Advanced visualization is radiology’s latest oxymoron. That is, in many enterprises, 3D tools have entered mainstream radiology. Early adopters of next-generation advanced viz solutions report that 3D functionality is no longer difficult to access or reserved for specialized cases. Instead, these sites are deploying a universal, democratic 3D model with advanced visualization functionality available across the enterprise.
Take for example the VA Maryland Health Care System in Baltimore. “Our philosophy is that as imaging grows more complex advanced visualization becomes an essential, basic tool. We use TeraRecon’s AquariusNET solution for nearly all clinical applications,” explains Khan Siddiqui, MD, chief, imaging informatics and body MR imaging. In fact, 96 percent of all CTA and MR studies are interpreted using AquariusNET. In the universal model, utility and access extends beyond radiology. Three years ago, the VA deployed AquariusNET enterprise-wide on all hospital computer systems, enabling users to access 3D anywhere in the enterprise. The investment paid off. Clinicians view a full 40 percent of imaging studies with advanced viz tools, says Siddiqui.
There are several ways to deploy advanced visualization across the enterprise. One option is the thin-client model, which relies on a central server for 3D processing. Images are processed on a central server that delivers 3D imaging to networked thin-client PCs. Other sites rely on the integrated PACS model with the 3D solution embedded in the PACS workstation.
Regardless of the route taken to universal 3D, adopters gain numerous benefits. Most importantly, this model addresses the double whammy of 21st century radiology. That is, it leads to improvements in both workflow and clinical care. It also streamlines and simplifies distribution and management of 3D images.
Despite its tremendous promise, the universal model is not without challenges. Advanced visualization means advanced technology, and it takes time and IT expertise to fully deploy advanced visualization. It also requires adjustment and training on the part of users. Neither issue is insurmountable; both can be overcome with clear planning and a solid vendor partnership.
3D: The clinical angle
The clinical rationale for enterprise 3D is clear. “The integrated 3D model allows us to quickly reach clinical decisions,” explains James Brunberg, MD, chair of radiology at University of California Davis (UC Davis) in Sacramento, Calif. For example, if a patient presents in the ER with a headache, he can be referred to CT. Within five to 10 minutes, the radiologist can review the reconstructed images to determine if the patient has a subarachnoid hemorr-hage. “We can view images on the PACS workstation and make an immediate decision about whether or not a contrast-enhanced angiogram is needed to detect an aneurysm,” continues Brunberg. UC Davis relies on Barco’s Voxar 3D integrated with Philips Medical Systems’ iSite Radiology PACS as its 3D solution.
Advanced visualization is particularly relevant in the new image-intense world of cardiac CT. “The CT process is very useful to rule out or rule in cardiovascular and peripheral vascular disease in both symptomatic and asymptomatic patients,” states Robert Schwartz, MD, medical director for Minneapolis Heart Institute Foundation in Minneapolis, Minn. Schwartz relies on Vital Images Inc. Vitrea software to create and navigate 2D, 3D and 4D images and rapidly assess vascular anatomy. “Vitrea helps us get the clinical job done while maintaining a high patient throughput,” sums Schwartz.
The widespread availability of 3D not only accelerates diagnosis and treatment. It also can eliminate other conventionally performed studies to hasten clinical decision-making and avoid the time and rigor of conventionally performed procedures like a cerebral angiogram. “In many cases, the 3D images meet our needs, and we no longer need to perform a catheter-based angiogram prior to surgery,” explains Brunberg.
VA Maryland Health Care has demonstrated improved diagnostic accuracy with its 3D program. Siddiqui explains, “Our internal studies show that radiologists can miss 19 percent of severe spine disease if they do not review a CT of the abdomen in the sagittal plane.” The thin-client model insures that the necessary functionality is available at the radiologist’s fingertips rather than at a separate specialized workstation, enabling users to rapidly render an accurate