Imaging Pearls ❯ 3D and Workflow ❯ Cinematic Rendering
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Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):269-276.
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):269-276.- “Non-traumatic thoracic aorta emergencies are acute conditions associated with substantial morbidity and mortality. In the emergency setting, timely detection of aortic injury through radiological imaging is crucial for prompt treatment planning and favorable patient outcomes. 3D cinematic rendering (CR), a novel rendering algorithm for computed tomography (CT) image processing, allows for life-like visualization of spatial details and contours of highly complex anatomic structures such as the thoracic aorta and its vessels, generating a photorealistic view that not just adds to diagnostic confidence, but is especially useful for non-radiologists, including surgeons and emergency medicine physicians.”
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):269-276. - “CR involves global illumination and path tracing models whereby numerous light rays from all directions propagate through and interact with the volumetric data to generate a voxel. Complex anatomical relations are better evaluated and enhanced depth and shape perception is achieved as the technique considers a natural lighting environment and its effects (e.g., reflection, diffusion, refraction). Postprocessing windowing and the use of clip planes/masks allow cutting into the volume and isolation of the area/organ of interest.”
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):269-276. - “As with other 3D post-processing methods, the individual slices are stacked to create a 3D volume, upon which the specialized CR lighting model is applied. This lighting model is unique in that it simulates the propagation of millions of photos through the volume dataset, and thus creates realistic interactions with the various tissue compositions, producing photorealistic images from the dataset. This in turn results in a greater degree of surface detail and shadowing as opposed to traditional VR. Where VR techniques employ a local lighting model, the global illumination model used in CR entails complex calculations for rendering, as both direct and indirect illumination are traced, as well as the effect of diffusion, scatter, and reflections.”
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):269-276. - “There are some limitations that come with 3D CR. Notably, shadows generated in the images might conceal certain pathologies when viewed from specific angles, necessitating meticulous optimization and assessment from diverse angles in conjunction with the multiplanar reformations. Thus, while an initial learning period to become adept in handling and familiarizing themselves with the CR process is required for radiologists, as demonstrated in our case studies, an experienced radiologist can efficiently execute the rendering process in under 5 min.”
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):269-276. - “Color mapping of different phases enhances visualization of the key pathology, such as the flow through the false and true lumens in a dissection that can be delineated by high contrast shading. CR rendering emphasizes textural changes attributable to inflammatory processes with realistic shadowing that is otherwise difficult to appreciate. The improved surface detail helps characterize an impending PAU or the nature of outpouchings suspicious for mycotic aneurysms and gives a clearer view of multiple plaques and sites of ulceration that could be otherwise missed.”
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):269-276. - Another application of 3D CR is via the black blood cinematic rendering (BBCR) preset.. BBCR is a preset we specifically developed to visualize intraluminal contours and structures of the heart and great vessels, all through adjustments that can be made in under a minute. This is especially useful in the setting of visualizing various zones of thrombi and occlusion, the degree of obstruction, and the subtle irregularities and internal arrangement of the thrombus that can only be appreciated due to enhanced depth perception and shadowing.
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):269-276. - “3D cinematic rendering (CR) represents an important advancement in radiological imaging, particularly in enhancing the visualization of complex anatomical structures and systems such as the thoracic aorta and its vessels. CR provides detailed, photorealistic illustrations crucial for diagnosis and surgical planning as we have seen in several cases. Future research is needed to evaluate CR’s diagnostic accuracy, both prospectively and in head-to-head comparisons with other rendering methods, as well as its role in other domains such as patient education and medical training. CR, therefore, is emerging as a promising, evolving tool for radiologists, surgeons, and the patients they treat.”
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):269-276. - “Black blood cinematic rendering (BBCR) is a newly described preset for cinematic rendering, which creates photorealistic displays from volumetric data sets with the contrast-enhanced blood pool displayed as dark and transparent. That set of features potentially provides for enhanced visualization of endomyocardial and intraluminal pathology, as well as cardiac devices. The similarity of the images to black-blood magnetic resonance imaging (MRI) may allow for expansion of the evaluation of certain types of pathology into patient populations unable to undergo MRI. In the emergency setting, the rapid acquisition time and reasonable post-processing time make this technique clinically feasible.”
Expanded experience with cardiovascular black blood cinematic rendering.
Brookmeyer C, Chu LC, Rowe SP, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):277-284. - “Importantly, in CR, the display color and transparency can be adjusted for each tissue component. This is analogous to window center and level adjustments for standard CT review. Typically, in CR, the contrast-enhanced blood pool is displayed as an opaque light color. Black blood cinematic rendering (BBCR) was a recently described color and transparency preset that displays the contrast-enhanced blood pool as both transparent and dark. That creates images similar to black blood cardiac magnetic resonance imaging (MRI). In our experience, BBCR excels in evaluation of cardiovascular intraluminal structures because of improved detail and delineation from the contrast-opacified blood pool.”
Expanded experience with cardiovascular black blood cinematic rendering.
Brookmeyer C, Chu LC, Rowe SP, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):277-284. - “BBCR can be created on any cinematic rendering software by adjusting the trapezoids of the voxel histogram and color Look-Up-Table. Our cardiac BBCR preset was developed at our institution by one of the authors (EKF). It was previously reported and has been published for use . Our preset can be used in SyngoVia 30, 40, 50, and 60. We have not tried this preset on other CR programs, so it is unclear exactly how to replicate it, but theoretically, the underlying concept should apply to all trapezoid-based CR programs. The general concept is to assign 0% opacity to the Hounsfield units of the contrast-enhanced blood pool. Use a narrow-plateau trapezoid to assign color(s) and high opacity to densities less than blood pool to visualize the soft tissues forming the endoluminal walls. Use a wide plateau trapezoid to assign color(s) and high opacity to densities greater than blood pool to visualize calcifications and cardiac implants.”
Expanded experience with cardiovascular black blood cinematic rendering.
Brookmeyer C, Chu LC, Rowe SP, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):277-284. - “Further, the images produced by BBCR, although derived from standard CT acquisitions, are also fundamentally different. The pixels on a BBCR image incorporate varying color and transparency based on the proportion of different tissue types that contribute to that pixel. As such, there may be information in BBCR images that cannot otherwise specifically be abstracted from standard reconstructions or reformations. How such images and data might feed into graphical processing unit-based artificial intelligence algorithms is not easily predictable but should be explored.”
Expanded experience with cardiovascular black blood cinematic rendering.
Brookmeyer C, Chu LC, Rowe SP, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):277-284. - “With the growing applications of cinematic rendering in cardiovascular imaging, BBCR is valuable for its visualization of intraluminal structures through a dark transparent blood pool. In this expanded experience, we have reviewed our initial experiences with BBCR with cardiac devices, native cardiac valves and coronaries, intracardiac masses, and aortic disease. Given the often-acute presentations of those conditions, many patients may first be evaluated in the emergency setting. Although the creation of any CR images requires a workflow with a standalone workstation and an experienced radiologist, the time to generate BBCR images would be well invested in the relatively rare patient that has an endoluminal cardiac or endovascular condition that needed to be optimally evaluated.”
Expanded experience with cardiovascular black blood cinematic rendering.
Brookmeyer C, Chu LC, Rowe SP, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):277-284. - ”Similar to intracardiac structures, intraluminal vascular structures are well seen on BBCR. Cinematic rendering has been used in the detection of acute aortic injury, and differentiation of blunt aortic injury from ductus diverticulum variant anatomy. Based on the utility of bright blood CR for the aorta, BBCR could add value in the setting of acute aortic syndrome or injury to detect subtle intraluminal irregularities. It can also be used to evaluate larger intraluminal lesions or clots and their relationship to nearby anatomy.”
Expanded experience with cardiovascular black blood cinematic rendering.
Brookmeyer C, Chu LC, Rowe SP, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):277-284. - “BBCR captures the cardiac valve anatomy and calcifications. CR has been used in the assessment of aortic valve variant anatomy, and BBCR improves the delineation of the valve cusps from the blood pool. Global valve and outflow tract calcification assessment can be challenging to fully capture on 2D imaging, and routine cinematic rendering displays often obscure the calcifications due to the opaque contrast-enhanced blood pool. BBCR has potential for the assessment of calcifications of the valve leaflets, annulus, and outflow tract in planning for transcatheter valve replacements .”
Expanded experience with cardiovascular black blood cinematic rendering.
Brookmeyer C, Chu LC, Rowe SP, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):277-284. 
Expanded experience with cardiovascular black blood cinematic rendering.
Brookmeyer C, Chu LC, Rowe SP, Fishman EK.
Emerg Radiol. 2024 Apr;31(2):277-284.
- “PNETs constitute up to 3% of clinically detected pancreatic tumors. Differentiating PNET from IPAS on CT is challenging as both may appear as well-circumscribed arterial phase enhancing lesions. Cinematic rendering is a 3D postprocessing technology that uses an advanced global lighting mode to generate photorealistic images. The precision with which cinematic rendering simulates intricate interactions of light passing through imaged volumes yields superb surface detail and textural perception.”
Cinematic Rendering for Differentiation of Pancreatic Neuroendocrine Tumor From Intrapancreatic Accessory Spleen.
Ahmed TM, Fishman EK.
AJR Am J Roentgenol. 2024 Mar;222(3):e2430862.
- Cinematic rendering (CR) is a novel CT post-processing technique that utilizes advanced light modeling to generate highly photorealistic anatomic visualization. This generates unique prospects in the evaluation of adrenal masses. As one of the first large tertiary care centers to incorporate CR into routine diagnostic workup, our preliminary experience with using CR has been positive, and we have found CR to be a valuable adjunct during surgical planning. Herein, we highlight the unique utility of CR techniques in the workup of adrenal lesions and provide commentary on the opportunities and obstacles associated with the application of this novel display method in this setting.
Three-dimensional CT cinematic rendering of adrenal masses: Role in tumor analysis and management.
Ahmed TM, Rowe SP, Fishman EK, Soyer P, Chu LC.
Diagn Interv Imaging. 2024 Jan;105(1):5-14. - “Recently, a novel method of 3D visualization, known as cinematic rendering (CR) has been introduced. While CR shares many similarities with VR, it utilizes a more complex global lighting model that incorporates elements of ray tracing and scatter to generate images that are photorealistic. Through more realistically modeling the complex interactions of photons passing through the imaged volume, CR images attain improved levels of surface detail and shadow realism. CR also allows for highly adjustable real-time post processing and windowing, enabling tailored visualization of any given region of interest, its vascular supply, and its adjacent structures. n region of interest, its vascular supply, and its adjacent structures. ”
Three-dimensional CT cinematic rendering of adrenal masses: Role in tumor analysis and management.
Ahmed TM, Rowe SP, Fishman EK, Soyer P, Chu LC.
Diagn Interv Imaging. 2024 Jan;105(1):5-14. - “Pheochromocytomas are neuroendocrine tumors that arise from the chromaffin cells of the adrenal medulla and are present in 0.1% to 0.2% of adults with hypertension. Although typically associated with the triad of new-onset, refractory or paroxysmal hypertension, palpitations, and headache, up to 10% of patients may remain asymptomatic. Pheochromocytomas have a number of syndromic associations, most notably multiple endocrine neoplasia 2, von Hippel-Lindau syndrome, neurofibromatosis, Sturge-Weber syndrome, and tuberous sclerosis. While the up to 95% of pheochromocytomas are typically benign, 10%–15% may be malignant. Diagnosis is established on the basis of elevated urinary and plasma fractioned metanephrines and catecholamines alongside characteristic imaging features. ”
Three-dimensional CT cinematic rendering of adrenal masses: Role in tumor analysis and management.
Ahmed TM, Rowe SP, Fishman EK, Soyer P, Chu LC.
Diagn Interv Imaging. 2024 Jan;105(1):5-14. - “CR visualizations in the workup of pheochromocytomas can accentuate the dynamic enhancement pattern through more distinctly highlighting the anatomy of the enhanced components within the mass .Additionally, CR confers the added benefit of dynamic window width and level adjustment, which can aid in delineating cystic regions and septations within the tumor. Beyond tissue characterization, CR vascular mapping can also potentially improve visualization of the vascular supply, which is especially important in laparoscopic resection of vascular tumors such as pheochromocytomas. It can also be useful for surgical planning of adrenal sparing procedures.”
Three-dimensional CT cinematic rendering of adrenal masses: Role in tumor analysis and management.
Ahmed TM, Rowe SP, Fishman EK, Soyer P, Chu LC.
Diagn Interv Imaging. 2024 Jan;105(1):5-14. - “ACC is a highly malignant neoplasm arising from the adrenal cortex ACC is a rare tumor with an annual incidence of 0.5–2 per million per year that peaks in the fourth and fifth decades of life, with a slight female preponderance. ACC can present as either a functional or nonfunctional tumor. Sixty p. cent of ACCs are functional and present with characteristic clinical manifestations, with Cushing syndrome being the most common manifestation . Alternatively, patients with nonfunctional tumors most commonly present with pain, a palpable mass or gastrointestinal complaints . Thirty p. cent of (nonfunctional ACCs present with metastatic disease at detection, due to their late presentation .”
Three-dimensional CT cinematic rendering of adrenal masses: Role in tumor analysis and management.
Ahmed TM, Rowe SP, Fishman EK, Soyer P, Chu LC.
Diagn Interv Imaging. 2024 Jan;105(1):5-14. - “Soft tissue sarcomas (STS) are a heterogenous group of mesenchymal tumors [28]. While STS can arise virtually anywhere within the body, involvement of the adrenals is exceedingly rare, and ascertaining definitive epidemiological data on adrenal involvement is difficult. Prior retrospective reviews have reported STSs to account for only 1.3% of all adrenal tumors . Among adult STSs, undifferentiated pleomorphic sarcoma, liposarcoma and leiomyosarcoma are the most common histological subtypes and typically present in the elderly. Typically, undifferentiated pleomorphic sarcoma appears as heterogenous soft tissue masse with irregular margins and attenuate similarly to muscle. Soft tissue areas within the mass enhance following intravenous administration of contrast material. Areas of decreased attenuation, representing hemorrhage and necrosis, are often centrally present, which can complicate radiological differentiation from ACC .”
Three-dimensional CT cinematic rendering of adrenal masses: Role in tumor analysis and management.
Ahmed TM, Rowe SP, Fishman EK, Soyer P, Chu LC.
Diagn Interv Imaging. 2024 Jan;105(1):5-14. - “Pancreatic neuroendocrine tumours (PNETs) are a rare subset of pancreatic tumours that have historically comprised up to 3% of all clinically detected pancreatic tumours. In recent decades, however, advancements in imaging have led to an increased incidental detection rate of PNETs and imaging has played an increasingly central role in the initial diagnostics and surgical planning of these tumours. Cinematic rendering (CR) is a 3D post-processing technique that generates highly photorealistic images through more realistically modelling the path of photons through the imaged volume. This allows for more comprehensive visualization, description, and interpretation of anatomical structures. In this 2-part review article, we present the first description of the various CR appearances of PNETs in the reported literature while providing commentary on the unique clinical opportunities afforded by the adjunctive utilization of CR in the workup of these rare tumours.”
Cinematic Rendering of Pancreatic Neuroendocrine Tumours: Opportunities for Clinical Implementation: Part 1: Tumour Detection and Characterization
Ahmed TM, Fishman EK, Chu LC.
Can Assoc Radiol J. 2024 Mar 20:8465371241239035. Epub ahead of print. PMID: 38509705. - At CT, PNETs typically appear as well circumscribed avidly enhancing masses that may arise from any portion of the pancreas. Enhancement patterns for small PNETs are usually uniform, and some may present with a characteristic rim enhancement that can help clue in the diagnosis. The degree and homogeneity of lesion enhancement is correlated with tumour grade, and among larger PNETs, which predominantly consist of non-hyperfunctioning variants, the presence of cystic degeneration, intralesional necrosis and calcification can result in an inhomogeneous pattern of enhancement. PNETs are classically best visualized in the arterial phase. While smaller PNETs can be particularly difficult to see on venous or delayed images, a small proportion of PNETs may atypically be better visualized on portal venous phase imaging.
Cinematic Rendering of Pancreatic Neuroendocrine Tumours: Opportunities for Clinical Implementation: Part 1: Tumour Detection and Characterization
Ahmed TM, Fishman EK, Chu LC.
Can Assoc Radiol J. 2024 Mar 20:8465371241239035. Epub ahead of print. PMID: 38509705. - Differential diagnoses of PNETs consist of pancreatic metastases, most often from renal cell carcinoma, solid variant serous cystadenoma, peripancreatic gastrointestinal stromal tumour, and intrapancreatic accessory spleen.5 In rarer cases of hypovascular PNETs, differentiation from adenocarcinoma is essential and carries significant implications for management.
Cinematic Rendering of Pancreatic Neuroendocrine Tumours: Opportunities for Clinical Implementation: Part 1: Tumour Detection and Characterization
Ahmed TM, Fishman EK, Chu LC.
Can Assoc Radiol J. 2024 Mar 20:8465371241239035. Epub ahead of print. PMID: 38509705. - “Cinematic rendering may allow for the detection of the presence of tumour in cases where subtle textural changes due to inherent differences between normal and abnormal tissue are present, but a defined mass is not yet visible. Through this, CR can potentially facilitate early disease detection and help differentiate PNETs from normal pancreatic parenchyma. CR can similarly assist in differentiating PNETs from intrapancreatic accessory spleens through accentuating textural differences that may not be appreciable at non-cinematic imaging . Display configurations of CR may also be manipulated to conceal uninvolved pancreatic parenchyma, allowing for isolated visualization of PNETs. This can make tumours remarkably conspicuous as well as highlight the spatial relationship of the tumour with extra-pancreatic anatomy.”
Cinematic Rendering of Pancreatic Neuroendocrine Tumours: Opportunities for Clinical Implementation: Part 1: Tumour Detection and Characterization
Ahmed TM, Fishman EK, Chu LC.
Can Assoc Radiol J. 2024 Mar 20:8465371241239035. Epub ahead of print. PMID: 38509705. - “While PNETs are typically solid tumours, the presence of cystic internal components is not uncommon, with up to 10% of PNETs being purely cystic. Cystic components in PNETs are most often encountered among larger PNETs that undergo cystic degeneration or necrosis. Rarely, small PNETs with cystic change are also encountered and can pose diagnostic challenges. Purely cystic PNETs generally exhibit more indolent behaviour and carry more favourable prognoses, which has also led to the rise of conflicting opinions regarding the value of resection in these cases.”
Cinematic Rendering of Pancreatic Neuroendocrine Tumours: Opportunities for Clinical Implementation: Part 1: Tumour Detection and Characterization
Ahmed TM, Fishman EK, Chu LC.
Can Assoc Radiol J. 2024 Mar 20:8465371241239035. Epub ahead of print. PMID: 38509705. - “Purely cystic PNETs generally exhibit more indolent behaviour and carry more favourable prognoses, which has also led to the rise of conflicting opinions regarding the value of resection in these cases.19 Simultaneously however, cystic PNET can be misdiagnosed as a potentially malignant cystic lesion (ie, mucinous cystic neoplasm, intraductal papillary neoplasm) that ought to be resected, or a benign cystic lesion (ie, serous cystadenoma) for which surgery is not indicated, which can lead to suboptimal patient outcomes. Radiological characterization of the internal architecture of these tumours is therefore particularly important due to the wide range of potential implications upon management.”
Cinematic Rendering of Pancreatic Neuroendocrine Tumours: Opportunities for Clinical Implementation: Part 1: Tumour Detection and Characterization
Ahmed TM, Fishman EK, Chu LC.
Can Assoc Radiol J. 2024 Mar 20:8465371241239035. Epub ahead of print. PMID: 38509705. - “Purely cystic PNETs generally exhibit more indolent behaviour and carry more favourable prognoses, which has also led to the rise of conflicting opinions regarding the value of resection in these cases.19 Simultaneously however, cystic PNET can be misdiagnosed as a potentially malignant cystic lesion (ie, mucinous cystic neoplasm, intraductal papillary neoplasm) that ought to be resected, or a benign cystic lesion (ie, serous cystadenoma) for which surgery is not indicated, which can lead to suboptimal patient outcomes. Radiological characterization of the internal architecture of these tumours is therefore particularly important due to the wide range of potential implications upon management.”
Cinematic Rendering of Pancreatic Neuroendocrine Tumours: Opportunities for Clinical Implementation: Part 1: Tumour Detection and Characterization
Ahmed TM, Fishman EK, Chu LC.
Can Assoc Radiol J. 2024 Mar 20:8465371241239035. Epub ahead of print. PMID: 38509705. - “Cinematic rendering is uniquely suited to visualization of these cases through its ability to greatly improve depth perception. Improved depth perception, in conjunction with dynamic textural visualization of CR may allow for optimal characterization of the internal architecture of cystic components. This can result in superior visualization of fine internal septations and mural nodularity within these lesions that may help in differentiating them from other cystic pancreatic lesions. In particular, the presence of an avidly enhancing hypervascular rim, owing to the rich blood supply of PNETs, is known to be a highly suggestive radiologic feature of cystic PNETs. Improved characterization of the cystic mural interface using CR may be especially advantageous in appreciating this key finding.”
Cinematic Rendering of Pancreatic Neuroendocrine Tumours: Opportunities for Clinical Implementation: Part 1: Tumour Detection and Characterization
Ahmed TM, Fishman EK, Chu LC.
Can Assoc Radiol J. 2024 Mar 20:8465371241239035. Epub ahead of print. PMID: 38509705. 
- “Precise evaluation of the presence and extent of vascular invasion is essential in determining the resectability of PNETs and to plan for possible vascular reconstruction. Though CT is considered to have excellent sensitivity in identifying major vessel involvement, prior studies have found that 25% to 50% of patients with PNETs who are radiologically determined to have vascular invasion, are confirmed to have true vascular invasion at the time of surgery. On the more concerning flipside of this, it is similarly possible that patients with softer radiological signs of vascular invasion may be denied surgery due to perceived vascular involvement in the absence of true involvement. In these equivocal cases, vascular abutment may be misinterpreted as vascular encasement and vice versa. CR may alleviate the diagnostic burden in these cases by generating exquisitely detailed vascular maps that allow radiologists to visualize the tumour-vessel interface with increased confidence. Through this, it may be possible to differentiate vascular stretching, abutment, and compression from true vessel invasion. Radiological assessment of vascular involvement in PNETs is also uniquely nuanced as PNETs may not traditionally encase vessels but instead tend to invade and expand venous vasculature.”
Cinematic Rendering of Pancreatic Neuroendocrine Tumours: Opportunities for Clinical Implementation: Part 2: Preoperative Planning and Evaluation of Metastatic Disease.
Ahmed TM, Fishman EK, Chu LC.
Can Assoc Radiol J. 2024 Mar 20:8465371241239035. Epub ahead of print. PMID: 38509705. - “Unlike PDAC, the presence of hepatic metastases in PNETs does not preclude surgical resection, and potentially curative resection of the primary tumour and metastatic hepatic implants is still possible in up to 25% of patients.14 Timely radiological identification of hepatic metastases and subsequent deliberation of their resectability is therefore critical to the management of metastatic PNETs. Using CR, rendering parameters can be modified to either highlight the characteristically hypervascular metastases but may also be adjusted to optimize visualization in cases of atypical hypovascular-appearing metastases. Display settings can also be further modified to render the background hepatic parenchyma translucent to further accentuate any hepatic metastases. Once lesions are identified, the enhanced depth perception of CR can also help differentiate them from benign liver lesions through improving visualization of their internal architecture. “
Cinematic Rendering of Pancreatic Neuroendocrine Tumours: Opportunities for Clinical Implementation: Part 2: Preoperative Planning and Evaluation of Metastatic Disease.
Ahmed TM, Fishman EK, Chu LC.
Can Assoc Radiol J. 2024 Mar 20:8465371241239035. Epub ahead of print. PMID: 38509705. - “CR augmentation also has the potential to go beyond optimizing disease detection and classification and may also impact surgical planning. This is achieved through the generation of photorealistic images that essentially serve as personalized anatomic models for the operating team. Anecdotally, pancreatic surgeons at our institution have found these reconstructions helpful for preoperative planning and in improving intraoperative situational awareness. This is particularly relevant in cases of laparoscopic surgery, where real-time intraoperative visualization is restricted.”
Cinematic Rendering of Pancreatic Neuroendocrine Tumours: Opportunities for Clinical Implementation: Part 2: Preoperative Planning and Evaluation of Metastatic Disease.
Ahmed TM, Fishman EK, Chu LC.
Can Assoc Radiol J. 2024 Mar 20:8465371241239035. Epub ahead of print. PMID: 38509705. - “While CR has shown promise in enhancing the diagnostics and surgical planning of PNETs in our institution, there remain certain limitations that hinder broader adoption. One significant constraint revolves around the specialized expertise required to generate CR images. Optimization of CR images is crucial to accurately represent the anatomy and pathology of interest. This task demands the dedicated training of radiologists who need to customize the display settings for each specific pathology. Using incorrect parameters can impede visualization and may result in incorrect diagnoses. This is compounded by the shadowing effects generated by the CR global lighting model which if not duly accounted for may potentially obscure visualization of significant pathology. As CR becomes more widely adopted, this aspect of CR is anticipated to become more standardized and perhaps even automated.”
Cinematic Rendering of Pancreatic Neuroendocrine Tumours: Opportunities for Clinical Implementation: Part 2: Preoperative Planning and Evaluation of Metastatic Disease.
Ahmed TM, Fishman EK, Chu LC.
