FAST: Fully Assisting Scanner Technologies

SIEMENS White Paper | siemens.com/FASTCARE FAST: Fully Assisting Scanner Technologies Efficiency enhancement through automatically suggested settings in the CT imaging process Isabel Schumann and Susanne v. Vietinghoff International version. Do not distribute in the US. FAST: Fully Assisting Scanner Technologies Abstract Within high end imaging modalities procedure as well as the overall radiology Computed Tomography (CT) scanning workflow, resulting in higher quality, is easy and fast. In complex cases like productivity, and reimbursement: In trauma examinations the preparation short, creating increased efficiency. and postprocessing of the scan can be Therefore, in addition to the medical timeconsuming and prone to errors. This perspective, the (health) economic view might result in non-comparable results is especially interesting. Based on a as well as avoidable delays and expenses. clinical study, this white paper explores However, the requirement to expedite the efficiency enhancements generated medical processes while enhancing quality by Siemens’ FAST portfolio in the CT and reducing costs is growing steadily. process. The result clearly shows that These conditions have been a driving with FAST Planning (automatic scan/recon force for Siemens in developing its “Fully planning) the number of adjustment has Assisting Scanner Technologies” – (FAST). halved and by using FAST Spine, These aim to streamline the CT scan processing time for spinal examinations was cut by 55 percent. 2 FAST: Fully Assisting Scanner Technologies Scan preparation Scan Reconstruction/ post processing Storing Reading Fig. 1: Simplified process model of the CT scan with its most critical steps of preparation and reconstruction or post processing. Introduction Every CT examination involves individual Delays and inaccuracies References and specific requirements to achieve the optimum clinical outcome. These vary within planning procedures [1] Bames, E. (2013) Clear scanner protocols can help from institution to institution, from user avoid CT radiation mistakes; to user, and from patient to patient. The With conventional planning procedures, URL: http://www.auntminnie. challenge is to find and apply the ideal errors can happen quickly. Especially com/index.aspx?sec=ser&sub= settings for every individual examination, when time is short, the wrong scan mode def&pag=dis&ItemID=103517, while at the same time achieving a high might be chosen, the scan ranges could published: 27.05.2013]. degree of reproducibility for the same type be set too short or too long, or a protocol [2] Prokop, M. et al. (2013) of examination when done by different selected that was meant for a different Ganzkörper-Computertomogra- operators. Today, much valuable time and organ [1] [2]. This can only be countered by phie: Spiral- und Multislice-CT, expertise of medical professionals is spent investing an increased amount of attention 2. Completely revised and preparing the scan and the image recon- (i.e. time) and expertise to thoroughly extended edition, Stuttgart, Thieme, p.120. struction in order to attain reliable and preparing the scan. reproducible clinical outcomes. Therefore, those steps in particular – scan planning and scan reconstruction – are the most critical onesin the complex CT scan pro- cess (Figure 1). 3 FAST: Fully Assisting Scanner Technologies References Spine reconstructions are Time-consuming proce- [3] Schwarzmüller-Erber G., very time consuming dures involve high costs Silberstein E. (2012) Angewandte Computertomo- graphie, 2. revised edition, In addition, the quality of postprocessing Achieving high medical quality, therefore, Wien, Facultas Verlags- und and reconstruction significantly influences requires high time resources and, conse- Buchhandel, p.258. the diagnostic validity. This makes these quently, high costs. Here is the crucial [4] Alkadhi, H. et al. (2011) steps, as mentioned before, highly critical point: Nowadays, healthcare providers – Wie funktioniert CT? Eine Ein- to the CT scan process. Currently, the including radiology departments – have führung in Physik, Funktions- reconstruction of images proceeds manu- to face the challenge of lowering costs, weise und klinische Anwendun- gen der Computertomographie, ally. Especially in case of the spine, this enhancing quality of care and increasing Berlin u.a., Springer, p. 156. requires many steps. Depending on the revenue, all of these challenges running medical question, the slices have to be concurrently. More and more emphasis is [5] Reiser, M.F. / Mildenberger P. oriented manually and individually along put on reaching higher reimbursement, (2013) Informationstechnologie und every vertebrae and disc of the spine. which is one reason why radiology depart- Management in der Radiologie Furthermore, the vertebral bodies have ments strive for methods of process opti- 53, 4, p.4. to be identified and labelled separately. mization and efficiency enhancement [5]. This can easily take up to half an hour or more, is user-dependent, and prone to error [3]. Particularly in total-body CT scans; for example to evaluate polytraumatized patients, reconstruction and postproces- sing are very time consuming. This might delay the initial diagnosis [4]. 