Embolization Guidance Workshop Workbook

SIEMENS Healthineers colthingers > 26 32; 118 / 79 119/0 97 ARTIS pheno Education Services www.usa.siemens.com/education AT Embolization Guidance Workshop Classroom Workbook Answers for life. User Services. Driven by More. More: Our philosophy for a lifelong improvement through continuing education and consulting. Working closely with you, we develop your personalized education and consulting strategy and support you and your staff with our comprehensive User Services to help gain: • More: Routine Confidence • More: Clinical Expertise • More: Superior Performance More: Personalized training, education, and consulting services from Siemens Healthcare Customer Services. For your leading edge in medical care. User Services. Driven by More. More: Personalized More: More: Superior Clinical Performance More: Routine Expertise Confidence 2 I Contact Information Summary Welcome to Siemens Healthineers Clinical Education Offerings: Siemens Healthcare is dedicated to helping you Call 1-888-221-8010 (follow the prompts) • get the most out of your investment throughout Classroom Training the entire product life cycle and beyond. Our goal (Offerings, Registration & Scheduling) • is to enable you to take technology further, Educational Symposia • profitability higher, and patient care to the next On-site Training • level. Find the information, resources, and tools Printed Self-studies • you need to get the most out of your recent Virtual Education (Offerings & Registration) • investment and stay up-to-date. Visit Workshops & Fellowships www.usa.siemens.com/Welcome2Healthcare. Visit www.usa.siemens.com/education for more information regarding the current Clinical Training and Siemens Clinical Training and Continuing Continuing Education Education portfolio. Siemens Customer Care Center: Call 1-800-888-7436 Siemens Training Centers • Troubleshooting assistance Immediate assistance for software Siemens Clinical Education • applications and workflow issues Training Center – TDC2 • For Tech Support press option 2 / for 110 MacAlyson Court applications support, press option 3 Cary, NC 27511 • Press the * key or enter the last six digits of your Functional Location Number Functional Location Number ____________________ Serial Number ________________________________ IP Address System _____________________________ IP Address PACS _______________________________ 3 II Contents I Contact Information Summary ............................................................................................... 3 II Contents .............................................................................................................................. 4 III Course Agenda .................................................................................................................... 6 Working with 3D Data ........................................................................................................ 6 Image Manipulation .......................................................................................................... 6 Advanced Features ............................................................................................................. 6 IV Course Objectives ................................................................................................................ 8 1. Working with 3D Data .......................................................................................................... 9 1.1 Objectives .................................................................................................................... 9 1.2 Import Images .............................................................................................................. 9 1.3 Identifying MPR and VRT Image Types ......................................................................... 10 2. Image Manipulation........................................................................................................... 11 2.1 Objectives .................................................................................................................. 11 2.2 Preset Gallery ............................................................................................................. 11 2.3 Window and Level Zoom and Pan .............................................................................. 11 2.4 Slice Thickness ........................................................................................................... 12 2.5 MPR and VRT Scroll and Rotation ................................................................................. 