Can Assoc Radiol J. 2024 Mar 20:8465371241239035. Epub ahead of print. PMID: 38509705. - “CR holds promising potential for enhancing the diagnostics and surgical planning of PNETs. Part 2 of this pictorial review highlights the utility of CR in vascular mapping, preoperative planning, and evaluation of metastatic disease of PNETs. In the words of Dr. O’Brien, cinematic rendering, though still in its infancy, is an exciting technique; future studies investigating implementation of CR into clinical practice have potential to add great value to our practice.”
Cinematic Rendering of Pancreatic Neuroendocrine Tumours: Opportunities for Clinical Implementation: Part 2: Preoperative Planning and Evaluation of Metastatic Disease.
Ahmed TM, Fishman EK, Chu LC.
Can Assoc Radiol J. 2024 Mar 20:8465371241239035. Epub ahead of print. PMID: 38509705.
Cinematic Rendering for Differentiation of Pancreatic Neuroendocrine Tumor From Intrapancreatic Accessory Spleen.
Ahmed TM, Fishman EK.
AJR Am J Roentgenol. 2024 Jan 24. doi: 10.2214/AJR.24.30862. Epub ahead of print- “PNETs constitute up to 3% of clinically detected pancreatic tumors. Differentiating PNET from IPAS on CT is challenging as both may appear as well-circumscribed arterial-phase enhancing lesions. Cinematic rendering is a 3D post-processing technology that utilizes an advanced global lighting mode to generate photorealistic images. The precision with which CR simulates intricate interactions of light passing through imaged volumes yields superb surface detail and textural perception.”
Cinematic Rendering for Differentiation of Pancreatic Neuroendocrine Tumor From Intrapancreatic Accessory Spleen.
Ahmed TM, Fishman EK.
AJR Am J Roentgenol. 2024 Jan 24. doi: 10.2214/AJR.24.30862. Epub ahead of print - “AI image generation has the potential to improve three-dimensional medical images for certain applications through added visual detail and appeal but ongoing collaboration is needed between radiologists and AI developers due to the overreliance on art and photography in the training data, which may result in inaccurate anatomic results. Moreover, the evolving landscape of ethical discussions and copyright stipulations warrants close attention.”
AI-powered Hyperrealism: Next Step in Cinematic Rendering?
Ramin Javan, MD • Navid Mostaghni, BS
Radiology 2024; 310(1):e231971 - Purpose: To demonstrate the current capabilities of diffusion technology by using Midjourney, version 5.2, a text-to-image generative AI tool, and present a practical guide for its use. Materials and Methods: This exploratory study investigates the principles, parameters, and prompt engineering techniques for 2023. Step-by-step instructions show the innate capability of this technology in creating realistic medical images.
Results: Thirty images were selected, including eye, skin, and vascular aneurysm images. Varying prompt phrasing and weighting techniques allowed for the customization of output image characteristics. Although the details of Midjourney’s model training are confidential, it is estimated that it was trained on at least hundreds of millions of images from the web.
AI-powered Hyperrealism: Next Step in Cinematic Rendering?
Ramin Javan, MD • Navid Mostaghni, BS
Radiology 2024; 310(1):e231971 - Materials and Methods: This exploratory study investigates the principles, parameters, and prompt engineering techniques for 2023. Step-by-step instructions show the innate capability of this technology in creating realistic medical images.
Results: Thirty images were selected, including eye, skin, and vascular aneurysm images. Varying prompt phrasing and weighting techniques allowed for the customization of output image characteristics. Although the details of Midjourney’s model training are confidential, it is estimated that it was trained on at least hundreds of millions of images from the web. Anatomic fidelity was not always maintained because the training data set is not necessarily based on accurate medical images. There are shortcomings in this nascent technology regarding its ability to create entities such as digits of the hand or precise text.
AI-powered Hyperrealism: Next Step in Cinematic Rendering?
Ramin Javan, MD • Navid Mostaghni, BS
Radiology 2024; 310(1):e231971 - “In conclusion, artificial intelligence (AI) image generation has the potential to improve three-dimensional medical images. This method can improve visual detail and appeal. However, ongoing collaboration is needed between radiologists and AI developers because of the overreliance on art and photography in the training data. Therefore, the images generated by Midjourney version 5.2 are geared toward general-use content creation and are currently not anatomically accurate. Overall, a multidisciplinary approach is necessary to ensure practical and ethical use.”
AI-powered Hyperrealism: Next Step in Cinematic Rendering?
Ramin Javan, MD • Navid Mostaghni, BS
Radiology 2024; 310(1):e231971 - “When working with fused dataset, such as CT in combination with position emission tomography (PET), the task of cinematic rendering is more complex, as there is nothing intrinsic to distinguish between the two image types within the visualization. To solve this, our group recently developed a method to include internal lighting for PET data so that it has a visually distinct signature from that of the CT data. This approach allows both datasets to be displayed as a combined rendering and provides a global overview of both abnormal PET uptake and its anatomic location.”
Cinematic rendering of 18F-DCFPyL PET/CT fusion data in a patient with metastatic clear cell renal cell carcinoma
Steven P. Rowe | Sebastian Krueger | Michael A. Gorin | Elliot K. Fishman
BJUI Compass. 2024;1–3. - “We performed cinematic rendering of a PET/CT performed with the PSMA-targeted radiotracer 18F-DCFPyL of a woman with oligometastatic clear cell renal cell carcinoma. The patient had radiotracer uptake in a discrete lesion in the left breast, which was highly conspicuous on the rendered images. In this case, the use of cinematic rendering allowed for the rapid identification and precise anatomical localization of the patient’s site of disease. Although demonstrative of the potential of this reconstructive method for visualizing PET/CT data, further effortsare needed to define the role of cinematic rendering in clinical practice.”
Cinematic rendering of 18F-DCFPyL PET/CT fusion data in a patient with metastatic clear cell renal cell carcinoma
Steven P. Rowe | Sebastian Krueger | Michael A. Gorin | Elliot K. Fishman
BJUI Compass. 2024;1–3. 
Cinematic rendering of 18F-DCFPyL PET/CT fusion data in a patient with metastatic clear cell renal cell carcinoma
Steven P. Rowe | Sebastian Krueger | Michael A. Gorin | Elliot K. Fishman
BJUI Compass. 2024;1–3.- “Black blood cinematic rendering (BBCR) is a newly described preset for cinematic rendering, which creates photorealistic displays from volumetric data sets with the contrast-enhanced blood pool displayed as dark and transparent. That set of features potentially provides for enhanced visualization of endomyocardial and intraluminal pathology, as well as cardiac devices. The similarity of the images to black-blood magnetic resonance imaging (MRI) may allow for expansion of the evaluation of certain types of pathology into patient populations unable to undergo MRI. In the emergency setting, the rapid acquisition time and reasonable post-processing time make this technique clinically feasible. In this expanded experience, we demonstrate an expanded clinical experience with the BBCR technique, highlighting the applications for intraluminal cardiovascular evaluation, especially focused on current and potential emergency radiology applications.”
Expanded experience with cardiovascular black blood cinematic rendering
Claire Brookmeyer · Linda C. Chu · Steven P. Rowe · Elliot K. Fishman
Emergency Radiology https://doi.org/10.1007/s10140-024-02209-1 - “Black blood cinematic rendering (BBCR) was a recently described color and transparency preset that displays the contrast-enhanced blood pool as both transparent and dark. That creates images similar to black blood cardiac magnetic resonance imaging (MRI). In our experience, BBCR excels in evaluation of cardiovascular intraluminal structures because of improved detail and delineation from the contrast-opacified blood pool. For example, in the emergency setting, intraluminal evaluation of the aorta may help identify a subtle intimal flap and extent of dissection, or characterization and emergent therapy planning of ventricular septal rupture.”
Expanded experience with cardiovascular black blood cinematic rendering
Claire Brookmeyer · Linda C. Chu · Steven P. Rowe · Elliot K. Fishman
Emergency Radiology https://doi.org/10.1007/s10140-024-02209-1 
Expanded experience with cardiovascular black blood cinematic rendering
Claire Brookmeyer · Linda C. Chu · Steven P. Rowe · Elliot K. Fishman
Emergency Radiology https://doi.org/10.1007/s10140-024-02209-1- “BBCR captures the cardiac valve anatomy and calcifications. CR has been used in the assessment of aortic valve variant anatomy, and BBCR improves the delineation of the valve cusps from the blood pool. Global valve and outflow tract calcification assessment can be challenging to fully capture on 2D imaging, and routine cinematic rendering displays often obscure the calcifications due to the opaque contrast-enhanced blood pool. BBCR has potential for the assessment of calcifications of the valve leaflets, annulus, and outflow tract in planning for transcatheter valve replacements >”
Expanded experience with cardiovascular black blood cinematic rendering
Claire Brookmeyer · Linda C. Chu · Steven P. Rowe · Elliot K. Fishman
Emergency Radiology https://doi.org/10.1007/s10140-024-02209-1 - “Further, the images produced by BBCR, although derived from standard CT acquisitions, are also fundamentally different. The pixels on a BBCR image incorporate varying color and transparency based on the proportion of different tissue types that contribute to that pixel. As such, there may be information in BBCR images that cannot otherwise specifically be abstracted from standard reconstructions or reformations. How such images and data might feed into graphical processing unit-based artificial intelligence algorithms is not easily predictable but should be explored.”
Expanded experience with cardiovascular black blood cinematic rendering
Claire Brookmeyer · Linda C. Chu · Steven P. Rowe · Elliot K. Fishman
Emergency Radiology https://doi.org/10.1007/s10140-024-02209-1 - “With the growing applications of cinematic rendering in cardiovascular imaging, BBCR is valuable for its visualization of intraluminal structures through a dark transparent blood pool. In this expanded experience, we have reviewed our initial experiences with BBCR with cardiac devices, native cardiac valves and coronaries, intracardiac masses, and aortic disease. Given the often-acute presentations of those conditions, many patients may first be evaluated in the emergency setting. Although the creation of any CR images requires a workflow with a standalone workstation and an experienced radiologist, the time to generate BBCR images would be well invested in the relatively rare patient that has an endoluminal cardiac or endovascular conditionthat needed to be optimally evaluated.”
Expanded experience with cardiovascular black blood cinematic rendering
Claire Brookmeyer · Linda C. Chu · Steven P. Rowe · Elliot K. Fishman
Emergency Radiology https://doi.org/10.1007/s10140-024-02209-1 - CR has been employed in cardiovascular, thoracic, musculoskeletal, and abdominopelvic imaging. Across all of these applications, we have found cinematic rendering to be clinically useful for several common themes: pre-procedural planning for complex anatomy, lesion detection, and lesion characterization. The ability to capture a large volume of tissue in realistic images is useful for global assessment of a disease process. CR also provides excellent representation of complex and detailed 3D anatomy which is not well-represented on 2D planar images, maximum intensity projections, or standard volume-rendered images. This offers immense opportunity for rapid comprehension by surgeons and other proceduralists as well as for other practitioners who are less comfortable using conventional two-dimensional methods.
Clinical implementation of cinematic rendering
Claire Brookmeyer, Linda C. Chu, Steven P. Rowe, Elliot K.Fishman
Current Problems in Diagnostic Radiology 
Clinical implementation of cinematic rendering
Claire Brookmeyer, Linda C. Chu, Steven P. Rowe, Elliot K.Fishman
Current Problems in Diagnostic Radiology- “Current limitations in the widespread use are radiologists’ lack of experience, limited reimbursement, and cumbersome workflow. We have found that radiologists are able to gain expertise with CR image manipulation relatively quickly using the presets in the CR software. While reimbursement is limited in some states and for some applications at this time, we expected that growing literature as well as ordering clinical provider experience will support reimbursement of CR in the future. While currently our CR processing is performed on a separate workstation, we predict that ongoing improvements in computing power will make CR more readily available on typical radiology work stations, enabling integration into routine workflow.”
Expanded experience with cardiovascular black blood cinematic rendering
Claire Brookmeyer · Linda C. Chu · Steven P. Rowe · Elliot K. Fishman
Emergency Radiology https://doi.org/10.1007/s10140-024-02209-1 - “CR is a valuable tool with broad-reaching applications. The photorealistic images capturing a large volume of tissue enable rapid global assessment of complex three-dimensional anatomy and disease. We find CR to be particularly helpful for pre-surgical planning, and evaluation of traumatic injuries, particularly for cardiovascular, musculoskeletal, and abdominopelvic processes. Creation of cinematic rendering starts with optimized imaging protocols, particularly for CT in the near-term, although also for MRI and PET/CT applications as the technology becomes more widespread. CR can routinely be performed quickly by trained and experienced radiologist”
Expanded experience with cardiovascular black blood cinematic rendering
Claire Brookmeyer · Linda C. Chu · Steven P. Rowe · Elliot K. Fishman
Emergency Radiology https://doi.org/10.1007/s10140-024-02209-1
- “While 10 %–20 % of SPTs demonstrate malignant behavior, the vast majority are indolent neoplasms that display excellent prognosis after surgical resection. Metastases, though rare, have also been reported in up to 2 % of cases, with the liver being the most common site of metastatic spread. Given their low malignant potential and excellent outcomes if appropriately treated, correct and timely radiological diagnosis is crucial in optimizing patient management and prognosis. Due to the rarity of SPTs however, in conjunction with the heterogeneity of their imaging features, establishing correct diagnosis has previously proven to be challenging. Prior studies have demonstrated that among cases of pathologically proven SPTs, preoperative suspicion of SPT based on imaging features was correctly raised in only 24 % of cases.”
Cinematic rendering of solid pseudopapillary tumors: Augmenting diagnostics of an increasingly encountered tumor
Taha M. Ahmed, MD, Elliot K. Fishman, MD, Linda C. Chu, MD*
Current Problems in Diagnostic Radiology (in press) - “Cinematic rendering is completed on an independent workstation equipped with Siemens Syngo Via (VB40) running cinematic rendering software. We have developed optimized rendering parameters for the pancreas which we have used for a range of pancreatic pathology. These pre-defined parameters are adjusted in real time to optimize output on a case-by-case basis. The final images are subsequently exported to PACS where they can be reviewed by the referring clinician.”
Cinematic rendering of solid pseudopapillary tumors: Augmenting diagnostics of an increasingly encountered tumor
Taha M. Ahmed, MD, Elliot K. Fishman, MD, Linda C. Chu, MD*
Current Problems in Diagnostic Radiology (in press) - “CT attenuation in cystic regions ranges from that of fluid attenuation equal to that of water to soft tissue attenuation of areas rich in blood. Internal hemorrhage, in the appropriate context of other imaging findings, is highly characteristic of these tumors and is present in between 29 and 88.9 % of cases. Calcifications are present in roughly one third of tumors and are more frequently encountered in larger tumors.19,20 Although peripheral curvilinear calcifications are most classic, calcification patterns may vary. The majority of SPTs (59.3 %) are located within the body and tail of the pancreas with a mean tumor size of 6.1 cm at the time of presentation.”
Cinematic rendering of solid pseudopapillary tumors: Augmenting diagnostics of an increasingly encountered tumor
Taha M. Ahmed, MD, Elliot K. Fishman, MD, Linda C. Chu, MD*
Current Problems in Diagnostic Radiology (in press) - “Differential diagnoses for predominantly solid SPTs consists of well differentiated pancreatic neuroendocrine tumor (PNET), pancreatic ductal adenocarcinoma (PDAC), serous adenoma (SCA) and metastases. For larger mixed solid and cystic SPTs, differential diagnoses consists of such as mucinous cystic neoplasm (MCN), SCA, intraductal papillary mucinous neoplasm (IPMN), cystic PNETs, calcified hemorrhagic pseudocyst, pancreatoblastoma in pediatric patients, and exophytic gastrointestinal stromal tumor (GIST) when arising in close relation to the pancreas.”
Cinematic rendering of solid pseudopapillary tumors: Augmenting diagnostics of an increasingly encountered tumor
Taha M. Ahmed, MD, Elliot K. Fishman, MD, Linda C. Chu, MD*
Current Problems in Diagnostic Radiology (in press) - “Computed tomography (CT) is the primary imaging modality used to assess SPT. At imaging, SPTs typically appear as well encapsulated mixed-density lesions composed of varying proportions of solid components and cystic components. Infrequently, they may be mostly solid or mostly cystic. SPTs are hypothesized to grow as solid tumors that outgrow their vascular supply and subsequently undergo cystic degeneration. As a result, cystic components tend to be centrally located while enhancing solid components are present peripherally. CT attenuation in cystic regions ranges from that of fluid attenuation equal to that of water to soft tissue attenuation of areas rich in blood. Internal hemorrhage, in the appropriate context of other imaging findings, is highly characteristic of these tumors and is present in between 29 and 88.9 % of cases.”
Cinematic rendering of solid pseudopapillary tumors: Augmenting diagnostics of an increasingly encountered tumor
Taha M. Ahmed, MD, Elliot K. Fishman, MD, Linda C. Chu, MD*
Current Problems in Diagnostic Radiology (in press) - “CR in these cases can better visualize internal septations, increase depth perception of cystic components and characterize the true cystic nature of the mass. Through this, the internal architecture of cystic components can be better appreciated which can help in differentiating between cystic neoplasms. In rare cases, SPT may also present as a purely cystic mass, making differentiation between SPT and MCNs challenging. In these equivocal cases, patient demographics, particularly age, may be used to help differentiate between the two entities.”
Cinematic rendering of solid pseudopapillary tumors: Augmenting diagnostics of an increasingly encountered tumor
Taha M. Ahmed, MD, Elliot K. Fishman, MD, Linda C. Chu, MD*
Current Problems in Diagnostic Radiology (in press) - “Vascular encasement, narrowing, occlusion and invasion in SPTs is rare and up to 95 % of SPT do not demonstrate any vascular involvement. CR in these cases can better characterize any vascular stretching, abutment, and compression from a large SPT and differentiate it from true vessel involvement from a PDAC or PNET. This can help rule in the correct diagnosis with more certainty. While most SPTs do not demonstrate vascular invasion, a small aggressive subset (4.6 %) of tumors can present with vascular involvement. Vascular invasion does not necessarily preclude surgical resection of SPT however, and previous reports have demonstrated long term improved outcomes when radical resection with vascular reconstruction is pursued. CR in such cases can better define the extent of vascular involvement through characterizing the length of involved vessel and degree of luminal narrowing."
Cinematic rendering of solid pseudopapillary tumors: Augmenting diagnostics of an increasingly encountered tumor
Taha M. Ahmed, MD, Elliot K. Fishman, MD, Linda C. Chu, MD*
Current Problems in Diagnostic Radiology (in press) - “Second, the display of CR images needs to be optimized to accurately depict the anatomy and pathology of interest. This requires the specialized expertise of radiologists who must tailor the display settings for each unique pathology. Utilization of incorrectly optimized parameters can hinder visualization and potentially lead to incorrect diagnoses. While this aspect of CR implementation may become more standardized and user-friendly in the future, and potentially automated with the help of artificial intelligence algorithms, currently radiologists must dedicate time to manually render each case. It takes an experienced radiologist approximately 5–7 min to render each case.”
Cinematic rendering of solid pseudopapillary tumors: Augmenting diagnostics of an increasingly encountered tumor
Taha M. Ahmed, MD, Elliot K. Fishman, MD, Linda C. Chu, MD*
Current Problems in Diagnostic Radiology (in press) - “Cinematic rendering has multiple applications in the abdomen and may serve as an important adjunct to standard CT images in the evaluation of a variety of abdominal conditions. Cinematic rendering offers the potential for comprehensive assessment of ileal NETs as it improves the appreciation of relationships between the tumor and surrounding organs, and delineation of the major vascular supply, which may influence surgical planning and help anticipate the radicality of associated ileal loop resection. Our findings provide additional evidence on the role of cinematic rendering for preoperative planning of ileal NETs compared to more traditional CT imaging.”
Comprehensive preoperative assessment of ileal neuroendocrine tumor with cinematic rendering.
Pellat A, Terris B, Soyer P.
Diagn Interv Imaging. 2024 Jan;105(1):40-41. - “Cinematic rendering is a 3D reconstruction technique inspired by the animated movie industry. It follows the same steps used for volume rendering in determining colour and opacity that models real-life physical propagation of light providing photorealistic 3D images with more surface details.2 The application of cinematic rendering in clinical practice has been described for pre-operative planning of tumours such as GIST. Originally clinical use of 3D imaging was confined to calculating organ volumes or orthopedic applications; however, the use of helical technology for the propagation of thin slice computed tomography (CT) in conjunction with advanced image reconstruction software has allowed this to be utilized for a variety of other applications.3 Applications for cinematic rendering have been reported to include lesion characterization, localization, and risk stratification in the pre-operative setting. This has been adopted in the literature to date for the assessment of liver masses, pancreatic cancer, gastric tumours, leiomyosarcomas, gastrointestinal bleeding and GIST, to name a few.”
Utilization of Cinematic Rendering for Evaluation of Gastrointestinal Stromal Tumours (GIST).
O’Brien C.
Canadian Association of Radiologists Journal. 2023;0(0). doi:10.1177/08465371231221936 - “Cinematic rendering of GIST helps demonstrate the submucosal origin of the mass and visualize the dynamic enhancement pattern within the tumour allowing for better anatomical evaluation of the lesion providing more information on areas of necrosis and enhancement. Additionally, there is increased information regarding the growth pattern, vascular supply, adjacent anatomic structures, and blood vessels which improves pre-operative planning. Active bleeding from a small bowel tumour is difficult to characterize on conventional CT. Cinematic rendering can more easily detect if there is bleeding from a small bowel tumour. It also provides increased information to differentiate GIST form other gastrointestinal tumours, especially at the ampulla and in the pelvis where anatomical detail is limited on conventional CT. The use of cinematic rendering in GIST is particularly useful as this technique provides exquisite mucosal detail which increases sensitivity for assessment of gastrointestinal mucosal fold changes. Lastly, the ability to produce vascular mapping of a GIST with cinematic rendering allows localization of the feeding vessel in a preoperative setting. Many of the features described are also used to risk stratify GISTs from very low to high risk for recurrence; the added value of cinematic rendering for assessment of GIST may provide a future role for imaging estimation of risk.”
Utilization of Cinematic Rendering for Evaluation of Gastrointestinal Stromal Tumours (GIST).
O’Brien C.
Canadian Association of Radiologists Journal. 2023;0(0). doi:10.1177/08465371231221936 - “As Barat et al discuss, there are limitations to adopting cinematic rendering into clinical practice. However, the scope for future developments is an exciting avenue for improving management of GIST including investigating gene mutations, and incorporating it into a hybrid imaging tool such as positron emission tomography/CT. This technique also has other potential applications including teaching anatomy with more photorealistic images simulating cadaveric specimens. Patient education could be improved with illustration of pathologic diseases in the pre-treatment setting and in the future to be used as an alternative to three-dimensional printing. Cinematic rendering is an exciting new technique currently in its infancy that has the potential to add great value to our practice. To fulfill the advice of Dr Brady: to move forward and keep up, the next step should be to investigate how to implement cinematic rendering into our day-to-day practice.
Utilization of Cinematic Rendering for Evaluation of Gastrointestinal Stromal Tumours (GIST).
O’Brien C.
Canadian Association of Radiologists Journal. 2023;0(0). doi:10.1177/08465371231221936 - “Cinematic rendering is an exciting new technique currently in its infancy that has the potential to add great value to our practice. To fulfill the advice of Dr Brady: to move forward and keep up, the next step should be to investigate how to implement cinematic rendering into our day-to-day practice.”
Utilization of Cinematic Rendering for Evaluation of Gastrointestinal Stromal Tumours (GIST).
O’Brien C.
Canadian Association of Radiologists Journal. 2023;0(0). doi:10.1177/08465371231221936 - “Non-traumatic thoracic aorta emergencies are acute conditions associated with substantial morbidity and mortality. In the emergency setting, timely detection of aortic injury through radiological imaging is crucial for prompt treatment planning and favorable patient outcomes. 3D cinematic rendering (CR), a novel rendering algorithm for computed tomography (CT) image processing, allows for life-like visualization of spatial details and contours of highly complex anatomic structures such as the thoracic aorta and its vessels, generating a photorealistic view that not just adds to diagnostic confidence, but is especially useful for non-radiologists, including surgeons and emergency medicine physicians. In this pictorial review, we demonstrate the utility of CR in the setting of non-traumatic thoracic aorta emergencies through 10 cases that were processed at a standalone 3D CR station at the time of presentation, including its role in diagnosis and management.”
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Jan 18. doi: 10.1007/s10140-024-02204-6. Epub ahead of print. - “Routinely employed 3D post-processing tools include maximum intensity projection (MIP) and volume rendering (VR) that allow for the generation of angiographic images and a more intuitive and interactive representations of the spatial information in the dataset, respectively. Improving upon traditional VR, 3D cinematic rendering (CR) is a Food andDrug Administration (FDA)-approved technique that employs a novel lighting model to generate photorealistic images. CR involves global illumination and path tracing models whereby numerous light rays from all directions propagate through and interact with the volumetric data to generate a voxel. Complex anatomical relations are better evaluated and enhanced depth and shape perception is achieved as the technique considers a natural lighting environment and its effects (e.g., reflection, diffusion, refraction). Postprocessing windowing and the use of clip planes/masks allow cutting into the volume and isolation of the area/organ of interest.”
