syngo Application Software VD20: syngo EVAR Guidance Job Aid

SIEMENS Healthineers Aorta CT syngo Application Software VD20 RPH syngo EVAR Guidance 5 cm VRT 364 RAO 12 / CRAN 20 C M 294 Template Effective Date: 05/27/2019 | HOOD05162003010284 Job Aid Effective date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Table of Contents Applications Reconstruction Show Mode View Orientation Tools Measure Volumes Options Help syngo EVAR Guidance introduction 3 SiemensHealthineers, ... SOMAT,OM Definition SiemensHealthineers, ... SOMATOM F 20102 BodyAngio 0.75 B26f 250 syngo CT 2010A 250 SiemensHealthineers, Pat 1 /1/1 900 HFS BodyAngio 0.75 B26f 1 41/1 900 CT 12/1 6/2013 CT 12/16/2013 3D 1:04:43 PM 1:04:43 PM O Create Vessel Tree 7 Review and Processing EVAR Guidance X Create Vessel Tree ? ## Define landmarks Add or delete vessel centerlines, if 11 necessary 4D Adding new landmarks 13 Show Vessel Color Saving Procedure planning 14 L lliac A L Renal R Renal SL 0.8 SL 0.8 R Iliac MPR LAO 90 /0 C MPR Intra-operative Fusion with syngo EVAR Guidance 15 Aorta SiemensHealthineers, ... SOMAT:OM Definition SiemensHealthineers, ... H SOMAT96 BF 26OR 250 250 BodyAngio 0.75 B26f syngo CT 2010A HFS BodyAngio 0.75 B26f 1/1/1 900 CT ^1/1/1 900 12/16/2013 CT 12/16/2013 1:04:43 PM 1:04:43 PM Registration 16 Define Landmarks Overlay Overlay 19 Volume Opacity Image | Tools |Meas ... Driving the C-arm to pre-defined Angulations 21 Segmentation 10 cm 3D Tools Overlay of DICOM volumes 22 Ranges A Bookmarks 23 SLO'S SL 0.8 MPR 330 SL 0.8 Embolization Guidance LAO 90 / 0 60 MPR 0/0 · EVAR Guidance SiemensHealthineers, Pa. SOMATOM Definition SiemensHealthineer MATOM D Needle Guidance 250 BodyAngio 0.75 B26f syngo CT 2010A 250 BodyAngio 0.75 B2 syngo Ci HFS Spine Guidance *1/1/1900 CT ^1/1/1 900 CT 12/1 6/2013 1:04:43 PM 12/16/2013 Stenosis Analysis 1:04:43 PM OK Cancel Volume Opacity mage Tools Meas .. R Segmentation 3D Tools F A Ranges SL 0.8 MPR 330 294 0 / CAUD 90 60 VRT 0/0 DE 6/27/2019 2:44:40 PM 5 Start syngo Effective Date: 06/02/2020 | HOOD05162003097077 EVAR Unrestricted © Siemens Healthineers, 2020 Guidance syngo EVAR Guidance SIEMENS Healthineers Start syngo EVAR Guidance syngo EVAR Guidance can be started with the CTA loaded as either: To ensure proper results, the following CT standards are recommended: • The Exam Patient or • CTA: arterial phase with homogeneous contrast in the aorta and • The Review Patient Iliac arteries. • Slice thickness: 1.5mm or less. Please note: Other aspects, for example anatomical details or calcification Exam patient Siemens, EVAR of vessels, may affect the accuracy of the planning results. Viewing Review patient Review and Processing EVAR Guidance x Create Vessel Tree Define Landmarks The Review Patient can be used for offline planning. The application will not connect to the C-Arm for Overlay. 6 Start syngo Effective Date: 06/02/2020 | HOOD05162003097077 EVAR Unrestricted © Siemens Healthineers, 2020 Guidance syngo EVAR Guidance SIEMENS Healthineers Create Vessel Tree Automatic Segmentation Patient Applications Reconstruction Show Mode View Orientation Tools Measure Volumes Options Help SiemensHealthineers, SOMATOM Definition SiemensHealthineers, ... SOMATOM Definition 250 syngo CT 2010A BodyAngio 0.75 B26f syngo CT 2010A HFS 250 BodyAngio 0.75 B26f SiemensHealthineers, Pat *1/1/1 900 ^1/1/1 900 CT 12/1 6/2013 CT 12/16/2013 3D 1:04:43 PM 1:04:43 PM • The automatic segmentation attempts to find the following vessels: Review and Processing EVAR Guidance X Create Vessel Tree ? # • Aorta: from the aortic bifurcation to the most proximal point seen Add or delete vessel centerlines, if necessary MITITMS in the CT (which includes the aortic arch root if visible in the CTA). 