13 3. Advanced Features ............................................................................................................ 14 3.1 Objectives .................................................................................................................. 14 3.2 Bone Removal and VOI Punching ................................................................................ 14 3.3 3D Polyline................................................................................................................. 15 3.4 3D Marker ................................................................................................................. 15 3.5 Overlaying 3D objects on the Live screen .................................................................... 16 3.6 Object List ................................................................................................................. 16 3.7 Bookmarking.............................................................................................................. 17 4. Fusion............................................................................................................................... 18 4.1 Objectives .................................................................................................................. 18 4.2 Parallel Processing ...................................................................................................... 18 4.3 PURE 2D/3D Fusion ..................................................................................................... 18 4.4 3D/3D Fusion for PURE ................................................................................................ 22 5. Additional 3D .................................................................................................................... 26 5.1 Objectives ................................................................................................................. 26 5.2 Program selection (DSA/DR/DCT) ................................................................................. 26 5.3 3D Wizard – New with PURE Image 113.................................................................... 27 5.4 Mechanical Acquisition ............................................................................................... 27 5.5 Interactive Reconstruction ......................................................................................... 28 5.6 Saving and Transferring Images .................................................................................. 30 6. Embolization Guidance Workflow ....................................................................................... 36 4 6.1 Perform Intra Procedure DCT or Import CT/MR ............................................................. 36 6.2 Mark Vessel ................................................................................................................ 36 6.3 Overlay ...................................................................................................................... 37 6.4 Segmentation (optional)............................................................................................. 39 7. Embolization Guidance Exercises ........................................................................................ 40 5 III Course Agenda Working with 3D Data Import CTA Image Review 3D Data Set Understanding MPR and Anatomy Understanding VRT and Anatomy Image Manipulation Preset Gallery Window/Level Zoom/Pan Slice Thickness Image Scroll MPR Image Rotation VRT Advanced Features Bone Removal VOI Punching Polyline 3D Markers Bookmarking Object List 6 Fusion Bone Removal VOI Punching Polyline 3D Markers Bookmarking Object List Additional 3D Program Selection 3D Wizard Interactive Reconstruction Embolization Guidanc Mark Vessel Overlay Segmentation 7 IV Course Objectives Course Overview: The AT Embolization Guidance Workbook will provide the experienced user with the skills and knowledge to use and perform the applications and functions of the syngo Workplace. Upon completion of this course, you will be able to: • Demonstrate Embolization Guidance software • Demonstrate Manipulation and Use of 3D Data set • Apply Advanced 3D features • Properly Perform Fusion • Properly Apply 3D Roadmap /Overlay • Perform Optional 3D Image Acquisition and Post processing • Save and Transfer Images 8 Classroom Workbook | Embolization Guidance Workshop 1. Working with 3D Data 1.1 Objectives Notes After completing this section, the technologist will be able to: • Import CTA Images • Identify and review MPR Images and Anatomy • Identify and review VRT Images and Anatomy 1.2 