Advanced Viz Adds a Whole New Dimension
Image courtesy of Vital Images
Everyone involved in healthcare recognizes that the utilization of diagnostic imaging has increased at an almost exponential rate. This surge of imaging data has led professional societies, such as the Society for Imaging Informatics in Medicine, to develop a new paradigm for the reading and reporting of radiological images, the Transforming the Radiological Interpretation Process (TRIP) initiative.

One of the tenets of the TRIP initiative is that radiologists need to examine different technologies for the visualization of images in order to achieve efficiencies that will meet the demands of the ever-larger volume of image data.

The developers of advanced visualization applications are providing tools to answer this challenge in the form of image display and analysis software to process large medical image datasets.

RSNA 2007 is the showcase for perhaps the largest display and demonstration of advanced visualization technologies, developed by vendors from around the world. Below is a preview of some of the leading-edge products that await attendees in the upcoming technical exhibits at McCormick Place.

3mensio Medical Imaging (Booth 5750) is featuring demonstrations of 3viseon 3D imaging software as well as its 3viseon Imaging Workstation for Radiologists.

The 3viseon software application enables large medical CT and MRI datasets to be displayed as three dimensional reconstructions using standard PC technology. In addition, the 3viseon application can be seamlessly integrated into existing PACS via DICOM.

The 3viseon 3D imaging workstation is a turnkey solution that enables datasets generated by CT and MRI to be displayed as 3D reconstructions using standard PC technology.

The firm also offers a Stereoscopy configuration, using StereoMirror display technology available from Planar Systems with monitors ranging from 17- to 23-inches. By using Stereoscopic display technology, a radiologist will be able to explain more clearly the abnormalities on the 3D images to referring clinicians. The multi-user, wide-angle viewing will allow a complete surgery team to see the interactive images as part of the pre-operative planning procedure simultaneously, according to 3mensio.

An additional option for the workstation is a vascular package that can be used for vascular analysis based on CT angiography (CTA) or MR angiography (MRA) exams.

One-click segmentation of the vessels, (semi) automatic central-lumen line detection, and interactive correction functionality provide an accurate measurement tool for pre-operative planning of vascular procedures.

aycan Medical Systems (Booth 6903) is introducing its aycan workstation OsiriX PRO, a high-performance, cost-effective and highly functional workstation for conventional, multidetector and other image reading equipped with advanced image processing tools.

aycan workstation OsiriX PRO, derived from the well-known open-source DICOM viewer Osirix, is FDA cleared and has a plug-in architecture built on the Macintosh operating system that allows for easy expansion capabilities.

The aycan workstation OsiriX PRO has been specifically designed for navigation and visualization of multi-modality and multi-dimensional images. It offers a 2D viewer, 3D viewer, 4D viewer (3D series with temporal dimension, such as cardiac CT), and 5D viewer (3D series with temporal and functional dimensions, such as cardiac PET/CT). The 3D viewer offers all of the most popular rendering modes including: multi-planar reconstruction (MPR), surface rendering, volume rendering, and maximum intensity projection (MIP). All modes support 4D data and are able to produce image fusion between two different series such as in PET/CT.

Barco (Booth 4714) is showcasing its Voxar 3D Enterprise capability to provide advanced visualization reading tools that support the same mouse controls and the same interface look and feel as clinicians’ existing PACS products. In addition, the company will be demonstrating the latest release of its Voxar 3D advanced visualization suite, version 6.3, as well as its custom imaging solutions capabilities.
The new Voxar 3D suite 6.3 comes with a full set of integrated clinical applications, including Voxar 3D ColonMetrix for CT colonography and Voxar 3D PET-CT Fusion for the interpretation of whole-body FDG oncology studies.
Voxar 3D ColonMetrix provides users with powerful, graphics processing unit (GPU)-accelerated automatic centerline finding. This makes it possible for radiologists and gastroenterologists to fly through prone and supine colon images smoothly and rapidly. An integrated gravity function keeps the camera position aligned with the scanner table to facilitate spatial understanding as you fly through the colon. This full set of powerful, automated features allows radiologists to interpret a colon study and generate a report typically within 10 minutes, the company says.
Voxar 3D PET/CT Fusion is a new clinical application that supports the effective interpretation of whole-body FDG oncology studies and allows real-time interaction with PET/CT images. It enables radiologists to accurately and efficiently blend PET and CT studies to combine anatomical and functional images for rapid lesion analysis and characterization. Voxar 3D PET/CT Fusion provides an automated workflow for hotspot triangulation and calculation and display of standardized uptake values (SUVs). The firm has developed a sophisticated attenuation correction algorithm that compensates for the difference in intensity between structures deep in the body and structures close to the surface.

