google ads
Search

Everything you need to know about Computed Tomography (CT) & CT Scanning

3D and Workflow: Applications Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ 3D and Workflow ❯ Applications

-- OR --

  • “Cinematic rendering images contain high levels of detail with shadowing and depth that are not available from traditional 3D CT techniques. As yet, the role of CR in evaluating colonic pathology has not been investigated. However, given the breadth of pathologic processes that affect the colon, including inflammatory bowel disease, diverticulitis, neoplastic conditions, herniation, and gastrointestinal bleeding, we undertook a survey of recent cases at our institution to demonstrate colon pathology as visualized with CR. The following review discusses the role of 3D CT visualizations for colonic pathology with an emphasis on CR example images.”
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • “Cinematic rendering makes use of volumetric data; however, it differs from the MIP and VR methods in using a global lighting model that incorporates complex path tracing and models how photons interact with the materials within the volume. This creates photorealistic images with improved surface detail relative to other 3D visualization methods. Cinematic rendering im- ages are derived from standard clinical CT protocols and can be created from any volumetric CT data composed of isotropic voxels."
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • For those patients with complications or who require surgical interventions, the overall photorealistic 3D representations provided by CR may be of value in preoperative planning. Figure 4 shows such a complication in which a fistulous tract between the sigmoid colon and the urinary bladder has occurred after an episode of acute diverticulitis.
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • “As with many arterially hyperenhancing tumors, 3D visualization methods offer high-contrast resolution that allows for clear delineation of the tumor from the bowel wall and bowel contents. Relative to MIP and VR images, CR can provide greater soft tissue detail, and varying the window width and level settings can modulate the amount of other soft tissue seen relative to the hypervascular tumor, aiding in tumor visualization and potentially in surgical planning.”
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • Overall, the detection and characterization of tumors may be a particularly important application of CR in the colon. The potentially high contrast combined with the surface detail and shadowing from the global lighting model can make tumors stand out from background bowel wall and luminal contents. Furthermore, as we come to understand more about the implications of textural features in tumors, the visual appearance of lesions on CR may allow for prognostication regarding tumor aggressiveness.
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • Although colonoscopy, invasive angiography, and tagged red blood cell scintigraphy remain important modalities in the workup of lower gastrointestinal bleed- ing, CT angiography has recently taken on a more prominent role given that it can be performed rapidly and can often suggest underlying cause of bleeding even in patients who are not actively bleeding. For example, Figure 11 demonstrates the appearance of angiodysplasia of the cecum and proximal ascending colon discovered incidentally in a 65-year-old man being imaged for chronic abdominal pain. Note that the spatial arrangement of numerous prominent vessels within the wall of the colon and the large, early draining veins are well displayed by the CR technique.
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • “For those patients who are actively bleeding, 3D methodologies including CR provide high-contrast images on which active contrast extravasation into the bowel lumen can often be easily appreciated. Maximum intensity projection images have utility in identifying very subtle sites of active extravasation given that even a single high-density voxel may stand out, whereas VR images can be useful for evaluating the bowel wall for pathology that can lead to lower gastrointestinal bleeding. The exact role of CR in evaluating the colon for a site of bleeding has yet to be specifically identified, yet the images would seem to maintain much of the high contrast of MIPs and at the same time allow for iden- tification of soft tissue abnormalities.”
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • ”Indeed, a great deal of work remains to be done to validate the utility of CR images in clinical practice, although the technique is promising given the enhanced detail and realistic shadowing intrinsic to the CR methodology. In particular, the use- fulness of CR images for preoperative assessment and correlation of findings as displayed by CR relative to intraoperative experi- ence will be of interest, and these aspects of this new visualization technique should be explored in the context of pathologies of the colon.”
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • ”CR will almost certainly be used for patient en- gagement and trainee education purposes, where the intuitive display of the relative relationships of objects within the imaged volume can aid in understanding complex anatomy and pathology. Furthermore, the global lighting model that underlies CR may prove useful for the detection and characterization of pathology, as well as after response to therapy, given its ability to accentuate different tissue types.”
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • AIM: To evaluate the precision of the centrality index (CI) measurement on three-dimensional (3D) volume rendering technique (VRT) images in patients with renal masses, compared to its standard measurement on axial images.
CONCLUSIONS: The present study showed that VRT and axial images produce almost identical values of CI, with the advantages of greater ease of execution and a time saving of almost 50% for 3D VRT images. In addition, VRT provides an integrated perspective that can better assist surgeons in clinical decision making and in operative planning, suggesting this technique as a possible standard method for CI measurement.
Value of three-dimensional volume rendering images in the assessment of the centrality index for preoperative planning in patients with renal masses.