Import Images 1. Click this icon in the toolbar. or – – Patient Search x Basic Sear Patient Name From To Node Patient ID Study Date Date of Birth Study Time Sex Any Accession Number Modality Advanced Search Study Description From 10 Study ID PPS Start Date Referring Physician PPS Start Time Reporting Physician Body Part Exam Study Instance UID Performing Physician Series Instance UID Request Procedure ID Series Number Scheduled Procedure ID Series Description Approval Status Reporting Search Search Clear Import mport Job Status Image Li Discard search results on close Close Help No node available . • Using the Patient Search, you can query and retrieve patient and examination data from workstations and long-term archives that are working with other DICOM program systems or older syngo program versions and are therefore not displayed in the navigation area of the Patient Browser. • Select Patient > Search... in the menu of the Patient Browser. • The Patient Search window is displayed. 2. Enter your search criteria and click Search 9 Classroom Workbook | Embolization Guidance Workshop 1.3 Identifying MPR and VRT Image Types Notes SAGITTAL CORONAL AXIAL VRT • Multi Planar Reformatting MPR is a rendering technique that projects the 3D volume onto a 2D image plane. During projection the averaged grey value is applied to the resulting image. • Volume Rendering Technique (VRT) is a way of creating color images in which a 3D effect is achieved with such parameters as transparency, shading, and color transition. The VRT algorithm calculates a parallel projection of the volume. Every voxel along a projection line is categorized by its pixel value (HU value) whether it belongs to a certain tissue class. By that, every voxel receives a color and an opacity value. 10 Classroom Workbook | Embolization Guidance Workshop 2. Image Manipulation 2.1 Objectives Notes After completing this section, the technologist will be able to: • Select Appropriate Preset from Preset Gallery • Window/Level Image • Slice Thickness • Zoom/Pan • Scroll and Rotate MPR and VRT Image 2.2 Preset Gallery • Selection of modality preset. (Identify the Preset Icon and choose appropriate Preset type. Proset Gallery Type AI Translucent Vasc VascDualy ... Unshaded VascBody VascHead more Shading Close Help 2.3 Window and Level Zoom and Pan • Window/Level. (Use the Middle mouse button. Up/Down the Screen for brightness and Right/Left on the screen for Contrast.) Window center! Brightness + Window width/ Window width! Contrast - Contrast + Window center Brightness - 11 Classroom Workbook | Embolization Guidance Workshop • Pan. Hold down the right mouse button. Press the mouse button in the 60% Notes inner area of the image segment and drag the mouse pointer. • Zoom. Hold down the right mouse button. Press the mouse button in the 20% outer area of the image segment and drag the mouse pointer. 2.4 Slice Thickness • Selecting MIP or MPR (From tools at the top of the screen select MPR or MIP) Manipulate Rotate Zoom/Pan Auto Pan VRT MIP MinIP VRT Thin MIP Thin MinIP Thin MPR MPR Thick Reset MPR Orientation Home Preset Home Zoom/Pan Show View Full-Screen MPR Reference Lines Record Movie .. Play Movie. Reset all Orientations • Changing slice thickness. Once you Select MIP/MPR go to the image tab and adjust slice thickness. Image | Tools |Meas ... | X-Ray Slice Thickness (mm) 0.4 • Change slice thickness under the image tab by either dragging the slide bar or enter the slice thickness in mm. 12 Classroom Workbook | Embolization Guidance Workshop 2.5 MPR and VRT Scroll and Rotation Notes • To Scroll through MPR’s • Press the Left mouse button in the image and move mouse up/ down. -or- • Rotate the mouse wheel upwards and downwards. -or- • Drag a reference line. • To Rotate MPR – Select Rotate mode • Move the mouse to the outer 5% of image segment • Dragging in upper outer area – press Left mouse and hold. • Right mouse movement rotates image clockwise. • Left mouse movement rotates image counter clockwise • To Rotate VRT – Select Rotate mode • Move the mouse pointer to the 90% inner area of the image segment • Press the left mouse button, keep it pressed and rotate the image. 