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Jan 18. doi: 10.1007/s10140-024-02204-6. Epub ahead of print. - “There are some limitations that come with 3D CR. Notably, shadows generated in the images might conceal certain pathologies when viewed from specific angles, necessitating meticulous optimization and assessment from diverse angles in conjunction with the multiplanar reformations. Thus, while an initial learning period to become adept in handling and familiarizing themselves with the CR process is required for radiologists, as demonstrated in our case studies, an experienced radiologist can efficiently execute the rendering process in under 5 min.”
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Jan 18. doi: 10.1007/s10140-024-02204-6. Epub ahead of print. - “Color mapping of different phases enhances visualization of the key pathology, such as the flow through the false and true lumens in a dissection that can be delineated by high contrast shading. CR rendering emphasizes textural changes attributable to inflammatory processes with realistic shadowing that is otherwise difficult to appreciate. The improved surface detail helps characterize an impending PAU or the nature of outpouchings suspicious for mycotic aneurysms and gives a clearer view of multiple plaques and sites of ulceration that could be otherwise missed.”
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Jan 18. doi: 10.1007/s10140-024-02204-6. Epub ahead of print. - “Another application of 3D CR is via the black blood cinematic rendering (BBCR) preset.. BBCR is a preset we specifically developed to visualize intraluminal contours and structures of the heart and great vessels, all through adjustments that can be madein under a minute. This is especially useful in the setting of visualizing various zones of thrombi and occlusion, the degree of obstruction, and the subtle irregularities and internal arrangement of the thrombus that can only be appreciateddue to enhanced depth perception and shadowing.”
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Jan 18. doi: 10.1007/s10140-024-02204-6. Epub ahead of print. - “The intrinsic features of 3D CR with its ability to provide a holistic field of view of the vascular map increases confidence in management and surgical planning. A global viewing angle of the thoracic aorta helps in tracking the dissection and its involvement of the aorta and the extent of mediastinal and pericardial bleeding where present .In cases where patients underwent thoracic endovascular aortic repair (TEVAR), coiling, or graft repairing, CR adds to surgical planning by improved depth perception, shadow effects, and realistic textures, demonstrating the anatomical relationships of the thoracic aorta, surrounding structures, and the pathology to be addressed, with photorealism providing the surgeon a familiar perspective to work with.”
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Jan 18. doi: 10.1007/s10140-024-02204-6. Epub ahead of print. - “3D cinematic rendering (CR) represents an important advancement in radiological imaging, particularly in enhancing the visualization of complex anatomical structures and systems such as the thoracic aorta and its vessels. CR provides detailed, photorealistic illustrations crucial for diagnosis and surgical planning as we have seen in several cases. Future research is needed to evaluate CR’s diagnostic accuracy, both prospectively and in head-to-head comparisons with other rendering methods, as well as its role in other domains such as patient education and medical training. CR, therefore, is emerging as a promising, evolving tool for radiologists, surgeons, and the patients they treat.”
Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.
Yasrab M, Rizk RC, Chu LC, Fishman EK.
Emerg Radiol. 2024 Jan 18. doi: 10.1007/s10140-024-02204-6. Epub ahead of print.
- “The adrenal gland is home to an array of complex physiological and neoplastic disease processes. While dedicated adrenal computed tomography (CT) is the gold standard imaging modality for adrenal lesions, there exists significant overlap among imaging features of adrenal pathology. This can often make radiological diagnosis and subsequent determination of the optimal surgical approach challenging. Cinematic rendering (CR) is a novel CT post-processing technique that utilizes advanced light modeling to generate highly photorealistic anatomic visualization. This generates unique prospects in the evaluation of adrenal masses. As one of the first large tertiary care centers to incorporate CR into routine diagnostic workup, our preliminary experience with using CR has been positive, and we have found CR to be a valuable adjunct during surgical planning. Herein, we highlight the unique utility of CR techniques in the workup of adrenal lesions and provide commentary on the opportunities and obstacles associated with the application of this novel display method in this setting.”
Three-dimensional CT cinematic rendering of adrenal masses: Role in tumor analysis and management,
T.M. Ahmed, S.P. Rowe, E.K. Fishman et al.
Diagnostic and Interventional Imaging (2023), https://doi.org/10.1016/j.diii.2023.09.004 - “CR has promising potential in the characterization of adrenal masses and can influence surgical planning. CR can potentially improve the appreciation of the spatial relationship between the adrenal mass and adjacent structures and delineation of the major vascular supply. Enhanced surgical planning is particularly important with laparoscopic surgeries, in which the surgeons’ real-time intraoperative visualization may be limited. Results from preliminary studies applying cinematic rendering to imaging of non-adrenal pathology to assess clinical benefit have been promising. In one study, orthopedic surgeons and radiologists performed significantly better in the assessment of pelvic instability when using combined dual-energy CT with cinematic rendering (AUC = 0.82) over single-energy CT alone (AUC = 0.67). While this generates optimism, and is in agreement with our initial institutional observations of using CR, a prior study reported that radiologists, in fact, had lower accuracy in diagnosing vascular invasion in deep soft tissue sarcomas with CR imaging compared to standard contrast-enhanced axial imaging and VR imaging.”
Three-dimensional CT cinematic rendering of adrenal masses: Role in tumor analysis and management,
T.M. Ahmed, S.P. Rowe, E.K. Fishman et al.
Diagnostic and Interventional Imaging (2023), https://doi.org/10.1016/j.diii.2023.09.004 - “While CR has demonstrated potential to improve the characterization and treatment planning of adrenal lesions at our institution, there remain several limitations to its widespread implementation. As previously discussed, availability of good quality, volumetric CT is a prerequisite to generating CR images. CR images are therefore critically dependent on the quality of the CT data set and optimization of the acquisition parameters from which they are generated. Secondly, since the CR global lighting model inherently produces shadowing effects, it is important to note that significant pathology may potentially be concealed by shadows or obscuration by overlying structures. This necessitates that CR images be reviewed from multiple viewpoints and be read in conjunction with the axial and multiplanar reformatted images.”
Three-dimensional CT cinematic rendering of adrenal masses: Role in tumor analysis and management
T.M. Ahmed, S.P. Rowe, E.K. Fishman et al.
Diagnostic and Interventional Imaging (2023), https://doi.org/10.1016/j.diii.2023.09.004 - “CR allows depicting adrenal pathologies in a highly photorealistic manner. Generating representations that are as realistic as possible has the potential to help physicians make the most appropriate management decisions. As CR technology becomes more widely available, it is likely to play an increasingly important role in diagnostics and treatment planning.”
Three-dimensional CT cinematic rendering of adrenal masses: Role in tumor analysis and management
T.M. Ahmed, S.P. Rowe, E.K. Fishman et al.
Diagnostic and Interventional Imaging (2023), https://doi.org/10.1016/j.diii.2023.09.004 
- “Lower extremity trauma is one of the most common injury patterns seen in emergency medical and surgical practice. Vascular injuries occur in less than one percent of all civilian fractures. However, if not treated promptly, such injuries can lead to ischemia and death. Computed tomography angiography (CTA) is the non-invasive imaging gold standard and plays a crucial part in the decision-making process for treating lower extremity trauma. A novel, FDA-approved 3D reconstruction technique known as cinematic rendering (CR) yields photorealistic reconstructions of lower extremity vascular injuries depicting clinically important aspects of those injuries, aiding in patient workup and surgical planning, and thus improving patient outcomes. In this article, we provide clinical examples of the use of CR in evaluating lower extremity vascular injuries, including the relationship of these injuries to adjacent osseous structures and overlying soft tissues, and its role in management of lower extremity trauma.”
Cinematic rendering in the evaluation of complex vascular injury of the lower extremities: how we do it.
Lugo-Fagundo, C., Lugo-Fagundo, E., Chu, L.C., Fishman EK, Rowe SP
Emerg Radiol (2023). https://doi.org/10.1007/s10140-023-02178-x - “Lower extremity trauma is one of the most common injury patterns seen in emergency medical and surgical practice, ranging from falls and motor vehicle accidents to blast and fragmentation injuries [4]. Accurate and rapid evaluation of clinical status, along with physical exam, within the context of the overall resuscitation of the patient according to Advanced Trauma Life Support protocols, is crucial in the management of lower extremity vascular injuries [5]. Limb vascular injuries may exhibit “absolute signs” or “hard signs,” including ischemia, absent pulses, active bleeding, and pulsatile hematoma, all of which have a high positive predictive value for severe vascular injury and require urgent surgical intervention. On the other hand, “relative signs” or “soft signs” consist of significant hemorrhage on history, decreased pulse in comparison to the contralateral extremity, injury to osseous structures or proximity to a penetrating wound, unexplained hypotension, and small hematoma.”
Cinematic rendering in the evaluation of complex vascular injury of the lower extremities: how we do it.
Lugo-Fagundo, C., Lugo-Fagundo, E., Chu, L.C., Fishman EK, Rowe SP
Emerg Radiol (2023). https://doi.org/10.1007/s10140-023-02178-x - “Patients with multiple injuries, not limited to the extremities, who are hemodynamically stable, will routinely undergo multiphasic CT with imaging of injured body regions in the appropriate phase of contrast enhancement. Any discrepancies between clinical and CT angiographic fndings prompt further assessment with digital subtraction angiography (DSA). However, an invasive diagnostic approach may delay treatment, resulting in complications such as arteriovenous fstulae, aneurysms, and/ or gangrene, and eventually increasing the risk of amputation and physical disability. In these cases of uncertainty, highly detailed CR visualizations may aid in prompt diagnosis of extremity vascular injuries, as well as any associated complications, and reduce patient morbidity. Diagnosis and treatment within 6–12 h after injury signifcantly improves survival.”
Cinematic rendering in the evaluation of complex vascular injury of the lower extremities: how we do it.
Lugo-Fagundo, C., Lugo-Fagundo, E., Chu, L.C., Fishman EK, Rowe SP
Emerg Radiol (2023). https://doi.org/10.1007/s10140-023-02178-x - “MIP images have also been the standard through which vascular occlusions or segmental narrowing of the vessel lumen have been identifed . Vascular occlusions are a result of external compression, dissection, thrombus, or vasospasm, which may be reactive or secondary to vascular contusion. For example, Fig. 5 demonstrates MIP and 3D CR visualizations of a gunshot entry wound in the upper medial thigh suggesting nearly occlusive SFA thrombus as a result of the injury. CR visualizations accurately depict SFA anatomy and demonstrate distal vasospasm of the vessel, which could otherwise be misinterpreted for extensive thrombus on 2D CT images.
Cinematic rendering in the evaluation of complex vascular injury of the lower extremities: how we do it.
Lugo-Fagundo, C., Lugo-Fagundo, E., Chu, L.C., Fishman EK, Rowe SP
Emerg Radiol (2023). https://doi.org/10.1007/s10140-023-02178-x - “The global illumination model employed by CR enhances visualization of fne vascular detail compared to classic VR and may provide an overall view that combines the traditional advantages of both MIP and VR. CR visualizations generate a 3D vascular map of the extremity that may be evaluated either in isolation through the “peeling away” technique [13] or relative to surrounding anatomic structures, including bones and soft tissues. The “peeling away” technique involves step-wise removal of overlying soft tissue and muscle to reveal underlying vascular and bony anatomy, providing a thorough assessment of the injury. For example, the “peeling away” of the skin in Fig. 1 allows accurate visualization of the underlying vastus intermedius muscle hematoma as a result of an injured branch of the SFA. On further examination and “peeling away” of soft tissues and muscle, the radiologist can confdently rule out any subtle fractures underlying the vascular injury.”
Cinematic rendering in the evaluation of complex vascular injury of the lower extremities: how we do it.
Lugo-Fagundo, C., Lugo-Fagundo, E., Chu, L.C., Fishman EK, Rowe SP
Emerg Radiol (2023). https://doi.org/10.1007/s10140-023-02178-x - “CR is a novel, promising 3D post-processing technique that provides photorealistic visualizations of lower extremity traumatic injuries, depicting clinically important aspects of those injuries, aiding in patient workup and surgical planning, and ultimately potentially improving patient outcomes. Current limitations of CR include post-processing time, approximately 5 additional minutes, compared to other methods given the higher computational power required to generate the 3D images. Also, the quality of the final image depends on the quality of the original dataset. Any reduction in image quality including patient or scanner-based artifacts will be translated into the 3D visualization. As mentioned by Rowe et al., application of these visualizations into routine clinical practice, as well as their advantages and disadvantages relative to traditional 3D techniques, will need to be further investigated through a series of quantitative and qualitative studies.”
Cinematic rendering in the evaluation of complex vascular injury of the lower extremities: how we do it.
Lugo-Fagundo, C., Lugo-Fagundo, E., Chu, L.C., Fishman EK, Rowe SP
Emerg Radiol (2023). https://doi.org/10.1007/s10140-023-02178-x
- “Inflammatory conditions that affect long segments of bowel and/or the mesentery and mesenteric vasculature are a common cause of emergency department visits and evaluation by cross-sectional imaging. Inflammatory bowel disease, specifically Crohn disease and ulcerative colitis, can be unsuspected at presentation and may only be eventually diagnosed based on initial imaging findings. Traditional 2D axial reconstructions and multi-planar reformations can be limited in their ability to globally assess the extent of disease. 3D methods such as volume rendering (VR) are often used as adjunctive means of visualizing the pathology in such patients. Recently, a novel technique known as cinematic rendering (CR) has emerged, utilizing advanced lighting models and ray tracing to simulate photon interactions with tissues, resulting in realistic shadows and enhanced surface detail compared to VR. Generating CR images from select presets takes an experienced radiologist approximately 5 min, meaning that the technique can be incorporated into meaningful emergency department workflows. Given the apparent advantages of CR, we highlight its application in a series of cases in which patients had inflammatory conditions that affected long segments of bowel and/or involved the mesentery, particularly those patients with inflammatory bowel disease, but also including patients with mesenteric venous thrombosis and lymphedema.”
Evaluation of extensive inflammatory conditions of the bowel using three-dimensional CT cinematic rendering: focus on inflammatory bowel disease.
Rowe SP, Kaddu G, Chu LC, Fishman EK
Emerg Radiol. 2023 Sep 4. doi: 10.1007/s10140-023-02165-2. Epub ahead of print - “In brief, the CR images represent a visualization of the 3D dataset. The individual reconstructed slices are stacked to generate the 3D volume, and then a CR-specific lighting model is applied to the volume. That lighting model simulates millions of photons passing through the volume and generates realistic interactions between those photons and the different types of matter composing the tissues in the volume. This leads to higher surface detail and more realistic shadowing effects than are generally possible with traditional volume rendering methods. However, those shadows can potentially obscure important pathology, requiring a diligent evaluation of multiple different views and presets.”
Evaluation of extensive inflammatory conditions of the bowel using three-dimensional CT cinematic rendering: focus on inflammatory bowel disease.
Rowe SP, Kaddu G, Chu LC, Fishman EK
Emerg Radiol. 2023 Sep 4. doi: 10.1007/s10140-023-02165-2. Epub ahead of print - “Physiologically, the terminal ileum is the most frequently involved segment of bowel in CD—the inflammation of the terminal ileum can lead to engorgement of the mesenteric vasculature. The maximum-intensity projection (MIP) shows the increased mesenteric vasculature known as the “comb sign,” which is frequently seen in patients with CD. Of note, the CR image demonstrates the same finding with a similar level of detail, while also having the advantage of improved image depth and soft tissue detail.”
Evaluation of extensive inflammatory conditions of the bowel using three-dimensional CT cinematic rendering: focus on inflammatory bowel disease.
Rowe SP, Kaddu G, Chu LC, Fishman EK
Emerg Radiol. 2023 Sep 4. doi: 10.1007/s10140-023-02165-2. Epub ahead of print - “The images are representative of a patient with severe active inflammation due to UC. The findings—which include severe mucosal hyperenhancement, bowel wall thickening, increased mesenteric vascularity, and loss of haustral markings (i.e., “lead-pipe appearance”)—are not subtle on any of the images. However, the CR image strikes a balance between a high-resolution display of the vasculature and soft tissue detail, thus recapitulating the features of both the MIP and the VR image.”
Evaluation of extensive inflammatory conditions of the bowel using three-dimensional CT cinematic rendering: focus on inflammatory bowel disease.
Rowe SP, Kaddu G, Chu LC, Fishman EK
Emerg Radiol. 2023 Sep 4. doi: 10.1007/s10140-023-02165-2. Epub ahead of print - “ An under-recognized cause of extensive small bowel inflammation is angioedema related to the use of angiotensin-converting enzyme inhibitors (ACEIs). ACEI-induced angioedema is important to recognize on imaging to avoid unnecessary surgery, as the appearance is very similar to bowel ischemia including wall thickening and ascites. CT plays an important role in making the diagnosis in the emergency room in the context of acute abdominal symptoms, although a clinical history of ACEI usage is most critical and communication of that history to the interpreting radiologist can be highly useful.”
Evaluation of extensive inflammatory conditions of the bowel using three-dimensional CT cinematic rendering: focus on inflammatory bowel disease.
Rowe SP, Kaddu G, Chu LC, Fishman EK
Emerg Radiol. 2023 Sep 4. doi: 10.1007/s10140-023-02165-2. Epub ahead of print - “The advent of 3D visualizations that can improve global evaluation of volumetric datasets has been an important step towards adding value to imaging of patients with bowel inflammation. CR has the potential to improve upon previously available 3D visualization methods. As noted above, the CR technique is predicated upon an advanced lighting model that generates realistic shadowing effects and added surface detail. An important aspect of CR in regards to its use in the emergency department is that an experienced radiologist can generate and interpret the added images in a few minutes, allowing for incorporation into clinical workflows. It remains important to utilize multiple presets and to examine the axial reconstructions and multi-planar reformations in order to ensure that important pathology is not obscured.”
Evaluation of extensive inflammatory conditions of the bowel using three-dimensional CT cinematic rendering: focus on inflammatory bowel disease.
Rowe SP, Kaddu G, Chu LC, Fishman EK
Emerg Radiol. 2023 Sep 4. doi: 10.1007/s10140-023-02165-2. Epub ahead of print - “While there are suggestions that CR may improve the speed of understanding complex anatomy and could better display the heterogeneity of tumors, the data remain sparse. The global field-of-view and intrinsic features of CR could lead to overall measurements of inflammation severity and extent. Limitations to the technique include the experience necessary for the reading radiologist to efficiently interpret the CR images and the potential for CR images to miss or underestimate certain findings such as fat stranding. In the future, further studies are warranted to best understand how CR may be utilized.”
Evaluation of extensive inflammatory conditions of the bowel using three-dimensional CT cinematic rendering: focus on inflammatory bowel disease.
Rowe SP, Kaddu G, Chu LC, Fishman EK
Emerg Radiol. 2023 Sep 4. doi: 10.1007/s10140-023-02165-2. Epub ahead of print
- “Cinematic rendering, a postprocessing technique that uses complex light paths and high dynamic range light maps, has enabled more photorealistic CT image reconstruction than contemporary postprocessing techniques such as volume rendering. In a study of 16 medical students, participants were able to read and comprehend cinematic rendering–reconstructed musculoskeletal anatomy models faster than conventional volume rendering reconstructions. Cinematic rendering reconstructions possess more depth and increased surface detail compared with volume rendering, attributable to cinematic rendering’s complex global lighting model. In addition, pictorial essays have highlighted the detail and clarity of cinematic rendering reconstructions in evaluating multifaceted clinical musculoskeletal pathologies, including complex fractures. As such, cinematic rendering represents an important innovation in postprocessing CT reconstruction, with both pedagogic and clinical utility in musculoskeletal imaging.”
Musculoskeletal CT Imaging: State-of-the-Art Advancements and Future Directions.
Demehri S, Baffour FI, Klein JG, Ghotbi E, Ibad HA, Moradi K, Taguchi K, Fritz J, Carrino JA, Guermazi A, Fishman EK, Zbijewski WB.
Radiology. 2023 Aug;308(2):e230344. doi: 10.1148/radiol.230344. PMID: 37606571. - “Cinematic rendering reconstructions possess more depth and increased surface detail compared with volume rendering, attributable to cinematic rendering’s complex global lighting model. In addition, pictorial essays have highlighted the detail and clarity of cinematic rendering reconstructions in evaluating multifaceted clinical musculoskeletal pathologies, including complex fractures. As such, cinematic rendering represents an important innovation in postprocessing CT reconstruction, with both pedagogic and clinical utility in musculoskeletal imaging.”
Musculoskeletal CT Imaging: State-of-the-Art Advancements and Future Directions.
Demehri S, Baffour FI, Klein JG, Ghotbi E, Ibad HA, Moradi K, Taguchi K, Fritz J, Carrino JA, Guermazi A, Fishman EK, Zbijewski WB.
Radiology. 2023 Aug;308(2):e230344. doi: 10.1148/radiol.230344. PMID: 37606571.
- “The relationship of pancreatic ductal adenocarcinoma (PDAC) to important peripancreatic vasculature dictates resectability. As per the current guidelines, tumors with extensive, unreconstructible venous or arterial involvement are staged as unresectable locally advanced pancreatic cancer (LAPC). The introduction of effective multiagent chemotherapy and development of surgical techniques, have renewed interest in local control of PDAC. High-volume centers have demonstrated safe resection of short-segment encasement of the common hepatic artery. Knowledge of the unique anatomy of the patient’s vasculature is important in surgical planning of these complex resections. Hepatic artery anomalies are common and insufficient knowledge can result in iatrogenic vascular injury during surgery.”
Concepts and techniques for revascularization of replaced hepatic arteries in pancreatic head resections.
Floortje van Oosten A, Al Efishat M, Habib JR, Kinny-Köster B, Javed AA, He J, Fishman EK, Quintus Molenaar I, Wolfgang CL.
HPB (Oxford). 2023 Jun 3:S1365-182X(23)00547-6 - ”A dual-phase CT scan is the primary modality for the clinical staging of patients with PDAC. The CT-imaging is combined with a post-processing technique, called a 3D-rendering, which generates detailed vascular maps with improved depth perception. These vascular maps assist surgeons in determining tumor resectability, and the need for vascular resection and reconstruction. In addition, cinematic rendering is applied to the CT-imaging data creating photorealistic 3D-images that are physically accurate representations of the imaging data .This provides improved visualization of potential vascular abutment, encasement, or invasion. Moreover, it generates meticulous vascular maps that can highlight vascular variations, such as replaced or accessory hepatic arteries.”
Concepts and techniques for revascularization of replaced hepatic arteries in pancreatic head resections.
Floortje van Oosten A, Al Efishat M, Habib JR, Kinny-Köster B, Javed AA, He J, Fishman EK, Quintus Molenaar I, Wolfgang CL.
HPB (Oxford). 2023 Jun 3:S1365-182X(23)00547-6
3D and cinematic rendering of abdominopelvic pathology in the peripartum period
Naveen Ghuman · Elliot K. Fishman · Erin Gomez
Abdominal Radiology (2023) 48:1383–1394- “3D reconstructions and cinematic rendering can be used to augment radiologists’ interpretation of abdominopelvic pathology in the peripartum and postpartum period. The photorealistic image quality of cinematic rendering shows the texture of different tissues and lesions, aids in defining spatial relationships, and portrays vascular anatomy in superb detail. These techniques have great promise in enhancing interpretation of otherwise complex abdominopelvic pathology in this unique patient population.”
3D and cinematic rendering of abdominopelvic pathology in the peripartum period
Naveen Ghuman · Elliot K. Fishman · Erin Gomez
Abdominal Radiology (2023) 48:1383–1394
- "Thoracic vascular anomalies in the pediatric population are a heterogeneous group of diseases, with varied clinical presentations and imaging findings. High-resolution computed tomography is widely available and has become a standard part of the workup of these patients, often with three dimensional images. Cinematic rendering is a novel 3D visualization technique that utilizes a new, complex global lighting model to create photorealistic images with enhanced anatomic detail. The purpose of this pictorial review is to highlight the advantages of cinematic rendering compared to standard 2D computed tomography and traditional volume-rendered 3D images in the evaluation of thoracic vascular anomalies. Although cinematic rendering remains a new visualization technique under continued study, the improved anatomic detail and photorealistic quality of these images may be advantageous for surgical planning in cases of complex vascular abnormalities. Cinematic rendering may also help improve communication among clinicians, trainees, and patients and their families.”
3D CT cinematic rendering of pediatric thoracic vascular anomalies
Hannah S. Recht, Edmund M. Weisberg, Elliot K. Fishman
European Journal of Radiology Open 10 (2023) 100485 - "Congenital intrathoracic vascular anomalies are a heterogeneous group of diseases with varied clinical presentations, ranging from asymptomatic to life-threatening. Cross-sectional imaging with 3D visualization has been the standard of care in diagnosis of aortic arch anomalies, aortic coarctation, pulmonary slings, as well as bronchopulmonary malformations with vascular involvement, such as pulmonary sequestration.”
3D CT cinematic rendering of pediatric thoracic vascular anomalies
Hannah S. Recht, Edmund M. Weisberg, Elliot K. Fishman
European Journal of Radiology Open 10 (2023) 100485 - “The examples in this case series highlight the advantages of CR over standard VR reconstructions. The ability of CR to extract additional data from standard CT datasets may obviate the need for additional testing and radiation exposure, which is particularly advantageous in the pediatric population, for whom minimizing radiation is of foremost concern. The 3D visualization and textural contrast provided by CR can improve visualization of complex vascular anatomy, as shown in the above cases, which is essential for preoperative evaluation. One small study assessing the value of CR for extracardiac anatomy in patients with congenital heart defects indicated that pediatric cardiac surgeons preferred the CR images to VR images due to improved “spatial impression in general” and “depth perception”
3D CT cinematic rendering of pediatric thoracic vascular anomalies
Hannah S. Recht, Edmund M. Weisberg, Elliot K. Fishman
European Journal of Radiology Open 10 (2023) 100485 - "Beyond potential diagnostic and treatment benefits, CR offers photorealistic representation of complex anatomy and pathology that can be more intuitively understood by those without a medical background, potentially improving communication between clinicians and patients and/or their families. For the same reasons, CR also may have a role in trainee education, as virtual anatomy becomes increasingly relevant. Although CR remains a relatively new technique under much study, it brings new possibilities for improving diagnosis and treatment in the pediatric population.”
