Advanced Visualization: Seeing More
The cries could be heard from imaging professionals throughout the halls of McCormick this year: help us efficiently manage image intense applications in this digital era! Developers of advanced visualization software, the medical imaging tool formerly known as 3D software, answered the call, showing new tools and enhancements to their 3D applications and analysis tools that pushed the envelope.
Beautiful, volumetric images flashed up on sleek, flat-panel monitors and even rotated in circles or performed vivid fly-throughs to give RSNA attendees a crystal clear view of newer capabilities of next-generation software. Companies pushed high performance with the image quality and measurements tools needed to reduce reading time.
The increased utilization (and so-called "image pollution") of multi-slice CT has fueled the demand for high-performance 3D visualization and analysis software that can be utilized on freestanding workstations, online and offline, as well as PACS diagnostic workstations. In a distributed PACS reading environment, imaging professionals no longer want to be locked to one individual workstation. As a result, this year saw the release of more visualization tools that can be accessed from a web-enabled, thin-client server.      
Companies showed tools that help in the pre-, intra- and post-operative stages of surgery, rendering images from many modalities and showing strength in image clarity, volume, texture and color. And as CT colonography gains greater clinical foot hold, companies have strengthened their reading and analysis tools so that reading time decreases and reporting standards can be achieved. Similar tools for lung analysis brought interest, too.

(Note: companies appear in alphabetical order.)

Able Software Corp. highlighted 3D-DOCTOR, a vector-based 3D medical modeling software at this year's RSNA.
Able Software's FDA-approved 3D-Doctor provides tools for physicians and medical researchers to create 3D polygonal mesh models from CT, MRI, PET or other volumetric images. Users of the software are able create 3D models for surgical simulation and planning, calculate 3D volume for quantitative analysis of cancer patient treatment, and visualize 3D images to further medical education and research.
3D-DOCTOR creates 3D polygonal models and volume displays from cross-sectional images on a real-time basis. Images are segmented using either the fully automated texture-based segmentation or the interactive threshold-based segmentation method. The software provides measurement functions to measure 3D volume, distance, 3D locations, thickness, area of a region, surface area, image density profile and image histogram of a region in any shape. This product's advanced image processing functions include template-based scanned film cropping, 3D image re-slicing to change slice thickness or re-slice along an arbitrary axis, registration and image fusion of multi-modality images.
3D-DOCTOR supports a wide variety of modalities in a number of formats: DICOM, Interfile, TIFF, BMP, JPEG, GIF, PNG, RAW, and other file formats as well. The software provides fully automated and semi-automatic image segmentation for extracting different tissues, and it supports an unlimited number of objects for 3D models with different colors.
Also, 3D STL and VRML (with colors) output files could be used directly by 3D printers or rapid-prototyping machines for high-quality 3D printing. Other output formats including IGES, AutoCAD DXF, Wavefront OBJ, 3Dstudio 3DS, and raw triangles are used for 3D mesh modeling, quantitative measurement and finite element analysis. Finally, Able Software has made its software relatively cost effective - which could facilitate academic use - without any additional modules needed to create 3D polygonal models from medical images.

AccuImage Diagnostics showed enhancements to its line of advanced visualization tools, including CalScoreM, PrimeLung and IllumiView.  
The CalScoreM calcium scoring module supports lesion-by-lesion and side-by-side comparisons for follow up or repeat scanning. It also provides an advanced coronary calcium scoring report generator.
PrimeLung lung nodule visualization and analysis package is designed for use with chest CT studies, and IllumiView 3D visualization technology for reviewing colon and other luminal studies.
Merge eFilm plans to acquire AccuImage, with a closing anticipated in early 2005.

