CT-MRI

Enterprise 3D Workflow

Today and Tomorrow - Interviews with TeraRecon leadership and luminaries.

Any image, anywhere, any time. In 1991, the first viable PACS to make diagnostic images available for viewing wherever they were needed within radiology was designed upon this premise. Ten years later, in 2001, TeraRecon introduced the revolutionary concept of allowing 3D volumetric review of CT and MR studies to be reviewed, economically throughout the healthcare enterprise. The AquariusNet server-client visualisation system empowered physicians using ordinary PCs containing a small client application with the ability to remotely display and interactively manipulate large CTA or MRA datasets. It provided a scalable, real-time and centrally shared rendering resource that enabled an unlimited number of concurrent thin client PC users.

With this unique innovation, TeraRecon launched a new global trend in medical image post-processing. By removing physician access constraints, AquariusNet has stimulated the widespread adoption of 3D volumetric image review for CTA and MRA and has become an essential tool for enabling image interpretation by providing remote access to advanced clinical applications and powerful 3D interactive visualisation tools. The elegance of the centralised processing architecture is its ability to extend 'server-side' processing capabilities immediately to all 'client-side' users throughout the enterprise. It leverages an expensive infrastructure investment by making the 3D tools available without the need for expanding existing network bandwidth, additional hardware costs or expensive user licensing fees. PACS are designed to distribute images, but few have the network infrastructure to efficiently move multi-gigabyte volume datasets, especially if these studies need to be transferred over an already busy hospital network backbone to multiple locations. Furthermore, 3D workstations or web servers connected on a PACS don't possess the computationally intensive processing hardware needed to manage 3D post-processing once the studies arrive at their destination.

Until thin client technology was introduced, 3D dedicated workstations were the only means by which multidetector CT, MRI and PET/ CT procedures could be efficiently interpreted and reviewed. With TeraRecon's thin client architecture, dedicated workstations are used by technologists for quality assurance after receiving

Coronary CT automatically preprocessed images. The technologist provides clinical measurements, applies analysis function and ultimately validates the pre-processed results in order for physicians to confirm the findings. Both vendor and user communities acknowledge that serverside 3D thin client technology is the only viable way to provide ubiquitous advanced visualisation functionality.

Dr Geoffrey D Rubin, Chief of Cardiovascular Imaging at Stanford University's Department of Radiology, said that he does not believe that adoption of 3D visualisation by physicians would be as prolific without the introduction of client-server based software. "More than any single technological advance over the past ten years, I believe it is the introduction of this system that has ushered in the widespread use of 3D visualisation for primary data interaction by radiologists and clinicians within our medical centre."

Dr Eliot Siegel, Chief of Imaging of the VA Maryland Health Care System and Vice Chairman of Information Systems at the University of Maryland School of Medicine in Baltimore is emphatic. "I'm absolutely convinced that the only model that is going to be sustainable and move forward is the server side rendering model." Dr Siegel predicts that in the near future all advanced visualisation tools will be available to all users via a fully integrated PACS workstation and through web access."

TeraRecon is playing the leadership role in meeting these new challenges. AquariusNet is already seamlessly integrated with most PACS. The company's new iNtuition™ workflow architecture is designed to provide a customisable workflow with personalised preferences activated upon user log-in and is based on the concept of 'automate, validate and read.' The AquariusAPS server performs automated preprocessing tasks based upon predefined user protocols. Upon receipt of images from the CT scanner, it searches its internal 'directory' of anatomy and automatically applies various processing 'filters.'

AquariusAPS Enterprise 3D Workflow can automatically segment bones and vessels, remove the CT table, extract luminal centerlines of vessels and automatically detect and label various parts of the anatomy. Pre-processed images are saved as portable scenes that are presented for validation. After validation, the study is ready for final interpretation, potentially saving up to 80 per cent of the manual processing and preparation steps traditionally required when performing a 3D interpretation. "The great thing about the Aquarius Intuition platform is that you almost feel you have a dedicated 3D technologist working for you behind the scenes," said Dr Christopher Herzog, Chief of Radiology at the Red Cross Hospital in Munich, Germany. "Certainly, a competent physician can get to the answer eventually on more or less any 3D workstation, but when 80 per cent of the routine work is done for you before you even open the case, it's a great benefit that allows us to focus precious time on clinical interpretation rather than struggling to prepare the case to a presentable form."

This new architecture is designed to fit the needs of a wide variety of imaging scenarios, from a single hospital with one CT scanner, to expansive healthcare enterprises with numerous locations and potentially hundreds of users. "The next generation of 3D volumetric imaging systems needs to be extraordinarily flexible and global in scope," explains Dr Robert Taylor, Executive Vice President and Chief Operating Officer of TeraRecon. "The software needs to be transparently tailored to the diverse requirements of individual users to further enhance productivity. It needs to be integrated with any PACS or other healthcare information system and designed for a 'single portal' concept of access to all the patient data and software a physician requires."

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