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Symbia Intevo Turnover Workbook

Symbia Intevo Turnover Workbook

SIEMENS SIEMENS Symbia Intevo Symbia Intevo (2, 6, and 16) Turnover Workbook www.usa.siemens.com/education Answers for life. Turnover Workbook | Symbia Intevo (2, 6, and 16) Table of Contents Table of Contents..................................................................................................................... 2 Introduction ............................................................................................................................ 5 Week One, Day One ................................................................................................................ 6 Day One: Topics.................................................................................................................. 6 1 Getting Started with your Symbia Intevo 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 QC Schedule......................................................................................... 49 3.2 Daily System Shutdown and Startup ............................................................................ 49 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 ................................................................................................................ 67 Week One, Day Two .............................................................................................................. 71 Day Two: Topics................................................................................................................ 71 4 Overview of Acquisition Console: MI Workplace Command Module ....................................... 72 4.1 Areas of Command Module ......................................................................................... 72 5 Anatomy of a Workflow....................................................................................................... 74 5.1 Workflow Navigator .................................................................................................... 74 6 Acquisition Workflows......................................................................................................... 76 6.1 Acquisition Types ....................................................................................................... 76 6.2 Acquisition Tab........................................................................................................... 76 6.2 Analyzer Tab............................................................................................................... 81 6.3 Display Analysis Tab.................................................................................................... 81 7 Modifying and Saving Workflow Templates .......................................................................... 82 7.1 Save Workflow Template ............................................................................................. 82 7.2 Save Workflow Template As......................................................................................... 82 8 Patient Setup and Positioning.............................................................................................. 83 2 Turnover Workbook | Symbia Intevo (2, 6, and 16) 8.1 Manually Registering a New Patient ............................................................................ 83 8.2 Registering an Existing Patient ................................................................................... 83 8.3 Registering a Patient from the HIS/RIS.......................................................................... 83 8.4 Positioning Patient for Exams ...................................................................................... 84 8.5 Performing a Hybrid Acquisition .................................................................................. 85 9 Processing Workflows.......................................................................................................... 89 9.1 Quality Control Activity ............................................................................................... 89 9.2 Advanced Reconstruction Options ............................................................................... 94 Week One, Day Three .......................................................................................................... 108 Day Three: Topics ........................................................................................................... 108 10 Organ Specific Processing................................................................................................ 109 10.1 Gastrointestinal Processing ..................................................................................... 109 10.2 Hepatobiliary Processing ........................................................................................ 110 10.3 Planar Gated (MUGA) Processing ............................................................................. 110 10.4 Lung Processing...................................................................................................... 111 10.5 Renal Processing..................................................................................................... 112 10.6 Series Calculator..................................................................................................... 113 10.7 Flexible Display....................................................................................................... 117 10.8 Saving JPEG and AVI files......................................................................................... 120 10.10 Dual Monitor Support ........................................................................................... 120 10.10 syngo Patient Browser........................................................................................... 121 Week One, Day Four ........................................................................................................... 124 Day Four: Topics ............................................................................................................. 124 11 Week One Exercises ........................................................................................................ 125 11.1 Patient Gantry ........................................................................................................ 125 11.2 Quality Control ....................................................................................................... 125 11.3 Patient Registration ................................................................................................ 126 11.4 Workflows .............................................................................................................. 126 11.5 syngo Patient Browser............................................................................................. 127 Week Two, Day One ............................................................................................................ 128 Day One: Topics.............................................................................................................. 128 12 CT System Overview ....................................................................................................... 129 12.1 CT Control Box........................................................................................................ 129 12.2 Emergency Stop Button........................................................................................... 129 12.3 CT Subsystem Power – Line Connection Box............................................................. 130 12.4 CT Table and Hand Controller .................................................................................. 130 12.5 Patient Positioning Monitor (PPM) ........................................................................... 131 Week Two, Day Two ............................................................................................................ 132 Day Two: Topics.............................................................................................................. 132 13 CT Exam ......................................................................................................................... 133 13.1 PPM Setup.............................................................................................................. 133 13.2 Positioning for the CT Exam..................................................................................... 133 3 Turnover Workbook | Symbia Intevo (2, 6, and 16) 13.3 Acquiring the CT Exam............................................................................................ 134 Week Two, Day Three........................................................................................................... 138 Day Three: Topics ........................................................................................................... 138 14 Image Registration/Fusion with MI Applications Software ................................................. 139 14.1 Using the Blending Tool and Color Bars.................................................................... 139 14.2 Reviewing and Modifying the Registration ............................................................... 140 15 syngo Viewing Task Card ................................................................................................. 142 16 syngo 3D Task Card......................................................................................................... 143 16.1 Loading the CT Images ........................................................................................... 143 16.2 Loading the SPECT Images ...................................................................................... 