Cardiac Dot Engine Online Training - USA

Welcome to the Cardiac Dot Engine online training. This online training provides a general overview of the key features of the Cardiac Dot Engine. You will gain an understanding of the underlying concept and we will show you the steps of a typical workflow of the technology for planning cardiovascular scans based on the example of the Ventricular Function. Upon successful completion of this online training, you will be able to:  describe the benefits of the Cardiac Dot Engine   understand the underlying concept of this planning tool for cardio scans    understand the steps of the workflows of the Cardiac Dot Engine   perform a typical workflow of the Dot Engine   To run the Cardiac Dot Engine the following pre-requisites are required: correct attachment of the ECG electrodes to the patient correct performance of the ECG learning phase  successful Patient Registration  correct Patient Orientation (Head First / Feet First)  Patient View is open. In the Patient View, you can select General Parameters, Breath-Hold Parameters and Physio Parameters. To complete the Patient View, click on the green Go button to move on to the first program step measuring the localizer. To learn more about the parameter settings or performing the ECG learning phase, please click on the tabs below.  Learn more about the ECG signal Learn more about the ECG signal Tab TitleTextECG signalThe electrocardiogram (ECG) signal records electrical activity of the heart using electrodes placed on the skin. Therefore, the ECG provides very important data about the function of the heart. The typical pattern of a good ECG is displayed as following:   The first peak (p-wave) shows how the electrical impulse propagates across the atria. The atria contract, pumping blood into the ventricles and immediately relax. Then the stimulation reaches the heart chambers. On the ECG this is visible as the Q, R and S waves, the so-called QRS complex, in which the heart chambers contract. Thereafter, the T-wave indicates that the stimulation reverts back and the heart chambers relax again.   Learning phaseOnce inside the bore a patient's heart rhythm changes and the aortic blood flow causes an artifactual pulse due to an interaction between the high magnetic field and ionic charges within the flowing blood. By using the Vector Cardio Gramm (VCG) signal processing you can eliminate the gradient and RF pulse noise and flow artifacts. VCG triggering requires a learning phase which obtains a clean VCG signal with the patient outside the bore.  Remember: In order to perform an optimum learning phase wait at least 10 artifact-free heart beats before the patient table is moved into magnet. Terminate the learning phase by immediately moving the table into the bore at least 30 cm before making any last minute adjustments to the patient, coils, or sheets.      Learn more about the Dot Engine Patient View Learn more about the Dot Engine Patient View Base ImageHotspotsText BlocksImage FileTrigger sourceExam Strategy Under the Exam Strategy you can select the following options: Breath-hold: Standard measurements Realtime: Measurements are performed with real-time protocols. You can select this option for patients with reduced breath-hold capacity or arrhythmias   Breath-Hold Capability This option enables you to specify the breath-hold capacity of the patient.  The breath-hold capacity depends on what health conditions the patient has. Therefore, the Breath-Hold Capability can be individually adapted to patient´s conditions.Overwrite RR interval This option enables you to overwrite the automatically captured heart rate by specifying an RR interval. If the patients’ heart rate changes while holding the breath, you can overwrite the heart rate captured automatically by returning to the Patient View later during the study.  Auto Breath-Hold Commands By default Auto-Breath Hold Commands are played automatically throughout the entire examination. If you want to turn off the breath-hold commands you can remove the checkmark next to the field Auto Breath-Hold Commands.  In the drop-down menu you can select a language for the breath-hold commands.  Pause Between Breath-Holds By default a pause between breath-holds and pause before the first breath-hold is set.  If necessary, you can also adapt parameters such as the examination strategy or the patients heart rate during an examination in the Patient View. To return to the Patient View, click the Dot Engine header directly above the queue and adapt the required parameters.To complete the Patient View click on the green Go button to move on to the first program step measuring the localizer. After completing the Patient View, the measurement of the localizer starts automatically. No user interaction is required. During the localizer step the system executes an automatic breath-hold command.  The localizer creates an overview of the heart based on the pre-configured Field of View (FoV) in 3 orientations: coronal, sagittal and transversal. After the measurement, the acquired images are displayed in the graphical slice positioning (GSP).   