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Inter- and Intraoperator Variability in Measurement of On-Site CT-derived Fractional Flow Reserve Based on Structural
Kanako K Kumamaru1, Erin Angel1, Kelsey N Sommer1
1Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan (K.K.K.); Canon Medical Systems USA, Tustin, Calif (E.A.); Department of Biomedical Engineering (K.N.S., C.N.I.), Department of Medicine (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S.) and Department of Medicine (Cardiology) and Nuclear Medicine (S.M.), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (K.N.S., C.N.I.); Clinical and Translational Research Center, University at Buffalo, Buffalo, NY (V.I., M.F.W., N.A., A.B., S.B.K., C.M., T.R., A.C.S., S.W., U.C.S., C.N.I.); Buffalo General Medical Center, Buffalo, NY (S.K., K.P., M.M.S.); Department of Cardiovascular Medicine, School of Medicine, Juntendo University, Tokyo, Japan (S.F.); and Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (F.J.R.).
Computed tomography-derived fractional flow reserve (CT FFR) measurements show good reproducibility among operators of varying expertise. On-site, face-to-face training for CT FFR may reduce variability compared to self-training.
Area of Science:
- Cardiovascular imaging
- Medical physics
- Interventional cardiology
Background:
- Coronary artery disease diagnosis relies on invasive methods.
- CT-derived fractional flow reserve (CT FFR) offers a non-invasive alternative.
- Standardization of CT FFR measurements is crucial for clinical adoption.
Purpose of the Study:
- To assess inter- and intraobserver variability in on-site CT FFR measurements.
- To compare reproducibility between specialist-led training and self-training methods.
- To evaluate CT FFR agreement with invasive catheter-derived FFR.
Main Methods:
- Retrospective analysis of 22 patients with coronary CT angiography and invasive FFR.
- Thirteen operators with varying expertise performed CT FFR measurements.
- Two training arms: on-site specialist training vs. self-training with written materials.
Main Results:
- Overall intraclass correlation coefficient (ICC) for CT FFR was 0.71.
- On-site specialist training (arm 1) showed less interoperator variability than self-training (arm 2).
- CT FFR correlated with invasive FFR (r=0.61), with a mean absolute difference of 0.096.
Conclusions:
- On-site CT FFR calculations demonstrate good reproducibility across different operator expertise levels.
- Face-to-face training appears to minimize variability in CT FFR measurements.
- CT FFR is a reproducible non-invasive tool for assessing coronary artery stenosis.
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