Artis with PURE

Artis with PURE You have now completed the course Artis with PURE.  You should now be able to:  Identify PURE software and hardware basic requirements Recall PURE product families; Artis zee, Artis Q, and Artis Q.zen Locate new table attachment options Describe features and benefits of the following core features: CLEARmatch and CLEARmap Heads Up Display 3D Wizard QuickZoom syngo 2D/3D Fusion syngo DynaCT SMART syngo Dyna 4D 3D Reconstruction 3D Visualization Parallel Patient Processing Bookmarks Preset Gallery       Object List  **Additional training aids for PURE can be found on www.siemenslearningcenter.com. The goal of this web-based training is to provide a comprehensive review of the new and updated features and functions found on the Artis with PURE systems including: Identify PURE software and hardware basic requirements Recall PURE product families; Artis zee, Artis Q, and Artis Q.zen Locate new table attachment options Describe features and benefits of CLEARmatch and CLEARmap Heads Up Display 3D Wizard QuickZoom syngo 2D/3D Fusion syngo DynaCT SMART syngo Dyna 4D 3D Reconstruction 3D Visualization Parallel Patient Processing Bookmarks Preset Gallery Object List   Saves time Fewer steps More efficient           Smart performance Expanded capabilities           Select each tab below to view descriptions of the general features that can be found on PURE systems. All menu option (filter) will display: All acquired scenes All store monitor images All reference images Only location for scenes of additional roadmap images   Non Zoomed Image Zoomed Image Zoomed Image Hide Annotations Button           Now with PURE Bi-plane systems, A & B reference images can be stored at the same time with a single icon. Previously they had to be captured one at a time. Select each tab below to view information on PURE's selection options to accommodate vendor tables and head holder options. Head Holder options to accommodate the following tables:   Artis neuro tabletop Trumpf surgical table Maquet surgical table Maquet  Trumpf  All programs can be activated with 1 single button  (Overlay Ref button disappears when roadmap is active) Similar buttons are available on the TSC You can zoom & pan during roadmap Activation via the TSC buttons for zoom & pan Activation only possible between X-rays DSA Roadmap Icons Tableside Control Room   Roadmap = Classic Roadmap or Additional Roadmap   CLEARmap = DSA Roadmap CLEARmap can be activated before or after a DSA run by simply selecting the Roadmap Reference image first and then clicking on the DSA Roadmap button second.  Select the tabs below to view the steps for activating CLEARmap before the DSA run (Workflow 1) and after the DSA run (Workflow 2). - Select and perform a DSA acquisition - Review the run and store a to serve as RDMP mask - Use fluoro foot pedal to continue with RDMP phase 3   - System will acquire a RDMP phase 3 mask   - System switches to RDMP phase 3 subtraction   - System overlays DSA ref image and RDMP phase 3 sub image - Perform a DSA acquisition - Review the run and store a to serve as RDMP mask - Select - Use fluoro foot pedal to continue with RDMP phase 3   - System will acquire a RDMP phase 3 mask    - System switches to RDMP phase 3 subtraction    - System overlays DSA ref image and RDMP phase 3 sub image Dose-saving zoom   Overlay/Ref button replaced with 2xZoom button   Live Monitor shows enlarged subtracted image   Assist Monitor shows native image in original size   Pan zoomed image with joystick        Select the tabs below to learn more about CLEARmatch and its features. "CLEARmatch" appears in the bottom right corner of the Live Monitor if activated. If CLEARmatch appears in brackets [CLEARmatch], this can be due to CLEARmatch being out of range.   Image can still be improved by using the Pixelshift in Post Processing. The boundaries for CLEARmatch are different for Roadmap versus DSA.  Roadmap extends + or - 16 pixels where DSA extends + or – 32 pixels.              CLEARmatch aligns the native "mask" image and all subsequent images in order to clean the subtracted image from motion artifacts. CLEARmatch compensates for patient movement during: Subtracted Fluoro (Roadmap, CLEARmap) DSA Acquisition & Review CLEARmatch compensates for: Translation motion Rotation motion Scaling Shearing DSA CLEARmatch Automatic roadmap mask reset while maintaining the vessel map. Once set in the Roadmap organ program, Progressive Show Progress can easily be enabled by stepping on the fluoro foot pedal.                Select the tabs below to view examples of the Heads Up Display in use. VRT Review Options VRT Workflow Options MPR Workflow Options MPR Review Options Two registration methods:  2D/3D & 3D/3D   Overlay prior data onto 2D live images    Integrates pre-op volumes for live image guidance   Reduces need for additional 3D acquisition      Dedicated OGP’s – 6sDSA Dyna4D Head and 12sDSA Dyna4D Head  6s use when just arterial inflow shall be evaluated along with the 3D volume of the vessel tree  12s used to display the arterial inflow and the venous outflow along with the 3D volume  Head side only with zero table rotation  Not available on the Multipurpose system  Landscape orientation only  Zoom 0, 1, & 2 possible; Zoom 3 with DynaCT Micro License Simultaneous start of Fill Run and Injection is important. Constant injection is required.  