Advanced Dyna4D Turnover Workbook
Advanced Dyna4D Turnover Workbook
Artis Artis Q With PURE® Advanced Dyna4D Turnover Workbook SIEMENS Healthineers www.usa.siemens.com/education I. Contact Information Summary Welcome to Siemens Healthineers Discover. Try. Buy. on webShop Siemens Healthineers is dedicated to helping you get the Do you want to “Discover. Try. Buy.” options, accessories, most out of your investment throughout the entire product and clinical education to make the most of your life cycle and beyond. Our goal is to enable you to take imaging equipment? Discover images, case studies, technology further, profitability higher, and patient care to and video demonstrations with the latest clinical the next level. Find the information, resources, and tools applications. Try advanced applications utilizing you need to get the most out of your recent investment free software trials. Buy applications, coils, clinical and stay up-to-date. education, and accessories, conveniently at any time. Visit www.usa.siemens.com/Welcome2Healthcare. Visit www.usa.siemens.com/webShop today! Clinical Training and Continuing Education Siemens Training Centers Customer Care Center - Clinical Application Support: Siemens Clinical Education Call 1-800-888-7436 Training Center – TDC2 Troubleshooting assistance 110 Mac Alyson Court • Immediate assistance for software Cary, NC 27511 • applications and workflow issues Siemens Healthcare Training Center Please provide the Functional Location Number when at the University of Utah calling for assistance. 421 Wakara Way Suite 140 Clinical Education Offerings: Salt Lake City, UT 84108 Call 1-888-221-8010 (follow the prompts) Classroom Training (Offerings, Registration • & Scheduling) Educational Symposia • On-site Training • Printed Self-studies • Virtual Education (Offerings & Registration) • Workshops & Fellowships • Visit www.usa.siemens.com/clinicaleducation for more information regarding the current Siemens Clinical Training and Continuing Education portfolio. 2 II Contents I. Contact Information Summary.....................................................................................................................................2 II Contents ..............................................................................................................................................................................3 III Course Agenda .................................................................................................................................................................4 IV Course Objectives ............................................................................................................................................................ 5 1 Basic 3D...............................................................................................................................................................................6 1.1 Objectives ....................................................................................................................................................... 6 1.2 Set system up. Select the appropriate Exam Program..................................................................... 6 1.3 Basic Manipulation and Documentation.............................................................................................. 8 2 Intermediate 3D .............................................................................................................................................................. 14 2.1 Objectives ......................................................................................................................................................14 2.2 Intermediate Post-Processing ..................................................................................................................14 2.3 syngo DynaCT SMART...............................................................................................................................19 2.4 Dyna 4D........................................................................................................................................................ 23 3 Advanced 3D....................................................................................................................................................................30 3.1 Objectives ..................................................................................................................................................... 30 3.2 Embo Guidance ...........................................................................................................................................31 3.3 PURE 2D/3D Fusion................................................................................................................................... 36 3.4 3D/3D Fusion for PURE ............................................................................................................................ 40 3.5 Aneurysm Analysis for PURE.................................................................................................................. 44 3.6 PBV .................................................................................................................................................................47 3.7 Stent Follow up .......................................................................................................................................... 48 3.8 Stenosis Analysis ....................................................................................................................................... 