Thinking Thin-Client

Utilizing thin-client-based advanced visualization, clinicians can access tools from any location—fostering more efficient patient care, physician communication, education and research—all at a reasonable cost.

Ron Gilbert, PACS administrator at Atlanta Medical Center in Georgia, installed Vitrea advanced visualization software and VitalConnect from Vital Images last fall. His philosophy is that “if I can make it easier for the doctors to do their jobs, overall the patients are benefiting.”

Thin-client offers several advantages, he says. It makes it easier for physicians to go online and obtain the information they want on their own. They can be more detailed about their diagnoses and reporting on the charts. Plus, two or more physicians can discuss findings more easily since they can access the same dataset at the same time.

Setting up the software was relatively easy, Gilbert says. “I used existing hardware so the costs were minimal. You’ll be stuck if all you have are stand-alone workstations. No hospital can spend $100,000 a pop to put [advanced visualization capabilities] all over the hospital.”

Gilbert began with the 15 to 18 users in the surgery department. The software “really turned their heads because it takes them much less time to go through a large CT scan.” One trauma package contains 900 to 1,200 slices, but with Vitrea, as soon as the study is launched on the 3D client, it comes up with all three planes and the 3D rendering model. The user can click on the injury and all three planes snap to it. “Within one minute, they can get the same information that would take at least five minutes to get by rolling through the study.”

Ever since the surgeons began using the software, other physicians have clamored for access as well, Gilbert reports. With 250 residents and 300 attending physicians, he says the best way to use the software is by making it available as a PACS web product. Since extending PACS to the facility’s wide-area network, “we also can use VitalConnect on our WAN [wide area network].”

Easy access outside radiology

Stuart A. Royal, MD, radiologist in chief at Children’s Health System in Birmingham, Ala., has been using Visage CS from Visage Imaging for about a year. The facility uses the system for a distributed architecture for physicians outside of the radiology department to do their own 3D manipulations. Although the radiologists find the software helpful on a daily basis, Royal says the biggest value is in letting the department create open, available and transparent radiology information. “The information can be used by the [clinicians] who order the tests and that’s the big advantage.”

Radiologists may look at studies a particular way to make a diagnosis, he says, but referring physicians may find a different view more helpful. For example, a surgeon can manipulate the study to plan the best surgical approach. “They’re the only ones who know exactly which way to go,” Royal says. “This has been a huge advantage for them—the freedom to use it anywhere in the system and to do it exactly how they want it.”

Royal views the software as beneficial for clinical care, education and research. The ability to answer questions such as the best surgical approach, how aggressive the physician can be on a lesion and how much vascular invasion is there, provide a direct clinical care benefit. He also uses the software during conferences with neurosurgeons and to demonstrate concepts to teach residents. When it comes to research, “it seems so obvious that it is beneficial, but you really need to prove it in a scientific study format,” he says. And, once you get really used to using it, you can develop the product further by creating new templates, new ways of calculating volumes and new image-guided aspects.”

Improved workflow

William Muhr, MD, radiologist at South Jersey Radiology Associates, a practice with eight locations in southern New Jersey, has been using syngo WebSpace from Siemens Medical Solutions for about a year. “We decided that with the number of studies requiring more advanced visualization, particularly coronary CTAs, we didn’t want to have to put all that raw data on PACS.”

The practice wanted to improve workflow so that when radiologists need to interact with datasets, they didn’t have to physically get up and move to a specialized workstation. The other goal was to try and get more doctors interacting with data in a 3D fashion instead of just axials, particularly neuroradiologists and body imagers. The functionality is not quite as fast as being right at a workstation, but the remote access capability more than makes up for that, Muhr says.

His own workflow has changed dramatically, he reports. With the ability to read about 80 percent of his studies from the PACS using thin-client, “I think I’m able to be more efficient.”

More competition

Jeffrey Hellinger, MD, is a long-term advanced visualization user who has been building up a 3D lab for pediatrics at Children’s Hospital of Philadelphia. The facility uses INtuition from Tera-Recon for everything from cardiovascular to body to neurology MR and CT studies.

Thin-client has allowed Hellinger to view studies while traveling in Europe and even wirelessly on an airplane. During his training, he worked with the earliest versions of software and workstations, which were very cumbersome. When he was looking for a job, he noticed a lot of reservations about thin-client. Now, the skeptics have not only converted, they can convert others.

The market is becoming more competitive, he says. The key now is that vendors need to demonstrate that thin-client advanced visualization’s utility is what people have been predicting it will be.

Steven D. Wolff, MD, PhD, director, Advanced Cardiovascular Imaging, an outpatient imaging center in New York City, has been using GE Healthcare’s AW (Advance Workstation) Remote Access for more than two years. About 90 percent of the center’s cases are cardiovascular CT or MR studies. The work performed by Wolff and his colleague is very specialized, so it’s not easy for another physician to fill in. That’s where he finds remote access to be very helpful.

Another benefit comes in working with referring physicians. Interventionalists, such as surgeons and cardiologists, feel it’s important to see the images themselves. “Seeing the picture and understanding the shape of what it is they’re seeing will often change their approach,” Wolff says. For example, they may see, in the case of vascular malformation, more than one feeding vessel. The images can help them decide whether to treat an aneurysm surgically. Although he can use words to describe a narrowing of an artery, “there’s nothing like seeing it to get a better feel of whether to treat a lesion.” Plus, he can view the same dataset with the referring physician and interact and answer questions.

Apt advice

Although the software is useful for those who want to access flat images, says Wolff, “where it’s really useful is for those specific areas of medicine where it’s important to interact with a 3D dataset and be able to reformat in different planes. You can ship people images, but you can’t ship every possible 3D view that they would want.”

Some might fear that thin-client advanced visualization could make radiologists unnecessary, says Royal. But, making imaging data accessible to more physicians is better for patients, he says. “Embrace it. Don’t be scared of it. Stay ahead of the curve so that we continue to add value to the clinicians’ understanding about our imaging techniques. That’s better for radiologists because we work hand-in-hand with referring physicians and they need to feel that we’re on the cutting-edge of what technology has to offer.”