Now You See It
By Keith Loria
Radiology Today
Vol. 25 No. 8 P. 18

Advanced visualization techniques transform CT imaging.

Advanced visualization techniques for CT are aiding diagnoses and patient care. The integration of 3D reconstructions, AI, and emerging virtual reality applications with CT is reshaping the way radiologists interpret complex medical images. Recent advances in these techniques enhance the visual clarity of scans and empower clinicians in surgical planning and patient education.

One example is Siemens Healthineers North America’s Cinematic Reality app, designed for Apple Vision Pro, that facilitates interaction with realistic 3D renderings of human anatomy. The app enables users to visualize clinical cases in cinematic detail without the need for additional hardware. This technology has potential applications in patient communication, medical education, and surgical planning.

“The main thing about the Vision Pro is that now you’re enabling customers to use that solution that we call Cinematic Reality to view immersive, interactive holograms of the human body in their real-world environment, without having to have a PC computer attached to it,” says Marcus da Silva, the senior director of product marketing for clinical and efficiency IT in the digital and automation business at Siemens Healthineers North America. “You can use and emulate the features and applications we have available on a server or cloud on a portable device.”

The app offers a more realistic visualization of organs or body parts, helping explain clinical cases to patients, discuss clinical questions around referrals or educate medical students. “The beauty is we are able to incorporate depth perception in those VRTs [volume rendering techniques],” da Silva says. “It helps you find the region of interest that you can focus on in your 2D images.”

Users can delve into the details of clinical images, zooming in to enlarge content and rotating around 3D renderings of the human body. The app also offers basic 2D reading tools, including scrolling features. “For now, it’s more for education, not for the clinical setting,” da Silva says. “It’s for communication and to present images for a conference and things like that.”

Looking ahead, the app could be used to help create a surgery plan, enhance interdisciplinary communication among specialists across various fields, and aid nonradiologists as well as patients in gaining a clearer understanding of scans and medical conditions.

Surgical Solutions
Novarad also offers advanced visualization tools. Novarad’s PACS system has CT-specific AI such as organ and bone segmentation, vascular segmentation, and subcutaneous fat segmentation. The company also offers CT/MR fusion, CT/ PET fusion, advanced visualization, and hanging protocols specific to CT.

“Novarad offers a surgical navigation solution that registers a CT onto a patient during surgery, providing superior visualization and spatial awareness,” says David GrandPre, senior director of product for Novard. “We also offer an image sharing platform that allows sites to route studies, such as CT, to an edge device and share it with either a QR code, a mobile device, or a specialized web-deployed router for direct ingestion into a PACS. Most of the AI in NovaPACS EI is focused on simplifying the diagnostic process and enhancing the images to improve the diagnosis.”

For example, the Edge Daemon is an advanced preprocessing AI solution that lives between the modality and the PACS. It performs AI and other algorithms, as defined by the facility, on CT scans and other modalities automatically. This provides “artificial assistance” to the doctor.

“The system will triage high-risk patients for [cerebrovascular accidents] and notify doctors so they can provide diagnosis and a report in a timely manner,” GrandPre says. “The AI and advanced visualization is accessed automatically through hanging protocols or through the Edge Daemon or manually, as desired by the doctor.”

Novarad’s VisAR system allows realtime viewing of CT images on a patient during surgery. VisAR reduces the need for fluoroscopy during surgery because the surgeon can see the patient’s anatomy in real time. This also applies to IR. AI enhances images to make them clearer and reduces the need for a second CT scan.

“It is FDA-cleared for spine surgery,” GrandPre says. “Because it utilizes the entire CT DICOM dataset, during a surgery, the surgeon can see all structures, window/level, create annotations, plan approaches, and identify landmarks easily and on the fly.”

Looking ahead, GrandPre says VisAR will have X-ray registration that will combine nonparallel fluoroscopic images with an older CT to register them to a patient in the operating room. “This will eliminate the need for a second CT scan to get images registered,” GrandPre says. “In the future, the Novarad technology will also use AI to diagnose particular diseases, such as lung nodules, brain tumors, etc. It will also highlight regions too small for the human eye to see, to expedite the diagnosis of disease. I think technology will be able to streamline the doctor’s ability and augment their skill to reduce medical error.”

