PCI Postoperative Coronary Artery Analysis

Abstract

Systems and methods for PCI post-operative coronary artery analysis. One example method includes acquiring a plurality of angiographic images depicting at least one blood vessel of a patient's heart, the angiographic images including two or more percutaneous coronary intervention (PCI post-operation) images depicting a PCI site where a PCI is included to perform a blood supply reconstruction of a lesion, and one or more diagnostic images depicting at least one blood vessel of the patient's heart, the PCI post-operation images depicting the PCI site where the PCI is included to perform a blood supply reconstruction of the lesion. And wherein the diagnostic image depicts a lesion; receiving a user input specifying a PCI site in the PCI post-operation image via a user interface presenting the PCI post-operation image; determining an indicator indicative of vascular function based on the angiographic image, where the indicator is derived based on a three-dimensional model of portions of the patient's heart, and where portions of the diagnostic image depicting the lesion are masked during generation of the three-dimensional model; and presenting, via a user interface, summary information associated with the PCI, the summary information including at least the determined indicator.

Description

Cross-references to related applications

[0001] This application claims priority to U.S. Provisional Patent Application No. 63 / 518536, filed August 9, 2023, entitled “Coronary Artery Analysis after PCI”, the entire disclosure of which is incorporated herein by reference in its entirety. Background Technology

[0002] Cardiovascular disease (CVD) is a leading cause of morbidity and mortality, affecting an estimated 244.1 million people worldwide, particularly due to a sub-component of CVD—coronary artery disease (CAD). CAD can be involved in acute coronary syndrome (ACS) and stable angina (SAP). CAD can occur in long, asymptomatic phases, with clinical manifestations frequently resulting in angina, acute myocardial infarction (MI), or cardiac death. The underlying mechanisms that can cause CAD involve atherosclerotic lesions in the coronary arteries. Atherosclerosis is the buildup of plaque that narrows the coronary arteries and reduces blood flow to the heart, causing localized ischemia or coronary artery stenosis.

[0003] Revascularization is the preferred treatment for patients with moderate to severe localized ischemia or stenosis, significantly improving their condition. Revascularization strategies include numerous techniques such as cardiac surgery with cardiopulmonary bypass, coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI) methods, including balloon angioplasty, bare-metal stents (BMS), and first- and second-generation drug-eluting stents (DES). The severity of CAD can be assessed using vascular computer models. Summary of the Invention

[0004] This disclosure generally considers systems and methods for determining the effectiveness of percutaneous coronary intervention (PCI) using non-invasive techniques.

[0005] In some aspects, the technology described herein relates to a method implemented by a system of one or more processors, the method comprising: acquiring multiple angiographic images depicting at least one vessel of a patient's heart, the angiographic images including at least one post-percutaneous coronary intervention (PCI) image and one or more diagnostic images, wherein the PCI post-PCI image depicts a PCI treatment site included for revascularization of a lesion, and wherein the diagnostic images depict the lesion; receiving information specifying the location of the PCI treatment site in the PCI post-PCI image; determining an indicator of vascular function based on the angiographic images, wherein the indicator is derived based on a three-dimensional (3-D) model of at least one vessel of the patient's heart, and wherein portions of the diagnostic images depicting the lesion are masked during the generation of the 3-D model; and presenting summary information associated with the PCI via a user interface, the summary information including at least the determined indicator.

[0006] In some respects, the technology described herein relates to a method in which receiving information about the location of a designated PCI treatment site includes: presenting post-PCI images via a user interface and receiving information via user input.

[0007] In some respects, the techniques described herein relate to a method in which receiving information about a PCI site in a specified post-PCI image includes the system determining the location of the PCI treatment site based on analysis of the post-PCI image.

[0008] In some respects, the techniques described herein relate to a method in which a three-dimensional model is generated based on matching features included in angiographic images, and in which portions of the diagnostic image depicting the lesion are not used to generate indicators.

[0009] In some respects, the techniques described herein relate to a method in which the location of a PCI site is matched with a corresponding location in a diagnostic image, and where the corresponding location is masked.

[0010] In some respects, the technique described in this article involves a method in which the metric is the diversion reserve value.

[0011] In some respects, the techniques described herein relate to a method in which an indicator is compared with different indicators determined based on a set of diagnostic images depicting at least one blood vessel of a patient’s heart, and wherein the comparison is included in summary information.

[0012] In some aspects, the technology described herein relates to a method in which a user interface includes: a first portion associated with different indicators, the first portion including: different indicators, and a graphical representation of at least one blood vessel, wherein a color is assigned to the portion of at least one blood vessel based on a decrease in a corresponding indicator associated with the different indicators; and a second portion associated with the indicators, the second portion including: the indicators, and a graphical representation of at least one blood vessel, wherein a color is assigned to the portion of at least one blood vessel based on a decrease in a corresponding indicator associated with the indicators.

[0013] In some respects, the techniques described herein relate to a method in which a set of diagnostic images includes at least one diagnostic image and at least one other diagnostic image.

[0014] In some respects, the techniques described herein relate to a method in which summary information includes labeled post-PCI indicators associated with a user-selected portion of a 3-D model, and labeled diagnostic indicators associated with a corresponding portion of a diagnostic 3-D model based on a set of diagnostic images.

[0015] In some respects, the techniques described herein relate to a method in which summary information includes a 3-D model and a diagnostic 3-D model based on a set of diagnostic images, the 3-D model and the diagnostic 3-D model being presented from the same perspective.

[0016] In some aspects, the techniques described herein relate to a method that further includes: adjusting at least one value in profile information associated with PCI via a user interface, presenting the adjusted at least one value via a user interface, and, in response to adjusting the at least one value, presenting an adjustment to a corresponding value in profile information associated with a set of diagnostic images for comparison.

[0017] In some respects, the techniques described herein relate to a method that also includes: presenting multiple angiographic images, the location of the PCI treatment site in post-PCI images, and masked portions of diagnostic images depicting lesions via a user interface.

[0018] In some respects, the techniques described herein relate to a method in which one or more diagnostic images are automatically selected from a plurality of diagnostic images based on a score determined by comparing each of the diagnostic images with at least one post-PCI image.

[0019] In some respects, the techniques described herein relate to a method in which a plurality of diagnostic images include a set of diagnostic images for determining diagnostic indicators of vascular function, the set of diagnostic images depicting at least one vessel of a patient’s heart captured at a time prior to capturing at least one post-PCI image.

[0020] In some respects, the technology described herein relates to a method, which also includes: presenting a set of angiographic images via a user interface, wherein multiple angiographic images are acquired from a set of angiographic images.

[0021] In some respects, the techniques described herein relate to a method that further includes filtering a set of angiographic images into a subset based on at least one of a quality score for each angiographic image or a timestamp for each angiographic image within the angiographic images.

[0022] In some respects, the techniques described herein relate to a method in which a subset of angiographic images cannot be acquired for use in multiple angiographic images.

[0023] In some respects, the technology described herein relates to a system comprising one or more processors and a nontransitory computer storage medium storing instructions that, when executed by one or more processors, cause one or more processors to perform the method.

[0024] In some respects, the techniques described herein relate to non-transitory computer storage media that store instructions executed by the system.

[0025] The systems, methods, techniques, modules, and apparatuses disclosed herein each have several innovative aspects, none of which are solely responsible for the desired properties disclosed herein. Attached Figure Description

[0026] Throughout the accompanying drawings, reference numerals are used repeatedly to indicate the correspondence between the referenced elements. The drawings are provided to illustrate examples of the subjects described herein, not to limit their scope.

