ECR 2014 - session SS105 - Trends in reporting, image management and mobile computing

10 presentations on different topics were covered in this scientific session:

CAD

Evaluation of a Siemens software tool called FastSpine to perform analysis of the spine with automatic labeling and curved reconstruction. They showed a high percentage of correct automatic labeling of 93.5%. FastSpine took about a minute to perform on average with manual correction where needed. The CAD provided time saving in more complex cases and had a comparable performance.

Two presentations focused on RECIST implementation. One looked at the implementation of dedicated tools for RECIST analysis and showed a clear saving in reading time while maintaing reproducibility. A Japanese group presented a cloud-based Lesion Management Solution that is used to track patients in lung cancer screening workup.

MOBILE DEVICES

This session showed again that mobile devices are of great interest and interesting applications are identified and implemented. Four of the presentations covered this topic.

A by dr von Falk showed that an iPad could be used for diagosis of CT data although screen size and security are still hampering the implementation. Another issue with mobile devices is the diiffering reading environments that cannot be controlled and thus could influence the reading quality. Mobile devices should probably be implemented as additional possibility and not for primary use. 

The dkfz demonstrated the use of an iPad for offline analysis of radiology information at a distant location to be used during autopsy. 

A group from Pisa also evaluated the iPad on CT images and showed the iPad to be faster for evaluation with even higher sensitivity and specificity for the iPad.

An important point to keep in mind with all the evidence for using iPads in radiology is that it is all focused on a limited, well defined, clinical question and mostly limits to CT.

Another group from Germany introduced the iPad in anatomical courses. The developed AnatomyMap a dedicated software tool for interactive exploration of volume rendered data running on a remote server using a web based interface.

QUALITY CONTROL

A group from switzerland showed that after transfer from free text to structured reporting they needed quaity control of those structured reports. They analysed about 250 reports on over 30 criteria. They showed that one third was excellent, one third good and one third non-optimal. The two worst performing radiologists were those not (properly) using the structured reporting. 

USABILITY

A Dutch group presented their work on interface customization. Most PACS systems have an adaptable interface, but the radiologist do not optimally use this capability. The showed that using adaptive support suggestions based on usage could help to improve radiology workflow and workstation usage. 

Publication: Postprocessing Pitfalls in Using CT for Global LV Function

This paper is a overview of the work we did on the evaluation of Left Ventricular (LV) function using Computed Tomography (CT). Earlier papers have already covered several aspects of this measurement. This paper, based on our poster presentation at RSNA 2010 provides a good overview of the problems that can arise in LV measurement.

Informatics in Radiology: Postprocessing Pitfalls in Using CT for Automatic and Semiautomatic Determination of Global Left Ventricular Function.
van Ooijen PM, de Jonge GJ, Oudkerk M.
Radiographics. 2012 Mar;32(2):589-99. 


Abstract
Recent advances in technical capabilities of computed tomographic (CT) scanners, including an increasing number of detector rows, improved spatial and temporal resolution, and the development of retrospective gating, have allowed the acquisition of four-dimensional (4D) datasets of the beating heart. As a result, the heart can be visualized in different phases and CT datasets can be used to assess cardiac function. Many software packages currently exist that allow automatic or semiautomatic evaluation of left ventricular function on the basis of 4D CT datasets. The level of automation varies from extensive, completely manual segmentation by the user to fully automatic evaluation of left ventricular function without any user interaction. Although the reproducibility of functional parameter assessment is reported to be high and intersoftware variability low for larger groups of patients, significant differences can exist among measurements obtained with different software tools from the same dataset. Thus, careful review of automatically or semiautomatically obtained results is required.

Radiology: Virtual colonoscopy effective screening tool in older patients

Virtual colonoscopy has been around for a long time already and since the beginning the clinical value was debated. A recent publication in Radiology suggests that it can be used as a primary screening tool for colorectal cancer in adults over the age of 65. There was no significant difference in the accuracy of CT colonography for the detection of large and intermediate-sized adenomatous lesions in participants aged 65 years or older compared with that in younger participants; per-participant sensitivity and specificity among the older and younger cohorts were 0.82 and 0.83 and 0.92 and 0.86, respectively. Radiology: Virtual colonoscopy effective screening tool in older patients

RapidPro 2012 - Patient specific implants produced with Additive Manufacturing Technology based on CT

Great presentation by Maikel Beerens from Xilloc Medical B.V. On patient specific implants produced with Additive Manufacturing Technology. They are a Dutch company that makes specially designed implants that are patient specific based on the CT dataset obtained from the patient. They are working on an online order system for the physician to easily construct and order the implants required. He really showed the direct application of additive manufacturing to build both the anatomical models of the patient and the actual implants based on convincing patient cases where the patient really had a large benefit from these implants. They use a hydroxy appetite coating on the implants to increase ingrowth of soft tissue.
It is difficult to get this technique accepted in medicine, but the cost reductions are significant.

TED: Visualizing the Medical Data Explosion

To see a very illustrative presentation on the medical data explosion that was caused by the introduction and constant improvement of Computed Tomography visit TED and watch the talk by Anders Ynnerman called 'Visualizing the medical data explosion'

Anders Ynnerman especially focusses on visualization of full body CT scand for evaluation and workup of virtual autopsies. To perform this task he also shows the virtual autopsy table they developed.

Mixed Reality in the Operating Theater

This group from Japan uses Osirix and a projector in the operating theater to project the three dimensional images obtain by pre-operative Computed Tomography onto the patient abdomen.
The authors claim that the image overlay surgical navigation system using OsiriX provided accurate image guided navigation for minimally invasive surgery.

Mirracle - Using Microsoft Kinect for interactive, augmented reality, anatomy education

Research groups at the technical university Munchen in Germany have developed an augmented reality system to study anatomy.

Their second version of the augmented reality magic mirror uses the Microsoft Kinect to detect a user standing in front of a screen. Subsequently, augmented reality is used to overlay a volume visualization of a CT onto the user. Using gestures the user can select 2D slices. The prototype was presented at the open day of Klinikum Ingolstadt. For more info see www.mirracle.de

Great development for education, but it also might find its way into clinical practice.

Enhanced four-dimensional presentation of cardiac CT data

Demonstrated again at the ESCR 2011 in Amsterdam last week, the PhyZiodynamic software of Ziosoft Inc. Incredible what they can do based on 4D imaging data obtained from CT. With advanced computing techniques they compute a fluent 4D moving heart with increased temporal and spatial resolution. Technically it is possible, as they demonstrate, and now they are looking for the clinical applications.

PhyZiodynamic solutions are based on uncompressed imaging data, using off-the-shelf hardware. Ziosoft's revolutionary PhyZiodynamic algorithms utilizes non-rigid (deformable) registration on lossless temporal images to reduce noise, improve motion coherence, and enable functional analytics.
 
Look at their website for some example movies.

Visualization table for collaborative viewing of 3D datasets

Check out the Sectra Visualization Table. I've played around with it at a conference. Basically, it is a large iPad showing the three-dimensional visualization of your CT or MR dataset. My guess is that the applications can primarily be found in education and teaching. The table works intuitive and after some minor instruction it is very simple to play around with. Great tool that looked like just a gadget in the beginning but clinical applications are starting to be found.