Both ColonMetrix and PET/CT Fusion feature Barco’s Live Images saved-state functionality, a feature that allows users to save a case at any time and return to it later to carry on reading exactly where they left off.
The Voxar 3D Enterprise solution delivers rapid access to advanced visualization within the radiology reading room and throughout the enterprise. It takes advantage of client-server technology and commonly available high-performance GPUs to accelerate the speed at which image studies can be loaded, read and communicated. Furthermore, Voxar 3D Enterprise provides real-time interaction with Voxar 3D's advanced visualization and analysis tools and clinical applications, the company says. It is designed to be much more than a thin-client solution. Fully integrated into PACS, it provides instant access to Voxar 3D's advanced visualization capabilities. Inside the radiology reading room, Voxar 3D Enterprise delivers large volumetric studies to high-performance workstations for local processing and reviewing. When the viewing station is a standard PC or laptop operating over a standard 100Mbit intranet bandwidth, Voxar 3D Enterprise performs all image processing and streams the results to the screen in real-time from anywhere in the enterprise.
The firm also provides custom-designed 3D and 4D platforms that can be integrated into a variety of modalities within very short time frames. Depending on the functionality needed, Barco can either provide a complete 3D rendering library, a customized version of its widely-used Voxar 3D ActiveX control or a custom-made visualization solution built from the ground up.

Carestream Health (Booth 2513) is demonstrating the 3D processing capabilities of its Kodak Carestream PACS; the system offers a virtual desktop environment that allows any application to be delivered to any desktop inside or outside and organization.

The latest Carestream PACS platform delivers native real-time 2D and 3D capabilities, including MIP (maximum intensity projection), MinIP (minimum intensity projection), MPR (multiplanar reconstruction), volume rendering, tissue definition and vessel tracking functionality. The product’s dynamic streaming capabilities reduce the need for large bandwidth network connections, even for viewing of 3D, cardiac CT and other extremely large image files, according to the company.

The system also offers integrated Siemens Medical Solutions’ Fusion7D software that enhances visualization of cancerous tumors and lesions. Image fusion software creates a composite image by overlaying image data from PET, CT, SPECT and MRI systems so that oncologists have better visualization of anatomic and metabolic information and can more confidently assess tumor volumes and disease progression. Siemens’ Fusion7D software provides advanced visualization tools and registration capabilities that govern how the images are overlaid.

Cedara Software (Booth 1316) is showcasing innovative new imaging concepts, both as technologies and as concepts for new markets.
Some of these include:
  • Advanced  Segmentation technology includes libraries for lesion contouring where  tumor identification in ultrasound, CT and MRI is greatly  simplified. Cedara also is showcasing Mammography Skinline detection for  optimal viewing mammography images and inverse rendering.
  • Cedara Image  Enhancement offers a complete x-ray pipeline workflow improvement from  image enhancement, shutter detection and removal, auto-stitching and optimum  window display.
  • Registration  Technology offers unique registration for use in clinical packages that  require rigid or deformable registration.
  • A new  server-side rendering engine, Cedara ISG, is able to serve up 2D and 3D  compressed images over the web and is being demonstrated using a customized  smart-client I-Response viewer. Cedara also is spotlighting a thin-client  G6 viewer WIP that can be run on Windows, Linux and Mac OS in standard  browsers.
In addition, the company’s custom engineering group is available to discuss its development services. Cedara team members have an average of 16 years experience—and most have advanced degrees. The group is highlighting examples of positive return—ranging from successful collaborations with large R&D departments to serving as the entire development team for small start-up ventures.

Emageon (Booth 8508) is displaying the capabilities of its RadSuite Express. This image-management application developer recently partnered with Dell to produce RadSuite Express for the small- to mid-size hospital and clinic market.

