Simple Education: Advances in Intravascular Imaging, September 2016


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The Simple Education team have run many successful courses over the last five years, demystifying the use of coronary physiology in the cath lab for thousands of doctors from around the world.

The team are now delighted to announce their first course on the use of Intravascular ultrasound in PCI.

Using a mixture of practical hands-on teaching, interactive learning aids, approachable tutors, internationally renowned lecturers and live interactive cases from cath labs in Europe, this course aims to take a new look at a key technology in the modern cath lab.


Dr Andrew Sharp

Royal Devon & Exeter

Prof Carlo Di Mario

Royal Brompton,

Prof Takashi Akasaka

Wakayama Medical University ,

Prof Jacek Legutko

Jagiellonian University Medical College,
Krakow, Poland

Agenda: Monday 12th September 2016

09.00 – 09.10
Welcome and introductions
Andrew Sharp & Carlo di Mario, Course Directors
09.10 – 09.25
When should we be using IVUS?
Carlo Di Mario
09.30 – 09.55
Clinical trial data to support the use of IVUS
Jacek Legutko
10.00 – 10.15
Basics of the science of IVUS
Jurgen Ligthart
10.20 – 10.35
Normal anatomy and vessel landmarks
Robert Gerber

10.40 – 11.00
Coffee break

11.00 – 11.30
Making measurements – Live case in a box
Sayan Sen operating ‘in a box’, Rasha Al-Lamee measuring live in room
11.35 – 12.30
Live case transmission from Madrid – IVUS optimisation of a PCI case
Operator: Javier Escaned
12.30 – 12.45
Case examples: Dissection
Takashi Akasaka 
12.50 - 13.10Case examples: A case of left main stem PCI
Amir Lerman

13.15 – 14.00


14.00 – 14.30
GRP 1: Assembling equipment
                 Rasha Al-Lamee
GRP 2: Making measurements
                 Robert Gerber
GRP 3: Case examples – thrombus, dissection or normal anatomy?
                 Jurgen Ligthart
14.30 – 15.00
GRP 1: Making measurements
                 Robert Gerber
GRP 2: Case examples – thrombus, dissection or normal anatomy?
                Jurgen Ligthart
GRP 3: Assembling equipment
                Rasha Al-Lamee
15.00 – 15.30
GRP 1: Case examples – thrombus, dissection or normal anatomy?
                Jurgen Ligthart
GRP 2: Assembling equipment
                Rasha Al-Lamee
GRP 3: Making measurements
                 Robert Gerber
15.30 – 15.50
Ongoing studies involving imaging and what do we still need to know?          
Manesh Patel 

15.50 – 16.10
Coffee break

16.10 – 16.35
Debate – Now that we have seen how useful IVUS can be, shouldn’t we be using it in ALL cases
For: Andrew Sharp
 Against: Jacek Legutko 
Close of the Day 1

Course Dinner

Tuesday 13th September 2016

09.00 – 09.10
Welcome and introductions
Andrew Sharp & Carlo Di Mario, Course Directors
09.10 – 09.50
Imaging in BVS is about picking the right scaffold off the shelf
Peter O’Kane
Imaging in BVS is about seeing problems with the scaffold
Patrick Serruys
09.55 – 10.10
IVUS has a unique role in CTO and we must learn these skills
Carlo Di Mario
10.15 – 10.30
Co-registration of IVUS and angiography - Syncvision
Andrew Sharp

10.35 – 11.00
Coffee break

11.00 – 11.55
Live case from the Hammersmith – Syncvision case
Operators: Iqbal Malik and Rasha Al-Lamee
12.00 – 12.20
Co-registration of the future - angiography, imaging and physiology all together
Sayan Sen
12.20 – 12.45
Stent failures 1 - Fractures, shortening, guide cath injury
Takashi Akasaka
12:45 - 13:05Case examples: Calcification
Peter O'Kane

13.10 – 14.00


14.00 – 14.30
What does this IVUS show?
Jacek Legutko
14.30 – 15.00
Best New Imaging Devices Coming to Interventional Cardiology
Patrick Serruys
Close of the meeting

Dr Justin DaviesDr Andrew Sharp is a Consultant Interventional Cardiologist, working at the Royal Devon and Exeter Hospital in South West England. His interests include coronary physiology, renal denervation, intra-coronary imaging, complex PCI and hypertension. He trained in Edinburgh, London and Milan, under the tutelage of Professor Antonio Colombo and leads an active research program, as an honorary senior lecturer at Exeter University.