143 16.3 Adjusting the CT/SPECT Balance Ratio ...................................................................... 143 16.4 Image Area Display ................................................................................................. 144 16.5 Image Navigation ................................................................................................... 145 16.6 Windowing............................................................................................................. 145 16.7 Common Tools ....................................................................................................... 145 16.8 Tools Sub Taskcard.................................................................................................. 146 16.9 Orientation Sub Taskcard ........................................................................................ 146 16.10 Type Sub Taskcard................................................................................................. 146 16.11 Creating Parallel Ranges........................................................................................ 147 16.12 Creating Radial Ranges.......................................................................................... 149 17 Workstream 4D............................................................................................................... 150 4 SIEMENS Symbia Intevo Introduction Purpose Learning Objectives The purpose of this training session is to provide The learning objectives for this workbook are: 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 over a 8-day • Demonstrate the steps in changing the collimators period; a total of 64 hours. Further details • Describe the workflow of the daily, weekly, and monthly QC procedures on location and specific times are included • in your registration confirmation. Demonstrate the system daily startup and shutdown • 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 • Provides the necessary knowledge and expertise Describe the function of the MI Apps Workstation • to accurately and safely operate the system. Describe the layout of the Command Module • Training Workbook Demonstrate the steps in patient selection Supports the System Owner’s Manual through and launching a workflow • “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 • Demonstrate the steps in the use of Workstream 4D 5 Turnover Workbook | Symbia Intevo (2, 6, and 16) Week One, Day One Day One: Topics • Getting Started with Symbia Intevo Scanner • System Control Orientation • PHS Orientation/Homing • Collimator Changing • Emergency Stops • Laser Lights • System Safety • MI Workstations • System Restart • Daily Nuclear Medicine Quality Control Procedures • Daily CT Quality Control Procedures • System Shutdown and Cleanup • Daily QC • Weekly QC • Monthly QC 6 Turnover Workbook | Symbia Intevo (2, 6, and 16) 1 Getting Started with your Symbia Intevo Scanner 1.1 Scanner Component Identification Notes Notes 10 2 8 3 12) 13) 14 15 4 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. Pallet Handle 15. Bed Index Handle 7 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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) 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 ........... ........... ........... ........... ........... ........... @ .......... ........... @ .......... 0000000.00 (1) Line Connection Box’s CT Subsystem Power Switch 8 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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. 2 3 (X) X) ON X -19 SNAC CAMERA MOTION X 5 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 (2, 6, and 16) 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 (2, 6, and 16) 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. 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 (2, 6, and 16) 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. 1 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 (2, 6, and 16) 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 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 (2, 6, and 16) 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 (W) 2) 3 1 4 2 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 (2, 6, and 16) 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 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 (2, 6, and 16) 1.6.2 Pallet Notes Notes 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. 2 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. 16 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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. 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 17 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 (50016 2 . ) DO NOT MPACT TI CAUTION PLECF 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 18 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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. 3 2 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. 1 227kg 1500 3 (2) 1. Manual Integrated Source Holder 2. Point Source Holder 3. Line Source Holder 4. AutoQC Shielded Storage Area 19 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 20 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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, (1 - O 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. 21 Turnover Workbook | Symbia Intevo (2, 6, and 16) 10 Notes Notes 1 11 (2) (3 1 12 4 13 5 (O) 14 -15 6 7 2 16 17 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 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 22 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 M 2) 4 5 6 8 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.. 23 Turnover Workbook | Symbia Intevo (2, 6, and 16) Notes Notes 1 2 Version syngo MI Applications VB10A 12.0.1.12 3 4 5) Restart Shutdow Touch Pad Test 6 X 7 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. 24 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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. 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 1 SPECT 2 0.0 kcts/s 22.0 cm 136.1 cm 95 % 100 % -6.00 C -96.00 34.4 cm 34.4 cm 1.00 * 1.00 140 KeV 140 KeV HiResPar HiResPar View 1/2 3 00:39 C 4 09:51 13 5 6 7 8 9 10 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 25 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 IQ SPECT Configuration QC SP Specialty Pallet Start/Resume AutoQC Source Attached Acquisition Exposed 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. 2 3 4 Repeat 1/4 View 13/32 Phase 1/1 Cycle 1/3 00:39 5 6 (V) 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. 26 Turnover Workbook | Symbia Intevo (2, 6, and 16) 1.8.10 Patient Bed Information Fields Notes Notes SIEMENS 1 1 0.0 kcts/s SPECT 0.0 kcts/s 222.0 cm 3- 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/s SPECT -1 [0.0 kcts/s 22.0 cm 2 4. 136.1 cm 3 2 4 95 % 100 % -6.09 -96.0º 34.4 cm 34.4 cm 1.00 6 1.00 140 KeV HiResPar HiResPar View 1/2 00:39 C 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 27 Turnover Workbook | Symbia Intevo (2, 6, and 16) 1.8.12 Gantry and Detector Information Fields Notes Notes SIEMENS 1 0.0 kcts/s SPECT 2 22.0 cm 136.1 cm 95 % 100 % 1 C -6 -6.0º -96.0º 2 34.4 cm 34.4 cm 3 1.00 1.00 4 140 KeV 140 KeV 5 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 49.50 36.1 cm 18.0 cm 6 36.1 cm 0.0 cm 0.0 cm 2) 136.1 cm 0.00 C 0.00 0.0º 5 1.00 1.00 140 KeV 140 KeV LEAP LEAP 3 (4) .- 135º 1 4050 X 09:01 1. Detector 1 Towards White or Gray Orientation Dot 2. Detector Angle 3. Detector 1 Rotation Angle 4. Acquisition Status 5. Detector Tilt 6. Camera Info Tab 28 Turnover Workbook | Symbia Intevo (2, 6, and 16) 90°, 76°, or Gurney Configuration Notes ` SIEMENS 1 90.00 1 2 90.0º 45.0º -45.0º 2 35.3 cm 22.0 cm 35.3 cm 136.1 cm 1. Configuration 2. Camera Information Tab CT Configuration SIEMENS 1 90.00 1 2 90.0º 45.0º -45.0º 22.0 cm 2 35.3 cm 35.3 cm 136.1 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 90º 76º 76º 3 4 X 1. Detector Reconfiguration Selections 2. Reconfiguration Tab 3. Proceed Button 4. Cancel Button 29 Turnover Workbook | Symbia Intevo (2, 6, and 16) IQSPECT Reconfiguration Screen Notes CT 3 5 IQ-SPECT 2 4 6) 7 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 900 90º CT Configuration 180º Configuration 90º Supine 90º Prone Configuration Configuration 76º 76º IQ-SPECT 76º Supine 76º Prone Configuration IQ.SPECT Configuration Configuration 30 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 100 2) 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 31 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 CT Q 2 3 3 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 32 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 HR HE 5 EHR SMARTZOOM Remove (6 X 13:57 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 33 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 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 34 Turnover Workbook | Symbia Intevo (2, 6, and 16) 1.9 Control Box Notes The CT Control Box is used to control the systems’ CT functionalities and some system motion. SIEMENS 1 3 (11) 8 2 STOP. 9 WARNING: 6 This X-ray unit may be dangerous to patient and operator unless safe exposure 3 factors, operating instructions and maintenance schedules are observed. 4 1. Hear Patient Button 2. Hold / Stop Radiation Button 3. Start Acquisition / Radiation Button 4. Radiation On LED 5. Speaker 6. Microphone 7. Move Patient Bed Button 8. Call Patient Button 9. Emergency Stop Button 35 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 they 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. 2 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 (2, 6, and 16) 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. 1 6 2 7 3 5 4) 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 (2, 6, and 16) 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 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 38 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Open collimator drawer 4. 