Some radiologists have relied on thin-client solutions as their primary advanced visualization tool for nearly a decade. Others are just discovering the benefits of thin-client computing that enables quick post-processing of CT and MR datasets and streaming to networked workstations. In fact, thin-client solutions for 3D reconstruction are hot. A number of factors are driving increased interest in and adoption of thin-client tools.
For starters, multidetector CT is nearly ubiquitous, and the massive datasets generated by 64-slice systems require 3D post-processing, which is bringing more facilities and healthcare enterprises into the market for a 3D post-processing solution.
The basic choice boils down to stand-alone workstations vs. thin clients or PACS integrations. The stand-alone workstation is a pricey powerhorse well-equipped to handle sophisticated 3D image manipulations and reconstructions. Vendors up the ante with an array of software packages tailored to specific advanced post-processing needs like cardiac viewing, virtual colonography and lung nodule analysis. On the downside, the workstation is a high-priced, fixed system that can accommodate a single user. What’s more, radiologists must break their PACS workflow to trek to the specialized workstation for 3D cases.
Thin clients approach the 3D world from a different angle. An enterprise server processes CT and MR datasets and streams 3D images to networked workstations. Thin clients allow radiologists and other clinicians to view and interact with 3D images on PACS workstations as well as personal computers and laptops. Users do not need to disrupt workflow to move to a separate workstation, and 3D is widely available for the clinical masses like surgeons who want to view images. Other factors also drive increased acceptance of thin-client systems.
“Thin clients have progressed to the point where radiologists can complete significant post-processing on the thin client,” explains Mark Beller, MD, director of advanced imaging for Renaissance Imaging Medical Associates in Los Angeles. “It used to be a major undertaking to complete 3D MIP [maximum intensity projection] and MPR [multiplanar reformats] for a brain aneurysm. Now, those tools are available on the PACS workstation, which is a significant advantage. Other functionalities facilitate vessel analysis, coronary artery angiogram analysis and calcium scoring at the PACS workstation.”
The use of advanced tools translates into diagnostic improvements. According to Allen Elster, MD, chairman of radiology at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., radiologists report an incremental yield of additional findings in the 20 to 25 percent range. That is, 3D tools help radiologists better detect pathology and diagnose complex injuries.
Finally, thin clients make sense from a cost perspective. A single proprietary workstation costs upwards of $100,000 or $100,000 per user seat, says Elliot Fishman, director, diagnostic imaging and body CT at The Johns Hopkins University School of Medicine in Baltimore, Md. A comparable thin-client solution may cost $200,000, but provides 10 licenses — dropping the cost of 3D post-processing to $20,000 per user.
This month, Health Imaging & IT examines thin-client solutions. Thin-client pioneers share the advantages and challenges associated with this approach. Think workflow, economics and patient care. It’s a recipe for success, and PACS and thin clients are primed to further penetrate the 3D market in the next few years.
The 99 percent solution
Beller spends 99 percent of his day reading studies on the Kodak Carestream PACS workstation, bypassing the practice’s stand-alone 3D workstation for the lion’s share of his cases. “3D post-processing is available with the click of a button, and streaming media downloads cases, even in studies containing 2,000 images, in a short time,” Beller says. As a result, Beller can read more cases in less time, a ‘tremendous’ improvement in workflow as the radiologist no longer travels between disparate workstations. Other efficiency improvements stem from the system’s progressive downloading capability. That is, images download by layers. The radiologist begins to interpret immediately as the first layer downloads. The balance of the dataset downloads in the background as the radiologist reads the case. The ability to avoid wait time is key in 3D cases as even short wait times add up over the course of a day.