Dr Javier EscanedProf Carlo Di Mario is currently Professor of Clinical Cardiology, NHLI, Imperial College of Sciences, Medicine & Technology, London. He is theme leader of the area Complex Coronary Artery Disease of the Cardiovascular Biomedical Research Unit of the Royal Brompton & Harefield Foundation Trust. He was appointed in 2010 Senior Investigator of the National Institute of Health Research. He maintains an active clinical involvement having performed more than 200 PCI per year in the last 10 years in London with the special interest in the treatment of chronic total occlusions, bifurcations, calcified lesions and diffuse disease. He is a regular TAVI operator and certified implanter for the Medtronic CoreValve and Edwards Sapien transcatheter aortic valves. In 2014 he successfully led a bid for the commissioning of MitraClip in his hospital (40/year for 3 years, worth £3.6 million only for the devices). He holds an NHS Bronze National Award. Professor Di Mario pioneered the use of intracoronary Doppler, pressure measurement, ultrasound and optical coherence tomography. These techniques have become the gold standard for physiological assessment of lesion severity and have revolutionised the technique of stent implantation with the use of high pressure dilatation which led to the universal application of this method in interventional cardiology. Professor Di Mario is now applying these intravascular techniques for the guidance of implantation of fully bioabsorbable stents and optimal stent apposition across bifurcations and in complex lesions. He has led or participated in studies and trials to improve technical success of recanalisation of chronic total occlusion and demonstrate its clinical usefulness. He cooperated with Dr J. Davies to the development of the concept of iFR to facilitate assessment of lesion severity and discriminate the contribution of individual lesions, and with Dr A Lyon to the intracoronary delivery of SERCA-2 genes via adenoviral vectors in the CUPID2 trial. Prof Di Mario was Principal Investigator of the CARESS in AMI trial, a large multicentre trial showing that patients who receive fibrinolytic therapy for ST-elevation myocardial infarction benefit from early angioplasty. This trial and a subsequent meta-analysis have led to a change in the European Society of Cardiology and AHA/ACC Guidelines for treatment of STEMI patients.

Dr Sayan SenProf Takashi Akasaka graduated from Wakayama Medical University in 1982 and finished his residency at Kobe City Medical Center General Hospital. He was  a clinical fellow at Harefield Hospital in the United Kingdom in 1987. Since 1989, he had done clinical research work in the field of coronary physiology using echocardiography, pressure wire and flow wire extensively at Kobe City Medical Center General Hospital as a director of cardiac catheterization laboratory for 8 years. After he moved to Kawasaki Medical School as an associate professor, he started OCT in addition to coronary physiology in 1999. He became Professor of Wakayama Medical University in 2005 and he has been devoted to the clinical research work using OCT. He has published many papers regarding the pathophysiology of ACS or DES healing process using OCT in collaboration with his colleagues in addition to coronary physiology research. Based on his clinical and research work, he has been an executive board member in various cardiology societies and a course co- director of several coronary live-demonstration courses in the world. 

Dr Rasha Al-Lamee

Dr Rasha Al-Lamee is an Interventional Cardiologist at Imperial College Healthcare NHS Trust. Her sub-speciality interests are complex coronary intervention, coronary physiology and invasive intra-vascular assessment. She has 8 years of Cardiology experience, including an Interventional Fellowship with Professor Antonio Colombo in Milan. She completed her speciality training at Hammersmith Hospital, London, and is currently working as both an Interventional Cardiologist and Clinical Researcher at Imperial College. She is currently leading the ORBITA trial as part of a PhD programme under Dr Justin Davies and Professor Darrel Francis.

Dr Christopher Cook

Prof Javier Escaned is Consultant Interventional Cardiologist / Associate Professor and Head of Section, Cardiology Department, Hospital Clinico San Carlos (Madrid, Spain). He trained as a cardiologist the United Kingdom (Queen Elizabeth University Hospital, Birmingham and Walsgrave Hospital, Coventry) before moving to the Thoraxcenter / Rotterdam (The Netherlands), where he obtained his PhD degree in 1994. Author of more than 200 scientific articles, books and book chapters on different aspects of interventional cardiology, imaging and physiology, his latest contribution is the textbook “Coronary Stenosis. Imaging, Structure and Physiology”, co-edited with Patrick W Serruys. He is currently co-director or EuroPCR. Some of his additional interests are philosophy, education and music.

