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Mapping intravascular ultrasound controversies in interventional cardiology practice.

Maresca D, Adams S, Maresca B, van der Steen AF - PLoS ONE (2014)

Bottom Line: Intravascular ultrasound is a catheter-based imaging modality that was developed to investigate the condition of coronary arteries and assess the vulnerability of coronary atherosclerotic plaques in particular.Intravascular ultrasound remains a niche technology; its clinical practice did not vastly expand, except in Japan, where intravascular ultrasound is an appraised tool for guiding percutaneous coronary interventions.While the technology is praised for its capacity to measure coronary atherosclerotic plaque morphology and is steadily used in clinical research, the lack of demonstrated benefits of intravascular ultrasound guided coronary interventions emerges as the strongest factor that prevents its expansion.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Engineering, Erasmus University Medical Centre, Rotterdam, the Netherlands.

ABSTRACT
Intravascular ultrasound is a catheter-based imaging modality that was developed to investigate the condition of coronary arteries and assess the vulnerability of coronary atherosclerotic plaques in particular. Since its introduction in the clinic 20 years ago, use of intravascular ultrasound innovation has been relatively limited. Intravascular ultrasound remains a niche technology; its clinical practice did not vastly expand, except in Japan, where intravascular ultrasound is an appraised tool for guiding percutaneous coronary interventions. In this qualitative research study, we follow scholarship on the sociology of innovation in exploring both the current adoption practices and perspectives on the future of intravascular ultrasound. We conducted a survey of biomedical experts with experience in the technology, the practice, and the commercialization of intravascular ultrasound. The collected information enabled us to map intravascular ultrasound controversies as well as to outline the dynamics of the international network of experts that generates intravascular ultrasound innovations and uses intravascular ultrasound technologies. While the technology is praised for its capacity to measure coronary atherosclerotic plaque morphology and is steadily used in clinical research, the lack of demonstrated benefits of intravascular ultrasound guided coronary interventions emerges as the strongest factor that prevents its expansion. Furthermore, most of the controversies identified were external to intravascular ultrasound technology itself, meaning that decision making at the industrial, financial and regulatory levels are likely to determine the future of intravascular ultrasound. In light of opinions from the responding experts', a wider adoption of intravascular ultrasound as a stand-alone imaging modality seems rather uncertain, but the appeal for this technology may be renewed by improving image quality and through combination with complementary imaging modalities.

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Room for innovation in intravascular ultrasound according to the respondents.Early experts are indicated with a star. Least central experts in the network appear at the bottom of the diagram and most central experts at the top.
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pone-0097215-g003: Room for innovation in intravascular ultrasound according to the respondents.Early experts are indicated with a star. Least central experts in the network appear at the bottom of the diagram and most central experts at the top.

Mentions: This result clearly indicates that two populations coexist in the IVUS network surveyed, one optimistic and one pessimistic about the technology perspective. We rearranged the responses into two categories, the positive opinions (values above 6) and the negative opinions (values below 6). Academic engineers were the most optimistic when rating the room for improvement that IVUS technology has (average of 7.8), which is natural considering that they are professionally invested in IVUS innovation. Academic IVUS users were optimistic as well (7.3) followed by IVUS corporate leaders (6.8). On the contrary, corporate engineers appeared pessimistic (4.5) while other corporate leaders were the most pessimistic (1.5). Logically, it appears that the judgment on the room for improvement of IVUS is directly dependent on the degree of investment the experts have in IVUS: engineers and corporate leaders involved with other intravascular technologies were negative about the innovation potential that IVUS has left. Results were projected on the tree diagram in Figure 3, showing that historic experts emerge as the principal subgroup sharing a positive opinion about the room for innovation left for IVUS technology. Note that most central experts, who are currently professional active, conveyed a rather negative opinion.


Mapping intravascular ultrasound controversies in interventional cardiology practice.

Maresca D, Adams S, Maresca B, van der Steen AF - PLoS ONE (2014)

Room for innovation in intravascular ultrasound according to the respondents.Early experts are indicated with a star. Least central experts in the network appear at the bottom of the diagram and most central experts at the top.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016260&req=5

pone-0097215-g003: Room for innovation in intravascular ultrasound according to the respondents.Early experts are indicated with a star. Least central experts in the network appear at the bottom of the diagram and most central experts at the top.
Mentions: This result clearly indicates that two populations coexist in the IVUS network surveyed, one optimistic and one pessimistic about the technology perspective. We rearranged the responses into two categories, the positive opinions (values above 6) and the negative opinions (values below 6). Academic engineers were the most optimistic when rating the room for improvement that IVUS technology has (average of 7.8), which is natural considering that they are professionally invested in IVUS innovation. Academic IVUS users were optimistic as well (7.3) followed by IVUS corporate leaders (6.8). On the contrary, corporate engineers appeared pessimistic (4.5) while other corporate leaders were the most pessimistic (1.5). Logically, it appears that the judgment on the room for improvement of IVUS is directly dependent on the degree of investment the experts have in IVUS: engineers and corporate leaders involved with other intravascular technologies were negative about the innovation potential that IVUS has left. Results were projected on the tree diagram in Figure 3, showing that historic experts emerge as the principal subgroup sharing a positive opinion about the room for innovation left for IVUS technology. Note that most central experts, who are currently professional active, conveyed a rather negative opinion.

Bottom Line: Intravascular ultrasound is a catheter-based imaging modality that was developed to investigate the condition of coronary arteries and assess the vulnerability of coronary atherosclerotic plaques in particular.Intravascular ultrasound remains a niche technology; its clinical practice did not vastly expand, except in Japan, where intravascular ultrasound is an appraised tool for guiding percutaneous coronary interventions.While the technology is praised for its capacity to measure coronary atherosclerotic plaque morphology and is steadily used in clinical research, the lack of demonstrated benefits of intravascular ultrasound guided coronary interventions emerges as the strongest factor that prevents its expansion.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Engineering, Erasmus University Medical Centre, Rotterdam, the Netherlands.

ABSTRACT
Intravascular ultrasound is a catheter-based imaging modality that was developed to investigate the condition of coronary arteries and assess the vulnerability of coronary atherosclerotic plaques in particular. Since its introduction in the clinic 20 years ago, use of intravascular ultrasound innovation has been relatively limited. Intravascular ultrasound remains a niche technology; its clinical practice did not vastly expand, except in Japan, where intravascular ultrasound is an appraised tool for guiding percutaneous coronary interventions. In this qualitative research study, we follow scholarship on the sociology of innovation in exploring both the current adoption practices and perspectives on the future of intravascular ultrasound. We conducted a survey of biomedical experts with experience in the technology, the practice, and the commercialization of intravascular ultrasound. The collected information enabled us to map intravascular ultrasound controversies as well as to outline the dynamics of the international network of experts that generates intravascular ultrasound innovations and uses intravascular ultrasound technologies. While the technology is praised for its capacity to measure coronary atherosclerotic plaque morphology and is steadily used in clinical research, the lack of demonstrated benefits of intravascular ultrasound guided coronary interventions emerges as the strongest factor that prevents its expansion. Furthermore, most of the controversies identified were external to intravascular ultrasound technology itself, meaning that decision making at the industrial, financial and regulatory levels are likely to determine the future of intravascular ultrasound. In light of opinions from the responding experts', a wider adoption of intravascular ultrasound as a stand-alone imaging modality seems rather uncertain, but the appeal for this technology may be renewed by improving image quality and through combination with complementary imaging modalities.

Show MeSH
Related in: MedlinePlus