Emergency 3D Imaging

Dr. Roy Dsouza,Teleradiology Solutions .

•What is 3D imaging?

•Types of 3D images

•Software vendors

•What is a Remote 3D Lab?

• Focuses on reimbursable cases and those which require intensive team interaction

• Building new protocols and clinical research• Standardization and quality assurance

• Overflow work can be managed through India Center

• Weekend and nighttime coverage• Replicates the Client setup

Client 3D Lab India 3D Lab

• MR / CT Angiographies for various Body parts• Head, Neck ,Pulmonary, Renal, Peripheral &

Extremity Angiographies, Multi Planar Reconstruction , Maximum Intensity projections (MPR/MIP), 3D Recon for Anatomical evaluation, for Maxillofacial/Plastic surgery, Aortograms etc

• MR / CT Perfusion• Virtual Endoscopy• 3D rendering of

fractures• Volumetry

Service Offerings

Remote 3D lab

•Manage the night time and overflow work from multiple centres

•Team of trained radiologists and technologists

•Detailed tailored and customized protocols

•Reproducible images

•365 day coverage

•HIPAA compliant

Remote 3D lab

• Shift commences at the end of shift in the client 3D lab• Shift ends at the start of the shift at the client 3D lab• Technical staff check the PACS (Picture Archive and Communication System) for

active cases requiring 3D images and download the same.• Entries are made in the RIS(Radiology Information System) and relevant clinical

data gathered to create worksheet• Relevant series are sent to 3D workstations (GE Advantage windows) for the

clinical staff( technologist and radiologist) to commence processing the 3D images.

• Once 3D images are created by clinical staff, these are sent back to the workstations of the technical staff.

• The completed 3D images are uploaded back to PACS and entries made in the RIS.

• At end of shift, worksheet is sent to client by email for which feedback is received.

Daily workflow

Emergency Imaging- case of stroke

PComPCom

Aneurysm

Bleed

Aneurysm

L PCOM

Emergency Imaging- Intracranial bleed

Axial CTA image

MIP and VR of LCCA pseudoaneurysm

Emergency Imaging- post operative endarterectomy complication

MIP and VR of Aortic dissection

Emergency Imaging- Aortic dissection

Musculoskeletal imaging

Volume rendered images Shoulder Joint fracture- manual separation of articulating bones

CT brain Extensive subarachnoid hemorrhage in the basal cisterns,

fissures, and distributed throughout the sulci. Predominance of the hemorrhage is left sided.

Emergency Imaging- Case 1

PComPCom

Aneurysm

Bleed

Aneurysm

L PCOM

Maximum IntensityProjection (MIPs)

Volume Rendering(VRs)

3 Dimensional (3D) images

Post Intervention CTA

• Status post coiling of left posterior communicating artery aneurysm. Grossly unchanged appearance of multiple additional intracranial aneurysms.

MIPs

VRs

3 Dimensional (3D) images

Emergency 3D request for suspected vertebral artery aneurysm

Maximum Intensity Projections ( MIPs)

Curved Reformats

Volume Rendering

Superior View

Inferior View

Posterior View

View from Right

View from Left

Emergency 3D request for suspected vertebral artery injury - Poor scan quality

Maximum Intensity Projections ( MIPs)

Curved Reformat

Emergency 3D request for branch vessel involvement of aortic dissection

Maximum Intensity Projections ( MIPs)

Thank you.