Technology Powers Laxative-Free Virtual Colonoscopies @ Massachusetts General Hospital

11 February 2011 | Chris Sullivan, National Managing Director, Microsoft Health Provider Solutions

​There are many aspects of a colonoscopy that might make you cringe, but drinking that terrible tasting laxative bowel cleansing drink the night before has to be one of the worst parts. Good thing researchers at Massachusetts General Hospital have developed a new, award-winning approach to the dreaded colonoscopy process.

For the last 10 years or so, it’s been possible to get a “virtual” colonoscopy. This “virtual” test eliminates the need for a colonoscope and anaesthesia, but with most virtual colonoscopies, the patient still has to drink that terrible-tasting prep drink the night before. And, once the procedure is finished, it can take over an hour for the digital imaging to render before the radiologist or physician can even look at the image, at which time the patient is long-gone.

Last month, our own Dr. Bill Crounse wrote about Mass Gen’s new spin on a virtual colonoscopy - a virtual cleanse. Here, Hiro Yoshida , Doctor of 3D Imaging at MGH and Associate Professor of Radiology at Harvard Medical School, used sophisticated algorithms, Intel’s Parallel Studio, parallel high performance computing methods from Microsoft, and cloud-driven compute power to digitally “cleanse” the colon so it appears as if the patient cleansed the old fashioned way.

The patient no longer needs to drink the bowel prep drink (instead, the patient drinks a very small amount of contrast agent before the procedure). High performance computing methods also cut down the digital image processing time from roughly an hour to just 3 minutes. This means that clinicians could potentially review the results while the patient is still on the table. If suspicious lesions are identified, a traditional colonoscopy can be scheduled before the patient leaves the appointment.

And Mass Gen didn’t stop here – using GPU volume rendering software developed by Microsoft Research and gesture-based (multi-touch) navigation controls developed by partner Vectorform, they were able to create advanced visualization capabilities to make it easier for physicians to rotate and zoom in on the images of the colon for a better view of potential polyps. And, consulting physicians or clinicians can view and control the images via multiple Windows 7 powered devices, including slate or tablet devices, Windows Phone 7, or desktop PCs, making this new technology available to doctors on-the-go. All in all, technology delivers faster results and faster diagnosis – a win-win for both patient and doctor.

Watch a Virtual Colonoscopy.

In this recent InformationWeek article, Dr. Yoshida described this new approach to virtual colonoscopies as “a safer procedure for the patient, there's no risk of perforation, there's no sedation, and there's no laxative.” And, thanks to this new, streamlined cleansing method, Dr. Yoshida estimates that the cost of virtual colonoscopies could drop to between $300 to $800, or potentially less, as compared to $2,000 to $3,000 for traditional optical colonoscopies.

Last week, we asked Dr. Yoshida a few questions about the project’s progress.

How many patients have received a virtual colonoscopy with the virtual cleanse at Mass General to date?
My colleagues are running a clinical trial on laxative-free (and thus, patient-friendly) virtual colonoscopy at the Massachusetts General Hospital, in which approximately 600 patients have already undergone the virtual colonoscopy exam with virtual cleansing.
How have the patients responded?
The overall patient feedback is very good—they like it much more than the traditional colonoscopy.
And who wouldn’t!? We also asked Dr. Yoshida what was next for the project.
We will implement the high-performance virtual colonoscopy on Windows Azure, so that it will run fast on the Azure cloud platform. This way, we can quickly and economically deliver the virtual colonoscopy as an “exam-as-a-service” to many hospitals around the country through the internet, even if the hospital does not have an expensive supercomputing facility. The Azure cloud technology will be the key for reducing the cost of the colon screening. As more patients undergo cloud-based virtual colonoscopy exam, more colon cancers will be detected early and removed, thus ultimately reduce the mortality due to colon cancer.
"The Task Parallel Library (TPL) in .NET 4 was the most important and useful component for speeding up the virtual colonoscopy processes, especially the virtual cleansing process. In our implementation on a multi-core CPU (the Intel Xeon X5000 series), the code parallelization alone delivered 10 times or more speed up."
– Dr. Yoshida
My colleague, Steve Aylward, echoed Dr. Yoshida’s view on the value of Azure in an interview with eWeek. “Hosting this type of service in the cloud allows the hospital or physician to pay per use, not have to pay for the infrastructure onsite...”

Whether it is the cloud, Windows 7, or mobile technology like tablets and Windows Phone 7 devices, technology has proven to dramatically improve quality and access to care, and ultimately reduce the overall costs associated with that care. Does your facility have a similar screening process or testing environment that you think could be improved with the smart use of technology? If so, please tell us about it here.
Chris Sullivan
National Managing Director, Microsoft Health Provider Solutions