c.cam Turnover Workbook

SIEMENS c.com c.cam User Services www.usa.siemens.com/education c.cam Turnover Workbook Answers for life. Turnover Workbook | c.cam 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 More: Clinical Performance Routine Expertise Confidence 2 Turnover Workbook | c.cam 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. Buy.” options, accessories, get the most out of your investment throughout and clinical education to make the most of your the entire product life cycle and beyond. Our goal imaging equipment? Discover images, case studies, is to enable you to take technology further, and video demonstrations with the latest clinical profitability higher, and patient care to the next applications. Try advanced applications utilizing level. Find the information, resources, and tools free software trials. Buy applications, coils, clinical you need to get the most out of your recent education, and accessories, conveniently at any time. investment and stay up-to-date. Visit Visit www.usa.siemens.com/webShop today! www.usa.siemens.com/Welcome2Healthcare. Clinical Training and Siemens Training Centers Continuing Education Siemens Clinical Education Training Center – TDC2 Siemens Customer Care Center 110 Mac Alyson Court Call 1-800-888-7436 Cary, NC 27511 • Troubleshooting assistance • Immediate assistance for software applications and workflow issues Please provide the Functional Location Number when calling for assistance. Clinical Education Offerings: 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. 3 Turnover Workbook | c.cam II Contents I Contact Information Summary ............................................................................................... 3 II Contents .............................................................................................................................. 4 III Course Agenda .................................................................................................................... 7 IV Course Objectives ................................................................................................................ 8 1 System Safety ....................................................................................................................... 9 1.1 Objectives .................................................................................................................... 9 1.2 Weight Limitation ......................................................................................................... 9 1.3 Emergency Stops .......................................................................................................... 9 1.4 Touch Pads ................................................................................................................... 9 1.5 Emergency Hand Crank............................................................................................... 10 2 Components and Controls ................................................................................................... 11 2.1 Objectives .................................................................................................................. 11 2.2 System Components ................................................................................................... 11 2.3 Hand Control.............................................................................................................. 12 2.4 Laptop Layout............................................................................................................. 14 3 System Power..................................................................................................................... 16 3.1 Objectives .................................................................................................................. 16 3.2 Recommendations ...................................................................................................... 16 3.3 Power Up .................................................................................................................. 16 3.3 Power Down.............................................................................................................. 16 4 Quality Control ................................................................................................................... 17 4.1 Objectives .................................................................................................................. 17 4.2 Daily QC..................................................................................................................... 17 4.3 Weekly QC.................................................................................................................. 21 4.4 Monthly QC................................................................................................................ 23 5 Patient Registration ............................................................................................................ 29 5.1 Objectives .................................................................................................................. 29 5.2 Manual Patient Registration ........................................................................................ 29 5.3 Worklist Patient Registration (optional)........................................................................ 30 6 Overview of Acquisition Workflows...................................................................................... 31 6.1 Objectives .................................................................................................................. 31 6.2 Modification of Acquisition Workflows......................................................................... 31 7 Acquisition Setup................................................................................................................ 32 7.1 Objectives ................................................................................................................. 32 7.2 Tomo Acquisition Setup .............................................................................................. 32 7.3 Gated Tomo Acquisition Setup..................................................................................... 34 8 Hand Controller and Special Keyboard Functions .................................................................. 36 8.1 Objectives .................................................................................................................. 36 8.2 Hand Controller.......................................................................................................... 36 4 Turnover Workbook | c.cam 9 Patient Database................................................................................................................. 39 9.1 Objectives ................................................................................................................. 39 9.2 Acquisition Page Database .......................................................................................... 39 9.3 Home Page Database .................................................................................................. 40 10 syngo® MI Apps Workstation ............................................................................................. 41 10.1 Objectives ............................................................................................................... 41 10.2 MI Workplace Command Module ............................................................................... 41 10.3 MI Apps (e.soft) Patient Browser................................................................................ 42 10.4 Workflow Template Browser ...................................................................................... 43 10.5 Workflow Manager ................................................................................................... 44 10.6 Launching a Workflow .............................................................................................. 45 10.7 Workflow Navigator .................................................................................................. 45 10.8 Modifying and Saving a Workflow Template ............................................................... 46 11 Processing Workflows........................................................................................................ 48 11.1 Objectives ................................................................................................................ 48 11.2 Quality Control Activity (Motion Correction)............................................................... 48 11.3 Auto Recon Activity................................................................................................... 50 11.4 Planar Gated (MUGA) Processing ............................................................................... 51 12 Display Activities............................................................................................................... 52 12.1 Objectives ................................................................................................................ 52 12.2 Flexible Display......................................................................................................... 52 12.3 Saving Pages as JPEGS and AVI Files........................................................................... 55 13 Patient Browser ................................................................................................................ 56 13.1 Objectives ................................................................................................................ 56 13.2 Accessing the Patient Browser................................................................................... 56 13.3 Patient Databases ..................................................................................................... 56 13.4 Correcting a Patient Name, ID Number, or Other Demographics .................................. 57 13.5 Rearranging a Patient Study and Series ...................................................................... 57 13.6 Manually Transferring Data ....................................................................................... 57 13.7 Manually Archiving Data ........................................................................................... 57 13.8 Retrieving Data from an Archival Device .................................................................... 