4 FAST: Fully Assisting Scanner Technologies Scan preparation Scan Reconstruction/ post processing Storing Diagnosis FAST Planning FAST Spine Fig. 2: FAST planning and FAST Spine tackle the critical steps of scan preparation and Reconstruction. Fully Assisting Scanner Technologies – as fast as a single click In other industries it is already common FAST technologies automatically suggest References practice to use automatized methods the best set of parameters for your to gain higher process efficiency. In the examination based on the selected body [6] Salomonowitz, E. (2009) Organisationsentwicklung im healthcare environment, too, and espe- region. As mentioned above, planning Krankenhaus: Mehr Personal cially for diagnostic purposes, automatized and reconstruction are the most critical spart Kosten! Gelebte Investition technologies will considerably influence steps in the CT scan process. Since FAST in Qualität, Know-how und process efficiency. [6] Planning and FAST Spine tackle these criti- Skills am Beispiel der Radiologie, Siemens has realized this and has sub- cal steps, these applications – as part of Wien, Springer, pp.5-6 sequently developed pioneering methods FAST CARE technologies1 – can be con- [7] Ludewig, M. (2007) for the automatic detection of organs and sidered to have high influence on the Implementierung und Robust- image reconstruction in CT: the unique process (Figure 2). heitsanalyse eines automatischen Verfahrens in der Medizinischen FAST technologies (powered by ALPHA Bildverarbeitung, Diplomarbeit technology2). With applications like these, Otto-von-Guericke-Universität the amount of time needed to produce Magdeburg, p.10 and evaluate medical images is reduced. Furthermore, the imaging process should be less prone to errors and less dependent 1 Further information on FAST CARE is available on the user and on the patient’s anatomy, http://www.healthcare.siemens.com/computed- resulting in higher reproducibility of tomography/technologies-innovations/fast-care diagnostic images and results [7]. All in all, 2 The pioneering ALPHA technology automatically identifies and understands anatomical structures “Fully Assisting Scanner Technologies” and thereby supports accelerated scanning and make the complex process of CT imaging reading. simpler and more efficient. To find out more about ALPHA technology please visit http://www.healthcare.siemens.com/ medical-imaging-it/clinical-imaging-applications/ syngovia/features 5 FAST: Fully Assisting Scanner Technologies Manually setting the scan range too short in the topogram can cut off relevant parts of the examined organ [A] or manually setting the scan range too long in the A B topogram can potentially over- radiate the patient [B]. Fig. 3: Without FAST Planning Direct scanning with FAST Planning assures covering the entire organ without over-scanning [A] and FAST Planning uses defined anatomical landmarks to set the correct ranges. When applied manually withour FAST applications, only based on the coronal view, the lower part of the lung could easily be missed (indicated by the reference line) [B]. A B Fig. 4: With FAST Planning FAST Planning – immediate, organ-based setting of scan and recon ranges for a safer, faster, and more standardized workflow at the scanner FAST Planning focuses explicitly on the In addition, the corresponding scan critical part of the process – planning range(s) are proposed in the topogram. the scan. Based on the topogram, FAST Even the lateral field of view is detected Planning support scan and reconstruction by the system automatically (Figure 4). planning to provide an easier, faster, and In the case of head examinations, the more standardized CT workflow. The user iso-center is automatically adapted can select the anatomical region of interest according to the position of the patient’s (ROI) from a list to prospectively define head including the gantry tilt to avoid the scan and reconstruction ranges. The the eye lenses (Figure 5). scan ROI(s) are automatically detected based on the characteristics of the organ that is to be scanned (powered by ALPHA technology1). 