The evolution to isotropic voxels and advances in cheap and powerful computer processing have transformed radiology from a planar science to one that is volumetric. And the rewards couldn't be more in tune with the times: improved lesion detection, reduced x-ray dose thanks to greater clarity, and increased productivity from faster interpretations.
But while many clinicians may want to look at 3D and other advanced visualization options, few want to spend much time creating them. The goal of vendors is for the majority of radiologists to be able to work with advanced postprocessing techniques straight out of the box. But it doesn't work quite that easily. Training is a necessary intermediate step.
Every major vendor of advanced visualization offers training in the use of its products. At Vital Images, which sells the Vitrea workstation, training is broken into modules on segmenting anatomy, disarticulating joints, planning endovascular stents, and peripheral and carotid angiography. Two-D leads to 3D, as multiplanar reformatting sets the stage for volumetric reconstructions; wide area detectors, such as Toshiba's Aquilion One, support brain perfusion studies; and multislice CT scanning allows CT colonography.
Radiologists and techs may attend Vital Images' ViTAL U classroom at its Minneapolis headquarters, or clinical applications specialists may conduct training onsite. Alternatively, Vital Images customers may choose training over the web with online demonstrations and hands-on practice accomplished by remote control (see related article on page 10).
Although even a novice can learn the clicks that unlock the best practices embedded in algorithms, creating the best reconstructions depends on knowing how to refine those rough models, as well as on knowledge about anatomy, physiology, and disease. That's why, when it comes to advanced visualization, physicians receive special training from Carestream Health, according to Karen Emaus, who supports U.S. and Canadian customers using the company's information systems products.
“The clinical aspects are clearly targeted toward radiologists and the people who are actually doing the readings,” Emaus said. “They absolutely need to know more, but they don't want it to be complicated.”
Therein lies the challenge in advanced visualization. The great ease with which systems reconstruct data typically shows itself at the fingertips of those who know the software best. This is especially so when the data sets are less than optimal, according to Heather Brown, Ziosoft's director of clinical solutions.
“When the contrast (bolus) is mistimed, or you have an obese patient who creates a lot of noise in the image, software programs frequently fail,” she said. “That's when training comes into play.”
Brown advocates a consultative approach to training, one that focuses less on button pushing and more on problem solving. Training in visualization techniques and an understanding on the user's part of how reconstructions should look are critically important for smart algorithms to reach their potential, she said. These algorithms carry out many of the tedious elements of postprocessing that otherwise would have made the adoption of advanced visualization impractical.
“The software has to be efficient, because at Scripps all the 3D reconstructions are done by radiologists,” said Dr. Nikunz K. Patel, vice chair of radiology at the Scripps Clinic in LaJolla, CA. “Software is getting smarter and its functionality is becoming more intuitive.”