58 13.9 Ejecting a CD or DVD................................................................................................. 58 13.10 Deleting Data ......................................................................................................... 58 14 MI Apps Cleanup............................................................................................................... 59 14.1 Objectives ................................................................................................................ 59 14.2 Procedure................................................................................................................. 59 15 Online Help ...................................................................................................................... 60 15.1 Objectives ............................................................................................................... 60 15.2 Purpose and Accessing.............................................................................................. 60 5 Turnover Workbook | c.cam 16 c.clear.............................................................................................................................. 61 16.1 Objectives ............................................................................................................... 61 16.2 Overview.................................................................................................................. 61 16.3 c.clear Quality Control .............................................................................................. 62 16.4 Far Blank Scan .......................................................................................................... 62 16.5 Source Replenishment .............................................................................................. 64 16.6 Near Blank Scan........................................................................................................ 64 6 cicam III Course Agenda Day 1 System Safety Components and Controls System Power Quality Control Day 2 Patient Registration Overview of Acquisition Workflows Acquisition Setup Hand Controller and Special Keyboard Functions Patient Database syngo® MI Workplace MI Apps Overview Processing a Workflow Display Activities Day 3 Patient Browser MI Apps Cleanup Online Help Day 4 c.clear Quality Control Schedule 7 IV Course Objectives The purpose of this training session is to provide you with the skills and knowledge to operate your c.cam system. Learning Objectives After completing this training session, you will be able to: • Demonstrate knowledge of system safety • Describe the component layout • Navigate the functions and location of the system controls • Perform the daily quality control procedures • Perform the system shutdown/restart • Demonstrate how to customize and make modifications to scanning workflows • Demonstrate proper patient positioning techniques • Describe the various types of acquisitions • Navigate the management of the patient database • Describe the purpose of the syngo® MI Apps Workplace • Describe the purpose and the function of a workflow • Navigate the processing workflows available on the MI Apps workstation • Describe the purpose of the Flexible Display Activity • Describe the function and use of the syngo Patient Browser • Demonstrate the steps required to correct patient demographics • Demonstrate the steps required to rearrange patient studies and series • Demonstrate the steps required to transfer patient data from one DICOM node to another • Navigate the steps required to archive patient data to a CD or DVD • Demonstrate the steps required to retrieve patient data from an archive device • Demonstrate the steps required to eject a CD or DVD from the drive • Demonstrate the steps required to delete patient data from the Patient Browser • Navigate the steps required to perform the MI Apps cleanup procedure • Describe the purpose of the On-line Help and demonstrate the steps to access it • Describe the purpose and function of the c.clear option • Perform the QC procedures necessary to operate the c.clear functions 8 Turnover Workbook | c.cam 1 System Safety 1.1 Objectives Notes By the end of this section, the attendee will be able to: • Demonstrate knowledge of system safety 1.2 Weight Limitation • Do not exceed the maximum patient weight limitation of 450 lbs. (204 kg.) 1.3 Emergency Stops EMERGENCY STOP ON GANTRY CONSOLE EMERGENCY STOP NEXT TO ACQUISITION PC cam Pressing the red Emergency Stop button at the top of the gantry console or the red Emergency Stop button located next to the acquisition PC stops and disables all motion. 1.4 Touch Pads If sufficient force is applied to the detector, collimator or gantry console touch pads due to a collision either with the patient or the chair, all motions are stopped and disabled. To re-enable motion: 1. Remove the cause of the collision, and then press the hand controller Collision Override button, or 2. Press the relevant hand controller motion button while simultaneously pressing and holding the Collision Override button. (See Hand Control, Section 2.3) 9 Turnover Workbook | c.cam As soon as the collision is cleared, motion without the use of the Collision Notes Override button is enabled. COVERS WITH COLLISION SWITCHES COLLISION STRIP COLLIMATORS WITH COLLISION COLLISION PADS PADS 1.5 Emergency Hand Crank If either the power is removed or control of the gantry is lost because of a hardware-related motion error while a patient is underneath the detectors, the detector can be raised away from the patient by using the crank supplied with the c.cam system. 1. Activate one of the Emergency Stop buttons. 2. Insert the crank in the dedicated socket at the top of the tower. 3. Turn the crank counter-clockwise (CCW) to slowly raise the detector arm. 10 Turnover Workbook | c.cam 2 Components and Controls 2.1 Objectives Notes By the end of this section, the attendee will be able to: • Describe the component layout • Navigate the functions and location of the system controls 2.2 System Components The c.cam system consists of the following parts: Acquisition PC Hand Controller Detectors Gantry Console Patient Chair • Gantry console • Fixed 90° dual detector with collimators • Patient chair • Hand controller (hand held control unit) • Acquisition PC - laptop computer mounted on PC stand (syngo MI Workplace) 11 Turnover Workbook | c.cam 2.3 Hand Control O COLLISION OVERRIDE LED COLLISION OVERRIDE STOP SEAT DOWN SEAT UP DETECTOR IN DETECTOR OUT DETECTOR DOWN DETECTOR UP ROTATE DETECTOR CCW ROTATE DETECTOR CW START ACQUISITION * MARK MOTION ENABLE/ACCELERATE D • The hand controller communicates with the gantry via a cable connected to the system next to the acquisition PC. • To use the hand controller, remove it from the holder and hold it in one hand. To activate a function, apply a steady pressure to the appropriate button, and release the button to deactivate the function. Notes 12 Turnover Workbook | c.cam Button Button name Description Seat Down Adjust the position of the seat of the patient chair. This allows patients of varying height to be positioned correctly for acquisition Seat Up The seat height should be adjusted to a position where the patient's arm pit is aligned with the upper edge of the cutout in the chair, WARNING Do not operate the chair seat up/down motion during acquisition. This will lead to artifacts in the acquired images Detector in Move the detector horizontally towards and away from the patient chair. Detector Out Detector Down Move the detector vertically. Le. up and down. Detector Up Rotate Detector CCW Rotate the detectors counterclockwise and clockwise (see Figure 3-6. page 3 | 11). Rotate Detector CW Motion Enable/ Accel- To activate a motion, first press and hold the Motion Enable Accelerate erate bution, and then press the appropriate motion bution All detector motions operate at variable speed. When a motion button and the Motion Enable Accelerate button are both activated, motion along the axis starts at low speed. While the Motion/Accelerate button is kept depressed, speed increases. When the Motion Enable/Accelerate bution is released, the motion continues at the selected speed as long as the motion bution is kept depressed Collision Override Enables motion at minimum speed in the following situations; Recovering from a colision. Activating detector in/out, up/down or rotation while the patient chair Is in the patient load (upright) position Manually tilting the chair to the patient load (upright) position without the detector being positioned for patient load. When the use of Collision Override is required, the Collision Override LED (see Figure 3-15, page 3 | 22) is lit. Keep pressing the Collision Overde button while activating any motion key. Note that motion will start four seconds after the Collision Override button has been pressed * Mark Used for marking points defining a tomography orbit. One mark is re- quired to define a circular orbit, and two marks must be entered to define a non-circular (contoured) orbit Start Acquisition Used to start an acquisition. The Start button becomes active once the acquisition has been properly set up. Stop Stops all motions. Pressing Stop during an acquisition interrupts the acquisition. To con- tinue the acquisition, press the Collision Override bution once before clicking Continue on the acquisition PC, Notes 13 Turnover Workbook | c.cam 2.4 Laptop Layout Notes When the c.cam application is started, the Home page is displayed. This is the starting page of the c.cam system. Statie Dynamic Gated Planar Tomio Gated Tome Patient Load Unload Patient Database Tools Static Acquisition Activates the Static Acquisition page. This page is used to acquire one image frame per energy set over time in one gantry position. Data is acquired from both detectors, resulting in two image data sets. Dynamic Acquisition Activates the Dynamic Acquisition page. This page is used to acquire multiple image frames per energy set over time in one gantry position. Data is acquired from both detectors, resulting in two image data sets. ------ Gated Planar Acquisition Activates the Gated Planar Acquisition page. This page is used to acquire multiple image frames per energy set over the cardiac cycle in one gantry position. During the acquisition, the R-wave histogram can be displayed instead of the energy spectrum for detector 2. Data is acquired from both detectors. Tomographic Acquisition Activates the Tomographic Acquisition page. This page is used to acquire multiple image frames per energy set by rotation of the detectors around the patient. Gated Tomo Acquisition