48 4 Angio Tab Card ................................................................................................................................................................50 4.1 Objective....................................................................................................................................................... 50 4.2 iFlow.............................................................................................................................................................. 50 3 SIEMENS SIEMENS Artis zee III Course Agenda Basic 3D Acquiring Images Basic Manipulation Selection of Presets Window/Level Zoom/Pan Image Rotation Bookmarking MIP/MPR Slice Thickness Document Images on PACS Storing Individual Images Creating Radial Ranges/MPR Ranges Intermediate 3D High Contrast and DynaCT Intermediate Post-Processing Custom MPR Presets Adjustment of Reference Lines iPilot Application iGuide Application Advanced 3D Perform EmboGuidance Perform 3D/3D Fusion Perform Virtual Stent Perform PBV Perform Stent Follow Up Angio Tab Card Perform iFlow Application 4 SIEMENS + IV Course Objectives Course Overview: The 3D Turnover Workbook will provide the experienced user with the skills and knowledge to use and perform the applications and functions of the syngo Workplace. Upon completion of this course, you will be able to: Properly Set system up • Understand Basic Manipulation and Documentation • Optimize Intermediate Post-Processing • Perform Advanced 3D Applications • Describe Angio Tab Card • Note: Please refer to manual for complete system capabilities 5 Turnover Workbook | Advanced Dyna4D 1 Basic 3D 1.1 Objectives Notes After completing this section, the technologist will be able to: Acquire images • Perform basic manipulation (selection of presets, window/leveling, zoom/pan, image • rotation, bookmarking, MIP/MPR, Slice Thickness) Document images for PACS (storing individual images, creating radial ranges/MPR • Ranges) 1.2 Set system up. Select the appropriate Exam Program. 1.2.1 Parallel Processing With PURE we now have the ability to review a previous study without interrupting • your current patient procedure. This allows review of a patient in the control room without interrupting the currently active procedure. The folder with the C-arm icon indicates the active patient registered on the Artis system. The folder without a C-arm icon indicates a different patient that may be loaded into the 4D tab for review. 1.2.2 Program selection (DSA/DR/DCT) Settings Exam Image Quant Physio 4D ? DSA Special SM FL Angio DSA 7.5 2 f/s 7.5 p/s DSA long 2 f/s DSA Venous RDMP DSA RDMP JOP VFR man DR ACQ 2 f/s ED DSA • DR (3D bone/ Needle Guidance) • DSA H (3D Angios/ CT with or without contrast) • DR H (CT with or without contrast) • AVG: Aortic Valve Guide • PBV: Stroke (With Contrast) • DynaCT Card (With contrast) • Large Volume Portrait or Landscape (Zeego only, With or without contrast) • 6 Turnover Workbook | Advanced Dyna4D 1.2.3 3D Wizard – New with PURE Notes 3D Wizard is an automated program selection tool with step by step prompts to guide you through the steps of obtaining a 3D rotation. First choose body region/study type • 3D Wizard will provide suggested injection protocols • Wizard will choose the appropriate organ program based on the body region selected • and list the steps necessary to obtain a 3D rotation Favorites * Head & Neck |Cardio & Thorax |Abdomen E Perfusion Imaging Bleeding Detection (native) High Contrast Vessel Tree Navigate Select Exit 1.2.4 Isocenter Press down on the C-arm joystick and deflect toward the table • (C-arm moves to AP) Press down on the C-arm joystick and deflect toward the table • (C-arm moves to Lateral) Press down on the C-arm joystick and deflect toward the table • (C-arm moves to Start Position ) Press down on the C-arm joystick and deflect toward the table • (C-arm performs Test Spin) 7 Turnover Workbook | Advanced Dyna4D 1.2.5 Fluoro to set technique and end setup Notes O 1.2.6 Set Injection 1.2.7 Perform acquisition from footswitch or hand switch 1.2.8 Auto Transfer (Manual Transfer- Post Processing, Image, send to 3D) 1.3 Basic Manipulation and Documentation 1.3.1 High Contrast Subtracted Selection of modality preset. (Identify the Preset Icon and choose appropriate • preset). Proset Gallery Type All Translucent Vasc VascDualV .. Unshaded VascBody VascHead more vi Shading Close Help Window/Level. (Use the Middle mouse button. Up/Down the Screen for brightness • and Right/Left on the screen for Contrast.) Window centeri Brightness + Window width Contrast - Window width! Contrast + Window center! Brightness - 8 Turnover Workbook | Advanced Dyna4D Notes • Pan. Hold down the right mouse button. Once you get the four arrows, you can center your image. • Zoom. Hold down the right mouse button. Towards the left or right side of the screen and move the mouse up or down. Bookmarking. Bookmarking saves all manipulated data of a volume and can be • quickly and easily restored. Left mouse click to save. Right click will take you to properties where you can name the bookmark. Bookmarks are retained when loading previous studies. 