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by Brian T. Horowitz
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How 3D Technology Is
Transforming Medical
Imaging
AI, cloud and supersonic networking speeds make images
clearer, crisper and more informative.
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2. Brian T. Horowitz is a writer and editor covering enterprise IT, innovation and the
intersection of technology and healthcare.
Medical imaging has come a long way from the early days of CT scanners and
mammography devices. With 3D medical imaging, healthcare professionals can now access
new angles, resolutions and details that offer an all-around better understanding of the
body part in question, all while cutting the dosage of radiation for patients.
“Modern radiology is completely dependent on 3D visualization,” says Dr. Frank Rybicki,
professor and chair of the University of Ottawa’s radiology department and chief of
medical imaging at The Ottawa Hospital. “It’s part of the culture of radiology at this point.”
In addition to volume, 3D medical imaging provides a clearer picture of blood vessels and
crisper images of bones.
What’s made this possible is evolutions in networking, computer power and software, as
well as a “thousand-fold increase in networking speed,” as the bandwidth available for the
transmission of medical images has grown from 10 megabits per second to 10 gigabits per
second. This is according to Gordon Harris, director of the 3D Imaging Service at
Massachusetts General Hospital’s Department of Radiology, who started the hospital’s
imaging program nearly 20 years ago.
“This increase in networking speed has enabled us to work with much larger data sets, to
be able to download and move them,” Harris says. “This improved network speed allows
client server- and cloud-hosted models to be available and for us to process cases for
other hospitals and imaging centers.”
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The Evolution and History of Medical Imaging
Over the last two decades, Harris has watched the number of 3D medical imaging cases
grow from two cases per day in his first month to around 130 cases per day in 2018. When
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Harris began working with 3D imaging, scanners turned out much less data and only
produced single-slice images. The result was lower-resolution images that included a lot of
noise.
“The scanner technology has become much more advanced in being able to create data
sets that can make far clearer 3D images with much higher resolution and less noise and
artifacts,” Harris says. “The underlying technology has improved the 3D software in terms
of its performance and capabilities.”
Medical imaging has advanced particularly when it comes to these slice counts, notes
Kimberly Powell, vice president of healthcare at technology company Nvidia. Over the last
decade, the company has worked with radiologists and medical equipment manufacturers
to redesign the computing infrastructure found in medical imaging today, such as
ultrasound, MRI and X-rays. In the early days of CT, radiologists would take anywhere
between four and 16 slices in a sweep across the body. Now they can take images with
hundreds or even thousands of slices in a single study.
“That slice count allows us to increase the resolution of the images that we're capturing
and also more precisely represent the 3D model of the anatomy,” Powell says.
Medical imaging has yet to hit its peak, however. With more speed and power at the
disposal of hospitals and radiologists, here are five types of medical imaging that are
advancing with upgrades in 3D medical imaging:
5 Types of Medical Imaging Impacted by 3D Medical Visualization
1. CINEMATIC RENDERING OFFERS A CLEARER PICTURE OF COMPLEX STRUCTURES
As doctors seek to study complex regions of the body, such as the heart, a new technology
known as cinematic rendering can help.
Developed by Dr. Eliot Fishman, director of diagnostic imaging and body CT and professor
of radiology and radiology science at Johns Hopkins Medicine, the technology produces
photorealistic images by merging 3D CT or 3D MRI scans with volumetric visualization as
well as other computer-generated imagery technology. It aids doctors when diagnosing
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4. illnesses, navigating through surgery and planning treatment. Cinematic rendering allows
healthcare professionals to see much more of the texture of the anatomy.
Much like how ray tracing makes a person’s skin look more real and porous in the movies,
cinematic rendering provides a better look at the texture of tumors, which can provide
more information for doctors to determine whether or not a tumor is cancerous.
“With those textures, the more accurately we can render and visualize them as humans —
the texture of the anatomy or the tumor — I think the richer the information for doctors to
interpret,” Powell says.
2. TOMOSYNTHESIS IMPROVES BREAST CANCER DETECTION
Breast imaging has advanced from traditional 2D mammography to 3D tomosynthesis
(sometimes referred to as 3D mammography), which allows radiologists to capture images
at multiple angles and display tissues at varying depths rather than a single set of images. It
can allow radiologists to see things more clearly in a 3D data set, Harris notes.
“Tomosynthesis has been shown to improve the care for breast cancer detection and is
more sensitive, particularly in patients at high risk or with dense breasts,” Harris explains.
“It helps to differentiate things that might be misinterpreted that are potentially other
artifacts. It's been a big improvement over 2D mammography.”