Dr John Davies

Dr Robert Gerber is a Consultant Cardiologist at both Conquest Hospital Hastings and Eastbourne District General Hospital in East Sussex Healthcare NHS Trust (ESHT). He graduated from Guy's, King's and St Thomas' Medical School which is part of King's College London in 2000. He was one of a select few that undertook the MB/PhD programme after being awarded the University of London Carpenter prize for Physiology 1994 and subsequently graduated with both academic and clinical qualifications. He holds dual accreditation in Cardiology and General Internal Medicine on the GMC specialist register and was awarded Fellowship of the Royal College of Physicians in 2014. He is also a member of the British Hypertension Society (BHS), the British Cardiovascular Intervention Society (BCIS) and the European Association of Percutaneous Coronary Intervention (EAPCI). His sub-specialty training in Interventional Cardiology was at Imperial College London (Hammersmith and St Mary's Hospitals) and the San Raffaele Hospital and Columbus Hospital in Milan. He is involved in Research and Teaching and is Module leader for the MSc in Cardiology at Brighton and Sussex University (BSUH). He has published extensively on interventional cardiology and has several published peer reviewed manuscripts on IVUS guided stenting, antiplatelet therapy and the long-term outcomes of PCI in multivessel coronary artery disease and the influence of gender on PCI outcomes. He is also the ESHT Principal Investigator of several randomised clinical trials (Atlantic, Pegasus, TAO, Flair, Orbita and Odyssey Outcomes). He enjoys cycling, skiing and triathlon.

Professor Carlo Do MarioProf Jacek Legutko graduated as a medical doctor in 1993 and has specialist degrees in both internal medicine and cardiology. His present appointments are as professor of medicine and interventional cardiologist at the Institute of Cardiology, Jagiellonian University Medical College, University Hospital in Krakow, Poland.Professor Legutko has been involved in more than 30 international clinical trials and has published more than 100 scientific papers in peer-reviewed medical journals. He is a member of several professional associations, including the European Society of Cardiology (ESC), Association for Percutaneous Cardiovascular Interventions of the European Society of Cardiology (EAPCI ESC), Polish Cardiac Society (PCS) and Association of Cardiovascular Interventions of the Polish Cardiac Society (ACVI PCS). Professor Legutko is Course Director of the Annual International Interventional Cardiology Workshop New Frontiers in Interventional Cardiology (NFIC) in Krakow. He has served as a life case operator and faculty member for several international meetings (TCT, EuroPCR, C3, WCCI, NFIC) and international preceptorships for FFR and IVUS. Professor Legutko received several awards, including the Polish Cardiac Society group award for innovations in cardiology in 2008, the Polish Cardiac Society group award for publication in 2007 and the 2013 Andreas Award for his personal impute on the development of interventional cardiology in Poland.

Dr Nicolas Foin

Prof Amir Lerman, is a professor of medicine and a consultant in the cardiovascular division at the Mayo graduate school of Medicine.  Dr Lerman serves as an associate chair and the director for research for the cardiovascular division and the director of the Mayo cardiovascular research center.  Dr Lerman graduated from the Technion school of Medicine in Haifa Israel and completed his training in internal medicine, cardiovascular diseases and invasive cardiology at the Mayo Clinic.  His interest is coronary physiology and imaging and innovation in cardiovascular disease as well as regenerative medicine. Dr Lerman published more than 480 manuscripts, book chapters and reviews; the NIH, AHA, and several foundations support his research.

Dr Allen Jeremias, M.D., M.Sc.

