The increasingly widespread adoption of multidetector CT technology has opened a window of opportunity for experienced CT technologists to diversify their careers. Those who specialize in 3D image processing and reconstruction are avidly sought after in most, but not all, medical institutions.
Aspiring and expert 3D imaging technologists need to choose their place of employment with care, however. The type of 3D imaging opportunity available to technologists is influenced by various factors outside their control that can accelerate or limit the experience.
For example, a technologist in the right place at the right time may have an influential role in the implementation of 3D services, managing a 3D lab, or initiating a training program. The type and volume of 3D image rendering assigned to a technologist, however, may be determined by the proficiency in 3D of individual radiologists or by their level of interest in real-time diagnosis using 3D imaging tools.
Some facilities will generate a diversity of image processing assignments. Others will limit technologist involvement to generating the most time-consuming images, such as volumetric reconstruction that can take 20-40 minutes to generate. Procedure volume and department operational procedures will also determine if 3D imaging is a full-time, part-time, or rotational activity.
Or there may be no opportunity to do 3D imaging at all. Some departments believe that it's the clinical responsibility of the radiologist making the diagnosis to do his or her own 3D processing, and that it's inappropriate to designate this work to anyone else, even a resident or a colleague.
The type and volume of CT procedures at a hospital or imaging center will determine the diversity of day-to-day experiences. Also, 3D workstation software is still differentiated enough that the ability to use more than one vendor's brand will enhance overall expertise.
Traits of a successful 3D imaging technologist include significant experience in CT and/or MRI imaging; an in-depth understanding of scan protocols, cross-sectional anatomy, and pathology; creativity; and an aptitude for problem-solving skills, according to 3D technologists interviewed by AuntMinnie.com. Other important traits include inquisitiveness, attention to detail, perseverance, profound patience, a willingness to ask questions of radiologists and surgeons, and the comfort level to work closely with them.
The large, high-volume, dedicated, heavily staffed 3D labs such as the ones pioneered by Massachusetts General Hospital in Boston and Stanford University Medical Center in California remain unusual trendsetters. More common are the emerging small 3D labs serving a single hospital or a cluster of affiliated facilities with one or two 3D techs.
Saint Alphonsus Regional Medical Center in Boise, ID, opened a dedicated 3D lab in 2004 that averages 200 procedures a month. Lead CT technologist Chris Hayden initially taught himself how to use 3D software in moments of idle time working nights and weekends.
"You sit down at an empty workstation, read the manual, and start experimenting," he said. "I was recruited for the 3D lab position because of this experience and my interest in the capabilities of 3D software."
The dedicated lab also provides 3D imaging services on an as-needed basis for the two imaging centers of Intermountain Medical Imaging. Each center has an onsite CT technologist proficient in image processing but whose primary responsibility is to perform CT procedures. The technologist transfers procedures to the 3D lab at Saint Alphonsus over dark fiber if the schedule is heavy or if a procedure like a CT angiography is scheduled at the end of the day.
Workload balancing and rapid 3D imaging turnaround reflect the department's philosophy to optimize radiologists' efficiency and is one of the reasons that the 3D lab is staffed from 7:00 a.m. to 11:30 p.m.
"If I can cut just two minutes per study for a radiologist by doing reformats or 3D work, I can save that radiologist 40-60 minutes a day," Hayden said. "We adhere to strict protocols, so the radiologists know exactly what to expect."
When Hayden isn't working with 3D software, he works on protocol issues and supports the CT technologists in his capacity as lead technologist, doing exams when needed.
Shannon Culver doesn't feel isolated as the only full-time 3D imaging technologist in western Michigan. His employer, Spectrum Health of Grand Rapids, opened a dedicated 3D lab in January 2005. Culver was still learning how to use 3D software when a position was posted to be the single 3D lab employee.
"In January, there were only 50 procedures to do, which gave me time to become proficient and also give myself a crash course in advanced anatomy and pathology," Culver said. "When it became apparent that the demand for processing of cardiac imaging was escalating every month, I needed to make a decision to stay on and go for the ride, or jump off and hand the job to somebody else. It's been an exhilarating ride."
By December 2005, the number of monthly procedures had risen to 250. Culver is enthusiastic about the diversity of the types of studies performed at Spectrum Health that require postprocessing.
"I get exposed to a multitude of studies: coronary procedures, traumatic injuries, cancer, the morbidly obese patient, and a wide variety of scans from head to toe," he said. "No day is ever the same."
Culver believes that his relationship with radiologists and surgeons has been enhanced. He was mentored by the radiologist most influential in implementing the dedicated 3D lab.
"I communicate more with the radiologists than I used to because they explain to me what they are trying to see," Culver said. "We work hand-in-hand so that I can produce the images they need. They ask me if I can help them visualize something in a different way. And I feel comfortable asking them questions."