[0027] Figure 1 This is a block diagram of an example PCI post-PCI assessment system that identifies post-PCI vascular parameters for inclusion in post-PCI evaluation.

[0028] Figure 2A This is a detailed block diagram of an example PCI post-operative assessment system.

[0029] Figure 2B This is an example of a diagnostic assessment.

[0030] Figure 3 This is a flowchart of an example process for determining one or more post-PCI vascular parameters for inclusion in post-PCI assessment.

[0031] Figure 4 This is a flowchart of an example process for determining post-PCI assessment using diagnostic evaluation.

[0032] Figure 5A This is the user interface for selecting angiography images.

[0033] Figure 5B This is an example of a user interface for post-PCI assessment.

[0034] Figure 5C This is a user interface illustrating a sample comparison between diagnostic assessment and example post-PCI assessment. Detailed Implementation Overview

[0035] This specification describes techniques for determining the effectiveness of percutaneous coronary intervention (PCI) using non-invasive techniques. PCI may include placing the PCI procedure at the site of treatment, such as a lesion. An example PCI procedure may include the use of a stent. To ensure the effectiveness of PCI, this specification describes a streamlined user interface flow and backend features for rapid and accurate quantification of effectiveness. In some instances, one or more indicators of vascular function may be determined based on angiographic images of the patient's heart. An example indicator may include the fractional flow reserve (FFR) value. In some instances, individual indicators may be determined for various locations along the vessel where the PCI procedure was performed. These locations may be discrete locations along the length of the vessel or reflect a continuous function such that a corresponding indicator can be identified for any location (e.g., length). These indicators may be included in an interactive user interface or report, referred to herein as post-PCI assessment.

[0036] As will be described, the techniques described herein advantageously allow the use of post-PCI images (e.g., angiographic images including PCI treatment) and diagnostic images (e.g., angiographic images including PCI treatment prior to PCI treatment). Typically, a medical professional has access to two post-PCI images to examine the placement of the PCI treatment. The techniques described herein allow the use of two post-PCI images, combined with a diagnostic image, to generate a three-dimensional (3D) model of the patient's heart or a portion thereof. For example, portions of the diagnostic image depicting the lesion can be masked or otherwise ignored during the generation of the 3D model. Analysis of this model allows for precise determination of indicators. In this way, the medical professional can follow his / her normal practice and obtain information indicating the effectiveness of the PCI treatment. In another example, a post-PCI image can be used in combination with a diagnostic image. In yet another example, only the post-PCI image can be used.

[0037] Coronary artery physiology assessment, also known as disease-related functional assessment, indicates the health of a patient's cardiovascular system by providing vascular characteristics. These characteristics can be lesions that indicate the presence of atherosclerosis or other forms of CAD. Quantitative coronary angiography (QCA) is a minimally invasive coronary artery physiology assessment that uses medical images obtained during the procedure to determine the characteristics of the cardiovascular system.

[0038] Medical images can be two-dimensional (2D) angiographic images. For example, as described above, during a PCI procedure for vascular reconstruction, many healthcare professionals may routinely capture two angiographic images illustrating one or more PCI procedures (e.g., stents) placed to correct one or more lesions in a vessel. These post-PCI angiographic images can be used in conjunction with diagnostic angiographic images to generate vascular characteristics of the cardiac vascular system at the site of the PCI placement. Diagnostic angiographic images can be captured during an evaluation prior to the PCI procedure (referred to herein as diagnostic evaluation), such as during catheter insertion procedures or diagnostic coronary physiology assessments of the cardiac vascular system. Vascular characteristics included in the evaluation may include one or more indicators of vascular function (e.g., fractional flow reserve (FFR)) or a decrease in one or more indicators at the PCI site (e.g., a reduction in FFR value) to indicate whether the PCI was effective for vascular reconstruction. Furthermore, the evaluation may also include additional information relating to the cardiac vascular system as shown in the angiographic images, including but not limited to pull-back plots, vessel diameter plots, 3D models, labeled and unlabeled angiographic images, color charts, and other measures of vascular health.

[0039] Descriptions of determining or calculating indicators of vascular function and determining three-dimensional models, etc., are contained in U.S. Patent Nos. 10,595,807 and 11,138,733, which are incorporated herein by reference in their entirety.

[0040] As will be described, the system described herein (e.g., PCI post-assessment system 100) can determine a PCI post-assessment to present to the user. As described herein, the PCI post-assessment may include information related to determining whether the PCI was effective. As mentioned above, example information may include pull-back graphs (e.g., Figure 5B (Element 519). As those skilled in the art will recognize, pull-back plots can map indicators of vascular function (e.g., FFR values) to length along the vessel. In some instances, the Y-axis may represent the value of the indicator or a decrease or drop in the indicator, while the X-axis may represent the length along the vessel. For example, a pull-back plot may reflect a line that begins at an initial length along the vessel (e.g., near a lesion in the vessel) and ends at a length near the distal end of the vessel (e.g., away from the lesion). Thus, the line may begin with a specific Y-axis value (e.g., 1) and then decrease along the length of the vascular system. This information may also include a three-dimensional (3D) model of a portion of the vascular system incorporating PCI. Figure 5B As shown, a 3D model can graphically describe indicators that indicate vascular function along the length of a vessel, including PCI treatment. For example, parts of the 3D model can be assigned colors based on the indicators (e.g., a lower indicator or a decrease in a higher indicator can be associated with a specific color such as red).

[0041] Advantageously, the disclosed technology allows for comparison between diagnostic assessments (e.g., generated based on diagnostic images prior to PCI) and post-PCI assessments. For example, diagnostic images may have already been taken of the patient, and the system may have already analyzed these images. In this example, prior to PCI, patient data reflecting one or more indicators of vascular function may have been generated using the diagnostic images. The system can compare these two assessments to measure the effectiveness of the PCI.

[0042] As an example, diagnostic indicators of vascular function and post-PCI indicators can be compared. These indicators can be correlated with the location of the lesion and the site of the PCI treatment that addressed the lesion. For example, the location could correspond to the length along the vessel after the threshold distance following the lesion. As another example, the location could correspond to the length of the vessel along the middle or center of the lesion. As yet another example, a diagnostic indicator could represent the average indicator value over a length associated with the tumor. The system can present comparisons between indicators to the user, for example, via a user interface or report, such as... Figure 5C As shown.

[0043] Additional comparisons may involve a decrease in an indicator along the length of the vessel (e.g., a reduction in the indicator value). For example, the system may compare pull-back plots generated for diagnostic assessment and post-PCI assessment. The system may also compare one or more of the following: the quality of the vessel involved in the lesion, such as the vessel diameter along its length (e.g., along the length of the lesion), measures of the vessel affected by stenosis (e.g., the area and total percentage of the vessel affected by stenosis), and a comparison between a diagnosis of the cardiac vascular system and a post-PCI 3D model.

[0044] The post-PCI assessment techniques disclosed herein improve upon conventional techniques and processes, which can be inflexible. Advantageously, the systems and methods described herein provide rapid response and assessment after PCI placement. Current techniques for post-PCI assessment can be time-consuming and may not provide immediate assessment of whether PCI placement was successful or whether the underlying cause of the PCI was met. In contrast, the systems and methods described herein provide an indication of vascular health by determining the long-term effects of placed PCI treatments.

[0045] “QCA” is not intended to be restrictive and can be used to refer to any other minimally invasive coronary physiological assessment, such as 2D radiographic imaging, 3D quantitative assessment, etc.

