Cardiovascular Business - October/November 2007 - (Page 39) Cardiac Cta volume reconstructions on the terarecon aquarius workstation highlight the coronary vessels: calcification in the proximal and mid portion of the laD, extracted coronary vessels without disease, and 3D volume rendering of extracted coronary tree including aortic root with color masks applied to cardiac anatomy. a clinician using terarecon workstations performs 2D and 3D chest-lung image review. very uniform picture elements to twist the images around without losing fidelity. That’s the result of a combination of improvements, says Rumberger. That comes with new considerations, however. “The electron beam images of 10 years ago might have been 60 to 70 images,” he says. “Now we’re talking about 3,000 to 5,000 images.” Newton started the cardiac CT imaging program at the South Carolina Heart Center in 2003 and the team learned as they went along. “In the beginning, there were no experts so we learned by doing. We developed our protocols, our own patient selection criteria, our pricing structure, our relationship with the local radiologists, and a method to look at the economic impact of CT scanning in the practice. We had to learn about networks, storage systems, and over-reading for quality assurance. We marketed our CT service and had to meet the demand we created with quality reports delivered to the referring doctor quickly.” These large volumes of information stressed the network terrifically so they developed a means, now commonplace, for a scan to be done in South Carolina, over-read in Arizona, and reported the same day back in South Carolina. Today, most centers have broadband networks and quick commercial connectivity. In the future… Despite the rapid technological changes that have already occurred, more advances are in the works for 3D imaging. Further advances in CT technology will continue to reduce the radiation dose and that will eliminate the safety arguments of cardiac CT, says Newton. The ability to take a snapshot of the heart with one momentary exposure with only 20 percent of the radiation exposure used now, takes “a very significant bite out of the risk element. That will probably arrive with the next generation of scanners.” More information about cardiac function and coronary artery perfusion will follow that, Newton says. How well the heart contracts and other details will soon be extractable from CT. “I think it’s just getting started,” he says. Rumberger anticipates increased ability to use advanced visualization software from any location, allowing for more convenient reading. Thin-client systems allow clinicians to log in on a standard computer from any location. “All of the heavy lifting is done by the server,” he explains. That breaks down the barriers of location, says Newton, and offers “the ability to move the images around to people who are wide awake or have particular expertise.” It is common in cardiology to comment in reports on several elements, even when those elements are normal. So, better integration of the reporting and reading tools would be welcome, says Bush. “Measurements are thought to have some value,” so the ability to add to the report during interpretation rather than dictating all the details at the end would be helpful. Aside from technological improvements, new applications may be on the horizon, says Lesser. “We’re going to try to see if 3D imaging can help not just with diagnosis but guide therapy.” Regardless of when the capability comes into practice, Lesser says the progress already made is “incredible.” CardiovascularBusiness.com Cardiovascular Business 39 http://www.CardiovascularBusiness.com
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