|Lumbar image captured on TeraRecon’s AquariusNET|
Sophisticated and more intuitive advanced visualization software makes intricate imaging capabilities possible and thin-client options are expanding access across the enterprise. Along with improvements in reconstruction tools, 3D functionality is saving time, improving patient care and facilitating overall workflow improvements.
CT angiography studies with 2,000 images that used to take Richard Hallett, MD, section chief of cardiovascular imaging and medical director at Riverview Hospital in Noblesville, Ind., 30 to 45 minutes to view via PACS now take about 15 minutes. Why? Hallett now uses AquariusNET and Aquarius workstations from TeraRecon. The AquariusNET viewer and server combination allows for processing in a thin-client interface. The software package, primarily used for CT angiography, can be installed on any computer.
Hallett says that there was an initial learning curve, but he found the system fairly easy to learn. As for workflow changes, “it adds time. You have to sit down and interact with the data.” Overall though, he has decreased the time spent on cases because he can get through large volumes of data more quickly and effectively. “It’s time well spent. It allows you to go through lots of information and focus on the things that are important.”
Hallett says that the ability to do reconstructions down the center of a vessel allows him to see an area of narrowing in multiple ways to determine whether the narrowing is due to soft or calcified plaque, and vessel morphology. It makes measurement more accurate and reproducible. The time savings and increased accuracy is a win-win. “It’s a great diagnostic tool from an ease of reading standpoint,” he reports. He also appreciates the ability to email images to referring physicians to keep them in the loop and eliminate their need to get on a PACS to review images. He also can send the same images back to PACS so that they are always available to other physicians.
Hallett’s system allows for 4D image review, including viewing of the beating heart and valve motion. More recently, Hallett says his partners are performing virtual colonoscopy, which is easy to look at on the viewer. Thanks to the server, he can use a remote link himself. Hallett is based in Indiana, but he is a part-time faculty member at Stanford University School of Medicine in Palo Alto, Calif. There is a group at Stanford studying stent grafts in the aorta. With this system, he can use the server at Stanford from his home to stay involved in the research.
Hallett has experience with several advanced visualization systems and says that the thin-client/server setup was selected because of the ease of implementation and ease of use of the software. He played a big role in implementing advanced visualization capabilities at Stanford, too. The facility was rolling out a cardiovascular services program in 2004 and they wanted to grow imaging along with that.
Today, coronary CTA studies are sent to the server, along with complicated orthopedic cases, such as hip evaluations or myelograms—“anything that we need a multiplanar evaluation for,” Hallett says. That accounts for about 20 run-off studies a month. The facility does about 100 CTAs for pulmonary embolis, 25 for thoracic and aorta, 20 for renal arteries and 10 to 15 for head and neck. All MR angiograms—about 50 a month—are sent to the server. They can set up a watermark and autodelete function so that when the server fills up, it will start to delete exams that aren’t locked.
Concentrating on cardio
Frank Rybicki, MD, PhD, co-director, cardiovascular imaging section and director of applied imaging sciences laboratory at Brigham and Women’s Hospital in Boston, Mass., has been using Vitrea software from Vital Images for about three years. The portfolio includes automated vessel measurement, CT brain perfusion, CT cardiac, cardiac functional analysis, CT lung, vessel probe and VScore, which were chosen because “they have excellent advanced post-processing tools for cardiovascular imaging.” Specifically, Rybicki uses multiplanar reformatting, orthogonal (curved) planes as well as 3D volume rendering and maximum intensity projection (MIP). The latest and most important feature in cardiovascular imaging is advanced curved planar reformation for flattening of vascular structures.
“The software is excellent,” Rybicki says. “The workability is excellent and it makes our day-to-day