A synchronized power injector is recommended. The new 3D Wizard is accessible from the exam room as well as the TSC.  The 3D Wizard guides you step by step through an acquisition.  The tabs below provide an example of how to use the 3D Wizard to perform a rotational angiography. Use the joystick to select the category or body region. Use the left joystick button to select the image.  This will automatically select the appropriate 3D Organ Program (OGP) along with detailed information associated with it. The Wizard will display the steps for a 3D acquisition along with additional information.  Edit Mode is available in the Control Room only. Edit Mode allows you to modify: Default options, Customizations, & Security Options Edit Mode is available in the Control Room only.   Access is password protected for security purposes.  Edit Mode functions include; Create new items, Customize items, Assign favorites and Hide items. A list of available 3D OGPs can provide assistance when selecting the appropriate OGP. Displays Step Overviews for different acquisition types including 3D DR, 3D DSA, 3D Large Volume, and PBV. You will be able to add comments to images. Broken images are easily identified by this symbol   If a link is broken due to OGP renaming, assign a new OGP name.  Select the tabs below to view an example of syngo 2D/3D Fusion. Load the existing 3D dataset into the 4D tab for the current examination patient. Click the Assign to Existing button at the bottom of the Loading window.  Once loaded, the images can be used as an overlay for the current examination patient. The 3D Roadmap process can be initiated from the Heads Up Display, Tableside Control icon, or from the Control Room. Heads Up Display Tableside Control Control Room Click on the 2D3D tab within the syngo 3D Registration window.  Perform 2 fluoro loops (or acquisitions) at least 30 degrees apart. The first fluoro capture appears in the left segment of the display window.  The second fluoro appears in the right segment. 1st Fluoro 2nd Fluoro Make any manual or automatic alignment adjustments to line up the anatomy.  Click on the Accept 2D3D button if you are in the Control Room or select Accept on the Heads Up Display. Control Room Heads Up Display The 3D Roadmap is now active and current.  Updates will occur automatically as system movements occur. A prompt to BLEND will appear over the Tableside joystick image.  This will fade the overlay in and out at different intensities. Select each tab below to view the process for using the DynaCT SMART feature. Load the volume into the 4D task card Click the Patient menu and select Interactive Reconstruction. Click in the SMART checkbox in the Interactive Reconstruction window.  This will automatically activate the 3D view of the Interactive Reconstruction window.     When segmenting is complete, click the Reconstruction button.    The 3D Reconstruction progress window displays during reconstruction. Volumes reconstructed with SMART are labeled with the suffix "Me" (metal extraction). When 3D reconstruction is complete, the metal artifact will be reduced. The message below will display if you did not window or VOI punch the image prior to reconstruction.  If this displays, you will need to repeat the SMART reconstruction process.  Segment the metal by windowing then perform VOI Punching.     Select the tabs below to view a workflow example for syngo Dyna4D. This example begins once the 4D spin has been completed.  The 4D spin in this instance is specific to a 6s or 12s 3D acquisition used to acquire the Dyna 4D dataset.  The Dyna 4D dataset appears in the 4D Task Card (Control Room) or the 4D Viewer (Exam Room). Access from Exam Room Access from Control Room The syngo Dyna4D window displays. This is where images can be played one at a time. To archive images to PACS, you will need to select and save the snapshot time ranges to the Patient Browser. Begin by adjusting the start and end time for the desired range.  Click the Save Time Window Range button to save post processing edits. If reviewing a previously created Dyna4d volume, you will have the option to display the entire volume or you can select a point within the range.      The columns on the next tab show the steps for each method. Saved time window range images are stored on the local database in a separate scene labeled SnapShot Time Ranges. Dyna4D arterial Sub To load the entire volume, double-click on the Dyna4D arterial Sub dataset in the Patient Browser. Select Tools then 4D from the Top menu. This will open the syngo Dyna4D viewer window. Dyna4D arterial Sub 4D To select a point within the range, double-click on the Dyna4D arterial Sub4D dataset from the Patient Browser. When the Loading window displays, left-click on the desired instance. Click on the Load Selected button. This will display the selected point within the volume in the syngo Dyna4D viewer window. Select each tab below to view additional information about the enhanced version of 3D Reconstruction.   Formerly Secondary Reconstruction Accessed from the Patient Browser under the Patient menu Updated feature now allows you to reconstruct the last two datasets Automatic Reconstruction = primary reconstruction Raw data sent to XWP is reconstructed & displayed in 4D Viewer.  