Biograph mCT and mCT Flow Advanced Applications Turnover Workbook

SIEMENS SIEMENS Biograph mCT SIEMENS User Services www.usa.siemens.com/education Biograph mCT and mCT Flow Advanced Applications Turnover Workbook Answers for life. User Services. Driven by More. More: Our philosophy for a lifelong improvement through continuing education and consulting. Working closely with you, we develop your personalized education and consulting strategy and support you and your staff with our comprehensive User Services to help gain: • More: Routine Confidence • More: Clinical Expertise • More: Superior Performance More: Personalized training, education, and consulting services from Siemens Healthcare Customer Services. For your leading edge in medical care. User Services. Driven by More. More: Personalized More: More: Superior Clinical Performance More: Routine Expertise Confidence 2 I Contact Information Summary Welcome to Siemens Healthcare Discover. Try. Buy. on webShop Siemens Healthcare is dedicated to helping you Do you want to “Discover. Try. 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current Siemens Clinical Training and Continuing Education portfolio. 3 II Contents I Contact Information Summary ............................................................................................... 3 II Contents .............................................................................................................................. 4 III Course Agenda .................................................................................................................... 5 IV Course Objectives ................................................................................................................ 6 I Cardiac Gating....................................................................................................................... 7 1.1 Objectives .................................................................................................................... 7 1.2 Cardiac gating Principles and Setup ............................................................................... 7 1.3 Cardiac Gating Reconstruction..................................................................................... 12 1.4 Cardiac Gated Scan..................................................................................................... 15 2 Respiratory Gating .............................................................................................................. 28 2.1 Objectives .................................................................................................................. 28 2.2 Respiratory Gating Principles and Setup....................................................................... 28 2.3 Respiratory Gating Equipment – Anzai ........................................................................ 28 2.4 Respiratory Gating Equipment – Varian ...................................................................... 32 2.5 Performing Respiratory Gating .................................................................................... 33 3 Whole Body Listmode.......................................................................................................... 41 3.1 Objectives .................................................................................................................. 41 3.2 Performing Whole Body Listmode................................................................................ 41 4 Additional Advanced Features ............................................................................................. 51 4.1 PET Image Statistics .................................................................................................... 51 4.2 PET Count Rate Info and Curve .................................................................................... 54 4 Biograph mCT STOP III Course Agenda Cardiac Gating Cardiac Gating Principles and Setup Cardiac Gating Reconstruction Cardiac Gated Scan Respiratory Gating Respiratory Gating Principles and Setup Respiratory Gating Equipment – Anzai Respiratory Gating Equipment – Varian Performing Respiratory Gating Whole Body Listmode Performing Whole Body Listmode Additional Advanced Procedures PET Image Statistics PET Count Rate Info and Curve 5 IV Course Objectives By the end of this turnover, you will be able to: • Correctly perform cardiac gated studies including HD Cardiac. • Navigate the TrueD Cardiac Layout display. • Demonstrate how to perform respiratory gated studies. • Demonstrate how to perform Wholebody Listmode and Dynamic studies using continuous bed motion (CBM). • Navigate Motion Frozen Listmode (MFL) studies. • Discuss the steps in performing PET Guided CT studies. • State the procedures for performing dynamic brain studies. • Discuss the purpose of the PET Statistics Image. • Utilize the PET count rate info/curve. 6 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications I Cardiac Gating 1.1 Objectives Notes After this section, the user will be able to: • List the principles behind cardiac gating. • Operate the controls of the ECG leads. • Perform a cardiac gated study. • Perform cardiac gating with cardiac matching. • Perform cardiac gating with Motion Frozen Listmode (MFL) • Perform cardiac gating with MFL utilizing cardiac matching. • Perform cardiac gating with MFL utilizing respiratory matching. • Navigate the steps in acquiring an HD Cardiac study. 1.2 Cardiac gating Principles and Setup 1.2.1 ECG Leads There are two sets of ECG leads, one for the United States and one for Europe. The red, black and white leads are for the United States and the Red, Yellow and Green leads are for Europe. See the images below for proper ECG Lead placement. Placement and Color Coding for USA Placement and Color Coding for Europe TRA 1.2.2 Universal Physiological Measurement Module (UPMM) (1) (2) (3) (4) (5) Connection point for PET and CT cardiac gating and receptacle for the EKG electrodes and a push button for changing the ECG measurement mode. 1. Hinged lid – close when the UPMM is not in use 2. Lead selector push button 3. ECG lead cable connector 4. Respiratory trigger connector 5. External trigger connector 7 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 1.2.3. ECG Pulsing • ECG Pulsing is a dose modulation mechanism where 100% of desired dose is only applied to the area when the heart is at rest (after R-peak and wave). The rest of the time, the tube current is reduced. • A typical application of ECG Pulsing is used for heart examinations when one of the following items is required: • Functional cardiac analysis is desired • A functional image based on reduced dose level is acceptable. • ECG Pulsing Options: • Auto Pulsing auto • Manual Range • MinDose– auto auto manual • MinDose– manual MinDose - auto • Off MinDose - manual off Routine Scar Recon • Auto: Reduces the tube current to 25% of the nominal current during the non-relevant phase of the cardiac cycle. • Uses the parameters configured in the ECG Pulsing Configuration (HeartView). • The resulting images are appropriate for functional analysis and sufficient for a coronary evaluation. • MinDose: Provides an option to reduce dose in the non-relevant cardiac phase to a minimum of 4%. • The resulting images are NOT appropriate for functional analysis. Heart Rate (bpm) Min: 60 Max 60 Avg: 60 60 60 60 60 60 60 Reduced Dose Area Reconstruction Area Notes 8 