13 Classroom Workbook | Embolization Guidance Workshop 3. Advanced Features 3.1 Objectives Notes After completing this section the technologist will be able to • Utilize Bone Removal • Utilize VOI Punch • Apply 3D Polyline • Apply 3D Marker • Identify Object List • Save Bookmarks VOI Punching X auto . Remove Inside >Remove Outside Apply to Volume IApply to Segmentation v Auto CY Close Help 3.2 Bone Removal and VOI Punching Bone Removal • Open Tools VIO Punching in the main menu • Click on Bone Removal auto VOI Punching • Click the VRT Image segment or MPR Image segment • Click this icon • Drawing Mode is enabled by default 14 Classroom Workbook | Embolization Guidance Workshop 3.3 3D Polyline Notes Image | Tools Meas. X-Ray Measurement Graphics Annotation more • Select MPR image • Click this icon -or- • Select Measure > 3D Polyline from main menu 1. Click the start point and drag mouse – the first segment of Polyline is displayed 2. Click intermediate points 3. To draw an open polyline double click to end 4. To draw a closed polyline click the start point again 5. To Delete a point in the polyline press DEL on the keyboard 6. To Add intermediate points after creation of Polyline Right click on the required position and select ADD 3.4 3D Marker • Click this icon -or- • Select 3D Marker in the main menu • To place a marker in the MPR or VRT image • Perform a single mouse click on the required position in the image 15 Classroom Workbook | Embolization Guidance Workshop 3.5 Overlaying 3D objects on the Live screen Notes Click this icon on the workflow blind. Live • Using Overlay objects on Live, you can display graphic objects from the 3D volume on the 2D live image. • Overlay objects on Live is used to display graphical references overlaid to the live image marking anatomical structures that are visible in the 3D volume. • With Overlay objects on Live, the 3D objects are projected to the perspective of the C-arm position. • All positions including C-arm angulation and rotation, longitudinal position, SID, zoom stage, and table position are taken into account. • The overlay is dynamically updated with geometrical changes. 3.6 Object List Object List Review and Processing Viewing Overlay Show Object Color| Live 4D Registration required for overlay 3D Objects M1 L2 Show Object L3 Group Measurements Needle Segmentation Overlay d1 d2 X Live Close Help Live • Central location for managing all graphical objects • Structures graphical objects in groups • New graphical objects are added by default to the active group (bold) • Workflows create their own groups and assign their graphical objects to those groups • Can be opened via menu (Tools -> Object List …) or – – • Click the ... button. • Show column: Click a check box to show or hide an object group. • Object column: Groups and object names. Click to mark an object or object group. • Color column: Click to change the color and opacity of the object or object group. • Live column: Click a check box to show or hide the object or object group on the Live screen. • 4D column: Click a check box to show or hide the object or object group on the 4D task card. 16 Classroom Workbook | Embolization Guidance Workshop 3.7 Bookmarking Notes • Bookmarking saves all manipulated data of a volume and can be quickly and easily restored. Bookmarks are retained when loading previous studies • To Store a study bookmark for the currently displayed volume. • Left-click Bookmark icon to store the study bookmark being named automatically. • Right-click Bookmark icon to enter the name/properties and then store the study bookmark. Review and Processing Viewing Review loaded or acquired volumes. New acquisitions will replace existing volumes. 12/21/2012 Gefäße 02___Aorta_Angio (Erwach ... 11/2/2016 VESSEL BONE Overlay 17 Classroom Workbook | Embolization Guidance Workshop 4. Fusion 4.1 Objectives Notes After completing this section, the technologist will be able to: • Identify Parallel Processing • Perform 2D/3D & 3D/3D Fusion 4.2 Parallel Processing Examination Patient Review Patient • With PURE we now have the ability to review a previous study without interrupting your current patient procedure. This allows review of a patient in the control room without interrupting the currently active procedure. The folder with the C-arm icon indicates the active patient registered on the Artis system. The folder without a C-arm icon indicates a different patient that may be loaded into the 4D tab for review. 4.3 PURE 2D/3D Fusion • Method to fuse (merge) a 3D dataset to the current patient using two fluoro loops that are over 30 degrees apart and use as an Overlay. • Load existing 3D dataset from Browser into 4D tab under the examination patient and “Assign to Existing”. This will allow this dataset to be used on the current examination patient as an overlay. Patient Browser Patient Applications Transfer Edit View Filter Sort Private Applications Options Help EE Loading X A 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 "15.08.24-07:54:23-DST", you can load and add them to this patient lecting 'Assign to Existing'. Enable the checkbox for confirmation before. 