Imaging leads to improvement of medical care

Imaging is providing new techniques in medicine and better outcomes to patients, two experts told the audience at the Oct. 2 Forum held at Simches Research Center at Massachusetts General Hospital.

Presenting were Gordon Harris, PhD, associate professor of radiology, and director, Radiology Computer Aided Diagnostics Laboratory, Harvard Medical School and MGH; and Leonard Kaban, DMD, MD, Walter Guralnick Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, and chief of service, Department of Oral and Maxillofacial Surgery, MGH.

Introducing Dr. Harris was Hiro Yoshida, PhD, associate professor, Harvard Medical School, and director, 3D imaging, Department of Radiology, MGH. Introducing Dr. Kaban was Maria Troulis, DDS, MSc, associate professor of oral and maxillofacial surgery and director of residency training, MGH.

Dr. Kaban spoke on “Bone lengthening by distraction osteogenesis (DO): An update on CIMIT projects in maxillofacial DO.”

Dr. Kaban said that modern techniques such as three-dimensional imaging and minimal invasive endoscopic access for distraction placement have resulted in major improvements in the medical outcomes in his department.

Using slides that portrayed patients, he showed how new techniques of distraction osteogenesis help bones grow correctly in children with malformed faces. (Distraction is defined as separation of bony fragments or joint surfaces of a limb by extension).

Much of his work and that of his colleague, Dr. Troulis, focuses on improving bone structure that enhances breathing, physical appearance or both. He thanked CIMIT for supporting his work in this field, and said that such technology has aided the families of patients as well as the patients themselves.

Dr. Harris discussed “3D imaging in radiology.” He said that modern medical 3D imaging has been aided by the availability of more images, as well as the improved quality of resolution, advances in computing hardware and the evolution of visualization software.

MGH has one of the largest 3D imaging departments in the country, and Dr. Harris said the result of the new technology has been faster, more reliable response to the treatment of patients.

  

A major challenge facing modern medicine is the need to integrate computer-aided imaging strategies into the clinical workflow.  Today’s imaging techniques generate more data than human beings can feasibly analyze, so if the full potential of these techniques is to be realized in a clinical setting, software must be developed to process imaging data into compact yet informative views.

Many algorithms are capable of creating 3-D images from stacks of 2-D images obtained via conventional techniques such as CT and MRI.  A volume rendering approach, for example, creates life-like views useful to surgeons planning procedures.  A maximum intensity projection, on the other hand, shows only the brightest pixel along each ray between the viewer and the bottom of the image stack and is valuable to doctors concerned with vascular anatomy.

3-D images are already proving useful in many areas of radiology.  As a means of studying stenotic vessels, non-invasive CT angiography has largely replaced invasive procedures.  3-D imaging can also be used to accurately measure organ and tumor volumes.  In cases of liver donation, for example, an exact 3-D image of the donor’s liver can be obtained, and a virtual hepatectomy can be performed to determine whether surgery will leave both the donor and the acceptor with enough liver tissue.  3-D image processing can also be used to accurately measure the size of brain tumors and to detect hard-to-see breast tumors. 

The advantages of 3-D imaging are clear.  3-D images provide more comprehensive and realistic views than those produced by traditional 2-D methods, and they save radiologists time.  3-D images also allow doctors to make faster and more confident diagnostic and treatment planning decisions, reducing the need for exploratory surgery.  When surgery is performed, having 3-D images ahead of time helps minimize the surgery’s invasiveness.  Finally, computer-automation allows more data to be analyzed than a team of physicians could ever analyze themselves.   

To take of advantage of new imaging technology, Massachusetts General Hospital has created a cutting-edge 3-D Imaging Center that now handles 2,500 cases each month.  The imaging center uses software and hardware from many vendors, and it is fully integrated with the hospital’s other electronic systems.  In the future, the imaging center hopes to scale up its services so that other hospitals can benefit from them. 

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