Nine Steps in the Entrepreneurial Journey for Academic Radiologists.

In this article, we explore the nine steps that we have found to be critical for success in our journeys in taking ideas in imaging to commercial products. These nine steps include 1) findings ideas that resonate, 2) protecting your intellectual property, 3) developing a great team that shares in the vision for the product, 4) building a low-fidelity prototype, 5) customer discovery to test your business hypothesis, 6) forming a company, 7) serving on a study section as a prelude to 8) seeking non-dilutive funding, and finally, 9) angel/venture funding.

Lessons Learned in Change Management in Deploying Novel Informatics Solutions: Experience Implementing a Point-of-Care Patient Photography System with Radiography.

We describe implementation of a point-of-care system for simultaneous acquisition of patient photographs along with portable radiographs at a large academic hospital. During the implementation process, we observed several technical challenges in the areas of (1) hardware-automatic triggering for photograph acquisition, camera hardware enclosure, networking, and system server hardware and (2) software-post-processing of photographs. Additionally, we also faced cultural challenges involving workflow issues, communication with technologists and users, and system maintenance. We describe our solutions to address these challenges. We anticipate that these experiences will provide useful insights into deploying and iterating new technologies in imaging informatics.

Mentor training for junior faculty: a brief evaluation report from the Georgia Clinical and Translational Science Alliance.

To provide a foundation for mentoring, junior faculty participated in a mentor training workshop informed by the Mentoring Clinical and Translational Researchers curriculum. The goal was to develop skills and behaviors that engender more rewarding and inclusive mentoring practices. Attendees responded to baseline and follow-up surveys assessing perceived mentoring skills. Follow-up surveys included closed- and open-ended questions about the value and satisfaction of the training, and intended behavior changes. Junior faculty respondents (n = 39) reported significantly higher overall mentoring skills after the training (t = -2.6, p = 0.012) with a medium effect size (Cohen's D = 0.59). Domains with statistically significant improvement from baseline to follow-up included aligning mentor-mentee expectations and assessing understanding. Thirty-eighty (97%) found the training valuable, and 32 (82%) indicated they would change mentoring-related behaviors because of the training. Intended behavior changes described in open-ended responses aligned with mentoring skills assessed (e.g., aligning expectations). An additional competency domain of evaluating mentoring relationships was also described. A mentor training workshop for junior faculty appeared to contribute to changes in mentoring skills and intended behaviors. Mentor training has the potential to enhance mentorship, which is critical to strengthening a diverse pipeline of clinical and translational science researchers.

Development and Characterization of a Micromagnetic Alternative to Cochlear Implant Electrode Arrays.

To stimulate the auditory nerve, cochlear implants directly inject electrical current into surrounding tissue via an implanted electrode array. While many cochlear implant users achieve strong speech perception scores, there remains significant variability. Since cochlear implant electrode arrays are surrounded by a conductive fluid, perilymph, a spread of excitation occurs. The functionality of the cochlea is spatially dependent, and a wider area of excitation negatively affects the hearing of the user. Importantly, magnetic fields are unaffected by the material properties of biological components. To utilize the electromagnetic properties of the human ear, a microcoil array was developed. The microcoils are 4-turn solenoids with a 250- [Formula: see text] turn radius and a 31.75- [Formula: see text] wire radius, coated with Parylene-C. The efficient design was implemented to accelerate testing. The obtained results describe stimulation capabilities. Functionality was validated using a frequency response analyzer to measure how the generated electromagnetic power radiates in space. 99.8% power loss was observed over a 100- [Formula: see text] separation between a pair of identical microcoils. Obtained through finite-element modeling, the microcoils can be driven by a 60 mA, 5 kHz, sinusoidal input for 10 minutes before predicted inflammation. Rattay's activating function was calculated to evaluate the magnetic stimulation effect of external fields on target neurons. Combined with the frequency response analysis, magnitude and spatial effects of the generated potential is established. As a result, each microcoil requires a 400- [Formula: see text]-wide area for each independent stimulation channel, which is 84% narrower than a commercial cochlear array channel, thereby suggesting greater spatial selectivity.

