Highlights from the MDCT 2014 Workstation Face-off

Menashe Benjamin.gif

Menashe Benjamin, Vice President, HCIS, Carestream

This year marked the 12th annual International Society for Computed Tomography’s (ISCT) Workstation Face-off at Multidtector-row CT (MDCT) 2014. Doctors representing four vendors (Siemens, Phillips, TeraRecon and Carestream) worked on four different cases with the vendor’s workstation to put each system to the test in terms of speed and accuracy of diagnosis. Once again, Carestream was the only vendor that used a PACS workstation to complete all the cases, while the other vendors used highly specialized, dedicated 3D workstations.

All cases were complex and required advanced and fast image processing, measurement and reporting capabilities. The cases included:

  • Following a lesion in the abdominal wall across four time points based on two PET-CT and two CT studies;
  • Segmenting two lesions in the liver and segmenting the whole liver into nine segments according to the Bismuth classification;
  • Providing a set of measurements from a CT scan to plan a transcatheter aortic valve replacement; and
  • Highlighting multiple rib fractures of a severely injured man following a motor vehicle accident.

Dr. Michalle Soudack, Head of Pediatric Radiology at the Safra Children’s Hospital in Israel, was our experienced representative on the Carestream Vue PACS system. As always, she demonstrated the various applications in a clear, concise and precise manner, all within the allotted time.

Three areas that stood out in this year’s face-off:

  1. Polling. These were not scientific, official polls, but questions were posed to the audience and they could text in their answers.  The questions and results are below and these findings, while not conclusive, are interesting in terms of the audience makeup at MDCT 2014. For instance, the first poll question, 11 respondents say they have never been asked to measure liver volume and, surprisingly, 10 respondents answered “Yes” to the fourth poll question. This is a promising sign that collaboration and cooperation are gaining ground in the medical imaging space.MDCT
  2. The case results. These differed widely among the vendors in the second case, where the competitors were asked to measure the whole liver volume and the tumor burden per liver segment.

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While the judges did not provide an official answer on which vendor was the most accurate, they did comment that validating the reproducibility and accuracy of automatic measurement results is an important factor in assessing workstation segmentation performance.

3. New product and application. During the presentation of the fourth case, Dr. Soudack was able to provide a look at two of Carestream’s newest technologies for radiology IT.

 a. The first was a work-in-progress called radial view. Dr. Soudack worked through a case focused on rib fractures and showed a new view that more clearly depicts the fractures, as can be seen below:

MDCT Radial View

Radial View is a special form of MIP (Maximum Intensity Projection) showing the ribs spread out as if they were looked upon from inside the body.

b. The second and more important new technology demonstrated by Dr. Soudack was a complete workflow highlighting Vue Reporting as a key tool for communicating findings and promoting collaboration between all radiology stakeholders. Vue Reporting brings radiology reporting into the rich, multimedia and interactive world. This new technology allows radiologists to couple findings and images into a single interactive report, as well as to inject into the report measurements and calculations created during image interpretation, thus helping to minimize chances for errors. Dr. Soudack demonstrated features such as live hyperlinks that enable instant access to live images and complete patient portfolios from the web, including validated mobile devices such as iPad and iPhone (for which Carestream has FDA clearance).

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As always, the workstation face-off was a thrill to watch because we were not only able to see expert radiologists maneuver throughout the different platforms, but we were able to see how the workstation technologies and applications are evolving. These advances are being made with the purpose of helping create a more efficient and error-free work environment for the radiologist, which can in turn provide better care to patients. The unique design of Carestream Vue PACS, with its unified backend and data model, strives to expand this environment to ALL radiology stakeholders, addressing the needs of referring physicians, administrators, and patients as well.

Where do you see PACS workstations in the future? Are there applications you hope to see added to your system down the road?

Vue PACS Workstation Proves its Multi-Modality Proficiency at MDCT 2013

Menashe Benjamin, Vice President, HCIS, Carestream

Menashe Benjamin, Vice President, HCIS, Carestream

The annual “Workstation Face-Off,” held on June 18 in Washington, D.C., is part of the International Symposium on Multidetector-Row CT. The event aims to define the limits of workstation performance. Each year radiologists use advanced workstations to process and interpret several complex CT studies under severe time pressure, but this year’s face-off implemented an additional challenge.

For the first time in its 10-year history the competition, which is part of the International Society of Computed Tomography (ISCT), included cases that challenged the workstation with the reading, processing and reporting across multiple modality studies with findings in multiple organs. The ability to handle multiple modalities and offer automated tools enhances overall productivity and avoids the need to resort to dedicated processing workstations that are not fully integrated in the reading workflow.

Participants were allotted 18 minutes to complete this year’s exams, which included longitudinal examination of lung disease, liver tumor tracking, cardiac functional analysis and neuro vascular assessment. All cases were complex and required advanced and automatic processing tools for fast and efficient diagnosis.

Radiologist Michalle Soudack, M.D,. Head of Pediatric Radiology at the Safra Children’s Hospital in Israel, presented the cases for Carestream, showcasing the CARESTREAM Vue PACS workstation. Her performance with the Vue PACS workstation, as in years past, supported the proficient reading, processing and reporting of all the images across multiple modalities. As always with Dr. Soudack, it was a rewarding experience to watch her maneuver the Vue PACS with such ease. Her presentations were a big hit with the audience, as several people commented on Dr. Soudack’s assessment of the complex neuro vascular multi-modality case, and the fact that she conducted the cardiac CT assessment via a PACS and not a dedicated workstation.

