Showing posts with label rsna. Show all posts
Showing posts with label rsna. Show all posts

Tuesday, December 15, 2009

3D is Not only Fun, It’s Coming to a PACS Near You

Ms. PACS: If you’re still hemming and hawing over the uneventful technologies on display at RSNA this year, then you definitely missed the fun at the Fuji booth. It was fun and funny to see radiologists ogling over a tomosynthesis viewer, while wearing 3D glasses on top of their own spectacles.

Does that mean 3D mammography plus 3D glasses adds up to 6D? I’m not sure, but they call it 3Dimensional Stereo Digital Mammography and the images definitely popped off the screen. Actually, they were viewing 3D images acquired from a full-field digital mammography system instead of individual slices displayed in 2D from 3D data sets. The idea is to see behind overlapping structures and read breast-imaging exams faster.

McKesson also featured a 3D monitor for viewing 3D clinical images - a heart beating in the air. If this type of visual enhancement proves to be useful for diagnostic accuracy, there may already be millions of radiologists in training – but most of them busy playing AVATAR.
AVATAR

Since, Mitsubishi made 3D video gaming a reality earlier this year with the release of Nvidia 3D technology on one of its 3D-enabled TVs, as well as on home entertainment PCs, with a souped up graphics card of course, software now creates 3D imagery from regular video games, and some day regular 3D volume data sets.

By the way, Avatar is a new video game that uses the same 3D technology as the James Cameron sci-fi movie, also called Avatar. Talk about back to the future, it’s like 3D at the movies in the 1950s when Hollywood was losing viewers to TV and released 3D flics to regain popularity. Hmmm...sounds like Hollywood today is banking on AVATAR to do the same.

Back to reality, in a study presented at RSNA 2009, and conducted at the Mayo Clinic in Rochester, Minn., researchers used 3D stereotactic surface projection (3D-SSP) software to improve accuracy in diagnosing Alzheimer’s disease. 3D-SSP has been used in some centers and is thought to improve the accuracy of experts, said Vance Lehman, M.D., lead author of the study, which included 54 patients (23 normal and 31 cognitively impaired individuals). Two readers with less than one year of experience and two nuclear medicine experts with at least 10 years of experience viewed and rated all the PET scans. The readers ranked the scans from 1 to 5, with 1 as a normal scan and 5 as severe dementia. They also evaluated the scans for diagnostic confidence, with 1 as uncertain diagnosis and 5 as complete diagnostic certainty. During the 3 to 3.5 years of patient follow-up, no one in the normal group developed cognitive impairment, which confirmed their initial diagnosis. To my knowledge, the images were not projected on 3D-enabled monitors nor were the clinicians wearing 3D glasses, but don’t be surprised if they do in a follow-up study.

Now that it’s looking more and more likely that 3D technology will soon be a common modality to view volumetric, live images in radiology rooms and in the ORs, maybe they should hand out free 3D glasses at next year’s RSNA – and win back some its popularity.

Note: On December 3, LG Display Co. of Seoul, Korea, rolled out, the world’s first commercial launch of 3D LCD panel boasting full HD resolution. The new 23-inch 3D monitor LCD panel is used with shutter glasses that deliver full HD resolution.

PACSman: Some women are easily impressed, and so too it seems to be with Ms P. and 3D. While tomosynthesis is a relatively new technology and has only been around 20 years or so, 3D has actually been around since 1922. Three D had its Golden Era in the mid 50’s, a revival in the 60’s and 70’s and went to a new dimension in the mid 80’s with IMAX film. Today many films can be found in 3D, including the latest from PIxar Studios, Up.

I’ve seen nearly every iteration of 3D imaginable, and while it’s really cool and does have its benefits in healthcare, the costs are still fairly substantial, even though they have dropped in recent years. Processing requirements also remain fairly intense as well. Reimbursement will largely determine whether 3D thrives or dies on the vine, but for now, like its film counterpart, medical 3D is enjoying a revival of sorts.

There was a lot shown at RSNA, but very little was what I consider earth shattering or that helped me justify the $1,500 it cost me to go this year. Unlike the vendors and even Miss P who works for a company, it all comes out of my pocket. Of course with the show being in Chicago Miss P also had the option of sleeping in her own bed at night and didn’t have to spend $225 a night to call some place home, so that’s yet another inequity I had to deal with.

3D really didn’t catch my attention anywhere near as much as it did Ms. P.’s , but then I am the world’s biggest cynic as well and focused mainly on PACS. What did catch my interest was the promotion of cloud-based solutions as an alternative to image distribution via the web… We’re still a few years out from making this a widespread reality and with it commensurate pricing, but the concept is still intriguing nonetheless. So why show it if its not real? RSNA - Real System Not Available. Next question. A few vendors are doing alpha and beta testing of their cloud solutions so within the next year or two these will become more and more real…

So what exactly does a cloud-based system do? Cloud-based systems allow multiple disparate systems to upload images and reports to a central data repository, or "cloud," and then resend them out to various clients from a single site. This is crucial in making a cardiologist, orthopedists or others’ job easier, especially since the clinician typically covers multiple hospitals. Instead of having to log into four, five or six disparate systems at various hospitals or deal with CD’s that all too often don’t work properly, they simply log into the cloud and viola - instant access to all their studies that have been downloaded for them. Of course, like everything, there is a cost associated with this that the hospital pays and currently that costs is quite high, but within a year or so once, these are more than a concept, then you’ll see prices drop.

