Advanced Visualization Software & Multimodality Workstations

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Increases in patient volume and image datasets, as well as the recent technological advancements to imaging equipment that enable physicians to obtain large amounts of anatomical and functional information, have made the world of medical imaging a data-intensive environment. RSNA 2005 made it apparent that advanced visualization software - and the range of sophisticated analysis tools integrated within the software - plays an ever-increasing role in the diagnosis and treatment of various diseases.

Not only are these post-processing tools and advanced applications available on dedicated workstations within an imaging department, companies at RSNA showcased innovations that allow the 3D software to be accessed on any number of PCs and shared across a dedicated network. Web viewing is a thing of the present, not the future. Vendors also displayed the integration of computer aided detection (CAD) tools within their software that help physicians detect and analyze lesions of interest.  


ADVANCED VISUALIZATION


3mensio Medical Imaging BV used RSNA to springboard 3viseon 2.0 advanced visualization software that enables large medical datasets, generated by CT and MR scanners, to be displayed as three dimensional reconstructions using standard PC technology.

The newest version of the software has been enhanced with functionalities that enable both radiologists as well as referring physicians to rapidly process the generated DICOM images. In addition, the technology benefits referring physicians in the field of neurological, oncological, or vascular surgery where 3D is an increasingly important part in the operative planning process and communication to the patients, the company said.



Barco at RSNA demonstrated technology that provides healthcare providers enterprise-wide access to 3D medical imaging on standard workstations and PCs, as well as introduced an advanced analysis tool that provides clinicians with high-quality visualization of 2D, 3D and 4D images of the heart.

Voxar 3D Enterprise, a server-based technology that enables enterprise-wide access to advanced visualization software tools, accelerates the speed at which users can load, review, report and communicate patient cases with clinical colleagues. Whether the user is working on a high-performance diagnostic workstation or a standard PC, Voxar 3D Enterprise quickly delivers large volumetric studies and provides rapid updates of MPR and 3D views.

Voxar 3D Enterprise can be integrated with a hospital's enterprise-PACS where users of high-performance diagnostic workstations in the radiology reading room can have access to optional clinical applications, such as VesselMetrix for vessel analysis, and CardiaMetrix for CT cardiac analysis. When using standard, off-the-shelf PCs throughout the enterprise, users can rapidly load and review volumetric image studies with the most commonly used 3D visualization tools.

Barco highlighted a new visualization software tool called CardiaMetrix that is designed for the rapid evaluation of multi-phase cardiac CT studies. CardiaMetrix is available within the company's flagship 3D software product, Voxar 3D.

CardiaMetrix includes advanced tools for structural and functional analysis of contrast-enhanced computed tomography angiography (CTA) studies. Several advanced clinical application modules within CardiaMetrix include coronary vessel analysis, calcium scoring, 4D cardiac analysis and cardiac (left ventricular) functional analysis. The software also has tools for the automatic calculation of heart function parameters and quantitative analysis of cardiac anatomy, including the coronary vessels.

Barco also announced at RSNA a new partnership with workstation graphics accelerator provider ATI Technologies Inc. Under the terms of the agreement, ATI will provide Barco with access to ATI's FireGL hardware and software graphics technology. The agreement will enable Barco to utilize ATI's graphics processors units (GPUs) to meet the specific needs of medical imaging applications.



Cedara Software, a Merge Healthcare company, showcased at RSNA lung and colon advanced visualization software, a coronary screening analysis tool, as well as introduced a works-in-progress software designed for the oncology community that addresses cancer screening, diagnosis and radiotherapy treatment and planning.

Cedara's CalScore Review software, which is designed for coronary screening, provides clinicians with quantification tools for arterial calcium buildup through CT imaging. According to Cedara, the software organizes findings in a customizable report, and Individual Score reports are based on the industry-standard Agatston as well as Volume or Mass score. Basic features include user-definable color scheme, report generation, and Hounsfield threshold. Additional gating and calibration capabilities can be added to the software as needed based on the user's CT equipment specifications, Cedara said.
    