4D • The common iliac artery and external iliac arteries (both left and 10 cm right). Show Vessel Color • Renal arteries (both left and right, if present). If the patient has V L Iliac LA L Renal more than one renal artery for one side, only one (usually the most R Renal SL 0.8 SLO! MPR R lliac MPR 839 LAO 90 /0 350 Aorta prominent one) is detected. SOMATOM Definition 250 SiemensHealthineers, ... SOMATOM Definition syngo CT 2010A 250 SiemensHealthineers, ... BodyAngio 0.75 B26f syngo CT 2010A BodyAngio 0.75 B26f *1/1/1 900 HFS CT M1/1/1 900 12/16/2013 CT Detected vessels 12/16/2013 1:04:43 PM 1:04:43 PM • The detected vessels are listed in the centerline list in the Create Define Landmarks Overlay Vessel Tree tab card. -@- Volume Opacity Image Tools |Meas .. Segmentation 3D Tools Ranges A SPlans O / CAUD 90 350 VRT 7 Create Vessel Effective Date: 06/02/2020 | HOOD05162003097077 Tree Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Create Vessel Tree Aortic arch branches Adding additional vessels After the automatic segmentation of the aorta, external iliac and renal arteries, any other required vessels can be manually added to the vessel tree. This can be direct branches of the aorta, for example: Celiac trunk • The superior mesenteric artery (SMA) SMA • The celiac trunk • The branches in the aortic arch It can also be indirect branches or sub branches of the aorta, for example: • The internal iliac arteries Internal iliac arteries 8 Create Vessel Effective Date: 06/02/2020 | HOOD05162003097077 Tree Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Create Vessel Tree Adding additional vessels Review and Processing EVAR Guidance X Create Vessel Tree To add additional vessels to the vessel tree: Add or delete vessel centerlines, if necessary i 1 1. Select the Add Vessel button in the Create Vessel Tree Tab. 2. 2 Click at the distal location of the desired vessel in either the MPR or 1 VRT. • The application traces the vessel back to the existing vessel tree and adds the corresponding centerline. 2 Show Vessel Color • To prevent the accidental adding of centerlines, the Add Vessel button L lliac is de-activated after each click. L Renal All additional vessels which have been added during this step, can be R Renal • R Iliac found in the Centerline list. Aorta • You can rename, delete or highlight the vessels. Centerline list Define Landmarks Overlay 9 Create Vessel Effective Date: 06/02/2020 | HOOD05162003097077 Tree Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Create Vessel Tree Patient Applications Reconstruction Show Mode Show Mode View Orientation Tools Measure Volumes Adding additional vessels when the aorta is not defined Review and Processing SiemensHealthineers, ... SOMATOM Definition SOMATOM Definition syngo CT 2010A syngo CT 2010A BodyAngio 0.75 B26f 250 SiemensHealthineets, ... 250 1/1/1900 HFS BodyAngio 0.75 B26f EVAR Guidance x M1/1/1900 CT CT 12/1 6/2013 1:04:43 PM 12/1 6/2013 1:04:43 PM Create Vessel Tree In some cases, for example, when an intra-operative DynaCT is used 2 No vessel objects available. Mark vessel centerlines manually. instead of CTA image data, the aorta will not be automatically segmented. Before you define other vessels, you must first define the aorta. 1 10 cm To define the aorta: 3 1 • Select the Add Vessel button. A 2 Click on the proximal end of the aorta. Splan • 800 SL 0.8 800 LAO 90 / 0 C 350 MPR 350 Show Object Color 3 • Click on the distal end of the aorta. SiemensHealthineets, ... SOMATOM Definition 250 SiemensHealthineers, ... HAL SOMATOM Definition 250 BodyAngio 0.75 B26f syngo CT 2010A *1/1/1 900 HFS BodyAngio 0.75 B26f syngo CT 2010A *1/1/1900 HFS CT CT 12/16/2013 1:04:43 PM 12/1 6/2013 1:04:43 PM This is known as two-click segmentation. TTITITTITI After the aorta has been added, continue with any other vessel in order to RAH create the required vessel tree. Define Landmarks 800 07 CAUD 90 350 VRT LAO 12 / CAUD 12 Overlay 10 Create Vessel Effective Date: 06/02/2020 | HOOD05162003097077 Tree Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Define Landmarks In the Define Landmarks workflow step, the application computes a surface mesh of the aorta and external iliac arteries and draws landmark proposals on the surface mesh. The following landmarks are automatically defined: Vessel ostium • Vessel ostia • Potential landing zones • The computed ostia all have a fixed initial size of 5mm (inner diameter), reflecting the common size of visceral branches. • The computed landing zones are drawn distally to the ostia (especially the lower renal ostium) and are perpendicular to the centerline. • Additionally, a C-Arm angulation associated with the landmarks is 1 cm proposed, which ensures an orthogonal (parallax-free) projection to the corresponding branch. Landing zone Please note: • The surface mesh does not need to be ‘perfect’, it only serves as a ‘canvas’ for the landmark proposals. • All landmarks need to be checked and adapted in size, position and angulation. • All angulations need to be checked to see if they can be reached in the current OR or Angiography suite. 