CHARTing the future: bridging disciplines to revolutionize non-invasive cardiovascular imaging
Editorial

CHARTing the future: bridging disciplines to revolutionize non-invasive cardiovascular imaging

Neng Dai1,2,3,4, Pranav Prakash Edavi5, Xiaoli Zhang6, Yuetao Wang7,8, Minfu Yang9, Hongcheng Shi10,11,12,13, Xianhong Shu1,14,15, Juying Qian1,2,3,4, Peng Hu16,17, Bin Lu18,19, Junbo Ge1,2,3,4; the Core Group and Members of the Committee of CHART

1Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China; 2State Key Laboratory of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; 3NHC Key Laboratory of Ischemic Heart Diseases, Shanghai, China; 4National Clinical Research Center for Interventional Medicine, Shanghai, China; 5Shanghai Medical College, Fudan University, Shanghai, China; 6Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; 7Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China; 8The Nuclear Medicine and Molecular Imaging Clinical Translation Institute of Soochow University, Changzhou, China; 9Department of Nuclear Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; 10Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; 11Institute of Nuclear Medicine, Fudan University, Shanghai, China; 12Shanghai Institute of Medical Imaging, Shanghai, China; 13Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, China; 14Department of Echocardiography, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China; 15Department of Ultrasound in Medicine, Shanghai Xuhui District Central Hospital, Shanghai, China; 16School of Biomedical Engineering, ShanghaiTech University, Shanghai, China; 17Shanghai Clinical Research and Trial Center, ShanghaiTech University, Shanghai, China; 18Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; 19State Key Lab and National Center for Cardiovascular Diseases, Beijing, China

Correspondence to: Neng Dai, MD, PhD. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China; State Key Laboratory of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Ischemic Heart Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Xuhui District, Shanghai 200032, China. Email: niceday1987@hotmail.com.

Keywords: Medical imaging; radiology; artificial intelligence; cardiovascular imaging; hemodynamics

Received: 26 January 2026; Accepted: 12 February 2026; Published online: 17 April 2026.

doi: 10.21037/rx-26-0025

Cardiovascular diseases (CVDs) continue to dominate global mortality statistics, accounting for over 34% of annual deaths worldwide according to 2025 epidemiological data (1). This persistent burden has galvanized multinational initiatives targeting both primary prevention and secondary intervention strategies.

Timely detection through non-invasive diagnostic imaging, such as X-rays, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound, is critical for early intervention (2). These modalities enable identification of vascular anomalies before symptom onset, forming the cornerstone of guideline-directed therapy to reduce disease progression and mortality.

For decades, engineering and medical imaging have shared a partnership, from genesis of imaging to today’s advanced imaging systems (3). In modern healthcare, medical imaging has become increasingly indispensable in clinical diagnosis, disease treatment, and monitoring. This has further propelled the advancement of medical imaging and established itself as a quintessential paradigm of medicine-engineering collaboration: clinicians identify unmet clinical needs, engineers develop new technologies or modalities to address them, and the solutions ultimately return to clinical practice to aid in disease diagnosis and treatment (4,5).

This precisely represents the origin, developmental model, and cornerstone of modern cardiology and interventional cardiology. In 1976, a then-obscure 37-year-old Swiss cardiologist Andreas Grüntzig presented the pioneering research on the first coronary angioplasty conducted on dogs and submitted his poster to the American Heart Association Scientific Sessions. Although the poster faced rejection from the cardiology section, it was enthusiastically embraced in the radiology segment of the conference (6,7). Dr. Andreas Grüntzig subsequently applied this pioneering technique to humans in 1977, marking a revolutionary shift in the treatment of coronary artery disease.

As demonstrated by Dr. Grüntzig and his colleagues, a collaborative approach unrestricted by subspecialization can be truly transformative for the medical field. My foray into the field of cardiovascular non-invasive imaging followed a similar trajectory. Since learning about the pressure wire-based fractional flow reserve (FFR) technique at an academic conference in 2009, I have been dedicated to exploring ways to obtain this metric using non-invasive coronary CT and hemodynamic simulation technologies (8,9). Despite encountering difficulties in interdisciplinary collaboration and the intersection of medicine and engineering in the early stages, the CT-derived FFR (CT-FFR) technique has now achieved significant success (10-14).

Inspired by Dr. Grüntzig’s pioneering spirit and the twists and turns of my own research journey, we began to envision the establishment of a platform in 2016 to facilitate interdisciplinary dialogue, knowledge sharing, and technology transfer, with the aim of advancing cardiovascular imaging research and enhancing patient healthcare.

CHART was thus born out of such a backdrop, it stands for “Chinese Non-Invasive Cardiovascular Imaging and Physiology Club”, which was originally “CHinese non-invasive cARdiovascular imaging and physiology sTudy group”, and is an organization for research and innovation networks.

The “Actions” under CHART serve to bridge research initiatives both within China and internationally, empowering researchers and innovators to cultivate and expand their ideas across diverse scientific and technological domains through peer-to-peer sharing.

