syngo Application Software VD20: syngo EVAR Guidance Hints and Tips Job Aid

SIEMENS Healthineers Aorta CT FFS syngo Application Software VD20 syngo EVAR Guidance RPH Hints and Tips 5 cm VRT W 364 RAO 12 / CRAN 20 C 294 Template Effective Date: 05/27/2019 | HOOD05162003010284 Job Aid Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 EVAR Guidance Hints and Tips – SIEMENS Healthineers Table of Contents Introduction 3 Missing Branches 4 Mis-detected Branches 5 Missing Aorta 6 Mis-detected Aorta 8 Correction of Vessel Tracing 10 Correct Automatically Generated Landmarks 11 Add New Landmarks 13 Redefine Landmark-associated C-arm Angulation 14 0/0 2 Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 Introduction SIEMENS Healthineers Depending on the patient’s anatomy (e.g. kinking of aorta or vessel stenosis), or the CT image quality, the automatic segmentation may fail to detect certain vessels. The following slides provide solutions to solve these situations during the automatic vessel segmentation and the workflow step define landmarks. 3 Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 Missing Branches SIEMENS Healthineers Situation Solution • The abdominal aorta is detected correctly. Add all missing branches by doing the following: • Some of the main branching vessels are completely 1. 1 Select Add Vessel to add the missing vessel. missing (e.g. the right renal artery and left iliac artery). 2. 2 Click at the distal location of the missing vessel. • Vessels which were detected automatically are detected correctly. Repeat the previous steps for all missing branching vessels. Review and Processing EVAR Guidance X Abdominal aorta Create Vessel Tree Add or delete vessel centerlines, if necessary 2 1 Show Vessel Color L Iliac L Renal V R Renal V R Iliac Aorta Define Landmarks Overlay 4 Automatic Effective Date: 06/02/2020 | HOOD05162003097077 Vessel Unrestricted © Siemens Healthineers, 2020 Segmentation Mis-detected Branches SIEMENS Healthineers Situation Solution Review and Processing EVAR Guidance x • The abdominal aorta is detected correctly. 1 1. To delete the mis-detected vessels, select with Create Vessel Tree • Some vessels are present, but detected incorrectly (e.g. the RMB the respective vessel in the Centerline Add or delete vessel centerlines, if necessary right renal artery and left iliac artery). List. 2 2. From the menu, select Delete. 3. 3 Select Add Vessel to add the missing vessels. Abdominal aorta 4. Click at the distal location of the missing vessel. 3 5. Repeat the previous steps for all missing branching vessels. Show Vessel Color L Renal 1 R Renal SMA Rename Properties Delete 2 Define Landmarks Overlay 5 Automatic Effective Date: 06/02/2020 | HOOD05162003097077 Vessel Unrestricted © Siemens Healthineers, 2020 Segmentation Missing Aorta SIEMENS Healthineers SiemensHealthineers. ... SOMATOM Definition SiemensHealthineets, ... SOMATOM Definition syngo CT 2010A 250 BodyAngio 0.7 HFS BodyAngio 0.75 B26f syngo CT 20126 *1/1/1900 12/1 6/2013 CT 12/1 6/2013 Situation 1:04:43 PM • The abdominal aorta is not detected at all. • Since the abdominal aorta could not be found, all other vessels cannot be detected and are therefore missing. IE 10 cm 10 cm LI A SL 0.8 800 SL 0.8 MPR 800 MPR C LAO 90 /0 C 350 350 SiemensHealthineers, ... SOMATOM Definition SiemensHealthineets, ... HAL SOMATOM Definition 250 250 BodyAngio 0.75 B26f syngo CT 2010A syngo CT 2010A HFS HFS *1/1/1 900 BodyAngio 0.75 B26f *1/1/1 900 CT CT 12/1 6/2013 1:04:43 PM 12/1 6/2013 1:04:43 PM RAH 10 cm SPIR MPR 0 / CAUD 90 LAO 12 / CAUD 12 6 Automatic Effective Date: 06/02/2020 | HOOD05162003097077 Vessel Unrestricted © Siemens Healthineers, 2020 Segmentation Missing Aorta SIEMENS