syngo.via Quick Guide for MM Oncology

SIEMENS Healthineers Education Services www.usa.siemens.com/education syngo.via Quick Guide for MM Oncology Classroom Workbook Answers for life. User Services. Driven by More. More: Our philosophy for a lifelong improvement through continuing education and consulting. Working closely with you, we develop your personalized education and consulting strategy and support you and your staff with our comprehensive User Services to help gain: • More: Routine Confidence • More: Clinical Expertise • More: Superior Performance More: Personalized training, education, and consulting services from Siemens Healthcare Customer Services. For your leading edge in medical care. User Services. Driven by More. More: Personalized More: More: Superior Clinical Performance More: Routine Expertise Confidence 2 I. 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Siemens Customer Care Center: Call 1-800-888-7436 Siemens Training Centers • Troubleshooting assistance Immediate assistance for software Siemens Clinical Education • applications and workflow issues Training Center – TDC2 • For Tech Support press option 2 / for 110 MacAlyson Court applications support, press option 3 Cary, NC 27511 • Press the * key or enter the last six digits of your Functional Location Number Functional Location Number ____________________ Serial Number ________________________________ IP Address System _____________________________ IP Address PACS _______________________________ 3 II. Contents I. Contact Information Summary .............................................................................................. 3 II. Contents ............................................................................................................................. 4 1. Introduction to syngo.via ..................................................................................................... 5 1.1 Starting syngo.via and Logging On ............................................................................... 5 1.2. Main Work Environments ............................................................................................. 7 1.3. Basic Functions to Read Images .................................................................................. 25 2. MM Oncology Engine......................................................................................................... 34 2.1. Purpose of MM Oncology Engine................................................................................ 34 2.2. Image Requirements .................................................................................................. 34 2.2. Loading Patient Data into the Viewer.......................................................................... 34 2.3. MM Oncology Tools and Shortcuts.............................................................................. 35 2.4. Layouts ..................................................................................................................... 40 2.5. 3D Reading Workflow Step ......................................................................................... 40 2.6. Trending Workflow Step ............................................................................................. 52 2.7. Documenting Results ................................................................................................. 54 2.8. Ending Workflows...................................................................................................... 59 3. Short Cuts ......................................................................................................................... 60 3.1. syngo.via General Shortcuts ...................................................................................... 60 3.2. MM Oncology Shortcuts............................................................................................. 66 4 Workbook | syngo.via Quick Guide for MM Oncology 1. Introduction to syngo.via 1.1 Starting syngo.via and Logging On Notes After starting the computer, you first have to log on to Windows. You can then start syngo.via in different ways: • Single sign-on • syngo.via integrated with a RIS or PACS • Windows log-in with a separate password for syngo.via • Logging on to a specific server 1.1.1. Single Sign-on syngo.via supports a comfortable single sign-on login. Thus you only have to log on to Windows and syngo.via starts immediately when you double-click the syngo.via - Single Sign On icon: syngo. via - Single Sign On 1.1.3. Logging on to syngo.via (separate password) You can start syngo.via using the icon on your desktop and log on with a separate password. As a new user, ask your administrator for a password. Normally, this password is provided to you only once and has not to be changed. Handle your password carefully. 