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications Notes (2) 1. High Dose Level 2. Low Dose Level 1.2.4 ECG Pulsing Configuration (HeartView) • ECG Pulsing Auto setting (includes MinDose) are configured in the ECG Pulsing Configuration. • HR Range = Patient’s Heart Rate • Start: Phase start where full dose will be applied. • End: Phase end of full dose. • Only the phases outside the Start and End range have reduced dose. • The default Start/End settings for <=50 and 51 – 75 are narrow at 70. It is recommended these be changed to maybe a Start of 65 and End of 85. HeartView X General Preview Series Multiphase ECG Pulsing ECG Pulsing settings Automatic phase start adaptation v Unit: % HR Range Start <= 50 70 End 51 - 75 70 10 70 76 - 95 35 70 96 - 119 40 65 >= 120 40 Modify Heartrate: --- Insert Window Start: End: Delete OK Apply Default Settings Cancel Help 1.2.5 Estimated Heart Rate Estimated HR Menu: auto • When scanning a retrospective ECG- >40 >50 gated spiral, continuous volume Pulsing manual >60 coverage in the same cardiac phase is Range 70to >70 only achieved when the pitch is >80 adapted to the patient’s heart rate. Unit >90 >100 • In general, low pitch is used to ensure Est. HR auto sufficient overlap in the scanned volume. 9 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications • The Auto function allows the system to monitor the patient’s heart rate over the Notes last 10 cardiac cycles. The system will instantly adjust the pitch before initiation of the scan based on the lowest heart rate measured during the last 10 cardiac cycles. • Siemens provides the user an option to manually change the pitch based on the patient’s heart rate but should only be done when clinically indicated, such as bigeminy or if the heart rate drops more than 10 beats during the breath hold. The manual feature prevents the system from adjusting pitch below the specified heart rate. 1.2.6 Preview Series The Preview Series option can be used to aid in finding the optimum Phase Start for additional reconstruction. The Preview Series generates several images at one slice position with different Phase Start values. Creating a Preview Series: • On the Recon card (of a new recon job), set the desired reconstruction parameters. • In the Tomo segment, display the image with desired slice position to generate Preview Series. • On the Trigger card, select “Manual” for Best Phase and set Phase Start, either in “ms’ or “%” unit. • Click on Preview Series icon. Default settings for the Preview Series are configured in the HeartView -> Preview Series tab. HeartView X General Preview Series |Multiphase ECG Pulsing Preview series settings Phase start defines: > Start Center . End Number of Images: 7 Interval: |5015 5 OK Apply Default Settings Cancel Help 10 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 1.2.7 Direct Viewer The Direct Viewer is intended to complete the workflow of Best Phase finding. It provides a direct view in 3D and supports finding the most suitable heart phase for reconstruction. • Only available for already scanned cardio spirals. • Use the Direct Viewer floating toolbar to navigate through the already reconstructed recon jobs as a planning base to determine the best cardio phase for reconstruction. H Univ of MI PETCT: 5100053822 E3/27/2013 :13:17:28.60 VRT 3 10cm A -330 ms CT GATED 3.0 B30f 0% 2CardiacGated_CardiacMatching (Adult) Idle al mAs: 1326 Topogram Heart Rate (bpm) Min: 72 Max 73 Avg: 73 73 . 73 . 73 . 73 www | buddh 72 72 72 - 73 72 . CT GATED Pause . PET REST Pause 8 9 10 11 12 13 14 15 . PET STRESS Pulsing off Icon for Direct BestPhase manual Pause Range 70 to 70 Viewer Phase Start 330 3| CT Unit % Unit ms Est. HR auto Original ECG Recon mono 165 ms TrueStack Hold Repon Recon Routine Scan Recon Auto Tasking Trigger Notes 11 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 1.3 Cardiac Gating Reconstruction 1.3.1 Types of Cardiac Gated Reconstruction: Single Phase • Reconstruction of a single phase of the cardiac cycle • Gates Multiphase • Reconstruction of multiple single phases of the cardiac cycle. HD•Cardiac (PET Only) also known as MFL (Motion From Listmode) • Reconstruction of PET cardiac gates within the area of minimal respiratory motion. • Accomplished with MFL (Motion From Listmode), which tracks the myocardial activity during the respiratory cycle. 1.3.2 PET Trigger and PET Recon: Static, Dynamic, Gated Recon Subtask Card Settings: Heart Rate (bpm) Min: 47 Max 98 Avg 92 Replay Type: Static 95. 94 95 92 94 94 94 94 92 Bed 92 84 1/1 Delay: 120 seconds 120 121 122 123 124 125 126 127 222 PET static recon 03 67 7$ 76 100 107 5pm Routine Scan Recon | Auto Tasking | Replay Trigger Recon Subtask Card Settings: Replay Type: Dynamic Heart Rate (bpm) Min: 66 Max 78 Avg: 71 Bed Frame: 5 second frames 70 1/1 74 76 73 30 31 33 34 36 37 A dynamic PET recon can be visualized by the lines displayed on Trigger sub-task card Routine Scan Recon |Auto Tasking Replay Trigger Notes 12 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications Recon Subtask Card Settings: Heart Rate (bpm) Min: 72 Max 73 Avg: 73 70 71 73 72 73 73 73 Replay Type: Gated Delay: 0 seconds -1 3 5 Pulsing off BestPhase manual Range 70 to 70 PET gated Unit recon Gates Unit Gates Est. HR auto Original ECG Recon mono 165 ms TrueStack Routine Scan Recon Auto Tasking Trigger 1.3.3 Identifying a Gated Series One indication of a gated series is the gated icon on the chronicle. Topogram Heart Rate (bpm) Min: 72 Max 73 Avg: 73 CT GATED 70 71 73 72. 72 73 . 73 73. 73 73 Pause PET REST 0 2 Pause 3 5 . PET STRESS Pulsing off BestPhase manual Pause Range 70 to Gates CT Unit % Unit Gates Est HR auto Original ECG Recon mono 165 ms TrueStack Hold Recon Recor Routine Scan Recon Auto Tasking Trigger Notes 13 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications Cardiac Icon Respiratory Icon PET Dual Gate Icon The Trigger sub-task card will be present for ALL PET and CT series in a gated protocol. This is independent of whether the series is actually gated. PETCT_Cardiac (Adult) est 1233456 Total mAS: CT Cardiac RT Eff. mAs 11 3 Pause KV 120 CTDIvol (32cm): 0.73 mGy DLP: 19.4 mGy cm PET Cardiac Scan time 2.54 s Delay 2 s Pause Slice 3.0mm Acq. 32x1.2 mm Topogram CT Cardiac RT No. of images 113 Pause Comments PET Cardiac Range: Begin End Position Height -684.52 -909.5 -670.0 147.0 Craniocaudal Load Hold Recon Recon Routine Scar Recon Auto Tasking Trigger Acquisition System Prepared Last Checkun 28 h ano Select Setun/Check Notes 14 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 1.4 Cardiac Gated Scan 1.4.1 Acquiring Cardiac Gated Scans Setup Placement and Color Coding for USA 1. Register a patient 2. Define a study – for example, Cardiac Gate 3. Select Exam 4. Position the patient for exam 5. Attach the ECG Leads Stopping the System In critical situations, press an E-Stop push button to stop all system movements immediately and to shut down radiation. Acquisition With cardiac gating, the user will acquire a single bed stop over the heart based on the topogram. The axial position of the scan range is adjusted by dragging the circle in the center of the scan range up or down. The topogram and CT are acquired as normal. The PET Routine sub-task card is below. Notice the Cardiac Gate icon in the chronicle. CardiacGated (Adult) gated, cardiac 164.0 mm 7 min 0 mCi Topogram Isotope Rb-82 Pharm. Rubidium chloride CT Cardiac RT Dose 0.00 mc Pause Date 11/18/2012 