Fluorospot Compact Module 3 - Postprocessing

Welcome to the Fluorospot Compact web based training series. This series of four modules will cover examination workflow, study and image handling, basic system setup, and postprocessing functions. In this module, we will review processing tab, the graphics tab, Rad tab, DSA option, and other system tracking functions.    You should now be able to: Successfully process an image utilizing all buttons on the FLC Utilize the Graphics tab to measure and label images Correctly apply parameter options via the Process tab Demonstrate how to use the options associated with DSA By the end of this module, you will be able to: Successfully process an image utilizing all buttons on the FLC Utilize the Graphics tab to measure and label images Correctly apply parameter options via the Process tab Demonstrate how to use the options associated with DSA In this section we will cover all the Processing Subtab options that can be utilized to make changes to images via the Postprocessing tab.  The button that looks like a house with an arrow is used to take the image back to its original state. The button that is an arrow, will take the image back one step from the most recent change made. Once an image is stored, the system will make a new image with any changes the user applied. The “Display image with 1:1 pixel size” allows the user to view the displayed image with one detector pixel equal to one monitor pixel. To activate this function select the icon and to deactivate, deselect the icon. Once active, the user can “pan” the image to the ROI. To invert the image select the Invert button on the process sub tab. This button allows the user to switch between Bones Black (BB) and Bones White (BW) regardless of how the image is acquired. To store the inverted image, select the “Store Image” button.             To move the electronic shutters on a fluoro image, select the button and manually drag the shutters to the desired location or use the X/Y axis scroll bars. The shutters will stay in position unless the user manually drags them back to the original location or selects the “Home” button.           To “Flip” an image after making the acquisition us the Flip Horizontal or Flip Vertical button. These buttons will allow the user to change the way the image is displayed on the monitor and sent to Archive. A small double arrow will display on the image if the Flip function is used.  This arrow can be moved but not deleted.                  To window the image select the “Brightness and Contrast” button in the process sub tab. To use the function utilize the scroll bars for the WW also known as contrast (image of a circle split in half) or the WC also known as brightness (image of a sun). To auto window select the “auto window” button To take the images back to their original WW/WC select the “Auto” button. To save an image with the new values select the “Save Image” button.                 The “Filter” button will allow the user to manually adjust the edge enhancement and harmonization of the fluoro image. This function allows the user to adjust the image impression via postprocessing without having to repeat an image. Siemens default settings are applied to the images via the Organ Programs located in the PEX Editor.                 Draw/Calculate Stenosis (Option) Laterality/Set position Arrow/Angles Distance Text Stenosis option is designed for Non-RAD images. The user can evaluate the stenosis area versus a reference point. %D is the percent of deviation in the diameter. %A is the percent of deviation in the area. %G is the percent of deviation in the Gray values. To place a Dicom right or left marker on an image, select the “Set Label” button. To move the placed marker, left click the marker and drag it to the desired location. To remove the marker, select the “Set Label” button and select clear, “Okay” the next pop-up box. To place an arrow on the image select the “Set Arrow” button. The first mouse click will represent the back of the arrow and the second click will represent the head of the arrow. To adjust the arrow, select the arrow and move the entire arrow or drag to adjust one of the ends. When the arrow is selected, the user will see a small box at both ends of the arrow. To remove the arrow, deselect the button and select the arrow followed by the delete key or the “Remove Graphics” button under the tools subtab. The “Select” button is a four way arrow with a hand and the “Remove Graphics” is the button that looks like an eraser. To measure angles on the image select the “Set Angle” icon. Draw the first line and left mouse click to set the beginning and ending points. Draw the second line in the same fashion to form the angle. Note the Angle will display the degrees by the last mouse click.  Depending on how the lines of the angle are drawn will determine if the angle is measuring the “inside” or “outside” angle. Note in our example the lines were drawn down in the same direction to the point of the angle.  The 12 degrees represents the inside angle. To define patient position, view position and image laterality select the “Patient Position” button. Siemens default is set for “Not Defined”. To select text on an image to move or delete, use the “Select Graphics” button in the tools subtab.  Engage the button and left click to select desired graphic in the image. To delete graphics in the image, select the “Remove Graphics” button.  This will delete and selected graphic.   Select the link below to view a demonstration of this function.   Demo - Select and Remove Graphics Demo - Select and Remove Graphics   The Rad tab offers post acquisition processing for Rad images. Tools that are available in the Rad subtab are; Cropping, Amplification, LUT, and Filter.  