1. Start the computer and log on with your Windows account. 2. Double-click the syngo.via icon on your desktop: The syngo.via Logon dialog box is opened. syngo. via 3. Enter your User Name and Password. Note that the password is case-sensitive. 4. You might have to select a Domain. After initial log-on, the domain is remembered by the system. 5. Click OK to confirm. 5 Workbook | syngo.via Quick Guide for MM Oncology 1.1.4. Logging on to a Specific Server Notes 1. Double-click the syngo.via - Server Selection icon on your desktop: The syngo.via Server Selection dialog box is opened. 2. In the Server field, enter a server name, IP address, or host name. or – – Select the desired server name, IP address, or host name from the list. The first list entry represents the last connected server. List entries may be generated by an automatic launch from a RIS or a PACS. 3. Select Login with the credentials of your operating system. or – – Select Login with other credentials. 4. Click the Connect button. The syngo.via Logon dialog box is opened. 5. In case of using other credentials, enter your User Name and Password. Note that the password is case-sensitive. 6. Click the OK button. 1.1.5. Closing syngo.via Click the Close icon at the upper right to close the syngo.via client software. × Please note the following: • If you have to leave the workplace unattended, be sure to lock the computer. • At a locked computer, only the user who has logged in to Windows can unlock the workplace. • If you are leaving the workplace for a longer period, make sure to log off the syngo.via application. 6 Workbook | syngo.via Quick Guide for MM Oncology 1.2. Main Work Environments 1.2.1. Patient Browser In the Patient Browser, you can search for patient data, correct and rearrange patient data, or load patient data into the Viewer. Patient Browser Worklist Bar Toolbar Shows up to 3 Browse Open Open DICOM Import Export with Retrieve worklists Search Search Area Set up for search ame, ID. Date, Description and Modality (Ctrl+F) More Filters criteria for the searches or set up worklists Results (604 results, 4:29:22 PM) Studies Patients Series Workflow Sta. Workflow De. Patient Name Date of Birth Patient ID Modality Study Date ... Study Descri. Series Descri. Modality Series Date. Ready MM Oncology KH_1935 2/12/1935 KH_1935 CT. OT. P 6/18/2015 1 .. CT-Thorax+ Results MM. CT 7/30/2015 1 Series List KH 1935 2/12/1935 KH 1935 6/15/2015 6: MR Schaedel Results MM. CT 6/22/2015 9 + KH_1935 2/12/1935 KH_1935 6/15/2015 4: CT Thorax A. Evidence Do SR Shows the series of Ready MM Oncology AN 1949 10/1/1949 AN 1949 6/10/2015 9: CT Schaedel Evidence Do SR 4/23/2015 the selected Results List AN_1949 10/1/1949 AAN 1049 AN 1949 6/10/2015 8 CT Abdomen Evidence Do. SR 11/19/2014 studies Shows the data that AN 1949 10/1/1949 AN 1949 6/3/2015 10: CT-Thorax Evidence Do. SR 11/19/2014 matches the current CCH_Breast ... 10/28/1970 20150612001 5/28/2015 1: ... Breast^lesio. Exported CT. CT 11/13/2014. search criteria Coronarias 7/13/1968 000 5/27/2015 1 Cardiac&CO Ready MM Oncology CM_1935 3/8/1935 CT, SR CM_1935 4/15/2015 1 CT Abdomen CM 1935 3/8/1935 CM_1935 4/13/2015 1 .. CT Thorax nstances List Preview Anonymous 2/26/2015 ANON 2/26/2015 1 ... Anonymous 2/26/2015 ANON 2/26/2015 1 Instances List 2/26/2015 ANON 2/26/2015 1 ... Shows the Anonymous 2/26/2015 CT. OT. S 2/26/2015 1 .. instances of the Anonymous 2/26/2015 ANON MR SR 2/26/2015 1. selected studies Ready MM Basic MR Prostat 1/1/1942 MAC 12/10/2014. Prostate Ready CT Dental FL ST_IMA. 1/1/1968 FLST_523 CT, OT, SE. 11/12/2014. Neck^01_Ne .. The selected data opened 4:29 PM Notes 7 Workbook | syngo.via Quick Guide for MM Oncology 1.2.1.1. Patient Browser Toolbar Loads patient data into the Viewer Exports DICOM data to external media, file sys- The corresponding Patient tab is displayed in the tems, or network nodes. Open Access Bar. Export (-> Page 80 Loading patient data into the Viewer) Lets you correct patient data. Lets you select the Workflow and loads patient data into the Viewer Correct Open with The corresponding Patient tab is displayed in the Access Bar. Cuts data to merge patients or rearrange stud- ies. (-> Page 80 Loading patient data into the Viewer) Cut Searches and retrieves studies from external Pastes data to merge patients or rearrange stud- media / DICOM Nodes. ies. DICOM This function only works if remote DICOM nodes Paste Retrieve are configured on the server or a CD/DVD/USB media containing a DICOMDIR is loaded on the local client PC. Deletes data from Short Term Storage (STS). Only available if the data is not protected from Delete deletion. Imports files from external media, file systems, Note that the data cannot be restored after dele- or network nodes. tion. Import This function works even if no DICOMDIR is available. Notes 8 Workbook | syngo.via Quick Guide for MM Oncology 1.2.1.2. Searching for Studies Notes 1. In the Access Bar, click the Magnifier icon: The Patient Browser opens. Q 2. Enter your search criteria in the Quick Search fields. Example: 2013/10/25 Meyer will find all patients whose name is “Meyer”, and whose birth date or study date is “2013/10/25”. 