Activates the Gated Tomo Acquisition page. This page is used to acquire multiple image frames per energy set throughout the cardiac cycle while rotating the detectors around the patient. During the acquisition, the R-wave histogram is updated and can be displayed instead of the energy spectrum for detector 2. Patient Database The Patient Database holds the data that was recorded for each acquisition, along with the acquisition setup used. The Patient Database Page provides a single point to browse and select information from the patient database. Selected data can be reviewed, exported to the syngo MI Workplace and deleted when it is no longer needed on the acquisition PC. 14 Turnover Workbook | c.cam Patient Load/Unload Notes Causes the detectors and gantry to move to the patient load position. Tools Displays the Calibration & Configuration (Tools) menu. This menu gives access to maintenance procedures such as QC checks and acquisition of uniformity and COR correction tables. From the Calibration & Configuration menu, there is access to the Service menu. 15 Turnover Workbook | c.cam 3 System Power 3.1 Objectives Notes By the end of this section, the attendee will be able to: • Perform the system shutdown/restart 3.2 Recommendations Normally, you would leave c.cam powered on at all times, however, the PC should be rebooted at least once a week to ensure fast and reliable functionality. Also, it is recommended to power cycle the gantry once a week to initiate a self-test of the system. Further, it is recommended to shut down the PC and any peripheral devices connected if the system is not to be used for an extended period of time (more than a few days). 3.3 Power Up To power up the gantry and the acquisition PC: 1. Switch on power by setting the system power switch in the gantry base to the ON position. ON o - 2. Press the acquisition PC’s power switch. 3. The acquisition PC takes approximately two minutes to load the operating system software. Do not press any keys during this booting process. 4. On the acquisition PC’s desktop, double-click the c.cam icon to start the c.cam application. 5. The PC displays the institution name and ID. Subsequently, the Home page appears. 6. To enable power to the motors, press the hand controller Collision Override button. The LED labeled Power OK on the LED panel next to the acquisition PC goes on. After motor power has been enabled, the c.cam system is ready for use. Note: In the event that the system has been without power for some time, a warm-up period is required before the system is ready for normal operation. As a rule, leave the system to warm up for the same period of time that it has been without power. However, the system will never need to warm up for longer than 5 hours. 3.3 Power Down To switch off the c.cam system: 1. Ensure that the c.cam application is displaying the Home page. 2. Click the Close button in the upper right corner of the c.cam application window. The c.cam application is closed down. 3. Click the Windows Start button and select Shut Down from the Start menu. 4. In the Shut Down dialog, select Shut Down. 5. When the acquisition PC has been shut down, switch off gantry power by setting the main switch on the gantry base connector panel to the OFF position. 16 Turnover Workbook | c.cam 4 Quality Control 4.1 Objectives Notes Quality Control is broken into three schedules: Daily, Weekly and Monthly. This section will provide details on how to perform the correct procedures to ensure your system is operating properly. By the end of this section, the attendee will be able to: • Perform the quality control procedures Performed QC Procedure Source Daily Daily Uniformity 1 mCi Tc99m Point Source Check Co57 Sheet Source Weekly COR Check 1 mCi Tc99m Point Source PMT Update 500 µCi Tc99m Point Source Monthly Intrinsic Calibration 1 mCi Tc99m Point Source CORCOR 1 mCi Tc99m Point Source Optional QC Resolution Check Co57 Sheet Source 4.2 Daily QC This may be done either Intrinsically or Extrinsically. 4.2.1 Intrinsic Daily Uniformity Check 1. Create a 1 mCi Tc99m point source with the supplied vial. 2. Select QC Uniformity Check in the Tools menu. 3. On the Acquisition Setup page, select Tc99m, specify the window width or leave it at 20%, enter the number of counts for termination (10 million for visual inspection or 30 million for NEMA values), specify the uniformity matrix for correction (U.NONE.140 for Tc99m), select Intrinsic and finally indicate the detector to be activated. 4. Click Continue to accept the automated motions. This will cause the detectors to move to the proper position. 17 Turnover Workbook | c.cam 5. Once the detectors have finished moving, place the point source in the Notes provided tri-pod and position it a minimum of 6.1 ft. away from the detector surface. MINIMUM DISTANCE 1.85 M 2 DETECTOR ANGLE 90º SOURCE 133 CM OVER FLOOR NOTE: SOURCE HEIGHT IS THE SAME USED FOR DETECTOR 1 AND 2 MINIMUM DISTANCE 1.85 M. N DETECTOR ANGLE 0º SOURCE 133 CM OVER FLOOR 6. Press F9 on the keyboard to display the crosshair in the center of the image window. Line up the point source with this crosshair to properly center the activity. 7. Once the source is properly positioned, you may remove the collimator of the detector to be checked and replace it with the FOV mask, then loosen the opposite collimator. Note: It is necessary to loosen the collimator of the other detector in order to ensure that the system is using the correct uniformity calibration file for the check. 8. On the acquisition laptop, verify the count rate is less than 40 kc/s, and then click Start 18 Turnover Workbook | c.cam Note: When the QC check images have been acquired, the system performs a Notes uniformity calculation provided enough counts have been acquired and displays the results in a pop-up window: • A result below 3.0% should be interpreted as excellent • Results in the range 3.0 – 4.0% are considered good • Results between 4.0 – 6.0% are acceptable • Should the result fall above 6%, the detector needs calibration 9. Proceed to the review page and visually inspect the flood for uniformity faults. 10. Click Exit to close the Reviewing page. 11. Replace the FOV mask with the collimator and restore the connection of the opposite collimator. Clear all collisions and repeat the procedure for the opposite detector. 4.2.2 Extrinsic Daily Uniformity Check 1. Select QC Uniformity Check in the Tools menu. 2. On the Acquisition Setup page, select Co57, specify the window width or leave it at 20%, enter the number of counts for termination (10 million for visual inspection or 30 million for NEMA values), specify the uniformity matrix for correction (U.LEHR.122 if available or U.NONE.140), select Extrinsic and finally indicate the detector to be activated. 3. Click Continue to accept the automated motions. This will cause the detectors to move to the proper position. 19 Turnover Workbook | c.cam 4. Once the detectors have finished moving, place sheet source holder on Notes top of the detector to be checked and then position the Co57 sheet source on top of the holder. 2 1 DETECTOR ANGLE -180" 2 DETECTOR ANGLE 90" 5. On the acquisition laptop, verify the count rate is less than 40 kc/s, and then click Start. 6. Just as with the intrinsic flood, once the acquisition is completed a pop- up window will appear with the results if enough counts are acquired. Click OK on this and then continue on to visually inspect the flood for uniformity faults. 7. Click Exit to close from the Reviewing page. Remove the source and source holder, clear any collisions and repeat the procedure for the opposite detector. Note: 30 million counts are required in order for the uniformity calculation to be statistically accurate. If only a visual inspection is to be performed, termination on 10 million counts or less is sufficient. If less than 30 million counts are acquired, no calculation result is displayed. To save time, it is recommended that you perform weekly QC checks with a minimum of 30 million counts and daily QC checks with 10 million counts for visual inspection only. 20 Turnover Workbook | c.cam 4.3 Weekly QC Notes 4.3.1 COR Check A center of rotation correction is used to correct for minor misalignment errors between the center of the tomographic images and the axis of rotation. To check the COR correction: • Acquire a tomography of a point source for each set of collimators used for tomo. • Apply the COR check procedure to each of the acquired point source tomographic acquisitions. The following describes this procedure: Tomo Acquisition 1. Verify that the collimators for which the COR Check is to be performed are mounted on the detectors. 2. Set up a tomographic acquisition. For COR Check, a dedicated workflow is provided which you can select in the workflow drop-down list. Set the Patient name to COR Check or something similar in order to allow easy recognition of the study. 3. Fill the supplied vial with 1 mCi Tc99m, being cautious that all of the activity is located in one area at the bottom of the vial. The volume should be between 0.2 and 0.3 milliliters. Seal the vial with the lid and then place the point source in the COR source holder. 4. Position the COR point source holder at the center of the back support pad of the chair, aligning the edge of the source holder with the edge of the pad facing the detectors. 21 Turnover Workbook | c.cam 5. Click Prepare Acquisition. Notes 6. Click OK to accept automated motions bringing the detector into mark position. 7. At a detector rotation of 45°, perform marking at X=450mm and Y=123mm. 8. Click Start to begin the acquisition. 9. When the acquisition terminates, click Exit to close the tomographic acquisition page. COR Check Procedure 1. On the Persistence page, click the Tools button to activate the Tools menu. 2. In the Tools Menu, click COR Check. The Patient Database page appears. 3. Select the patient named COR Check in the patients listed at the top of the page. 4. In the series at the bottom of the page, select the recently acquired Tomo. 5. Click Load to bring up the COR Check page. The COR Check routine automatically calculates the center of rotation error in the acquired tomography data set and displays the results 21 Pentistence 30000 / 15000 COR check Collimator: LEHR C.O.R. Matrix: 256 X 256 Date: 17/03/2003 22 Turnover Workbook | c.cam The results must be as follows: Notes X errors: • Mean must be between –2.00 and +2.00 • Max must be less than 4.6 mm • Min must be greater than –4.6 mm • Range must be less than 4.6 mm Y errors: • Max must be less than 4.6 mm • Min must be greater than –4.6 • Range must be less than 4.6 mm 6. Check that the COR Check result is within specifications and also visually inspect the cine for jumps in the Y direction and the sinogram for jumps in the X direction. 