1 | confirm that the data belongs to patient "15.08.24-07:54:23-DST" Assign to Existing Load to Review Cancel Loading 15.08.19 3d roadmap Patient name 2D3D. Fusion Date of birth 8/24/1970 Patient ID 12345€ 2 3 5 Current Filter: Off • Move C-arm into area of interest- • Select Fusion Bookmark- 18 Classroom Workbook | Embolization Guidance Workshop Notes • When ready for 3D Roadmap, select the Overlay workflow step from Heads up display, General Review and Processing Viewing Overlay V Aneurysm Analysis Aortic Valve Guidance Cong. Heart Disease Guidance EP Planning Embolization Guidance • Or control room 4D tab Review and Processing Viewing Overlay Overlay planning objects for guidance. New acquisitions will be registered and fused with existing volumes. Show Object ... Group Live Live • Or the 3D Overlay icon from TSC. 19 Classroom Workbook | Embolization Guidance Workshop • The system will then automatically prompt you to perform Fusion. Choose Notes 2D/3D fusion and perform two fluoro loops more than 30 degrees apart. 90 degrees is ideal. syngo 3D Registration ? X Check registration result. If necessary, align data manually or automatically. 2D3D 3D3D Select image Alignment Visualization Undo Accept 2D3D Cancel • First and Second Fluoro Positions 20 Classroom Workbook | Embolization Guidance Workshop Notes • Protect the alignment (this prevents registration scenes from being replaced), then utilizing Manual or Auto Alignment, line up the anatomy between both datasets (this can be performed from tableside or control room). Angle = 90º • When alignment is complete, then select ACCEPT 2D3D icon from control room Accept 2D3D Cancel • Or select ACCEPT from the Heads Up display menu. 1y0go 30 Registras VRT VRT 2 LD Manual Alignment O Auto-Alignment > Reset Alignment rung Accept Cancel 21 Classroom Workbook | Embolization Guidance Workshop • 3D Roadmap is now active and current. All system movements will be updated Notes automatically as they occur. The TSC joystick graphics will now prompt for BLEND which will allow the user to fade the overlay in and out at different intensities. I Blend Windowing Rotate Menu 4.4 3D/3D Fusion for PURE • Method to fuse (merge) two 3D datasets and use as an Overlay for current patient. • Load existing 3D dataset from Browser into 4D tab under the examination patient and “Assign to Existing”. This will allow this dataset to be used on the current examination patient as an overlay. Patient Browser Patient Applications Transfer Edit View Filter Sort Private Applications Options Help ? Loading X Different patient demographics! diu Use 'Load to Review' to close the current review patient and load the selected images for review. images belong to the patient "15.08.24-07:54:23-DST", you can load and add them to this patient by selecting 'Assign to Existing'. Enable the checkbox for confirmation before. | confirm that the data belongs to patient "15.08.24-07:54:23-DST" Assign to Existing Load to Review Cancel Loading 15.08.19-08:23:46- 3d roadmap Patient name 2D3D, Fusion tudy description of birth 8/24/1970 te 8/24/2015 Patient ID 1234 3 15 6 Current Filter: Off 22 Classroom Workbook | Embolization Guidance Workshop Notes • When ready for 3D Roadmap, select the Overlay workflow step from Heads up display X-WP 40 050 Review General Workhow Review and Processing Viewing Overlay Aneurysm Analysis Aortic Valve Guidance Cong. Heart Disease Guidance EP Planning Embolization Guidance Or control room 4D tab Review and Processing Viewing Overlay Overlay planning objects for guidance. New acquisitions will be registered and 4D fused with existing volumes. Show Object ... Group Live Live • Or the 3D Overlay icon from TSC. 23 Classroom Workbook | Embolization Guidance Workshop • The system will then automatically prompt you to perform Fusion. Choose Notes 3D/3D fusion and perform a 5sDR CARE or another spin of physician’s choice. syngo 3D Registration 12 X Acquire the first 2D image for 2D/3D registration. Alternatively you can switch to 3D/3D registration by acquiring a volume. 