Quantification of RV/LV ratio can be done with several methods: volumetric measurements, four-chamber reformatted images or even in axial slices with equivalent prognostic value. Producing such measurement is time consuming and is subject to the experience of the reading radiologists.

The Technical University the Madrid, together with the Brigham and Women’s Hospital and the Massachusetts Institute of Technology have designed a completely automated algorithm to compute the RV/LV axial diameter ratio. Without need for radiologists interaction, the algorithm detects the heart, segments the right and left ventricles, detects the inter-ventricular septum and finds the maximum ratio of the right ventricle with respect to the left ventricle to compute the diameter ratio. The algorithm is integrated in the Osirix radiology workstation. The radiologist can review and correct the automated measurements before reporting them to the physician, so that he/she can make the best medical decision for the patient.

 “An automated tool that will help physicians making the best medical decision for patients suffering from pulmonary embolism without incurring in extra analysis time of the images  by part of the radiologists”

• Pulmonary embolism (PE) affects between 300,000-600,000 Americans every year and result in 12,000-80,000 deaths/year in the USA [U.S. Department of Health and Human Services, 2008].

• Accurate numbers for Europe are scarce. However, the incidence of PE has been reported to be 6-20.8 cases/10,000 people/year in Brittany (France) and Malmo (Sweden) respectively [Torbicki et al., 2008].

• There is an estimated number of 60,000 cases of PE a year in Spain, resulting in 50,000 hospitalizations, and more than 19,000 deaths [Juretschke Moragues & Barbosa Ayúcar, 2002] most of them without being diagnosed before death.

• Between 300,000 and 600,000 patients suffer PE every year in the U.S. The average time for a radiologist to estimate a RV/LV diameter ratio is 300 seconds, which at the current salary of a radiologist amounts for 10$. This gives a total market potential of 6 M$ in savings. Radiology departments do not report the RV/LV diameter ratio because of such costs.

• While the dollar amount does not seem large, the software solution becomes interesting for teleradiology companies, since they can provide better service with very little extra cost. For instance, vRad serves more than 2000 hospitals and radiology groups. Our software can be easily integrated in their workflow. With minimal investment, they can capitalize in such savings by offering the hospitals automated RV/LV diameter measurements.

• An alternative route for commercialization is to embed our software with the already existing radiology workstations. Examples of them are Fuji, Phillips, Vital Images and Siemens.

• Performance and robustness have been evaluated within the clinical setting on the routinely diagnostic study of PE (CTPA).

• High accuracy when compared to measurements made by a radiologist, and prognostic significance when tested against reference standards outcomes.

• Having an automated tool will reduce the increase of time spent by radiologists in the computation of such ratio (approximately 5 minutes/case). This will result in savings to the hospital.

• Noise and blur artifacts typically occur in CTPA studies and the timing of the contrast can cause great differences among different CTPA scans. The key improvement of our method, with respect to algorithms designed for other cardiac CT, is the robustness with respect to these effects.

• This tool can not only be useful in the case of acute PE, but holds promise to be used in other cardiovascular diseases, which are the leading cause of death in developed countries.