Healthineers Patient Applications Reconstruction Show Mode View Orientation Tools Measure Volumes Options Help SiemensHealthineers, ... SOMATOM Definition SiemensHealthineers, ... H SOMATOM Definition 250 syngo CT 2010A 250 BodyAngio 0.75 B26f BodyAngio 0.75 B26f syngo CT 2010A HFS SiemensHealthineers, Pat *1/1/1 900 "1/1/1900 CT 12/16/2013 CT Solution 1:04:43 PM 12/1 6/2013 3D 1:04:43 PM Re-plan manually the segmentation. The abdominal aorta 2 Review and Processing EVAR Guidance X needs to be added first. Create Vessel Tree No vessel objects available. Mark vessel centerlines manually. R 1 1. Select the Add Vessel button. 10 cm 10 cm 2 2. Click at the proximal end of the abdominal aorta in the 1 3 aortic arch. Show Object Color 3. 3 Click on the distal end of the aorta (i.e. the aortic bifurcation). SL 0.8 SL 0.8 MPR MPR 800 C LAO 90 /0 350 SiemensHealthineets, ... SOMATOM Definition SiemensHealthineers, ... HAL SOMATOM Definition 250 BodyAngio 0.75 B26f syngo CT 2010A 250 HFS BodyAngio 0.75 B26f syngo CT 2010A *1/1/1 900 1/1/1900 HFS After the abdominal aorta has been added, continue with any CT CT 12/1 6/2013 1:04:43 PM 12/1 6/2013 :04:43 PM other vessel in order to create the required vessel tree. Define Landmarks Overlay Volume Opacity Image | Tools |Meas .. RAH Segmentation 3D Tools Ranges F O / CAUD 90 VRT LAO 12 / CAUD 12 6/27/2019 3:21:37 PM 7 Automatic Effective Date: 06/02/2020 | HOOD05162003097077 Vessel Unrestricted © Siemens Healthineers, 2020 Segmentation Mis-detected Aorta SIEMENS Healthineers Situation • The abdominal aorta and potentially branching vessels are identified. However, the aortic centerline of the abdominal aorta is mis-detected, and the entire vessel tree is not shown correctly. This can either be: • A too short centerline of the aorta (i.e. not tracing until the Abdominal aorta proximal point seen in the CT) • The aorta is reaching into one of the iliac arteries and e.g. does not stop at the aortic bifurcation • Some other branching vessels might be detected correctly or incorrectly. 8 Automatic Effective Date: 06/02/2020 | HOOD05162003097077 Vessel Unrestricted © Siemens Healthineers, 2020 Segmentation Mis-detected Aorta SIEMENS Healthineers Solution Review and Processing EVAR Guidance X Review and Processing EVAR Guidance 1. Create Vessel Tree X 1 Delete the mis-detected aorta. This will also delete all Add or delete vessel centerlines, if Create Vessel Tree branching vessels, whether they are correct or incorrect. necessary 1 No vessel objects available. Mark vessel centerlines manually. 2 2. Create a completely new vessel tree by starting with the abdominal aorta. Select Add Vessel to add the aorta again. After that, select Add Vessel again to add all the other vessels (see page 4 and 7). 2 Show Vessel Color Show Object L Renal Color R Renal R Iliac 1 Aorta Define Landmarks Overlay Define Landmarks Overlay 9 Automatic Effective Date: 06/02/2020 | HOOD05162003097077 Vessel Unrestricted © Siemens Healthineers, 2020 Segmentation Correction of Vessel Tracing SIEMENS Healthineers Situation Solution The centerline of a branching vessel is partly outside of the If the deviation is minor, you can leave the centerline as it is. vessel wall seen in the CTA, e.g. it takes a short-cut branch. The resulting ostium can be corrected later when defining Especially in small or stenosed vessels, or vessels with landmarks. calcification, the centerlines can “leave” the vessels seen in CT. If the centerline is not achievable, then an ostium can be added manually without any centerline presence when defining landmarks. -------- 10 Automatic Effective Date: 06/02/2020 | HOOD05162003097077 Vessel Unrestricted © Siemens Healthineers, 2020 Segmentation Correct Automatically Generated Landmarks SIEMENS Healthineers Situation Especially in small vessels, when the centerline has e.g. taken short-cuts, the initial position of the ostia landmark may be placed incorrectly. 