syngo.via VB20 - MM RT Image Suite

syngo.via® VB20 – MM RT Image Suite The delivery of cutting-edge radiation therapy relies heavily on advanced multi-modality imaging and the ability to accurately delineate target lesions. syngo.MM RT Image Suite is a dedicated imaging-for- RT software solution that enables advanced multi-modality image evaluation and tumor contouring that complements the functionalities on most treatment planning systems. 1. From the Patient Worklist, load an appropriate data set into the MM RT Image Suite 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 > MM RT Image Suite. • Drag and drop the desired image series from the Series Drag drop data from series navigator Navigator into the working area. • Right click and drag a second series to Add, Replace, or Add Fuse. Replace Fuse (MPR/MPR) 2. Segmentation and 4D Management For more accurate volume target contouring it is often helpful to use multi-modality images if the anatomical or functional information in the CT images alone is limited. In syngo.via MM RT Image Suite, MR sequences or PET images can be fused with the planning CT to help support the contouring process. • Segmentation Once images are loaded, RT Image Suite will automatically perform a rigid registration to the left-most image (unless a registration is already available). Registration editing can be enabled from the upper-left watermark or in the Case Navigator. When registration is complete, contouring can be started. o Create a new structure. o Click the Draw Freehand icon on the contouring toolbar. 2D enables slice by slice contouring and 3D enables 2D 3D automated volume contouring of the Draw Nudge Segment Pan/Scale dataset. Freehand Contour by Value Rotate o Draw the lesion contour in a continuous motion or click and drop points around the tumor border. Double click to end the contour. o Use the nudge tool to refine the drawn contour. This will update simultaneously in all associated segments. SIEMENS Healthineers www.usa.siemens.com/healthcare HRT#HOOD05162002614143 Effective Date: 06/27/17 Page 1 of 7 • Semiautomatic/Automatic Segmentation Tools o Semiautomatic tools are available for skin segmentation and PET threshold segmentation. o Segment by Value enables Absolute, 2D Skin, or Relative (%) thresholding 3D Draw Nudge Segment Pan/Scale Freehand Structure by Value Rotate 2D @ Absolute . Skin Relative (%) 3D Segment Min -660 2958 Max x o The Auto Contour (auto segmentation) mode will apply margins to nine dedicated organs – the brain, lungs, kidney, liver, femoral heads, or Draw Nudge Pan/Scale Fill i Freehand Auto Contour Rotate Contol heart. These margins can be edited if Organ Contours necessary, and structures can be Create Combine Crop Reflect Margin combined or cropped. Structure Contour Brain Preview On/Off Femur L Femur R Heart Kidney_L Kidney_R Liver Structure Templates Lung_L Lung_R Select Structure Template Ling OK Cancel Lung Name Type CTV CTV PTV PTv A Apply Close o The configurable Structure Templates gives you the flexibility to create a list of organs, rename structures, and apply colors. o The structure set can be saved and sent to the treatment planning system by clicking the Save and Send button. SIEMENS Healthineers www.usa.siemens.com/healthcare HRT#HOOD05162002614143 Effective Date: 06/27/17 Page 2 of 7 • 4D Management MM RT Image Suite helps clinicians realize the full potential of 4D imaging. Time-saving tools in an integrated workflow help promote more confident lesion contouring and subsequent treatment planning. Using multiple data sets such as the temporal MIP and the individual respiratory phases can help accurately contour tumor extension in the lung. The Average CT is needed in order to calculate the dose. o Using the 3D freehand tool, segment the full tumor volume by simply drawing the tumor extension in at least two orthogonal projections. o Use the nudge tool to refine the drawn contour. This will update simultaneously in all associated segments. The application allows for contouring on individual Jose Evaluation All Resp 3.0 B31f 100 Ex - 100 In TRIGGEI breathing phases, but contours can also be drawn on Resp 3.0 B31f 100 Ex - 100 In TRIGGEI one phase and propagated across respiratory phases. Resp 3.0 B31f 100 Ex - 100 In TRIGGEI RT Navigator Findings Resp 3.0 B31f 100 Ex - 100 In TRIGGER Resp 3.0 B31f 100 Ex - 100 In TRIGGEI Structures POI Resp 3.0 B31f 100 Ex - 100 In TRIGGEI Name Type Resp 3.0 B31f 100 Ex - 100 In TRIGGEI o Right mouse click on the desired structure in NewStructure ARA Rename Resp 3.0 B31f 100 Ex - 100 In TRIGGEI Change Type Resp 3.0 B31f 100 Ex - 100 In TRIGGEI the RT Navigator Show as defined in › Doen 3 0 R31f 100 Fv . 