Advanced visualization is here—and here to stay, promising to improve patient care with exquisite visualization of everything from cerebral aneurysms to vascular disease and colon polyps. Advanced visualization has become an integral and essential component of the 21st century radiology department. "If you have high quality [imaging] equipment, it's a waste without the ability to perform 3D reconstructions. It's the equivalent of buying a Ferrari and not putting good tires on the car," states Hal Folander, MD, chairman of the department of radiology at St. Luke's Hospital and Health Network in Bethlehem, Pa. Volumetric imaging cures the slice harassment caused by the proliferation of multislice scanners that generate more than 1,000 images per exam (or more), says Folander.
Yet, the same time, administering the advanced visualization cure brings its own set of woes. The top challenge? Integration. "If you don't have PACS integration, you're just making pretty pictures," argues Donald Peck, PhD, division head for physics at Henry Ford Health System in Detroit, Mich. Workflow rears another issue.
A lack of integration between the advanced visualization solution and PACS can slow the radiologist by forcing him or her to get up and move to a second workstation, says Peck. In other cases, the radiologist must separately launch the 3D application from the PACS workstation and physically pull in hundreds of images, a process that can take up to a minute per study. "It's unacceptable from a workflow point of flow," states Christoph Wald, MD, PhD, director of 3D Lab for Advanced Image Analysis and Virtual Surgical Planning at Lahey Clinic in Burlington, Mass. Integration is not a black and white proposition. Less than seamless integrations translate into additional log-ins and more mouse clicks.
Integration can address the other major advanced visualization issues: cost-effectiveness and efficiency. Integration enables the department to tap into and maximize its investment in PACS workstations and circumvents delays like re-launching or losing data as images are transferred between machines.
Other key issues in the advanced visualization implementation process include communication with and distribution to referring physicians as the real purpose of every advanced visualization solution is to improve the clinician's ability to deliver excellent, efficient patient care. A thorough review of options and assessment of related solutions—especially PACS and workstations—and clinical needs and goals helps ensure that the advanced visualization program is primed for success.
Integration: Before & after
The integrated department is the picture of efficiency and productivity. Take for example Henry Ford Health System. The radiology department relies on a Philips Medical Systems (Stentor) iSite PACS. The PACS is integrated with Barco's Voxar 3D and Vital Images Vitrea workstation. The two advanced visualization and analysis software packages are used for the majority of the day-to-day reconstructions. The department relies on GE Healthcare's Advantage Workstation (AW) and Siemens Medical Solutions Leonardo workstation for additional modality 3D reconstructions.
"With Voxar and Vital Images integrated into Stentor, we can pull images directly from the PACS," explains Peck. Physicians can right-click on an image to continue working with a reconstruction that had been started by a tech or colleague—without losing previous processing. PACS also provides storage for 3D data, eliminating the need for an additional server for storage. PACS integration allows the department to move data without an intermediary server and eliminates pre-fetching.
Lahey Clinic is taking a different tact. The organization plans to deploy TeraRecon's AquariusNET server to facilitate a more integrated advanced visualization environment. The clinic found itself in a difficult spot with its primary 3D software not yet integrated into its PACS. The PACS vendor promised integration in its next upgrade. Wald explains, "Our PACS upgrade wasn't scheduled for a while, and it isn't always wise to rush into the next PACS release. We needed an integrated advanced visualization solution now."
The clinic plans to install AquariusNET server in its data center. Data will be sent from the modality to the server, or physicians can request 3D with data pulled nearly instantly from the PACS. Wald lists the pluses of this approach. "At the client end, hardware requirements are extremely