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Symbia T Turnover Workbook

Workbook to accompany Symbia T System Turnover

SIEMENS SIEMENS 000 Symbia TruePoint SPECT.CT Symbia T Turnover Workbook www.usa.siemens.com/healthcare Answers for life. Table of Contents Introduction. . . . . . . . . . . . . . . . . . . . . . . . 3 Modifying and Saving Week 2 53 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . 3 a Workflow Template. . . . . . . . . . . . . . 32 Day One 53 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Patient Setup and Positioning. . . . . . . 33 Learning Objectives. . . . . . . . . . . . . . . . . 3 Manually Registering a Patient. . . . . . .33 CT System Overview . . . . . . . . . . . . . .53 Emergency Stop . . . . . . . . . . . . . . . . . 54 Learning Materials. . . . . . . . . . . . . . . . . . 3 Registering a Patient from the HIS/RIS. . 33 CT Power On/Off. . . . . . . . . . . . . . . . . 54 Manually Registering an CT Table and Hand Controller . . . . . . 54 Week 1 4 Existing Patient . . . . . . . . . . . . . . . . . . .34 Positioning the Patient for Exams. . . . 35 Day One . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Processing Workflows. . . . . . . . . . . . . .36 Day Two . . . . . . . . . . . . . . . . . . . . . . . .55 Overview of Symbia T . . . . . . . . . . . . . . . 4 Quality Control Activity. . . . . . . . . . . . 36 CT System Overview Continued . . . . .55 Camera Detectors . . . . . . . . . . . . . . . . . . 5 Patient Table (PHS). . . . . . . . . . . . . . . . . 6 Tomo Reconstruction Activity. . . . . . . 37 Patient Positioning Monitor (PPM). . . 55 AutoRecon Activity. . . . . . . . . . . . . . . . 38 Acquiring the CT Scan . . . . . . . . . . . . 56 Integrated Collimator Changer. . . . . . . 7 Flash 3D. . . . . . . . . . . . . . . . . . . . . . . . 38 Automatic Collimator Changer. . . . . . . .7 Day Three. . . . . . . . . . . . . . . . . . . . . . .59 Hand Controller. . . . . . . . . . . . . . . . . . . . 8 Day Three . . . . . . . . . . . . . . . . . . . . . . 39 Image Registration/Fusion (MI Apps) . 59 Patient Bed Accessories. . . . . . . . . . . . . 9 Organ-Specific Processing . . . . . . . . . . .39 Viewing Data in the Setting Gurney and Wheelchair Height . . 9 Gastrointestinal Processing . . . . . . . . . .39 syngo Viewing Task Card. . . . . . . . . . .60 Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . .9 3D Task Car. . . . . . . . . . . . . . . . . . . . . 60 Patient Positioning Monitor (PPM) . . . . . 9 Hepatobiliary Processing . . . . . . . . . . . .39 Planar Gated (MUGA) Processing . . . . .40 Loading the CT Images. . . . . . . . . . . . 60 Workstations . . . . . . . . . . . . . . . . . . . . . .10 Loading the Nuclear Images . . . . . . . .60 Quality Control . . . . . . . . . . . . . . . . . . . 11 First Pass Processing . . . . . . . . . . . . . . . 40 Adjusting the CT/Nuclear Balance Ratio .60 Symbia T Daily QC Flow Chart. . . . . . . . 12 Lung Processing . . . . . . . . . . . . . . . . . . .41 Symbia T Weekly QC Flow Chart. . . . . . 12 Renal Processing . . . . . . . . . . . . . . . . . . 41 Thyroid Processing . . . . . . . . . . . . . . . . .42 Day Four. . . . . . . . . . . . . . . . . . . . . . . .62 Symbia T Monthly QC Flow Chart. . . . . 13 Week Two Exercises. . . . . . . . . . . . . . .62 1. System Daily Shutdown and Startup..14 Pixon Processing . . . . . . . . . . . . . . . . . . 42 Series Calculator . . . . . . . . . . . . . . . . . . 43 2. Restarting Additional Workstations. .14 Series Reformat . . . . . . . . . . . . . . . . . . . 43 3. CT Checkup . . . . . . . . . . . . . . . . . . . . 16 Series Filter . . . . . . . . . . . . . . . . . . . . . . .44 4. CT Quality . . . . . . . . . . . . . . . . . . . . . 16 Series Merge . . . . . . . . . . . . . . . . . . . . . 44 5. CT Calibration . . . . . . . . . . . . . . . . . . 17 Series Extract . . . . . . . . . . . . . . . . . . . . 44 6. Daily NM QC . . . . . . . . . . . . . . . . . . . 18 7. Weekly QC . . . . . . . . . . . . . . . . . . . . . 22 Flexible Display . . . . . . . . . . . . . . . . . . . 45 8. Monthly QC . . . . . . . . . . . . . . . . . . . . 23 Saving JPEG and AVI files . . . . . . . . . . . 45 Dual Monitor Support . . . . . . . . . . . . . 46 Patient Browser . . . . . . . . . . . . . . . . . . .47 Day Two. . . . . . . . . . . . . . . . . . . . . . . . 28 Overview of MI Apps Workstation. . . .28 Accessing the Patient Browser . . . . . . 47 Patient Databases . . . . . . . . . . . . . . . . 47 Command Module. . . . . . . . . . . . . . . .28 Correcting Patient Name, Patient Browser. . . . . . . . . . . . . . . . . . 28 ID Number, and Other . . . . . . . . . . . . .48 Workflow Template Browser . . . . . . . .28 Rearranging a Patient Series . . . . . . . . 48 Workflow Manager . . . . . . . . . . . . . . 29 Manually Transferring Data . . . . . . . . .48 View PPM . . . . . . . . . . . . . . . . . . . . . . 29 Manually Archiving Data . . . . . . . . . . 48 Workflow Navigator . . . . . . . . . . . . . . 29 Retrieving Data from Archival Device. .49 Launching a Workflow . . . . . . . . . . . . 29 Ejecting a CD or DVD . . . . . . . . . . . . . .49 Acquisition Workflows . . . . . . . . . . . . 30 Deleting Data . . . . . . . . . . . . . . . . . . . 49 Acquisition Types . . . . . . . . . . . . . . . .30 MI Apps Cleanup . . . . . . . . . . . . . . . . .50 Acquisition Tab . . . . . . . . . . . . . . . . . .30 Analyzer Tab . . . . . . . . . . . . . . . . . . . .32 Day Four . . . . . . . . . . . . . . . . . . . . . . . 51 Display Analysis Tab . . . . . . . . . . . . . . 32 Week One Exercises. . . . . . . . . . . . . . . 51 2 Symbia TruePoint SPECT-CT 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 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 7-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 Systems Owner 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 • 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 • 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 (2) (10) ( 3 ) - -(8) ( 4 ) (9) (9) ( 6 ) (10) 14 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) (4) IM CAMERA MOTION SNAC 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 (1) (2) (1) - ( 3) 1. Touch Pads on Detectors 2. Touch Pads on Yokes 3. A touch pad covers three sides of the detector’s yoke .. (4) (1) (3) (2)- (1) 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 y-(1) (2) ( 3) (3) ( 6) (9) (12) (4) (8) D (10) ( 6 ) "(7 ) ( 11 ) ( 13 ) W - 1. Patient Positioning Monitor 2. Rear Bed 3. Foot End 4. Pallet with Pad 5. Patient Bed pivots way from gantry 6. Patient Bed Handles 7. Docking Pin (beneath bed) – Foot Pedal not shown 8. ECG Connection 9. Pallet Handle 10. Bed Index 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 - (2) -(3) (1) 1. Integrated Collimator Changer with Handles 2. Drawer opened 3. Collimator clamp raised for collimator removal Automated Collimator Changer (ACC) (1) CAUTION DO NOT PARAGIONS 1. Automated Collimator Changer (ACC) -(7) (2)- ( 1 ) (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 6. Bed Index Button 7. Wheelchair Button 8 Week One, Day One Patient Bed Accessories Notes 1. Head Holder 2. Whole-body 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) 0.0 