CT Technology Including 3D - Learning Modules

Learning Modules ❯ CT Technology Including 3D

A Beginner's Guide to Cinematic Rendering in Clinical Practice: What You Need to Know

Linda C. Chu, MD, Steven P. Rowe, MD PhD, and Elliot K. Fishman, MD
The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD

Cinematic Rendering (CR)

Cinematic rendering was initially described in 2016
As of fall of 2022, there are ~125 publications on CR applications in Pubmed
Also known as global illumination rendering (Cannon Medical Systems) or volume illumination (GE Healthcare), although the term cinematic rendering (Siemens Healthineers) is most commonly used

Comaniciu D et al. Med Image Anal. 2016;33:19-26. Fellner FA et al. J Biomed Sci Eng. 2016;9:170-5. Eid M et al. AJR. 2017;209(2):370-9. Johnson PT et al. AJR. 2017;209(2):309-12.

Cinematic Rendering (CR)

CR uses global illumination model that takes direct and indirect illumination into account to generate photorealistic images

Volume Rendering (VR)

Simple ray casting method
Each pixel is formed by one light ray passing through the volumetric dataset

Cinematic Rendering (CR)

Monte Carlo path tracing and global illumination
Each pixel is formed by thousands of light rays passing through the volumetric dataset
Includes effects from light rays from scatter and from voxels adjacent to the paths of the rays

Comaniciu D et al. Med Image Anal. 2016;33:19-26. Fellner FA et al. J Biomed Sci Eng. 2016;9:170-5. Eid M et al. AJR. 2017;209(2):370-9. Johnson PT et al. AJR. 2017;209(2):309-12.

Why We Do It?

When We Do It?

Troubleshooting for cases with diagnostic uncertainty
Preoperative planning for cases with complex anatomy
Illustrate potential clinical applications:
- Cardiovascular
- Chest
- Trauma/Musculoskeletal
- Oncologic

Cardiovascular Applications

Improve appreciation of complex anatomy in congenital and coronary anomalies
Improve visualization of complex vascular anatomy and reconstructions
Improve visualization of subtle pathologies
Define anatomy important for surgical planning

Röschl F et al. Interact Cardiovasc Thorac Surg. 2019;28(6):916-921.

Cardiovascular – Congenital Anomalies

Cardiovascular – Coronary Artery Anomalies

Cardiovascular – Complex Vascular Anatomy

Cardiovascular – Vasculitis

Cardiovascular – Preoperative Planning

Chest Applications

Enhancement to virtual bronchoscopy in assessment of airway pathology
Improve appreciation of global lung disease burden
Improve assessment of congenital anomalies

Lin CT et al. Emerg Radiol. 2021;28(1):193-199.

Chest Applications

Chest Applications

Recht HS et al. Diag Interv Imaging. 2022;103(2):123-124.

Chest Applications

Trauma/Musculoskeletal Applications

Improve depiction of complex anatomic relationships among bones, joints, muscles, tendons, and soft tissues in acute injuries
Improve visualization of superficial lesions due to improved depth perception

Wollschlaeger LM et al. Eur J Radiol. 2020;126:108911. Berger F et al. Am J Roentgenol. 2018;211:887-890. Yu TJ et al. Radiology. 2022;304(2):353-362. Chu LC et al. Emerg Radiol. 2019;26(5):573-580.

Trauma/Musculoskeletal

Trauma – Musculoskeletal Injury

Trauma – Vascular Injury

Musculoskeletal – Infection/Oncology

Oncologic Applications

Improve lesion detection and characterization by accentuating focal textural change and internal architecture
Enhance appreciation of global disease burden
Improve appreciation of local tumor extension and vascular involvement and assist in treatment planning

Chu LC et al. Abdom Radiol (NY). 2018;43(11):3009-3015. Javed AA et al. Curr Probl Diagn Radiol. 2022 [Online ahead of print]

Oncologic – Lesion Detection and Characterization

Oncologic – Global Disease Burden

Oncologic – Preoperative Planning

Fusion PET/CT Data

Rowe SP et al. Abdom Radiol (NY). 2022 [Online ahead of print]

Fusion PET/CT Data

How We Do It?

Radiologists perform CR at our institution since they are the most knowledgeable about what imaging findings and displays are most relevant for the referring clinicians
Presets are available in the CR software that are designed for specific applications (e.g., vascular, MSK, soft tissue)
Minor modifications to accentuate anatomy and pathology of interest
Can be done in 5 min with experience
Most commonly performed on CT datasets, but can be performed on MRI and PET/CT datasets

How We Do It?

