Using advanced viz to balance quality and cost
Advanced visualization plays a central role in delivering optimal quality while maintaining cost-effectiveness. Achieving these occasionally competing outcomes represents a challenging but doable balancing act.

On the advanced visualization front this month is a technique for analyzing CT lung scans, originally developed to show the response of brain tumors to treatment, that could help physicians better assess patients with chronic obstructive pulmonary disease (COPD), according to a paper published online in Nature Medicine.

Researchers from the University of Michigan Medical School reported that parametric response mapping (PRM) allows them to better distinguish between early-stage damage to small airways in the lungs and the more severe damage of emphysema.

The researchers used PRM to identify COPD-specific changes in 3D lung regions over time by overlaying a CT scan taken during a full inhalation with an image taken during a full exhalation. Density of healthy lung tissue will change more between the two images than the density of diseased lung tissue based on the ability of the lung to push air out of the small sacs. The differences between scans allows for the creation of a 3D “map” of the patient’s lungs, with small voxels color-coded green for healthy, yellow for reduced ability and red for severely reduced ability.

Using scans of patients with COPD who took part in the national COPDGene study funded by the National Heart, Lung and Blood Institute, the researchers have shown that the severity of disease measured with PRM matches closely with the patient’s performance on standard lung tests of breathing ability.

In other developments, Japanese researchers demonstrated that adding SPECT/CT to whole-body scintigraphy with Iodine-131 can deliver incremental diagnostic value compared with scintigraphy alone in patients diagnosed with thyroid cancer. SPECT/CT more clearly localizes and defines hot spots.

In a study published online Sept. 25 in Radiology, researchers found the addition of SPECT/CT changed the interpretation of radioactive foci at scintigraphy in 40 of 147 patients, which changed clinical staging according to tumor-node-metastasis classification and therapeutic planning in nine and three patients, respectively.  

These and other studies provide a glimpse of the future of image-guided decision-making.

This month’s portal also previews other futuristic applications of advanced visualization. Be sure to check out the “Hola AMIGO!” slide show. It details the world’s first intraoperative operating suite housed at Brigham & Women’s Hospital in Boston. Multimodality integration plays a central role in the suite, which is designed to enable surgeons and researchers to introduce and share a wide range of image-guided procedures.

Meanwhile, in Canada, a consortium of institutions detailed the promise of a 3D virtual reality surgical simulator. Conventional surgical training can decrease operating room efficiency by as much as 35 percent. In contrast, the virtual 3D approach is efficient and cost-effective, according to early users. Use of the system may be extended to patient-specific rehearsal based on the conversion of patient imaging data into simulation models, which might ultimately translate into increased efficiency and improved outcomes.

Is your organization leveraging advanced visualization to achieve its goals and does it have the IT infrastructure in place to do so? Please share your experience.

Beth Walsh
Clinical Innovation + Technology Editor