Enterprise Visualization in the Pediatric Environment

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The worst advanced visualization system in the world for a pediatric setting is one wherein the only way that referring physicians from across the organization can see 3D reconstructions of diagnostic images is by physically visiting a radiologist at his or her workstation.

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Stuart Royal

“Believe it or not, this is still a far too common way of conducting business—this having to look over the radiologist’s shoulder and then ask for a view that’s rotated perhaps a little more this way, and then a little more that way, before ultimately getting just the desired view,” according to Stuart Royal, MD, MS, radiologist in chief at Children’s Hospital of Alabama in Birmingham, which boasts the fifth-largest pediatric radiology department in the nation.

It does not help if the enterprise visualization system in question is based on a state-of-the-art RIS/PACS solution that distributes 3D images everywhere, but requires the actual processing of the 3D images—the reconstructions themselves—to occur at a thick-client workstation located in the radiology department.

That was the way that 3D reconstructions were performed at Children’s Hospital until 2007, when the institution switched from workstation processing to server processing, a vastly more efficient and effective method. “It is now possible for our radiology customers, wherever they might be in the hospital or out in the community, to access, from their particular locations, the 3D images they want, when they want, and to manipulate them in the manner they want,” Royal says.

Thick as a Brick

The problem with processing 3D reconstructions at the workstation—also known as the thick-client approach—is its impracticality in an enterprise with more than a handful of customers. Part of the reason is the data volume generated by 3D CT and by multiphase, contrast-enhanced, and functional MRI studies. The huge (and growing) number of slices produced by these modalities pushes the limits of an organization’s IT infrastructure, causing traffic slowdowns network wide.

“With a thick client, it takes time for the image data to migrate down to the workstation,” Royal says. “Each time the user wants to manipulate the image, even just a little, the full set of data must be transmitted to the workstation.”

It’s not just the need to move a heavy payload of data from a server to the workstation repeatedly that creates problems, however; it’s also the fact that 3D reconstructions performed at the workstation require exorbitant amounts of processing power. That can be expensive. The cost is not so great if the enterprise visualization solution involves a handful of workstations, but it will turn very costly once the number of workstations required extends to tens or hundreds. In a similar vein, implementing updates of the reconstruction software residing on each workstation in a sizable enterprise imaging environment can be a chore involving monumental expenditures.

Server-side processing, or the thin-client approach, carries none of these liabilities. “Thin client means that all of the image manipulations take place on a central server before being transmitted to the workstation,” Royal says. “Consequently, the processed image is available for viewing at the workstation almost instantly, yet traffic on the network is not significantly increased, and in some instances, may actually be reduced.”

Software updates are easily implemented, since only the programming of the server needs to be altered in order to affect all users. Whatever changes are made to the software automatically show up on each user’s computer the next time it’s used.

Thin Is In

At Children’s Hospital, the foundation of enterprise visualization is a highly evolved, integrated RIS/PACS that includes voice-recognition software. “We wanted enterprise-wide access to 3D images because we felt it would increase the efficiency and productivity of our radiologists and our customers,” Royal says. “We also wanted our referring physicians to have the tools necessary to perform their own 3D image manipulations, but before you can achieve good things systemically, you first must have a good, efficient solution in place. You can have the best enterprise image-distribution technology in the world, but what good is it if it takes three days to get out a report of findings?”

The quest to achieve all this via server-side processing led Children’s Hospital to acquire thin-client technology from Visage Imaging, Andover, Mass.