kcts/s SPECT 2 22.0 cm 2) 1 136.1 cm 3) 95 % 100 % 4) -6.0º -96.0º 34.4 cm 34.4 cm 1.00 1.00 5 140 KeV 140 KeV 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 Notes (1) ( 2) (3) e.media 1. E-media Player (optional) Workstations syngo® MI Workplace Image Control System (ICS) 1. Registration 2. Scan Acquisition 3. Reconstruction 4. Data Management/Filters 5. Data Correction 6. Data Transfer 7. Workflow Selection 8. Workflow Management 9. Archiving 10. Importing of Data 11. Data Deletion 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 Performed Quality Control Procedure Source Daily for NM • Intrinsic Verification, or • 35 μCi of 99mTc, or • Extrinsic Verification or • Co-57 sheet source Extrinsic Sweep • AutoQC source Daily for CT • CT Checkup: every 12 hours • CT Quality: daily • CT Calibration: after 1 hour or if ring artifacts occur Weekly for NM • Intrinsic Verification • 35 μCi of 99mTc with Tune • AutoQC source Monthly for NM • Intrinsic Calibration • 35 μCi of 99mTc with Tune • AutoQC source Monthly for NM • Multiple Head Registration • 1-2 mCi of 99mTc per (MHR) 180° source (Match sources • Head Alignment Verification within 20% for 99mTc only) • AutoQC source Monthly for CT • CT Constancy Test (Appendix C) Every 6 months or per • Perform a leak test of the • Gd-153 line source and Regulatory/License automated quality control Co-57 point source requirements device sources If the collimator is damaged • Intrinsic Calibration, and • See source strengths above or replaced • Extrinsic Calibration for collimator • MHR for collimator • Head Alignment Calibration for collimator Significant change to Head • Multiple Head Registration • 1-2 mCi of 99mTc per source Alignment values for the (MHR) 180° (Match sources within 20% reference of Low Energy • Head Alignment Calibration for 99mTc only) Parallel Hole collimator • AutoQC source Notes 11 Week One, Day One Symbia T Daily QC Flow Chart Symbia T 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 GD153 Rod 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 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 Step 1 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 switches to OFF 10. T6 and T16 systems with line connection box: Flip the CT Subpower system switch to OFF (green toggle) 11. No line connection box: Go to circuit breaker box and flip the CT subsystem circuit breaker to OFF 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. If line connection box is present: Turn the CT subsystem power switch ON (green toggle) 5. If no line connection is present: Go to circuit breaker box and flow the CT subsystem circuit breaker ON 6. syngo MI Workplace: Crtl, Alt and Delete to log on 7. Username and password: esoft Restarting the Additional Workstations (Processing, Reading Workstations) Step 2 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 Attaching the Phantom Notes 1. Remove the pallet pad 2. Insert the bracket into the slot at the end of the patient bed (1) (2) 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) (3) 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) 15 Week One, Day One CT Checkup Notes Step 3 1. Checkup Dialog box is automatically displayed after restart. But if it’s not, pull down Setup > Checkup from the syngo menu. Checkup 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 dick on Cancel to stop procedure Tiene since last successful checkup: 05:42 chkup Cancer 2. Click Checkup 3. Press Start on control box when prompted CT Quality Step 4 (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. Record this position, bed height, and distance for later use 16 Week One, Day One Performing CT Daily Quality Measurements Notes 1. Perform Checkup prior to Quality Measurement 2. Position the phantom 3. Select Setup > Quality 4. OK the Quality Daily dialog 5. Press Start on Control Box 6. To evaluate the final results, go to CT Quality Reports 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 Step 5 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. Examination Tab > Setup > Calibration from the main menu 2. Start on control box to start the calibration 17 Week One, Day One Daily NM QC Notes Step 6 Intrinsic Verification – Manual QC 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 10 8. On the first Tuning activity for Detector 1, select Start Tuning and Peaking 9. On the second Tuning activity for Detector 2, select Start Tuning and Peaking 10. When completed, a message appears for each activity above of success or failure. If fails, repeat Tuning and Peaking for each head. If repeated failures, place a Service Call Peaking and Acquisition 11. Adjust table height to center the source so count rates are similar between heads 12. If you skipped tuning activity, go to Static activity of the workflow and select Analyzer tab. 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 Static Acquisition activity, enter the date on series information tab and click the Start button to acquire the flood 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. 18 Week One, Day One Intrinsic Verification – Auto QC Notes Scheduling AutoQC 1. Command Module > Options > Configuration Menu > MI Acquisition Settings 2. Adjust dates and time for AutoQC scheduled completion 3. Click OK Setup 1. On workstation, highlight current QC patient. 2. Double click the Intrinsic Verification workflow. 3. Enter tomorrow’s 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 press Start. Review the Results 6. On the 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, 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 Verification – Manual QC May be performed instead of intrinsic verification. However the intrinsic verifications should be performed once a week for detector tuning. Setup 1. Home the system 2. Install appropriate collimators on the detectors 3. Attach the sheet source holder (See users manual for more detailed instructions) 4. Center the sheet source within the sheet source holder defined source areas 5. On workstation, highlight current QC patient 6. Double click the Extrinsic Verification workflow Acquisition 7. Check that the collimators have been installed and click the Start button. 19 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. Extrinsic Verification – AutoQC May be performed instead of intrinsic verification. However the intrinsic verifications should be performed once a week for detector tuning. Scheduling AutoQC 1. Command Module > Options > Configuration Menu > MI Acquisition Settings 2. Adjust dates and time for AutoQC scheduled completion 3. Click OK Setup 1. Home the system 2. Install appropriate collimators on the detectors 3. Attach the sheet source holder (See users manual for more detailed instructions) 4. Center the sheet source within the sheet source holder defined source areas 5. On workstation, highlight current QC patient 6. Double click the Extrinsic Verification workflow 7. Enter tomorrow’s date on the series information tab 8. Ensure that nothing is obstructing the motion of the detector heads 20 Week One, Day One Acquisition Notes 9. Check that the collimators have been installed and click the Start button. Review the Results 10. On the Flood Calculation Activity, visually inspect the flood and make sure the flood is uniform. Review the values. If the values are within limits, accept and save the values. Reject unacceptable values. These values are used for service trending purposes only. Uniformity CFOV UFOV Integrated 5% 6% Differential 3.5% 4% SMARTZOOM collimator floods will have a different appearance than those from a parallel hole collimator. See Users Manual for example of differences. 