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Symbia Intevo Bold Onsite Turnover Workbook

SIEMENS SIEMENS Symbia Intevo Bold Symbia Intevo Bold (VB20) Turnover Workbook www.usa.siemens.com/education Answers for life. 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 • the entire product life cycle and beyond. Our goal Classroom Training is to enable you to take technology further, (Offerings, Registration & Scheduling) profitability higher, and patient care to the next • Educational Symposia level. Find the information, resources, and tools • you need to get the most out of your recent On-site Training investment and stay up-to-date. Visit • Printed Self-studies www.usa.siemens.com/Welcome2Healthcare. • Virtual Education (Offerings & Registration) • Workshops & Fellowships Clinical Training and Visit www.usa.siemens.com/education Continuing Education for more information regarding the current Siemens Customer Care Center: Siemens Clinical Training and Continuing Education portfolio. Call 1-800-888-7436 • Troubleshooting assistance • Immediate assistance for software applications and workflow issues Siemens Training Centers For Tech Support press option 2 / for Siemens Clinical Education • applications support, press option 3 Training Center – TDC2 110 MacAlyson Court • Press the * key or enter the last six digits of your Functional Location Number Cary, NC 27511 Functional Location Number ____________________ Serial Number ________________________________ 2 Turnover Workbook | Symbia Intevo Bold (VB20) II Table of Contents I Contact Information Summary ............................................................................................... 2 II Table of Contents.................................................................................................................. 3 III Introduction ........................................................................................................................ 6 1. Getting Started with your Symbia Intevo Bold Scanner........................................................... 7 1.1 Scanner Component Identification ................................................................................ 7 1.2 System Power............................................................................................................... 8 1.3 Gantry ....................................................................................................................... 10 1.4 Nuclear Medicine Detectors......................................................................................... 12 1.5 CT Detectors............................................................................................................... 14 1.6 Patient Bed, Pallet and Rear Bed .................................................................................. 15 1.7 Hand Control.............................................................................................................. 21 1.8 Patient Positioning Monitor (PPM) ............................................................................... 23 1.9 Control Box ................................................................................................................ 35 2. Changing the Collimators ................................................................................................... 36 2.1 Collimator Changing Options ...................................................................................... 36 2.2 Collimators................................................................................................................. 37 2.3 Changing the Collimator ............................................................................................. 38 3. Quality Control and Assurance............................................................................................ 49 3.1 Symbia Intevo Bold QC Schedule ................................................................................. 49 3.2 Daily System Shutdown and Startup ............................................................................ 50 3.3 Manual and Automatic QC Procedures ......................................................................... 51 3.4 Daily NM QC – Manual ................................................................................................ 52 3.5 Daily NM QC - Automatic............................................................................................. 55 3.6 Weekly NM QC............................................................................................................ 56 3.7 Monthly NM QC.......................................................................................................... 58 3.8 CT Daily QC ................................................................................................................ 75 4. Overview of Acquisition Console: MI Workplace Command Module ...................................... 79 4.1 Areas of Command Module ......................................................................................... 79 5. Anatomy of a Workflow..................................................................................................... 81 5.1 Workflow Navigator .................................................................................................... 81 6. Acquisition Workflows........................................................................................................ 83 6.1 Acquisition Types ....................................................................................................... 83 6.2 Acquisition Tab........................................................................................................... 83 6.2 Analyzer Tab............................................................................................................... 88 6.3 Display Analysis Tab.................................................................................................... 88 7. Modifying and Saving Workflow Templates ......................................................................... 89 7.1 Save Workflow Template ............................................................................................. 89 7.2 Save Workflow Template As......................................................................................... 89 8. Patient Setup and Positioning............................................................................................. 90 8.1 Manually Registering a New Patient ............................................................................ 90 8.2 Registering an Existing Patient ................................................................................... 90 8.3 Registering a Patient from the HIS/RIS.......................................................................... 90 3 Turnover Workbook | Symbia Intevo Bold (VB20) 8.4 Positioning Patient for Exams ...................................................................................... 91 8.5 Performing a Hybrid Study .......................................................................................... 92 9. Processing Workflows....................................................................................................... 103 9.1 Quality Control Activity ............................................................................................. 103 9.2 Advanced Reconstruction Options ............................................................................. 108 10. Organ Specific Processing............................................................................................... 125 10.1 Gastrointestinal Processing ..................................................................................... 125 10.2 Hepatobiliary Processing ........................................................................................ 126 10.3 Planar Gated (MUGA) Processing ............................................................................. 126 10.4 Lung Processing...................................................................................................... 127 10.5 Renal Processing..................................................................................................... 128 10.6 Series Calculator..................................................................................................... 129 10.7 Flexible Display....................................................................................................... 133 10.8 Saving JPEG and AVI files......................................................................................... 136 10.9 Dual Monitor Support ............................................................................................. 136 10.10 syngo Patient Browser........................................................................................... 137 11. Week One Exercises ....................................................................................................... 140 11.1 Patient Gantry ........................................................................................................ 140 11.2 Quality Control ....................................................................................................... 140 11.3 Patient Registration ................................................................................................ 141 11.4 Workflows .............................................................................................................. 141 11.5 syngo Patient Browser............................................................................................. 142 12. CT System Overview ...................................................................................................... 143 12.1 CT Control Box........................................................................................................ 143 12.2 Emergency Stop Button........................................................................................... 143 12.3 CT Subsystem Power – Line Connection Box............................................................. 144 12.4 CT Table and Hand Controller .................................................................................. 144 12.5 Patient Positioning Monitor (PPM) ........................................................................... 145 13. CT Exam ........................................................................................................................ 146 13.1 PPM Setup.............................................................................................................. 146 13.2 Positioning for the CT Exam..................................................................................... 146 13.3 Acquiring the CT Exam............................................................................................ 147 14. Image Registration/Fusion with MI Applications Software ................................................ 151 14.1 Using the Blending Tool and Color Bars.................................................................... 151 14.2 Reviewing and Modifying the Registration ............................................................... 152 15. syngo Viewing Task Card ................................................................................................ 154 16. syngo 3D Task Card........................................................................................................ 155 16.1 Loading the CT Images ........................................................................................... 155 16.2 Loading the SPECT Images ...................................................................................... 155 16.3 Adjusting the CT/SPECT Balance Ratio ...................................................................... 155 16.4 Image Area Display ................................................................................................. 156 16.5 Image Navigation ................................................................................................... 157 4 Turnover Workbook | Symbia Intevo Bold (VB20) 16.6 Windowing............................................................................................................. 157 16.7 Common Tools ....................................................................................................... 157 16.8 Tools Sub Taskcard.................................................................................................. 158 16.9 Orientation Sub Taskcard ........................................................................................ 158 16.10 Type Sub Taskcard................................................................................................. 158 16.11 Creating Parallel Ranges........................................................................................ 159 16.12 Creating Radial Ranges.......................................................................................... 161 17. Workstream 4D.............................................................................................................. 162 5 SIEMENS Symbia Intevo III Introduction Purpose Upon completion of this course, you will be able to: The purpose of this training session is to provide you with the skills and knowledge to operate • Describe the function of the Symbia Intevo components your system. • Demonstrate the operation of the gantry • Demonstrate the operation of the Patient Bed Overview • Demonstrate the operation of the Patient Positioning Monitor (PPM) The training program occurs with an 32 hour period, • Demonstrate the steps in changing the collimators and a 32 hour follow up. Further details on location • Describe the workflow of the daily, weekly, and monthly QC procedures and specific times are included in your registration • Demonstrate the system daily startup and shutdown confirmation. • Demonstrate restart of additional workstations • Demonstrate the steps for the CT Quality Control Learning Materials • Demonstrate the steps for the NM Daily Quality Control The following instructional materials are • Demonstrate the steps for the Weekly Quality Control referenced throughout this training session: • Demonstrate the steps for the Monthly Quality Control System Owner Manual • Describe the function of the MI Apps Workstation Provides the necessary knowledge and expertise • to accurately and safely operate the system. Describe the layout of the Command Module • Demonstrate the steps in patient selection Training Workbook and launching a workflow Supports the System Owner’s Manual through • “big picture concepts”, examples, stories, Demonstrate how to modify a workflow template and save it interactive exercises and references to online • Demonstrate how to set up and position a patient documentation. This book is yours to keep • Describe the purpose and demonstrate the use of the so you can write in the book. processing workflows Step-by-Step • Describe the purpose and demonstrate the use of the These documents provide quick reference tips organ-specific workflows to aid customers in “just-in-time” learning • Demonstrate the purpose of xSPECT Bone and xSPECT Quant and how opportunities. they are applied during the reconstruction process. • Demonstrate the use of the Volumetric Analysis activity. • Demonstrate the basic operation of the Flexible Display activity • Demonstrate the steps for saving JPEG and AVI files • Demonstrate how to use dual monitors • Describe the layout of the CT components of the Symbia Intevo • Demonstrate the steps in setting up and acquiring a CT study • Demonstrate the steps in Image Registration in MI Applications software • Describe the function of the 3D Task Card • Demonstrate the steps to perform image fusion in the 3D Task Card 6 • Demonstrate the steps in the use of Workstream 4D Turnover Workbook | Symbia Intevo Bold (VB20) 1. Getting Started with your Symbia Intevo Bold Scanner 1.1 Scanner Component Identification Notes Notes 10 2 8 12) 13) 14 15 ( W) 4 9 5 6 11 10 7 1. Emergency stop buttons 2. Hand Control 3. Nuclear Medicine (NM) Subsystem 4. Computed Tomography (CT) Subsystem 5. Rear Bed 6. Siemens Nuclear Acquisition Controller (SNAC) 7. Power Switches 8. Patient Positioning Monitor (PPM) 9. Touch Pads 10. NM Detectors 11. Integrated Source Holder (retracted) 12. Pallet 13. Patient Bed 14. PHS Pallet Handle 15. CT Bed Index Handle 7 Turnover Workbook | Symbia Intevo Bold (VB20) 1.2 System Power Notes Notes 1.2.1 Power Switches Power switches provide electrical power to system components. Some switches control power to individual components, while others control power to a group of components. Most switches will remain in the On position during normal use. The Symbia system power switches for the various Intevo systems are found in or on: • Circuit box • Line connection box • Gantry • Workplace systems • UPS for the Image Control System (ICS), Image Reconstruction System (IRS), and Dedicated Reconstruction System (DRS) Circuit Box This box is supplied by you, the customer. Contains 3 breakers. System Circuit Breaker: The largest of the three breakers, it supplies power to the two breakers that follow. CT Subsystem Circuit Breaker: Generally either 60 or 80 amps, it supplies three-phase power to the CT subsystem. NM Subsystem Circuit Breaker: Generally 20 amps, it supplies single phase-power to the NM subsystem. CT Subsystem Power Switch The CT subsystem power switch should be used to apply and remove power to the CT subsystem. It is located on the line connection box. 1 .......... ........... ........... ........... @ .......... @ .......... @ .......... 000000.0000 000000.0000 0000000000 (1) Line Connection Box’s CT Subsystem Power Switch 8 Turnover Workbook | Symbia Intevo Bold (VB20) Gantry Power Switches Notes Notes At the bottom of the gantry’s left side are the electrical power switches. 1 (1) Gantry Power Switches Location Power to various system components can be controlled with the gantry power switches. Hand controller and external ECG connections can also be found near the gantry power switches. 3 ..... An X) X X ON X -19 SNAC C/AMERA MOTION 4 X) 5 (X) 6 X 1. External ECG R-Wave Trigger Connection 2. Hand Control Connection 3. External ECG Power Outlet 4. SNAC Power Switch 5. Camera Power Switch 6. Motion Power Switch 9 Turnover Workbook | Symbia Intevo Bold (VB20) 1.3 Gantry Notes Notes 1.3.1 Emergency Stop Buttons An Emergency Stop button is located on each side of the gantry. Pressing the Emergency Stop button cancels all electrical power to the system, stopping all system motion. The Bed Index and Pallet are also unlocked, allowing for the patient to be quickly removed from the gantry. 1 (1) Top down view of gantry with Emergency Stop Buttons located on each side of Gantry. Restart button above one of the gantry’s Emergency Stop buttons. Check that the Emergency Stop buttons light when pressed as part of the daily quality control procedure. 2 1. Restart Button 2. Emergency Stop Button 10 Turnover Workbook | Symbia Intevo Bold (VB20) 1.3.2 Intercom System Notes Notes The gantry’s intercom speakers are located at the top, inside of the gantry’s ring. By using the CT control box’s Call Patient (microphone) and Hear Patient (speaker) buttons, the user can communicate with the patient. 1 2 4 3 5 1. The intercom speaker is activated by pressing the CT control box’s Hear Patient button. 2. Respiration Display 3. The laser, used for patient and QC positioning, is activated by pressing the hand control’s Laser button. 4. CT Subsystem Plastic Shield Opening for CT Acquisition’s Laser 5. Intercom Speaker 1.3.3 Respiratory Display The respiration display, located on the top inside of the CT gantry’s ring, signals the patient when to stop breathing during a CT acquisition, and then when to begin. 11 Turnover Workbook | Symbia Intevo Bold (VB20) 1.3.4 Lasers (Lightmarkers) Notes Notes Lasers aid in positioning the patient and the quality control phantom. Three lasers can be turned on by double clicking the hand control’s Laser button. There are lasers on each side of the gantry’s ring, and one directly above. Another set of lasers is activated automatically during a CT acquisition, and are projected through a plastic shield around the inside of the gantry’s ring. dillllo 1 2 1. Laser Openings (external) 2. Three additional lasers are behind the plastic shielding for CT 1.4 Nuclear Medicine Detectors The NM detectors can be rotated around the gantry, and rotated around their yokes at various angles. The detectors have an automatic infrared, body-contour feature that allows for automatic body contoured (noncircular) acquisitions. Additionally, look-ahead sensors view the patient’s contour prior to entering the field of view for whole body acquisitions. 1.4.1 Orientation Dots Orientation dots appear on each side of a detector (one white/unfilled and the other gray/filled). The gantry also has dots on each side. These dots work as reference points when moving the detectors using the hand control. Dots also appear on the hand control to indicate towards which dot (direction) a detector will move when a motion button is pressed. SIEMENS 1 . 1 1. Orientation Dot 12 Turnover Workbook | Symbia Intevo Bold (VB20) 1.4.2 Touch Pads Notes Notes There are four touch pads that halt all system motion when contact occurs. One touch pad covers each detector’s collimator. The other two touch pads cover three sides of the area behind each detector’s yoke. 1 2 + 1. Touch Pads on Detectors 2. A touch pad covers three sides of the detector’s yoke. 1.4.3 Infrared Body Contour System (Light Rails) The infrared body-contour system has the following features and functionality. • One pair of light rails per detector, between which an infrared beam passes, creating a light curtain across the surface of the detector. • Assists in adjusting the relative positions of the detector(s) and patient during precision movements. • Assists non-circular SPECT and autocontoured whole body studies. 13 Turnover Workbook | Symbia Intevo Bold (VB20) The look-ahead sensors have the following features and functionality: Notes Notes • Light rails detect body contours for detector radius adjustments while the patient bed is traveling out of the gantry • Used to prevent possible collisions with Detector 1 • Located at each corner of Detector 1 nearest the gantry 4 3 2) 3 1 4 1. Automatic Infrared Body-Contour System (Light Rails) for automatically adjusting detector position, patient bed position, and detector orbit, thus avoiding contact with collimator touch pad surface 2. Detector Look-Ahead Sensor (only on Detector 1) for detecting raised body parts, especially the feet 3. Yoke Look-Ahead Sensors for detecting raised body parts, especially the knees 4. Gantry Sensors (physical contact sensor) for detecting raised body parts, especially the toes 1.5 CT Detectors Within the CT subsystem, an ultrafast ceramic (UFC™) detector and collimator are aligned opposite an x-ray tube to measure transmitted radiation as the assembly rotates around the patient. 14 Turnover Workbook | Symbia Intevo Bold (VB20) 1.6 Patient Bed, Pallet and Rear Bed Notes Notes The patient bed supports the pallet and bed index, and raises them to go between the detectors, and through the gantry’s ring. The rear bed and bed index support the pallet when it extends through the gantry’s ring. 7 9 1 (2 3 4 8 5 10 1. Rear Bed 2. Foot End 3. Pallet with Pad 4. Patient Bed Handles 5. Docking Pin (beneath bed) - Foot Pedal not shown. 6. ECG Connection 7. Pallet Handle 8. Bed Index 9. Bed Index Handle 10. Head End 1.6.1 Patient Bed Handles Recessed patient bed handles are located on each side of the patient bed to provide a hand grip when pivoting the patient bed. 1 1. Patient Bed Handle 15 Turnover Workbook | Symbia Intevo Bold (VB20) 1.6.2 Pallet The pallet is the surface that the patient lies on during an acquisition. It moves horizontally, and can be moved using the hand control, Examination task card, or CT control box. 1.6.3 Pallet Pad The pallet pad is attached to the pallet and provides patient comfort. The pad can be removed for cleaning or quality control procedures. 