The “Crop” button is used to adjust the electronic shutters of a RAD image. After selecting the button, manually drag or re-draw the dotted lines to form a square around the desired anatomy. To confirm the newly cropped region select the “Ok” (check mark button).  Select the link below to view a demonstration of this function.     Demo - Crop Demo - Crop   Amplification is set up in the in the organ program within the PEX Editor. Default Amplification is set for 2.0 The Auto Amplification is set up with manual technique OGPs in the default database. This allows the system to automatically adjust the amplification as needed with the set technique. Amplification can be used as a postprocessing function in order to adjust the “brightness/darkness” of an image. Moving from an amplification of 2.0 to 4.0 is equivalent to doubling the density. Moving from an amplification of 2.0 to 1.0 is equivalent to cutting the density in half. Select the link below to view a demonstration of the Amplification function   Demo - Amplification Demo - Amplification   The filter button houses all of the following processing parameters: Spatial Filters DiamondView Plus Edge Enhancement Harmonization The default Filter selections are pre-set in the OGPs within the Pex Editor. The Filters can be changed manually post a RAD acquisition. Digital Subtraction Angiography (DSA) is an option on the Siemens Fluoro systems that allows end users to subtract out anatomy/objects that may hinder good visualization of the desired region of interest. The available processing options post acquisitions are Remask Averaging Opacification Native Display Pixelshift Landmark Filter The mask frame can be changed by utilizing the “Change Mask” button. Adjusting the mask will help improve the image impression in order to see the desired contrast filled vessel/anatomy. Use the plus/minus frame buttons to find the best frame for the mask image. Select the “Change Mask” button and move to the desired frame. Summation/Averaging is used to take several fill and or mask images and average them together. This function helps improve the noise impression of the subtracted images. In the Pop-up Box the “Image” represents the “Fill” frame and the “Mask” represents the “Mask” frame. When averaging the “Image” (Fill), averaging occurs on both sides of the selected frame. When averaging the “Mask”, averaging occurs from the current mask frame and forward. Opacification is a postprocessing function used to visualize an image with MAX/Min contrast filling. Once the last frame is selected in the series activate the function by selecting the Opacification button. Indicated if the images are for MIN (CO2) or MAX (Iodine) medium and select the current “mask” frame. After selecting “Ok” the new image will display on the screen and can be stored.                 Native display takes the subtracted image and brings the bones back into view. Images can be stored in native display.     Landmark gives the user the ability to fade in and out anatomical background (bony anatomy). This is helpful to the user when visualizing contrast filled anatomy with a need for a bony landmark. Once the button is selected use the slider bar/arrows or the middle mouse function to bring in the desired amount of background information/anatomy into the subtracted image.             Adjust Filter allow for an increase or decrease in the image Edge post acquisition. To use this function, select the button and use the slider bar to make adjustments. When the function is selected the user can Zoom in and Pan the image to focus on a ROI (Region of Interest). In order to return the image to its original size, manually un-zoom the image or select the “Home” button in the Image subtab.             To use the rotation options, select the rotation button.  A box will display with all the rotation options, select your desired rotation function. To remove the added rotations, select the rest rotation button. To measure on the FLC select the “Calibration and Distance” button. RAD images are automatically calibrated via pixel size. Digital Fluoro Radiograph (DFR) images can be manually calibrated with a known object in the image at the level of the area of interest. To calibrate/recalibrate an image select the button with the ruler and the cross-hair. Enter the appropriate calibration parameters. Select the button with a ruler and cross-hair within the pop-up box. Draw the calibration line in the image by left clicking on the starting point, and then left click the end point. Enter the exact distance in millimeters and select “Ok”. Now the user can draw a line to measure a region of interest. The “Enter text and Comments” is used to add any additional information to the image.  For example Upright or Inspiration/Expiration. Text can be saved in the drop down by typing the desired text, highlighting the word and selecting “Insert” on the keyboard. To delete text, highlight the text to delete and select “Delete” on the keyboard. Note the order text are entered is how the text will display in the drop down.  There is not a function to move the order of text. Comments are always displayed on the bottom middle of the image.   Look Up Tables (LUT) also called Gradation Curves are set up in the Pex Editor per OGP. There are 15 available LUT’s LUT 1 and 2 are not for diagnostic purposes Typically the LUT is selected based on the Organ that is being imaged. LUT’s can be changed in the postprocessing mode after acquisition. To accept the new LUT, select the checkmark button.   Pixelshift can be used to adjust fractions of pixels in the image.  When utilizing Pixelshift the user can minimize movement artifacts and or bony anatomy that may be blocking the desired Region of Interest. The X axis adjusts the horizontal axis The Y axis adjusts the vertical axis Select the link below to view a demonstration on Distance and Calibration Distance and Calibration - Demonstration Distance and Calibration - Demonstration