11. Make appropriate selections in the Hard Copy activity for save screens and hard copies 12. Complete the workflow 13. Remove the source and the source holder and reattach the pallet pad 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. Home the system and leave the collimators on the detectors 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 5. Ensure that nothing is obstructing the motion of the detector heads Acquisition 6. Click the Start button in the AutoQCStart activity Review the Results 7. 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. 21 Week One, Day One Uniformity CFOV UFOV Notes 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 for save screens and hard copies 9. Complete the workflow Weekly QC Step 7 1. Follow the steps for the acquisition of Intrinsic Verification Manual QC or Intrinsic Verification Auto QC in Step 7 Daily QC. Tuning must be performed during this procedure. Review the Results of AutoQC (Consists of Intrinsic Flood Verification and Extrinsic Sweep Floods). 2. On the 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, accept and save the values. Reject unacceptable values. Uniformity CFOV UFOV Integrated 5% 6% Differential 3.5% 4% 3. Go to the second Flood Calculation Activity, visually inspect the extrinsic sweep 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 3.5% 4% 4. If the values are not within the limits, click the button Reject These Calibrations. Review the Results of Manual QC (Consists of Intrinsic Flood Verification Only) 5. On the 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, accept and save the alues. Reject unacceptable values. Uniformity CFOV UFOV Integrated 5% 6% Differential 3.5% 4% 22 Week One, Day One Monthly QC Notes Step 8 Monthly AutoQC This procedure should be used if you have the AutoQC Productivity package. Perform the Intrinsic Calibration, Intrinsic Verification, MHR, and Extrinsic Sweep. 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 on the Intrinsic Calibration activity. 4. Enter today’s date on the series information tab on the Intrinsic Verification activity. 5. Enter today’s date on the series information tab on the Head Alignment activity. 6. Enter tomorrow’s date on the series information tab on the Extrinsic Sweep activity. 7. Ensure that nothing is obstructing the motion of the detector heads. Acquisition 8. Click the Start button in the AutoQCStart activity. Review the Results 9. 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 23 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 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. 11. On first Flood Calculation Activity, visually inspect the intrinsic verification flood and make sure the flood is uniform. Review the values. If the values are within limits, click the button Accept These Calibrations and Make them Current to save the values. Uniformity CFOV UFOV Integrated 5% 6% Differential 2.5% 3% 12. If the values are not within the limits, click the button Reject These Calibrations. Neither the calibration database nor the internal quality monitors are updated. 13. Go to the second Flood Calculation Activity, visually inspect the extrinsic sweep 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 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 extrinsic sweep 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. If Calibration Integral Uniformity exceeds 7%, call service; system can be used with values up to 10% 24 Week One, Day One Monthly Manual QC Notes 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 8. On the second Tuning activity for Detector 2, select Start Tuning and Peaking 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 Start button to acquire the 200 Million Count Flood. 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 the values. 12. If unacceptable, click Reject These Calibrations. If Calibration Integral Uniformity exceeds 7%, call service; system can be used with values up to 10%. 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. 25 Week One, Day One Review the Results Notes 14. On the Flood Calculation Activity, visually inspect the intrinsic calibration flood making sure the flood is uniform. Review the values, click the button Accept These Calibrations and Make them Current to save the values. Uniformity CFOV UFOV Integrated 5% 6% Differential 2.5% 3% 15. Make appropriate selections in the Hard Copy activity. 16. Complete the workflow. 17. Retract the source holder and remove the protective cover. 18. 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 1-2 mCi Tc99m point sources. a. 3 Point Sources: EHE, MELP, HE, All Others b. 5 Point Sources: HRES, UHR, LEAP, Fanbeam, SMARTZOOM 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 or you system.) 4. Use MHR phantom instructional screening to place point sources in the appropriate configuration. SIEMENS MHR Phantom 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 Calibration workflow. 7. Enter today’s date on the series information tab. 8. Ensure that nothing is obstructing the motion of the detector heads. 26 Week One, Day One Notes Acquisition 9. Prepare and Start Review the Results 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 Head Alignment Calibration Results (SMARTZOOM) Collimators) The tolerances for the head alignment processing results for SMARTZOOM collimators are different from all other collimators because of the new IQ•SPECT reconstruction algorithm. Center of Rotation < ± 20.0 mm Axial Shift < ± 5.0 mm Back Projection Angle < ± 2.0 degrees Principal Ray X and Y < ± 10.0 mm Principal Ray Angle X and Y < ± 5.0 degrees Long Focal Length X = 4480 mm to 6268 mm Long Focal Length Y = 4703 mm to 5837 mm Short Focal Length X = 482 mm to 590 mm Short Focal Length Y = 472 mm to 604 mm 19. Make appropriate selections in the Hard Copy activity. 20. Complete the workflow. 21. Remove the MHR phantom and replace the pad and home the system. CT Constancy Test Step 9 See Appendix C in the Operator’s Manual 27 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 Study Dace ALL Congary arms SVISA Up Time: 2 Hours 30 Mins Database Local biograph Biograph 1, Pet CT Thorax Thora PETCTS 6/12/2002 Biograph 2, PET CT Biograph 3. PET CT Thorax ThorPETCT1 biograph Chorio CA. Therap ThoraPETCTS biograph LSO, Normal Bloodpool TOMO Equilibrium Gated Car Bone, 3 Phiace Bore, Torno Flow & Stitics Bone Scan Bone, WB & 2 Tomo Bone Scan Brain, Diamox Pre Post Bone Scan Brain, MP_rCBF5 Brain Scan Brain, MP ICOFS CHAMP Col Mp Drain Lassen COF La Tomo Acq Brain MVP ICB Brain Card oc 4, Myo Pert Cardiac 4, Stress & Rest Gated Cardiac S. Myo Pert Abocemal Cardi ac 6, Viability Cardiac 7. Profile Te TI DICOM PET DICOMPET DICOM PET Carsac Coengory Al Workstation SIEMENSESOFT Launch Suspend Compt 3 Stage All MI Apps (e.soft) Patient Browser Refresh Study Listing, Patient Browser, Patient Register, Study Name: ALL Study Date: ALL Show All List Patients, System Up Time: 2 Hours 30 Mins Database: Local Find List Studies, and 190 studies found on the system .. Study dates: (all dates] Image Space Available 67641 MB List Series buttons Patient Name PZtent DI | Study Name Study Date # Senes |Database Le biograph biograp ... PETCT 6/12/2002 3 Local Datab Biograph 1. Pet CT KM Thorax ThoraxPETCT1 6/5/2001 3 Local Datab Summary Biograph 2, PET CT 2 Thorax ThoraxPETCT1 6/13/2001 4 Local Datab Information Biograph 3. PET CT 47000 Thorax ThoraxPETCT1 6/14/2001 Local Datab biograph Chope CA HES_4 PET CT 4/9/2002 4 Local Datab biograph | 30, Normal 2 PET CT 6/13/2002 1 Local Datab Bloodpool, TOMO ecam Equilibrium Gated Car ... 