1.6.4 Pallet Handle The pallet handle is not used for routine patient positioning. It is used to remove the pallet from the gantry’s ring in an emergency. In an emergency situation, pressing the Pallet Release button will release the pallet and enable you to move the pallet with its handle. A 2 1 1. Pallet Handle 2. Pallet Release Button 1.6.5 Bed Index The bed index lies beneath the pallet, and moves horizontally to predetermined positions to support the pallet during CT acquisitions. For NM acquisitions, the bed index does not move. Notes 16 16 Turnover Workbook | Symbia Intevo Bold (VB20) Notes Notes 17 Turnover Workbook | Symbia Intevo Bold (VB20) 1.6.6 Bed Index Handle Notes Notes Like the pallet handle, the bed index handle is not used for routine patient positioning. It is used to remove the bed index and pallet from the gantry’s ring in an emergency. 2 1 1. Pallet Handle 2. Bed Index Handle 1.6.7 Foot Pedal The patient bed is typically docked (securely positioned) in front of the gantry. It can be undocked and pivoted away from the gantry for acquisitions between the detectors or gurney imaging. The foot pedal is used to release and secure the patient bed at the end closest to the gantry. The right side of the foot pedal is pressed down to raise the docking pin from the floor socket and releases the patient bed for pivoting. The left side of the foot pedal is pressed down (leveling the foot pedal) to lower the docking pin. The patient bed pivots in only one direction which is determined at installation. The user pivots the patient bed by pressing the foot pedal’s right side and pushing the patient bed, thus avoiding any trip hazards that might occur if the patient bed were pulled. The patient bed always pivots to the side opposite the foot pedal. 1 2 3 1. Press the left side of the foot pedal to lower the docking pin into the floor socket. 2. Press the right side of the foot pedal to raise the docking pin from the floor socket. 3. Floor Socket 18 Turnover Workbook | Symbia Intevo Bold (VB20) 1.6.8 Integrated Source Holder Notes Notes The integrated source holder is a retractable rod built into the foot end of the patient bed. It is manually pulled out of the patient bed for quality assurance procedures, and pushed back in when complete. A point source vial is inserted into the end of the integrated source holder, enabling source positioning for peaking, tuning, and intrinsic verifications and calibrations. The integrated source holder can be retracted by pushing it back into the patient bed. < 227kg (500lb) (2) . 3 ) DO NOT CAUTION BLE CH PACT TY 1. Hinge enables holder to be lifted up if detector is accidentally raised. 2. Integrated Source Holder 1.6.9 AutoQC Point Source Holder The point source holder will extend or retract a source as required to complete system quality control. A 50 mCi Co-57 point source is installed by a Siemens Customer Service Representative. 2 3 1. Line Source Holder 2. Point Source Holder 3. Lead Cap 19 Turnover Workbook | Symbia Intevo Bold (VB20) 1.6.10 AutoQC Line Source Holder Notes Notes The line source holder will extend or retract a line source as required to complete system quality control. A 10 mCi Gd-153 line source is installed by a Siemens Customer Service Representative. 2 3 1. Point Source Holder 2. Line Source Holder 3. Lead Cap 1.6.11 AutoQC Shielded Storage Area The source holders are retracted and stored within the AutoQC shielded storage area within the patient bed. - 4 3 1. Manual Integrated Source Holder 2. Point Source Holder 3. Line Source Holder 4. AutoQC Shielded Storage Area 20 Turnover Workbook | Symbia Intevo Bold (VB20) 1.6.12 Rear Bed Notes Notes The rear bed provides additional support for the pallet as it passes through the gantry’s ring. As the patient bed moves up and down, so does the rear bed. However, once the patient bed and rear bed reach a certain downward position, only the patient bed will continue its downward motion (unless the pallet is extended, in which case both rear bed and patient bed stop). 1.6.13 Integrated ECG This accessory is housed beneath the pallet handle with an ECG leads connection opening directly behind where the patient’s head lies. The ECG information is displayed and controlled using the PPM. 1 1. Integrated ECG Connection 21 Turnover Workbook | Symbia Intevo Bold (VB20) 1.7 Hand Control Notes Notes The hand control is used to manually communicate with the system. It can control gantry, patient bed, and detector movements, as well as initiate acquisitions and programmed positioning. To better understand the hand control and system motions, use the gantry icon, 11 - detector numbers (1 and 2), and the white O SIEMENS and gray orientation dots on the hand control as a reference a motion’s direction. The detector number, appearing on the fronts of the detectors, and the white and gray orientation dots, appearing on the detectors and the gantry, help in identifying the relationship between system orientation and the hand control. 22 Turnover Workbook | Symbia Intevo Bold (VB20) 1 10 Notes Notes (2) (3) 1 12 4 ( 73 5 O 14 15 2 16 77 8 9 18 1. Rotate Detector 1 Counterclockwise 2. Detector 1 Towards White Orientation Dot 3. Detector 1 White Orientation Dot 4. Detector 1 Inward 5. Rotate Gantry Ring Counterclockwise 6. Detector 2 Towards White Orientation Dot 7. Detector 2 White Orientation Dot 8. Detector 2 Outward ....... M 2 6 8 9. Rotate Detector 2 Clockwise 10. Rotate Detector 1 Clockwise 11. Detector 1 Outward 12. Detector 1 Gray Orientation Dot 13. Detector 1 Towards Gray Orientation Dot 14. Rotate Gantry Ring Clockwise 15. Detector 2 Inward 16. Detector 2 Gray Orientation Dot 17. Detector 2 Towards Gray Orientation Dot 18. Rotate Detector 2 Counterclockwise 23 Turnover Workbook | Symbia Intevo Bold (VB20) 1.8 Patient Positioning Monitor (PPM) Notes Notes The PPM is mounted on an arm (boom) extending from the top of the gantry. The arm can be moved to either side of the gantry with the PPM swiveling left or right, and tilting forward or backward. 1 SIEMENS 2 3 1. PPM Arm 2. PPM 3. PPM Monitor Buttons 1. Decrease Volume 2. Increase Volume 3. Display e.media / PPM 4. Left Arrow submenu selection - Service use only. 5. Display Menu Service use only. 6. Right Arrow submenu selection - Service use only. 7. Power On / Off 8. Power On / Off Light Emitting Diode LED. - A blue LED indicates power on; an amber LED indicates power-save mode.. 24 Turnover Workbook | Symbia Intevo Bold (VB20) Notes Notes 1 Version syngo MI Applications VB10A 2 12.0.1.12 3 4 5 Restart Shutdown Touch Pad Test 6 X 7) 09:51 1. PPM Tab 2. Camera Info Tab 3. Reconfiguration Tab 4. ECG Tab 5. Offset Zoom / FOV Limit Tab 6. Collimator Change Tab 7. Setup Tab 1.8.1 PPM Tab Pressing this tab displays the screen containing status information for the patient bed, persistence images, and fields containing information to assist in positioning the patient for an acquisition. 1.8.2 Camera Info Tab Pressing this tab displays the screen containing camera, detector, patient bed settings, and also displays acquisition status. 1.8.3 Reconfiguration Tab Pressing this tab displays the screen containing available detector configurations for selection. 1.8.4 ECG Tab Pressing this tab displays the screen displaying ECG output, and contains settings for monitoring the patient. 25 Turnover Workbook | Symbia Intevo Bold (VB20) 1.8.5 Offset Zoom/FOV Limit Tab Notes Notes Pressing this tab displays the screen containing persistence images and settings to set the position and zoom factor of the images within the persistence displays. It is also used for IQ•SPECT setup and setting the CT FOV. 1.8.6 Collimator Change Tab Pressing this tab displays the screen containing available collimators. 1.8.7 Setup Tab Pressing this tab displays the screen containing controls for camera operations including shutdown and restart. 1.8.8 Function Buttons and Information Fields These buttons run along the bottom of the screen. Pressing a button initiates an action. The information fields display system status or study information. STEIVIENS 2 1- U.U KOISTS SPECT 2 0.0 kcts/s 22.0 cm 12 136.1 cm 1 2 3 4 Repeat 1/4 View 13/32 Phase 1/1 Cycle 1/3 00:39 5 6 3 00:39 C X 4 09:51- 13 5 6 7 8 9 11 12 1. System Status Icons Area 2. Detector Number 3. Acquisition Progress Area 4. Text Message Area 5. Start / Resume Button 6. Pause Button 7. Stop Button 8. Home Button 9. Auto retract Detectors Button 10. Clear Button 11. Proceed Button 12. Cancel Button 13. Workplace Time Area 26 Turnover Workbook | Symbia Intevo Bold (VB20) System Status Icons Notes Notes Displayed across the top of the PPM when error conditions or system status changes occur. System Status Icons High Rate Warning Low Rate Warning Lost Lead Warning Flex Mode QC SP AutoQC Source Specialty Pallet Exposed Attached IQ SPECT 1.8.9 Acquisition Progress Area This area displays the acquisition state in terms of cycles, repeats, phases, views, and scans. The acquisition progress area displays dynamically updating status bars which fill with color to indicate the progression of the acquisition, with units of measure indicated for the type of acquisition being performed. 1. Repeats - This area displays the acquisition’s progress state as Repeat/ Repeats only for dynamic tomo.. 2. Views - This area displays the acquisition’s progress state as View/ Views not for gated planar.. 3. Phases - This area displays the acquisition’s progress state as Phase/ Phases only for dynamic and dynamic tomo.. 4. Cycles - This area displays the acquisition’s progress state as Cycle/ Cycles only for dynamic tomo.. 5. Acquisition Elapsed Time - This area displays the amount of time that has passed during the acquisition by shading the status bar. 6. Status Bar - This area displays the acquisition’s progress by shading the bar. 7. Remaining Acquisition Time - This area displays the amount of time remaining to complete the acquisition by displaying the amount of unshaded bar. 27 Turnover Workbook | Symbia Intevo Bold (VB20) 1.8.10 Patient Bed Information Fields Notes Notes SIEMENS 1 1 0.0 kcts/s SPECT 2 0.0 kcts/s 2 22.0 cm 4. 136.1 cm 95 % 100 % 1. Bed Index Position 2. Bed Height 3. Bed Index In/Out Position 1.8.11 Persistence Image Buttons and Information Fields SIEMENS 1 0.0 kcts/sSPECT 0.0 kcts/s 22.0 cm 2 4 136.1 cm (4 2 (W) 95 % 100 % ., -6.0º -96.00 34.4 cm 34.4 cm 1.00 6 1.00 140 KeV 140 KeV HiResPar HiResPar iew 1/2 00:39 C X 10:42 1. Count Rate Per Second 2. Persistence Image 3. Persistence Level 4. Persistence Window Level 5. Persistence Value Controls 6. Persistence Window Level Controls 28 Turnover Workbook | Symbia Intevo Bold (VB20) 1.8.12 Gantry and Detector Information Fields Notes SIEMENS 0.0 kcts/s SPECT 2 22.0 cm . 136.1 cm 95 % 100 % -6,0º -96.0º 3 34.4 cm 34.4 cm 1.00 1.00 4 140 KeV 140 KeV HiResPar HiResPar View 1/2 00:39 C X 09:01 1. Gantry Rotation Angle 2. Detector In or Out 3. Zoom Factor 4. Energy Window 5. Collimator Type 1.8.13 Camera Information Screens The camera information screen contains system, detectors, and patient bed’s settings, as well as acquisition status. 180° Configuration SIEMENS 1 2 -130.5º 49.5º 6 $ 36.1 cm 18.0 cm 36.1 cm 0.0 cm ( 2 ) =( 0.0º 136.1 cm 0.0 cm 0.00 0.0º 5 1.00 1.00 140 KeV 140 KeV LEAP LEAP 3 4 -135º 4050 X 09:01 1. Detector 1 Towards White or Gray Orientation Dot 2. Detector Angle 3. Full gantry capability 4. Position 5. Detector Tilt 6. Camera Info Tab 29 Turnover Workbook | Symbia Intevo Bold (VB20) 90°, 76°, or Gurney Configuration Notes ` SIEMENS 90.00 1 2 90.00 45.0º @ -45.00 2 35.3 cm 22.0 cm 35.3 cm 136.1 cm 1. Configuration 2. Camera Information Tab CT Configuration SIEMENS 2 1 CT (1) CT 2 ( CT 22.50 -67.5 4.6 cm 0.0 cm -4.6 cm 3 3 0.0 cm 1. CT Configuration 2. Study Type 3. Bed Index Position 1.8.14 Reconfiguration Screen The Reconfiguration screen displays the available detector configurations for selection. Reconfiguration Screen SIEMENS 1 CT 2 90º 76º 76º 3 4 X 09:05 1. Detector Reconfiguration Selections 2. Reconfiguration Tab 3. Proceed Button 4. Cancel Button 30 Turnover Workbook | Symbia Intevo Bold (VB20) Notes IQSPECT Reconfiguration Screen CT 3 5 IQ - SPECT 2 4 6 X Configuration completed. 13:57 1. IQ•SPECT Icon 2. 180° Configuration Button 3. CT Configuration Button 4. IQ•SPECT Configuration Button 5. Reconfiguration Tab 6. Proceed Button 7. Cancel Button Detector Reconfiguration Buttons 180 Configuration with Outer Room Left Outer Room Right Gurney +90 and -90º Configuration Configuration Configuration CT 90º 90º CT Configuration 180º Configuration 90º Supine 90º Prone Configuration Configuration 76º 76º IQ-SPECT 76º Supine Configuration 76º Prone IQ.SPECT Configuration Configuration 31 Turnover Workbook | Symbia Intevo Bold (VB20) 1.8.15 Integrated ECG Screen Notes The Integrated ECG Screen displays information from the internal or external integrated ECG gate. When used with the internal ECG gate, an ECG wave and heart rate are displayed. When used with the external ECG gate, only heart rate, in beats per minute (BPM), is displayed. The Integrated ECG Screen contains settings used to monitor the patient when an integrated ECG gate is present. ECG alarms alert the user when the patient’s heart rate rises or falls past set limits. 1 80 BPM 30 100 2 4) 6 Do 8 9 10 3 X 18:12 1. ECG Display 2. Wave Height Increase 3. Wave Height Decrease 4. Integrated ECG Device Selection 5. External ECG R-Wave Trigger Device Selection 6. Audible Alarm On 7. Audible Alarm Off 8. Audible Alarm Lower Limit 9. Audible Alarm Upper Limit 10. ECG Tab 32 Turnover Workbook | Symbia Intevo Bold (VB20) 1.8.16 Offset Zoom / FOV Limit / Cardio-Centric Orbit Notes The Offset Zoom / FOV Limit screen displays a persistence screen, and settings for the position and zoom factor of the image within the persistence display. SIEMENS 1 CTO 2 3 3 2 SPECT 1.00 0.0 6 4 5 C X 11:42 1. CT FOV Upper-Range Planning Line Control 2. CT FOV Lower-Range Planning Line Control 3. Persistence Images 4. SPECT FOV Zoom Factor 5. FOV Offset Controls with X and Y axis settings 6. Offset Zoom / FOV Limit Tab 33 Turnover Workbook | Symbia Intevo Bold (VB20) 1.8.17 Collimator Change Screen Notes The collimator change screen displays the collimators available for selection. 1 SMARTZOOM 2 SMARTZOOM MELP Pinhole 4 3 UHR HE 5 LEHR SMARTZOOM Remove 6 X 1. IQ•SPECT Icon 2. Collimator Name - This area lists the name of the collimator installed. 3. Collimator Selection Buttons - Pressing a button selects a collimator for the collimator change sequence. 4. Collimator Scroll Controls - Pressing the forward or backward button scrolls and displays those collimators available for installation. 5. Collimator Remove Button - Pressing this button signals the system to remove a collimator. 6. Collimator Change Tab 34 Turnover Workbook | Symbia Intevo Bold (VB20) 1.8.18 Setup Screen Notes The setup screen displays the controls for preparing the system for acquisition, including homing the system, performing the touch pad test, automatically retracting the detectors, and shutting down or restarting the SNAC. 1 -Version syngo MI Applications VB10A 12.0.1.12 2 3 4 5 6 7) 8 KI Restart Shutdown Touch Pad Test 9 10 09:51 1. System Version - This area displays the current revision of acquisition controller application. 2. Restart Button - Pressing this button restarts the SNAC system. 3. Shutdown - Pressing this button shuts down the SNAC system. 4. Home Button - Pressing this button begins the system homing process. 5. Retract Detectors Button - Pressing this button retracts the detectors away from the center of the gantry. 6. Touch Pad Test Button - Pressing this button displays the Touch Pad Screen for testing the detectors and yokes’ touch pads. 7. Proceed Button - Pressing this button, when enabled, begins or continues a selected process. 8. Cancel Button - Pressing this button, when enabled, cancels a selected process. 9. Setup Tab 10. Text Message Area 35 Turnover Workbook | Symbia Intevo Bold (VB20) 2. Changing the Collimators 2.1 Collimator Changing Options Notes There are 3 different types of collimator changing options that may come with your system, depending on the types of collimators and options that you have purchased. 2.1.1 Integrated Collimator Changer (ICC) The Integrated Collimator Changer (ICC) is a collimator change server that is permanently mounted under the patient bed. The ICC holds two pairs of collimators and is intended to store most frequently used collimators. It does not store high energy, extra-high energy, or pinhole collimators. 3 W 1 2 1. Integrated Collimator Changer with Handles 2. Drawer opened. 3. Collimator clamp raised for collimator removal. 2.1.2 Automatic Collimator Changer (ACC) The automated collimator changer (ACC) is an option and requires the ICC. The ACC is attached to the ICC and automates the opening and closing of drawers when performing collimator changes. ACC supports the same collimators as the ICC. It is similar in design to the ICC for collimator changing, and uses the same PPM screens, but does not have the collimator drawer handles as with the ICC. 36 Turnover Workbook | Symbia Intevo Bold (VB20) 2.1.3 Collimator Cart Notes The collimator cart provides storage and transportation, and enables installation and removal of collimators. There are four collimator drawers for storage. A pinhole collimator can be stored in the second drawer. Each drawer is numbered on the side of the collimator cart. 6 2 7 3 5 1. Pinhole Collimator 2. Collimator Cart Drawer Numbering 3. Collimator in drawer which slides in and out 4. Collimator cart leg slides into patient bed guide for docking 5. Collimator Cart Connector 6. Collimator Cart Handle 7. Collimator Cart Drawer Handle 2.2 Collimators The collimators come in sets of two, one for each detector (except for pinhole). Collimator thickness and construction vary. Various acquisitions require or restrict the use of certain collimators. Each collimator, except the pinhole, has a touch pad. Contact with a touch pad stops detector and system motion. 2 1. Collimator with Touch Pad 2. Collimator Clamp 37 Turnover Workbook | Symbia Intevo Bold (VB20) 2.3 Changing the Collimator Notes 2.3.1 ICC Procedure Collimator Removal 1. Dock patient bed 2. PPM -> Press Collimator Change tab 3. Collimator Change screen 7 SMARTZOOM 1 SMARTZOOM MELP Pinhole UHR HE 2 LEHR SMARTZOOM Remove 6 3 5 X 13:57 1. Collimators installed on the detectors 2. Available collimators 3. Home button 4. Remove button 5. Proceed button 6. Collimator Change Tab 7. IQ•SPECT Icon 4. Press Remove button 5. Press Proceed button 6. System reconfigures for ACC/ICC. While the detectors are in motion, PPM text message reads: Please wait SIEMENS CV X 38 Turnover Workbook | Symbia Intevo Bold (VB20) System Preparing for Drawer Opening Notes 7. Bottom detector rises to collimator drawer height and its collimator clamp rises. PPM Text: Open collimator drawer (number). SIEMENS X 8. Slide collimator drawer open and stop before collimator clamp. Make contact and hold until detector movement begins and beep is heard. PPM Text: Please wait 1. Contact Area 9. PMM Text: Close collimator drawer (number) SIEMENS CV X se collimator cart drawer 4. 39 Turnover Workbook | Symbia Intevo Bold (VB20) 10. Slide and close collimator drawer until the beep sound. PPM Text: Notes Please wait. 11. Second detector moves into position. 12. Repeat steps 7-10 for second collimator. 13. Collimator removal procedure is complete. Collimator Installation 1. Press the Home button 2. Press the Proceed button 3. PPM -> Press Collimator Change tab 1 MELP LEAP UHR LEHS 2 LEHR Remove 4 3 X 11:54 1. The not available symbols and blank collimator-name fields indicate that no collimators are installed. 2. Available collimators 3. Proceed button 4. Collimator Change Tab 4. PPM -> Press the desired collimator selection button. PPM Text: Press PROCEED to change collimators or press CANCEL to exit. 5. Press Proceed button. 6. If collimators are on ACC/ICC: PPM Text: Please wait, while detectors are in motion. 7. If collimators are on collimator cart, please proceed to step 8 in Collimator Cart Installation procedure. 8. Bottom detector rises to collimator drawer’s height and collimator clamp rises. PPM Text: Open collimator drawer. 9. Slide collimator drawer open and stop before collimator clamp. Make contact and hold until detector movement begins and beep is heard. PPM Text: Please wait 10. PPM Text: Close collimator drawer (number) 11. Slide and close collimator drawer until the beep sound. PPM Text: Please wait. 12. Second detector moves into position 13. Repeat step 8-10 for second 14. Proceed to Touch Pad Test. 40 Turnover Workbook | Symbia Intevo Bold (VB20) 2.3.2 ACC/ICC Procedure Notes Collimator Removal 1. Dock patient bed 2. PPM -> Press Collimator Change tab 3. Collimator Change screen SMARTZOOM SMARTZOOM MELP Pinhole UHR HE 2 LEHR SMARTZOOM 4- Remove 6 5- X 13:57 1. Collimators installed on the detectors 2. Available collimators 3. Home button 4. Remove button 5. Proceed button 6. Collimator Change Tab 7. IQ•SPECT Icon 4. Press Remove button 5. Press Proceed button 6. System reconfigures for ACC/ICC. While the detectors are in motion, PPM text message reads: Please wait SIEMENS X 41 Turnover Workbook | Symbia Intevo Bold (VB20) System Preparing for Drawer Opening Notes 7. Bottom detector rises to collimator drawer height and its collimator clamp rises. 8. System will automatically remove the collimators from both detectors. 9. Collimator removal procedure is complete. Collimator Installation 1. Press the Home button 2. Press the Proceed button 3. PPM -> Press Collimator Change tab MELP LEAP UHR LEHS 2 LEHR Remove (4 3 X 11:54 1. The not available symbols and blank collimator-name fields indicate that no collimators are installed. 2. Available collimators 3. Proceed button 4. Collimator Change Tab 4. PPM -> Press the desired collimator selection button. PPM Text: Press PROCEED to change collimators or press CANCEL to exit. 5. Press Proceed button. 6. If collimators are on ACC/ICC: PPM Text -> Please wait, while detectors are in motion. 7. If collimators are on collimator cart, please proceed to step 8 on Collimator Cart Installation procedure. 8. Chosen collimators will automatically be installed on both collimators. 9. Proceed to Touch Pad Test. 42 Turnover Workbook | Symbia Intevo Bold (VB20) 2.3.3. Collimator Cart Procedure Notes Docking Collimator Cart To connect the collimator cart to the Symbia system, a collimator cart leg is inserted into the patient bed’s Collimator Cart Guide, found on the front of the patient bed. When the leg is fully inserted, the cart connects to the Patient Bed Docking Connector, which then confirms successful docking. 2 3 1. Patient Bed Docking Connector 2. Collimator Cart Guide on patient bed 3. Collimator Cart Leg 1 2 1. Collimator Cart Connector 2. Collimator cart leg inserted into patient bed’s Collimator Cart Guide 43 Turnover Workbook | Symbia Intevo Bold (VB20) Notes Collimator Removal 1. Dock patient bed 2. PPM -> Press Collimator Change tab 3. Collimator Change screen SMARTZOOM 1 SMARTZOOM MELP Pinhole UHR HE 2 LEHR SMARTZOOM 4 Remove 6 3 5 13:57 1. Collimators installed on the detectors 2. Available collimators 3. Home button 4. Remove button 5. Proceed button 6. Collimator Change Tab 7. IQ•SPECT Icon 4. Press Remove button 5. Press Proceed button 6. System reconfigures for collimator cart. 7. If here is an ACC/ICC present, let this lower to the floor before the collimator cart is docked. 8. If there is no ACC/ICC present or if the ACC/ICC is lowered, PPM Text: Dock the collimator cart. SIEMENS CV x Dock the collimator cart. 9. Dock the appropriate collimator cart with empty drawers. 10. PPM Text: Please wait 44 Turnover Workbook | Symbia Intevo Bold (VB20) Notes System Preparing for Drawer Opening 11. Bottom detector rises to collimator drawer’s height and collimator clamp rises. 12. PPM Text: Open collimator drawer (number) SIEMENS X Open collimator drawer 4. 13. Slide collimator drawer open and stop before collimator clamp. Make contact and hold until the beep is heard and the detector movement begins. PPM Text -> Please wait. 14. PMM Text: Close collimator drawer (number) SIEMENS X Close collimator cart drawer 4. 45 Turnover Workbook | Symbia Intevo Bold (VB20) 15. Slide and close collimator drawer until you hear the audible beep. Notes PPM Text: Please wait. 16. Second detector moves into position. 17. Repeat steps 13-15 for second collimator. 18. Patient bed lowers to lock drawers. 19. System unlocks collimator cart 20: PPM Text: Undock the collimator cart. Remove collimator cart to safe storage. 