4.4 Monthly QC The c.cam system requires the user to perform a number of calibrations: • Uniformity calibration • PM tube tuning • Center of rotation calibration 4.4.1 PMT Update The PMT Update is used to correct for any drift in gain of the Photomultiplier Tubes. The procedure should be performed as the first step in the monthly QC. 1. In the Tools menu, click PMT Update. 2. On the PMT Update page, select the isotope and first detector to be used for PMT tuning. 3. Click Continue to accept automated motions. 4. Using the supplied vial, create a 0.5 mCi Tc99m point source. 5. Place the point source in the tri-pod and position it at a minimum distance of 6.1 ft. from the surface of the detector. 6. Ensure that the point source is centered on the detector to be tuned by pressing F9 on the keyboard and using the center crosshair. 7. Remove the collimator from the detector to be tuned. 8. Verify that the count rate is less than 40 kc/s. 23 Turnover Workbook | c.cam 9. Click Start to start the PMT gain update. When the PMT gain update Notes starts, the detector 2 spectrum is replaced by a matrix displaying individual tune values in the PM-tube gain table. PM tune values displayed in yellow indicate PM tubes being tuned. Values displayed in green indicate tubes that have been tuned successfully. Values displayed in red indicate tubes that cannot be tuned due to an error. If red tuning values appear, check the position of the point source and run the PMT update procedure again. The field above the PM-tube gain table displays the number of times the tuning has been performed. 33.8 91 Persistence 16/ 17 PMT update Spectrum 1 10. After a successful calibration, click Exit to return to the Persistence page. 11. Remount the collimator and press the hand controller Collision Override button. 12. Repeat the procedure to update the PMT tuning of the other detector. 24 Turnover Workbook | c.cam 4.4.2 Intrinsic Uniformity Calibration Notes To compensate for non-uniformity, the c.cam requires monthly uniformity calibrations for each isotope used in patient acquisitions. 1. In the Tools menu, click Uniformity Calibration. The Uniformity Correction page appears. 2. Specify the energy settings for the uniformity correction table to be acquired. Window Center 1 (keV) 122 Window Center 2 (keV) Window Center 3 (keV) Window Width (%) 20 Tc99m 140 keV Tl201 72 and 167 keV 3. Enter the number of counts required. This value should be greater than 30 million. 4. Select Intrinsic. 5. Click Continue. 6. Click OK to accept automated motions, bringing the detectors into position for the uniformity calibration. 7. Using the supplied vial, create a 1.0 mCi Tc99m point source. 8. Place the point source in the tri-pod and position it at a minimum distance of 6.1 ft. from the surface of the detector. 9. Ensure that the point source is centered on the detector to be calibrated by pressing F9 on the keyboard and using the center crosshair. 10. Remove the collimator from the detector to be tuned and replace it with the FOV mask. 11. Verify that the count rate is less than 40 kc/s. 12. On the other detector, loosen the collimator in order to ensure the uniformity calibration file is named correctly. 13. Click Start to start the acquisition. When the calibration is complete, the table is stored in the database. If a uniformity correction table already exists for the entered energy setting, the system prompts you to confirm the replacement of the old table. 14. Click Exit to close the Uniformity Correction page. 15. On the detector that has been calibrated, replace the FOV mask with the collimator. 25 Turnover Workbook | c.cam 16. Slide the collimator on the other detector back in place. Notes 17. Press the hand controller Collision Override button. 18. Repeat the procedure to calibrate the other detector. 4.4.3 Center of Rotation Calibration (CORCOR) A center of rotation (COR) correction is used when reconstructing tomographic data to correct for minor misalignment between the center of the image and the axis of rotation. 1. Verify that the collimators for which the COR Correction is to be acquired are mounted on the detectors. Also, check that the collimator type is correctly displayed on the acquisition PC. 2. In the Tools menu, select CORCOR. The Center of Rotation page is displayed. Default settings for energy window, window width and number of counts are displayed. 3. If the settings are acceptable, continue the procedure. If the settings need to be changed, enter the new energy value for the appropriate isotope. Use a 20% window width with a termination count of minimum 25 kc. 4. Click Start to proceed. 5. Click OK to accept automated motions, bringing the gantry into position for the COR acquisition. 6. Using the supplied vial, create a 1.0 mCi Tc99m point source in 0.2 to 0.3 milliliters. Use a syringe to fill the vial cautiously so that no activity lands on the walls of the vial. 7. Place the point source in the COR source holder supplied with the system. 8. Place the COR point source holder on the back support pad of the chair. 9. Verify that the count rate is approximately 5-10 kc/s. 10. Click Start to start the COR acquisition. The system rotates 180° in 256 steps. After the acquisition, the acquired COR corrections for the specified collimator are stored under the matching file name. 11. Click Exit to close the Center of Rotation page. 12. Check the acquired COR correction by performing a COR Check. (See section 4.3.1) 26 Turnover Workbook | c.cam 4.4.4 QC Resolution Check Notes Optionally, the image resolution of the c.cam system can be checked intrinsically or extrinsically. To perform this check, two different four-field bar phantoms are available for the c.cam. Extrinsic QC Resolution Check The extrinsic QC resolution check is based on the acquisition of a static image with a four-field bar phantom that is placed on top of the collimator. 1. In the Tools menu, click the QC Resolution Check button. The QC Resolution Check page appears. 2. Select Co57, window width at 20%, desired termination counts (5 million is the default), the appropriate uniformity matrix, the detector to be checked and finally choose Extrinsic. 3. Click Continue to move the detectors into position for QC Resolution check of the selected detector. 4. Place the flood phantom frame on the collimator surface. 5. Place the four-field bar phantom on top of the flood phantom frame. 6. Place the Co57 sheet source on top of the flood phantom. 7. Verify that the count rate is less than 40 kc/s. 8. Click Start to begin the acquisition. 9. When the acquisition is complete, the c.cam application will automatically switch to the Reviewing page. Inspect the image to verify that all lines and fields have been resolved. Some blur along the edges is normal. 10. When done, click Exit to close the Reviewing page. Repeat the procedure for the other detector. 27 Turnover Workbook | c.cam Intrinsic QC Resolution Check Notes The intrinsic QC resolution check is based on the acquisition of a static image while the collimator is replaced by a four-field bar phantom. 1. In the Tools menu, click the QC Resolution check button. The QC Resolution Check page appears. 2. Select Tc99m, window width at 20%, desired termination counts (5 million is the default), the appropriate uniformity matrix, the detector to be checked and finally choose Intrinsic. 3. Click Continue to move the detectors into position for QC Resolution check of the selected detector. 4. Using the supplied vial, create a 1.0 mCi Tc99m point source. 5. Place the point source in the tri-pod and position it at a minimum distance of 6.1 ft. from the surface of the detector. 6. Ensure that the point source is centered on the detector to be checked by pressing F9 on the keyboard and using the center crosshair. 7. On the detector to be checked, replace the collimator with the four-field bar phantom. 8. Verify that the count rate is less than 40 kc/s. 9. Click Start to begin the acquisition. 10. When the acquisition is complete, the c.cam application will automatically switch to the Reviewing page. Inspect the image to verify that all lines and fields have been resolved. Some blur along the edges is normal. 11. When done, click Exit to close the Reviewing page. 12. On the detector just checked, replace the four-field phantom with the collimator. 13. Clear any collisions with the hand control Collision Override button. Repeat for the other detector. 28 Turnover Workbook | c.cam 5 Patient Registration 5.1 Objectives Notes Patient registration can be done either manually or if the option is available, through a worklist. This section will explain both procedures. By the end of this section, the attendee will be able to: • Demonstrate manual and worklist patient registration 5.2 Manual Patient Registration 1. From the Home page, click on the desired acquisition type. 2. On the right hand side of the page click on New Patient. 3. The patient information form becomes available at the bottom of the screen. 4. Enter the patient and visit information. At a minimum, name, ID, date of birth, and sex are required. 5. Click on Apply. 6. The patient will then be available for selection in the local patient list at the top of the page. 7 1ª Pertence 30000 / 15000 Local Parimis in c.com LIST OF PATIENTS AND VISITA FUNCTION Done-John PATIENT HOHM FREE SPACE INDICATOR 29 Turnover Workbook | c.cam 5.3 Worklist Patient Registration (optional) Notes 1. From the Home Page, click on the Worklist Function icon along the left hand side of the screen. 