Time 1:38:49 PM PET Cardiac Scan range Match CT Range 2 No. of beds Scan duration 7 min Range: Begin End Table: Position Height Scan direction Load Hold Recon -566.0 402.0 -601.0 99.0 Caudocranial Recor Routine Scan Recon Auto Tasking Replay Trigger Notes 15 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications You will notice an added sub-task card, the Trigger card. This will show us the patient’s ECG trace along with a graph showing a histogram of the patient’s heart rate. CardiacGated (Adult) gated, cardiac 164.0 mm 7 min 0 mCi Topogram Heart Rate (bpm) Min: 2 Max: 70 Avg: 36 60 60 60 60 60 60 CT Cardiac RT Pause Sh PET Cardiac 2 652 - 489 326 - 163 Load Hold 8 14 20 26 32 38 44 50 56 62 68 74 80 86 92 bpm Recor Recor Routine Scan Recon Auto Tasking Replay Trigger You will also notice the Replay sub-task card which we will configure for 2 reconstructions each for our rest and stress studies. CardiacGated (Adult) gated, cardiac 164.0 mm 7 min 0 mCi Topogram Recon job 1 2 3 4 5 6 7 6 Series description PET Cardiac CT Cardiac RT Recon range (bed) Begin 1 End 1 Pause Replay Type Static Save Replay Sinograms PET Cardiac 2 Bed Delay (s) Duration (s) 30 240 Load Hold Recon Recon Routine Scar Recon Auto Tasking Replay Trigger Notes 16 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications Notes The 2 reconstructions for each rest and stress cardiac study will include a NAC PET and AC Gated PET. PET Recon 1: NAC Static PET for Fusion Registration Recon job 1 2 3 5 6 7 8 Series description PET Cardiac Recon range (bed) Begin 1 End 1 Replay Type Static Save Replay Sinograms Bed Delay (s) Duration (s) 1 30 240 Routine Scar Recon Auto Tasking Replay Trigger PET Recon 1: Auto Load to TrueD is enabled. AC CT and NAC PET are automatically loaded to TrueD for registration. Manual registration and saving of registration matrix can be performed. If customer purchased Auto Cardiac Registration, this too can be enabled to further automate this process. Recon job 1 2 3 4 5 6 7 8 Series description PET Cardiac Auto recon Auto Display TrueD Auto Cardiac Registration Auto transfer None Requested Procedure PET CardiacGated (Acv None Body part examined 4 None Routine Scan Recon Auto Tasking | Replay Trigger 17 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications PET Recon 2: PET 8 Gates Notes Auto recon is disabled so that registration matrix from Recon 1 will be available for selection if needed. Note that recon duration is longer than the duration set for Recon ! Static NAC PET, which was set at 240 seconds. Recon job 2 3 4 5 6 1 8 Series description PET Cardiac Gated Recon range (bed) Begin 1 1 . Replay Type Gated Save Replay Sinograms Replay Mode Cardiac Skip Beats 0 Bed Delay (s) Duration (s) 1 30 390 Routine Scan Recon Auto Tasking Replay Trigger 1.4.2 Acquiring Cardiac Gating – Cardiac Matching Provides phase matched synchronization of gates for both PET and CT cardiac gating. The centers of the CT and PET gates are automatically aligned. • Requires cardiac gating device, ECG Leads • Cardiac gated CT is used for PET gated AC • Cardiac gated PET • Corrects for cardiac motion only. 18 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications Notice the Phase selection after “Match CT” was enabled on the PET Trigger card. Heart Rate (bpm) Min: 72 Max: 73 Avg: 73 73 73 73 73 73 73 73 73 72 8 10 1 Pulsing off BestPhase manual Range 70 to 70 10 20 30 40 50 60 70 80 90 100 Unit % Est. HR auto Original ECG Recon mono 165 ms Routine Scan Recon Auto Tasking Trigger Heart Rate (bpm) Min: 47 Max: 98 Avg: 92 Bed 1/1 95 94 95 92 94 94 94 94 92 92 94 120 121 122 123 124 125 126 127 296 Match CT 222 10 11 12 13 14 15 16 % 148 - 74. Selected phases: 2% 22% 42% 62% 82% 47 51 55 59 63 67 71 75 79 83 87 91 95 99 103 107 bpm Routine Scan Recon Auto Tasking Replay Trigger Notes 19 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 1.4.3 Acquiring Cardiac Gating – MFL (Motion From Listmode) Notes This method of cardiac gating is designed to remove respiratory motion artifacts in cardiac studies. Cardiac gates are only reconstructed within the respiratory cycle with the least motion. Cardiac movement within the respiratory cycle is determined from the listmode data. There is no respiratory gating device required due to MFL – Motion From Listmode. Respiratory Source Motion From Listmo Auto Tasking Replay Trigger • Non-gated spiral CT for PET AC • Cardiac gated PET • Requires gating device for PET cardiac only. 20 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications The “MFL Score” is the standard deviation of the MFL signal. MFL represents a direct measurement of the motion of radiotracer in the field of view. The magnitude of that motion has a direct relationship to the motion of the organs which carry the radiotracer. In cardiac imaging, the radiotracer is in the myocardium and the primary motion is the actual beating of the heart, but respiratory motion is also present. MFL is a proportional measurement, an average of “moving radiotracer” and “non-moving radiotracer.” Below you can see the Trigger card with the ECG trace in red and the MFL trace in blue. Patient name Date of birth Spread Patient ID Study description PET 2UMCardiacGatedMFL (Adult) Study date 3/27/2013 Modality PT Instanc ... = Instance Type Instance Date and Ti ... |Instance Comment 3000 [ORIGINAL] [PI3/27/2013 8:01:53 AM PET Scan 3 Count Rate |3001 [ORIGINAL] [PI 3/27/2013 7:55:20 AM PET Scan 3 Bed 1 Sinogram 3001 [ORIGINAL] [PI3/27/2013 7:54:50 AM PET Scan 3 Bed 1 Listmode 3000 [ORIGINAL] [PI 3/27/2013 7:54:50 AM PET Scan 3 Physio MFL Scale : 0.58 3000 [ORIGINAL] [PI 3/27/2013 7:54:50 AM PET Scan 3 Physio Cardiac 2000 [ORIGINAL] [PI 3/27/2013 7:51:04 AM PET Scan 2 Count Rate Example of a Rest/Stress R82 exam. 2001 ORIGINAL] [PI3/27/2013 7:46:01 AM PET Scan 2 Bed 1 Sinogram Note 2 "Physio MFL Scale" instances. 2001 [ORIGINAL] [PI 3/27/2013 7:44:01 AM PET Scan 2 Bed 1 Listmode 2000 [ORIGINAL] [PI3/27/2013 7:44:01 AM PET Scan 2 Physio MFL Scale : 0.73 2000 2000 [ORIGINAL] [PI3/27/2013 7:44:01 AM PET Scan 2 Physio Cardiac [ORIGINAL] [PI3/27/2013 7:43:00 AM PET Scan 2 - Protocol [ORIGINAL] [PI 3/27/2013 6:05:08 AM PET Normalization Current Filter. Of 1.4.4 Acquiring Cardiac Gating MFL – Cardiac Matching MFL trace is in blue. Provides RPM. The "blue dots" mark Cardiac ECG trace in red. Provides BPM. The "red peak inspiration on top and dots" mark the R peaks. peak expiration on bottom. Heart Respiration Rate (bpm, rpm) Min: 54, 5 Max: 125, 58 Avg: 69, 15 Bed 1/1 84 64 6. 