The 3D Imaging Lab:In-house or Outsource?

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Staying abreast with (or, better yet, staying ahead of) the imaging-technology curve clearly follows a clinical imperative. Better imaging tools—in this case, 3D postprocessed reconstructions—have an immediate payoff for patient care. When a surgeon can use 3D imaging to measure and plan a vascular procedure better, for instance, the clinical outcome may be enhanced. Both patient and surgeon will then be rewarded, but so will the institution that offers the imaging service.

This is so frequently true that hospitals and health networks often opt for imaging-technology upgrades long before the financial reasons become apparent. Marketing clout and patient satisfaction can override direct ROI considerations.

One example is the 3D-imaging lab set up by Spectrum Health in Grand Rapids, Mich. Spectrum Health, organized in 1997, comprises seven hospitals and is Western Michigan’s largest not-for-profit health system. It had operating revenues in fiscal 2007 of about $2.3 billion, according to its Web site.

About four years ago, Spectrum committed to opening Western Michigan’s first (and still only) full-time 3D-imaging lab. Demand for the lab came partly from clinicians and the radiology departments of various hospitals, but an equally important impetus was Spectrum’s vision of itself as a provider.

“The opening of the 3D lab was part of the vision,” Shannon Culver, RT(R)(CT),the imaging specialist in charge of the lab, explains. “Our goal is to be up there with, or surpass, places like Massachusetts General Hospital, Stanford, and the University of Michigan.”

According to a Spectrum vision-statement excerpt provided by Culver, that goal was explicitly stated: “To be the nation’s highest quality and most successful health care enterprise by 2010.”

Culver himself was working at Spectrum as a CT technologist when he heard of the plan to open the 3D laboratory. He had already started work on a degree in computer information systems in order to add technology-related skills to his CV, he says. What he knew about 3D postprocessing and reconstruction intrigued him.

“I started to come in during the middle of the night and volunteered to learn it,” he says. “I was doing that for several months.” Watching the radiologists and learning from the 3D workstation vendor’s application specialist, Culver spent 15 to 20 hours per week reading and researching to get a better understanding of the fundamentals, and then sending samples to the radiologists for their review.

Culver was rewarded for his efforts by being named the new lab’s specialist, effectively, running the new lab. He began by doing CT reconstructions. The lab has since hired a second specialist to do MRI reconstructions. The lab does no ultrasound reconstruction, Culver says.

One Room

When the lab opened in 2004 at Spectrum’s Butterworth Hospital in Grand Rapids, it was located in a single room, where Culver worked alone. He now has his fellow worker, but the room is the same, measuring perhaps 15 by 20 feet.

Culver says that there are now seven 3D workstations at locations throughout the various Spectrum hospitals, but the 3D lab itself contains three of them. All use a thin-client server, with postprocessing application software residing on the server and accessed remotely through the workstations.

Images from as many as 10 CT scanners are autorouted to the 3D lab when postprocessing is required. The CT mix includes four 64-slice machines, but reconstructions are done using images from scanners with as few as 16 slices.

“We do everything from trauma injuries to pre- and postsurgical planning,” Culver says. “Most of it is an accessory to the original radiology dataset. Our vascular surgeons used to take their own measurements, but then they realized we could do the measurements for them, right off our workstations.”

When the images come into the lab for reconstruction, they are accompanied by patient histories, which technologists have sent by fax. “I do the reconstruction and send it out for interpretation to another hospital and the radiologist’s office.” When the reconstructions are sent, the patient histories are sent again, by fax, along with them. After that, Culver says, “The reconstruction will automatically append to the original study on the PACS.”

According to a Spectrum brochure on the 3D lab, the enhanced renderings can “minimize exploratory surgery, allow for noninvasive surgical planning, reduce operating time, minimize damage to healthy tissues