[0046] "PCI" and "post-PCI" are not intended to be limited to the state after percutaneous coronary intervention and PCI has been performed, but can refer to any revascularization.

[0047] “Local ischemia,” “stenosis,” and / or “coronary artery stenosis” are not intended to be limiting and are interchangeable, or may refer to any other condition related to narrowing of a blood vessel that can be treated with revascularization. “Lens” refers to a narrower portion of a blood vessel in the cardiac vascular system and is not intended to be limited to local ischemia or coronary artery stenosis, but is related to any CAD.

[0048] The term “stent” is not intended to be restrictive and can refer to any other method of dilating a blood vessel, whether by physical intervention, chemical intervention, any other intervention, or a combination of interventions. Although “stent” is used in the context of PCI, this does not imply restriction to either, and any other widening method can be used for PCI, or any other vascular reconstruction technique can use a stent.

[0049] In some instances, additionally or alternatively, the vascular system may be of another organ, such as the kidneys, retina, and / or brain. It should be understood that in the specific description of the cardiac vascular system, instances relating to the vascular system of another organ are also implicitly referred to. Block Diagram - Post-PCI Management System

[0050] Figure 1 This is a block diagram of an example post-PCI assessment system 100 that determines post-PCI vascular parameters 140 based on angiographic images 110 to 120. As described herein, parameter 140 may correspond to an indicator of vascular function (e.g., fractional flow reserve (FFR) value) of a portion of a vessel (e.g., a coronary artery) that has undergone PCI treatment (e.g., stenting). Post-PCI vascular parameters 140 and / or angiographic images 110 to 120 may be displayed and / or adjusted on a user interface 130. The post-PCI assessment system 100 may represent a system of one or more computers, one or more virtual machines running on one or more computer systems, etc. In some instances, the post-PCI assessment system 100 may represent an application or other software running by a computer system (e.g., a mobile device).

[0051] Post-PCI assessment system 100 can analyze post-PCI images 120 individually or in combination with diagnostic images (one or more) 110 to determine or otherwise output post-PCI vascular parameters 140. Post-PCI vascular parameters 140 can represent at least one parameter of a portion of the patient's vascular system, such as the FFR value. For example, system 100 can determine the FFR value after PCI treatment (e.g., at a threshold distance along the vessel length from the treatment). System 100 can also determine the FFR value at the end of PCI treatment. System 100 can also determine the average FFR value across the PCI treatment length. System 100 can also determine a pull-back map including a portion or specific vessel that underwent PCI treatment. As described herein, a pull-back map maps individual FFR values ​​to locations along a specific vessel length. The pull-back map can include discrete FFR values ​​or substantially continuous information, such that for any length along a specific vessel, system 100 can acquire a corresponding FFR value.

[0052] As described above, system 100 can obtain diagnostic images 110 after a diagnostic procedure. For example, the diagnostic procedure may include obtaining angiographic images from multiple viewpoints. As those skilled in the art will know, each viewpoint may correspond to a specific rotation and / or angle of a C-arm or other imaging device around the patient. System 100 can determine a diagnostic assessment based on the images. As an example, system 100 can generate a three-dimensional model of a portion of the patient's vascular system depicted in the angiographic images. For example, this portion may include one or more blood vessels, which may include one or more lesions.

[0053] As another example of diagnostic assessment, system 100 can generate one or more indicators of vascular function (e.g., FFR values). As described herein, system 100 can determine the FFR value after lesion (e.g., at a threshold distance from the lesion along the vessel length). System 100 can also determine the FFR value at the end of the lesion. System 100 can also determine the average FFR value across the length of the lesion. System 100 can also determine pull-back plots including portions of the lesion or specific vessels. As described herein, pull-back plots map individual FFR values ​​to locations along a specific vessel length. Pull-back plots can include discrete FFR values ​​or can include substantially continuous information such that system 100 can acquire a corresponding FFR value for any length along a specific vessel.

[0054] Therefore, the post-PCI assessment system 100 can acquire diagnostic images 110 and / or previously determined diagnostic assessments. As will be described, the system 100 can use at least one diagnostic image 110 to determine post-PCI vascular parameters 140. For example, the system 100 can use a set of post-PCI images 120 (e.g., two images, three images, etc.) and one or more diagnostic images 110. In some instances, the system 100 can use two post-PCI images and one diagnostic image. The system 100 can analyze the images and advantageously mask portions of the diagnostic images that have been altered due to PCI. For example, lesions depicted in the diagnostic images can be masked.

[0055] In some instances, users (e.g., healthcare professionals) can select post-PCI image 120 via a user interface. See below for reference. Figure 5A The angiography image selection screen 501 describes an example user interface in more detail. For example, post-PCI image 120 could represent an image obtained by a medical professional after PCI treatment to address a lesion. The user can also select one or more diagnostic images 110 for use by system 100. In some instances, a single diagnostic image may be used. A diagnostic image can be included from any angiography images taken prior to PCI treatment.

[0056] In some instances, as described below, the post-PCI assessment system 100 can select a diagnostic image 110 as a reference image from a set of images. For example, the system 100 can select the diagnostic image 110 based on the analysis of the post-PCI image 120. In this example, the system 100 may prefer a diagnostic image 110 associated with the C-arm angle, which provides a different viewpoint than the post-PCI image 120, allowing the image to be used to generate an accurate 3D model. The system 100 may also prefer diagnostic images that are clear and have good contrast, etc.

[0057] For example, system 100 may calculate scores related to one or more of the following: sharpness, contrast score, quantity or metric associated with vessels displayed in the image, applicability to a target portion / side of the vascular system, number of vessels marked from a previously existing diagnostic assessment, percentage overlap with other selected images after selecting post-PCI image 120, etc. In such examples, system 100 may determine which diagnostic images 110 are suitable candidates by examining diagnostic images 110 that meet a threshold score (the threshold score may be indicated by markers on the diagnostic images 110, such as a green indicator for scores above the threshold and a red indicator for scores below the threshold). In such instances, system 100 may then select a single diagnostic image captured at the angle furthest from two selected post-PCI images 120 and use it for post-PCI assessment. For example, the selected diagnostic image may have the highest angle score, which is determined by adding the angular distances from the first and second selected post-PCI images. This angle score may vary based on the selection of different post-PCI images.

[0058] Alternatively, system 100 may determine a threshold angle score to identify a subset of diagnostic images 110, and / or select diagnostic images with the highest sharpness score, contrast score, etc.

[0059] In some instances, system 100 can determine whether an angiographic image is a diagnostic image 110 or a post-PCI image 120 based on a timestamp associated with each image. For example, if an angiographic image used for evaluation is selected as a diagnostic image, all angiographic images with timestamps earlier than the selected diagnostic image can be classified as unsuitable as post-PCI images, and similarly, if two angiographic images are selected as post-PCI images, any angiographic image with a timestamp after the earlier post-PCI angiographic image can be classified as unsuitable as a diagnostic image. In such instances, unsuitable angiographic images can be indicated by markers (e.g., white indicators).

[0060] In some instances, system 100 may select post-PCI images based on the user's selection of diagnostic images. System 100 may similarly select post-PCI images as described above regarding diagnostic images. In some instances, the user may manually select both post-PCI and diagnostic images. In these instances, the user may choose whether an angiography image is a post-PCI or diagnostic image, for example, by responding to prompts after image selection and / or dragging the angiography image to a designated field corresponding to the angiography image type. In these instances, system 100 may include classification to determine a subset of angiography images, such as suitable images based on meeting a threshold score and timestamp, invalid images based on not meeting the threshold score, and unsuitable images based on not meeting the timestamp.

