View From the Podium: Stanford MDCT Face-Off

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By stipulation, there were to be no winners when eight vendors of advanced imaging workstations and their physician teams competed in the Seventh Annual Original Workstation Face-off, held May 20 in San Francisco, California, at Stanford Radiology’s 11th Annual International Symposium on Multidetector-row CT. Even so, according to two radiologists who made presentations at the competition, the stakes were high because conference attendees might later be making purchasing decisions based on workstation performance at the face-off. Both physicians were ready to go when the signal sounded to demonstrate five cases of varying anatomical and clinical complexity.

Bernhard Meyer, MD

The face-off has become a highly anticipated event. Moderator Geoffrey Rubin, MD, told participants that the face-off was originally designed to give workstation vendors a level playing field to demonstrate their wares. “In theory, it is a level playing field,” William W. Boonn, MD, says, “but there is always the question of whether some vendors do some preprocessing.”

Boonn presented on behalf of Visage Imaging (Andover, Massachusetts); both he and the second Visage presenter, Bernhard Meyer, MD, say that they played strictly by the rules and postprocessed only on stage. Neither saw evidence that other vendors fudged, and say this year’s face-off went more smoothly than last year’s for all vendors, when a number of technical glitches could be observed for some of the cases.

Presenters prepare for the 2009 face-off.

“There were some differences, this year, in what tasks the vendors could do,” Boonn says. “Some did not perform the tasks within the time required, but it was hard to fault them fully. If someone makes a mistake, there isn’t time to fix it. In a real-world situation where you aren’t limited in time, that workstation would have done a fine job.”

The time constraints, which were severe, and the pressure of performing in front of an audience were both reasons that a winning solution couldn’t be named, Boonn and Meyer note. The larger reason was that some workstations fit well into use niches that others might not fill.

“One could not say that there was one system that performed best,” Meyer says. “Every system has its pros and cons. It was hard to compare them when you were sitting on stage waiting for your presentation. I wouldn’t say there was one that was the winner, in my eyes.”

Visage Thin Client

Meyer and Boonn both note that the Visage CS Thin Client/Server is different from other solutions presented at the face-off in that the Visage system relies on a server and accompanying software to perform image calculation, manipulation and processing. All viewing and postprocessing can be done on a PACS workstation, but also on an office computer like that of the typical referring physician.

Whereas other vendors were making their presentations using big, high-powered workstations, the Visage server box was connected to a conventional laptop computer. The images were displayed and postprocessed on the laptop, showing how adaptable the Visage system is to a hospital or multispecialty setting where technologists, radiologists, referring clinicians, and surgeons might have differing display and reconfiguration needs.

Presenters watch as a case is demonstrated.

“Visage is server based, and I can use any PC to access the server,” Meyer says. “There’s no special hardware needed for a thin client. We had a server there on stage, and I was using a very small laptop to do all this stuff.” Boonn adds, “It was impressive that the Visage system is fully thin client. We presented on a run-of-the-mill laptop with processing done on the server, so that was a distinguishing feature. We were able to get through all the cases with time to spare.”

Meyer notes, “The main advantage, with Visage, was that it was so easy to use, and there weren’t so many clicks and buttons. There were others that were quite good, but I’m not convinced I should use another system. I’m very happy with what I have.”


Boonn and Meyer were asked to present for Visage because both have helped the company develop specialized postprocessing applications. Both also presented for Visage in last year’s face-off. Boonn is chief of 3D and advanced imaging and associate clinical director of imaging informatics in the radiology department at the Hospital of the University of Pennsylvania in Philadelphia. He is also an assistant professor of cardiovascular