MAMMOMAT Inspiration Tomosynthesis Training for Technologists

MAMMOMAT Inspiration Tomosynthesis for Technologists By the end of this course the learner will be able to: List the accessories necessary to perform a tomosynthesis mammography study Identify the steps necessary to perform a tomosynthesis mammography study Identify the steps necessary to perform Insight 2D & 3D imaging. Identify the steps necessary to perform calibration and phantom quality control tests   Tomosynthesis: a special kind of mammogram that produces a 3-dimensional image of the breast by using low dose x-rays obtained at different angles.    Breast is positioned and compressed in the same way it is for a mammogram X-ray tube moves in a circular arc around the breast.  Approximately 10 seconds for the imaging.  Information from the x-rays is sent to a computer, which produces a focused 3-D image of the breast. Dose is similar to that of a regular mammogram.   Tomography software license 26x35cm tomo compression paddle or 24x30cm standard low edge compression paddle. Tomography face shield Siemens mammography tomosynthesis study: takes just under 1 minute from exposure to end of reconstruction captures 25 projections with a tube angle of 25º in each direction Click the link below to view a step by step procedure of the process to complete a tomosynthesis study. Performing a TOMO Study Checklist Performing a TOMO Study Checklist Checklist TitleChecklist TypeChecklist ContentStep 1HTMLFrom the scheduler, select the patient, and register your patient. Step 2HTML Choose a Tomo procedure in one of the following ways: Option 1: If there is a RIS procedure, the correct procedure will automatically populate in the procedure dropdown on the Open Patient subtask card.   Option 2: From the procedure dropdown on the Open Patient subtask card, select a pre-defined Tomo procedure. Step 3HTMLActivate the first icon in the icon gallery.  Step 4HTMLPosition patient, and compress.  Step 5HTMLPerform exposure.  Compression will release after the exposure is completed.    Step 6HTMLThe First view will appear with the Bounding Box displayed. The reconstructions will begin immediately and will take less than a minute to complete.  Step 7HTMLThe next exposure will automatically be activated. Step 8HTMLPerform any additional exposures as needed. NOTE:  If a 2D + Tomo or a PRIME + Tomo has been acquired, when the exposure is completed, the First view will be a normal 2D image that can be used for diagnostic purposes. After initial reconstruction, an evaluation of the images should be performed.  If the volume from the initial capture needs to be adjusted an additional reconstruction must be performed.  Click the link below to view a step by step procedure of the image review process. Review of Images Checklist Review of Images Checklist Checklist TitleChecklist TypeChecklist ContentStep 1HTMLClick on the First view icon in the Tomo subtask card. The First view with the bounding box is displayed.  Step 2HTMLProjections are unavailable in VB60D. Icon will be dimmed. Step 3HTMLClick the Slices icon in the Tomo subtask card to view the reconstructed slices. Step 4HTML Adjust the Bounding Box, if necessary by clicking on the bounding box, and dragging from the boxes. Step 5HTML   Click on the "Reconstruct…" button,  to reconstruct this image with your new settings There will now be an additional Reconstruction listed in the Reconstr available dropdown in the Tomo subtask card. Step 6HTML There are 3 options to adjust the Reconstruction Parameter Group (RPG) if requested by the Radiologist.  Option 1 Click the  Reconstruct… button From the RPG name dropdown, select the correct RPG. Click Ok. Option 2 Right click the image icon. Select Reconstruct Tomo Scan.  The Reconstruction of Scan window opens. From the RPG dropdown, select the correct RPG.  Click Ok. Option 3 Right click the image itself. Select Reconstruct Tomo Scan.  The Reconstruction of Scan window opens. From the RPG dropdown, select the correct RPG.  Click Ok. Step 7HTMLIf more than 2 Reconstructions are in the Reconstr…available dropdown in the Tomo subtask card, this message will appear when you try to close the patient.                 Step 8HTML Delete any unnecessary reconstructions. In the Tomo subtask card, select the reconstruction to be deleted from the Reconstr. Available dropdown box and click Delete Reconstuction.     Step 9HTMLOn the Close Exam sub task card, close the exam. Calibration Test  - must be completed every three months or if the room temperature deviates by more than 7º C  or 12.4º F from the temperature at the last calibration.    