2/20/2001 3 Local Datab Done, 3 Phase 012718 Bone Scan 4/23/2002 2 Local Datab Column Bone, Tomo Flow & Stetics ecam1 Bone Scan 2/6/2001 Local Datab Bone. WB & 2 Tomo Brain, Diamox Pre Post ecam2 Bone Scan 2/11/2000 Local Datab Headings ocam Brain Scan 5/8/2000 4 Local Datab Brain, IMP_rCBF5 Chf-IMP 9/29/1993 4 Local Datab Brain, IMP_rCBF5 2001 10 ... Cbf-IMP 9/29/1993 Local Datab Search Brain, Lassen ECAM e.soft Patient Browser Area CBF_Lassen 4/1/1993 Local Datab Brain, NIMS_7file Brain, PatlakPlotCBFPh2 Local Datab Local Datab Brain, PatlakPlotPh2 2001 10 ... GMS_DATA 3/16/1991 Local Datab Cardiac 1, Myo Perf Duet MIBI Myocardial Perfusion 2/1/2001 Local Datab Cardiac 2. Myo Perf Duet MIBI Myocardial Perfusion 1/25/2001 Local Datab Cardiac 3, Dual Study Duet My ... Myocardial Perfusion 1/2/2001 Local Datab Cardiac 3, Dual Study Duet My ... Myocardial Perfusion 1/9/2001 Local Datab Cardiac 3, Myo Perf Duet My. Myocardial Perfusion 1/2/2001 Local Datab Cardiac 4, Myo Perf Duet My ... Myocardial Perfusion 1/9/2001 Local Datab Cardiac 4, Stress & Rest Gated 124-58 -. Myocardial Perfusion 3/25/2002 4 Local Datab Cardiac 5, Myo Perf Abnormal Duet My ... Myocardial Perfusion 1/8/2001 Local Datab Cardiac 6. Viability Duet ML .. Myocardial Perfusion 11/20/2000 A Local Datab Cardiac 7, Profile Tc TI profile Myocardial Perfusion 2/21/2001 10 Local Datab DICOM PET 1 DYNAMIC Brain FDG 3/12/1997 Local Datab DICOM PCT WB Volume 2/14/2001 Local Datab DICOM_PET STATIC Brain FDG 5/26/2000 Local Datab 28 Week One, Day Two Workflow Template Browser Notes Refresh Workflows Category AI Category Local or Network- L Ado Fite) Auto Filter 3 3 3 3 hase Bon. Phase Bon .. Phese Bon. . Phase Bone DOP OP 4DMSPEC 4CMSPEC 4DMSPE. c 1 Save ... 4 TDM TReview AO AOP Workflowone Aerosol rent-Pe. Vent-Pe .. Vent.Perf Tomo Acq Template Workflow Template Bone Browser MPICB Brein Tomo OP AO List Area Brain Brein Brain Bran assen C ... NIMS Reco ... Patlak Pl .... AOP Tomo Acq CC Brain Cardiac Cardiac Cardiac Tomo OP Bloodpo .. Compariso _Compariso ADOA AOP Cardau Workflow Manager Work Status Category Workstation Stage Launch Category All Workstation SENENSE SOFT Complete Complete Work Staus: All Stago: Al Workflow Manager Area Suspend View PPM 1. Command Module > Utilities > View PPM Workflow Navigator #1 Common Workflow Configuration #1 Selector #2 A workflow that contains acquisition, processing Selecto (two in this example). displaying, and hard copy Acquisition Activity in one workflow. Activity Common Workflow Processing Configuration #2 Activity Activity A workflow that contains processing, displaying. and hard copy in one Processing workflow. Activity Flexible Flexible Display ACTIVIDADY Hard Copy Activity Launching a Workflow 1. Highlight the patient from Patient Browser Play Button Aspasion 2. In the Workflow Template Browser > Select Category Pause Button 3. Double click the workflow desired Suspend Button Complete Setup 29 Week One, Day Two Acquisition Workflows Overview Notes Acquisition Types • Static • Dynamic • Whole Body • Tomo • Gated Planar • Gated Tomo • Dynamic Tomo Acquisition Tab Summary Tab Used to review the acquisition parameters Patient Lune 2. VIC Study Lung"Perfusion Scan Series ssenes name> Summary Series Information Camera Parameters |Stop Conditions Name Description Patient Name Lung 2. VIQ Patient ID PEN04337143 Study Name LungoPerfusion Scan Series Name «series name> Series «seres name> Technologist Reading Physician Removing Referring Physician Elapsed Organ Isotope 1 99m Technetium, 0.00 mCi, Matrix Size 256 X 256 Zoom 1.00 Camera Preset Tc99m-NMG Detectors Both Detectors Anterior 500 Kcts Posterior NA Head Out / Supine 500 Kcts N/A Orientation Head Out / Supine 250 X 250 TEDAMPANG Prepare Acquisition Series Information Tab Series name is required. The rest of the fields are optional. mmary Series Information Camera Parameters Stop Conditions Series: < series name > Technologist Reading Physician: Referring Physician: Organ Radiopharmaceutical Dose: Isotope: MBg 99m Technetium Pharmaceutical: nterventional Drug Interventional Drug: Injection Time (hh:mm:ss): 0 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 Paramet Camera Parameters Matrix Size: 256 X 256 Zoom: 1.00 Camera Preset Tc99m-NMG Detectors: Both Detectors Calibrations - Apply Uniformity Correction Orientation Body Position Supine 30 Week One, Day Two Stop Conditions Notes Allows you to modify the stop conditions, label the view, and determine number of views. Summary Series Information Camera Parameters Stop Conditions Stop Conditions Stops on both detectors. Detector 1 Detector 2 Use the same parameters for Detector 2. Time First View by Counts › Counts Time or Counts Count Density Manual Counts cts Any Window Group ew Control Detector 1: Rt. Lateral Detector 2: Lt. Lateral Add View Insert View Gate Allows you to select gated parameters amera Parameters Gate |Stop Conditions Framing Beat Window Number of Frames Selected Window. 1 Center. 72 Time per Frame : Width (%): 20 0 msec Autocenter Primary Window Average of: Forward 10 Beats Forward/Backward by Thirds Peak Bin of: 10 Beats Autotracking Reject PVC Beats Beats To Reject Post PVC: 1 PVC Threshold (msec): 30 Histogram 1 Window 3 Window ms Beat ms/Beat Save Curve Acquire with Statics Select Acquire with Statics on the Stop Conditions tab Step 1 Stop Conditions Cati- Step 2 Stop Conditions Time msec El Acquire with R-Wave Gate Acquire with Statics Phase Parameters . No Pause or Delay Pause Before Phase Number of Frames Phase Control Add Phase Insert Phase Update Phase Delete Phase Phase Pause | Time/Frame # of Frames Off 8 sec 60 Allows you to modify stop conditions for the statics acquired during a dynamic study, modify views, and change matrix size. Comora Paramotors Stop Conditions Static Stop Conditions Start time for Start Time (mm ss) the static view Duration for (Duration to begin after the static view the Dynamic Stop Time 3:00 acquisition has begun Camera Parameters Stato Matrix Size 128X 128 New Names Test View Control Add View Insert View Update View Delete View View Start Time |Duration |Stop Time |Detector 1 Detector 2 31 2:00 60 sec 3.00 Test 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 Dead Time (%) | Peak Status 1 2 14 5 New Preset Name: Detector 1 1.00 PEAKED 1.00 ~Detector 2 1.00 PEAKED 1.00 Save Preset Begin Peaking Pause Between Peaks A1 Window Number|Center (keV) Shift (9%) 140 Width (%) Type Photopeak 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 Now Workflow Worklow Norme Workflow Description esoft, Thyroid Static, Thyroid Scan, 2/11/2001 File Static Acquisition View Template Workflow Activities Help Save Workflow Template .. Category Save Workflow Template AS ... > Acquisition Analyzer Display/Analysis Template > Save Workflow Template As (to create a new template) Workhow Characteristics Workflow Name Workdow Description esoft, Thyroid Static, Thyroid Scan, 2/11/2001 File Static Acquisition View Template Workflow Activities Help Save Workflow Template. Save Workflow Template As .. > ACOP Acquisition Analyzer Display/Analysis Cancel Enter the name, description, category, and appropriate icon and click OK. 32 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. Paciort Registration PATIENT Lust numa Bran First name Acc RequestID Requested - Brain Scan char Pet ent Name's] procedure(s) Etnic Group Study list Brain Scon Mitty Rant Patient ID 14027196 (Date of Birth 515/1938 Female Cthat May Ersin Scon Age 36 Heigre Jainmm ] 5:3º 1049 Step2 Add oss 2501 North Barrington Root Patient position INSTITUTION Adat onal info Requires a wheel chair Performing chytk Requesting phylacim operator Aderling dagnosis Wand Step 3 Registering a Patient from HIS/RIS 1. Open Patient Browser from Command Module: Patient > Browser Step 2 Patient Browser 0x View )Eilter Sort Private Applications Options Help Step 6 Local Dassbase Step 5 Scheduler COST. Tomo CDROM CDRW Worklist Time Range Step 3 - Start/End Date: 15/07/2004 - 10/4/2004 StartEnd Time 12:00:00 AM - 11:59:59 PM Step 4 BeWorklis Cancel COST , Tomo Help Current Finer Off 2. View > Update Worklist 3. Set the State/End Date and Start/End Time 4. Click Get Worklist to update the browser 5. Highlight Scheduler icon in the tree 6. Highlight the patient at the Series level Cardiac 2, Myo Perf Stress MYOVIEW GATED-Gat Cardiac 3 - Smith, Du. Myocardial Pert [1] Rest MYOVIEW Cardiac 3. Myo Perf Myocardial Perf 7. Patient > Register Patient Browser Patient Applications Transfer Register Emergency Load to Viewing Filming Layout .. Film Task Status. 33 Week One, Day Two 8. Check patient and study information for correctness. Notes Click Exam. atient Registration PROCEDURE ATIENT Last name Liver Accession No First name GSA Dynamic Request ID Title Sffix Requested Adrenal Scan Other Patient Name(s) procedure[s) Cther Patient ID(5) Ethnic Group study list Adrenal Scan Military Rank Patient ID 879531 Date of Birth 2/06/1831 Sex . Male . Female Study Mdranal Scen Years Study comment Adrenal Scen Bone Scan ight: Inn'mm] Brain Scan Weight: [b] Breastimaging Wholebody Imaging Address Patient position Coincidence maging CSF Leak Eoull bducol Gated Cacdiac Additionalinto ISTITUTION istituto on name Details Performing physician Performing physician HOSPITAL Hetetring physicien . Operator Requesting physicien 2. Operator Admitting dagnosis Admission D Exam Search cancel Emergency Help Manually Registering an Existing Patient 1.Open Patient Browser from Command Module: Patient > Browser 2. Click the Local Database icon in the tree 3. Highlight the patient name 4. Patient > Register Step 4 - dit View Eltor Sopt Private Applications Optons Help Load to Viewing Filming Layout .. Film Task Status. ICON. 1H/1W/64R/51 Film Preview Expose Elm Took Ctrl+ P ICON, 2H/1W/1024R/ Copy to Film Sheet Num Enter ICON. 2H/1W/1024R/ ....... Print Preview ICON.MRCTN220C Print List ICON, MRCTN220C ........ Step 3 . Search ICON.MRCTN220C Search Select IMP_rCBF5 Close Browser Alt+F4 Step 2 Local Databaco Liver. GSA Dynamic_ Liver Scan [1] GSA Tomo Schoduler Lung 1, Porf Vent Aer [1] GSA Dynamic COROM Lung 2, V/Q [1] GSA Dynamic Raw Ising Paif Varr AarM Work Status|Mark Status | Requesting Physici. [Study Desal 8/11/2001 905-21 A 4 Curiert Filter, of 5) Select Study from pull down menu. Click Exam. atient Registration PATIENT PROCEDURE Last name Liver Accession No First name GSA Dynamic Request ID Title Suffix Requested -Adrenal Scan Other Patient Name(s) procedure[s) Other Patient ID(s) Ethnic Group Studylist Adrenal Scan Military Rank Patient ID 879531 Date of Birth 2/6/1831 Sex . Male . Female @ Other Study Ach anal Scan Age 6 Years Study comment Adrenal Scan Bone Scan Brain Scan Breast Imaging Wholebody Imaging Address Patient position Coincidence maging CSF Leak dationalinto NSTITUTION Instituto on name Details Performing physician Performing physician HOSPITAL Hetetring physici en 1. Operator Requesting physicien 2. Operator Admitting dagnosis Admission D Exam Search Cancel Emergency Heb 34 Week One, Day Two Positioning the Patients for Exams 1. From the PPM, press the Reconfiguration tab. Notes SIEMENS (5 (1) (2) 90º 90º 76º 76º (3) (4) X (6) 09:05 2. Choose detector configuration > Proceed 3. To stop all system motions, press emergency stop button on gantry or any button on hand control. 4. Raise or lower the patient table to patient access height. OR 5. Press the Wheelchair Height button twice to automatically lower table. 6. Press the Gurney Height button to automatically raise the table. (1) (1) ( 4 ) (2) (4) (2) (3) (3) (5) ( 6) (7) 7. Select the patient and launch the workflow on the MI Workplace and start the acquisition (see page29 for details in launching workflow). 35 Week One, Day Two Processing Workflows: Quality Control Activity Notes (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 Step 2 Step 4 Step 1- step 5 - Step 3 Step 6 7. Drag the red ROI over the heart, centering the box over the heart. Resize and reposition if needed 8. Review cine sonogram and linogram in the After section 9. Click OK Motion Corraction Acitornatic Manual Autemmitic Correction Uce AI Projections w: Soit al projecpont edcost Apply X Shit W Host Miesciermon Step 7 Sindgrom Step 8 Sinogram Linggran Step 9 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 36 Week One, Day Two Dynamic Correction Notes 1. Select the Quality Control Activity in the workflow 2. Pull down Series > Select appropriate series 3. Choose Correction Mode (Single or Multiframe) 4. Click the Position icon to position image 5. You can use the Shift tools to make adjustments to the position. The cursor changes to a hand. 6. Click inside the desired frame(s) and drag to shift the frame(s). 7. Review the cine and summed data to make sure the motion correc- tion is acceptable. 8. Click the OK button to accept the changes Motion Correction Manual Manual Correction Results Step 3 Detector 1 Single Frame Mode Isotope: A Multiframe Mode Step 4 Step 5 Step 6 Sur Step 7 X Shift 0,00 Y Shift 0.00 Step 8 Tomo Correction 1. Select the Quality Control Activity in the workflow 2. Pull down Series > Select appropriate series 3. Choose Correction Mode (Single or Multiframe) 4. Click the Position icon to position image 5. You can use the Shift tools to make adjustments to the position. The cursor changes to a hand. 6. Click inside the desired frame(s) and drag to shift the frame(s). 7. Review the cine and summed data to make sure the motion correc- tion is acceptable. 8. Click the OK button to accept the changes. Motion Correction Manual Manual Correction Results Step 3 Single Frame Mode Sinogram Mutiframe Mode Step 4 Step 5 Linogram Step 6 Sum Step 7 XShit 0:00 Y Sht: 900 Step 8 37 OK Week One, Day Two Notes Tomo Reconstruction Activity 1. Select the Tomo Reconstruction activity in the workflow. 