Cedara's virtual colonoscopy software - Colon Review - integrates software tools needed to visualize the lumen, record findings, and automatically generate a report. The study can be reviewed working primarily on the 2D images (using the 3D view for problem solving), or the study can be reviewed working primarily from the 3D view, according to the user's preference, Cedara said.

Cedara Lung Review is a lung nodule visualization and analysis package that incorporates a four-pane viewing tool with MPR and sliding slab MIP functionality to examine the lung and any candidate regions identified by the user. Automated nodule segmentation generates a 3D representation of the nodule, measures its signal and dimensional characteristics, and incorporates a customizable decision tree based on ELCAP recommendations.

Cedara also introduced a works-in-progress suite of applications named OncologyWorks that provides collaborative tools for radiologists and radiation oncologists. Addressing the unique requirements for cancer screening, diagnosis and radiotherapy treatment and planning, the technology includes quantitative PET/CT fusion, ultrasound navigation positioning, tumor tracking, patient follow-up management and more.

In addition, the company featured I-Response, an application in OncologyWorks that provides technology for early detection of treatment response in brain cancer care. According to Cedara, the molecular imaging technique assesses tumor response from cellular mechanisms. Advantages include its potential to evaluate the impact of anti-cancer drugs and radiation therapy on tumors at a fast rate, the company said.



ContextVision highlighted its suite of image enhancement products which include GOPView US, GOPView XR, GOPView MAMMO, as well as a works-in-progress for CT.

GOPView US is a real-time ultrasound image enhancement designed for DSP (digital signal processor) platforms. The visualization tool provides high quality image enhancement with a significant reduction of noise and speckle in real-time, and achieves fine structural and edge enhancement. GOPView EX, an image enhancement tool for computed radiography and direct digital radiography, reduces noise and simultaneously preserves or enhances desired features of a captured image, such as tissue borders and other edge structures, ContextVision said.

GOPView Mammo is an image management product for digital mammography that provides advanced functionality for retrieving subtle and important structures while simultaneously suppressing noise in mammography images. The product offers advanced thickness equalization that enables optimal visualization of the whole breast without windowing, as well as an adaptive functionality for different types of breasts, allowing homogeneous and reliable display from patient to patient.

Currently a works-in-progress, GOPView CT is targeted towards achieving dose reduction within CT imaging while enhancing image quality. Priority can be given to either dose reduction or to image quality improvements depending on the subject. For less dose-sensitive abdomens, normal dosage can be selected while sensitive abdomens receive lower doses.



Emageon showcased version 5.30.1 of its enterprise visual medical system (EVMS) software that combines content management for various 'ologies.' The newly released software helps users manage the complexities of today's large datasets, as well as manages the workflow of the data.
   
According to Emageon, the upgraded software focuses on enterprise workflow requirements, open standards and native multi-specialty support. Native volume rendering has been added, which leverages the OpenGL graphics standard to manipulate 3D volumes with high-quality ray-tracing in real time. Also new is an integrated administrative toolset that provides a collaborative environment for content management, including a new quality control workstation for radiologic technologists.

Emageon enhanced enterprise workflow with a new physician tool that manages exams and increased productivity, including personal content manager with JPEG2000, teleconferencing, StudyNotes and an exam worklist with new integrated enterprise-wide folder views. 



Hologic used RSNA to highlight its research collaboration with the Johns Hopkins University for the development of tomographic 3D image reconstruction of the hip utilizing the company's Discovery line of bone densitometers. The technology is a new generation of osteoporosis assessment tools.

Hologic displayed tomographic 3D images from the joint effort in what it said was an effort to recruit researchers to assist with the clinical validation of the new imaging feature. While 2D bone mineral density is recognized as a strong predictor of fracture risk, bone structure is also an important contributor to overall bone strength, Hologic said. The accurate assessment of complex femur structure requires a 3D volumetric density model, the company added.

