Advanced visualization adds new practice dimension
It’s been said that a picture is worth a thousand words; when it comes to the deployment of advanced visualization technology in cardiology, an image may be worth even more in referrals, according to practices that have adopted it.

“The whole world has been changed by the advent of ultrafast, multidetector cardiac CT,” said Robert S. Schwartz, MD, FACC, a cardiologist with the Minneapolis Heart Institute in Minneapolis. “It gives us extremely rapid three-dimensional images, which allows us to capture the entire beating heart.”

The downside to this achievement is that massive amounts of data are generated to deliver the 3D data sets from today’s multi-slice CT systems, Schwartz noted.

   Image courtesy of TeraRecon.   “One needs to be able to handle those massive amounts of data in a very efficient and facile way to make a diagnosis,” he observed

The adoption of advanced visualization tools provided his practice the capability to look at 3D representations through time, essentially delivering a 4D image: three dimensions in space, one dimension in time.

“This gives us the capability of looking at all structures of the heart, completely and accurately,” he said.

The implementation of advanced visualization at the Minneapolis Heart Institute was driven by an uptick in coronary CT angiography (CCTA) studies.

“Our CCTA service line really started to take off once we got high-speed multi-detector CT systems,” Schwartz noted. “We simply could not handle the huge amount of interpretative data being put out by these systems in an efficient manner. The workload we would have had by not having advanced visualization technology in place would have been simply staggering.”

Prior to the deployment of advanced visualization tools in the practice, the interpretation time for a CCTA procedure was anywhere between 20 and 30 minutes per exam.

“Since we’ve deployed our advanced visualization system, our read time has dropped down to 3 or 4 minutes for the more straightforward exams. More complex exams, of course, take a little longer,” he said.

An additional benefit of the technology has been the ability of the cardiologists to consult more efficiently and effectively with their referring clinician base.

“Because of the efficiency of the software, we’re able to be doing something else, put it aside, and pull up a 3D image and review it with a clinical colleague in a very short space of time; we’re quickly able to demonstrate the exact results of an exam,” Schwartz said.

Referrals to the practice have also increased since the addition of advanced visualization tools.

“We’re seeing more referrals since we adopted the technology; we’re able to send the reconstructions over the network or burn a CD that a referrer can take with them,” Schwartz said. “Many times, it’s the patients who want a CD of their 3D images—and we’re happy to help them out with that because it’s good for patients to understand their disease. It has a positive impact because patients can see their disease; so they’re much more likely to loose weight, to exercise, to do all those things that they’re supposed to do.”

From Schwartz’s perspective advanced visualization represents a disruptive technology for cardiology practices; as it has the capability to positively impact workflow, diagnosis, treatment and outcomes.

“It’s definitely a necessity, the sooner you get into it, the sooner you become good at it and it markedly advances your ability to take care of patients,” he said.

   Image courtesy of Visage Imaging.   Michael Ridner, MD, a cardiologist at the Heart Center in Huntsville, Ala., and an associate professor of medicine at the University of Alabama School of medicine in that city, has also found the addition of advanced visualization technology to be a boon to his practice’s capabilities.

“What it has allowed to provide is network-wide visualization of cardiac CT angiograms, at any site, in any location,” he said. “This permits the cardiologists in our practice to work on these exams anywhere, including at home. In addition, we’re able to share our 3D reconstructions in our consultations with our referring physicians, as well as with the patients.”

He also has noted a change behavior as a result of sharing 3D images with patients.

“The technology allows us to provide patients with a very compelling image of their diagnosis,” Ridner said. “By showing them an image of their arteries, we are able to convincingly demonstrate why they should follow the therapeutic regimen that we’ve laid out for them.”

The technology has paid unexpected dividends in the Heart Center’s affiliation with local hospitals. He noted that the cornerstone of the advanced visualization software is for diagnostic purposes in the practice, but it has expanded its capabilities well beyond that primary utilization.

“In the ER, we’re able to perform a reconstruction in the department and make a decision as to whether a patient should be admitted or released, which vastly expedites the workflow in that department for patients presenting with chest pain,” Ridner said.

Other clinical departments in their hospital client base have also sought access to the technology, with very positive results.

“It’s also shown great benefit for our cardiothoracic surgeons, where we’ve had a large screen display installed in the operating theaters for their use,” he said. “The surgeon can call up the 3D image in real time and use it to determine anatomy in order to better guide their surgical intervention.”

The success in the operating rooms has led other interventional groups to utilize the advanced visualization images from the Heart Center.

“We’ve also started using advanced visualization technology in our peripheral vascular lab,” Ridner noted. “This has allowed the clinicians to use the image to plan their intervention without having to take additional guiding images of the patient for their procedure.”

To demonstrate the capabilities of advanced visualization technology, Ridner and his partners at the Heart Center offered their entire referring clinician base the opportunity to have a no-cost CT heart scan conducted. They then performed 3D reconstructions and met with the physicians one-on-one to show them the images and discuss the results.

“We had more than 300 doctors take advantage of this opportunity,” he said. “What happened is that when they saw the results, they were sold for life.”

   Image courtesy of Vital Images.   Elliot Fishman, MD, professor of radiology and oncology at the Johns Hopkins University School of Medicine in Baltimore and director of diagnostic imaging and director of the division of abdominal imaging and CT at the Johns Hopkins Hospital has been a long-time user of advanced visualization technology.

At a recent meeting of the North American Society for Cardiovascular Imaging in Phoenix, he offered practical advice for a private practice looking to place the technology into its service line.

“The first thing, of course, is the ability to acquire the data sets,” he said. “So, whatever CT scanner you need to know how to use the scanner well. You need to have it optimized, because when all is said and done unless you have a good data set, nothing else happens.”

Achieving expertise on the advanced visualization application is the next step a practice must take for successful deployment of the technology, Fishman said.

“The interpreting clinician must gain expertise on the advanced visualization software; it’s this post-processing that allows you to make an accurate diagnosis,” he said. “You need to know how to do the post-processing both accurately and in a timely fashion.”

Fishman stated that the reasons most often cited for not performing cardiac CT studies are that it’s too hard to get the data and its too time consuming in the post-processing of the image data.

“Advanced visualization applications have changed—they’re much better; the tools are easier, simpler and more quantitative, but you still have to learn how to use it,” he said. “I strongly recommend that, as the interpreting physician, you know how to do it yourself. It can’t be something a third-party does and then gives you the information—you need to be interactive with the data set or you’re just not going to feel comfortable reading the studies.”