The user selects the most appropriate preset (left panel). He or she highlights different tissues and pathologies of interest by adjusting the window, level, and imaging plane. Process took < 1 min.

How We Do It?

How We Do It?

Vascular and bony pathologies tend to be easier to depict due to the high inherent tissue contrast between vessels and bone on contrast-enhanced CT
With our busy clinical workloads, technologists can potentially assist with post-processing of select vascular and musculoskeletal cases

Reimbursement

Reimbursement for 3D post-processing varies by institution and state regulations
At our institution, if clinicians specifically request 3D post-processing (e.g. preoperative planning for pancreatic surgery), we can generate a separate 3D post-processing billing code for cinematic rendering
In other cases, the 3D post-processing is bundled into the exam (e.g. CTA heart)
Our referring clinicians appreciate the added value of these 3D renderings, which may help increase referrals to our imaging centers

Cinematic Rendering – Value Added

Cases series have shown many potential applications of CR in diagnosis and treatment planning
Subjective added value has been demonstrated through surveys of radiologists, referring clinicians, and trainees
A few preliminary studies have shown that CR can improve diagnostic performance in our understanding of anatomy and pathology, which need to be further validated

Binder J et al. Ann Anat. 2019;222:159-165. Binder JS et al. Anat Sci Educ. 2021;14(1):22-31. Elshaefei M et al. JAMA Surg. 2019;154(8):738-744.

Cinematic Rendering – Future Directions

Integration with augmented reality

Augmented reality with holographic reconstructions is an advanced visualization technique that combines immersive experience and allows the user to interact with the data
Several pilot studies have shown promising results in augmented reality for surgical planning of pancreatic, hepatobiliary, and renal surgeries
CR can be viewed through holographic glasses to enhance the immersive experience

Okamoto T et al. Dig Surg. 2015;32(2):117-123. Onda S et al. J Hepatobiliary Pancreat Sci. 2014;21(4):281-287. Antonelli A et al. Urol Int. 2019;102(2):212-217. Uppot RN et al. Radiology. 2019;291(3):570-580. Rowe SP et al. J Comput Assist Tomogr. 2022 [Online ahead of print]

Cinematic Rendering with Augmented Reality

Rowe SP et al. J Comput Assist Tomogr. 2022 [Online ahead of print]

Cinematic Rendering with Augmented Reality

Conclusion

Cinematic rendering is a recently described post-processing technique that can generate photorealistic images from CT, MRI and PET datasets
It has the potential to more accurately depict anatomic detail and complex anatomy
Preliminary studies have shown that CR can improve subjective assessment and diagnostic performance compared to volume rendering
Future potential to integrate CR with augmented reality

References

Antonelli A et al. Urol Int. 2019;102(2):212-217.
Berger F et al. Am J Roentgenol. 2018;211:887-890.
Binder J et al. Ann Anat. 2019;222:159-165.
Binder JS et al. Anat Sci Educ. 2021;14(1):22-31.
Chu LC et al. Emerg Radiol. 2019;26(5):573-580.
Chu LC et al. Abdom Radiol (NY). 2018;43(11):3009-3015.
Comaniciu D et al. Med Image Anal. 2016;33:19-26.
Eid M et al. AJR. 2017;209(2):370-9.
Elshaefei M et al. JAMA Surg. 2019;154(8):738-744.
Fellner FA et al. J Biomed Sci Eng. 2016;9:170-5.
Javed AA et al. Curr Probl Diagn Radiol. 2022 [Online ahead of print]
Johnson PT et al. AJR. 2017;209(2):309-12.
Lin CT et al. Emerg Radiol. 2021;28(1):193-199.
Okamoto T et al. Dig Surg. 2015;32(2):117-123.
Onda S et al. J Hepatobiliary Pancreat Sci. 2014;21(4):281-287.
Recht HS et al. Diag Interv Imaging. 2022;103(2):123-124.
Röschl F et al. Interact Cardiovasc Thorac Surg. 2019;28(6):916-921.
Rowe SP et al. Abdom Radiol (NY). 2022 [Online ahead of print]
Rowe SP et al. J Comput Assist Tomogr. 2022 [Online ahead of print]
Uppot RN et al. Radiology. 2019;291(3):570-580.
Wollschlaeger LM et al. Eur J Radiol. 2020;126:108911.
Yu TJ et al. Radiology. 2022;304(2):353-362.