The importance of improving clinical quality and efficiency has focused attention on the benefits of comparing patients’ new imaging exams with all of their available relevant prior exams. These efforts are increasingly supported by the fact that numerous prior exams are likely to be online and available on a PACS, at the time the new exams are being read by the radiologist or other clinical specialists. This trend is pressuring radiologists to rapidly assimilate this information in an effort to maintain their productivity. These seemingly conflicting forces, increasing productivity and more information to integrate, have created opportunities for a new type of automated image registration.
Health IT System Benefits
The benefits and opportunities for automated registration may be most compelling within radiology, but the increasing conversation around enterprise imaging portends to the broader benefits of this technology. The significant work being done by the HIMSS/SIIM enterprise imaging working group is driving understanding about what enterprise imaging entails, and is bringing into focus a broad range of opportunities for leveraging automated registration in departments such as neurology, oncology, and ophthalmology.
This shift in thinking towards enterprise imaging creates a logical opportunity to think about automated registration in terms of the imaging enterprise. The emergence of enterprise IT systems that connect multiple clinical departments either through unified clinical viewing, image sharing or archiving solidifies this opportunity. These enterprise IT approaches create a framework for implementing a centrally managed, server-based study pre- automated registration solution whose resources can be shared among clinical, IT and software development teams by leveraging DICOM standard connectivity that may already be in place.
Health systems with in-house development teams are often tasked with supporting specialized clinical and research programs. These programs often span multiple clinical departments or technical domains as organizations strive to extract additional clinical value from their unique range of expertise. The collaboration and information sharing needed for successful execution of such projects can benefit from centralized 3D image processing that simplifies access to information that may exist on many IT systems and may need to be shared on a common viewing and analysis platform. In addition, programs that involve comparing historical imaging information with new studies may need to develop customized visualization or analytics tools that leverage pre-processed exam data. These development efforts can be simplified when there is a common backend IT infrastructure upon which to connect and build.
Clinical Applications Benefits
Clinical specialties, treatment programs, or exam types that involve periodic imaging follow-up may benefit from automated registration. This can be particularly true for exams with complex and time-consuming reading workflow, such as lung screening follow-up. Each phase of the diagnostic workflow, including setup, exam review, feature comparison, and dictation, can be made more efficient. In addition, follow-up or comparison exams may be performed on different imaging modalities, at different locations and be read on multiple PACS. While repeating an exam may sound simple enough, there is much variability that comes into play, which can be difficult to control and may inadvertently burden the radiologists and interfere with the achievement of key clinical and operational goals. This impact may be amplified in multi-disciplinary clinical situations where a number of specialists are involved and the amount of clinical information being integrated is amplified.
Because the Blackford Workflow Server supports automated registration with both deformable and rigid registration processing, a wide range of clinical imaging modalities and applications are relevant and can be integrated. Here are some examples of clinical exams that often benefit from routine imaging follow-up and comparison and can benefit from the automated registration process:
|Type of Registration||Body Part||Clinical Exam||Modalities|
|Rigid||Head||Brain tumors||CT, MR, PET/CT|
|Rigid||Body||Liver, kidney and pancreatic lesions||CT, PET/CT|
|Deformable||Chest||Lung tumor and lung screening applications.
|Deformable||Spine||Spinal tumors||CT, PET/CT|
Companies looking to expand their product offerings with new application or visualization tools that leverage automated registration can also benefit from integrating the Blackford Workflow Server. As an integrated, back-end processing platform it can facilitate more rapid development and implementation of advanced pre-processing capabilities across existing clinical IT systems and product lines or facilitate the development of enterprise IT visualization and analytics applications that leverage automated registration. It can also shorten time to market and lower development costs by reducing validation and verification requirements. The need to create applications that work across third party, proprietary systems, and modalities, and leverage a centralized processing platform that supports the DICOM standard, can also be important considerations when developing vendor agnostic applications.
Enterprise pre-processing solutions like the Blackford Workflow Server can simplify the development of visualization tools, like the Blackford Smart Localizer, that are intended to be integrated with existing clinical applications or have new clinical applications built around them. These applications can have relevance to broad areas of the healthcare ecosystem and facilitate the development of important visualization tools that address a range of critical needs.