Symbia T and Intevo Excel Turnover Workbook

SIEMENS SIEMENS Symbia Intevo Symbia T and Intevo Excel Turnover Workbook www.usa.siemens.com/education Answers for life. Table of Contents Introduction. . . . . . . . . . . . . . . . . . . . . . . . 3 Manually Registering a New Patient . .36 Week 2 62 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Registering an Existing Patient. . . . . . . 36 Day One 62 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Registering a Patient from the HIS/RIS. .36 CT System Overview . . . . . . . . . . . . . .62 Learning Objectives. . . . . . . . . . . . . . . . . 3 Positioning the Patients for Exams.. . .37 Emergency Stop . . . . . . . . . . . . . . . . . 63 Learning Materials. . . . . . . . . . . . . . . . . . 3 Processing Workflows. . . . . . . . . . . . . .38 CT Power On/Off. . . . . . . . . . . . . . . . . 63 Quality Control Activity. . . . . . . . . . . . 38 CT Table and Hand Controller . . . . . . 63 Week 1 4 Dynamic Correction. . . . . . . . . . . . . . . 39 Day One . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Tomo Correction. . . . . . . . . . . . . . . . . . 41 Day Two . . . . . . . . . . . . . . . . . . . . . . . .64 Overview of Symbia T . . . . . . . . . . . . . . . 4 AutoRecon Activity. . . . . . . . . . . . . . . . 42 CT System Overview Continued . . . . .64 Camera Detectors . . . . . . . . . . . . . . . . . . 5 Flash 3D. . . . . . . . . . . . . . . . . . . . . . . . 43 Patient Positioning Monitor (PPM). . . 64 Patient Table . . . . . . . . . . . . . . . . . . . . . . 6 Acquiring the CT Scan . . . . . . . . . . . . 65 Integrated Collimator Changer. . . . . . . 7 Day Three . . . . . . . . . . . . . . . . . . . . . . 44 Automatic Collimator Changer. . . . . . . .7 Organ-Specific Processing . . . . . . . . . 44 Day Three. . . . . . . . . . . . . . . . . . . . . . .68 Hand Controller. . . . . . . . . . . . . . . . . . . . 8 Gastrointestinal Processing . . . . . . . . 44 Image Registration/Fusion (MI Apps) . 68 Patient Bed Accessories. . . . . . . . . . . . . 9 Hepatobiliary Processing . . . . . . . . . . 45 Viewing Data in the Setting Gurney and Wheelchair Height . . 9 Planar Gated (MUGA) Processing . . . 45 syngo Viewing Task Card. . . . . . . . . . .69 Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . .9 Lung Processing . . . . . . . . . . . . . . . . . 46 3D Task Card. . . . . . . . . . . . . . . . . . . . 69 Patient Positioning Monitor (PPM) . . . . . 9 Renal Processing . . . . . . . . . . . . . . . . 47 Loading the CT Images. . . . . . . . . . . . 69 Workstations . . . . . . . . . . . . . . . . . . . . . .10 Thyroid Processing . . . . . . . . . . . . . . . 48 Loading the Nuclear Images . . . . . . . .69 Quality Control . . . . . . . . . . . . . . . . . . . 11 Pixon Processing . . . . . . . . . . . . . . . . . 49 Adjusting the CT/Nuclear Balance Ratio .69 Symbia T Daily QC Flow Chart. . . . . . . . 12 Series Calculator . . . . . . . . . . . . . . . . . 49 Symbia T Weekly QC Flow Chart. . . . . . 12 Series Reformat . . . . . . . . . . . . . . . . . . 49 Day Four. . . . . . . . . . . . . . . . . . . . . . . .71 Symbia T Monthly QC Flow Chart. . . . . 13 Series Filter . . . . . . . . . . . . . . . . . . . . . 51 Week Two Exercises. . . . . . . . . . . . . . .71 System Daily Shutdown and Startup.. 14 Static Merge . . . . . . . . . . . . . . . . . . . 52 Restarting Additional Workstations. . 14 Series Extract . . . . . . . . . . . . . . . . . . . 52 Appendix A: . . . . . . . . . . . . . . . . . . . .72 Daily QC . . . . . . . . . . . . . . . . . . . . . . . . . 15 Flexible Display . . . . . . . . . . . . . . . . . . 53 Appendix B: . . . . . . . . . . . . . . . . . . . . 78 Weekly QC . . . . . . . . . . . . . . . . . . . . . 19 Saving JPEG and AVI files . . . . . . . . . . 55 Monthly QC . . . . . . . . . . . . . . . . . . . . 20 Dual Monitor Support . . . . . . . . . . . . 55 CT Daily QC . . . . . . . . . . . . . . . . . . . . 27 Patient Browser . . . . . . . . . . . . . . . . . 56 Accessing the Patient Browser . . . . . 56 Day Two. . . . . . . . . . . . . . . . . . . . . . . . 30 Patient Databases . . . . . . . . . . . . . . . 56 Overview of MI Apps Workstation. . . .30 Correcting Patient Name, Command Module. . . . . . . . . . . . . . . .30 ID Number, and Other . . . . . . . . . . . . 57 Patient Browser. . . . . . . . . . . . . . . . . . 30 Rearranging a Patient Series . . . . . . . 57 Workflow Template Browser . . . . . . . .31 Manually Transferring Data . . . . . . . . 57 Workflow Manager . . . . . . . . . . . . . . 31 Manually Archiving Data . . . . . . . . . 57 Workflow Navigator . . . . . . . . . . . . . . 31 Retrieving Data from Archival Device. 58 Launching a Workflow . . . . . . . . . . . . 31 Ejecting a CD or DVD . . . . . . . . . . . . . 58 Acquisition Workflows . . . . . . . . . . . . 33 Deleting Data . . . . . . . . . . . . . . . . . . 58 Acquisition Types . . . . . . . . . . . . . . . .33 MI Apps Cleanup . . . . . . . . . . . . . . . . 58 Acquisition Tab . . . . . . . . . . . . . . . . . .33 Analyzer Tab . . . . . . . . . . . . . . . . . . . .35 Day Four . . . . . . . . . . . . . . . . . . . . . . . 60 Display Analysis Tab . . . . . . . . . . . . . . 35 Week One Exercises. . . . . . . . . . . . . . .60 Modifying and Saving a Workflow Template. . . . . . . . . . . . . . 35 Patient Setup and Positioning. . . . . . . 36 2 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® T and Intevo Excel components your system. • Demonstrate the operation of the gantry • Demonstrate the operation of the Patient Handling System (PHS) 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 • Describe the function of the MI Apps Workstation Provides the necessary knowledge and expertise • to accurately and safely operate the system. Describe the layout of the Command Module • 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 • opportunities. 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 T and Intevo Excel • Demonstrate the operation of the gantry • Demonstrate the steps in setting up and acquiring a CT study • Demonstrate the steps to perform Image Fusion in MI Apps software • Describe the function of the 3D Task Card • Demonstrate the steps to perform image fusion in the 3D Task Card 3 Week One, Day One Day One: Topics Notes • Overview of Symbia T and Intevo Excel • 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 • Weekly QC • Monthly QC Overview of Your Symbia T and Intevo Excel (1) ( 2 ) (10) -(8) (3) (15) 14) (4). (9) (9) (11) (12) (13) (5) - (6) - (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 9. Touch Pads 10. NM Detectors (2) (3) 1. External ECG R-Wave Trigger Connection 2. Hand Control Connection 3. External ECG Power Outlet 4. SNAC Power 5. Camera Power Switch 6. Motion Power Switch 4 Week One, Day One Camera Detectors Notes (2) (1) - 1. Touch Pads on Detectors 2. Touch Pads on Yokes 3. A touch pad covers three sides of the detector’s yoke (3). ( 1 ) (4) (2) 1. Auto Infrared Body Contour System (Light Rails) 2. Detector Look-Ahead Sensor 3. Yoke Look-Ahead Sensors 4. Gantry Sensors 5 Week One, Day One Patient Table Notes ( 2 ) (9) (12) (4) (3) (6) (8)-D (7) 11) (13) 1. Patient Positioning Monitor 2. Rear Bed 3. Foot End 4. Pallet with Pad 5. Patient Bed pivots way from gantry (not shown) 6. Patient Bed Handles 7. Docking Pin (beneath bed) – Foot Pedal not shown 8. ECG Connection 9. Pallet Handle 10. Bed Index (not shown) 11. Stationary Pin (beneath bed) 12. Bed Index Handle 13. Head End Weight limit: 227.2 kg or 500 lb WARNING: Do not exceed weight limit! Patient injury or system damage can result. The patient bed supports a patient weight of approximately 227 kg (500 lb). For the patient’s safety and to prevent pallet damage, do not exceed this weight limit. Pallet fully retracted measures 136.1 cm Pallet fully extended measures 214.0 cm (1) -(4) (2) (3) 1. Manual Integrated Source Holder 2. Point Source Holder 3. Line Source Holder 4. AutoQC Shielded Storage Area 6 Week One, Day One Integrated Collimator Changer (ICC) Notes (3) (2) (1) - NW 1. Integrated Collimator Changer with Handles 2. Drawer opened 3. Collimator clamp raised for collimator removal Automated Collimator Changer (ACC) (1) CAUTION 1. Automated Collimator Changer (ACC) ( 1 ) -(7) (2)- (6) (3) (4)- (5)- 1. Pinhole Collimator 2. Collimator Cart Drawer Numbering 3. Collimator in drawer, which slides in and out 4. Collimator Cart Connector 5. Collimator Cart Leg slid into patient bed guide for docking 6. Collimator Cart Drawer Handle 7. Collimator Cart Handle 7 Week One, Day One Hand Control Notes (1) (2) 3 1. Start/Stop Acquisition 2. Fast 3. Clear PPM ( 9 ) (2) (3) ( 10) (4) (11 ) (12) (5) (13) (6) (73 (14) 1. Detector 1 Counterclockwise 2. Detector 1 Toward White Orientation Dot 3. Detector 1 In 4. Gantry Counterclockwise 5. Detector 2 Toward White Orientation Dot 6. Detector 2 Out 7. Detector 2 Clockwise 8. Detector 1 Clockwise 9. Detector 1 Out 10. Detector 1 Toward Gray Orientation Dot 11. Gantry Clockwise 12. Detector 2 In 13. Detector 2 Toward Gray Orientation Dot 14. Detector 2 Counterclockwise (1) (4) (2) (3) (5) (6) (7) 1. Bed Up Button 2. Bed Out Button 3. Bed Down Button 4. Bed In Button 5. Gurney Height Button (Double Click) 6. Bed Index Button (Double Click) 7. Wheelchair Button (Double Click) 8 Week One, Day One Patient Bed Accessories Notes 1. Head Holder 2. Wholebody Armrests 3. Body Wraps 4. Patient Bed Ruler 5. Armrest 6. IQ SPECT Armrest (Optional) 7. Integrated ECG Setting Gurney and Wheelchair Height 1. Dock Patient Bed 2. Press Bed Out on hand control 3. Press and hold the Bed Up or Bed Down button 4. Release the button once the appropriate height is reached 5. Press and hold Gurney or Wheelchair Height button for 5 seconds Cleaning 1. Do not pour liquids on system 2. Spray cleaning solution onto cloth and wipe where necessary 3. Touch Pads: Use caution and avoid scrubbing detectors and touch pad surfaces 4. Disinfection: Lightly wipe with bleach, alcohol, or other germicides 5. Do not use abrasive cleansers or organic solvents Patient Positioning Monitor (PPM) SIEMENS (1) 1 0.0 kcts/s SPECT 2 0.0 kcts/s 22.0 cm 2) 136.1 cm W 95 % 100 % -6.0º -96.0º 34.4 cm 34.4 cm 1.00 1.00 5 HiResPar HiResPar View 1/2 (6) . 