Jurgen Ligthart has been working on intervention cardiology as a Cath lab technician since 1982, firstly to support the cardiologists in working with X-rays and positioning, or “how to get better angiograms and less X-ray dosage”.
With the first IVUS performed in man in 1989, he was soon interested in invasive imaging and especially in the interpretation of the images or “what lies between the lumen and the media”. With IVUS initially used as research tool he was soon convinced that using IVUS (and later other modalities) can make a difference for patients. A standard acquisition protocol for all patients, no exceptions, was in his opinion a must but it took till 1997 before he implemented the standard acquisition protocol in Erasmus MC, which is still the standard of all invasive imaging procedures. With the standardisation he started to review, interpret and report IVUS procedures like a radiologist would do. In 2006, he developed for Erasmus MC the first 2 days interactive IVUS course for physicians, with live cases from the Cath lab. This formula is still used for all their invasive imaging courses (IVUS and OCT). In 2008, he developed an invasive imaging database in Erasmus MC that is still in use and growing, containing 4600 patients and 12000 pullbacks, available for viewing and reviewing at any time.
In 2011, he started a part time one man consultancy company (LIMIC Medical) customers: Boston Scientific, Philips Volcano, St. Jude Medical, Terumo, InfraredX, ACIST, Abbott and congress and course-organising hospitals.
Jurgen has had the great honour to work almost 35 years with Professor Patrick Serruys and also several years with Professor Carlo Di Mario, who was in Rotterdam his “partner in invasive imaging crime”.

Dr Iqbal Malik

Dr Peter O’Kane qualified from Charing Cross and Westminster Medical School in 1995 and commenced specialty training in Cardiology as a research registrar at St Thomas’ Hospital in 1998. He was subsequently awarded an MD by the University of London for his Thesis on The Role of Nitric Oxide in Coronary Heart Disease. He trained in clinical cardiology on the South Thames NTN scheme working at Worthing Hospital, St Peter’s Hospital Chertsey, and St George’s Hospital London before completing a 2-year sub-specialization program in Interventional Cardiology at St Thomas’ supervised by Professor Simon Redwood. He was appointed as a Consultant Interventional Cardiologist at the Royal Bournemouth Hospital in July 2007.

This is currently the UK’s highest volume non-surgical PCI centre and he annually performs more than 450 PCI cases including participation in a 24 hour primary PCI service. The case mix is complex particularly amongst the many elderly patients who have multi-vessel coronary disease, which includes extensively calcified lesions, bifurcations including left main stem disease and chronic total occlusions.

He is committed to teaching and is a National Proctor for Rotational atherectomy and Optical Frequency Domain Imaging (OFDI), European proctor for Laser atherectomy and International proctor for the Axxess dedicated bifurcation stent and Absorb bioresorbable vascular scaffold implantation. He has trained Consultant colleagues from the UK, Europe, Asia and the US in these multiple adjunctive devices in PCI, intra-coronary imaging and for the implantation techniques and rationale for use of Axxess stents and Absorb scaffolds.

He has published over 35 manuscripts in the last decade including original work, international collaboration and case studies. He has authored 10 book chapters with many related to Laser atherectomy. He is regularly invited as faculty to National and International meetings as a presenter and live case operator. He is a local principal Investigator for a number of National and International multi-centre clinical trials and is dedicated to patient recruitment to studies, which ultimately determine best practice guidelines and improve clinical outcome. Within the Directorate of Cardiology he has led numerous quality improvement programs and has achieved local clinical excellence award level 5.

Dr Allen Jeremias, M.D., M.Sc.

Dr Iqbal Malik is an Honorary Senior lecturer at Imperial College London, and Consultant Interventional Cardiologist at Hammersmith and St Mary’s Hospitals. His research interests are in complex coronary disease and structural heart disease. He qualified from Cambridge University with a 1st Class degree, and then moved to Guys Hospital, London, winning the Golding Bird Medal as an undergraduate. He trained in Medicine and then Cardiology, before completing a PhD at Imperial College London, looking at the role of Inflammation in Coronary Artery Disease. He was awarded a BHF junior research fellowship for 3 years. He was appointed as a Consultant in 2003, having completed sabbaticals in Italy and Germany to hone his skills in Structural Heart Disease. He is clinical lead for the care of acute coronary syndromes and Structural Heart Disease at Imperial College Healthcare NHS trust, including the Transcatheter Valve (TAVI) and Septal Defect Closure programs. He has been involved with Simplephysiology since the inception of the concept of iFR as a way to simplify the use of coronary physiological assessment.  His meticulous verification of data with the more complex technique of coronary flow measurement, has allowed validation of the science behind iFR. Starting from normal arteries, simple and complex native coronary lesions, and bypass grafts, the group has now studied the effects of hemodynamic support device such as balloon pumps and Impella devices on coronary physiology. Next is the unique opportunity to assess the effect of immediate removal of aortic stenosis using TAVI!

