|
|||||||||||||||
|
Home
|
New Dimensions
— Adding 3D Reconstructions to Teleradiology Service Imaging technology advancements have delivered more and substantially enhanced anatomical and functional detail at significantly greater speed. But with innovations and attendant benefits come complications, such as the huge datasets those exams typically generate. Three-dimensional volumetric imaging assists clinicians in managing the enormous datasets, but facilities have learned that 3D image processing can be expensive and labor intensive. In particular, required postprocessing is time-consuming. It can disrupt workflow and, in turn, inhibit patient throughput. As imaging technology continues to evolve, outsourced imaging services—teleradiology companies—are responding to these complexities by expanding their services and offering or developing cost-effective and labor-saving solutions. Vikas Narula, director of radiologic technology and development for Virtual Radiologic, a Minneapolis-based teleradiology services and solutions provider, observes that teleradiology began in an emergent setting and evolved into round-the-clock-operations for an increasing range of services. “Obviously, radiology involves usage of advanced visualization capabilities such at CTA [CT angiography]. One of the big drivers within that area is cardiac visualization, which requires 3D imaging. Certainly, as teleradiology companies provide interpretive services, they’ll want to provide services for this procedure as well, and that involves use of 3D postprocessing technology,” he says. Hospital radiology departments and imaging centers are starting to utilize 3D postprocessing and image reconstruction services offered by teleradiology providers. Bottlenecks That’s where a bottleneck often occurs. While data acquisitions are accomplished in 12 to 15 seconds, and patient table time requires roughly 5 to 10 minutes, postprocessing can take anywhere from 20 to 60 minutes, depending on case complexity. “It’s very time consuming,” says Shea. And costly, he adds: “Both the hardware and software required to download the data are very expensive.” Radiologists, for the most part, have little interest in doing advanced image processing, explains Robert L. Falk, MD, cofounder, managing director, and chief medical officer of 3DR Laboratories, a teleradiology service provider founded in 2005 to specialize in outsourced 3D image processing. “Most simply, they don’t have the time,” he says. By outsourcing some, if not all, of its advanced image processing, an organization can make the process more efficient. The key to efficiency maximization, according to Falk, is centralization. At the heart of the expanding teleradiology model is a centralized laboratory that handles 3D postprocessing and reconstruction. “Teleradiology companies are hiring 3D techs to postprocess the images in their labs and export the images back for radiologists to review the outcome of the postprocessing,” says Narula. Potential Clients At the other end are the large hospitals utilizing coronary CT in the chest pain clinics they’re developing. “They just don’t have the technical or professional staff to maintain full-service capabilities,” says Shea. When 3DR Laboratories was launched, the company anticipated that its services would best benefit small community hospitals and stand-alone imaging centers, as these facilities would find it more difficult to equip themselves with the necessary and expensive workstations. Moreover, they’d have low volumes and may only have one or two cases per day that require advanced image processing. The company envisioned that market segment as the so-called “sweet spot.” However, as 3DR has grown, it has realized its greatest traction from large, multihospital systems. Why? They’ve “been there” and have “felt the pain,” as Falk puts it. “They’ve already done some degree of postprocessing, and it hasn’t worked out too well for them,” he explains. “They realize there are a lot more complications to providing advanced image processing than they thought. They can’t retain trained technologists or provide 24/7 coverage, and their workstations aren’t adequate to their needs. They don’t know where they can go from there.” New Kentucky Home Falk, who founded the company with Michael Lillig, says 3DR grew from the need for centralized advanced imaging processing that he perceived while practicing as a radiologist at Jewish Hospital in Louisville. “As the hospital advanced in its use of CT technology, and we were buying the scanners and expensive workstations, we were putting all of these elements in different locations without a thought to centralizing,” he recalls. At first, he recognized that efficiency could be gained by centralizing within a hospital system. But then his perception extended beyond a single location. Centralization among multiple hospital systems, and even among small hospitals and imaging centers, could generate savings in up-front costs such as workstations, as well as in continuing costs. “It’s a time-share kind of concept,” indicates Falk. “We wanted to create a laboratory where you can time-share the advanced image processing as well as the infrastructure costs of the workstations and the clinical expertise of the technologists.” Along with Falk’s clinical experience, the business model also integrated Lillig’s background in the blood lab arena. “He built and sold several blood labs on the West Coast in the late 1980s and early 1990s and immediately saw the parallel between what had happened in the clinical lab business and the application of advanced image processing in radiology,” explains Falk. “Essentially, 3DR is doing for radiology what a Quest or LabCorp does for blood work.” Lab Central The company provides a fast, secure, HIPAA-compliant service through its telecommunications portal. Its dedicated, trained 3D imaging technologists can provide same-day turnaround for stat 3D volumetric images and 24-hour turnaround on all other studies. In addition, it provides visualization on PACS, personal