Workstations face off in three-hour battle

The floodgates of advanced processing sprang wide Wednesday, unleashing a three-hour torrent of 2D and 3D renderings from eight workstations in what has become an annual event at the International Symposium on Multidetector-Row CT.

Working under deadlines from two to four minutes, CT jockeys reconstructed five cases involving skeletal/vascular, carotid/intracranial, genitorurinary/vascular, pulmonary, and cardiac data. Workstation operators were hand-picked by the eight vendors – Carestream, GE, Philips, Siemens, TeraRecon, Visage, Vital Images, and Ziosoft.

Reconstruction speed was spurred by one-click algorithms that did the tedious registrations and data subtractions that in previous years ground demonstrations to a snail’s pace. Some renditions took less time than moderator Dr. Geoffrey Rubin spent introducing the cases.

“They consistently completed the majority of tasks and there were no major stumbles,” said Rubin, radiology professor at Stanford University and medical director of the 3D Laboratory there. “But I do think the audience had an opportunity to see some substantial differences."

Each vendor’s system put its own stamp on the data, splashing pseudo color renditions on the split projection screens at the front of the symposium hall. Black-and-white 2D slices set the context for red-, green- and blue-coded volumetric reconstructions. In one, the heart, lungs, and surrounding thorax replaced soup cans and Marilyn Monroe in Warhol-like frames. In another, virtual endoscopy conjured a mildly unsettling view of the aorta that looked more like a head-first tapeworm than a major artery.

Rubin chided operators for “mag views,” offering a “zoom award” to those who complied, while hurrying them with 30-second advisories as the clock ticked down. When one workstation temporarily locked up, Rubin pressed the user to “talk fast” after it came back online, noting that more than a minute had been lost. Frustration crept into the voice of one workstation driver who urged his system to “come on baby” then, like a father grown impatient with a dawdling child, said “this will pop up soon…tomorrow.”

Minor glitches aside, the face-off was remarkably free of the crashes that had plagued those of years past. The relative ease of reconstruction underscored the redundancy of views from eight workstations processing the same data. One operator commented: “Everyone will go home knowing exactly where the ureter is.” Rubin ad libbed that the 3D recon of a pulmonary nodule looked “like chewing gum” – as, in fact, it did.

In the one quantitative task, the differences among vendors’ systems was conspicuous. Each correctly determined that the pulmonary nodule had grown significantly from one faux patient visit to the next, but calculations ranged from 53% to 93% growth. Several estimates landed in the mean between the high 60s and low 70s, but there was no telling whether they were right or wrong.

No problem there, said Rubin, donning the cap of a little league coach. The goal of the face-off was to create a level playing field on which vendors could showcase their workstations.

“There is no winner,” he said. “They are all winners.”