3. To refine your search, click More Filters and enter additional search criteria in the search condition fields of the More Filters area. 4. Click the Search icon. Q 1.2.1.3. Worklists Work lists are predefined queries to find studies. The number next to the work list name indicates the number of items matching the work list. Read (9) Up to five work lists are shown in the work list bar. If more than five work lists are available, the remaining work lists are shown when clicking on the Arrow head icon. You can configure which work lists are displayed in the work list bar. 9 Workbook | syngo.via Quick Guide for MM Oncology Notes 1.2.1.3.1. Creating Worklists You can customize and save work lists. As a clinical administrator, you can save your work list for all users (public work list). The Patient Browser is open 1. To clear the entry in the Quick search field, click the X in the Quick search field. X 2. Click More Filters and enter your search criteria in the search condition fields of the More Filters area. 3. If required, you can add or remove search condition fields. 4. In the More Filters area, click the Save Work List icon. or - - In the work list bar, click the Plus icon. + 5. The Save Work List dialog box is opened. 6. To save the work list for all users, select the Available for all users check box. (This option is only available for clinical administrators.) 7. Enter the name of the work list and click Save. The work list is saved and displayed in the work list bar. 1.2.1.4. Assigning Workflows to Studies The system automatically assigns workflows to studies based on configured rules. You can check the assignment in the Workflow Description column in the result list. However, when the column is empty, no workflow has been assigned. When you double-click a study that has no workflow assigned, a default workflow is assigned and the workflow is started. When you double-click a series or an instance of a study that has no workflow assigned, a default workflow is assigned and the workflow is started with limited write access. 10 Workbook | syngo.via Quick Guide for MM Oncology Notes 1.2.1.4.1. No Workflows Assigned to the Study 1. In the Result list of the Patient Browser, select the study. 2. Right-click and choose Assign Workflow from the context menu. or - - 3. From the list of workflows, select the appropriate workflow. The new workflow is assigned to the study. 1.2.1.4.2. Switching the Currently Active Workflow 1. In the Case Navigator portion of the viewer, click the Switch Workflow icon. 2. From the list of workflows, select the appropriate workflow. 3. The current workflow is closed and unsaved results are saved. The new workflow is assigned to the study. The Patient tab is opened, the workflow is started, and the images are loaded into the Viewer. 1.2.1.5. Loading Patient Data into the Viewer 1. In the Result list of the Patient Browser, select the corresponding study 2. To open the study with the assigned workflow, click the Open icon. or - - To assign another workflow to the study before opening, click the Open with icon and select the appropriate workflow. The Patient tab is opened, the workflow is started, and the images are loaded into the Viewer 11 Workbook | syngo.via Quick Guide for MM Oncology 1.2.1.5.1. Loading Additional Data Notes From the Series Navigator 1. In the Series Navigator, click the Add Study icon. The Add Study dialog box opens Add Study ? X 20141009.1, IIIIIII, 11/9/1967, SAS001431 Refresh Add Study Study Description Study Date and Time Modality Availability MR Scan Knee Left 10/10/2014 1:55:24 PM SR, MR Online Last updated: 10/15/2014 11:34:18 AM Close 2. In the Add Study dialog box, select the desired study and click the Add Study button. 3. Make sure that the additionally loaded data really belongs to the same patient and confirm the load operation. Note: Additional patient data is only available on server if it was successfully imported from archive. From the Patient Browser 1. In the Patient Browser, select the desired data from the Result list, Series list, or Instances list. 2. Drag the data onto the corresponding Patient tab. 3. Make sure that the additionally loaded data really belongs to the same patient and confirm the load operation. 