Use of 3D advanced visualization technology has become a routine part of the interpretation process for the vast majority of radiologists and cardiologists, according to a survey presented at the 2006 RSNA meeting in Chicago.
"Given the extent of the use of both MPRs (multiplanar reconstructions) and MIPs (maximum intensity projections), these tools should no longer be considered advanced visualization tools," said Dr. Krishna Juluru, an imaging informatics fellow at the VA Maryland Health Care System in Baltimore. "They really should be part of the routine interpretation process."
Juluru presented the research, which was a collaborative effort between the VA Maryland Health Care System; the University of Maryland School of Medicine in Baltimore; Stanford University School of Medicine in Stanford, CA; and GE Healthcare of Chalfont St. Giles, U.K.
To assess the current need for an integrated 2D/3D PACS network and the utilization of 3D visualization tools by various practice environments, the study team created a Zoomerang survey. Invitations were then sent out using an e-mail marketing list of clinicians using imaging services.
The 30 questions, most of which were multiple-choice, were designed to assess the type of practice, responder's status, available facilities and 3D visualization tools, the impact of 3D visualization on the interpretation process, and communication with referring physicians, according to the researchers.
Of the 103 responses, 54% were from academic institutions, 24% were from private practices, and 12% were from community hospitals. The remainder were from government, military, HMO, and teleradiology sites, Juluru said.
The respondents included academic radiologists (31%), cardiologists (25%), private-practice radiologists (20%), radiology residents (13%), and radiology fellows (5%). Cardiology fellows and technologists rounded out the sample.
When asked if they currently review CT or MR images using multiplanar or 3D reformatting, 96.2% of radiologists and 92.3% of cardiologists said they did. The difference was not statistically significant (p = 0.595).
When asked who usually creates multiplanar, 3D, or volume-rendered images for interpretation, 79.2% of radiologists and 69.2% of cardiologists said they created images personally. The difference was not statistically significant (p = 0.40). Other options included another radiologist, technologist, fellows, and residents.
Overall, users learned 3D visualization techniques from training by vendor employee (51.5%), on their own (51.5%), by a radiologist (28.2%), from printed instruction manuals (26.2%), online resources (23.3%), by a radiology resident/fellow (9.7%), and from technologist or 3D lab personnel (11.7%). Users could select more than one form of training.
Of the academic radiologists, 65.5% learned on their own without training, compared with 47.6% of private-practice radiologists. There was no statistically significant difference between the two groups (p = 0.20).
When comparing radiologist and cardiologist respondents, 58.5% of radiologists and 38.5% of cardiologists learned on their own. Again, the difference was not statistically significant (p = 0.15).
Sixty-six percent of radiologists reported they learned or are learning 3D visualization techniques from training provided by a vendor employee, compared with 42.3% of cardiologists. The difference was not statistically significant (p = 0.55).
In other questions, 96.1% of radiologists and 83.3% of cardiologists answered that the availability of coronal reformats increased their diagnostic confidence. The difference was not statistically significant (p = 0.08).
When asked about MIP images, 82.4% of radiologists and 95.8% of cardiologists said those images increased their diagnostic confidence. There was no significant difference between the groups (p = 0.15).
3D visualization was extensively used by more than 92% of cardiologists and radiologists in the sample, Juluru said.
"By various means, whether it's personal training, from the vendor, or from online resources, these groups are learning to use 3D visualization as part of their interpretation process, and they find it very valuable," he said.
Given the widespread use of 3D visualization, there is an increasing need for a PACS network that can generate 3D and multiplanar images as part of the routine interpretation process, preferably using automated hanging/display protocols, Juluru said.
"The days of a (standalone) 3D workstation are numbered," he said.
By Erik L. Ridley
AuntMinnie.com staff writer
December 18, 2006
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