2. Click the Settings tab. 3. Make adjustments in the reconstruction settings in needed. 4. Change the filter, if needed, using the Change Filter button 5. Click Apply Parameters to All Series to accept. tep 2 Brain, Dianox Pre Post, ecam - Brain Scan, 5/8/2000 Ele Tomo Reconstrucion View Template Workflow Scbvites Hap AI Settings Reconstruction Masking Centering Chang's AC Date Sdoctor Reconstruction Parameters Step 5 Apply to Sonos Eran Scan - Series POSTDIAMOX Appy Parameters to All Senes Comgure Isotope Settings Reconstruction Options Reconstruction Limits Zoom Thresheld, Filter Step 3 Starting Angle: - 170 Zoom 186. 180 Rance: · 360 @ 180 Threshold Filtered Backprojection i Stbeste. 4 .. · toritive Reconstrucion # berations 8 Gaussian 10.00 . OSEM 20 Charge Filter .. Step 4 OSEM 30 Step 1 ADDy Attenuation MAD 1. 103 Puoi Size ( 380. 380) 6. Click the Reconstruction tab 7. Click and drag the limits to adjust the range. Step 1 Reconstruction sking/Centering Chang's AC Limits ones POST DIAMOX Transverse Zoom Step 2 Preshold Gaussian 10:00 Change Filter Limits Bran Scan. Sones PRE DIAMOX Transverse Zoom Threshold Gaussian 10:00 Change Eiter eries 3 - Isotope A Transverse Puces Coronal Droshold Gaussian 10:00 Change Eiter les 4 - Isotope A Transverse Coronal Zoom Ruces Dreshold Gaussian 10:00 Charge Filter Auto Recon Activity 1. Select the AutoRecon Activity in the workflow 2. Go to the Settings Tab 3. Make necessary adjustments to the Reconstruction Set- tings. 4. Make necessary adjustments to the Filter Settings, 5. Click to apply settings Step 2 Settings Reconstruction Masking/Centering Step 3 Data Selector Reconstruction Para Apply to Item: Myocardial Perfusion - Stress Mibi - Isotope A 1/25/2001 Configure Data Paths ... Reconstruction Limits Anterior Zoom, Threshold, and Filter Step 4 Starting Angle: ils Zoom 1.00 190 Range: -180, 180 Step 1 - Threshold 0 No Reorientation · Automatic Orientation & Positio Manual Orientation & Position Defaut Mask Range: 30 - 55 Lt Lateral terative Reconstruction Walis OSEM 2D . Flash 3D . Flash de # Iterations: 16 Apply Scatter Correction Step 5 # Subsets: 8 Save as Original Matrix 18 - 43 Change Fitter Save as 64x64 (4.8 mm/pixel) Reconstruction Range: Save as 64x64 (6.6 mm/pixel) Gaussian 9.00 Preserve Negative Values Preserve Low Count Data 38 Week One, Day Two Notes 6. Select the Reconstruction tab 7. Adjust range Step 6 Satti Reconstruction Masking/Centering Myocardial Penusion - Suess Mibi - Isotope A 1/25/2001 HLA VLA Data Selector Anterior Lt Lateral Step 7 % Transverse Angle -43.0 Sagittal Angle: 19 -16.5 Quality Control Scrollable Views Auto Angles play Zoom - ardial Perfusion - Rest Mibi - Isotope A 1/25/2001 HLA VLA SA Anterior Lt Lateral Transverse Angle -40.1 Sagittal Angle: -11.4 Scrollable Views Auto Angles omo for Non-AC - Isotope A Lt Latera VIA 100 Transverse Angle -42.6 Sagittal Angle: .8.7 Scrollable Views Auto Angles cted] - Isotope A 11/14/2011 VLA Transverse Angle: 43 0 Sagittal Angle: -165 Scrollable Views Auto Angles Flash 3D Flash 3D is a statistically based iterative reconstruction method based on OSEM, where the distance-dependent collimator blurring is accurately modeled in all 3 dimensions. Adjusting Settings to Improve Image Quality Image is Possible Solution Too smooth Ensure Flash 3D is selected Decrease FWHM filter (guideline: roughly 2 pixel size). Check image quality with 0 mm. Increase iterations. Usually more than 6-8. Increase subsets. Check number of subsets, and change to next valid value. Check for any workflow connection changes Too noisy, or sharp Increase FWHM (in particular for Tl201 rest studies) Decrease subsets Decrease iterations Check for motion, and correct if needed 39 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 2. Click the Cine tool 3. Check the ROI placement 4. Click ROI Tool to redraw the ROI NM_Gastric - single isotope. e.cam - Gastric Emptying. 2/20/2001 Ejlo Gastrointestinal View Template Worldlow Activities Help Settings ROI Step 3 Data Selector GASTRIC EMPTYING [Results] 9/30/2004 % Step 2 Isotope: 99m Technetium ROI C Create Rol Using Emptying Curves ertoty Step 4 Counts per sac 0 5 10 15 20 25 35 40 45 56 60 70 75 00 90 95 105 115 Minutes Fr1.11793 64784 Results Summary Parameter 99m Technetium ........... pocer correction Emptying Geometric Mean on 53 % Emptying begin (TO) 10 mins ROI Tool . Emptying end 60 mins T 1/2 61 mins TO -> T 1/2 51 mins First Frame: ast Frame: 20 5. Drag the T0 to the Start of the empty 6. Drag the Tfit to the End of the empty 7. Drag T Empty to position desired for % of empty calculation Isotope: 99m Technetium .. un Teched Emptying Curves 699.154 Step 5 - 499.154 That Step 7 399.154 299.154 emtoty 199.154 99.1541 Counts per sec -0.845856 -100.846 0 5 10 15 20 25 35 40 45 55.60 70 75 80 90 95 105 115 Step 6 Minutes 40 Week One, Day Three Notes Hepatobiliary Processing 1. Select the Gastrointestinal Activity in the workflow 2. Click the Cine icon 3. Check the ROI placement 4. Click the ROI Tool to redraw ROI if required. 5. Drag the Start marker to the start of the calculation allbladder 2. GBEF Dynamic, ECAM - Gallbladder EF. 4/1/2002 Gastrointestinal View Template Worldlow Activities Help AI tep 3 Settings ROI Gallbladder [Results] 9/30/2004 Hector Step 2 Create ROLUsing Ejection Fraction Curves Step 4 10 Minutes Results Summary Parameter 99m Technetium 88 Decay Correction Ejection Fraction 52 % EF interval begin 7 mins ROI Tool EF interval end 29 mins T Max 7 mins 6. Drag the End marker to the end of the calculation Planar Gated (MUGA) Processing 1. Select the Gated Bloodpool Activity and then the Processing tab of the workflow 2. Center the LV in the box 3. Click Determine LV Center button 4. Mouse click the center of the LV 5. Click the Cine icon to review the ROI position Step 1 Step 5 Step 4 - Step 2 Cancel Threshold: Step 3 Determine LV center ROYTool .. ROL TOON 6. Click the ROI Tool buttons to modify the ROIs for LV and background if needed. cular RO Found Ro Fr1 154K68.64 EX:10 151X 68184 Edit ROI Threshold : Step 6 ROI TOOL ROI Tool ... 41 Week One, Day Three 7. Review the Results and Fitting Results tabs. Notes 8. See the Settings tab to review or modify parameters for this activity. First Pass Processing 1. Select the Gated Bloodpool Activity and on the Dynamic > Gated tab of the workflow 2. Click the Define Range button to set the range limits 3. Click the first image in the range. 4. Click the last image in the range 5. Review the cine. Repeat steps 2, 3 and 4 if needed. 6. Drag yellow lines to define acceptable beat range. A First Pass, First Pass, 12/17/2001 Elle Gated Eloogpool View Template Workdow Actvises Hep Step 1 Dynamic -> Gate RV Processing RV Results Filing RUSuts Step 3 Step 4 Step 2 - Define R1000 4 - 6 Left Ventricle Range [3] 20 Step 6 - Step 5 7. Select the RV Processing Tab 8. Click the ROI Tool to draw RV ROI in the Ventricular ROI field 9. Click the ROI Tool to draw Background ROI in the Background ROI field. 