11 Define Effective Date: 06/02/2020 | HOOD05162003097077 Landmarks Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Define Landmarks 1. Select the Define Landmarks tab card. • All identified landmarks (vessel ostia and potential landing zones) Review and Processing are listed in the Landmark list. EVAR Guidance × 2. Check the suggested landmark’s size, position and angulation. Create Vessel Tree Define Landmarks • The landmarks can be selected directly out of the list and can be Add or edit landmarks, if necessary. adapted according to the CTA. Check position and angulation of any ictina landmarkin Go to next Landmark • Another possibility to check the landmarks is to use the Go to the next Landmark button. 0 • Toggle through the landmarks. Show Landmark ... L Renal C R Renal Landmark3 Landmark4 Landmark list 3 O + Overlay 12 Define Effective Date: 06/02/2020 | HOOD05162003097077 Landmarks Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Define Landmarks To add an additional landmark, activate the Add Landmark button and select the desired location in either the MPR or VRT view. Review and Processing EVAR Guidance × The type of landmark depends on where it is placed: Create Vessel Tree Define Landmarks • When you click on the mesh outline: an ostium is added. Add or edit landmarks, if necessary. • When you click on the mesh centerline: a landing zone is added. Check position and angulation of any existing landmarks. • When you click on any other structure: a ‘general’ (ring shaped) marker is added. 0 You can store a new C-arm angulation to the selected landmarks. 1. Adjust the required landmark. Show Landmark ... L Renal 2. Save the new C-arm angulation with the Store new angulation button. R Renal C Landmark3 Landmark4 Add Landmark Centerline + Store new angulation 13 Define Effective Date: 06/02/2020 | HOOD05162003097077 Landmarks Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Saving the procedure planning The planning (all centerlines, landmarks and associated angulations) are Patient Applications Reconstruction Show Mode View Orientation Tools Measure Volumes Options Help SiemensHealthineers, HR TOM Definition SiemensHealthineers, HPR SOMATOM Definition 250 stored automatically when the patient is closed. BodyAngio 0.75 B26f 250 syngo CT 2010A BodyAngio 0.75 B26f yngo CT 2010A HFS SiemensHealthineers, Pat 1/1/1900 1/1/1900 CT 3D 1.04.23 PM 12/16/2013 1:04:43 PM Review and Processing When the patient is re-opened and the syngo EVAR Guidance workflow is EVAR Guidance X Create Vessel Tree started, the corresponding information is loaded and displayed Define Landmarks Add or edit landmarks, if necessary. Check position and angulation of any 4D automatically. RA existing landmarks Show Landmark LI ... L Renal R Renal SL 0.8 SL 0.8 MPR MPR LAO 100 / CRAN 1 LAO 9/ CPAN 28 SiemensHealthineers, AHR SOMATOM Definition SiemensHealthineers, Centerline Surface 250 BodyAngio 0.75 B26f syngo CT 2010A 250 HFS 1/1/1900 Bod Angio 0.75 B26f M171900 CT 12/16/2013 CTO 12/16/2013 1:04:43 PM 1.04:43 PM Overlay -O- Volume Opacity 1.00 Image | Tools Meas .. RF RA Measurement 1 cm Graphics 5 cm Annotation more Plan 800 LAO 12/ CAUD 62 350 VRT LAO 31 / CRAN 17 6/27/2019 4: 17:10 PM 14 Saving the Effective Date: 06/02/2020 | HOOD05162003097077 procedure Unrestricted © Siemens Healthineers, 2020 planning syngo EVAR Guidance SIEMENS Healthineers Intra-operative Fusion with syngo EVAR Guidance General functionality of Fusion Imaging The main purpose of syngo EVAR Guidance is the Fusion of the 3D planning volume with the 2D intra-operative fluoroscopy to provide continuous 3D guidance throughout the procedure. Fusion imaging basically consists of the following steps: 1. Registration of the 3D Volume to the C-Arm geometry This ensures that the 3D volume is in the same coordinate system as the C-Arm. It can also be regarded as a ‘virtual placement’ of the 3D volume at the anatomical 2 3 corresponding position ‘in the patient’. 