Cinematic Rendering With Positive Oral Contrast: Virtual Fluoroscopy

Imaging of acute small bowel pathologies in oncology patients in the ER part I: the role of Computed Tomography (CT) for the evaluation of Tumor and infections

Acute abdominal complaints constitute up to 40% of all emergency department (ED) presentations in oncology patients due to a multitude of causes. Small bowel pathologies present a diagnostic challenge due to their diverse range and frequently overlapping clinical presentation. In oncology patients, structural changes resulting from tumor growth, surgery and treatment effects can further complicate the diagnostic process. Due to a weakened immune system, oncology patients are also highly susceptible to infections of the gastrointestinal tract (GIT). Traditional computed tomography (CT) scans are used as the gold standard diagnostic modality. However, three-dimensional (3D) postprocessing techniques including maximal intensity projection (MIP), volume rendering (VR) and cinematic rendering (CR) have been employed to aid image evaluation. For a balanced and organized approach to describe diagnostic challenges in this complex population, we have divided the pictorial essay into two parts. The first part focuses on tumor- and infection-associated causes, as summarized below in the visual abstract. The second part will address treatment-related complications, including chemotherapy, radiotherapy, immunotherapy, graft-versus-host disease and post-surgical complications.

Clinical implementation of cinematic rendering

Cinematic rendering is a recently developed photorealistic display technique for standard volumetric data sets. It has broad-reaching applications in cardiovascular, musculoskeletal, abdominopelvic, and thoracic imaging. It has been used for surgical planning and has emerging use in educational settings. We review the logistics of performing this post-processing step and its integration into existing workflow.

Evaluation of extensive inflammatory conditions of the bowel using three-dimensional CT cinematic rendering: focus on inflammatory bowel disease

Inflammatory conditions that affect long segments of bowel and/or the mesentery and mesenteric vasculature are a common cause of emergency department visits and evaluation by cross-sectional imaging. Inflammatory bowel disease, specifically Crohn disease and ulcerative colitis, can be unsuspected at presentation and may only be eventually diagnosed based on initial imaging findings. Traditional 2D axial reconstructions and multi-planar reformations can be limited in their ability to globally assess the extent of disease. 3D methods such as volume rendering (VR) are often used as adjunctive means of visualizing the pathology in such patients. Recently, a novel technique known as cinematic rendering (CR) has emerged, utilizing advanced lighting models and ray tracing to simulate photon interactions with tissues, resulting in realistic shadows and enhanced surface detail compared to VR. Generating CR images from select presets takes an experienced radiologist approximately 5 min, meaning that the technique can be incorporated into meaningful emergency department workflows. Given the apparent advantages of CR, we highlight its application in a series of cases in which patients had inflammatory conditions that affected long segments of bowel and/or involved the mesentery, particularly those patients with inflammatory bowel disease, but also including patients with mesenteric venous thrombosis and lymphedema. Those conditions included inflammatory bowel disease, mesenteric venous thrombosis, and bowel lymphedema. We present examples of those conditions in this pictorial essay and describe the potential of CR to visualize key findings. As CR exhibits possible advantages, further studies are warranted to support its broader clinical adoption and assess its efficacy in diagnosing and guiding managing of inflammatory conditions in emergency settings.

3D CT cinematic rendering of pediatric thoracic vascular anomalies

Thoracic vascular anomalies in the pediatric population are a heterogeneous group of diseases, with varied clinical presentations and imaging findings. High-resolution computed tomography is widely available and has become a standard part of the workup of these patients, often with three dimensional images. Cinematic rendering is a novel 3D visualization technique that utilizes a new, complex global lighting model to create photorealistic images with enhanced anatomic detail. The purpose of this pictorial review is to highlight the advantages of cinematic rendering compared to standard 2D computed tomography and traditional volume-rendered 3D images in the evaluation of thoracic vascular anomalies. Although cinematic rendering remains a new visualization technique under continued study, the improved anatomic detail and photorealistic quality of these images may be advantageous for surgical planning in cases of complex vascular abnormalities. Cinematic rendering may also help improve communication among clinicians, trainees, and patients and their families.