After the localizer step, the center on heart step will automatically open and you can find the resulting images in the graphical slice positioning (GSP).  To ensure the best possible image quality, you first identify the center of the heart as the reference for the Local range (LOC) mode for all subsequent measurements.   In order to identify the center of the heart as the reference for the Local range (LOC) mode, have a look at the video.   In the Guidance View the Cardiac Dot Engine shows you an example image on how to position the slices correctly in the reference images to localize the heart. You can follow the instructions of the Guidance View or position the slices as required. In order to position the slices, please have a look at the video. After positioning the slices you need to inform the patient about possible table movements. To start the measurement of localizer_heart click Go.  Please note: The Guidance View shows you only recommended positions of the slices. It is your own responsibility to check and adapt the final position of the slices. The more accurate the localization of the heart is, the more accurate the pathologies and functional interferences will be displayed in the clinical images at the end of the examination.   The thoracic overview step starts automatically and you need to position the coronal and transverse slices in the reference images. As in the previous step, the Cardiac Dot Engine shows in the Guidance View an example image, if you need help to position the slices. Please have a look at the video to see how to perform the thoracic overview step. After completion of the measurement the thoracic overview images are displayed in the GSP.   In the AutoAlign (AA) Heart *scout step, an algorithm performs 3D segmentation of the 2D contiguous slices and generates MPRs. These MPRs are not shown on the user interface, but are used to calculate marker points and slice position for subsequent measurements.  The measurement parameters of the AAHeart scout step are automatically generated and usually do not require any user interaction. Please note: The Guidance View shows you only the recommended position of the slices. It is your own responsibility to ensure the complete coverage of the heart from base to apex.  It is recommended not to modify any measurement parameters of AAHeart_scout except the slice shift in Anterior >> Posterior or Feet >> Head direction, if necessary. *scout: This step is based on the measurements of the localizer heart step.   After the AAHeart_scout step five marker points on anatomical landmarks are automatically placed: Left atrium Aortic root Right ventricle Left ventricle Apex Long-axis views are calculated based on those marker points. Please note: The Marker Localization tab shows you only recommended marker localizations. It is your own responsibility to check the calculated marker points and heart views in the GSP.   To learn more about the measuring Define long-axis and CINE long-axis view, please click on the tab below. Measuring Define and CINE long-axis views Measuring Define and CINE long-axis views Tab TitleTextMeasuring Define long-axis views Measuring CINE long-axis views       In the Define short-axis and the CINE short-axis step you can select between Shortaxis All and Shortaxis Subset. Under Shortaxis All you can review the orientation and position of all short-axis slices. The Shortaxis Subset* tab provides you a subset of short-axis slices, that partially cover the heart. By default, the position of the subset slices is related to the position of all short-axis slices. The defined subset slices can also be used in subsequent measurements. To perform the Define short-axis and the CINE short-axis view step, please have a look at the video. After the Define short-axis and CINE short-axis step, an Inline Ventricular Function analysis is performed with a stack of parallel short-axis and long-axis images. *not required for the clinical workflow Ventricular Function     After reading the disclaimer, please proceed to the final assessment to complete the online training. Please note that the learning material is for training purposes only!  For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training.  The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system.  Certain products, product related claims or functionalities described in the material (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages.  All names and data of patients, parameters and configuration dependent designations are fictional and examples only.  