Creating a More Efficient Workflow for Reading High-Volume CT and MR Studies

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1 Creating a More Efficient Workflow for Reading High-Volume CT and MR Studies Summary Advancement in modality technologies has brought benefits to radiology, such as quicker image capture and enhanced image resolution. However, these advantages have also resulted in a substantial increase in the amount of information available for interpretation. Since 2002 there has been, on average, a four-fold increase in the number of images a radiologist has to review in a single day. This volume change is primarily due to the increase in the thin-slice capabilities of CT (computerized tomography) and MR (magnetic resonance) scanners. As the amount of available data rises, so does the amount of time a radiologist requires for interpretation. The use of embedded multiplanar reconstruction tools, which allow for efficient manipulation of the data, allows radiologists to take advantage of modality advancements while simultaneously providing a streamlined and effective workflow. The Progression of CT and MR Technology In the early 2000s, CT scanner technology averaged eight to 10 slices per rotation. The resulting data sets were relatively small and manageable in the reading process. In 2002, 16-slice CT scanner technology was introduced. Although this technological advance at a minimum doubled the amount of data produced, it produced a reasonable number of images per study, which allowed radiologists to continue primary interpretations without a real impact to their productivity. From 2004 to 2009, modality vendors introduced 64-, 128-, 256- and even 320-slice CT technology. Although these advancements have enhanced patient care by acquiring better quality images in less time, the resulting volume of data per study has left radiologists feeling overwhelmed. And with MR scanners following a similar path of advancement, PACS vendors needed to provide a solution that meets the changing reading needs of the radiologist by allowing for quicker interpretation of CT and MR studies. The Problem Solutions currently available for reading large volume CT and MR data sets do not provide an efficient streamlined workflow that improves radiologist productivity. Vendors simply repeated the process with the same workflow tools used for smaller studies. This approach results in lost productivity as the number of studies a radiologist can read in a single day is reduced. This reduction, in turn, leads to slower turnaround time in patient diagnosis and care and more workload (longer days) for the radiologist.

2 2 The Current Industry Solution There are a number of advanced visualization vendors offering a wide variety of tools and viewing features for manipulating CT and MR data sets. Although these solutions have been available as standalone systems, PAC-integrated, advanced visualization tools dramatically increase radiologists productivity. Ideally, a solution that uses the power of display protocols and allows this advanced functionality to be embedded within the protocol itself would provide the greatest efficiencies to the radiologist. Multiplanar views, slab, projection and oblique angle visualization are the most common advanced visualization tools used by radiologists. These tools can be used on the majority of CT and MR studies, and they promote efficiency within the workflow by reducing the amount of time required for a radiologist to interpret a study. These tools also assist with accurate diagnosis, which leads to improved patient care. The general workflow involved with these solutions involves the launching of a third-party application from the PACS workstation. Although this approach provides the advantage of offering PACS and advanced visualization capabilities on a single workstation, it often still requires a manual launch and load requirement. As a result, users have to continually launch a third-party application to use the tools, adding extra steps, disrupting the continuity of their reading process and losing context between the previous studies and current high-volume interpretation. Some users may choose not to launch a third-party application because of the disruption and thus miss out on the benefits of using advanced visualization tools. To overcome this problem, commonly used advanced visualization tools should be natively embedded within a PACS solution. This solution would provide efficiencies in workflow, reducing the amount of time required to interpret a study, increasing the accuracy of diagnosis and improving patient care. The Next Step: Intelligent Display Protocols Ideally, a solution that uses the power of display protocols and allows this advanced functionality to be embedded within the protocol itself would provide the greatest efficiencies to the radiologist. For example, a radiologist who prefers to read the majority of CT lung exams in a 4mm slab coronal MIP format should have a display protocol that automatically loads the exam with these fields set. A Step Further: Efficient Comparison Although there are efficiencies to gain with native advanced visualization tools that launch automatically within predefined display protocols, the ability to view sequential studies side by side with these same tools is equally important. Most third-party vendors only allow the interpretation of a single time point exam. This approach results in the radiologist