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 1. Contact Area 9. PMM Text: Close collimator drawer (number) SIEMENS X Close collimator cart drawer 4. 39 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 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 (2, 6, and 16) 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 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 X 41 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Oben collimator drawer 4. 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 JHR LEHS 2 LEHR Remove (4) (3) 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 42 Turnover Workbook | Symbia Intevo (2, 6, and 16) 4. PPM -> Press the desired collimator selection button. PPM Text: Press Notes 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. 2.3.3. Collimator Cart Procedure 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 43 Turnover Workbook | Symbia Intevo (2, 6, and 16) Notes 1 2 1. Collimator Cart Connector 2. Collimator cart leg inserted into patient bed’s Collimator Cart Guide 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 4) Remove 6 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 44 Turnover Workbook | Symbia Intevo (2, 6, and 16) 4. Press Remove button Notes 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 X Dock the collimator cart. 9. Dock the appropriate collimator cart with empty drawers. 10. PPM Text: Please wait 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 45 Turnover Workbook | Symbia Intevo (2, 6, and 16) 13. Slide collimator drawer open and stop before collimator clamp. Make Notes contact and hold until detector movement begins and beep is heard. PPM Text -> Please wait. 14. PMM Text: Close collimator drawer (number) SIEMENS X Close collimator cart drawer 4. 15. Slide and close collimator drawer until you hear the audible beep. 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 undocks collimator car 20: PPM Text: Undock the collimator cart. Remove collimator cart to safe storage. 21. Collimator removal is complete. 46 Turnover Workbook | Symbia Intevo (2, 6, and 16) Collimator Installation Notes 1. Press the Home button 2. Press the Proceed button 3. PPM -> Press Collimator Change tab MELP LEAP JHR 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. System Preparing for Drawer Opening 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 detector movement begins and beep is heard. 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. 47 Turnover Workbook | Symbia Intevo (2, 6, and 16) 2.3.4 Touch Pad Test Notes 1. When the Touch Pad screen appears, press the 4 touch pads by hand. SIEMENS 1 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 2 Gentry Touch Pad Gentry Touch Pad X Press PROCEED to confirm the successful Touch Pad Test. 3. Press Proceed 4. Press Home. 48 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 QC Schedule Performed Quality Control Procedure Source Daily for NM Intrinsic Verification, or 35 uCi of Tc99m, or Extrinsic Verification or Extrinsic Sweep Co-57 sheet source 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 uCi of Tc99m AutoQC source Monthly for NM Intrinsic Calibration with Tune 35 HCi 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 Verification each other for Tc99m only) AutoQC source Monthly for users performing Sensitivity Calibration 1-5 mCi of Tc99m, or quantitative studies Precision Co-57 point 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, and See source strengths above. replaced. Extrinsic Calibration for collima- tor MHR for collimator 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 3.2 Daily System Shutdown and Startup 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) 49 Turnover Workbook | Symbia Intevo (2, 6, and 16) Turning off the Acquisition Consoles UPS Notes 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) 12. Flip the line connection box’s CT subsystem power switch to OFF 3.2.2 Startup 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. 50 Turnover Workbook | Symbia Intevo (2, 6, and 16) 3.2.3 Touch Pad Test Notes 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. 51 Turnover Workbook | Symbia Intevo (2, 6, and 16) 3.4 Daily NM QC – Manual Notes Symbia Intevo Daily QC Flow Chart Daily NM QC Auto QC? Yes No Intrinsic or Extrinsic? Intrinsic or Extrinsic? Int. Ext Int. Ext Co57 Button Gd153 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. 52 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 5% 6% 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. 53 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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. 54 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Intrinsic Verification Auto 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 55 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 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 56 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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% 57 Turnover Workbook | Symbia Intevo (2, 6, and 16) 3.7 Monthly NM QC Notes Symbia Intevo Monthly QC Chart 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: Sensitivity Performed on most Calibration commonly used low energy collimator CT Constancy Sensitivity Calibration 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. Extend the integrated source holder and insert the point source. 8. Count rate should be between 15 kcts/sec and 50 kcts/sec. 58 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 (2, 6, and 16) 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 O *^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 (2, 6, and 16) 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 180º 90º 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 cm 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 (2, 6, and 16) 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 (2, 6, and 16) 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 (2, 6, and 16) 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 (2, 6, and 16) 3.7.3 Sensitivity Calibration 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) 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. System Configuration + Cali- Tuning and Peaking Source Sensitivity Calibration Source bration Source System with AutoQC Option + AutoQC Co-57 point source Precision Co-57 Calibration xSPECT Quant Calibration ource Source Kit System without AutoQC Option xSPECT Quant Co-57 Peaking Precision Co-57 Calibration + xSPECT Quant Calibration Source Source Source Kit with Peaking Source System without AutoQC Option Tc-99m point source Tc-99m point source + TC-99m only xSPECT Quant Calibration Kits xSPECT Quant Calibration Source Kit (AutoQC users) • Precision Co57 Calibration Source and Shield • Dose Calibrator Source Holder for positioning the calibration source in a dose calibrator xSPECT Quant Calibration/Peaking Source Kit • Precision Co57 Calibration Source and Shield • Dose Calibrator Source Holder for positioning the calibration source in a dose calibrator • Co57 Peaking Source SIEMENS SPECT Quant 2 3 1. Co57 Peaking Source 2. Precision Co57 Calibration Source and Shield 3. Dose Calibrator Source Holder for positioning the calibration source in a dose calibrator 65 Turnover Workbook | Symbia Intevo (2, 6, and 16) Sensitivity Calibration Procedure Notes Setup 1. Home the system. 2. Tune and peak the system with isotope before installing collimators. 3. Install LEHR collimators. Starting the Workflow 4. On workstation, highlight current QC patient. 5. Double click the Sensitivity Calibration workflow template. 6. Select the Analyzer tab and select the following presets. • For Co57, select SC-Co57-NMG. • For Tc99m, select SC-Tc99m-NMG. Camera Presets Select Existing Preset: SC-Co57-NMG New Preset Name: Save Preset 7. Do not select the Apply Uniformity Correction checkbox (no checkmark in box). 8. Click on the Static Acquisition activity. Select the Series Information tab. Go to the Calibration source area. 9. From the Reference / Assay area, enter the dose numeric value. 10. Enter the unit (uCi (microcuries), mCi (millicuries), MBq (megabecquerels), KBq (kilobecquerels). 11. Enter the date in the field for when the isotope was measured. 12. Prepare the acquisition; motion will occur. 13. Extend the integrated point source holder from the end of the patient bed. Ensure the holder is fully extended. Tc99m sources should be pushed into the end of the integrated source holder. For instructions on inserting the Co57 source, see the Operators Manual. 14. Check that the count rate displayed on the PPM is below 30 kcts/sec per detector. 15. Click the Start button. System acquires an uncorrected image for both detectors simultaneously. 66 Turnover Workbook | Symbia Intevo (2, 6, and 16) Reviewing the Results and Saving Notes 16. From the Sensitivity Calculation activity, review the sensitivity calibration processing results. 17. Sensitivity Calibration Processing tab is displayed. The results for the following are displayed: • Sensitivity – Nominal • Sensitivity – Measured • Deviation for Nominal Values 18. If the results are acceptable, click the Accept These Calibrations and Make Them Current button. If they are not acceptable, click the Reject These Calibrations button. 19. Click the Complete button. 20. Remove the point source. 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. 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. 67 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 This is to be performed after the first 60 minutes of a full patient load and within an hour prior to any patient scan. 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) 68 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 2- 3 X 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. 