00:39 C x (7) 1. PPM Tab 2. Camera Configuration Tab 3. Reconfiguration Tab 4. ECG Tab 5. Offset Zoom/CT FOV Limit Tab 6. Collimator Change Tab 7. Setup Tab 9 Week One, Day One .media Notes (1) (2) (3) (4) (5) (6) (7) (8) M Workstations syngo® MI Workplace Image Control System (ICS) 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 LED Image Reconstruction System (IRS) Calculates the images for each CT slice and passes the data to the ICS. 10 Week One, Day One Quality Control *Acquisition of a bar phantom is not required by Siemens, but can be done at the discretion of the user. It is subject to state or federal requirements set forth in the user’s radioactive materials license. Performed Quality Control Procedure Source • Intrinsic Verification, or • 35 μCi of 99mTc, or Daily for NM • Extrinsic Verification, or • Co-57 sheet source • Extrinsic Sweep Verification • AutoQC source • CT Checkup – Every 12 hours • Daily for CT CT Quality - Daily • CT Calibration - after 1 hour or if ring artifacts occur • Weekly for NM • Intrinsic Verification with Tune 35 μCi of 99mTc, or • AutoQC source • Monthly for NM • Intrinsic Calibration with Tune 35 μCi of 99mTc, or • AutoQC source • • Multiple Head Registration (MHR) 1-2 mCi of 99mTc per source Monthly for NM 180° (Match sources within 20% for 99mTc only) • Head Alignment Verification • AutoQC source Monthly for CT • CT Constancy Test (Appendix C) • Every 6 months or per Regulatory/ Perform a leak test of the • License requirements automated quality control device Gd-153 line source and Co-57 point source sources • Intrinsic Calibration, and • Extrinsic Calibration for collimator If the collimator is damaged or • MHR for collimator • See source strengths above replaced • Head Alignment Calibration for collimator Notes 11 Week One, Day One Symbia T and Intevo Excel Daily QC Flow Chart Symbia T and Intevo Excel Weekly QC Flow Chart Daily NM QC Weekly NM QC Auto QC? Auto QC? Yes No Yes No Intrinsic or Extrinsic? Intrinsic or Extrinsic? NM Intrinsic Verification NM Intrinsic Auto with Tuning Verification Performs Int. Manual with Tuning Verification Flood Performs Int. Int. Ext Int. Ext and Ext. Sweep Flood Verification Flood Co57 Button Gd 153 Line Tc99m Co57 Source Source Point Sheet NM Intrinsic NM Extrinsic NM Intrinsic NM Extrinsic Verification Sweep Verification Verification Auto Auto Manual Manual Notes 12 Week One, Day One Symbia T and Intevo Excel Monthly QC Flow 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 MHR/COR 180º Config: Performed on most commonly used low energy collimator CT Constancy Notes 13 Week One, Day One System Daily Shutdown and Startup Notes Shutdown 1. Ensure all workflows and data are saved, suspended, or completed 2. System > End 3. Select Shutdown 4. Yes to confirm shutdown. This will shutdown the ICS and IRS 5. Press and hold the ICS and IRS UPS OFF button (0) until UPS powers down 6. Go to PPM > Setup tab 7. Shutdown 8. Proceed 9. When message appears to shutdown the SNAC, flip SNAC switch to OFF 10. Flip the CT Subpower system switch to OFF (green toggle) Startup 1. Turn ICS and IRS UPS button ON (I) 2. Turn SNAC switches ON 3. Before CT is powered on, reset emergency stop buttons: Press green RESTART button on side of gantry 4. Turn the CT subsystem power switch ON (green toggle) 5. syngo MI Workplace: Crtl, Alt and Delete to log on 6. Username and password: esoft Restarting the Additional Workstations (Processing, Reading Workstations) 1. Exit/Complete running all workflows and applications. Ensure that the Nuclear Medicine and CT gantries are powered on 2. On the syngo MI Workplace menu: System > End, Restart and Yes 3. To log on: Ctrl, Alt, Delete keys 4. Username and password: esoft 14 Week One, Day One Daily QC Notes Daily NM QC - Manual Intrinsic Verification – Manual 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 Tuning the System 7. 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 8. 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. 9. 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. 10. 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 11. Adjust table height to center the source so count rates are similar between heads. 12. 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. 13. If peak shift is >± 3%, you must exit the workflow, restart the workflow and Tune the system. Perform steps 8 and 9. 14. Go to the Acquisition tab, enter the date in series information and click Prepare Acquisition and Start to acquire the flood. 15 Week One, Day One Notes Review the Results 15. 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% 16. Make appropriate selections in the Hard Copy activity. 17. Complete the workflow. 18. Remove source and retract the source holder, remove the protective cover, and attach the collimators. Extrinsic Verification – Manual An extrinsic verification flood may be performed instead of an intrinsic verification, however the intrinsic verification should be performed once a week for the purpose of tuning the detectors. Setup 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. Click Prepare Acquisition and then 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. 16 Week One, Day One Review the Results Notes 8. 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. Daily NM QC - Automatic Scheduling AutoQC 1. Command Module > Options > Configuration Menu > MI Acquisition Settings 2. Adjust dates and time for AutoQC scheduled completion 3. Click OK Intrinsic Verification (Quick Flood) – AutoQC Setup 1. On workstation, highlight current QC patient 2. Double click the Intrinsic Verification Quick Flood workflow 3. Enter date on the series information tab 4. Ensure that nothing is obstructing the motion of the detector heads Acquisition 5. Return to AutoQC activity and click Start 17 Week One, Day One Review the Results Notes 6. 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% 7. Make appropriate selections in the Hard Copy activity 8. Complete the workflow 9. Attach the collimators 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 Acquisition 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 18 Week One, Day One Weekly QC Notes Weekly NM QC - Manual Follow the steps for the acquisition of Intrinsic Verification Manual. Tuning must be performed during this procedure as described in steps 7-10. Weekly NM QC – Automatic Setup 1. On workstation, highlight current QC patient 2. Double click the Intrinsic Verification Auto workflow 3. Enter date on the series information tab for both the Tomo Acquisition and Static Acquisition activities 4. Ensure that nothing is obstructing the motion of the detector heads Acquisition 5. Return to AutoQC activity and press Start. The system will proceed to remove the collimators for both detectors, tune each detector head, acquire an intrinsic verification flood and then recollimate and set itself up for the following day’s Extrinsic Sweep Verification Review the Results (Consists of Intrinsic Flood Verification and Extrinsic Sweep Floods) 6. 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% 7. 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% 19 Week One, Day One Monthly NM QC Notes Monthly Manual QC Intrinsic Calibration with Fine Tune – 35 uCi Tc99m Performs an Intrinsic Calibration and Intrinsic Verification 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 Tuning the System 7. 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. 8. 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. 9. 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 and Intrinsic Verification Floods 10. Go to 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 11. 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. 12. 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% 20 Week One, Day One Notes 13. 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. 14. Make appropriate selections in the Hard Copy activity. 15. Complete the workflow. 16. Retract the source holder and remove the protective cover. 17. Attach the collimators, home the system, and perform touch pad test. Multiple Head Registration (MHR)/ Center of Rotation (COR) — Manual Must be performed on most commonly used low energy collimators at 180º configuration. Setup 1. Prepare 5 1-2 mCi Tc99m point sources. 2. Home the system and remove the pad. 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. SIEMENS MHR Phantom . . . O O . O . O O Source Location Extra High Energy Collimator UHR.HRES,LEAP & Fan Beam Collimator SMARTZOOM Collimator All Others Use mild detergent to clean. Do not use alcohol based cleaners 5. On workstation, highlight current QC patient. 6. Double click the MHR/COR 180 Calibration 5 points workflow. 7. Enter date on the series information tab. 8. Ensure that nothing is obstructing the motion of the detector heads. Acquisition 9. Click the Prepare Acquisition and Start buttons. The system automatically configures the gantry and patient bed for the acquisition. 21 Week One, Day One Review the Results Notes 10. 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 22 Week One, Day One Head Alignment Calibration Results (SMARTZOOM) 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 11. Make appropriate selections in the Hard Copy activity. 12. Complete the workflow. 13. Remove the MHR phantom and replace the pad and home the system. Siemens recommends that the MHR/COR calibration be performed monthly as part of routine quality control. The user may acquire only the MHR/COR calibration at 180° for their most commonly employed low energy collimator. Values from that calibration may be checked against the values reported during the last full calibration of the 180° configuration for that collimator. If the recent calibration deviates by less than 0.5 pixels (2 mm) in x-shift/ center of rotation and y-shift/axial shift, and less than 0.1° in the back projection angle, then the calibration of the remaining collimators and configurations may be skipped. If the values fall outside the acceptable range, the MHR/COR for all the collimators and configurations should be performed. 