computers, or handheld devices so referring physicians and radiologists can view the same images. Thinking Thin “Initially, we used the fat client model, which moves a DICOM dataset from place A to B over the Internet, either over a local area network or a wide network. The finished product is sent back over the Internet,” explains Falk. The company still accomplishes the bulk of its business in that fashion, but it’s rapidly morphing from the fat client model to the thin client model, which means that the server resides at a customer site, according to Falk. “Our technologists log onto that server, usually over a virtual private network [VPN], and do the postprocessing by reaching to that server from our lab,” he says. “That also enables customers to get into that workstation so that they have access to the data and can actually do some of the cases themselves, which increases our flexibility. We can do everything for you, or we place the server in your enterprise and provide you with enterprisewide distribution of 3D capability.” The company’s biggest value proposition, according to Falk, is that its infrastructure costs less than if customers placed 3D workstations in their own environments. “As far as up-front costs, we shift everything from a capital acquisition to an operating budget,” he says. There is no money to be made in postprocessing, Falk points out. “It’s just a necessary task within the study. The money is made in the throughput.” Coronary Examinations The first set includes existing customers developing coronary CT projects. Of the company’s 1,350 customers, 175 had 64-slice CTs, and NightHawk wanted to offer them the ability to do postprocessing and remote interpretations on a 24/7 basis. “We also realized that the number of customers implementing 64-slice CT would increase dramatically in the next few years,” Shea adds. The second set includes new customers that hadn’t
yet utilized NightHawk services and were developing cardiac CT programs.
“They approached us to help them,” he says. As for the first issue, NightHawk sought to implement and integrate a network that effectively deals with all available PACS entities, according to Shea. “We wanted a logical and efficient workflow scheme, so we devised a system of IT implementation that went above and beyond what NightHawk had already established for the smaller datasets that we had been sending.” Addressing the second issue, NightHawk chose TeraRecon, a provider of advanced image processing and 3D visualization techniques, to supply the technology platform. TeraRecon provides its dual redundant AquariusNET servers and an Aquarius advanced preprocessing server (APS). At NightHawk’s new, dedicated 3D lab in Austin, Tex., company technologists working from the centrally located workstations and banks perform postprocessing. “We call them ‘supertechs’ because they’re highly trained and experienced CT technologists,” says Shea. After the processing, the image data and 3D work product are transmitted back to customers, who can view the results and further manipulate images volumetrically via the AquariusNET servers. As a result of the partnership, NightHawk, like 3DR, employs the flexible, thin client strategy. “TeraRecon enabled us to use their thin client server solution, which would give us greater flexibility in dealing with our customer base. And we liked their workstation,” says Shea. With its thin client model, NightHawk provides customers free software that can be downloaded onto a PACS workstation or PC. For a limited time, they can access the data through the server using a specific VPN. “Essentially, they have access to the outsourcing company’s workstation capabilities,” says Shea. “They can look at the cases they’ve sent to us, or they can convert their workstations or computer into a mini-TeraRecon workstation.” Subspecialty Teleradiology “Six months ago, we launched our cardiac subspecialty program, and we’re providing interpretations for CTAs,” says F&S President Scott Seidelmann. “That’s the program’s primary product.” TeraRecon provides F&S with 3D reconstruction software and viewer technology. The service came in response to customer demand. “Also, we believe that CTA will become a significant portion of clinical practice for cardiac disease,” says Seidelmann, whose Cleveland-based company primarily serves outpatient imaging centers, along with some hospitals, through its data centers in Florida and New York. Essentially, a customer approaches the company, indicating they have a multidetector CT and would like to perform CTAs. F&S then works with the customer’s technologists on image acquisition, making sure acquisitions are performed correctly. Once a study is performed, the raw, unconstructed images are transported to a data center, where they’re distributed to a radiologist who could be located anywhere around the country. The radiologist then does the reconstruction and provides the interpretation. “We believe that the radiologist actually has to do the reconstruction in order to provide the right interpretation,” says Seidelmann. “Historically, with CTAs, reconstructions are performed and the radiologist reads off of the reconstruction. But we feel that leaves a lot of data unavailable to the radiologist, so we give them the raw data, and they do the reconstruction and interpretation.” Meanwhile, as far as outsourced postprocessing, this is an area of teleradiology that is only going to grow. “We believe it is going to increase dramatically as the use of coronary CT increases, especially in the emergency room setting,” says Shea. “Almost everyone sees that value,” says Falk. “So far, the greatest acceptance has come from people who have already worked with multidetector CT technology, and it hasn’t turned quite as well as they thought. To them, the business model makes perfect sense.” — Dan Harvey is a freelance writer based in Wilmington, Del., and a frequent contributor to Radiology Today.
|
|
3801 Schuylkill Rd • Spring City, PA 19475 Publishers of Radiology Today All rights reserved. |