3D ICA 5 aneurysms, 5 %€ C 15.09.08-15:01:04-DST 3D Review and Processing Viewing Review volumes loaded from the patient browser 4D RAD OR PROCEDURE C Angio RAD 1 / CAUD 8 1_20160831 Overlay Volume Opacity 1.00 Image Tools Meas. X-Ray Clip Clip Plane more 9/9/2015 3:03:01 P 9 Turnover Workbook | Advanced Dyna4D Saving individual images or radial ranges. Notes • Identify the “Snapshot” Icon for individual images. Left click to save individual • image or Right click to Save All Four Segments. Right click -> Save As allows you to label the saved folder. Identifying images on browser. (Identify “Refresh” on the Browser and find the • images that you named in previous step). Transfer to PACS. (Identify the appropriate PACS node on the “Transfer” menu.) • Radial Ranges on the Tools tab card allows image snapshots to be saved from a 3D • rotating volume in a predefined range. Radial Ranges X High resolution Include reference image Number of images 18 Angular range [*] 90 Thickness [mm] 0.2 Comment Series Name Close Help 10 Turnover Workbook | Advanced Dyna4D 1.3.2 Soft Tissue Notes Selection of modality preset. (Identify the Preset Icon and choose appropriate • preset.) Proset Gallery Type All VascDualy ... Unshaded VascBody VascHead more Shading Close Help Window/Level. (Use the Middle mouse button. Up/Down the Screen for brightness • and Right/Left on the screen for Contrast) Window center! Brightness + Window width! Window width! Contrast - Contrast + Window center! Brightness - 11 Turnover Workbook | Advanced Dyna4D Selecting MIP or MPR. (From tools at the top of the screen select MPR or MIP.) Notes • Manipulate Rotate Zoom/Pan Auto Pan VRT MIP MinIP VRT Thin MIP Thin MinIP Thin MPR MPR Thick Reset MPR Orientation Home Preset Home Zoom/Pan Show View Full-Screen MPR Reference Lines Record Movie Play Movie .. Reset all Orientations Changing slice thickness. Once you Select MIP/MPR you go to the image tab and • adjust the Slice thickness. Change slice thickness under image tab. • Image | Tools |Meas ... |X-Ray Slice Thickness (mm) 0.4 12 Turnover Workbook | Advanced Dyna4D Transfer to PACS. (Identify the appropriate PACS node on the “Transfer” menu.) Notes • Parallel Ranges can be created using planning lines. Series/Folder name, Slice • Thickness, Image Spacing, and Output can be customized from the Parallel Ranges window. St .- Marien-Hospital Gmb. AXIOM-Artis N cerebr Bleeding, Rel.f ... 0000455343 St-Marien-Hospital Gmb ... VC13D 081121-2 VE31A DynaCT Nat Fill HU Nor ... AXIOM-Artis VC13D 081121-ZIVE31A C N cerebr Bleeding, Rel.f.1 "11/21/1942 HES 15.09.08-15:01:04-DST # 000 163179702827 XA 12/29/2009 3:04:21 PM Viewing Regent prossiga to. Parallel Ranges X No bookmarks available Angio Review> SL 6.0 MIP Thin 2094 LAO 90 / 0 574 SL 5.0 MIP Thin N cerebr Bleeding, Rel.f ... 0000455343 St-Marien-Hospital Gmb .. DynaCT Nat Fill HU Nor ... AXIOM-Artis VC13D 081121-2 VE31A 0000455343 DynaCT Nat Fill HU Nor. *11/21/1942 # 000163179702827 HES *11/21/1942 # 000 163179702827 High resolution XA 12/29/2009 XA 3:04:21 PM 12/29/2009 3:04:21 PM Include reference image Number of images 54 Distance [mm] 30 Thickness [mm] 5.0% Volume Opacity Comment Image | Tools |Meas ... | X-Ray Series Name 19 Close Help less 13 Turnover Workbook | Advanced Dyna4D 2 Intermediate 3D 2.1 Objectives Notes After completing this section, the technologist will be able to: Perform High Contrast and DynaCT Intermediate Post-Processing • Use of custom MPR presets • Adjustment of reference lines • Perform 3D Roadmap • Perform Needle Guidance • 2.2 Intermediate Post-Processing 2.2.1 High Contrast Subtracted Performing an interactive 3D reconstruction If raw data are available on the syngo X Workplace, e.g. when an automatic 3D reconstruction was performed before, you can modify 3D reconstruction parameters by performing an interactive 3D reconstruction. Select an image segment in the 4D task card. • Select Patient > Interactive Reconstruction... in the main menu of the 4D task card. • Interactive Reconstruction ? X Define job list jobs. Parameters, and se Body Region Head & Neck Job List 5sDual Volume VOI Size: Manual Num VOI Slice Matrix 512×512 Define VOI in . 2D view 3D view Voxel Size: 0.28 mm Number of Slices: 512 SMART Series Name 5sDual Volume* PAO 90/0 Rendering Preset DualVolume Reconstruction Job Sub Kemel Type EE Image Characteristics Auto Reconstruction Mode Sub Motion Correction O Kernel Type HU Close Help 8/8/2015 4 17 14 Turnover Workbook | Advanced Dyna4D To select an image pair from the scene: Notes Click a single step button. • Click in the mid areas of the sides of the cuboid. • To move and adjust the VOI Click and drag the rectangle to the required position and size. • 15 Turnover Workbook | Advanced Dyna4D In the 3D view, a preliminary reconstructed 3D volume is displayed Notes VOI Punching • Vessel Measurements • Image | Tools |Meas. X-Ray 0 less Clip Planes • Creating custom modality presets • 16 Turnover Workbook | Advanced Dyna4D 2.2.2 DynaCT Notes Use of custom MPR presets • Adjustment of reference line • Viewing Review and Processing Viewing Review volumes loaded from the patent browser 3D No bookmarks available Angio Overlay Volume Opacity Image | Tools Meas ... | X-Ray Slice Thickness [mm] 0.5 Plup Device Mourees - Driveof ] Total 3pc(7501 M3) 4/2014 5 02-23 2.2.3 3D Roadmap Live Live vs. Dynamic Adjust to patient • • Overlay. Blending of image, adjust to the patient, and invert of the image. Overlay ? X Blending 17 Turnover Workbook | Advanced Dyna4D 2.2.4 Viewing Layouts in the Control Room Notes Review and Processing Revi Viewing Review volumes loaded from th patient browser Ravie Review and Processing Viewing No bookmar Select a thumbnail to activate the appropriate layout Review and Processing Review Viewing Select a thumbnail to activat appropriate layout VRT + IMPR 2 VRT + MPR MPR + VRT 2 VRT OSA VRT + NPR 2 VRT + MPR Compare Overlay MPR 2 VRT Overlay Control Room 2.2.5 Viewing Layouts in the Exam Room RUVIEW SITO Processing Viewing syngo 4D Layouts - Plan Overlay syngo 4D Layouts - Compare 1 fred v acquis lace e MPR 2 VRT MPR + VRT volum syngo 4D Layouts syngo 4D Layouts syngo 4D Volume Presets Rotate I Exam Room 18 Turnover Workbook | Advanced Dyna4D 2.3 syngo DynaCT SMART Notes SMART only possible for all Body Regions • Only for native volumes • Using Smart: 1. Check SMART check box in Interactive Reconstruction. CT Head Nat Fill VD10D 131213\VD15 1952 8470180 Punch volume using the VCl punching tool the volume to visualice mecy structures 2014 6 PM Body Region Head & Neck Job List DynaCT Head VOI Size Ful Num MOI Slice Matrix 512x512 Define VOI in 2D vtew . 