23 Week One, Day One Monthly AutoQC Notes This procedure should be used if you have the AutoQC Productivity package. It performs the Intrinsic Calibration, Intrinsic Verification, MHR, and Extrinsic Sweep Verification. 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. Acquisition 8. Click the Start button in the AutoQC activity. Review the Results 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. 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 24 Week One, Day One Head Alignment Calibration Results (SMARTZOOM Notes 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. Siemens recommends that the MHR/COR calibration be performed monthly as part of routine quality control. The user may acquire only the MHR/COR calibration at 180° for their most commonly employed low energy collimator. Values from that calibration may be checked against the values reported during the last full calibration of the 180° configuration for that collimator. If the recent calibration deviates by less than 0.5 pixels (2 mm) in x-shift/ center of rotation and y-shift/axial shift, and less than 0.1° in the back projection angle, then the calibration of the remaining collimators and configurations may be skipped. If the values fall outside the acceptable range, the MHR/COR for all the collimators and configurations should be performed. 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% 25 Week One, Day One 12. If the values are not within the limits, click the button Notes Reject These Calibrations. Neither the calibration database nor the internal quality monitors are updated. 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. 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. 26 Week One, Day One CT Daily QC Notes Attaching the Phantom 1. Remove the pallet pad 2. Insert the bracket into the slot at the end of the patient bed (1) (2) (3) 3. Spin the bracket clamp to tighten it against the pallet 4. Place the CT quality phantom’s clamp over the bracket and tighten with the knob (1) ( 2) 5. Adjust the bed height so the bed index stage clears the detectors (approx. 16.5 cm) 6. Hand Control: Press Bed Index button twice 7. Press the CT Brain (Bed Up) button (1) 8. The Phantom will move into the gantry 27 Week One, Day One CT Checkup Notes 1. The Checkup Dialog box is automatically displayed after restart but if it’s not, pull down Setup > Checkup from the syngo menu on the Examination Card. For best image quality please run checkup procedure. Please leave the scan room The table wil move out of the gantry X-rays will be produced during the checkup procedure Time since last successil checkup: 05:42 Checkup Cancel Help 2. Click Checkup 3. Press Start on control box when prompted CT Quality (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 Positioning the Phantom 1. Double click the laser button to activate the lasers 2. Move PHS in and adjust until the phantom’s slice thickness etchings are aligned with the laser. 28 Week One, Day One Performing CT Quality 1. From the Examination Card, select Setup > Quality Notes 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 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 CT Constancy Test See Appendix C in the Operator’s Manual 29 Week One, Day Two Day Two: Topics Notes • Overview of MI Apps Workstation • Command Module • Launching a Workflow • Workflow Modification and Saving • Patient Setup and Positioning • Patient Registration • Acquisition Workflows • Processing Workflows Overview of MI Apps Workstation: MI Workplace Command Module Areas of Command Module 1. MI Apps (e.soft) Patient Browser 2. Workflow Template Browser 3. Workflow Manager Study Name ALL Show All Study Date ALL Network Category All Pestoen Up Time: 12 Mins Database. Local Find 18 studies found on the system. Study dates (all dates) Inage Space Available 75400 MB atient Name Patent D Study Nome Study Date |# Series | Database Locabor fone. 3 Phase 012718 Bone Scan 4/23/2002 Bone, Lumbar Tomo 673 Bone Scan 4/22/1993 Local Database Local Database Bone. Spine Torno 2: Bon, WB and Statics E CAM 81156 Bone Scan 11/30/1989 Local Database Bone Scan 4/19/2002 Brain, Ictalfinterictal Local Database 12345 Duet MEI Brain Scan Myocardial Pert 5/19/2003 2/1/2001 Local Database Local Database Duet MBI Duet Myoutew Myocardial Pert Myocardial Pert 1/25/2001 Local Database Cardiac 3. Dual Study Old .. Duet Myoview 1/9/2001 of Pert 1/2/2001 Local Database 124-58-5106 124-58-5100 3/25/2002 Local Database los Pert Local Database Duet Myoview 1 o Pert 3/25/2002 Local Database 2 12162212 lo Pert 1/8/2001 Local Database Jo Pert 2/21/2001 123456 Local Database COL91362704 Jo Pert 2/23/2000 Local Database Cardiac, Shurt First Pass COL91620666 Equilibrium Gate First Pass 1/7/2002 12/17/2001 Local Database Local Database FU 1 Siemens PET @/18/2002 FUI Philipps CT 8/6/2002 Local Database Local Database FU-6 e soft Fusion Di Bran 8/15/2002 4/5/2001 Local Database Perrose 0333443 GEEF Local Database ECAM Galbladder EF 2/22/2001 Local Database 4/1/2002 Local Database 912533 Galbladder EF 5/17/2000 callum. 2 WB & 1 Tomo Tumor Imaging Local Database Gastric Emp, Static A/P 2429453 5/17/2000 Local Database Gastric, Dynamic Single Is 520730 Penrose 7051808 Gastric Emptying Seted Bloodpool, TOMO Gastric Emptying 11/23/2001 2/20/2001 Local Database Local Database ting. Aerosol 12345 22085-48 1UOM Equilibrium Gate. Lung Verglation 2/20/2001 2/16/2001 Local Database Local Database ung. V/Q VM Data, AX Coroneries 381201STM 42711 Lung WO Scan 2/22/2000 Local Database 4/23/1997 Local Database ONNN Work Stars AM Scope AT Launch Suspend Complne 3 MI Apps (e.soft) Patient Browser Patient Browser Patient Register List Patients List Studies List Series Search Study Name: ALL Show Al Refresh Study Date: ALL System Up Time: 12 Mins Database: Local Find Summary 48 studies found on the system .. Study dates: (all dates) mage 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 Local Database Bone, WB and Statics 81156 Bone Scan 4/19/2002 Local Database Headings Brain, Ictal/Interictal 12345 Brain Scan 5/19/2003 Local Database Cardiac 1, Myo Perf Duet MIBI Myocardial Perf ... 2/1/2001 Local Database Cardiac 2, Myo Perf Duet MIBI Myocardial Perf ... 1/25/2001 Local Database Cardiac 3, Dual Study Old ... Duet Myoview Myocardial Perf ... 1/9/2001 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 ... 1/8/2001 Local Database OLLOOOONNN 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 Local Database Gallbladder 1, GBEF Dyn ... Penrose 0333443 GBEF 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 Imagina 5/17/2000 Local Database N N - 30 Week One, Day Two Workflow Template Browser Notes >Local Refresh Nohund Local or Workflows Category: All Network Auto Filter Category Cardiac Detector hase Bon Slice ... centering Detector Centering Convergen ... AO AO Auto Filter Workflow Display Example Example Example Template Dynamic Gated Tom AD AO AD List Example Example Example Gated Static (DH) Tomo (DH) WB and St. AO AD Example Example Example Extrinsic WB and T ... Wholebo ... WholeBo ... Calibration Extrinsic Extrinsic Full General Verification Dot Regen Slice 1 1 Workflow Manager Refresh Category Workstation Launch Suspend Category: All Workplace: SYNGO26 Work Status: AM Launch View PPM 1. Command Module > Utilities > View PPM Workflow Navigator # 1 Common Workflow Configuration #1 Data 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 Processing Configuration #2 Reccostruction Activity Activity A workflow that contains processing, displaying. PARde Daylar and hard copy in one workflow. Processing Flexible Activity Display Hard Copy Activity Flexible Display Hard Copy Activity Activity Canplots Hard Copy Activity 31 Week One, Day Two Notes Play Button Argestion Pause Button *+ suspend Suspend Button Complete Setup Launching a Workflow 2 Select Category Show AN Study Date ALL Category A Network System Up Time: 12 Mins Database: Local Fino 48 studies found on the system. Stady dates (al dates) Inage Space Available 75460 MB Auto Fiber Patient Name Patort D Study Nome Study Date |# Series | Database Locator Bone, 3 Phase 012718 Bone Scan 4/23/2002 Bone, Lumbar Tomo Bons, Spine Torno 2 Local Database Bons, WB and Statics E CAM 4/22/1993 Local Database 673 Bone Scan 11/30/1989 81156 Bone Scan Local Database 3 Cardiac Brain, Ictalintencial 12345 Bone Scan 4/19/2002 Local Database 5/19/2003 Local Database nase Bon. Detector Slice Centering Convergen Brain Scan Cardiac 1, Myo Perf Duet MBI Myocardial Part 2/1/2001 Local Database AD 1. Highlight Candiac 2 Mun Bart Mancandial Point 1/25/2001 ardrac 3. Dual Study Ofd . Duet Myoview Myocardial Pert 1/9/2001 Local Database Local Database Display Example SPONNN -- Patient Cardi ac 4, Stress & Rest 124:58-5106 Cardioc 4, Stress & Rest 124-58-5100 Myocardial Pert 3/25/2002 Dynamic Gated Tom Cardiac 5, Myo Perf Abno 3/25/2002 Local Database Local Database Myocardial Pert Local Database Local Database Cardiac 7. Profile Tc TI Duet Myoview 12162212 Myocardial Pert 1/8/2001 Cardi ac, Cardiac Motion 2/21/2001 Local Database Local Database Local Database 123456 Myocardial Pert Local Database Example Example Cardiac, Shurt COL91362794 Myocardial Pert 2/23/2000 Local Database Local Database Equilibrium Gate 1/7/2002 Local Database Local Database Gated Stade (DH) Tomo (De) Tomo (DH 3. Double First Pass COL01620666 First Pass 12/17/2001 Local Database Local Database Fusion 1, PETICT WB @18/2002 Local Database Local Database Fusion 1. PETICT WB FU 1 Siemens PET FUI Philipps CT 8/6/2002 Local Database Local Dacabase Click Fusion 6. MR/PET Head FU 6 Brans 8/15/2002 Local Database Local Database Example MB and T. Example Example Example Fusion Desplay. WB PET Galbladder 1, GBEF Dyn. e soft Fusion Di 4/5/2001 Local Database Wholebo WholeBo WholeBo Galbladder 2, GBEF Dyn Penrose 0333443 GBEF ECAM Gallbladder EF 2/22/2001 Local Database Local Database Local Database Workflow Gatbladder, Dyn & Stabc 912533 Gatbladder EF 4/1/2002 5/17/2000 Local Database Local Database Local Decobase Gallium, 2 WB & 1 Tomo 2429453 520730 Tumor Imaging 5/17/2000 Local Decobase Local Database Local Dacabase Exinsic Extrinsic Ful Gastric Emp, Static A/P Gastric Emptying 11/23/2001 Local Database Local Database Service Venfication Dot Regen Gastric, Dynamic Single Is. Perrose 7051808 Gastric Emptying Gated Bloodpool, TOMO Equilibrium Gate 2/20/2001 2/20/2001 Local Database Local Database 12345 Local Database 22085481UOIM Local Database Lung. Aerosol Lung. W/Q Lung Veralation MM Data, AX Coronaries 381201STM 42711 Lung WQ Scan 2/16/2001 Local Database Local Database 2/22/2000 4/23/1997 Local Database Local Database Intrinsic Intrinsic Intrinsic Local Database Local Database Colbracon Service Verification ONNN LC Vorkplace SYNGO26 Work Stairs A Launch Suspend Complace Stage: Al 1. Highlight the patient from Patient Browser 2. In the Workflow Template Browser > Select Category 3. Double click the workflow desired 32 Week One, Day Two Acquisition Workflows Notes Acquisition Types • Static • Dynamic • Whole Body • Tomo • Gated Planar • Gated Tomo • Dynamic Tomo Acquisition Tab Summary Tab Used to review the acquisition parameters. Acquisition Analyzer|Display/Analysis Patient Bone, 3 Phase & WB Docacade on Display Detector 2 Study Bone Scan Series Summary Series Information Camera Parameters Stop Conditions Nome Description Patient Name Bone, 3 Phase & WB Patient ID Symbia T Study Name Bone Scan Series Name Series Technologist Reading Physician Remaining Referring Physician Elapsed Organ Matrix Size Zoom 1.00 Camera Preset Phase Frame Detectors Orientation Patient Position Parameters Phase Both Detectors Prepare Acquisition Series Information Tab Series name is required. The rest of the fields are optional. Summary Series Information Camera Parameters Stop Conditi Series: Bone Flow Technologist: JD Reading Physician: Referring Physician: Organ: Skeletal Radiopharmaceutical Dose: Isotope: 25.0 99m Technetium Pharmaceutical: Interventional Drug Interventional Drug: Injection Time (hh:mm:ss): 0 Inject Dose (mg): 0 Camera Parameters Allows you to select matrix size, zoom, camera preset, detectors, apply uniformity correction, orientation, and body position. ummary Series Information Camera Parameters|Stop Conditi_ Camera Parameters Matrix Size: 64 X 64 Zoom. 1:00 Camera Preset Tc99m-NMG Detectors: Both Detectors - Apply Uniformity Correction Orientation Supine 33 Week One, Day Two Stop Conditions Notes Allows you to modify the stop conditions, label the view, and determine number of views. ummary 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 O Count Density Manual Time: sec Counts: 500 Kcts Any Window Group View Conector 1 Ant Detector 2 : Post Add View Insertoet Gate 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 Beats Autotracking Reject PVC Beats Beats To Reject Post PVC: PVC Threshold (msec): 300 Beat Histogram 100 80 60 40 Beats 20 0 20 40 60 80 100 140 180 220 Beats/Min . 1 Window ms/Beat Save Curve Acquire with Statics Camera Parameters|Stop Condition Static 2. Static Tab Stop Conditions Appears Time 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 Allows you to modify stop conditions for the statics acquired during a dynamic study, modify views, and change matrix size. Camera Parameters Stop Conditions Static Stop Conditions Start Time (mm:ss): Duration: StopTime: Camera Parameters Static Matrix Size: 64 X 64 View Names Anterior Detector 2 Posterior View Control Add View Insert View Update View Delete View ime Duration Stop Time Detector 1 Detector 2 20 min 22 .00 Anterior Posterior 34 Week One, Day Two 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 New Preset Name: v Detector 1 Peak Status Detector 2 NOT EAT 12 3 4 5 6 7 8 Save Preset Begin Peaking Pause Between Peaks Window Number | Center (kev) |Width (% ) Shift ( 6 ) 140 Type Photopeak Parent Display Analysis Tab Used to review images. Modifying and Saving a Workflow Template 1. Review the parameters in the current workflow template 2. Make appropriate modifications 3. Template > Save Workflow Template (to overwrite the current template) > OK [emplate Workflow Activities Save Workflow Template ... > OK Save Workflow Template As Template > Save Workflow Template As (to create a new template) ow Characteristics Enter New Workflow Name wonton those New Worldlow [emplate | Workflow Activities H Enter New Description (Optional) Workdow Descripbon This workflow acquites static acquisitions Save Workflow Template .. > Save Workflow Template As .. Select Icon JureToe 50 Salivary eland SORric Testicular thyroid Urecentic Vesical Caibration Concoince Display Dynamic Dynamic Tome Garnd Gated Tema Click OK to Save Cancel Enter the name, description, category, and appropriate icon and click OK. To modify the category list, Configure is found in this category drop down. Select this option and Add, Remove or Reorder the category list as desired. 35 Week One, Day Two Patient Setup and Positioning Notes Manually Registering a New Patient 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 PATIENT PROCEDURE Last name Accession No First name Request ID Title Suffix Requested ther Patient Name(s) procedure(s) Other Patient ID(s) Ethnic Group Study list Step 2 Military Rank Patient ID Delete Date of Birth Sex Male Female Othe Study Age Years Study comment Height [ft'in"] Weight [ 16] Address Patient position Additional info Institution name Details ... 1. Performing physician warren moore, md forming physician HOSPITAL NOTIMITISNI Referring physician 1. Operator Requesting physician 2. Operator Admitting diagnosis Step 3 Admission ID Preregie Exam Search Cancel Emergency Help 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 Registering a Patient from 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 36 Week One, Day Two Positioning the Patients for Exams 1. From the PPM, press the Reconfiguration tab Notes SIEMENS (5) (1) 90º 90º 76º 76º (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) 6. Select the patient and launch the workflow on the MI Workplace and start the acquisition (see page 32 for details in launching workflow) 37 Week One, Day Two Processing Workflows Notes Quality Control Activity (Motion Correction) Used on the following data types: • Cardiac Gated Tomo • Cardiac Non-Gated Tomo • Dynamic • Tomo • Dynamic Tomo Cardiac Gated Tomo and Non-Gated Tomo Correction 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 Settings Correction 2. Select Series Series: Stress Mibi-Gated [Corrected) Before Sinogram After Sinogram % 100 % 100 33 4. Click and drag red Linogram Linogram line to center heart 100 100 5. Click the Cine button to view 250 200 - Sum 150 18 2 100 Beats 50 3. Apply Beat Normalize (Optional) 0 10 20 30 40 50 60 70 80 90 100 120 140 160 180 200 220 Beats/Min O Quality Control To Beat Normalize Beat Histogram: . Beats/Min Beats vs. Projections Unapply Correction ms/Beat HR vs. Projections 6. Click Motion Correct Series button Motion Correct Series ... Isotope: Revert to Original 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 38 Week One, Day Two Notes Motion Correction Automatic Manual Automatic Correction Use All Projections M Shift all projections Isotope ~ Apply X Shift 7. Center red ROI over Apply Y Shift heart. Head Misregistration 100 224.99 264.99 304.99 344.99 384.99 X Motion Sinogram Linogram 224.99 264.99 304.99 344.99 384.99 Y Motion After % 100 100 33 224.99 264.99 304.99 344.99 384.99 X Motion O Sinogram Linogram 4.99 264.99 304.99 344.99 384.99 Y Motion 8. Click to Review cine 9. Click OK 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 Dynamic Correction 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 Before After % TRenal Mag 3 20 O Sum Sum 100 100 Quality Control Tools Unapply Correction 3. Select Motion Detector: Isotope : A Motion Correct Series ... Revert to Origina 39 Week One, Day Two 4. Choose for 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 Manua Manual Correction Results Detector: 1 Single Frame Mode 4. Choose correction Isotope A Multiframe Mode mode 5. Cross Tool 6. Shift Tools to make adjustments in position 20 0 Sum 100 0 7 Click to cine images X Shift: 10.00 Y Shift: 8 Click OK to accept the changes. OK 40 Week One, Day Two Tomo Correction Notes 1. Select the Quality Control Activity in the workflow 2. Pull down Series > Select appropriate series 3. Click Motion Correct Series button Settings Correction 2. Select the series Series: Chest Before Sinogram After Sinogram 100 Pelvis 100 O Linogram Linogram 10 100 Sum 10 % 100 0 Quality Control Tools Unapply Correction 3. Click to motion correct series Isotope: A Motion Correct Series .... Revert to Original 4. Choose for Single Frame Mode or Multiframe Mode 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 mode 6. Vertical Shift Tool to 5. Cross Tool make adjustments in _inogram 52 18 0 Sum 100 7. Click to cine images X Shift: 0.00 Y Shift: 0.00 8 . Click OK to accept the changes. OK 41 Week One, Day Two 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 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 Anterior Transverse Sagittal Coronal Data Selector % 71 7. Click and drag red lines to adjust range Scrollable Views Display Zoom Bone Scan - Thorax - Isotope A 3/17/2003 AutoRecon Anterior Transverse Sagittal Corona % 4 68 Flexible Display Scrollable Views -7 Display Zoom: 3rd Tomo for Non-AC - Isotope A Hard Copy Transverse Sagittal Corona 100 Scrollable Views o Display Zoom: 4th Tomo for Non-AC - Isotope A Anterior Transverse Sagittal Coronal % 100 Scrollable Views 0 Setup Display Zoom: eady 6. Click the Reconstruction tab 7. Click and drag the limits to adjust the range 42 Week One, Day Two Flash 3D Notes 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 Tl201 rest studies) Decrease subsets Decrease iterations Check for motion, and correct if needed 43 Week One, Day Three Day Three: Topics Notes • Organ-Specific Processing • Series Calculator • Flexible Display • Saving JPEG and AVI files • Dual Monitor Support • Patient Browser Organ-Specific Processing Gastrointestinal Processing 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 ngs ROI and placement ric empting [Results] 2/21/2014 Quality Contre 51 2. Click Cine button Switch to Cine Mode Isotope: 99m Technetium ROI Create ROI Using: - gom Technet .. Emptying Curves Composite Image -00m Techneti .. ] exible Display 600 100 500 400 Tfit 300 Tempty- Thalt Hard Copy 200 100 Counts per sec 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 Minutes 4. Click the ROI Tool Fr1 1179K 64x64 to redraw ROI if needed. Threshold Results Summary Parameter 99m Technetium ......... Bkga Correction Emptying 41 % Decay Correction Geometric Mean On Emptying begin (TO) 3 mins Emptying end 60 mins ROI Tool Complete Suspend 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 Techr 6. Drag Tfit to 99m Techneti .. Empt end of empty 99m Techneti .. 