3D CT cinematic rendering of pediatric thoracic vascular anomalies
Hannah S. Recht, Edmund M. Weisberg, Elliot K. Fishman
European Journal of Radiology Open 10 (2023) 100485 - OBJECTIVE To develop an imaging modality for the postoperative phalloplasty urethra. Despite high urologic complication rates after masculinizing genital surgery, existing methods for postsurgical evaluation after phalloplasty have drawbacks. Fluoroscopic studies like the retrograde urethrogram have limitations like user-dependence and need for meticulous positioning but also are inadequate for them evaluation of the anatomically complex post phalloplasty urethra. We developed a novel protocol utilizing CT urethrography with 3D reconstruction using cinematic rendering (3DUG) for neourethral imaging.
CONCLUSION We present a new protocol for the use of 3D CT urethrography with cinematic rendering for neourethral reconstruction. This technique has the potential to improve surgical planning and surveillance of urologic complications in postphalloplasty patients.
3D CT Urethrography With Cinematic Rendering (3DUG): A New Modality for Evaluation of Complex Urethral Anatomy and Assessment of themPostoperative Phalloplasty Urethra
Stephanie Preston, James Liu, Lauren Eisenbeis, Andrew Cohen, Elliot K. Fishman, and Devin Coon
UROLOGY 00: 1−6, 2023. - “3DUG provides a view of the urethra that is easy to interpret. We have created and optimized a protocol for multiplanar imaging and 3D reconstruction for phalloplasty. It can be performed either retrograde or antegrade by a surgeon, nurse or technologist. It can also be used for metoidioplasty or typical reconstructive indications like stricture disease. Development of the protocol took protracted efforts because of unique challenges present in this population (e.g., filling a nondistensible urethra such that enough contrast is delivered to not leave layered air superiorly yet also not so much as to challenge fresh suture lines) but has proven consistent and reliable after optimization. A voiding scan may arguably be safer than pressurizing the urethra via retrograde contrast administration and involves less discomfort.”
3D CT Urethrography With Cinematic Rendering (3DUG): A New Modality for Evaluation of Complex Urethral Anatomy and Assessment of themPostoperative Phalloplasty Urethra
Stephanie Preston, James Liu, Lauren Eisenbeis, Andrew Cohen, Elliot K. Fishman, and Devin Coon
UROLOGY 00: 1−6, 2023. - “ limitations of this study include the experimental nature of cinematic rendering in CT urethrography. In most cases, we do not have a cystoscopy or a VCUG/RUG to compare CT results directly, and to determine its true sensitivity and specificity. This was not possible as it became apparent almost immediately that 3DUG was providing better data than RUG, so we stopped performing the latter.”
3D CT Urethrography With Cinematic Rendering (3DUG): A New Modality for Evaluation of Complex Urethral Anatomy and Assessment of themPostoperative Phalloplasty Urethra
Stephanie Preston, James Liu, Lauren Eisenbeis, Andrew Cohen, Elliot K. Fishman, and Devin Coon
UROLOGY 00: 1−6, 2023. - ”Compared with traditional black and white two-dimensional images and three-dimensional volume rendering (VR) images, CR images were more colorful, layered, and closer to the truth. CR has potential in diagnosing and preoperative planning of adrenal tumors, allowing vivid and realistic visualization of tumor location, morphology, different components (solid, cystic, fat, calcification, etc.), the pattern of enhancement, and the relationship with surrounding tissues and organs.”
Virtual or real: lifelike cinematic rendering of adrenal tumors
Lei Tang et al.
Quant Imaging Med Surg 2021;11(8):3854-3866 - “CR simulates the physical transmission of light in different environments in the real world, giving colorful vitality to the black-and-white image world. It presents the fine anatomical structures of different parts of the human body realistically and vividly, giving clinicians and patients a deeper perception. It also shows good potential application value in adrenal tumor localization, diagnosis, differential diagnosis, preoperative planning, teaching, and doctor-patient communication, which needs to be further verified in future studies.”
Virtual or real: lifelike cinematic rendering of adrenal tumors
Lei Tang et al.
Quant Imaging Med Surg 2021;11(8):3854-3866
- Cinematic rendering (CR) is a novel post-processing technique similar to volume rendering (VR), which allows for a more photorealistic imaging reconstruction by using a complex light modelling algorithm, incorporating information from multiple light paths and predicted photon scattering patterns. Several recent publications relating to adult imaging have argued that CR gives a better “realism” and “expressiveness” experience over VR techniques. CR has also been shown to improve visualisation of musculoskeletal and vascular anatomy compared with conventional CT viewing, and may help non-radiologists to understand complex patient anatomy. In this review, we provide an overview of how CR could be used in paediatric musculoskeletal imaging, particularly in complex diagnoses, surgical planning, and patient consent processes.We present a direct comparison of VR and CR reconstructions across a range of congenital and acquired musculoskeletal pathologies, highlighting potential advantages and areas for further research.
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology 77 (2022) 274-282 - “CR uses a Monte Carlo path-tracing method to simulate howphotons have passed through the imaged tissue fromall directions. As there are theoretically an infinite number of directions fromwhich a photon could travel, theMonte Carlo simulation generates a randomnumber of light paths, which are averaged over time to create an image, approximating photon travel from all directions. This complex interaction of light rays better imitates how we visualise objects in real life, resulting in the so-called “photorealistic” image. The path tracing method also takes into account any overlying structures, generating shadows to help improve depth perception of the final digital 3D model.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology 77 (2022) 274-282 - "In addition to musculoskeletal pathology, CR has been shown to provide improved visualisation of underlying vascular anatomy (over 2D CT images) for undergraduate medical education and several studies have published examples of CR use in depicting cerebrovascular, mesenteric, and aortic vascular pathology. In relation to trauma, we have found that traumatic pseudoaneurysms can be well depicted in relation to surrounding bony anatomy and may help in explaining treatment plans during patient consent for interventional procedures.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology 77 (2022) 274-282 - “Despite the improved aesthetic appearances of CR, there are clear potential drawbacks in relying on this technique alone, some of which are similar to the VR technique. These include the potential to “mask” important findings, either by incorrect windowing or the superimposition of overlying structures. Furthermore, where the pathology is subtle or injuries (e.g., fractures) are present without significant displacement or angulation, they may be easily overlooked and “smoothened out” by the reconstruction algorithm. As such, any 3D reconstruction (CR and VR) should thus always be reviewed with the original source material (e.g., axial CT sections), as is conventional radiology practice. Care should also be taken in these circumstances to determine whether the 3D model should be shown at all, as it could provide false reassurance if the findings are too subtle to demonstrate.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology 77 (2022) 274-282 - “As with all post-processing software, the quality of the CR reconstruction also depends on the original CT image quality. Image reconstructions require thin, isovolumetric sections in order to create accurate, non-pixelated, and aesthetically pleasing 3D models. This can result in a longer post-processing times and the higher computational demand is one main drawbacks of CR (compared to VR). Realtime display of a rotating CR image is at present limited by the need for repetitive recalculation of complex light paths, which can take the reconstruction software anywhere from 5-30 seconds per rotation.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology 77 (2022) 274-282
- “Traumatic thoracic aortic injury is a surgical emergency with very high morbidity and mortality rate. Timely detection of aortic injury and its extent is a crucial step in patient management to allow early surgical intervention. At present, multidetector CT (MDCT) angiography is the study of choice to evaluate for acute traumatic aortic injury due to very high accuracy, easy access to CT scanners in the emergency department, and short acquisition time. Three dimensional(3D) rendering of MDCT datasets, including volume rendering (VR) and maximum intensity projections (MIPs), are a valuable adjunct to standard imaging planes for a more comprehensive review of the aortic anatomy that are particularly helpful for communication of critical findings to non-radiologists including emergency medicine physicians and surgeons.”
Visualization of acute aortic injury with cinematic rendering.
Al Khalifah A, Zimmerman SL, Fishman EK.
Emerg Radiol. 2022 Sep 1. doi: 10.1007/s10140-022-02086-6. Epub ahead of print. - "The CR technique is a unique advanced volume-rendering algorithm that utilizes a new lighting model to generate photorealistic images from MDCT volumetric datasets. The creation of volumetric images using other VR techniques is achieved by utilizing a local lighting model that models the path of individual beams of light from a light source and creating a surface whenever these simulated light beams face anatomic details within the MDCT dataset. The difference of the CR lighting model is that it uses a global illumination model requiring advanced calculations to create 3D images. This model includes not only the direct light path, but also other indirect illumination beams created by reflection from a multitude of sources in the datasets. The result is that a model allows for a higher degree of photorealistic visualization of the contours, shadowing, and 3D spatial relationships of the aorta and other adjacent anatomical structures.”
Visualization of acute aortic injury with cinematic rendering.
Al Khalifah A, Zimmerman SL, Fishman EK.
Emerg Radiol. 2022 Sep 1. doi: 10.1007/s10140-022-02086-6. Epub ahead of print. - "All cases were patients undergoing workup for high risk trauma in our emergency department. CT angiography was ordered for timely diagnosis given the high sensitivity and specificity. CR was performed on a dedicated 3D workstation to delineate any subtle contour abnormality of the aorta and increase the confidence of the diagnosis. Additionally, surgical treatment options to manage acute aortic injuries include endovascular aortic stent graft or open surgical repair making CR a useful tool for preoperative surgical planning.”
Visualization of acute aortic injury with cinematic rendering.
Al Khalifah A, Zimmerman SL, Fishman EK.
Emerg Radiol. 2022 Sep 1. doi: 10.1007/s10140-022-02086-6. Epub ahead of print.
- “Cinematic Rendering (CR) is a recently developed, three dimensional display technique. It uses the same standard acquisition CT volumetric data with a complex global lighting model to create photo-realistic images. The more realistic representation of complex lighting interactions givesmore surface detail and enhances evaluation of spatial relationshipsrelative to volume-rendered images. CR hasbeen used in the evaluation of liver masses and renal cell carcinoma, as well as the pre-operative planning of ovarian cancer. CR may have unique roles in the evaluation and treatment planning of gastric masses, and serve as an important adjunct to standard high-resolution CT. CR is of particular interest in the evaluation of gastric masses becauseits superior evaluation of surface detail is applicable to the evaluation of gastric mucosa, and its ability to represent large volume of tissue in a single image is ideal for vascular mapping and surgical and endoscopy planning.”
Implementation of cinematic rendering of gastric masses into clinical practice: a pictorial review
Claire Brookmeyer · Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdominal Radiology 2022 https://doi.org/10.1007/s00261-022-03604-3 - “The mucosal changes that occur in gastric adenocarcinoma are of particular interest, and can be evaluated through the application of CR. Gastric adenocarcinoma is the most common gastric malignancy. Adenocarcinoma originates in the mucosal layer and so the mucosal fold pattern is often focally altered at the site of disease. CR is capable of showing a large volume of mucosal tissue in a single image, thus offering direct juxtaposition between normal mucosal pattern and focally abnormal folds. At this time, imaging is not used to evaluate the depth of invasion within the gastric wall or the intramural submucosal spread of disease, but CR may provide a further avenue to investigate for these applications, as subtle textural changes can often be appreciated on CR. Even if such textural changes are difficult for the human eye to appreciate, machine learning and artificial intelligence algorithms may be able to leverage the input from CR images to improve detection.”
Implementation of cinematic rendering of gastric masses into clinical practice: a pictorial review
Claire Brookmeyer · Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdominal Radiology 2022 https://doi.org/10.1007/s00261-022-03604-3 - “Although we have found CR to be useful at our institution in the evaluation of gastric masses, there are several limitations in its application. First and foremost, CR images are limited by the quality of the CT volumetric data set from which they are created, sooptimal CT acquisition parameters and patient preparationwith gastric distention is critical. Additionally, CR rendering may require a separate workflow from other radiologic exams. Currently, cinematic rendering software is separate from most PACS due to the complex calculations needed for the global lighting model, so this may necessitate an independent workstation for creation of CR images. It also takes time and radiologist expertise to manipulate many CR parameters to create optimal images,”
Implementation of cinematic rendering of gastric masses into clinical practice: a pictorial review
Claire Brookmeyer · Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdominal Radiology 2022 https://doi.org/10.1007/s00261-022-03604-3 - “ CR has tremendous potential in the treatment planning for gastric masses, although its exact role and effect on surgical planning and endoscopy planning has yet to be delineated. Studies in which surgeons were randomized to having access to CR images or not would be capable of prospectively identifying any changes in outcomes related to the opportunity to review CR images for pre-operative planning. CR may also be employed as a problem-solving tool in clinically suspected gastric abnormalities that are not detected or incompletely characterized on routine multiplanar CT. This may include evaluation of non-mass gastric abnormalities, including suspected GI bleed or gastric ulceration “
Implementation of cinematic rendering of gastric masses into clinical practice: a pictorial review
Claire Brookmeyer · Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdominal Radiology 2022 https://doi.org/10.1007/s00261-022-03604-3 - Background: Cinematic Rendering (CR) is a recently introduced post-processing three-dimensional (3D) visualization imaging tool. The aim of this study was to assess its clinical value in the preoperative planning of deep inferior epigastric artery perforator (DIEP) or muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps, and to compare it with maximum intensity projection (MIP) images. The study presents the first application of CR for perforator mapping prior to autologous breast reconstruction
Conclusion: The current study serves as an explorative study, showing first experiences with CR in abdominal-based autologous breast reconstruction. In addition to MIP images, CR might improve the surgeon’s understanding of the individual’s anatomy. Future studies are required to compare CR with other 3D visualization tools and its possible effects on operative parameters
The third dimension in perforator mapping—Comparison of Cinematic Rendering and maximum intensity projection in abdominal-based autologous breast reconstruction
Journal of Plastic, Reconstructive & Aesthetic Surgery 75 (2022) 536–543 - “CR is a promising 3D visualization technique and can assist surgeons in understanding the patient’s anatomy with all de- tails. There is a continuous development of the underlying algorithms, and the use of artificial intelligence might help to refine the tool in newer software versions. Future studies may consider comparison of CR with other 3D visualization tools. Moreover, the technique might aid the understanding of anatomy in different fields of reconstructive surgery, for example, in the treatment of complex tissue defects or hand surgery. Future studies are needed to investigate the use of CR in other free flap options and its possible positive effects concerning operative parameters, for example, flap harvest time or the occurrence of intraoperative complications”
The third dimension in perforator mapping—Comparison of Cinematic Rendering and maximum intensity projection in abdominal-based autologous breast reconstruction
Journal of Plastic, Reconstructive & Aesthetic Surgery 75 (2022) 536–543
- “Cinematic rendering allows for nuanced visualization of areas of interest. Our preliminary experience, as one of the first centers to incorporate the routine use of CR, has proven very useful in surgical planning. For local determination of resectability, vascular mapping allows for accurate assessment of major arteries and the portovenous system. For the portovenous anatomy it assists in determining the optimal surgical approach (extent of resection, appropriate technique for reconstruction, and need for mesocaval shunting). For arterial anatomy, vessel encasement either represents dissectible involvement via periadventitial dissection or true vessel invasion that is unresectable. CR could potentially provide superior ability than traditional PPCT to discern between the two. Additionally, CR allows for better 3D visualization of arterial anatomic variants which, if not appreciated preoperatively, increases risk of intraoperative ischemia and postoperative complications. Lastly, CR could help avoid unnecessary surgery by enhanced identification of occult metastatic disease that is metastatic disease that is otherwise not appreciated on a standard PPCT.”
Cinematic Rendering: Novel Tool for Improving Pancreatic Cancer Surgical Planning
Ammar A. Javed, Robert W.C. Young, Joseph R. Habib, Benedict Kinny-K€oster, Steven M. Cohen, Elliot K. Fishman,Christopher L. Wolfgang
Curr Probl Diagn Radiol. 2022 Apr (in press) - “A pancreas protocol computed tomography (PPCT) scan is the single most important imaging modality in the determination of local resectability. The PPCT allows precise visualization of vascular structures in relation to the tumor. While advancements have been made in the radiological assessment of pancreatic lesions, the reported ability of PPCT to accurately classify tumor resectability as compared to MRI and histopathological findings ranges from 73% to 83%. In many cases, this may be dependent on inter-operator variability when determining the degree of tumor-vessel involvement and as many as 8% of all pancreatectomies are aborted due to the presence of metastatic disease that was not previously seen on imaging.”
Cinematic Rendering: Novel Tool for Improving Pancreatic Cancer Surgical Planning
Ammar A. Javed, Robert W.C. Young, Joseph R. Habib, Benedict Kinny-K€oster, Steven M. Cohen, Elliot K. Fishman,Christopher L. Wolfgang
Curr Probl Diagn Radiol. 2022 Apr (in press) - “We believe that CR has potential to more confidently determine patient candidacy for successful oncological resection and to aid in pre-surgical planning, particularly in complex cases of tumor-vascular involvement. Herein we describe the first routine implementationof CR in our pancreas multidisciplinary clinic, and the ways in which we utilize CR for our surgical planning.”
Cinematic Rendering: Novel Tool for Improving Pancreatic Cancer Surgical Planning
Ammar A. Javed, Robert W.C. Young, Joseph R. Habib, Benedict Kinny-K€oster, Steven M. Cohen, Elliot K. Fishman,Christopher L. Wolfgang
Curr Probl Diagn Radiol. 2022 Apr (in press) - “As described previously byour group, a halo sign is present when there is >180 degrees encasement of the SMA with tumor infiltration of surrounding lymphatic and neural tissue, however the vessel itself remains fully patent and without apparent tumor invasion. Here, the affected tissue surrounding the artery forms a halo, which appears hypodense, similar to the cancer itself, with circumferential abutment of the artery. In the case of perineural invasion an R0 resection can often be achieved through periadventitial dissection, whereas true arterial wall invasion would require a formal resection. We have found that CR is capable of detecting a thin plane of tissue separating vessel from overlying tumor and is helpful in making determining true invasion. Briefly, a string sign represents >180 degrees encasement of the SMA by tumor infiltration of lymphatic and neural tissue results in the narrowing of a segment or segmental stenosis of the SMA owing to true arterial invasion and/or mechanical compression. In general, we do not offer surgery to patients with true superior mesenteric artery invasion.”
Cinematic Rendering: Novel Tool for Improving Pancreatic Cancer Surgical Planning
Ammar A. Javed, Robert W.C. Young, Joseph R. Habib, Benedict Kinny-K€oster, Steven M. Cohen, Elliot K. Fishman,Christopher L. Wolfgang
Curr Probl Diagn Radiol. 2022 Apr (in press) - “Cinematic rendering has the potential to detect and differentiate subtle liver and peritoneal metastases from surrounding tissue in the preoperative setting. Anecdotally, we have encountered instances in which CR visualized OMD in patients, despite no evidence of OMD on their initial PPCT scan read. These findingswere later confirmed on diagnostic laparoscopy. Further studiesare underway in order to validate the use of CR as a means to avoid diagnostic laparoscopy or aborted pancreatectomies. If validated, in the near future CR could help to avoid unnecessary laparotomy or laparoscopy, allow for the patient to receive appropriate counselling at the time of presentation, and avoid unnecessary delays in starting chemotherapy.”
Cinematic Rendering: Novel Tool for Improving Pancreatic Cancer Surgical Planning
Ammar A. Javed, Robert W.C. Young, Joseph R. Habib, Benedict Kinny-K€oster, Steven M. Cohen, Elliot K. Fishman, Christopher L. Wolfgang
Curr Probl Diagn Radiol. 2022 Apr (in press) - "Based on our experience, CR can provide additional information about tumor-vessel relationship, venous collateralization patterns and the presence of OMD. We have found CR to be particularly useful in differentiating true tumor infiltration from simple proximity to vessels. We have found this to be most helpful in evaluating encasement of the SMA based on the halo and string sign previously described. In our experience, patients with a halo sign usually proceed to surgery with periadventitial dissection of the SMA and most often undergo a negative margin (R0) resection. As systemic therapies continue to improve, we anticipate performing increasingly complex pancreatic operations, further enhancing the benefits of the routine implementation of CR.”
Cinematic Rendering: Novel Tool for Improving Pancreatic Cancer Surgical Planning
Ammar A. Javed, Robert W.C. Young, Joseph R. Habib, Benedict Kinny-K€oster, Steven M. Cohen, Elliot K. Fishman, Christopher L. Wolfgang
Curr Probl Diagn Radiol. 2022 Apr (in press) - "While cinematic rendering has potential to improve the determination of resectability, there remain several limitations to its widespreadi mplementation. CR requires specialized hardware andsoftware that may not be readily accessible at most institutions. Additionally,a radiologist requires specialized training in order to appropriately generate and adjust the parameters in real time for each unique pathology. To date there have been few studies investigating CR’s ability to impact surgical planning or ultimately improve patient outcomes. Future studies by our group will be directed toward elucidating its true impact. Additionally, while this review comments only on CR’s ability to assist in surgical planning, future studies are planned to investigate the utility of CR in the initial diagnosis and staging of pancreatic lesions, as well as the radiologic assessment of treatment response to preoperative chemotherapy.”
Cinematic Rendering: Novel Tool for Improving Pancreatic Cancer Surgical Planning
Ammar A. Javed, Robert W.C. Young, Joseph R. Habib, Benedict Kinny-K€oster, Steven M. Cohen, Elliot K. Fishman, Christopher L. Wolfgang
Curr Probl Diagn Radiol. 2022 Apr (in press)
- “In this review, we provide an overview of how CR could be used in paediatric musculoskeletal imaging, particularly in complex diagnoses, surgical planning, and patient consent processes. We present a direct comparison of VR and CR reconstructions across a range of congenital and acquired musculoskeletal pathologies, highlighting potential advantages and areas for further research.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology, https://doi.org/10.1016/j.crad.2022.01.033 - “In addition to musculoskeletal pathology, CR has been shown to provide improved visualisation of underlying vascular anatomy (over 2D CT images) for undergraduate medical education and several studies have published examples of CR use in depicting cerebrovascular, mesenteric, and aortic vascular pathology. In relation to trauma, we have found that traumatic pseudoaneurysms can be well depicted in relation to surrounding bony anatomy and may help in explaining treatment plans during patient consent for interventional procedures.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology, https://doi.org/10.1016/j.crad.2022.01.033 - “As with all post-processing software, the quality of the CR reconstruction also depends on the original CT image quality. Image reconstructions require thin, isovolumetric sections in order to create accurate, non-pixelated, and aesthetically pleasing 3D models. This can result in a longer post-processing times and the higher computational demand is one main drawbacks of CR (compared to VR). Real-time display of a rotating CR image is at present limited by the need for repetitive recalculation of complex light paths, which can take the reconstruction software anywhere from 5-30 seconds per rotation.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology, https://doi.org/10.1016/j.crad.2022.01.033 - “In conclusion, CR may provide useful 3D reconstructions for a broad range of paediatric musculoskeletal pathologies, and could complement or replace other useful but more costly visualisation techniques, such as 3D printing and augmented/virtual reality. Potential benefits of improved visualisation for the patient includes better understanding of complex anatomy and proposed surgical therapies, and for the clinician, to help surgical planning and improved patient communication around consent and during multidisciplinary team settings. Although the diagnostic value offered by CR may not necessarily be superior to VR for the radiologist, better anatomical understanding and visualisation by non-radiologists could translate into improved patient outcomes.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology, https://doi.org/10.1016/j.crad.2022.01.033
- “The purpose of this study is to demonstrate the utility of cinematic rendering (CR) techniques for imaging of patients who have undergone hybrid repair of thoracoabdominal aortic aneurysms that are difficult to assess given anatomic complexity, particularly in the emergency setting. In this pictorial essay, we will explain why CR techniques are uniquely suited to improving anatomic visualization in patients with complex postoperative vascular anatomy. Verification of vessel patency is critical to optimal care of these patients in any setting, particularly in the emergency patient when clinical history may be lacking.”
Cinematic rendering of CT angiography for visualization of complex vascular anatomy after hybrid endovascular aortic aneurysm repair
Stefan L. Zimmerman, Steven P. Rowe, Elliot K. Fishman
Emergency Radiology (2021) 28:839–843 - "Cinematic rendering (CR) is a recently developed CT post-processing technique for creating photorealistic anatomic visualization. Hybrid abdominal aortic aneurysm repairs involve the use of multiple tortuous and overlapping grafts to preserve blood flow to visceral arteries, which are difficult to adequately evaluate using standard orthogonal planes and with traditional VR techniques. Several examples of complex aortic repairs show the utility of CR for improved visualization of these structures. CR improves upon standard 3D volumetric techniques through improved depiction of the spatial relationships of anatomic structures in 3D space, permitting near life-like visualization that allows the imager to simplify the visualization of highly complex anatomy.”