    Sofia C et al.
Clin Radiol. 2017 Jan;72(1):33-40.

  • INTRODUCTION: The aim of this study was to assess if the complex anatomy of aortic aneurysm and aortic dissection can be accurately reproduced from a contrast-enhanced computed tomography (CT) scan into a three-dimensional (3D) printed model.

    CONCLUSION:  Encouraging results were achieved with regards to reproducing 3D models depicting aortic aneurysm and aortic dissection. Variances in vessel diameter measurement outside a standard deviation of 1 mm tolerance indicate further work is required into the assessment and accuracy of 3D model reproduction.


    Modelling of aortic aneurysm and aortic dissection through 3D printing
Ho D et al.
J Med Radiat Sci 2017 Jan 30. doi: 10.1002/jmrs.212.
  • “Three-dimensional printed models were generated with strong and flexible plastic material with successful replication of anatomical details of aortic structures and pathologies. The mean difference in transverse vessel diameter between the contrast-enhanced CT images before and after 3D printing was 1.0 and 1.2 mm, for the first and second models respectively (standard deviation: 1.0 mm and 0.9 mm). Additionally, for the second model, the mean luminal diameter difference between the 3D printed model and CT images was 0.5 mm.”


    Modelling of aortic aneurysm and aortic dissection through 3D printing
Ho D et al.
J Med Radiat Sci 2017 Jan 30. doi: 10.1002/jmrs.212.
  • 1985-2017
What has changed?
    • CT Scan data (slice thickness, spatial resolution)
    • Network transfer of data
    • Computer hardware (cost and performance)
    • Computer software (including imaging algorithms)
    • Clinical need for interpretation of large datasets beyond axial imaging
    • Clinical applications that have been introduced (virt colon, coronary CTA, GI bleeding)
    • New technologies ( 3D modeling, deep learning)
  • SAR 2017 and 3D Imaging
    • Liver
    • Pancreas
    • Kidney
    • Adrenal
    • Small bowel
    • Colon
    • Stomach
    • Vasculature
  • 3D Medical Imaging: The Changes Than Changed the Landscape
    • CT scan datasets ( 4 mm sections every 3 mm for 60-100 slices to .75 mm slices every . 5 mm for 800-2500 slices every case
    • Post processing speeds (decreased hardware costs by factor of 50X and speed increase by 1000X. We used to take 24 hours to process 60 slices and can do real time on an iPhone)
    • Reconstruction algorithms available (Shaded Surface to Volume Rendering and MIP and now Cinematic Rendering)
  • 3D Medical Imaging: The Changes Than Changed the Landscape
    • Routine use in all clinical practices
    • Routine reimbursement for 3D codes
    • Real time 3D post processing built into PACs systems and reading stations
    • Full scale integration by clinicians (surgeons and non-surgeons alike) of 3D into their practices
    • Integration of new display techniques for surgical planning
  • Why is changed so slow? What will make things change over the next few years?

    “Progress is not an illusion; it happens, but it is slow and invariably disappointing.” 
    
― George Orwell
  • CT of the Ureter: Data Analysis
    - Axial images reviewed at .75mm-3mm
    - Coronal and Sagittal or Oblique MPRs
    - Volume Rendering and MIP Images
  • CT of the Ureter: Role of 3D Imaging in Lesion Detection
    - Accentuation of subtle strictures and sites of narrowing
    - Accentuate subtle abnormal urothelial enhancement and thickening
    - Better visualization of the distal ureter
    - Better visualization of flat polypoid lesions
  • “Proper diagnosis hinges not only on appropriate interpretation of the source axial images (with recognition of several suggestive CT features of malignancy), but also upon the utilization of 3-D technique (CR and MIP technique) as an ancillary diagnostic tool.  In our experience, proper utilization of 3-D technique can be incredibly useful in the diagnosis of subtle tumors that are barely perceptible on the source axial images, and which may be missed otherwise.”
    MDCT Evaluation of Ureteral Tumors:
    Advantages of 3-D Reconstruction and Volume Visualization
    Raman SP, Horton KM, Fishman EK
    AJR (in press)
  • Computed Tomography Dataset Postprocessing: From Data to Knowledge