464 Existence 5135/ 5164 WORKLIST FUNCTION BUTTON 2. The Worklist Scheduler Database window will be displayed. WorkList Patient Name Patient ID Ecam Nune Accession Get manual worklist SailIL Bob 33510322 Myocardial Perfu - 63114636 Washington George 41381929 Myocardial Perfu 05521097 43643553 Dynamie First Pa 83347248 Get auto worklist Lincoln Abbe Connor Jim 860-49707 MPI 24287365 Delete selected Delete all Register selected Register all Exit Smith^Bob ----- 33510322 Patient Information Visit Information Last Name Visit Date Smil 02/12/2008 12 Feb 2008 First Name Physician Bob Munsell" Robert Patient ID 33518322 Accession Number Date of Birth 68114636 06/12/1945 12 Juin 1945 Exam Name Myocardial Perfusion Apply Sex- 1 Male Female Patient Height Patient Weight 10 220 pounds Cancel ][Lecal DB: 73 % tree. Status: Worklist Query completed successfully 3. If your system is set up for Scheduled Worklist, you should see a list of patients available for selection. Otherwise clicking on Get Manual Worklist will allow you to type in a patient name/ID to search for, or Get Auto Worklist will update the patient list. 4. Once you see the correct patient, click the Register Selected button. If the registration is successful, the system will dismiss the Scheduler Worklist pane and will return to the Home Page. 30 Turnover Workbook | c.cam 6 Overview of Acquisition Workflows 6.1 Objectives Notes The c.cam system’s acquisition pages have a number of features in common. This section describes these common features, accounting for minor differences between acquisition modes for a few of them. The illustration below depicts the more common features of the acquisition page. By the end of this section, the attendee will be able to: • Demonstrate how to customize and make modifications to scanning workflows Exit 170 Save Protecci Protocol Solution Drop Down Sorios Hame Acquisition Pararnetors Stop Cond tions Spectrum I 6.2 Modification of Acquisition Workflows 1. Select a workflow by clicking  to display the items in the workflow drop- down list box at the top of the acquisition setup area. 2. Choose a workflow by clicking on its name in the drop-down list. 3. The selected workflow is loaded and the acquisition parameters are displayed. 4. Acquisition setup parameters can be edited directly in the acquisition setup area. 5. To store the modified parameters as a user-defined workflow: • Click the Save button at the top of the acquisition setup area. • When prompted, enter a new workflow name. • If you specify the name of an existing workflow, a pop-up message prompts you to confirm that you wish to overwrite this workflow. 6. To delete a workflow: • Select the workflow to be deleted. • Click the Delete button at the top of the acquisition setup area. • When prompted to confirm that the workflow should be deleted click Yes to proceed to delete the file. 31 Turnover Workbook | c.cam 7 Acquisition Setup 7.1 Objectives Notes In an effort to keep this tutorial brief, we are limiting the instruction to Tomo and Gated Tomo Acquisitions. By the end of this section, the attendee will be able to: • Describe the various types of acquisitions 7.2 Tomo Acquisition Setup There are several types of acquisitions you can perform on the c.cam (Planar, Gated Planar, Dynamic, Tomo and Gated Tomo) and this section will describe in general how to set up a Tomo image. 1. On the Home page, click the Tomographic Acquisition button. 2. Either manually register your patient or select them from the list of available patients at the top of the page. Verify you have the correct demographic information and then click Select Visit. 3. The Tomographic acquisition page will then appear. 470 Pursisinge 6501 / 6768 070 Tomographie ACOURTTION SETUP ARTA 4. Select the proper workflow from the workflow drop-down list box at the top of the acquisition setup area. 5. Verify that all of the acquisition parameters are correct. 6. Position patient on the chair with their arms properly raised and supported by the head/arm rest. 7. Assess the environment for any collision hazard and then click on Prepare Acquisition. 8. The patient chair will lower and detectors will move over the patient’s torso. 32 Turnover Workbook | c.cam 9. Marking is required to determine the orbit in tomographic acquisitions. Notes Note: For patient positioning marking, a non-circular orbit is preferred over a circular orbit to ensure minimum distance from detector to patient. This orbit requires one mark. 10. Use the Detector In/Out and Detector Up/Down buttons on the hand controller to position the detector in close proximity to the patient. MARKING AT 0º - NON-CIRCULAR ORBIT PIVOT POINT DET 1 RVER DET Y RHOR ------ CENTER OF ROTATION X DET X X = 0 11. When both detectors are close to the patient, press the hand controller Mark button to enter the mark. * 12. Click OK on the acquisition laptop to accept the automated motions bringing the detectors into the start acquisition position. 13. Click Start on the acquisition laptop. The detectors will move down and begin the imaging process. The bar at the top of the page will give you information such as views acquired, counts, radius, total time and time remaining. 14. Once all the views have been acquired the display automatically switches to the Reviewing Page. Here you may see the images and click through them using the Cine button in the lower right hand corner. 33 Turnover Workbook | c.cam 15. If your system has been configured to do so, the dataset will be Notes automatically transferred to the MI Apps Workstation for reconstruction. 16. Click on the Exit button in the upper left hand corner twice, getting you back to the Home Page. From here, you can click on the Camera Home button. The detectors will move away from the patient and the chair will return to an upright position. ₺71900 Cine 7.3 Gated Tomo Acquisition Setup 1. On the Home page, click the Gated Tomo Acquisition button. 2. Either manually register your patient or select them from the list of available patients at the top of the page. Verify you have the correct demographic information and then click Select Visit. 3. The Gated Tomographic acquisition page will then appear. 118 470 Persistence 6974 / 6598 Gated Tomo RK Histogran CW Spectrum [ 34 Turnover Workbook | c.cam 4. Select the proper workflow from the workflow drop-down list box at the Notes top of the acquisition setup area. 5. Verify that all of the acquisition parameters are correct. 6. Connect the patient to gating device. 7. Position patient on the chair with their arms properly raised and supported by the head/arm rest. 8. Assess the environment for any collision hazard and then click on Prepare Acquisition. 9. The patient chair will lower and detectors will move over the patient’s torso. 10. Marking is required to determine the orbit in gated tomographic acquisitions. Note: For patient positioning marking, a non-circular orbit is preferred over a circular orbit to ensure minimum distance from detector to patient. This orbit requires one mark. 11. Use the Detector In/Out and Detector Up/Down buttons on the hand controller to position the detector in close proximity to the patient. 12. When both detectors are close to the patient, press the hand controller Mark button to enter the mark. 13. Click OK on the acquisition laptop to accept the automated motions bringing the detectors into the start acquisition position. 14. Click Start on the acquisition laptop. The detectors will move down and begin the imaging process. The bar at the top of the page will give you information such as views acquired, counts, radius, total time and time remaining. 15. Once all the views have been acquired the display automatically switches to the Reviewing Page. Here you may see the images and click through them using the Cine button in the lower right hand corner. 16. If your system has been configured to do so, the dataset will be automatically transferred to the MI Apps Workstation for reconstruction. 17. Click on the Exit button in the upper left hand corner twice, getting you back to the Home Page. From here, you can click on the Camera Home button. The detectors will move away from the patient and the chair will return to an upright position. 35 Turnover Workbook | c.cam 8 Hand Controller and Special Keyboard Functions 8.1 Objectives Notes By the end of this section, the attendee will be able to: • Navigate the hand controller • Demonstrate the special keyboard functions that can be used on the acquisition PC 8.2 Hand Controller • The hand controller communicates with the gantry via a cable connected to the system next to the acquisition PC. • To use the hand controller, remove it from the holder and hold it in one hand. To activate a function, apply a steady pressure to the appropriate button, and release the button to deactivate the function. Note: To activate a motion, press and hold the Motion Enable button while at the same time activating the appropriate motion button. Note: If the hand controller appears not to work, check that the connector cable is fully inserted into the connector next to the acquisition PC. Note: Hand controller operation is disabled during preprogrammed motions. 8.2.1 During the Acquisition During a tomography acquisition, the hand controller can be used to adjust detector radius. • Use the hand controller Enable Motion and Start Acquisition button to increase the detector radius in steps of 5 mm. • Use the hand controller Enable Motion and Mark button to reduce detector radius in steps of 5 mm. K The Det Rad field at the top left corner of the page shows the increase or decrease in mm. When the detectors are rotated for the next projection, the radius change request will be executed. 36 Turnover Workbook | c.cam Collision Override Notes If during an acquisition, a touch pad collision occurs, the following Error message will appear: Collision on detector 1 wing Please clear the collision and press handset OVERRIDE to apply motion power OK To clear the collision error: 1. Press the hand controller Collision Override button. 2. Check that the Collision LED goes OFF and that the collision error message disappears from the acquisition PC. 3. If collision persists, simultaneously activate the Collision Override button and detector motion buttons on the hand controller to clear collision. 