2. Projection of the registered 3D volume This means that the registered 3D volume is ‘virtually projected’ with the same 1 parameters as the actual X-Ray image was acquired. This is a mathematical procedure which additionally requires extensive knowledge about the current C-Arm position and imaging parameters. 3. Combined Visualization Here the ‘virtually’ projected 3D volume and the ‘actually’ projected X-Ray are displayed in the same image. In syngo EVAR Guidance usually the landmarks and outlines of the mesh are displayed. 15 Fusion Effective Date: 06/02/2020 | HOOD05162003097077 imaging Unrestricted © Siemens Healthineers, 2020 introduction syngo EVAR Guidance SIEMENS Healthineers Registration possibilities of the pre-op Planning to the C-arm You can choose between two different registration options: 2D/3D Registration: • To align the pre-operative 3D dataset to two 2D images (e.g. acquisitions or fluoroscopy), taken from different angulations (preferably 90° apart). 3D/3D Registration • To align the pre-operative 3D dataset to a native syngo DynaCT (without the injection of contrast). During a registration process, there are three possible shift directions and three possible rotations that need to be adjusted in order to align the pre- lintnormen operative 3D dataset with the intra-operative images. Angle = 90º 2D/3D registration offers only information from two projection images. • 3D/3D registration offers information from the entire 3D volume. 2D/3D Registration 3D/3D Registration • 16 Registration Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Registration possibilities of the pre-op Planning to the C-arm The differences between the registration methods can be summarized as follows: 2D/3D registration • This registration method comes with a very little workflow impact, since only two 2D images need to be acquired. High 3D3D 3D3D The potential accuracy is less than for the 3D/3D registration, since the registration • (via syngo (via syngo method itself has limitations. Also, the focus on bony structures does not DynaCT) DynaCT) automatically ensure an alignment of the aorta. Registration on Registration on Pelvis/Spine Aortic Calcifications 3D/3D registration 2D3D • The workflow impact is higher, since a full rotation of the C-Arm needs to be (via 2 2D performed. Images) Workflow Impact • The potential accuracy is higher, since the entire 3D volume can be used as a basis to Registration on adjust all rotations and translations, and also the registration can focus on the Pelvis/Spine alignment of the aorta itself (for example, by aligning calcifications). Low In summary, the question of which registration to choose is more of a workflow rather than Low Potential Registration Accuracy High an accuracy decision. The decision for performing a syngo DynaCT for registration should depend more on the OR room setup and staff experience. 17 Registration Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Registration possibilities of the pre-op Planning to the C-arm Important considerations! • Due to different patient positioning for CT and in the OR and the time elapsed during the different acquisitions, the rigid registration might not be able to achieve a 100% match. • Active or passive patient movement can occur at any time. Even a very accurate 3D/3D registration can be compromised by patient movement. • The accuracy of both registration types can be compromised by the introduction of stiff devices in the aorta. • Due to this potential inaccuracy it is highly required to perform an Angiography-based re-registration after the insertion of stiff devices. • Before performing sensitive operations (e.g. releasing stent grafts etc.) always confirm that the Overlay matches the anatomy. When in doubt, perform a DSA or other ways to confirm the overlay. Angle = 90º 18 Registration Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Overlay 1. Select the Overlay tab card to start the registration process. EVAR Guidance × • If one of the options Overlay on Live or Overlay on 4D is activated, Create Vessel Tree Define Landmarks the registration is started automatically. Overlay 2. Perform the registration as described (pages 15 and 16), depending on Select a