Augmented Reality With Cinematic Rendered 3-Dimensional Images From Volumetric Computed Tomography Data

ABSTRACT

Recent advances in 3-dimensional visualization of volumetric computed tomography data have led to the novel technique of cinematic rendering (CR), which provides photorealistic images with enhanced surface detail and realistic shadowing effects that are generally not possible with older methods such as volume rendering. The emergence of CR coincides with the increasingly widespread availability of virtual reality (VR)/augmented reality (AR) interfaces including wearable headsets. The intersection of these technologies suggests many potential advances, including the ability of interpreting radiologists to look at photorealistic images of patient pathology in real time with surgeons and other referring providers, so long as VR/AR headsets are deployed and readily available. In this article, we will present our initial experience with viewing and manipulating CR images in the context of a VR/AR headset. We include a description of key aspects of the software and user interface, and provide relevant pictorial examples that may help potential adopters understand the initial steps of using this exciting convergence of technologies. Ultimately, trials evaluating the added value of the combination of CR with VR/AR will be necessary to understand the potential impact of these methods on medical practice.

Implementation of cinematic rendering of gastric masses into clinical practice: a pictorial review

High-resolution CT is the gold standard diagnostic imaging study for staging of gastric malignancies. Cinematic rendering creates a photorealistic evaluation using the standard high-resolution CT volumetric data set. This novel display method offers unique possibilities for the evaluation of gastric masses. Here we present further observations of the role of cinematic rendering in the evaluation of gastric masses at a large tertiary care center. We offer three valuable teaching points for the application of the cinematic rendering for gastric masses with several case examples for each teaching point, discuss potential limitations of cinematic rendering, and review future directions for cinematic rendering in this setting.

Cone-beam computed tomography cinematic rendering: clinical, teaching and research applications

Cone-beam computed tomography (CBCT) is an essential imaging method that increases the accuracy of diagnoses, planning and follow-up of endodontic complex cases. Image postprocessing and subsequent visualization relies on software for three-dimensional navigation, and application of indexation tools to provide clinically useful information according to a set of volumetric data. Image postprocessing has a crucial impact on diagnostic quality and various techniques have been employed on computed tomography (CT) and magnetic resonance imaging (MRI) data sets. These include: multiplanar reformations (MPR), maximum intensity projection (MIP) and volume rendering (VR). A recent advance in 3D data visualization is the new cinematic rendering reconstruction method, a technique that generates photorealistic 3D images from conventional CT and MRI data. This review discusses the importance of CBCT cinematic rendering for clinical decision-making, teaching, and research in Endodontics, and a presents series of cases that illustrate the diagnostic value of 3D cinematic rendering in clinical care.

Evaluation of the urinary bladder using three-dimensional CT cinematic rendering

Three-dimensional (3D) visualizations of volumetric data from computed tomography (CT) acquisitions can be important adjuncts to interpretation of two-dimensional (2D) reconstructions. Recently, the 3D technique known as cinematic rendering (CR) was introduced, allowing photorealistic images to be created from standard CT acquisitions. CR methodology is under increasing investigation for use in the display of regions of complex anatomy and as a tool for education and preoperative planning. In this article, we will illustrate the potential utility of CR for evaluating the urinary bladder and associated pathology. The urinary bladder is susceptible to a multitude of neoplastic and inflammatory conditions and their sequelae. The intrinsic properties of CR may prove useful for the display of subtle mucosal/luminal irregularities, the simultaneous display of soft tissue detail with high-resolution maps of associated tumor neovasculature, and the improved display of spatial relationships to aid pre-procedural planning. Further refinement of presets for CR image creation and prospective evaluation of urinary bladder CR in real-world settings will be important for widespread clinical adoption.