Cinematic rendering of CT angiography for visualization of complex vascular anatomy after hybrid endovascular aortic aneurysm repair
Stefan L. Zimmerman, Steven P. Rowe, Elliot K. Fishman
Emergency Radiology (2021) 28:839–843 - "CR imaging, however, uses a global rather than local model that accounts not just for the direct path of light from a source but also indirect illumination caused by light scatter and reflection from a multitude of sources in the dataset. The relative paths of thousands of light rays are calculated by the rendering models using complex equations solved by Monte Carlo techniques. This leads to more realistic depiction of surface texture and also realistic shadows in and around objects. Improved visualization of shadows makes the images more realistic and improves visualization of complex anatomy and overlapping structures.”
Cinematic rendering of CT angiography for visualization of complex vascular anatomy after hybrid endovascular aortic aneurysm repair
Stefan L. Zimmerman, Steven P. Rowe, Elliot K. Fishman
Emergency Radiology (2021) 28:839–843 - "Patients who have undergone hybrid abdominal aortic repairs will often have many overlapping, tortuous grafts that extend across long distances from pelvic vessels to target visceral vessels in the upper abdomen in combination with endovascular stents in the aorta and aortic branches. Display of this complex anatomy is difficult with traditional imaging techniques. CR methods, with improved shadowing and photorealistic surface textures, are able to clearly demonstrate the spatial relationships of these structures which will be use- ful for both the imager and surgeon in the emergency setting and beyond.”
Cinematic rendering of CT angiography for visualization of complex vascular anatomy after hybrid endovascular aortic aneurysm repair
Stefan L. Zimmerman, Steven P. Rowe, Elliot K. Fishman
Emergency Radiology (2021) 28:839–843
- “Utilizing complex lighting models, cinematic rendering is a novel technique for demonstrating computed tomography data with exquisite 3D anatomic detail. The tracheal lumen, tracheal wall, and adjacent soft tissue structures are represented with photorealistic detail exceeding that of conventional volume rendering or virtual bronchoscopy techniques. We applied cinematic rendering to a spectrum of emergent tracheal pathologies: traumatic tracheal tears, tracheoesophageal fistulas, tracheal foreign bodies, tracheal stenosis (intrinsic and extrinsic causes), tracheal neoplasms, and tracheomalacia. Cinematic rendering images enable visually accessible evaluation and comprehensive understanding of acute tracheal pathology, which is likely to be of value to both interventional pulmonologists and thoracic surgeons who are determining patient treatment plans.”
Cinematic rendering enhancements to virtual bronchoscopy: assessment of emergent tracheal pathology
Cheng Ting Lin, Steven Rowe, Linda C. Chu, Hannah Recht, Elliot K. Fishman
Emergency Radiology (2021) 28:193–199 - "Cinematic rendering (CR) is a novel technique for demon- strating the same data with 3D anatomic detail via the use of complex lighting models. This method fully visualizes the relationship of the trachea to adjacent mediastinal structures with a photorealistic level of detail that is not available with conventional volume rendering or virtual bronchoscopy techniques. CR utilizes a more complex lighting model that more accurately depicts the manner in which photons act when coming into contact with real-world objects.”
Cinematic rendering enhancements to virtual bronchoscopy: assessment of emergent tracheal pathology
Cheng Ting Lin, Steven Rowe, Linda C. Chu, Hannah Recht, Elliot K. Fishman
Emergency Radiology (2021) 28:193–199 - "Tracheal stenosis is fixed airway narrowing caused by various congenital and acquired disorders. The severity of stenosis generally stays stable during respiration, although occasionally, tracheomalacia may coexist. Severe and extensive tracheal stenosis obstructs airflow and requires urgent intervention. Via multiplanar reformats and 3D rendering, CT imaging pro- vides reliable diagnostic information that aids in preprocedural planning and subsequent posttreatment surveillance.”
Cinematic rendering enhancements to virtual bronchoscopy: assessment of emergent tracheal pathology
Cheng Ting Lin, Steven Rowe, Linda C. Chu, Hannah Recht, Elliot K. Fishman
Emergency Radiology (2021) 28:193–199 - “Tracheomalacia is defined by excessive weakness and collapsibility of the airway, leading to transient expirato- ry collapse. Traditionally, the diagnosis is made with bronchoscopy by directly visualizing airway collapse during forced exhalation. A dynamic decrease in luminal cross-sectional area of at least 50% compared to end- inspiration is considered diagnostic, although this thresh- old can be exceeded by some healthy volunteers; therefore, 70% collapse would be a more specific criterion. Using a 3D technique is valuable for global visualization of the tracheobronchial tree and the extent of airway collapse beyond that visible on bronchoscopy.”
Cinematic rendering enhancements to virtual bronchoscopy: assessment of emergent tracheal pathology
Cheng Ting Lin, Steven Rowe, Linda C. Chu, Hannah Recht, Elliot K. Fishman
Emergency Radiology (2021) 28:193–199 - "CR images enable visually accessible evaluation and comprehensive understanding of acute tracheal pathology. The tracheal lumen, tracheal wall, and adjacent soft tissue structures are represented with photorealistic detail exceeding that of conventional volume rendering. Assessment of tracheal disorders using CR confers several advantages, including clear delineation of the spa- tial relationship between the trachea and surrounding structures, rapid recognition of the configuration and severity of tracheal stenosis, and improved visualization distal to the occluded airway.”
Cinematic rendering enhancements to virtual bronchoscopy: assessment of emergent tracheal pathology
Cheng Ting Lin, Steven Rowe, Linda C. Chu, Hannah Recht, Elliot K. Fishman
Emergency Radiology (2021) 28:193–199
- Cinematic Rendering in the Literature (86 articles to date)
- Cinematic Rendering: Applications are Expanding
- Fetal skeletal dysplasias
- Surgical planning
- Cardiac disease
- Virtual Bronchoscopy and Airways
- Post-mortem CT
- Learning/teaching anatomy
- Neuroradiology apps including base of skull - What needs to be done for Cinematic Rendering to prosper?
- Clinical studies that measure outcomes with and without cinematic rendering
- More clarity into the variability of image quality and its impact on its clinical utility
- Clinical studies comparing radiologist accuracy with and without cinematic rendering
- Clinical studies looking at end user (i.e. surgeon, oncologist, etc.) impact of the studies - Cinematic Rendering: Future Directions
- AI to help optimize study visualizations
- AI to help detect findings hidden in the dataset
- Better visualization techniques beyond the screen like Hololens (Microsoft Inc)
- More tools to optimize image quality including lighting models
- “Three-dimensional (3D) visualizations of volumetric data from computed tomography (CT) acquisitions can be important adjuncts to interpretation of two-dimensional (2D) reconstructions. Recently, the 3D technique known as cinematic rendering (CR) was introduced, allowing photorealistic images to be created from standard CT acquisitions. CR methodology is under increasing investigation for use in the display of regions of complex anatomy and as a tool for education and preoperative planning. In this article, we will illustrate the potential utility of CR for evaluating the urinary bladder and associated pathology. The urinary bladder is susceptible to a multitude of neoplastic and inflammatory conditions and their sequelae. The intrinsic properties of CR may prove useful for the display of subtle mucosal/luminal irregularities, the simultaneous display of soft tissue detail with high-resolution maps of associated tumor neovasculature, and the improved display of spatial relationships to aid pre-procedural planning. Further refinement of presets for CR image creation and prospective evaluation of urinary bladder CR in real-world settings will be important for widespread clinical adoption.”
Evaluation of the urinary bladder using three-dimensional CT cinematic rendering
S.P. Rowe, A.R. Meyer, MA Gorin, L.C. Chu, E.K. Fishman
Diagnostic and Interventional Imaging (2020) (in press) - "Cinematic rendering (CR) is a relatively new method of 3D volume visualization that utilizes a complex global lighting model in order to provide enhanced surface detail and realistic shadowing. Relative to traditional VR methods, CR is qualitatively more photorealistic and gives the reader the perception of added image depth. CR allows for the rapid understanding of anatomy in the pre-operative planning setting and appears to offer utility in the evaluation of complex pathology in the cardiovascular system, the musculoskeletal system, and other regions with multiple structures with intricate relative positions.”
Evaluation of the urinary bladder using three-dimensional CT cinematic rendering
S.P. Rowe, A.R. Meyer, MA Gorin, L.C. Chu, E.K. Fishman
Diagnostic and Interventional Imaging (2020) (in press) 
Evaluation of the urinary bladder using three-dimensional CT cinematic rendering
S.P. Rowe, A.R. Meyer, MA Gorin, L.C. Chu, E.K. Fishman
Diagnostic and Interventional Imaging (2020) (in press)
Evaluation of the urinary bladder using three-dimensional CT cinematic rendering
S.P. Rowe, A.R. Meyer, MA Gorin, L.C. Chu, E.K. Fishman
Diagnostic and Interventional Imaging (2020) (in press)- "The high-contrast that is possible with appropriate windowing with CR can produce high conspicuity of bladder tumors, given that they are generally outlined by low-attenuation urine in the early phases of a multi-phase CT and by excreted intravenous contrast in the delayed/excretory phase. Fig. 2 is an example of the typical appearance of muscle-invasive bladder cancer (arrows), with a primarily intraluminal tumor that grows along the bladder wall, demonstrates some degree of heterogeneity, and contains frond- like projections. These characteristics are appreciated on both 2D multi-planar reformatted images as well as the CR visualizations. However, the heterogeneity of the tumor at its interface with the bladder wall is more apparent on CR.”
Evaluation of the urinary bladder using three-dimensional CT cinematic rendering
S.P. Rowe, A.R. Meyer, MA Gorin, L.C. Chu, E.K. Fishman
Diagnostic and Interventional Imaging (2020) (in press) - "Muscle-invasive urothelial cancers are aggressive tumors and frequently metastasize. The high contrast and detail inherent to CR images provides adequate visualization of both primary and metastatic urothelial tumors. Beyond that, the CR technique demonstrates the internal heterogeneity and textural features of tumors, and may be able to improve efforts at radiomic- and machine-learning-based prognosis.”
Evaluation of the urinary bladder using three-dimensional CT cinematic rendering
S.P. Rowe, A.R. Meyer, MA Gorin, L.C. Chu, E.K. Fishman
Diagnostic and Interventional Imaging (2020) (in press) - “A variety of pathologic conditions involving the urinary bladder are amenable to evaluation with CR. The intrinsic high surface detail and image depth of CR, combined with the potential to display structures with widely varying attenuations in single images by appropriate manipulation of presets and trapezoidal functions on voxel histograms, and the textural features that become apparent with CR visualizations, all indicate this technique may become an important part of CT evaluation of the bladder. Further study will be needed to elucidate the specific scenarii in which CR adds clinical value.”
Evaluation of the urinary bladder using three-dimensional CT cinematic rendering
S.P. Rowe, A.R. Meyer, MA Gorin, L.C. Chu, E.K. Fishman
Diagnostic and Interventional Imaging (2020) (in press)
- Purpose: Cinematic rendering (CR), a recently launched, FDA-approved rendering technique converts CT image datasets into nearly photorealistic 3D reconstructions by using a unique lighting model. The purpose of this study was to compare CR to volume rendering technique (VRT) images in the preoperative visualization of multifragmentary intraarticular lower extremity fractures.
Conclusions: CR reconstructions are superior to VRT due to higher image quality and higher anatomical accuracy. Traumatologists find CR reconstructions to improve visualization of lower extremity fractures which should thus be used for fracture demonstration during interdisciplinary conferences.
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lower extremity fractures?
Lena M. Wollschlaegera et al.
European Journal of Radiology 126 (2020) 108911 - "CR uses a unique lighting model which is far more complex than the ray casting methods used in VR [5]. In CR, the algorithm is based on the global illumination model. This model incorporates information of billions of photons traveling through the volumetric dataset, and the interactions of these rays of light with a joining voxels. Complex lighting effects such as refraction, absorption, depth of field, soft shadows and ambient occlusion can be created.”
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lower extremity fractures?
Lena M. Wollschlaegera et al.
European Journal of Radiology 126 (2020) 108911 - "Recently, Dappa et al. published a review comparing the potential value of CR to conventional VRT images and illustrated potential clinical applications of CR such as preoperative treatment planning. In their experience, CR is especially striking for visualizing structures with high density and high contrast such as bones. Further- more, they highlighted the high quality of CR images and their ability for the perception of depth and the photorealistic representation of human anatomy.”
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lower extremity fractures?
Lena M. Wollschlaegera et al.
European Journal of Radiology 126 (2020) 108911 - “CR provides a more detailed visualization of multifragmentary intraarticular lower extremity fractures with improved image quality and higher anatomical accuracy compared to VRT, thus facilitating the understanding of fracture morphology in multifragmentary intraarticular fractures. Therefore, CR improves traumatological pre-operative fracture visualization in patients with multifragmentary in- traarticular lower extremity fractures and thus can be recommended for fracture demonstration during interdisciplinary conferences.”
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lower extremity fractures?
Lena M. Wollschlaegera et al.
European Journal of Radiology 126 (2020) 108911
- “Computed tomography with multiple detectors and the advancement of processors improved rendered images and three-dimensional reconstructions in clinical practice. Traditional axial slices form non-intuitive images because they are seen in only one plane. The three-dimensional reconstructions can show structures details and diseases with complex anatomy in different perspectives. Cinematic rendering is a newly three-dimensional reconstruction technique, already approved for clinical use, which can produce realistic images from traditional computed tomography data.”
Cinematic rendering for three-dimensional reconstructions of the chest wall: a new reality
Altair da Silva Costa Jr., Norman Gellada
DOI: 10.31744/einstein_journal/2020MD5223 - “The possibility of simultaneous visualization of different anatomical structures of a larger body region in colors introduced by volume rendering has changed imaging assessment standards. This different depiction of image data may be useful for anatomically complex structures and diseases and provides a more user-friendly illustration of imaging findings for medical training and treatment planning.”
Cinematic rendering for three-dimensional reconstructions of the chest wall: a new reality
Altair da Silva Costa Jr., Norman Gellada
DOI: 10.31744/einstein_journal/2020MD5223 - “As light ray passes through the volume, volume contributions are accumulated and calculated at specific points along the ray using the aforementioned sampling process. Each sample point is classified and assigned a color and an opacity value via transfer functions. This step allows the construction of a color representation from gray scale sections. Composition is the process by which color and opacity values from each line of sample points are accumulated using a mathematical formula to generate.”
Cinematic rendering for three-dimensional reconstructions of the chest wall: a new reality
Altair da Silva Costa Jr., Norman Gellada
DOI: 10.31744/einstein_journal/2020MD5223 - "Useful as they may be for complex anatomy assessment, volume rendering techniques are not perfect and have some downsides, such as potential masking of anatomical information and pathological changes. Therefore, images must be interpreted by trained, experienced professionals. Visualization tools (i.e., filtering and subtraction) increase diagnostic accuracy. The fact that nothing is added to what is actually present in original images acquired from patients must be emphasized. In dubious cases, reconstructions must be correlated and compared with corresponding original multiplane images.”
Cinematic rendering for three-dimensional reconstructions of the chest wall: a new reality
Altair da Silva Costa Jr., Norman Gellada
DOI: 10.31744/einstein_journal/2020MD5223 - "Medical imaging has become an increasingly important tool in anatomy teaching. Three-dimensional technology has the potential to improve virtual anatomy even further and adds value by providing more realistic, patient-based images of normal as well as altered anatomy associated with several diseases. Students may interact with the anatomy of different patients and diseases anytime via a three-dimensional technology workstation.”
Cinematic rendering for three-dimensional reconstructions of the chest wall: a new reality
Altair da Silva Costa Jr., Norman Gellada
DOI: 10.31744/einstein_journal/2020MD5223 - "In a different study involving 18 surgeons and comparing the value of cinematic rendering and conventional CT for the understanding of tomographic surgical anatomy in 40 patients, cinematic rendering allowed faster and more accurate understanding of surgical anatomy compared to conventional CT, regardless of surgeon expertise.”
Cinematic rendering for three-dimensional reconstructions of the chest wall: a new reality
Altair da Silva Costa Jr., Norman Gellada
DOI: 10.31744/einstein_journal/2020MD5223
- “Congenital heart disease is often associated with severe clinical presentations demanding prompt imaging diagnosis and appropriate treatment. Therefore, radiologists, particularly radi- ology residents, should be familiar with essential cardiac anatomy in order to diagnose congenital heart disease. In our clinical practice, cardiac anatomy is commonly depicted on CT images acquired with state-of-the art CT imaging techniques; however, the related imaging findings may be overlooked due to lack of attention, experience, or knowledge. It is partly due to the fact that CT-based illustration of cardiac anatomy to help understand congenital heart disease is currently scarce. In this article, cardiac imaging planes; crucial anatomical landmarks; morphological features of cardiac chambers, septa, and valves; and connections of cardiac segments are illustrated using cardiac CT images to facilitate understanding of congenital heart disease.”
CT-Based Essential Cardiac Anatomy for Radiology Residents to Understand Congenital Heart Disease
Goo HW
Journal Korean Radiology 2019;80(6):1107-1120 - “In our clinical practice, cardiac anatomy is commonly depicted on CT images acquired with state-of-the art CT imaging techniques; however, the related imaging findings may be overlooked due to lack of attention, experience, or knowledge. It is partly due to the fact that CT-based illustration of cardiac anatomy to help understand congenital heart disease is currently scarce. In this article, cardiac imaging planes; crucial anatomical landmarks; morphological features of cardiac chambers, septa, and valves; and connections of cardiac segments are illustrated using cardiac CT images to facilitate understanding of congenital heart disease.”
CT-Based Essential Cardiac Anatomy for Radiology Residents to Understand Congenital Heart Disease
Goo HW
Journal Korean Radiology 2019;80(6):1107-1120 - Purpose This study compared the accuracy and timeliness of two-dimensional computed tomography (2DCT) and three- dimensional computed tomography (3DCT) in the diagnosis of different types of acetabular fractures and by different groups of interpreters using the Letournel and Judet classification system.
Conclusions Standardized 3DCT provides greater reliability and faster diagnosis of acetabular fractures and helps improve the accuracy in transverse- and posterior wall-type fractures. In addition, it helps improve the accuracy of less experienced interpreters.
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6 - “Overall, correct classifications with 3D required just over half the time of 2D images (60 vs. 32 s, a reduction of 28 s). Significant time reductions with 3D were observed for both study groups and for all types of fractures.”
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6 - “At all levels of experience among orthopedic surgeons, accuracy is greater with 3D than 2D, but the difference is more noticeable among less experienced surgeons. A study by Sebaaly et al. found 35% improvement in correct classification (from 28 to 63%) with trainees when 3D images were added but only 7% (from 85 to 92%) among the experts. Our results also noted improvement in both ac- curacy and inter-observer reliability among graduate trainees when the interpretation was performed with 3D images versus 2D.”
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6 - “A 3D image set should contain a set of elec- tronic hip disarticulation images with adequate representative views using appropriate rendering techniques. Reported accuracies are higher among studies with images of hip disarticulation compared with non-hip disarticulation. A study by Boudissa et al. reported an improvement in accuracy from 52 to 83%, with the addition of hip disarticulation images, a 31% increase.”
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6 - “In summary, using 3D images results in increased inter- observer reliability and faster interpretation. It helps improve accuracy in cases where classification involves simple types of fractures and also helps improve the overall accuracy of less experienced interpreters. Standardized 3D images can be produced without extensive knowledge of the Letournal classification system and are therefore appropriate for use in an emer- gency unit. We recommend routinely producing this set of 3D images for trauma patients with pelvic bone fractures.”
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6
- “The visualization with CR allowed a more correct and faster comprehension of the surgical anatomy compared with conventional CT imaging, independent of level of surgeon experience. Therefore, CR may assist general surgeons with preoperative preparation and intraoperative guidance.”
Comparison of Cinematic Rendering and Computed Tomography for Speed and Comprehension of Surgical Anatomy.
Elshafei M et al.
JAMA Surg. 2019 Aug; 154(8): 738–744. - “In many fields of general surgery (eg, hepatopancreatobiliary surgery), accurate knowledge and understanding of the patient’s anatomy with all details (eg, vasculature) is the key requirement in surgical decision making. The interpretation of complex anatomy based on conventional cross-sectional imaging is difficult and susceptible to errors because it requires advanced spatial reasoning abilities. Misinterpretation of imaging data corrupts preoperative decision making and the designated surgical approach, which, in turn, may jeopardize patient outcomes. Virtual 3-dimensional (3-D) reconstruction techniques have been developed to overcome this subjective limitation, ultimately facilitating comprehension of patient anatomy. However, conventional volume-rendering techniques provide images of limited quality that do not allow an adequate evaluation of complex intra-abdominal structures, such as the liver. In this regard, a more photorealistic visualization may facilitate image interpretation and improve the comprehension of the surgical anatomy.”
Comparison of Cinematic Rendering and Computed Tomography for Speed and Comprehension of Surgical Anatomy.
Elshafei M et al.
JAMA Surg. 2019 Aug; 154(8): 738–744. - “Misinterpretation of imaging data corrupts preoperative decision making and the designated surgical approach, which, in turn, may jeopardize patient outcomes. Virtual 3-dimensional (3-D) reconstruction techniques have been developed to overcome this subjective limitation, ultimately facilitating comprehension of patient anatomy. However, conventional volume-rendering techniques provide images of limited quality that do not allow an adequate evaluation of complex intra-abdominal structures, such as the liver. In this regard, a more photorealistic visualization may facilitate image interpretation and improve the comprehension of the surgical anatomy.”
Comparison of Cinematic Rendering and Computed Tomography for Speed and Comprehension of Surgical Anatomy.
Elshafei M et al.
JAMA Surg. 2019 Aug; 154(8): 738–744. - “Cinematic rendering is a physically based volume-rendering technique. This crossover study used a Monte Carlo path-tracing method to compute the interaction of photons with the scanned patient data. This path-tracing method was first deployed in computer animation programs by the entertainment industry. This rendering method works with data retrieved from conventional CT or magnetic resonance scans. Hence, the image quality is determined by the original resolution and increases with the number of light paths that are traced. The use of high-dynamic-range–rendering light maps for illumination and the real-time computation of complex lighting effects produce a photorealistic depiction of the image data.”
Comparison of Cinematic Rendering and Computed Tomography for Speed and Comprehension of Surgical Anatomy.
Elshafei M et al.
JAMA Surg. 2019 Aug; 154(8): 738–744. - “Third, because this is a nonclinical study, we can only speculate about the potential influence that CR imaging may have on surgeons owing to an improved comprehension of the patient anatomy. Thus, it remains to be determined whether the routine clinical use of CR may improve surgical decision making, ultimately leading to a reduction of intraoperative mistakes and an improvement in patient outcome.”
Comparison of Cinematic Rendering and Computed Tomography for Speed and Comprehension of Surgical Anatomy.
Elshafei M et al.
JAMA Surg. 2019 Aug; 154(8): 738–744.
- “Cinematic rendering needs isotropic voxels from volumetric CT data similar to those used for MIP, volume rendering and surface rendering visualizations. Basically, cinematic rendering is very similar to volume rendering, although it utilizes a more complex global lighting model. The global lighting model produces high degrees of surface detail and shadowing effects that generated depth in the 3D visualizations and give a photorealistic quality to the images. Preliminary works show that cinematic rendering produces photorealistic images with enhanced detail by comparison with other 3D visualization methods.”
Cinematic rendering: When virtuality comes true.
Soyer P
Diagn Interv Imaging. 2019 Sep;100(9):465-466. 
- “Cinematic rendering (CR) is a photorealistic visualization method for volumetric imaging data that are being investigated for a variety of potential applications including the life-like display of complex anatomy and visual characterization of mass lesions. In this review, we describe the CR appearance of different types of pancreatitis and complications of pancreatitis. We also note possible future directions for research into the utility of CR for pancreatitis.”
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print] 
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print]
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print]
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print]
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print]
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print]
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print]- “Studies addressing the potential utility of CR to improve differentiation of focal autoimmune pancreatitis from pancreatic ductal adenocarcinoma, particularly whether CR soft tissue presets can be optimized for this application, would be of value.”
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print] - “Pseudoaneurysms, which can be a source of sometimes catastrophic hemorrhage, can also be seen as a complication of pancreatitis. Although pseudoaneurysms appear to more commonly result from chronic pancreatitis, a small percentage are seen as sequelae of acute pancreatitis. Given the apparent advantages of 3D imaging for evaluation of abdominal vasculature, and the ability of CR to display contrast-enhanced vasculature with high levels of photorealistic detail, the diagnosis, evaluation, and pre-procedural planning for pseudoaneurysms related to pancreatitis may be a particularly important application of this rendering technique.”
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print] - “As shown by the examples in this manuscript, the anatomic detail of CR may have a role in the evaluation of patients presenting with pancreatitis, although studies addressing potential applications have yet to be carried out. For patients requiring interventions such as percutaneous drainage of fluid collections or open debridement of infected tissue, the photorealistic detail and shadowing effects afforded by CR may aid in pre-procedural/pre-operative anatomic understanding. Beyond that, CR could prove to be a valuable tool to drive machine learning/artificial intelligence applications that may be useful in the differentiation of difficult diagnostic cases (e.g. focal autoimmune pancreatitis versus pancreatic ductal adenocarcinoma) or could be used to derive prognostic information based on higher-order imaging features.”