    1. Pamela T. Johnson MD
    2. Elliot K. Fishman MD

    Article first published online: 7 JUN 2012
    DOI: 10.1002/msj.21316

    Abstract
    The introduction of spiral computed tomography from the days of single-slice spiral to today's 64-row multidetector computed tomography and beyond creates datasets with unprecedented spatial and temporal resolution. The key to computed tomography imaging in the big picture is not in the acquisition of data, but in the use of the data acquired. By supplementing traditional axial interpretation with 3-dimensional rendering of the computed tomography volume, the greatest amount of information available is extracted. The information provided by a comprehensive postprocessed study, which includes multiplanar reconstruction in the coronal, sagittal, and oblique plane, as well as 3-dimensional maps of both the arterial and venous phase datasets using volume rendering and maximum intensity projection techniques, allows for key clinical decisions to be made with a high degree of accuracy. Postprocessing of computed tomography data is thus no longer an option, but a true requirement in this era of 64-row multidetector computed tomography and beyond. Mt Sinai J Med 2012 DOI: 10.1002/msj.21316
  • “ The introduction of spiral computed tomography from the days of single-slice spiral to today's 64-row multidetector computed tomography and beyond creates datasets with unprecedented spatial and temporal resolution. The key to computed tomography imaging in the big picture is not in the acquisition of data, but in the use of the data acquired. By supplementing traditional axial interpretation with 3-dimensional rendering of the computed tomography volume, the greatest amount of information available is extracted. The information provided by a comprehensive postprocessed study, which includes multiplanar reconstruction in the coronal, sagittal, and oblique plane, as well as 3-dimensional maps of both the arterial and venous phase datasets using volume rendering and maximum intensity projection techniques, allows for key clinical decisions to be made with a high degree of accuracy. Postprocessing of computed tomography data is thus no longer an option, but a true requirement in this era of 64-row multidetector computed tomography and beyond.”
    Computed Tomography Dataset Postprocessing: From Data to Knowledge
    Johnson PT, Fishman EK
    Mt Sinai J Med 2012 May;79(3);412-21
  • “ The introduction of spiral computed tomography from the days of single-slice spiral to today's 64-row multidetector computed tomography and beyond creates datasets with unprecedented spatial and temporal resolution. The key to computed tomography imaging in the big picture is not in the acquisition of data, but in the use of the data acquired. By supplementing traditional axial interpretation with 3-dimensional rendering of the computed tomography volume, the greatest amount of information available is extracted.”
    Computed Tomography Dataset Postprocessing: From Data to Knowledge
    Johnson PT, Fishman EK
    Mt Sinai J Med 2012 May;79(3);412-21
  • “The key to computed tomography imaging in the big picture is not in the acquisition of data, but in the use of the data acquired. By supplementing traditional axial interpretation with 3-dimensional rendering of the computed tomography volume, the greatest amount of information available is extracted. The information provided by a comprehensive postprocessed study, which includes multiplanar reconstruction in the coronal, sagittal, and oblique plane, as well as 3-dimensional maps of both the arterial and venous phase datasets using volume rendering and maximum intensity projection techniques, allows for key clinical decisions to be made with a high degree of accuracy.”
    Computed Tomography Dataset Postprocessing: From Data to Knowledge
    Johnson PT, Fishman EK
    Mt Sinai J Med 2012 May;79(3);412-21
  • “Postprocessing of computed tomography data is thus no longer an option, but a true requirement in this era of 64-row multidetector computed tomography and beyond.”
    Computed Tomography Dataset Postprocessing: From Data to Knowledge
    Johnson PT, Fishman EK
    Mt Sinai J Med 2012 May;79(3);412-21