The turnkey solution allows facilities producing 80,000 studies annually or fewer to start using a PACS in a matter of days. RadSuite Express gives specialists and referring physicians in smaller facilities access to the same high-end, multi-disciplinary 3D imaging tools used by specialists in some of the largest facilities and hospital systems in the U.S.

Exxim Computing (Booth 8931) is set to unveil the features and capabilities of COBRA 6.0, the latest iteration of its Cone Beam Reconstruction software package for PCs.

With more than four years in the field since its first release, and close to 1,000 installations worldwide, Exxim believes that its COBRA package is one of the most robust and feature rich implementations of Feldkamp’s algorithm for cone beam tomography.

The company has improved performance in the COBRA 6.0 version by porting part of the algorithm onto the GeForce8800GTX graphic card, manufactured by NVidia. Exxim says this boosts reconstruction speed by almost an order of magnitude.

The company also has added a correction for typical Feldkamp artifacts, which otherwise show up at large cone angles, especially in asymmetric detector configurations.

For users without direct access to a medical workstation, Exxim is debuting an optional visualization module comprising full functionality volume rendering, MIP, MPR and analysis tools.

These features are now available for end-users as well as OEM partners using COBRA software development kit (SDK) libraries in their products. The GPU option (use of a graphics card for hardware acceleration), and the volume rendering option are available now at a competitive price point.

Fujifilm Medical Systems USA (Booth 1129) continues to enhance its advanced visualization tools in the areas of 3D reconstruction and full-field digital mammography (FFDM).

At RSNA 2007, the firm is demonstrating future extensions to its distributed 3D software, including PET/CT fusion capabilities. Work-in-progress advancements to existing diagnostic MIP/MPR capabilities for Fuji’s Synapse PACS also are being displayed. All of the company’s 3D applications are designed to be available anywhere on a network that Synapse PACS is available. 

In the area of FFDM, Fuji is featuring advanced visualization advances for its Synapse digital mammography system.

GE Healthcare (Booth 1729) is demonstrating PET VCAR, advanced imaging software for its PET/CT product line, as well as Lung VCAR, an advanced visualization tool for the GE family of CT scanners.

GE Healthcare's next-generation volume PET/CT application, PET VCAR (Volume Computer-Assisted Reading), helps clinicians diagnose, stage, treat, and monitor tumors and other lesions in the body. The software optimizes tumor management, allowing for early quantification and understanding of treatment effectiveness for optimal treatment planning.

It is designed to identify, delineate and quantify areas of increased metabolic activity in PET/CT scans, in addition to providing advanced registration capability for quick comparison of tumor response over time. The product is part of GE's suite of oncology applications, including Lung VCAR, Advantage 4D, SIM MD, and 4Dx. 

GE's Lung VCAR offers the capability to find, isolate and measure lung nodules over time. Much like a global navigation system, Lung VCAR automatically highlights the precise location of lung nodules. After the software assists physicians to detect lung nodules, it then isolates and analyzes the nodules, comparing the measurements to previous results to determine if the nodules are growing. The application effectively replaces traditional manual measurements, which are tedious, prone to error, and lead to subjective analysis, according to GE.

Median Technologies (Booth 8548) is set to unveil its complete portfolio of lesion management solutions, highlighted by its LMS-Lung/Track and LMS Liver applications.

The applications segment user-identified lesions and measure their key characteristics such as volume and longest axial diameters. They also automatically pair the lesions in follow-up exams, compute their growth and doubling time and then generate reports according to the RECIST criteria used in oncology to assess the response to treatment of solid tumors, according to Median.

LMS-Lung/Track and LMS-Liver support chest or liver images acquired on any multidetector CT scanner, and can be integrated with modality or PACS/RIS workstations. The company said its development efforts have resulted in delivering the applications to clinicians’ desktops instead of having them move to dedicated workstations.

Integrating advanced clinical applications with PACS or RIS workstations is key in diagnostic oncology imaging, Median says. It guarantees access to the patients’ previous exams necessary to perform follow-up studies, and allows for an immediate report transmission to oncologists.

Median Technologies is currently deploying its LMS applications in 15 countries across Europe and expects to do the same in the U.S. in the coming months, with the recent extension of its American sales force.

