RSNA 2013 - RC326 - Quantitative Imaging: A Revolution in Evolution (In Association with the Society for Imaging Informatics in Medicine)

Vendors provide easy tools to perform quantitative imaging but the question is how reliable and repeatable this quantification is. 

Many clinical examples can already be listed where quantitative imaging is used in clinical practice. Such as carotid stenosis, coronary artery stenosis, calcium scoring, pulmonary nodules, renal donor evaluation, liver and tumor volumetry, brain perfusion, emphysema quantification. 

Each of these show good results in literature and could be applied in clinical practice.

However, the question is whether the numbers we get out of the software are usefull and what is reality. Different vendors provide different results in the same patient and even within one software system measurements are influenced by postprocessing choices but also by decisions during the acquisiiton. 

One of the things that can be done to get proper quantification we should provide reference datasets.

QIBA is ran by a group of stakeholders to improve quantitative imaging. They define profiles to get precise, repeatable measurements. QIBA has setup a imaging data warehouse (QIDW) including standard datasets that can be used to validate quantitative imaging algorithm.

The QIDW is free, open source, modular software based on MIDAS.

In conclusion tagging of the image data in radiology is essential to allow computers to work with the information. The quantification is part of this tagging. Developments like AIM are trying to cover this and allow export in XML or DICOM SR, however current PACSs and EMRs do not yet support these kind of measurement. When the storage and data mining of all the information available in the images becomes possible it will provide the key information to get to personalized diagnosis and treatment.

Realview - Holographic Visualization in the OR during heart surgery

Check out this video from Realview. They developed a holographic visualization system that was actually used in the Operating Theatre.
This really looks like a breakthrough technology that could have major impact on the way three-dimensional imaging data of patients is used in the operating room. Their current hardware looks a bit bulky for the already crowded OR, but this might become smaller in the future to allow real integration. Big advantage is the ability to have touch-less interaction with the 3D holographic image which is a huge benefit in the OR.
Also check-out their website at www.realviewimaging.com

CARS 2013 - Cardiovascular and Angiographic Imaging

The first presentation in this session was by Tuncay on segmentation of the aortic valve area on CT. They have deviced a novel method to semi automatically segment the opening area of the aortic valve. They created an adaptive grayscale image to get the boundaries more clear and an adaptive algorithm to remove the calcium from the image. The technique proved effective and more reproducible in 21 patient datasets.

The second presentation by Haase was on Model based 3D registration of a CS catheter: application to single X-ray projections from a rotational angiographic sequence. They use a model of the catheter and combine this with the recorded Xray data to obtainna 3D representation of the orientation and movement of the catheter in 3D. They showed high accracy in the tracking in a simulated phantom setup. In clinical datasets also a high accuracy was obtained. Overall accuracy was 0.33 mm in 2D and 2.04 mm in 3D.

The third and final presentation by Masuda was on full automatic calculation of ejection fraction of left ventricle from either of short-axis view by processing succesive ultrasound images. The aim of their study was to design a method that does not require any initial input of the user. They envision to include this algorithm into a portable echography device for use in emergency situations. They demonstrate an interactive real-time detection of the LV cavity during the acquisition of the ultrasound. A subjective scoring by sonographers showed a high level of correct segmentation. Their algortihm was succesfull both in two and four chamber view. Good correlation was shown of the EF based on the new and conventional method.

CARS 2013 - Image Processing Workflow and Management in Clinical Practice

Regge gave an interesting presentation on getting from bench to desktop with image processing illustrated with his own example on CT colonography. His take home points are that an Imaging lab should be embedded in a cliinical unit, should be cautious with industrial partners, and must start from a clinical problem and build the software on that problem.

Glinkowski presented about what information the clinician really needs. The questions a clinician asks are: what? Where? How? Decision making - what to do? In answering these question the clinicians are heavily depending on imaging an Radiology is essential in answering many of the questions a clinician may have in a muti disciplinary collaborative effort to get the optimal outcome for the patient.

Where we stand on costs and reimbursements of image processing was the topic of a presentation by Turchetti. He started to show that the total healthcare expenditure in Europe and the US is increasing. First cause of this increase is innovation because of growing indications and applications of the innovations, growing area of treatable conditions, increasing use of technologies for the same conditions with less discomfort, broadening definition of diseases and life extending effects. Note that all issues are positive: we live longer and better... Most countries try to tackle these issues with increasing efficiency, redesign of the supply side (closing hospitals, reducing beds, etc), regulation of price and/or quantity of services, and the reduction of the services granted for free and introduction of higher level of co-payment.
The reimbursement mechanism could stimulate efficiency and reduce the opportunistic behavior of hospitals. But if not used properly it could impede the transfer of innovation to the clinical practice.
Studies to calculate real cost of procedures should be promoted and reimbursement should be defined accordingly. Define for which indications the image processing is approriate from a clinical point of view and from a cost effectiveness point of view. Cost and reimbursement should be properly aligned.