The face-off has routinely been an event that showcases areas of proficiency in today’s CT interpretation technologies, as well as pointing out where improvements are needed. This is always an exciting and intense event to be a part of, and we are already looking forward to next year.

RSNA ’12 Preview: Digital Breast Tomosynthesis and PACS Integration

Anne Richards, Carestream

Anne Richards, Clinical Development Manager, Women’s Healthcare, Carestream

When RSNA opens on Sunday, we can expect digital breast tomosynthesis (DBT) to dominate the attention of providers and radiologists interested in women’s imaging. A scan of the scientific and educational sessions featured in AuntMinnie’s “Road to RSNA 2012: Women’s Imaging Preview” highlights the early evidence of increased cancer detection and lower recall rates, which is driving interest in DBT in spite of lingering questions about reimbursement.

For providers who have adopted or on the cusp of offering DBT, however, we expect the discussions in the exhibit halls to extend beyond potential clinical benefits to the IT considerations raised by DBT early adopters. For example, DiagnosticImaging.com reported earlier this Spring on a KLAS report that highlighted the PACS integration challenges of DBT:
“Doctors are reporting interruptions in their day because not all PACS accept tomosynthesis studies. “It has created a workflow concern for radiologists who have to leave their office or reading room and come out to the tomosynthesis workstation to read the study,” said Monique Rasband, author of the report, Women’s Imaging 2012: Tomosynthesis Makes a Splash.” The doctors do say, however, that this extra time seems worth the effort because of the procedure’s effectiveness, she said.
While capturing the best breast images possible is important, it is just one piece of the care continuum. For DBT to succeed the reading environment must help radiologists make a fast, accurate diagnosis with minimal disruption to the diagnostic workflow.

At RSNA, we’ll be demonstrating our Digital Breast Tomosynthesis (DBT) Module for our CARESTREAM Vue Mammo Workstation that lets radiologists read all procedures from a single desktop. The workstation displays digital breast tomosynthesis studies, traditional mammograms, breast ultrasound, breast MRI and general radiology exams to help equip radiologists to work efficiently from a single desktop.

Here a quick video overview of how it works:

[youtube=http://www.youtube.com/watch?v=CtvAfhh-p5E&w=640&h=360]
Comparison tools enable radiologists to use personalized hanging protocols for DBT exams along with other procedures. Specialized tools can further enhance productive reading: automatic positioning of DBT and mammograms eliminates manual manipulations; automatic “same sizing” of DBT and mammograms aid in comparing changes in anatomy; and concurrent magnifying glasses provided close-up comparison of pathology across multiple views and procedures. DBT exams can be viewed in cine mode or by scrolling.

If digital breast tomosynthesis is on your agenda at RSNA, swing by the Carestream booth (#2636) to get hands on with our DBT module or schedule your appointment now. 

WHITHER or WITHER the WORKSTATION?

 

Dr. David S. Channin

Guest-post from David S. Channin, M.D., CPHIMS, CRA, CIIP

So, another annual meeting of the Radiological Society of North America has come and gone. The ghosts of contracts past fade as we await the transmogrification of handshakes present into the ghosts of contract future. We sit back and decompress a bit, perhaps loosen the belt a notch, crack open a ‘vieux Armangnac’, gaze into the pensieve and begin to winnow the chaff that are customer dreams. It is an eternal conundrum that potential customers want what they know but know not what they need and existing customers have what they need but now know what they want. Yet, come Monday, January 4, father time will be burning engineering hours (at both ends?!) to do something! But, what?!

The key to the workstation must be radiologist productivity in a complex workflow aggravated by increasing procedure volume, increasing procedure set size, increasing regulation all the while amidst declining reimbursements. We need to examine each part of THE use case* (see below) to make sure that both the human and machine are each doing what they do best in absolutely the most efficient way possible; a truly cyborg relationship. It turns out that the computer’s and the human’s abilities are complimentary. The computer can be notoriously good at managing the process and the human, remembering things, searching, organizing, filtering, displaying and communicating. The human, as it turns out, is spectacularly bad at those tasks yet surprisingly good at some very hard tasks; image segmentation, content-based image memory retrieval and general and specific medical knowledge inferencing.

It would seem, therefore, relatively straightforward to provide the computer with all of the data and interfaces it needs to get its job done while providing the human with the minimum graphical user interface to get its job done as rapidly and as accurately as possible. Looking at the use case, it becomes apparent where the computer’s smarts can be applied: clever use of worklists to gather necessary data, sophisticated hanging protocols, fast, automated display, context sensitive, embedded lexicons and reference materials. For the human, the workstation can provide fast, standards based annotation and markup tools, and powerful embedded reporting in a variety of flavors.

The good news is that there are de facto, if not true standard ways to assimilate all of this functionality into the workstation. Remember, “We are the Borg. Lower your shields and surrender. We will add your biological and technological distinctiveness to our own. Your culture will adapt to service us.”

- David S. Channin, M.D., CPHIMS, CRA, CIIP

* The Radiology use case grammar (anything enclosed in [] is optional):

  [Resident Display [with historical(s)]] [Resident Annotation] [Resident Prelim Report] [Resident Critical Result Notification] Radiologist display [with historical(s)] [Radiologist Annotation] Radiologist Final Report [Resident Feedback] [Resident Discrepancy Notification] [Radiologist Critical Result Notification] [Technical QA] [ Professional QA] [Clinical Trial Specific Processing] [Clinical Trial Specific Annotation] [Clinical Trial Case Report Form Submission]  [TF Creation]

Editor’s Note: Dr. Channin is a paid guest-speaker for Carestream Health.