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print] - “Similar to VR, CR best visualizes high density and high contrast structures such as bones and contrast-enhanced vessels, but at the same time provides a more natural and photo-realistic illumination of the rendered data. Further research will be necessary for determining possible advantages of CR over conventional VR and over two-dimensional (2-D) image post-processing for CT image data.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856. - “Finally, it should be kept in mind that visualization of imaging data with VR – as with all other post-processing techniques such as MIP or SSD—never adds information to the reader beyond what is present in the original source images. It always remains an option for a different representation of imaging data, which might be helpful for anatomically complex structures and disease, and for easier and comprehensible illustration of imaging findings to clinicians.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856. - “The VR technique consists of the following two steps: classification of each voxel and image projection. Classification determines how each point on the artificial rays that pass through the data contributes to the pixel value on the picture. For separation of different tissues (e.g., bone, soft tissue), a trapezoid is used for each tissue type. The tissue represented in each voxel of the volume dataset is determined by using predefined attenuation threshold levels and is assigned to a specific color and opacity. Then, the weighted sum of the percentage of each tissue type represented in the voxel is calculated to determine the overall color and transparency of each voxel. This step is performed for each voxel and for the whole volume dataset.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856. - "As opposed to conventional VR methods, CR solves the multi-dimensional and non-continuous rendering equation to integrate the light scattered from all possible directions along a ray. Thus, path tracing used in CT integrates a huge number of light rays, each with different paths to form each pixel of the rendered image. Since the number of light paths which can be traced is in theory infinite, and tracing of light paths is computationally expensive, Monte-Carlo simulations are used to generate a randomized subset of light paths with an adequate distribution. The final image is obtained iteratively by progressively averaging numerous Monte Carlo samples representing radiance at random positions with light scattered in random directions.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856. - “As a result, the physically based VR method called CR computes in real-time the complex physics of lighting effects. It models shadows, ambient occlusion, multi-scattering, and color transmittance as well as sophisticated camera properties, which include concepts such as aperture, exposure and shutter speed. This approach leads to a natural and physically accurate presentation of the medical data, with a focus on an enhanced depth and shape perception.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856. - “Both, VR and CR have the same general rendering concept in common: segmentation of data based on voxel attenuation and use of color look-up tables taking into account opacity and brightness. As a consequence, both VR and CR share also the same problem of potentially masking findings in datasets by inappropriate use of rendering parameters and by adjacent structures.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856. - “In VR, the differences in light emitted to the voxels are rather small. In contrast, CR uses a more complex lighting model taking into account the effect of lighting for other voxels and subsequent reflections as well. Also, the effect of body parts blocking the trace from the artificial light source to other structures introduces shadowing into the images. As a result of the differences in lighting functions—as being illustrated in the representative image examples of this pictorial review—CR images go along with a more natural image impression as compared to conventional VR.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856. - "Our initial experience indicates that CR of CT images is particularly impressive when high density and high contrast structures such as bones and contrast-enhanced vessels are to be visualized. The main innovation as compared to conventional VR appear to be the more natural and photo-realistic representation of the CT image data, with an enhanced and more natural depth and shape perception.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856.
- “Cinematic rendering needs isotropic voxels from volumetric CT data similar to those used for MIP, volume rendering and surface rendering visualizations. Basically, cinematic rendering is very similar to volume rendering, although it utilizes a more complex global lighting model. The global lighting model produces high degrees of surface detail and shadowing effects that generated depth in the 3D visualizations and give a photorealistic quality to the images. Preliminary works show that cinematic rendering produces photorealistic images with enhanced detail by comparison with other 3D visualization methods.”
Cinematic rendering: When virtuality comes true.
Soyer P
Diagn Interv Imaging. 2019 Sep;100(9):465-466. - “Cinematic rendering (CR) is a photorealistic visualization method for volumetric imaging data that are being investigated for a variety of potential applications including the life-like display of complex anatomy and visual characterization of mass lesions. In this review, we describe the CR appearance of different types of pancreatitis and complications of pancreatitis. We also note possible future directions for research into the utility of CR for pancreatitis.”
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print]
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print]
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print]
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print]
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print]
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print]
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print]- “Studies addressing the potential utility of CR to improve differentiation of focal autoimmune pancreatitis from pancreatic ductal adenocarcinoma, particularly whether CR soft tissue presets can be optimized for this application, would be of value.”
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print] - “Pseudoaneurysms, which can be a source of sometimes catastrophic hemorrhage, can also be seen as a complication of pancreatitis. Although pseudoaneurysms appear to more commonly result from chronic pancreatitis, a small percentage are seen as sequelae of acute pancreatitis. Given the apparent advantages of 3D imaging for evaluation of abdominal vasculature, and the ability of CR to display contrast-enhanced vasculature with high levels of photorealistic detail, the diagnosis, evaluation, and pre-procedural planning for pseudoaneurysms related to pancreatitis may be a particularly important application of this rendering technique.”
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print] - “As shown by the examples in this manuscript, the anatomic detail of CR may have a role in the evaluation of patients presenting with pancreatitis, although studies addressing potential applications have yet to be carried out. For patients requiring interventions such as percutaneous drainage of fluid collections or open debridement of infected tissue, the photorealistic detail and shadowing effects afforded by CR may aid in pre-procedural/pre-operative anatomic understanding. Beyond that, CR could prove to be a valuable tool to drive machine learning/artificial intelligence applications that may be useful in the differentiation of difficult diagnostic cases (e.g. focal autoimmune pancreatitis versus pancreatic ductal adenocarcinoma) or could be used to derive prognostic information based on higher-order imaging features.”
Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications
Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdom Radiol (NY). 2019 Nov 6. doi: 10.1007/s00261-019-02310-x. [Epub ahead of print] - “Similar to VR, CR best visualizes high density and high contrast structures such as bones and contrast-enhanced vessels, but at the same time provides a more natural and photo-realistic illumination of the rendered data. Further research will be necessary for determining possible advantages of CR over conventional VR and over two-dimensional (2-D) image post-processing for CT image data.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856. - “Finally, it should be kept in mind that visualization of imaging data with VR – as with all other post-processing techniques such as MIP or SSD—never adds information to the reader beyond what is present in the original source images. It always remains an option for a different representation of imaging data, which might be helpful for anatomically complex structures and disease, and for easier and comprehensible illustration of imaging findings to clinicians.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856. - “The VR technique consists of the following two steps: classification of each voxel and image projection. Classification determines how each point on the artificial rays that pass through the data contributes to the pixel value on the picture. For separation of different tissues (e.g., bone, soft tissue), a trapezoid is used for each tissue type. The tissue represented in each voxel of the volume dataset is determined by using predefined attenuation threshold levels and is assigned to a specific color and opacity. Then, the weighted sum of the percentage of each tissue type represented in the voxel is calculated to determine the overall color and transparency of each voxel. This step is performed for each voxel and for the whole volume dataset.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856. - "As opposed to conventional VR methods, CR solves the multi-dimensional and non-continuous rendering equation to integrate the light scattered from all possible directions along a ray. Thus, path tracing used in CT integrates a huge number of light rays, each with different paths to form each pixel of the rendered image. Since the number of light paths which can be traced is in theory infinite, and tracing of light paths is computationally expensive, Monte-Carlo simulations are used to generate a randomized subset of light paths with an adequate distribution. The final image is obtained iteratively by progressively averaging numerous Monte Carlo samples representing radiance at random positions with light scattered in random directions.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856. - “As a result, the physically based VR method called CR computes in real-time the complex physics of lighting effects. It models shadows, ambient occlusion, multi-scattering, and color transmittance as well as sophisticated camera properties, which include concepts such as aperture, exposure and shutter speed. This approach leads to a natural and physically accurate presentation of the medical data, with a focus on an enhanced depth and shape perception.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856. - “Both, VR and CR have the same general rendering concept in common: segmentation of data based on voxel attenuation and use of color look-up tables taking into account opacity and brightness. As a consequence, both VR and CR share also the same problem of potentially masking findings in datasets by inappropriate use of rendering parameters and by adjacent structures.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856. - “In VR, the differences in light emitted to the voxels are rather small. In contrast, CR uses a more complex lighting model taking into account the effect of lighting for other voxels and subsequent reflections as well. Also, the effect of body parts blocking the trace from the artificial light source to other structures introduces shadowing into the images. As a result of the differences in lighting functions—as being illustrated in the representative image examples of this pictorial review—CR images go along with a more natural image impression as compared to conventional VR.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856. - "Our initial experience indicates that CR of CT images is particularly impressive when high density and high contrast structures such as bones and contrast-enhanced vessels are to be visualized. The main innovation as compared to conventional VR appear to be the more natural and photo-realistic representation of the CT image data, with an enhanced and more natural depth and shape perception.”
Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging
Evelyn Dappa et al.
Insights Imaging. 2016 Dec; 7(6): 849–856.
- “Evaluation of stomach neoplasms by traditional 3-dimensional (3D) computed tomography methods such as volume rendering and maxi- mum-intensity projection plays an important role in lesion detection and characterization, preoperative planning, staging, and follow-up. Recently, a new 3D visualization method has become available known as cinematic rendering (CR). This novel technique makes use of a complex global lighting model to impart photorealistic levels of detail to 3D images. Although this new technique has yet to be systematically studied for the evaluation of stomach neoplasms, its intrinsic ability to create realistic shadowing effects to enhance understanding of the 3D relative locations of anatomic structures and to enhance detail and texture may prove valuable for a variety of applications. In this article, we demonstrate the CR appearance of multiple different gastric neoplasms, describe potential advantages of CR, and suggest future research directions.”
Evaluation of Stomach Neoplasms With 3-Dimensional Computed Tomography: Focus on the Potential Role of Cinematic Rendering
Steven P. Rowe, Linda C. Chu, Elliot K. Fishman
J Comput Assist Tomogr 2018;42: 661–666 - “Evaluation of stomach neoplasms by traditional 3-dimensional (3D) computed tomography methods such as volume rendering and maxi- mum-intensity projection plays an important role in lesion detection and characterization, preoperative planning, staging, and follow-up. Recently, a new 3D visualization method has become available known as cinematic rendering (CR). This novel technique makes use of a complex global lighting model to impart photorealistic levels of detail to 3D images. Although this new technique has yet to be systematically studied for the evaluation of stomach neoplasms, its intrinsic ability to create realistic shadowing effects to enhance understanding of the 3D relative locations of anatomic structures and to enhance detail and texture may prove valuable for a variety of applications.”
Evaluation of Stomach Neoplasms With 3-Dimensional Computed Tomography: Focus on the Potential Role of Cinematic Rendering
Steven P. Rowe, Linda C. Chu, Elliot K. Fishman
J Comput Assist Tomogr 2018;42: 661–666 - “Recently, a novel method of 3D CT volumetric data visualization became available. This method, known as cinematic rendering (CR), makes use of standard acquisition CT volumetric data composed of isotropic voxels and is fundamentally similar to VR. However, whereas VR uses a ray casting lighting model to create 3D images from acquired volumes, CR instead makes use of a complex global lighting model that takes into account a number of potential interactions of photons with the material in the imaged volume; this leads to enhanced surface detail and a photorealistic quality to the images.”
Evaluation of Stomach Neoplasms With 3-Dimensional Computed Tomography: Focus on the Potential Role of Cinematic Rendering
Steven P. Rowe, Linda C. Chu, Elliot K. Fishman
J Comput Assist Tomogr 2018;42: 661–666 - ”Computed tomography is the imaging method of choice for evaluating stomach neoplasms, and traditional 3D methodologies have previously been shown to have value in lesion detection, staging, and follow-up for treatment response. With the addition of enhanced surface detail intrinsic to CR, the role of 3D CT visualizations in stomach neoplasm imaging may be expanded. Prospective trials with pathologic correlation that evaluate the ability of CR to enhance detection of subtle mucosal irregularities, study whether CR provides better lesion characterization through highlighting intratumoral texture, and lead to improved preoperative planning would be of value.”
Evaluation of Stomach Neoplasms With 3-Dimensional Computed Tomography: Focus on the Potential Role of Cinematic Rendering
Steven P. Rowe, Linda C. Chu, Elliot K. Fishman
J Comput Assist Tomogr 2018;42: 661–666 - “Recently, a novel 3-dimensional visualization methodology for volumetric computed tomography data has become available. This method, known as cinematic rendering, uses an advanced lighting model to create photorealistic images from standard computed tomography acquisition data composed of isotropic voxels. We have observed that cinematic rendering visualizations in which patients have been administered dense, positive oral contrast do not have any substantive visual artifacts and can be used to demonstrate bowel pathology to advantage (ie, “virtual fluoroscopy”). In this technical note, we describe our acquisition and visualization parameters, and we also include demonstrative examples.”
Cinematic Rendering With Positive Oral Contrast: Virtual Fluoroscopy
Steven P. Rowe, Linda C. Chu, MD, Elliot K. Fishman,
J Comput Assist Tomogr 2019;43: 718–720 - “In this article, we describe our observation that CR can effectively display bowel anatomy and pathology after the administration of positive oral contrast with no perceptible visual artifacts. Indeed, the presence of positive oral contrast in CR images allows for highly detailed displays of the bowel mucosal fold pattern and might be considered a type of “virtual fluoroscopy.”
Cinematic Rendering With Positive Oral Contrast: Virtual Fluoroscopy
Steven P. Rowe, Linda C. Chu, MD, Elliot K. Fishman,
J Comput Assist Tomogr 2019;43: 718–720 
Cinematic Rendering With Positive Oral Contrast: Virtual Fluoroscopy
Steven P. Rowe, Linda C. Chu, MD, Elliot K. Fishman,
J Comput Assist Tomogr 2019;43: 718–720- “As demonstrated in this article, CR can produce photorealistic images of the oral contrast–opacified bowel without significant vi- sual artifact. The intrinsic advantages of CR, including high levels of surface detail and realistic shadowing, contribute to the visualization of the bowel in a manner analogous to fluoroscopic studies. In- deed, the quality of the visualizations would suggest that CR may have the ability to replace fluoroscopy in certain contexts, while preserving the anatomic and pathologic information that would normally be obtained from a fluoroscopic examination, with the exception that real-time imaging of motion of the bowel and compression maneuvers are not possible. The preset parameters included in this article may be helpful as a starting point for further evaluation of the utility of CR in this context.”
Cinematic Rendering With Positive Oral Contrast: Virtual Fluoroscopy
Steven P. Rowe, Linda C. Chu, MD, Elliot K. Fishman,
J Comput Assist Tomogr 2019;43: 718–720 - “Photorealistic CR images of the bowel after administration of positive oral contrast demonstrate detailed anatomy and pathology without evidence of visual artifacts. We postulate that CR of the bowel with positive contrast may be able to function as a “virtual fluoroscopy” in some contexts, although this will require significantly more studies to validate.”
Cinematic Rendering With Positive Oral Contrast: Virtual Fluoroscopy
Steven P. Rowe, Linda C. Chu, MD, Elliot K. Fishman,
J Comput Assist Tomogr 2019;43: 718–720 - Results: The BBCR technique was successfully utilized to demonstrate intraluminal cardiac findings in a patient with a normal left ventricle, a patient with a left ventricular mural thrombus, and a patient status-post transcatheter aortic valve replacement.
Conclusions: BBCR is a new method of utilizing volumetric chest CT data in order to provide detailed images of intraluminal anatomy and pathology of the heart. Further study of this promising method is warranted.
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press) - “We have empirically developed a preset for the visualization of intraluminal structures within the heart and great vessels. We refer to this preset as black-blood cinematic rendering (BBCR) due to the observation that the visual effect is similar to the appearance of black-blood magnetic resonance imaging. In the following manuscript, we describe the BBCR methodology and provide relevant clinical examples of its application to gated cardiac CT data.”
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press) - ”The examples in this manuscript demonstrate the potential utility of the BBCR preset to allow the visualization of normal intraluminal cardiac anatomy as well as important pathologic processes. Although this technique will need to be rigorously compared to other methods of cardiac imaging, there appears to be significant promise in utilizing BBCR for cardiac intraluminal visualization. In particular, the utility of BBCR for identifying changes in myocardial trabeculation (e.g. thinning due to prior infarct or left ventricular non-compaction cardiomyopathy), depicting artificial valves and other devices and diagnosing vegetations, and providing intraluminal views of aneurysms and pseudoaneurysms are all applications that merit exploration.”
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press) - “In conclusion, the BBCR method appears to provide high levels of intraluminal anatomic detail for cardiac CT imaging. This may facilitate the detection of important pathologic entities such as intramural thrombus, and may also allow improved evaluation of cardiac devices.”
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press) 
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press)
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press)
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press)
- “Upper tract urothelial carcinoma (UTUC) is a relatively uncommon but aggressive genitourinary malignancy for which multi-phase contrast-enhanced computed tomography (CT) plays an important role in evaluation and staging. 3D imaging with maximum intensity projection (MIP) and volume-rendered (VR) images has been described as a useful means of evaluating UTUC. In this study, we describe the technique of a novel 3D methodology known as cinematic rendering (CR) and provide clinical examples of UTUC visualized with CR. CR utilizes a complex universal lighting model in order to create photorealistic images with improved detail and depth in comparison to MIP or VR images.”
The application of cinematic rendering to CT evaluation of upper tract urothelial tumors: principles and practice
Steven P. Rowe · Linda C. Chu · Alexa R. Meyer · Michael A. Gorin · Elliot K. Fishman
Abdominal Radiology 2019 (in press) https://doi.org/10.1007/s00261-019-02154-5 - “The ability to use multiple overlapping soft-tissue trapezoids to create complex variations in the visibility, translucency, and color of different structures within the imaged volume is another aspect of CR that requires further study. In the case series presented in this study, this principle of CR is perhaps best displayed in Figs. 3d and 4c, d, where the CR visualizations were manipulated to emphasize intraluminal details within the renal collecting systems and ureters. In a way, this could be thought of as similar to minimum intensity projection (MinIP), although in our experience it has been possible to display intraluminal findings as well as preserve the display of other soft tissue types in a manner that is not typically performed with MinIP images.”
The application of cinematic rendering to CT evaluation of upper tract urothelial tumors: principles and practice
Steven P. Rowe · Linda C. Chu · Alexa R. Meyer · Michael A. Gorin · Elliot K. Fishman
Abdominal Radiology 2019 (in press) https://doi.org/10.1007/s00261-019-02154-5 
- As with other regions with complex anatomy for which 3D visualization is a helpful adjunct to standard axial and multiplanar reformatted images, the evaluation of UTUC with CR may ultimately be found to provide important information regarding lesion identification and characterization, as well as therapeutic planning. Further study of the role of CR in UTUC should be carried out to investigate the impact on lesion detection and classification as well as in patient triage and management.
The application of cinematic rendering to CT evaluation of upper tract urothelial tumors: principles and practice
Steven P. Rowe · Linda C. Chu · Alexa R. Meyer · Michael A. Gorin · Elliot K. Fishman
Abdominal Radiology 2019 (in press) https://doi.org/10.1007/s00261-019-02154-5
- “Three-dimensional (3D) imaging is now a useful tool to routinely obtain important information and not only a cosmetic adjunct to two-dimensional images. Studies that are now 30-year-old have demonstrated that 3D imaging techniques provide additional data unattainable with other imaging modalities that improve the preoperative assessment of the resectability of hepatic metastases and allow planning a safer surgical approach. 3D imaging has also been used to better understand the complex anatomy of a variety of intra-abdominal or intra-thoracic organs and to identify anatomical variations. Currently, 3D is part of daily routine and is shared by many specialties.”
Cinematic rendering: When virtuality comes true
P.Soyer
Diagnostic and Interventional Imaging (in press July 2019) - “Cinematic rendering needs isotropic voxels from volumetric CT data similar to those used for MIP, volume rendering and surface rendering visualizations. Basically, cinematic rendering is very similar to volume rendering, although it utilizes a more complex global lighting model. The global lighting model produces high degrees of surface detail and shadowing effects that generate depth in the 3D visualizations and give a photorealistic quality to the images. Preliminary works show that cinematic rendering produces photorealistic images with enhanced detail by comparison with other 3D visualization methods .”
Cinematic rendering: When virtuality comes true
P.Soyer
Diagnostic and Interventional Imaging (in press July 2019) - In this issue of Diagnostic and Interventional Imaging, three articles are devoted to the application of cinematic rendering to CT data to obtain breath-taking 3D images. These three articles nicely illustrate how cinematic rendering shows promise in improving the visualization of enhancement pattern and internal architecture of abdominal lesions, local tumor extension, and global disease burden, which may be helpful in a variety of diseases for lesion characterization and pretreatment planning and also the potential applications in forensic imaging. Although the utility of cinematic rendering in terms of diagnostic capability improvement has not yet been fully established, these articles should suggest future directions for researchers to pursue.
Cinematic rendering: When virtuality comes true
P.Soyer
Diagnostic and Interventional Imaging (in press July 2019) 
Cinematic rendering of focal liver masses
L.C.Chu, S.P.Rowe E.K.Fishman
Diagnostic and Interventional Imaging (In Press)
Cinematic rendering of focal liver masses
L.C.Chu, S.P.Rowe E.K.Fishman
Diagnostic and Interventional Imaging (In Press)
- IMPORTANCE Three-dimensional (3-D) volume rendering has been shown to improve visualization in general surgery. Cinematic rendering (CR), a novel 3-D visualization technology for postprocessing of computed tomography (CT) images, provides photorealistic images with the potential to improve visualization of anatomic details.
Comparison of Cinematic Rendering and Computed Tomography for Speed and Comprehension of Surgical Anatomy
Elshafei M et al.
JAMA Surg. doi:10.1001/jamasurg.2019.1168 - CONCLUSIONS AND RELEVANCE “The visualization with CR allowed a more correct and faster comprehension of the surgical anatomy compared with conventional CT imaging, independent of level of surgeon experience. Therefore, CR may assist general surgeons with preoperative preparation and intraoperative guidance.
Comparison of Cinematic Rendering and Computed Tomography for Speed and Comprehension of Surgical Anatomy
Elshafei M et al.
JAMA Surg. doi:10.1001/jamasurg.2019.1168 - This study shows that CR imaging speeds up and improves the understanding of complex anatomical situations compared with CT. Surgeons perceive CR imaging as a helpful tool that not only promotes their anatomical understanding but may also enhance preoperative and intraoperative decision making. Additional studies are needed to further explore the benefits of CR imaging in the clinical setting.”
Comparison of Cinematic Rendering and Computed Tomography for Speed and Comprehension of Surgical Anatomy
Elshafei M et al.
JAMA Surg. doi:10.1001/jamasurg.2019.1168 
Comparison of Cinematic Rendering and Computed Tomography for Speed and Comprehension of Surgical Anatomy
Elshafei M et al.
JAMA Surg. doi:10.1001/jamasurg.2019.1168
- “In this pictorial essay, we provide demonstrations of the appearance of a number of renal pathologies as visualized with CR. While this will not be a comprehensive review of all possible renal pathologic conditions, it will serve to demonstrate the potential utility of CR in evaluating the kidney—potential that must still be borne out in prospective studies evaluating the technique.”
3D CT of renal pathology: initial experience with cinematic rendering
Steven P. Rowe, Alexa R. Meyer, Michael A. Gorin, Pamela T. Johnson, and Elliot K. Fishman
Abdom Radiol (2018) 43:3445–3455 - “VR has demonstrated accuracy in identifying accessary renal arteries and variant renal venous anatomy in the pre- operative setting, and may be of particular value in patients with complex underlying anatomy. While a study outlining the utility of CR for evaluation of renal vascular anatomy has not yet been reported, the highly detailed vascular maps produced by the CR technique may provide similar information to that obtained from VR but with a more photorealistic appearance.”
3D CT of renal pathology: initial experience with cinematic rendering
Steven P. Rowe, Alexa R. Meyer, Michael A. Gorin, Pamela T. Johnson, and Elliot K. Fishman
Abdom Radiol (2018) 43:3445–3455 - “While older 3D CT methods have previously been successfully applied to identify the cause of obstruction and appropriately guide surgical intervention, the added anatomic detail and realistic shadowing effects of CR may be particularly helpful in preoperative planning prior to treatment of UPJ obstruction.”
3D CT of renal pathology: initial experience with cinematic rendering
Steven P. Rowe, Alexa R. Meyer, Michael A. Gorin, Pamela T. Johnson, and Elliot K. Fishman
Abdom Radiol (2018) 43:3445–3455 - “Both the arterial and venous vasculature of the kidneys are susceptible to a number of pathologic conditions. On the arterial side, any number of pathologic conditions such as atherosclerosis, dissection, transection, and aneurysms can be encountered in the renal arteries just as they can be in other arterial systems. 3D CT angiography can play a role in the evaluation of all of these entities. In addition, 3D visualizations of volumetric CT data can be utilized to evaluate for fibromuscular dysplasia, an uncommon cause of renovascular hypertension, but one that is amenable to treatment with antihypertensives and/or angioplasty.”
3D CT of renal pathology: initial experience with cinematic rendering
Steven P. Rowe, Alexa R. Meyer, Michael A. Gorin, Pamela T. Johnson, and Elliot K. Fishman
Abdom Radiol (2018) 43:3445–3455 - “Although CR as a means to visualize fibromuscular dysplasia has not been studied, the highly detailed vascular anatomy that can be displayed with this technique is likely to readily allow for the identification of patients with this condition.”
3D CT of renal pathology: initial experience with cinematic rendering
Steven P. Rowe, Alexa R. Meyer, Michael A. Gorin, Pamela T. Johnson, and Elliot K. Fishman
Abdom Radiol (2018) 43:3445–3455 - “Potential advantages of CR in this context include improved preoperative planning via better understanding of the relative positions of anatomic objects within the imaged volume and facilitation of patient engagement and education as these images may be more intuitive for those without a formal medical background.”
