At ISCT 2010, Carestream used a PACS workstation to interpret three CT exams in the annual Workstation Face-Off. Image source: Carestream Health

In front of a full conference room at the International Symposium on Multi-Detector Row CT last week, Carestream Health, GE Healthcare, Philips, Siemens, TeraRecon, Vital Images and Ziosoft competed in the eighth annual Workstation Face-Off in San Francisco, yielding “impressive and surprising results,” the event's moderator Geoffrey D. Rubin, MD, said in an interview.

Under the newly-formed offices of the International Society for CT (ISCT), the conference--which had more than 550 attendees--is the second course of the society. According to Rubin, the first course was held in January of this year in Germany and had over 1,100 attendees. The structure and format of the course followed the same format as the past several years of the conference, consisting of nine-minute lectures covering the “full spectrum of ISCT technology and applications and is intended to focus predominately on state-of-the-art applications and integration of new technology, as well as covering particularly hot topics,” said Rubin.

For the last eight years, Rubin, a professor of radiology and associate dean for clinical affairs at Stanford University School of Medicine in Stanford, Calif., said that the Workstation Face-off has been one of the best attended and anticipated parts of the meeting, not only by professional attendees, physicians and technologists, but also the industry. And this year was no different, he noted.

Competing in this year's Face-Off, which was held on May 19, the seven companies participated in their presentation of three cases, screening for colon polyps, aortic valvular stenosis as part of a preoperative evaluation and evaluation of a patient with metastatic cholangiocarcinoma on experimental treatment, selected prior to the event by Rubin.

In selecting the cases upon which the competition is based, Rubin explained, “I want to give the audience the opportunity to see some of these substantial differences, as well as similarities between these different workstations in managing some of the more challenging aspects of image processing for CT data.”  Each year, Rubin selects cases that have not been touched upon by the event in years past to highlight strengths of, expose deficiencies and shortcomings of the implementations and “stretch the abilities of the workstations to their limits,” noted Rubin.

In his choices of case topics this year, Rubin said that one cardiac topic is chosen each year (aortic valvular stenosis as part of a preoperative evaluation), colon topics have been done intermittently (screening for colon polyps) and this year marked the first time a liver topic was done (evaluation of a patient with metastatic cholangiocarcinoma on experimental treatment). Each company is represented by a physician customer of the product that completes the task on their workstation while narrating to the audience their steps via a microphone, under a time constraint of four minutes.

New to the colon case this year were issues relating to fecal tagging and Rubin noted that it was the first time he had asked participants from the companies to use computer-aided detection for any topic. In this case, it was for the detection of polyps. He said that he also evaluated the ability of the workstation to provide supine and prone views, as well as the demonstration of effectively communicating the results to their referring physicians.

For the cardiac case, a patient with aortic stenosis was selected for the Face-Off. Rubin noted that he specifically chose a case that was not related to coronary artery disease, as it is very popular. He evaluated the workstations’ ability in quantifying the systolic areas of the stenotic valve, as well as the quantification of left and right ventricular ejection fraction and left ventricular mass, measurements that had never been asked of participants in the past, noted Rubin.

For the liver case, tumor volumetrics and characterization in a patient that had an aggressive metastatic neoplasm, who was on an experimental chemotherapy treatment method was evaluated.  The participants were asked to determine whether or not the patient was responding by identifying lesions.

Rubin said that it is helpful if the attendees have used workstations before. “I think that the audience this year took away from the Face-Off the fact that the workstations continue to all get better as a whole, but there remain substantial differences within the different workstations, with one perhaps excelling in certain areas and another excelling in other areas.”

Noting that no one company experienced any major mishaps, that there were no large segments of the tasks that couldn’t be completed and all tasks were completed within the four-minute window, Rubin said that overall the Face-Off ran smoothly and was “very impressive,” noting that he was surprised by the advanced capabilities of several of the workstations.

Despite the outcomes of workstation performance, Rubin said, “one of the fundamentals of the Face-Off is that there is value added for the participants and for the audience when it is complete.  There would be a lot less value added if there were claims of, or the determination of one company ‘winning.’”