  • “ Recent software developments enable interactive, real-time axial, 2D and 3D CT display on an iPad by cloud computing from a server for remote rendering. The purpose of this study was to compare radiologists' interpretative performance on the iPad to interpretation on the conventional picture archive and communication system (PACS). Fifty de-identified contrast-enhanced CT exams performed for suspected pulmonary embolism were compiled as an educational tool to prepare our residents for night call. Two junior radiology attendings blindly interpreted the cases twice, one reader used the PACS first, and the other interpreted on the iPad first. After an interval of at least 2 weeks, the cases were reinterpreted in different order using the other display technique. Sensitivity, specificity, and accuracy for identification of pulmonary embolism were compared for each interpretation method. Pulmonary embolism was present in 25 patients, ranging from main pulmonary artery to subsegmental thrombi. Both readers interpreted 98 % of cases correctly regardless of display platform. There was no significant difference in sensitivity (98 vs 100 %, p = 1.0), specificity (98 vs 96 %, p = 1.0), or accuracy (98 vs 98 %, p = 1.0) for interpretation with the iPad vs the PACS, respectively. CT interpretation on an iPad enabled accurate identification of pulmonary embolism, equivalent to display on the PACS. This mobile device has the potential to expand radiologists' availability for consultation and expedite emergency patient management.”
    The iPad as a mobile devise for CT display and interpretation: diagnostic accuracy for identification of pulmonary embolism
    Johnson PT, Zimmerman SL, Heath D, Eng J, Horton KM, Scott WW, Fishman EK
    Emerg Radiol 2012 Mar 27
  • “ Recent software developments enable interactive, real-time axial, 2D and 3D CT display on an iPad by cloud computing from a server for remote rendering. The purpose of this study was to compare radiologists' interpretative performance on the iPad to interpretation on the conventional picture archive and communication system (PACS). CT interpretation on an iPad enabled accurate identification of pulmonary embolism, equivalent to display on the PACS. This mobile device has the potential to expand radiologists' availability for consultation and expedite emergency patient management.”
    The iPad as a mobile devise for CT display and interpretation: diagnostic accuracy for identification of pulmonary embolism
    Johnson PT, Zimmerman SL, Heath D, Eng J, Horton KM, Scott WW, Fishman EK
    Emerg Radiol 2012 Mar 27
  • “Fifty de-identified contrast-enhanced CT exams performed for suspected pulmonary embolism were compiled as an educational tool to prepare our residents for night call. Two junior radiology attendings blindly interpreted the cases twice, one reader used the PACS first, and the other interpreted on the iPad first. After an interval of at least 2 weeks, the cases were reinterpreted in different order using the other display technique. Sensitivity, specificity, and accuracy for identification of pulmonary embolism were compared for each interpretation method. Pulmonary embolism was present in 25 patients, ranging from main pulmonary artery to subsegmental thrombi. Both readers interpreted 98 % of cases correctly regardless of display platform. There was no significant difference in sensitivity (98 vs 100 %, p = 1.0), specificity (98 vs 96 %, p = 1.0), or accuracy (98 vs 98 %, p = 1.0) for interpretation with the iPad vs the PACS, respectively.”
    The iPad as a mobile devise for CT display and interpretation: diagnostic accuracy for identification of pulmonary embolism
    Johnson PT, Zimmerman SL, Heath D, Eng J, Horton KM, Scott WW, Fishman EK
    Emerg Radiol 2012 Mar 27
  • “ The average estimated weight was 99.7% of the actual weight. The interquartile range (25th to 75th percentile) which represents the “middle half” of these patients was 91-109%, indicating that half of the patients had an estimated weight within 9% of the actual weight, however there was a large range (70-133%). ”
    Three-Dimensional Computed Tomographic Angiography to Predict Weight and Volume of Deep Inferior Epigastric Artery Perforator Flap for Breast Reconstruction
    Rosson GD, Shridharani SM,Flores JI, Fishman EK
  • “ 3D CTA with stereotactic fiducials allows surgeons to adequately estimate abdominal flap volume before surgery, potentially giving guidance in the amount of tissue that can be harvested from a patients lower abdomen.”
    Three-Dimensional Computed Tomographic Angiography to Predict Weight and Volume of Deep Inferior Epigastric Artery Perforator Flap for Breast Reconstruction
    Rosson GD, Shridharani SM,Flores JI, Fishman EK
    Microsurgery 2011 Jul 18. doi: 10.1002/micr.20910. [Epub ahead of print]
    Microsurgery 2011 Jul 18. doi: 10.1002/micr.20910. [Epub ahead of print]
  • "A combination of pancreatic parenchymal phase and PVP imaging is necessary and efficient for the assessment of pancreatic adenocarcinoma. The addition of coronal and sagittal MPR images increased the performance of MDCT, especially in the evaluation of local extension."