64 65 63 118- Acquisition Time 119 120 121 122 123 124 125 126 Respiratory Cardiac Match CT 10 Amplitude Range 38-51% Unit Rest In/EX Duty Cycle 35 ~ 5 9 13 17 21 25 20 3 37 41 45 49 63 67 61 65 Routine Scan Recon Auto Tasking Replay Trigger Notes 21 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications This method provides phase matched synchronization of gates for both PET and CT cardiac gating. The PET cardiac gates are reconstructed in the area of minimal respiratory motion. The phase matched CT cardiac gates are used for the PET AC. • Dual gated PET, with respiratory motion from MFL – Motion From Listmode. • Requires cardiac gating device, ECG leads • Cardiac gated CT • Cardiac gated PET Topogram Recon job 1 2 3 4 56 Series description PET Cardiac MFL Rest In/Ex 8 Ga [B] . CT Cardiac RT Recon range (bed) Begin 1 End 1 Pause Replay Type Gated Save Replay Sinograms _ PET Cardiac 00 2 Replay Mode Cardiac Skip Beats 0 Bed Delay (s) Duration (S) 1 30 30 Load Hold Recon Recon Routine Scar Recon Auto Tasking Replay Trigger Notes 22 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 1.4.5 Acquiring Cardiac Gating MFL – Respiratory Matching This method provides phase matched synchronization for both PET and CT respiratory gating. This process will utilize a single phase of the respiratory CT for the PET AC. • Dual gated PET, with respiratory motion from MFL – Motion From Listmode • Requires a respiratory gating device for CT • Requires cardiac gating device, ECG leads • Respiratory gated CT • Cardiac gated PET Topogram Recon job 1 2 3 4 5 6 7 8 Series description PET Cardiac MFL Rest In/Ex 0-50; ] ALL CT Lung Recon range (bed) Begin 1 End 1 Pause Replay Type Gated Save Replay Sinograms PET Cardiac 2 Replay Mode Dual Skip Beats 0 Bed Delay (s) Duration (s) 1 30 30 Respiratory Source Motion From Listmo Load Hold Recon Recon Routine Scan Recon Auto Tasking Replay Trigger 1.4.6 Acquiring Dual Cardiac Gated This method of cardiac gating is designed to remove respiratory movement artifacts in cardiac studies by using both PET cardiac and PET respiratory gating. PET cardiac and PET respiratory gating will be acquired simultaneously. DualCardiacGated (Adult) • Non-gated spiral CT for AC • Cardiac gates are only reconstructed within the specified IN or EX Topogram respiratory phase. Requires both cardiac and respiratory gating devices. CT Cardiac RT • • dUser must define the respiratory phase (IN or EX) where the cardiac gates will be Pause reconstructed. The intended output is cardiac gates, not respiratory gates. PET Dual 2 Notes 23 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications Note that the respiratory waveform and cardiac trace are synced in the Trigger card. Heart/Respiration Rate (bpm, rpm) Min: 71, 19 Max: 78, 19 Avg: 75, 19 Bed 1/1 75 74 75 74 75 73 74 75 76 19 19 30 31 32 33 34 35 36 37 96 Respiratory Cardiac 72 Match CT Phase Start 29 48 Unit % Ex 24 Phase Width 35 19 21 23 25 27 29 31 33 35 37 39 41 4 43 45 47 49 rpm Routine Scan Recon Auto Tasking Replay Trigger The Trigger card will have separate subtask cards for Respiratory and Cardiac settings. The Respiratory card supports selection of Phase Start, Unit, and PET Phase Width. This will define where the cardiac gates are placed in the respiratory region. The Cardiac subtask card supports the selection of Gates or Phase that will be reconstructed in the defined respiratory range. Heart/Respiration Rate (bpm, rpm) Min: 71, 19 Max: 78, 19 Avg: 75, 19 Bed 1/1 75 74 75 74 75 73 74 75 76 19 19 30 31 32 33 34 35 36 37 Respiratory Cardiac 96 72 Gates 8 48 Unit Gates 24 71 73 75 77 79 81 83 85 87 89 91 93 95 97 99 101 bpm Routine Scan Recon Auto Tasking Replay Trigger Notes 24 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications Replay mode must be set to Dual to enable the Respiratory/Cardiac cards on the Notes Trigger card. There is no “Respiratory” image series generated from Dual reconstruction. The respiratory settings simply define the location where cardiac phase or gates will be reconstructed. The user can select Replay mode “Respiratory”, instead of “Dual”, and generate a respiratory image series, but the intent of this protocol is for cardiac gating. Respiratory Cardiac Match CT Amplitude Range Unit Rest In/Ex Phase Width 35 ~ Auto Tasking Replay Trigger Recon job 1 2 3 4 5 6 7 8 Series description PET Cardiac Dual Rest In/Ex 8 Ga m] Recon range (bed) Begin 1 End 1 Replay Type Gated Save Replay Sinograms Replay Mode Dual Skip Beats Cardiac Respiratory Bed Del Dual (s) 1 30 390 Respiratory Source HW Device Routine | Scan Recon | Auto Tasking | Replay Trigger 1.4.7 Acquiring Dual Gated – Cardiac Matching The purpose of this method of cardiac gating provides phase matched synchronization of cardiac gates for both PET and CT. The centers of the CT and PET cardiac gates are automatically aligned. The intent is for respiratory “motion frozen” PET cardiac gates using CT cardiac gates for AC. • Dual gated PET • Requires both Cardiac and Respiratory gating devices. • Define the PET respiratory phase (IN or EX) and the width where PET cardiac gates will be reconstructed. The more narrow the respiratory width, the fewer PET cardiac beats that are included. The wider the PET respiratory width, the more respiratory motion is included in cardiac reconstruction. DualGated_CardiacMatching (Adult) Topogram CT Cardiac RT Pause PET Dual 2 25 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 1.4.8 Acquiring Dual Gated – Respiratory Matching Notes The purpose of this method of cardiac gating provides phase matched synchronization of gates for both PET and CT respiratory gating. The intent is to acquire a respiratory “motion frozen” PET cardiac with CT respiratory AC. • Respiratory gated CT • Dual Gated PET (Cardiac and Respiratory) • Requires both Respiratory and Cardiac gating devices DualGated_RespMatching (Adult) Topogram AN CT Lung RT Pause PET Dual 26 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 1.4.9 TrueD Cardiac Layout Notes There are additional views available in TrueD that allow the user to view the Cardiac studies easier. These new views are Patient Axis View which auto zooms on the heart and Cardiac Axis View which auto zooms on the heart in the SA, VLA and HLA. Patient Transfer Edit View Image Orientation VRT Type Quantification Tools Reports Q UM_VG40_CUT_42 UM_VO40_CUT_42 1517664470.9340.1331250052 UnivofMichigan PETCT MB10556J UM_VO40 CUT 42 Univofmichigan PETCT 10105548 Blographi0 1517664470.9340.1331250052. CT. Tuesday, March 06, 2012 "01-Jan-1928 06-Mar-2012 syngo MI.PET/CT 2012A "01-Jan-1928 PT NAC, Tuesday, March 06, 2012 06-Mar-2012 18:11:44 18:11:44 FUSED MPR FUSED MPR Intervention R Viewing Baseline 50 % PET 50 % CT Volume Registration Data Sets F A Baseline 3D Result CQ CT/PT : 50/ 50 *Default SP FS47.7 W 300 T 9786.0 PROPOPS SL: 3.000 C 40 B 1979.0 PROPOPS UM_VC40_CUT_42 1517664470.9340.1331250052 UnivofMichigan PETCT #810556W "01-Jan-1928 Biographto syngo MI.PET/CT 2012A 08-Mar-2012 18:11:44 Cardiac Registration FUSED MPR TrueD Visualization MIP Quantification Report VLI 02-Nov-2012 10:58.50 Patient Axis View Patient Transfer Edit View Image ge Orientation VRT Type Quantification Tools Reports Options Help UM_VG40_CUT_42 UM_VG40_CUT_42 ALF UnivofMichigan PETCT //@10556/ UM_VG40_CUT_42 Univofmichigan PETCT 18105560 1517664470.9340.1331250052 ... Biograph40 1517664470.9340.1331250052 .. CT, Tuesday, March 06, 2012 "01-Jan-1928 06-Mar-2012 syngo MI.PET/CT 2012A "01-Jan-1928 PT NAC, Tuesday, March 06, 2012 06-Mar-2012 18:11:44 18:11:44 FUSED MPR FUSED MPR Intervention 8 B Viewing 50 % PET Baseline 50 % C Volume Registration Data Sets LAIL Baseline 3D Result CQ! CT/PT : 50/50 CQ *Default SP F469.3 W 300 T 9786.0 PROPOPS St. 3.000 C 40 B 1979.0 PROPCPS SP A312.5 HLA SL: 3.000 UM_VG40_CUT_42 1517664470.9340.1331250052. Sichigan PETCT JB10556/ "01-Jan-1928 Biograph40 syngo MI.PETACT 2012A auto 06-Mar-2012 18:11:44 Cardiac Registration FUSED MPR TrueD Visualization MIP Quantification LP Report 02 . Nov- 2012 11:00: Cardiac Axis View 27 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 2 Respiratory Gating 2.1 Objectives Notes By the end of this section, the user will be able to: • State the principles behind respiratory gating. • Learn about the Anzai Respiratory Gating Device • Learn about the Varian Respiratory Gating Device • Perform respiratory gating exam with Varian • Explain respiratory gating reconstructions • Acquiring Respiratory Gating Step and Shoot or CBM • Acquire Respiratory Gating Respiratory Matching 2.2 Respiratory Gating Principles and Setup 2.2.1 CT Respiratory Gating Basics There are two methods of respiratory gating the CT study. The first method is CT Prospective Acquisition. This is a sequential, non-helical acquisition which is triggered by the patient’s respiration at a set phase in the respiratory cycle. This method utilizes either the Anzai or Varian gating device which must be configured to provide a “trigger” (X-Ray ON) signal. The other method is CT Retrospective Reconstruction. This method uses a helical acquisition which is limited to 100 seconds in duration. The CT scan is acquired simultaneously with the recording of the respiratory waveform utilizing either the Anzai or Varian RPM configured to record full respiratory cycle. This allows for reconstruction of single, multi-phase and gated datasets post acquisition at any phase in the respiratory cycle. 