At 20 years old, 3D is not exactly the new kid on the radiology block. But in the last few years 3D has evolved from a high-end, primarily academic means of producing pretty pictures to an essential clinical tool. “If you have multislice CT you need a 3D workstation,” states Steven Strobbe, MD, CEO, of Gulf Coast Medical Center in Port Richey, Fla. The leap is evident in the array of options from diagnostic modality workstations to third-party solutions and thin-client systems that can put 3D on every desktop.
With a wide range of hardware and software solutions, it’s easy to make a misstep. “Some sites decide what to buy without thinking through the purchase. They don’t buy what they need and then need to buy a second workstation,” notes Strobbe.
With price tags that stretch from the low six-figure range for a single workstation up to $1 million for an enterprise-wide deployment, it’s essential that radiology finds a way to harness 3D technology while meeting both workflow and financial needs.
This month Health Imaging & IT visits with a variety of users to determine the key factors to evaluate when investing in diagnostic workstations. Items to consider include workflow, features and functionality and the practice environment. The right solution can make a world of difference, enabling radiologists to read multidetector CT, MRI and other imaging studies quickly and efficiently, add diagnostic value to an array of studies and share key findings with clinicians.
Workstations, workflow and more
3D is second nature to Elliot K. Fishman, MD, director, diagnostic imaging and body CT at The Johns Hopkins University School of Medicine in Baltimore, Md. The radiologist has used a Siemens Medical Solutions Leonardo workstation in conjunction with Siemens 16 and 64-slice scanners for several years and completes 30 CT angiographies daily with the system. That type of workflow is no longer limited to the academic medical center; large hospitals, community hospitals and diagnostic imaging centers are entering the 3D realm en masse. “Transitioning from 2D to 3D is a whole new story. The challenge is building 3D into the workflow,” explains Fishman.
That challenge has held back the workstation market, says Strobbe, who relies on Vital Images Vitrea 2 workstation and ViTALConnect web solution for interpreting coronary CT angiograms. “All of the vendors are trying to make workstations simpler and more automated. Studies should be presented in a format that is quickly readable,” explains Strobbe.
While a single case can gobble up 45 to 60 minutes, the ideal is a four to five minute process. If it takes several mouse clicks or keyboarding to complete a task, the system may not be as fast or as interactive as it should be. Strobbe’s practice relies on 3D technologists to complete reconstructions in about 10 to 15 minutes; the radiologist or cardiologist reads and completes the case online via ViTAL Connect in five to 10 minutes. Fishman urges radiologists to avoid thinking about what the workstation can do and instead focus on what they can do with the workstation. “Bells and whistles are great, but radiologists should be able to do 99 percent of their work in a timely and efficient fashion,” he continues. For example, if the practice load is heavy on CT runoffs and it takes an hour to edit out the bones with one workstation, it isn’t the right solution.
“It’s important to remember that no two practices are the same. Think about what your business is, and make sure the system does it,” says Fishman. Cardiac studies require a different solution than 3D bones, says Strobbe. Another key angle is the future of the business. Essential questions to ask and answer include prior to investing in a solution include: what is your roadmap and where does 3D fit in?
Speed is essential, says James Gruden, MD, senior associate consultant radiologist, Mayo Clinic Arizona in Phoenix. Gruden uses GE Healthcare’s Advantage Workstation as his primary reading station. “Images load very quickly, and I can interact in real-time with the data,” notes Gruden. Processing power is critical with large datasets; a 3D CT angiography of the chest may comprise more than 3,000 images. The workstation must be capable of holding all of the images in its memory, and additional power is needed to display images in a cine loop.
The Advantage Workstation is essential to optimizing the site’s VCT 64-slice CT scanner. “It’s impossible to harness the benefits of VCT with a