69 Turnover Workbook | Symbia Intevo (2, 6, and 16) Notes 1) 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 results 70 Turnover Workbook | Symbia Intevo (2, 6, and 16) Week One, Day Two Day Two: Topics • Overview of Acquisition Console • Command Module • Launching a Workflow • Workflow Modification and Saving • Patient Setup and Positioning • Patient Registration • Acquisition Workflows • Processing Workflows 71 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Study Name ALL Show A · Local Study Date ALL a Network Apps 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 Patient Horne Patiort D Study Nomo Auto File Study Date |# Series | Database Locator - Sone. 3 Phase 0127 18 Bone Scan 4/23/2002 Local Database Sone, Lumbar Tomo 673 Bone Scan 4/22/1993 Bone. Spine Torno 2 E.CAM Local Database Bone Scan 11/30/1989 Local Database Bonne, WB and Statics 81156 Bone Scan 4/19/2002 Local Database Cardiac Detector Detector Brain, ktolintencial 12345 Brain Scan 5/19/2003 Local Database aso Bon. Sice Centering Convergen AD AO Cardiac 1. Myo Perf Duet MBI Cardi ac 2, Myo Perf Myocardial Pert 2/1/2001 Local Database Duet MBI Cardrac 3. Dual Study Cd Duet Myoview Myocardial Pert 1/25/2001 Local Database Myocardial Pect 1/9/2001 Local Database Duet Myoview al Pert 1/2/2001 Local Database Display Example Example Example Cardi ac 3. Dual Study Cod. Cardrac 4, Stress & Rest 124-58-5106 ot Pert 3/25/2002 Local Database c Goed Tom Cardioc 4, Stress & Rest 124-58-5100 o Pert 3/25/2002 Local Database Cardiac 5, Myo Perf Abnio Duet Myoview al Pert 1/8/2001 Local Database 2 Cardiac 7. Profite Te TI 12162212 o Pert 2/2 1/2001 Local Database Scomple DALOOOONNN.W Card oc, Cardiac Motion 123456 Jol Pert 2/23/2000 Local Database Gated Example Cardioc. Shurt COL91362794 Equilibrium Gate 1/7/2002 Local Database Stage (DH) ) 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 FUI Philipps CT 8/6/2002 Local Database Fusion 6. MRIPET Head FU 6 Brain 8/15/2002 Local Database Example Example Example Extrinsic Fusion Desplay. WB PET e soft Fusion Di 4/5/2001 Local Database BandT Wholebo WholeBo Casbrapor halbladder 1. GBEF Dyn Perrose 0333443 GEEF 2/22/2001 Local Database hatbladder 2, GBEF Dyn ECAM Hatbladder, Dyn & Static 012533 Gatbladder EF 4/1/2002 Local Database Galbladder EF 5/17/2000 Local Database Galiumn, 2 WB & 1 Tomo 2429453 Turnor Imaging 5/17/2000 Local Database Sarinic Extrinsic General astric Emp, Static A/P 520730 Gastric Emptying 11/23/2001 Local Database Service Venfication Sice -NONNO Gastric, Dynamic Single Is. Perrose 7051808 Gastric Emptying 2/20/2001 Local Database Gated Bloodpool, TOMO 12345 Equilibrium Gate 2/20/2001 Local Database ung. Aerosol 22005481UMMMM Lung Veralation 2/16/2001 Local Database long. V/O 381201STM Lung WO Scan 2/22/2000 Local Database Intrinsic Intrinsic Intrinsic Kitess VM Data, AX Coronaries 42711 4/23/1997 Local Database de bracion Service Verification ONN N .. .. & N . . ..... LC Category All Workplace SYNGO26 Work Status: All Stage: Bunch 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 Bone, WB and Statics 81156 Bone Scan 4/19/2002 2 Local Database Headings Brain, Ictal/Interictal 12345 Brain Scan 5/19/2003 2 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 Local Database Cardiac 3, Dual Study Old ... Duet Myoview Myocardial Perf. 1/2/2001 Local Database Cardiac 4, Stress & Rest ... 124-58-5106 Myocardial Perf. 3/25/2002 Local Database Cardiac 4, Stress & Rest .. 124-58-5106 Myocardial Perf. 3/25/2002 Local Database Cardiac 5, Myo Perf Abno ... Duet Myoview Myocardial Perf. 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 ... 4/5/2001 4 Local Database Gallbladder 1, GBEF Dyn ... Penrose 0333443 GBEF 2/22/2001 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 - 72 Turnover Workbook | Symbia Intevo (2, 6, and 16) 4.1.2 Workflow Template Browser Notes . Local Refresh Local or Workflows Category: All Network Auto Filter Category Cardiac Detector Detector Phase Bon. Slice Centering Convergen. AO AO AD Auto Filter Workflow Display Example Example Example Template AD Dynamic Dynamic Gated Tom. AO AO List Example Example Example Example Gated Static (DH) Tomo (DH) WB and St AO AO Example Example WB and T ... Wholebo. Example Extrinsic WholeBo Calibration Extrinsic Extrinsic Full Verification Dot Regen General Slice ... 1 4.1.3 Workflow Manager Refresh Category Workstation Launch Suspend | Category: All Workplace: SYNG026 Work Status: All Stage: All Launch Suspend omplete 4.1.4 Launching a Workflow 2 Select Category SHOW AN Study Date ALL Category Al System Up Time: 12 Mins Database: Local Find 48 studies found on the system. Study dates (all dates) Image Space Avariable 75460 MB Auto Filter Patient Name | Patent D | Study Nome Study Date |# Series .|Database Locator Bone, 3 Phase 012718 Bone Scan 4/23/2002 Bone, Lumbar Tomo Local Database Bone Scan 4/22/1993 Bone, Spine Torno 2 Local Database Bone Scan Bone, WB and Statics E.CAM 11/30/1989 Local Database 81156 Bone Scan Brain, Italintenctal 4/19/2002 Local Database Detector 12345 nase Bon. Cardiac Sice Centering Convergen AO Cardiac 1. Myo Perf Brain Scan 5/19/2003 Local Database dac 2 Min Darf Duet MBI Myocardial Pert Muncandial Paint 2/1/2001 1/35/2001 Local Database AD 1. Highlight Lacal Derabase ardrac 3. Dual Study Ofd . Duet Myoview Myocardial Perf 1/9/2001 Local Database Example OPPONNN -W Cardi ac 4, Stress & Rest Cardioc 4, Stress & Rest 124-58-5106 Myocardial Pert 3/25/2002 Dynamic Gated Tom Patient 124-58-5106 Myocardial Pert 3/25/2002 ocel Database Cardiac 5, Myo Perf Abno Cardiac 7. Profile Tc TI Duet Myoview Myocardial Pert 1/8/2001 Cardi ac, Cardiac Motion 12162212 123456 Myocardial Pert 2/2 1/2001 Cardiac, Shurt COL91362794 Myocardial Pert 2/23/2000 Example Equilibrium Gato 1/7/2002 0 and St First Pass COL91620006 FU 1 First Pass 12/17/2001 3. Double Fusion 1, PET/CT WB Fusion 1. PETICTWB Siemens PET @18/2002 FUI Fusion 6. MR/PET Head FU 6 Philipps CT 8/6/2002 8/15/2002 WBand whotubo Click Brain Fusion Desplay, WB PET Gallbladder 1, GBEF Dyn e soft Fusion Di Penrose 0333443 GBEF 4/5/2001 Gallbladder 2. GBEF Dyn .. ECAM Gallbladder EF 2/22/2001 Workflow 4/1/2002 Gatbladder, Dyn & Static Gallium, 2 WB & 1 Tomo 912533 Ganbladder EF 5/17/2000 Gastric Emp, Static A/P 2429453 Local Database 520730 Tumor Imaging 5/17/2000 Local Database Excinsic Extrinsic Ful General Gastric Emptying Sice Gastric, Dynamic Single Is. Penrose 7051008 Gated Bloodpool, TOMO 12345 Gastric Emptying 11/23/2001 Service Venfication Dot Regen 2/20/2001 Local Database Local Database 22085-48 1UOIM 2/20/2001 Local Database Lung. Aerosol Equilibrium Gate. Lung. W/Q 381201STM Lung Veralation Lung WO Scan 2/16/2001 Local Database 2/22/2000 Local Database Intrinsic Intrinsic Intrinsic MM Data, AX Coronaries 4/22/1997 Local Database Calibracion Service Verification ONNN -- UN -- AN -- LC Work Status Al Workplace SYNGO26 Stage: Al Launch Suspend Complete 1. Highlight the patient from Patient Browser 2. In the Workflow Template Browser Category > Select Category 3. Double click the workflow desired 73 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Data Configuration #1 Selector #2 A workflow that contains Activity acquisition, processing Data (two in this example). Selector displaying, and hard copy Acquisition Activity in one workflow. Activity Common Workflow Processing Configuration #2 Percochakeine Processing Activity ctivity A workflow that contains processing, displaying. and hard copy in one workflow. Processing Flexible Activity Display ad Copy Activity Flexible Display Hard Copy Activity Activity anghe Hard Copy Activity 5.1 Workflow Navigator 1? AI XY Rest Tc-99m. Stress Tc:09m, 2/24/2005 Rest Tc 99m, Stress Tc-99m Gated, 2/24/2005 Rest Tc-99m, Rest Tc-99m, 2/24/2005 est Tc-99m 2/24/2005 Data Selector Hard Copy Pocs 4mm Te:99m Pics.4mm To:29am Pick dmm To -90m Pick them To-20m Pock form Te- 80m Fuck timm Te- 50m Pich smn Te -fim Fr30 71K F1 21 72K FC23 71K Fr24 70K 74 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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. 75 Turnover Workbook | Symbia Intevo (2, 6, and 16) 6 Acquisition Workflows 6.1 Acquisition Types Notes • Static • Dynamic • Whole Body • Tomo • Gated Planar • Gated Tomo • Dynamic 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 Referring Physician Remaining Elapsed Organ Matrix Size 64 X 64 Zoom 1.00 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 76 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Symbia T Study Name 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 1 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 77 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Calibrations 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 . Counts Time or Counts Count Density Manua Time: sec Counts 500 Kcts Any Window Group View Control Detector 1: Ant Detector 2: Post Add View Insert View 78 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 0 msec Autocenter Primary Window Average of . Forward 10 Beats Forward/Backward by Thirds Peak Bin of 10 Beats Autotracking PVC Reject PVC Beats Beats To Reject Post PVC: 1 PVC Threshold (msec): 300 Beat Histogram 100 80 60 40 20 Beats 20 40 60 80 100 140 180 220 Beats/Min . 1 Window Beats/Min @ ms/Beat Save Curve 79 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Condition Static 2. Static Tab Stop Conditions Appears Time: 0 msec ] 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): 2 Duration 20 min Stop Time 22: 00 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 80 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Dead Time (%) | Peak Status |1 |2|3 |4 |5 |6 7 8 New Preset Name: Detector 1 ~ Detector 2 NOT PEAK. Save Preset Begin Peaking il Pause Between Peaks Window Number |Center (keV) Width (% Shift (% Type Parent 140 15 0 Photopeak LX Window Center (keV): Window Width (%) Window Shift (%). Window Group A 99m Technetium 13000 Window Group B. 11000 10000 Window Group C 9000 8000 Window Group Di 6000 5000 Window Group E 4000 Counts 3000 - Window Group F 2000- 1000- 50 100 150 200 250 300 350 400 450 500 550 600 650 kev Detector 1 Detector 6.3 Display Analysis Tab Used to review images. 