2.2.2 PET Respiratory Gating Basics During respiratory gating of the PET, emission data and respiratory waveform data are recorded simultaneously. Reconstruction of this data is always retrospective. This provides support for single phase, multi-phase, gates, or “motion frozen” respiratory reconstruction in the same protocol. Reconstruction options are dependent upon licensing. PET respiratory gating supports both Anzai and Varian RPM systems. 2.3 Respiratory Gating Equipment – Anzai 2.3.1 Load Cell Fixing Belt: • Available in 4 sizes, XS, S, M, L, LL 28 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 2.3.2 Load Cell or “Pressure Sensor” (Low and High Load Cells) Notes • Low = Low Sensitivity (best for deep breathing patients.) • High = High Sensitivity (best for shallow breathing patients.) 2.3.3 Wave Deck and Laptop Computer • With Anzai’s Gating Software 2.3.4 Sensor Port • Amplifies analog respiratory signal SENSOR PORT 29 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 2.3.5 Anzai Load Cell Calibration Notes Anzai load cell calibration is recommended at least one per year to maintain required performance levels. Complete instructions can be found in the Anzai Operators Manual. Required equipment for calibration is provided by Anzai. In the case of Load Cell (Low) Turning LOAD CELL CAL. OFF ON Max. R.R. LOW Clockwise : 20 R.R. HIGH Counter Clockwise : 20 R.R. ZERO Caution: In both direction the trimmer can Load Cell Zero Adjustment Trimmer GATE be turned over 20 R.R. but it does Load Cell Calibration Zero Adjust LED not affect adjustment any more. Load Cell Calibrator Load Cell Flat Surface 2.3.6 Gating Switch Box For CT Prospective gating, the Gating Switch Box will be set to Trigger mode. The Anzai laptop must be used with the Gate Out ON enabled. BLACK BOX SWITCH Anzai Setting Gate Out ON Black Box on Trigger For Retrospective CT and PET gating, the Gating Switch Box will be set to Waveform mode. The Anzai laptop is NOT needed for this type of gating. 30 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 2.3.7 Respiratory Curve on the Trigger Card Notes The VG50 software by default will scale the respiratory curve in the Trigger card. There is also manual adjustment, and if used, disables the auto adjustment until the exam is ended. For manual adjustment, click the Curve Setup icon on the Trigger card. The Trigger card display mode changes to allow adjustments for both Gain and Offset The Gain slider controls the curve Amplitude. The Offset slider shifts the entire curve along the Y-axis. Click Close to return to the normal display mode. RespiratoryGated (Adult) RespGated 253.1 mm 4 min 0 mCi Topogram Respiration Rate (rpm) Min: 14 Max: 15 Avg: 14 CT Lung 15 Paus AL PET Lung Load Recon Gain: - 2.9 Offset - 20 Close Routine Scan Recon Auto Tasking Replay Trigger 31 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 2.4 Respiratory Gating Equipment – Varian Notes Marker Block Marker Block Infrared Camera VARIAN RESP GATE TEST Gating Interface Box RPM Workstation Varian RPM is supported by the Open Interface Option. Open Interface essentially informs the software that an external “unknown” gating device will be used for respiratory gating. To activate Open Interface, from Options -> Configuration -> Respiratory Gating -> select Open Interface. ` Respiratory Gating X General General settings Respiratory Gating Demo Mode Respiratory Synthetic Sync Open Interface (or Average CT without gating device) OK Apply Default Settings Cancel Help 32 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications After enabling Open Interface in Options -> Configuration, you will get this Notes message when loading a respiratory gating protocol. Enabling Open Interface provides the options Continue and allows the user to proceed with the respiratory protocol. Without this checked, you will only get Try Again or Cancel. Respiratory Gating x No communication with Respiratory Gating system. X Please check the Respiratory Gating system and try again or continue without CT Respiratory Gating system. If you press CANCEL, Respiratory ranges will not be scanned. Try Again Continue Cancel 2.5 Performing Respiratory Gating 2.5.1 CT Respiratory Gating Acquisition with Varian CT Prospective Gating Varian gating should start AFTER the Topogram and just PRIOR to the CT scan. 1. In the Varian software, select Record and Enable Gating. This provides the trigger (X-Ray ON) signal to the CT gantry. 2. Start the CT scan and allow the CT sequence scan to complete. 3. Stop the Varian gating. There is no need to save the .vxp file, as retrospective reconstruction is not an option. The Trigger card is not present in prospective CT protocol. CT Retrospective Varian gating should start AFTER the Topogram and just PRIOR to the CT scan. 1. In the Varian software, select Record. 2. Start the CT scan and allow the scan to complete. 3. Then stop the Varian gating and save the .vxp file for import. 4. It is important to Start/Stop the Varian gating with each subsequent CT scan, so that each CT scan has a unique .vxp file. 5. The Trigger card is present in retrospective CT protocols, but the waveform is not viewable until imported from Varian. 33 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 2.5.2 PET Respiratory Gating Acquisition with Varian Notes PET Gating Varian gating should start AFTER the Topogram and CT scan, and just PRIOR to starting the PET acquisition. 1. In the Varian software, select Record (“Enable Gating” is not required, but there is no harm if it is enabled.) 2. Start the PET acquisition and allow it to complete. 3. Stop the Varian gating and save the .vxp file for import. 