Virginia Commonwealth University

Understanding the Human Heart

Professor John Grizzard and research fellow Dr. Tony Moore study cardiac MRI motion images from the WebPAX web server.

The benefits of WebPAX are “immediate, intuitive, and obvious,” says John Grizzard. “That’s just a fantastic way to display the images. At VCU we use WebPAX to display 30 28-frame motion studies of a patient’s heart at a time.

“That’s not all. Sometimes we’re asked to scan a patient who has new cardiac symptoms. We know the patient has heart damage from an earlier problem. We can see from the WebPAX motion images that heart action is impaired, but we can’t be sure that the impairment is caused by the earlier infarct or by more recent damage. WebPAX lets us take a still-frame image of the known infarct and display it against the new motion images in very precise registration. Watching heart motion in the area of the old injury helps us discern whether the new symptoms are caused by the old problem or by a new one.”

“I’ve been using two linked flat-panel Barco monitors with fairly high resolution... They cost about $12,000 each. You can replicate that almost exactly by using a split screen on a 30-inch Apple Cinema Display for less than $2000.”

A Better Way to View

The VCU Radiology Department, which initiated its cardiac MRI program in 2005, currently operates two Siemens Avanto MRI scanners and five Siemens CT scanners, three of which are 64-slice systems. Cardiac scan images from the MRI scanners are automatically routed to WebPAX.

The reading area includes two 20-inch iMacs, which Grizzard uses as teaching tools for residents and cardiology fellows. Grizzard’s own primary reading station is a Power Mac driving a typical dual-monitor setup, but that may change.

“I’ve been using two linked flat-panel Barco monitors with fairly high resolution, mounted side by side, giving us about a 14-inch vertical screen height,” says Grizzard. “They cost about $12,000 each. You can replicate that almost exactly by using a split screen on a 30-inch Apple Cinema Display for less than $2000. The quality is as good or better. And with the two-monitor setup, scrolling through images with the mouse wheel gives you an unpredictable, non-linear, herky-jerky movement. The Apple display scrolls smoothly and seamlessly.”

Grizzard also likes the combination of WebPAX and the Mac as teaching aids. When he uses his browser to view cardiac studies and sees animated GIF images useful for teaching, he just drags them to his desktop. He can easily drop them into a Keynote presentation, where it plays as an animated sequence during a lecture.

Happier Radiologists and Better Diagnoses

The Mac-based WebPAX platform is exciting for VCU radiologists and cardiologists because it reduces PACS costs and is easy to use. They know they can access patient PACS studies from any location. WebPAX’s presentation of multiple synchronized animated images gives them a more complete understanding of the pathology and the ability to diagnose heart ailments with greater confidence.

“We use WebPAX to unwind what can be a very twisted pretzel,” says Grizzard. “It gives us the best shot at doing that — to mentally construct a three-dimensional anatomy from two-dimensional images.”

The speed of the WebPAX process alone can make a life-or-death difference in cardiac medicine, where emergencies become routine. Motion studies of the patient’s heart are usually available online to the radiologist, the cardiologist, and the referring physician before the patient has finished getting dressed.

“In radiology, there exists what we call the fly-in-amber scenario,” says Grizzard. “You’re waiting for data to come over the network or for a page to pop up. You’re stuck. You feel like you’re never going to get moving. WebPAX makes that disappear. It’s instantaneous. The images are always there, moving in real time.

“Frankly, I don’t know how people are doing cardiac MRI without this technology. Once you’ve used it, you can’t go back.”

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