Thinnovation – Boosting Your PACS Workflow with Thin Client 3D Viewers and Integrated Applications

Furthermore, the gap between the “2-D world”, e.g. a traditional PACS, and the “3-D world”, usually consisting of a number of specialized workstations, is widening in many places due to lack of true integration. A paradigm shift is needed to address these issues – combining a high-performance 3-D thin-client platform with true diagnostic workflow integration and fully integrated advanced visualization applications.

Deficiencies of the isolated workstations paradigm

Currently, many hospitals have a centralized PACS, along with a number of loosely integrated 3-D review and post-processing workstations. Data is sent from the modalities to the PACS, then forwarded to (or pre-fetched by) selected workstations.
This “isolated workstation” paradigm creates many problems: Original data is not always available where needed; considerable time is spent sending original and processed data between different workstations and servers; additional quality control is needed to ensure all diagnostic images generated are correctly archived and transferred to all recipients; user preferences and work results are lost when switching to a different workstation; workstation hardware is often too slow or does not have enough memory to efficiently review large 3-D studies; versions and optional application packages must be installed and monitored, but are not always consistently available across workstations; and referring physicians and clinicians can only review snapshot images.

Integrated diagnostic workflow requirements

It is important to look closely at the current product offerings – some solutions clearly focus on 2-D, and offer some basic 3-D capabilities that lack the performance for efficient processing of large multi-slice CT studies such as for CT runoff or cardiac CT. Other solutions focus entirely on 3-D, and are very limited in terms of protocols and image resolution for viewing large 2-D images such as for thorax or mammography.

Radiologists and clinicians need access to medical imaging data and clinical applications throughout the entire hospital with the click of a mouse in order to interpret and manipulate medical imaging data. Two-dimensional, 3-D and 4-D data, as well as large studies and reports, should be accessible immediately throughout the hospital enterprise to enable efficient diagnosis and patient treatment. Different types of studies need to be displayed using different preset protocols, and these protocols should be adaptable for an individual site, group, or user.

Moreover, all clients (i.e., radiologists, surgeons, physicians and referring physicians) must be able to visualize using multiplanar, volume-reconstructed and countless other advanced visualization methodologies. There is a pressing need today for a PACS-integrated, thin-client approach to advanced visualization and image processing.
A truly integrated diagnostic workflow requires advanced, thin-client technology that is capable of processing and visualizing 2-D, 3-D and also 4-D datasets throughout the entire hospital enterprise, thus enabling an efficient sharing of medical imaging
data, as well as patient records across the borders of the different modalities, specialties and groups.

The key differentiator of a thin-client-enabled PACS is a truly central, high- performance 3-D processing paradigm, along with efficient streaming technology to enable any client computer to act as fully capable front-ends to all basic and advanced viewing and processing functions of the PACS. All DICOM data remains on the server (no data transfer prior to launching the 3-D viewer), all operations are performed directly on the server, and all functions can be accessed instantly from anywhere in the enterprise via web clients and/or thin clients. Thin-client PACS can be accessed anywhere, including off-site locations, from any PC with access to the network.

Performance matters

In addition to the workflow and integration requirements mentioned above, performance is of increasing importance. When you think about the current size of image volumes for a single patient and even a single study, and see the fast evolution of diagnostic imaging technology, one can clearly see the trend towards even larger amounts of data to be processed. A CT runoff can easily consist of 3,000 slices, cardiac CTs are already done at 8,000 slices and more. With the current CT in-plane resolution of 512 x 512 this amounts to 1.5 GB and 4 GB, respectively, just for fast image display out of main memory. Once the in-plane resolution is doubled in each dimension, these numbers will go up by a factor of four.

When this happens, hospitals and imaging centers should make sure to have a thin- client PACS solution installed. If not, all workstations on which that data is to be viewed or processed will need to be updated accordingly.

Furthermore, customers must make sure to get a demo of the actual performance of the system – both for large number of images (runoff, cardiac) as well as for large image resolutions (thorax, mammography). There are significant differences, since many systems have originally been designed either for 2D, or for 3D only.

Improved patient care

From the hospital’s point of view, a thin-client PACS removes technical barriers between different modalities and departments and creates a much more homogeneous and manageable IT infrastructure, thus allowing for more efficient diagnosis and
patient treatment. Furthermore, clinical applications, such as CT cardiac analysis and surgical planning, can be integrated directly within the clinical workflow, thereby providing access to state-of-the-art image quality and manipulation for all departments inside and outside the hospital network.

At Visage Imaging, we are cooperating with leading clinical partners worldwide to develop innovative, thin-client technology and diagnostic imaging systems that optimize the visualization of image data for modern healthcare procedures. We are proud to be able to assist healthcare professionals in improving delivery and saving lives, and we are committed to delivering continuous innovation and quality products by “visioneering science for life.”

Marcelo Lima is the president of Carlsbad, California-based Visage Imaging Inc. (www.visageimaging.com)