um that we're happy to be partner, partnering with them. Um And we're looking forward to this being available at center in the next year or so. So, thank you.
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