Coronary computed tomographic angiography: A review of the techniques, protocols, pitfalls, and radiation dose.

Coronary computed tomographic angiography (CCTA) is a viable alternative to catheter coronary angiography for several clinical indications, chiefly because it is fast and non-invasive. For effective clinical use of CCTA, various technical and patient factors should be considered. In this brief review article, we discuss the indication and contraindications for CCTA, technical requirements for CCTA including radiation dose, patient preparation principles, image post-processing, and pitfalls and artifacts of CCTA.

Combining Optical Character Recognition With Paper ECG Digitization.

OBJECTIVE: We propose a MATLAB-based tool to convert electrocardiography (ECG) waveforms from paper-based ECG records into digitized ECG signals that is vendor-agnostic. The tool is packaged as an open source standalone graphical user interface (GUI) based application. METHODS AND PROCEDURES: To reach this objective we: (1) preprocess the ECG records, which includes skew correction, background grid removal and linear filtering; (2) segment ECG signals using Connected Components Analysis (CCA); (3) implement Optical Character Recognition (OCR) for removal of overlapping ECG lead characters and for interfacing of patients' demographic information with their research records or their electronic medical record (EMR). The ECG digitization results are validated through a reader study where clinically salient features, such as intervals of QRST complex, between the paper ECG records and the digitized ECG records are compared. RESULTS: Comparison of clinically important features between the paper-based ECG records and the digitized ECG signals, reveals intra- and inter-observer correlations of 0.86-0.99 and 0.79-0.94, respectively. The kappa statistic was found to average at 0.86 and 0.72 for intra- and inter-observer correlations, respectively. CONCLUSION: The clinically salient features of the ECG waveforms such as the intervals of QRST complex, are preserved during the digitization procedure. Clinical and Healthcare Impact: This open-source digitization tool can be used as a research resource to digitize paper ECG records thereby enabling development of new prediction algorithms to risk stratify individuals with cardiovascular disease, and/or allow for development of ECG-based cardiovascular diagnoses relying upon automated digital algorithms.

Characterization and Miniaturization of Silver-Nanoparticle Microcoil via Aerosol Jet Printing Techniques for Micromagnetic Cochlear Stimulation.

According to the National Institute of Deafness and other Communication Disorders 2012 report, the number of cochlear implant (CI) users is steadily increasing from 324,000 CI users worldwide. The cochlea, located in the inner ear, is a snail-like structure that exhibits a tonotopic geometry where acoustic waves are filtered spatially according to frequency. Throughout the cochlea, there exist hair cells that transduce sensed acoustic waves into an electrical signal that is carried by the auditory nerve to ultimately reach the auditory cortex of the brain. A cochlear implant bridges the gap if non-functional hair cells are present. Conventional CIs directly inject an electrical current into surrounding tissue via an implanted electrode array and exploit the frequency-to-place mapping of the cochlea. However, the current is dispersed in perilymph, a conductive bodily fluid within the cochlea, causing a spread of excitation. Magnetic fields are more impervious to the effects of the cochlear environment due to the material properties of perilymph and surrounding tissue, demonstrating potential to improve precision. As an alternative to conventional CI electrodes, the development and miniaturization of microcoils intended for micromagnetic stimulation of intracochlear neural elements is described. As a step toward realizing a microcoil array sized for cochlear implantation, human-sized coils were prototyped via aerosol jet printing. The batch reproducible aerosol jet printed microcoils have a diameter of 1800 µm, trace width and trace spacing of 112.5 µm, 12 µm thickness, and inductance values of approximately 15.5 nH. Modelling results indicate that the coils have a combined depolarization-hyperpolarization region that spans 1.5 mm and produce a more restrictive spread of activation when compared with conventional CI.

JTEHM: The EMB Journey to Open Access.