21. Collimator removal is complete. Collimator Installation 1. Press the Home button 2. Press the Proceed button 3. PPM -> Press Collimator Change tab MELP LEAP UHR LEHS 2) LEHR Remove 4 3- X 11:54 1. The not available symbols and blank collimator-name fields indicate that no collimators are installed. 2. Available collimators 3. Proceed button 4. Collimator Change Tab 4. PPM -> Press the desired collimator selection button. PPM Text: Press PROCEED to change collimators or press CANCEL to exit. 5. Press Proceed button. 6. If ACC/ICC is present, it will be lowered to the floor. 7. If ACC/ICC is not present or if the ACC/ICC is lowered, PPM Text: Dock the collimator cart. 8. Dock the collimator cart with appropriate collimators. 9. PPM Text: Please wait. 46 Turnover Workbook | Symbia Intevo Bold (VB20) System Preparing for Drawer Opening Notes 10. Bottom detector rises to collimator drawer height and collimator clamp rises. 11. PPM Text: Open collimator drawer (number) 12. Slide collimator drawer open and stop before collimator clamp. Make contact and hold until the beep is heard and the detector movement begins. PPM Text -> Please wait. 13. Collimator clamp lowers and second detector is moved into position. Collimator clamp is raised. 14. Repeat steps 11 and 12. 15. PPM Text: Close collimator drawer (number) 16. Close the collimator drawer. Audible beep sounds. 17: PPM Text: Please wait. 18. Patient bed lowers to lock drawers. 19. System undocks collimator cart 20: PPM Text: Undock the collimator cart. Remove collimator cart to safe storage. 21. Proceed to Touch Pad Test. 2.3.4 Touch Pad Test 1. When the Touch Pad screen appears, press the 4 touch pads by hand. SIEMENS 2 Collimator Touch Pad Collimator Touch Pad Gantry Touch Pad Gantry Touch Pad X 2. Confirmation clicking sounds and dimmed squares show with each successful contact. SIEMENS 1 2 Gentry Touch Pad X Press PROCEED to confirm the successful Touch Pad Test. 3. Press Proceed 4. Press Home. 47 Turnover Workbook | Symbia Intevo Bold (VB20) 3. Quality Control and Assurance *Acquisition of a bar phantom is not required by Siemens, but can be Notes done at the discretion of the user. It is subject to state or federal requirements set forth in the user’s radioactive materials license. 3.1 Symbia Intevo Bold QC Schedule Performed Quality Control Procedure Source Initial feature use - Broad Quan- Volume Sensitivity Calibration Appropriate clinical isotope for tification per isotope/collimator combina- Broad Quantification tion Daily for NM Intrinsic Verification 35 Ci ofTc99m - or - or - Extrinsic Verification or Extrin- Co-57 sheet source sic Sweep - or - AutoQC source Daily for CT CT Checkup - every 12 hours CT Quality - daily CT Calibration - after 1 hour or if ring artifacts occur Weekly for NM Intrinsic Verification with Tune 35 Ci ofTc99m AutoQC source Monthly for NM Intrinsic Calibration with Tune 35 uCi of Tc99m AutoQC source Monthly for NM Multiple Head Registration 1-2 mCi of Tc99m per source (MHR) 180º (Match sources within 20% of Head Alignment Calibration each other for Tc99m only) .AutoQC source Monthly for users performing Sensitivity Calibration 1-5 mCi of a clinical isotope quantitative studies Cross Calibration - or - Precision source Monthly for CT CT Constancy Test Every 6 months or per Regula- Perform a leak test of the auto- Gd-153 line source and Co-57 tory/License requirements mated quality control device point source sources. If the collimator is damaged or Intrinsic Calibration See source strengths above. replaced. - and - Extrinsic Calibration for colli- mator MHR for collimator - and - Head Alignment Calibration for collimator Significant change to Head Multiple Head Registration 1-2 mCi of Tc99m per source Alignment values for the refer- (MHR) 180º (Match sources within 20% of ence of Low Energy Parallel Hole collimator Head Alignment Calibration each other for Tc99m only) AutoQC source 48 Turnover Workbook | Symbia Intevo Bold (VB20) 3.2 Daily System Shutdown and Startup Notes Before starting your daily QC, you need to recycle power to your system. 3.2.1 Shutdown 1. Ensure all workflows and data are saved, suspended, or completed 2. From the acquisition console: Options -> End Session 3. Select Shutdown System button 4. Yes to confirm shutdown. This will shutdown acquisition console, ICS, IRS and DRS (if present) Turning off the Acquisition Consoles UPS 5. Wait until the ICS, IRS, and DRS (if present) are powered off. Press and hold the acquisition console’s UPS OFF (O) button until the UPS powers off. (The on and off buttons may be the same button on your UPS or they may be separate buttons) 6. Go to PPM -> Setup tab 7. Shutdown 8. Proceed 9. PPM Message: OK to Shut Down 10. At the bottom left of the gantry, turn off SNAC power switch to OFF. ON SNAC 11. At the line connection box, flip the CT Subsystem Power switch to OFF (green toggle) 49 Turnover Workbook | Symbia Intevo Bold (VB20) 3.2.2 Startup Notes 1. Turn acquisition console’s UPS button ON (I). If the ICS, IRS and DRS (if present) do not turn on, press their respective power buttons. 2. Turn SNAC power switch to ON 3. Before CT is powered on, reset emergency stop buttons. Press green RESTART button on side of gantry 4. Flip the line connection box power switch to ON. 5. Acquisition Console: Crtl, Alt and Delete to log on 6. Click the esoft user icon. 6. Password is esoft and press the ENTER key. 3.2.3 Touch Pad Test If collimators are installed on both detectors, press the Touch Pad Test button on the PPM, and then the Proceed button to initiate the touch pad test. See section 2.3.4 in this workbook on performing the Touch Pad Test. If collimators are not installed, move to the Homing the System section below. 3.2.4 Homing the System 1. PPM -> Setup tab. 2. Press HOME button 3. Press PROCEED button 4. System will proceed with homing. 3.2.5 Preparing the System 1. Press Windows key on the keyboard. (located between Ctrl and Alt) 2. Task bar across the bottom of the monitor is displayed. 3. Click the Quality Hint task. 4. The Quality Hint dialog appears. Click the OK button. 5. The Checkup dialog appears. 6. If the Checkup has not been performed within the last 24 hours, perform the Checkup procedure. (See section 3.8.1 in this manual) 7. If Checkup has been performed within the last 24 hours, click Cancel to skip procedure. 3.3 Manual and Automatic QC Procedures The QC procedures can be performed manually by: • Inserting a point source in an integrated point source holder, • Using a sheet source, or • Using a phantom Otherwise, the QC procedures can be performed automatically by using the internal AutoQC device with: • An internal point source, or • An internal line source. 50 Turnover Workbook | Symbia Intevo Bold (VB20) 3.4 Daily NM QC – Manual Notes Symbia Intevo Bold Daily QC Flow Chart Daily NM QC Auto QC? Yes No Intrinsic or Extrinsic? Intrinsic or Extrinsic? Int. Ext Int. Ext Co57 Button Gd 153 Line Tc99m Co57 Source Source Point Sheet NM Intrinsic NM Extrinsic NM Intrinsic NM Extrinsic Verification Sweep Verification Verification Auto Auto Manual Manual 3.4.1 Intrinsic Verification – Manual An intrinsic verification uses a point source, flooding uncollimated detectors to verify the detectors’ corrected performance. Setup 1. Home the system and remove collimators 2. Prepare 35 uCi point source 3. On workstation, highlight current QC patient 4. Double click the Intrinsic Verification workflow 5. Cover the Detector 2 surface with a protective material to avoid contamination 6. Extend point source holder and place point source in, cap end in 7. Count rate should be between 15 kcts/sec and 50 kcts/sec. 51 Turnover Workbook | Symbia Intevo Bold (VB20) Tuning the System Notes 8. Tuning the system is only necessary on a weekly basis. If you do not need to tune, Skip to Next Activity and go to step 11 9. On the first Tuning activity for Detector 1, select Start Tuning and Peaking. The system automatically configures the gantry and patient bed for the acquisition. 10. On the second Tuning activity for Detector 2, select Start Tuning and Peaking. The system automatically configures the gantry and patient bed for the acquisition. 11. When completed, a message appears for each activity above of success or failure. If it fails, repeat Tuning and Peaking for each head. If repeated failures, place a Service Call. Peaking and Verification Acquisition 12. Adjust table height to center the source so count rates are similar between heads. 13. If you skipped the tuning activity, go to the Static Acquisition activity of the workflow and select the Analyzer tab. Click Begin Peaking, to peak the system. 14. If peak shift is >± 3%, you must exit the workflow, restart the workflow and Tune the system. Perform steps 8 and 9. 15. Go to the Acquisition tab, enter the date in series information and click Prepare Acquisition and Start to acquire the flood. Review the Results 16. On the Flood Calculation Activity, visually inspect the flood and make sure the flood is uniform. Review the values. If the values are within limits, accept and save the values. Reject unacceptable values. These values are used for service trending purposes only. Uniformity CFOV UFOV Integrated 6% un Differential 2.5% 3% 17. Make appropriate selections in the Hard Copy activity. 18. Complete the workflow. 19. Remove source and retract the source holder, remove the protective cover, and attach the collimators. 3.4.2 Extrinsic Verification – Manual An extrinsic verification uses a sheet source, flooding collimated detectors to verify the detectors’ corrected performance. An extrinsic verification may be performed instead of an intrinsic verification to verify the detector’s performance. However, intrinsic verification with tuning should be performed at least once per week. 52 Turnover Workbook | Symbia Intevo Bold (VB20) Setup Notes 1. Home the system 2. Install the appropriate collimators 3. Attach the sheet source holder (See users manual for more detailed instructions) 4. Center the sheet source within the defined source area 5. On workstation, highlight current QC patient 6. Double click the Extrinsic Verification workflow Acquisition 7. Go to the Acquisition tab and enter the date in the series information field. 8. Click Prepare Acquisition 9. Start to acquire the flood. A warning message indicating system motion is displayed. The system automatically lowers the patient bed, rotates Detector 1 to 0°, and adjusts the patient bed’s height and in/out position so that the sheet source is in the detector’s FOV. The system acquires a corrected 10 million count flood for Detector 1. Upon completion, the system automatically retracts the pallet, rotates Detector 2 to 0°, moves the pallet back in, and acquires 10 million counts on Detector 2. Upon completion, the workflow proceeds to the Flood Calculation activity. Review the Results 10. On the Flood Calculation activity, visually inspect the flood and make sure the flood is uniform. Review the values. If the values are within limits, accept and save the values. Reject unacceptable values. These values are used for service trending purposes only. Uniformity CFOV UFOV Integrated 5% 6% Differential 3.5% 4% SMARTZOOM collimator floods will have a different appearance than those from a parallel hole collimator. See Users Manual for example of differences. 9. Make appropriate selections in the Hard Copy activity for save screens and hard copies. 10. Complete the workflow. 11. Remove the source and the source holder and reattach the pallet pad. Home the system. 53 Turnover Workbook | Symbia Intevo Bold (VB20) 3.5 Daily NM QC - Automatic Notes 3.5.1 Scheduling AutoQC 1. Command Module -> Options -> Configuration Menu -> MI Acquisition Settings 2. Adjust dates and time for AutoQC scheduled completion 3. Click OK 3.5.2 Intrinsic Verification (Quick Flood) – Auto QC An intrinsic verification uses a point source, flooding uncollimated detectors to verify the detectors’ corrected performance. Setup 1. On workstation, highlight current QC patient 2. Double click the Quick Flood workflow 3. Enter date on the series information tab 4. Ensure that nothing is obstructing the motion of the detector heads 5. Extend the integrated source holder, and insert the point source. 6. Count rate should be between 15 kcts/sec and 50 kcts/sec. Acquisition 7. Return to AutoQC activity and click Start Review the Results 8. On the Flood Calculation Activity, visually inspect the flood and make sure it is uniform. Review the values. If the values are within limits, accept and save the values. Reject unacceptable values. These values are used for service trending purposes only. Uniformity CFOV UFOV Integrated 5% 6% Differential 2.5% 3% 9. Make appropriate selections in the Hard Copy activity 10. Complete the workflow 11. Attach the collimators 3.5.3 Extrinsic Sweep Verification — AutoQC An automatic daily extrinsic sweep verification uses a gadolinium line source over collimated detectors to verify extrinsic detector performance. Setup 1. Ensure desired collimators are on the detectors (HRES, LEAP or SMARTZOOM) 2. On workstation, highlight current QC patient 3. Double click the Extrinsic Sweep Verification workflow 4. Enter tomorrow’s date on the series information tab of the Tomo Acquisition activity 5. Ensure that nothing is obstructing the motion of the detector heads 54 Turnover Workbook | Symbia Intevo Bold (VB20) Acquisition Notes 6. Return to AutoQC activity and press Start. The system homes itself, aligning the detectors and patient bed. The Gd153 line source will extract and get a count rate to determine the proper start time. Review the Results 7. (Typically done the following morning) On the Flood Calculation activity, visually inspect the flood and make sure the flood is uniform. Review the values. If the values are within limits, accept and save the values. Reject unacceptable values. These values are used for service trending purposes only. Uniformity CFOV UFOV Integrated 5% 6% Differential 3.5% 4% SMARTZOOM collimator floods will have a different appearance than those from a parallel hole collimator. See Users Manual for example of differences. 8. Make appropriate selections in the Hard Copy activity 9. Complete the workflow 3.6 Weekly NM QC Symbia Intevo Bold Weekly Flow Chart Weekly NM QC Auto QC? Yes No NM Intrinsic Verification NM Intrinsic Auto with Tuning Verification Performs Int. Manual with Tuning Verification Flood Performs Int. and Ext. Sweep Flood Verification Flood 55 Turnover Workbook | Symbia Intevo Bold (VB20) 3.6.1 Weekly NM QC – Manual Notes Intrinsic Verification with Tune - Manual Follow the steps for the acquisition of Intrinsic Verification- Manual. Tuning must be performed during this procedure as described in steps 7-10 3.6.2 Weekly NM QC – Automatic Intrinsic Verification with Tune – Automatic An intrinsic verification uses a point source, flooding uncollimated detectors to verify the detectors’ corrected performance. Setup 1. Home the system 2. System will automatically remove the collimators 3. On workstation, highlight current QC patient 4. Double click the Intrinsic Verification Auto workflow 5. Enter date on the series information tab for both the Tomo Acquisition and Static Acquisition activities 6. Ensure that nothing is obstructing the motion of the detector heads Acquisition 7. Click the Start button. The detectors will be tuned and an intrinsic verification is performed according to the AutoQC schedule. Review the Results (Consists of Intrinsic Flood Verification and Extrinsic Sweep Floods) 8. On the first Flood Calculation activity, visually inspect the Intrinsic Verification and make sure the flood is uniform. Review the values. If the values are within limits, accept and save the values. Reject unacceptable values. Uniformity CFOV UFOV Integrated 5% 6% Differential 2.5% 3% 9. Go to the second Flood Calculation activity, visually inspect the Extrinsic Sweep Verification and make sure the flood is uniform. Review the values. If the values are within limits, accept and save the values. Reject unacceptable values. Uniformity CFOV UFOV Integrated 5% 6% Differential 3.5% 4% 56 Turnover Workbook | Symbia Intevo Bold (VB20) 3.7 Monthly NM QC Notes Symbia Intevo Bold Monthly QC Chart (Non xSPECT system) Monthly QC Auto QC Productivity Package? Yes No Monthly QC Suite: Intrinsic Calibration Performs: Performs: Tuning Tuning Int. Calibration Int. Calibration Int. Verification Int. Verification MHR Ext. Sweep MHRICOR 180º Config: Performed on most CT Constancy commonly used low energy collimator CT Constancy 57 Turnover Workbook | Symbia Intevo Bold (VB20) Symbia Intevo Bold Monthly QC (Systems with xSPECT option) Notes Monthly QC Auto QC Productivity Package? Yes No Monthly QC Suite: Intrinsic Calibration Performs: Performs: Tuning Tuning Int. Calibration Int. Calibration Int. Verification Int. Verification MHR Ext. Sweep MHR/COR 180º Config: Performed on most CT Constancy commonly used low energy collimator Sensitivity Calibration CT Constancy xSPECT Broad Quant Sensitivity Calibration xSPECT Broad Quant 3.7.1 Monthly NM QC – Manual Intrinsic Calibration with Tune - Manual Performs an Intrinsic Calibration and Intrinsic Verification using a 35 µCi Tc99m point source Setup 1. Remove objects that will interfere with gantry and PHS motion and home the system 2. Remove the collimators 3. Cover the Detector 2 surface with a protective material to avoid contamination 4. Extend point source holder and place point source in, cap end in 5. On workstation, highlight current QC patient 6. Double click the Intrinsic Calibration workflow 7. Count rate should be between 15 kcts/sec and 50 kcts/sec. 58 Turnover Workbook | Symbia Intevo Bold (VB20) Tuning the System Notes 9. On the first Tuning activity for Detector 1, select Start Tuning and Peaking. The system automatically configures the gantry and patient bed for the acquisition. 10. On the second Tuning activity for Detector 2, select Start Tuning and Peaking. The system automatically configures the gantry and patient bed for the acquisition. 11. When completed, a message appears for each activity above of success or failure. If fails, repeat Tuning and Peaking for each head. Acquisition of Intrinsic Calibration 12. Click on the Static Acquisition activity, enter the date on series information tab, and click the Prepare Acquisition and Start button to acquire the 200 Million Count Matrix Correction Flood. The system automatically positions the point source. Review the Results of Intrinsic Calibration 13. On the Flood Calculation activity, visually inspect the intrinsic calibration flood making sure the flood is uniform. Review the values, then click the button Accept These Calibrations and Make them Current to save. 14. If unacceptable, click Reject These Calibrations. If Calibration Integral Uniformity exceeds 7%, call service; system can be used with values up to 10%. Uniformity CFOV UFOV Integrated 5% 6% Differential 2.5% 3% Acquisition of Intrinsic Verification 15. Go to the second Static Acquisition activity, enter the date on series information tab, and click the Start button to acquire the 10 Million Count Flood. 16. Make appropriate selections in the Hard Copy activity. 17. Complete the workflow. 18. Retract the source holder and remove the protective cover. 19. Attach the collimators, home the system, and perform touch pad test. 59 Turnover Workbook | Symbia Intevo Bold (VB20) Multiple Head Registration (MHR), Center of Rotation (COR) – Notes Manual Setup MHR/COR calibrations are performed for each collimator and configuration used clinically. The calibration aligns the detector to the gantry’s center of rotation and to one another. You may only need to do the 180º configuration MHR/COR for the most used low energy collimator. You will need to compare the new values to last performed MHR/COR. If the recent calibration is <0.5 pixels (2 mm) in x-shift/center of rotation and y-shift/axial shift and <0.1º in the back projection angle, then you can skip the MHR/COR for the remaining collimators and configurations. If the values fall outside of the acceptable range, you will need to perform the MHR/COR for all the collimators and configurations. 1. Prepare five 1-2 mCi Tc99m point sources. 2. Number of sources needed: 3-Point Source Collimators: a. Medium Energy Low Penetration (ME) b. High Energy (HE) 5-Point Source Collimators a. High Resolution (LEHR) b. Ultra High Resolution (UHR) c. Low Energy All Purpose (LEAP) d. Fanbeam (FB) e. SMARTZoom f. Low Penetration High Resolution (LPHR) g. All Others 3. Mount the MHR phantom on top of the pallet and fasten. (For more information on this, see the operator’s manual for you system.) 4. Use MHR phantom instructional screening to place point sources in the appropriate configuration for your collimator. SIEMENS MHR Phantom O Source Location Extra High Energy Collimator UHR, HRES, LEAP, LPHR & Fan Beam Collimator SMARTZOOM Collimator * All Others Use mild detergent to clean. Do not use alcohol based cleaners 60 Turnover Workbook | Symbia Intevo Bold (VB20) 5. Home the system Notes 6. Configure the system for the collimator being used using the table below. Parallel Hole Collimators Fanbeam Collima- SMARTZOOM tors Collimators Configure 1800 900 760 * 180º IQ.SPECT * Detectors Bed In / Out 39.5 cm - 39.5 cm - 39.5 cm 136.1 cm - 41.0 cm Bed Up / Down 9 cm 9 cm 9 cm - 1.5 cm 15.6 cm Radius 22 cm 22 cm 22 cn 16 cm + 0.5 cm 28 cm Done automatically. Start MHR/COR Calibration Workflow 7. On workstation, highlight current QC patient. 8. Double click the MHR/COR 180 Calibration 5 points workflow. 9. Enter date on the series information tab. 10. Ensure that nothing is obstructing the motion of the detector heads. Acquisition 11. Click the Prepare Acquisition and Start buttons. The system automatically configures the gantry and patient bed for the acquisition. Review the Results and Save 12. On the Head Alignment Processing activity, visually inspect the MHR COR Calibration Results. Review the values. If the values do not meet system specifications, they will be displayed in red. a. If this occurs, click the Reject These Calibrations and Use Existing Set button, review point source placement, and repeat calibration b. If acceptable, click the button Accept These Calibrations and Make them Current to save the values Head Alignment Calibration Results (Parallel Hole Collimators) • |Center of Rotation| < 10 mm • offset of detector center relative to the system’s center of rotation • |Axial Shift| < 5 mm - axial offset of detectors relative to each other • |Back Projection Angle| < 0.8 degrees • angular offset of detectors relative to each other Head Alignment Calibration Results (Fanbeam Collimators) • Center of Rotation < 10 mm • Axial Shift < 5 mm • Back Projection Angle < 0.5 degrees • Principal Ray < 8mm • Focal Length = factory calibrated values 61 Turnover Workbook | Symbia Intevo Bold (VB20) Head Alignment Calibration Results (Fanbeam Collimators) Notes The tolerances for the head alignment processing results for SMARTZOOM collimators are different from all other collimators because of the new IQ•SPECT reconstruction algorithm • Center of Rotation < ± 20.0 mm • Axial Shift < ± 5.0 mm Back Projection Angle < ± 2.0 degrees • Principal Ray X and Y < ± 10.0 mm • Principal Ray Angle X and Y < ± 5.0 degrees • Long Focal Length X = 4480 mm to 6268 mm • Long Focal Length Y = 4703 mm to 5837 mm • Short Focal Length X = 482 mm to 590 mm • Short Focal Length Y = 472 mm to 604 mm 13. Make appropriate selections in the Hard Copy activity. 14. Complete the workflow. 15. Remove the MHR phantom and replace the pad and home the system. 3.7.2 Monthly NM QC – Automatic AutoQC Monthly QC Suite This procedure should be used if you have the AutoQC Productivity package. It performs the Intrinsic Calibration, Intrinsic Verification, MHR, and Extrinsic Sweep Verification. MHR/COR calibrations are performed for each collimator and configuration used clinically. The calibration aligns the detector to the gantry’s center of rotation and to one another. You may only need to do the 180º configuration MHR/COR for the most used low energy collimator. You will need to compare the new values to last performed MHR/COR. If the recent calibration is <0.5 pixels (2 mm) in x-shift/center of rotation and y-shift/axial shift and <0.1º in the back projection angle, then you can skip the MHR/COR for the remaining collimators and configurations. If the values fall outside of the acceptable range, you will need to perform the MHR/COR for all the collimators and configurations. Setup 1. On workstation, highlight current QC patient. 