81 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Workflow Characteristics Enter New Workflow Name Workrow Name Enter New Description (Optional) Workdow Description: This workflow acquites static acquisitions Select Category Select Icon bert Type: Lymphatic Workflow loon Parathyroid Renal Saivary gland Soknic Testicular Q Thyroid Tumor Unecertc Vesical Calibration a Coincidence Dispuy Dynarnic Dynamic Tomo Good Click OK 1010 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. 82 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 procedure(s) Other Patient Name(s) Other Patient ID(s) Ethnic Group Study list Step 2 Military Rank Patient ID Date of Birth Sex Male Female Other Study Age Years Study comment Height [ft'in'] Weight Address Patient position Additional info Institution name Details .Performing physician warren moore, md 2. Performing physician HOSPITAL NOTIMITISNI Referring physician Requesting physician 1. Operator 2. Operator Admitting diagnosis Ward Step 3 Admission ID Preregiste 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 83 Turnover Workbook | Symbia Intevo (2, 6, and 16) 8.4 Positioning Patient for Exams Notes 1. From the PPM, press the Reconfiguration tab SIEMENS (5) (1) (2) 90 90º 76º 76º 3) (4) X (6) 09:05 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 84 Turnover Workbook | Symbia Intevo (2, 6, and 16) 8.5 Performing a Hybrid Acquisition 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. 8.5.1 CT Setup 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 85 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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/A1C297/ 6/21/1950, M, 55Y CT 2006A0.1.03>Symbia T6>5.0.28.5 F-SP 6/21/2005 12:20:12.94 1 IMA 1 DOP 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 Ocn KV 130 mA 20 TI 5.9 GT 0.0 SL 1.0 512 0/0 T20s SOPO 1 1. Purple Box over Topogram 86 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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. 209 SOPO 350 500 0/0 808$ L300 A2 SPECT_AC_Cardiac (Adult) Phantom, Siemens 1234 Total MAS 282 Topogram Recon job 2 8 8 4 8 7 Series description AC AC_Cardiac 5.0 B40s AC_Cardiac Slice 5.0 mm Recon begin -1125.5 mm 2 1 Kernel B40s medium Recon end -965.5 mm 2 Window Mediastinun Image order Craniocaudal Recon increment 5.0 mm 2 FoV 500 mm 2 No. of images 33 2 Center X 3 Overview Center Y 0 mm 2 Comments Mirroring None Load Hold Recon Extended CT scale 4 Routine Scan Recon 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. 87 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Perform SPECT Reconstruction 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. 88 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 O 0 4. Click and drag red inogram Linogram line to center heart % 100 100 5. Click the Cine button to view motion 250 - 200 - Sum Sum 150 - 100 100 100 Beats 50 3. Apply Beat Normalize (Optional) 10 20 30 40 50 60 70 80 90 100 160 200 220 Beats/Min Beat Normalize Beat Histogram: . Beats/Min Beats vs. Projections Unapply Correction ms/Beat HR vs. Projections lick 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 89 Turnover Workbook | Symbia Intevo (2, 6, and 16) Motion Correction Notes Automatic |Manual Automatic Correction Use All Projections Shift all projections Isotope: A Apply X Shift 7. Center red ROI over Apply Y Shift heart. Head Misregistration Before % 100 % 100 224.99 264.99 304.99 344.99 384.99 X Motion 5 0 0 Sinogram inogram 224.99 264.99 304.99 344.99 384.99 Y Motion After % 100 100 O 33 224.99 264.99 304.99 344.99 384.99 X Motion 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 90 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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_ O Sun Sum 100 Quality Control Tools Unapply Correction 3. Select Motion Detector. 1 Isotope: A Motion Correct Series .. Revert to Original 91 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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: 5. Cross Tool Multiframe Mode 6. Shift Tools to make adjustments in position 20 O Sum % 7 Click to cine images X Shift 0.00 Y Shift: 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 ettings Correction 2. Select the series Series: Chest Berore Sinogram After Sinogram 100 TChest 100 100 0 Linogram Linogram 10% Sum Sum % 100 Quality Control Tools Unapply Correction 3 . Click to motion correct series Isotope: A Motion Correct Series .... Revert to Original 92 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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: Multiframe Mode 6. Vertical Shift Tool to 5. Cross Tool make adjustments in % Linogram 52 100 0 Sum % 100 0 7. Click to cine images X Shift: 0.00 Y Shift: 0.00 8. Click OK to accept the changes. OK 93 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 File 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 % 4 7. Click and drag red lines to adjust range Quality Control Scrollable Views -19 Display Zoom: Bone Scan - Thorax - Isotope A 3/17/2003 Anterior ransverse Sagittal Caranal % 68 xible Display Scrollable Views -7 Hard Copy 3rd Tomo for Non-AC - Isotope A Display Zoom: Transverse Sagittal Corona 100 Scrollable Views Display Zoom: 4th Tomo for Non-A.C - Isotope A Transverse Sagittal Coronal wspend Scrollable Views Setup Display Zoom: Ready 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 94 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Entire Settings 4 36 1 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] 95 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 O Acquisition Analyzer Display/Analysis Acquisition Display Detector 1: 99en Technetium Detector 2 99m Technetum Study Series Bone Torno 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 Regstnabio Camera Parameters Body Position Supine Supine 256 X 256 1.0 Complete Suspend SC-Tc9Am-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 5 mm x [2,2,2, 1,1] > 6 Million Settings 3 24 5 mm x [2,2,2,1,1] Counts for Settings 4 48 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] -A-NO 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 CT Acquisition Stop Condition Basic Data Advanced Data Time per View. 20 sec First View by Counts: 96 Turnover Workbook | Symbia Intevo (2, 6, and 16) CT Setup Notes Scan Sub Task card opogram AbdRoutine Quality ref. MAS Eff. mAs 17 Slice 3,0 mm ] Acq 2x2.5mm 00 CARE DOSAID P Pioch 1.5 3 KV 130 MJ Direction Craniocaudal CTDMOI 1.45 mGy Scan time 32 93 5 24 Scan start Start button Roostion time 0.8 $ -J Delay 35 API None Load Routine Scan Recon Auto Tasking Recon Sub Task card (B31 Kernel Selected) Topogram O Reconjob 1 8 8 8 2 8 2 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 Fov r FoV 500 mm 2 No of images Center X Center Y Comments Mirroring None Extended CT scale r Load tecon 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 AutoRecon View Template Workflow Actribes Help Settings Reconstruction Masking/Centering Data Selector 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 Quality Control Poel Size: (2 40 2 40) mm Range: . Al O 180 .180. 1 Performance terations: 24- · No Reorientation Anterior Subsets: 2 100 AY * * * Quality Speed Registracion Analytical ktorative Advanced 0 Smoothness 0.00 [mm] AutoRecon . OSCG . Enhanced truction Range Preset 46 - 171 Y ...... Start Less More Flexible Display Water Pharcom Pharcom with Contrast Advanced Options Scatter Estimation Il Preserve Negative Values Apply To Photopeak Photopook 1 Energy windows Preserve Data Précision Method Type Window Weights Filter Properties Automatic None Automatic Apply Scatter Correction O DEW Lower Window Weight 0.50 Change Fiber Gaussian 12:00 Setup Quantitative Dose/Time Info ... 97 Turnover Workbook | Symbia Intevo (2, 6, and 16) 6. From the Performance/Smoothness field, select your iterations and Notes subsets. Elle AutoRecon View Template Workflow Activities Help Settings Reconstruction Masking/Centering Dits Selecto 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 Quality Control Starting Angle: Pixel Size: (0.00 0.00) mm Range: · All 0.180 Performance berations: 24- · No Reorientation Subsets: 2 . Y . . . Quality Image GOT Speed Registration Analytical Rerativo Advanced 0.00 [mm] 0 Smoothness : ABRecon OSCG . OSCG . Enhanced Reconstruction Range: Y ...... Preset 1 - 256 Skeletal Start Loss More Semble Display Advanced Options Scatter Estimation Preserve Negative Values Apply To Photopeak Phocopeak 1 Energy windows Preserve Data Precision Method Type Window Weights Filter Properties Apply Scatter Correction Automatic None Automatic 0.50 Change Filer · DEW Lower Window Weight Gaussian 12.00 Quantitative Dose/Time Info ... TEW 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 5 mm x [2,2,2,1,1] Entire Acquisition Settings 5 60 1 5 mm x [2,2,2,1,1] Settings 6 72 1 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 1 5 mm x [2,2,2,1,1] < 6 Million Settings 3 18 5 mm x [2,2,2,1,1] Counts for Settings 4 36 1 5 mm x [2,2,2,1,1] Entire 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. 