There were the obvious improvements to PACS that every vendor made a big hoopla over. VNA’s all over the place, data migration services being offered by a host of vendors, and, of course, a number of Rajivs in Ramanathapuram’s Radiology Renderings, Inc. who offered teleradiology services at a price that my dog wouldn’t even touch.

Would I go to RSNA again? I feel the same way that vendors do - you have to go because if you don’t it raises more questions than not, and once you start you can’t stop even though each year its becoming harder and harder to justify the costs. Of course, over 100 vendors out of the 700 or so who displayed at RSNA 2008 didn’t show up at RSNA 2009 - so it does happen. I just can’t let it happen to me, especially since the PACSMan Awards are among the top five stories to come from the floor of the RSNA, and people look forward to a little levity in their lives. God knows we all need some after walking all over creation and back listening to so much bull I feel like I’m in Dallas instead of Chicago. But as I’ve grown to know after more than two decades of shows, it’s all a part of the game…and next year I may even get to see to see RSNA virtual - and in 3D!!

Monday, November 23, 2009

RSNA 5-Day Forecast


Ms. PACS: I was looking into my crystal ball, trying to see what to expect at RSNA 2009 next week, when I saw...a huge smudge - I needed Windex. So in my quest to seek out truth and wisdom, I turned on the TV. Clicked on the weather channel. To my surprise, standing in front of a large map, it was Willard Scott! I wondered if it was an old VCR recording…but realized it was in fact 2009. Maybe Willard’s 401K had taken a nosedive, forcing him out of retirement. In any case, despite his feeble yet rotund state, he did provide some sound data in his RSNA 5-Day Forecast.

Willard said: “You can expect to see:

1. Low res images sent from PACS to EMR: If you go to the BRIT Systems booth, you will see their new Webworks solution. Referring physicians and their patients now have access to diagnostic images with a new browser-based application for viewing patient images and reports on any computer with an Internet connection and a browser. The new application also provides access to radiologists for low volume review. The platform uses AJAX for real-time updating of patient lists and clustering technology for redundancy and load balancing.

INFINITT Accent also allows PACS-based medical images to be accessed along with all other types of medical information on any Internet-enabled terminal. A new PACS offering for EMR, HIS and practice management vendors fully integrates the complete range of medical images with EMR software of almost any kind.

2. Vendor-neutral archiving will be one of the big themes on the exhibit hall floor.
Carestream will show its vendor neutral PACS and storage/archive solutions, which brings disparate PACS and data systems into a shared, long-term data management solution that can streamline management tasks and reduce costs.

3. Bathroom breaks:
The bathroom wait times on the RSNA exhibit hall floor will be approximately 3 minutes long (which is a 2 minute drop from last year)…except in the ladies room - that will remain the standard 15 minutes.

4. New PACS: Siemens will introduce the new PACS that appeared on Dalai’s PACS Blog last week (http://doctordalai.blogspot.com/)

5. RSNA unveils structured reporting templates – The RSNA has established a Radiology Reporting Committee to identify and promote "best practices" in radiology reporting. June 2008: RSNA convened a workshop to plan the future of radiology reporting. More than 50 radiologists, medical informatics specialists, and representatives of cardiology, oncology, and pathology participated. Consensus was reached on a global template for diagnostic radiology reports, including standardized radiology report headings.

December 2009: RSNA will release the first set of reporting templates, freely available for downloading and use. (http://reportingwiki.rsna.org/index.php?title=Main_Page)

Have you seen the Google “radiology-report” site with RSNA radiology structured reporting templates. It contains RELAX-NG templates for radiology-structured reports. The code is from the GNU free software operating system. Someone at Medical College of Wisconsin is developing it.

By the way, Stage 6 of the EMR Adoption Model requires structured reporting systems.

6. Fuji 86's its annual House of Blues (HOB) party – is it due to NEMA code of ethics? When did fun equate unethical behavior? Do you really think a doctor is going to buy equipment just because you buy him a beer…and it's only a buffet dinner – not an intimate candlelight engagement with a contract on the table. Granted, I have witnessed some embarrassing behavior at such events…but the moral infractions usually happen after the party, not on HOB premises. The silver lining is that like any enforced code of conduct, there’s a loophole, or a lawyer to find one for you. Some companies are keeping it ethical by throwing a charity event. At least some of the frivolity goes to those in need. It’s all about balance.

7. White flag:
The CT slice wars will officially come to a stalemate as attentions focus on lowering the dose.

8. Pocket diagnostics:
Ultrasound debuts as a new iPhone feature – for both diagnostic purposes and pure entertainment. Talk about consumer driven healthcare.

9. E-Ordering imaging exams: To meet with stage 4 of the EMR adoption, CPOE and CDSS (Clinical Decision Support Systems). Evidence-based medicine makes sense, but it’s hard to get physicians to actually use it. IT tools that provide decision support at the time they make decisions may help close that gap. Kind of like the little Einstein on PCs (or you can make it a cat) that alerts you when it has a suggestion or detects a potential error. I heard Bill Gates’ wife, Melinda, came up with the idea for that little alert icon – but man is it annoying. I have to use the cat icon so at least its cute and I don’t get as aggravated.


10. Last, but not least. While perusing the IHE demo exhibit, the PACSman will find his true love – she will not be a PC or a MAC this time. But one thing is for sure - she will have a pulse.