23 First Pass, First Pass, 12/17/2001 Step 7 AI Step 10 RV Processing RV Resalta Fitting Results Inios & ROIs Fint Paar [CEP RV Results) 9/20/2004 9 Step 9 Threshold : Step 8 RON TOON ROYTool 10. See Settings Tab to review or modify parameters for this activity. 42 Week One, Day Three Lung Processing Notes 1. Select the Lung Processing Activity and on the ROI tab of the workflow 2. Review the ROI placement 3. Click the ROI Tool to modify ROIs 4. Use slider bar to align Ant and Post view 5. Click the Registration button when aligned. mal Analysis Washout Analysis : 3 2 AM images Step 4 Pert ANT rt aerosol 100 Step 2 Threshold : Threshold Adjust Frame X Shift X Shift Y Shift Y Shift 0 ROI TOOL Angle: Angle O Step 5 Step 3 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 and on the ROI tab of the workflow 2. Review the ROI placements 3. In the Edit ROI field, click and drag the slider bar to modify ROIs or click the ROI Tool button to redraw. 4. Click the Results tab to review the results. Step 2 Aorta Step 4 Processing dit RCI Step 3 Threshold Threshold ROI Tool Composite Image First Frame: 00: First Freme : Lost Frome: Lost From: 30 43 Week One, Day Three Thyroid Processing Notes 1. Select the Thyroid Processing Activity in the workflow 2. Select the ROI tab 3. Select the correct series from the Series pull down menu. 4. If necessary, drag the correct image to proper field 5. Review ROIs and redraw if necessary using the ROI Tool buttons 6. Click the Results tab to view the results. Step 2 wer POSE Syringe Step 3 Step 4 Step 6 Full Svirge Erroty Swings Step 5 - FRON Toel 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 dos- age. Alternatively, you may elect to maintain the counts and enhance image quality, or both reduce counts and enhance image quality. Series Calculator The Series Reformat activity is used to perform the following for data manipulation:: Series Calculator: Masking 1. Select the image 2. Click on the ROI Tool button Step 2 - Rvore To Original hout 1 : Entre Sortes Step 1 44 Week One, Day Three 3. Draw masking area using one of the tools available. Notes 4. Select to Keep Outside or Keep Inside to apply. ROI Tool User Interaction Prompt ROI Tool Display Frames - 1x1 6 1x2 . 2x1 0 22 Sum ROIS: PLUSEs Masa Step 3 ROI Color ROI Name : Threshok Usor Mask Step 4 - Keep Outsid Keep Inside Cancel 5. To remove masking, click Revert to Original button Series Calculator: Series Filter 1. Click on the Series Filter activity and the Series Filter tab. 2. In the menu bar, choose a filter. You can choose a Spatial Filter or a Frequency Filter Spatial Frequency Filter Filter Button Button GATED BLOOD ROOL, 10/16/1996 Elle Sonos ricor Vlow WordON ActiDes Bilp Step 2 XD AI Step 1 Revert Series Original Series 1 : Entro Sorios 24HNO . 5 Al Frames FRES ADOORG. NO FIRST Fiteced Series 1 PS 2: 30 . E Al FraTes 3. Select desired filter from Filter Menu. 4. Click the button Trial Filter to apply the filter 5. Check the cine display to view the Before and After filter selection. 45 Week One, Day Three 6. Select the desired filter and click OK. Notes Step 3 0.15560 0, 66863 0 15569 Step 5 Update Step 4 Boxcar Rerations: 3 Carsslan FWHM.5.00 Netz FWHIM 0.00 Order:1 Step 6 OK 7. See the Settings tab to review and modify parameters for this activi- ty. Series Calculator: Static Merge 1. Select the study and double click the workflow. Flow & Statics, ecam1 - Bone Scan, 2/6/2001 Nsplay Vier Template Workflow Activities Help O * 0 * AI Single Series Static Display Study Name Bone. Tomo Flow, Statics DOB: 7/30/1953 Series Calculator: Series Extract 1. Select the Series Extract activity in the workflow 2. Select the Arithmetic tab 3. Select the Series from the pull down menu. 4. Choose the phase or individual frames. 5. Click the Extract icon in the activity toolbar. 6. View the extracted phase or images in the result series. Step 5 C Step 2- Arithmetic Operand 1 Senes 1: Phase 3 Step 3 Step 4 Step 6 46 Week One, Day Three Flexible Display 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. This object is used to display all the images of a series. This object is used to cine data, specify a single image from a Patient Name Bone, Tomo Flow flancs series to display, or select a subset of frames to display. Study Name Bone Scas Patient I. U of M Study Date: 2/6/2001 This object is used to display up to four reconstructed tomo series in a volumetric display. This object is used to insert blocks of text, either from study information (such as a patient name or series name) or free text. This object is used to insert print areas (such as processing results) created from other activities. This object is used to display curves associated with a series. A This object is used for bitmap formatted graphic images. Multiple Statistic This object is used to display frame and ROI statistics in a table Display format. Fusion Series Display This object is used to display fused series data. Fusion Slice Display This object is used to display fused slice data. 3D Display This object is used to render and cine volume data. Bons Torno Flow Stets, Ual M Bone, Tand Flow Stieics, Uaf M Bone Scan 24/2001 1 21 31 PM Bone Scan 2/6/2001 1:21:31 PM Three-slice Display This object is used to display one to four volumetric series in a slice view, containing transverse, sagittal, and coronal views in a 40 llone SPECT Piaceej 900/0004 12:35 17 81 Bone SPECT 30/2001 4:56:31 PM single window. Multi-modality Display This object is used to display multi modality fused data. Below are examples of how different display objects are used. * DAI Text - Display Cara& 1. Me Pef.DuitME Image 10 A 41 Galad Saves 21/0001 11 51 Display Mycarda Petavan 2/10001 8 57 43 AM Slice - Facol 800000€ 12:29:00 PM mag Dipiw Cadac 1. Ma Por Duit SE Wecards Podesge 390001 8 Display Curve Display Text Display ame: Renal, MAG3 Abnormal Patient Name: Renal, MAG3 Abnormal D: 614 Patient ID: 614 Print DOB: 8/26/1940 DOB: 8/26/1940 Study Name: Renal Scan Study Name: Renal Scan Study Date: 12/1/2000 Study Date: 12/1/2000 Display Curve Parameters Right Posts/ 9300004 1241 34 7MM Total Split Function (%) Display chey Counts (cpm) 7.351 Time of Max (min) 3.001 2510.2 34145 0.868 Time of % Maximini 0.889 Series Display Muhple Frame and RiCi Tait stica Draplay Multiple Penal Scas 12/1/0000 #06:10 AM (M/100004 12:41:34 PM # Penal Mag 3. 12 92000 8 21:59 AM Frame and ROI Statistics Saving Pages as JPEGS and AVI Files 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 47 Week One, Day Three AVIs Notes 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. 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. 48 Week One, Day Three Patient Browser Notes 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. The system displays the browser. Patient Browser Patient Applications Transfer Edit View Filter Sort Private Applications Options Help IMP_rCBF5 Lassen Local Database Liver, GSA Dynamic Liver Scan [1] GSA Tomo Scheduler Lung 1, Perf Vent Af [1] GSA Dynamic CDROM Lung 2, VIQ [1] GSA Dynamic Raw Lung, Perf Vent Aert [1] Pre.syringe NIMS_7file PalRa (ECToolbox / Parathyroid. Tc & Se Patient name Liver, GSA Dynamic Date of birth 2/6/1937 Patient ID 0 Work Status Mark Status Requesting Physici ... Study Descri ... Study Date and ... Series R/// /E// Liver Scan 8/17/2001 9:05:27 Al 4 Current Filter. Off 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. 