All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH, 2020 Congratulations. You have completed the Cardiac Dot Engine Online Training course. Listed below are the key points that have been presented. Take time to review the material before you proceed to the final quiz. Concept and key features of the Cardiac Dot Engine The Cardiac Dot Engine is a step-by-step user guidance, that supports you with planning and imaging the heart. It provides automated workflow support to disease specific adaption of protocols and suitable selection of the exam strategy based on the patient’s physiological conditions. This helps you to reduce workflow steps and to handle your workload with more ease by reproducible patient scanning. Key features of the Cardiac Dot Engine: Automated heart rate tracking and automated parameter adaption Automated localization of long-axis views and short axis-views Steps of the Cardiac Dot Engine Three main workflows: Ventricular function, Ischemic Heart Disease and Myocarditis. The Myocarditis is only available for 1.5T systems. The first exam steps of the Ventricular Function workflow correlate with the first steps of the Myocarditis and the Heart Disease workflow with minor differences. a) Completing the Cardiac Dot Engine Patient View Pre-requisites to run the Cardiac Dot Engine: correct attachment of the ECG electrodes to the patient: The electrocardiogram (ECG) signal records electrical activity of the heart using electrodes placed on the skin.  Inside the bore a patient's heart rhythm changes and the aortic blood flow causes an artifactual pulse. By using the Vector Cardio Gramm (VCG) signal processing you can eliminate the gradient and RF pulse noise and flow artifacts.  correct performance of the learning phase of the ECG curve:  In order to perform an optimum learning phase, wait at least 10 artifact-free heart beats before the patient table is moved into magnet.  The learning phase is terminated by immediately moving the table into the bore at least 30 cm. successful Patient Registration correct Patient Orientation (Head First / Feet First) Patient View is open b) Measuring the localizer  No user interaction is required. The localizer creates an overview of the heart in 3 orientations: coronal, sagittal and transversal.  c) Center on heart step To ensure the best possible image quality, you first need to move the center of the heart into the isocenter of the scanner. To identify the center of the heart, drag the yellow triangle up or down until it points to the middle of the heart and click Go to confirm the selected center of the heart. d) Localizer heart step Follow the instructions shown in the Guidance View to position the slices in the reference images or position the slices as required. To start the measurements click Go.  e) Measuring thoracic overview images  Position the coronal and transverse slices in the reference images. The Guidance View shows an example image to help to position the slices. To start the measurement click Go.  f) Performing the AAHeart scout step Slice orientations and five marker points are calculated by an algorithm based on the AAHeart scout images: Left atrium, Aortic root, Right ventricle, Left ventricle, Apex. g) Measuring Define long-axis and CINE long-axis views In the Define long-axis step, you can check and move the calculated five marker points from the AAHeart scout step. Usually no user interaction is required. In the CINE long axis step, you can select the heart view in the Settings for function window and add the Frequency scout step (This is an option only for 3 T systems). h) Measuring Define short-axis and CINE short-axis views In the Define short-axis and the CINE short-axis step you can select between Shortaxis All and Shortaxis Subset. Under Shortaxis All you can review the orientation and position of all short-axis slices. The Shortaxis Subset tab provides you a subset of short-axis slices that partially cover the heart. By default, the position of the subset slices is related to the position of all short-axis slices.  Planning additional heart views and adapting the exam queue Select an exam strategy and the exam queue will be automatically adapted to the appropriate workflow steps. In order to add an additional measurement protocol from the Dot Cockpit select the plus. Drag the required protocol e.g. from Siemens Cardiac Dot library of the Cardiac Dot Engine to the measurement queue. To acquire additional heart views after an examination right-click in the exam queue on one of the protocols, that has already been measured. Select Repeat and Open from the context menu and click Add/Remove. Drag those heart views that you measured earlier in your study from the Selectable Views to the Available Views list.   The Cardiac Dot Engine guides you through a typical MR cardiac examination, helping you to plan and image the heart.  The Dot Engine encompasses the following steps: Completing the Cardiac Dot Engine Patient View Performing the exam strategy Planning additional heart views and adapting the exam queue (customizable) To learn more about the steps of the different Cardiac Dot Engine workflows, please click on the tab below.   