syngo.via - CT Neuro Perfusion

syngo.via® CT Neuro Perfusion syngo.via CT Neuro Perfusion is designed to aid in the diagnostic evaluation of cerebral perfusion. By provid- ing images of blood flow, blood volume, and local bolus timing (such as mean transit time or time to peak) from one set of dynamic CT images, it allows fast evaluation of tissue at risk (TAR) and non-viable tissue (NVT) in the brain. 1. From the Patient Worklist, load an appropriate data set into the CT Neuro Perfusion Workflow: • If the examination has been correctly mapped, double click to load • If manual mapping is required, right-click the examination and select Open With > CT Neuro Perfu- sion 2. Timely evaluation of potential stroke is critical to improving patient outcomes. In the CT Neuro Perfu- sion workflow, Auto Stroke enables automated post-processing of the Motion Correction, Segmenta- tion, Vessel Definition, and Results Preview steps to help facilitate faster results. • Auto Stroke is performed when an auto stroke-enabled template is selected • The Motion Correction, Segmentation, Vessel Definition, and Results Preview steps are hidden while Auto Stroke is running • When Auto Stroke is finished, the usual workflow steps are displayed along with the Results Pre- view step with the calculated result maps. • If you are satisfied with the results in the Results Preview step, press the Confirm button. • You can now manually navigate through the various workflow steps if desired. CT Neuro Perfusion Q + CT Neuro Perfusion CT Neuro Perfusion CT Neuro Perfusion + CT Neuro Perfusion + 5 CT Neuro Perfusion CT Neuro Perfusion CT Neuro Perfusion Stroke Stroke Stroke Stroke TAC Reset TAC TAC Reset TAC Reset 0.00S 0.00s Auto Stroke Auto Stroke Auto Stroke Auto Stroke Step 1/4 Motion Correction Step 2/4 Segmentation Step 3/4 Vessel Definition Step 4/4 Results Preview Perfusion Evaluation Perfusion Evaluation Perfusion Evaluation Perfusion Evaluation MM Reading MM Reading MM Reading MM Reading V V V 11 CT Neuro Perfusion 4: Results Preview Check result images. Click Confirm to save and start the evaluation. Unsaved results will be deleted. Confirm Findings Navigator SIEMENS Unrestricted 0 Published by Siemens Healthcare GmbH “ Siemens Healthcare GmbH, 2020 Healthineers Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 06/29/17| HOOD05162002616061 Job Aid | syngo.via CT Neuro Perfusion Effective Date: 06/29/17| HOOD05162002616061 3. In the Perfusion Evaluation step, Circular or Freehand ROIs can be drawn to obtain additional quanti- tative information about the neuro perfusion data set. Results are populated to the Statistics tab, which can be exported with a right mouse click. Perfusion Evaluation Statistics O. ROI/VOI MIP Circular Freehand CBFD CBVD MTTD TTDD VOI TAC Marker [1] ROI $7.86 15.91 2.93 4 57 4.36 Deviation / HU Area/cm2 or Vol/cm3 [1] ROI (MPR) Mean: 57.86 HU 5.7 4. Auto Stroke is configured and enabled/disabled in the CT Neuro Perfusion Configuration dialog box • Open the CT Neuro Perfusion configuration dialog box by clicking the settings icon on the workflow step CT Neuro Perfusion Configuration Template: Stroke Create New Delete Common Calculason Visualization Results Penumbra CT Neuro Perfusion HU Thresholds Smoothing Strength • Clinical administrators can create or delete templates to be Result Sice used in Neuro Perfusion evaluation. Thickness 5 mm Distance 3 m CBF/CBV Normalization • User-defined configurations to the motion correction base Vessel Suppression in Results time point, brain segmentation and stroke evaluation base Auto Stroke Enable values, initial display, automatic preparation and archiving, and penumbra/tissue at risk properties and color coding can be made on the Common, Calculation, Visualization, Results, Restore Default Settings and Penumbra tabs. OKCancel SIEMENS Unrestricted 0 Published by Siemens Healthcare GmbH “ Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Healthineers Job Aid Effective Date: 06/29/17| HOOD05162002616061 Page 2 of 6 Job Aid | syngo.via CT Neuro Perfusion Effective Date: 06/29/17| HOOD05162002616061 5. Should a manual evaluation be desired or necessary, return to the CT Neuro Perfusion workflow step and select the desired non-auto stroke template. Evaluate the quality of the CT examination by navigating through the time points of the data