2. Double click the Monthly QC Suite workflow. 3. Enter today’s date on the series information tab for the Intrinsic Calibration activity. 4. Enter today’s date on the series information tab for the Intrinsic Verification activity. 5. Enter today’s date on the series information tab for the Head Alignment activity. 6. Enter tomorrow’s date on the series information tab for the Extrinsic Sweep activity. 7. Ensure that nothing is obstructing the motion of the detector heads. 62 Turnover Workbook | Symbia Intevo Bold (VB20) Start the Workflow Notes 8. Click the Start button in the AutoQC activity. Review the Results and Save 9. (Typically done the following day) Click on the Head Alignment Processing activity. Review the head alignment calibration results. If the values are within limits, click the button Accept These Calibrations and Make Them Current to save the values. MHR/COR Results Head Alignment Calibration Results (Parallel Hole Collimators) • Center of Rotation <10 mm • offset of detector center relative to the system’s center of rotation • Axial Shift <5 mm • axial offset of detectors relative to each other • Back Projection Angle <0.8 degrees • angular offset of detectors relative to each other Head Alignment Calibration Results (Fanbeam Collimators) • Center of Rotation <10 mm • Axial Shift <5 mm • Back Projection Angle <0.5 degrees • Principal Ray <8mm • Focal Length = factory calibrated values Head Alignment Calibration Results (SMARTZOOM Collimators) The tolerances for the head alignment processing results for SMARTZOOM collimators are different from all other collimators because of the new IQ•SPECT reconstruction algorithm. • Center of Rotation < ± 20.0 mm • Axial Shift < ± 5.0 mm • Back Projection Angle < ± 2.0 degrees • Principal Ray X and Y < ± 10.0 mm • Principal Ray Angle X and Y < ± 5.0 degrees • Long Focal Length X = 4480 mm to 6268 mm • Long Focal Length Y = 4703 mm to 5837 mm • Short Focal Length X = 482 mm to 590 mm • Short Focal Length Y = 472 mm to 604 mm 10. If the values are not within the limits, click the button Reject These Calibrations and Use Existing Set. Neither the calibration database nor the internal quality monitors are updated. 63 Turnover Workbook | Symbia Intevo Bold (VB20) Intrinsic Verification Results Notes 11. On first Flood Calculation Activity, visually inspect the intrinsic verification flood and make sure the flood is uniform. Review the values. If the values are within limits, click the button Accept These Calibrations and Make them Current to save the values. Uniformity CFOV UFOV Integrated 5% 6% Differential 2.5% 3% 12. If the values are not within the limits, click the button Reject These Calibrations. Neither the calibration database nor the internal quality monitors are updated. Extrinsic Sweep Verification Results 13. Go to the second Flood Calculation activity, visually inspect the Extrinsic Sweep Verification and make sure the flood is uniform. Review the values. If the values are within limits, accept and save the values. Reject unacceptable values. Uniformity CFOV UFOV Integrated 5% 6% Differential 3.5% 4% 14. If the values are not within the limits, click the button Reject These Calibrations. Intrinsic Calibration Results 15. To review intrinsic Calibration Flood, go to Flexible Display activity and visually inspect the savescreen image and uniformity values. If the Calibration’s Integral Uniformity exceeds 7%, call service; system can be used with values up to 10% 16. Make appropriate selections in the Hard Copy activity 17. Complete the workflow. 64 Turnover Workbook | Symbia Intevo Bold (VB20) 3.7.3 xSPECT Quant Sensitivity and Cross Calibration Procedure Notes This QC procedure is only required if you have the xSPECT Quant package and are acquiring scans that you are going to quanitify. The sensitivity calibration uses Low Energy, High Resolution (LEHR), Low Penetration, High Resolution (LPHR), and Medium Energy, Low Penetration (MELP) collimators installed on the detectors. The Integrated source holder is pulled out from the patient bed storage area and extended. A precision Co57 point source (or Tc99m if Co57 is unavailable) is inserted into the tip of the integrated source holder. The collimated detectors are automatically positioned 10 cm from the point source. Two planar images are produced. The results from this calibration are stored in the calibration database. The following table describes which sources to use for tuning, peaking and sensitivity calibration, based on your system configuration and available calibration sources. Precision Collimator used during Camera preset Generated sensitivity source used calibration used during during calibra- calibration Collimator Camera preset tion Co-57 LEHR SC-Co57-NMG LEHR SC-Tc99m-NMG Co-57 LPHR SC-Co57-NMG LPHR SC-Tc99m-NMG SC-1123-NMG Se-75 MELP SC-Se75-LME- MELP SC-1123-NMG NMG SC-In 111-NMG SC-Lu177-208- NMG The following table details the setup for tuning, peaking, and sensitivity calibration, based on your system configuration and available calibration sources: Calibration AutoQC Required Calibration Tuning Peaking Sensitivity Cal- Isotope Equipped Source Kit ibration Co-57 Yes Co-57 xSPECT Quant Co-57 point Co-57 point Co-57 precision Calibration Source Kit source ource source without peaking source (AutoQC) (AutoQC) CO-57 No Co-57 xSPECT Quant Co-57 peak- Co-57 peak- Co-57 precision Calibration Source Kit ing source ing source source with peaking source (source kit) (source kit) Se-75 Yes Se-75 xSPECT Quant Co-57 point Se-75 peak- Se-75 precision Calibration source kit source ing source ource (AutoQC) source kit) Se-75 No Se-75 xSPECT Quant Tc99m point Se-75 peak- Se-75 precision Calibration source kit source ing source source source kit) Clinically Yes None Co-57 point Peaking Sensitivity used isotope source source of iso- source of iso- measured in (AutoQC) tope to be tope to be cali- dose calibra- calibrated brated tor Clinically No None Tc99m point Peaking Sensitivity used isotope source source of iso- source of iso- measured in tope to be tope to be cali- dose calibra- calibrated brated tor 65 Turnover Workbook | Symbia Intevo Bold (VB20) Calibration/Peaking Sources Notes Co57 xSPECT Calibration/Peaking Source Kit (for use with LEHR and LPHR collimators) SIEMENS 2 3 1. Co57 Peaking Source 2. Precision Co75 Calibration Source and Shield 3. Dose Calibrator Source Holder for positioning the calibration source in a dose calibrator Note: If your scanner has Automatic Quality Control (AQC), your kit will not have a peaking source. The name of the kit is Co57 xSPECT Calibration Source Kit. Se75 xSPECT Calibration/Peaking Source Kit (for use with MELP collimators) SIEMENS ===== 2 3 1. Se75 Peaking Source 2. Precision Se75 Calibration Source and Shield 3. Dose Calibrator Source Holder for positioning the calibration source in a dose calibrator 66 Turnover Workbook | Symbia Intevo Bold (VB20) Cross Calibration Source (peaking and calibration sources for Notes respective clinical isotope to be calibrated) Performing the xSPECT Sensitivity Procedure Description: In order to enable xSPECT Quant acquisitions, the system must be calibrated with the following calibration procedure. Siemens recommends these calibrations to be performed once a month. Overview of Procedure Tuning and Peaking • Tuning is a calibration that adjusts the gains of the PMTs • Peaking shifts the analyzer window that it is centered around the actual energy peak as detected by the camera. Sensitivity Calibration • The sensitivity calibration measures the difference between the system’s ability to detect the radioactivity and the true amount of radioactivity using a precision source and collimator. Cross Calibration • The cross calibration measures dose calibrator bias using a measured point source and collimator. This step is optional but recommended as it enables unbiased SUV quantification. Steps to Perform Procedure Sensitivity Calibration or Cross Calibration 1. Home the system and remove the collimators 2. Mount the peaking source. a. Unscrew vial holder cap from the end of the integrated source holder b. Loosen thumb screw on the top of peaking source. c. Slide peaking source over end of the source holder. d. Remove the calibration source from the room e. If performing the Cross Calibration, place the peaking source in the holder. 67 Turnover Workbook | Symbia Intevo Bold (VB20) 3. On the syngo MI Acquisition Workplace, register or select the patient Notes and launch the Sensitivity Calibration workflow or Cross Calibration workflow that is located in the Calibration category. 4. Peak the system a. Camera Parameters Tab b. Select the appropriate camera preset from the pulldown menu. Sensitivity Calibration • Se75 – SC-Se75-LME-NMG • Co57 – SC-Co57-NMG Cross Calibration • Tc99m – SC-Tc99m-NMG • In111 – SC-In111-NMG • I123 – SC-I123-NMG • *Lu177 – SC-Lu177-208 NMG c. Go to the Analyzer Tab d. Peak the camera. e. Put away peaking source f. Install the collimators 68 Turnover Workbook | Symbia Intevo Bold (VB20) 5. Sensitivity Calibration: If this is the first time that you are using this Notes source, you need to next enter the Precision Source Registration. a. Select the Analyzer tab b. Select the Source Management tab. c. Select Entry Type from pull down d. Label Menu: Enter source serial number e. Assay: i. Enter dose information from system apparent activity on source label. ii. Assay Date iii. Make sure correct isotope is selected on the Camera Parameters tab. iv. Save. Your registered source will show in the Registered Labels pull down menu. a Parameters |Stop Conditions |Source Mgmt Registered Labels: New Item Entry Type: 75 Selenium Dose Calibrator 75 Selenium Label: 57 Cobalt Assay. Dose: 0 MBq 8/ 4/2016 Save Delete f. Navigate to the Series Information Tab and go to the Calibration Source menu. Select the precision source you are using. Summary Series Information Camera Parameters Stop Conditi € Series: Technologist Reading Physician Referring Physician Organ Calibration Source Isotope Label 75 Selenium M6.483 Dose: MBq &/ 4/2016 12:00:00 AM 69 Turnover Workbook | Symbia Intevo Bold (VB20) 6. Cross Calibration: If this is the first time you are using a particular Notes dose calibrator, you need to next enter the Dose Calibrator Registration. a. Go back to the Source Management tab. b. Enter the dose calibrator name in the Label field c. Make sure the correct isotope is selected on the Camera Parameters tab. d. Save Camera Parameters Stop Conditions Source Mgmt Registered Labels: New Item Entry Type: Dose Calibrator Label DC1| Assay Dose 0 MBq 8/ 4/2016 Save Delete e. Navigate to the Series Information Tab and go to the Calibration Source menu. Select the dose calibrator used to measure the point source. 70 Turnover Workbook | Symbia Intevo Bold (VB20) 7. Install the Calibration source. Notes a. Screw the source to the end of the integrated source holder b. Active element is contained in the sphere at the pointed end of the calibration source. c. Position the active element over the center of the detectors. d. If you are preforming the Cross Calibration, install the point of the isotope into the end of the integrated source holder. e. Position the activity in the vial over the center of the detectors. 71 Turnover Workbook | Symbia Intevo Bold (VB20) 8. Acquire the Sensitivity/Cross Calibration Notes a. Press Prepare Acquisition • System initiates motion to the position the detectors with a 10 cm source to collimator distance. b. Press Start • Acquires an uncorrected image for both detectors simultaneously. • Proceeds to Sensitivity Calculation activity. Camera Parameters Supine 1024 X 1024 1.0 SC-Tc99m-NMG Both Detectors Done Prepare Acquisition Camera Parameters Supine 1024 × 1024 1.0 SC-Tc99m-NMG Both Detectors Done Prepare Acquisition II 9. Sensitivity Calculation Activity a. Processes the Calibration data. b. Review the following: • Patient • Collimator • Isotope • Presets • Crystal Thickness 72 Turnover Workbook | Symbia Intevo Bold (VB20) c. Photopeak menu Photopeak Notes • Measured sensitivity results are displayed • If results acceptable Accept These Calibrations and Make Them Current • If results not acceptable Reject These Calibrations and Use Existing Set d. Click Complete • Image data and Sensitivity Calculation save screen are saved to the patient database e. Remove calibration source f. Retract integrated source holder. g.Replace source holder and retract rod. 10. Review the Sensitivity Calibration Dashboard. a. A calibration dashboard is available on the Series Information tab to show available calibration for collimators and presents. Series Information Camera Parameters Stop Conditions |Sourc Series: Technologist Reading Physician: Referring Physician: Organ Calibration Source Isotope: Label: 99m Technetium Date Time Dose: MBq @/ 4/2016 Y 12:00:00 AM o Available Calibrations Date |Colli ... | Preset Source ID 10-Jun-16 LPHR SC-Co57-NMG N1-641 10-Jun-16 LPHR SC-Tc99m-NMG N1-641 10-Jun-16 LPHR SC-1123-NMG N1-641 10-Jun-16 MELP SC-Se75-LME-NMG M6-483 10-Jun-16 MELP SC-1123-NMG M6-483 10-Jun-16 MELP SC-Lu177-208-NMG M6-483 10-Jun-16 MELP SC-In111-NMG M6-483 25-May-16 N1-641 25-May-16 LEHR SC-Co57-NMG LEHR SC-Tc99m-NMG N1-641 Troubleshooting If the Sensitivity Calibration results are out of tolerance, consider performing the following: • Check to make sure the dose calibrator is correctly calibrated. • Tune the detectors again. Peak shift should be within +/- 1% • Perform the calibration again. If still out of tolerance, contact Siemens Service. 73 Turnover Workbook | Symbia Intevo Bold (VB20) Notes 3.8 CT Daily QC 3.8.1 CT Checkup You are prompted to perform a CT checkup after a system restart or an application restart. The CT Checkup procedure automatically executes a set of CT tube warm up acquisitions, automatic function checks, and air calibration. The CT checkup procedure guarantees optimum image quality. If this procedure is not performed during start-up, reduced image quality may result. The Exam button on the Examination task card will not be accessible after a system restart or an application restart if the CT checkup procedure has not been completed or cancelled. Setup 1. Bed should be in the CT Brain position before clicking the Checkup button. a. Hand Control: Press Bed Index button twice. Calibration Source Isotope: 57 Cobalt Reference / Assay: Date: Time: Dose: 0 MBq 4/26/2013 12:00:00 AM b. Press the CT Brain button (Bed Up button) 2. The Checkup dialog box automatically appears after startup. If it doesn’t, pull down menu item Setup -> Check up from the Examination Task Card. 74 Turnover Workbook | Symbia Intevo Bold (VB20) Performing Checkup Notes 9. When the Checkup dialog is displayed, press the Checkup button. 10. Press START button on the Control box when prompted. 3.8.2 CT Calibration To ensure consistantly high quality images, the CT scanner must be calibrated at least once a day. It is part of the Check up routine that is prompted after a CT system restart. Patient bed MUST be in CT Brain position before beginning CT Calibration 1. From the Examination Card, select Setup -> Calibration 2. Start on control box to start the calibration. 3.8.3 CT Quality The CT Quality procedure verifies the dose and scaling of the CT system, and must be performed daily before starting examinations. This procedure automatically performs the tests listed below for all available voltage settings, using the CT quality phantom’s water section. • CT value of water (HU) • Pixel noise (calculated as a standard deviation) • Tube voltage (measured directly on the x-ray tube) Attaching the Phantom 1. Insert the bracket into the slot at the end of the patient bed 2 3 1. Bracket is hand tightened to pallet to secure phantom. 2. Foot End of Patient Bed 3. Bracket Release Button (located beneath the bracket) 75 Turnover Workbook | Symbia Intevo Bold (VB20) 2. Spin the bracket clamp to tighten it against the pallet Notes 3. Place the CT quality phantom’s clamp over the bracket and tighten with the knob (1) (2) 3 1. The phantom’s clamp has a knob to tighten the clamp to the bracket attached to the pallet. 2. The bracket attached to the pallet holds the phantom in place. 3. The bracket clamp has a knob to tighten its clamp to the pallet. Positioning the CT Quality Phantom 4 (1) 2) 3 1. CT Quality Phantom Clamp 2. Water Section 3. Slice Thickness Section with etchings (highlighted in black) for positioning with the laser markers. 4. Wire Section 1. Adjust the bed height so that the bed index stage clears the detectors (approximately 16.5 cm). 2, Using the hand control, press the Bed Index button twice. 3. Press the CT Brain (Bed Up) button. 76 Turnover Workbook | Symbia Intevo Bold (VB20) Notes 2 3 1. CT Brain SPECT Study Position 2. CT Body Study Position 3. SPECT Study Position 4. Double click the Laser button. The lasers activate. 5. Use the hand control to move the patient bed until the quality phantom’s slice thickness section etchings are aligned with the laser. Record the bed height and distance. Performing CT Quality Check 1. From the Examination Card, select Setup > Quality 2. OK the Quality Daily dialog 3. Press Start on Control Box 4. To evaluate the final results, go to CT Quality Reports (See below) If system is out of tolerance, home the system, reposition the phantom, and repeat procedure a second time. Call for service if test remains out of tolerance. Accessing CT Quality Reports 1. From MI Apps Command Module: Options > Service > Local Service 2. Delete the Service Password fields 3. Click OK 4. From the top menu, select Reports 5. Click Quality Assurance file in the left column 6. Click Daily 7. Locate desired report and double click to open 8. Select Print to save a hard copy of your result 77 Turnover Workbook | Symbia Intevo Bold (VB20) 4. Overview of Acquisition Console: MI Workplace Command Module 4.1 Areas of Command Module Notes 1. MI Applications Patient Browser 2. Workflow Template Browser 3. Workflow Manager MI Apps Study Name ALL Show Al · Local Study Date ALL @ Network Category Al System Up Time: 12 Mins Database: Local Find 18 studies found on the system. Study dates (at dates) Inage Space Available 75400 MB Auto File Patient Horne Patott D Study Nomo | Study Date |# Sorties |Database Locahora Bone. 3 Phase 0127 18 Bone Scan 4/23/2002 Local Database X Sone, Lumbar Tomo 673 4/22/1993 Bone. Spine Torno 2 E.CAM Bone Scan Local Database Bone Scan 11/30/1989 4/19/2002 Local Database Bonne, WB and Statics 81156 Bone Scan Local Database Detector Detector Brain, ktolintencial 12345 Brain Scon 5/19/2003 Local Database aso Bon. Centering Convergen Cardiac 1. Myo Perf Duet MBI Myocardial Pert 2/1/2001 Local Dacabase ONNN - W Cardi ac 2, Myo Perf Duet MBI Myocardial Pert 1/25/2001 Local Database Cardiac 3. Dual Study Cd Duet Myoview Myocardial Pect 1/9/2001 Local Database Cardi ac 3. Dual Study Cid: Duet Myoview al Pert 1/2/2001 Local Database Display Example Example Example Cardiac 4, Stress & Rest 124-58-5106 ot Pert 3/25/2002 Local Database Dynamic Good Tom Cardioc 4, Stress & Rest 124-58-5106 o Pert 3/25/2002 Local Database Cardi ac 5, Myo Perf Abno Duet Myoview al Pert 1/8/2001 Local Database 2 Cerdioc 7. Prodie Te TI 12162212 o Pert 2/2 1/2001 $7 Local Database Cardoc, Cardiac Motion 123456 al Pert 2/23/2000 Local Database Cardioc. Shurt COL91362794 1/7/2002 Local Database Gated WB and St First Pass COL91620666 First Pass 12/17/2001 Local Database Fusion 1. PETICT WB FU 1 Siemens PET @/18/2002 Local Database Fusion 1. PETICT WB FU 1 Philipps CT 8/6/2002 Local Database Fusion 6. MRIPET Head FU 6 Brain 8/15/2002 Local Database Example B and T. Example Example EXtrinsic usion Desplay. WB PET e soft Fusion Di 4/5/2001 Local Database Wholebo WholeBo ambraoor hatbladder 1. GBEF Dyn Perrose 0333443 GEEF 2/22/2001 Local Database Gallbladder 2, GBEF Dyn ECAM Gatbladder EF 4/1/2002 5/17/2000 Local Database Catbladder, Dyn & Static 012533 Galbladder EF Local Database Calium, 2 WB & 1 Tomo 2429453 Turnor Imaging 5/17/2000 Local Database Extrinsic Ful General Gastric Emp, Static A/P 520730 Gastric Emptying 11/23/2001 Local Database Service Venfication Dot Regen Sice gastric, Dynamic Single k. Perrose 7051808 Gastric Emptying 2/20/2001 Local Database Gated Bloodpool, TOMO 12345 Equilibrium Gate. 2/20/2001 Local Database ung. Aerosol 22085481U0MM Lung Veralation 2/16/2001 Local Database Long. V/Q 381201STM Lung WO Scan 2/22/2000 Local Database Intrinsic Intrinsic Intrinsic Kidess VM Data, AX Coronaries 42711 4/23/1997 Local Database dª brad on Service Verification ONNN LC Category All Workplace SYNGO26 Work Status: All Stopo Al ounch Suspend Complete 3 4.1.1 Patient Browser Area Patient Browser Patient Register List Patients List Studies List Series Search Study Name: ALL Refresh Show All Study Date: ALL System Up Time: 12 Mins Database: Local Find Summary 48 studies found on the system .. Study dates: (all dates) Image Space Available 75460 MB Information Patient Name Patient ID Study Name Study Date # Series Database Location Bone, 3 Phase 012718 Bone Scan 4/23/2002 3 Local Database Bone, Lumbar Tomo 673 Bone Scan 4/22/1993 Local Database Column Bone, Spine Tomo 2 E.CAM Bone Scan 11/30/1989 2 Local Database Headings Bone, WB and Statics 81156 Bone Scan 4/19/2002 2 Local Database Brain, Ictal/Interictal 12345 Brain Scan 5/19/2003 Local Database Cardiac 1, Myo Perf Duet MIBI Myocardial Perf ... 2/1/2001 Local Database Cardiac 2, Myo Perf Duet MIBI Myocardial Perf. 1/25/2001 Local Database Cardiac 3, Dual Study Old ... Duet Myoview Myocardial Perf ... 1/9/2001 6 Local Database Cardiac 3, Dual Study Old ... Duet Myoview Myocardial Perf .. 1/2/2001 6 Local Database Cardiac 4, Stress & Rest ... 124-58-5106 Myocardial Perf ... 3/25/2002 4 Local Database Cardiac 4, Stress & Rest .. 124-58-5106 Myocardial Perf .. 3/25/2002 4 Local Database Cardiac 5, Myo Perf Abno ... Duet Myoview Myocardial Perf. 1/8/2001 Local Database Cardiac 7, Profile Tc TI 12162212 Myocardial Perf ... 2/21/2001 17 Local Database Cardiac, Cardiac Motion 123456 Myocardial Perf ... 