In the next presentation Fatehi discussed the composition of the image processing research team including the clinician, radiologist, radiographer, computer scientist, biomedical engineers, and ... He stated that image processing reeserach is done to answer a clinical need, to refine engineering methods and to support management. As stated already many times during the conference he also stresses that imaging research should be a multi-disciplinary effort. The cooperation should include the following topics.

Clinical to Technical:

• Defining the clinical question


• Defining the components of the applications


• Providing the most relevant datatsets


• Defining the workflow before and after the image processing


• Validating the test protocol


• Improving the user interface

Technical to clinical:

• Specify potential methods to achieve the clinical goal


• Specify technical limitations of implementing the application development


• Provide a comparative list of already tested methods in the literature


• Translating the clinical workflow into an engineering language with technical block diagrams


• Keeping engineering standards in the final product/application


• Taking care of the integration issues


• Taking care of the licensing issues


• Providing information about open source to avoid high costs.

Finally, Schilling presented on bridging the radiology/surgery gap. He advocated the introduction of new visualization protocols with higer dimension imaging with direct interaction with the data using easy to use devices. They want to have intuitive 2D and true 3D. Clinical efficacy and worflow can both be optimal using true 3D.

CARS 2013 - Medical Imaging Informatics Simulators

After a short introduction and welcome by prof. Neri, prof. Huang presented a tutorial on Medical Imaging Informatics Simulators. In this tutorial a Medical Imaging Informatics Infrastructure was introduced together with its simulator environment. The simulators are plugged into the MIII layers which integrates with PACS/RIS/ePR/HIS/etc. The simulators can be built in different forms for a variety of applications utilizing different components. They use the actual 'live' information to provide a simulated environment for training and testing. The other simulators described by prof Huang are systems setup to achieve the standards based integration of different components within one single workflow enabling easy acces to and deployment of those different components. After a proven implementation in the simulator environment, the simulators can be moved into patient care.

Microsoft's Robot Touch Screen Lets You Palpate a Brain

Microsoft is working on haptic feedback integrated into a touch display. So when going to a stack of slices from a CT or MR haptic feedback can be provided based on the image displayed.



Microsoft's Robot Touch Screen Lets You Palpate a Brain

Preliminary version of e-book on Medical Visualization published

I've just published a preliminary version of my e-book on medical visualization at this blog. It is far from complete and some whole chapters are still unfinished or even empty, but I wanted to put out this priliminary version out for my students in the Biomedical Engineering course that I am teaching. So please download the e-book and give me your comments. Do you like it or not? What should be changed or added? Any comments are most welcome. New versions will appear in the near future on this page.

Just go to the e-books and whitepapers tab on this blog to get to the download location.

iPod during knee surgery

A novel application of the iPod was recently published. The iPod is used to display pre-operatively acquired images of the patient operated upon. These images are displayed on the iPod correctly by using tracking devices to detect the position and orientation of the iPod in the operating theatre. The surgeon can review images during surgery of specific locations on the iPod. An iPad can be placed in the operating theatre to allow other people involved in the procedure see the images the surgeon has on his/her iPod.

Read this article of USA Today on the use of an iPod during knee surgery.

RSNA 2012 - Poster stating the top 5 apps for radiological images on the iPad

According to a poster presented at RSNA, the top five apps to get onto your IPad for reviewing radiological images are:
1- Mobile MIM
2- ResolutionMD mobile
3- eFIlm mobile HD
4- OsirixHD
5- iClarity
Of these ResolutionMD Mobile and Mobile MIM have obtained FDA approval. All these viewers have basic viewing functionality and safe connection protocols.
The authors conclude that 'far from substituting radiologists workstations, the iPad can be a good and useful portable device for visualizing radiological images'

RSNA 2012 - Rapid Application Development with XIP™ - the eXtensible Imaging Platform

The eXtensible Imaging Platform (XIP™) is an open source framework supporting rapid development of imaging and visualization applications. Imaging software developers can utilize XIP's visual ‘drag-and-drop’ programming tool (the XIP Builder™) and associated libraries (the XIP Libraries™) in creating applications. In addition to functions from the popular ITK and VTK libraries, the XIP Libraries include modules tailored for medical imaging, many of which are hardware accelerated via GPU programming (e.g., OpenGL® GLSL or OpenCL or CUDA C). Applications created with XIP can either run standalone, or as DICOM Hosted Applications. Through the DICOM Application Hosting interfaces (DICOM WG-23), a Hosting System, such as the XIP Host™, relieves the application developer from the need to re-implement infrastructure common to all applications (e.g.DICOM network connectivity, database, etc.). Users can execute Hosted Applications, such as those created with the XIP Libraries, via the XIP Host.