99m Techneti. 600 5. Drag to 500 start of empty 400 300 Tempty Thalf -------. 200 100 Counts per 7. Drag to position O 0 5 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 44 Week One, Day Three Hepatobiliary Processing Notes 1. Select the Gastrointestinal activity in the workflow Gallbladder 1 GBEF Dynamic, ECAM - GBEF. 2/22/2001 6 X File Gastrointestinal View Template Workflow Activities Help AI Settings ROLL Pan GallBladder [Results] 2/21/2014 Data Selector 33 Quality Control 0 3. Check for ROI placement 2 . Click the Cine icon 5. Drag to adjust Start 6. Drag to adjust End Tutops. com Technetium Create ROI Using: site Image Bem Techneti. Ejection Fraction Curves 4500 Max Flexible Display 4000 3500 Start 3000 2500 2000 Hard Copy 1500 End 1000 Min Counts per sec 500 C 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 O Minutes 4. Click to Fr:1 17002K 64x64 redraw the ROI Threshold Results Summary 25 Parameter 99m Technetium Bkgd Correction Ejection Fraction 85 % Decay Correction EF interval begin 2 mins ROI Tool EF interval end 35 mins Implete T Max 2 mins Composite Frame Range T Min 35 mins First Frame: 1 Setup Last Frame: 40 Moves the image position within the frame. Ctrl-click to center the image. ulator is RUNNING 2. Review results 3. See Settings tab to review or modify parameters for this activity 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 6 X ed Bloodpoo pool View Template Workflow Activities Help AI Settings (Processing > sults|Fitting Results 1. Click the Gated Bloodpool Data Selector Image & ROIs activity and the Processing Tab LAO-Gated [Results] 2/21/2014 % 100 Gated Bloo Ventricular ROI x Duration : 31 mser Turation 35 ms Flexible Display 5. Cine to check ROI Hard Copy 3 G E All Frame % Background ROI 2. Center LV ir green box Cancel 0 Fr.1 262K 6 1X64 Fr.11 260K 64x64 Edit ROI 6. Use to modify ROIs Suspend 3. Click to determine LV center 4. Click in center of LV Setup Determine LV center ... ROI Tool ... ROI Tool .. Ready 45 Week One, Day Three Lung Processing Notes 1. Select the Lung Processing activity on the ROI tab of the workflow 2. Review ROI Settings | ROI Regional Analysis Washout Analysis placement Perfusion Series Ventilation Series Perfusion Lung 2/24/2014 DTPA Aerosol Ventilation 2/24/2214 % % 100 100 100 100 1810 180 0 0 0 Perfusion RPO Perfusion LAO Perf Rt lat Lt Lat All Images @ [ All Images AR AR Off POST -ReWANT Post aerosol aerosol 100 % 100 100 13 2 O 0 Edit RO Threshold Adjust Frame Edit For Sh Xswift Threshold Adjust Frame X Shift. Y Shift : Y Shift: ROITO Angle: Angle: ROI Tool 3. Click to modify ROIs Registration 4. Click to adjust registration of the ventilation scan 2. See Regional Analysis tab to review or modify results for this activity 3. See Settings tab to review or modify parameters for this activity 46 Week One, Day Three Notes Renal Processing 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 EX File Renal Processing View Template Workflow Activities Help AI A 2. Review ROI ias Display ROIS Results placements Kidney Aorta Data Selector 5. Click to view results Left Kidney 81 Right Kidney Quality Control 3. Use sliders to edit thresholds Renal Processing Fr.1 1752K 256x256 Fr:1 294K 256x256 Flexible Display Edit ROI Edit ROI Threshold : Threshold : 31 ......... Hard Copy ROL Tool. ........................................................... ................................. osite Image Composite Image First Frame: 60 First Frame: 1 4. User ROI Last Frame: 70 Last Frame: 30 Tool to redraw ROI ispent Setup Ready Renal MAG 3. Symbia T - Renal Scan, 1/26/2006 File Renal Processing View Template Workflow Activities Help AI A Settings Display ROIs Results Kidney Aorta Data Selector Left Kidney Kidney Right Kidney Left Backgr ... Right Back ... Quality Contr Processing Fr.1 1752K 256x256 Fr:1 294K 256×256 Table of Patient Parameters Parameters Values Counts/Second Renal Protocol Generic (None) 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 34 36 38 Sex Other Age Reference BSA 1 73 m 2 1.73 m Hard Copy Split Uptake Interval ( ... 2.0 - 3.0 Radiopharmaceutical 10.0 mCi 99m Technetium MAG3 Method Adult Lon Kidhay Plate Kidney Flow Hematocrit 0.00 Table of Result Summary Parameters Left Tota Split Function (%) 46.9 53.1 Kidney Counts (cpm) 57001 64629 21630 Renal Retention 0.182 0.248 Time of Max (min) 2.501 3,001 Time of 1/2 Max (min) 7.634 9.990 Time from Max to 1/2 M ... 5.134 6.989 Counts/Second 883838885888 Setup ightness Levels: 0% (0) -> 8% (187) 47 Week One, Day Three Thyroid Processing Notes 1. Select the Thyroid Processing activity Thyroid 1123 Uptake Syringe, H46545 - Thyroid Scan, 12/18/2008 File Thyroid Processing View Template Workflow Activities Help AI A Settings ROIS Result Series: CAPSULE 3. Select series Data Selector CAPSULE 12/18/2008 % 100 2. Select ROI Tab 6. Click Results tab Thyroid to review results Processing 3. If necessary, you can drag/drop correct images into the fields below. Flexible Display CAPSULE 134K Durationiodine Hard Copy hyroid Image Full Syringe Empty Syringe Antecubit % 4. Review ROI placement 5. Redraw ROIs, if needed, using ROI Tools 0 Ant 24 HR 50K Duration:511 sec CAPSULE 134K Durata-iodine 256x256 Pic:0.7mm 123-lodine Edit ROI Edit ROI Edit ROI Treshold Threshold : Threshold : ........... Setup ROI Tool .. ROI Tool ROI Tool ROI Tool .. rightness Levels: 0% (0) -> 91% (202) Simulator is RUNNING Thyroid 1123 Uptake Syringe, H46545 - Thyroid Scan, 12/18/2008 le Thyroid Processing View Template Workflow Activities Help AI O A Settings ROls Result Data Selecto Thyroid Image 100 Result Statistics Total Left Right/Left Uptake Rate (%): 12.5 88 3.6 24 Thyroid Uptake Rate/Pixel (%/Pixel) : 3.1e-00 3.5e-00 2.3e-00 1.5 Processing Vert. Length (cm) : Hor. Length (cm) : Flexible Display Area (cm2) : 22.8 14.0 8.8 1.6 Volume (cm3) : Allen Weight (g) : Hard Copy Pixel Size (mm) : 0.7 Total Count (KCounts) : Right LOIL 5.1 5kg 12.4 0.4 Number of Pixels : 2494 1564 255 Ruler Location Calibration Information Isotope : 123 lodine Injected dose (Kcpm): 59.6 Full Syringe Activity (Kcpm): Ant 24 HR 50K Duration:511 sec 256x256 Pic0.7mm 123-lodine Empty Syringe Activity (Kcpm): Show Regions M Smooth Restore Antecubital Activity (Kcpm): suspen Setup Click to display the Result tab. 2. See Settings tab to review or modify parameters for this activity 48 Week One, Day Three Notes Pixon Processing (Optional Purchase) Clinical value: The Planar Processing activity uses the patented Pixon® Method to enhance the quality of planar images as though they were obtained with higher counts. This enables you to produce planar images of comparable quality to those obtained using your current protocols from raw images acquired using either lower than standard acquisition time and/or lower than standard radiopharmaceutical dosage. Alternatively, you may elect to maintain the counts and enhance image quality, or both reduce counts and enhance image quality. Display Input Series Statics Fatics Statics [EPP-Complete] 2/24/2014 % Statics 4/19/2002 % 30 % 0 100 100 100 256x256 Pbc2.4mm 99m 100 100 00 100 PLAT 601K Duration: 146sec 256x256 Pix.2.4mm 99m Technetium Auto RAO 900k Duration: 161 sec 256x256 Pc2.4mm 99m 0 808k Duration: 161 sec 56X256 Pix.2.4mm 99m 100 100 100 100 A98238 Piration: 1705 BC 256x256 Pix2.4mm 99m 3 of 8 frames processed. Series Calculator Series Reformat The Series Reformat activity is used to perform the following for data manipulation: Resize Matrix 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 Select Series: Bone Statics MOI Tool .. Revert To Original Input 1: Entire Series Matrix Size: 128 Resize 100 100 100 100 100 Series Reformat 0 0 0 R Anterior L 377K L Posterior R 275K RT LAT 205K LT LAT 215K ANT ARMS UP 664K POST ARMS UP 736K Flexible Display Duration:300sec Duration:300sec Duration:300sec Duration:300sec Duration:300sec Duration:300sec 28x1 28 Pic4.8mm 128x128 Pic4.8mm 128x128 Pbc4.8mm 128x1 28 Pic4.8mm 128x128 Pbc4.8mm 128x128 Pbc4.8mm 99m Technetium 99m Technetium 99m Technetium 99m Technetium 99m Technetium 99m Technetium Setup 30 [ All Images All Detectors 49 Ready imulator is RUNNIN Week One, Day Three Image Masking Notes Hands-on Lab Computer MI Sim 1 You are in Hands-on Lab Bone WB and Statics, ECAM - Bone Scan, 4/19/2002 Eile SeriesReformat View Template Workflow Activities Help AI A Settings Series Reformat Data Selector Select Series: Wholebody ROI TOOL ... Revert To Original Input 1 : Entire Series Matrix Size: 256 Resize 100 % 100 Series Reformat 2 . Select the ROI Tool Flexible Display 1. Select image Hard Copy 0 RT ANTERIOR LT LT POSTERIOR RT 5758K 5145K Duration:1701 sec 56x1024 Pix 2 . 4 mm 256x1024 Pix:2.4mm 99m Technetium Setup [ All Detectors Ol Tool ROI User Interaction Prompt ROI Tool . 1x1 1x2 2x1 2x2 Sum : 1 Select ROI User Mask 3. Select ROI Tool used to draw . Draw mask ROI Color O RT ANTERIOR LT 5758K Duration:1701 sec 256x1024 Pix:2.4mm 99m Technetium Edit ROI 5. Select to Keep ROI Name : Inside or Outside Threshold : User Mask Keep Outside Keep Inside Cance To remove masking, click Revert to Original button 50 Week One, Day Three Notes Series Filter 1. Click on Series Filter activity and Series Filter tab Hands-on Lab Computer MI Sim 1 You are in Hands-on Lab DE MUGA 5 2 View. Symbia S - Equilibrium Gated Cardiac, 1/26/2006 Eile Series Filter View Template Workflow Activities Help O AI SettingsSeries Filter 3. Select Spatial or Temporal filter Select Series: LAO Revert Series Original Series 1: Entire Series 100 Series Filt 2. Select series LAO 5531K Duration:599sec 64x64 Pix:3.6mm 99m Flexible Display Technetium Hard Copy Filter Applied: No Filter Filtered Series 1 0 LA0 5531 K Techmm 99 uspen Setup Filter Tool Wiener [S] Delete Save Test Specified Filter 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 ON - After . 