2/23/2000 2 Local Database Cardiac, Shunt COL91362794 Equilibrium Gate. 1/7/2002 Local Database First Pass COL91620666 First Pass 12/17/2001 Local Database Fusion 1, PET/CT WB FU 1 Siemens PET 9/18/2002 Local Database Fusion 1, PET/CT WB FU 1 Philipps CT 8/6/2002 Local Database Fusion 6, MR/PET Head FU 6 Brain 8/15/2002 2 Local Database Fusion Display, WB PET ... e.soft Fusion Di ... B.SOIL 4/5/2001 4 Local Database Gallbladder 1, GBEF Dyn ... Penrose 0333443 GBEF ECAM 2/22/2001 1 Local Database Gallbladder 2, GBEF Dyn ... ECAM Gallbladder EF 4/1/2002 Local Database Gallbladder, Dyn & Static 912533 Gallbladder EF 5/17/2000 Local Database Gallium, 2 WB & 1 Tomo 2429453 Tumor Imaging 5/17/2000 Local Database WN 78 Turnover Workbook | Symbia Intevo Bold (VB20) 4.1.2 Workflow Template Browser Notes · Local Refresh klohworke Local or Workflows Category: All Network Auto Filter Category Detector Phase Bon. Detector AD Centering Convergen. AO AO Auto Filter Workflow Display Example Example Example Template Dynamic Gated Tom AD AO AO List Example Example Example Example Gated Static (DH) Tomo (DH) WB and St. AO AO AO WB and T Example Wholebo ... Example Extrinsic WholeBo .. Calibration Extrinsic Extrinsic Full Service Verification Dot Regen General 4.1.3 Workflow Manager Refresh Category Workstation Launch Suspend Category: All Workplace: SYNGO26 Work Status: All Stage:" All omplete Work Status Stage Complete 4.1.4 Launching a Workflow 2 Select Category Study Name ALL Show All Study Date ALL Category Al Database: Local Find 48 studies found on the system. Study dates (all dates) Image Space Available 75460 MB ALto Fine Patient Name =|Patent D Study Nome Study Date # Series | Database Locator Bone: 3 Phase K Bone, Lumbar Tomo 012718 Bone Scan Bone, Spine Torno 2 Bone Scan 4/23/2002 4/22/1993 Local Database Local Database Bons, WB and Statics E.CAM Bone Scan 11/30/1989 Local Database 81156 4/19/2002 3 Brain, Ictalintencial 12345 Bone Scan Brain Scan Local Database 5/19/2003 Local Database hase Bon. Detector Detector Centering Convergen Cardiac 1. Myo Perf Duet MBI Myocardial Pert 2/1/2001 . Highlight dac 2 Min Bart 1/35/2001 BONNNEW ardrac 3. Dual Study Ofid : Duet Myoview Myocardial Perf Display SPONNN Patient Cardi ac 4, Stress & Rest 124:58-5106 124-58-5100 Myocardial Pert 3/25/2002 Dynamic Gated Tom Cardiac 4, Stress & Rest Cardiac 5, Myo Perf Abno Myocardial Pert 3/25/2002 Local De Local DE Cardiac 7. Profile Tc TI Duet Myoview 12162212 Myocardial Pert 1/8/2001 Card ac, Cardiac Motion Myocardial Pert 2/21/2001 123456 Example Cardi ac, Shurt COL91362794 Myocardial Pert 2/23/2000 COL01620666 Equilibrium Gato 1/7/2002 Gated Stade (DH) 3. Double First Pass Fusion 1. PET/CT WB FU 1 First Pass 12/17/2001 FUI Siemens PET @/18/2002 Fusion 1. PETICT WB Philipps CT 8/6/2002 Click Fusion 6. MR/PET Head Fusion Display. WB PET FU.6 Bran 8/15/2002 Example Example 4/5/2001 VB and T Wholebo WholeBo Gallbladder 1, GBEF Dyn. e soft Fusion Di Pecrose 0333443 GBEF Workflow Gallbladder 2. GBEF Dyn. ECAM Galbladder, Dyn & Static 912533 Gallbladder EF 2/22/2001 Galbladder EF 4/1/2002 5/17/2000 Gallium, 2 WB & 1 Tomo Vonnesmon DorRegen Gastric Emp, Static A/P 2429453 Tumor Imaging 5/17/2000 Sonic Gastric, Dynamic Single Is. Penrose 7051808 Gastric Emptying 520730 Gastric Emptying 11/23/2001 Gated Bloodpool, TOMO 2/20/2001 Lung. Aerosol 12345 Equilibrium Gate Lung. W/Q 22005481UOIM Lung Veralation 2/20/2001 Local Database 2/2420 Local Database Intrinsic MM Date, AX Coronaries 381201STM 4271 Lung WO Scan Local Database Local Database Colbracon LC Workplace SYNGO26 Launch Suspend Complace Stape: Al 1. Highlight the patient from Patient Browser 2. In the Workflow Template Browser Category > Select Category 3. Double click the workflow desired 79 Turnover Workbook | Symbia Intevo Bold (VB20) 5. Anatomy of a Workflow A workflow template contains a sequence of syngo MI applications Notes activities. Each activity performs a particular procedure (acquisition, processing, display, motion correction, etc.). #1 Common Workflow Configuration #1 Data Selector #2 A workflow that contains Activity acquisition, processing fare Data (two in this example). Acquiston Selector displaying, and hard copy Activity Acquisition in one workflow. Activity Common Workflow Processing Configuration #2 Processing Activity ctivity A workflow that contains processing, displaying. and hard copy in one workflow. Processing Flexible Activity Display Activity Hard Copy Flexible Display Hard Copy Activity Activity Canjht Hard Copy Activity 5.1 Workflow Navigator 1? O Al XY Rest Tc-99m, Stress Tc:09m, 2/24/2005 Resto 99m, Stress 99m Gated, 2/24/2005 Rest Tc-99m, Rest Tc-99m, 2/24/2005 est Tc-99m 2/24/2005 Data Selector Hard Copy 68364 Fax8.4mm Durasondese 82284 Duration 26 584 D Fr1273K FE1374K Fr1473K Fr1573K Fr16 73K Fr20 71K Fr21 726 Fr22 71K Durasn assem blib1 Duratorasser Bist Duratonasser bist Duratonzeser bist Durasonzeser bede Durnonat freek Dumbomassa Gers1 Durasen 25sec Bibl 80 Turnover Workbook | Symbia Intevo Bold (VB20) 5.1.1 Activity States Notes Complete: The checkmark indicates the activity is complete. Data has successfully passed through the activity. Error: The caution sign indicates an error. Data has not successfully passed through the activity. Click on the activity to disclose the error message Active: The start symbol. This is the current activity which contains the data. Data may be currently Processing or Acquiring. Stopped: The stop symbol. This is the current activity which has your data when the workflow Navigator was paused. Manual Interaction Needed (MIN): This activity requires the user to perform a manual interaction before continuing. 5.1.2 Workflow Navigator Controls Pause and Play: The automation with the controls above the activities. Complete: The proper way to close a workflow. Once you Complete, all data requested is saved to the patient database. Suspend: Saves the data to the hard disk on the PC so that you can resume at any time to complete it. Complete Suspend Setup: Automates tasks for data post completion. The Setup function allows for the following: • Automatically, Save selected data to the database. • Automatically, Print specified outputs defined in the Hardcopy activity. • Automatically, Send selected data to another DICOM node. • Automatically, Archive selected data to a configured archive device. • Automatically, Use Modality Performed Procedure Steps. • Automatically, Start (link) another workflow with the currently selected patient. 81 Turnover Workbook | Symbia Intevo Bold (VB20) 6. Acquisition Workflows 6.1 Acquisition Types Notes • Static • Dynamic • Whole Body • Tomo • Gated Planar • Gated Tomo • Dynamic Tomo • Wholebody Tomo 6.2 Acquisition Tab The acquisition tab displays the patient information, the acquisition displays for both detector 1 and detector 2, camera controls and the sub tabs. Acquisition Analyzer Display/Analysis Patient Bone, 3 Phase & WB Acquisition Display Detector 1; Detector 2 Study: Bone Scan Series Summary Series Information Camera Parameters Stop Conditions Name Description Patient Name Bone. 3 Phase & WB Patient ID Symbia T Study Name Bone Scan Series Name Series Technologist Reading Physician KCounts Referring Physician Remaining KCourts: Organ Matrix Size 64 X 64 Zoom Camera Preset Detectors Both Detectors Phase Frame Orientation Head In Patient Position Supine Phase Parameters Camera Parameters Supine 64 X 64 1.0 Both Detectors Prepare Acquisition Acquisition Analyzer Display/Analysis Patient Bone, 3 Phase & WB Study Bone Scan Series Summary Series Information Camera Parameters Stop Condition Name Description Patient Name Bone, 3 Phase & WB Patient ID Symbia T Study Name Bone Scan Series Name 82 Turnover Workbook | Symbia Intevo Bold (VB20) 6.2.1 Summary Sub Tab Notes Used to review the acquisition parameters. Summary Series Information Camera Parameters Stop Conditions Name Description Patient Name Bone, 3 Phase & WB Patient ID Study Name Symbia T Bone Scan Series Name Series Technologist Reading Physician Referring Physician Organ Matrix Size 64 X 64 Zoom 1.00 Camera Preset Detectors Both Detectors Orientation Head In Patient Position Supine Phase Parameters 6.2.2 Series Information Sub Tab Series name is required. The rest of the fields are optional. Summary Series Information Camera Parameters Stop Conditi Series: Bone Flow Technologist JD Reading Physician Referring Physician: Organ: Skeletal Radiopharmaceutical Dose Isotope: 25.0 mCi 99m Technetium Pharmaceutical MDP Interventional Drug Interventional Drug: Injection Time (hh:mm:ss): 0 0 0 Inject Dose (mg): 0 83 Turnover Workbook | Symbia Intevo Bold (VB20) 6.2.3 Camera Parameters Sub Tab Notes Allows you to select matrix size, zoom, camera preset, detectors, apply uniformity correction, orientation, and body position. Summary Series Information Camera Parameters Stop Conditi Camera Parameters Matrix Size: 64 X 64 Zoom: 1.00 Camera Preset Tc99m-NMG Detectors: Both Detectors Callbrations Apply Uniformity Correction Orientation Body Position: Supine 6.2.4 Stop Conditions Sub Tab Allows you to modify the stop conditions, label the view, and determine number of views. Summary Series Information Camera Parameters Stop Conditions Stop Conditions Stops on both detectors. Detector 1 |Detector 2 Use the same parameters for Detector 2. Time El First View by Counts · Count Time or Counts Count Density Manual Time: sec Counts: 500 Kcts Any Window Group View Control Detector 1: Ant Detector 2: Post Add View Insert View 84 Turnover Workbook | Symbia Intevo Bold (VB20) 6.2.5 Gate Notes Allows you to select gated parameters. Camera Parameters |Gate |Stop Conditions Framing Beat Window · Number of Frames: Selected Window: 1 8 Center: 72 Time per Frame Width (%): 20 10 msec Autocenter Primary Window * Average of . Forward 10 Beats Forward/Backward by Thirds Peak Bin of Beats Autotracking PVC Reject PVC Beats Beats To Reject Post PVC: 1 PVC Threshold (msec) 300 Beat Histogram 100 80 60 40 20 Beats 0 20 40 60 80 100 140 180 220 Beats/Min . 1 Window Beats/Min ms/Beat Save Curve 85 Turnover Workbook | Symbia Intevo Bold (VB20) 6.2.6 Acquire with Statics Sub Tab Notes Allows you to modify stop conditions for the statics acquired during a dynamic study, modify views, and change matrix size. Camera Parameters |Stop Conditio Static 2. Static Tab Stop Conditions Appears Time: 0 msec I Acquire with R-Wave Gate ~Acquire with Statics 1. Check Acquire with Statics Phase Parameters No Pause or Delay Pause Before Phase Number of Frames: 1 Camera Parameters Stop Conditions |Static Stop Conditions Start Time (mm:ss): 0 N Duration: 20 min StopTime: 22 : 0 Camera Parameters Static Matrix Size: 64 X 64 View Names Detector 1 Detector 2 Anterior Posterior View Control Add View Insert View Update View Delete View View Start Time Duration Stop Time Detector 1 Detector 2 2:00 20 min 22 : 00 Anterior Posterior 86 Turnover Workbook | Symbia Intevo Bold (VB20) 6.2 Analyzer Tab Notes Verify the selection of the correct isotope, or make changes to this selection. Also, shows verification that the isotope is peaked. Acquisition Analyzer Display/Analysis Camera Presets Detector Status Select Existing Preset: Peak Shifts (%) Tc99m-NMG ~Detector 1 Dead Time (%)| Peak Status 11 2 3 4 5 8 New Preset Name: NOT PEAK Detector 2 NOT PEAK. Save Preset Begin Peaking 1 Pause Between Peaks Window Number | Center (key) Width (%) Shift (% ) 15 LType_ Parent 140 Photopeak UX Window Center (keV): Window Width (%) Window Shift (% ) Window Group A 99m Technetium 13000 Window. Group B 11000 10000 Window Group C 9000 8000 7000 Window Group D 6000 5000 count Window Group E 4000 4 3000 Window Group F 2000 1000 100 150 200 250 300 350 400 450 500 550 600 650 O . Detector Detector 6.3 Display Analysis Tab Used to review images. 87 Turnover Workbook | Symbia Intevo Bold (VB20) 7. Modifying and Saving Workflow Templates 7.1 Save Workflow Template Notes 1. Review the parameters in the current workflow template 2. Make appropriate modifications 3. Template > Save Workflow Template (to overwrite the current template) > OK Template Workflow Activities Save Workflow Template. OK Save Workflow Template As. 7.2 Save Workflow Template As 1. Template > Save Workflow Template As (to create a new template) Template | Workflow Activities H Save Workflow Template. Save Workflow Template As ... Now Workflow Worknow Characteristics Enter New Workflow Name Workflow Name Enter New Description (Optional) Workflow Description: ftis workflow acquites static acquisitions Select Category Select Icon vert Type Lymphatic Vammary Workflow Icon Parathyroid Pulmonary Renal Salvary gland Soknic Testicular Q Thyroid Tumor Uneceric Vesical loin Calibration a Coincidence Dispuy Dynarnic Dynamic Tomo Gared Tema Click OK to Save OK Cancel 2. Enter the name, description, category, and appropriate icon and click OK. 3. To modify the category list, Configure is found in this category drop down. 4. Select this option and Add, Remove or Reorder the category list as desired. 88 Turnover Workbook | Symbia Intevo Bold (VB20) 8. Patient Setup and Positioning 8.1 Manually Registering a New Patient Notes 1. From Command Module > Patient > Register 2. Fill in the following mandatory fields: Last Name, Patient ID, Date of Birth, Sex, and Study (optional). All other fields are optional. 3. Click the Exam button. Patient Registration PROCEDURE PATIENT Last name Accession No First name Request ID Title Suffix Requested ther Patient Name(s) procedure(s) Other Patient ID(s) Ethnic Group Study list Step 2 Military Rank Patient ID Date of Birth IMidiwwwwl Sex @ Male · Female · Other Study Age Years Study comment Height [ft'in'] Weight [b] Address Patient position INSTITUTION Additional info Institution name Details 1. Performing physician warren moore, md 2. Performing physician HOSPITAL Referring physician Requesting physician 1. Operator Admitting diagnosis 2. Operator Ward Step 3 Admission ID Preregister Search Cancel Emergency Help 8.2 Registering an Existing Patient 1. Open Patient Browser from Command Module: (See Patient Browser section) 2. Patient > Browser 3. Click the Local Database icon in the tree 4. Highlight the patient 5. Patient > Register 8.3 Registering a Patient from the HIS/RIS 1. Open up the Patient Browser (See Patient Browser section) 2. Highlight Scheduler icon in the tree 3. Pull down View > Update Worklist 4. Highlight the patient at either the Patient or Study level 5. Double left click to load patient into Local Database 89 Turnover Workbook | Symbia Intevo Bold (VB20) 8.4 Positioning Patient for Exams Notes 1. From the PPM, press the Reconfiguration tab SIEMENS (5) (1) (2) 90º 90º 76 76º '3 (4) X (6) 2. Choose detector configuration > Proceed 3. Raise or lower the patient table to patient access height OR 4. Press the Wheelchair Height button twice to automatically lower table 5. Press the Gurney Height button to automatically raise the table. (1) (1) (4) (2) (4) (2) (3) (3) (5) (6) o (6) (7) 6. Select the patient and launch the workflow on the MI Workplace and start the acquisition 90 Turnover Workbook | Symbia Intevo Bold (VB20) 8.5 Performing a Hybrid Study Notes This is an example of performing a hybrid acquisition on the Symbia Intevo with a CT scan first and then a SPECT scan. Consult your user’s manual for more details on other types of acquisitions. Warming up the X-ray Tube with eStart For 6 and 16 slice systems, the X-Ray tube can be warmed up with eStart, after an hour of inactivity. eStart should be used throughout the day to warm up the X-Ray tube, in place of the once-daily CT Checkup. When performed, the eStart procedure will run enough scans to bring the X-Ray tube to a temperature that will also help extend its lifetime. Before performing an eStart warmup, the Symbia system must first be in CT Brain Mode and have the collimators installed. Select eStart from the Setup dropdown menu. -OR- Click the eStart message prompt/icon at the bottom of the screen if it’s available. Patient Applications Edit lasert View Setup Image Options System Help API/ Comment. Calibration ... eStart Examination 2 3 Reco 800.2 E 150 0 Tube Warmup is expect, please select Setup WarmUp 06/20/2014 07:59:2 Examination task card with eStart ready to be performed (1) eStart menu option (2) eStart message prompt (3) eStart icon 91 Turnover Workbook | Symbia Intevo Bold (VB20) 8.5.1 CT Setup Notes For the CT setup, perform the following steps: 1. From the Command Module, register a new patient or select one previously registered. 2. From the Workflow Template Browser Category menu, select the category that contains the workflow template. 3. Double click the appropriate workflow template. 4. Center the area of interest of the patient in the NM detector’s FOV. 5. From the PPM, press the Offset Zoom / FOV Limit tab. 6. Press the FOV controls to set the CT range planning lines for the organ of interest. 7. Press the Proceed button. C 8.5.2 Topogram Acquisition To acquire a topogram, perform the following steps: 1. From the CT Acquisition activity, click the Prepare button. The CT Examination task card is displayed. 2. Whenever a range is invalid (region unable to be acquired), it is highlighted in yellow on the Examination task card. 3. To change the topogram range, click the protocol step Topogram, and then click the Topogram length pull-down menu to select the scan length. The reference range which appears as a white box comes from the PPM’s Offset Zoom / FOV Limit screen where CT FOV planning is set using the CT range planning line controls. 4. Click the Load button to load the topogram acquisition parameters. Load 92 Turnover Workbook | Symbia Intevo Bold (VB20) 5. The system prompts you to Press MOVE Key to move table [pallet] or Notes Click Cancel to keep the same position. 6. From the CT control box, press and hold the Move button until the patient bed is moved to the topogram starting position. 7. From the CT control box, press the Start button when prompted to begin the topogram acquisition. 8. When the topogram acquisition is complete, a purple box will be displayed over the topogram showing the CT scan range. 9. Adjust the vertical size of the purple box to further refine the CT acquisition limits set on the PPM. If it is out of range, the boxes are yellow. Adjust the acquisition range. Phantom. Siemens Hospital/A1 C297/ 1234 CT 2006A0 1.03-Symbia T6>5.0.28.5 6/21/1950, M, 56Y 6/21/2005 2:20:12.94 IMA 1 OOP 1 1 SP -1144.5 SP 1: -1125.5 SP 2: -965.5 LEN: 160.0 GT: 0.0 FoV: . 500 CE: 0 /0 R KV 130 mA 20 TI 5.9 GT 0.0 SL 1.0 512 0/0 T20s SOPO 1 1. Purple Box over Topogram 93 Turnover Workbook | Symbia Intevo Bold (VB20) 8.5.3 Acquiring the CT Notes To start the CT acquisition, perform the following steps: 1. Review the acquisition parameters for the CT acquisition and make changes if needed. 2. Click the Load button to load the acquisition parameters for the CT acquisition. 3. The system prompts you to Press MOVE Key to move table [pallet] or Click Cancel to keep the same position. 4. From the CT control box, press and hold the Move button so that the patient bed is moved to the CT acquisition starting position. 5. Give the patient breathing instructions as needed. 6. From the CT control box, press the Start button to begin the acquisition. 8.5.4 Reconstructing the CT The first reconstruction proceeds automatically. A total of eight reconstructions are possible. 1. When the CT acquisition is complete, click the Recon tab. 9208 80P0 1 38 8085 L300 A SPECT_AC_Cardiac (Adult) Phantom, Siemens 1234 Totarmas: 282 Topogram Series description AC AC_Cardiac 5.0 B40s AC_Cardiac Slice 5.0 mm Recon begin -1125.5 mm Kernel B40s medium Recon end -965.5 mm Window Mediastinum mage order Craniocaudal -2 Recon increment 5.0 mm 2: FOV 500 mm 2 No. of images 33 2 Center X 0 mm2 3 Overview Center Y 0 mm 2l Comments Mirroring None Load Extended CT scale 4 Recon Routine Scan Auto Tasking Automatic checkup procedure completed successfully. Ou 6/21/2005 12:25:30 PM 1. Protocol Step’s Reconstruction Icons 2. Close Current Patient Button 3. Recon Button 4. Recon Tab 2. If additional reconstructions are desired, choose one of the following: • Click the Recon button to reconstruct an open job, or • Click the scan protocol’s reconstruction icon to display the Recon tab, and then make the desired adjustments. 3. Click the Recon button. 4. All reconstructed jobs must be completed or deleted prior to closing out of the patient. 5. If the CT reconstructions are acceptable, click the Close current patient button. If not, perform another reconstruction. 6. The system will go back to the MI Applications user interface with your SPECT acquisition highlighted. 94 Turnover Workbook | Symbia Intevo Bold (VB20) 8.5.5 SPECT Acquisition Setup Notes For SPECT acquisition setup, perform the following steps. 1. When the workflow appears, click the appropriate SPECT acquisition activity. 2. Review the Summary tab information. If the information is correct, and no changes are made, skip to the next section. If incorrect, select the appropriate tab, and then enter the required information. 3. If information is not correct or needs to be entered, click the Series Information tab, and then enter the required information. 4. From the Camera Parameters tab, click the Enable Study Based Setup check box if not selected. 5. Click the Prepare Acquisition button. The patient bed indexes back to the nuclear imaging position. The pallet will move out of the gantry until it returns to the in/out position where it was when the CT FOV range planning lines were saved. 8.5.6 Performing the SPECT Acquisition To start the SPECT acquisition, perform the following steps. 1. Click the Start button. 2. When the SPECT acquisition activity is completed, click the Quality Control activity to check the studies for motion. 3. Click the Reconstruction activity. 8.5.7 Performing a CT Only Exam PPM Setup 1. Clear any objects in the path of the detectors 2. On the PPM, press the Reconfiguration Tab 95 Turnover Workbook | Symbia Intevo Bold (VB20) 3. Press the CT Positioning Configuration icon. Notes SIEMENS CT 90º 90º 76º 76º X 09:05 4. Detectors will move into CT configuration. 8.5.8 Positioning for the CT Only Exam 1. After configuration is complete, place the patient on the Patient Table. 2. Using the Hand Control, press the Bed Index button twice. Bed Index Button Press twice to activate 96 Turnover Workbook | Symbia Intevo Bold (VB20) 3. Press the Hand Control button for the type of study you wish to Notes perform. 4. On the Acquisition Console, register the patient. 5. Open the syngo Patient Browser. 6. Locate the patient and highlight (single click) the Study folder. 7. Pull down menu item Patient and select CT Examination Patient Applications Transfer Edit Vi Register. Emergency ... Load to Viewing Load Report Load Last Report CT Examination CT Recon 8. The Patient Model Dialog window will appear. Select the desired protocol from the menus. Patient Model Dialog Adult En Protocol & Replace Child C Append Topogram @ Cut ascu . Keep RT Auto reference lines None ceci PET API Language English Cancel 97 Turnover Workbook | Symbia Intevo Bold (VB20) 8.5.9 Acquiring the CT Only Exam Notes Topogram 1. In the chronicle, select the Topogram entry 2. In the Routine subtask card, check the topogram parameters • Topogram length [mm] • Tube position • Table position (horizontal, vertical) • Scan direction • Correct the topogram length and tube position, if necessary AbdomenRoutine (Adult) Abdomen 123 Total mas Topogram MA Abdomen 120 - Scantime 5.95 06 mm Chronicle opograrn length 512 mm Tube position Top Bottom Lateral 1 Commerts" How Position Height Load 328 5 - 100 0Craniocaudal Routine Scan Auto Tasking 2 3. Click Load • The topogram parameters are confirmed. 4. The Press START message is displayed next to the “Topogram” entry. Topogram Press START 5. Press the START button on the CT control box. Suspend Button Start Button Hint: You can manually stop the topogram as soon as the desired scan region has been covered using the (Suspend) Hold/Stop Radiation button on the control box. 98 Turnover Workbook | Symbia Intevo Bold (VB20) Planning an Exam Range Notes 6. The exam range should be planned on a topogram to cover the desired anatomic region for diagnosis. First of all, you can zoom or pan the topogram for a better view. Several ways help you to define a range efficiently. The range of a tomo scan is graphically represented in the topo segment. (2) (1)- '3) (4) Graphic objects in the topo segment (1) Radiation exposure range (2) Scan step No. (3) An exam range (4) Table position Colors are used to identify the status of a range: Magenta: the active (selected) range White: all other (unselected) ranges Yellow: an invalid range (1) + (3) O +(4) (2) Illustration of an exam range object (1) FOV (2) Scan direction (3) Scan begin position (4) Scan end position 99 Turnover Workbook | Symbia Intevo Bold (VB20) Notes I (1) (1) (2) Manipulation of an exam range object (1) Resize (2) Move FAST Planning The FAST Planning function automatically locates a desired body region on a topogram. On the Recon sub-task card, you can select the body region from the Recon region list. To turn off FAST Planning, select None from the list. Recon region: Narrow Wide Abdomen - Diaphragm to pubic arch Depending on the patient physique, Narrow or Wide can be selected on the Recon sub-task card. The Narrow option does not include soft tissue. The Wide option includes soft tissue. Acquiring the Tomogram 7. In Chronicle, select a tomo entry and check corresponding exam parameters on sub-task cards. 8. Click the LOAD button. Load 9. If prompted, hold down Move on CT control box to move the patient table to the scan starting position. 10. Press Start on CT control box. 100 Turnover Workbook | Symbia Intevo Bold (VB20) 8.5.10 Perform SPECT Reconstruction Notes After the SPECT and CT acquisitions are complete, the SPECT data is reconstructed without attenuation correction. To start the SPECT reconstruction, perform the following steps: 1. Click the Image Registration activity. 2. Use the Image Registration activity to check if the registration of the SPECT and CT data are correctly aligned. 