Thin is in, but thick-client still has its place

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Thin may be in when it comes to deployment strategies for advanced visualization clients, but dedicated technology workstations still have a place in the clinical continuum. Although developers are resolutely focused on streamlining delivery of 3D diagnostic imaging tools to the desktop, standalone systems that can deliver the capabilities of the technology are remaining a viable practice partner.

Minal Jagtiani Sangwaiya, MD, and colleagues from the department of radiology at Massachusetts General Hospital (MGH) in Boston looked at the workflow effect of thin-client servers in a narrated electronic poster presentation from the 2009 Healthcare Information and Management Systems Society (HIMSS) conference this week in Chicago.

"The aim of the presentation is to identify the need for a thin-client based image interpretation and 3D reconstructions in the workflow of the radiology department," the authors wrote.

Sangwaiya and her colleagues looked at the limitations of conventional thick-client systems. They found that current thick-client products are workstation-based and demonstrated a compromised post-processing speed in comparison with thin-client based systems.

When it comes to selecting a thin- or thick-based client for image post-processing the MGH team said that it is a need-based decision.

"The healthcare enterprise must make its decision based on the existing setup, system, staff requirements and resource availability," they wrote. "Points to consider during setup are the business plan and cost-benefit analysis, which includes the cost of film handling, potential liabilities, improved workflow, decreased workload and improved patient care."

Thin-client servers focus on conveying input and output between the users of the system and the remote server. They are inherently quicker than thick-clients, stated the authors; however, they noted that it is debatable whether the thick-client brings a richer experience to the user at the cost of its speed.

Thin-client systems effect the image interpretation, viewing and 3D reconstruction of data in the radiology and medical workflow, the authors said.

"For example, if a radiologist in the emergency department wishes to reconstruct the abdominal aorta in three dimensions to confirm a small leak; the 3D laboratory might have to be contacted with a request to trace the aorta then reload the reformatted images onto the PACS," the authors wrote. "This is often time consuming and cumbersome but crucial for proper decision making in context. Thin-client servers solve this problem by enabling real-time reconstructions of thin-slice images."

The authors believe that thin-client strategies have many benefits including Web-based remote-access capabilities, speed and easier IT administration. However, they note that thin clients are limited by the speed of the internet connection and that the interface of these systems may be more complex than conventional PACS.

They also see additional capabilities for thin-client systems such as real-time imaging and image manipulation consults conducted between a surgeon in the operating theater and a radiologist such as when dissecting a tumor or ablating a metastatic lesion.

"Thick-client workstations are adequate for routine workflow in most departments," the authors wrote. "However, Web-based thin-client servers can help, with not only routine radiology image interpretation, but also with interactive 3D and 4D reconstructions."