Hologic's Discovery technology uses patented rotating C-arm capability, to acquire multiple views of the femur at different angles. The collaboration with the Johns Hopkins utilizes this low dose acquisition to construct a 3D volumetric model of the femur.



Mercury Computer Systems demonstrated its Visage 3D to the Core imaging and visualization software platform that includes the Visage CS Thin Client/Server, Visage VR Volume Rendering, Visage RT Image Reconstruction and Visage WS Workstation.

Mercury highlighted its Visage CS Thin Client/Server that provides the capabilities of a specialized medical workstation anywhere throughout a healthcare enterprise. The server-based technology enables all medical image data processing and visualization to be performed on a central server, and the resulting screen content is streamed to the thin-client via a standard network connection. As a result, Visage CS allows multiple clients throughout the enterprise to concurrently access and visualize multiple independent data sets.
   
The cost-effective software can plug seamlessly into legacy hospital IT systems and eliminate reliance on a few, expensive 3D workstations, Mercury said. The company announced at the show the installation of Visage CS Thin Client/Server at the Baltimore VA Medical Center, affiliated with the University of Maryland School of Medicine.

Also on board at the show was Mercury's Visage RT Image Reconstruction that is GPU-based reconstruction technology that reduces reconstruction times by 40x to 60x. Visage VR Volume Rendering is volume-rendering software that can be embedded within OEM applications to support extremely large data-set volume rendering and advanced visualization. Visage WS Workstation is workstation visualization software, combined with clinical applications with accelerated 3D rendering, to optimize the diagnostic workflow.



Siemens Medical Solutions, combining molecular imaging and advanced visualization software, highlighted at RSNA its syngo TrueD - an analysis tool that enables physicians to compare patient scans from two different points in time, such as pre- and post- therapy. Also highlighted was Scenium, an application which aids in neurological analysis. Scenium advances neurological evaluation by enabling automatic correlation of the patient study with an average brain for assessment of abnormalities.



TeraRecon at RSNA introduced the AquariusNET VLE 3D server that is capable of reconstructing up to 30,000 images for instant diagnostic review.

The AquariusNET Server distributes 3D visualization capabilities throughout an entire hospital or group of hospitals by connecting to the facilities' network. To activate 3D functionality, users download a small thin-client application from the server to any number of PC systems, located anywhere from physician reading rooms to surgical suites. The AquariusNET Server may also be accessed from outside the hospital using VPN over broadband Internet or a WAN connection.

The AquariusNET VLE consists of quadruple 4GB TeraRecon VolumePro 1000 rendering boards. The new server is designed to meet the increasing demands for 3D post-processing by large integrated hospital networks where extreme capacity and performance are required, TeraRecon said.

TeraRecon used RSNA to springboard EliteAccess, which is used to combine the AquariusNET thin-client with the advanced Aquarius Workstation to increase radiology reading efficiency and enhance workflow. EliteAccess provides access to workflow tools and high-end workstation applications through a single AquariusNET thin-client user interface.



Viatronix showcased enhancements to its advanced visualization software offerings, as well as showcased integrated, advanced CAD (computer aided detection) tools within its software that are pending FDA approval.
   
Viatronix has enhanced its virtual colonoscopy software, which provides clinicians 3D images, flythroughs, movies and interactive examination. V3D-Colon can now take advantage of the latest generation of dual-core processors and provide a detailed 3D examination for virtual colonoscopy studies.

New features to the company's coronary and vessel analysis, V3D-Vascular, includes improved post-processing and segmentation that will automatically detect and segment the carotid arteries and create 3D movies ready to be sent to PACS. The time-saving tool allows clinicians to spend more time on examination and not manual segmentation. The enhancement is being offered as a standard option on the V3D-Vascular platform.

Viatronix also showcased an open CAD interface for its V3D-Colon platform and Lung CAD platform. The company recently announced two separate agreements with two CAD companies - Quantitative Imaging (QI) and Medicsight. As a result, Viatronix will offer users CAD tools as an option in the near future after receiving regulatory approvals.