101 Turnover Workbook | Symbia Intevo Bold (VB20) 9. Processing Workflows 9.1 Quality Control Activity Notes Used on the following data types: • Cardiac Gated Tomo • Cardiac Non-Gated Tomo • Dynamic • Tomo • Dynamic Tomo 9.1.1 Cardiac Gated Tomo and Non-Gated Tomo Correction Settings Correction 2. Select Series Series: Stress Mibi-Gated [Corrected] Before Sinogram After Sinogram % % % 100 33 4. Click and drag red Linogram Linogram line to center heart 100 100 5. Click the Cine button to view 200 - Sum Sum 100 % 150 - 100 100 Beats 50 3. Apply Beat Normalize (Optional) 0 10 20 30 40 50 60 70 80 90 100 120 140 160 180 200 220 Beats/Min Beat Normalize Beat Histogram: . Beats/Min Beats vs. Projections Unapply Correction ms/Beat HR vs. Projections 6. Click Motion Correct Series button Isotope: A Motion Correct Series. Revert to Original 1. Select the Quality Control Activity in the workflow 2. Pull down Series > Select appropriate series 3. Select Beat Normalize if desired 4. Click and drag red horizontal line to the center of the heart 5. Click the Cine button to view image for motion 6. If motion correction is needed, click Motion Correct Series button 7. Center the red ROI over the heart. Resize and reposition if needed 8. Review cine sonogram and linogram in the After section 9. Click OK 102 Turnover Workbook | Symbia Intevo Bold (VB20) Motion Correction Notes Automatic |Manual Automatic Correction v Use All Projections Shift all projections Isotope A Apply X Shift 7. Center red ROI over Apply Y Shift heart. Head Misregistration Before % 100 100 33 224.99 264.99 304.99 344.99 384.99 X Motion O Sinogram Linogram 224.99 264.99 304.99 344.99 384.99 Y Motion After % 100 33 224.99 264.99 304.99 344.99 384.99 X Motion 0 0 Sinogram Linogram 224.99 264.99 304.99 344.99 384.99 Y Motion 8. Click to Review Cine 9. Click OK 10. If satisfied, continue with processing 11. If not satisfied, click Revert to Original button 12. Repeat steps 2–9 on additional series if required 103 Turnover Workbook | Symbia Intevo Bold (VB20) 9.1.2 Dynamic Correction Notes 1. Select the Quality Control Activity in the workflow 2. Pull down Series > Select appropriate series 3. Select Motion Correct Series button Settings | Correction 2. Select series Series: Renal Mag 3 Before After Renal Mag 3 20 Sum Sum 100 100 0 Quality Control Tools Unapply Correction 3. Select Motion Detector : 1 Isotope : A Motion Correct Series .. Revert to Original 104 Turnover Workbook | Symbia Intevo Bold (VB20) 4. Choose from Single Frame Mode or Multiframe Mode Notes 5. Select the Cross Tool 6. Use the Shift Tools to adjust the position 7. Click the Cine Tool to check the images 8. Click OK to save the changes Motion Correction Manual Manual Correction Results Detector: Single Frame Mode 4. Choose correction Isotope: Multiframe Mode mode 5. Cross Tool 0+ 6. Shift Tools to make adjustments in position % 20 Sum 100 Click to cine images X Shift: 0.00 Y Shift: 0.00 8 Click OK to accept the changes. OK 9.1.3 Tomo Corrections 1. Select the Quality Control Activity in the workflow 2. Pull down Series > Select appropriate series 3. Click Motion Correct Series button Settings |Correction 2. Select the series -Series: Chest Before Sinogram After Sinogram 100 Pelvis 100 100 Linogram inogram 100 100 Sum Sum % 100 100 Quality Control Tools Unapply Correction 3 . Click to motion correct series Isotope : A Motion Correct Series .. Revert to Original 105 Turnover Workbook | Symbia Intevo Bold (VB20) 4. Choose for Single Frame Mode or Multiframe Mode Notes 5. Select the Cross Tool 6. Use the Vertical Shift Tool to adjust the position 7. Click the Cine Tool to check the images 8. Click OK to save the changes Motion Correction Manual Manual Correction Results Single Frame Mode 4. Choose correction Isotope: A Multiframe Mode mode 6. Vertical Shift Tool to 5. Cross Tool make adjustments in 0 % 79 Linogram % 52 100 Sum % 100 0 7. Click to cine images X Shift: 0.00 Y Shift: 0.00 8. Click OK to accept the changes OK 106 Turnover Workbook | Symbia Intevo Bold (VB20) 9.1.4 Auto Recon Activity Notes 1. Select the AutoRecon Activity in the workflow 2. Go to the Settings Tab 3. Make necessary adjustments to the Reconstruction Settings 4. Make necessary adjustments to the Filter Settings 5. Click to apply settings 6. Click the Reconstruction tab 7. Click and drag the limits to adjust the range Bone - WB Tomo, e.cam - Bone Scan, 3/17/2003 AutoRecon View Template Workflow Activities Help Settings Reconstruction 6. Click the Reconstruction Bone Scan - Abdomen - Isotope A 3/17/2003 Tab Anterior Transverse Sagittal Coronal Data Selector % 71 7. Click and drag red lines to adjust range Quality Control Scrollable Views -19 Display Zoom : AutoRecon Bone Scan - Thorax - Isotope A 3/17/2003 ansverse Sagital Coronal % Flexible Display Scrollable Views isplay Zoom: 3rd Tomo for Non-AC - Isotope A Hard Copy Transverse Sagittal Coronal 100 Scrollable Views Display Zoom: 4th Tomo for Non-AC - Isotope A Transverse Sagittal Coronal 100 omplete uspend ~ Scrollable Views Setup Display Zoom: Ready Simulator is RUND 9.2 Advanced Reconstruction Options The Advanced reconstruction options require a specific license 9.2.1 Flash 3D Flash 3D is a statistically based iterative reconstruction method based on OSEM, where the distance-dependent collimator blurring is accurately modeled in all 3 dimensions. Adjusting Settings to Improve Image Quality Image is Possible Solution Too smooth Ensure Flash 3D is selected Decrease FWHM filter (guideline: roughly 2 pixel size). Check image quality with 0 mm. Increase iterations. Usually more than 6-8. Increase subsets. Check number of subsets, and change to next valid value. Check for any workflow connection changes Too noisy, or sharp Increase FWHM (in particular for TI201 rest studies) Decrease subsets Decrease iterations Check for motion, and correct if needed 107 Turnover Workbook | Symbia Intevo Bold (VB20) 9.2.2 xSPECT Notes xSPECT is an optional feature that is available on the Symbia Intevo systems. There are two types of xSPECT features, xSPECT Bone and xSPECT Quant. This section will give an an overview of both. xSPECT Bone xSPECT integrates SPECT and CT data by using the high-precision CT as the frame of reference. This means xSPECT uses the CT coordinate system for reconstruction. This enables precise SPECT and CT registration in a 256x256 high-resolution matrix size. xSPECT Bone Tomo Acquisition SPECT Setup 1. On the Series Information sub tab, for the Organ drop down, select Skeletal. Default settings for all Advanced Recon for Low Count Studies Smoothness Post-Smoothing Vector Bar Iteration Subset Setting 4 or 1x [mm] Settings 1 12 2 5 mm x [2,2,2,1,1] Proposal 1 Settings 2 24 1 5 mm x [2,2,2,1,1] < 6 Million Settings 3 18 2 5 mm x [2,2,2,1,1] Counts for Settings 4 36 1 Entire 5 mm x [2,2,2,1,1] Acquisition Settings 5 24 2 5 mm x [2,2,2,1,1] Settings 6 48 1 5 mm x [2,2,2,1,1] Settings 7 30 2 5 mm x [2,2,2,1,1] 108 Turnover Workbook | Symbia Intevo Bold (VB20) 2. Set the following parameters on the Camera Parameters tab. Notes • Matrix: 256 x 256 • Zoom: 1 • Camera Preset: SC-Tc99m – NMG Elle Tomo Acquisition View Template Workflow activities Help AI Acquisition Analyzer Display/Analysis fou Acquisition Display Detector 1: Detector 2 Study 99m Technetium com Technosum Series Bone Tomo Acquisition Summary Series Information Camera Parameters Stop Conditions Camera Pa Matrix Size: 256 X 256 Zoom 1.00 Camera Preset SC.Tc99m-NMG Detectors: Both Detectors Enable Study Based Setup KCourts: KCourts: Remaining Elapsed View Apply Uniformity Correction Orientation Camera Parameters Body Position Supine Supine 258 X 256 10 Suspend SC-Tco/fm-NMG Both Detectors Prepare Acquisition Default settings for all Advanced Recon for High Count Studies Performance Post-Smoothing Vector Bar Iteration Subset Setting 4 or 1x [mm] Settings 1 6 6 5 mm x [2,2,2,1,1] Proposal 1 Settings 2 8 6 5 mm x [2,2,2, 1,1] > 6 Million Settings 3 24 2 5 mm x [2,2,2,1,1] Counts for Settings 4 48 1 5 mm x [2,2,2,1,1] Entire Acquisition Settings 5 60 5 mm x [2,2,2,1,1] Settings 6 72 5 mm x [2,2,2,1,1] Settings 7 84 5 mm x [2,2,2,1,1] 3. Set the following parameters on the Stop Conditions tab: • Select Advanced Data from the Data Types drop down menu Summary Series Information Camera Parameters|Stop Conditions Data Types: Advanced Data Basic Data CT Acquisition Stop Condition Advanced Data Time per View. 20 sec First View by Counts: 109 Turnover Workbook | Symbia Intevo Bold (VB20) CT Setup Notes Scan Sub Task card Topogram Quality ref. mAs AbdRoutine Eff. MAS Slice 3.0 mm JAcq 2×2.5mm 00 CARE DOSAID P Pioch KV 130 J Direction Craniocaudal CTDMOI 1.45 mGy Scan time 32 93 5 24 Scan start Start button Rocstion time Delay 3s API None Load Routine Scan Recon Auto Tasking Recon Sub Task card (B31 Kernel Selected) Topogram Reconjob 1 8 8 8 2 8 7 8 Series description AbdRoutine 3.0 B31s AbdRoutine Sice 3.0 mm ] Recon begin -2187 0 mm= Komel (B31s medium smooth . Recon end -1887 0 mm Window Lung Image order Craniocaudal Recon increment 3.0 mm Extended For Fo 500 mm 2/ No of images Center X Overview Center Y Comments Mirroring None Load Extended CT scaler Recon Routine Scan Recon Auto Tasking xSPECT Bone Tomo Reconstruction 1. In the AutoRecon activity, select the Settings Tab. 2. In the Apply to Item drop down, select series for Tomo Processing – AC Enhanced 3. Select the Advanced sub tab. 4. Select OSCG + Enhanced. 5. Select Skeletal from the Preset drop down menu. Elle AutoBecon View Template Workflow Activibes Help 11 Settings |Reconstruction Masking/Centering Data Selector onstruction Par Apply to Rem: SUN - SPECT Thorax- Isotope A 8/6/2013 Apply Recon Range to All Configure Data Paths Tomo Processing . AC Enhanced Reconstruction Limits Performance / Smoothness Ousity Contre Pool Size: (2 40 2 40) mm Range: . All @ 180 -180, 18 Performance : Aut&Reco terations: 24- · No Reorientation Anterior Subsets: 2 100 .. Y . . . Quality Speed Registration Analytical kerative Advanced Smoothness : 0.00 [mm] AutoRecon OSCG . OSCG . Enhanced Reconstruction Range Y ...... Preset 46 - 171 Skeletal Start LOSS More Water Phartom Pharcom with Contrast Advanced Options Scatter Estimation Preserve Negative Values Apply To Photopeak Photopeak 1 Energy windows @ Preserve Data Précision Method Type Window Weights Filter Properties Complete Automatic None Automatic Apply Scatter Correction Change Fiber . DEW Lower Window Weight 0.50 Gaussian 12:00 Quantitative Dose/Time Info .... 110 Turnover Workbook | Symbia Intevo Bold (VB20) 6. From the Performance/Smoothness field, select your iterations and Notes subsets. Ello AutoBecon View Ismolate Workflow Activities Holo Settings Reconstruction Masking/Centering Data Selector Reconstruction Parameters Apply to Rem: Ist Tomo for AC Enhanced . Isotope A Apply Recon Range to All Configure Daca Paths_ Tomo Processing . AC Enhanced Reconstruction Limits Performance / Smoothness Ousity Central Starting Angle: Pixel Size: (0.00 0.00) mm Range: · All 0 180 Performance AMBRecen berations: 24- . No Reorientation Anterior Subsets: 2 100 Speed Quality Registration Analytical Rorativo Advanced Smoothness: 000 [mm] AutoRecen OSCG . OSCG . Enhanced Reconstruction Range Preset 1 - 256 Y ...... Skeletal Start Loss More Advanced Options Scatter Estimation Preserve Negative Values Apply To Photopeak Phooopeak 1 Energy windows Preserve Dota Precision Method Typ Window Weights Filter Properties Complete Apply Scatter Correction AutomaDc None Automatic Change Filter · DEW Lower Window Weight 0.50 Gaussian 12.00 Q TEW Setup Quantitative Dose/Time Info Default settings for all Advanced Recon for High Count Studies Performance Post-Smoothing Vector Bar Iteration Subset Setting 4 or 1x [mm] Settings 1 6 6 5 mm x [2,2,2, 1,1] Proposal 1 Settings 2 5 mm x [2,2,2,1,1] > 6 Million Settings 3 24 5 mm x [2,2,2,1,1] Counts for Entire Settings 4 48 5 mm x [2,2,2,1,1] Acquisition Settings 5 60 5 mm x [2,2,2,1,1] Settings 6 72 5 mm x [2,2,2,1,1] Settings 7 84 5 mm x [2,2,2,1,1] Default settings for all Advanced Recon for Low Count Studies Smoothness Post-Smoothing Vector Bar Iteration Subset Setting 4 or 1x [mm] Settings 1 12 2 5 mm x [2,2,2, 1,1] Proposal 1 Settings 2 24 5 mm x [2,2,2,1,1] < 6 Million Settings 3 18 2 5 mm x [2,2,2,1,1] Counts for 1 Entire Settings 4 36 5 mm x [2,2,2, 1,1] Acquisition Settings 5 24 2 5 mm x [2,2,2,1,1] Settings 6 48 1 5 mm x [2,2,2,1,1] Settings 7 30 2 5 mm x [2,2,2,1,1] 7. Press Start if you have made any changes to the AutoRecon activity parameters. 111 Turnover Workbook | Symbia Intevo Bold (VB20) xSPECT Quant Notes xSPECT Quant Tomo Acquisition SPECT Setup 1. On the Series Information sub tab, for the Organ drop down, select appropriate organ. 2. Check the Enable Quantitative Acquisition box. 3. Enter initial assay, injection and residual dose information. Summary Series Information Camera Parameters |Stop Conditions Series: Bone Tomo CT Acquisition Technologist Reading Physician: Quality Control Referring Physician: Organ: Skeletal Enable Quantitative Acquisition AutoRecon Radiopharmaceutical Isotope: Pharmaceutical: 99m Technetium MDP Initial Assay. Date: Time: Image Dose: 700 MBq 7/15/2013 1:00:00 AM Registration Injection Date and Time: 7/15/2013 2:00:00 AM Residual Dose: Dose: 10 MBq 7/15/2013 3:00:00 AM Effective Dose: Dose: 612.547 MBq 7/15/2013 2:00:00 AM xSPECT Quant Acquisition Types Advanced Detector Configuration 180 Acquisition Orbits Noncircular/Circular Acquisition Mode Step and Shoot Collimator Support LEHR Isotope Support Tc-99m Matrix Size 128x128, 256x256 Zoom 1 Camera Preset SC-Tc99m-NMG 112 Turnover Workbook | Symbia Intevo Bold (VB20) 4. Set the following parameters on the Camera Parameters tab. Notes • Matrix: 256 x 256 • Zoom: 1 • Camera Preset: SC-Tc99m – NMG Elle Tomo Acquisition View Template Workdow activities Help O AI Acquisition Analyzer Display/Analysis fou Acquisition Display Detector Study 99m Technetium 99m Technetum Series: Bone Tomo Acquisition Summary Series Information Camera Parameters Stop Conditions Camera Para Matrix Size: 256 X 256 Zoom: 1.00 Camera Preset SC.Tc99m-NMG Detectors: Both Detectors Ouvity Contre Enable Study Based Setup I KCourts: KCourts Remaining View AutoRecon CalibrationE. Apply Uniformity Correction Registration Orientation Camera Parameters Body Position Supine Supine 258 X 256 1.0 Complet Suspend SC-Tc9fm-NMG Both Detectors Setup Prepare Acquisition xSPECT Quant Acquisition Types Advanced Detector Configuration 180 Acquisition Orbits Noncircular/Circular Acquisition Mode Step and Shoot Collimator Support LEHR Isotope Support Tc-99m Matrix Size 128x128, 256x256 Zoom 1 Camera Preset SC-Tc99m-NMG 5. Set the following parameters on the Stop Conditions tab: • Select Advanced Data from the Data Types drop down menu Summary Series Information Camera Parameters|Stop Conditions Data Types: Advanced Data Basic Data CT Acquisition Stop Condition Advanced Data >Time per View. 20 sec First View by Counts: 113 Turnover Workbook | Symbia Intevo Bold (VB20) CT Setup Notes Scan Sub Task card Topogram AbdRoutine Quality ref. MAS Eff. MAS Saco 3.0 mm ] Acq 2x2.5mm 00 CARE DOS+4D P Pitch KV 130 MJ Direction Craniocaudal CTDIMol 1.45 mGy Scan time 32 93 5 24 Scan start Start button Roostion time 0.8$ -J Delay API None Load Routine Scan Recon Auto Tasking Recon Sub Task card (B31 Kernel Selected) Topogram Reconjob 1 8 2 8 2 8 7 8 Series description AbdRoutine 3.0 B31s AbdRoutine Sice 3.0 mm ] Recon begin -2187 0 mm Komel B31s medium smooth Recon end -1887 0 mm Window Lung Image order Craniocaudal Recon increment 3.0 mm zil Extended For Fo 500 mm al No of images Center X Ownview Center Y Comments Mirroring None Load Extended CT scaler Recon Routine Scan Recon Auto Tasking xSPECT Tomo Reconstruction xRecon Activity You will see two xRecon activities in an xSPECT workflow. The first is reconstruction for the image registration. The second xRecon activity is for the final reconstructed series. The xRecon activity can reconstruct up to 5 beds. 114 Turnover Workbook | Symbia Intevo Bold (VB20) Settings Tab Notes 1. The Settings tab is the main page used to view reconstruction Settings Resuits Advanced Bone Scan 05/13/2014 SCAC KELETAL Reconstruction Method Flash3D Scatter Correction On Attenuation Correction on Parameter Setting Parameters View 51 Fast Best 2. Toggle between "Image" and "Parameters" Views 3. Initiates the Recon Process Start Recon Show may WB Bone Scan Scan 5, 12:35 57 PM Body 25 B31 +FOV, 12:47:54 PM WB Bone Scan Scan 4, 12:25:15 PM WB Bone Scan Scan 3, 12:14:46 PM WB Bone Scan Scan 2, 12 04 21 PM WB Bone Scan Scan 1. 11:53:56 AM 4. Raw Data Inputs and Reconstructions 1) The Parameters View is shown. Pull down menu allows selection of the parameters setting. 2) To switch to the Image view, click the Show Image button. 3) Reconstruction will happen automatically after acquisition, but if the user makes any changes to the parameters, the Start Recon button initiates the reconstruction process. 4) This area displays the raw data inputs and the reconstructions. 2. When the Start Recon is initiated, a progress bar will appear above the Parameters Display Settings Results Advanced Reconstruction1 Bone Scan 05/13/2014 SCAC Bone Scan 05/13/2014 SCAC 5. Progress bar appears when reconstruction is SKELETAL initiated. Reconstruction Method Flash3D Reconstruction Method Flash30 Scatter Correction on Scatter Correction on Attenuation Correction Attenuation Correction On Parameter Setting Parameter Seting Fast Standard Start Recon Show Image Raw Data Inputs WB Bone Scan Scan 5, 12: 35:57 PM Body 25 B31 eFoV. 1247:54 PM WB Bone Scan-Scan 4, 12 25.15 PM WB Bone Scan Scan 3. 12 14 46 PM WB Bons Scan-Scan 2, 12:04:21 PM WB Bone Scon-Scan 1. 11:53:56 AM 115 Turnover Workbook | Symbia Intevo Bold (VB20) 3. When all the slices are reconstructed, the image is available to view Notes by clicking the Show Image button. Settings Results Advanced Reconstruction 1 Reconstruction 2 Bone Scan 05/13/2014 SCAC Bone Scan 05/13/2014 SCAC 300 36 19 3244 Start Recon Edt Paramices Edt Parameters Raw Data Inputs WB Bone Scan-Scan 5, 12:35.57 PM Body 25 B31 eFoV. 12:47.54 PM WB Bone Scan-Scan 4, 12:25:15 PM WB Bone Scan-Scan 3, 12:14:46 PM WB Bone Scan-Scan 2, 12:04:21 PM WB Bone Scan- Scan 1. 11.53.56 AM 4. If you need to edit the dose information, the top left corner of the Settings Tab allows you to edit the dose information as well as accessing the cross calibration. Click the Edit Dose Info button and enter the correct parameters. Click OK. Sedings RENAs Edit Dose Corrected Dos 320 000/33 2/17/2015 12:00AM Information Eat Dose Irfo Radiopharmaceutical Isotope: Pharmaceutical 99m Technetium Initial Assay. Date: Time: Dose: 370 MBqY 12/ 8/2014 12:00:00 AM Dose calibrator identifier Injection Date and Time: 12/ 8/2014 12:00:00 AM Residual Dose: Dose: O MBq 12/ 8/2014 12:00:00 AM Dose calibrator identifier Effective Dose Dose: 370.000 MBq 12/8/2014 12:00:00 AM OK Cancel Artator 116 Turnover Workbook | Symbia Intevo Bold (VB20) Results Tab Notes 5. The Results Tab allows the user to review the reconstructed images produced in the xRecon activity. amigs Results Advanced Bone Scan 05/13/2014 SCAC Apply Mark Recon Tom 2. Display Selector 1. Scroll through Jobs 1) Toggle allows scrolling through the reconstruction job. 2) Display select allows you to view Recon Tomo, Zone Map and Mu Maps. Advanced Tab 6. The Advanced Tab houses the reconstruction parameters and settings. a. The parameter settings of Fast, Standard and Best have predefined parameters that are not available to be changed. b. If you want to create your own settings, select the parameters setting User Defined, and the rest of the parameter settings will become available. Settings Results Advanced Prepare for Registration Enable 2nd Reconstruction Job Advanced Options - Reconstruction Job 1 Advanced Options - Reconstruction Job 2 Exam Type Skeletal Exam Type Skeletal Reconstruction Method Flash3D Reconstruction Method Flash3D Zone Preset None Zone Preset None Parameter Setting Fast arameter Setting User-Defined Reconstruction Param Reconstruction Param berations: 25 Subsets: Rerations: 30 Subsets: 2 Filtering 3D Gaussian FWHM: 10.00 mm Filtering 3D Gaussian FWHM: 10.00 mm Apply Scatter Correction Apply Scatter Correction Scatter Estimation Scatter Estimation Apply To: Photopeak 1 Energy Windows Apply To: Photopeak 1 Energy Windows ... Window Weights Automatic Window Weights Automatic Lower Window Weight 0.50 Lower Window Weight 0.50 Filtering 2D Gaussian FWHM: 20.00 mm Filtering 2D Gaussian FWHM: 20.00 mm Apply Attenuation Correction Apply Attenuation Correction Attenuation Coefficients Determination Attenuation Coefficients Determination Apply To: Photopeak 1 Apply To: Photopeak 1 Energy Settings Energy Settings · Isotope Energy value 99m Technetum · Isotope Energy value 99m Technetium O User Defined User Defined Beam Model Beam Model · Narrow . Narrow Filtering 3D Gaussian FWHM: 0.00 mm Filtering 30 Gaussian FWHM: 0.00 mm 117 Turnover Workbook | Symbia Intevo Bold (VB20) 7. Selecting the Exam Type. Notes The exam type should be selected based on the type of study being performed. Each advanced method defines the proceeding option (i.e. Exam Type -> Reconstruction Method -> Zone Preset -> Parameter Setting). All exam types decay correct to the injection time, with the exception of WholeBody-Theranostic which decay corrects to acquisition start time. Organ Protocol Exam Type Skeletal Diagnostic Skeletal Whole Body Diagnostic Whole Body Whole Body Theranostic Whole Body - Theranostic Brain Diagnostic Brain Endocrine Diagnostic Endocrine Pulmonary Diagnostic Pulmonary Gastrointestinal Diagnostic Gastrointestinal Renal Diagnostic Renal General Diagnostic General Cardiac - not Diagnostic not shown shown 8. Selecting the Reconstruction Method The two selections that are available for this are Flash 3D and xSPECT Reconstruction. 9. Selecting the Zone Preset The Zone Present will only be available when the Skeletal exam type is selected. Available Zone Presets for Skeletal Exam: a. Skeletal – to be used with xSPECT Bone imaging b. Water Phantom – to be used for phantom studies c. Phantom with Contrast – to be used for phantom studies 10. Selecting the Parameter Setting The first xRecon activity in a workflow will have the parameters Ultra-Fast or User Defined. The second xRecon activity in a workflow will have four parameters: Fast, Standard, Best, or User Defined. The Parameter Settings selections have predetermined reconstruction parameters based on the total counts, reconstruction method, and parameter setting. See the charts below for the assignments. 118 Turnover Workbook | Symbia Intevo Bold (VB20) xSPECT and xSPECT Bone Iterations and Subset Assignments Notes Total Counts <0.25M 20.25M 20.5M 23M 26M 212M Best SS 1 1 1 1 1 it L2 24 24 72 Normal SS 1 1 1 1 1 it 10 16 36 48 48 SS 2 2 2 Fast 1 it 8 24 24 24 UltraFast SS 1 1 1 2 3 Not Recommended (Image Reg) it 6 8 12 12 12 Flash 3D Iterations and Subset Assignments Total Counts <0.25M 20.25M 20.5M 23M 26M 212M Best SS 4 12 it 50 30 15 00 00 Normal SS 1 2 4 8 12 it 50 30 25 15 12 Fast SS 1 2 6 10 16 it 25 15 10 8 UltraFast SS 1 2 6 12 20 Not Recommended Image Reg) it 25 20 10 8 5 User Defined Parameter Setting Enables the following: • Reconstruction Parameters • Scatter Estimation • Window Weights • Filtering • Attenuation Coefficients Determination • Energy Settings • Beam Model • Filtering 11. When reconstruction is complete, use Volumetric Analysis, TrueD or syngo.via to view and analyze images. 119 Turnover Workbook | Symbia Intevo Bold (VB20) 9.1.5 Volumetric Analysis Activity Notes The Volumetric Analysis Activity allows for 2D and 3D processing of SPECT, PET and CT data. It provides image manipulation, image fusion displays, ROI and VOI analysis and visualization including Standard Uptake Value calculations, curve creation and the display of Maximum Intensity Projections for SPECT, PET whole body and static data and CT data. Multiple PET, SPECT, and CT series can be quantified simultaneously such as in the case of pre- and post-therapy. Data Sets Supported Supports up to 2 PET/CT’s or SPECT/CT’s of types: • NM Recon TOMO • NM Recon Gated TOMO • NM Recon Dynamic TOMO • PET Static • PET Gated • PE Dynamic • CT 3D Analysis Tab The 3D Analysis tab offers you the ability to view fused images for evaluation and create VOIs for quantitation. Segmentation Save/Print Options VOI Selector Layout Dialog Select Isocontour Control VOI Tools Layout Buttons LOS IX Y Analysis CTWR, 1/28/200 100 Color Bars Results VOI Comparisons Parameter Value 120 Turnover Workbook | Symbia Intevo Bold (VB20) Layout Buttons Notes 3 Slice Axial Slices Mode Sagittal Slices Slices in 3 Planes Coronal Slices Slice Display Properties Blend to fuse data sets Slice Di play Layout Dialog Pair [ Default ]-SPECT NUD [CGZAS-24/15-5mm - A Slice Blend Show 3D Display Display [Default ]-CT LWS 8315 Show 3D Display Properties Display Data Select Data Types (check Types box to display) [Defait] Blend Show 3D Display - [Default] Show 3D Displ Check to Show Displays the 3D Display Results Table Interloved Show Resut Table image on page on page OK Cancel Segmentation Options Options available: a. Ellipsoid b. 3D Isocontour c. Multi-frame Polygon d. Multi-frame Isocontour Iso Row A 1 VOI Results: Ellipsoid % Bone SP Parameter Value 3D Isocontour Multi-frame Polygon Multi-frame Isocontour When isocontour is selected, isocontour slider will become active. 