Advanced visualization aims to expand in the enterprise

It wasn't long after radiologists began viewing digital images on cathode-ray tube monitors that they realized they could also manipulate the data. In the 1980s Diagnostic Imaging carried crude images of 3D CT colon scans. Today the 3D colon quest is solved and advanced visualization vendors are on to lots of other things.

This year you'll see them introduce enhancements for existing functions. But they are also looking at ways to better extend advanced visualization throughout the enterprise and over wi-fi networks to appear on mobile computing devices like the iPhone. Some are looking at advanced visualization applications for specialties outside radiology facilitated by centralized database storage. And tapping into the growth in digital mammography, vendors are promoting advanced workstations for this modality.

Five vendors-Carestream, TeraRecon, Visage, Vital Images, and Ziosoft-stand out as providing advanced visualization systems. Three of the four major modality vendors-GE, Philips, and Siemens-also participate in the advanced visualization market via their PACS offerings. All eight of these companies compete in “workstation shootouts” where their advanced visualization systems are tested against one another. Other companies occupy niche segments of the market such as MedImage (nuclear medicine) and MIMVista (PET and radiation oncology).

Vital Images, which in July launched the Vitrea Enterprise Suite, will focus on the product at this year's RSNA exhibition with enhancements for its neurologic, cardiac, and endovascular stent planning functions. The suite combines 2D, 3D, and 4D clinical applications with a centralized solution for managing volumetric image data. Called Vital Image Management System, that feature provides universal access across the medical enterprise to a single source of imaging data.

Vital Images sees opportunities in trying to reach other specialties within the enterprise, said Nichole Gerszewski, the firm's senior marketing communications and brand manager.

Carestream Health is highlighting its PowerViewer, which goes far beyond the functionality offered by integrated or native 3D capabilities by automatically registering and matching, directly within the standard viewer, volumetric data created at different times and by different modalities.

Radiologists can dynamically view image data in different planes without switching to other applications or workstations, according to the company. Automatic registration also enables radiologists to manipulate one data set in any spatial plane knowing the other data sets will automatically follow. This advanced comparison includes different rendition types such as multiplanar reformatting (MPR), minimum intensity projection (MinIP), and others.

The PowerViewer represents a new departure, said Hadas Padan, director for product management and strategic development, healthcare information solutions, at Carestream Health.

“Until now, we were bringing dedicated applications such as vessel analysis, cardiac analysis, and PET/CT into the workstation so that all these applications could be accessed from one desktop,” she said. “Now, in addition to dedicated applications, the PowerViewer incorporates advanced visualization for most volumetric procedures as part of the radiologist's standard viewing tool, greatly improving radiologists' productivity and enabling faster reporting.”

Japan-based Ziosoft, a relative newcomer to the U.S. advanced visualization market, is emphasizing the origins of its product, which was designed from the ground up to be a thin-client system, said Terry Chang, director of marketing. Many of the others in the market have thick-client origins, whereby much of the processing is done where the image is displayed. In the thin-client model, it is done on a server and the images are sent out to the user in processed form.

At this year's RSNA exhibit, Ziosoft will be highlighting MR applications, which Chang said could be of greater interest because of growing concerns about CT dose. These include cardiac function analysis, MR cardiac perfusion, cardiac delayed-enhancement analysis, and MR perfusion. Ziosoft will also emphasize CT applications such as 4D brain perfusion (compatible with Toshiba's Aquilion One 320-slice scanner), and SPECT/CT cardiac perfusion applications along with improvements in its colon, vessel analysis, and reporting modules.

Finally, Ziosoft will promote ZioTerm, a free basic viewer for 2D/3D applications in academic research. Unlike its other applications, ZioTerm is not FDA-approved and thus is not cleared for clinical use, but the company hopes it will find a following among student researchers and help build support for the main product, Chang said.

Among the major modality vendors, Siemens has a new suite of products that will place a special focus on automated case preparation and structured case navigation for multimodality images based on CT, MR, molecular imaging, x-ray, and ultrasound, the company said. The aim of the new approach is to efficiently execute cases across specialties such as cardiology, oncology, and neurology. It also supports quantitative reading in radiology.

Additionally, Siemens will demonstrate the benefits of offering an integration of image acquisition modalities and image reading software in one complete solution, showcasing the company's position as an integrated healthcare provider.

Earlier this year, Philips launched the MammoDiagnostVU mammography workstation worldwide. At the RSNA exhibition, Philips will extend this momentum with the launch of the Integral Breast Workspace, a multimodality, multivendor workstation that brings together mammography, ultrasound, and MRI studies. The approach meets a customer need for integrated information management, enhancing workflow and increasing diagnostic confidence, the company said.

Also new from Philips is the iSite CT/MR Vessel Explorer, an application for the fast assessment of 3D vascular structures from MR and CT angiography data. The package is optimized for radiologists using PACS.

Throughout the year, GE has been touting its Open Desktop technology, a web-based viewer that allows users to integrate best-of-breed applications with enterprise connectivity regardless of department or clinical specialty. At the RSNA exhibition, GE will demonstrate the value of a single database for patient selection, reporting, and archiving for review of multimodality patient studies, including nuclear medicine tools and reprocessing capabilities. The ease of software integration enables radiologists or specialists to perform multiple tasks on a patient's exam from a single workstation, said Don Woodlock, vice president and global general manager of GE Healthcare IT.

As part of Open Desktop, GE will be demonstrating the Xeleris for Nuclear Medicine, Advanced Imaging for Centricity PACS, and Oncology Workflow for Centricity PACS-IW. The Xeleris application provides imaging tool sets for the viewing and analysis of perfusion and metabolic pathways in SPECT/CT and PET/CT studies serving neurology, cardiology, and oncology departments. The Oncology Workflow application integrates PET/CT fusion and standardized uptake value (SUV) measurement capabilities into the web-based PACS-IW and automatically fuses and displays rotating maximum intensity projections from source axial series acquired from multivendor PET/CT scanners.

MedImage has been in the business for more than 20 years and grew mainly from a nuclear medicine background, said Tod Henderstein, sales manager. This year at RSNA 2009 MedImage will be showing its latest works-in-progress software, MedView Version 11.8, with release scheduled for late 2009 or early 2010. New features include linking of two template windows for easy alignment of current and prior PET/CT and SPECT/CT studies, the addition of annotation tools for DICOM save screens, the creation of 3D regions of interest, and tools to allow cloning, duplication, and saving of regions for use with additional views or studies.

The company is seeing increased interest in having its software run as a PACS plug-in, Henderstein said. Radiology departments would much rather invest in a solution that adds to or builds more functionality into their PACS.

MIMVista officials are enthusiastic about their MobileMIM radiology software for the iPhone and iPod Touch. This is paired with MIMCloud connectivity that gives mobile devices immediate access to radiology images through the Internet.

Although wireless access has been achieved through hospital IT systems, it's a cumbersome approach, since each hospital typically has its own virtual private network, said Mark Cain, chief technology officer for MIMVista. With the MIMCloud, the images reside in a digital “cloud” of multiple servers, fully encrypted and ready to be downloaded for immediate viewing by radiologists and clinicians on the go.

“We expect it to be big,” Cain said. “What's going to be unique is that it will be diagnostically viable for emergency reads.”