37 Turnover Workbook | c.cam 8.2.2 Special Keyboard Functions The keyboard of the acquisition PC includes the normal alphanumeric and punctuation keys in a standard laptop layout, along with a number of function keys (F-keys) and other special keys. Key Operation Description F1 Display patient On the Home page, [F1] activates the patient database. Refer to section Pa- database tient Database Overview in Chapter 4 for a detailed description. F3 Clear display [F3] clears the image windows and refreshes the spectrum windows. [F3] is only active in Persistence mode and is used during patient positioning to re- fresh the image after repositioning detectors or patient. Color palette [F4] activates the color palette tool. The c.cam system uses a color encoding F4 tool scheme to display acquired data in the image windows, that is, a color value is assigned to each count value. The color palette allows you to select a color encoding scheme (including grayscale encoding) and to determine how color values will be assigned to count values. See the section Color Palette Tool in Chapter 4 for details. Change color [F5] and [F6] enable you to browse through the different color palettes. [F5] F5 palette and [F6] change the color encoding scheme of the currently displayed image, regardless of whether the color palette tool is visible or not ([F4] function key). F6 [F5] activates the different color palettes in se- quence. [F6] does the same, but activates the color palettes in the opposite order. F9 Center cross [F9] activates a red center cross hair in each image window. The center cross hair hair facilitates patient and detector positioning. Pressing [F9] once again switches off center cross hair. [F10] activates a scroll bar to the immediate left of the image windows. The F10 Gray scale saturation scroll bar is used to set the saturation point of the gray scale, permitting opti- mum separation of closely located uptake points. Pressing [F10] again switches off the scroll bar. Notes 38 Turnover Workbook | c.cam 9 Patient Database 9.1 Objectives Notes The c.cam system’s patient database provides facilities for: • Storing and retrieving information about patients • Storing and retrieving information about individual acquisitions performed. This includes both information about acquisition setup and the actual acquired images • Transferring acquisition information to the syngo MI Workplace By the end of this section, the attendee will be able to: • Navigate the management of the patient database 9.2 Acquisition Page Database You can access the patient database both from an Acquisition page and from the Home page. Dependent on how you get to the database, different functionality is available. When you activate the patient database from an Acquisition page, you can: • Select a patient and visit from the patient database. • Enter patient and visit information. 0.0 Persistence 10000 / 15000 4: -- /+-++ Local Patients in LIST OF PATIENTS AND VISITS TUNOTION BUTTON'S PATH NE NICHMATION FORM VISIT INFORMATION FORM TALL SPALL INDICATOR 39 Turnover Workbook | c.cam 9.3 Home Page Database Notes When you access the patient database from the Home page, you can: • Clean up the database (that is, delete entries that are no longer wanted). • Transfer information to the syngo MI Workplace. • Select a study setup that was stored in the database prior to the patient’s visit. • Select completed studies stored in the database for review on the Reviewing page. 385 Persistance 20 / 14 Local Philicis CI FUNCTION BUTTONS LISTOF PATICH STUDY Doe Joli 03/06/2005 INFORMATION LEITOR FREE SPACE 40 Turnover Workbook | c.cam 10 syngo® MI Apps Workstation 10.1 Objectives Notes The MI Apps workstation is used for reconstruction, post-processing and displaying patient images along with database management (archiving, deleting, transferring and correcting DICOM data). By the end of this section, the attendee will be able to: • Describe the purpose of the syngo MI Apps Workplace 10.2 MI Workplace Command Module Areas of Command Module 1. MI Apps (e.soft) Patient Browser 2. Workflow Template Browser 3. Workflow Manager 3 41 Turnover Workbook | c.cam 10.3 MI Apps (e.soft) Patient Browser Refresh Study Listing Patient Browser Patient Register Study Name: ALL Show All List Patients Study Date: ALL System Up Time: 18 Hours 42 Mins Find List Studies 46 studies found on the system. Study dates: (all dates) Image Space Available 47938 MB List Series Buttons Patient Name Patient ID Study Name Study Date # Series Database Location ymora Brain; DIAMOX Gen CI AC SO Brain Scan 8/9/2005 Local Database 3 Symbia, Bone Sarcoma Gen CT ASC Bone Scan 7/7/2005 Local Database Summary Information 4 Symbia, Bone Tomo CT Goa CT AC SC Bone Scan 7/21/2005 Local Database 4 Symbia, Bone Tomo CT Gen CT AC SC Bone Scan 7/21/2005 3 9 Local Database 50 Symbia, Cardine Symbia Card Di Myocardial Perf 1/11/2006 17 Local Database 51 Symbia Cardiac Normal Symbia Card Di. Myocardial Perf. 1/10/2006 7/9/2003 16 Local Database Column Heading Bioorapn WB1 98-45082 AHI THORAX Local Database Brograph WB2 85-60337 AHI Thorax 1W. 7/3/2003 Local Database Bone 3 (complete), flow.p. 111111 Bone Scan 1/18/2008 6 Local Database Bone 5. 2 tomos 111111 Bone Scan 1/18/2008 Local Database Bone 6, WB and Statics 2 111111 Bone Scan 1/18/2008 Local Database Bone 7. 3 Phase & WB Symbia T Bone Scan 1/18/2008 Local Database Search Bone, 3 Phase 012718 Bone Scan 4/23/2002 Local Database Cardiac A, 16 frame gate. 570719 MI Apps Patient Cardiac B, both stress an. 09405862 Cardiac D. moderate isc TL/TO Cardiac E, severe ischemia TL /Tc Myocardial Perf Cardiac F. anthat rev defe .. TL /TC Browser Area base 12004 col Database y Database Cardiac G. comparison ol .. 7754 Cardiac G. comparison ol. 7754 Local Database Cardiac N. Gated Bloodp Myocard 2116574 Tomo MUGA 1/13/2010 3 Local Database Cardiac O. Bloodpool To. 0014 Tomo MUGA 1/19/2010 Local Database Daily Flood QC 03/03/2006 Daily Intrinsic Fl ... 3/3/2006 Local Database Gastric Emptin- dyn norm 12345678 Gastric Emptying 2/20/2001 Local Database Gastric Empting dyn abno 212 Gastric Emptying 4/1 1/2008 Local Database Gastric Empty (4 hr), Pt 1 06514450 Gastric Emptying 11/20/2009 Local Database Gastric Empty 4 hr. Pt 3 0056 Gastric Emptyin 1/14/2010 Local Database GI Bleed (positive), 2 pha 1000469630 GI Bleed 2/21/2008 Local Database Hepatobiliary, gallbladder 91836 Galbladder 2/7/2008 Local Database Hepatobiliary, GB EF (Dy ... Penrose 0333443 Gallbladder EF 2/22/2001 Local Database Liver Hemangioma 110099 Gated Bloodpoo. 12/29/2006 Local Database Lung 2, Vent / Perfusion-n ... 0038276 Lung V/Q Scan 7/3 1/2008 Local Database Muga, 2 View GL 87306 MUGA 12/18/2000 Local Database Muga, 3 View - flashing 1322122 MUGA 4/1/2002 Local Database Parathyroid 381145STM Parathyroid Scan 2/22/2000 Local Database Parathyroid ECAM Parathyroid Scan 2/22/2000 AMAIMARA Local Database Notes 42 Turnover Workbook | c.cam 10.4 Workflow Template Browser Refresh Workflows o Local Netwnde Category Cardiac Category Local or Network Auto Filter Auto Filter 1.REST 2 gSTRESS 3.CARDIAC CARDIAC CARDIAC TC ACQ OP TC ACQ PROC DISPLAY PROC O P AOP Q 4DM Cedars Cedars Corridor4 .. MUGA QGS Workflow 3 VIE Workflow OP MUGA Template Template 3 VIE IL PROC List TL_24HR Browsers ACO Area Notes 43 Turnover Workbook | c.cam 10.5 Workflow Manager Category Stage Suspend Work Status Workstation Launch Complete Category: All Workplace: S6/BIA01 Work Status All Stage: All Launch Suspend Complete Workflow Template Manager Area Notes 44 Turnover Workbook | c.cam 10.6 Launching a Workflow Notes A workflow is a series of activities that allow you to process and display images. You can also transfer images, archive and pend workflows upon completion. 1. Highlight the patient from Patient Browser. 2. In the Workflow Template Browser > Select Category. 3. Double click the workflow desired. 10.7 Workflow Navigator Play, Pause, Suspend, and Play Complete Buttons - Control the Pause Operation of a Workflow Play Button • Resumes a paused workflow Suspend Button- • Temporarily stops a workflow in the running state • Removes it from the computer’s memory • Saves data to hard disk Complete Pause Button Suspend • Temporarily stops the workflow in running state • Not in suspended state, so utilizing memory Complete Button • When pressed, it performs all the selections in the Completion Setup: • Saving data • Sending to the another node • Archiving • Pending another workflow 45 Turnover Workbook | c.cam 10.8 Modifying and Saving a Workflow Template Notes 1. Review the parameters in the current workflow template. 2. Make appropriate modifications. 3. Template > Save Workflow Template (to overwrite the current template) > OK. Template | Workflow Activities He Save Workflow Template. Save Workflow Template As ... New Worktion PROCESSES GATED AND NON GATED CARDIAC STUDIES Cardio OK Cande 46 Turnover Workbook | c.cam 4. Template > Save Workflow Template As (to create a new template). Notes Template Workflow Activities H Save Workflow Template ... Save Workflow Template As ... Now Workflow Wonnow Chinctantes CC 5. Enter the name, description, category and appropriate icon and click OK. 47 Turnover Workbook | c.cam 11 Processing Workflows 11.1 Objectives Notes By the end of this section, the attendee will be able to: • Navigate the user interface of the Quality Control activity • Navigate the user interface of the AutoRecon activity 11.2 Quality Control Activity (Motion Correction) Used on the following data types: • Cardiac Gated Tomo • Cardiac Non-Gated Tomo • Dynamic 11.2.1 Cardiac Gated Tomo and Non-Gated Tomo Correction 1. Select the Quality Control Activity in the workflow. 2. Pull down Series > Select appropriate series. 3. Select Beat Normalize if desired. 4. Click and drag red horizontal line to the center of the heart. 5. Click the Cine button to view image for motion. Step 2 Step 4 Step 1 Step 5 Step 3 Step 6 6. If motion correction is needed, click Motion Correct Series button. 48 Turnover Workbook | c.cam 7. Drag the red ROI over the heart, centering the box over the heart. Resize Notes and reposition if needed. 8. Review cine sinogram and linogram in the After section. 9. Click OK. Step 7 Step 8 Step 9 10. If satisfied, continue with processing. 11. If not satisfied, click Revert to Original button. 12. Repeat steps 2–9 on additional series if required. 49 Turnover Workbook | c.cam 11.3 Auto Recon Activity Notes (Cardiac Tomo and Gated Tomo Recontruction) 1. Select the AutoRecon Activity in the workflow. 2. On the Reconstruction Tab adjust your reconstruction limits on the left hand side of the page (yellow circle). 3. Make necessary adjustments to the HLA and VLA angles using the slider bars under the slices on the right hand side of the page. 2. Adjest Limits [Yellow Circle) 3. Ache HLA and VLA angles O 1. AutoRecon 4. Go to the Masking/Centering Tab and center the crosshairs over the SA, VLA and HLA slices. You may optionally apply a mask to cut out extracardiac activity. 4. Masking Centering Center crosshairs/apply mask O P O 50 Turnover Workbook | c.cam 11.4 Planar Gated (MUGA) Processing Notes 1. Select the Gated Bloodpool Activity and then the Processing tab of the workflow. 2. Center the LV in the box. 3. Click Determine LV Center button. 4. Left mouse click the center of the LV. 5. Click the Cine icon to review the ROI position. Step 1 Step 5 Step 2 Step 4 Step 3 6. Click the ROI Tool buttons to modify the ROIs for LV and background if needed. Step 6 7. Review the Results and Fitting Results tabs. 8. See the Settings tab to review or modify parameters for this activity. 