Medis Medical Imaging Systems (Booth 7032) is introducing new quantification software, QPlaque MR, that can help detect vulnerable plaques in atherosclerosis patients; and will debut its new QBrain MR analysis software.

QBrain is Medis’ solution for analyzing MRI studies of the brain. Automatic calculation of volumes and volume changes offer objective insight in disease development and the success of patient treatment.

The application can analyze and compare follow-up studies, which enables physicians to monitor volume changes in the brain over time. The product is currently in use for evaluation of white matter lesions in multiple sclerosis clinical trials being conducted at the VU Medical Center, Amsterdam, in the Netherlands, according to Medis.

QBrain features manual and automatic 3D registration, manual and automatic segmentation of brain volumes and lesions, accurate calculation of volumes and lesions in the brain, and multiple time-point analysis, which allows quantitative comparison of follow-up studies. QBrain has received FDA marketing clearance and is expected to be available in the U.S. and in other countries worldwide in the fourth quarter.

Medis’ new quantification software QPlaque MR enables cardiologists and radiologists to measure thickness, area and volume of diseased cardiac vessel walls and plaque components. These results aid medical specialists in detecting plaque composition and high-risk plaques before they rupture, and enabling physicians to more effectively treat patients.

The application post-processes multi-spectral MR images and provides tools for semi-automatically determining the boundaries of vessel, lumen, and plaque components; calculating vessel wall and plaque volumes; and measuring the thickness of the vessel wall and the fibrous cap. QPlaqueMR also provides advanced editing tools, and automatic registration of different MRI sequences.

Medis expects the software to be available in the U.S. market and other countries worldwide in the first quarter 2008.

MIMvista (Booth 4174) is showcasing new and innovative tools for radiation oncology, radiology, and nuclear medicine in the latest release of its MIM 4.1 software. The product features automatic deformable contouring, therapy response tools, and enhanced workflows.

MIMcontouring Advanced provides automatic atlas-based deformable contouring and adaptive re-contouring using MIMvista’s VoxAlign Deformation Engine for initial contour generation of entire structure sets and quick re-planning, making adaptive radiation therapy practical.

Therapy Response Tools include automatic registration, PET tumor segmentation, contour propagation, and RECIST/WHO calculations across time points. Enhanced workflow capabilities can be customized for any analysis, treatment, or research application.

In addition, the firm is highlighting its MIM Extensions, which provides a programming interface for customizable functionalities developed in IDL (ITT Visual Information Solutions) which can be easily distributed to clinical MIM users.

Philips Medical Systems (Booths 4048, 4165, and 4129) is unveiling its iSite 3.6 and 4.1 advanced visualization tools, spotlighting its works-in-progress iSite Colonography and iSite Pulmonary Embolism, and debuting iSite Volume Vision application.

Philips iSyntax3D technology, employed in the iSite visualization products, provides rendering performance and scalability without additional server cost and complexities. In addition, iSyntax3D utilizes minimal bandwidth to load volumetric (DICOM) datasets. 

The iSite 3.6 and 4.1 advanced visualization tools are designed to speed the reading of volumetric datasets such as multidetector CT and MRI cases. The toolset sports a dedicated user interface and workflow features specifically tailored to facilitate PACS workflow.

The toolset features MIP/MPR/3D Volume rendering, on-demand task guidance, and a simplified volume user interface provide step-by-step help. Philips anticipates general market availability of the applications during the first quarter of 2008.

The iSite advanced visualization suite is bolstered by iSite Volume Vision, which features task-guided segmentation and classification tools, the capability for protocol-based and freestyle movie generation and capture. Advanced review protocols will allow for easy review of complex cases and merging and color mapping of CT and MRI datasets is provided. The iSite Volume Vision is scheduled to be available in the first quarter of 2008.

Rendoscopy (Booth 4787), a provider of 3D software visualization and software analysis tools, is demonstrating the features and capabilities of its new angiography and virtual colonoscopy applications.

