Medical Imaging Workstations
What Is Missing and What Is Coming?
Michael W. Vannier, MD
D uring 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
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
early stage of a similar evolution and may beneﬁt from a client workstations in radiology. We download sets of im-
report on how radiology made this change in technology. ages to these workstations and locally operate the work-
More importantly, where will radiology be in the future? stations (ie, without the need for a remote host computer
Many of those experiences were not entirely pleasant, and to manipulate the images).
your awareness of the potential pitfalls might prove useful The thin client portals are display stations like those you
for planning and decision making. might have on your ofﬁce or home desk or on a wireless
To a clinician, the most visible and important compo- device, such as a Web-enabled cell phone or personal dig-
nents of a digital imaging system are medical imaging ital assistant. These thin client displays work similar to
workstations and, more recently, image-guided therapy Google (Mountain View, California) in that they both pro-
workstations, particularly those used in surgery and ra- vide computing resources using a remote set of host com-
diotherapy. This article explains how workstation appli- puters. Imaging Web services can now be found every-
cations are evolving in clinical practice. I introduce work- where, especially in a modern hospital or medical center.
ﬂow issues and some key acronyms. My objective is to It is common today for radiologists to carry a cell phone
help you understand the workstations, what motivated and pager; therefore, if paged while on call, we can im-
their development, and their interfaces to imaging mo- mediately and remotely review images from anywhere.
dalities. Knowing this, you can appreciate how radiology, Today, we can combine the cell phone and image review
surgery, and radiation oncology can work together pro- station in a single portable wireless appliance, so images
ductively in a clinical enterprise. are available anytime and anywhere they are needed.
THICK CLIENT AND THIN CLIENT WORKSTATIONS IMAGE-GUIDED THERAPY WORKSTATIONS
There are 2 distinct types of workstations. The ﬁrst type Surgery represents an important type of image-guided
is called a ‘‘thick client’’ workstation. These high-perfor- therapy where workstation technology is signiﬁcantly
mance and high-resolution workstations are where radi- changing clinical practice. Surgeons place demands on
ologists spend most of their time and make most of their workstations for high-quality images and for local inter-
decisions. In contrast, there are ‘‘thin client’’ enterprise action, similar to how radiologists are using thick client
workstations that might be found on the clinic ﬂoor, on a systems. However, surgical workstations have become
physician’s desk or in his or her home ofﬁce, or most re- highly specialized and are now able to do certain tasks
cently as part of a wireless device. These thin client work- exceptionally well.
stations include specially programmed Web browsers. In radiotherapy, we provide imaging services by mov-
There is another way to think about all of this. The thick ing data between modalities. For example, the results of a
client workstations are somewhat akin to the familiar computed tomography (CT) scan or magnetic resonance
gaming platforms (eg, Xbox [Microsoft Corporation, Red- imaging (MRI) can be sent to a picture archiving and com-
mond, Washington] and PlayStation [Sony Computer En- munications system (PACS) and then through the hospital
tertainment America, Inc, Foster City, California]). The network to various workstations. Radiotherapy worksta-
gaming platforms contain high-performance computing tions may look similar to the workstations radiologists
use; however, they offer virtual simulation, dosimetry, and
treatment planning. Radiotherapy workstations are highly
Accepted for publication October 31, 2008. optimized for delivering therapy, for example, by control-
From the Department of Radiology, University of Chicago Medical ling a linear accelerator. In this specialized treatment en-
Center, Chicago, Illinois. vironment, the general purpose nature of workstations is
Dr Vannier is a member of the Board of Directors for Vital Images, of less importance than the specialized, suited-to-task per-
Inc, Minnetonka, Minnesota, a medical imaging software company.
Presented at the College of American Pathologists Futurescape of formance.
Pathology Conference, Rosemont, Illinois, June 7–8, 2008. MODEL-BASED THERAPY
Reprints: Michael W. Vannier, MD, University of Chicago Medical
Center, 5841 S Maryland Ave, Chicago, IL 60637 (e-mail: mvannier@ Because any given patient often has multiple encounters
uchicago.edu). with an imaging modality, such as a C