Barco came to RSNA with the former Voxar now integrated following its acquisition of the 3D software company in September. Barco used RSNA to introduce a new version of Voxar 3D and a new vessel analysis module.
The 3D vessel analysis tool, VesselMetrix, provides for quantitative analysis of contrast-enhanced computed tomography angiography (CTA) and magnetic resonance angiography (MRA) studies including stenosis, stent and stent-graft planning, and stent-graft surveillance. The module increases productivity, helps physicians report key images faster and makes the clinical task of reading CTA and MRA studies easier with minimal user intervention, Barco said.
In addition, the Live Images capability within Barco's flaghip 3D software, Voxar 3D, has been extended into VesselMetrix. With Live Images, users can prepare a study for viewing and save their work for subsequent reading by a radiologist.
VesselMetrix is an optional extension to Voxar 3D and takes full advantage of Voxar 3D's integration capability into PACS. VesselMetrix is not currently available for commercial distribution in the United States.
Barco also introduced Voxar 3D version 5.1. Enhancements have been made to its multi-planar reconstruction (MPR) and 3D reconstruction functionalities. Users can launch the Voxar 3D software directly within the PACS workstation, which allows them to access the MPR and 3D tools as needed.
Version 5.1 provides radiologists with the ability to work with increasingly large studies, produced by the newest generation of multi-detector CT scanners, such as a runoff CTA with more than 2,000 slices, Barco said. In addition, the new version of the software provides enhanced image quality, including specular lighting effects that improve depth perception and surface detail to provide radiologists with life-like views of patient anatomy. The update to image quality aids 3D reviews of bones, vascular structures and soft-tissue surfaces, Barco said.

ContextVision revealed at RSNA GOPView XR-T, a new tool for the customization of digital x-ray image processing.
GOPView XR-T offers a visual and intuitive method to achieve high image quality when using ContextVision's GOPView XR. With GOPView XR-T, OEMs can adapt to their customers` requirements for specific image processing. GOPView XR-T enables manufacturers building GOP image-enhancing technology into their products to create specific medical image processing capabilities with a point-and-click approach.

Fujifilm Medical Systems USA and Silicon Graphics Inc. announced that they are teaming to bring the benefits of Silicon Graphics Prism visualization platform to Fuji's Synapse PACS. Fuji said its goal is to bring visualization into the routine diagnostic process. Silicon Graphics Prism, introduced last month, delivers interactive visualization with scalability and high bandwidth to accelerate workflows.

GE Healthcare showed its next-generation CT colonography technology, AdvantageCTC, which provides clinicians with added viewing capabilities.
The new technology allows a 360-degree dissection view of the colon as an alternative to the standard 2D or 3D reading approach. AdvantageCTC provides three different perspectives of the internal colon at one time. In addition, AdvantageCTC displays the anatomy of the colon acquired in the supine and prone positions in multiple layouts displayed simultaneously, in a synchronized, orientated, and correlated fashion that improves workflow and diagnostic analysis.

MedWeb showcased its single-click reconstruction tool for its 3D virtual colonoscopy application, Medweb VC.
The tool permits faster reconstruction of 3D images of the colon. Medweb's 3D technology offers MPR, volume rendering, MIP and fusion imaging so that technologists can produce coronal, oblique, curved and sagittal images to supplement the initial CT images. Medweb VC also includes automatic bone segmentation and other advanced 3D tools.
MedWeb VC runs as a standalone application on a PC or a server- based volume rendering system with a web-based thin client to provide speed and 3D functionality.
MedWeb VC features include automatic fly-through mode, automatic colon segmentation, automatic centerline extraction, interactive navigation, synchronized 2D/3D windows, 3D polyp measurement tool, interactive colon model window, multiple colon segment support, integrated reporting and AVI movie creation.

Mercury Computer Systems used RSNA to highlight its new advanced visualization software, VisageRT, as well as launch the XB series and ExamineRT Workstation.
VisageRT software, for visualization and reconstruction of CT, MR, digital x-ray, SPECT, PET, and ultrasound imaging data, is designed for integration into existing system frameworks of life sciences OEM customers. VisageRT components are available for both 32-bit and 64-bit Microsoft Windows and Linux platforms.
VisageRT volume-rendering components include advanced visualization techniques such as MPR and thick slab rendering, MIP, shaded volume rendering, shaded surface display, flexible clipping, and perspective viewing, Mercury said. The VisageRT image reconstruction components support a multitude of algorithms such as Fourier techniques, Pi methods, algebraic reconstruction technique (ART), and expectation maximization (EM).
Mercury introduced the ExamineRT family of workstation and server applications for medical OEMs. The ExamineRT software application provides advanced visualization capabilities, server and thin-client support, and complete DICOM integration, resulting in increased productivity for OEM applications in diagnostic, interventional, and molecular imaging, as well as for PACS.
ExamineRT applications leverage Mercury's product portfolio for life sciences by integrating Mercury's VisageRT software components with interactive graphical user interface. Furthermore, ExamineRT is optimized for certified acceleration hardware, such as Mercury GPeXpress accelerators and XBi high-density imaging platforms. The software runs on standalone workstations as well as on a scalable application server that can be connected to multiple thin-clients.
The XB Series is Mercury's high-density imaging and visualization platforms for medical imaging, geosciences and virtualization/simulation markets. The XB Series workstations and servers enable the efficient use of multiple processors and acceleration boards for high-performance computation and visualization. Applications include medical image reconstruction, rendering application servers, PACS, biotechnology computation, and interactive visualization of very large data.
The XB Series modules offer the latest in processing power, bandwidth, 3D graphics, and acceleration options. A hallmark of the XB Series is the high ratio of PCI Express and PCI-X option slots that can be used within a 4U space. The XB Series is built using industry-standard, mainstream components, and is designed to support a wide range of processor types from different vendors. The first family member, the XBi system, uses Intel Xeon processors and supports both the Microsoft Windows environment and the Linux operating system.