set using the Time Slider. CT Neuro Perfusion Stroke TAC Reset 2.43s Stroke 0.00s 1: Motion Correction 2: Segmentation 3: Vessel Definition 4: Results Preview • Motion Correction and Time Point Exclusion: During preprocessing, syngo.via performs a motion correction of the dynamic data set. Use the Motion Correction step to improve images that still show motion. • To perform an automated neuro motion correction, click the Align icon. Align • To define a new motion correction base:  Navigate on the Time Slider to the desired time point. Align  Click the Align Base icon on the Case Navigator, and the white triangle will jump Base to the selected time point. • To exclude time points from evaluation:  Navigate on the Time Slider to the desired time point. E  In the Case Navigator, click the Exclude icon to exclude the currently displayed time point, or click the Range Exclude icon to exclude all time points from the cur- rently displayed to the last available time point. SIEMENS Unrestricted 0 Published by Siemens Healthcare GmbH “ Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Healthineers Job Aid Effective Date: 06/29/17| HOOD05162002616061 Page 3 of 6 Job Aid | syngo.via CT Neuro Perfusion Effective Date: 06/29/17| HOOD05162002616061 • Segmentation and 4D Noise Reduction: Use the Segmentation step to reduce image noise and to check and define the volume and structures for evaluation. • If the images are very noisy because of low kV or low dose, enable the Reduce Noise icon Reduce to perform a 4D Noise Reduction. Noise • Brain Segmentation removes all structures automatically except for the brain. Brain • You can also exclude structures that lie outside a defined minimum and maximum HU threshold. The HU-based segmentation operates exclusively in the baseline volume (i.e. those time points with no appreciable contrast).  Enable the HU Segmentation icon.  Enter desired values in the min or max HU fields and press Return. min -50 HU Segment max 150 HU • Vessel Definition: On the temporal MIP data, check that the vessels appear magenta, the major arteries are red, that the light blue reference vessel ROI is present (typically in the superior sagittal sinus), and the green hemisphere plane is visible and accurate. • To define an artery manually: Enable the Reference Vessel Defini- 3: Vessel Definition  tion icon. max. Enhance auto R'ference 512 HU Click and drag an ROI in the superior Window Arteries  sagittal sinus, if possible. A carotid R'ference artery can also be used. Carotis Interna  Disable the icon to complete. SIEMENS Unrestricted 0 Published by Siemens Healthcare GmbH “ Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Healthineers Job Aid Effective Date: 06/29/17| HOOD05162002616061 Page 4 of 6 Job Aid | syngo.via CT Neuro Perfusion Effective Date: 06/29/17| HOOD05162002616061 • Results Preview: Click the Results Preview step once the vessels are properly defined. 5: Results Preview Check result images. Click Confirm to save and start the evaluation. Unsaved results • Check the displayed result images will be deleted. Confirm • Click Confirm to start the evaluation and to proceed to the Results step. 5: Results • Results: In the Results step, Circular or Freehand ROIs can be drawn to obtain additional quantita- tive information about the neuro perfusion data O set. Circular Show Align Penumb. Settings The Tissue at Risk (TAR) can be evaluated by clicking the Penumbra icon. Core infarct and non-viable tissue (NVT) will be displayed in red and yellow based on user-configured settings. Results are populated to the Statistics tab, which can be exported with a right mouse click. SIEMENS Unrestricted 0 Published by Siemens Healthcare GmbH “ Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Healthineers Job Aid Effective Date: 06/29/17| HOOD05162002616061 Page 5 of 6 Job Aid | syngo.via CT Neuro Perfusion Effective Date: 06/29/17| HOOD05162002616061 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 ŶOperator Manualŷ) 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 ŶFunctionalityŷ) 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 Phone: +49 9131 84-0 siemens-healthineers.com SIEMENS Unrestricted 0 Published by Siemens Healthcare GmbH “ Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Healthineers Job Aid Effective Date: 06/29/17| HOOD05162002616061 Page 6 of 6