The ultimate goal of engineering in medicine and biology (EMB) researchers is to improve medical care for patients and communities all over the world by providing a collaborative environment for engineer-scientists and clinicians. In order for this collaboration to occur, however, there must be a widely indexed platform that promotes communication among researchers across a spectrum of nations, both economically developed and underdeveloped, and between engineer-scientists and clinicians who are less likely to have access to IEEE Xplore. In response to this need, the EMB Society (EMBS) created the Journal of Translational Engineering in Health and Medicine (JTEHM), its first Gold Open Access (OA) journal. At its inception in 2012, JTEHM outlined a bold, comprehensive objective: Our unique mission-to bring together scientific researchers, practicing clinicians, and engineers to develop actionable, practical solutions for patients, families, and caregivers-requires open communication and free access.

I-Corps@NCATS trains clinical and translational science teams to accelerate translation of research innovations into practice.

INTRODUCTION: A key barrier to translation of biomedical research discoveries is a lack of understanding among scientists regarding the complexity and process of implementation. To address this challenge, the National Science Foundation's Innovation Corps™ (I-Corps™) program trains researchers in entrepreneurship. We report results from the implementation of an I-Corps™ training program aimed at biomedical scientists from institutions funded by the National Center for Advancing Translational Sciences (NCATS). METHODS: National/regional instructors delivered 5-week I-Corps@NCATS short courses to 62 teams (150 individuals) across six institutions. Content included customer discovery, value proposition, and validating needs. Teams interviewed real-life customers and presented the value of innovations for specific end-users weekly, culminating in a "Finale" featuring their refined business thesis and business model canvas. Methodology was developed to evaluate the newly adapted program. National mixed-methods evaluation assessed program implementation, reach, effectiveness using observations of training delivery and surveys at Finale (n = 55 teams), and 3-12 months post-training (n = 34 teams). RESULTS: Innovations related to medical devices (33%), drugs/biologics (20%), software applications (16%), and diagnostics (8%). An average of 24 interviews was conducted. Teams reported increased readiness for commercialization over time (83%, 9 months; 14%, 3 months). Thirty-nine percent met with institutional technology transfer to pursue licensing/patents and 24% pursued venture capital/investor funding following the short courses. CONCLUSIONS: I-Corps@NCATS training provided the NCATS teams a rigorous and repeatable process to aid development of a business model based on customer needs. Outcomes of this pilot program support the expansion of I-Corps™ training to biomedical scientists for accelerating research translation.

Initial Experience With Patient Visible Light Images Obtained Simultaneously With Portable Radiographs.

OBJECTIVE. Visible light images in the form of point-of-care photographs obtained at the time of medical imaging can be useful for detecting wrong-patient errors and providing image-related clinical context. Our goal was to implement a system to automatically obtain point-of-care patient photographs along with portable radiographs. CONCLUSION. We discuss one academic medical center's initial experience in integrating the system into the clinical workflow and initial use cases ranging from cardiothoracic and abdominal imaging to musculoskeletal imaging, for which such point-of-care photographs were deemed clinically beneficial.

Interpreting Radiographs with Concurrently Obtained Patient Photographs.

A technology for automatically obtaining patient photographs along with portable radiographs was implemented clinically at a large academic hospital. This article highlights several cases in which image-related clinical context, provided by the patient photographs, provided quality control information regarding patient identification, laterality, or position and assisted the radiologist with the interpretation. The information in the photographs can easily minimize unnecessary calls to the patient's nursing staff for clarifications and can lead to new methods of physically assessing patients. Published under a CC BY 4.0 license.

Patient Photographs: Privacy Versus Protection.

OBJECTIVE: Technologies to obtain point-of-care photographs along with medical imaging studies are now available. We discuss the protections that photographs can provide in radiology and the potential privacy and legal issues that can arise with their incorporation. CONCLUSION: Point-of-care photographs that are simultaneously obtained with medical imaging studies can provide biometric identification that enables detection of wrong-patient errors. Photographs also provide image-related clinical context. However, successful implementation of such technologies requires consideration of the privacy and legal issues perceived by stakeholders.