1 The pioneering ALPHA technology automatically identifies and understands anatomical structures and thereby supports accelerated scanning and reading. To find out more about ALPHA technology please visit http://www.healthcare.siemens.com/ medical-imaging-it/clinical-imaging-applications/ syngovia/features 6 FAST: Fully Assisting Scanner Technologies 10.10.29-14:01:26-DST-Specials . H Hospital 10.10.29-14:01:26-097-1.3.1. SOMATON Definition AS+ +18-Nov-1858, 0, 151Y CT 2011A 1.02 PO2 29-Oct-2010 H-SP 44:03:16.44 2 IMA 1- TOP 2 SP -751 0 SP 1: -1064 SP 2: -1064.2 -917.4 LEN 145.8 GT Fov: 10cm Automatic adaption of scan settings for head examinations. Fig. 5 FAST Spine – accurate and anatomically aligned preparation of spine recons As explained above, reconstructing CT slices that are orthogonal to the spinal images is time consuming, especially in canal and all vertebrae are labeled. The spinal examinations. Therefore, FAST Spine angulation of each single slice refers to shortens the lengthy procedure of recon- the curvature of the spinal column. Spine structing spinal images by providing disc mode provides a reconstruction range various modes that automatically create that is placed and oriented on a specific anatomically orientated spine recon ranges. disc. Of course, the clinical expert always FAST Spine delivers an automatic segmen- makes the final decision. All modes tation of the spinal canal and automatic offer the possibility to adapt the results labeling of the vertebrae. When certain manually if needed. Figure 6 shows the parts of the spine – or perhaps the entire functionality of FAST Spine. spine – are to be reconstructed, Spine multimode provides anatomically oriented 7 FAST: Fully Assisting Scanner Technologies Screenshots H Hospital C7 MPR 2 T2 TA 10 cm TS Vertebral bodies TO are automatically labeled with FAST Spine. SL 3. 350 nel Fig. 6 Increased efficiency through FAST Planning and FAST Spine References Users of FAST Planning and FAST Spine The results show that both process qual- [8] Greiling, M. / Marschner, C. are interested not only in how the tech- ity and outcome quality are enhanced. (2007) nology works but especially in how far With FAST Planning, the number of adjust- Nutzeneffekte von Prozess- the scanning procedure really is affected ments for the desired size (field of view) optimierungen: Workflow- and to what extent an economic impact while preparing the scan decreased on Management im Gesundheits- can be generated as well as medical qual- average by half. Notably, after implemen- wesen, Kulmbach, Baumann ity increased. Importantly, data gathered ting FAST Planning all technicians needed Fachzeitschriften Verlag, p.64. from a scientific case study have indicated the same number of adjustments, regard- [9] Schöffski, O. (2011) significant efficiency-increasing effects of less of work experience and the amount Grundformen gesundheits- FAST Planning and FAST Spine. of adjustments they had previously ökonomischer Evaluationen, Each of the 64 spinal scans was observed required. in: Schöffski, O., Graf. v. d. Schulenburg, J.M. (editor) first without the aforementioned technol- Moreover, outcome quality was increased: (2011), Gesundheitsökono- ogies and then with to assess differences The number of examinations carried out mische Evaluationen, 4. Completely revised edition, in process efficiency. without any errors grew by more than Heidelberg, Springer Gambler, Quality, time, and costs make it possible 10%, reaching almost 100%. The process pp.43-70. to determine process efficiency, although also becomes less dependent on the staff they are interrelated [8]. In other words, an or on anatomical anomalies in the patient. efficient allocation of resources requires Overall, this results in increased ease of not only considering and evaluating the use, process standardization, and repro- medical or qualitative benefit but also ducibility. the costs of medical performances – and finally weighing them up [9]. 8 FAST: Fully Assisting Scanner Technologies 1 2 3 4 5 6 Process time without Process time with FAST in minutes FAST in minutes 1 Registration 00:13 00:12 2 Scan planning 00:54 00:51 3 Topogram 00:08 00:10 4 Adjustments for scan 02:21 01:03 5 Scan 00:11 00:12 6 Reconstruction 05:50 01:54 09:36 overall 04:22 overall Comparison of process time 1 2 3 4 5 6 without FAST Planning and FAST Spine in phase 1 (top figure) and with the technologies in phase 2 (bottom figure). Fig. 7 As mentioned, time plays an important Time savings highly influence the costs role in evaluating process efficiency. of the process. With five spine examina- Therefore, time savings resulting from tions daily, these time savings amount to the implementation of FAST technologies almost half an hour per day. Additional significantly impact the efficiency of CT revenues can be realized due to increased diagnostics. The duration of the imaging time resources. process was cut on average by more than half, from about ten to less than five Compared with the current number of minutes. This mostly results from reduced spinal examinations, the time savings time for reconstruction and postproces- make at least one