landmark from the list. Deflect registration method (2D/3D or 3D/3D registration). joystick to drive to the nocition of the selecte Landmark list • The registration is not opened if a registration is already available (for example if you jumped back to one of the previous steps and jumped Show Landmark ... back to Overlay, the registration is skipped) or if the planning has L Renal been performed on a contrasted syngo DynaCT which is per se R Renal registered to the C-Arm. R lliac • The Overlay tab card includes a Landmark List where you can select Centerline Contour single landmarks to: • Switch on/off for display • Select the corresponding associated angulations • The Overlay buttons can be used to select the display on which the Overlay on Live Registration overlay is shown: Live • Overlay on Live: the overlay is shown on the Live screen Overlay on 4D • Overlay on 4D: The overlay is shown in the 4D tab card. • The Registration button opens the different registration tools. 19 Overlay Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Overlay You have three possibilities to display the EVAR planning graphics, which can HPR EVAR Guidance X be controlled by the Display Options Check Boxes and Drop Down: Create Vessel Tree Define Landmarks • Display of the 3D volume centerlines, for example, to display the Overlay vessel shape or for measurements. The centerline is graduated with Select a landmark from the list. Deflect different dots, where the larger blue ones denote 5cm distances, the joystick to drive to the position of the selected landmark. smaller green ones 1cm. • Contour: Display of the aorta and Iliac contour. RA Show Landmark • Surface: Display of the aorta and Iliac mesh surface. V L Renal R Renal Also, the entire vessel visualization can be switched off. R lliac 5 cm AL Display centerline Contour/Surface selection Centerline Contour Contour AO 31 / CRAN 17 Surface Contour Contour with centerline Display on/off Live 20 Introduction Overlay Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Driving the C-arm to pre-defined Angulations You can use the Landmark list to drive the C-arm directly to the pre-defined EVAR Guidance × angulations. Create Vessel Tree Define Landmarks Overlay ? ¡ Views for landmark positions which can be reached by a C-arm angulation are Select a landmark from the list. Deflect marked by a C-arm symbol. joystick to drive to the position of the selected landmark. 1. Select the required landmark from the Landmark list. Show | Landmark • The angulation is transferred from the Landmark list to the C-arm. L Renal R Renal C-arm angulation stored 2. Deflect the joystick of the control module away from you until the target position has been reached. V R lliac Centerline M Contour Live 21 Overlay Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Overlay of DICOM volumes In some situations, you might find it useful to display not only Mode View Orientation Tools Measure Volumes the graphic elements on live fluoroscopy but also entire DICOM volume or VRT parts of the DICOM volume. MIF MinIP In such cases, the (additional) volume overlay can be switched on and VRT Thin off via the View Menu entry Show Volume Data in VRT. MIP Thin MinIP Thin MPR MPR Thick Synchronized MPR Synchronized MPR Compare Orthogonal MPRs Synchronized VRT Synchronized VRT Compare Locked VRT Rotation Show MPR Planes in VRT Show Volume Data in VRT 22 Overlay Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 Siemen Healthingers, HPL SOMATOM Definition 250 syngo CT 2010A HFS SIEMENS Bod Angio 0.76 B26f Healthineers 41/11900 12/16/2013 1:04 :43 PM Additional information: Bookmarks RHA 5.cm 23 VPT 391 Click to add footnote Effective Date: 06/02/2020 | HOOD05162003097077 second line ILAO 37 / CRAN 14 504 Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Bookmarks introduction Patient Applications Reconstruction Show Mode View Orientation Tools Measure Volumes Options Help SiemensHealthineers, HR SOMATOM Dempiton Siemens Healthingere, ... HP SOMATOM Definition 260 250 Bookmarks save a specific status of volume processing, like cropping or BodyAngio 0.75 B261 syngo CT 2010A SiemensHealthineers, Pat *1/1/1900 HFS Body Angio 0,75 B261 CT *1/1/1900 12/16/2013 CT 3D 12/16/2013 1:04:43 PM 1:04:48 PM