Advanced visualization allows radiologists, surgeons, and other specialists to determine the extent of a medical problem and plan for treatment very quickly. The decision to operate, or not, can be made with more confidence. The thin-client model lets clinicians access and manipulate data from any computer. Advances under way will incorporate artificial intelligence, better integration with PACS, and the ability of users to choose and incorporate best-of-breed solutions.
Diagnosing appendicitis via CT can be difficult, says Gregg Gaylord, MD, director of diagnostic imaging at St. Nicholas Hospital in Sheboygan, Wis. With advanced visualization, he can put the images into multiplanar reformat for coronal or oblique views and spin the whole study around to be sure there is inflammation. "The decision can be made instantly."
Gaylord also uses advanced visualization to quickly determine whether stroke patients have clots. "We can have the CT angiograms up in minutes and see if there are clots and where they are in the brain. Before we had to have techs do reconstructions, and it was a mess." It took hours, sometimes even overnight, for the CT techs to perform the reconstructions.
In one case that showcases the dramatically improved patient care advanced visualization can deliver, a male patient was admitted with a one-week history of recurrent transient ischemic attacks. A CT scan of the brain was negative, and he was then referred for immediate MRI and MR angiography. A non-contrast MRI displayed multiple small areas of diffusion-weighted abnormalities in the distribution of the right middle cerebral artery and the right lenticulostriate arteries. Following the diffusion weighted study, a 3D time-of-flight non-contrast brain MRA was performed. The data set was automatically transferred from the MR scanner to the TeraRecon AquariusNET server and was immediately available for analysis on the AquariusNET viewer. Even before the remainder of the MRI study could be completed, Gaylord was able to determine that there were no large intracranial embolic lesions. The views were available without the MR technologists having to process the images on the MR computer. Using AquariusNET, all views were easily captured, saved to PACS, and were immediately available to the vascular surgeon and neurologist in their offices for review.
Thin-client capability is invaluable, says Gaylord. Think thin-client first and then worry about the workstation, he recommends. If you need full cardiac capabilities, then the workstation is still a necessity. However, "at some point, the thin-clients will be able to do that."
Steven Strobbe, DO, CEO, of Gulf Coast Medical Center in Port Richey, Fla., agrees that thin-client is the way to go. He uses Vitrea 3D software from Vital Images as well as the company's VITALconnect web solution. He knows the advantages of thin-client firsthand. He often spends time at his home in Alaska but can access his practice's workstation and manipulate the data through a web browser. "Thin-client is where everything is going." This ability to access and manipulate data from any location saves money and lets physicians be mobile.
Strobbe points out that not every practice can afford high-powered workstations, let alone $2 million for a 64-slice CT scanner. "Cardiologists need to be able to interpret exams — that's why thin-client networks are very important," he says. "They can sign in from a conventional PC and provide an interpretation from their office." And with coronary CT angiography emerging as the new gold standard for heart disease over cardiac catheterization, the process needs to be as efficient as possible. "You cannot have cardiologists and radiologists always have to go to high-powered workstations and work these cases up." The setup also lets imaging studies be viewed in a format that allows cardiologists and radiologists to quickly interpret from their office.
Three-dimensional imaging helps improve efficiency of heart disease cases by reducing the large data set to just the critical decision-making images. When a patient is scanned, there are 2,000 to 3,000 images. "You cannot look at them all. It would take forever," Strobbe says. Once he has a 3D heart to look at, he may only need to look at 100 images and sometimes, depending on the amount of disease, only 25 to 30 images.
With the rate of heart disease on the rise, determining which patients really need treatment is an important benefit