Boston Children's Hospital: Notes From an AV Superuser

Advanced visualization technology in imaging continues to garner acceptance within the radiology arena, yielding improvements in practice patterns and opportunities for enhanced cooperation with clinicians. Sanjay Prabhu, MBBS, FRCR, is a staff radiologist at Boston Children’s Hospital in Massachusetts and director of Boston Children’s Advanced Image Analysis Laboratory. He says that advanced visualization has, indeed, dramatically changed radiologists’ practice patterns, in part because the detail level of 3D models has rendered radiologists significantly more confident about the accuracy of their interpretations.

“The key is to tweak and tailor; otherwise, you construct unnecessary barriers to technology adoption. The way I see it, as a superuser, I don’t need to give everyone all the recipes—just the four they want to eat. Otherwise, they will get indigestion.”

—Sanjay Prabhu, MBBS, FRCR, Boston Children’s Hospital

As radiologists acquire more ready access to advanced visualization tools on their desktops, they are becoming more inclined to avail themselves of the department’s advanced visualization arsenal. To illustrate this point, Prabhu cites the example of a patient with a skull fracture. In the past, he explains, a radiologist would be presented with, at best, 2D images of the skull, but would need to wait until the following day for the laboratory to produce a reconstruction model. “By having the visualization tools at our fingertips, we see immediately and at a glance what has happened and have a visual to show to the parents, usually within one hour,” Prabhu says. “With 3D models at our fingertips at the time of reporting, we know we aren’t speculating about maybe a crack here and a crack there or whether, if we are going with the example of the skull, something looks different from one angle than from another.” Adding Subspecialist Value Subspecialists can enhance their practices with 3D imaging applications. Neuroradiologists, Prabhu points out, can use data produced during MR diffusion tractography to generate 3D maps of neural tracts within the brain. “With a conventional MRI image, the white matter looks like a single homogenous-looking area, and from far away, you cannot see small breaks or flaws,” he elaborates. “Conversely, with diffusion tractography, a neuroradiologist can see whether there are breaks or displacements of the tracts within the white matter, and potentially provide useful information in the situation of a child with a developmental delay or seizures whose brain looks structurally normal on plain MRI.” Moreover, cooperation between radiologists and clinicians has been enhanced. Clinicians appreciate the fact that they can harness visuals and associated information to plan their surgical approaches precisely and ensure that they are approaching procedures in the proper manner. For instance, Prabhu observes, there is no guesswork as to the length of an aorta, how the skull will look after the surgeon does something, or the volume and blood supply of a tumor. The Evolution From 2D to 3D With these benefits, however, have come challenges. According to Prabhu, advanced imaging has garnered a higher degree of acceptance among clinicians who are simply more comfortable with traditional radiology reporting solutions. Conversely, those who have grown up with all types of technology view 3D as just another innovation to use in the course of practice. “The key is to tweak and tailor; otherwise, you construct unnecessary barriers to technology adoption,” Prabhu says. “The way I see it, as a superuser, I don’t need to give everyone all the recipes—just the four they want to eat. Otherwise, they will get indigestion.” Prabhu adds that as radiologists have transitioned away from 2D viewing to 3D viewing, what they are looking for has changed. They place great value on the level of dimensional detail visible with 3D modeling, and they now want the flexibility needed to satisfy clinicians’ desire for visuals that are easier to understand and use for their own purposes (for instance, when plotting their surgical approaches). Prabhu is currently striving to refine Boston Children’s Hospital’s advanced visualization capabilities; he is attempting to make it possible to generate diagnostic 3D bone reconstruction models for images acquired with reduced radiation doses. “The MRI piece is a work in progress,” he concludes. “There are still questions to answer, but we’ve come very far, as a whole, and I think we will get there.”Julie Ritzer Ross is a contributing writer for Radinformatics.com.