Although it depends on each system, typically, the clinical and technical training that is provided is sufficient. “There are also videos, a customer portal, and surgical onsite assistance available,” GrandPre says. “A surgeon can be up and running in a few weeks with VisAR, and a radiologist can be trained on advanced imaging solutions in a few hours with the help of provided quick reference guides.”

Addressing Accessibility
United Imaging provides a full suite of advanced visualization and analyses for all of its CT customers. “There are 17 different specialty packages included with each uCT scanner, along with an advanced workstation, that assist with defining the care pathway for patients,” says Guillaume Grousset, vice president of CT for United Imaging North America. “Each analysis package offers specialized tools to improve technologist and radiologist workflow, such as the Vessel Analysis package that features automatic bone removal, vessel tracking, center line editing, and stenosis and plaque analysis.

“Advanced visualization from United Imaging provides quantitative analysis that helps physicians feel more confident in diagnosing their patients,” Grousset says. For example, a patient may need a cardiac calcium score or a liver analysis, which are labor-intensive without automated tools. On the included uCT advanced workstation, these analyses can be performed with a single click. This speeds up diagnosis and reduces the burden placed on radiologists and technologists.

Advanced visualization technology is integrated into the daily workflow of radiologists and surgical teams, and it’s often site-dependent. “Radiologists, cardiologists, and technologists will have their preferred workflows, depending on the symptoms a patient presents with,” Grousset says.

United Imaging offers several doselowering features on all of the uCT scanners, including Auto-ALARA mA and Auto-ALARA kVp, KARL 3D iterative noise reduction, and the AI-powered uAI Organ-based Dose Modulation. uAI AI-IR, which is featured on the uCT ATLAS products, is the only AI-based iterative and model-based image reconstruction on the market. It can help users reduce dose by up to 90% while maintaining low contrast detectability.

In most cases, the main challenge of advanced visualization is the cost to the hospital, which in turn limits patient access. Grousset says many rural hospitals are unable to financially compete and purchase elite hardware and/or subscription- based software. “All-in configurations mean every customer receives the same fully equipped computed tomography scanner with all software applications, all AI-empowered workflows, and all of the equipment that they need to take advantage of it,” he says.

Grousset adds that United Imaging has a clinical applications team that trains all of its customers on site at the time of installation, with a return visit for further training within the first month of installation. “This is usually enough time to get radiology professionals trained, and we offer yearly follow-up training for new professionals, as needed or when there is a software upgrade for life, and the customer is receiving new features,” Grousset says. “Artificial intelligence will continue to improve workflows, lower dose, and provide beautiful images. Provided that hospitals have access to these advanced AI technologies, this will help them to serve more patients, be more confident in their diagnosis, and work more efficiently.”

Around the Back
Tommy Carls, vice president of product management and marketing at Proprio, says there are new advanced visualization tools in CT related to spine images. “Three-dimensional understanding of anatomy is increasing, particularly in the spinal world,” he says. “The evolution of understanding this three-dimensional world is why these advanced techniques are becoming more common.”

Carls says new approaches enable the combination of an initial CT scan with light field and depth sensor technologies that provide real-time anatomical visualizations throughout spine procedures. Proprio’s Paradigm platform uses light field technology in spinal surgery navigation, offering a real-time 3D visualization of both anatomy and the surgical environment. The system is equipped with an advanced suite of sensors that captures high-definition, multimodal, intraoperative images and integrates them with preoperative scans. This enables surgeons to access information such as intraoperative imaging and enhanced visualization features while avoiding harmful radiation and maintaining workflow efficiency.

To reduce radiation exposure, many existing strategies focus on restricting scans to the smallest essential areas and employing low-dose protocols when feasible. However, in situations such as spine surgery that require precise alignment across multiple vertebrae, this strategy is insufficient. Therefore, Carls says, there is a need for advancements that enable detailed imaging with reduced radiation levels.

— Keith Loria is a freelance writer based in Oakton, Virginia. He is a regular contributor to Radiology Today.