Dr Iqbal Malik

Dr Manesh Patel is cardiology section leader in Interventional Cardiology and is the Director of Cardiac Catheterization Laboratories for the Duke University Health System. Dr Patel previously served as the Director of Duke Cath Lab Research.  His clinical interests include diagnostic and interventional coronary angiography, peripheral angiography and percutaneous intervention. He is involved in several clinical trials involving patients with vascular disease and in cardiac imaging. He is also a member of the American College of Cardiology Task Force for Appropriate use of Cardiovascular Procedures and is Chair of the American Heart Association Diagnostic and Interventional Cath Committee. Patel’s interest in cardiac imaging, quality of care, and cardiac devices is also evident in his research. His integration of these efforts into his roles at Duke was recognised in 2010 when he received the prestigious Duke Cardiology Fellowship Mentorship Award.  In 2011, Dr Patel was named the endowed John Bush Simpson Assistant Professor of Cardiology.  

In 2013, Dr Patel took over the role of Director of Interventional Cardiology and the Cardiac Catheterization Laboratories for the Duke University Health System with the goal of integrating patient-centered invasive care across the health system. Dr Patel has published over 150 peer-reviewed articles in high impact journals, several reviews and over 20 editorials. Most recently, his articles in the Journal of the American College of Cardiology, Journal of the American Medical Association, and the New England Journal of Medicine garnered national attention from the scientific and lay press. Patel received his medical degree from Emory University School of Medicine in 1997. He completed his residency at Duke in 2000, followed by fellowships in cardiology and interventional cardiology at Duke University.

Dr Sukhjinder Nijjer

Dr Ricardo Petraco  is a Cardiology Specialist Registrar and a Research Fellow at the International Centre for Circulatory Health and National Heart and Lung Institute at Imperial College London. Dr Petraco graduated from The Federal Faculty of Medical Sciences (FFFCMPA) and undertook his junior General Medical Training at the Santa Casa University Hospital in Porto Alegre, Brazil. He came to the UK in 2006 to start his higher specialist training in Cardiology. Throughout his career, Dr Petraco has been a high achiever on clinical and academic grounds. As an undergraduate, he was awarded two Scientific Initiation Scholarships by the National Research and Technology Council (CNPq, Brazil). In the UK, he worked as a junior Research Fellow at the Royal Brompton Hospital, in the Adult Congenital Heart Unit under Professor Gatzoulis. He helped to identify markers of poor prognosis in adult patients with congenital heart disease. After passing his membership examination (MRCP UK), he started clinical work as a Specialist Registrar in Cardiology at the Royal Brompton and St Mary’s Hospitals. He has completed his PhD in the pathophysiology of coronary artery disease, coronary haemodynamics and myocardial ischaemia.

Dr Ricardo Petraco Dr Sayan Sen is a Cardiologist and NIHR Clinical Lecturer at Imperial College London. His research interests are dedicated to improving patient care. As such, they include the development and validation of new diagnostic tools, determining how the design of comparative efficacy studies can affect clinical use of competing therapies and the development and application of tools that permit a more patient centered approach to therapy. He studied Medicine at University College London (UCL), achieving a First Class (Honours) Bachelor of Science degree in Medical Sciences & Neuroscience in 2000 and graduated with distinction (Surgery) in his final MBBS Examinations in 2003. He trained as a junior doctor on the Hammersmith and UCL medical rotations prior to being appointed as a Cardiology Specialist Registrar in the North West London region in April 2006 and a NIHR clinical Lecturer in 2013. One of the themes of his research is to determine the need for potent vasodilators when assessing coronary stenosis severity. Working with Dr Justin Davies, Dr Sen’s PhD introduced and developed a new technique of stenosis evaluation (the instantaneous wave-free ratio, iFR). He is the first author of ADVISE and CLARIFY - two investigator lead studies that demonstrate the potential of iFR and challenge current concepts of coronary physiology. Currently, in addition to being the Principal Investigator of several first in man physiological studies, he is also the Medical Director of the FLAIR trial – a global multi-centre randomized study comparing iFR to existing techniques.


