Advanced Visualization: More Uses, More Confidence

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Carotid CTA showing stenosis using Vitrea software from Vital Images.

Post-processing software allows clinicians to better track cancer therapies, plan surgeries, and diagnose heart, brain and intestinal disease. Newer tools let users subtract unnecessary structures, allowing for better evaluation of problem areas. Use of and uses for the software will only increase as data sets grow and new applications are added to the list.

In his 25 years as a radiologist, Monte Golditch, MD, of Memorial Health System in Colorado Spring, Colo., has seen the evolution from “taking a simple x-ray to where we’re at now which is heavily computer-oriented, very high-tech with the ability to cut, dice and slice the body in many different facets. It’s really made a difference. I’m a much better radiologist now than I ever could have been regardless of my own skills and experience because of the ability to use higher level computer analysis and multiplanar reconstructive imaging to glean more data and extract greater information than was ever possible before.

Golditch uses Vitrea software from Vital Images, which helps him present information to other clinicians in “a much more understandable way. When we process a case, we can depict the boiled down essence of our processing and our findings. One picture may do more than all of my written words to explain what’s happening [with the patient].

Golditch uses advanced visualization for vascular work, such as aortic, thoracic or abdominal aneurysms, carotid dissection, trauma cases, aneurysm searches for patients with severe headaches, and long-leg runoff studies for evaluation of peripheral artery disease and peripheral insufficiency. For cardiac patients, Vitrea lets Golditch analyze the coronary arteries. “It’s very sophisticated and very helpful. Noninvasive coronary CT evaluation would not have been possible without the software. Whenever we evaluate a case on Vital, we always extract more information that is useful and helpful. I can be more confident of a rendered diagnosis having used the software.

Even more uses

To Ted Wen, MD, pediatric radiologist at Presbyterian Hospital, a Texas Health Resources facility in Plano, Texas, “3D and 4D imaging is an invaluable tool. We use it everyday.

Wen, who works with VolumePro software from TeraRecon, studies vessels without having to perform an invasive angiogram, and several-day hospital stay. “With a simple peripheral IV access in a vein, we use a CT scanner or MRI scanner and can perform images at a thicker slice for lower radiation exposure and a very fast exam [a few minutes] and then process the images to as thin as 0.625 mm. With this raw data, we then analyze the images on a 3D workstation and can generate not only beautiful images but potentially more accurate images than simply viewing the images 2D.

In a recent brain aneurysm case, on 2D imaging Wen initially thought the aneurysm originated off the anterior cerebral artery. However, when he viewed the images in three dimensions, he could see that the aneurysm originated off the anterior cerebral artery as well as the anterior communicating artery. That altered the surgical planning.

Wen also uses 3D imaging for all complex fractures “where we generate images that look like the actual bone with color and show all of the fracture fragments at different angles. The orthopedic surgeons find this very helpful. We can even sequentially subtract the skin to show the muscles, then subtract the muscles to show the vessels and nerves, then subtract the vessels and nerves to show just the bones.

Craniosynostosis—premature fusion of the skull sutures in infants—calls for a 3D image of the skull to aid in finding very short segments of the suture that may be fused. That gives craniofacial surgeons a roadmap of where to operate.

Wen also uses 4D imaging to study the heart, such as watching how the heart contracts. That helps him quantify the amount of blood being pumped by different chambers and also assess valve function. “We can study the entire coronary arteries with a five-heartbeat scan and generate 3D images of the coronary arteries, then fly-through the vessels as well as fly 360 degrees around the vessel looking for peripheral plaques that may be missed with a routine angiogram.” 

Hybrid imaging usage

Ninety percent of the business done at Northern California PET Imaging Center is oncology, says Steven Falen, MD,PhD, medical director. The facility installed TrueD from Siemens Medical Systems