URL's http://www.OpenXIP.org

The next step in augmented reality

Published at ISMAR conference 2012. This video shows first steps towards a Superman-like X-ray vision where a brain-computer interface (BCI) device and a gaze-tracker are used to allow the user controlling the augmented reality (AR) visualization. A BCI device is integrated into two medical AR systems. To assess the potential of this technology first feedback from medical doctors is gathered. While in this pilot study not the full range of available signals but only electromyographic signals are used, the medical doctors provided very positive feedback on the use of BCI for medical AR.

Virtual Holography for Medical 3D imaging?

Check out the coverage on the diagnostic imaging website on the topic of virtual holography.

They have an article on the development of two companies called Echopixel Technologies and Infinite Z that are attempting to join forces to develop these kind of displays in order to provide the 'real 3D experience'.

Infinite Z already is distributing holographic devices for mechanical engineering as can be seen from their website and the movie displayed below of a product called zSpace.

Top 25 articles in Journal of Medical Informatics

The Journal of Medical Informatics has published a list of the 25 most downloaded articles of 2011. The list provide a good overview of the field of Medical Informatics and contains top-rated papers on all kind of different topics. The list can be found here.

Another application of visualization: 3D animation to explain a procedural problem in court

In this, Dutch, video an interesting example is given of medical visualization. This forensic visualization was made to demonstrate the procedure in which a surgeon left a guidewire in the body of the patient. 

Gesture Interface using Kinect for Medical Imaging Visualization in Surgeries

This work was developed in the Renato Archer Center for Information Technogy - CTI (www.cti.gov.br) in Campinas - SP, Brazil (3D Technologies Division) published at the 5th International Conference on Advanced Research in Virtual and Rapid Prototyping (VRAP2001).  The system allows the surgeon to control the medical imaging software InVesalius (also developed by CTI) without any physical contact, just by hand gestures. The system uses the OpenNI/NITE framework and is cross-platform (Windows/Linux).  Invesalius website: http://svn.softwarepublico.gov.br/trac/invesalius

Wii Remote-enhanced Hand-Computer Interaction for 3D Medical Image Analysis

Look at this movie for a more serious application of the wii remote using a very simple glove with some IR LEDs attached to it.

RSNA 2011 - Pre-meeting Glance at the schedule

During the RSNA, the largest radiology conference in the world running from November 27 to December 2, many sessions will focus on medical imaging informatics. Topics included into the programme are for example:

1. Informatics (Education and Research) in room S403A on Sunday
2. Informatics support for Quantitative Imaging in room E353A on Sunday
3. Advanced Image Analysis in room S401CD on Monday
4. Practical Informatics for the Practicing Radiologist: Part One in room S501ABC on Monday
5. Decoding the Alphabet Soup (IHE, MIRC, RADLEX, Reporting): Worldwind Tour on RSNA Informatics Projects in room S401AB on Monday
6. Standardized Terminology in Radiology: Applications and New Developments in room S403A on Tuesday
7. Virtualization and remote rendering for Medical Imaging in room E263 on Friday

Besides these scientific sessions, the technical exhibit includes virtually all major players in the field of Medical Imaging Informatics and in many cases the RSNA is used to launch and introduce new developments.

I will be attending RSNA and use this blog during the meeting to report on the scientific sessions I attend and to share news from the technical exhibit.

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.

Cloud Computing in Imaging Informatics

Also from the HealthImaging Virtual Conference a nice presentation on Cloud Computing in Imaging Informatics.

During this presentation Dr. Shrestha indicates the following issues as being the big issues facing Imaging Informatics:

1) Imaging Overload
2) Pay for Performance
3) Clinical Validation
4) System Integration
5) Reforming the Imaging Report
6) Image Sharing

The question he addresses based on these issues is "Is 'Cloud' the big saver?"

New blog on Medical Imaging Informatics

This new blog will cover Medical imaging informatics in the broadest sense. Ranging from HIS and RIS to advanced visualization I will be covering conference sessions, publications, scientific research and scientific papers.