121 Turnover Workbook | Symbia Intevo Bold (VB20) Creating a Elliptical VOI Notes 1. Select Ellipsoid VOI from the Segmentation menu. 2. Click the center of the area where the VOI is to be positioned. 3. Adjust the size and the position of the ellipse as necessary using by clicking and dragging VOI handles. 4. Left click outside VOI to complete. 5. Observe the results in the Results Table. Iso: VOI Results: ROW A 1 % 8 Ellipsoid Bone SP 3D Isocontour Parameter Value Multi-frame Polygon Multi-frame Isocontour Iso: 50 VOU XY TS Transverse Coronal VOIResuts PET Whole body [Transverse], 6/2/200 CT WB, 1/28/2003 Biograph, WholeBody MA Moorabbie % 50 HU Parameter | Value biograph 100 7/20/1952 1/28/2003 2. Click the center of area of VOI placement 3. Adjust the size and position of ellipse /Ol Comparisons: Parameter Value VOI Results: Parameter Value Recon Tomo 1 Max 388.00 Count: Min 194.00 Counts Total 48421 Counts Avg 250.89 Count: Std. Dev. 48.36 Vol. 14.72 cm3 X size 35.16 mm Y size 39.06 mm Z size 35.00 mm CT 1 Max 166.00 HU Min 49.00 HU Avg 92.85 HU Std. Dev. 20.38 Wal 11.70 cm3 VOI Comparisons: Parameter Value 122 Turnover Workbook | Symbia Intevo Bold (VB20) Creating a 3D Isocontour VOI Notes 1. Select 3D Isocontour VOI from the Segmentation menu. 2. Click the center of the area where the VOI is to be positioned. 3. Adjust the size and the position of the region as necessary using by clicking and dragging VOI handles. 4. Left click outside VOI to complete. 5. Observe the results in the Results Table. Iso: ROW A 1 VOI Results: Ellipsoid % 3 Bone SP ¥ 3D Isocontour Parameter Value Multi-frame Polygon Multi-frame Isocontour Transverse Bone SPECT-CT [Transformed Object], 5/21/2014 Sagittal Coronal AC CT_BoneSPECT 5.0 8085, 717/2007 69 HU 2. Click the center of area of VOI placement 3. Adjust the size and position of ROI T: 5.0 T: 6.0 ompressed P: 232.0 808s P: 172.6 308$ 47 Compressed 35 Compressed VOI Results: Parameter Value Recon Tomo 1 Max 388.00 Count: Min 194.00 Counts Total 48421 Counts Avg. 250.89 Count: Std. Dev. 48.36 Vol. 14.72 cm3 X size 35.16 mm Y size 39.06 mm Z size 35.00 mm CT 1 Max 166.00 HU Min 49.00 HU Avg. 92.85 HU Std. Dev. 20,38 Val 11.70 cm3 VOI Comparisons: Parameter Value 123 Turnover Workbook | Symbia Intevo Bold (VB20) 10. Organ Specific Processing 10.1 Gastrointestinal Processing Notes 1. Select the Gastrointestinal activity in the workflow Gastric Emptin- Normal dyn- normal w/ solids, 12345678 - Gastric Emptying- Solids, 2/20/2001 File Gastrointestinal View Template Workflow Activities Help O AI 3. Check ROI igs ROI and placement ric empting [Results] 2/21/2014 51 Quality Control 2. Click Cine button Switch to Cine Mode sotope: 99m Technetium ROI Create ROI Using: Emptying Curves Composite Image 99m Techneti . Flexible Display 600 500 400 Thit Thalf 300 Tempty- 200 100 Counts per sec 30 35 40 45 50 55 60 65 70 75 80 85 linutes 4. Click the ROI Too Fr:1 1179K 64x64 to redraw ROI if Results Summary needed. Threshold : Parameter 99m Technetium ..... Bkgd Correction Emptying 41 % Decay Correction On Emptying begin (TO) 3 mins Geometric Mean Emptying end 60 mins omplete Ausper ROI Tool T 1/2 68 mins 65 mins Composite Frame Range TO -> T 1/2 First Frame: 1 Setup Last Frame: 20 The cine mode allows for cinematic viewing of a series in a single pane. imulator is RUNNING Isotope: 99m Techn 6. Drag Tfit to -99m Techneti . ...... 99 m Techneti. Empt end of empty 90m Techneti .. ] 600 5. Drag to 500 start of empty 400 Ifit Tempt Thalt 300 200 100 Counts per 7. Drag to position O 5 10 15 20 O for % emptying 60 65 70 75 80 85 2. Review results 3. See Settings tab to review or modify parameters for this activity 124 Turnover Workbook | Symbia Intevo Bold (VB20) 10.2 Hepatobiliary Processing Notes 1. Select the Gastrointestinal activity in the workflow 2. Review results 3. See Settings tab to review or modify parameters for this activity Gallbladder 1 GBEF Dynamic, ECAM - GBEF. 2/22/2001 File Gastrointestinal View Template Workflow Activities Help AI A Settings ROI Pan GallBladder [Results] 2/21/2014 Data Selector % 3. Check for ROI placement 2. Click the Cine icon 5. Drag to adjust Start hnetium 6. Drag to adjust End RO Create ROI Using: Bom Technest . am Technet! Ejection Fraction Curves Composite Image 4500 WITHX lexible Displa % 4000 Start 100 3500 3000 2500 2000 Hard Copy 1500 End 1000 Min 500 Counts per se 0 - 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 Minutes 4. Click to Fr:1 17002K 64x64 redraw the ROI Threshold: Results Summary Parameter 99m Technetium 3kgd Correction on Ejection Fraction 85 % Decay Correction EF interval begin 2 mins EF interval end 35 mins ROI TOO T Max 2 mins Composite Frame Range T Min 35 mins First Frame: 1 Setup Last Frame: 40 loves the image position within the frame. Ctrl-click to center the image. 10.3 Planar Gated (MUGA) Processing 1. Select the Gated Bloodpool activity on the Processing tab of the workflow 2. Review results on Results and Fitting Results tabs 3. See Settings tab to review or modify parameters for this activity ool View Template Workflow Activities Help AI Settings (Processing > sults|Fitting Results 1. Click the Gated Bloodpool Data Selector Image & ROIs activity and the Processing Tab LAO-Gated [Results] 2/21/2014 % 100 Gated Bloodp Ventricular ROI 100 Flexible Display Duration: 350k Duration. 25mse 5. Cine to check ROI Hard Copy All Frame Background ROI 100 Center LV in green box Cancel KMa Fr.1 262K 6 3x64 dit ROI Fr:11 260K 64X64 3. Click to determine LV center 6. Use to modify ROls 4. Click in center of LV Setup Determine LV center ... ROI Tool .. ROI Tool ... Ready 125 Turnover Workbook | Symbia Intevo Bold (VB20) 10.4 Lung Processing Notes 1. Select the Lung Processing activity on the ROI tab of the workflow 2. Review ROI Settings ROI Regional Analysis Washout Analysis placement Perfusion Series Ventilation/Series Perfusion Lung 2/24/2014 DTPA Aerosol Ventilation 2/24/2214 % % % % % 100 100 100 0 0 Perfusion RPO Perfusion LAO Perf Rt lat Lt Lat All Images HP [ All Images Porf POST Porf AM Post aerosol aerosol 00 100 0 0 0 Edit ROI Edit ROI Threshold : Adjust Frame Threshold : Adjust Frame X Shift X Shift: Y Shift 0 Y Shift: ROI Tool .. Angle: ROI Tool Angle: 3. Click to modify ROIs Registration 4. Click to adjust registration of the ventilation scan 2. See Regional Analysis tab to review or modify results for this activity 3. See Settings tab to review or modify parameters for this activity 126 Turnover Workbook | Symbia Intevo Bold (VB20) 10.5 Renal Processing Notes There are many parameters that can be modified on the Settings tab. There are several tabs on the Settings tab that may be selected. The tabs displayed depend upon which renal method has been selected. 1. Select the Renal Processing activity on the ROI tab of the workflow Renal MAG 3. Symbia T - Renal Scan, 1/26/2006 File Renal Processing View Template Workflow Activities Help O AI A 2. Review ROI Display ROIs Results placements Kidney Aorta % 5 . Click to view results 81 Right Kidney Quality Control 3. Use sliders to edit thresholds Processing Fr:1 1752K 256x256 Fr:1 294K 256x256 Edit ROI Edit ROI Threshold : Threshold : 31 Hard Copy ROL Tool ........... ....................... osite Image Composite Image First Frame: 60 First Frame: 1 4. User ROI Last Frame: 70 Last Frame: 30 Tool to redraw ROI Complet Suspen Setup Ready Renal MAG 3. Symbia T - Renal Scan, 1/26/2006 File Renal Processing View Template Workflow Activities Help AI A Settings Display |ROIs Results Kidney Aorta Data Selector Left Kidney Kidney Right Kidney Left Backgr ... Right Back ... 1200 TMax- R 1100 Quality Control 1000 TMay-L 900 800 TYL 700 600 Renal Processi Fr.1 1752K 256x256 Fr:1 294K 256×256 500 Table of Patient Parameters 400 Parameters Values 300 Renal Protocol Generic (None) Counts / Second 200 Flexible Display Kidney Depth Method Standard Patient Name Renal MAG 3 100 Patient ID Symbia T Sex Other 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 Age 0.07 Minutes Reference BSA 1.73 m2 Hard Copy Split Uptake Interval ( ... 2.0 - 3.0 Radiopharmaceutical 10.0 mCi 99m Technetium MAG3 Method Adult Left Kidne Flow Hematocrit 0.00 Table of Result Summary Parameters Left Left Right Total Split Function (%) 46.9 53.1 Kidney Counts (cpm) 57001 64629 121630 17 Renal Retention 0.182 0 2.48 Time of Max (min) 2.501 3.001 Time of 1/2 Max (min) 7.634 9.990 Time from Max to 1/2 M ... 5.134 6.989 Counts / Second Complete Suspen 35 55 Setup rightness Levels: 0% (0) -> 8% (187) 2. See Settings tab to review or modify parameters for this activity 127 Turnover Workbook | Symbia Intevo Bold (VB20) 10.6 Series Calculator Notes 10.6.1 Series Reformat The Series Reformat activity is used to perform the following for data manipulation: Bone 3 Phase & WB. Symbia T - Bone Scan, 11/15/2005 File SeriesReformat View Template Workflow Activities Help AI 1. Select the desired 2. Click Resize to adjust pries Reformat matrix size matrix. Data Selector Select Series: Bone Statics ROTool Revert To Original Input 1: Entire Series Matrix Size: 128 Resize % 100 100 100 100 Series Reforma 100 0 0 0 0 R Anterior L 377K L Posterior R 275K RT LAT 205K Flexible Displ Duration:300sec Duration:300sec Duration:300sec Duration: 300sec ANT ARMS UP 664K POST ARMS UP 736K Duration:300sec Duration:300sec 128x128 Pix:4.8mm 128x128 Pbx:4.8mm 128x128 Pbc4.8mm 128x128 Pbc4.8mm 128x128 Pbc:4.8mm 99m Technetium 99m Technetium 99 28 Pix:4.8mm 99m Technetium 99m Technetium Complete Suspen Setup All Images All Detectors Ready mulator is RUNNING 128 Turnover Workbook | Symbia Intevo Bold (VB20) 10.6.2 Image Masking Notes Hands-on Lab Computer MI Sim 1 You are in Hands-on Lab Bone WB and Statics, ECAM - Bone Scan, 4/19/2002 File SeriesReformat View Template Workflow Activities Help 0 AI A Settings Series Reformat Data Selector Select Series: Wholebody ROI Tool ... Revert To Original Input 1: Entire Series Matrix Size: 256 Resize % 100 2. Select the ROI Tool Flexible Displ Hard Copy 1. Select image RT ANTERIOR LT 5758K 5145 K Duration:1701 sec 256x1024 Pix:2.4mm 256 x 1 024 Px : 2 . 4 mm 99m Technetium Setup KPC All Detectors OI Tool ROI User Interaction Prompt: Y ROI Tool Display Frames · 1×1 = 1×2 @ 2×1 2×2 Sum: 1 Select ROI ROIs : User Mask 3. Select ROI Tool used to draw . Draw mask ROI Color RT ANTERIOR LT 5758K Duration:1701 sec 256x1024 Pbc2.4mm 99m Technetium Edit ROI 5. Select to Keep Threshold User Mask Inside or Outside Keep Outside Keep Inside Cancel To remove masking, click Revert to Original button 129 Turnover Workbook | Symbia Intevo Bold (VB20) 10.6.3 Series Filter Notes 1. Click on Series Filter activity and Series Filter tab Hands-on Lab Computer MI Sim 1 You are in Hands- on Lab MUGA 5 2 View. Symbia S - Equilibrium Gated Cardiac, 1/26/2006 -X File Series Filter View Template Workflow Activities Help O A 44 SettingsSeries Filter 3. Select Spatial or Select Series: LAO Revert Series Temporal filter Original Series 1: Entire Series Series Filter 2. Select series LA0 5531K ibx:3.6mm 99 m Flexible Display Hard Copy Filter Applied: No Filter Filtered Series 0 duration: 599sec 64x64 Plc : 3.6 mm 99 m Setup Filter Tool Test Specified Filter Wiener [S] Delete Save Before: % Filter Parameters 100 Kernel 1 2. 3 0.04328 0.12148 0.04328 2 . 4. Select filter 0.12148 0.34099 0.12148 0.04328 0.12148 0.04328 5. Make desired updates to filter parameters 6. Trial Filter to visually inspect. Size Wiener - 2D × 3 SNR 0.26 FWHM 6 mm Update Trial Filter Trial Views 100 7. Select the desired 8. Click OK Boxcar Iterations:3 Gaussian FWHM:6.00 Wiener FWHM: 6.00 SNR:0.26 OK Cancel 2. See Settings tab to review or modify parameters for this activity 130 Turnover Workbook | Symbia Intevo Bold (VB20) 10.6.4 Static Merge Notes 1. Select the study and double click the Static Merge Proc workflow. Up to 20 static series can be merged into one 10.6.5 Static Extract Select the Series Extract activity Lung Aerosol, ECAM - Lung Scan, 2/16/2001 Eile Flexible Display View Template Workflow Activities Help O x ? Single Series Static Display Patient Name: Lung Aerosol Patient ID: ECAM DOB: 7/5/1962 Study Name: Lung Scan Series Arithm Study Date: 2/16/2001 withmetic x + Perfusion Lung [Concatenated] 2/24/2014 % 100 100 100 100 Arithmetic 0 0 0 0 Ant aerosol 198K Post aerosol 198K RAO Aerosol 198K LPO aerosol 198K Rt Lat Aerosol 150K Arithmetic Duration:203sec 128x128 Duration:203sec 128x128 Duration:268sec 128x128 Duration:268sec 128x128 Duration:315sec 128x128 % % % % % x + 100 100 100 100 100 Arithmetic x + 0 0 O O Lt Lat Aerosol 151K RPO aerosol 198K LAO aerosol 198K Perfusion RPO 316K Perfusion LAO 316K Duration:315sec 128x128 Duration:298sec 128x128 Duration:298sec 128x128 Duration:78sec 128x128 Duration:78sec 128x128 % % % % 100 100 100 100 100 0 Perf Rt lat 316K Lt Lat 316K Duration:127sec Duration:127sec 128x128 uration:79sec 128x128 Duration: 79sec 128x128 Duration:96sec 128x128 % 100 0 Perf POST 495K Duration:96sec 128x128 Setup (8:0%, T:100%) All Images Bone WB and Statics, ECAM - Bone Scan, 4/19/2002 File Series Arithmetic View Template Workflow Activities Help Jo,Q. C Process Workflow 1. Select the images or phase to 2. Click the Data Selector Settings Ari extract in Operand 1 Extract icon Select Series: Stalles perand 1 Series 1: Multiple Frame 100 on 100 % % 100 100 Arithmetic x. + 0 0 Flexible Disp RLAT 601K LLAT 468K RAD SHE LPO 808K Duration:1 46sec Duration:146sec Duration: 161 sec Duration:161 sec Duration: 170 Duration:170sec Duration: 170sec 256x256 Pix2.4mm 256x256 Pix:2.4mm 256x256 Pic2.4mm aam Tarhnatifim QQm Technetium Qam Technetium Qam Technetium aam Tarhnatiim All Images All Detectors Hard Copy Select Senes: Statics Operand 2 Series 1: Entire Series 100 % % % 00 100 100 0 RLAT 601K LLAT 468K LPO 808K RPO 813K Duration:146sec Duration:146sec aration:161 sec Duration:161 sec Duration:170sec Duration: 170sec 256x256 Pix2.4mm 256x256 Pix:2.4mm am Technetiim 256x256 Pc2.4mm 56x256 Pix2.4mm 56X256 Pix 2.4 m QQm Torhnetium QQm Technetium 9Qm Technetium 9qm Technetium All Images All Detectors Operation: Extract [Multiple Frame) 3. Result will have the extracted Result Series 1 images or phase 0 Susper 10 RAO 900K LPO 808K RPO 813K Duration:1 61 sec Duration:1 61 sec Duration:170sec 256x256 Pix2.4mm 256x256 Pix2.4mm 256x256 Pic2.4mm Qam Technetium Qam Technetium All Images Setup 131 Turnover Workbook | Symbia Intevo Bold (VB20) 10.7 Flexible Display Notes The Flexible Display activity is used to arrange and display all data acquired and processed in the MI Apps application. The Flexible Display activity can contain one or more display pages (tabs) with each page displaying one or more display objects. Results Composite Curve Display Flow (Phase 1) Filling (Phase 2) Excretion (Phase 3) Tools X Patient Name: Renal Lasix Patient ID: Symbia DOB: 12/30/1981 Study Name: Renal Scan Operator Name: Study Date: 4/6/2006 Radiopharmaceutical 1: 0.0 MBq (0.00 mCi) Tools x ? A Print Area Object Print Area Obje Results Composite, Series Display (#25) Renal Lasix, Symbia Renal Scan 4/6/2006 7:44:24 AM #1000 Renal [Results] 10/8/2013 1:45:44 PM A Print Area Object Print Area Object M 132 Turnover Workbook | Symbia Intevo Bold (VB20) Below are examples of how different display objects are used. Notes Text - Display OOOD O Image Display Slice - Display Curve Display 2. 2/1/200 AI DOU 2/21/1/148 Cane Digia 39/2001 9 133 Turnover Workbook | Symbia Intevo Bold (VB20) Text Notes Display ame: Renal, MAG3 Abnormal ID: 614 Print DOB: 8/26/1940 Study Name: Renal Scan Study Date: 12/1/2000 Display of Resa Summary Curve Parameters Total Split Function (%) 7.351 Display @chey Counts (cpm) 31895 3.001 2510.2 34145 Time of Max onin) 0 868 Time of % Maxémini 0 859 Series Display Multiple Frame and ROI Statistics * D AI Clave Patient Name: Renal, MAG3 Abnormal Patient ID: 614 DOB: 8/26/1940 Study Name: Renal Scan L Study Date: 12/1/2000 ---- 12:48:34 754 Penali Scas: 12/1/2000 800 10 AM May 3 12V2000 11 21:58 AM 134 Turnover Workbook | Symbia Intevo Bold (VB20) 10.8 Saving JPEG and AVI files Notes 10.8.1 JPEGs 1. Click the Flexible Display activity 2. To save or print a page, click the menu (Flexible Display activity), and then select the Save Page As menu item The Save page-name Print Area As window is displayed 3. Select a save location 4. Type a file name 5. Select a file type (.jpg, .bmp, .emf) 6. Click the Save button 10.8.2 AVIs 1. From within the Flexible Display activity, right click anywhere in the cine control bar 2. From the pop-up menu, select the Save Cine As AVI menu item 3. From the Save As window, select a location to save the file in 4. Type a file name 5. Select a file type. By default, the .avi file extension is the only selection 6. Click the Save button 10.8.3 Recording Offline Files (This is often done to create CDs of JPG and AVI files) 1. Copy desired files to H:\Site Data\CDR_OFFLINE 2. From syngo browser, select Transfer>Local Job Status and clear 3. Insert a blank DVD into the recording device 4. Transfer>Record Offline Files 10.9 Dual Monitor Support The dual monitor option aids in positioning workflows across two monitors. 10.9.1 Launching a Workflow on the Left Monitor 1. Select the patient data 2. Double click on the desired workflow By default, all workflows will be launched on the left monitor, keeping the MI Apps Browser displayed on the right monitor. 10.9.2 Launching a Workflow on the Right Monitor 1. Select the patient data 2. Hold down the Shift key 3. Double click the desired workflow. When the Shift key is held down while launching a workflow, the workflow will be launched on the right monitor. This feature is useful if there is a workflow on the left monitor, and a side-by-side comparison is desired. * Workflows designed to be displayed across both monitors will have a DM in the workflow name. Press the ALT key when double clicking the DM workflow to use the DM feature. 135 Turnover Workbook | Symbia Intevo Bold (VB20) 10.10 syngo Patient Browser Notes 10.10.1 Accessing the Patient Browser The Patient Browser displays all the patient and examination data stored in each database or external archive medium. To access the patient browser, select Patient > Browser from the menu bar. The system displays the browser. 10.10.2 Patient Databases The types of databases are symbolized on the left-hand side of the navigation area. Click an icon to see its contents displayed in the content area of the browser Local Database The Local Database is where the patient data and results of the examinations performed on the local workstation are stored. Scheduler The Scheduler contains the data on all pre-registered patients. Archive Devices One or more DVD devices may be connected to MI Apps workstation. 10.10.3 Correcting a Patient Name, ID Number, or Other Demographics If incorrect patient information was entered when registering the patient, it can be corrected using the following steps. 1. Access the syngo Patient Browser 2. Click the Local Database icon 3. Click the patient/study/series to be corrected 4. Edit > Correct 5. Make the needed corrections > Enter initials > OK 10.10.4 Rearranging a Patient Series The following steps may be used if data is acquired under the wrong patient name (for example, if Mr. Doe’s Rest series is acquired under Mrs. Smith’s name). 1. Access the syngo Patient Browser 2. Select the Rest series under Mrs. Smith’s name 3. Edit > Cut 4. Click the appropriate study name under Mr. Doe 5. Edit > Paste 136 Turnover Workbook | Symbia Intevo Bold (VB20) 10.10.4 Manually Transferring Data Notes Patient data may be manually sent to another workstation using the following steps: 1. Access the syngo Patient Browser 2. Click the Local Database icon 3. Click the patient/study/series name to be sent 4. Transfer > Send to 5. Select the destination workstation 6. Send 7. To check the status of the transfer, click the Transfer menu, and then select Network Job Status 10.10.5 Manually Archiving Data A patient, study, or series data may be manually copied to an archive device using the following steps: 1. Access the syngo Patient Browser 2. Insert the media into the archival device 3. Click the Local Database icon 4. Click the patient/study/series to be copied to the DVD 5. Transfer > Archive To (name of the destination device) 6. If required, label the medium 7. To check the status, pull down Transfer > Local Job Status 10.10.6 Retrieving Data from an Archival Device Data may be retrieved from DVD devices and copied into the local database by using the following steps: 1. Insert media in the DVD drive (located in the Acquisition Console Tower) 2. Access the syngo Patient Browser 3. Click the DVD icon 4. Select the patient, study, or series to be imported 5. Transfer > Import 10.10.7 Ejecting a DVD The DVD media must be ejected using the following method or database errors may occur. 1. Access the syngo Patient Browser 2. Click the Transfer menu, and then select Eject from DVD . 10.10.8 Deleting the Data Patient, study, or series data may be deleted from the database by using the following steps: 1. Access the syngo Patient Browser 2. Click the Local Database icon 3. Click the patient, study, or series to be deleted 4. Edit > Delete 5. Yes Caution: Deleted data is gone when deleted and cannot be restored. 137 Turnover Workbook | Symbia Intevo Bold (VB20) Notes 10.10.9 MI Apps Cleanup The MI APPS Cleanup activity is used when the system becomes unstable/locks up. When using the MI Apps Cleanup activity, all data in currently running activities is lost. 1. From the Windows Start menu, select MI APPS > MI APPS Cleanup Applications Workflows Lilities Options System Help Study Name: ALL Show All >Local Study Date: ALL Network Category: All System Up Time: 1 Hour 22 Mins Database Local Find Image Space Available : 45174 MB sddw IIN 104 patients found on the system. Study dates: (all dates) Auto Filter Patient Name Patient ID Most Rece ... # Studies # Series Databas Template Name Template Desc. A Gastric Emptin- Normal, dyn- normal w/ solids 12345678 2/20/2001 Local D: Series Static Extractor Proc Extracts a singl Gastric Empting abnormal. dynamic-abn. w/ s ... 212 4/1 1/2008 Local D. Series Tomo Composite Proc Creates a stati .. Gastric Empty (4 hr), Pt 1 06514450 11/20/2009 Local D: Series Tomo Detector Extractor EXTRACTS D .. Gastric Emptying, Dual Isotope 30644173 7/6/2009 Local Di Series Tomo Extractor Det 2 EXTRACTS D .. GI Bleed (positive), 2 phase dynamic & statics 1000469630 2/21/2008 Local D: Series Tomo Extractor Proc Extracts a singl --- IQ SPECT good case2. Case #2 H0233973 1/25/2011 Local D. SITUS INVERSIS PROC This worklow w IQ SPECT SYMBIAT, symbiaT 0171544 3/20/2012 Local D. SITUS INVERSIS REST ACQ ACQUIRES A .. IQ SPECT, NICE CASE H1151800 2/28/2011 Local D: SITUS INVERSUS gSTRESS ACQ ACQ SITUS IN .. HONPULLEY= IQ SPECT, T6 11.01.19-09:18 1/19/2011 Local D: Situs Inversus Proc v4_0 This worldflow w - IQSPECT 2. T2 11.01.19-08:17: 1/19/2011 Local D: Slice Comparison Displays and c .. IQSPECT, SYMBIA S SYMBIA S 3/20/2012 Local D. SMARTZOOM NM CT FOV Calibr ... Acquires a NM Liver Hemangioma 110099 12/29/2006 Local D: SMARTZOOM NM CT FOV Verifi ... Acquires a NM Liver, Complete TC99m_SC 4/17/2003 Local D: SMV 1Det Spot Display Displays spot v. 0103/2000 Get Logs Local D. SMV 3 Phase Bone Display DISPLAYS A MI Apps BUIMALA /2001 Local D. SMV Cardiac Proc. processes a ga -- syngo MI Apps Cleanup 12003 Local D: SMV Lung Display LUNG DISPLA. Start MI Apps $2009 Local Di SMV Slice display displays the S. -- Set Program Access and Defaults 5/2008 Local D: SMV Wholebody Bone Displays a whol MIBG 3/15/2006 Local D. SMV Wholebody Masking MASK A WHO. Windows Catalog Symbia S 1/26/2006 Local Di Source Replenishment AQC Use this workfl .. Windows Explorer ECAM 4/1/2002 Local D: SPECT_CT Display Displays correc 100329 2/5/2008 Local D: STATIC CCK ACQ ACQUIRES 5 Windows Update Symbia T 11/17/2005 Local D. STATIC DISPLAY. Multiple Static .. ECAM 2/22/2000 Local D. Static Display Displays static . eventvwr.msc ECAM 2/26/2002 Local D: Static Gastric Emptying Proc. Will generate th Paint ECAM 9/2/2003 Local D: STATIC GASTRIC PROC Processes up t Symbia T 1/18/2008 Local D. Static Masking Will mask regio explorer.exe 269351859 11/8/2011 Local D.v Static Merge Proc Merges 1 to 20. SU shutdown_at_twenty_hour.bat Programs ry. All Workplace SYMBIA01 Suspend Complete Documents atus: A Stage: All Launch Settings Search Bun ... O Shut Down ... Windows XP Professional Adds a Normal Priority Worklist Item. Checkup not completed, system should not be us 014 12:46:45 Clean Up X This application may be used to clean up processes if the system becomes unstable or if a workflow no longer responds to the user. WARNING: Using this application will cause data in running workflows to be lost. Use this application only after you have exited all the workflows that you can. Comment to be logged: Use this first Force Shutdown of High-Level Processes Use this only if the previous button does not solve system instability. Force Shutdown of High-Level Processes and Low-Level Servers www Exit ... 