additional examination sing thanks to FAST Spine (Figure 7). possible. Assuming that one examination Without FAST Spine, between four and generates an average reimbursement of twenty image series per study have to be 80 Euro (for head, neck, thorax, abdomen, reconstructed; with FAST Spine it is only or spinal examinations2, this roughly leads one (Figure 8). Moreover, it again came to an increase of 80 Euro in reimburse- to light that all technicians needed almost ments per day. Assuming 250 business the same amount of time and that there days, this represents an increase of are no varations of reconstructions even 20,000 Euro per year. though they were performed by different technicians. Before using FAST Planning and FAST Spine, huge differences in process time due to different approach 1 Based on German outpatient reimbursement and levels of experience were seen. data 2014 (EBM Radiology); without 3D recon- struction, contrast media, and auxiliary services; statutory to private insurance ratio 9:1, according to distribution of insured persons in Germany. 9 FAST: Fully Assisting Scanner Technologies Manual workflow FAST Spine workflow Identify vertebrae and discs Label vertebrae and discs Plan recon layer for every vertebra or disc depending on anatomical orientation Reconstruct respective layer Repeat for every vertebra Select predetected and and discs to be examined pre-defined recon range for the spine examination Repeat the 4 steps Single click depending on the number of Comparison of workflow vertebrae to be examined without and with FAST Spine. Fig. 8 Summary and conclusions The CT imaging process and the time- Efficiency increases were found primarily consuming and complex procedures with regard to the indicators time, quality, associated with it are clearly simplified and costs (Figure 9). With the help of and automated with FAST Planning and Siemens technology, the imaging process FAST Spine. By creating reproducible generally becomes simpler and more results and streamlined examinations, reproducible, provides higher quality, FAST technologies improve efficiency and involves less time and fewer costs. and optimize the overall clinical outcome. Therefore, the positive impact of these technologies on the radiological work- flow is substantiated both from a medical and economic perspective. 10 FAST: Fully Assisting Scanner Technologies ◾ Simplification of process structure ◾ Decrease in number of ◾ Reduction in individual dependency adjustments / editing ◾ Increase in standardization and ◾ Improvement of patient and reproducibility employee satisfaction ◾ Increase in ease of use and ◾ Enhancement of data quality controllability Quality (homogenous and ontime labeling, less storage space) ◾ Reduction in process time Process results in ◾ Decrease of process costs by 55 percent comparison by 55 percent ◾ Increase of time resources ◾ Decrease in use of resources and scanner availability ◾ Increase in number of cases, ◾ Increased time capacity for output, and revenues is critical process activities Time Costs possible Fig. 9: Summarized results. Diverse benefits through time savings – especially in acute care and older patients Although 70 percent of spinal examina- Against the background of rising obesity tions are carried out using magnetic and the higher weight capacity of CT resonance tomography (MRI), the field of scanners in comparison with MRI scanners, applications is quite diversified. Compared the advantage is obvious. Both the plan- with MRI, computed tomography can ning and reconstruction of image data of score through brief examination time. With obese patients present medical staff with the FAST portfolio, additionally generated challenges, so that support in the form time savings could become particularly of FAST is of great service. relevant in the context of emergency and polytrauma care. In general, it can be stated that the imple- mentation of automated CT scanner Moreover, patients suffering from back technologies such as FAST Planning and pain due to degenerative changes are not FAST Spine considerably influences the able to lie down for a longer period and profitability and efficiency of radiology will benefit from accelerated examinations. departments. Therefore, with Siemens’ FAST solutions radiologists meet both medical and economic requirements. 11 In the event that upgrades require FDA The information in this document clearance, Siemens cannot predict contains general technical descriptions whether or when the FDA will issue of specifications and options as well as its clearance. Therefore, if regulatory standard and optional features which clearance is obtained and is applicable do not always have to be present in to this package, it will be made available individual cases. according to the terms of this offer. 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