3D CT of renal pathology: initial experience with cinematic rendering
Steven P. Rowe, Alexa R. Meyer, Michael A. Gorin, Pamela T. Johnson, and Elliot K. Fishman
Abdom Radiol (2018) 43:3445–3455 - “Additionally, the anatomic detail provided in CR images may allow for the perception of tumoral textures that are otherwise not appreciated, which could lead to more accurate differentiation of benign from malignant tumors without the need for complex statistical textural analysis.”
3D CT of renal pathology: initial experience with cinematic rendering
Steven P. Rowe, Alexa R. Meyer, Michael A. Gorin, Pamela T. Johnson, and Elliot K. Fishman
Abdom Radiol (2018) 43:3445–3455 - “Similar to traditional 3D methodologies, CR may prove to be a useful adjunct to 2D imaging in the evaluation of the upper urinary tract. Indeed, the ability of CR to accentuate textural features could provide added diagnostic yield for the detection of subtle and/or infiltrative tumors. Again, the ultimate utility of CR in this context will need to be explored in dedicated studies.”
3D CT of renal pathology: initial experience with cinematic rendering
Steven P. Rowe, Alexa R. Meyer, Michael A. Gorin, Pamela T. Johnson, and Elliot K. Fishman
Abdom Radiol (2018) 43:3445–3455 - “CR allows for a new level of anatomic detail with 3D CT visualization. The role of CR in renal pathology has yet to be thoroughly explored, although the potential suggested by the photorealism of the figures in this review indicates that further study would be warranted. Ultimately, studies that explore the utility of CR in a wide range of conditions and that are backed by extensive surgical and/or pathological correlation are needed to establish the potential diagnostic benefits of this new technique.”
3D CT of renal pathology: initial experience with cinematic rendering
Steven P. Rowe, Alexa R. Meyer, Michael A. Gorin, Pamela T. Johnson, and Elliot K. Fishman
Abdom Radiol (2018) 43:3445–3455
- “With emerging virtual reality technologies, application of new tools in forensic medicine and anthropology will require adjustments, technical optimization, and validation. This study serves as an example of the anticipated level of efficacy and some of the limitations of virtual skeletons using current technology. Technical improvements should focus on searching for appropriate 3D-rendering parameters and minimization of stair-step artifacts. When virtual pelvic bones are used in an assessment, the cinematic volume rendering 3D CT has a high level of efficacy in revealing relevant details on the pubic bone, but remains unsuitable for evaluation of the auricular surface because of the poor demonstration of transverse organization and porosity.”
Technical note: Efficacy of three-dimensional cinematic rendering computed tomography images in visualizing features related to age estimation in pelvic bones
Nuttaya Pattamapaspong et al. Forensic Science International (in press) - - Virtual skeletons created from 3D CT images have the potential to be used as a substitute for real bones.
- For age estimation, 3D CT can reveal relevant details on the pubic symphyses.
- 3D CT cannot effectively display the transverse organization or the porosity of the auricular surface.
- Appropriate rendering parameters and reduction of artifacts in 3D CT are required.
Technical note: Efficacy of three-dimensional cinematic rendering computed tomography images in visualizing features related to age estimation in pelvic bones
Nuttaya Pattamapaspong et al. Forensic Science International (in press) - “Cinematic volume rendering is a newly introduced technique inspired by the photorealistic appearance of some animation movies. Owing to advances in computer technology, cinematic volume rendering resembles casting billons light rays from all possible directions to create an image. This technique integrates natural light effects which improves the rendering of shape, depth, and shading on the surface of 3D images.”
Technical note: Efficacy of three-dimensional cinematic rendering computed tomography images in visualizing features related to age estimation in pelvic bones
Nuttaya Pattamapaspong et al. Forensic Science International (in press)
- "Kawasaki’s disease (KD) is a vasculitis that predominantly affects children and can lead to the development of coronary artery aneurysms. These aneurysms can subsequently thrombose and occlude, which may lead to chest pain and other signs and symptoms of acute coronary syndrome in young patients. Coronary CT angiography, including 3D visualization techniques, is a common modality used in the follow-up of KD patients."
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering
Rowe SP, Zimmerman SL, Johnson PT, Fishman EK
Emergency Radiology (2018) 25:449–453 - "The most important potential complication of KD is in- flammatory damage to the coronary arteries, which classically leads to the formation of coronary artery aneurysms. These aneurysms will often undergo vascular remodeling and partial
thrombosis in order to produce a psuedonormal vascular lumen. However, progressive thrombosis and other stenotic processes such as fibrosis can, over time, precipitate cardiac ischemia that can lead to emergency room presentations for chest pain or other signs of acute coronary syndrome and necessitate invasive and/or surgical interventions."
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering
Rowe SP, Zimmerman SL, Johnson PT, Fishman EK
Emergency Radiology (2018) 25:449–453 - " While the advantages of this new technique are still under investigation, potential applications include improved visualization of complex anatomic structures that obviates the need for expensive 3D printing, better display of soft tissue texture that may improve detection and characterization of subtle lesions, improved pre-operative planning, and better trainee and patient engagement."
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering
Rowe SP, Zimmerman SL, Johnson PT, Fishman EK
Emergency Radiology (2018) 25:449–453 - "As with other 3D visualization methods, CR would be expected to provide a global overview of the disease process that is not easily appreciated on 2D axial or multi-planar reformatted images. In particular, this may help to identify relatively distal, small caliber sites of aneurysmal enlargement, which stand out with high contrast on the 3D images but can be subtle when only 2D images are viewed."
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering
Rowe SP, Zimmerman SL, Johnson PT, Fishman EK
Emergency Radiology (2018) 25:449–453 - "Given the anatomic complexity of the mediastinum with many adjacent vascular structures, it may be that CR has intrinsic advantages relative to other 3D methods in being able to accurately display the relative positions of those structures in a manner that may be more intuitively grasped in comparison to less photorealistic depictions. At the same time, the shadowing effects produced by CR can potentially obscure important sites of pathology, so a careful inspection of CR visualizations from multiple viewing angles and with multiple different window settings is necessary."
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering
Rowe SP, Zimmerman SL, Johnson PT, Fishman EK
Emergency Radiology (2018) 25:449–453 - "Acute aortic injuries are not common in the setting of severe blunt trauma, but lead to significant morbidity and mortality. High- quality MDCT with 2D MPRs and 3D rendering are essential to identify aortic trauma and distinguish anatomic variants and other forms of aortic pathology from an acute injury. Misinterpretation of mimics of acute aortic injury can lead to unnecessary arteriography and thoracic surgery. Since most traumatic injuries occur in the distal arch, radiologists must be cognizant of the range of appearances of variants related to the ductus diverticulum. Cinematic rendering (CR) is a new 3D post-processing tool that provides even greater anatomic detail than traditional volume rendering."
MDCT of ductus diverticulum: 3D cinematic rendering to enhance understanding of anatomic configuration and avoid misinterpretation as traumatic aortic injury
Steven P. Rowe, Pamela T. Johnson, Elliot K. Fishman
Emergency Radiology (2018) 25:209–213 - "However, not all abnormalities of the aorta indicate an acute process, and multiple pitfalls that can mimic acute aortic injury have been described. Among these is the ductus diverticulum—a remnant of the ductus arteriosus that arises from the lesser curvature of the aortic arch, which can be mistaken for a traumatic aortic pseudoaneurysm, dissection, or incomplete rupture. The distal aortic arch, and in particular the undersurface, is the most common location for acute traumatic aortic injury. "
MDCT of ductus diverticulum: 3D cinematic rendering to enhance understanding of anatomic configuration and avoid misinterpretation as traumatic aortic injury
Steven P. Rowe, Pamela T. Johnson, Elliot K. Fishman
Emergency Radiology (2018) 25:209–213 - "Cinematic rendering produces volume rendered images with photorealistic image quality. It uses a global illumination model, which takes direct and indirect illumination into account when constructing an image, to achieve rendering quality. The mathematical models that describe this visualization technology include complex integral equations that are solved numerically using the Monte Carlo integration. The result of the integration is a numerical rendering algorithm known as path tracing: thousands of light rays are traced to compute the resulting image."
MDCT angiography with 3D rendering: A novel cinematic rendering algorithm for enhanced anatomic detail
Johnson PT, Schneider R, Lugo-Fagundo C, Johnson M, Fishman EK
AJR 2017 Aug;209(2):309-312 - "To achieve photorealistic quality an "environment map" or "light map" must be used as this light source provides realistic effects achieved by real world light scenarios. The light map consists of texture maps containing information on the brightness of surfaces in a virtual scene that allow the reproduction of the light environment in which the map was generated."
MDCT angiography with 3D rendering: A novel cinematic rendering algorithm for enhanced anatomic detail
Johnson PT, Schneider R, Lugo-Fagundo C, Johnson M, Fishman EK
AJR 2017 Aug;209(2):309-312 - "The light model off of which cinematic rendering and classic volume rendering are based when reconstructing the images accounts for the difference between the two technologies. The primary reason why classic volume rendering results in images that are relatively less photorealistic is the use of the local lighting model – only local properties, such as the local gradient, influence the resulting image. Inversely, cinematic rendering assumes the global illumination model, which accounts for the impact that all light rays have on image reproduction."
MDCT angiography with 3D rendering: A novel cinematic rendering algorithm for enhanced anatomic detail
Johnson PT, Schneider R, Lugo-Fagundo C, Johnson M, Fishman EK
AJR 2017 Aug;209(2):309-312 - "Additionally, cinematic rendering and classic volume rendering differ in their respective light sources. The light sources in classical volume rendering are either single unidirectional light sources or multiple light sources. Although cinematic rendering could use the same light sources as those of classic volume rendering, it also uses environment maps to produce the best visual results. Moreover, classic volume rendering assumes that light passing through the transparent participating medium is absorbed. This assumption leads to less realistic images because in reality light particles are scattered in such a medium. Thus, to achieve photorealism, classic volume rendering would have to account for scattering effects."
MDCT angiography with 3D rendering: A novel cinematic rendering algorithm for enhanced anatomic detail
Johnson PT, Schneider R, Lugo-Fagundo C, Johnson M, Fishman EK
AJR 2017 Aug;209(2):309-312 - "In cinematic rendering, the most important parameter available to manipulate the resulting image is the transfer function. A parameter that was already available in classic volume rendering, the transfer function assigns a color and an opacity property to each voxel value. The opacity can be zero, one or any number between zero and one. If the opacity is zero, then the voxel value represents a vacuum that does not influence rendering computation. If the opacity is equal to one, then the voxel value represents a region that is fully opaque."
MDCT angiography with 3D rendering: A novel cinematic rendering algorithm for enhanced anatomic detail
Johnson PT, Schneider R, Lugo-Fagundo C, Johnson M, Fishman EK
AJR 2017 Aug;209(2):309-312 - "The limitations related to cinematic rendering’s photorealistic quality also must be acknowledged. While photorealism improves the image quality and allows for a better perception of structures, it is possible to have scenarios when too much photorealism is bad. For example, if some tissue parts are obstructed from the light source, the tissue becomes darker, which can be very realistic but it can omit information about the vasculature."
MDCT angiography with 3D rendering: A novel cinematic rendering algorithm for enhanced anatomic detail
Johnson PT, Schneider R, Lugo-Fagundo C, Johnson M, Fishman EK
AJR 2017 Aug;209(2):309-312 - Cinematic Rendering: Future Directions
● Implement algorithm on faster hardware or GPU’s
● Optimization of lighting models may be possible with AI to select best parameters
● Integration into Radiology work flow
- “Acute aortic injuries are not common in the setting of severe blunt trauma, but lead to significant morbidity and mortality. High- quality MDCT with 2D MPRs and 3D rendering are essential to identify aortic trauma and distinguish anatomic variants and other forms of aortic pathology from an acute injury. Misinterpretation of mimics of acute aortic injury can lead to unnecessary arteriography and thoracic surgery. Since most traumatic injuries occur in the distal arch, radiologists must be cognizant of the range of appearances of variants related to the ductus diverticulum. Cinematic rendering (CR) is a new 3D post-processing tool that provides even greater anatomic detail than traditional volume rendering. In this case series, CR is used to impart to radiologists a better understanding of various anatomic configurations that can be seen with a ductus diverticulum.”
MDCT of ductus diverticulum: 3D cinematic rendering to enhance understanding of anatomic configuration and avoid misinterpretation as traumatic aortic injury Steven P. Rowe1 & Pamela T. Johnson1 & Elliot K. Fishman Emergency Radiology (2018) 25:209–213 - “Postprocessing with 2D multiplanar reconstructions and 3D rendering has become standard of care in CT angiography. One of the advantages of volume rendering over maximum intensity projection is the ability to convey 3D anatomic relationships. For complex anatomic configurations like the thoracic aorta and pulmonary arteries, the lighting model in cinematic rendering adds even greater anatomic detail, as demonstrated by these cases.”
MDCT of ductus diverticulum: 3D cinematic rendering to enhance understanding of anatomic configuration and avoid misinterpretation as traumatic aortic injury Steven P. Rowe1 & Pamela T. Johnson1 & Elliot K. Fishman Emergency Radiology (2018) 25:209–213 - “One of the most pronounced advantages of cinematic rendering is the production of realistic shadowing effects, allowing for very clear representation of the relative positions of objects within the imaged volume; this is well demonstrated in Fig. 1, where the shadowing from the aortic arch onto the underlying ductus diverticulum and pulmonary arterial vasculature allows the viewer to easily grasp the internal arrangement of these structures. Although the rate of incorrectly diagnosed traumatic aortic injuries was low even in the era when invasive aortography was the primary imaging modality, and has remained low with CT angiography as the frontline modality, the consequences of a missed diagnosis (potential death from massive hemorrhage) or an overcalled finding (unnecessary thoracotomy) underscore the importance of any new technique to improve diagnostic accuracy or diagnostic confidence.”
MDCT of ductus diverticulum: 3D cinematic rendering to enhance understanding of anatomic configuration and avoid misinterpretation as traumatic aortic injury Steven P. Rowe1 & Pamela T. Johnson1 & Elliot K. Fishman Emergency Radiology (2018) 25:209–213 - “Since most traumatic injuries occur in the distal arch, radiologists must be cognizant of the range of appearances of variants related to the ductus diverticulum. Cinematic rendering (CR) is a new 3D post-processing tool that provides even greater anatomic detail than traditional volume rendering. In this case series, CR is used to impart to radiologists a better understanding of various anatomic configurations that can be seen with a ductus diverticulum.”
MDCT of ductus diverticulum: 3D cinematic rendering to enhance understanding of anatomic configuration and avoid misinterpretation as traumatic aortic injury Steven P. Rowe1 & Pamela T. Johnson1 & Elliot K. Fishman Emergency Radiology (2018) 25:209–213 - “CR has the potential to improve visualization of subtle pancreatic neoplasms, differentiation of solid and cystic pancreatic neoplasms, assessment of local tumor extension and vascular invasion, and visualization of metastatic disease.”
Cinematic rendering of pancreatic neoplasms: preliminary observations and opportunities Linda C. Chu , Pamela T. Johnson, Elliot K. Fishman Abdom Radiol (2018) https://doi.org/10.1007/s00261-018-1559-3 - “Pancreatic cancer is the third most common cause of cancer death and CT is the most commonly used modality for the initial evaluation of suspected pancreatic cancer. Post-processing of CT data into 2D multiplanar and 3D reconstructions has been shown to improve tumor visualization and assessment of tumor resectability compared to axial slices, and is considered the standard of care. Cinematic rendering is a new 3D- rendering technique that produces photorealistic images, and it has the potential to more accurately depict anatomic detail compared to traditional 3D reconstruction techniques.”
Cinematic rendering of pancreatic neoplasms: preliminary observations and opportunities Linda C. Chu , Pamela T. Johnson, Elliot K. Fishman Abdom Radiol (2018) https://doi.org/10.1007/s00261-018-1559-3 - “Pancreatic cancer is the 12th most common cause of cancer and the 3rd most common cause of cancer death. It is estimated that 53,670 new pancreatic cancer cases will be diagnosed in the United States in 2017. CT is the most commonly used imaging modality for the initial evaluation of suspected pancreatic cancer.”
Cinematic rendering of pancreatic neoplasms: preliminary observations and opportunities Linda C. Chu , Pamela T. Johnson, Elliot K. Fishman Abdom Radiol (2018) https://doi.org/10.1007/s00261-018-1559-3 - “CR differs from traditional VR in the use of the lighting model. While VR uses a simple ray cast method to generate 3D images, CR uses Monte Carlo path tracing and global illumination model that takes direct and indirect illumination into account. With CR, each pixel is formed by thousands of rays passing through the volumetric dataset and includes effects of light rays from scatter and from voxels adjacent to the paths of the rays.”
Cinematic rendering of pancreatic neoplasms: preliminary observations and opportunities Linda C. Chu , Pamela T. Johnson, Elliot K. Fishman Abdom Radiol (2018) https://doi.org/10.1007/s00261-018-1559-3 - “The photorealistic quality of CR can accentuate subtle textural change of the pancreatic neoplasm compared to background pancreatic parenchyma, which can improve visualization of subtle cases. CR also provides greater appreciation of the global shape and size of the pancreas. This highlights parenchymal atrophy, which is a useful secondary sign associated with pancreatic adenocarcinoma. The photorealistic images of CR mimic real anatomic specimens that may be more intuitive for non-radiologists and may facilitate communication with referring clinicians and patients.”
Cinematic rendering of pancreatic neoplasms: preliminary observations and opportunities Linda C. Chu , Pamela T. Johnson, Elliot K. Fishman Abdom Radiol (2018) https://doi.org/10.1007/s00261-018-1559-3 - “Just as CR can highlight subtle hypoenhancement and textural change of pancreatic adenocarcinoma, the display settings can be modified to highlight structures with high Hounsfield units, such as neuroendocrine tumors. The wider dynamic range of color and depth helps to improve tumor conspicuity. CR improves depth perception, which can be particularly helpful in visualizing fine internal septations and mural nodularity in cystic pancreatic neoplasms. The improved appreciation of the internal architecture of the cystic pancreatic neoplasms may help in differentiating different types of cystic neoplasms.”
Cinematic rendering of pancreatic neoplasms: preliminary observations and opportunities Linda C. Chu , Pamela T. Johnson, Elliot K. Fishman Abdom Radiol (2018) https://doi.org/10.1007/s00261-018-1559-3 - “The exquisite vascular maps generated by CR can highlight the extent of vascular invasion (i.e., length of involved vessel, degree of luminal narrowing), which can assist in determining tumor resectability and in determining vascular reconstruction planning. The improved depth perception of CR can assist surgeons in visualizing the pancreatic tumor and the intrinsic vascular anatomy of the pancreatic bed. This is especially important if the patient may be a candidate for laparoscopic- or robot-assisted pancreatic surgery, since these minimally invasive surgery offer limited field of view compared with open surgery.”
Cinematic rendering of pancreatic neoplasms: preliminary observations and opportunities Linda C. Chu , Pamela T. Johnson, Elliot K. Fishman Abdom Radiol (2018) https://doi.org/10.1007/s00261-018-1559-3 - “There are several limitations of CR technique. CR uses a more complex algorithm compared to VR and requires higher computational power. This requires more powerful workstations and network bandwidth. Each manipulation during interactive rendering requires a new set of calculations, which increases post-processing time. Second, the CR display needs to be optimized to depict the anatomy and pathology of interest. Therefore, CR needs to be performed by the radiologist and the display needs to be tailored to different clinical indications. Lastly, while CR dramatically improves photorealism of the CT images, it is currently unclear whether this photorealism improves diagnostic accuracy and/or patient outcomes. At the current time, the potential role of CR in pancreatic imaging remains speculative. These preliminary observations show potential application of CR in pancreatic imaging, which will require validation in future studies.”
Cinematic rendering of pancreatic neoplasms: preliminary observations and opportunities Linda C. Chu , Pamela T. Johnson, Elliot K. Fishman Abdom Radiol (2018) https://doi.org/10.1007s00261-018-1559-3 - “There are several limitations of CR technique. CR uses a more complex algorithm compared to VR and requires higher computational power. This requires more powerful workstations and network bandwidth. Each manipulation during interactive rendering requires a new set of calculations, which increases post-processing time. Second, the CR display needs to be optimized to depict the anatomy and pathology of interest. Therefore, CR needs to be performed by the radiologist and the display needs to be tailored to different clinical indications.”
Cinematic rendering of pancreatic neoplasms: preliminary observations and opportunities Linda C. Chu , Pamela T. Johnson, Elliot K. Fishman Abdom Radiol (2018) https://doi.org/10.1007s00261-018-1559-3 - “Lastly, while CR dramatically improves photorealism of the CT images, it is currently unclear whether this photorealism improves diagnostic accuracy and/or patient outcomes. At the current time, the potential role of CR in pancreatic imaging remains speculative. These preliminary observations show potential application of CR in pancreatic imaging, which will require validation in future studies.”
Cinematic rendering of pancreatic neoplasms: preliminary observations and opportunities Linda C. Chu , Pamela T. Johnson, Elliot K. Fishman Abdom Radiol (2018) https://doi.org/10.1007s00261-018-1559-3 - “An apparent limitation of CR is illustrated in the 2nd case. While the shadowing effects that arise from the global lighting model that is used contribute to the photorealistic quality of the images, shadowing can also potentially obscure important pathology. Therefore, as with any 3D rendering technique, it is important for the user to examine CR visualizations from multiple different views and to interactively alter the windowing settings to increase and decrease the transparency of overlapping anatomic structures, and to use CR in conjunction with axial display, 2D MPRs, MIP and VR. Other limitations of CR may come to light as the method becomes more widely clinically available.”
Cinematic rendering of cardiac CT volumetric data: Principles and initial observations Steven P. Rowe, Pamela T. Johnson, Elliot K. Fishman Journal of Cardiovascular Computed Tomography 12 (2018) 56–59 - “CR is a promising method to enhance display volumetric CT data and should prove useful in diagnosis, treatment planning, surgical navigation, trainee education, and patient engagement. However, further study is needed to establish the advantaged and disadvantages of CR in comparison to other 3D methods.”
Cinematic rendering of cardiac CT volumetric data: Principles and initial observations Steven P. Rowe, Pamela T. Johnson, Elliot K. Fishman Journal of Cardiovascular Computed Tomography 12 (2018) 56–59 - “Additional considerations that refine CR photorealism include the incorporation of shadowing effects that derive from assuming that the light source can be obscured by objects within the visualized volume. Such shadowing is not typically included in traditional VR, although it is possible to incorporate.8 Furthermore, while CR can use one or more unidirectional light sources as is done in VR, more typically an en- vironment map is used (i.e. texture maps that are related to the brightnesses of surfaces within a virtual scene and more accurately reflect realistic lighting scenarios).”
Cinematic rendering of cardiac CT volumetric data: Principles and initial observations Steven P. Rowe, Pamela T. Johnson, Elliot K. Fishman Journal of Cardiovascular Computed Tomography 12 (2018) 56–59 - “Kawasaki’s disease (KD) is a vasculitis that predominantly affects children and can lead to the development of coronary artery aneurysms. These aneurysms can subsequently thrombose and occlude, which may lead to chest pain and other signs and symptoms of acute coronary syndrome in young patients. Coronary CT angiography, including 3D visualization techniques, is a common modality used in the follow-up of KD patients. In this series of three patients, we present the typical coronary artery imaging findings that can appear in these patients, with an emphasis on the use of the novel 3D technique of cinematic rendering (CR). CR utilizes a different lighting model than other 3D methods and is able to produce highly-detailed, photorealistic images. The potential advantages of CR images in understanding the complex mediastinal vascular anatomy and the relationships of coronary artery aneurysms to other anatomic structures are emphasized.”
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering Steven P. Rowe1 & Stefan L. Zimmerman1 & Pamela T. Johnson1 & Elliot K. Fishman Emergency Radiology (in press) - “The most important potential complication of KD is in- flammatory damage to the coronary arteries, which classically leads to the formation of coronary artery aneurysms. These aneurysms will often undergo vascular remodeling and partial
thrombosis in order to produce a psuedonormal vascular lu- men. However, progressive thrombosis and other stenotic pro- cesses such as fibrosis can, over time, precipitate cardiac is- chemia that can lead to emergency room presentations for chest pain or other signs of acute coronary syndrome and necessitate invasive and/or surgical interventions. Of note, computed tomography (CT) angiography, including 3D methods such as volume rendering (VR), has been found to provide suitable non-invasive evaluation of the coronary arteries in patients with KD.”
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering Steven P. Rowe1 & Stefan L. Zimmerman1 & Pamela T. Johnson1 & Elliot K. Fishman Emergency Radiology (in press) - “As with other 3D visualization methods, CR would be expected to provide a global overview of the disease process that is not easily appreciated on 2D axial or multi-planar reformatted images. In particular, this may help to identify relatively distal, small caliber sites of aneurysmal enlargement, which stand out with high contrast on the 3D images but can be subtle when only 2D images are viewed. Given the anatomic complexity of the mediastinum with many adjacent vascular structures, it may be that CR has intrinsic advantages relative to other 3D methods in being able to accurately display the relative positions of those structures in a manner that may be more intuitively grasped in comparison to less photorealistic depictions.”
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering Steven P. Rowe1 & Stefan L. Zimmerman1 & Pamela T. Johnson1 & Elliot K. Fishman Emergency Radiology (in press) - “Even if CR demonstrates no, or only marginal, advantages relative to VR in terms of clinical applicability, the photorealistic appeal of these images will almost certainly lead to wide- spread use in trainee and patient education.”
