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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleInterventional
Open Access

High-Definition Zoom Mode, a High-Resolution X-Ray Microscope for Neurointerventional Treatment Procedures: A Blinded-Rater Clinical-Utility Study

S.V. Setlur Nagesh, V. Fennel, J. Krebs, C. Ionita, J. Davies, D.R. Bednarek, M. Mokin, A.H. Siddiqui and S. Rudin
American Journal of Neuroradiology February 2019, 40 (2) 302-308; DOI: https://doi.org/10.3174/ajnr.A5922
S.V. Setlur Nagesh
aFrom the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
fDepartments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
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V. Fennel
eDepartment of Neurosurgery (V.F., J.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
fDepartments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
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J. Krebs
aFrom the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
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C. Ionita
aFrom the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
bDepartments of Biomedical Engineering (C.I., S.R.)
fDepartments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
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J. Davies
eDepartment of Neurosurgery (V.F., J.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
fDepartments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
gBioinformatics (J.D.)
iJacobs Institute (J.D., A.H.S.), Buffalo, New York
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D.R. Bednarek
aFrom the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
fDepartments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
hRadiology (D.R.B., A.H.S., S.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
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M. Mokin
jDepartment of Neurosurgery and Brain Repair (M.M.), University of South Florida, Tampa, Florida.
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A.H. Siddiqui
aFrom the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
fDepartments of Neurosurgery (S.V.S.N., V.F., C.I., J.D., D.R.B., A.H.S.)
hRadiology (D.R.B., A.H.S., S.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
iJacobs Institute (J.D., A.H.S.), Buffalo, New York
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S. Rudin
aFrom the Canon (formerly Toshiba) Stroke and Vascular Research Center (S.V.S.N., J.K., C.I., D.R.B., A.H.S., S.R.)
bDepartments of Biomedical Engineering (C.I., S.R.)
cMechanical and Aerospace Engineering (S.R.)
dElectrical Engineering (S.R.), University at Buffalo, State University of New York; Buffalo, New York
hRadiology (D.R.B., A.H.S., S.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
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    Fig 1.

    Sample single-image sequence pair acquired under DSA exposures. The average RP air kerma per frame for DSA was calculated to be 1.40 mGy for the FPD mode and 1.34 mGy for the HiDef mode. Due to more quanta reaching the detector, the image quality is improved for both the FPD and HiDef modes compared with On-line Fig 4 and On-line Fig 5. The amount of information available in the HiDef native image is higher than in the FPD native image. For the reader to appreciate the difference between HiDef and FPD images, especially the visualization of the stent, the native images are zoomed-in to the ROI showing the stent area.

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    Fig 2.

    Histogram distribution of rater-assigned scores (raters A and B) for all 5 aneurysm geometries, A, The first criterion: overall image preference in terms of visualization of anatomic features and image noise. B, The second criterion: visual quality of the stent for all 3 exposure modes: fluoroscopy (Fluoro), DA, and DSA. The raters were asked to score their image preference as either similar (∼), better (>), much better (≫), or substantially better (≫>) than the other image.

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    Fig 3.

    Distribution of detector preference scores for 60 image sequence pairs (all 5 aneurysm geometries) for both criteria. On the basis of the rater-assigned scores (Fig 2), the detector from which the selected image was acquired was recorded as the preferred detector.

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    Table 1:

    Statistical test results—binomial exact CI test for intrarater agreementa

    CriteriaRater-Assigned Scores
    Intrarater Agreement1-Sample T Test
    Rater 1Rater 2Rater 1 P ValueRater 2 P Value
    P(agr)95% LC95% UCP(agr)95% LC95% UC
    C1.70.500.85.830.650.94<.001<.001
    C2.560.370.75.830.650.94<.001<.001
    • Note:—P(agr) indicates probability of agreement; LC, lower confidence; UC, upper confidence; C1, overall image preference in terms of visualization of anatomic features and image noise; C2, the visual quality of stent.

    • ↵a One-sample t test for analysis of the scores.

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    Table 2:

    Statistical test results—binomial exact CI test for interrater agreementa

    CriteriaDetector-Preference Scores
    Interrater Agreement1-Sample T Test
    P(agr)95% LC95% UCRater 1 P ValueRater 2 P Value
    C1.960.820.99<.001<.001
    C2.90.730.97<.001<.001
    • Note:—P(agr) indicates probability of agreement; LC, lower confidence; UC, upper confidence; C1, overall image preference in terms of visualization of anatomic features and image noise; C2, the visual quality of stent.

    • ↵a One-sample t test for analysis of the scores.

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American Journal of Neuroradiology: 40 (2)
American Journal of Neuroradiology
Vol. 40, Issue 2
1 Feb 2019
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Cite this article
S.V. Setlur Nagesh, V. Fennel, J. Krebs, C. Ionita, J. Davies, D.R. Bednarek, M. Mokin, A.H. Siddiqui, S. Rudin
High-Definition Zoom Mode, a High-Resolution X-Ray Microscope for Neurointerventional Treatment Procedures: A Blinded-Rater Clinical-Utility Study
American Journal of Neuroradiology Feb 2019, 40 (2) 302-308; DOI: 10.3174/ajnr.A5922

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High-Definition Zoom Mode, a High-Resolution X-Ray Microscope for Neurointerventional Treatment Procedures: A Blinded-Rater Clinical-Utility Study
S.V. Setlur Nagesh, V. Fennel, J. Krebs, C. Ionita, J. Davies, D.R. Bednarek, M. Mokin, A.H. Siddiqui, S. Rudin
American Journal of Neuroradiology Feb 2019, 40 (2) 302-308; DOI: 10.3174/ajnr.A5922
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