Building Diverse Careers in Clinical and Translational Research: Evaluation of a Certificate Program in Translational Research.

Introduction: The Certificate Program in Translational Research (CPTR) at the Georgia Clinical and Translational Science Alliance provides PhD students, post-doctoral fellows and faculty with didactic, mentored, and experiential training in clinical and translational research. Methods: Quantitative evaluation includes tracking trainee competency, publications, grants and careers in clinical and translational research. Qualitative evaluation includes interviews with trainees about program experiences. Results: The CPTR provided knowledge and skills in clinical and translational research through coursework, clinical rotation, and collaboration with interdisciplinary scientists. Trainees reported increased confidence in 22 program competencies. Trainees have published more than 290 peer-reviewed articles and received over four million dollars in grants from the NIH, over $15 from the U.S. Department of Defense, and more than $300,000 from foundations. Trainees who completed the program remained in clinical and translational research. Conclusions: Programs like the CPTR are needed to train investigators to advance biomedical discoveries into population health.

Seismocardiography-Based Cardiac Computed Tomography Gating Using Patient-Specific Template Identification and Detection.

To more accurately trigger cardiac computed tomography angiography (CTA) than electrocardiography (ECG) alone, a sub-system is proposed as an intermediate step toward fusing ECG with seismocardiography (SCG). Accurate prediction of quiescent phases is crucial to prospectively gating CTA, which is susceptible to cardiac motion and, thus, can affect the diagnostic quality of images. The key innovation of this sub-system is that it identifies the SCG waveform corresponding to heart sounds and determines their phases within the cardiac cycles. Furthermore, this relationship is modeled as a linear function with respect to heart rate. For this paper, B-mode echocardiography is used as the gold standard for identifying the quiescent phases. We analyzed synchronous ECG, SCG, and echocardiography data acquired from seven healthy subjects (mean age: 31; age range: 22-48; males: 4) and 11 cardiac patients (mean age: 56; age range: 31-78; males: 6). On average, the proposed algorithm was able to successfully identify 79% of the SCG waveforms in systole and 68% in diastole. The simulated results show that SCG-based prediction produced less average phase error than that of ECG. It was found that the accuracy of ECG-based gating is more susceptible to increases in heart rate variability, while SCG-based gating is susceptible to high cycle to cycle variability in morphology. This pilot work of prediction using SCG waveforms enriches the framework of a comprehensive system with multiple modalities that could potentially, in real time, improve the image quality of CTA.

A Low-Power ASIC Signal Processor for a Vestibular Prosthesis.

A low-power ASIC signal processor for a vestibular prosthesis (VP) is reported. Fabricated with TI 0.35 µm CMOS technology and designed to interface with implanted inertial sensors, the digitally assisted analog signal processor operates extensively in the CMOS subthreshold region. During its operation the ASIC encodes head motion signals captured by the inertial sensors as electrical pulses ultimately targeted for in-vivo stimulation of vestibular nerve fibers. To achieve this, the ASIC implements a coordinate system transformation to correct for misalignment between natural sensors and implanted inertial sensors. It also mimics the frequency response characteristics and frequency encoding mappings of angular and linear head motions observed at the peripheral sense organs, semicircular canals and otolith. Overall the design occupies an area of 6.22 mm (2) and consumes 1.24 mW when supplied with ± 1.6 V.

A dual-axis single-proof-mass angular accelerometer for a vestibular prosthesis.

A dual-axis single-proof-mass angular accelerometer has been developed for a vestibular prosthesis. Designed to sense head rotations both in the yaw and the pitch planes, the output of the inertial sensor may be coded as amplitude or rate modulated biphasic current pulses to stimulate vestibular nerves. Fabricated with a high aspect ratio commercial process, a sensor with small form factor (1.4 mm × 0.8 mm) is achieved with a scale factor of 95.5 µV/rad/sec2 and 145.8 µV/rad/sec2 in the yaw and the pitch planes, respectively. Superior linear acceleration rejection was demonstrated for both rotating axis, and an overall power consumption of 296 µW was estimated including sensor and interface circuit.