2D3D 3D3D Select image Alignment Visualization Undo Accept 2D3D Cancel • Then utilizing Manual or Auto Alignment, line up the anatomy between both datasets (this can be performed from tableside or control room). Overlay Tact 1234547390 raining Conter AxiMANI VD11 B 16070PSD11BY 1234547099 DCT Body fit FarJ H GOworley, Test 30/30 Fusion necessary, align data manually o automaticaly Algr mar Visualization Undo Himayor Thick Reset Fusion Result (new] Chien Carter AxoVant 123456 7890 2016-03-02_07-49 82707 2016 OK Cancel ciume Opacity Image Tools |Meas .. |X-Ray Segmentation D Tools A) Ranges 24 Classroom Workbook | Embolization Guidance Workshop Notes • When alignment is complete, select ACCEPT 3D3D icon from control room Fusion Result (new) 2015-08-24 10-57 Accept 3D3D Cancel • Or select ACCEPT from the Heads Up display menu. VRT VRT 2 Manual Alignment Auto-Alignment Reset Alignment Accept Cancel • 3D Roadmap is now active and current. All system movements will be updated automatically as they occur. The TSC joystick graphics will now prompt for BLEND which will allow the user to fade the overlay in and out at different intensities. Blend Windowing Rotate Menu 25 Classroom Workbook | Embolization Guidance Workshop 5. Additional 3D 5.1 Objectives Notes After completing this section, the technologist will be able to: • Select the proper Exam Set and Acquire images • Perform Interactive Reconstruction • Save Images • Send Images to PACS 5.2 Program selection (DSA/DR/DCT) Settings Exam mage Quant Physio 4D ? DSA Special SM FL Angio DSA 7.5 2 f/s REF 7.5 p/s DSA long 2 f/s DSA Venous RDMP RDMP VFR man DR ACQ 2 f/s • DSA • DCT (DCT with or without contrast) • DR (3D bone/ Needle Guidance) • DSA H (3D Angios/ CT with or without contrast) • DR H (CT with or without contrast) • AVG: Aortic Valve Guide • PBV: Stroke (With Contrast) • DynaCT Card (With contrast) • Large Volume Portrait or Landscape (Zeego only, With or without contrast) 26 Classroom Workbook | Embolization Guidance Workshop 5.3 3D Wizard – New with PURE Image 113 Notes 3D Wizard is an automated program selection tool with step by step prompts to guide you through the steps of obtaining a 3D rotation. • First choose body region/study type • Wizard will provide suggested injection protocols • Wizard will choose the appropriate organ program based on the body region selected and list the steps necessary to obtain a 3D rotation Favorites* Head & Neck Cardio & Thorax Abdomen Perfusion Imaging Bleeding Detection (native) High Contrast Vessel Tree 5.4 Mechanical Acquisition • Press down on the C-arm joystick and deflect toward the table (C-arm moves to AP) • Press down on the C-arm joystick and deflect toward the table (C-arm moves to Lateral) • Press down on the C-arm joystick and deflect toward the table (C-arm moves to Start Position ) • Press down on the C-arm joystick and deflect toward the table (C-arm performs Test Spin) 5.4.1 Fluoro to set technique and end setup (O) 5.4.2 Set Injection 5.4.3 Perform acquisition from footswitch or hand switch 27 Classroom Workbook | Embolization Guidance Workshop 5.4.5 Auto Transfer (Manual Transfer- Post Processing, Image, send to 3D) Notes • Selection of modality preset. (Identify the Preset Icon and choose appropriate preset). Prosot Gallery X Type Al ranslucent VascDualy ... Unshaded VascBody VascHead more Shading Close Help 5.5 Interactive Reconstruction 5.5.1 Performing an interactive 3D reconstruction • If raw data are available on the syngo X Workplace, e.g. when an automatic 3D reconstruction was performed before, you can modify 3D reconstruction parameters by performing an interactive 3D reconstruction. • Select an image segment in the 4D task card. • Select Patient > Interactive Reconstruction... in the main menu of the 4D task card. teractive Reconstruction Define job list, jobs, parameters, and series name Start interactive 30 reconstruction. Body Region AI Job List DynaCT Card VOI Size: Full Num VOI Slice Matrix 256 x 256 Define VOl in . 2D view . 3D view Voxel Size: 0.97 mm Number of Slices 200 SMART Series Name DynaCT Card Viewing Preset DynaCTCardiac Reconstruction Job Nat Fil Kernel Type Image Characteristics HU Normal Motion Correction Close Help 28 Classroom Workbook | Embolization Guidance Workshop Notes • To select an image pair from the scene: • Click a single step button. • Click in the mid areas of the sides of the cuboid. To move and adjust the VOI • Click and drag the rectangle to the required position and size. 29 Classroom Workbook | Embolization Guidance Workshop • In the 3D view, a preliminary reconstructed 3D volume is displayed Notes 5.6 Saving and Transferring Images 5.6.1 Saving the image to the Local Database • Left-click this icon (when Save image is set). or – – Select Patient > Save image in the main menu. or – – • Examination room, Onscreen menu: • Select Save Image in the VRT or MPR post processing menu. • Graphics are not displayed Saving a snapshot to the Local Database • To save a snapshot of all image segments or the active image segment: • Left-click this icon (when Save snapshots all segments is set). Image 126 –or – • Select Patient > Save snapshot • LMB to save