3 3 consecutively launching each exam into the application to use the tools required. Ideally a solution would provide the ability to view multiple studies at the same time while providing access to the most common advanced visualization tools. Trend analysis would be further simplified by providing automatic navigation between current and prior studies. For example, substantial efficiency would be gained if a system was to use marked lesions from prior studies and quickly or automatically locate the same lesions on a current study. Tools that assist with locating a previously marked lesion in a volume would also be beneficial. It is also important to consider the impact of large CT and MR data sets after the primary read. Modifying the oblique angle of captured data may make the reading process easier; however, downstream users attempting to locate lesions may find the process challenging. A solution must exist that allows physicians or downstream clinicians to easily locate the area of interest that was referenced within the study by the interpreting radiologist. This solution must also include the ability to return to the exact area and presentation used at the time of interpretation. This approach would include any modified parameters such as slab thickness, projection, window/level and zoom/pan. Usability It is important not to forget the impact that the usability of a product has on the end users. When PACS vendors integrate with third-party solutions, the user interface (UI) for the launched application is often different from the interface of the PACS environment. This situation requires users to learn different interfaces and interactions, including keyboard and mouse shortcuts for each system. Not only do users find this situation frustrating, facilities implementing these solutions find that training often takes longer and is more involved, requiring additional ongoing support. A unified interface would allow users to quickly become comfortable navigating and manipulating images with advanced visualization tools. Radiologist reading times would further decrease, and productivity enhancements would be realized by the radiology department. When considering an investment in a PACS and/or third party advanced visualization solution, the following questions should be addressed: Does the vendor natively offer the most common advanced visualization tools? Are the advanced visualization tools integrated as part of the user-defined display protocols?

4 4 Is the launching and use of the tools seamless within the standard interpretation workflow? Will the radiologist be able to compare current and prior studies concurrently using the tools? Are downstream clinicians able to benefit from the tools? The McKesson solution offers the most common advanced visualization tools natively available within the PACS environment. The McKesson Solution The McKesson solution offers the most common advanced visualization tools natively available within the PACS environment. These tools include the ability to manipulate the images by interactively modifying the slab thickness, projection algorithm (i.e., minip, AveIP, MIP) and arbitrary oblique angle of projection. Access to these tools from a single UI streamlines the workflow and encourages radiologists to use these time-saving tools. Radiologists accuracy of diagnosis is also improved when they use these tools. For example, lung nodules are more accurately visualized when a MIP rendering is applied. The McKesson solution extends its display protocol support by including the ability to set slab, projection and oblique angle for studies so that these user-defined settings are automatically applied when a study is opened. This functionality allows the radiologist to immediately begin interpretation of a study upon load. It also provides time-saving benefits to technologists as they no longer have to manually set these preferences to prepare the study for interpretation. As this solution is offered natively within the PACS environment, radiologists are able to seamlessly use the advanced visualization tools on multiple studies at the same time. By registering multiple studies together the radiologist can compare regions of interest in both the current and prior study. This functionality streamlines the interpretation of follow-up cases as the radiologist is able to use a previously located nodule on a prior study to update the current study to the exact same location. This flexibility in navigation also extends to viewing original acquisition data alongside the MPR of the volume. The ability to cross reference the 2-D location with the MPR views gives radiologists the confidence that their diagnosis is accurate and artefacts are not being interpreted. One of the most common concerns radiologists have when using advanced visualization tools is the ability to locate the exact area in which the prior diagnosis was made. McKesson solves this problem by allowing easy access

5 5 to the exact location where the reference was made as well as the exact presentation settings used at the time of interpretation. This capability gives downstream clinicians the assurance that they are viewing the correct referenced images. The McKesson solution natively provides the most advanced visualization tools required for interpretation of large data sets, promoting efficiency within radiologists workflow and increasing the accuracy of patient care. The Sales Pitch McKesson s solution represents a departure from the generally accepted way of reading high-volume CT and MR studies offered by modality-based PACS vendors. Their approach adversely affects workflow and productivity and complicates the downstream availability of information needed for patient care. Recognizing that radiologists should not have to fit complex multislice studies into tools and protocols developed for much simpler studies, McKesson has created a solution that revolutionizes the way radiologists read and analyze the high-volume data sets from CT and MR modalities. This solution is a huge win for radiologists because it improves efficiency and productivity by providing tools and display protocols that are seamless and natively integrated as part of the normal reading process. As a result, users do not need to change their reading process nor learn a distinct set of third-party commands the tools required and workflow needed are integrated within an existing and familiar workflow. McKesson Provider Technologies 5995 Windward Parkway Alpharetta, GA Copyright 2009 McKesson Corporation and/or one of its subsidiaries. All rights reserved. All other product or company names mentioned may be trademarks, service marks or registered trademarks of their respective companies. WHT298-05/09