Medical Imaging Workstations: What Is Missing and What Is Coming?

Abstract

During the past 2 decades, radiology has undergone a transformation from film to digital. Now moving from glass slides to digital imaging, pathology is in an early stage of a similar evolution and may benefit from a report on how radiology made this change in technology. More importantly, where will radiology be in the future? Many of those experiences were not entirely pleasant, and your awareness of the potential pitfalls might prove useful for planning and decision making.To a clinician, the most visible and important components of a digital imaging system are medical imaging workstations and, more recently, image-guided therapy workstations, particularly those used in surgery and radiotherapy. This article explains how workstation applications are evolving in clinical practice. I introduce workflow issues and some key acronyms. My objective is to help you understand the workstations, what motivated their development, and their interfaces to imaging modalities. Knowing this, you can appreciate how radiology, surgery, and radiation oncology can work together productively in a clinical enterprise.There are 2 distinct types of workstations. The first type is called a “thick client” workstation. These high-performance and high-resolution workstations are where radiologists spend most of their time and make most of their decisions. In contrast, there are “thin client” enterprise workstations that might be found on the clinic floor, on a physician's desk or in his or her home office, or most recently as part of a wireless device. These thin client workstations include specially programmed Web browsers.There is another way to think about all of this. The thick client workstations are somewhat akin to the familiar gaming platforms (eg, Xbox [Microsoft Corporation, Redmond, Washington] and PlayStation [Sony Computer Entertainment America, Inc, Foster City, California]). The gaming platforms contain high-performance computing capabilities and computer graphics hardware, both of which are run by local software. The gaming platforms can operate autonomously, similar to the way we use thick client workstations in radiology. We download sets of images to these workstations and locally operate the workstations (ie, without the need for a remote host computer to manipulate the images).The thin client portals are display stations like those you might have on your office or home desk or on a wireless device, such as a Web-enabled cell phone or personal digital assistant. These thin client displays work similar to Google (Mountain View, California) in that they both provide computing resources using a remote set of host computers. Imaging Web services can now be found everywhere, especially in a modern hospital or medical center. It is common today for radiologists to carry a cell phone and pager; therefore, if paged while on call, we can immediately and remotely review images from anywhere. Today, we can combine the cell phone and image review station in a single portable wireless appliance, so images are available anytime and anywhere they are needed.Surgery represents an important type of image-guided therapy where workstation technology is significantly changing clinical practice. Surgeons place demands on workstations for high-quality images and for local interaction, similar to how radiologists are using thick client systems. However, surgical workstations have become highly specialized and are now able to do certain tasks exceptionally well.In radiotherapy, we provide imaging services by moving data between modalities. For example, the results of a computed tomography (CT) scan or magnetic resonance imaging (MRI) can be sent to a picture archiving and communications system (PACS) and then through the hospital network to various workstations. Radiotherapy workstations may look similar to the workstations radiologists use; however, they offer virtual simulation, dosimetry, and treatment planning. Radiotherapy workstations are highly opti