3D vtew Woooel Staw. 0.45 mm Number Sicos 391 SMART Senes M DynaCT Head Rendering Prosct DynaCTHead Reconstruction Job Kemel Type HU Image Charactersbcs Normal Reconstruction Mode Motion Correction hore 2. 3D VOI is activated automatically (selection of 2D VOI will deselect SMART) 3. Segment metal by windowing 4. Reconstruct 19 Turnover Workbook | Advanced Dyna4D Workflow Notes : 1. Load volume into the 4D Tab. 01R. B Review and Processing Viewing Review volumes loaded from the patient browser No bookmarks available Overla Volume Opacity Image Tools |Meas ... X-Ray Slice Thickness (mm) 0.5 PNP Device Mounted - Drive(F ) Total Space(7591 MB) 8/4/2014 4:57:27 P 2. Go to the Patient drop down. Select Interactive Reconstruction. Patient Applications Show Mode View Browser Num . Cloth Pabert Close Patient Save image O1R.B Save snapshot [segment) Save Save snapshot [layout) Save Image Monochrome Viewing Review volumes loaded from the Save to File. patent browser Copy image to Sensis Interactive Reconstruction. No bookmarks available Volume Opacity Image Tools Meas_ XRay Slice Thickness (mm) 05 Plop Deice Mounted . Driveof > Total Space(7591 M3) 20 Turnover Workbook | Advanced Dyna4D 3. Check the Smart box. Notes 01R.B Interactive Reconstruction x Define job list, jobs, parameters, and series nome. Start interactive 30 reconstruction Body Region Job List DynaCT Head VOI SER FUI Num VOI Slice Matrix 512x512 Define VOI in O 2D view 30 view 0.46 mm Number of Sices 306 SMART Series Nag DynaCT Head mg Preset DynaCTHead Reconstruction Job y NaFa Kemel Type HU Image Characteristics Normal Reconstruction Mode Nat Close Help more FLIP Device Mounted - DeveoF ) Total Spx (7501 M3) 8:4/2014 4 57-37 PM 4. Segment metal by windowing. 01 R. B Interactive Reconstruction Define job Ist, jobs, parameters, and series nome Start interactive 30 reconstruction. Body Region Head & Neck Job List DynaCT Head VOI SkDe Ful Num VOI Sice Matrix 512x512 Define Vol in . 20 view 30 view 0.46 mm Number of Sices Number of Sices 396 SMART Series Nag DynaCT Head Preset DynaCTHead Reconstruction Job Nat Fill Kemel Type HU Image Characteristics Normal Reconstruction Mode Close Help more LAO 23 / CRAN 9 PIJP Device Mounted - DriveF ) Total Space(7591 MB) Dax 4/2014 4.57.38 21 Turnover Workbook | Advanced Dyna4D 5. Segment metal complete. Notes 01R. B Interactive Reconstruction Punch volume using the VOI punching tool and window the volume to visualize metal structures Body Region Head & Neck Job List DynaCT Head VOI SO Ful Num VOI Sice Matrix 512×512 Define VOI in 20 view . 30 views Click on Vowel Size 0.45 mm Number of Sices 396 Secondary Reconstruction D SMART Series Name DynaCT Hesd Rendering Preset DFACTHead Icon Reconstruction Job . Nat Fill Kemel Type HU Image Characterisacs Normal Reconstruction Mode N Close LAO 23 / CRAN 9 PIP Device Mounted - Driveof ) Tout Space(7501 MB) 914/2014 4:57:44 PM 6. 3D reconstruction is running. Viewing 01 R. B Review and Processing Viewing Review volumes loaded from the pabent browser No bookmarks available 4D BO Reconstruction 30 reconstruction is running Angio Cancel Volume Opacity Image | Tools Meas. | X- Ray Clip Plane more PHP Device Mounted . Drive(F ) Total Space(7591 MB) 8/4/2014 5.01:44 PM 22 Turnover Workbook | Advanced Dyna4D 7. 3D reconstruction complete. Metal artifact reduced. Notes 01R. B Viewing piovere volumes loaded from the No bookmarks available 4D Overlay Volume Opacity Image | Tools |Meas ... | X-Ray Slice Thickness (mm) 0.5 PIP Device Mounted - Drive(F ) Total Space(2591 MB) 9/4/2014 5:02:23 PM 2.4 Dyna 4D 1. Perform specific 6s or 12s 3D acquisition to acquire Dyna 4D dataset. 2. Dataset will appear in the 4D task card. 3. To start playback of 4D image from tableside, Review Dyna4D from Heads Up display menu. General 3D Wizard El. Save Bookmark Reset All Orientations Review Dyna4D Hide All Objects O Refine Volume 23 Turnover Workbook | Advanced Dyna4D 4. Or from Control Room top main menu Notes Tools Measure Volumes Option Record Movie. Play Movie .. 3D/3D Fusion Radial Ranges ... Parallel Ranges ... Segmentation Tools. VOI Punching ... Enable master clip plane AD .... Object List. Delete All Objects 5. This will open up the SyngoDyna 4D viewer where images can be played one at a time, time range can be selected and saved to Browser. All basic functions can still be performed as well (ie: rotation, zoom/pan, Quickzoom, etc.) syngo Dyna4D Select viewing window. Start the Dyna4D scene Viewing window 0 OU 60 O Close Help 6. Dyna 4D allows demonstration of the inflow and/or outflow of AVMs, AVFs, or other pathology. NRWige PURE AVME Krupp Krhs. Ess ... NR zee PURE AVM Es .... led Krupp Auto Ex AXIOM-Artis 141024\VD10D\ ... X-WP HFS Dyna4D arterial Sub4D *1/1/1956 2 IMA 21 XA 2 IMA 154 7. If loading from the Browser in a Review capacity, you can select either dataset to load: Dyna4D arterial Sub4D or Dyna4D arterial Sub • 8. Selection of Dyna4D arterial Sub will load in dataset and you will then repeat step #4 above. 