snapshot of all (displayed)segments incl. an overview of all segments • RMB to define save properties … (prefix) or – – • Examination room, Onscreen menu: • Graphics are “burnt” into the image 30 Classroom Workbook | Embolization Guidance Workshop 5.6.2 Creating radial ranges from a planar view Notes • Click the planar image segment you want to use for calculating the radial ranges, e.g. an MPR image segment. • The image segment has the focus (dotted frame). • Click the Radial Ranges icon on the Tools subtask card. –or – • Select Tools > Radial Ranges... in the main menu. Radial Ranges ? X High resolution Include reference image Number of images 18 Angular range [o] 90 Thickness [mm] 0.2 % Comment Series Name Close Help • Enter the slice Thickness [mm]. • Enter or select a Comment. • Enter a Series name. To switch to standard medical orientation: • Click this icon. 31 Classroom Workbook | Embolization Guidance Workshop To save the series of ranges: Notes • Click this icon. • The series of ranges is saved as a new series to the current study. • The saved series will be of the same type. 5.6.3 Creating radial ranges from a volume view • In order to store views of a volume from different angles, e.g. in a PACS, you can generate radial ranges. In this way, you simulate step by-step rotation around a reference axis of the volume • Click the image segment you want to use for calculating the radial ranges, i.e. the VRT image segment. • The image segment has the focus (dotted frame). • Click the Radial Ranges icon on the Tools subtask card. –or – • Select Tools > Radial Ranges... in the main menu. Volume Ranges ? X Presets Axis Vertical · Clockwise Counterclockwise Number of images Angular range [*] 90 Comment Series Name High resolution Close Help 32 Classroom Workbook | Embolization Guidance Workshop Notes • Enable the High resolution check box. • Change the Angular range [°] (angle between first and last slice), if required. • Change the Number of images to be generated, if required. • Select Clockwise or Counterclockwise • Change to Horizontal or Vertical Axis • Enter or select a Comment. • Enter a Series name. • Click this icon. • The series of ranges is saved as a new series to the current study of the active patient. • The saved series will be: • The screen captured images will contain the orientation, all currently visible graphics, the current window values (in case of AX, MR, CT, Fused volume or PET/SPECT data), and the color bar (in case of a PBV volume). 5.6.4 Creating parallel ranges • In order to view a volume in a specific direction, you can generate parallel ranges. • Click a planar image segment you want to use for calculating the parallel ranges, e.g. an MPR segment. The image segment has the focus (dotted frame). • Click the Parallel Ranges icon on the Tools subtask card. 33 Classroom Workbook | Embolization Guidance Workshop Notes –or – • Select Tools > Parallel Ranges... in the main menu. Parallel Ranges ? Presets 19 High resolution Include reference image Number of images 19 : Distance [mm] 6.2 - Thickness [mm] 2.0 Comment Series Name 19 Close Help • Enable the High resolution check box. • Disable the Include reference image check box • Change the Number of images to be generated, if required. • Enter the Distance (mm) between the images • Enter a slice Thickness (mm) • Enter or select a Comment. • Enter a Series name. • Click this icon. • The series of ranges is saved as a new series to the current study of the active patient. The saved series will be: • The screen captured images will contain the orientation, all currently visible graphics, the current window values (in case of AX, MR, CT, Fused volume or PET/SPECT data), and the color bar (in case of a PBV volume). 34 Classroom Workbook | Embolization Guidance Workshop 5.6.5 Image Transfer Notes • Identifying images on browser. (Identify “Refresh” on the Browser if you don’t find the images that you named in previous steps). • Transfer to PACS. (Identify the appropriate PACS node on the “Transfer” menu.) 35 Classroom Workbook | Embolization Guidance Workshop 6. Embolization Guidance Workflow 6.1 Perform Intra Procedure DCT or Import CT/MR Notes Select Embolization Guidance Workflow • Select the Embolization Guidance Workflow from the drop down -or- • Select the Workflow from Onscreen Menu from the Examination Room Select syngo 4D application ? 