Advanced visualization (AV) is no longer defined by image manipulation alone. Today's users demand solutions that tightly integrate primary reads, reconstruction, image management and data distribution, with clinical enhancement capabilities that are flexible, accessible, reliable and upgradeable.

Thick clients that require entire datasets to reside locally are "a thing of the past," says Rob Royea, vice president of sales and marketing for Ziosoft, as customers require sophisticated processing at the point of care. Via thin-client and centralized server technologies, advanced visualization providers are solving the challenges of image review and flow for multiple users.

TeraRecon Inc. simply states: "Our innovations greatly reduce the need to search, pull, push, store and process images manually."

Anytime, anywhere

Vendors seek to combine thin-client technology with "smart" client-side caching, according to Hartmut Schirmacher, PhD, director of product management for Visage Imaging, "so that you can still do everything on any computer regardless of its location and capacity; but you always get the best possible performance for viewing and processing data.[with] a single application for reading and processing everything from anywhere." This trend was apparent at the Radiological Society of North America's (RSNA) 95th Scientific Assembly and Annual Meeting late last year.

The sheer volume of imaging data sets acquired by today's scanners has changed industry's ideas about thick-client workstation solutions. They're neither cost-effective nor efficient. Users still need advanced high-performance visualization technologies for image access and interaction in a timely, proficient manner.

The key to achieving massive scalability, according to Jeff Sorenson, VP of sales for U.S. and Canada at TeraRecon, "is the ability to render hundreds of thousands of images simultaneously using a very small amount of off-the-shelf computing hardware, and the ability to deploy these render nodes using image management methods."

Simplicity in function is often paramount for getting automatic, understandable and reproducible interpreter results. Ease-of-use and cost-effectiveness drive these demands.

Critical communication

Server solution options ensure on-demand image access outside the walls of diagnostic imaging reading rooms across the continuum of care, says Mark Wagner, director of product management at Calgary Scientific. "A specific benefit of the convenient access to and sharing of medical images is increased communication and collaboration between radiologists and other health care professionals," further enhanced by the convenience of mobile device capabilities, Wagner also notes.

"With the strong trend of enterprise solutions for advanced visualization enabled by the pervasiveness of GPUs [graphics processing units], there is now ubiquitous access of 3-D visualization for patient-physician, physician-physician, and physician-surgeon/specialist communication," says Kimberly Powell, a medical sales rep at NVIDIA, citing the collaborative value of ultra-thin client solutions.

The ability to navigate cases across multiple modalities and specialties improves patient care by simplifying and streamlining workflow. Siemens Healthcare notes that via tight PACS integration to cardiology, oncology and neurology from various vendors, their software supports efficient volume-based reading and pre-processing, optimizing multimodality planning.

"Advanced visualization systems no longer benefit only a single department," says Royea. "Any care area that can benefit from assessing the body in three or four dimensions over time is a beneficiary. Surgical and oncology planning are ideal areas where AV can have an immediate impact on the way clinicians treat their patients."

Clinical, secure use

According to J. Martin Pfaff, PhD, president of Intuitive Imaging Informatics, specific, common areas for quantitative techniques include calcium scoring, cardiac wall thickening and ventricular function, flow analysis, stenosis measurement, mammography computer aided detection (CAD) and PET fusion. Physicians can easily assess both anatomic and functional information both visually and quantitatively, improving interpretation and diagnostic delivery speed.

Additionally, data access for image delivery and manipulation must be efficient and secure. With VPN technology's limited scope of delivery, some vendors are using Secure Socket Layer (SSL) technology for clinical access. Employed by the online banking industry, this technology provides data encryption between the server and the workstation no matter what wide area network is being used, explains Dr. Pfaff. Ideally, clients run the solution natively and securely within a Web browser with no need to download software, says Sorenson of TeraRecon, which provides HIPAA-compliant security via SSL.

Keys to success

Advanced visualization is becoming the norm for all PACS workstations, and anytime/anywhere access will grow continuously in value to hospital enterprises, says Powell. Workflow will be further automated, says Nikolaus Bolle, vice president of product marketing, syngo.via, image and knowledge management, Siemens Healthcare. "The entire reading of medical images will become client-server based and be supported by modern algorithms for segmentation, registration as well as various visualization techniques."

Royea emphasizes that AV won't be defined just by "viewing pretty pictures." "The accumulation and display of sophisticated data should result in FDA-approved applications, not just a different way to display data . Our future will depend not upon obtaining more data, but on how we process that data to effectively produce measurable results and improved outcomes through advanced imaging algorithms."

Facilities want a technology that allows them to improve outcomes, efficiency and care while containing costs. Vendors must show value through innovation and integration with PACS, RIS, HIS and the EMR, providing a reduced total cost of ownership, says Dr. Pfaff.

"Access is key for AV," agrees Dr. Schirmacher, noting the demand for native integration. "[When it's] poor, this breaks workflow and productivity. PACS and AV must grow together quickly, and become one solution for all radiology and diagnostic imaging tasks."

"The biggest hurdle has been to 'commercialize' the technology so that it's become commonplace on off-the-shelf computers, while maintaining high-end servers to provide 'high availability' resources for critical care facilities," Dr. Pfaff says. "The ease of access to demographic, visual and quantitative informatics has improved speed and quality. We need to continue to develop technology that not only improves the quality of health care, but also reduces the cost of delivery."

Kerri Reeves is senior associate editor of ADVANCE.