Customer Case Study
An Enterprise Solution for Advanced Visualization at St. Marianna University
School of Medicine Hospital
St. Marianna University School of
Medicine Hospital
2-16-1 Sugao, Miyamae-ku, Kawasaki City,
Kanagawa Prefecture 216-8511, Japan
Specialties: 27
Total Beds: 1,208 The Customer
The Department of Radiology at St. Marianna University School of Medicine Hospital ranks high among Japanese hospitals in terms of scale and volume. It has a number of modalities, including 5 CT, 4 MR, 4 angiography, 4 fluoroscopy, 10 standard X-ray and 2 mammography devices. The staff consists of more than 100 members, including physicians, technicians, nurses and others. Over 700 procedures are performed per day in which more than 50% of all images yielded are evaluated by radiologists throughout the day.
The Importance of Volumetric Data
Of the 5 CT devices currently available at this hospital, a 16-detector multi-slice CT and a 64-detector multi-slice CT are used to collect volumetric data. The images are evaluated not only in the form of transverse images but also in the form of three-dimensional data (Multi-Planar Reconstruction (MPR), Volume Rendering (VR), etc.).
 "It is desirable that volumetric data become available in all specialties that require such data."
– Dr. Yasuyuki Kobayashi According to Dr. Yasuyuki Kobayashi, "A diagnosis based on volumetric data is indispensable if a multi-slice CT device is used." When conventional data (thickness: 10 mm or 8 mm) was evaluated, the radiologist needed to imagine the lesion by combining the data with anatomical information. However, thin-slice isotropic data contains accurate information as to the location and size of the lesion. Thus, if such data is evaluated not only in the form of transverse images, but also in the form of MPR in any direction needed, it is possible to improve the detection of small lesions and to determine the morphological features of a given cancer or mass.
 "Volumetric diagnosis is good for the patient."
– Dr. Tsuyoshi Morimoto Regarding the usefulness of volumetric data, Dr. Yasuyuki Kurihara and Dr. Shin Matsuoka, who are experts in the field of lung evaluation, also recognize that multi-dimensional approaches using MPR images allows rapid and more accurate diagnosis.
The Challenge
For the Department of Radiology, advanced visualization workstation functions are needed in the film-reading room, each modality room and the critical care center. Previously, a total of 6 stand-alone devices were installed in rooms other than the Nuclear medicine and MRI offices. However, as the volumetric data yielded from each modality were utilized more extensively, the demand for workstations grew throughout the hospital.
One possible means of meeting this demand was to install additional stand-alone workstations. However, this raised problems related to accessibility, space, cost, data transfer, and management of such a large system.
Additionally, the PACS viewers of other manufacturers were previously used within the framework of the image network. However, since viewers differ from advanced visualization workstations, two terminals were required if both viewers and workstations were to be used concurrently.
The Solution
To efficiently and effectively address these needs, the introduction of networked thin client workstations was planned and implemented in close cooperation with radiologists who were involved in the project from its initial stage.
The image network system implementation, which began in March 2006, involved the Ziosoft ZIOSTATION™ consisting of a large-capacity data server, an image processing server (used for intensive image processing) and 21 thin client workstations. The 21 thin client workstations are networked clients (VGR clients) based on Ziosoft’s VolumeGRID™ technology. To realize the operation of networked workstations, first, an image processing server was installed in the server room. Second, personal computers (PCs) previously used for the PACS viewers were installed with VGR client software. This established an environment allowing simultaneous use of advanced visualization and PACS viewers on the workstations. In the Department of Radiology, 5 standard PCs were introduced to expand the workstation to offices in which no PACS viewer terminals had been available, and VGR client software was installed. If additional standard PCs and the appropriate network infrastructure are available, these could also be utilized by adding VGR client software as the need arises, thus avoiding waste. In this way, an optimal workstation environment can be maintained.
 "The ZIOSTATION is good because it can be used intuitively, requiring no (user) manual."
– Dr. Shin Matsuoka The Result
Being able to analyze volumetric images throughout the hospital has provided numerous benefits. Clinicians now have the tools they need throughout the care areas without having to compromise on functionality. This has enabled them to make quicker and more accurate diagnosis. Since advanced visualization and PACS viewer functionalities are now combined on single workstations, workflow and space utilization is now more efficient resulting in cost savings. The ultimate benefit is better patient care.
The Future
In the processing of volumetric data, speed is of great importance. At St. Marianna University, high-speed processing has been achieved by combining a high-speed network with high-speed data transfer technology based on a unique protocol. However, physicians routinely dealing with massive amounts of data often desire an even faster system.
 "What I desire is closer linkage to reports and greater speed."
– Dr. Yasuyuki Kurihara There are increasing demands for automated computer-aided detection (CAD), etc., and for histogram presentation (i.e., additional functions related to analysis). It is essential to make efforts to satisfy these demands so that the system becomes even more useful in daily practice.
The Critical Care Center
The Critical Care Center of St. Marianna University Hospital serves 50-60 patients on a daily basis. Twenty physicians (including 2 radiologists) and 5 technicians work at this center.
The optimal time required after arrival of the patient for diagnosis and performance of tests is approximately 15 minutes. This time has been determined to be nearly ideal for critical centers, where rapidness and accuracy are essential. Availability of volumetric images, in addition to transverse images, is useful in making a rapid and accurate diagnosis. The availability of these images also provides helpful information for determination of a plan of care.
 "Diagnostic imaging, making use of volumetric data, is significant and indispensable for critical care," says Dr. Junichi Matsumoto. He adds that volumetric data has been utilized in actual practice at this center and that he has found such data to be extremely useful. However, volumetric data has been adopted only at a limited number of critical centers in Japan. Dr. Matsumoto strongly desires to spread awareness of the necessity of this kind of data. He adds, "Speed may be further improved if protocols specific to frequent cases or diseases are available."
 Dr. Yasuo Nakajima
Professor, Director of Radiology Radiologist Perspective"Since the introduction of volumetric data, the conventional method of image evaluation where the examiner combines transverse images with anatomical information and estimated the extent of the lesion using his or her imagination is no longer valid. There is no need for the examiner to estimate based on small amounts of information. What is now needed is to select the necessary information from an abundance of information. How that data is presented is also becoming an important point. Radiologists should bear this in mind during diagnostic imaging, and at the same time should educate other clinicians. If clinicians are informed with regard to the latest technology in diagnostic imaging, they will be able to weigh which cases require a high level of accuracy and which cases do not. It is also a necessary task for radiologists to prepare environments where patients can receive sophisticated health care in the appropriate manner."
Professor Nakajima is also strongly interested in research for the development of CAD and for new methods of diagnostic imaging for dissemination throughout the world.
|
