After more than five years on the market, 3D options continue to evolve to better meet the diverse needs of radiologists, cardiologists and a variety of specialists. With a wide array of options available, hospitals can devise a 3D rendering program to meet their unique needs. For some, the 3D lab approach offers the best first-line model. Other sites aim to put 3D tools in the hands of heavy users like orthopedic and trauma surgeons via a thin-client system. Outsourcing is another option that suits sites that lack the volume to justify a full-time solution or require overflow coverage. In many cases, a hybrid approach that blends various models offers the ideal solution. This month, Health Imaging & IT visits a few sites to learn more about the ins and outs of a variety of 3D rendering models.
The 3D lab approach
The 3D lab is a commonly employed 3D rendering option. Many facilities and groups centralize 3D post-processing in a lab, using super-techs to complete the lion’s share of 3D post-processing and reconstructions. Take for example Spectrum Health in Grand Rapids, Mich. The health system uses a full-fledged 3D lab with six facilities porting CT and MRI studies to the central lab for 3D post-processing. The lab is staffed by two full-time 3D imaging specialists with an additional six techs trained to handle 3D reconstructions, which ensures 24/7 coverage. The 3D solutions include TeraRecon Aquarius and GE Healthcare AW workstations and TeraRecon AquariusNET thin-client system for enterprise wide access to 3D applications and GE Remote Access software for remote access to GE 3D workstation functionality. The clinical caseload is varied, but predictable, with vascular studies like emergency carotids dominating the 3D workload, says 3D Imaging Specialist Shannon Culver. The lab completes between 600 and 650 billable 3D cases monthly; about 400 cases are CT reconstructions, and the remainder are MR studies.
With nearly four years under its belt, Spectrum Health’s 3D lab has fine-tuned its workflow. Routine outpatient 3D studies are auto-routed to the 3D lab, post-processed according to protocols and sent to PACS for storage with the original study. “The workflow was challenging when we opened the lab. It took some time to determine if it would be best to pull studies or auto-route them and if patient information should be phoned, texted, emailed or faxed,” recalls Culver. Currently, paperwork for routine cases is faxed to the lab. The health system uses text paging to facilitate rapid turn-around for emergency cases. In addition, AquariusNET is integrated with PACS, so physicians can access 3D applications enterprise-wide.
The 3D lab model optimizes patient care, says Culver. “It takes consistency and continuity to provide the best patient care. Spectrum Health has dedicated many man hours to developing and tailoring 3D protocols. As a result, our physicians receive consistent, replicable 3D reconstructions.”
Similarly, University of Minnesota Medical Center Fairview in Minneapolis, Minn., has employed an Advanced Imaging/Post-Processing Lab for five years. The lab is equipped with three post-processing workstations that run Vital Images Vitrea, Tera-Recon Aquarius and Barco Voxar 3D software and handles about 200 3D cases monthly.
The clinical caseload at the medical center consists primarily of pre-operative organ donor studies like mapping vascular systems or liver volume. The workflow is fairly straightforward. Original images are transmitted from the acquisition workstation to the 3D lab, where 3D Advanced Imaging Technologist Steven Horowitz completes the reconstructions and sends them back to the referring physician. After the physician dictates the case, reconstructions are stored in PACS with the original images. Although the current model provides medical center staff access to the raw data, reconstructed images and reports via PACS, the medical center plans to deploy Vital Images ViTALConnect web-based software later this year.
The new software should improve the current workflow, which requires physicians to visit or call the 3D lab to request additional views. “When we add ViTALConnect, physicians can complete reconstructions on their own. It will provide better and faster access to images, which should improve patient care,” explains Horowitz. For example, if a surgeon requires a different view during surgery, he can view images on the PACS workstation and create the required view during the procedure.