4. After importing the .vxp file, the waveform will be present in the Trigger card and reconstructions can then be performed. The Varian .vxp file should be saved with a unique name that can be easily identified with the corresponding CT or PET data set. Remember, during the CT or PET acquisition, the Biograph software only knows that an external gating device is being used, and there is no direct link between the .vxp file and the CT/PET data. Importing Varian .vxp File To perform CT and/or PET gating reconstructions, the Varian .vxp waveform file must be imported. There are two options to import this file: • Network Share – Requesting your CSE to create a new directory in the H: partition and share the directory. • Transport the data via USB 34 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications When the acquisition is complete, you will have the opportunity to import the file Notes through the Trigger card. ICHEN INTERFACE - Poina inport migratory ditalia Routine Som Recon Replay | Incoer mport Respiratory File Fie Foder O BRAWDATA F he Folder 3/23/2011 6 59 O MInic wo Fie Folder 3/15/2011 10 1 DERROR F te Folder 3/14/0011 123 Fie Foider 3/15/2011 10 1 O SMALLSLOPE F he Folder 9/16/2011 2:04 OTemp Fle Fokder 3/18/2011 3:48 OWO LUNO Fie Folder Fle Folder 3/23/2011 5:15 3/23/2011 6:44 -- 35 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications Once the .vxp file has been imported, it will populate the Trigger card. Reconstruct Notes the data with the desired outcome. PET EN Im Examination Filming 3D PETCT_RespWaveform_Gated (haut) Berciar. on-ple gating Varien Topogram GT LUN Pause AL ., PET Lung Ricon Replay Bercier, on-site gating Varian 220.9 mm 3 min 10 mC Reconjob 1 2 2 2 2 2 2 2 Senes descripbon PET Lung Gated Recon range (bed) Begin 1 End 1 . Replay Type Gated P Save Replay Sinograms Bed Delay (s) 0 180 Wawfont Rest inEx Duy Cyde 5. Amplitude Range 0.2% Routine Scan Recon Auto Tasking Replay Trigger PNP Device Mounted . Drie(F ) Total Space(205242 MC) 320/2011 3:24 36 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 2.5.2. Respiratory Gating Reconstruction Notes Types of Respiratory Gated Reconstructions: • Single Phase • Multiphase • Gates • HD – Chest (PET Only) Single Phase/Multiphase: This method reconstructs a single phase at the specified location in the respiratory cycle. The phase start can be anywhere between 0 – 100%. Gates This method utilized up to a maximum of 24 gates. CT respiratory gates are defined based on the time between respiratory cycles. The cycle time is divided evenly by the number of gates and the gate is placed in the center of each gate. The CT gate width is determined by temporal resolution (rotation time of the protocol.) The PET gate definition follows similar rules, but is not limited by temporal resolution, so the PET gate spans the entire gate width with no gaps between gates. HD – Chest (PET Only) This type of respiratory gating uses an amplitude-based method for respiratory gated reconstruction. The respiratory waveform is stored along with the listmode data from the PET scanner. A computer program analyzes the entire waveform to determine the “optimal” or area of least respiratory motion within the waveform. The Phase Width allows the user to change the relative duration of the gate to accept more or less respiratory motion. Respiration Rate (rpm) Min: 12 Max 12 Avg 12 Bed 14 12 12 12 12 14 Match CT Amplitude Range 0-8% Unit Rest MYEx Phase Width 35 Routine Scan Recon Auto Tasking Replay Trigger 37 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 2.5.3 Acquiring Respiratory Gating – Step and Shoot or CBM Notes 1. Register a patient 2. Define a study – for example, RespiratoryGated, RespiratoryGatedCBM 3. Select Exam 4. Position the patient for exam 5. Attach the Respiratory Gating device, ie Anzai or Varian Stopping the System: In critical situations, press an E-Stop push button to stop all system movements immediately and to shut down radiation. 6. Acquiring the Respiratory Gated scan The topogram and CT are acquired as normal. The PET Routine sub-task card is below. Notice the Respiratory Gate icon in the chronicle. Respiratory Gated PET can be either Step and Shoot which allows for multiple beds to be gated or CBM (Continuous Bed Motion) which allows the user to define a custom scan range over the area of interest. (No need to align “beds” over the lungs.) ` Topogram CT Lung 1 Pause JA, PET Lung 2 The user can either acquire the respiratory acquisition with the trigger method or with HD Chest (waveform) method by selecting the correct method on the black box. 7. Reconstruction will then be done with one of the three methods, Single/ Multiphase, Gates or HD-Chest (Motion Frozen). 38 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 2.5.4 Acquiring Respiratory Gating – Respiratory Matching (S&S or CBM) This acquisition provides phase matched synchronization of gates for both PET and CT respiratory gating. The centers of the CT and PET gates are automatically aligned for improved AC. The user will be able to acquire in either Step and Shoot or Continuous Bed Motion. This will require a respiratory gating device. RespGated_RespMatching (Adult) Resp Gated, Resp Matching 12.11.20-14:39:45-STC Total mAs: O Topogram MA 35 # A, CT Lung KV 120- Pause Scan time 5.3 9 AM, PET Lung 0000 Slice 0.6 mm Topogram length -12mm Tube position >Top Bottom · Lateral Comments Table: Position Height 590.0 99.0 Craniocaudal Load Cancel Recor Routine Scar Auto Tasking Trigger This is a good example of the challenges of matching CT and PET respiratory gates. Because of the temporal resolution of the CT, note the gaps between CT gates. RespGated_RespMatching (Adult) RespGated_RespMatching 12.11.16-16:41:34-STC Total mAs: 4560 Topogram Respiration Rate (rpm) Min: 15 Max: 15 Avg: 15 AA CT Lung 1000 15 15 15 15 Pause AL PET Lung 0000 36 46 48 Gates Unit Gates Original RESP Average CT Load Hold Recon Recon Routine Scan Recon Auto Tasking Trigger Notes 39 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications Match CT is enabled on the Trigger card, so the centers of the PET gates will match the CT gates, but the phase width of the gates are not the same. RespGated_RespMatching (Adult) RespGated_RespMatching 164.0 mm 1 min 6 mC Topogram Respiration Rate (rpm) Min: 15 Max: 15 Avg: 15 Bed 1/1 AA CT Lung 15 15 15 Pause A PET Lung 2 30 32 34 36 38 40 42 44 16 Match CT 12 Gates 8 Unit Gates Load Hold Recon 16 rpm Recon Routine Scan Recon Auto Tasking Replay Trigger Notes 40 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 3 Whole Body Listmode 3.1 Objectives After this session, the user will be able to: • Acquire Whole Body Dynamic Step and Shoot or CBM • Acquire Whole Body Listmode • Acquire PET Guided CT 3.2 Performing Whole Body Listmode 3.2.1. Acquiring Whole Body Dynamic – Step and Shoot and CBM This protocol allows the user to perform multiple passes with variable bed time durations. The maximum number of passes is 25. The acquisition mode is Sinogram. WholebodyDynamic (Adult) PETCT, test 787.7 mm 48 min 0 mCi Topogram Isotope F-18 Pharm. Fluorodeoxyglucose CT WB 1 Dose 0.00 mCi Pause Date 5/1/2013 Time 9:26:11 AM PET WB Dyn Scan range Match CT Range 2 Bed Duration min Passes 2 wwwa Pass : 2 Pass Delay 0 Sec Range: Begin End Table: Position Height Scan direction Load Hold Recon -1534.0 -746.0 -850.0 102.0 Caudocranial Recon Routine Scan Recon Auto Tasking Notes 41 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications The user can define the number of passes to include in the reconstruction and the number of beds within those passes. WholebodyDynamic (Adult) PETCT, test 787.7 mm 48 min 0 mCi Topogram Recon job 1 2 3 4 5 6 7 8 Series description PET WB Dynamic CT WB RT Pass 2 Bed 1 8 Attenuation correction CT Pause Output Image type Corrected AC CT WB 5.0 HD_FoV (1v PET WB Dyn Recon method TrueX+TOF (ultraHD-PET) Registration Matrices 2 Iterations 2 Subsets 21 Default Image size 200 Zoom 1.0 Scatter correction Filter Gaussian FWHM (mm) 5.0 v Match CT slice location Save mu-map image Offset (mm) x 0.00 0.00 Metal Artifact Reduction Comments Load Hold Volume Scaling Recor Recon