24 Turnover Workbook | Advanced Dyna4D 9. If selection of Dyna4D arterial Sub4D is selected, an additional popup box opens to Notes choose what volume to load. Left click on line item to highlight and select Load Selected. Loading X ? The chosen images may belong to different volumes Which volume would you like to load? Instance Frames Time 1 397 10:09:28 AM 111 4 397 10:09:28 AM 7 397 10:09:28 AM 10 397 10:09:28 AM 13 397 10:09:28 AM Load Selected 2.5 Needle Guidance for PURE 1. A 3D volume has been loaded or acquired into the 4D task card. 2. NOTE: Fusion can be performed and this volume can be loaded into the 4D task card. 3. From the workflow drop down select Needle Guidance. Review and Processing Needle Guidance X Define Path Define needle path by marking target and entry point in the planning volume (first loaded volume) Selection N1 (new) ... Progress Needle 25 Turnover Workbook | Advanced Dyna4D 4. Define Path: Notes 5. Select TARGET. This icon will automatically be highlighted when the Needle Guidance workflow is selected. You may use any of the MPR views or the VRT to select your target. Left click to select target. A circle will appear at the target point. 6. Select ENTRY POINT. This icon will automatically be highlighted after the Target Point has been selected. You may use any of the MPR views or the VRT to select your entry point. Left click to select entry point. A cross will appear at the entry point. 7. When Target and Entry Points are selected, the needle path is displayed as a line. The length of the path is defined in centimeters. Both points can be moved by left clicking and dragging into different positions. 8. Progress Needle: Review and Processing Needle Guidance X Define Path Progress Needle Use Bull's Eye View to align needle. Use Progression Views to check needle position. Selection N1 ... Live 26 Turnover Workbook | Advanced Dyna4D 9. The automatic drive to Bull’s Eye icon is preselected. At this point, activate stand Notes movement to drive system into position. Graphics are displayed on the Live monitor. Once position is reached; it is now ready to align the graphics so the ROI/Target is in isocenter. This is achieved by changing table height and/or longitudinal or lateral table position. General graphics Laser graphics (Artis without laser positioner) (Artis with laser positioner) R R Position not adjusted R Position adjusted 10. Once system is in correct alignment, needle can now be placed. This can be done utilizing the laser light or under fluoroscopy. Advance needle in the Bull’s Eye View and then proceed to Progression Views. The graphics will update with system movement and fluoroscopy. 11. 3D Overlay is now also activated. Example of Needle placement under fluoroscopy in Bull’s Eye View 27 Turnover Workbook | Advanced Dyna4D Example of Progression View 1 with distance graphics Notes Example of Progression View 2 with distance graphics 12. Continue placement of needle, following graphic guides and utilizing Bull’s Eye and Progression Views, until target point is reached. Large distance markers equal 1cm and small distance markers equal 0.5cm. 28 Turnover Workbook | Advanced Dyna4D 13. Additional Information: Notes Multiple Needle paths: You can now plan as many needle paths as you need. • Under the “Define Path” menu select the drop down arrow under selection. • Select NEW • Review and Processing Needle Guidance X Define Path Check needle path. Option: Create a new needle path via the list entry "New" Selection 3 New N1 N2 Progress Needle Then repeat your steps for needle path planning. • ADV_DCT_NEEDLE_G ... H AXIOM-Artis ADV_DCT_NEEDLE_G ... HPL AXIOM-Artis 1 VC21A 1/30321\VE52A 1 VC21A 130321\VE528 iGuide_SoftTissue Nat Fi ... HFS iGuide_SoftTissue Nat Fi ... *11/8/1942 *11/8/1942 XA XA 8/15/2013 8/15/2013 8:33:39 AM 8:33:39 AM AR RP. N1 143.09 mm N2 133.82 mm LLLLLLLLLLLLLLLLLLL SL 2.0 Thick MPR W 1113 SL 2.0 1.112 LAO 65 / 0 C 299 Thick MPR RAO 25 / CRAN 7 ADV_DCT_NEEDLE_G. AXIOM-Artis ADV_DCT_NEEDLE_G ... HLA AXIOM-Artis 1 VC21A 130321\VE52A VC21A 130321\VE52A iGuide_SoftTissue Nat Fi .. HFS iGuide_SoftTissue Nat Fi ... HFS *11/8/1942 *11/8/1942 ...................... XA XA 8/15/2013 8/15/2013 8:33:39 AM 8:33:39 AM RH IRPH 143.09 mr cm IF SL 2.0 Thick MPR 1113 RAO 25 /CAUD 83 299 VRT 2668 RAO 12 / CRAN 1 29 Turnover Workbook | Advanced Dyna4D 3 Advanced 3D 3.1 Objectives Notes After completing this section, the technologist will be able to: Perform Embo Guidance • Perform 2D/3D & 3D/3D Fusion • Perform Aneurysm Analysis • Stenosis Analysis • Perform PBV • Perform Stent Follow Up • Stenosis Analysis • 3.1.1 Object List Object List ? X Review and Processing Viewing Overlay Show Object Color Live 4D Volume Registration required for overlay Group v with reg. X 3D-M1 CT1 & Reg 3D-PLN1 CT1 & Reg Show Object Needle v with reg. Group 3D-NDL1 CT1 & Reg Needle Segmentation Overlay Segmentation Ove .. vwith reg. 3D-SEG 1left atrium CT1 & Reg + Live Live Close Help Live Central location for managing all graphical objects • Structures graphical objects in groups • New graphical objects are added by default to the active group (bold) • Workflows create their own groups and assign their graphical objects to those groups • Can be opened via menu (Tools -> Object List …) • • Show column: Click a check box to show or hide an object group. Object column: Groups and object names. Click to mark an object or object group. • • Color column: Click