Vital Images at RSNA showcased VitalConnect, its fully featured web browser distribution tool, as well as enhancements to its cardiac image analysis software and CAD-integrated tools to its flagship Vitrea advanced visualization software.
   
VitalConnect, a medical diagnostic tool that allows physicians to use PCs or notebook computers to access 2D, 3D and 4D advanced visualization using a Microsoft web-enabled browser, has been integrated with software collaboration tools that facilitate communication between radiologists and referring physicians. According to Vital, the enhancements include the ability for remote users to restore the original Vitrea workflow and report.

Vital focused on its integration with medical communication systems provider Commissure that will enhance the radiologist's and referring clinician's workflow by consolidating status information and producing a real-time work list. From the worklist, Vital said a user may launch directly into a clinical application workflow supplied by Vital, which is linked to a voice-driven report authoring system, and create a multi-media report for the clinicians. 

VitalCardia, cardiac image analysis software that addresses the requirements for 3D and 4D cardiac imaging and review, has been enhanced to support large data sets acquired for careful cardiac evaluation, and easy communication throughout the enterprise with customizable cardiac reports. Components of VitalCardia include: CT cardiac, general vessel probe, cardiac functional analysis, VScore for coronary artery calcium scoring, and automated vessel measurement for stenosis measurement. VitalCardia can be enabled on VitalConnect.

Vitrea, Vital's advanced visualization software for diagnostic evaluation of CT, MR and other modality image data, was highlighted with integrated CAD-driven (computer aided detection) workflow applications. Vital featured its long-term relationship with R2 Technology, showcasing automatic lung nodule detection, automatic measurement of temporal change and pulmonary arterial review. InnerviewGI, the company's CT colonography application, features a work-in-progress application for automated polyp detection and measurement in partnership with Medicsight, PLC. Vital Images also displayed the integration of Confirma's CADStream application for the automatic detection of breast lesions using MRI.


MULTIMODALITY WORKSTATIONS


Cedara Software, a Merge Healthcare company, brought to RSNA a number of technologies geared for softcopy review, including I-ReadMammo, OrthoWorks and Cedara PET/CT.

Cedara showcased I-ReadMammo, a soft-copy reading workstation designed for Breast Imaging. According to Cedara, the workstation enables radiologists to optimize their reading speed and improve patient care through multi-vendor, multi-modality and multi-CAD support.

Cedara OrthoWorks is a suite of diagnostic tools for an orthopedic specialist that offers image acquisition, surgical planning, templating, archiving and web distribution. OrthoWorks allows users to perform automated orthopedic measurements designed to minimize calculations and human error while facilitating quick and accurate planning. Also within the OrthoWorks suite of applications, Cedara highlighted Care Manager and Cedara Spine Analyzer, definitive tools for implant tracking and spinal analysis.

With the industry's growing reliance on image fusion, Cedara highlighted its PET/CT workstation gives the user a workspace for reading the stream of data in a PET/CT study. Built with radiology workflow in mind, PET/CT Workstation has standard features for worklist management and optimizes productivity with configurable layouts.



GE Healthcare showcased its Advantage Workstation (AW) VolumeShare that provides customized applications and protocols for MR, CT, PET and x-ray imaging studies, as well as highlighted a remote access application which allows users to visualize, analyze and share multi-modality digital imaging and communications.

AW VolumeShare, which also has service-line tools for oncology, cardiology, women's healthcare, orthopedics and neurology, enables 2D, 3D and 4D visualization and analysis with no loss of image resolution and no down sampling of large data sets.

Workflow improvements include DirectConnect, which provides clinicians post-process data residing on acquisition systems without time-consuming data transfers, as well as Search Advantage and FilterViews. Together the features allow clinicians to more efficiently manage high exam volumes and large data sets, GE said.
   
In addition, GE said users have the option to add the newly released AW RemoteAccess to their AW VolumeShare package, which enables remote users to engage AW advanced applications via PC or laptop computer.