Phantom Test  - must be completed weekly when tomosynthesis studies are performed. The Calibration test is performed quarterly to ensure the system is properly calibrated for tomosynthesis studies. Click the links below to view a video and step by step instructions for the Calibration test process. Calibration Video Calibration Video   Calibration Checklist Calibration Checklist Checklist TitleChecklist TypeChecklist ContentStep 1HTMLFrom the Patient drop down menu, select Detector Calibration. Step 2HTMLOn the Calibration subtask card, select Tomosynthesis for the calibration type. Click Start Calibration.  Step 3HTML   7 scans will populate into the image icon gallery. The system automatically populates the manual technique Step 4HTMLAttach the 40mm collimator mountable PMMA phantom. Step 5HTMLRemove the compression paddle. Step 6HTML The first icon will automatically enable. Step 7HTML Press the exposure button on the control box until all 26 exposure pulses have been completed.  The gantry will remain in 0 degree position         Step 8HTML For each exposure, click the 1st view icon in the upper right corner and window level appropriately.  Click ACCEPT if the exposure is suitable.  Click REJECT if the exposure is not suitable.  If an image is rejected, a new exposure icon is automatically added. NOTE:  As you acquire or accept an image, the number acquired or accepted will increase.    Step 9HTML Repeat steps 7 and 8 until you have produced 7 suitable exposures. Step 10HTML  The calibration process ends, and the following message appears:   Confirm by clicking YES Step 11HTML When calculation is successful, the following message window displays:  Confirm with OK.  Calibration closes automatically. Step 12HTMLRecord calibration complete on the appropriate QC form.Step 13HTML  When calibration is unsuccessful, the following message will appear. “Detector calibration process has successfully performed in Tomosynthesis mode.  The criteria for image quality are out of range.   Image quality may be insufficient.  Please call service.” This means that non-functioning pixels were found during calibration and a system check must be performed by a Siemens service technician. The Phantom Test must be completed weekly when tomosynthesis studies are performed. Click the link below to view a step by step for the Phantom test process. Phantom Checklist Phantom Checklist Checklist TitleChecklist TypeChecklist ContentStep 1HTML  Register a patient named TOMO PHANTOM. Step 2HTML   From the Procedure dropdown in the Open Patient subtask card, select the procedure “QC PROCESSEDTOMO”, Step 3HTML From the exposure dropdown menu, select AEC 28kvp and W/rh filter. Step 4HTML  Click the Adv. Button, to open ADVANCED SETTINGS Step 5HTML  Select the following in the Advanced Settings dialog box: Auto Decomp : OFF  OpComp: ON AEC Segmentation: OFF  Dose Level: Normal Step 6HTMLClick on the Acqusition Subtask Card and select RPG Standard Phantom. Step 7HTML   Position Phantom on detector center with no gap. Step 8HTMLPerform compression to OpComp. Step 9HTMLPerform exposure.   Step 10HTML After reconstruction, scroll through the slices and select the slice where the objects are best visible. To evaluate the image, use the magnification tool, zoom, or grayscale inversion to adapt the window values, if necessary.   If the viewing conditions are considered to be poor when the image is reviewed on the AWS, send the image to the reporting station for further examination.  Ensure that the following number of objects are visible: Fibers: 4 or more, Specks: 3 or more, Masses: 3 or more   Step 11HTML  Record the result on the Test 4 Test Report form. Step 12HTML   On the Close Exam sub task card, close the exam. The learner should now be able to: List the accessories necessary to perform a tomosynthesis mammography study Identify the steps necessary to perform a tomosynthesis mammography study Identify the steps necessary to perform Insight 2D & 3D imaging Identify the steps necessary to perform calibration and phantom quality control tests   The Tomo subtask card contains all the necessary tools to complete a tomographic study and Insight 2D and Insight 3D imaging. Select the highlighted areas on the image below to see details about each tool.   Select the highlighted areas for descriptions. Select to view the Tomo subtask card and more detailed info. Base ImageHotspotsText BlocksImage FileProjections dimmedFirst View Icon - Click here to display the 2D image.Slices Icon - Click here to display the reconstructed tomographic slices.Movie/Cine Icon - Click here to view the slices in quick succession like a movie.Reconstruct - Click here to repeat the reconstuction after adjusting the bounding box RPG.Delete Reconstruction - Click here to remove unnecessary reconstructions and preserve disk space.3D Insight icon2D Insight icon