Another professional benefit is the opportunity to talk with the vendor's product development managers and application specialists about ways to improve 3D software.
Working with radiologists to develop protocols for 32- and 64-slice CT scanners has enriched Randall Jorgenson's career. A CT tech who transitioned into MRI, he was recruited by the Center for Diagnostic Imaging to be chief CT technologist of its Federal Way, WA, freestanding imaging center. He supervises the CT staff, manages the 3D program, and trains his colleagues in 3D imaging.
Onsite applications training provided the basics, but Jorgenson says he perfected his skills by calling his vendor's help desk whenever he had a question that wasn't answered by the user's manual.
"Everybody on that help desk got to know me," he observed. "But the questions I asked were valid. Of paramount importance is to fully understand how to perform the exam and to have the right dataset of images to work with. You need to know when what appears to be a routine exam is not, and to be able to identify motion artifacts and a breach of scanning protocol."
3D is dynamic, similar to ultrasound, according to Jorgensen.
"I can make things appear or disappear," he said. "It's imperative to have a solid understanding of cross-sectional anatomy to produce clinically valuable images."
Another site, King's Daughters Medical Center in Ashland, KY, is doubling the number of its MDCT scanners from four to eight, and its use of 3D imaging is escalating. Lead CT technologist Jeffery Caudill spends 80% of his day doing 3D imaging and 20% in training support.
After formal offsite training, Caudill worked directly with a radiologist trained in 3D so that he could emulate exactly what the radiologist wants done. He says that the most successful 3D techs are like artists who see through the perspective of radiologists' eyes. Caudill stresses the need for close collaboration between radiologists and technologists.
The 16-slice scanner at Langlade Memorial Hospital in Antigo, WI, generates only a handful of exams each week that require the 3D imaging skills of CT scan team leader Tony Wadzinski. He feels that his job has more responsibility, though, with the addition of 3D.
Lee Goodwin, the CT technical coordinator of a technologist staff of 48 at Northwestern Memorial Hospital in Chicago, supervises all 3D CT imaging activities in this large department, and is the person who directly interacts with the team of "supertechs," who do complex postprocessing on a rotational full-time basis.
Goodwin works directly with a CT section head who represents Northwestern's team of CT subspecialists. This communications structure for 3D is very formal, but is the most effective to maximize workflow, he said.
Radiologists' role
A number of radiologists believe that in spite of technologists' expertise, they should not be doing 3D because it requires interpretation that is the responsibility of the person making a diagnosis.
Dr. Elliot Fishman, director of diagnostic radiology and body CT at Johns Hopkins Medical Institutions in Baltimore, believes that 3D imaging used for diagnostic interpretation must be created by the radiologist.
"With 3D, the images you create are based on what you see when you do the study," Fishman said. "If somebody else creates the images for you, then you are relying on their interpretation of what they thought was important about the image. In almost any 3D case, I could intentionally leave information out, or create misleading information, depending upon how I render. That is how 3D is."
Dr. Henry Krebs, chief of radiology of Saint Joseph's Hospital of Atlanta, concurs. He feels that radiologists must become proficient with 3D imaging software, especially since many postprocessing applications have become more automated and easier to use. He believes that while technologists may do an excellent job of 3D imaging, they may not have access to the patient history, comparison studies, or know the reason why the scan is being done and what specific clinical problems they should be looking for.
Krebs estimates that his use of 3D software increases the amount of time he spends looking at a particular exam by 20% to 25%.
"The information that I can provide to my surgeons and other physicians is far worth the extra minutes of time I spend incorporating 3D imaging," Krebs said. "It saves me from repeating exams or recommending additional studies, and it may allow me to be much more accurate in my diagnosis."
Does 3D imaging represent a limited opportunity that will be overtaken by improvements in automated 3D postprocessing and by 3D-savvy radiology residents who have no need for 3D imaging support? Only a crystal ball can predict whether 3D imaging will evolve into its own specialized discipline or be of value for the period of time required for software development to achieve a desired level of intelligent automation.
Right now, the technologists who've taken the plunge say that the career enrichment 3D imaging provides is worth the effort. Those interviewed for this article don't expect to be obsolete any time soon.
By Cynthia Keen
AuntMinnie.com contributing writer
April 25, 2006
Related Reading
3D ultrasound predicts fetal pulmonary hypoplasia, April 21, 2006
Part 1: Automated CT lung nodule assessment advances, April 17, 2006
Expanded role looms for 3D in breast imaging, April 11, 2006
Setting up a cutting edge 3D lab, April 7, 2006
Technological advances drive new 3D CPT codes, February 21, 2006
How to find and train a 3D technologist, June 17, 2005
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