Embolization Guidance - Control Room (VD1xx to VD2xx)

Embolization Guidance - Control Room (VD1xx-VD2xx) Job Aid Advanced Therapies - Application Software VD1xx to VD2xx. **There is an additional job aid available on PEPconnect to determine SW version of the system. XA, CT, MR, or PET volumes can be used with Embolization Guidance. 1. Perform a 3D spin or load a previously acquired dataset into the 4D taskcard. 2. If a previous dataset is imported and being used, 2D3D or 3D3D Registration will need to be performed first. 2D3D or 3D3D Registration is not required to plan the workflow, however, it will be required when the dataset and planning information is being used the day of the procedure. If loading an outside dataset into the 4D taskcard, pay attention to which folder it is being loaded into. If loading into the c-arm folder (currently registered patient on the ARTIS), user may get the message to Assign to Existing if patient demographics are different. If the data being loaded is the same as the patient that is currently registered on the ARTIS, put a check mark in the box and select Assign to Existing. This will load the dataset into that folder. If user is just wanting to review images, no choose Load to Review and image will load into Review folder. C New Patient Review and Processing Loading X Different patient demographics! Use 'Load to Review' to close the current review patient and load the selected images for review. If the images belong to the patient "20.05.26-06:39:00-STD", you can load and add them to this patient by selecting 'Assign to Existing'. Enable the checkbox for confirmation before. vl confirm that the data belongs to patient "20.05.26-06:39:00-STD" Assign to Existing Load to Review Cancel Loading SIEMENS Healthineers Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 07/08/2020 | HOOD05162003101312 Job Aid | Embolization Guidance – Control room Effective Date: 07/08/2020 | HOOD05162003101312 3. Open Workflow menu. New Patient 30 Review and Processing 4. Select Embolization Guidance. Select syngo 4D application X Select the 4D application you want to work with Aneurysm Analysis Aortic Valve Guidance Cong. Heart Disease Guidance · CTO Guidance EP Planning Embolization Guidance EVAR Guidance Needle Guidance Stenosis Analysis OK Cancel Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 07/08/2020 | HOOD05162003101312 Page 2 of 13 SIEMENS Healthineers Job Aid | Embolization Guidance – Control room Effective Date: 07/08/2020 | HOOD05162003101312 5. Embolization Guidance workflow has 3 steps: a. Segmentation – optional step to perform a stroke-based segmentation to define anatomy of interest such as a tumor. Workflow bypasses this step and goes directly to Mark / Identify Vessel. User has the choice to return to Segmentation as needed. b. Mark Vessel (VD11) / Identify Vessel (VD20) – Allows user to define vessel path, that can be used as an overlay, to use for navigation. VD20 introduces Auto Vessel Detection. i. Manual vessel detection works for all types of datasets, i.e. livers, prostates, renals, etc. ii. Auto vessel detection ONLY works for liver datasets. c. Overlay – manipulate and/or analyze objects/graphics and additionally overlay with 3D Overlay (Show Live on 3D). VD11 Menus Embolization Guidance X Embolization Guidance × Embolization Guidance X Segmentation Segmentation Segmentation Select a segmentation result. Draw at Mark Vessel Mark Vessel least one (+) stroke and one (-) stroke Mark vessel by setting two or more Overlay in the image. Select 'Calculate'. Check seed points result. Select 'Calculate'. Overlay segmentation and vessel results for guidance. To modify Selection planning results go to previous steps New ... Show Object Color ... + 3D Objects Selection Segmentation VT1 ... Seed Points Show Vessel Vessel Overlay 8 Show Volume Data in VRT 1 E Bifurcations Show Vessel Branches Mark Vessel Live Overlay Overlay Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 07/08/2020 | HOOD05162003101312 Page 3 of 13 SIEMENS Healthineers Job Aid | Embolization Guidance – Control room Effective Date: 07/08/2020 | HOOD05162003101312 Mark Vessel / Identify Vessel To manually create a new vessel tree: 1. Select New from the drop-down menu within workflow step. 2. Select Add Vessel icon. VD11 VD20 Embolization Guidance × Review and Processing Segmentation Embolization Guidance X Mark Vessel Segmentation Mark vessel by setting two or more Identify Vessel seed points. Select 'Calculate'. Select function to add/refine vessel tree Selection auto VT1 ... Selection New .. ... Show Vessel Show Object Color 8 7 V Bifurcations Overlay Overlay 3. Mark at least two points to identify vessel in either VRT or MPR. To scroll through the MPRs or rotate the VRT while marking points, hold down the SHIFT key then start scrolling or rotating. Release SHIFT key to mark points. Increasing Slice Thickness can help with identifying vessel. Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 07/08/2020 | HOOD05162003101312 Page 4 of 13 SIEMENS Healthineers Job Aid | Embolization Guidance – Control room Effective Date: 07/08/2020 | HOOD05162003101312 4. Then select Calculate Path icon for VD11 software. VD20 will automatically calculate the path after two seed points are manually placed into the image. 5. To create additional vessel paths, repeat steps 1-4 of this section; remembering to select NEW with each new vessel. To use Auto Vessel detection: VD20 1. Select New from the drop-down menu within workflow step. 2. Center tumor in all three MPRs. 3. Select Auto Vessel detection icon. Review and Processing Embolization Guidance x Segmentation Identify Vessel Select function to add/refine vessel tree auto Selection New ... ... Show Object Color K Overlay Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 07/08/2020 | HOOD05162003101312 Page 5 of 13 SIEMENS Healthineers Job Aid | Embolization Guidance – Control room Effective Date: 07/08/2020 | HOOD05162003101312 4. When Auto Detection is started, the algorithm starts searching for the catheter tip. Please make sure the catheter is in the volume being used. A previous CTA of the liver will NOT have a catheter in the dataset so Manual vessel detection would be required. 5. Draw a line across the tumor in a single MPR image. User DOES NOT need to mark catheter tip. A blue sphere will mark the region of interest (ROI) and a purple detection zone will automatically be displayed and vessel(s) will automatically be detected and tracked back to the tip of the catheter. A color-coded vessel tree will be displayed. Initial color-coding is green, red and yellow but these can be modified per case. a. Green segment – main branch b. Red and yellow segments – secondary branches Viewing Procosting Embolization Cuidance Idaritaly Veaseil Overlay Dvetzy segmentation and veasd lesuti for gatitce to today Bow V12 4D I Shte Vessel Branches Volume Opacity Tools Meas X Ray Stice Thickness (mm) 52 Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 07/08/2020 | HOOD05162003101312 Page 6 of 13 SIEMENS Healthineers Job Aid | Embolization Guidance – Control room Effective Date: 07/08/2020 | HOOD05162003101312 6. Additional vessel trees can be created and existing vessel trees can be edited and ”pruned“ to remove all distal vessels. Click on Prune icon and click in vessel. All vessels distal to prune point will be removed. 7. Additionally, existing vessels can be added to. This is done by selecting the vessel tree (VT1, VT2, etc.) from the drop down menu, selecting Mark Vessel icon and single clicking in the vessel distal to farthest point. The vessel will track to new point, increasing the length or adding a branch. Embolization Guidance Embolization Guidance x X Segmentation Segmentation Identify Vessel Identify Vessel Select function to add/refine vessel Select function to add/refine vessel tree tree auto auto Selection Selection VT1 ... VT1 ... Show Vessel Color Show Vessel Color Detection Zone Detection Zone Bifurcations Bifurcations 5 V 5 3 3 K Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 07/08/2020 | HOOD05162003101312 Page 7 of 13 SIEMENS Healthineers Job Aid | Embolization Guidance – Control room Effective Date: 07/08/2020 | HOOD05162003101312 8. Click on Overlay to bring up next menu with all overlay options. NOTE: if using an imported dataset, please refer to 2D3D Registration or 3D3D Registration Job Aid found on PEPconnect. A registration will need to be performed before an overlay can be visualized. Review and Processing Embolization Guidance × Patient Applications Reconstruction Show Mode View Orientation Tools Measure Volumes Options Help Segmentation EmboGuidance_Liver HRA National Canser Center ... 0000000005 AXIOM-Artis New Patient Identify Vessel CTA 08s-DR Nat Fill H .. VC13D 081121-2\VB13E 1/1/2009 HFS Overlay 4/9/2009 Review and Processing Embolization Guidance X Segmentation Overlay segmentation and vessel 4:13:00 PM Identify Vessel Overlay results for guidance. To modify Overlay segmentation and vessel 4D results for guidance. To modify planning results go to previous steps planning results go to previous steps. Color ... Show | Object Color PF Show Volume Data in VRT Show Vessel Branches SEG1 VT4 Live Volume Opacity 0.35 Image Tools Meas. X-Ray Overlay X RA Blending Ranges Show Volume Data in VRT VRT 364 IRAO 64 / CAUD 7 294 Show Vessel Branches 2/3/2017 11:56:28 AM Live Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 07/08/2020 | HOOD05162003101312 Page 8 of 13 SIEMENS Healthineers Job Aid | Embolization Guidance – Control room Effective Date: 07/08/2020 | HOOD05162003101312 Segmentation -- This menu allows for the marking of a region of interest, such as tumor or aneurysm. It requires strokes inside (+) and outside (-) of region of interest in at least two MPR