Jon P. Bradrick, DDS - Director of Oral and Maxillofacial Surgery, MetroHealth Medical Center; Associate Professor, Case Western Reserve University, Cleveland, Ohio.
Pedro J. Diaz, PhD - Vice Chair, Imaging Systems and Informatics, Assistant Professor of Radiology and Biomedical Engineering, Case Western Reserve University; MetroHealth Medical Center.
Introduction
Trauma patients undergoing maxillofacial surgery typically have a computed tomography (CT) scan before the procedure. In a trauma situation, immediate access to these images for advanced visualization is of the essence. Powerful advanced visualization workstations generally reside within the radiology department. If the surgeon needs to access such workstations, it may require a trip to radiology, adding cost and taking up valuable time.
IntelliSpace Portal thin-client technology brings CT, MR or NM images that have typically been available to the surgeon in radiology only and improves visualization of the patient's anatomy. The ability to view and manipulate three-dimensional CT, MR or NM images on a computer in the operating room (OR) gives surgeons a detailed map of the patient’s anatomy as they are doing the procedure.
Philips IntelliSpace Portal can improve maxillofacial surgery workflow by making the three-dimensional imaging datasets available on any computer, anywhere the hospital network reaches—even remotely, using a secure VPN. Portal is designed to reduce diagnosis response time, shorten procedure length through improved surgical planning, and facilitate collaboration with radiologists. Physicians can use Portal to review cases interactively with their patients in the office, or to consult from home. Thin-client technology has also proven to be a useful teaching tool.
Portal helps improve the clinical workflow of oral and maxillofacial surgery, and many of the benefits seen in this field apply to other surgical procedures.
Availability
The Portal server handles large MDCT datasets, while software on the client computers allows clinicians to analyze the scans using Philips imaging applications. The resulting thin-client solution avoids the pitfalls of long download times or limited processing speed, while making any computer into a remote CT workstation.
Portal allows physicians to use their time more effectively by making images available whenever and wherever they are needed. With IntelliSpace Portal, clinicians can interactively view three-dimensional images in the OR, office, ambulatory clinic, or anywhere they have access to the network. Physicians can view after-hours trauma cases at home to make critical determinations without returning to the hospital. Even at an out-of-town conference, clinicians can review current cases using a secure VPN connection to the hospital network.
Faster response time
In maxillofacial trauma cases, the course of treatment can often only be decided after a surgical consult. In these cases, waiting for the physician to respond to a page or to return to the hospital from home can lead to significant delays in treatment.
Portal technology can facilitate a faster response. The physician can view the CT images via the Portal and respond with a determination from elsewhere in the hospital, at home, or even on vacation. In one case at the clinic, a patient entered the ER at night with an unusual abscess presentation.
“I was able to quickly determine if the patient required incision and drainage surgery using the Portal from home,” - Dr. Jon Bradrick.
Pre-surgery planning
Interactive three-dimensional visualization on IntelliSpace
Portal can help in planning surgical procedures. The image
can be rotated and adjusted to find the optimal location,
angle, and depth for surgery.
For example, the oral and maxillofacial surgeon can locate
tooth fragments embedded in the palate of the mouth.
With careful planning, the surgeon can potentially reduce
the amount of bone removed to locate and remove
supernumerary teeth. Planning with three-dimensional
images also helps in estimating the thickness of bone
when drilling and inserting metallic dental implants.
Clinicians can generate simulated dental X-rays using
curved MPR images. And slab MPR images can be set
parallel to the optic nerve to determine the extent
of fractures.
With IntelliSpace Portal, clinicians can plan surgeries at
any time, in the office or at home.
Patient care and education
Prior to surgery, patients often feel apprehensive,
and physicians can find it difficult to explain surgical
procedures. The three-dimensional imaging from Portal
helps in patient education. Using it, physicians can explain
the procedure to patients with an interactive visual aid.
Patients can more clearly visualize the procedure after
viewing the images. Patient response at MetroHealth has
been very favorable. After displaying three-dimensional
images to patients, there is a higher acceptance rate
of procedures. With a clear understanding of what the
surgeon is planning, patients feel better about the
whole procedure.
Operating room
Surgeons find it useful to display images through Portal
in the OR. For complex cases, three-dimensional imaging
can be oriented to the surgeon’s perspective. During
the procedure, the images provide a map identifying
important structures and can help indicate where
fractured bone is located. This can help surgeons
determine the location, angle, and depth required
for surgery.
Post-surgery follow-up
Following the surgical procedure, clinicians can use Portal
for review to verify that the procedure was successful
and that no bone fragments were missed.These images
can also help determine if further surgery is necessary.
Comparing the before and after procedure images helps
surgeons to learn from experience.
Teaching aid
MetroHealth also uses Portal as a teaching aid. With CT images projected onto a dry erase board, surgical residents draw how they intend to perform the surgery. Residents can also use Portal to review recent cases and to learn about optimal procedures. A resident can plan a surgery and then use the three-dimensional imaging as a guideline to verify that the intended procedure is correct.
A simple user interface makes the Portal easy to use and encourages residents to adopt it. Residents who left to go to other hospitals without this capability expressed missing it in their daily practice.
Conclusion
Use of Portal at MetroHealth has shown the workflow benefits of this technology. By reducing response time, improving planning capabilities, and bringing three-dimensional images to the surgeon, Portal saves time. Moreover, with its uses as a teaching aid and in patient education, Portal has the potential to improve patient care.