3. ARTIFICIAL INTELLIGENCE TAKES MEDICAL IMAGING TO THE NEXT LEVEL
The last five years have brought significant advancements in imaging, thanks to the
powerful combination of artificial intelligence and 3D medical imaging. At the GPU
Technology Conference in March, Nvidia introduced Project Clara, a “virtual medical AI
supercomputer” that offers accelerated computing capability and can handle 3D
volumetric rendering, according to Powell.
AI could inject efficiency into medical imaging, particularly when it comes to detecting
organs or anomalies. For example, by combining image visualization and AI, cardiologists
can measure ejection fraction — the percentage of blood pumped through the heart each
time it contracts — in a much shorter period of time without having to sort through massive
data sets and examine the anatomy by sight.
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5. “Oftentimes cardiologists and radiologists have experience, so they just notionally know
what's going on, but AI is able to give an accurate, hard-number measurement to really
increase the chances that the diagnosis is as good as it can be,” Powell says.
4. 3D COMPUTING TOMOGRAPHY ANGIOGRAPHY MAPS VASCULAR ANOMALIES
At Massachusetts General Hospital, Harris is leading an effort in 3D computed tomography
angiography (CTA), in which medical professionals can visualize arterial and venous vessels
via a CT technique. Harris and his team use CTA to map stenoses, aneurysms, dissections
and other vascular anomalies.
In conjunction with 3D imaging, medical professionals can get a better sense of what
they’re viewing in anatomy and pathology, as well as any potential artifacts.
“Where CTA scans may have hundreds of cross-sectional images, our 3D technologists
can succinctly summarize a small set of 3D images for the case so radiologists and referring
physicians can read it efficiently without having to do all the processing themselves,” Harris
says. “The radiologist can then focus on clinical work, research and teaching.”
Moreover, although MRIs and CT scans start out as 2D, they can be transformed into 3D
through manipulation in 3D software, Harris explains. “It's not 3D by default, but you can
take a stack of 2D data sets and manipulate it in 3D in a variety of different ways,” he says.
5. 3D ULTRASOUND SIMPLIFIES THE IMAGING PROCESS
With 3D ultrasound, ultrasonographers use a probe to examine a patient’s anatomy. They
capture 3D image sweeps in addition to key snapshots and send the images to a 3D
workstation. A 3D ultrasound technologist then reviews the images and creates additional
3D views before they go to the radiologist.
“The technologist will see whether the sonographer has captured the entire anatomy with
the scan, if there's poor image quality or if they have missed anything,” Harris says. “They
can have the ultrasonographer update the scan if necessary.”
Prior to 3D ultrasound, radiologists would have to physically go to each scan and check the
patient, because once the patient left, no additional images could be acquired. If there were

6. later questions, the patient would be called back for rescanning, for which radiology
wouldn’t be reimbursed, according to Harris.
In 2003, Harris and his team began using an attachment for the probe that takes a “smooth
sweep of the anatomy” and reconstructs the information as a 3D data set.
“If there's something in the snapshots they don't see clearly, we can reconstruct additional
views from the raw data without having to call the patient back,” Harris says. Not only does
this process improve efficiency for radiologists, ultrasonographers and patients, it also
introduces flexibility into the process, as ultrasound exams can now be acquired during off
hours and at satellite imaging sites.
The Future of Medical Imaging: AI, Cloud and Beyond
While medical sensors have played a key role in imaging in the last two decades, future
approaches will revolve around computation and more-intensive compute power.
Computation and AI make image gathering more efficient and shorten image acquisition
times. In addition, the field will likely see more cloud-hosted medical imaging data.
“We're seeing a lot more movement toward cloud-hosted applications and technology
using compute servers and more-intensive compute power that can be hosted remotely,”
Harris says, adding that he would like to see AI algorithms cut down imagine processing
time as well.
“We're looking at trying to replace some of that time-intensive work with a better
segmentation that will allow us to produce the results in less time,” Harris says. “We have
some cases that take us one to two hours, and if we can cut that time in half using
advanced algorithms, that would be really great.”
In addition, AI will help radiologists spot images they would not be able to see with the
human eye.
“There's a tremendous amount of data in the images that is currently lost because the
human eye can't process it,” Harris says. “With the help of AI, there's a tremendous amount

7. More On
of information that could be gleaned quantitatively from that data and presented to the
radiologist and referring physicians to help with diagnosis and treatment planning.”
With technologies like 3D medical imaging and artificial intelligence at doctors’ disposal,
Powell thinks medical professionals can become “superhuman.”
“It's a brand-new tool in their toolbox,” she says of 3D imaging. “It has some really
incredible superpowers.”
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Jul 27 2018
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