It only affects VOI size. (Refine Volume is a secondary reconstruction option; affects VOI size only) Interactive Reconstruction  = secondary reconstruction Datasets just reconstructed can be reconstructed a second time with different parameters   Select each tab below to view additional information and examples of PURE's enhanced visualization options.                      NOTE: Contrast has been applied to the Compare MPR Layout above to better identify individual images. Streamline workflow   Improved system productivity   Improved room utilization     Select each tab below to view a workflow example for Parallel Patient Processing.   Able to load 2 patients into 4D Task Card The C-Arm folder indicates the current examination patient The opened folder icon indicates the patient whose images are shown in the control room& The second folder indicates the review patient who may differ from the examination patient Exam room only displays examination patient     To open a second dataset, double-click on the dataset to review.   When the Loading window displays, click on the Load to Review button to load the data into the review folder.   Click the check box to activate the;Assign to Existing button which will allow you to assign the images to the current patient. This will also replace the 3D images (if any are being displayed) currently being shown in the Exam Room.     No preset gallery pops up   A default preset is chosen by a default preset mechanism   In case no default preset or no fitting rendering parameter section can be found in the default preset, a global default will be used   The preset will be applied to the selected segment and all segments linked to it   Factory presets are write protected & cannot be deleted   The presets can be filtered within the preset gallery   Select each tab below to view additional information about and examples of the Object List feature. Object List provides a location to view and work with patient and study specific graphical objects. Manage and work with objects in one central location. Access the Object List by selecting the Tools menu then Object List. Selection and deletion of groups/objects  Editing of group/object properties (e. g. visibility, name, color)  Properties for groups/objects available via context menu Overlay options available for group/objects (Needle Guidance & Segmentation Overlay)  Moving objects from one group to another Display options for objects in current layout for objects  (e.g. Reposition MPR segments, so that object is visible)  Creation of new groups  Setting the active group  Show/Hide all objects and labels Show/Hide graphical objects on the live monitor Objects are saved within the patient study upon close, depending on the workflow selected.   Object List is not saved when in EMBOGuidance.   Saved object can be recalled along with their properties.     In complex interventions, placing multiple needles is time-consuming. The Multiple Needle Guidance feature allows you to plan several needle paths in one step. You will simply call up each path one by one during the intervention to streamline your procedure. Calculation in Live mode, but with a few images delay Some latency might be visible during live acquisition due to constant patient movement   No latency during replay in Artis PostProc Task Card Angio Task Card on the XWP is not able to perform CLEARmatch CLEARmatch off   CLEARmatch on       Able to save and recall procedure planning data easily   Able to access data during an intervention tableside from the Layout Gallery Menu button   Accessible from Viewing tab/4D Task Card   Bookmarks reference the volume or dataset   Select each tab below to view workflow examples for the enhanced Bookmarks feature. To save a bookmark from the Exam Room, choose from the following options: Select the Bookmark icon in the 4D tab from the Tableside Control.      OR Select General then Save Bookmark from the Heads Up Display.  Control Room Exam Room To save a bookmark from the Control Room, left-click on the Bookmark button. To change the name of an existing bookmark, right-click on the bookmark itself.  Select Properties from the pop-up menu.  You will then be prompted to enter a name for the bookmark. Once entered, click the Close button to save and close the window. To simultaneously save and name a bookmark from the Control Room, right-click on the Bookmark button.  Enter a name then click the Close button.  Select the Play button to view a short video demonstrating the Bookmarks feature.     QuickZoom Demonstration View a demonstration of the QuickZoom feature.   Operating Quick Zoom Tab Learn more about operating the QuickZoom tab. Element HTMLQuickZoom enables you to focus on the correct anatomy and can be used in slices and in volumes. Centers all segments containing that volume   QuickZoom combines: Centering the point/anatomy of interest Zooms the point/anatomy of interest Clips the volume defined by the zooming Sound File Audio ScriptTo operate QuickZoom, use the joystick to click as well as navigate and zoom in on the anatomy or point of interest.  QuickZoom even provides high-resolution refinement of your 3D volume. Streak Metal Artifact Reduction Technique Reduces metal artifacts in Interactive Reconstruction SMART reduces artifacts caused by metals present in the 3D Reconstruction volume Available for all protocols Only for native volumes SMART Feature Demonstration View a demonstration of the DynaCT SMART feature.