The logo incorporates a blend of a circular form and a cross (Figure 1), featuring subtle concentric circles at its core, symbolizing vision and precision targeting. The pictographic heart is placed at the logo’s center, together forming a “bull’s eye chart”. Numerous non-invasive cardiac imaging results are presented utilizing a 17-segment “bull’s eye chart”, which acts as a standardized visual representation across all non-invasive cardiovascular imaging techniques (15). The “heart” at the core is composed of two distinct sections: the lower part portrays a schematic representation of the parasternal long-axis view as seen in an echocardiogram, highlighting that the majority of non-invasive imaging examinations observe the heart or blood vessels through various cross-sectional views. The upper section, on the other hand, depicts the general appearance of the heart. The integration of these two sections symbolizes the convergence and mutual enhancement of diverse information in non-invasive cardiovascular imaging. It underscores the significance of focusing on both the anatomical and physiological aspects of the cardiovascular system, heralding the dawn of an era characterized by comprehensive assessment that seamlessly combines structural and functional evaluations. In terms of its color scheme, initially, the results from X-ray, CT, and ultrasound examinations of the heart were mainly rendered in black-and-white. However, with ongoing technological advancements, novel examination techniques have progressively emerged, including ultrasonic Doppler technology, radionuclide myocardial imaging, CT perfusion imaging, CT-FFR, cardiac MRI, among others. These techniques not only infuse cardiac assessments with vivid hues but also furnish comprehensive and varied data for cardiovascular evaluation, spanning structural, functional, and even cellular dimensions. The “colored heart” signifies not merely a superficial display of examination outcomes but also encapsulates the profound and extensive insights these examinations yield.

Figure 1 The central image represents the CHART logo, while the eight surrounding graphics symbolize CHART’s primary research domains: CT/MRI/nuclear medicine, ultrasound, coronary physiological assessment (exemplified by FFR), pan-vascular medicine, genomics/proteomics/metabolomics, biomechanics, radiomics, and artificial intelligence. CHART, Chinese Non-Invasive Cardiovascular Imaging and Physiology Club; CT, computed tomography; FFR, fractional flow reserve; MRI, magnetic resonance imaging.

CHART will convene exceptional researchers who bring together diverse scientific expertise and state-of-the-art technologies to establish a collaborative platform for sharing insights, innovations, and educational materials. By doing so, it aims to drive scientific and imaging advancements that accelerate progress in the field and improve therapeutic outcomes for patients with cardiovascular conditions.

The initiative will leverage recent advancements and pivotal breakthroughs in scientific methodologies (as depicted in Figure 1), including (but not limited to):

  • Omics-based technologies;
  • Hemodynamics;
  • Artificial intelligence;
  • In vivo imaging to level with pathology.

These complementary resources will facilitate the development of harmonized and integrative approaches that extend from laboratory research to clinical application, offering novel insights not only into imaging techniques but also into their clinical significance. Meanwhile, CHART aims to make these accomplishments widely available to the entire imaging ecosystem.

A pivotal facet of the CHART initiative is the dissemination of knowledge. To achieve this, it will direct and promote the transfer of knowledge through a diverse range of channels:

  • Multicenter innovative researches;
  • Guideline or consensus development;
  • Hands-on training for emerging techniques;
  • Community-based knowledge dissemination;
  • Digital centers/platform construction.

To date, CHART has conducted several pivotal clinical trials, including CHART-Blueprint (Brain-heart Interaction in Coronary Plaque Stability and Cardiovascular Events, Clinicaltrials.gov, unique identifier: NCT05545618), CHART-ACCORD [Lp(a) With CCTA Assessed Parameters and Clinical Outcomes, Clinicaltrials.gov, unique identifier: NCT05323227], and CHART-VISION (CHART Study of Coronary CT Angiography in Coronary Artery Disease, Clinicaltrials.gov, unique identifier: NCT05380622). These trials (16-21) have equipped clinicians with improved tools for diagnosing coronary artery disease, evaluating cardiovascular risks, and refining treatment strategies.

To enhance public awareness of diseases, information about the key accomplishments of the Action will be disseminated through a dedicated CHART Action website, newsletters, press releases, and social media platforms. On May 27, 2023, CHART convened its inaugural meeting in Shanghai (Figure 2).

Figure 2 Members of CHART during the kick-off meeting at the 17th Oriental Congress of Cardiology in Shanghai, China, on 27 May 2023.

Additionally, a significant milestone was marked by the formation of the CHART Alliance within the Guangdong-Hong Kong-Macao Greater Bay Area. By developing a lifecycle-oriented active health technology engine, CHART is spearheading a transformative shift from reactive healthcare to proactive health management.

By bridging regional gaps through these strategies, CHART drives a cohesive, global effort to advance cardiovascular science and patient outcomes.

Acknowledgments

None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Radiology-X. The article did not undergo external peer review.

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://rx.amegroups.com/article/view/10.21037/rx-26-0025/coif). N.D. serves as the Editor-in-Chief of Radiology-X. J.G. serves as the Honorary Editor-in-Chief of Radiology-X from February 2026 to January 2028. P.H. serves as an unpaid editorial board member of Radiology-X from February 2026 to January 2028. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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doi: 10.21037/rx-26-0025
Cite this article as: Dai N, Edavi PP, Zhang X, Wang Y, Yang M, Shi H, Shu X, Qian J, Hu P, Lu B, Ge J; the Core Group and Members of the Committee of CHART. CHARTing the future: bridging disciplines to revolutionize non-invasive cardiovascular imaging. Radiology-X 2026;1:3.