syngo Application Software VD20: syngo EVAR Guidance Video

Welcome to the Syngo EVAR guidance workflow video. This video will demonstrate how to perform EVAR guidance using your artist system and syngo application software. Syngo evar, endovascular aortic repair guidance, provides the ability to safely plan and perform image guided catheter based procedures for the treatment of larger vessels, in particular, the aorta. Using a previously acquired CT angiogram CTA. The single application software automatically segments the aorta. Centerlines of the vessel tree are automatically calculated in landmarks of the segmented vessel. Branches are automatically created. The external iliac and renal arteries are calculated automatically. Other vessels, for example, the esmay, the celiac trunk and the internal iliac arteries must be manually added. When using an interop contrast filled I nocete the segmentation results can be achieved manually. Or syngo evar. Guidance the 3D information can be fused with a live image to enable 3D road map such that the vessel tree and landmarks can be overlaid on the live image. The guiding structures ring markers help to locate the entrances of vessels. With central lines, the run off of vessels can be seen, and measurement estimates can be done based on the graphical dots. Please note that Syngo Ivarr guidance is not a stent planning tool. The information in this video relates to Syngo Ivarr guidance with the following system requirements. Artist systems with software version Pure VD 11 or higher or artist Fino with software version V10 or higher. Single application software with software version V D20 or higher. Before starting the Syngo Ivarr guidance workflow, ensure that the patient is correctly positioned on the table and is registered on the imaging system. To start Syngo EVAR guidance, load the CTA data to the 4D viewer, click on the select workflow icon and select the Ivart guidance workflow. Workflow guidance messages are given in the application. Please follow the guidance. To activate Ivar guidance from the exam room display, select EVAR. Guidance from the workflow menu via the onscreen menu. Workflow guidance is given on the 4D screen in the exam room. Please follow the guidance. Please note the creation of the vessel tree is not supported from the exam room. When using the Prehab CTA volume ideally with the slice thickness of 1 millimeter, the vessel tree aorta, iliac, and renal arteries is detected automatically. Vessel centerline should be checked to evaluate accurateness. Scroll through the empires and rotate the vert to check the segmentation result. It is possible for the vessel Centerlines to be incorrect due to the following factors. The loaded volume does not contain the aorta. Patient movement during the volume acquisition. Insufficient contrast in the volume. Or inappropriate acquisition settings. In addition, anatomical factors such as calcification can cause problems with the accurateness of the segmentation result. When using an Intraop dynasty T or if the detection of the vessel Centerlines fails or the result is not satisfactory, you can manually mark the vessel tree. In the create vessel tree workflow step, select the icon to add a vessel segment. Select the vessel to be detected. If the order has already been defined, you can use one click segmentation to identify the vessel. Click on the distal end of the vessel. The software automatically segments the vessel and it appears in the list. You can rename the vessel on the vessel list by double clicking on the name. If the aorta was not previously defined, you must first define the aorta before defining other vessels. To define the aorta, first click on the proximal end of the aorta. Then click on the distal end of the aorta. This is known as two click segmentation. Please note that it is not possible to add vessels from the exam room. After you have checked all of the vessels, you can check and define additional anatomical landmarks of the vessels. Select the workflow step define landmarks. The vessel Ostia and landing zones are automatically defined. To check each landmark, click on the icon to progress to the next landmark at the top of the workflow step. The NPR invert views will align to demonstrate the selected landmark. To reposition an osteon marker, move the mouse cursor over the landmark. When the ostian marker can be selected for movement, the cursor symbol will change shape. Click on the center of the ostian marker and move it with the mouse. To change the size or orientation of the Ostia landmarks, select the specific ostia marker and grab the handle at the end of the marker. Use the handle to resize and reposition the ostian marker. To reposition the landing zone, click on the landing zone and move it using the mouse. Please note that landing zones can only be repositioned along the centerline. To add a landmark click on the add landmark icon in the workflow step. Click on the landmark on a centerline within a vessel. The type of landmark created Ostia or landing zone depends on the position of the landmark. If you create a landmark on the centerline, the landmark is automatically defined as a landing zone. If you click outside the vessel, a general ring marker is created. Manually added landmarks do not have an angulation associated with the landmark by default. If you would like to associate the see arm angulation to the landmark, adjust the vert and save the C arm angulation. If needed, you can also adjust automatically calculated angulations by pressing on the save button. Please note that it is not possible to add landmarks from the exam room. To delete a landmark, you can select the landmark in the landmark list and right click and select delete. Or select the landmark in the image segment and right click. In the context menu, select delete. Alternatively, you can open the object list and delete the landmark. Select the object, right click and select delete. You can save the see arm angle for a selected landing zone or ostium. First, mark the landmark in the landmark list on the workflow step, rotate the volume to the desired view. Select the icon to save the See arm position. When the angulation is saved, the landmark will be marked with the see arm symbol in the landmark list. The created landmarks can be overlaid on the live fluoroscopy image. Select the overlay step in the workflow. If you are operating syngo EVAR, guidance from the exam room, select the overlay workflow step from the onscreen menu. A registration of the see T data set and the live image must be performed. After selection of the overlay workflow step, the registration window will open automatically. If not, open the registration window can be opened by selecting the registration icon in the bottom right corner of the workflow step. Select the two D3D tab to perform a 2D3D registration. Select the three D3D tab to perform a 3D3D registration. For two D3D registration 22D fluoroscopy images must be taken. A minimum of 30 degrees apart. 90 degrees is optimal. Align the 3D volume with the live 2D image using the anatomical landmarks. After successful registration, the anatomical landmarks are overlaid on the live image. You can check the position of the overlay with angiography and adjust the result if necessary. To adjust the result, select manual alignment from the Vert or NPR menu on the onscreen menu. Align the guidance structures on the angio image during alignment. Align the structures on the angio image and the region of interest. To adjust the, see arm position to a landmark position, select the landmark on the landmark list. If operating from the exam room, select adjust to landmark from the Varty menu on the on screen menu. A message is displayed on the exam room display prompting you to activate movement automatic run, activate stand movement. Press the stand see I'm joystick down and deflected away from you until the target position has been reached. The graphic overlay rotates as the system movement occurs. When the system has reached the target position, a message will be displayed on the exam room display. Automatic run position reached. When fluoroscopy is released, the overlay is adjusted to the new system position. Hint When devices are being deployed, the anatomy may be altered to the initial alignment. Therefore, landmarks may be displaced. Please check regularly and make a new alignment as necessary.

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