2. Select Force Shutdown of High-Level Processes. 3. YES to continue with Cleanup Warning X WARNING: This action may result in a loss of data. Are you sure that you want to do this? Yes 4. When cleanup is complete you will be prompted to copy log files if necessary, if not choose Cancel 5. If this step was unsuccessful, repeat Step 2 but choose Force High level Processes and Low Level Servers 138 Turnover Workbook | Symbia Intevo Bold (VB20) 11. Week One Exercises 11.1 Patient Gantry 1. The maximum weight the PHS will hold is __________ lbs. 2. Match the labels on the following: (1) ( 2) (10) -(8) (3) ......... (15) ...... (14) (4) ................. (9) (9) (11) (12) (13) (5) - (6) - (10) (7)- ... ______Siemens Nuclear Acquisition Controller (SNAC) ______Nuclear Medicine (NM) Subsystem ______Touch Pads ______Computed Tomography (CT) Subsystem ______Read Bed ______Emergency stop buttons ______Power Switches ______Hand Control NM Detectors ______ ______Patient Positioning Monitor 11.2 Quality Control 1. Perform the daily QC from start to finish. 2. List the steps needed to complete the Weekly QC: a. _____________________________________ b. _____________________________________ c. _____________________________________ 139 Turnover Workbook | Symbia Intevo Bold (VB20) 3. List the steps for Monthly Quality Control a. _____________________________________ b. _____________________________________ c. ______________________________________ d. ______________________________________ e. ______________________________________ f. _______________________________________ 4. Which Monthly Quality Control procedure only needs to be completed if you have xSPECT Quant? a. ______________________________________ 11.3 Patient Registration 1. Demonstrate how to register a patient manually and through the scheduler to acquire a WB Bone Scan. 2. Which 4 fields of information are required to register a patient? a. _______________________ b. _______________________ c. _______________________ d. _______________________ 11.4 Workflows 1. Modify the acquisition parameters on a Renal Scan 2. Process a Renal Study 140 Turnover Workbook | Symbia Intevo Bold (VB20) 11.5 syngo Patient Browser 1. Match the icon with the name a. Scheduler b. Local Database c. Local Archive 2. Practice archiving patient data to your desired media. 3. Where can you view the status of jobs relating to sending data to another network node? ____________________ 141 Turnover Workbook | Symbia Intevo Bold (VB20) 12. CT System Overview 12.1 CT Control Box Notes SIEMENS (1) -(6) (2) m. (5) ( 2 ) STOP 3 -(9) (4) 1. Hear Patient Button 2. Hold/Stop Radiation Button 3. Radiation On LED 4. Start Acquisition/Radiation Button 5. Speaker 6. Call Patient Button 7. Emergency Stop Button 8. Microphone 9. Move Patient Bed Button 12.2 Emergency Stop Button Press the Emergency Stop button to stop all gantry and patient bed motion, and turn off X-ray radiation. STOP 142 Turnover Workbook | Symbia Intevo Bold (VB20) 12.3 CT Subsystem Power – Line Connection Box Notes The CT receives power from the CT subsystem. The CT subsystem power button on the line connection box, controls electrical power to the CT. The CT subsystem power switch should be used to apply and remove power to the CT subsystem. 1. Line Connection Box’s CT Subsystem Power Switch 12.4 CT Table and Hand Controller 1. Using the hand controller, press the Bed Index button twice to activate. CT Brain Study Position (1) Bed Index Button Press twice to activate CT Body Study (2) (3) SPECT Position Study Position 2. Press Bed Up (1) for CT Brain Study Position 3. Press Bed In (2) for CT Body Study Position 4. Press Bed Out (3) for SPECT Study Position 143 Turnover Workbook | Symbia Intevo Bold (VB20) 12.5 Patient Positioning Monitor (PPM) Notes SIEMENS 1 (1)CT 2 Define Upper CT (2 Boundary Limits (4) (3) SPECT 1.00 (6) 60 7) Define Lower CT (9) Boundary Limits (8) C X 11:42 1. Study Type 2. CT FOV Upper Line Limit Control 3. CT FOV Lower Line Limit Control 4. Persistence Image 5. Zoom Factor FOV 6. Y Axis Setting 7. X Axis Setting 8. Offsets FOV Control 9. Offset Zoom/CT FOV Limit Tab 144 Turnover Workbook | Symbia Intevo Bold (VB20) 13. CT Exam 13.1 PPM Setup Notes 1. Clear any objects in the path of the detectors 2. On the PPM, press the Reconfiguration Tab. 3. Press the CT Positioning Configuration icon. SIEMENS CT 90€ 90º 76º 760 X 4. Detectors will move into CT configuration. 13.2 Positioning for the CT Exam 1. After configuration is complete, place the patient on the Patient Table. 2. Using the Hand Control, press the Bed Index button twice. Bed Index Button Press twice to activate 3. Press the Hand Control button for the type of study you wish to perform. 4. On the Acquisition Console, register the patient. 5. Open the syngo Patient Browser. 6. Locate the patient and highlight (single click) the Study folder. 7. Pull down menu item Patient Patient Applications Transfer Edit and select CT Examination Register ... Emergency ... Load to Viewing Load Report Load Last Report CT Examination CT Recon 145 Turnover Workbook | Symbia Intevo Bold (VB20) 8. The Patient Model Dialog window will appear. Select the desired Notes protocol from the menus. Patient Model Dialog Adult En Protocol & Replace ~ Child C Append ardi Topogram & Cut ascu . Keep RT Auto reference lines None PET API Language Engish OK Cancal 13.3 Acquiring the CT Exam 13.3.1 Topogram 1. In the chronicle, select the “Topogram” entry 2. In the Routine subtask card, check the topogram parameters 3. Topogram length [mm] 4. Tube position 5. Table position (horizontal, vertical) 6. Scan direction 7. Correct the topogram length and tube position, if necessary AbdomenRoutine (Adult) Abdomen 123 Total mAs 0 Topogram MA 36 , Abdomen 120 - Scantime 5.35 Stic 06 mm Chronicle topogarn langt? 512 mm Tube position Top @ Bottom Lateral 1 Comment Tabl Portion Height 323 5 - 100 0 | Craniocaudal Load Scan Auto Tasking SimFE clobed 27-Nov 2007 14 33 2 8. Click Load 9. The topogram parameters are confirmed. 146 Turnover Workbook | Symbia Intevo Bold (VB20) 10. The Press START message is displayed next to the “Topogram” entry. Notes 11. Press the START button on the CT control box. Topogram Press START Suspend Button 191 Start Button (4) Hint: You can manually stop the topogram as soon as the desired scan region has been covered using the (Suspend) Hold/Stop Radiation button on the control box. 13.3.2 CT Scan Acquisition 12. The topogram is displayed in the upper left segment (topo segment) of the Examination task card. 13. The scan and reconstruction ranges of the subsequent scans are displayed in the topogram. 14. Select the upper and lower handles of the range. 14. Drag the left mouse to adjust the upper and lower FOV limits. 15. The length of your range will change in the Routine sub taskcard. MI ADDS. Examination Viewing -.... Patient TempPatient-1.3.15.2.22. Total mAs O Topogram Eff. MAS 30 CARE DOSM4D BONE KV 130 - CTDo 4.01 mGy Scan time Delay Slice - 5.0 mm Acq. 6 x 1.0 mm No. of images 31 Comments Range: Begin End Table Position Height Land Reco 1411.0 | 156 369.0 - 222.0 Craniocaudal - 14 |>I Scan Recon Auto Tasking p 27 h aco Select Setup/Check 7/17/2012 10-15 16. Review and modify the acquisition parameters if required. 147 Turnover Workbook | Symbia Intevo Bold (VB20) Notes 17. Click the LOAD button in the Examination task card Load 18. Press and hold the MOVE button on the control box until the START prompt displays in the chronicle. 19. Press the START button on the control box. Hold Stop Radiation Start Button Examination real-time images are" displayed in the TOMO SEGMENT TOPOGRAM SEGMENT Abdonenfo.line (ACL.t) abdamen 123 10.10.14-13:24-07-31D Totalmas Troigan Bbentren CHRONICLE Hecon 148 Turnover Workbook | Symbia Intevo Bold (VB20) 13.3.3 CT Reconstruction Notes 1. When the acquisition is complete, click on the Recon tab. 2. Review the parameters and modify if needed. Patient Applications Edit Insert View Setup Image Options System He MI Apps Examination Viewing Filming SPECT_CT_BONE (Adult) Temp, Patient TempPatient-1.3.15.2.22: Total mAs: O opogram Recon job - 8 8 Series description AC BONE 5.0 B08s BONE Slice 5:0 mm ] Recon begin 1411.0 mm Kernel B08s SPECT AC Recon end 1561 0 mm 3D Window Abdomen Image order Craniocaudal Recon increment 5.0 mm FoV 468 mm 2 No of images Center X 0 mm al Overview Center Y -16 mm 2: Comments Mirroring None Extended CT scale Load Recor Routine Scan Recon Auto Tasking some range positions will be adapted when the table is moved. Send successfully completed to PACS for patient name: BROCKMAN 7/17/2012 2:18:39 PM 3. The reconstruction will automatically start. 4. If you wish to create an additional recon job, click another radio button in the Recon Job entry. Recon job 5 6 5. Press the RECON button on the Examination taskcard. Recon 6. When the recon jobs are complete, click the Close Current Patient button in the Examination taskcard. 7. Click YES to confirm closing of patient. 8. All images are closed and removed from the Examination task card. 9. If you are using a workflow, the system will return to the Workflow Navigator. 10. Check image registration and complete the workflow. 149 Turnover Workbook | Symbia Intevo Bold (VB20) 14. Image Registration/Fusion with MI Applications Software The Image Registration activity allows you to view and manipulate the Notes SPECT and CT images so that there is proper registration. When using this activity, the CT is the Target and the SPECT is the Object. 1. When the acquisition completes, click on the Image Registration activity in the Workflow Navigator. 2. Click on the Registration tab. O Settings Registration 2. Click the Registration Tab Object vs Target Optional vs Objec Optional vs Targe Transverse Sagittal AC CT_BoneSPECT 5.0 008s, 7/7/2005 14.1 Using the Blending Tool and Color Bars. The Blending Tool and Color Bars give you the ability to adjust the blending of the SPECT and CT images, adjust the brightness and contrast, and change the Look Up Tables (LUTs). 1. The color bar for the CT is on the left. The color bar for the SPECT is on the right. 2. The Alpha Blending bar is at the center left. This allows you to blend between the CT and SPECT images using the slider. 3. The Transparency Blending bar is at the center right. This allows you to adjust the transparency of the object image. HU 0 % CT Color SPECT Bar Color Bar 37 Alpha Transparency Blender Blender 0 0 150 Turnover Workbook | Symbia Intevo Bold (VB20) 4. Brightness/Contrast adjustments support: Notes • Percentage • Data Units • Hounsfield Units • SUV 5. The top of the color bar shows the Display Units. 100- 6. The Window Top slider adjusts the image intensity 7. The Window Bottom slider adjusts the image contrast. 8. Right clicking on the color bars will show you options to change display units and LUTs. (3) (1) Display units (2) Window top slider (3) Window bottom slider 14.2 Reviewing and Modifying the Registration 1. Move the Alpha Blending Tool to the middle of the scale. 2. At the bottom of the images, use the scroll tool to select the reference slice. JORDANX Settings Registration Object vs Target Object vs Target Matrix Optional vs Object Matrix O Optional vs Object Default Default O Optional vs Target Transverse Sagittal Coronal AC CT_BoneSPECT 5.0 808s, 7/7/2005 Bone SPECT-CT [Recon - NoAC ], 1/1 2/2012 HU 41 % 1. Move the Alpha Blending tool to middle of 2. Scroll to select reference slices S. 4.8 2: 305.0 3085 insverse Sagittal Coronal ....................... Rotation Z 0 ..................... Rotation X 0 ........ Rotation Y 0 151 Turnover Workbook | Symbia Intevo Bold (VB20) 3. Select one plane (transverse, sagittal, or coronal) to align the two Notes volumes. Scroll through the images to select a slice to be used as a reference for alignment. 4. If needed, adjust the horizontal and vertical position using pan tool or the vertical and horizontal scroll bars. 5. Adjust the rotation using either the rotate tool, the rotate slider, or by entering a value in the Rotation edit box corresponding to the correct image. 6. Repeat Steps 3 through 5 for the other slice planes. AI A Settings Registration . Object vs Target Object vs Target Matrix Optional vs Object Matrix O Optional vs Object Default Default O Optional vs Target Sagittal SPECT . CT (Recon 60 5. Use the Rotate 4. Use Pan Tool or Tool, the Slider, or enter value in Vertical/Horizontal the Rotation Edit Scroll bars to box adjust registration T: 1.0 S: 4.8 P: 305.0 808$ S: 1.0 P: 309.6 64 Compressed 317 - Transverse Sagittal Coronal .................. Rotation x 0 ................ Rotation Z 0 Rotation Y 0 Translation (mm): X 0 Landmarks ... 152 Turnover Workbook | Symbia Intevo Bold (VB20) 15. syngo Viewing Task Card The following steps may be used to view images in the syngo Viewing Notes Task Card. 1. Access the syngo Patient Browser 2. Click the Local Database icon 3. Click the patient name 4. Click the Patient menu, and then select Load to Viewing 5. Click the Viewing tab to view the patient data 153 Turnover Workbook | Symbia Intevo Bold (VB20) 16. syngo 3D Task Card 16.1 Loading the CT Images Notes 1. On the syngo Acquisition Workplace or syngo MI Workplace, click on the 3D task card 2. Patient > Browser 3. Highlight the CT images you want to load and load the image series by double-clicking on it or dragging onto the 3D task card 4. To change the window center, place the mouse on an image and press the middle mouse button while moving the mouse up or down 16.2 Loading the SPECT Images 1. Patient > Browser 2. Highlight the processed Nuclear Images (Recon-AC) to fuse with the CT images 3. Click the 3D Fusion button in the Patient Browser toolbar 16.3 Adjusting the CT/SPECT Balance Ratio From the 3D task card menu, select Type > Fusion Definition. The system displays the Fusion Definition dialog. Fusion Definition X NM (1) 50% 50% 100% (3) Color Lookup table Gray Scale (8 Bit) Hot Body (8 Bit) Window Valus (2) (4) 40- W 300% B 00003 T 0.0103 Close Advanced >> Help 1. Alpha Blending Ratio Slider 2. CT Window 3. Color Table Selectors 4. Nuclear Threshold 154 Turnover Workbook | Symbia Intevo Bold (VB20) 16.3.1 Adjusting the CT Image Notes Fusion Definition x Muting Ratio NM 100% 100% 0% 100% Calor Lookup Table Gray Scale (8 Bit) Hot Body (8 Bit) Window Value SUV C 40 W 300 B 0.0003 T 0.0103- Close Advanced >> Help 1. Slide the Mixing Ratio slider at the top all the way to the left. 2. Manipulate the color range and max/min using the slider on the left and the bars that define it, or type values into the (C)enter and (W)indow fields and press [Return]. 16.3.2 Adjusting the SPECT Image 3. When you are satisfied with the CT image, move the Mixing Ratio slider over to the right so that you see 100% nuclear image. 4. Use the controls on the right side of the Fusion Definition dialog to adjust this image in the same way. 5. When satisfied with the nuclear image, move the Mixing Ratio slider to the desired mix of CT and nuclear. 16.4 Image Area Display 1. Sagittal, coronal, and transverse planes are depicted in quadrants 1-3. 2. Output segment is depicted in quadrant 4. 3. Each of the 3 planes is highlighted by a colored border. 4. Each plane contains reference lines corresponding to the other planes. • Red = Sagittal • Green = Coronal • Blue = Transverse 5. To Blow Up the image, double click on the desired quadrant to fill the screen. DAISTO 1.500 × 1000 Rotating Mil? ZA60003 sopragh, Senssoon 162 F SUV F/ 18 155 Turnover Workbook | Symbia Intevo Bold (VB20) 16.5 Image Navigation Notes 1. Use dog ears at the top right of each quadrant. 2. Use reference lines. 3. Use the Image + and Image – keys on the number pad of the keyboard. 4. Right click to activate SMART menu and select Parallel Shift. Use left mouse and drag up and down to page through images. 16.6 Windowing 1. Middle Mouse: a. Move cursor to image to window. b. Press down middle mouse. c. Drag vertically to increase and decrease window brightness (Window Center). d. Drag horizontally to increase and decrease image contrast (Window Width). 2. Image Subtask Card • Window 1 - Select primary Type Orien ... | Image window. Also, reset to Window 1. • Window 2 - Select secondary window. Also, reset to Window 2. -Ò 2 16.7 Common Tools 1. Free Mode - Enables free rotation of reference lines. 2. Hide Ref Lines – Toggle reference lines on and off. 3. Orientation Control – Insures proper orientation for planar images, i.e., MPR, MIP Thin, and VRT Slab. 4. Rotation- Enables free rotation of images. 5. Zoom/Pan – Toggle Zoom/Pan on and off. 6. Reset Zoom/Pan – Resets images to original display size. 3 4 5 6 156 Turnover Workbook | Symbia Intevo Bold (VB20) 16.8 Tools Sub Taskcard Setti ... Tools Notes 1. ROI Circle - Displays mean density and maximum/minimum densities. 2. Distance - Straight line distance and maximum/minimum densities on the line. 3. Angle - Angle between two drawn LA 6 lines. Lines need not intersect. 4. ROI Rectangle - Displays mean density and maximum/minimum densities. 8A 5. Pixel Lens - Displays average value for a 5 x 5 pixel matrix under the crosshair. 6. Annotate - Annotate image with an arrow. 7. Freehand ROI - Displays mean density and maximum/minimum densities. 8. Freehand Distance – Non-linear distance measurement. 16.9 Orientation Sub Taskcard Type Orientation 1. Standard Views – Change any segment to another orientation. 2. Default Orientation – Reset all segments to default. 3. Ortho Sync – Synchronize all segments to active segment. Used with Free Mode to create orthogonal relationship to off-axis images. 2 13 16.10 Type Sub Taskcard 1. MPR – Multiplanar Reconstruction Type |Orien ... | Image 2. MPR Thick– Multiplanar Reconstruction Thick 1 2 3. SSD – Surface-Shaded Display 4. MIP – Maximum Intensity Projection 5. MIP Thin – Maximum Intensity Projection Thin 6. Fused – Fused Image 7. VRT – Volume-Rendered Projection 8. VRT Thin – Volume-Rendered Fused | 8 Projection Thin 157 Turnover Workbook | Symbia Intevo Bold (VB20) 16.11 Creating Parallel Ranges Notes The 3D Task Card gives you the ability to create slices to send to another workstation, such as a PACs system. 1. Click the plane from where you would like to create the slice. Original Image Ranges Created Tranverse Coronal and Sagittal Sagittal Transverse and Coronal Coronal Transverse and Sagittal 2. Click the Parallel Ranges icon on the Settings sub taskcard to open Setti. the Parallel Ranges window. 3. Choose horizontal . or vertical ranges 4. If you need to swap the range order, use this icon. 5. To keep the number of images constant, use this icon. 158 Turnover Workbook | Symbia Intevo Bold (VB20) 6. To change the output type, use this menu. Notes Output Type CT_PT 7. Type the desired parameters in the field and press enter to set. Parallel Ranges X Presets DefaultParallelSet Output Type CT_PT Image thickness 5.0 mm Distance between images 2.9 mm Number of images 40 Start Close Help 8. Use middle yellow line to position range (Red arrow). Drag bottom and top range limits to encompass the range area. (Blue arrows). 9. Click the START button. Slices will be created in the fourth quadrant. 10. Click the SAVE button to save ranges with default name. Save 11. Click the SAVE AS button to save the ranges with a designated name. 159 Turnover Workbook | Symbia Intevo Bold (VB20) 16.12 Creating Radial Ranges Notes Below are examples of basic rotational views. X-axis rotations are planned from a lateral presentation. Y-axis rotations are planned from a lateral presentation. Z-axis rotations are planned from an axial presentation. 1. Highlight the plane where you want to create the radial range. 2. Choose the MIP image icon to create a rotating MIP. 3. Click the RADIAL RANGE icon in the Settings Tab. Setti ... 4. Center the rotation area. 5. Drag cursor around the image to create the rotation. 6. Adjust the number of images and the angle degree in the Radial Range window if needed. 7. Click START to create the ranges. 8. Save the ranges using the SAVE or SAVE AS buttons. 160 Turnover Workbook | Symbia Intevo Bold (VB20) 17. Workstream 4D Workstream 4D is an optional software license. It allows for the Notes reconstruction of sagittal, coronal and/or oblique MPRs and thin MIPs directly in the Examination -> Recon card without the need for thin, overlapped data sets or dedicated post-processing in the 3D card. 1. On the Examination Recon card, select 3D as the Recon job type. Series description Abdomen 5.0 SPO ax Slice 5.0 mm Recon job type @ axial 6 3D RIS Recon axis axial Kernel B30f medium smooth Window Abdomen Type SP oblique Image order Head to feet Position increment 5.0 mm FOV 342 mm x 342 mm No. of images 41 Comments Routine Scan Recon Auto Tasking 2. The screen layout will change to display coronal, axial and sagittal planning images. The pink box represents the desired FOV. The orange boxes represent the recon range and direction. Adjust these boxes to include the anatomy desired in the reconstruction. Rotate boxes as necessary to plan oblique ranges. ATIENT Hospital TEST. PATIENT TEST. PATIENT Hospital 01234567 01234567 62, M. 50Y "12-Sep-1962, M, 50Y "12-Sep-1962. M. 50) 12-Sep-2012 12-Sep-2012 18:15:14.39 18:15:14.39 MPR 2 MPR 2 LAL 3. If desired, a non-square reconstruction matrix can be defined to further limit the anatomy included in the reconstruction, e.g. for spines. esolution 512 square Planning base Abdomen 5.0 B30f 512 square ST, PAT 512 non-square 34567 Total mAs: 1033 256 non-square(reduced image resolution) AJ. SL 3.0 161 Turnover Workbook | Symbia Intevo Bold (VB20) 4. Additional reconstruction parameters should be defined on the Recon Notes card, such as desired slice thickness and increment, image order, kernel, and the Type of image to be reconstructed (MPR or MIP Thin). These parameters can be stored in the protocol for future use. Recon job ~ 7 Series description Abdomen 5.0 SPO sag Slice 5.0 mm Recon job type @ axial 3D IRIS Recon axis sagittal Kernel B30f medium smooth Window Abdomen Type SP oblique Image order Left to right Position increment 5.0 mm FoV 126 mm x 326 mm No. of images 26 Comments Routine Scan Recon Auto Tasking 5. Click Recon to begin the reconstruction of the 3D series. Recon 162 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 and options as well as standard and optional features which do not always have to be present in individual cases. Local Contact Information Siemens reserves the right to modify the Siemens Medical Solutions USA, Inc. design, packaging, specifications and options 40 Liberty Blvd. described herein without prior notice. Please Malvern, PA 19355-9998 contact your local Siemens sales representative USA for the most current information. Telephone: +1-888-826-9702 Note: Any technical data contained in this siemens.com/healthcare document may vary within defined tolerances. Legal Manufacturer Original images always lose a certain amount Siemens Medical Solutions USA, Inc. of detail when reproduced. Molecular Imaging 2501 N. Barrington Road Hoffman Estates, IL 60192 Regulatory No. HOOD05162002732592 USA Printed in USA 01-2018x | All rights reserved Telephone: +1 847 304-7700 © 2018 Siemens Healthcare GmbH siemens.com/mi Global Siemens Healthcare Headquarters Siemens Healthcare GmbH Henkestraße 127 91052 Erlangen Germany Phone: +49 9131 84-0 siemens.com/healthcare www.siemens.com/healthcare

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