June 19, 2006

An afternoon series of 10-minute talks on Day 3 of the Stanford Radiology 8th Annual International Symposium on Multidetector-Row CT, Friday, June 16, focused on optimizing workflow for the prolific 64-slice scanners. Guest lecturers discussed a wide variety of settings—from major research hospitals to community radiology practices—and an equally broad array of challenges, including those posed by workstations, software, ergonomics, and different patient conditions.

Elliot K. Fishman, MD, director of Diagnostic Radiology and Body at Johns Hopkins, began his presentation on the subject with a quote from Da Vinci: “Simplicity is the ultimate sophistication.” How to attain that sophisticated simplicity, however, was the question on everyone’s minds as expert after expert provided models for managing the exploding amount of information gathered by 64-slice scanners.

Ergonomics were increasingly in focus, with operator discomfort costing valuable minutes in already-overloaded post-processing labs. Speakers applied writing advice from Oliver Stone—“keep butt in chair”—to demonstrate the necessity of ergonomically-contoured and intuitively-designed workstations.

Fishman emphasized the importance of dedicated post-processing tools. “3-D post-processing is a critical clinical service,” he said. “It’s not optional.” He hinted at a client server model soon to be launched at Johns Hopkins, but purposefully kept details vague.

Geoffrey Rubin, MD, chief of cardiovascular imaging at Stanford University, highlighted Stanford’s workflow methods, which include employing 5 full time technologists and, interestingly, a software engineer. Stanford uses internally-developed software which “really facilitates” processing, churning out reproducible reports, detailed measurements, complex segmentation and a reliable archive entirely on-site.

In discussing which rendering tasks can be automated, Stanford’s Laura Pierce, MPA, RT (CT), 3-D Laboratory Manager, touched on computerized segmentation, generation of centerline paths, and creation of curved planar reformations. Allowing software to take over for humans in these areas, she noted, can shave one to three valuable minutes off processing time. But she added, “Humans have been shown to be better than computers at anatomical identification.”

While perspectives on how best to streamline post-processing were varied, the problem of workflow was considered ongoing, if not escalating, by each presenter. With data flooding in and reimbursement decreasing, efficiency is paramount. “3-D rendering, if done correctly, is indeed very profitable,” Fishman said. “Technology defines the potential possibilities of what we can do with CT.”