100 In TDIGGFI o Select Propagate to Propagate to Copy Show Movement o Choose the desired series Tools Create ITV Erase Contours Duplicate Delete Lock Semi-automatic identification of mid-ventilation phases and Structures POI Name Type quantitative assessment of 3D tumor trajectory and amplitude are NewStructure Rename also possible. Change Type Show as defined in Propagate to o Right mouse click on the contour in the Findings Navigator Show Movement and select Show Movement. Create ITV Erase Contours Duplicat Delete Tumor Curve Lock Structure/POI : NewStructure1 Head-Feet Amplitude : 0.5 cm Left-Right Amplitude : 0.2 cm Anterior-Posterior Amplitude - 0.2 cm The Tumor Curve is displayed, indicating the Head-Feet Phase Closest to Midposition : 60 In Tumor Trajectory Distance to Midposition Amplitude, the Left-Right Amplitude, and the Anterior- 0.6 0.5 Posterior Amplitude. You can also toggle between visualizing the Tumor Trajectory or the Distance to Midposition. Distance (cm) 100 Ex 80 Ex 60 Ex 40 Ex 20 Ex 0Ex 20 In 40 In 60 In 80 In 100 In Phase SIEMENS Healthineers www.usa.siemens.com/healthcare HRT#HOOD05162002614143 Effective Date: 06/27/17 Page 3 of 7 3. Re-contouring and Registration It is often necessary to re-contour and re-register the patient for adaptive therapy protocols or when anatomy changes during treatment. This process is easily facilitated by loading in both the current and prior examinations. • Re-contouring o Load the new planning CT next to the one previously contoured o Disable contour reflection to see the contours previously drawn Reflect On/Off • Registration Zoom/Pan o From the upper-left segment watermark or from the Case Navigator, O' Windowing open the Edit Alignment/Registration dialogue box o Here, you can perform another rigid registration or a deformable Correlated Cursors registration 7 Lock Reference Lines Registration Home Position Edit Registration for Scroll AXIAL_B50 Fit to Segment Registration Edit Alignment Auto Registration o There are three different methods of deformable registration: Rigid Deformable o VOI-based - to focus on a target area o Deform Image - focusing on the whole dataset Show Show Vectors Restrict Strength Set Deform Reset o Set Markers (Landmark registration) - by defining the same VOI Markers Image X points on the two data sets. • Deformation Vectors and Contours Adaptation o Look to the Deformation Vectors to check the registration Show Show Strength Vectors impact. Both the original CT and the original contours will be modified to match the new anatomy. 12% ₹ 90,00 SIEMENS Healthineers www.usa.siemens.com/healthcare HRT#HOOD05162002614143 Effective Date: 06/27/17 Page 4 of 7 RT Navigator Findings o Simply copy the deformed contours using the Copy Dialogue, selecting the deformed old planning CT as the source and the new planning CT as Copy Structures and POIS the target. To TAP SS Nawie Name O Structures and Pois sie copied in accordance to the currently visible regaliation between the two image OK Cancel o You can identify the changes in the volume and RT Navigator Findings the position of the structures by using the information dialog in the RT Navigator. Structure Set Overview -47-11 481 KJ ............ 