to change the color and opacity of the object or object group. Live column: Click a check box to show or hide the object or object group on the Live • screen. • 4D column: Click a check box to show or hide the object or object group on the 4D task card. • Volume column: Volume the object group belongs to. 30 Turnover Workbook | Advanced Dyna4D Notes Create a new object group. • Hide all the objects and object groups. • Delete all the objects and object groups. • XYZ Display overlay of objects on the Live screen. • Live 3.2 Embo Guidance A 3D volume has been loaded or acquired into the 4D task card. • From the workflow drop down select Embolization Guidance. • Segmentation Tab This menu allows for the marking of a VOI such as • tumor or aneurysm. It requires strokes in the interior Review and Processing Embolization Guidance X and exterior of the volume in at least two MPR Auto Check Volume segments. Segmentation ? .. Select a segmentation result. Draw at least one (+) stroke and one (-) stroke in the image. Select 'Calculate'. Check result. Selection New ... + Mark Vessel Overlay 31 Turnover Workbook | Advanced Dyna4D Segmentation Workflow Notes Mark VOI interior: Object strokes • + Mark VOI exterior: Background strokes • 32 Turnover Workbook | Advanced Dyna4D Start Segmentation Notes • Review and Processing Embolization Guidance × Auto Check Volume Segmentation Mark Vessel Overlay Overlay segmentation and vessel results for guidance. To modify planning results go to previous steps Show Object ... Group Seed Points Vessel Overlay Show Volume Data in VRT Show Vessel Branches Live Once completed you may go back to the Overlay menu. • Review and Processing Embolization Guidance X Auto Check Volume Segmentation Select a segmentation result. Draw at least one (+) stroke and one (-) stroke in the image. Select 'Calculate'. Check result. Selection SEG1 ... + Mark Vessel Overlay 33 Turnover Workbook | Advanced Dyna4D Notes Identify vessel by left clicking on at least 2 points within the vessel in any of the four • views. These seed points will display in all views. To verify Review and Processing • positioning, scroll through the MPR’s or rotate VRT. Embolization Guidance Auto Check Volume X Segmentation Mark Vessel ? : Mark vessel by setting two or more seed points. Select 'Calculate'. Show Object ... Group Overlav After seed points are dropped, select to calculate vessel tree. • 09:38:06 AX 34 Turnover Workbook | Advanced Dyna4D Click on Overlay to bring up your next menu with all your overlay options. Notes • Review and Processing Embolization Guidance x Auto Check Volume Segmentation Mark Vessel Overlay Overlay segmentation and vessel results for guidance. To modify planning results go to previous steps. Show Object ... Group Seed Points Vessel Overlay Show Volume Data in VRT Show Vessel Branches Live Overlay functions can now be performed. • NOTE: If using an outside CT/MRI please refer to the steps for fusion. • Important! If you have done vessel mapping before the segmentation steps, your • vessel map will disappear. It WILL return after leaving the segmentation menu. 35 Turnover Workbook | Advanced Dyna4D 3.3 PURE 2D/3D Fusion Notes 1. Method to fuse (merge) a 3D dataset to the current patient using two fluoro loops that are over 30 degrees apart and use as an Overlay. 2. Load existing 3D dataset from Browser into 4D tab under the examination patient and “Assign to Existing”. This will allow this dataset to be used on the current examination patient as an overlay. Patient Browser Patient Applications Transfer Edit View Filter Sort Private Applications Options Help Loading Different patient demographics! diu Use 'Load to Review' to close the current review patient and load the selected images for review. If the images belong to the patient "15.08.24-07:54:23-DST", you can load and add them to this patient by selecting 'Assign to Existing'. Enable the checkbox for confirmation before. 1| confirm that the data belongs to patient "15.08.24-07:54:23-DST" Assign to Existing Load to Review Cancel Loading 15.08.19-08:23:46- 3d roadmap Patient name 2D3D, Fusion Study description Date of birth 8/24/1970 Study date 8/24/2015 Patient ID 123456 3 4 6 8 Current Filter: Off 36 Turnover Workbook | Advanced Dyna4D 3. When ready for 3D Roadmap, select the Overlay workflow step from Heads up Notes display, Workhow Review and Processing Viewing Overlay Aneurysm Analysis Aortic Valve Guidance Cong. Heart Disease Guidance EP Planning Embolization Guidance 4. Or control room 4D tab Review and Processing Viewing Overlay Overlay planning objects for guidance. New acquisitions will be registered and 4D fused with existing volumes. Show Object ... Group Live Live 5. Or the 3D Overlay icon from TSC. 37 Turnover Workbook | Advanced Dyna4D 6. The system will then automatically prompt you to perform Fusion. Choose 2D/3D Notes fusion and perform two fluoro loops more than 30 degrees apart. syngo 3D Registration X Acquire the first 2D image for 2D/3D registration. Alternatively you can switch to 3D/3D registration by acquiring a volume. 2D3D 3D3D Select image Alignment Visualization Undo Accept 2D3D Cancel First Fluoro 2D3D, Fusion Siemens Training 123456 Dyna3D Head Nat Fill M ... VD118 1503 20 08482110 "8/24/1970 XA 8/24/2015 24/2015 8:38:59 AM Angle = 0. LI AO 10010 2 288 YRO 1001 Angular distance not supported 38 Turnover Workbook | Advanced Dyna4D Second Fluoro Notes BoasD Head Nat FIU NM . Siemens Training and D ... 