[0061] Post-PCI assessment system 100 can identify the treated portion of a blood vessel, such as the site of PCI treatment, based on image analysis of post-PCI image 120. In such instances, image analysis can compare the geometry of the blood vessel represented in the post-PCI image to determine the site of PCI treatment. In other cases, the site of treatment can be based on user input (e.g., input provided to a user interface). Based on the determined treated portion, post-PCI assessment system 100 can mask the corresponding portion in diagnostic image 110, which may be a lesion. When generating a 3D model, the masked portion of reference diagnostic image 110 can be ignored in calculations and modeling. Masking the portion in reference diagnostic image 110 corresponding to a lesion can increase the accuracy of indicating the correct site of PCI treatment in post-PCI image 120. Therefore, post-PCI image 120 can be used to determine information for the 3D model, such as the radius or diameter of the treated portion.

[0062] The PCI post-operative assessment system 100 can output post-PCI vascular parameters 140 (e.g., shunt reserve value), optionally along with other vascular characteristics from the post-PCI assessment. Post-PCI vascular parameters 140 indicate the success of revascularization and its long-term feasibility. See below for reference. Figure 5B Post-PCI assessment can include user-friendly evaluations of the cardiovascular health of healthcare professionals, patients, or other interested parties, such as color-coated 3D models of the cardiovascular system and color maps of vascular parameters for specific vessels. Furthermore, post-PCI assessment can include information and graphics related to the vascular characteristics of vessels after PCI, which may include 3D models, vascular parameters at the treatment area of ​​the target vessel, vascular parameter pie charts, vessel diameter comparison charts, pull-back charts, and post-PCI vascular parameter maps.

[0063] Figure 2AThis is a detailed block diagram of an example PCI post-operative assessment system 100 for determining post-PCI evaluation. In the illustrated example, the PCI post-operative assessment system 100 outputs a user interface 130 that graphically depicts the PCI post-operative assessment. The example user interface includes... Figures 5A to 5C The following description, and in more detail below, describes how system 100 uses diagnostic assessment 210 to determine post-PCI assessment. For example, diagnostic images from assessment 210 may be used. As another example, vascular parameters may be compared between diagnostic assessment 210 and post-PCI assessment. It will be understood that in some instances, system 100 may use post-PCI images and one or more diagnostic images that have not yet been analyzed by system 100 to determine post-PCI assessment.

[0064] Regarding diagnostic assessment 210, the patient may have already had angiographic diagnostic images taken. For example, the diagnostic assessment may identify at least one lesion. As described herein, diagnostic assessment 210 may include information and graphics related to vascular characteristics. For example, diagnostic assessment 210 may include one or more indicators indicating vascular function (e.g., FFR value), 3D models, etc.

[0065] Figure 2B The illustration shows an example of a user interface that includes information associated with diagnostic assessment 210. In the illustrated example, a 3D model 240 is depicted along with indicators 242 indicating vascular function, corresponding to a selected site 244 on the model 240. A pull-back plot 244 is also included in the user interface, which, as described herein, can map or otherwise associate sites along the blood vessel with indicator values ​​(e.g., FFR values). Medical professionals can use diagnostic assessment 210 to determine how to proceed with PCI procedures. In some instances, diagnostic assessment 210 may indicate that PCI or any revascularization procedure is unnecessary. Where PCI is applicable, as described above, medical professionals can perform PCI procedures to place PCI treatment at the site of the lesion. Figure 2A The diagnostic image illustration shows an example lesion 214. After PCI treatment, medical professionals can capture post-PCI images 120 and select at least two.

[0066] like Figure 2B As shown, diagnostic assessment 210 may include optional options (e.g., post-PCI transition graph 246) to initiate analysis of the post-PCI assessment. For example, a healthcare professional can view diagnostic assessment 210 and then transition to the post-PCI analysis described herein. In this way, diagnostic assessment 210 can facilitate easy movement from diagnostic assessment to post-PCI assessment.

[0067] about Figure 2AHealthcare professionals can obtain post-PCI images 120 in a manner similar to obtaining diagnostic images 110 during the initiation of a cardiac catheterization procedure. A diagnostic image can then be selected for post-PCI evaluation. For example, if it is the same cardiac vascular system, the system can acquire one of the diagnostic images 110 used to generate diagnostic evaluation 210. If post-PCI images 120 are ready, post-PCI evaluation can occur immediately after the processing of the diagnostic evaluation. Healthcare professionals can either reanalyze diagnostic images 110 for diagnostic evaluation 210 or open a saved copy of diagnostic evaluation 210. Alternatively, as described above, healthcare professionals can run diagnostic evaluation 210 to determine where to perform the PCI procedure and capture post-PCI images 120 after the PCI procedure to run the post-PCI evaluation.

[0068] Therefore, a selected set of angiographic images 220 can be obtained, including post-PCI images 120 and at least one diagnostic image. As described herein, portions of the post-PCI image 120 depicting the site of PCI treatment (e.g., stent) can be identified (e.g., labeled by a medical professional, automatically detected by system 10). For example, a vascular labeling engine 230 can perform the labeling. In this example, engine 230 can use machine learning techniques (e.g., convolutional or attention-based networks) to label portions of the image describing the PCI treatment. Engine 230 can also label corresponding portions of the diagnostic images that depict the location prior to the PCI treatment (e.g., the location of the lesion). In some instances, a medical professional can identify or otherwise label the site of the lesion. In some instances, system 100 can identify the site of the lesion based on stored information from diagnostic evaluation 210. For example, evaluation 210 can indicate that the lesion is located in a specific portion of the diagnostic image. In the illustrated example, engine 230 has identified diagnostic lesion 232 and post-PCI treatment 234 to form a labeled angiographic image 236.

[0069] In some instances, system 100 can respond to user input that uses a PCI tag (e.g., Figure 5AThe unit 507 shown selects the site of post-PCI treatment 234. After selecting the site for PCI marking, the vascular marking engine 230 can generate vascular markings, such as those in the marked angiographic image 236. Vascular markings may include markings for the PCI site, ostium, selected vessel, major collateral vessels, etc. In such instances, the site of lesion 232 may also be manually selected or automatically determined by the vascular marking engine 230, such as by using a previously selected site during diagnostic evaluation 210. Markings on the diagnostic image may be generated by the vascular marking engine 230 based on the determined site of lesion 232 or by using previously determined markings during diagnostic evaluation 210. Markings associated with lesion 232 may be displayed to the user to indicate that they will be masked during post-PCI evaluation. These markings may represent information indicating the site of lesion 232 and post-PCI treatment 234 in image 236. In some instances, graphic markings may be presented in different colors in the user interface.

[0070] Therefore, in some instances, system 100 can generate a post-PCI assessment using a combination of post-PCI images and diagnostic images. For example, two post-PCI images and one diagnostic image can be used.

[0071] System 100 can display a user interface 130 for post-PCI assessment. Figure 5B An example of a post-PCI assessment is shown. In some instances, the user interface 130 can also compare the post-PCI assessment with the diagnostic assessment 210. Examples of this type of comparison are shown in... Figure 5C The information is shown and includes summary information related to diagnosis and post-PCI assessment within the same user interface. For example, the summary information may include diagnostic indicators of vascular function (e.g., diagnostic FFR value) and post-PCI indicators of vascular function (e.g., post-PCI FFR value). In some instances, this comparison may indicate the extent to which post-PCI treatment improves indicators of vascular function (e.g., fractional flow reserve). Healthcare professionals can use this to determine the impact of treatment (e.g., surgery) on local ischemia in real time. Example Flowchart

[0072] Figure 3 This is a flowchart of an example procedure 300 for determining vascular parameters after PCI. For convenience, procedure 300 will be described as being performed by a system of one or more computers (e.g., PCI post-assessment system 100).