11 Define Effective Date: 06/02/2020 | HOOD05162003097077 Landmarks Unrestricted © Siemens Healthineers, 2020 Correct Automatically Generated Landmarks SIEMENS Healthineers Solution 1 1. All ostia can be selected subsequently, checked, and potentially adjusted. To correct an ostia landmark, the respective landmark needs to be selected. It is then 1 centered in the MPR views. The MPR slices are adjusted accordingly, so that they align with the landmark orientation. • Change the position by grabbing the center. Change the angle or size by grabbing the edge of the ostia landmark. 2 2 • All landing zones can be changed in position by grabbing 1 cm and moving them along the centerline. Due to the fixed initial size of the ostia of 5mm (inner diameter), the user should thus also check and adapt the diameter correspondingly to the CT. 12 Define Effective Date: 06/02/2020 | HOOD05162003097077 Landmarks Unrestricted © Siemens Healthineers, 2020 Add New Landmarks SIEMENS Healthineers Situation Solution In rare cases, if the vessels are very small and calcified, the 1 1. Within the Define Landmark workflow step, select Add centerline and/or the ostia are detected incorrectly, or missing Landmark to add the ostium. completely. In these cases, ostia landmarks can be added 2 2. Adjust the ostium in position, size and angulation in the manually. MPR view. Review and Processing EVAR Guidance × Create Vessel Tree Define Landmarks Add or edit landmarks, if necessary. Check position and angulation of any 2 existing landmarks. O K Show Landmark ... 1 cm L Renal R Renal Centerline M Surface 1 + Overlay 13 Define Effective Date: 06/02/2020 | HOOD05162003097077 Landmarks Unrestricted © Siemens Healthineers, 2020 Re-define Landmark-associated C-Arm Angulations SIEMENS Healthineers Situation In some cases, especially for SMA, celiac trunk or internal branches, the C-Arm angulation might be too steep and therefore the angulation is not reachable in certain OR settings or angio suites due to potential collisions. In other situations, the user might prefer a different angulation than the suggested one. In these cases, the user can overwrite the proposed angulations. 14 Define Effective Date: 06/02/2020 | HOOD05162003097077 Landmarks Unrestricted © Siemens Healthineers, 2020 Re-define Landmark-associated C-Arm Angulations SIEMENS Healthineers Patient Applications Reconstruction Show Mode View Orientation Tools Measure Volumes Options Help SiemensHealthineers, ... HL SOMATOM Definition SiemensHealthineers, HPP SOMATOM Definition 260 syngo CT 2010A 250 BodyAngio 0.75 B26f HFS BodyAngio 0.75 B26f syngo CT 2010A SiemensHealthineers, Pat *1/1/1900 *1/1/1900 Solution CT CT 3D 12/1 6/2013 1:04:43 PM 12/16/2013 1:04:43 PM 1 1. Select the required landmark which needs to be Review and Processing EVAR Guidance X adjusted. Create Vessel Tree Define Landmarks 2. 2 Rotate the VRT to the preferred angulation. Add or edit landmarks, if necessary. Check position and angulation of any 4D ALF RAH existing landmarks. 3. 3 Press Store New Angulation. Show Landmark ... L Renal R Renal Plan> Landmark3 800 SL 0.8 LAO 110 / CAUD 4 1 350 MPR 23 / CRAN Landmark4 SiemensHealthineers, AHR SOMATOM Defin 2 hensHealthineers, Centerline M Surface 250 BodyAngio 0.75 B26f syngo CT 20 *1/1/1900 JodyAngio 0.75 B26f 1/1/1900 CT CT 3 0 12/16/2013 1 2/16/2013 1:04:43 PM 1:04:43 PM + Overlay -O Volume Opacity 1.00 Image | Tools |Meas .. RFA HAR Segmentation 3 LLLLLLLLLLU 3D Tools Ranges Plan SL 0.8