2D3D, Fusion AXIOM-Artis 123456 VD11B 150326WD10EL ... HFS Dyna3D Head Nat Fil M ... *8/24/1970 82/2015 XA 8/24/2015 8:38:59 AM LI Angle = 115º RAO 16/0 7. Then utilizing Manual or Auto Alignment, line up the anatomy between both datasets (this can be performed from tableside or control room). 8. When alignment is complete, select ACCEPT 2D3D icon from control room Accept 2D3D Cancel Or select ACCEPT from the Heads Up display menu. 29 30 Re General VRT 2 Manual Alignment Auto-Alignment i Reset Alignment L Protect 2D Images la manua utomatical O Hide Punching Accept Cancel 39 Turnover Workbook | Advanced Dyna4D 9. 3D Roadmap is now active and current. All system movements will be updated Notes automatically as they occur. The TSC joystick graphics will now prompt for BLEND which will allow the user to fade the overlay in and out at different intensities. Blend 1ª Windowing Rotate Menu 3.4 3D/3D Fusion for PURE 1. Method to fuse (merge) two 3D datasets and use as an Overlay for current patient. 2. Load existing 3D dataset from Browser into 4D tab under the examination patient and “Assign to Existing”. This will allow this dataset to be used on the current examination patient as an overlay. Patient Browser X Patient Applications Transfer Edit View Filter Sort Private Applications Options Help ? Loading Different patient demographics! Use 'Load to Review' to close the current review patient and load the selected images for review. If the images belong to the patient "15.08.24-07:54:23-DST", you can load and add them to this patient by selecting 'Assign to Existing'. Enable the checkbox for confirmation before. Il confirm that the data belongs to patient "15.08.24-07:54:23-DST" Assign to Existing Load to Review Cancel Loading 15.08.19-08:23:46- 3d roadmap Patient name 2D3D, Fusion Date of birth 8/24/1970 Study date 8/24/2015 Patient ID 123456 5 16 7 8 Current Filter: Off 40 Turnover Workbook | Advanced Dyna4D 3. When ready for 3D Roadmap, select the Overlay workflow step from Heads up Notes display, EX-WP 40 050 General Review and Processing Viewing Overlay Aneurysm Analysis Aortic Valve Guidance Cong. Heart Disease Guidance EP Planning Embolization Guidance 4. Or control room 4D tab Review and Processing Viewing Overlay Overlay planning objects for guidance. New acquisitions will be registered and 4C fused with existing volumes. Show Object ... Group Live Live 5. Or the 3D Overlay icon from TSC. 41 Turnover Workbook | Advanced Dyna4D 6. The system will then automatically prompt you to perform Fusion. Choose 3D/3D Notes fusion and perform a 5sDR CARE or another spin of physician’s choice. syngo 3D Registration ? X Acquire a volume. Alternatively, close the registration and load a new volume registered to the exam patient. 2D3D 3D3D Alignment Visualization Undo Fusion Result (new) 2015-08-24 10-57 Accept 3D3D Cancel 7. Then utilizing Manual or Auto Alignment, line up the anatomy between both datasets (this can be performed from tableside or control room). Pre Alignment Siemens Training and D ... AXIOM-Artis Fusion Siemens Transgare Du 3456789 2APPa Hond Not FU M ... VD118 150326\VD 10E). Dyna3D Head Nat Fal M .. VOTIB 150320 VD1008 ES "8/24/1948 XA 8/24/2015 8:55:31 AM 2D3D, Fusion 123456 59 AM "8/24/1970 8:38:59 AM _LLI BLELELELELELE Two MPR Thick MPR Thek MPR/Thick MPR jemens Training and D ... Fusion Siemens Training and Ph AXIOM-Artis D118 150326\VD 10E\ ... 3456789 Dyna3D Head Nat Fall M .. VDL18 1502. voices HFS 28/24/1948 XA 8/24/2015 8:55:31 AM 8/24/2015 8:55:31 AM 2D3D, Fusion 2D3D, Fusion 123456 "8/24/1970 123456 8:38:59 AM "8/24/1970 8:38:59 AM R 696 ED VERT 42 Turnover Workbook | Advanced Dyna4D Post Alignment Notes Siemens Training and D ... Fusion G. yna3D Head Nat Fil M. Siemens Training and PL AXIOM-Artis VD11B 150326\VD 10E\ .. 3456789 Dyna3D Head Nat Fill M ... VD11B 1503261VD105- HES *8/24/1948 XA 8/24/2015 8:55:31 AM 2D3D, Fusion 123456 *8/24/1970 8:38:59 AM TAG SUPpy Thick MPR 098 MPR/Thick MPR Fusion Siemens Training and D ... Fusion G Siemens Training and DE 3456789 AXIOM-Artis 3456789 Dyna3D Head Nat Fill M. VD11B 1503261 VD10E "8/24/1948 /D11B 150326\VD 10E ... Dyna3D Head Nat Fill M. HFS *8/24/1948 XA 8/24/2015 XA 8/24/2015 8:55:31 AM 8:55:31 AM 2D3D, Fusion 2D3D, Fusion 123456 123456 "8/24/1970 *8/24/1970 8:38:59 AM 8:38:59 AM LLLLLLLLLLLL LA 588 FU 646 ED VR 8. When alignment is complete, select ACCEPT 3D3D icon from control room Fusion Result (new) 2015-08-24_10-57 Accept 3D3D Cancel 9. Or select ACCEPT from the Heads Up display menu. 10 30 Registration Er Manual Alignment O Auto-Alignment Reset Alignment jack registration result ecessary. ta manualy or Q Protect 2D Images Hide Punching Accept Cancel 43 Turnover Workbook | Advanced Dyna4D 10. 3D Roadmap is now active and current. All system movements will be updated Notes automatically as they occur. The TSC joystick graphics will now prompt for BLEND which will allow the user to fade the overlay in and out at different intensities. Blend Windowing Rotate Menu 3.5 Aneurysm Analysis for PURE 1. Select Aneurysm Analysis from the work flow drop down icon. 2. Under the “Mark Aneurysm” menu select, Mark Aneurysm. NOTE: It is recommended this step be performed using the MPR views 3. Now select the proximal and distal points of the vessel with the aneurysm in question. NOTE: It is recommended this step be performed using the MPR views 4. Now select the “Calculate” icon. 44 Turnover Workbook | Advanced Dyna4D 5. You will now be automatically put in the “Analyze Aneurysm” menu. Notes Review and Processing Aneurysm Analysis X Auto Check Volume Mark Aneurysm Analyze Aneurysm Verify analysis results Show Object ... Group Aneurysm Seed Point O Vessel Seed Points Simulate Stent ADV_ANEURYSM_ANA ADV_ANEURYSM_ANA. 03221047 Angio Sub HU Normal [1 ... AXIOM-Artis VC14J 120329IVB15D 03221047 Angio Sub HU Normal (1 ... AXIOM-Artis VC14J 1203291VB150 *1/1/1965 "1/1/1965 XA XA 5/7/2013 5/7/2013 9:13:44 AM 9:13:44 AM 10.4 mm BLLLLLLLLLLI Mean D: 8 8.9 mm SL 0.5 MPR LAO 162 / CRAN 59 ADV_ANEURYSM_ANA ... 