Fellowship for Sean Hamlet: Bringing Advanced Heart MRI into Pediatric Clinics Using an Interactive Videogame

Congenital heart disease (CHD) affects roughly 2 million people in the US and remains responsible for twice as many years of life lost as all of childhood cancer combined (1). To reduce this mortality burden, clinicians have shifted their focus towards monitoring cardiovascular function over time, after initial surgeries, in order to make decisions about when and how to intervene. Cardiac magnetic resonance (CMR) imaging has become the gold standard technique to fill this role due to its excellent accuracy and reproducibility and lack of ionizing radiation. Advanced CMR techniques can now quantify three dimensional flow and motion of both the myocardium and the blood. These techniques offer unlimited potential for improving our ability to diagnose and treat patients with CHD. However, advanced CMR techniques currently require long acquisition times which limit their feasibility in the clinic. Our overall goal is to make these advanced CMR techniques clinically feasible through dramatically reducing the time required to acquire the image data. We propose a new CMR system, which we call videogame interface for diaphragm location (VIDLoc), that can reduce 60 minute scans to 22 minutes. VIDLoc works by advising children how to alter their breathing patterns in real-time, during CMR, in order to dramatically reduce the total time required to acquire CMR data. The concept is simple: the heart moves up and down on the diaphragm as children breathe. Thus, imaging can only be performed when the diaphragm is within a narrow region called the “acceptance window”. Since children breathe very erratically, the amount of time they spend in the acceptance window is often as low as 20% (thus imaging can only be performed 1/5th of the time). VIDLoc overcomes this by taking a picture of the child’s diaphragm in real-time and using this to generate a videogame. The videogame will show a car driving on a road where the car’s location relative to the road will represent the diaphragm location relative to the acceptance window. VIDLoc will provide instructions to children to guide their diaphragm (or car) to be within the acceptance window (or road) (Fig 1), where the heart can then be imaged. We hypothesize that using VIDLoc will optimize the amount of time spent in the acceptance window and therefore reduce CMR acquisition times.