5. Make desired updates to filter parameters 6. Trial Filter to 100 visually inspect. Size Wiener - 2D SNR 0.26 WHM mm Update Trial Filter 6ª 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 Cancel 2. See Settings tab to review or modify parameters for this activity 51 Week One, Day Three 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 Lung Aerosol, ECAM - Lung Scan, 2/16/2001 File Flexible Display View Template Workflow Activities Help X O AI X Y Single Series Static Display Patient Name: Lung Aerosol Patient ID: ECAM DOB: 7/5/1962 Study Name: Lung Scan Series Study Date: 2/16/2001 Arithmetic Perfusion Lung [Concatenated] 2/24/2014 x + % % 100 100 Arithmes 0 0 0 0 O Series Ant aerosol 198K Post aerosol 198K RAO Aerosol 198K LPO aerosol 198K Rt Lat Aerosol 150K Arithmetic Duration:203sec 128x128 Duration:203sec 128x1 28 Duration:268sec 128x128 Duration:268sec 128x128 Duration:315sec 128x128 % % % % % 100 100 100 100 100 Series Arithmetic 0 0 0 0 Lt Lat Aerosol 151K RPO aerosol 198K LAO aerosol 198K Perfusion RPO 316K Perfusion LAO 316K 10 Dicom Toolbox Duration:315sec 128x128 Duration:298sec 128x1 28 Duration:298sec 128x1 28 Duration:78sec 128x128 Duration:78sec 128x128 % % % % % 100 100 100 100 100 Flexible Display 0 O O O O Perf Rt lat 316K Lt Lat 316K Duration:127 sec Perf RAO 316K Perf LPO 317K Perf ANT 495K Duration:127sec 128x128 128x1 28 Duration:79sec 128x128 Duration:79sec 128x128 Duration:96sec 128x128 % 100 complete uspen 0 Perf POST 495K Duration:96sec 128x1 28 Setup (8:0%,T:100%) Ky AR All Images Series Extract Select the Series Extract activity Bone WB and Statics, ECAM - Bone Scan, 4/19/2002 File Series Arithmetic View Template Workflow Activities Help × Jo,9. C Process Workflow Data Select 1. Select the images or phase to 2. Click the Settings Ari extract in Operand 1 Extract icon Select Sen perand 1 Series 1: Multiple Frame % 10 100 % 100 100 Arithmetic RLAT 601K LLAT 468K RAO 900K LAO 901K exible Display 256 X 25 6 Pix 2 . Am Duration:146sec Duration:161 sec 56x256 PC2 sec Duration: 170sec 56X256 Pix 2.4 mm Duration:170sec 256x256 Pix:2.4mm 256x256 Pic:2.4mm aam Torhnatiim 256x256 Pix:2.4mm QQm Technotium Qqm Technetium QQm Torhnetium Iam Tochnatif um " Qqm Technetium All Images All Detectors Hard Copy Select Series: Statics Operand 2 Series 1: Entire Series 0 0 0 0 RLAT 601K LLAT 468K RAO 900K RPO 813K Duration:146sec Duration:146sec Duration:161 sec Duration : 161 sec Duration:170sec 29puration:170sec 256x256 Pixc2.4mm 256x256 Pix:2.4mm 256x256 Pbc:2.4mm Son:161 sec 256x256 Pbc2.4mm 256X256 Pix.2.4mm Qam Technotium Qam Technotium Qam Tarhnetium Qam Technatium All Images All Detectors Operation: Extract [Multiple Frame] 3. Result will have the extracted images or phase Result Series 1 % 100 Suspen RAO 900K LPO 808K RPO Ser Duration: 161 sec Duration:161 sec 256x256 Pix2.4mm 256x256 Pix:2.4mm 56x256 Pix: 2.4 mm Qam Technetium Qam Technetium All Images Setup 52 Week One, Day Three 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 DOB: 12/30/1981 Study Name: Renal Scan Operator Name: Study Date: 4/6/2006 Radiopharmaceutical 1: 0.0 MBq (0.00 mCi) Tools X V ? ? Print Area Object Print Area Object Results Composite, Series Display (#25) Renal Lasix, Symbia L ...... Renal Scan 4/6/2006 7:44:24 AM #1000 Renal [Results] 10/8/2013 1:45:44 PM Print Area Object Below are examples of how different display objects are used. Text - Display Image Display Slice jui Display Curve - Display 53 Week One, Day Three Notes * DAI Carda 1. Me Pef. DuitMES I Gatad Sovss 31/0001 11 51 Caraac to Put.Duit ME 13/ 10001 8 57 43 AM 09/2006 12: 39: 00 PM #1 mal mit: 2/10001 9:42:54 AM Cune Display Carsac 1. My Pet, Duet ines Text Display ame: Renal, MAG3 Abnormal HE ID: 614 Print DOB: 8/26/1940 Study Name: Renal Scan Study Date: 12/1/2000 Display of Resuit Summary Curve Parameters Total Split Function (%) 92.6 7.351 Display Kchey Counts (cpm) 31635 2510.2 34145 Time of Max omnino 3.001 0 868 Time of % Maxémini 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 Cuneo Display 1 9300004 12 41 34 7M2 Mutiple Framwe and ROI That itca Draplay Peral sig) Aonommal 654 Pas San:12/1/2000 # Os 10 AM Penal Scas 12/1/2000 #0€ 10 AM 730/2004 12:41:34 PM May 3 12/9/2000 8 21:58 AM 54 Week One, Day Three Saving Pages as JPEGS and AVI Files Notes 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 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 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 Dual Monitor Support The dual monitor option aids in positioning workflows across two monitors. Launching a Workflow on Left Monitor To launch 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. Launching a Workflow on Right Monitor To launch 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. 55 Week One, Day Three Notes Patient Browser 111 2D ANDHER SAVE BREENSE [1] PETOMFA11 Cardiac 7 Premio Te Lood DEcaboso 15 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. 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. The Local Database is where the patient data and results of the examinations performed on the local workstation are stored. The Scheduler contains the data on all pre-registered patients. One or more DVD or CD devices may be connected to MI Apps workstation. 56 Week One, Day Three Notes 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 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 Manually Transferring Data 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 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 57 Week One, Day Three Retrieving Data from an Archival Device Notes 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 ICS 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 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) Deleting 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. MI Apps Cleanup The MI APPS Cleanup activity is used when the system becomes unstable/locks up. When using the MI Apps Cleanup activity, all data in currently running activities is lost. 1. From the Windows Start menu, select MI APPS > MI APPS Cleanup Study Name: ALL Show All Local MI Apps Study Date: ALL Category: 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. Examination Gastric Emptin- Normal, dyn- normal w/ solids 12345678 2/20/2001 4/1 1/2008 Local D. Series Static Extractor Proc Extracts a singl Gastric Empting abnormal, dynamic-abn. w/ s ... 212 Local D. Series Tomo Composite Proc Creates a stati .. Gastric Empty (4 hr), Pt 1 06514450 11/20/2009 Local D. Series Tomo Detector Extractor EXTRACTS D .. Gastric Emptying, Dual Isotope 30644173 7/6/2009 Local D. Series Tomo Extractor Det 2 EXTRACTS D .. GI Bleed (positive), 2 phase dynamic & statics 1000469630 2/21/2008 Local D. Series Tomo Extractor Proc Extracts a singl IQ SPECT good case2, Case #2 H0233973 IQ SPECT SYMBIAT, symbiaT 0171544 1/25/2011 SITUS INVERSIS PROC This worklow w 3/20/2012 Local D. Local D. SITUS INVERSIS REST ACQ ACQUIRES A .. IQ SPECT, NICE CASE IQ SPECT, T6 H1151800 2/28/2011 Local D: SITUS INVERSUS gSTRESS ACQ ACQ SITUS IN .. 11.01.19-09:18 1/19/2011 Local D: Situs Inversus Proc v4_0 This workflow w 0000 IQSPECT 2. T2 11.01.19-08:17 .... 1/19/2011 IQSPECT, SYMBIA S SYMBIA S 3/20/2012 Local D. Local D. Slice Comparison Displays and c .. Viewing SMARTZOOM NM CT FOV Calibr ... Acquires a NM Liver Hemangioma 110099 12/29/2006 Local D: SMARTZOOM NM CT FOV Verifi ... Acquires a NM Liver, Complete TC99m_SC Local D: SMV 1Det Spot Display Displays spot v. HE MIAPPS Get Logs Local D. SMV 3 Phase Bone Display DISPLAYS A .. Local D. SMV Cardiac Proc. SMV Lung Display processes a ga EHH syngo MI Apps Cleanup Local D: SMV Slice display LUNG DISPLA. D Start MI Apps Local D: displays the S. Set Program Access and Defaults Local D: SMV Wholebody Bone Displays a whol MIBG 3/15/2006 Local D. SMV Wholebody Masking MASK A WHO. Filming Windows Catalog Symbia S 1/26/2006 Local D: Source Replenishment AQC Use this worldfl .. Windows Explorer ECAM 4/1/2002 Local D: SPECT_CT Display 2/5/2008 STATIC CCK ACQ Displays correc 100329 Local D: ACQUIRES 5 .. Windows Update Symbia T 11/17/2005 Local D. STATIC DISPLAY. Multiple Static .. ECAM 2/22/2000 Local D. Static Display Displays static -- eventvwr.msc ECAM 2/26/2002 Local D Static Gastric Emptying Proc. Will generato th Paint ECAM 9/2/2003 Local D: STATIC GASTRIC PROC Processes up t. Symbia T 1/18/2008 explorer.exe 269351859 11/8/2011 17 Local D. Static Masking Will mask regio Local D. Static Merge Proc Merges 1 to 20. ---- 3D shutdown_at_twenty_hour.bat pory A Workplace: SYMBIA01 Documents Stage: All Launch Suspend Complete Settings Shut Down. 58 Week One, Day Three 2. Choose Force Shutdown of High Level Processes Notes Clean Up 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 Chim Exit .. 3. YES to continue with Cleanup Warning X WARNING: This action may result in a loss of data. Are you sure that you want to do this? Yes 4. When cleanup is complete you will be prompted to copy log files if necessary, if not choose Cancel 5. If this step was unsuccessful, repeat Step 2 but choose Force High level Processes and Low Level Servers 59 Week One, Day Four Week One, Day Four Day Four: Topics Notes • Troubleshooting • Review • Questions and Answers • Week One Exercises Week One Exercises Patient Gantry 1. The maximum weight the PHS will hold is __________ lb. 2. Match the labels on the following: (1) ( 2) (10) (8) (3) ... (15) (4) ... (9) (9) (11) (12) (13) (14) (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 ______ Quality Control 1. Perform the daily QC from start to finish. 