[0073] At block 302, the system acquires vascular images. As described above, vascular images can be 2D angiographic images captured during the PCI procedure for post-PCI imaging, and 2D angiographic images captured during catheter insertion for diagnostic imaging. In some instances, vascular images may be solely post-PCI images.

[0074] At block 304, the system acquires at least two post-PCI images. As mentioned above, the post-PCI images can be selected by the user or determined by the system based on prior diagnostic assessments. The post-PCI images can be obtained during the PCI procedure.

[0075] In block 306, the system acquires at least one diagnostic image. As described above, the diagnostic image may be selected by the user, determined by the system based on acquired post-PCI images, or acquired from diagnostic images used for diagnostic evaluation. In instances where only post-PCI images can be used, block 306 may be skipped, or at least one diagnostic image may be replaced by the acquisition of at least one other post-PCI image.

[0076] In block 308, the system identifies portions of post-PCI images depicting PCI treatment. The system also identifies portions of diagnostic images depicting diagnostic lesions that have been treated with PCI.

[0077] Therefore, this system masks the portions of the diagnostic image that depict the lesion. For example, the system can match image features between a post-PCI image and a diagnostic image. Masking may include, for example, the system storing information indicating that the lesion site will not be used when generating a 3D model. That is, because the size of the lesion (e.g., the diameter of the vessel at the lesion site) has changed, the system can ignore the portions of the diagnostic image that depict the lesion. In some instances, the user can identify the lesion site. In some instances where the system has previously analyzed the diagnostic image to generate a 3D model, the system can obtain information indicating the location of the lesion.

[0078] As described above, in some instances, the system can generate a 3D model using only two post-PCI images. In such instances, two post-PCI images can be captured from two different viewpoints and / or angles. A description of generating a 3D model of the vascular system is contained in U.S. Patent No. 9,814,433, which is incorporated herein by reference in its entirety.

[0079] In block 310, the system determines PCI vascular parameters for post-PCI evaluation. For example, vascular parameters can represent fractional flow reserve (FFR) values. In this example, the system can determine geometric information associated with the vessels depicted in the image. Geometric information can indicate the diameter or radius of various parts of the vessel. As described herein, FFR values ​​can therefore be determined in part based on geometric information. As mentioned above, the system can determine multiple vascular parameters, such as individual FFR values ​​that map various parts to the vessel length including PCI treatment. These determined parameters can be used to form… Figure 5B The pullback chart shown.

[0080] In some instances, post-PCI assessment may include other vascular characteristics. As mentioned above, vascular parameters in post-PCI assessment may include PCI vascular parameters and / or post-PCI vascular parameter maps. Post-PCI vascular parameter maps can be used to analyze overall revascularization and local ischemia. PCI vascular parameters can indicate revascularization of previous lesions and, based on FFR thresholds, indicate long-term revascularization. Figures 5B to 5C The illustration shows an example of post-PCI assessment.

[0081] Figure 4 This is a flowchart of an example procedure 400 for comparing post-PCI vascular parameters and diagnostic vascular parameters. The description in procedure 400 can be included in discussions of... Figure 3 In procedure 300, the reverse is also true. For convenience, procedure 400 will be described as being performed by a system of one or more computers (e.g., post-PCI system 100).

[0082] At block 402, the system acquires vascular images. As mentioned above, vascular images can be 2D angiographic images captured during the PCI procedure for post-PCI images, and 2D angiographic images captured during catheter insertion for diagnostic images. In some instances where both occur during the same procedure, acquisition of post-PCI images occurs after block 404, because the PCI procedure may only occur after a diagnostic assessment indicates the need.

[0083] At block 404, the system obtains diagnostic vascular indicators as part of the diagnostic assessment. The system can also obtain other vascular characteristics during the diagnostic assessment. As described above, the system can generate a diagnostic assessment by inputting diagnostic images into the diagnostic processor. In instances where the diagnostic assessment does not result in a PCI procedure during catheter insertion, the system can obtain diagnostic vascular indicators from a previously performed diagnostic assessment.

[0084] In block 406, the system acquires post-PCI images. As described above, in block 404, the post-PCI images can be selected by the user or determined by the system based on previous diagnostic assessments. The system can also acquire reference diagnostic images, which can be selected by the user, determined by the system based on the acquired post-PCI images, or acquired from diagnostic images used for diagnostic assessment.

[0085] At block 408, the system obtains PCI vascular parameters as part of the post-PCI assessment. The system can also obtain other vascular characteristics during the post-PCI assessment. As described above, the system can use a post-PCI engine to generate a 3D model and use the 3D model and the input vascular image to calculate vascular characteristics, thereby generating a diagnostic assessment. The system can then display the post-PCI assessment to the user.

[0086] In optional block 410, the system can generate a comparison between PCI vascular markers and diagnostic vascular markers. As described above, healthcare professionals can use post-PCI comparisons to determine the impact of PCI on vascularization and whether PCI is feasible for long-term vascularization. In some instances, the comparison may be a comparison of vascular markers at points associated with the treatment area assessed post-PCI with vascular markers at points associated with the lesion assessed in the diagnostic evaluation. In some instances, the comparison may be between aggregates and / or averages of relevant points. In some instances, the comparison may include a complete post-PCI assessment and a complete diagnostic assessment, or any part thereof. Example User Interface

[0087] Figure 5A Figures 1 to 10 illustrate example user interfaces that identify aspects of the features described herein. These user interfaces may be rendered in part by a computer system implementing the PCI post-operative assessment system 100. User interfaces may also represent front-end user interfaces associated with web applications, such as interfaces presented on a user's device.

[0088] Figure 5A This illustration shows a user interface 500 for an example angiographic image selection screen 501 used in a post-PCI assessment system. In the illustrated example, the user interface 500 includes information requesting the selection of unselected post-PCI images 502 and a carousel subset illustrating selected post-PCI images 503 and selected diagnostic images 504. These images may come from different viewpoints about the patient (e.g., C-arm angle). The user interface 500 illustrates that the selected post-PCI image 503 is a post-PCI image by displaying a post-PCI indicator 508a, and indicates that the selected diagnostic image 504 is a diagnostic image by displaying a diagnostic indicator 508b.

[0089] In some instances, after selecting two post-PCI images 502 to 503, the user interface 500 can be updated with the automatic selection of a third post-PCI image or a diagnostic image. For example, in some instances, the user can first select two post-PCI images, such that no diagnostic image has been selected yet. As described above, unselected angiographic films shown in the four angular quadrants 505a to 505d (e.g., those other than those with the used diagnostic image indicator 509a) can include a suitability indicator 509b based on threshold scores and timestamps. Furthermore, an invalid message 509d can be displayed for angiographic films determined to be invalid. In some instances, the system can automatically select angiographic films based on further evaluation of a subset of angiographic films indicated as suitable. Figure 5A As shown, unselected angiographic images can be further categorized based on the angle at which the angiographic images are captured (e.g., C-arm angles) (e.g., four angular quadrants 505a to 505d). In some instances, the system can be implemented using a single post-PCI image. For example, diagnostic images can be selected based on different viewpoints (e.g., the C-arm angle of the diagnostic image can be a threshold angle derived from the post-PCI C-arm angle), as described above.