98 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Radiopharmaceutical AutoRecon 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 MBg 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 128×128, 256×256 Zoom 1 Camera Preset SC-Tc99m-NMG 99 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Worldlow activities Help O AI Acquisition Analyzer Display/Analysis Oats Select fou Acquisition Display Detector 1: Decoctor Study 99m Technetium 99m Technetum 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 Ouvity Control Enable Study Based Setup KCourts: KCourts: Remaining Empsod View Aut&Reco Calibrations .... Apply Uniformity Correction Registration Orientation Camera Parameters Body Position Supine Supine 258 X 256 10 Complet Suspend SC-Tc9/fm-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, 256×256 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 · Time per View: Advanced Data 20 sec First View by Counts: 100 Turnover Workbook | Symbia Intevo (2, 6, and 16) CT Setup Notes Scan Sub Task card Topogram AbdRoutine Quality ref. mAs Eff. MAS 12 Sice 3.0 mm ] Acq 2×2.5mm 00 CARE DOSAID P Pitch 1.53 KV 130 MJ Direction Craniocaudal CTDIMol 1.45 mGy Scan time 32 93 5 24 Scan start Start button Roostion time 0.8s .J Delay 35 API None Load Routine Scan Recon Auto Tasking Recon Sub Task card (B31 Kernel Selected) opogram Reconjob 1 2 2 8 2 8 2 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 mm2 Extended Fov r FOV 500 mm No. of images Center X 0 mm Overview Center Y 0 mmal Comments Mirroring None Extended CT scaler Load Recon Routine Scan Recon Auto Tasking xSPECT Quant Tomo Reconstruction 1. In the AutoRecon activity, select the Settings Tab. 2. In the Apply to Item drop down, select Tomo Processing - Non-AC 2. Select the Advanced sub tab. 3. Select OSCG Elle AlsoBecon View Temolace Workflow Activises Halo 11 Settings Reconstruction Masking/Centering Data Selector Apply to Item: 1st Torno for Non-AC - Iscope A Tomo Processing . Non AC Smoke . SPECT LWS NUD . 1200990 A 1/26/2013 Reconstruction Limits Performance / Smoothness Quality Control Pixel Size (0.00 0:00) mm Range: . All O 180 Performance : torations 24- .No Reoriercation Artenice Subsets 2 Speed Quality Analytical Iterative Advanced O Smoothness : 7.50 [mm] AutoRecon . OSCG OSOG + Enhanced Reconstruction Range - 64 Stort Less More lexible Displa Advanced Options Scatter Estimation Preserve Negative Values Apply To Photopeak Photopeak 1 Energy windows w Preserve Data Précision Method Type Window Weights Filter Properties Complet Apply Scatter Correction Automatic @ None Automatic Change Fiber O DEW Lower Window Weight 0.00 . TEW Upper Window Weight Gaussian 12.00 0.00 Setup 101 Turnover Workbook | Symbia Intevo (2, 6, and 16) 4. From the Performance/Smoothness field, select your iterations and Notes subsets. to AutoBecon View Ismolate Workflow Activities Holo Settings Reconstruction Masking/Centering Duts Selector Reconstruction Parameters Apply to Rem: 1 st Tomo for AC Enhanced · Isotope A Apply Recon Range to All Configure Data Paths Tomo Processing . AC Enhanced Reconstruction Limits Performance /Smoothness Starting Angle: Pixel Size: (0.00 0.00) mm 90 Range: . All D 180 Performance berations: 24- No Reorientation Anterior Subsets 2 .. . . . . City Spond Analytical Rtorativo Advanced Smoothness : 0.00 [mm] AutaRecon . OSCG · OSCG . Enhanced Reconstruction Range: 1 - 256 Y ..... Skeletal Start Loss More Advanced Options Scatter Estimation Preserve Negative Values Apply To Photopeak Photopeak Energy windows Preserve Dota Precision Method Typ Window Weights Filter Properties Ceerplate Apply Scatter Correction Automatic O None Automatic Change Filer · DEW Lower Window Weight 0.50 Gaussian 12.00 O 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 8 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 Proposal 1 Settings 2 24 1 5 mm x [2,2,2,1,1] < 6 Million Settings 3 < 6 Million Settings 3 18 2 5 mm x [2,2,2,1,1] Counts for Entire Settings 4 36 1 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] 102 Turnover Workbook | Symbia Intevo (2, 6, and 16) 5. If you need to change the dose information, you can change it in the Notes Quantitative Dose/Time Info. Settings Reconstruction Masking/Centering Outs Selector Reconstruction Parameters Apply to born Unknown study. - SPECT - Isotope A 7/8/2013 Apply Recon Range to AI Configure Data Pattis Tomo Processing - AC Reconstruction Limits Performance / Smoothness Quality Control Starting Angle Range: · All 180 Poel Size: (2.40 2.40) mm Performance AutoRecon torations 24- · No Recrientation Subsets: 2 100 .Y. . . .. Speed Quality Analytical Iterativo Advanced Smoothness : 5.00 [mm] ActofRecon OSCG . OSCG + Enhanced Reconstruction Range 63 ~ 179 ....... Start Less More Advanced Options Scatter Estimation Preserve Negative Values Apply To Photopeak Photopeak 1 Energy windows Preserve Data Precision Method Type Window Weights Filter Properties Complete Suspend Apply Scamer Correction Automatic O None Automatic . DEW Lower Window Weight Change Fiber 0.50 Gaussian 12:00 Setup Quaretative Dose/Time Info ... 6. Press Start if you have made any changes to the AutoRecon activity parameters. 9.1.5 Volumetric Analysis Activity 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 103 Turnover Workbook | Symbia Intevo (2, 6, and 16) 3D Analysis Tab Notes 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 Ratio Iso Analysis VOIROSUES PET Whole CTIR, 1/28/200 Color Bars Results vor Compansons Layout Buttons 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 1 st Ser Pair Slice [ Défaut |SPECT NUD |CGZAS-24115.5mm. Blend Show 3D Display Display [ Default ]-CT LWS 831s Properties Show 3D Display Display Data Select Data Types (check Types box to display) [ Default ] Blend Show 3D Display [ Default ] Show 3D Display Check to Show Displays the 3D Display Interleaved Results Table image on page Show Resut Table on page Ok Cancel 104 Turnover Workbook | Symbia Intevo (2, 6, and 16) Segmentation Options Notes Options available: a. Ellipsoid b. 3D Isocontour c. Multi-frame Polygon d. Multi-frame Isocontour Iso: ROW A 1 VOI Results: Ellipsoid % 3 Bone SP Value ¥ 3D Isocontour Parameter Multi-frame Polygon Multi-frame Isocontour When isocontour is selected, isocontour slider will become active. 105 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Ellipsoid % 8 Bone SP Parameter Value 3D Isocontour Multi-frame Polygon Multi-frame Isocontour Iso: 50 % VOL XY TS Transverse Coronal VOI Resuts. PET Whole body [Transverse]. 6/2/2005 CT WB, 1/28/2003 100 biograph, WholeBody MIA Moorabbin MA Moorabbie % 50 HU Parameter | Value biograph 7/20/1952 100 1/28/2003 Thin MPR 2. Click the center of area of VOI placement 3. Adjust the size and position of ellipse Vol Comparisons Parameter | Value /01 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 1/1 70 cm3 VOI Comparisons: Parameter Value 106 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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, 717/2005 7 DU 69 HU 2. Click the center of area of VOI placement 3. Adjust the size and position of ROI T: 5.0 BOBS 1726 Compressed P: 232.0 808s 250.9 47 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 1/1 70 cm3 VOI Comparisons: Parameter Value 107 Turnover Workbook | Symbia Intevo (2, 6, and 16) Week One, Day Three Day Three: Topics • Organ-Specific Processing • Series Calculator • Flexible Display • Saving JPEG and AVI files • Dual Monitor Support • Patient Browser 108 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 AI A 3. Check ROI igs ROI and placement [ric empting [Results] 2/21/2014 51 Quality Control Gastrointestin .. Click Cine button Switch to Cine Mode Isotope: 99m Technetium ROI Create ROI Using: com Techneti. Emptying Curves Composite Image % 009 500 100 400 300 Hard Copy Art 200 100 Counts per sec 15 20 25 3 35 40 45 50 55 60 65 70 75 80 85 4. Click the ROI Tool 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 ROI Tool ... Geometric Mean Emptying end 60 mins T 1/2 68 mins Composite Frame Range TO -> T 1/2 65 mins First Frame: 1 Setup Last Frame: 20 The cine mode allows for cinematic viewing of a series in a single pane. Isotope: 99m Techn 6. Drag Tfit to - gem Techneti .. 8 am Technett . Empf end of empty TUTS 600 5. Drag to 500 art of empty 400 Tempty Thalf 300 200 100 Counts per 7. Drag to position 0 10 15 20 for % emptying 60 65 70 75 80 85 2. Review results 3. See Settings tab to review or modify parameters for this activity 109 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 -Ex File Gastrointestinal View Template Workflow Activities Help AI A Settings ROI Pan GallBladder [Results] 2/21/2014 Data Selector % 4 Quality Contro - KM @ 3. Check for ROI placement 2 . Click the Cine icon 5. Drag to adjust Start 6. Drag to adjust End topo vom rechnetium Create ROI Using: - 89m Techneti .. - 00m Techneti Ejection Fraction Curves osite Image 4500 Flexible Display 4000 3500 Start 3000 2500 2000 Hard Copy 1500 End 1000 Min Counts per sec 500 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 Minutes 0 Fr:1 17002K 64X64 4. Click to redraw the ROI Threshold : Results Summary 25 Parameter 99m Technetium Bkgd Correction Ejection Fraction 85 % Decay Correct EF interval begin 2 mins EF interval end 35 mins Suspen ROI Tool . 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 -EX ed Bloodpool View Template Workflow Activities Help AI *A 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 % 9 100 Gated Bloodpool Ventricular ROI 100 Slot6 260K Flexible Display 5. Cine to check ROI Hard Copy All Frame Background ROI . Center LV in green box Cancel Fr:1 262K 6 4x64 Fr:11 260K 64x64 Edit RO 6. Use to modify ROIs complete 3. Click to determine LV center 4. Click in center of LV Setup Determine LV center ... ROI Tool ROI Tool .. Ready 110 Turnover Workbook | Symbia Intevo (2, 6, and 16) 10.4 Lung Processing Notes 1. Select the Lung Processing activity on the ROI tab of the workflow ORAFOCAR* 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 % % 100 100 100 18 % 0 0 Perfusion RPO Perfusion LAO Perf Rt lat Lt Lat All Images All Images Porf POST ROH ANI Post aerosol Laerosol 100 100 100 0 0 0 Edit ROI Adjust Frame Edit ROI Threshold : Threshold : Adjust Frame ....................... X Shift: X Shift - Y Shift Y Shift ROI Tool Angle: Angle: ROI Tool .. 