2. List the steps needed to complete weekly QC? 3. List the Monthly Quality Control Procedures? a. b. c. d. e. 60 Week One, Day Four Patient Registration Notes 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. Workflows 1. Modify the acquisition parameters on a Renal Scan 2. Process a Renal Study Patient Browse 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? 61 Week Two, Day One Week Two, Day One Week 2 Objectives Notes After this week, you will be able to: • Describe the layout of the CT components of the Symbia T • Demonstrate the operation of the gantry • Demonstrate the steps in setting up and acquiring a CT study • Demonstrate the steps to perform Image Fusion in MI Apps software • Describe the function of the 3D Task Card • Demonstrate the steps to perform image fusion in the 3D Task Card Day One: Topics • Overview of Symbia T CT Features • Emergency Stops • CT Power • Hand Control • PHS CT System Overview SIEMENS (7 -(6) (2) S' (1 (113 (7) ( 5 ) STO (3) ( 8 ) -(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 62 Week Two, Day One Emergency Stop Notes Press the Emergency Stop button to stop all gantry and patient bed motion, and turn off X-ray radiation. STOP CT Power On/Off CT Detector Power The CT receives power from the CT subsystem. The CT subsystem power button on the line connection box (depending on the T series) controls electrical power to the CT. CT Table and Hand Controller 1. Using the hand controller, double click the Bed Index button to activate. CT Brain Study Position (1) CT Body ( 2 ) (3) Study SPECT Position Study Position 63 Week Two, Day Two Week Two, Day Two Day Two: Topics Notes • PPM • Acquiring the CT Scan CT System Overview Continued SIEMENS (1)CT Q 2 (2) (4) (3) SPECT (5) 6) Y (7) (9) (8) C X SIEMENS 1 (1)CT ℮ 2 Define Upper CT '2) Boundary Limits 4) (3) SPECT (5) (6) ... (7) Define Lower CT (9) Boundary Limits (8) X 11:42 Patient Positioning Monitor (PPM) 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 Setting up System for CT Scan (See Appendix A: Registering a Patient for a CT Exam on Symbia T and Intevo Systems) 64 Week Two, Day Two Acquiring the CT Scan Notes 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) Abdome 123 Total mAs: Topogram MA Abdomen 120 Scan time 5.35 06 mm Chronicle opograrn length 512 mm Tube position Top Bottom Lateral 1 Commert #: Position Height 3285 - 100 0 Craniocaudal Scan Auto Tasking 2 8. Click Load The topogram parameters are confirmed. The Press START message is displayed next to the “Topogram” entry. Topogram Press START 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. CT Scan Acquisition The topogram is displayed in the upper left segment (topo segment) of the Examination task card. Suspend Button- Start Button opo segment ------- resit 65 Week Two, Day Two The scan and reconstruction ranges of the subsequent scans Notes are displayed in the topogram. Select the upper or lower handle of the range. Drag the mouse (holding the mouse button pressed). The length of the range is changed. TempPatient- 1.3.15.2.22. Total mas: Europeu,wex sdde IN Topogram Eff. mAs 30 CARE DOSMD BONE KV 130 CTDIvol 4.01 mGy Scan time 21.98 s3 Delay 3 5- Slice 5.0mm x1.0mm No. of images al 31 Comments Range: Begin End Table Position Height 14110 / Craniocaudal 1 14 M Checkup 27 hago. Select Setup/Checkup 7/17/2012 10-13 Review and modify acquisition parameters if needed BUIMeIA uopeu,wex sddy in SPECT_CT_BONE (Adult) Temp, Patie TempPatient-1.3.15.2.22. Total mas Topogram Quality ref. MAS 30 BONE ARE Dose type AEC+DOy Slice 5.0 mm - Acq. 6× 1.0 mm Pitch 0.75 2 KV 130 -J Direction Craniocaudal CTDIvol 4.01 mGy Scan time 21.98 s 2| Scan start Start button Rotation time 0.6 s .J Delay Recon Auto Tasking 9. Click Load. The scan parameters are confirmed. Load 10. Click and hold Move button until START message displays. Hold Stop Radiation Start Button Topo segment ------ VATER 66 Week Two, Day Two 11. Click the Start button to start the scan. 12. After scan is completed, go to Reconstruction tab. et Applications Edit Insert View Setup mage Optons System Het real-time images are displayed in the TOMO SEGMENT Review and TOPOGRAM SEGMENT modify reconstruction Tuoneuwex3 sddV IN parameters if needed SPECT_CT_BONE (Adult) Temp, Patient TempPatient-1.3.15.2.22: Total mAs: AbdomenRacine at) abdomen 123 10.10.14-13:24 07-31D Total mais Topogram Recon job 2 2 2 7 8 Series description AC BONE 5.0 B08s BONE Slice abcintien 5.0 mm Recon begin 1411.0 mm=) Kernel B08s SPECT AC Recon end 1561.0 mm2l Window Abdomen age order Craniocaudal Recon increment 5.0 mm 2 FoV 468 mm 3 No of images 31= CHRONICLE Center X 0 mm # Overview Center Y -16 mm 2 Comments Mirroring None Extended CT scale M dagted when the table is move Auto Tasking Send successfuly completed to PACS for patient name BROCKMAN ( U Hucon 13. The reconstruction will automatically start. To create 14. Reconstruction starts an additional recon job, click another Recon job. Recon job 3 2 za Recon 15. Click Close current patient 16. In the Chronicle dialog box, click Yes Yes 17. All images of the patient are closed and removed If you are in an acquisition workflow, the software from the Examination task card. will return back to the Workflow Navigator, where you can check the image registration and complete A Do you want to dose Bo current peseet ? the workflow. NO Notes 67 Week Two, Day Three Week Two, Day Three Day Three: Topics • Image Registration with MI Apps software • Acquiring the CT Scan • syngo Viewing Task Card • 3D Task Card Image Registration/Fusion (MI Apps) AI Settings Registration Settings Registration 1. Click the . Object vs Target Object vs Target Matrix Optional vs Object Matrix O Optional vs Object Default Default Registration Tab Object vs Target Object vs Target Matrix O Optional vs Target Optional vs Object Default Optional vs Object Matrix @ Default Transverse Sagittal Sagittal Coronal Optional vs Target AC CT_BoneSPECT 5.0 B08$, 7/7/2005 Bone SPECT-CT [Recon - NoAC ], 1/1 2/2012 HU 41 AC CT_BoneSPECT 5.0 8085, 7/7/2005 Bone SPECT-CT [Recon - NOAC 1. 1/1 2/2017 H 41 % 2. Use the Blending Tool to adjust NM Blending Tool to and CT blending. 60 5 . Scroll to select LESS reference slice 3. Adjust NM color bar Fansverse P. 305 0 508. 309.6 Rotation 2 0 Rotabon x 0 Rotation Y 0 ompressed Translation (mm) x 0 Landmark 1. Click on the Image Registration Activity, Registration tab. 4. Move the blender tool’s slider bar to the middle of the scale. 2. Use Blending Tool. Move to 100 for nuclear image. Move 5. Select one plane (transverse, sagittal, or coronal) to align the to 0 for CT image. two volumes. Scroll through the images to select a slice to be 3. Adjust the Nuclear color bar so that the data is at the used as a reference for alignment. desired intensity. Notes Settings Registration Object vs Target Object vs Target Matrix Optional vs Object Matrix Optional vs Object Default Default Optional vs Target Transverse Sagittal Coronal AC / _BoneSPECT 5.0 008s, 7/7/2005 Bone SPECT-CT [Recon - NoAC ], 1/12/2012 HU 41 Tool , the slideate 6. Use Pan Tool or enter value in Vertical/Horizontal Scroll bars to adjust registration fansverse Rotation Z 0 "Rotation x o" Rotation Y 0 Translation (mm): X 0 YO Landmarks ... 6. If required, adjust the horizontal and vertical position using pan tool or the vertical and horizontal scroll bars. 7. 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. 8. Repeat Steps 5 through 7 for the other slice planes. 68 Week Two, Day Three Viewing Data in the syngo Viewing Task Card Notes The following steps may be used to view images in the syngo Viewing 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 3D Task Card Loading the CT Images 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 Loading the Nuclear 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 Adjusting the CT/Nuclear Balance Ratio From the 3D task card menu, select Type > Fusion Definition. The system displays the Fusion Definition dialog. Fusion Definition CT Mreng teauto NM (1) 50% 50% 100% 3) Color Lookup table Gray Scale (8 Bit) Hot Body (8 Bit) Window SUV (2) 40 W 300 010003 T 0.0103 == (4) Close Advanced >> Help 1. Alpha Blending Ratio Slider 2. CT Window 3. Color Table Selectors 4. Nuclear Threshold 69 Week Two, Day Three Adjusting CT Image Notes usion Definition Mixing Ratio NM 100 % 100% 0% 100% Calor Lookup Table Gray Scale (8 Bit) Hot Body (8 Bit) SUV W 300 B 0.0003 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]. Adjusting NM 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. syngo Image Fusion and Creating Ranges (See Appendix B: syngo Image Fusion) 70 Week Two, Day Four Day Four: Topics Notes • Troubleshooting • Review • Questions and Answers • Week Two Exercises Week Two Exercises Quality Control 1. Perform CT Checkup and CT Quality procedures. 2. What is the first step before performing a CT calibration? Acquisition 1. Modify the acquisition parameters on the CT study. 2. Add an additional reconstruction job to a CT study. Reconstruction 1. Bring a SPECT_CT study into the 3D Task Card and adjust the color and intensity of the nuclear Images. 2. Create sagittal, coronal, and axial parallel ranges. 71 Appendix A: Registering a Patient for a CT Exam on Symbia T and Intevo Systems 72 Registering a Patient for a CT Exam on Symbia T and Intevo Systems 1. Using the PPM (Patient Positioning Monitor), select the CT positioning icon. Note: Make sure there is nothing in the way of the detectors. SIEMENS (5) (1) CT (2) 90º 76* 76º (3) (4) x 2. After the configuration is complete, place the patient on the PHS and position for a diagnostic CT the exam. 3. Using the hand controller, select the following buttons for exam types. Press the button once to activate. ( 1 ) (2 ) SIEMENS www.usa.siemens.com/healthcare Page 1 of 5 4. On the Symbia T hand controller, press the CT Index button twice. (6) (1) (4) (2) (3) (5) (6) 7) 5. CT Brain Exams: Attach the head holder. Use the Bed Up button (1) to position. (1) (2) (3) 6. CT Body Exams: Always position the patient feet first. Make sure the desired body part is within the PHS scan limitations. Use the Bed In button (2) to position. A(1) (2) (3) SIEMENS 74 www.usa.siemens.com/healthcare Page 2 of 5 7. Once you have selected the Head or Brain buttons, the table will move to the approximate area to be scanned. Use the Bed In (2) or Bed Out (3) buttons. Make sure the patient is isocenter in the FOV. (1) (2) (3) 8. On the MI Workplace, pull down the Patient menu and select Registration. Patient Applications Workflows Query ... Register .. Num 0 Emergency ... Examination Job Status Browser ... Num . 