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering Steven P. Rowe1 & Stefan L. Zimmerman1 & Pamela T. Johnson1 & Elliot K. Fishman Emergency Radiology (in press)
- “ Cinematic rendering (CR) is a new rendering algorithm that incorporates a more advanced lighting model than that used for VR, to create photorealistic 3D CT images. The post-processing tool is not yet widely available and its ultimate clinical utility has yet to be assessed in well-designed studies. Nonetheless, the striking level of detail and enhanced depiction of 3D anatomic relationships holds potential for improvements in diagnosis, interventional or operative planning and patient centered care.”
Initial Experience with Cinematic Rendering for Chest Cardiovascular Imaging Rowe SK, Johnson PT, Fishman EK Br J Radiol. 2017 Sep 22:20170558. - “Nonetheless, the striking level of detail and enhanced depiction of 3D anatomic relationships holds potential for improvements in diagnosis, interventional or operative planning and patient centered care. In this pictorial essay, a series of complex cardiovascular cases are presented to demonstrate the enhanced display capabilities associated with cinematic rendering and the utility to guide patient management and understanding are discussed.”
Initial Experience with Cinematic Rendering for Chest Cardiovascular Imaging Rowe SK, Johnson PT, Fishman EK Br J Radiol. 2017 Sep 22:20170558. - “Nonetheless, the striking level of detail and enhanced depiction of 3D anatomic relationships holds potential for improvements in diagnosis, interventional or operative planning and patient centered care. In this pictorial essay, a series of complex cardiovascular cases are presented to demonstrate the enhanced display capabilities associated with cinematic rendering and the utility to guide patient management and understanding are discussed.”
Initial Experience with Cinematic Rendering for Chest Cardiovascular Imaging Rowe SK, Johnson PT, Fishman EK Br J Radiol. 2017 Sep 22:20170558. - “Imaging of thoracic vasculature presents a unique set of challenges owing to the complex relationships between systemic and pulmonary arteries, in addition to artifacts that result from cardiac and respiratory motion. Retrospective and prospective gating can be used to address the motion artifact. For interpretation and display, this anatomic region is best evaluated with rendering algorithms that preserve the 3D relationships of these intertwined arteries. Accordingly, volume rendering and cinematic rendering are the optimal post-processing tools for pulmonary and aortic imaging.”
Initial Experience with Cinematic Rendering for Chest Cardiovascular Imaging Rowe SK, Johnson PT, Fishman EK Br J Radiol. 2017 Sep 22:20170558.
- “However, instead of ray casting methods, in which each pixel is formed by one light ray, the algorithm used in cinematic rendering is based on path-tracing methods and the global illumination model which simulate the different paths of billions of photons traveling from all possible directions through a volumetric dataset and their interaction with the volume to form one pixel. As a result, the technique models the real-life physical propagation of light and generates a highly photorealistic 3D image based on the acquired data.”
Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique Eid M et al. AJR 2017; 209:370–379 - “To attain photorealistic quality, high dynamic range rendering light maps are used to create a natural lighting en- vironment by simulating realistic lighting effects from real-world environments, which are then applied to the rendering scene.”
Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique Eid M et al. AJR 2017; 209:370–379 - “Compared with the results of volume rendering, the more realistic light me- ulation of cinematic rendering although it does not affect spatial resolution enhances evaluation of spatial relations, particularly in the through plane. .”
Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique Eid M et al. AJR 2017; 209:370–379 - “Cinematic rendering entails the use of complex high dynamic range rendering maps to create a natural lighting environment, as opposed to the synthetic light source of vol- ume rendering. The result of this difference in lighting functions available in cinematic rendering is an overall more lifelike and vi- sually appealing 3D image, compared with a volume-rendered image, that has a focus on improving depth and shape perception .”
Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique Eid M et al. AJR 2017; 209:370–379 - “Although surgical planning is classically done by mentally integrating multiple images, possibly obtained with different modalities, cinematic rendering generates an all-in one highly realistic 3D representation of the structures of interest with a single modality. Image manipulation allows visualization of anatomic details from different perspectives.”
Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique Eid M et al. AJR 2017; 209:370–379 - “Moreover, 3D imaging can be a helpful tool for preoperative and postoperative assessment of renal and liver grafts, paricularly in establishing vascular anatomy. The complexity of gastrointestinal anatomy also lends itself to 3D visualization techniques, as already evidenced in virtual colonoscopy. Cinematic rendering may have an adjunct role in detecting gastrointestinal diseases such as occlusions, strictures, herniation, and tumors and aid physicians and surgeons in treatment planning.”
Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique Eid M et al. AJR 2017; 209:370–379
- “Based on our experiments we conclude that stochastic MC based simulation of light transport is an attractive solution to the problem of photo realistic rendering in interactive DVR. Stochastic MC based simulation of light transport is particularly interesting because it allows to integrate various physically based effects into a unified approach without significant effort, whereas other solutions restrict the number of lights, the shape of lights, the camera model, and so forth. Furthermore, due to its sampling nature, problems with aliasing and stepping artifacts are dealt with easily. The proposed solution is able to cope with complex lighting on the fly, and the increased quality of the images help to convey shape and detail.”
Interactive direct volume rendering with physically-based lighting T.Kroes et al. EUROGRAPHICS 2012 - “Based on our experiments we conclude that stochastic MC based simulation of light transport is an attractive solution to the problem of photo realistic rendering in interactive DVR. Stochastic MC based simulation of light transport is particularly interesting because it allows to integrate various physically based effects into a unified approach without significant effort, whereas other solutions restrict the number of lights, the shape of lights, the camera model, and so forth. Furthermore, due to its sampling nature, problems with aliasing and stepping artifacts are dealt with easily. The proposed solution is able to cope with complex lighting on the fly, and the increased quality of the images help to convey shape and detail.” Interactive direct volume rendering with physically-based lighting T.Kroes et al. Technical Report 2011-11, Delft University of Technology, Number 2011-11 - 2011
- Interactive direct volume rendering with physically-based lighting
T.Kroes et al.
EUROGRAPHICS 2012
- “In contrast to many of the existing approximations, Monte Carlo ray tracing (MCRT), combined with physically based light transport, is able to simulate real-world light interaction without compromising accuracy of light transport computations, thus resulting in more realistic images. Monte Carlo rendering algorithms are capable of dealing with complex lighting, material and camera configurations. It has been demonstrated that MCRT, with suitable modifications addressing hardware peculiarities, can be performed on the the GPU.”
Exposure Render: An Interactive Photo-Realistic Volume Rendering Framework Thomas Kroes et al. PLOS ONE 7(7): e38586. doi: 10.1371/journal.pone.0038586 - “In addition to the fact that photo-realistic volume renderings tend to be aesthetically more pleasing, it has been shown that realistic lighting contributes to 3D understanding and can improve depth-related task performance . With this work and the implementation that we have made available, we hope to contribute to the uptake of realistic illumination in interactive direct volume rendering applications.”
Exposure Render: An Interactive Photo-Realistic Volume Rendering Framework Thomas Kroes et al. PLOS ONE 7(7): e38586. doi: 10.1371/journal.pone.0038586 - “Volume rendering (VR) represents today’s standard three-dimensional (3-D) image post-processing technique, and often is used to visualize complex anatomical information. Recently, a novel 3-D technique for post-processing of computed tomography (CT) image data has been introduced, which is called cinematic rendering (CR). The objective of this review is to illustrate the image appearance and potential value of CR in comparison with conventional VR in a number of various applications and different anatomical regions. Similar to VR, CR best visualizes high density and high contrast structures such as bones and contrast-enhanced vessels, but at the same time provides a more natural and photo-realistic illumination of the rendered data. Further research will be necessary for determining possible advantages of CR over conventional VR and over two-dimensional (2-D) image post-processing for CT image data.”
- “Volume rendering (VR) represents today’s standard three-dimensional (3-D) image post-processing technique, and often is used to visualize complex anatomical information. Recently, a novel 3-D technique for post-processing of computed tomography (CT) image data has been introduced, which is called cinematic rendering (CR). The objective of this review is to illustrate the image appearance and potential value of CR in comparison with conventional VR in a number of various applications and different anatomical regions.”
Cinematic rendering - an alternative to volume rendering for 3D computed tomography imaging. Dappa E et al. Insights Imaging 2016 Dec;7(6):849-856 - “Similar to VR, CR best visualizes high density and high contrast structures such as bones and contrast-enhanced vessels, but at the same time provides a more natural and photo-realistic illumination of the rendered data. Further research will be necessary for determining possible advantages of CR over conventional VR and over two-dimensional (2-D) image post-processing for CT image data.”
Cinematic rendering - an alternative to volume rendering for 3D computed tomography imaging. Dappa E et al. Insights Imaging 2016 Dec;7(6):849-856 - “As opposed to conventional VR methods, CR solves the multi-dimensional and non-continuous rendering equation to integrate the light scattered from all possible directions along a ray. Thus, path tracing used in CT integrates a huge number of light rays, each with different paths to form each pixel of the rendered image. Since the number of light paths which can be traced is in theory infinite, and tracing of light paths is computationally expensive, Monte-Carlo simulations are used to generate a randomized subset of light paths with an adequate distribution. The final image is obtained iteratively by progressively averaging numerous Monte Carlo samples representing radiance at random positions with light scattered in random directions.”
Cinematic rendering - an alternative to volume rendering for 3D computed tomography imaging. Dappa E et al. Insights Imaging 2016 Dec;7(6):849-856 - “Due to the abovementioned similarities between CR and VR, there are no major differences in the visualization of CT image data when regarding the diagnostic value of the presentation. Similar to VR, we found that particularly high-contrast structures such as contrast-enhanced vessels and bones can be depicted with high quality also with CR. At the same time, we found a major improvement of CR for the perception of depth and soft tissue structures providing a more photo-realistic depiction of human anatomy and disease .”
Cinematic rendering - an alternative to volume rendering for 3D computed tomography imaging. Dappa E et al. Insights Imaging 2016 Dec;7(6):849-856 - “In contrast, CR uses a more complex lighting model taking into account the effect of lighting for other voxels and subsequent reflections as well. Also, the effect of body parts blocking the trace from the artificial light source to other structures introduces shadowing into the images. As a result of the differences in lighting functions—as being illustrated in the representative image examples of this pictorial review—CR images go along with a more natural image impression as compared to conventional VR .”
Cinematic rendering - an alternative to volume rendering for 3D computed tomography imaging. Dappa E et al. Insights Imaging 2016 Dec;7(6):849-856 - “Our initial experience indicates that CR of CT images is particularly impressive when high density and high contrast structures such as bones and contrast-enhanced vessels are to be visualized. The main innovation as compared to conventional VR appear to be the more natural and photo-realistic representation of the CT image data, with an enhanced and more natural depth and shape perception. Future studies should aim at determining whether the CR technique offers advantages over cross-sectional and 3-D CT images in terms of a diagnostic gain .”
Cinematic rendering - an alternative to volume rendering for 3D computed tomography imaging. Dappa E et al. Insights Imaging 2016 Dec;7(6):849-856 - “CRT, which is similar to conventional VRT, is not primarily intended for diagnostic radiologic image analysis, and therefore it should be used primarily as a tool to deliver visual information in the form of radiologic image reports. Using CRT for forensic visualization might have advantages over using VRT if conveying a high degree of visual realism is of importance. Most of the shortcomings of CRT have to do with the software being an early prototype.”
Forensic 3D Visualization of CT Data Using Cinematic Volume Rendering: A Preliminary Study. Ebert LC et al. AJR Am J Roentgenol. 2017 Feb;208(2):233-240 - “The 3D volume-rendering technique (VRT) is commonly used in forensic radiology. Its main function is to explain medical findings to state attorneys, judges, or police representatives. New visualization algorithms permit the generation of almost photorealistic volume renderings of CT datasets. The objective of this study is to present and compare a variety of radiologic findings to illustrate the differences between and the advantages and limitations of the current VRT and the physically based cinematic rendering technique (CRT)..”
Forensic 3D Visualization of CT Data Using Cinematic Volume Rendering: A Preliminary Study. Ebert LC et al. AJR Am J Roentgenol. 2017 Feb;208(2):233-240
- BACKGROUND: The interpretation of CT scans for the evaluation of calcaneal fractures is difficult. Three-dimensional (3D) reconstruction (volume rendering technique [VRT]) has been valuable in the evaluation of irregularly shaped bones. However, their value for the analysis of calcaneal fractures is still debated. Therefore, the objective of this study was to assess the effect of additional use of 3D CTs in calcaneal fractures.
CONCLUSION: The evaluation of CT scans of calcaneal fractures was improved by the additional use of 3D images (VRT).
Value of 3D Reconstructions of CT Scans for Calcaneal Fracture Assessment. Roll C et al. Foot Ankle Int. 2016 Nov;37(11):1211-1217 - METHODS: In a prospective multicenter study, the CT data set of 5 different fractures was presented to 57 evaluators. First, the participating surgeons were asked to assess the fractures on the basis of axial, coronal, and sagittal reconstructions using a multiple-choice questionnaire. Second, 3D reconstructions (VRT) were presented. The CT scans were validated by the intraoperative findings and the results were compared to the model solution of 3 foot and ankle surgeons. Intra- and interrater reliabilities were calculated.
Value of 3D Reconstructions of CT Scans for Calcaneal Fracture Assessment. Roll C et al. Foot Ankle Int. 2016 Nov;37(11):1211-1217 - “CRT, which is similar to conventional VRT, is not primarily intended for diagnostic radiologic image analysis, and therefore it should be used primarily as a tool to deliver visual information in the form of radiologic image reports. Using CRT for forensic visualization might have advantages over using VRT if conveying a high degree of visual realism is of importance. Most of the shortcomings of CRT have to do with the software being an early prototype.”
Forensic 3D Visualization of CT Data Using Cinematic Volume Rendering: A Preliminary Study Ebert LC et al. AJR 2017; 208:233–240 - “On the basis of most of the renderings presented, CRT appears to be equal or superior to VRT with respect to the realism and understandability of the visualized findings. Overall, in terms of realism, the difference between the techniques was statistically significant (p < 0.05). Most participants perceived the CRT renderings to be more understandable than the VRT renderings, but that difference was not statistically significant (p > 0.05).”
Forensic 3D Visualization of CT Data Using Cinematic Volume Rendering: A Preliminary Study Ebert LC et al. AJR 2017; 208:233–240 - “With the advent of increasingly affordable and increasingly faster computers, VRTs have become the established standard for real-time 3D visualization, offering more image detail and, thus, more realism than SSD. This trend has been fueled by the ever-increasing computational power of workstations and desktop computers.”
Forensic 3D Visualization of CT Data Using Cinematic Volume Rendering: A Preliminary Study Ebert LC et al. AJR 2017; 208:233–240 - “Depth-of-field effects display the area around a focal point as a sharp image, and the objects that are closer to or more distant from the focal point are displayed as blurred images. To further increase depth perception, shadows are calculated correct- ly. In addition, the reduction of ambient light exposure in partially occluded areas is simulated (i.e., through ambient occlusion mapping).”
Forensic 3D Visualization of CT Data Using Cinematic Volume Rendering: A Preliminary Study Ebert LC et al. AJR 2017; 208:233–240 - “This prototype CRT already provides some insight into what we do or do not consider to be better images. With these insights, it offers a glimpse into a future where medical image reconstruction might use certain features of photorealism that add clarity for the viewer, such as lens blur, surface appearance, 3D model lighting, and better color distinction.”
Forensic 3D Visualization of CT Data Using Cinematic Volume Rendering: A Preliminary Study Ebert LC et al. AJR 2017; 208:233–240 - “CRT, which is similar to conventional VRT, is not primarily intended for diagnostic radiologic image analysis and thus should be used primarily as a tool to deliver visual information in the form of radiologic image reports.”
Forensic 3D Visualization of CT Data Using Cinematic Volume Rendering: A Preliminary Study Ebert LC et al. AJR 2017; 208:233–240
- “Cinematic rendering produces volume rendered images with photorealistic image quality. It uses a global illumination model, which takes direct and indirect illumination into account when constructing an image, to achieve rendering quality. The mathematical models that describe this visualization technology include complex integral equations that are solved numerically using the Monte Carlo integration. The result of the integration is a numerical rendering algorithm known as path tracing: thousands of light rays are traced to compute the resulting image.”
MDCT angiography with 3D rendering: A novel cinematic rendering algorithm for enhanced anatomic detail Johnson PT, Schneider R, Lugo-Fagundo C, Johnson M, Fishman EK AJR (submitted) - “To achieve photorealistic quality an “environment map” or “light map” must be used as this light source provides realistic effects achieved by real world light scenarios. The light map consists of texture maps containing information on the brightness of surfaces in a virtual scene that allow the reproduction of the light environment in which the map was generated.”
MDCT angiography with 3D rendering: A novel cinematic rendering algorithm for enhanced anatomic detail Johnson PT, Schneider R, Lugo-Fagundo C, Johnson M, Fishman EK AJR (submitted) - “The light model off of which cinematic rendering and classic volume rendering are based when reconstructing the images accounts for the difference between the two technologies. The primary reason why classic volume rendering results in images that are relatively less photorealistic is the use of the local lighting model – only local properties, such as the local gradient, influence the resulting image. Inversely, cinematic rendering assumes the global illumination model, which accounts for the impact that all light rays have on image reproduction.”
MDCT angiography with 3D rendering: A novel cinematic rendering algorithm for enhanced anatomic detail Johnson PT, Schneider R, Lugo-Fagundo C, Johnson M, Fishman EK AJR (submitted) - “Additionally, cinematic rendering and classic volume rendering differ in their respective light sources. The light sources in classical volume rendering are either single unidirectional light sources or multiple light sources. Although cinematic rendering could use the same light sources as those of classic volume rendering, it also uses environment maps to produce the best visual results. Moreover, classic volume rendering assumes that light passing through the transparent participating medium is absorbed. This assumption leads to less realistic images because in reality light particles are scattered in such a medium. Thus, to achieve photorealism, classic volume rendering would have to account for scattering effects.”
MDCT angiography with 3D rendering: A novel cinematic rendering algorithm for enhanced anatomic detail Johnson PT, Schneider R, Lugo-Fagundo C, Johnson M, Fishman EK AJR (submitted) - “In cinematic rendering, the most important parameter available to manipulate the resulting image is the transfer function. A parameter that was already available in classic volume rendering, the transfer function assigns a color and an opacity property to each voxel value. The opacity can be zero, one or any number between zero and one. If the opacity is zero, then the voxel value represents a vacuum that does not influence rendering computation. If the opacity is equal to one, then the voxel value represents a region that is fully opaque.”
MDCT angiography with 3D rendering: A novel cinematic rendering algorithm for enhanced anatomic detail Johnson PT, Schneider R, Lugo-Fagundo C, Johnson M, Fishman EK AJR (submitted) - “The limitations related to cinematic rendering’s photorealistic quality also must be acknowledged. While photorealism improves the image quality and allows for a better perception of structures, it is possible to have scenarios when too much photorealism is bad. For example, if some tissue parts are obstructed from the light source, the tissue becomes darker, which can be very realistic but it can omit information about the vasculature.”
MDCT angiography with 3D rendering: A novel cinematic rendering algorithm for enhanced anatomic detail Johnson PT, Schneider R, Lugo-Fagundo C, Johnson M, Fishman EK AJR (submitted) - Cinematic Rendering: Future Directions
• Implement algorithm on faster hardware or GPU’s
• Ability for real time rendering is needed to help develop pre-sets for 3D images
• GPU based rendering may be needed for interactive displays
• Study of Cinematic Rendering vs Classic VRT will be necessary for documentation
- “Cinematic Rendering which computes in real-time the interaction of visible photons with the scanned patient anatomy. The algorithm uses a Monte Carlo path tracing method to generate photorealistic or even hyper-realistic images by light transport simulation along hundreds or thousands of photons paths per pixel through the anatomy using a stochastic process .”
Shaping the future through innovations: From medical imaging to precision medicine Comaniciu D et al. Medical Image Analysis (in press) - “The medical data is illuminated using image-based lighting by high-dynamic range lighting environments, which can either be captured photographically or generated synthetically. Photographically captured lighting leads to a very natural appearance of the data when compared to images created using the traditional ray casting method. Such natural lighting in combination with the accurate simulation of photon scattering and absorption, leads to photorealistic images that resemble many shading effects that can be observed in nature, such as soft shadows, ambient occlusion, volumetric scattering and subsurface photon interaction.”
Shaping the future through innovations: From medical imaging to precision medicine Comaniciu D et al. Medical Image Analysis (in press) - “While diagnostics will certainly still rely on traditional planar reconstruction based visualization methods, we have strong in- dictations that special diagnostic applications might benefit from the flexibility and expressiveness of the new Cinematic Rendering technology. For instance, a robust demand for such visualization methods can be seen for surgery planning and intraoperative imaging, where a good spatial understanding of the anatomy and processes in the human body is required.”
Shaping the future through innovations: From medical imaging to precision medicine Comaniciu D et al. Medical Image Analysis (in press) - “The Monte Carlo path tracing integration method solves the following multi-dimensional and non-continuous rendering equation:
Shaping the future through innovations: From medical imaging to precision medicine Comaniciu D et al. Medical Image Analysis (in press) - “In the mid-80s, advances in image processing hardware and the integration of new data manipulation techniques led to the simultaneous development of Volume Rendering at the University of North Carolina and at Pixar in San Rafael, whereby the latter had originally been an upshot of work by computer specialists in the Computer Graphics Group at Lucasfilm . The work at Pixar culminated in collaboration with the CT research group at Johns Hopkins Hospital. Today, Volume Rendering is an established post-processing technique for 3-D CT and MR data sets, one used routinely in clinical practice.”
Introducing Cinematic Rendering: A Novel Technique for Post-Processing Medical Imaging Data Fellner FA J. Biomedical Science and Engineering, 2016, 9, 170-175 - “Conventional Volume Rendering techniques employ predefined color, turbidity and brightness values, whereby they proceed under the assumption of an artificial light source. Cinematic Rendering performs a physical simulation of the light diffusion, as a result of which effects such as environmental influences, shadowing, re- fraction, occlusion, dispersion and soft shadows attain a high dynamic range.”
Introducing Cinematic Rendering: A Novel Technique for Post-Processing Medical Imaging Data Fellner FA J. Biomedical Science and Engineering, 2016, 9, 170-175 - “To achieve this, a so-called spherical panorama is recorded—for example, with a reflecting ball—which registers the actual lighting conditions in
order to apply them to all synthetic elements added later. In comparison to simple ray casting based Volume Rendering, Cinematic Rendering is based on the Monte-Carlo path tracing of volumetric data.”
Introducing Cinematic Rendering: A Novel Technique for Post-Processing Medical Imaging Data Fellner FA J. Biomedical Science and Engineering, 2016, 9, 170-175 - To achieve photorealistic effects, it is further important to use a light source that allows simulating real world light scenarios. Such a realistic light source is known as “environment map” or “light map” where one has stored for a center point the incoming light for each point on a sphere that surrounds it. This allows reproducing the light environment in which the map was generated.
- Volume Rendering vs Cinematic Rendering: Differences
Another difference that has to be mentioned is the light source itself. The light sources used as input for shading computations in classical volume rendering are typically either directional lights where all light comes from the same direction or using one or multiple point lights. Cinematic rendering could theoretically also use classical light sources, but the best visual results are achieved when using environment maps as a realistic real life light source
- “We developed a physically-based volume rendering method called Cinematic Rendering which computes in real-time the interaction of visible photons with the scanned patient anatomy. The algorithm uses a Monte Carlo path tracing method to generate photorealistic or even hyper-realistic images by light transport simulation along hundreds or thousands of photons paths per pixel through the anatomy using a stochastic process.”
Shaping the future through innovations: From medical imaging to precision medicine. Comaniciu D et al. Med Image Anal. 2016 Jun 15 (in press) - “The medical data is illuminated using image-based lighting by high-dynamic range lighting environments, which can either be captured photographically or generated synthetically. Photographically captured lighting leads to a very natural appearance of the data when compared to images created using the traditional ray casting method. Such natural lighting in combination with the accurate simulation of photon scattering and absorption, leads to photorealistic images that resemble many shading effects that can be observed in nature, such as soft shadows, ambient occlusion, volumetric scattering and subsurface photon interaction.”
Shaping the future through innovations: From medical imaging to precision medicine. Comaniciu D et al. Med Image Anal. 2016 Jun 15 (in press) - “Fast and robust anatomical concept extraction is a fundamental task in medical image analysis that supports the entire workflow from diagnosis, patient stratification, therapy planning, intervention and follow-up. Current state-of-the art solutions are based on machine learning, being enabled by the availability of large annotated medical databases and the increased computational capabilities . Typical methods use example images of the anatomy of interest to learn a classifier that will be able to discriminate between inputs that contain the target anatomy or something else. Such classifiers can be used to automatically label images, detect landmarks or segment the target object.”
Shaping the future through innovations: From medical imaging to precision medicine. Comaniciu D et al. Med Image Anal. 2016 Jun 15 (in press) - “In this paper we discussed recent technologies that will most likely make an important impact on medical imaging. Techniques like Cinematic Rendering will help increasing the sensitivity and specificity of images, by enhancing the pathology conspicuity. Advanced image understanding will streamline the image measurements and image interpretation, by increasing the speed of reading, while introducing more reproducibility in the system.”
Shaping the future through innovations: From medical imaging to precision medicine. Comaniciu D et al. Med Image Anal. 2016 Jun 15 (in press)