    MDCT of Pancreatic Adenocarcinoma: Optimal Imaging Phases and Multiplanar Reformatted Imaging
    Ichikawa T et al.
    AJR 2006; 187:1513-1520
  • "The addition of coronal and sagittal MPR images to the MDCT protocol increases the sensitivity of MDCT and improves its agreement with surgical findings regarding local staging factors."

    MDCT of Pancreatic Adenocarcinoma: Optimal Imaging Phases and Multiplanar Reformatted Imaging
    Ichikawa T et al.
    AJR 2006; 187:1513-1520
  • "Virtual bronchoscopy produces high-resolution images of the tracheobronchial tree and endobronchial views that simulate the findings at conventional bronchoscopy. Interest in virtual bronchoscopy is increasing as a result of improvements in computer hardware and software and advances in MDCT that allow acquisition of isotropic data."

    Advanced Visualization of Airways with 64-MDCT:3D Mapping and Virtual Bronchoscopy
    Horton KM, Horton MR, Fishman EK
    AJR 2007 Dec;189(6):1387-13964
  • 3D Clinical Applications

    - Orthopedics
    - Emergency Room Trauma
    - Surgical Oncology
    - Medical Oncology
    - Gastroenterology
    - Cardiology
    - Vascular Surgery
    - Neurosurgery
  • Clinical Impact of 3D

    - Improve detection of disease
    - Improve patient triage by selecting appropriate therapy
    - Optimize surgical planning
    - Replace more invasive/more expensive studies with a non-invasive 5-15 second study
  • 3D Post Processing:

    "MDCT and refined 3D imaging processes can offer a full examination of the small bowel as well as powerful information about the bowel and its surrounding structures."

    MDCT of Small-Bowel Disease: Value of 3D Imaging
    Hong SS et al.
    AJR 2006;187;1212-1221
  • "In most cases of small bowel disease, various 3D technologies can help radiologists make an easy, rapid, and accurate diagnosis while avoiding unnecessary examinations."

    MDCT of Small-Bowel Disease: Value of 3D Imaging
    Hong SS et al.
    AJR 2006;187;1212-1221
  • "Isotrophic scanning of the abdomen and pelvis allows creation of reformats with similar image quality as similar thickness axial source images. These reformats are of sufficient quality to form the basis of clinical interpretation."

    Isotropic CT Examination of Abdomen and Pelvis: Diagnostic Quality of Reformat
    Sandrasegaran K et al.
    Acad Radiol 2006; 13:1338-1343
  • "In conclusion, we have shown that axial and coronal reformats of isotropic resolution acquisitions are of acceptable image quality. In our experience, such acquisitions of the entire abdomen and pelvis are possible with 40 and 64-slice scanners in almost every patient."

    Isotropic CT Examination of Abdomen and Pelvis: Diagnostic Quality of Reformat
    Sandrasegaran K et al.
    Acad Radiol 2006; 13:1338-1343
  • "These reformats may be used as the basis of routine image interpretation, changing the long established tradition of using only axial images for reporting."

    Isotropic CT Examination of Abdomen and Pelvis: Diagnostic Quality of Reformat
    Sandrasegaran K et al.
    Acad Radiol 2006; 13:1338-1343
  • 3D Imaging

    "The volume-rendering technique uses computed tomography data to produce simulated images of conventional barium and endoscopic studies of the stomach. Various tumors are detected on volume rendered images."

    Computed Tomography Gastrography with Volume Rendering Technique: Correlation with Double Contrast Barium Study and Conventional Gastroscopy
    Kim AH et al.
    J Comput Assist Tomogr 27(2):140-149,2003
© 1999-2019 Elliot K. Fishman, MD, FACR. All rights reserved.