3D imaging requires overhaul of radiology

With development of imaging systems and 3D workstations moving at lightening speed, radiology diagnosis is undergoing a metamorphosis from projection and cross-sectional imaging to 3D/4D imaging. High-level imaging systems like multidetector CT and fast MR provide thinner, better, and many more cross-sectional images for one exam.

The increased number of images require 3D/4D imaging to handle and deliver the full capacity of these advanced services. But are 3D and 4D imaging processing systems ready for the mainstream yet?

Recently, 3D/4D imaging clinical research has made rapid inroads. Potential clinical services for the technology include:
? virtual endoscopy
? CT angiography
? MRA
? 3D neuro-, cardio-, and body imaging
? disease screening through coronal artery calcification scoring
? bone density measurement
? lung cancer screening
? colon cancer screening
? surgical planning

The last category includes planning for cancer resection, organ transplantation, trauma/plastic surgery, interventional radiology, and radiotherapy.

Many traditional examinations could be replaced by 3D/4D imaging examinations, and clinicians may soon consider 3D imaging analysis a routine imaging examination. Meanwhile, 3D workstations and their capacity undergo technology upgrades every year. There are currently eight viable PC-based workstations on the market:
? 3D-Doctor
? AccuImage
? Analyze
? Rapidia
? TeraRecon
? Viatronix
? Vital Images
? Voxar

Major imaging system-related workstations are provided by GE, Seimens, and Philips.

Although 3D/4D imaging diagnosis technology has been in the works for many years, it is still not widely used in radiology departments due to several complex factors.

First, it requires additional technical and personnel support. Projection and cross-sectional imaging diagnosis is based on directly obtained images from systems such as x-ray, CT, and MRI. For 3D/4D imaging diagnosis, radiologists will need to invest in information systems to retrieve images, as well as 3D workstations to perform further image processing. Of course, all this additional equipment requires regular maintenance and updates.

It requires image postprocessing. Postprocessing involves a lot more work than simple projection and cross-sectional imaging diagnosis. Postprocessing also requires the multidisciplinary knowledge and skills to use a variety of special tools. Performing postprocessing is time-consuming, which can affect the productivity of 3D/4D imaging diagnosis. Today's radiologists do not usually receive the required postprocessing training during residency.

As a clinical service, 3D images, 4D movies, and diagnostic data need to be stored and provided to referral clinicians and even patients. Clinicians and patients often ask to look at projection and cross-sectional images and will, of course, do so with 3D images and 4D movies. While storing the larger data sets involved with 3D/4D images may be more time- and labor-intensive, in the final analysis, these images are can be much easier to understand than traditional images.

Finally, radiologists and clinicians need to have a common language to understand, order, and report 3D/4D diagnosis. Both radiologists and clinicians need to update their knowledge with current research. They also need to establish better communication standards for image/movie presentation and diagnosis according to disease pathological processes and examination features.

As if all of these speed bumps weren't enough, radiologists facing these challenges must also contend with a severe staffing shortage. A new job position will be needed to support 3D/4D image postprocessing for services and a new society will be required to create and implement new regulations and quality assurances for the new job market. These difficulties should be overcome, and the big change to 3D/4D imaging diagnosis may come within the next five years.

Dr. Shezhang Lin is a research assistant professor of radiology at the Imaging Science and Information Systems Center at Georgetown University Medical Center in Washington, DC. He can be reached by e-mail at sz_lin@hotmail.com.