Moving image data beyond radiology promises to transform working practices | Better and faster imaging enables more accurate diagnoses with less risk and at lower cost than ever before. Faster scanning techniques also mean a change from static to dynamic information, while increasing computer power and faster and more complex postprocessing algorithms can deal with enormous datasets and provide new types of information, such as functional imaging.

“These changes require new expertise from radiologists,” said Dr. Erik Ranschaert, a radiologist at the Jeroen Bosch Ziekenhuis (JBZ), ‘s-Hertogenbosch, the Netherlands, and a speaker at this afternoon’s refresher course on image sharing. “We need to be aware of the entire disease process and able to analyze this dynamic and functional information. Multidisciplinary collaboration is also a prerequisite for useful integration of these new imaging techniques with the patient’s treatment. For example, cardiologists are increasingly using noninvasive imaging techniques, and advanced postprocessing with supercomputer technology will eventually allow them to choose less invasive procedures. These are exciting developments.”

An increasing number of surgical interventions use computer-based image-guided navigation techniques, such as computer-assisted orthopedic and spinal surgery (see, computer-assisted head and neck and ear, nose and throat surgery, image-guided neurosurgery, and minimally invasive cardiovascular and thoracoabdominal surgery. Also, the increasing development of surgical laparoscopy pushes for a better organization of image distribution because it is of major importance for preoperative planning and intraoperative guidance, he noted.

In oncology, there is increasing integration of imaging, particularly interventional radiology, with treatment in several areas: CT/MR diffusion and perfusion for planning and follow-up of tumor treatment — e.g., to differentiate between necrotic and viable parts of the tumor; 3D segmentation for planning of treatment of liver tumors; robotics used for automated navigation of a needle or other instrument in brain surgery, surgery, and radiation oncology; interventional techniques for embolization of tumors, TACE (transarterial chemoembolization), radioembolization, intra-arterial chemotherapy, radiofrequency ablation (RFA), cryoablation, etc.

This trend has contributed to the formation of multidisciplinary societies such as the Society of Cardiovascular Computed Tomography (SCCT), the International Cancer Imaging Society (ICIS), the Intraoperative Imaging Society (IOIS), the Society for Molecular Imaging (SMI), and others.

At the JBZ, the new operating suite is being equipped with large screens that can be pulled down from the ceiling so that surgeons can make better use of imaging, as the diagram shows. Real-time guidance using ultrasound also will be offered. Surgery is becoming more and more microinvasive due to the use of endoscopic techniques, and precise guidance is increasingly important. Radiologists and surgeons will work together closely in areas such as selective tumor ablation using RFA with ultrasound, followed by partial liver resection.

Sharing images with colleagues outside of a radiologist’s own hospital is also becoming easier, according to Ranschaert. For most second opinions offered in secondary or tertiary centers, previous imaging studies are still transferred on CD or DVD, but a more efficient and less costly solution is to make images automatically available by storing them in a “virtual cloud” that is accessible to other healthcare providers and patients. Several companies are already providing this type of service, especially in the U.S.


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