51 Turnover Workbook | c.cam 12 Display Activities 12.1 Objectives By the end of this section, the attendee will be able to: • Describe the purpose of the Flexible Display Activity 12.2 Flexible Display The Flexible Display activity is used to arrange and display all data acquired and processed in the MI Apps application. The Flexible Display activity can contain one or more display pages (tabs) with each page displaying one or more display objects. AI Text Display - This object is used to insert blocks of text, either from study information (such as a patient name or series name) or free text. Tools ? Print Display - This object is used to insert print areas (such as processing results) created from other activities. Curve Display - This object is used to display curves associated A with a series. Bitmap Display - This object is used for bitmap formatted graphic images. Multiple Statistic Display - This object is used to display frame and ROI Notes statistics in a table format. 52 Turnover Workbook | c.cam Fusion Series Display - This object is used to display fused series data. Fusion Slice Display - This object is used to display fused slice data. 3D Display - This object is used to render and cine volume data Three Slice Display - This object is used to display one to four volumetric series in a slice view, containing transverse, sagittal, and coronal views in a single window. Multi-modality Display - This object is used to display multi-modality fused data. Series Display - This object is used to display non fused series data. Image Display - This object is used to display a single image. Slice Display - This object is used to display multiple slices from a single series. Display Page - This object is used display the page in Display mode. ? Page Properties - This object takes you into the Page Properties where you can change labels, layout format, background color and other properties. Notes 53 Turnover Workbook | c.cam Below are examples of how different display objects are used. Text Display O O Image Display O O Slice Display Curve Display == Series Display Empliving Curves Print Display Notes 54 Turnover Workbook | c.cam 12.3 Saving Pages as JPEGS and AVI Files Notes JPEGs 1. Click the Flexible Display activity. 2. To save or print a page, click the Flexible Display drop down menu (top of the page), and then select the Save Page As menu item. 3. The Save [page-name] Print Area As window is displayed. 4. Select a save location. 5. Type a file name. 6. Select a file type (.jpg, .bmp, .emf). 7. Click the Save button. AVIs 1. From within the Flexible Display activity, right click anywhere in the cine control bar. 2. From the pop-up menu, select the Save Cine As AVI menu item. 3. From the Save As window, select a location to save the file. 4. Type a file name. 5. Select a file type. By default, the .avi file extension is the only selection. 6. Click the Save button. 55 Turnover Workbook | c.cam 13 Patient Browser 13.1 Objectives Notes By the end of this section, the attendee will be able to: • Describe the function and use of the syngo Patient Browser • Demonstrate the steps required to correct patient demographics • Demonstrate the steps required to rearrange patient studies and series • Demonstrate the steps required to transfer patients’ data from one DICOM node to another • Navigate the steps required to archive patient data to a CD or DVD • Demonstrate the steps required to retrieve patient data from an archive device • Demonstrate the steps required to eject a CD or DVD from the drive • Demonstrate the steps required to delete patient data from the Patient Browser 13.2 Accessing the Patient Browser • The Patient Browser displays all the patient and examination data stored in each database or external archive medium. • To access the patient browser, select Patient > Browser from the menu. The system displays the browser. 13.3 Patient Databases • The types of databases are symbolized on the left-hand side of the navigation area. Click an icon to see its contents displayed in the content area of the browser. • The Local Database is where the patient data and results of the examinations performed on the local workstation are stored. • The Scheduler contains the data on all pre-registered patients. • One or more DVD or CD devices may be connected to MI Apps workstation. 56 Turnover Workbook | c.cam 13.4 Correcting a Patient Name, ID Number, or Other Notes Demographics If incorrect patient information was entered when registering the patient, it can be corrected using the following steps. 1. Access the syngo Patient Browser. 2. Click the Local Database icon. 3. Click the patient/study/series to be corrected. 4. Edit > Correct. 5. Make the needed corrections > Enter initials > OK. 13.5 Rearranging a Patient Study and Series The following steps may be used if data is acquired under the wrong patient name (for example, Mr. Doe’s Rest series is acquired under Mrs. Smith’s name). 1. Access the syngo Patient Browser. 2. Select the Rest series under Mrs. Smith’s name. 3. Edit > Cut. 4. Click the appropriate study name under Mr. Doe. 5. Edit > Paste. 13.6 Manually Transferring Data Patient data may be manually sent to another workstation using the following steps: 1. Access the syngo Patient Browser. 2. Click the Local Database icon. 3. Click the patient/study/series name to be send. 4. Transfer > Send to. 5. Select the destination workstation. 6. Send. 7. To check the status of the transfer, click the Transfer menu, and then select Network Job Status. 13.7 Manually Archiving Data A patient, study, or series data may be manually copied to an archive device using the following steps: 1. Access the syngo Patient Browser. 57 Turnover Workbook | c.cam 2. Insert the media into the archival device. Notes 3. Click the Local Database icon. 4. Click the patient/study/series to be copied to the CD or DVD. 5. Transfer > Archive To (name of the destination device). 6. If required, label the medium. 7. To check the status, pull down Transfer > Local Job Status. 13.8 Retrieving Data from an Archival Device Data may be retrieved from DVD or CD devices and copied into the local database by using the following steps: 1. Insert CD media into the CD-ROM, CD_RW, or DVD drive (MI Apps Workstation Tower). 2. Access the syngo Patient Browser. 3. Click the CD_ROM, CD_RW, or DVD icon. 4. Select the patient, study, or series to be imported. 5. Transfer > Import. 13.9 Ejecting a CD or DVD The CD or DVD media must be ejected using the following method or database errors may occur. 1. Access the syngo Patient Browser. 2. Click the Transfer menu, and then select Eject from CD_RW (or DVD, depending on the media). 3. If the DVD or CD is full, or you do not wish to record anymore data, select Finalize Medium and Eject. 13.10 Deleting Data Patient, study, or series data may be deleted from the database by using the following steps: 1. Access the syngo Patient Browser. 2. Click the Local Database icon. 3. Click the patient, study, or series to be deleted. 4. Edit > Delete. 5. Yes. Caution: Deleted data is gone when deleted and cannot be restored. 58 Turnover Workbook | c.cam 14 MI Apps Cleanup 14.1 Objectives Notes The MI APPS Cleanup activity is used when the system becomes unstable/locks up. When using the MI Apps Cleanup activity, all data in currently running activities is lost. By the end of this section, the attendee will be able to: • Navigate the steps required to perform the MI Apps Cleanup procedure 14.2 Procedure 1. From the Windows Start menu, select MI APPS > MI APPS Cleanup. 2. Choose Force Shutdown of High Level Processes. 3. YES to continue with Cleanup. Clean Up This appacation may be used to cken up processes if the system becomes unstable or if a worldlow no. longer responds to the user WARNING Using this application will cause data in running worldflows to be lost. Use this application only after you have exited all the workflows that you can Comment to be logged Use this first Force Shutdown of High-Level Processes Use this only if the previous button does not solve system instability Force Shutdown of High Level Processes and Low Level Servers Cinan X This application may be used to clean up processes if the system becomes unstable or if a workflow no longer responds to the user WARNING: Using this application will cause data in running workflows to be lost Uso this application only after you have exited all the workflows that you can Warning WARNING: This action may result in a loss of data. Are you sure that you want to do this? Yes No Uso this only if the previous button does not solve systom instability. Force Shutdown of High-Level Processes and Low-Level Servers Exit 4. When cleanup is complete you will be prompted to copy log files if necessary, if not choose Cancel. 5. If this step was unsuccessful, repeat Step 2 but choose Force High level Processes and Low Level Servers. 59 Turnover Workbook | c.cam 15 Online Help 15.1 Objectives Notes By the end of this section, the attendee will be able to: • Describe the purpose of the Online Help and demonstrate the steps to access it 15.2 Purpose and Accessing If you are requiring additional information for the MI Apps Workstation and included applications, you can use the Online Help available on your system. Access the Online Help by pressing the F1 key on your keyboard. You can search for specific topics using the search function or scroll through the library table of contents to locate the topic you are interested in. 60 Turnover Workbook | c.cam 16 c.clear 16.1 Objectives Notes By the end of this section, the attendee will be able to: • Describe the purpose and function of the c.clear option • Perform the QC procedures necessary to operate the c.clear functions 16.2 Overview c.clear is an attenuation correction option that you can purchase to enhance your cardiac imaging workflow. c.clear uses two arrays of 14 (7 pairs) solid Gd153 (gadolinium-153) line sources that are mounted on the detectors. Each line source is enclosed in a collimated lead alloy housing minimizing radiation exposure. Each array of line sources has a common shutter that opens only while transmission images are being acquired. When the shutter is open, photons from the line sources pass through a collimated opening in the line source housings and are detected by the opposite detector. When the transmission images have been acquired, the shutter closes to shield the line source array. Unnecessary radiation exposure occurs if a shutter is open at any time other than during the acquisition of transmission images. In c.clear, an open shutter condition is indicated by a mechanical indicator and a red LED. The green light indicates that the shutters are closed. LED GREEN LED AED SIEMENS SIEMENS c.cam HANDLE IN c.cam HANDLEIN 61 Turnover Workbook | c.cam 16.3 c.clear Quality Control Notes Performed QC Procedure Source 1 mCi Tc99m Point Source Daily Daily Uniform Check Co57 Sheet Source Weekly COR Check 1 mCi Tc99m Point Source PMT Update 500 µCi Tc99m Point Source Monthly Intrinsic Calibration 1 mCi Tc99m Point Source CORCOR 1 mCi Tc99m Point Source Far Blank Scan Gd153 Source Array Optional QC Resolution Check Co57 Sheet Source After Source Near Blank Scan and Far Replenishment Blank Scan Gd153 Source Array 16.4 Far Blank Scan • A far blank scan is the image that the detector “sees” when the Gd153 transmission source is open and no obstruction exists between the source and the detector. A far blank scan is performed with neither a patient nor the patient chair in the field of view of the detectors. • A far blank scan calibration is required: • Once a month. • Following a major service call. • Following source replenishment. • If the c.clear wings have been removed from the c.cam system. Note: Before acquiring a far blank scan, perform a QC uniformity check of both detectors. If the result of the QC uniformity check indicates that PMT tube tuning is required, also perform a PMT tube tuning of both detectors. To acquire a far blank scan, proceed as follows: 1. Ensure that LEHR collimators are mounted on the detectors. 