SmartPACS featured at RSNA its Rapidia 3D advanced visualization software as well as previewed for meeting-goers a new FDA-approved version of the software that is slated for release in the first quarter of 2005.
Rapidia version 2.8 incorporates brain subtraction and vessel analysis in the software's existing rendering modes that include 2D editing and segmentation, MPRs, 3D shaded/unshaded volume rendering, and MIP/MinIP. The brain subtraction tool extracts brain vessels in less than 15 seconds from CT angiography images, and is especially useful for detecting aneurysms. The vessel analysis tool analyzes vessel structures for vascular abnormality detection.  
In addition, SmartPACS said it also is marketing standalone 3D diagnostic screening programs. These include Rapidia COLON, an application used for virtual colonoscopy and reporting, and Rapidia CA, an application to qualify and report the presence of calcium plaque in coronary arteries.

Siemens Medical Solutions
introduced advanced applications for CT that included syngo Colonography with PEV (Polyp Enhanced Viewing) software, the first FDA 510(k) cleared and commercially available enhanced colon viewing technology, the company said. Future CT applications from Siemens include Advanced Bone Removal for syngo InSpace4D, syngo Body Perfusion CT, and CT Respiratory Gating for radiation therapy planning. Advanced Bone Removal and Respiratory Gating are currently under 510(k) review. syngo Body Perfusion is works in progress. These applications are expected to be available in mid-2005. Siemens currently offers NEV, Nodule Enhanced Viewing.

Polyp Enhanced Viewing (PEV), an optional add-on to the syngo Colonography application, is designed as a second-reader tool for automated identification of lesions in the colon. PEV can be activated as the radiologist begins the primary read, with the results ready for reviewing as the radiologist confirms the end of the primary read. The PEV tool then highlights potential lesions that were not marked by the radiologist, in addition to all potential lesions marked by the radiologist during the first read, and also indicates potential lesions marked by the radiologist that were not visualized by the PEV tool. Further workflow enhancements to syngo Colonography include automated polyp measurement and visualization of unseen areas.

Viatronix used RSNA to show its new open PACS interface for its entire visualization platform - V3D Colon, V3D Explorer, V3D Vascular and V3D Calcium Scoring - as well as exhibit an open CAD (computer-aided detection) platform for its V3D Colon.
Regarding the importance of PACS in the digital age of radiology, Viatronix said the PACS interface combines high-end 3D applications directly to PACS. Viatronix released its first PACS interface module in the third quarter.
The V3D Open CAD platform integrates CAD into Viatronix's V3D Colon module, combing high sensitivity with guidance through automatically detected suspicious areas. Since 2002, Viatronix said it has worked jointly with selected CAD partners to integrate such technology, with the V3D Open CAD platform allowing for additional features per finding to be displayed.

Vital Images featured ViTALConnect and showed as a works in progress Vitrea 3.7.
ViTALConnect is the company's web-based 3D visualization and distribution system introduced earlier this year. The tool gives radiologists access to images and analysis tools from anywhere in the healthcare enterprise. Hospitals that have the software also can provide imaging services, including 3D, to their referring clinicians.
Vital previewed a new version of the web-based technology still in the R&D pipeline. Key features of ViTALConnect 3.2 include access anywhere via web, 2D/3D/4D integrated review, advanced MPR and slab MIP, volume rendering tools and collaboration mode. The latter allows radiologists to consult with clinicians remotely by interactively and synchronized viewing of images and mouse movements.   
As a works in progress, Vital showed Vitrea 3.7, an enhanced version of its flagship visualization software Vitrea 2. Clinical applications include colon enhancements, lung nodule probe and cardiac function analysis. The new version is awaiting FDA clearance. Vital said Vitrea 3.7 will be available in the first quarter of 2005.