Prof Flavio Ribichini

Prof  Patrick  Serruys with respected h-index – 145 is a professor of Interventional Cardiology at the Interuniversity Cardiological Institute of the Netherlands (1988-1998) and Erasmus MC. Since 1980 he was a Director of the Clinical Research Program of the Catheterization Laboratory, Thorax Center at Erasmus University, and till April 1, 2014 (retirement date) the Head of the Interventional Department, Thorax Center, Erasmus MC (University Medical Center Rotterdam), Rotterdam, The Netherlands. Since April 2013, he holds the position of Professor of Cardiology in the Cardiovascular Science Division of the National Heart and Lung Institute (NHLI) at the Faculty of Medicine, within the Imperial College of Science, Technology and Medicine, London.

He is a Fellow of the American College of Cardiology and a Fellow of the European Society of Cardiology and scientific council of the International College of Angiology.

In 1996, he received the TCT Career Achievement Award and in 1997 he was awarded the Wenkebach Prize of the Dutch Heart Foundation. In 2000, he was awarded the Gruentzig Award of the European Society of Cardiology. In 2001, he held the Paul Dudley White Lecture at the American Heart Association in the USA. In 2004, he received the Andreas Gruentzig Award of the Swiss Society of Cardiology. In 2005, he held the 4th International Lecture at the AHA and Mikamo Lecture at the Japanese heart Association. In 2006, he received the highest award of the Clinical Council of the American Heart Association: the James Herrick Award. In 2007, he received the Arrigo Recordati International Prize (Italy) and the ICI Achievement Award (bestowed by the President of Israel – Shimon Perez). In 2008, he received the Einthoven Penning (Leiden). In 2009, he became Doctor Honoris Causa from the University of Athens. In 2011, he received the Lifetime Achievement Award, bestowed by the American College of Cardiology, in recognition of many years of service and invaluable contributions to the ACC. At the end of 2011, Prof Serruys received the Ray C. Fish Award, bestowed by the Texas Heart Institute, for outstanding achievement and contribution to cardiovascular medicine. In 2012, he received a Golden Medal of the European Society of Cardiology. In 2013, he became Doctor Honoris Causa from the Complutense University of Madrid. In 2016, he will become Doctor Honoris Causa of the Melbourne University, Australia.

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Moment Components

Clinical trial data to support the use of IVUS - Prof Jacek Legutko
Basics of the science of IVUS - Jurgen Ligthart
Normal anatomy and vessel landmarks - Dr Robert Gerber
When should we be using IVUS? - Prof Carlo Di Mario
Making measurements – Live case in a box - Dr Rasha Al-Lamee
Live case transmission from Madrid - Prof Javier Escaned
Using IVUS to identify coroanry dissection - Prof Takashi Akasaka
Case examples: A case of left main stem PCI - Prof Amir Lerman
A-Z of how to assemble IVUS equipment - Dr Rasha Al-Lamee
Using IVUS to explore coronary thrombus, dissection and normal anatomy - Jurgen Lighthart
Debate – Now that we have seen how useful IVUS can be, shouldn’t we be using it in ALL cases - Dr Andrew Sharp & Prof Jacek Legutko
Ongoing studies involving imaging and what do we still need to know? Dr Manesh Patel
Imaging in BVS Debate - Dr Peter O'Kane & Prof Patrick Serruys
IVUS has a unique role in CTO and we must learn these skills - Prof Carlo Di Mario
Co-registration of IVUS and angiography - Syncvision - Dr Andrew Sharp
Live case transmission from Hammersmith Hospital, London - Dr Iqbal Malik & Dr Rasha Al-Lamee
Co-registration of the future - angiography, imaging and physiology all together - Dr Sayan Sen
Stent failures 1 - Fractures, shortening, guide cath injury - Dr Takashi Akasaka
Using IVUS to evaluate coronary calcification - Dr Peter O'Kane
What does this IVUS show? - Prof Jacek Legutko
Best New Imaging Devices Coming to Interventional Cardiology - Prof Patrick Serruys

Target Audience

Learning Objectives

We know that sometimes IVUS appears difficult to understand and look forward to making things Simple for you in this course.


  • International faculty
  • Hands on experience (break-out sessions:
    • Assembling the kit
    • Making Measurements (iPad/computer)
    • Case practice with instructor support
  • Latest clinical evidence
  • Structured case-based lectures on identification of thrombus, dissection, malapposition and more
  • Live case demonstrations using IVUS co-registration

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