The Munich, Germany-based developer is making the North American debut of its angiography tool at RSNA 2007. The application provides automated segmentation of the entire vessel tree, automated track finding and analysis, automated curved MPR with 2D and 3D image correlation, and volume and surface rendering of segmented vessels. Rendoscopy’s angiography engine handles nearly the complete post-processing with minimal manual interaction—generally one or two mouse clicks. In addition, a file creation option provides users with the ability to make findings available to other workstations as well as on-line and off-line storage media.

The developer is unveiling a new 3D virtual colonoscopy solution created for high-volume facilities. The new colon engine can handle up to 1,000 cases per day without manual interaction. A multi-path tracking system displays the number of tracks entered in the application preferences automatically, while a single screen displays every kind of cross-sectional information in order to provide clinicians with the necessary tools for diagnosis.

Rendoscopy products are in use at imaging facilities in Boston, San Francisco, New York, Stockholm, Bergen, London, Roeselare, Rome and Paris.

ScImage (Booth 2551) is spotlighting the advanced visualization software built into its PicomEnterprise image management application.

Capable of comparative review of datasets of more than 4,000 images, ScImage's advanced visualization software is designed for performing complex image review. Users are able to conduct interactive MPR, oblique slicing, and sliding MIPs using the axial datasets.

Standard functions include MPR, pan and zoom, preset and customizable window levels. Measurement and annotation can be performed using line, area and volume calipers. Users also may define multiple, independent cut planes to simplify review of large data sets.

ScImage has taken its standard MPR and oblique slicing functionality and developed several productivity applications around these two functions. Applications for calcified plaque analysis and CT/MR angiography also are available.

Siemens Medical Solutions (Booths 8313, 7713, and 8320) is showcasing its syngo TrueD application as part of the developer’s syngo software platform for RIS, PACS, post-processing and image distribution.

The syngo TrueD 3D-application provides advanced image analysis and comparison, supporting physicians in diagnosis and decision-making. The application enhances clinical workflow by enabling efficient reading of multimodality patient scans from multiple time points, including PET/CT, SPECT/CT as well as the fusion of CT or MRI with PET or SPECT images.

TeraRecon (Booth 7762) is rolling out its Aquarius iNtuition thin-client platform architecture for the Aquarius suite of products.

The Aquarius iNtuition client, the evolution of the Aquarius Workstation, delivers workstation-class applications to regular PCs or PACS stations throughout the department and enterprise, blurring the line  between advanced 3D workstations and thin-client 3D.

TeraRecon is showcasing the following clinical innovations on the iNtuition edition of the Aquarius product suite:

  • Support for dual-energy CT scanning
  • Automatic anatomy identification and labeling
  • CT /PET fusion with automatic registration
  • Fusion for blood pooling MRI contrast agents
  • Parametric mapping for time-dependent MRI (such as breast studies)
  • CT-CT angiography registration and subtraction for “CT-dual subtraction angiography”
  • Full cardiovascular clinical workup capabilities on a thin client.
The AquariusAPS server provides real-time automatic pre-processing to perform routine tasks and prepare the case for human interaction. During the validation step, a technologist or physician reviews the work done for accuracy. This feature allows for optimal interpretation with the minimum time requirement from a busy physician.

The company is demonstrating the scalable nature of the solution by deploying a server cluster capable of concurrently rendering hundreds of thousands of CT slices. Data flow to multiple servers is managed with AquariusGATE scheduled routing technology, while rendering load between the servers is managed with automatic, headless load balancing, such that the cluster behaves as a virtual server.

Aquarius iNtuition features a simple and open application programming interface (API) for RIS/PACS integration, and partnerships are being showcased at various booths throughout McCormick Place.

Aquarius iNtuition is designed for the global market with user interface localization supported to a wide range of languages.

Viatronix (Booth 3303) is introducing a V3D-Colon virtual colonoscopy application and a V3D-Cardiac module.

V3D-Colon features the capability to load any two colon image series for review and
comparison; provide a view of the dissected colon segment without distortion or flattening; and delivers a Colon CAD interface that seamlessly integrates MedicSight’s CAD without changing workflow. The Colon CAD interface is currently available commercially for the European and Canadian markets.

In addition, the V3D-Colon application has automatic measurement of maximum diameter/volume of polyps with morphology analysis (also available for the European market); a new set of “translucent view” color schemes that are user editable, and enables the creation of reports compliant with C-RADs guidelines.