segments, preferably all three MPR segments. NOTE: An additional Job Aid for Segmentation for Tissue Volume can also be found on PEPconnect. Important! If you have done vessel mapping before the segmentation steps, your vessel map may disappear while you are in the Segmentation menu; this is normal. It WILL return after leaving the Segmentation menu. 1. To create a new segmentation result, choose New under Selection drop down menu. Review and Processing Embolization Guidance X Auto Check Volume Segmentation Select a segmentation result. Draw at least one (+) stroke and one (-) stroke in the image. Select 'Calculate'. Check result. Selection New ... Mark Vessel Overlay Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 07/08/2020 | HOOD05162003101312 Page 9 of 13 SIEMENS Healthineers Job Aid | Embolization Guidance – Control room Effective Date: 07/08/2020 | HOOD05162003101312 2. Mark inside region of interest – object strokes. + IBT_LIVER_EMBOGUIDE ... Uni IBT_LIVER_EMBOGUIDE ... H Examination 1082577 DynaCT Nat Fill HU Norm ... 14D 090928 D 1082577 DynaCT Nat Fill HU Norm ... AXIOM-Artis VC14D 090923 (20.05.26-06:39:00-STD 4/29/1953 *4/29/1953 IBT_ANEURYSM_ANALYSIS # 2028468 # 2028468 XA XA 1/26/2010 1/26/2010 11:22:06 AM 11:22:06 AM 50 Review and Processing Embolization Guidance × Segmentation For a new segmentation result: Choose two different images and draw PostProc at least one (+) and one (-) stroke per image. Select 'Calculate'. Selection New ... + 10 cm 10 cm Quant L LA SL.17.8 MPR Thick W 1564 582 MPR Thick M 1564 LAO 90 / 0 IBT_LIVER_EMBOGUIDE ... Uni IBT_LIVER_EMBOGUIDE ... H Identify Vessel 1082577 AXIOM-Artis DynaCT Nat Fill HU Norm ... 1082577 AXIOM-Artis * 4/29/1953 VC14D 090923 DynaCT Nat Fill HU Norm ... HFS *4/29/1953 4D 090828 Overlay Filming # 2028468 # 2028468 XA XA 1/26/2010 1/26/2010 -O 11:22:06 AM 11:22:06 AM Volume Opacity Image | Tools |Meas ... | X-Ray Slice Thickness (mm) 17.8 4D R 10 cm F A Plans W 1564 C 582 VRT ₾ 1774 Deleted successfully job for 20.05.26 .. 0/0 Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 07/08/2020 | HOOD05162003101312 Page 10 of 13 SIEMENS Healthineers Job Aid | Embolization Guidance – Control room Effective Date: 07/08/2020 | HOOD05162003101312 3. Mark outside region of interest – background strokes. IBT_LIVER_EMBOGUIDE ... Uni IBT_LIVER_EMBOGUIDE ... 1082577 AXIOM-Artis Examination DynaCT Nat Fill HU Norm ... VC14D 090923 AXIOM-Artis VC14D 090923 20.05.26-06:39:00-STD *4/29/1953 DynaCT Nat Fill HU Norm ... *4/29/1953 IBT_ANEURYSM_ANALYSIS # 2028468 # 2028468 XA XA 1/26/2010 1/26/2010 11:22:06 AM 11:22:06 AM 30 Review and Processing Embolization Guidance X Segmentation For a new segmentation result: Choose two different images and draw PostProc at least one (+) and one (-) stroke per image. Select 'Calculate'. A Selection New ... 10 cm 10 cm Quant L SL 17.8 SL 17.8 MPR Thick 382 MPR Thick 1564 LAO 90 / 0 IBT_LIVER_EMBOGUIDE ... A Uni IBT_LIVER_EMBOGUIDE ... 1082577 DynaCT Nat Fill HU Norm ... AXIOM-Artis VC14D 090923 1082577 DynaCT Nat Fill HU Norm ... AXIOM-Artis Identify Vessel /C14D 090923 Overlay 4/29/1953 Filming # 2028468 # 2028468 XA XA 1/26/2010 1/26/2010 11:22:06 AM 11:22:06 AM Volume Opacity Image | Tools |Meas ... |X-Ray Slice Thickness (mm) 17.8 4D 10 cm 10 cm F A 1564 582 VRT ₩ 3152 Deleted successfully job for 20.05.26 .. Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 07/08/2020 | HOOD05162003101312 Page 11 of 13 SIEMENS Healthineers Job Aid | Embolization Guidance – Control room Effective Date: 07/08/2020 | HOOD05162003101312 4. Calculate Segmentation. The segmented volume is calculated and displayed in the VRT segment and also marked in all MPR segments. Note: More than one segmentation can be performed. Repeat previous steps to create additional MPR Thick LAO POSO segmentations. IBT LIVER EMBOGUIDE IBT LIVER EMBOGUIDE 1002577 Dynact Nat Fill HU Norm ... 1032577 4.2 01968 DynaCT Nat Fill HU Norm .. "4/29/1963 # 2028468 # 2028458 1/28/2010 XA 22:06 AM 1/26/2010 11:22:06 AM 5. Segmentation results can be modified with the Sculpting tool or creating a new segmentation. R F [A] Sculpting from the inside 07 CAUD 90 435 MPR Thick 115g 435 Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 07/08/2020 | HOOD05162003101312 Page 12 of 13 SIEMENS Healthineers Job Aid | Embolization Guidance – Control room Effective Date: 07/08/2020 | HOOD05162003101312 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 co llectively “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's 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 (hereinafter collectively “Functionality”) may not (yet) be comme rcially 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 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84-0 siemens-healthineers.com Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 07/08/2020 | HOOD05162003101312 Page 13 of 13 SIEMENS Healthineers