windowing. So different bookmarks of the same volume can be saved which Review and Processing EVAR Guidance X show specific details of the volume, like vessels, bones etc. Create Vessel Tree Define Landmarks Add or edit landmarks, if necessary. Check position and angulation of any 4D existing landmarks. Bookmarks save the volume status and also the corresponding workflow status. Show Landmark L Renal R Renal Bookmarks can be made from all workflow steps within syngo EVAR 800 SL 0.8 LAO 98 / CRAN 2 350 MPR LAO 13 / CRAN 32 SiemensHealthineers, AHR SOMATOM De nition SiemensHealthingers Centerline Surface Guidance. The results will appear in the Review and Processing tab in the 250 BodyAngio 0.75 B26f HFS 250 Bod Angio 0.75 B26f *1/1/1900 11 1900 CT Viewing sub-tab. 12/16/2013 1:04:43 PM DE 43 PM Overlay O- Volume Opacity Please note: Bookmarks that you want to use in the syngo EVAR Guidance Image | Tools |Meas .. RF RHA workflow have to be created in the syngo EVAR Guidance workflow. Segmentation 3D Tools Bookmark Rang MPR Plan> LAO 13 / CAUD 62 0 37 / CRAN 14 24 Bookmarks Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Bookmark Generation To properly prepare bookmarks, the patient has to be opened as Review 2 M Centerline Surface Patient (not as Exam Patient) before starting the workflow. A good point in Save bookmark as ... X time to prepare the bookmarks is after the entire planning is finished, for example when the Define Landmarks step is finished. Name: Prepare the 3D dataset as needed for intra-operative display. Close Help Image Tools |Meas ... |X-Ray To save a bookmark: 1. 1 Left mouse click on the Save Bookmark button. Segmentation • A bookmark is saved with a timestamp within Viewing in the Review and Processing step. 3D Tools To store the bookmark with a specific name: Ranges 1 1 1. Right-click on the Save Bookmark button. 2. 2 A new window opens. Enter the bookmark name and save it. You can save multiple bookmarks in the same way, for the 3D dataset. For example, you could create a ‘Bone’ bookmark for Registration or a ‘Vessel’ bookmark for Overlay. 25 Bookmarks Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Recall a stored Bookmark in syngo EVAR Guidance Within the Review and Processing tab you will find the sub-tab: Viewing. In Review and Processing the Viewing sub-tab all of the saved bookmarks are displayed. Viewing Review volumes loaded from the When a 3D dataset is loaded into the viewer, the list of attached bookmarks patient browser appears in the Viewing tab card. • After selecting a bookmark, the corresponding workflow (for example, 6/4/2009 SCAN ABDOMINO- syngo EVAR Guidance) is started. PELVIEN C+ -ABD • The application jumps to the corresponding step (for example, Define Landmarks) and the stored volume settings are applied. The workflow can then be continued. The corresponding volume can 10/17/2018 • also be used during overlay. Bone Vessel 26 Bookmarks Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 syngo EVAR Guidance SIEMENS Healthineers Switching Bookmarks in the Overlay step You may want to switch between different bookmarks, for example, you may Review and Processing want to switch from a ‘Bone’ bookmark for Registration to a ‘Vessel’ EVAR Guidance x Create Vessel Tree bookmark for Overlay. Define Landmarks Overlay To change the bookmark in the Overlay step: Select a landmark from the list, if available. For landmarks with angulation information, deflect joystick 1. In Overlay Step go to Review and Processing. This will leave the to drive to the position workflow and bring you to the Viewing tab card. Show Landmark 2. Select the new bookmark. L Renal 3. The application jumps to the workflow step where the bookmark was R Renal created, for example, Define Landmarks. 4. Select Overlay again. 5. The application continues the Overlay with the latest registration, but M Centerline Contour with the newly selected bookmark. 27 Bookmarks Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020 SIEMENS Healthineers Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH 2020 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Telephone: +49 9131 84-0 siemens.com/healthineers 28 Effective Date: 06/02/2020 | HOOD05162003097077 Unrestricted © Siemens Healthineers, 2020