Viatronix expects to release the V3D-Cardiac module by the end of 2007, pending FDA approval. The module is being developed around the needs of physicians and it contains a number of automated tools, providing for optimized workflow and time-efficient analysis. The V3D-Cardiac module will allow the user to perform coronary as well as functional analysis in a single software suite.

Visage Imaging (Booth 2591) is highlighting a new release of Visage Cardiac Analysis, a comprehensive CT cardiac application based on thin-client technology.

Visage, a wholly owned subsidiary of Mercury Computer Systems, also plans to demonstrate its integrated Visage PACS/CS solution with advanced tools for 2D, 3D, and 4D image review and interpretation, post-processing, data management, and image distribution. The image data, as well as the applications within Visage PACS/CS, are not bound to specific workstations and are accessible anywhere, anytime via its thin-client enabled architecture within the PACS workflow.

The preview of Visage PACS/CS also features new and optimized tools for radiology, cardiology, neurology, oncology, surgery, and other subspecialties in general, such as application-specific display and post-processing protocols, saving and sharing of annotations and post-processing results, volume analysis of lesions and structures in 3D and improved automatic bone removal.

The upcoming version of Visage Cardiac Analysis will include a rich set of new tools and optimizations such as calcium scoring, myocardial segmentation, wall thickening computation, improved reporting, and efficient manual editing. The integrated cardiac analysis application is not bound to a specialized workstation and is delivered to a desktop via the firm’s thin-client technology.

Vital Images (Booths 6520 and 8301) is using RSNA to showcase enhancements and tools available on the recently released Vitrea 4.0 and VitalConnect 4.1 enterprise-wide advanced visualization and analysis product solutions.

In addition to the new version enhancements, Vital is demonstrating Vital EP, a new electrophysiology (EP) planning application to augment its cardiovascular suite of products and Medicsight’s ColonCAD for Vital Image’s InnerviewGI virtual colonoscopy application.

The Vitrea 4.0 and VitalConnect 4.1 releases include significant enhancements to the company’s cardiovascular, neurovascular and gastrointestinal applications as well as improved web-based cardiovascular analysis and distribution capabilities.

Enhancements to the company’s Vitrea 4.0 workstation-client release include cardiovascular workflow improvements such as automatic segmentation and probing of the coronary tree, easier vessel management and labeling, centerline editing and comprehensive reporting with automatic population of findings.

Neurovascular improvements include motion correction and simultaneous multidetector computation for 4D perfusion for stroke patients. This release also includes improved colon enhancements such as fly-through capabilities, polyp probe and automatic registration of prone and supine. Among other useability improvements are computer aided detection (CAD) designed to identify suspicious regions in the colon.

The firm’s web-client enhancements in the VitalConnect 4.1 release include new cardiovascular tools, including automatic segmentation of the coronary tree, centerline editing and automatic stenosis calculation all designed to increase efficiency and productivity. Additional enhancements include improved 2D performance and integrated reporting features. The combined workstation and web-client solution enables a streamlined workflow designed to improve efficiency.

The new EP planning application, Vital EP, contains a 3D advanced visualization and modeling tool for the EP lab. VitaL EP automatically segments out the pulmonary veins and creates a 3D anatomic model of the heart for superimposed EP mapping. In addition to its clinical features, Vital EP automatically exports a 3D model for display on the St. Jude Medical EnSite system, which is used to facilitate therapy for the treatment of arrhythmias.

Medicsight ColonCAD, designed to automatically identify suspect regions in the colon, is available in Europe with Vitrea 4.0, and will be available in the U.S. pending FDA clearance.

Ziosoft (Booth 8951) is showcasing its FDA-cleared Ziostation 3D visualization and analysis software. The Ziostation provides advanced volumetric imaging tools to quickly access, analyze, and share the information required for the best patient care. Intelligent clinical tools include automatic segmentation, multi-data fusion, coronary analysis, and colon analysis. A customizable user-interface and flexible action macros further simplifies the user experience.

The Ziostation’s full range of scalable configurations, from dedicated workstations to comprehensive server/thin client systems, support critical functions for both physicians and technologists. With end-to-end product integration, every software and non-proprietary hardware component integrates efficiently.