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MR Cardiac Function - Left Ventricle- Numaris X

BMR MR Cardiac Function – Left Ventricle - Numaris X The MR Cardiac Ventricular Analysis provides assessment of the left and right ventricles. The left ventricle is automatically contoured during the work-flow assignment, while the right ventricle contours can be created with a set of intuitive tools. 1. From the Patient Browser, load the appropriate data set into the MR Cardiac Analysis Workflow  Rght-click on the patient examination and select Assign Workflow > MR Cardiac Analysis  Double Left Click on Patient to open 2. The Cardiac Reading Step enables you to view functional, dynamic, tissue characterization and flow data using the common tools 3. Select the MR Cardiac Function Step MR Cardiac Analysis MR Cardiac Reading MR Cardiac Function Normal Manual Mode  Note: MR Cardiac Analysis performs segmentation of the left ventricle automatically by recognizing the anatomical landmarks (Apical Extent, LV Blood Pool Point, RV In- sertion Point and the Base Plane Points) SIEMENS Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2018 Healthineers Job Aid MR Cardiac Function – Left Ventricle Numaris X Effective Date01/02/2019 HOOD05162002981766 4. If you need to edit the segmentation of the LV analysis , select Guidance LV Analysis Refine Segmentation O. .  Note: The Guidance feature assists you with a recommended workflow for refining seg- mentation and guides you through each of the steps required to perform the segmentation. The Set Landmarks tab and the Refine Contours tab guide you through segmentation. When you select the Refine Contours tab, the corresponding icons are activated in the Case Navigator. If you do not want to use the Guidance, contours can be created and refined using the contour editing and contour creation tools. 5. Start Segmentation refinement and follow guidance steps: A. Check the ED and ES phase for accurate segmentation. If the Set Landmarks tab is selected > correct the selection in the TVG segment. Drag the ED and ES slider to the appropriate positions. Set Landmarks Refine Contours Check ED and ES Step 1 of 5 Check if the position of the ED/ES slider correctly identifies ED and ES. To correct the position drag the ED/ES slider as shown in guidance image. 10 20 30 40 50 88 175 263 351 439 ED ES Next Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2018 Page 2 of 7 Job Aid MR Cardiac Function – Left Ventricle Numaris X Effective Date01/02/2019 HOOD05162002981766 B. Define the Apical Extent by setting the corresponding landmark in the short axis working segment. The Set Landmarks tab is selected > set the landmark at the anatomically correct location Set Landmarks Refine Contours Apical Extent Step 2 of 5 Check and correct landmark on ED and ES according to guidance images. Slice position of apex at ED and ES might be different due to through-plane motion. Please note: Existing contours below apex will be removed. C. Define the LV blood pool – performs three tasks in this application: I. Defines target object. If a wrong object was picked by segmentation, you can try to correct it by moving the LV Blood Pool Point in a basal to mid-ventricular slice into the LV blood pool II. Defines the position of the base plane if only short-axis slices are used/included in the analysis. The base plane is always parallel to the short-axis slices. You can model the through plane motion of the base by setting the LV Blood Pool Point in different slices in different phases. III. Defines the interval used for the wall thickening analysis. Only the short-axis slices are included in the thickening analysis that lies between the LV Blood Pool Point and the Apical Extent Point. Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2018 Page 3 of 7 Job Aid MR Cardiac Function – Left Ventricle Numaris X Effective Date01/02/2019 HOOD05162002981766 Set Landmarks Refine Contours Blood Pool Step 3 of 5 This landmark is used to correct the segmentation in case the wrong structure has been segmented (e.g. RV) 1) Check if the current LV contours encompass the LV. 2) If not, set the landmark into the LV in a basal SAX slice at ED. This landmark defines the base of the left ventricle in case only SAX orientation is loaded. Please note: Existing contours will be changed. D. Define the RV insertion point in the ED phase. This step is not mandatory, however the RV insertion point is used for calculating the wall thickening using the AHA (American Heart Association) model for the patient report. Set Landmarks Refine Contours RV Insertion Point Step 4 of 5 This step can be skipped if wall thickening is not relevant for this study. Check/Refine the RV insertion landmark at ED phase. Please note This landmark has no effect on contours. It is used for dividing the myocardium into AHA conformant sectors. Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2018 Page 4 of 7 Job Aid MR Cardiac Function – Left Ventricle Numaris X Effective Date01/02/2019 HOOD05162002981766 E. Define the base plane in the long axis working segment by defining two points at the height of the base plane. Note: This is typically performed on a 4 chamber orientation. Set Landmarks Refine Contours Base Plane Step 5 of 5 These landmarks define the base of the left ventricle based on available LAX views. This step can be ignored for SAX only mode. Check and correct landmarks on ED and ES on standard LAX views (2ch, 3ch, 4ch) according to guidance images. Please note: For optimal accuracy check correct landmarks for all phases. This is required if you are interested in parameters that are not determined by the segmentation on ED/ES alone (e.g. peak ejection rate). F. Check the Refine Contours tab gives you an overview of the different tools to either refine the existing contours or to replace all contours and start segmentation refinement. Check & Change Contours Step 1 of 2 Set Landmarks Refine Contours Select endo or epi contour icon to define which contour you Replace all Contours Step 2 of 2 want to adapt. 1) Delete all contours (endo and epi). Check contours in ED and ES for every SAX slice. 2) Select a mid-ventricular to basal slice. 1) If refinements are needed start changing contours on the first phase and check propagation. 3) Draw endo/epi contour on the first phase. O 2) If further changes are needed continue adapting contours first 4) Propagate in space (endo/epi). at ED/ES. Please note: For optimal accuracy check/correct contours for all 5) Use segmentation refinement guidance from step 1. phases. This is required if you are interested in parameters that are not determined by the segmentation on ED/ES Please note: Temporal contour propagation is automatic(3), spatial alone (e.g. peak ejection rate). contour propagation has to be triggered manually(4). Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2018 Page 5 of 7 Job Aid MR Cardiac Function – Left Ventricle Numaris X Effective Date01/02/2019 HOOD05162002981766 6. Create/editing MR Cardiac Function Findings – Throughout MR Cardiac Analysis, all standard measurement tools are available to create findings. The results of the current functional analy- sis are available in the Findings details. The wall thickening results of the LV functional analysis is documented in an AHA-conforming model. LV and RV findings can be created separately us- ing the corresponding buttons in the Findings details. A. Select the Findings details icon in the Findings Navigator > a Findings details dialog box will open Findings Navigator Name Value Source B. In the Findings details dialog box – Choose the heart rate of the patient  The heart rate influences the cardiac output Findings details Patent lame: udine Cardiac Dot Engine Export R Age: 50 Years ED undES Height 56 905114 Inches None Weight 154 185 Lbs Create LV Findings Create RV Findings C. If contours are to be sent to PACS, choose a selection from export results images. Findings details dac Dot Engine E Age 50 Years ED WWES Height 56 92514 Inches None Weight 154 185 LBS Create LV Findings Create RV Findings None is the default D. Select the check box to use the Long-axis and short-axis or to use short-axis only for a LV functional analysis Results Long- axis and short- axis Short-adds only TXT LV LV NORM RV RV NORM LV Thickening E. Click Create LV Findings – The findings are listed in the Findings Navigator and are added to the report. Findings details ? X Pabe cardiac Flow'd Cardiac Dot Engine Export Age 50 Yours ED and ES Height 56 50514 Inches None Weight 154. 185 Lbs Heart Rate: - beats/min Create LY Findings Digale RY Findings Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2018 Page 6 of 7 Job Aid MR Cardiac Function – Left Ventricle Numaris X Effective Date01/02/2019 HOOD05162002981766 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 Instruc- tions 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'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 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 2018 ………………………………………………………… Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Telephone: +49 9131 84-0 siemens.com/healthineers Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2018 Page 7 of 7