3. Click to modify ROls 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 111 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 HEX File Renal Processing View Template Workflow Activities Help AI A 2. Review ROI as Display ROIS Results placements Kidney Aorta % 5. Click to view results Right kidney 3. Use sliders to edit thresholds Fr:1 1752K 256x256 Fr.1 294K 256x256 Edit ROI Edit ROI Threshold : Threshold : 31 ...... Hard Copy ROLTool .............. ......................... .............................................................. Sosite Image Composite Image First Frame: 60 First Frame: 1 4. User ROI Last Frame: 70 Last Frame: 30 Tool to redraw ROI Setup Ready Renal MAG 3. Symbia T - Renal Scan, 1/26/2006 File Renal Processing View Template Workflow Activities Help AI Settings Display ROIs Results Kidney Aorta Data Selector % Righe kidney Kidney Left Backer TMax R Quality Control 0 Processing Fr:1 1752K 256x256 Fr.1 294K 256x256 Table of Patient Parameters Parameters Values Renal Protocol Generic (None) Counts / Second exible Display Kidney Depth Method Standard Patient Name Renal MAG 3 Patient ID Symbia T 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 Sex Other Age 0,07 Reference BSA 1.73 m2 Hard Copy Split Uptake Interval ( ... 2.0 - 3.0 Radiopharmaceutical 10.0 mCi 99m Technetium MAG3 Method Adult Left Kidney Hematocrit 0,00 Ripte Kidney Flow 600 550 Table of Result Summary 500 450 Parameters Left Right Total 400 Split Function (%) 350 Kidney Counts (cpm) 57001 121630 300 Renal Retention 0.182 0.240 Time of Max (min) 2.501 3.001 250 Time of 1/2 Max (min) 7.634 9.990 200 Time from Max to 1/2 M ... 5.134 6.989 150 Counts/Second 100 50 O Setup CALRUE BEV. Brightness Levels: 0% (0) -> 8% (187) 2. See Settings tab to review or modify parameters for this activity 112 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 A 1. Select the desired 2. Click Resize to adjust pries Reformat matrix size matrix. Data Selector elect Series: Bone Statics Too Revert To Original Input 1: Entire Series Matrix Size: 128 Resize 100 100 100 Series Reforma 0 0 0 R Anterior L 377K L Posterior R 275K POST ARMS UP 736K Flexible Displa Duration:300sec Duration:300sec Duration: 30036 LT LAT 215K ANT ARMS UP 664K Duration:300sec Duration:300sec 128x128 Pix4.8mm 128x128 Pic4.8mm 3x1 28 Please am fecha 4 . 8 m 28x1 28 Pix: 4.8 m 128x1 28 Pic4.8mm 128x128 Pix4.8mm 99m Technetium 99m Technetium 99m Technetium 99m Technetium Setup All Images All Detectors Ready Simulator is RUNNING 113 Turnover Workbook | Symbia Intevo (2, 6, and 16) 10.6.2 Image Masking Notes Hands-on Lab Computer MI Sim 1 You are in Hands - on La Bone WB and Statics, ECAM - Bone Scan, 4/19/2002 File SeriesReformat View Template Workflow Activities Help AI A 444 Settings Series Reformat Data Selector Select Series: Wholebody ROI Tool. Revert To Original Input 1: Entire Series Matrix Size: 256 Resize % 100 Series Reformat 2 . Select the ROI Tool Flexible Displa 1. Select image Hard Copy RT ANTERIOR LT LT POSTERIOR RT 5758K 5145K Duration:1701 sec Duration:1701 sec 256x1024 Pbc2.4mm 256x1024 Pic2.4mm 99m Technetium 99m Technetium Setup LOCALI Detectors ROI Tool ROI User Interaction Prompt: OI Tool Display Frames . 1x1 # 1x2 @ 2x1 # 2×2 Sum : 1 Select ROI ROIs : User Mask 3. Select ROI Tool used to draw mask ROI Color : O RT ANTERIOR LT 5758K Duration:1701 sec 256x1024 Pix:2.4mm 99m Technetium Edit ROI 5. Select to Keep Inside or Outside Threshold User Mask Keep Outside Keep Inside Cancel To remove masking, click Revert to Original button 114 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Eile Series Filter View Template Workflow Activities Help AI A SettingsSeries Filter 3. Select Spatial or Revert Series Temporal filter Select Series: LAO Original Series 1: Entire Series Series Filte 2. Select series O ation:599sec 64x6 Technetiumm exible Displa Hard Copy er Applied: No Filter Filtered Series 1 100 LAO 5631 K 64 X6 Pix :3. 6mm com Technetium Suspend Setup ter Tool Wiener [S] Test Specified Filter Delete Save Before: % Filter Parameters 100 Kernel 1. 2. 3 . 0.04328 0.12148 0.04328 4. Select filter 0.12148 0.34099 0.12148 0.04328 0.12148 0.04328 WN - After . 5. Make desired updates to 6. Trial Filter to 100 filter parameters visually inspect. Size Wiener - 2D SNR 0.26 FWHM 10 mm 0 Update Trial Filter % Views 100/ 7. Select the desired filter 8. Click OK Boxcar Iterations:3 Gaussian FWHM:6.00 Wiener FWHM:6.00 SNR:0.26 OK Cance 2. See Settings tab to review or modify parameters for this activity 115 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 File Flexible Display View Template Workflow Activities Help x O A XY Single Series Static Display Patient Name: Lung Aerosol Patient ID: ECAM DOB: 7/5/1962 Study Name: Lung Scan Arithmetic Study Date: 2/16/2001 Perfusion Lung [Concatenated] 2/24/2014 % % % 100 100 100 Arithmetic 0 0 0 0 0 Ant aerosol 198K Post aerosol 198K RAO Aerosol 198K LPO aerosol 198K Rt Lat Aerosol 150K Duration:203sec 128x1 28 Duration:203sec 128x128 Duration:268sec 128x128 Duration:268sec 128x128 Duration:315sec 128x128 % % % % % x + 100 100 100 100 100 Arithmetic 0 0 O O Lt Lat Aerosol 151K RPO aerosol 198K LAO aerosol 198K Perfusion RPO 316K Perfusion LAO 316K m Toolbox Duration:315sec 128x128 Duration:298sec 128x128 Duration:298sec 128x128 Duration:78sec 128x1 28 Duration:78sec 128x128 % % % % 100 100 100 100 Flexible Display 0 0 0 0 Perf Rt lat 316K Lt Lat 31 6K Duration:127 sec Perf RAO 316K Duration:127 sec 128x1 28 128x128 Duration:79sec 128x128 ation:79sec 128x128 uration:96sec 128x128 % 100 0 Perf POST 495K Duration:96sec 128x128 Setron (B:0%, T:100%) All Images Bone WB and Statics, ECAM - Bone Scan, 4/19/2002 File Series Arithmetic View Template Workflow Activities Help x C++ C Process Workflow 1. Select the images or phase to A 2. Click the Data Selector Settings Ari extract in Operand 1 Extract icon Select Series. States erand 1 Series 1: Multiple Frame 100 100 100 Arithmetic x + 0 0 0 0 cible Display RLAT 601K LLAT 468K RAO 900K LPO 808K ation : 1 70SE Duration: 146sec Duration:146sec Duration:161 sec Duration:161 sec Duration:170sec 256x256 Pix2.4mm 256x256 Pbx2.4mm 256x256 Pbc2.4mm 256x256 Pbc2.4mm 56x256 Pix.2.4m aam tochnatiim QQm Terhnetium Qqm Technetium 9Qm Technetium QQm Technetium All Images All Detectors Hard Copy Select Series: Stands Operand 2 Series 1: Entire Series 10 % % 100 100 100 RLAT 601K LLAT 468K RAO 900K Duration:146sec Duration:146sec Duration:161 sec Duration- 1615 Duration:170ser on: 170SEC 256x256 Pix2.4mm 256x256 Pix2.4mm 56×256 Pbc2.4mm 56X256 Pix: 2.4 mm 56X256 Pix : 2.4MM a6x256 Pix. 2. QQm Technetium QQm Technetium QQm Technetium All Images All Detectors Operation: Extract [Multiple Frame] 3. Result will have the extracted Result Series 1 % % images or phase 100 100 0 Suspend RAO 900K LPO 808K Duration:161 sec Duration:161 sec uration : 170s 256x256 Pix2.4mm 56x256 Pix2.4mm 2 56 Pix:2.4 mm Qam Technatium Qam Tech K All Images Setup 116 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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. esults Composite Curve Display Flow (Phase 1) Filling (Phase 2) Excretion (Phase 3) Tools X Patient Name: Renal Lasix Patient ID: Symbia Study Name: Renal Scan Operator Name: Study Date: 4/6/2006 Radiopharmaceutical 1 0.0 MBq (0 . 00 mC ) Tools X] V ? A Print Area Object Print Area Object 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 117 Turnover Workbook | Symbia Intevo (2, 6, and 16) Below are examples of how different display objects are used. Notes . 2/1/2001 DAI Text - Display Image Display Slice Display Curve Display 2/1/2001 AI DOU: 2121/1948 V ? Carda 1 Me Pref.DuitMe BB AL 3Y 2 Caraac tino Part Duit MO Mecards Petere 312001 9 Cane Diggla 118 Turnover Workbook | Symbia Intevo (2, 6, and 16) Text Notes Display ame: Renal, MAG3 Abnormal 614 Print DOB: 8/26/1940 Study Name: Renal Scan Study Date: 12/1/2000 Display al Resse summary Curve Parameters Right Total Split Function (%) 92.6 Display ochey Counts (cpm) 31635 7.351 2510.2 34145 Time of Max omnino 3.001 0 868 Time of % Maximini 9.294 0.859 Series Display Multiple Frame and ROI Statistics Patient Name: Renal, MAG3 Abnormal Patient ID: 614 DOB: 8/26/1940 Study Name: Renal Scan Study Date: 12/1/2000 2/ 9300004 12-48:34 PM Penai Scas: 12/1/02000 8 00 10 AM 119 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 CD or DVD into the recording device 4. Transfer>Record Offline Files 10.10 Dual Monitor Support The dual monitor option aids in positioning workflows across two monitors. 10.10.1 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. 10.10.2 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. 120 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 or CD 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 121 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 CD or 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 or CD devices and copied into the local database by using the following steps: 1. Insert CD media in the CD-ROM, CD_RW, or DVD drive (located in the Acquisition Console Tower) 2. Access the syngo Patient Browser 3. Click the CD_ROM, CD_RW, or DVD icon 4. Select the patient, study, or series to be imported 5. Transfer > Import 10.10.7 Ejecting a CD or DVD The CD or 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 CD_RW (or DVD, depending on the media) 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 cannot be restored. 122 Turnover Workbook | Symbia Intevo (2, 6, and 16) 10.10.9 MI Apps Cleanup Notes 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 Patient Applications Workflows Utilities 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 104 patients found on the system. Study dates: (all dates) Image Space Available : 45174 MB 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 5 Local Di 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 Di Series Tomo Extractor Proc Extracts a singl IQ SPECT good case2. Case #2 H0233973 1/25/2011 Local D: SITUS INVERSIS PROC This workflow 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 .. 