[0090] When post-PCI assessment is determined after diagnostic assessment 210, such as when triggered by interaction with post-PCI transition graphics 211, the diagnostic image 110 used in diagnostic assessment 210 can be automatically selected for post-PCI assessment. In some instances, the diagnostic assessment is selected from three or a threshold number of diagnostic images used for diagnostic assessment. Figure 5A As shown, diagnostic images can be caroused as selected diagnostic images 504, which can be switched using carousel buttons 504a and indicated via carousel indicators 504b. Diagnostic images 110 included in the carousel subset can be indicated by carousel markers 509c in the angiography images shown in the four angular quadrants 505a to 505d, numbered from one to three to correspond to the carousel indicators 504b. In some instances, after the user has selected two post-PCI images, the system will automatically select a diagnostic image from this carousel subset, such as by comparing the highest angular score or other techniques described above. In some instances, the carousel indicator can display checkmarks (not shown) at points corresponding to the diagnostic images selected by the system.

[0091] As another example, instead of locating diagnostic images to the selected diagnostic image 504 point, the system can individually select all three diagnostic images and allow the user to manually deselect diagnostic images that will not be used for post-PCI evaluation, replacing them with post-PCI image 120. Furthermore, the timestamps of the carousel subset can be used to categorize unselected angiographic images in the four angular quadrants 505a to 505d (excluding those with the used diagnostic image indicator 509a as part of the carousel subset, or, in some instances, those selected as post-PCI images), such as by determining that all angiographic images with timestamps later than the latest diagnostic image in the carousel subset are post-PCI images, since medical professionals may have already performed PCI procedures immediately or shortly after running the diagnostic evaluation. In some instances, the user can be prevented from using diagnostic images from the carousel subset as post-PCI images, and / or prevented from using invalid and / or inappropriate angiographic images. In some instances, the angiography image selection screen 501 may include filter buttons (not shown) to show or hide subsets of angiography images in the four angular quadrants 505a to 505d, such as according to the suitability indicator 509b.

[0092] When performing a post-PCI assessment (not shown) without running diagnostic assessment 210, three areas are used to select the angiographic images (in... Figure 5A The images shown as unselected post-PCI image 502, selected post-PCI image 503, and selected diagnostic image 504 can each appear more similar to the unselected post-PCI image 502. One of the three areas can be labeled "Select Diagnostic Angiography" instead of "Select Post-PCI Angiography". In some instances, an angiography selected in one of the two areas for post-PCI angiography is evaluated as a post-PCI angiography, while an angiography selected in the area for diagnostic angiography is evaluated as a diagnostic angiography. In other cases, an angiography selected in any area can trigger a prompt with an indicator, similar to the post-PCI indicator 508a and diagnostic indicator 508b, for the user to choose how the angiography will be evaluated. Alternatively, such prompts can be displayed in instances where the area displays "Select Diagnostic Angiography" instead of "Select Angiography".

[0093] Therefore, in some embodiments... Figure 5AThis can be used to select combinations of diagnostic images and post-PCI images. For example, the system can automatically select two post-PCI images. In this example, the two post-PCI images may represent images associated with a specific cardiac phase (e.g., end-diastolic image). Additionally, in some instances, two post-PCI images can be selected such that they are offset via a thresholded C-arm imaging angle. In this way, they can be used to generate a 3D model of a portion of the cardiovascular system (e.g., via stereo matching techniques or other techniques). Diagnostic images can be selected by the system according to the techniques described above and can represent diagnostic images used during diagnostic evaluation. As described herein, a portion of a diagnostic image depicting one or more lesions can be masked during the generation of the 3D model. For example, a 3D model can be generated using post-PCI images, and diagnostic images can be used to enhance the accuracy of the model. As an example, image portions of diagnostic images outside of one or more lesions can be used to refine the 3D model.

[0094] Figure 5B This is the user interface 510 for an example PCI post-operative assessment 511. The PCI post-operative assessment 511 can be based on two PCI post-operative images and one diagnostic image, as shown with respect to element 516, where the diagnostic image is indicated by a diagnostic indicator 508b. In some instances, the PCI post-operative assessment 511 can be based on at least one PCI post-operative image. As shown, the PCI post-operative assessment 511 can include a PCI post-operative vascular indicator (e.g., ".95"). As mentioned above, this indicator can represent an indicator further away from the PCI treatment threshold, an average indicator value across PCI treatments, a value selected based on user interaction with element 514 to indicate the location along the vessel, and so on.

[0095] Post-PCI assessment 511 may also include a vascular index map 512 (e.g., a pull-back plot) depicting index values ​​indicating vascular function along the vessel length. Post-PCI assessment 511 may also include a vascular index pie chart 513, which depicts the overall health of the target vessel through visual indicators illustrating the volume of indices below a threshold in the target vessel and the distribution of index values ​​across the target vessel. In some instances (not shown), post-PCI assessment 511 may also include a vessel diameter map depicting the actual diameter of the vessel along its length, which can be compared to a simulated healthy vessel diameter map to visualize the comparison between the PCI-treated vessel and a healthy vessel.

[0096] Post-PCI assessment 511 may also include a 3D model 515 of the cardiac vascular system. Parts of the 3D model 515 may be assigned colors based on an associated index value (e.g., FFR value) or the amount of FFR decrease. For example, a portion of the 3D model 515 depicting a lesion may be colored yellow, red, or black. In this example, the portion of the 3D model 515 downstream of the lesion (e.g., downstream) may similarly be colored yellow, red, or black. The portion preceding the lesion may be white, orange, etc. Furthermore, lesions can cause an index decrease, thus yellow, red, or black can be used. These colors can be selected based on the degree of index decrease (e.g., black can be used for a higher index decrease, while yellow can be used for a lower index decrease).

[0097] The 3D model 515 may include lesion markers 514 that can be adjusted by the user to move along different portions of the 3D model 515. This can adjust the value of the post-PCI vascular index 140 at the portion of the vessel represented by the 3D model 515 corresponding to the location of the lesion marker 514. Furthermore, the post-PCI assessment 511 may include a pull-back chart tab 519 in the user interface to bring up a pull-back chart with the post-PCI vascular index 140 along the vessel (e.g., Figure 512). The post-PCI assessment 511 may include a post-PCI graph 518 to indicate to the user that the depicted information is relevant to the post-PCI assessment 511, rather than to the diagnostic assessment. The post-PCI graph 518 may include an option to exchange the assessment for a diagnostic assessment via the user interface. The diagnostic assessment 210 may include information similar to that of the post-PCI assessment 511 (e.g., graphs, numerical values, models, angiography, etc.). As described above, the diagnostic assessment 210 may include a post-PCI transition graph 211 that the user can select to transition from the diagnostic assessment 210 to begin the process of the post-PCI assessment 511.

[0098] Figure 5C This is the user interface 520 for a post-PCI comparison 521 between the illustrated diagnostic assessment 210 and the post-PCI assessment 511. In some instances, the user interface 520 can be obtained by saving (or printing) the post-PCI assessment 511, and the user interface 520 may include options to display only the post-PCI assessment 511 (which may look similar to user interface 510) or the post-PCI comparison 521. When saving the post-PCI assessment 511 or the post-PCI comparison 521, the user interface 510 or user interface 520 can be static (e.g., a report, such as an image, .pdf, document, etc.) or dynamic (e.g., an interactive user interface).