Steps of the Dot Engine Steps of the Dot Engine Slide NumberText BlocksCalloutsAudio ScriptImage File1The Cardiac Dot Engine assists you in performing the following clinical workflows: Ventricular Function, Ischemic Heart Disease and Myocarditis. Furthermore, you can add additional steps to a workflow, such as cardiac mapping or flow measurements to determine the cardiac output of the ventricle and the different shunt volumes. In the table you can see the three main workflows: Ventricular Function, Ischemic Heart Disease and Myocarditis. The Myocarditis is only available for 1.5T systems. In order to perform a clinical workflow, you need to select an appropriate Cardiac Dot Engine workflow from the Dot Cockpit with pre-defined examination protocols. In the following training we will introduce you to the Cardiac Dot Engine based on the example of the Ventricular Function workflow. The exam steps of this workflow strategy correlate with the first exam steps of the other two workflows with minor differences. Note: The examination protocols for each workflow will be predefined in cooperation with your Siemens application specialist. Click on page 2 in the upper right corner to proceed with the training.The Cardiac Dot Engine assists you in performing the following clinical workflows: Ventricular function, Ischemic Heart Disease and Myocarditis. Furthermore, you can add additional steps to a workflow, such as cardiac mapping or flow measurements to determine the cardiac output of the ventricle and the different shunt volumes. In the table you can see the three main workflows: Ventricular function, Ischemic Heart Disease and Myocarditis. The Myocarditis is only available for 1.5T systems. In order to perform a clinical workflow, you need to select an appropriate Cardiac Dot Engine Workflow from the Dot Cockpit with pre-defined examination protocols. In the following training we will introduce you to the Cardiac Dot Engine based on the example of the Ventricular function workflow. The exam steps of this workflow strategy correlate with the first exam steps of the other two workflows with minor differences. Note: The examination protocols for each workflow will be predefined in cooperation with your Siemens application specialist.2Based on the example of the Ventricular Function the Cardiac Dot Engine is made up of the following typical steps: 1. Measuring the localizer 2. Defining the center position of the heart 3. Measuring the localizer heart step 4. Measuring thoracic overview images 5. Performing the AutoAlign (AA) Heart scout step 6. - 7. Measuring Define long axis views and CINE long axis views 8. -  9. Measuring Define short axis views and CINE short axis views 10. Planning additional heart views and adapting the exam queue The Cardiac Dot Engine performs most of the steps automatically, so there is minimal user input needed.Based on the example of the Ventricular Function the Cardiac Dot Engine is made up the following typical steps: 1. Measuring the localizer 2. Defining the center position of the heart 3. Measuring the localizer heart step 4. Measuring thoracic overview images 5. Performing the AutoAlign(AA)Heart scout step 6. - 7. Measuring define long axis views and CINE long axis views 8. - 9. Measuring define short axis views and CINE short axis views 10. Planning additional heart views and adapting the exam queue. The Cardiac Dot Engine performs most of the steps automatically, so there is minimal user input needed. During and after an examination you can change the exam strategy or add some additional workflow steps to adapt the workflow to your specific needs. If you want to learn more about how to adapt the workflow, please click on the tab below.   Adapt a Cardiac Dot Engine workflow Adapt a Cardiac Dot Engine workflow Tab TitleTextAdapt and optimize the exam queue If you need to select a different exam strategy, you can easily adapt the exam queue appropriately. Have a look at the video to see how it works.       Planning additional heart views During the examination you have the option to plan additional heart views that were not scheduled in the previous steps, such as a 2 - Chamber view RV. Additionally you can repeat a measurement due to an insufficient image quality of a specific region of interest (because of suboptimal breath-holding or issues with the ECG curve). If you want to learn how to repeat a measurements and to plan additional heart views, please have a look at the video.     The Cardiac Dot Engine provides an automated workflow support for: suitable selection of the exam strategy based on the patient’s physiological conditions disease specific adaption of all protocols planning of cardiac views This helps you to reduce workflow steps and to handle your workload with more ease by reproducible patient scanning. In addition, the key features of the Cardiac Dot Engine are: Step-by-step user guidance AutoAlign Heart for the automated planning of the standard heart views. Automated heart rate capturing and automated parameter adaptation Automatic localization of long-axis views and of short-axis views Standardized cardiovascular views, which can be selected as protocol parameters