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 Di SMARTZOOM NM CT FOV Verifi ... Acquires a NM Liver, Complete TC99m_SC 4/17/2003 Local Di SMV 1Det Spot Display Displays spot v. CALMA 0103/2000 Get Logs $/2001 Local D. SMV 3 Phase Bone Display DISPLAYS A MI Apps Local D. SMV Cardiac Proc. processes a ga syngo MI Apps Cleanup 12003 LUNG DISPLA. Start MI Apps $2009 Local Di SMV Lung Display 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 Di 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 Di Static Display Displays static . eventvwr.msc ECAM 2/26/2002 Local Di 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 Div Static Merge Proc Merges 1 to 20. shutdown_at_twenty_hour.bat Programs pory. Workplace SYMBIAO Stage: A aunch Suspend Complete Documents tus: All Settings Search Bun ... O Shut Down ... Windows XP Professional Adds a Normal Priority Workist Item Checkup not completed, system should not be us 014 12:46:45 2. Select Force Shutdown of High-Level Processes. 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 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 NO ] 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 123 Turnover Workbook | Symbia Intevo (2, 6, and 16) Week One, Day Four Day Four: Topics • Troubleshooting • Review • Questions and Answers • Week One Exercises 124 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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. _____________________________________ 125 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 126 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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? ____________________ 127 Turnover Workbook | Symbia Intevo (2, 6, and 16) Week Two, Day One Day One: Topics • Overview of Symbia Intevo CT Features • Emergency Stops • CT Power • CT Functions on the Hand Control • CT Patient Bed • Patient Positioning Monitor (PPM) 128 Turnover Workbook | Symbia Intevo (2, 6, and 16) 12 CT System Overview 12.1 CT Control Box Notes SIEMENS (1) -- (6) (2) (7) ( 5 ) STOP (3) CO -f . -(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 129 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 @000000 0000000 00000000 00000000 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 130 Turnover Workbook | Symbia Intevo (2, 6, and 16) 12.5 Patient Positioning Monitor (PPM) Notes SIEMENS 1 (1)CT 2 Define Upper CT (2) Boundary Limits 4) (3) SPECT (5) 1.00 6) 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 131 Turnover Workbook | Symbia Intevo (2, 6, and 16) Week Two, Day Two Day Two: Topics • Setting up the scanner for CT Acquisition • Acquiring the CT scan 132 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 900 760 X D 09:05 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 133 Turnover Workbook | Symbia Intevo (2, 6, and 16) 8. The Patient Model Dialog window will appear. Select the desired Notes protocol from the menus. Patient Model Dialog Adult En Protocol & Replace ~ Child Append Topogram & Cut Keep RT Auto reference lines None ET 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: O Topogram MA , Abdomen 120 - Scantime 5.35 06 mm Chronicle Topogarn length 512 mm Tube position Top Bottom Lateral 1 Comments Tabl Position Height 328 5 - 100 0 Craniocaudal Load Routine Scan Auto Tasking AFE closed 27-1or 2007 14 3 2 8. Click Load 9. The topogram parameters are confirmed. 134 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Start Button 14) 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 Apps| Examination Viewing Filming 3D Patient TempPatient-1.3.15.2.22. Total mas Topogram Eff. MAS 30 CARE DOS+4D BONE 00 KV 130 - CTDIvol 4.01 mGy Scan time 21.98 52| Delay 35 Slice 5.0 mm Acq 6 × 1.0 mm No. of images 31 Comments Range: Begin End 14110 1561 0 able Position Height Fond Recor 369.0 222. Craniocaudal Scan Recon Auto Tasking Last Checkup 27 h aco Select Setup/Check 7/17/2012 10-133 16. Review and modify the acquisition parameters if required. 135 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Abdon enfo.Hne (ACLt) abdomen 123 10.10 14-13:24 07-31D Total mas 164 Trovigoth bomtren CHRONICLE bw a. Hecon 136 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 MI Apps Examination Viewing Filming SPECT_CT_BONE (Adult) Temp, Patient TempPatient-1.3.15.2.22: Total mAs: o Topogram U Recon job Series description AC BONE 5.0 B08s BONE 00 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 2: FOV 468 mm 2 No of images 3 Center X Overview Center Y -16 mm2| Comments Mirroring None Load Extended CT scale Recon Routine Scan Recon Auto Tasking ome 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 1 4 6 001 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. 137 Turnover Workbook | Symbia Intevo (2, 6, and 16) Week Two, Day Three Day Three: Topics • Image Registration/Fusion with MI Applications software • Acquiring the CT Scan • syngo Viewing Task Card • 3D Task Card • syngo Image Fusion • Workstream 4D 138 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 D Settings Registration 2. Click the Registration Tab Object vs Target Optional vs Objec Optional vs Targe Transverse Sagittal AC CT_BoneSPECT 5.0 B08s, 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 0 139 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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. 0- (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. Settings Registration o Object vs Target Object vs Target Matrix Default Optional vs Object Matrix O Optional vs Object Optional vs Target AC CT_BoneSPECT 5.0 8085, 75712005 Sagittal Bone SPECT-CT [Recon - NOAC 1. 1/12/2012 41 % 1. Move the 60 Alpha Blending tool to middle of 2. Scroll to select reference 3: 305 9 O ansverse Sagitta Corona .................... Rotation Z 0 Rotation X 0 140 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 Settings Registration o Object vs Target Object vs Target Matrix Optional vs Object Matrix O Optional vs Object Default Default O Optional vs Target Sagittal Bone SPECT.CT (Recon- NOAC 1. 1/12/2012 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 S. 4.8 P: 305.0 808s 64 Compressed Transverse Sagittal ........... ..................... .................. Rotation Z 0 Rotation X 0 Translation (mm): X 0 YO ZO Landmarks .. 141 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 142 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 CT NM (1) 50% 50% 100% (3) Color Lookup table Gray Scale (8 Bit) Hot Body (& Bit) Window Valus SUV (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 143 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 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. PAISLO CRotating Mil' Biogragh, Sentabon 162 F SUV F/ 18 144 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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. 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. 2 3 ........................... 4 5 6 145 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 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 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 Fused I 8. VRT Thin – Volume-Rendered 8 Projection Thin 146 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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. 147 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 mage 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. 148 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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. 149 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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. Recon job 1 8 8 4 8 8 7 8 Series description Abdomen 5.0 SPO ax Slice 5.0 mm Recon job type @ axial 6 3D IRIS 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 2: 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. TEST. PATIENT TEST. PATIENT Hospital 01234567 "12-Sep-1962, M. 50Y 01234567 "12-Sep-1962, M. 50Y 12-Sep-2012 12-Sep-2012 18:15:14.39 18:15:14.39 MPR 2 MPR 2 AL FI 5 SL 5.0 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 T-1 Planning base Abdomen 5.0 B30f 512 square ST, PATI512 non-square :34567 Total mAs: 1033 256 non-square(reduced image resolution) LAJ 28 SL3.0 2 98 SL3.0 150 Turnover Workbook | Symbia Intevo (2, 6, and 16) 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 1 8 8 8 8 8 7 8 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 326 mm No. of images 26 Comments Routine Scan Recon Auto Tasking 5. Click Recon to begin the reconstruction of the 3D series. Recon 151 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 Local Contact Information present in individual cases. Siemens Medical Solutions USA, Inc. Siemens reserves the right to modify the 51 Valley Stream Parkway design, packaging, specifications and options Malvern, PA 19355-1406 described herein without prior notice. Please USA contact your local Siemens sales representative Telephone: +1-888-826-9702 for the most current information. www.usa.siemens.com/healthcare Note: Any technical data contained in this document may vary within defined tolerances. Global Business Unit 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 60192-2061 Order No. A914CX-CS-151338-P1-4A00 USA Printed in USA 05-2015 | All rights reserved Telephone: +1-888-826-9702 © 2015 Siemens Medical Solutions USA, Inc. www.usa.siemens.com/healthcare Global Siemens Headquarters Global Siemens Healthcare Siemens AG Headquarters Wittelsbacherplatz 2 Siemens AG 80333 Muenchen Healthcare Sector Germany Henkestrasse 127 91052 Erlangen Germany Telephone: +49 9131 84-0 www.siemens.com/healthcare www.siemens.com/healthcare

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