[0099] User interface 520 may include information that highlights or otherwise clarifies the benefits of PCI treatment. For example, diagnostic assessment 210 indicates an FFR value of 0.78 (less than the 0.8 threshold), while post-PCI assessment 511 indicates an FFR value of 0.95. The user interface may include indicators corresponding to the same location of the vessel for both diagnostic assessment 210 and post-PCI assessment 511, and may be adjusted accordingly based on any changes in the selected location in either assessment.

[0100] The user interface can also display additional metrics for both diagnostic assessment 210 and post-PCI assessment 511, such as the distal FFR value (i.e., the FFR value from the base of the vessel to 20% of the vessel's origin), or the average FFR value across the vessel length or affected area for each of the diagnostic assessment 210 and post-PCI assessment 511. The affected area 210 for the diagnostic assessment can be the vessel length associated with the lesion, while the affected area 511 for the post-PCI assessment can be the vessel length associated with the post-PCI treatment area. In some instances, the vessel lengths associated with the lesion and the post-PCI area can be the same. Similarly, the 3D model of the vessel can be colored differently to graphically illustrate the benefits (e.g., the diagnostic 3D model on the upper left includes black indicating severe stenosis).

[0101] In the static user interface, the post-PCI comparison 521 can be a snapshot of the post-PCI assessment 511 and the diagnostic assessment 210, which may prevent the user from adjusting values ​​in either assessment, such as the location of indices 514A to 514B or the viewpoint of the 3D models 515A to 515B. The values ​​indicated in the static user interface can reflect the options selected in the post-PCI assessment 511 before obtaining the post-PCI comparison 521. For example, values ​​such as the viewpoint and the location of indices 514b and / or their related values ​​(e.g., post-PCI vascular indices 140b) displayed on the post-PCI comparison 521 of the post-PCI assessment 511 can match those selected by the user before saving the post-PCI assessment 511. In such examples, the location of indicator marker 514A of the diagnostic assessment 210 displayed in the post-PCI comparison 521 can be synchronized to indicator marker 514B to be at the same location along their corresponding 3D models 515A to 515B, to provide relevant values ​​at the same vascular location (e.g., diagnostic vascular indicator 140a and post-PCI vascular indicator 140b) for comparison. Similarly, the viewpoint of the diagnostic 3D model 515A can be synchronized with the viewpoint of the post-PCI 3D model 515B (e.g., models 515A to 515B can be adjustable, such as rotatable, or the user can zoom in and out of the models). In alternative examples, the values ​​indicated on the diagnostic assessment 210 of the post-PCI comparison 521 can be based on the selection made by the user when the diagnostic assessment 210 was last obtained individually, which can be done immediately before operating the post-PCI assessment system 100, or based on the selection of a default location.

[0102] In the dynamic user interface of the post-PCI comparison 521, one or both of the PCI post-assessment 511 and the diagnostic assessment 210 can allow the user to interact to adjust values ​​or user interface elements. In some instances, a user's selection in one assessment can be synchronized to cause a similar adjustment to the value in the other assessment. For example, adjusting indicator marker 514b to a different position along the post-PCI 3D model 515B can automatically move indicator marker 514a to a corresponding position along the diagnostic 3D model 515A. In this example, the corresponding indicator value (e.g., the FFR value) can be updated simultaneously. As another example, the post-PCI comparison can include pull-back plots for the diagnostic assessment 210 and for the post-PCI assessment 511, and an adjustment to a value in one pull-back plot can cause a corresponding change in a value in the other pull-back plot. Similarly, adjusting the perspective in one assessment can cause a corresponding adjustment in the perspective of another assessment, or opening different values ​​to be displayed in one assessment (such as switching between the vessel diameter chart and pull-back chart tabs 519, or opening an associated angiography film) can cause the opening of the corresponding values ​​to be displayed in another assessment. In some instances, diagnostic assessment 210 and post-PCI assessment 511 may be asynchronous.

[0103] Graphs 522 and 523 may be additionally included, with graph 522 of the diagnostic assessment 210 indicating a severe decline in indicators. Various optional graphs, values, and images may be displayed alongside either or both of the diagnostic assessment 210 and the post-PCI assessment 511, and options may be available to select what content is displayed on the post-PCI comparison 521. For example, the post-PCI comparison 521 may include the post-PCI assessment 511 and a diagnostic 3D model 515a from the diagnostic assessment 210 alone. In another example, the post-PCI comparison 521 may include only a post-PCI 3D model 515b from the post-PCI assessment 511 and a diagnostic 3D model 515a from the diagnostic assessment 210. In some instances, the post-PCI comparison 521 may display a user interface 520 on the same application as the post-PCI assessment system 100 or other similar systems without needing to save (or print). In such instances, the post-PCI comparison 521 may also be static or dynamic. Other examples

[0104] All processes described herein can be embodied and fully automated via software code modules executed by a computing system comprising one or more computers or processors. These code modules can be stored on any type of non-transitory computer-readable medium or other computer storage device, and some or all of them can be embodied in dedicated computer hardware.

[0105] In addition to those described herein, many other variations will become apparent from this disclosure. For example, depending on the instance, certain actions, events, or functions of any algorithm described herein may be performed in a different order, or may be added, combined, or omitted entirely (e.g., not all described actions or events are necessary for the practice of the algorithm). Furthermore, in some instances, actions or events may be performed concurrently, for example, through multithreading, interrupt handling, or on multiple processors or processor cores or other parallel architectures, rather than sequentially. Moreover, different tasks or processes may be performed by different machines and / or computing systems that can work together.

[0106] The various illustrative logic blocks, modules, and engines described in conjunction with the examples disclosed herein can be implemented or executed by a machine, such as a processing unit or processor, a digital signal processor (DSP), an application-specific integrated circuit (ASIC), a field-programmable gate array (FPGA) or other programmable logic device, discrete gate or transistor logic, discrete hardware components, or any combination thereof designed to perform the functions described herein. The processor may be a microprocessor, but alternatively, it may be a controller, a microcontroller, or a state machine, a combination thereof, etc. The processor may include circuitry configured to process computer-executable instructions. In another example, the processor includes an FPGA or other programmable device that performs logical operations without processing computer-executable instructions. The processor may also be implemented as a combination of computing devices, such as a combination of a DSP and a microprocessor, multiple microprocessors, one or more microprocessors combined with a DSP core, or any other such configuration. Although this document is primarily described with respect to digital technologies, the processor may also primarily comprise analog components. For example, some or all of the signal processing algorithms described herein may be implemented in analog circuitry or mixed-signal circuitry. The computing environment can include any type of computer system, including but not limited to microprocessor-based computer systems, mainframe computers, digital signal processors, portable computing devices, device controllers, or computing engines within devices.

[0107] Unless otherwise specifically stated, conditional language such as “may,” “will,” “may,” or “can” is understood in context to generally convey that certain instances include certain features, elements, and / or steps, while other instances do not. Therefore, such conditional language is generally not intended to imply that features, elements, and / or steps are necessary in any way for one or more instances, or that one or more instances must include logic for determining whether such features, elements, and / or steps are included in or will be performed in any particular instance, with or without user input or prompts.

[0108] Unless otherwise specifically stated, delimited language such as the phrase “at least one of X, Y, or Z” should be understood as generally used to present a context in which items, terms, etc., can be X, Y, or Z or any combination thereof (e.g., X, Y, and / or Z). Therefore, such delimited language is generally not intended to, nor should it, imply that certain instances require the presence of at least one of X, at least one of Y, or at least one of Z.