Routine Scar Recon Auto Tasking Notes 42 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 3.2.2 Acquiring Whole Body Listmode This protocol supports Whole body Listmode acquisition without the need of a cardiac or respiratory device. The user can also define variable bed durations. The acquisition is really not any different than the original Whole body protocol that is acquired in sonogram mode. WholebodyListmode (Adult) PETCT, test 787.7 mm 24 min 0 mCi Topogram Isotope F-18 Pharm. Fluorodeoxyglucose CT WB Dose 0.00 mCi E Pause Date 5/1/2013 Time 9:28:23 AM PET WB Scan range v Match CT Range 2 Bed Duration min 2 3 4 5 Range: Be nd Table: Position Height Scan direction wwwww a Load Hold Recor -1534. -746.0 -850.0 102.0 Caudocranial Recon Routine Scan Recon Auto Tasking Replay Notes 43 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications This protocol will support multiple bed static reconstructions with Delay and/or Duration changes. The user will also be able to reconstruct Dynamic single bed positions with Delay and/or Duration changes. WholebodyListmode (Adult) PETCT, test 787.7 mm 24 min 0 mCi m Topogram Recon job 1 2 3 4 5 6 7 8 Series description PET WB CT WB Recon range (bed) Begin 1 End 8 E Pause Replay Type Static vSave Replay Sinograms PET WB 2 Bed Delay (s) Duration (s) 180 O 180 0 180 4 0 180 5 0 180 180 180 0 180 O Load Hold Recor Recon Routine Scar Recon Auto Tasking Replay Notes 44 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 3.2.3 Acquiring PET Guided CT – Whole Body Topo Notes PET Guided CT is a single regular PET exam which then allows the user to plan the CT acquisition for AC and/or diagnostic purposes off of the acquired PET, thus reducing exposure to areas that are not of interest. PET Guided CT is NOT a “fast” PET plus a full diagnostic PET like a CT Topogram/ Spiral combination. The PET drives the CT with a PET Topogram followed by a CT Spiral scan range based on the PET Topogram. This will avoid the CT dose from the CT Topogram and any CT dose that is outside of the area of focus “guided” by the PET. This is a low dose alternative for sites that want to perform PET screening and therapy monitoring, lower dose for pediatrics or in Biomarker research support. This protocol can be acquired as either Step and Shoot or Continuous Bed Motion. Patient Applications PET Edit Insert View Setup Image Options System Help H Examination 3D WholebodyTopo (Adult) PET, Topo 609.5 mm 18 min 12 mCi - PET WE sotope F-18 Pharm. Fluorodeoxyglucose L PET Topogram Dose 12.00 Pause Date 06-Feb-2013 Time 14:07:20 CT WB RT Scan range Match CT Range No. of beds 6 Scan duration/bed min Range: Begin End Table: Position Height Scan direction Load 1010 econ -1781.5 -932.0 74.5 99.0 Caudocranial Routine Scan Recon Auto Tasking Automatic checkup procedure completed successfully 06-Feb-2013 14:07:50 1% 45 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications The user will utilize the Table Begin/End position buttons (8) on the VG50 gantry Notes to tell the system where you want the scan to start and stop. On the VG40 gantry, the user will utilize the Top Gantry Tilt button for Begin and the Bottom Tilt Button for End (8). Always use the inside laser when configuring the Begin and End positions. (1) (2) (3) (12) * (4) (14) (9) (9) STOP (15) (7) (8) (13) (10) (11) (5) (6) VG50 (9 * * (1) (2) 8 (3) STOP Q1 4 6 (5) (15) (10) (11) (12) (13) (14) VG40 46 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications The user must wait for the PET Topo reconstruction to complete before planning for the CT. The CT is then planned from the 2nd PET WB recon job. Patient Applications PET Edit Insert View Setup Image Options System Help Examination | PET, Topo H Altair 13.02.06-14:07:00-STD-1.3.1. Biograph 64_mCT *06-Feb-1968, M. 45Y VG50A 06-Feb-2013 H-SP 14:14:59.00 2 IMA 2 PET_1001 SP -249.6 3D 10cm: 139 WholebodyTopo (Adult) PET, Topo 609.5 mm 60 sec 12 mCi - PET WB Isotope F-18 Pharm. FluorodeoxyglucoseY PET Topogram 2 Dose 12.00 mCi Pause Date 06-Feb-2013 Time 14:08:5 CT WB RT Scan range Match CT Range No. of beds Scan duration/bed 10 sec RH Range: Begin End Table: Position Height Scan direction Load Hold Recon -249.5 -859.0 -1391.5 v 99.0 Craniocaudal Recon Routine Auto Tasking TrueD started 06-Feb-2013 14:18:47 Notes 47 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications The Step and Shoot PET beds will be reconstructed based on the CT Scan Range. You can see in this picture that the PET Recon range is reduced to a single bed position with the CT scan range adjusted to match. Patient Applications PET Edit Insert View Setup Image Options System Help test H University of Tennessee Medica .. 13.04.03-09:05:50-S *04-03-91. M. 22Y Biograph 64_mCT 04-03-13 H-SP 12:51:33.00 2 IMA 2 PET_1001 SP 108.4 13-1 MAMAMAN T 777% M ??8 777% WholebodyTopo (Adult) test 472.3 mm 3 min 10 mCi - PET WB Recon job 2 3 4 5 6 7 8 Series description PET WB - PET Topogram Recon range (bed) Begin 2 End 2 Attenuation correction CT Pause Output Image type Corrected AC CT WB 5.0 eFoV (3-1) CT WB RT Recon method TrueX+TOF (ultraHD-PET) Registration Matrices Iterations 2 Subsets 21 Default Image size 200 Zoom 1.0 Scatter correction Filter Gaussian FWHM (mm) 5.0 Match CT slice location Save mu-map image Offset (mm) X 0.00 Y 0.00 Metal Artifact Reduction Hold Comments Volume Scaling Load Recon Recon Routine Scan Recon Auto Tasking Notes 48 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications The Continuous Bed Motion (CBM) scan will allow you to choose a “Custom” recon range which allows the user to define the range by adjusting the recon range lines to the desired range. The CT scan range will automatically match the PET for accurate attenuation correction. atient Applications Edit Insert View Image Options System Help test H University of Tennessee Medica. 13.04.03-09:08:46-STD-1.3.1 Biograph 64_mCT 04-03-91. M. 22Y VG50A 04-03-13 H-SP 13:02:22.28 2 IMA 2 PET_1001 SP -153.5 O T 100% WholebodyTopoCBM (Adult) test 582.0 mm 116 sec 10 mCi - PET WB Recon job 1 2 3 4 5 6 7 8 Series description PET WB - PET Topogram Recon range Custom Begin -306.0 End -579.6 Attenuation correction CT Pause Output Image type Corrected AC CT WB 5.0 eFoV (3-1) CT WB RT Recon method TrueX+TOF (ultraHD-PET) Registration Matrices Iterations 3 Subsets 21 Default Image size 200 Zoom 1.0 Scatter correction Filter Gaussian FWHM (mm) 2.0 F Match CT slice location Save mu-map image Offset (mm) × 0.00 Y 0.00 Metal Artifact Reduction Hold Volume Scaling Recon Comments Load Recon Routine Scan Recon Auto Tasking Notes 49 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications After the CT is acquired and reconstructed, submit the second (AC) PET recon job. Patient Applications PET Edit Insert View Setup Image Options System Help PET, Topo H Altair Examination 13.02.06-14:07:00-STD-1.3.1 *06-Feb-1968, M, 45Y Biograph 64_mCT VG50A 06-Feb-2013 H-SP 14:14:59.00 2 IMA 2 PET_1001 SP -249.6 3-1 3D 10 cm V WholebodyTopo (Adult) PET, Topo 609.5 mm 60 sec 12 mCi - PET WB Reconjob 1 2 3 4 6 7 8 Series description PET WB PET Topogram Recon range (bed) Begin 5 End 6 Attenuation correction CT Pause Output Image type Corrected AC CT WB 5.0 HD_FoV (3 CT WB Recon method TrueX+TOF (ultraHD-PET) Registration Matrices 4 Iterations 2 Subsets 21 Default Image size 200 Zoom 1.0 Scatter correction Filter Gaussian FWHM (mm) 5.0 Match CT slice location Offset (mm) X 0.00 =Y 0.00 Save mu-map image