Improvement in Detection of Wrong-Patient Errors When Radiologists Include Patient Photographs in Their Interpretation of Portable Chest Radiographs.

This study was conducted to determine whether facial photographs obtained simultaneously with radiographs improve radiologists' detection rate of wrong-patient errors, when they are explicitly asked to include the photographs in their evaluation. Radiograph-photograph combinations were obtained from 28 patients at the time of portable chest radiography imaging. From these, pairs of radiographs were generated. Each unique pair consisted of one new and one old (comparison) radiograph. Twelve pairs of mismatched radiographs (i.e., pairs containing radiographs of different patients) were also generated. In phase 1 of the study, 5 blinded radiologist observers were asked to interpret 20 pairs of radiographs without the photographs. In phase 2, each radiologist interpreted another 20 pairs of radiographs with the photographs. Radiologist observers were not instructed about the purpose of the photographs but were asked to include the photographs in their review. The detection rate of mismatched errors was recorded along with the interpretation time for each session for each observer. The two-tailed Fisher exact test was used to evaluate differences in mismatch detection rates between the two phases. A p value of <0.05 was considered significant. The error detection rates without (0/20 = 0%) and with (17/18 = 94.4%) photographs were different (p = 0.0001). The average interpretation times for the set of 20 radiographs were 26.45 (SD 8.69) and 20.55 (SD 3.40) min, for phase 1 and phase 2, respectively (two-tailed Student t test, p = 0.1911). When radiologists include simultaneously obtained photographs in their review of portable chest radiographs, there is a significant improvement in the detection of labeling errors. No statistically significant difference in interpretation time was observed. This may lead to improved patient safety without affecting radiologists' throughput.

A novel technology for automatically obtaining digital facial photographs near-simultaneously with portable radiographs.

Our objective is to design, implement, and phantom-test a device to automatically obtain point-of-care patient photographs along with portable radiographs. Such photographs could help with detection of wrong-patient errors. Our device consists of a camera controller (CC) and a camera that can be mounted on a portable conventional radiography (CR) machine. Radiation from the CR machine triggers an identification module (IM) embedded in the CR cassette. The IM then sends the cassette identifier--Plate_ID--to the CC along with a trigger to activate the camera. This trigger ensures simultaneous acquisition of radiograph and photograph, and the Plate_ID along with a time stamp ensures binding of the two images. We conducted phantom tests to determine if clinical portable radiography exposure settings (90 to 120 kVp and exposure time ranging from 0.63 to 8.0 ms) are sufficient to trigger the IM. Phantom experiments demonstrate acceptable sensor performance for clinical portable radiography exposures. Simultaneous acquisition of photographs is achieved by integrating a low-cost identification module containing a scintillator-detector into the radiographic cassette. Incident X-rays activate the scintillator-detector triggering photograph acquisition by a camera controller.

Relationship between cardiac quiescent periods derived from seismocardiography and echocardiography.

The seismocardiogram (SCG) is a measure of chest wall acceleration due to cardiac motion that could potentially supplement the electrocardiogram (ECG) to more reliably predict cardiac quiescence. Accurate prediction is critical for modalities requiring minimal motion during imaging data acquisition, such as cardiac computed tomography (CT) and magnetic resonance imaging (MRI). For seven healthy subjects, SCG and B-mode echocardiography were used to identify quiescent periods on a beat-by-beat basis. Quiescent periods were detected as time intervals when the magnitude of the velocity signals calculated from SCG and echocardiography were less than a specified threshold. The quiescent periods detected from SCG were compared to those detected from B-mode echocardiography. The quiescent periods of the SCG were found to occur before those detected by echocardiography. A linear relationship between the delay from SCG- to echocardiography-detected phases with respect to heart rate was found. This delay could potentially be used to predict cardiac quiescence from SCG-observed quiescence for use with cardiac imaging modalities such as CT and MRI.