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 Cance 6.2 Mark Vessel • Mark Vessel workflow is selected • Mark at least 2 seed points on the MPR • May select additional lesions at any time • Place first seed point near catheter tip • Place last seed point on lesion to be embolized • Once seed points have been placed, click on the calculator icon • Program will calculate vessel path to include any bifurcations 36 Classroom Workbook | Embolization Guidance Workshop 6.3 Overlay Notes 6.3.1 Perform 2D3D Fusion if using an outside data set (refer to section 4.0) Embolization Guidance X Segmentation Mark Vessel Overlay ?FEE Overlay segmentation and vessel results for guidance. To modify planning results go to previous steps. Show Object Color ... 3D Objects Segmentation O Seed Points Vessel Overlay Show Volume Data in VRT Show Vessel Branches Live 6.3.2 Modify segmentation and overlay graphics • Modify segmentation and vessel overlay graphics, e.g. change vessel centerline graphic to a vessel outline graphic, change color of overlay graphics, etc. • Show vessel branches, i.e. perform a volume punch along the vessel centerline. It helps to better validate the accuracy of the vessel overlay graphic. • Adjust 2D/3D overlay blending. It helps to check micro catheter / guidewire positions during overlay. 37 Classroom Workbook | Embolization Guidance Workshop 6.3.3 Overlay on Live Screen/4D Notes Embolization Guidance × Segmentation Mark Vessel Overlay Overlay segmentation and vessel results for guidance. To modify planning results go to previous steps Show Object Color ... 3D Objects Segmentation Seed Points Vessel Overlay Show Volume Data in VRT Show Vessel Branches Live • Once calculations have completed, user has the option to overlay on live and/or 4D screen • Select “LIVE” to overlay vessel path on Live screen • Select “3D Roadmap” to have 3D volume displayed on 4D screen 38 Classroom Workbook | Embolization Guidance Workshop 6.4 Segmentation (optional) Notes Embolization Guidance × Segmentation Select a segmentation result, Draw at least one (+) stroke and one (-) stroke in the image. Select 'Calculate', Check result. Selection Now ex Mark Vessel Overlay • For segmentation, you must mark the object of interest by segmentation strokes. • The segmentation algorithm requires both object strokes and background strokes in at least two MPR views. • The anatomy to be segmented is a 3D object. In order to obtain a reasonable result, you should place strokes in more than one MPR view. Placing strokes in all three MPR views is suggested. • In order to specify complex anatomy in the most advantageous views, you may adjust the MPR slice positions or orientations to draw additional strokes. All existing strokes will be maintained. 39 Classroom Workbook | Embolization Guidance Workshop 7. Embolization Guidance Exercises 1. Import 3D data set and utilize VOI Punching to remove excess data and name Notes bookmark 2. Register a patient – Open Bookmark – Select Overlay and follow instructions for 2D/3D Fusion 3. Blend Overlay Image - Move C-Arm – Zoom Image – Turn off 3D overlay 4. Create Vessel path using Embolization Guidance software 5. Change vessel tree to a contour outline 6. Register a new patient– Load Imported 3D data set to Current Patient and follow instructions for 3D/3D Fusion 7. Perform an Interactive Reconstruction using Quick zoom 8. Perform an Interactive reconstruction changing VOI and HU and EE parameters 9. Rename and create a snapshot image 10. Rename and Save volume ranges 40 Classroom Workbook | Embolization Guidance Workshop Notes 41 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 Local Contact Information and options as well as standard and optional Siemens Medical Solutions USA, Inc. features which do not always have to be 40 Liberty Blvd. present in individual cases. Malvern, PA 19355-9998 Siemens reserves the right to modify the USA design, packaging, specifications and options Telephone: +1-888-826-9702 described herein without prior notice. Please www.usa.siemens.com/healthcare contact your local Siemens sales representative for the most current information. Global Business Unit Note: Any technical data contained in this Siemens AG document may vary within defined tolerances. Medical Solutions Original images always lose a certain amount Imaging & Therapy Systems of detail when reproduced. Angiography & Interventional X-ray Systems Siemensstr. 1 DE-91301 Forchheim Order No. A914CX-CS-121836-P1-4A00 Germany Printed in USA 08-2012 | All rights reserved Telephone: +49 9191 18-0 © 2012 Siemens Medical Solutions USA, Inc. www.siemens.com/healthcare Global Siemens Headquarters Global Siemens Healthcare Siemens AG Headquarters Wittelsbacherplatz 2 Siemens AG 80333 Muenchen Healthcare Sector Germany Henkestrasse 127 91052 Erlangen Germany Telephone: +49 9131 84-0 www.siemens.com/healthcare 42 www.siemens.com/healthcare