2. On the c.cam application’s Home page, click the Tools button. The Configuration & Calibration menu appears. 3. Click the Blank Scan button. The Blank Scan acquisition page appears. 4. In the Apply Uniformity drop-down list, select the correction applicable to the isotope energy to be used during acquisition. You can select U. NONE.140 or U.LEHR.140 (intrinsically or extrinsically acquired uniformity correction with LEHR collimators). 62 Turnover Workbook | c.cam 5. Enter the acquisition time in the Termination Time field. The default Notes setting of 120 seconds is suitable for acquisition of far blank scans. However, it is recommended to increase the acquisition time as the line sources age and the count rate goes down. As a rule of thumb, start increasing the acquisition time when the count rate resulting from the line sources falls below approx. 60,000 counts per second. You should maintain approximately 7,500,000 counts in the far blank scan. 6. Click Continue and then OK to accept automated motions bringing c.cam into position to acquire far blank scans. 7. During the automated motion, follow on-screen directions to move c.clear wings into/away from the scanning position: • Take a firm hold of the wing by the arm holding the source compartment. • Release the line source compartment by pulling out the release handle and then pushing it down. • Turn the wing into the requested position. • If touching the wing caused a collision, press the hand controller Collision Override button to reset the collision. • Click OK in the pop-up. 8. Click Start to acquire the far blank scan. After the acquisition is started, the line source shutters remain closed while the detectors measure background radiation levels within the Gd153 and scatter energy ranges. The purpose of this is to check the effectiveness of the shutters. If the count rate exceeds 500 counts per second, a warning is given. After this, the detectors automatically proceed to acquire the far blank scan images simultaneously for the specified amount of time. When the far blank scan acquisition is completed, the scans are automatically stored in the database under the patient name “Blank Scans”. The acquisition PC switches to the Reviewing page, displaying the detector II far blank scan. 63 Turnover Workbook | c.cam 9. Carefully inspect the detector II far blank scan. A valid reference scan Notes must be uniform in the vertical plane and show distinct “profiles” from the source array in the horizontal plane. The blank scan must clearly show that the strongest sources are mounted at center position with sources growing progressively weaker towards the sides. 10. Click the F1 button on the Reviewing page to inspect the detector I far blank scan. 11. After completing the visual inspection, click Exit to return to the Home page. 16.5 Source Replenishment Over time, the Gd153 transmission line sources of the attenuation correction system decay. As the sources get weaker, the penetration through the patient decreases and, as a result, the quality of the transmission data is adversely affected. In order to keep the performance of the system within specifications, the transmission source arrays need to be replenished every six months, starting from the original installation date. Source replenishment involves the following steps: • Preparing for line source replenishment • Performing the actual line source replenishment • Acquiring near blank scans • Acquiring far blank scans • Returning the used line sources to the vendor Please refer to your c.clear Operator’s Manual for further instructions. 16.6 Near Blank Scan After the line source replenishment has been performed, near blank scans must be acquired for both line source arrays. While the line source assemblies are still dismounted from the c.clear wings: 1. The acquisition PC will prompt you to click OK following the source replenishment procedure. 2. Click OK to accept automated motions bringing the c.cam system into position for performing the near blank scan of detector I and line source array II (the line source array mounted on detector II). 3. During the automated motion, follow on-screen directions to move c.clear wings into/away from the scanning position. 4. The system moves to the position for performing the first near blank scan for line source array II. 64 Turnover Workbook | c.cam CAUTION: When acquiring near blank scans, be very careful to use the correct Notes line source array. Line source array I must be placed on top of detector II and line source array II must be placed on top of detector I when acquiring near blank scans. 5. Remove the collimator on detector II. This is necessary in order for the line source assembly to be positioned for the left near blank scan which will be acquired shortly. 6. Click OK on the acquisition PC to remove the pop-up message notifying you of the collision caused by the collimator being removed. Note: The collision message is caused by one detector being uncollimated and may reappear while detector II is without the collimator. You may safely ignore the message and remove it by clicking OK. 7. Place the near blank scan bracket on detector I, as close to detector II as possible. 8. Place line source assembly II on the bracket, in the position for RIGHT near blank scan. The edge of the line source array must rest against the socket headed screw mounted in the near blank scan bracket as seen in the image below. Bracket and line source array in position for right neer blank scan Caution: When placing the line source assembly on the bracket, be very careful to hold the line source assembly horizontally, in order to avoid exposing the uncollimated detector to radiation from the line sources. Caution: When placing the line source assembly on the bracket, be very careful that the label with the arrow is pointing towards the head end of the patient chair. 9. Click OK on the acquisition PC to acquire the RIGHT blank scan. 65 Turnover Workbook | c.cam 10. When on-screen instructions prompt you to move the line source Notes assembly to the LEFT near blank scan position, move the line source assembly (array II) to position LEFT. The edge of the line source array must rest against the socket headed screw mounted in the near blank scan bracket as seen in the image below. Bracket and line source array in position for left near blank scan 11. Click OK to acquire the LEFT near blank scan. 12. When the LEFT near blank scan has been acquired, remove the line source assembly and the flood frame from detector I. 13. Remount the collimator on detector II and press the Collision Override. 14. After removing the line source assembly and flood frame and remounting the collimator, click OK to accept automated motions bringing the c.cam system into position for near blank scan of detector II and line source array I. 15. During automated motions, follow on-screen directions to move c.clear wings into/away from the scanning position. 16. Remove the collimator of detector I. This is necessary in order for the line source assembly to be positioned for the RIGHT near blank scan. 17. Click OK on the acquisition PC to remove the pop-up message notifying you of the collision caused by the collimator being removed. 18. Place the near blank scan bracket on detector II, as close to detector I as possible. 19. Place line source assembly I on the bracket, in the position for RIGHT near blank scan. 20. Click OK on the acquisition PC to acquire the RIGHT blank scan. 21. When prompted to do so, move the line source assembly to the LEFT near blank scan position and click OK to acquire the LEFT near blank scan. 22. When the LEFT near blank scan has been acquired, remove the line source assembly and the bracket from detector II. 66 Turnover Workbook | c.cam 23. Remount the collimator on detector I and press the Notes Collision Override button. Completing Near Blank Scans After removing the line source assembly and flood frame and remounting the collimator: 1. Click OK to accept automated motions bringing the system back into the source replenishment position. 2. During automated motions, follow on-screen directions to move c.clear wings into/away from the scanning position. When the system has reached the line source replenishment position, it prompts you to remount both line source arrays in their respective wing. 3. Mount both line source arrays inside the respective line source compartments. Mount and tighten the 4 socket-headed screws holding them. Note: The line source assemblies are coded ensuring that they can only be mounted into the correct c.clear wing, i.e. line source array I can only be mounted in wing I and line source array II only in wing II. 4. Mount the top cover on the wings and click OK. 5. On the Transmission Source Replenishment page, click the Transmission Source Replenishment Done button. This causes the system to update the transmission source replenishment date. 6. Click the Exit button to exit the Transmission Source Replenishment page. Traumrustion Source 7. Click Exit to return to the Home page. 67 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. 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