03221047 Angio Sub HU Normal [] ... VC14J 1203291VB15D *1/1/1965 XA 5/7/2013 9:13:44 AM POR CV 3782 RPH Analysis Results more Segment L: 18.9 mm Volume: 158.3 mm3 MPR Properties A Max.D. 194 mm Dome Height Ostium (Neck) L" 6 mm SL 0.5 MPR LAO 162 / CRAN 59 ADV_ANEURYSM_ANA .. 03221047 Angio Sub HU Normal [1 ... AJ 12AXIOM-Aris *1/1/1965 XA 5/7/2013 9:13:44 AM MPR CV OY CRAN 9 LPF Analysis Results more Segment L: 18.9 mm Volume 158.3 mms Max D 194 mm Max Dome Width : 58 mn Ostium (Neck) L: 6.6 m Plan> RAO 140 / CRAN 18 NOTE: To save the results you must make a snapshot. If you wish to save all four screens you must right click on the “snapshot” icon and ............... select “Save snaphots all segments” 46 Turnover Workbook | Advanced Dyna4D 3.6 PBV Notes IV vs. IA • Injection protocols • Manual triggering • start CM end CM start saline end saline veins visible 1 3 5 6 Scan Direction Scan Direction Rotate back patient patient Bolus Watching (<30s) patient 8s 5s Xs 8s Contrast Material Saline chaser 60ml@5ml/s 60ml@5ml/s 12s injection time 12s injection time Total scan time: 13s + Xs (Bolus Watching) + 8s ~30s Loading of dataset (automatic) • InSpace Reconstruction Reconstruction in progress. Cance ROI • Image Tools Meas. X-Ray less 47 Turnover Workbook | Advanced Dyna4D 3.7 Stent Follow up Notes Intravenous access • Injection protocols • Patient 10 % 5 s rotate back Bolus watching 10 s mask run arterial contrast fill run Contrast injection 60 ml @ 5ml/s Saline chesar 60 ml @ 5 ml/s total program time appr. 30 s Manual triggering • Loading of dataset (automatic) • In Space Reconstruction i Reconstruction in progress Cancel 3.8 Stenosis Analysis 1. Click this icon, select the Stenosis Analysis workflow, and click OK. or – – Examination room, Onscreen menu: 2. Select Stenosis Analysis in the Workflow menu. Stenosis Analysis X Auto Check Volume Mark Vessel Mark vessel by setting two or more seed points. Select 'Calculate'. Analyze Stenosis Simulate Stent 48 Turnover Workbook | Advanced Dyna4D Notes 3. Click this icon. Now it is possible to single-click within the MPR and VRT segments without • placing seed points. It allows for easier volume handling, like rotating, zooming, panning, annotating, etc. It is especially useful when controlling via the joystick in the exam room. 4. To continue, click the icon again. 5. To start the calculation, click this icon. Example of stenosis analysis results Stenosis Analysis X Auto Check Volume Mark Vessel Analyze Stenosis Verify analysis results HULP Show Object ... Group Seed Points Centerline 111 VC14 00914 VB 158 Bifurcation Proximal and Distal Plat Cutting Plane LA08 | CAUD 29" Analysis Results Vessel Segment Analysis Length 311 mm mm Area 180 Mean.A 12.2 mm2 57.6 % MinA 3.9 mm2 DO % Max A 44,9 mm2 Ratereran Min Diameter Mean D 2.8 mm 25 mm Min. D: 1.0 mm LAOB- YCAUD 28" 5.0 mm2 Max D: 18.0 mm Simulate Stent Simulating a virtual stent Stenosis Analysis You can simulate a virtual stent or graft and overlay the Auto Check Volume graphics on the Artis Live screen. Mark Vessel Analyze Stenosis Simulate Stent ? Adjust virtual stent dimensions and position. Activate overlay. Show Object Group Seed Points Centerline *-* 62.0 mm Show Volume Data in VRT 49 Turnover Workbook | Advanced Dyna4D 4 Angio Tab Card 4.1 Objective Notes After completing this section, the technologist will be able to: Perform iFlow • 4.2 iFlow Acquire DSA • Launch program • Mark POI/ROI • 6.67 s 5.335 Adjustment of beginning/end times • “Snapshot”/Transfer to PACS • 50 Turnover Workbook | Advanced Dyna4D Notes 51 On account of certain regional limitations of sales rights and service availability, we cannot guarantee that all products included in this brochure are available through the Siemens sales organization worldwide. Availability and packaging may vary by country and is subject to change without prior notice. Some/All of the features and products described herein may not be available in the United States. The information in this document contains general technical descriptions of specifications and options as well as standard and optional features which Local Contact Information do not always have to be present in Siemens Medical Solutions USA, Inc. individual cases. 40 Liberty Blvd. Malvern, PA 19355-9998 Siemens reserves the right to modify the USA design, packaging, specifications and Telephone: +1-888-826-9702 options described herein without prior siemens.com/healthcare notice. Please contact your local Siemens sales representative for the Legal Manufacturer most current information. Imaging & Therapy Systems Angiography & Interventional X-ray Note: Any technical data contained in Systems this document may vary within defined Siemensstr. 1 tolerances. Original images always lose DE-91301 Forchheim a certain amount of detail when Germany reproduced. Telephone: +49 9191 18-0 siemens.com/healthcare Siemens Healthcare Headquarters Siemens Healthcare GmbH Healthcare Sector Henkestr. 127 91052 Erlangen Germany Telephone: +49 9131 84-0 siemens.com/healthcare Published by Siemens Healthcare GmbH · Order No. A914CX-CS-151730-P1-4A00 · Printed in USA · ©Siemens Healthcare GmbH, 2017 52
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