Radiologists operate in a fast-paced work environment, juggling a combination of tasks that includes interpreting studies, and calls from referring physicians. And as imaging volume rises while reimbursements decline, individual specialists are under more pressure than ever.
Reading 3D MR often means that radiologists must exit their PACS workstations and use a separate program to view the 3D images; they waste precious minutes waiting for those programs to load or navigating menus. But when 3D functionality is integrated into a radiologists’ everyday workflow, it can expedite the care process and limit many of those interruptions.
Tiron C.M. Pechet, MD, Assistant Medical Director and CMIO at Shields Health Care Group, is a long time user of McKesson Radiology’s embedded 3D functionality, called VTRIP (Variable Thickness Regional Intensity Projection) . “When you open the case, the prerequisite tasks for interpretation are done automatically; everything is hung in the correct viewports with the correct angles and slice thickness and synchronized to the routine 2D portions of the examination” he says. “It takes about 12 seconds to get to reading, where using a separate 3D viewing application would eat up at least two minutes.”
The fact that the toolset to read 3D studies is embedded into the McKesson Radiology PACS core functionality with its display protocols and familiar toolset has allowed Shields to dramatically increase the amount of 3D studies they interpret, adding sequences to nearly every exam of the brain, spine, and even about half of their pelvic exams. It’s also entered the workflow for diseases such as multiple sclerosis, offering automatic lesion tracking and assisting with preoperative planning for many musculoskeletal examinations. One of the most notable advantages VTRIP offers is that it allows radiologists to quickly compare 3D studies side-by-side, a tedious process on third-party software.
“If you have two 3D studies to compare, a third-party tool can take four or five minutes just to set up, but with VTRIP and the McKesson Radiology display protocols, the relevant sequences are loaded and ready to be compared without any mouse clicks,” Pechet says. “You can do it on third-party software, but it’s a nightmare and very inefficient.”
The ability to have a case displayed with minimal user input—even for complex studies—is one thing that makes VTRIP valuable, Pechet explains. While reading examinations with 3D sequences might take longer than a traditional exam, the additional information engenders a more confident conclusion by the radiologist.
In fact, Pechet doubts that a large center could even use 3D MR without an integrated program like VTRIP, citing his experiences at a partnering imaging practice where Shields provides MR reads.
“They are hamstrung by an archaic PACS,” he says. “I would love to provide them with 3D images, but their PACS can’t handle it. Instead, they churn out study after study of 2D images because radiologists have to open up another tool to read 3D images.”
“Now that they’ve seen what we can do on our system, they’re including a 3D dataset in every exam because they recognize the value,” Pechet adds.
A healthy dialogue
Pechet explains that Shields Health Care has been using VTRIP since the very beginning—they were an early rollout customer.
“We had transitioned to McKesson Radiology,” Pechet says, “and I got involved with the development of VTRIP fairly early on because being on the forefront of 3D MR was important to us.”
Even in the mid-2000s, Shields recognized the value of 3D MR to the entire patient care chain, and their long relationship with McKesson has proven to be collaborative and rewarding for both parties.
While day-to-day issues are handled by McKesson’s 24/7 support team, Pechet is in regular contact with members of the product development team, providing advice and a clinical perspective. He says the McKesson team’s openness to his input helped them concentrate on developing features that are critical to clinicians who use 3D interpretation in their daily workflow. The teamwork between client and vendor has been instrumental in moving Shields forward.
A radiologist’s toolset will need to evolve to reflect growing emphasis on proving their value to the greater organization. According to Pechet, “We have to figure out how to broadcast our presence and expertise as radiologists to wherever care is being delivered.” Quantifying time spent on tasks can show how radiologists are a crucial part of care.
As 3D MR continues to progress, Pechet believes that solutions that demonstrate clinical intelligence and depth will remain indispensable in the future direction of PACS development. Radiologists need solutions that optimize complex tasks and intelligently present imaging information where and when it’s needed. “There is no substitute for the core functionality of the system,” Pechet says. “It may morph, but the way that radiologists process imaging data will remain the same—their eyes will acquire images just as they always have.”