AW RemoteAccess gives users a choice of two modes with which to access an AW. In remote review mode, multiple users can simultaneously access one host AW,   performing interactive MIP/MPR (maximum intensity project/multi-planar reformat) tasks on any exam available at that AW. Clinicians may choose 3D review, multi-planar reformatting, real-time rotations, even ROI (region of interest), distance and angle measurements.

Alternatively, GE said a remote user can tap the software's Virtual AW mode. In this mode, the user actually "drives" the host AW remotely, as if he or she was actually sitting in front of the AW. The user can use any of AW's specialty applications and features on any of the images in the AW database. Multiple users can be online to that AW at the same time, using it for remote review functions such as 3D image review.



Hologic was on board at RSNA featuring its SecurView diagnostic workstation. The workstation is equipped with tools designed specifically to address the unique needs of digital mammography. According to Hologic, SecurView facilitates diagnostic review of digital mammograms from any vendor as well as breast images from other modalities such as MRI, PET and ultrasound.

Technical features include dual Xeon IV processors with 2.oGB fast memory and 140MB high speed RAID 5 hard drive array, dual 5MP high resolution, high brightness medical grade monitors, and enables display of 1024 shades of gray.



Maxant Technologies highlighted MediPort, a digital viewing workstation that combines all of the space saving construction of a wall-mounted film viewer with the functionalities of a digital workstation.

According to Maxant, MediPort is constructed to save space and fit into virtually any environment with a choice of wall mount or recess mount. The system is easy to operate, featuring a pop-up keyboard complete with a trackball or optional mouse. The medical grade workstation accommodates isolated power systems found in the OR, ER, ICU, CCU and other key areas.

In addition, the workstation serves as either a comprehensive clinical review station or a diagnostic workstation, with up to four displays available in 1.3MP color, 2.0MP gray scale, or 3.0MP gray scale. The workstation can be combined with Maxant Tech Line Illuminators for an integrated digital/analog workstation.



Philips Medical Systems showcased a new PET/CT viewer available on its Extended Brilliance Workspace (EBW).

According to Philips, the viewer offers PET/CT users complete access to a full suite of PET and CT clinical applications. Customized to meet different physician requirements, the application delivers slice to slice PET/CT display for diagnostic case review, a display interface that allows clinicians to optimize review for specific clinical needs and a comparison review of multiple studies of the same patient for follow-up evaluation. 

In addition, Philips GuidedFlow technology features a graphical user interface for ease of use and enhanced workflow efficiency from diagnostic review to printing and reporting processes, while advanced software applications provide tools to aid in quantitative analysis of cardiovascular and neurological diseases.


Sectra at RSNA showed as works in progress new ways of retrieving and displaying image data of extreme size and arbitrary dimensions on its Sectra's next-generation diagnostic workstation. Combined, these methods increase the display speed of radiology images by a factor of 100 times or more compared with traditional methods, the company says. 
           
The first implementation in a series of the new methods is incorporated in Sectra's next-generation diagnostic workstation. The workstation has an integrated visualization tool that allows instantaneous user interaction independent of the size of the dataset. First release of the new workstation is planned during 2006.
           
One of the inventions is based on research conducted in cooperation between Sectra and the Center for Medical Image Visualization at Linköping University in Sweden.


TeraRecon at RSNA highlighted its Aquarius Workstation 3.5 that is driven by VolumePro, a real-time 3D volume rendering hardware engine.

The workstation is integrated with modules that are designed with protocol-driven streamlined workflow that automatically generates a report during the reading process. Tools include single-click coronary vessel extraction using vessel tree in addition to region-growing tools; time-volume analysis for CTA and MRA for measuring myocardial dynamics for LV functions with a perfusion map on the 3D model; time-density analysis for measuring contrast enhancement of perfused areas of the brain; CT colonography module with unfolded views and auto flythrough navigation; vessel analysis for endovascular stent-graft planning that generates a completed stent-graft plan; single-click bone removal; soft plaque quantification tools and so much more.