49 Week One, Day Three Correcting a Patient Name, ID Number, or Other Demographics Notes 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 ar- chive 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 50 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 e.cam/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 us- ing 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. 51 Week One, Day Three MI Apps Cleanup Notes The MI APPS Cleanup activity is used when the system becomes unstable/locks up. When using the MI Apps Cleanup activity, all data in currently running activities is lost. 1. From the Windows Start menu, select MI APPS > MI APPS > MI APPS Cleanup 2. Choose Force Shutdown of High Level Processes Clean Up This application may be used to clean up e soft 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 soive sysoffice. Force Shutdown of High-Level Processes and Low-Level Servers 3. YES to continue with Cleanup This application may be used to clean up e soft 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. Warning x WARNING: This action may result in a loss of data. Are you sure that you want to do this? Yes No Use this only if the previous button does not solve system instability Force Shutdown of High-Level Processes and Low-Level Servers Exit 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 52 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: ( 2 ) (10) -(8) (3) ( 4) (9) (9) (5) ( 6 )- (7 ) (10) |::::: :::::: ______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. 53 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? 54 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 55 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 56 Week Two, Day Two Week Two, Day Two Day Two: Topics Notes • PPM • Acquiring the CT Scan CT System Overview Continued 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 SIEMENS 1 (1) CT 2 2) X (4) (3) SPECT 1.00 6)Y 6 (7) (9) ‹ (8) C X SIEMENS 1 (1)CT Q 2 Define Upper CT 2) Boundary Limits (4) (3) SPECT (5) 1.00 (6). ... (7) Define Lower CT (9) Boundary Limits (8) C X 11:42 57 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 36- Abdomen 120 Scan time 5.35 Slice 06 mm Chronicle ppogarn 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 58 Week Two, Day Two The scan and reconstruction ranges of the subsequent scans Notes are displayed in the topogram. Batent Applications Edit lasert View Setup Image Options Select the upper or lower handle of the range. Drag the mouse (holding the mouse button pressed). The length of the range is changed. Patient TempPatient-1.3.15.2.22. Total mAs: Topogram Eff. mAS 30 CARE Dose4D BONE KV 130 - CTDIvol 4.01 mGy Scan time 21.98 s2 Delay 3 5 Slice 5.0 mm Acq. 6 x 1.0 mm No. of images 31 Comments Range: Begin End Table:Position Height 1411.0 J 1561.0 369.0 J 222.0 Craniocaudal Routine Scan Recon Auto Tasking Review and modify acquisition parameters if needed BUIMBIA uoHeulwex] addy IN SPECT_CT_BONE (Adult) Temp, Patient TempPatient-1.3.15.2.22. Total mas: Topogram BONE 00 Quality ref. mAs 30 2| CARE Dose type AEC+DOM 5.0 mm il Aca. 6 x 1.0 mm KV 130 CTDIVOl 4,01 mGy Direction Craniocaudal Scan time 21.98 s otation time 0.65 Scan start Start button Routine 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 ------ 59 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 Options System Hey 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 Wat) abdomen 123 10.10.14-13:24 07-31D Total mas Topogram Recon job 2 2 2 7 8 Series description AC BONE 5.0 B08s BONE Slice ascntion 5.0 mm Recon begin 1411.0 mm=) Kernel B08s SPECT AC Recon end 1561.0 mmal 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 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 60 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) BECT Aman ConT. Eligeical Phantom, 123, 10/25/2002 Ele ImageRegisusion Yow Template Watdow activities Hop Step 1 Settings Registration Step 2 Step 4 Step 3 RossBon Z Rotation Y O Landmarks Landmarks: Step 5 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 Step 6 Step 7 Rotation 2 0 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. 61 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) (4) 40 W 300 010003 T 0.0103 == Close Advanced >> Help 1. Alpha Blending Ratio Slider 2. CT Window 3. Color Table Selectors 4. Nuclear Threshold 62 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. 63 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. 64 Contact Information Summary Welcome to Siemens Healthcare Discover. Try. Buy. on webShop Siemens Healthcare is dedicated to helping you get Do you want to “Discover. Try. Buy.” options, accessories, the most out of your investment throughout the entire and clinical education to make the most of your product life cycle and beyond. Our goal is to enable imaging equipment? Discover images, case studies, you to take technology further, profitability higher and video demonstrations with the latest clinical and patient care to the next level. Find the information, applications. Try advanced applications utilizing resources and tools you need to get the most out free software trials. Buy applications, coils, clinical of your recent investment and stay up-to-date. education, and accessories, conveniently at any time. Visit www.usa.siemens.com/Welcome2Healthcare. Visit www.usa.siemens.com/webShop today! Clinical Training and Continuing Education UPTIME Clinical Application Support: Call 1-800-888-7436 • Troubleshooting assistance • Immediate assistance for software applications and workflow issues Please provide the Functional Location Number when calling for assistance. Clinical Education Offerings: Call 1-888-221-8010 (follow the prompts) • Classroom Training (Offerings, Registration & Scheduling) • Educational Symposia • Onsite Training • Printed Self-studies • Virtual Education (Offerings & Registration) • Workshops & Fellowships Visit www.usa.siemens.com/clinicaleducation for more information regarding the current Siemens Clinical Training and Continuing Education portfolio. Siemens Training Centers Siemens Clinical Education Training Center – TDC2 110 Mac Alyson Court Cary, NC 27511 Siemens Healthcare Training Center at the University of Utah 421 Wakara Way Suite 140 Salt Lake City, UT 84108 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 Local Contact Information and options as well as standard and optional Siemens Medical Solutions USA, Inc. features which do not always have to be 51 Valley Stream Parkway present in individual cases. Malvern, PA 19355-1406 Siemens reserves the right to modify the USA design, packaging, specifications and options Telephone: +1-888-826-9702 described herein without prior notice. Please www.usa.siemens.com/healthcare contact your local Siemens sales representative for the most current information. Global Business Unit Note: Any technical data contained in this Siemens AG document may vary within defined tolerances. Medical Solutions Original images always lose a certain amount Imaging & Therapy Systems of detail when reproduced. 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  • Symbia T Turnover Workbook