[0109] Any process descriptions, elements, or blocks in the flowcharts described herein and / or depicted in the accompanying drawings should be understood as potentially representing modules, code segments, or code portions that include one or more executable instructions for a particular logical function or element during implementation. Alternative implementations are included within the scope of the examples described herein, wherein elements or functions may be omitted, performed not in the order shown or discussed, including substantially simultaneously or in reverse order, depending on the functionality involved, as will be understood by those skilled in the art.

[0110] Unless otherwise expressly stated, the article “a” or “an” should generally be interpreted as including one or more of the described items. Therefore, phrases such as “configured to” are intended to include one or more of the described devices. Such one or more described devices may also be configured together to perform the stated descriptions. For example, “processors configured to perform descriptions A, B, and C” could include a first processor configured to perform description A working in conjunction with a second processor configured to perform descriptions B and C.

[0111] As used in this article, the term “about” means within ±10%.

[0112] The terms “comprises,” “comprising,” “includes,” “including,” “having,” “such as,” and their variations mean: “including but not limited to.”

[0113] As used herein, the terms “example” and “exemplary” mean “used as an example, instance, or illustration.” Any instance described as an “example” or “exemplary” is not necessarily to be construed as superior to or better than other instances, and / or excludes the inclusion of features from other instances.

[0114] As used herein, the term “method” refers to the manner, means, techniques, and procedures for accomplishing a given task, including but not limited to those manner, means, techniques, and procedures known to or readily developed from known methods, means, techniques, and procedures by practitioners in the fields of chemistry, pharmacology, biology, biochemistry, and medicine.

[0115] In this application, various embodiments of the invention may be presented in a scope format. It should be understood that the scope format is merely for convenience and brevity and should not be construed as an immutable limitation on the scope of the invention. Therefore, the scope description should be considered to have specifically disclosed all possible sub-scopes and individual numerical values ​​within those scopes. For example, a scope such as 1 to 6 should be considered to have specifically disclosed sub-scopes such as 1 to 3, 1 to 4, 1 to 5, 2 to 4, 2 to 6, 3 to 6, etc., and individual numbers within those scopes such as 1, 2, 3, 4, 5, and 6. This applies regardless of the breadth of the scope.

[0116] Whenever a range of numbers is indicated herein, it is intended to include any referenced numbers (fractions or integers) within the indicated range. The phrases “range of variation between the first indicated number and the second indicated number” and “range of variation from the first indicated number to the second indicated number” are used interchangeably herein and are intended to include the first indicated number and the second indicated number, as well as all fractions and integers in between. It should be emphasized that various variations and modifications can be made to the above examples, and the elements of the examples should be understood as part of other acceptable examples. All such modifications and variations are intended to be included within the scope of this disclosure.

Claims

1. A method implemented by a system of one or more processors, the method comprising: Acquire multiple angiographic images depicting at least one vessel of a patient's heart, the angiographic images including at least one post-percutaneous coronary intervention (PCI) image and one or more diagnostic images, wherein the post-PCI image depicts the PCI treatment site, the PCI treatment site being included to revascularize the lesion, and wherein the diagnostic image depicts the lesion. Receive information specifying the location of the PCI treatment site in the post-PCI image; Indicators indicating vascular function are determined based on the angiographic images, wherein the indicators are derived based on a three-dimensional (3-D) model of at least one vessel of the patient's heart, and wherein portions of the diagnostic image depicting the lesion are masked during the generation of the 3-D model; and A summary of information associated with PCI is presented via a user interface, the summary of which includes at least the determined metrics.

2. The method of claim 1, wherein receiving information specifying the location of the PCI treatment site includes: The user interface displays the post-PCI images and receives the information via user input.

3. The method according to any one of the preceding claims, wherein receiving the information specifying the PCI site in the post-PCI image comprises: The system determines the location of the PCI treatment site based on the analysis of the post-PCI images.

4. The method according to any one of the preceding claims, wherein the three-dimensional model is generated based on matching features included in the angiography image, and wherein the portion of the diagnostic image depicting the lesion is not used to generate the three-dimensional model.

5. The method according to any one of the preceding claims, wherein the location of the PCI region is matched to a corresponding location in the diagnostic image, and wherein the corresponding location is masked.

6. The method according to any one of the preceding claims, wherein the indicator is a diversion reserve value.

7. The method according to any one of the preceding claims, wherein the indicator is compared with different indicators determined based on a set of diagnostic images depicting the at least one blood vessel of the patient's heart, and wherein the comparison is included in the summary information.

8. The method of claim 7, wherein the user interface comprises: The first part, associated with the different indicators, includes: The different indicators, and A graphical representation of the at least one blood vessel, wherein color is assigned to portions of the at least one blood vessel based on a decrease in a corresponding index associated with the different indices, and The second part associated with the aforementioned indicator includes: The aforementioned indicators, and A graphical representation of the at least one blood vessel, wherein colors are assigned to portions of the at least one blood vessel based on a decrease in a corresponding index associated with the index.

9. The method according to any one of claims 7 or 8, wherein the set of diagnostic images comprises at least one diagnostic image and at least one other diagnostic image among the one or more diagnostic images.

10. The method of claim 9, wherein the summary information includes labeled post-PCI indicators associated with the user-selected portion of the 3-D model and labeled diagnostic indicators associated with the corresponding portion of the diagnostic 3-D model based on the set of diagnostic images.

11. The method according to any one of claims 9 or 10, wherein the summary information includes a 3-D model and a diagnostic 3-D model based on the set of diagnostic images, the 3-D model and the diagnostic 3-D model being presented from the same perspective.

12. The method according to any one of claims 9 to 11, further comprising: At least one value in the profile information associated with PCI can be adjusted via the user interface. The adjusted at least one value is presented via the user interface, and In response to adjusting the at least one value, adjustments to the corresponding values ​​in the summary information associated with the set of diagnostic images are presented for comparison.

13. The method according to any one of the preceding claims further comprises: The user interface presents the plurality of angiographic images, the location of the PCI treatment site in the post-PCI image, and the masked portions of the diagnostic image depicting the lesion.

14. The method according to any one of the preceding claims, wherein the one or more diagnostic images are automatically selected from the plurality of diagnostic images based on a score determined by comparing each of the plurality of diagnostic images with the at least one post-PCI image.

15. The method of claim 14, wherein the plurality of diagnostic images includes a set of diagnostic images for determining diagnostic indicators of vascular function, the set of diagnostic images depicting the at least one vessel of the patient's heart captured at a time prior to capturing the at least one post-PCI image.

16. The method according to any one of the preceding claims further comprises: A set of angiographic images is presented via the user interface, wherein the plurality of angiographic images are obtained from the set of angiographic images.

17. The method of claim 16, further comprising: The set of angiographic images is filtered into a subset based on at least one of the quality score for each angiographic image or the timestamp for each angiographic image in the angiographic images.

18. The method of claim 17, wherein the angiographic images in the subset cannot be acquired for use in the plurality of angiographic images.

19. The method according to any one of the preceding claims, wherein two post-PCI images and one diagnostic image form the plurality of angiographic images.

20. The method of claim 19, wherein one of the diagnostic images is selected from diagnostic images used to determine a threshold number of diagnostic assessments associated with the lesion.

21. A system comprising one or more processors and a nontransitory computer storage medium, the nontransitory computer storage medium storing instructions that, when executed by the one or more processors, cause the one or more processors to perform the method according to claims 1 to 20.

22. A nontransitory computer storage medium storing instructions that, when executed by a system of one or more processors, cause the system to perform the method according to claims 1 to 20.

Images