Metal Artifact Reduction Load Hold Volume Scaling Recon Comments Recon Routine Scan Recon Auto Tasking Reconstruction range has been adapted to match to associated CT TrueD started 06-Feb-2013 14:24:23 Note: Concerning PET Guided CT Workflow: Due to no X-Ray Topogram being performed, CARE Dose is not an option during the CT Spiral. The user should be aware of the mAs settings in the CT chronicle and adjust accordingly. Notes 50 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 4 Additional Advanced Features 4.1 PET Image Statistics Notes The PET Image Statistics option is configurable in PET Examination in the Option -> Configuration pull down. There are three options you can configure: Recon, Gating and Count Rate. The files will be created after the acquisition is complete. The files are selectable from the Patient Browser and are called PET Statistics. The file will be displayed in the syngo Viewing Task Card Patient Applications PET Edit Insert View Setup Image Options System Help Examination min max 6 199 Flintstone, Fred H Hospital :Flintstone, Fred Hospital mAs/rot. 5551212 *31-Oct-1962, M, 50Y Biograph40 :5551212 Biograph40 MI.PET/CT 2013A : 31-Oct-1962, M, 50Y MIPETICT 2013A 31-Oct-2012 H-SP :31-Oct-2012 H-SP-CR 06:44:47 68 06: 48 15 88 1 IMA 1 TOP 1 15 Patient Browser LO x SP -66 Patient Applications Transfer Edit PET View Filter Evaluation Sort Options Help ? × uma 3D PET - 11111 / INP/LOC [2] CT Cardiac 3.0 B30f 0% 11/11 / INP/LOC [3] PET Cardiac 11111 / INP/LOC Local Database Flintstone, Fred PET CardiacGated CLAPET Statistics 11111 Prot OPEN 11111 Prot OPEN MA 35 Scheduler 103012 PET CardiacGatec [5] CT Cardiac 3.0 B30f 8 Gates Matr JDICOM ///// / OPEN 11111 Proy OPEN 11111 / INP/LOC GT 0.0 CD_DVD FROM, FREE [6] PET Cardiac 8 Gates 512 00 ///// / OPEN /11/ / INP/LOC T80fU Cardiac [7] CT Cardiac 3.0 B30f 0-50% Card 1111el / OPEN /// / INP/LOC lui [8] PET Cardiac 0% 3998 ///// / OPEN #1/11 / INP/LOC 102912 [101] AC CT Cardiac RTD ///// / OPEN 102812 [4011 ECG CT Cardiac 3.0_B30f 0% Patient name Flintstone, Fred Date of birth 31-Oct-1962 Patient ID 5551212 Study description PET CardiacGated CardiacMatching (Adult) Study date 31-Oct-2012 Modality PT Instanc ... Instance Type Instance Date and Time Instance Comment 40 2000 [DERIVED] [SECONDARY] [OTHER] 31-Oct-2012 06:51:50 PET Cardiac Count Rate Statistics 2001 [DERIVED] [SECONDARY] [OTHER] 31-Oct-2012 07:05:32 PET Cardiac Gating Statistics 2002 [DERIVED] [SECONDARY] [OTHER] 31-Oct-2012 06:51:47 PET Cardiac Reconstruction Settings 2002 [DERIVED] [SECONDARY] [OTHER] 31-Oct-2012 07:05:32 PET Cardiac Reconstruction Settings Current Filter. Off Recon mono 150 ms Load Reco Recor Routin Scan Recon Auto Tasking Trigger TrueD started 31-Oct-2012 07:07:25 51 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications Patient Applications Transfer Edit View Image Tools Scroll Evaluation Options Help Notes 5551212 *31-Oct-1962, M, 50Y EXAM 31-Oct-2012 EXAM 06:43:50 4 IMA 2000 PET Count Rate Curve Intervention Trues Randoms 258.0 Viewing 215.0 172.0 3D Tools Image View 129.0 86.0 TrueD 43.0 Vi Patient | Eval 11 23 34 46 57 69 80 91 103 x 1000 counts/sec 114 Start Time 31-Oct-2012 06:49:48 Min Trues 251716@98 Scan Duration (sec) 120 Max Randoms 68616@62 Max Trues 257992@42 Min Randoms 66272@40 PET Cardiac Count Rate Sta tistics W 512 C 2048 31-Oct-2012 07:13:25 The PET Recon Statistics Patient Applications Transfer Edit View Image Tools Scroll Evaluation Options Help 5551212 *31-Oct-1962, M, 50Y EXAM 31-Oct-2012 EXAM 06:43:50 4 IMA 2001 AC Intervention PET Cardiac Gating Statistics Delay (sec) Match CT Gating Duration (sec) Total Cycles Viewing Heart Rate (bpm) Accepted Cycles Number of gates Rejected Cycles Gating Definition Skipped Cycles Phase (or Gate) Width 3D 100 Tools | Image | View 50 TrueD 40 80 120 160 200 240 bpm Patient Eval PET Cardiac Gating Statist W 512 ics C 2048 31-Oct-2012 07:14:49 The PET Count Rate Curve 52 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications Patient Applications Transfer Edit View Image Tools Scroll Evaluation Options Help Notes 5551212 31-Oct-1962, M, 50Y EXAM 31-Oct-2012 EXAM 06:43:50 4 IMA 2002 Intervention PET Recon Statistics Series Description PET Cardiac 8 Gates Offset X,Y(0.00, 0.00) Output Image Type Corrected Scatter Correction Yes Viewing Attenuation Correction CT CT Cardiac 3.0 Match CT Slice Location Yes Recon Method Iterative3D TOF Save mu-map No 3 Metal Artifact Reduction No Subsets 21 Volume Scaling No Image Size 200×200 Requested Procedure PET CardiacGated Zoom 2 Body Part Examined 3D Filter Gaussian Decay Correction Date/Time 31-Oct-2012 06:49:49 Filter Order 3 Image Units BQML Louis Image | View FWHM TrueD Patient | Eval E PET Cardiac Reconstruction W 512 Settings C 2048 31-Oct-2012 07:15:49 The PET Gated Statistics The type of acquisition will determine which image statistics are generated: • Non-gated routine protocols – Recon Parameters only • Non-gated listmode protocols – Recon Parameters, Count Rate Statistics is provided for single bed Step and Shoot only. (Multiple bed S&S and CBM excluded) • Cardiac Gated protocols – Recon Parameters, Count Rate Statistics and Cardiac Gating Statistics will be available. • Respiratory Gating protocols – Recon Parameters and Respiratory Gating Statistics will be provided. Count Rate Statistics is provided for single bed S&S only. (Multiple bed S&S and CBM excluded) 53 Turnover Workbook | Biograph mCT and mCT Flow Advanced Applications 4.2 PET Count Rate Info and Curve Notes The count rate curve will be present on the PET Scan subtask card after the PET exam is complete. By default, Trues and Randoms values are displayed for time 0 and will report low values. You are able to place a cursor on the count rate curve graph and display the corresponding time, Trues and Randoms rates. The user also has an option to Export Count Rate Data to Excel as a CSV file. The Count Rate Curve can be helpful in determining delay and/or frame rate times. Auto Load 5841 Auto Move 4764 Auto Start 3688 2612 Language English 1535 459 API None -618 x1000 counts/sec 64 128 192 256 320 384 Time 74 Cardiac Type None Trues 646 Randoms 2333 Routine Scan Recon Auto Tasking Replay Trigger 54 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 do not always have to be Local Contact Information present in individual cases. Siemens Medical Solutions USA, Inc. Siemens reserves the right to modify the 51 Valley Stream Parkway design, packaging, specifications and options Malvern, PA 19355-1406 described herein without prior notice. Please USA contact your local Siemens sales representative Telephone: +1-888-826-9702 for the most current information. www.usa.siemens.com/healthcare Note: Any technical data contained in this document may vary within defined tolerances. Global Business Unit Original images always lose a certain amount Siemens Medical Solutions USA, Inc. of detail when reproduced. Molecular Imaging 2501 N. Barrington Road Hoffman Estates, IL 60192-2061 Order No. A914CX-CS-15231-P1-4A00 USA Printed in USA 12-2014 | All rights reserved Telephone: +1-888-826-9702 © 2014 Siemens Medical Solutions USA, Inc. www.usa.siemens.com/healthcare Global Siemens Headquarters Global Siemens Healthcare Siemens AG Headquarters Wittelsbacherplatz 2 Siemens AG 80333 Muenchen Healthcare Sector Germany Henkestrasse 127 91052 Erlangen Germany Telephone: +49 9131 84-0 www.siemens.com/healthcare www.siemens.com/healthcare