9. In the Registration window, you must enter the minimum of the 4 bolded areas: Name, Age, Sex and ID. Click Exam when all information is entered. Patient Registration PROCEDURE Last name Jones Accession No First name Middle name sor Requested procédure(s) Title Other Patient Narne(s) Other Patent ID(s) Study list Ethnic Group Military Rank Patient ID Date of Birth 5/12/1960 SONOy Sex O Malo & Female & Other Study comment Age 53 Years Height Weight [b) Insatution name Acasonal into 1. Peloeming physician .Performing physician NOTIMITISN 1. Operator HOSPITAL Referring physician 2. Operator Requesting physician Admitting diagnosis Ward Admission ID Eroregister Exam Search Cancel Emergency Hob SIEMENS www.usa.siemens.com/healthcare Page 3 of 5 10. Open the syngo Patient Browser. 11. Locate the desired patient and highlight (single click) the Study. Patient Browser Patient Applications Transfer Edit View Filter Evaluation Sort Options Help Ca Gastric Empty 4 hr. F GI Bleed (positive). : Local Database Hepatobiliary, gallbla JAZZ, dynamic CCK Scheduler Hepatobiliary, GB E @ All,Dynamic hida dvdR Liver Hemangioma Lung 2. Vent / Perfus Patient name Hepatobiliary, gallbladder (abnormal) Study description Gallbladder Study date 2/7/2005 64 Current Filter . Off 12. Go to the Patient menu item in the syngo Patient Browser and select CT Examination. Patient Applications Transfer Edit V Register ... Emergency ... Load to Viewing Load Report Load Last Report CT Examination CT Recon 13. The Patient Model Dialog window will appear. Select your desired protocol from the menus. Patient Model Dialog Adult Protocol & Replace ~ Child C Append Topogram & Cut @ Keep Auto reference lines None API Language Engish OK Cancel 14. Acquire the CT exam. SIEMENS 76 www.usa.siemens.com/healthcare Page 4 of 5 15. SPECT Exam: Patient is position Feet In for these exams. Use the Bed Out button (3). (3) 16. When the exam is complete, use the Bed Out button to move the patient out of the gantry. (1) (2) (3) SIEMENS www.usa.siemens.com/healthcare Page 5 of 5 Appendix B: syngo Image Fusion 78 syngo® Image Fusion Uses for syngo® Image Fusion syngo® Image Fusion utilizes the syngo® 3D Task Card to fuse anatomical images (MR and CT) with functional images (SPECT and PET). Along with image fusion, you have the ability to perform manipulation of the images and create ranges. Supported Datasets Any dataset that is loaded into syngo® Image Fusion must be a reconstructed dataset. Supported modalities for this application are MR, CT, SPECT, and PET. Loading the Anatomical Series 1. On the left side of your screen, select the 3D Task Card. 2. Pull down Patient menu item and select Patient Browser 3. Open your Patient and Study folders for your anatomical image and double click the reconstructed series you wish to load into the 3D Task Card. 4. The anatomical series will load and you will see the study in 3 planes. 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. A 4. Each plane contains reference lines corresponding to the other planes. Holating Mil? Red = Sagittal Eliograph. Sontuition 162 Green = Coronal Blue = Transverse 5. To Blow Up the image, double click on the desired quadrant to fill the screen. F Page 1 of 9 Scrolling Images Window 1. Use dog ears at the top right of each Center +/- Window + Width +/- quadrant. Scrolling Configurable Study +/- 2. Use reference lines. + B Send to Scrolling Node 1 3. Use the Image + and Image – keys on the Series +/- + 2 number pad of the keyboard. Correct Mark Scrolling 4. Right click to activate SMART menu and Image +/- + select Parallel Shift. Copy to Film Sheet Patient Registration Browser Windowing Type Orien ... Image 1. Middle Mouse: Move cursor to image to window. Press down middle mouse. Drag vertically to increase and decrease window brightness (Window Center). Drag horizontally to increase and decrease image contrast (Window Width). 2. Image Subtask Card 2  Window 1 - Select primary window. Also, reset to Window 1.  Window 2 - Select secondary window. Also, reset to Window 2. 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 1 2 3 images, i.e., MPR, MIP Thin, and VRT Slab. 4. Rotation- Enables free rotation of images. 4 5 6 5. Zoom/Pan – Toggle Zoom/Pan on and off. 6. Reset Zoom/Pan – Resets images to original display size. Page 2 of 9 Tools 1. ROI Circle - Displays mean density and maximum/minimum densities. 2. Distance - Straight line distance and maximum/minimum densities on the line. Setti Tools 3. Angle - Angle between two drawn lines. Lines need not intersect. 4. ROI Rectangle - Displays mean density and XYZ maximum/minimum densities. 6 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. Orientation Subtask Card 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. AD Page 3 of 9 Type Subtask Card Type Orien ... | Image 1. MPR – Multiplanar Reconstruction 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 4 5 6 6. Fused – Fused Image 7. VRT – Volume-Rendered Projection 8. VRT Thin – Volume-Rendered Projection Thin 7 8 Fused Fusion 1. Open the Patient Browser. 2. Highlight the functional series for the patient. 3. Select the Fusion icon in the Patient Browser toolbar. X 1 2 4. Rotating MIP opens with the images on certain software versions. If you no longer want to view the MIP, close it by clicking the close icon X  or pulling down the Type menu item and deselecting Rotating MIP.  To show the Rotating MIP again, pull down the Type menu item and reselecting Rotating MIP. Page 4 of 9 Type Orien ... | Image Fusion Definition To Open: 1. Select the Type subtask card. 2. Right click the Fusion icon. 3. Or pull down the Fusion menu and select Fusion Definition. Ised : Right mouse click Use: Fusion Definition x: 1. Mixing Ratio: Toggles between CT 1 Mixing Ratio anatomical and functional image, adjusting PT blending. 100% 0% 100% 100% 2. Color Lookup Table: Allows selection of 2 Color Lookup Table LUTs for anatomical and functional images. Gray Scale (8 Bit) Hot Body (8 Bit) 3. Window Values: Allows you to change 3 Window Value SUV center and width for anatomical image. For the functional image, allows adjustment of C 50% W 420% B 0.0000% T 16.0740 background and threshold or percentage of uptake. Close Advanced >> Help Side-by-Side Images Side-by-Side images allows you to go to a layout where the anatomical, functional, and fused images for each plane are separated out. This icon is found on the Image subtask card. Page 5 of 9 Image Registration Type |Orien ... Image Auto Registration To Open: 1. Select the Registration icon on the Image subtask card. 2. Or, pull down the Fusion menu item and select Fusion Registration. Fusion Registration X Use: Registration Matrix *Default 1. Click the Auto Registration icon in the Fusion Registration window. ++ auto 2. Select Fast or Precise Registration. Visual Alignment  Precise Registration is the default method that performs a precise calculation but takes more time due to more iterations.  Fast Registration is less exact but faster because of less iterations. OK Cancel Help Visual Registration Use: Fusion Registration 1. Click the Visual Registration icon in the Fusion Registration Matrix Registration window. 2. Move your cursor over the image plane that you want to adjust. Visual Alignment 3. Left mouse click and drag the image to the desired position. You can translate and rotate the image. 4. Or you can use the toggles to adjust the translation and rotation of the images. 10 degree rotation/10 mm shift steps OK Cancel Heb 1 degree rotation/1 mm shift steps Page 6 of 9 5. Click OK and save the registration. Creating Parallel Ranges 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 Setti 2. Click the Parallel Ranges icon on the Settings subtask card to open 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. 6. To change the output type, use this menu. Output Type CT PT Page 7 of 9 7. Type the desired parameters in the field and press enter to set. Parallel Ranges X Presets DefaultParallelSet - Output Type CT_PT Image thickness 5.0 mm Distance between images 29 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). Spin: Tilt: -90 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. Page 8 of 9 Creating Radial Ranges Below is an example of basic rotational views. X-axis rotations are planned from a lateral presentation. A Y-axis rotations are planned from an AP or PA presentation. Z-axis rotations are planned from an axial presentation. Setti 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. 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 icons. Save Page 9 of 9 Contact Information Summary Welcome to Siemens Healthcare Discover. Try. Buy. on webShop Siemens Healthcare is dedicated to helping you Do you want to “Discover. Try. Buy.” options, get the most out of your investment throughout accessories, and clinical education to make the most the entire product life cycle and beyond. Our goal of yourimaging equipment? Discover images, case is to enable you to take technology further, studies,and video demonstrations with the latest profitability higher, and patient care to the next clinicalapplications. Try advanced applications level. Find the information, resources, and tools utilizingfree software trials. Buy applications, coils, you need to get the most out of your recent clinicaleducation, and accessories, conveniently at investment and stay up-to-date. Visit any time. Visit www.usa.siemens.com/webShop today! www.usa.siemens.com/Welcome2Healthcare. 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Contact Information Summary 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-14510-P1-4A00 USA Printed in USA 07-2014 | All rights reserved Telephone: +1-888-826-9702 © 2014 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