12 1h12 4. Dose Evaluation MM RT Image Suite allows for the integration of images, findings, and dose volumes from current and previous planning CTs for more robust treatment planning and response assessment. Dose Evaluation o Right-mouse click Dose Evaluation to choose from the Dose Level Preset available RT plans. Default Preset Display Dose Display Mode Isodose Colorwash Dose DVH Algebra Display o The display mode allows you to visualize the dose levels as isodose curves and/or visualize the dose distribution as color wash overlay. ese Velemie fotogram o Compare two dose files visually side by side or via dose volume histograms (DVH) with the DVH Display icon. Dose Algebra 2 x BedmWs 20 80988 o Add or subtract two dose files by selecting the Dose Algebra icon. SIEMENS Healthineers www.usa.siemens.com/healthcare HRT#HOOD05162002614143 Effective Date: 06/27/17 Page 5 of 7 5. Patient Marking with Direct LAP Laser Steering Patient Marking allows you to define Points of Interests (POIs) in the acquired images (e.g. isocenter) and to send the coordinates to an external laser system, which projects the position of the POIs on the patient skin. This technique allows for reproduction of the POI location on the daily treatment for more accurate patient positioning. Marking the patient with this technique allows for reproduction of the POI location later during treatment and more accurate patient positioning for treatment. Direct Laser Steering supports direct transfer of coordinates to compatible LAP laser systems without the need to access an additional workstation: o Direct Laser Steering for LAP lasers o DICOM and text-file-based data exchange with lasers (other Vendors) o Visualization of laser lines on 3D patient model (VRT) with Direct Laser View o For CT, PET/CT and MRI • MM RT Image Suite Configuration MM RT Image Suite Q + o In the Case Navigator go to Options. RT Image Suite Patient Marking o Start with Patient Marking will enable the system to automatically go to MM RT Image Suite Configuration ? × Patient Marking when loading a patient to RTiS Laser Configuration POI Configuration o Select Create Laser Origin and Create Workflow Setup Isocenter on startup. The system will Start with Patient Marking Create Laser Origin on startup automatically create a place holder in Default color and name of Laser Origin LaserOrigin Create Isocenter on startup POI for Laser Origin (not needed in the Default color and name of Isocenter toCenter Allow markerless workflow markerless workflow) and the Isocenter Laser System Properties o Enable Allow Markerless Workflow and 1 movable laser axis Calibration Offset 50.00 cm reload the patient to RTiS Export to Laser System o Configure your 1-, 2-, or 3 moveable Export as LAP File Format 2.0 Export Path lasers under Laser System Properties. Export as RT Plan o Select the desired export parameters PlanName Network Node Enable Direct Communication to the LAP System under Export to Laser System IP Address 132 186 262 121 Port 2000 o Click OK and load your patient to MM RT Image Suite. OK Cancel SIEMENS Healthineers www.usa.siemens.com/healthcare HRT#HOOD05162002614143 Effective Date: 06/27/17 Page 6 of 7 • Markerless Workflow MM RT Image Suite @ + o Once images have been acquired Patient Marking Isocenter POIS and while the patient is still on Offset EC (cm) – the CT table - load the patient data into MM RT image Suite (- Patient XYZ). RT Navigator Findings Structures Name Type MARKER Absolute o In the POI tab, the Isocenter 2.91. placeholder is available (if Tools configured. If not isocenter must -- be created manually) o Move the crosshair to the Tumor/region of interest and select Set POI. For easier visualization the crosshairs are simulated and visualized on the surface shaded VRT. Patient Marking o In the Patient Marking tab, the Offset automatically populates Isocenter POIS NewReferencePoil Offset IEC (cm) -3,11 -2,2 7,55 o Click on the Send to Laser Icon and the Send to Laser System Table Position -460,5 dialog box opens. Select the correct point, and click Send and Close the window. send to Laser o The status of the POI changes to Saved and the POI is set to read only. The POI will be saved in the DICOM RT Structure Set. o Depending on the available laser system/configuration, the system moves to the required position and the laser system projects the coordinates on the patient’s surface. Now, the patient can be marked. SIEMENS Healthineers www.usa.siemens.com/healthcare HRT#HOOD05162002614143 Effective Date: 06/27/17 Page 7 of 7