12 Workbook | syngo.via Quick Guide for MM Oncology 1.2.1.6. Handling Workflows Notes 1.2.1.6.1. Saving a Workflow When you save a workflow, the workflow is closed and all unsaved results are saved in the Short Term Storage (STS). All result series in the Results section of the Series Navigator will remain in this section upon re-opening the study. Workflow has been started and images are loaded into the Viewer Click the Save icon. II The workflow is closed. In the Result list of the Patient Browser, the state of the workflow is set to Saved. 1.2.1.6.2. Discarding the Workflow When you discard a workflow, the workflow is closed, and all unsaved results are lost. Workflow has been started and images are loaded into the Viewer 1. In the Patient tab, click the X icon to open the Close Patient dialog box. 2. Click Discard Changes. X 3. Confirm the message. The workflow is closed and unsaved results are lost. 1.2.1.6.3. Completing the Workflow When you complete a workflow, the workflow is closed and all unsaved results are saved in the Short Term Storage (STS). The results are sent to the configured archive. The result series are saved as DICOM series. If you open the workflow again, the result series will be displayed in the Current, Later or Prior section of the Series Navigator. Workflow has been started and images are loaded into the Viewer Click the Save and Send icon. The workflow is closed. In the Result list of the Patient Browser, the state of the workflow is set to Completed. 13 Workbook | syngo.via Quick Guide for MM Oncology 1.2.2. The Viewer SIEMENS Shelley Deblase 1 ¡ CT Por ResoGated, Restu ... MM Oncology ala Group Q + 2 MM Oncology Reading PETCT_Flow_3+RespOsted. Rectum Ca. Edge MI_PETCT_Flow_3+RespOsted, RectumCa. Edge 18 FOO Ref.: MMM Oncology 1/1/1944. M Biograph 128 Edge F-18 FOG Blograph ize Edge "1/1/1944. M 3D Reading URRENT CURRENT C CT 3D 1301 3 (2) AC_CT 3.0 13Of 3 [2] Current RECIST 1.1 A01:A1 -- > AD1:Al 10/2014 7/10/2014 CT PET, 7/10/2014 :12:48 AM 11:12:43 /4A WB LUNG RECIST IMAn.a. FRMn.a. 2 Min.a. FRMn.a. + VOI P A201.5 SP R7D . PET.CT 1 " AC_CT 3.0 130f 3 [2] "AC_CT 2.0 1501 3 [5] Lung CAD AET Auto Zoom . TrueX+TOF 5 MBg/kg 3121s ... 3 Trending + 8Gates TrueX+TOF 3121s5m. . HDChest 35% TrueX+TOF 32. MM Reading * 3DOSEM+TOF 3:21s3mm (NAC) - Additional Data Results MM Reading LAJ MAPR LJ 300 Results lesuts MM Oncology Reading lesuts MM Oncology Reading [1209] 7 Findings Navigator I PETCT_Flow_3+RespGated. RectumCa. Edge 18 FDG Ref.: MMM Oncology MI_PETCT_Flow_3+Resp Gated, Rectum Ca, Edge 4 1/1/1944. M Biograph 120 Edge_mCT F-18 FOG Biograph iza Oncology *1/1/1944. M LIV013 URRENT CURRENT LIVOR 28 .56 ... MM ... ueX+TOF 5 MBq/kg 321:3mm (AC) TrueX+TOF 5 MBgkg 321:3mm (AC) 11 ROIC A01:F1 -> 501:F1 TUDY 7/10/2014 STUDY 7/10/2014 10/2014 7/10/2014 :13:18 AM 11:13:18 AM 8 IMAn.a. FRMna. 4 MAna. FRMn.a. P A001.5 Tools 5 Full Ted Hide Hoe Lines Reset Graphics Timepoints MPR LAJ AC 2001 SF-TOF #215, XYZ Gauss3.00 200"200 L PSF+TOF 3215, XYZ Gauss3.00 5.00 SUV-bv EQ Fiker: ??? mm 6 0.00 SUV-bv (1) Access Bar - The Access Bar enables you to switch between (5) Common Tools Area - The Common Tools area provides the Patient Browser and the Patient tabs. Additionally, the functions which are usually available for all workflows. Access Bar displays your user name, the currently selected server, and provides access to the Configuration Panel, Online (6) Status Bar - The status bar is an area at the bottom of the Help, and other services. screen that displays information about the system status and the current time. (2) Case Navigator - Displays the current workflow steps and corresponding functions. Below the workflow steps, workflow (7) Image Area - The image area displays images and series in controls allow you to complete and save workflows segments. Corner menus are available in the segments. (3) Control Area - Contains the following: Case Navigator, (8) Series Navigator - The Series Navigator lists all currently Findings Navigator, Common Tools, and Status icons. loaded data within a workflow. You can load data groups, functions, as well as switch time points in the image area. (4) Findings Navigator - The Findings Navigator allows you to navigate through evidence objects (measurements, graphical objects, annotations, and snapshots) that are declared as findings. Notes 14 Workbook | syngo.via Quick Guide for MM Oncology 1.2.3. Image Segments Notes 2 3D_Normal 111 *11.11.1036 Plus 4 Volume Zo Current Test_Series -- > Current. 3 STUDY 09.07 09.07.1999 MPR THICK 3D_Normal_Patient Klinikum Nord 111 11.11.1935, M. B3Y Plus 4 Volume Zoor Current Test_Series_3014 3 4 (1) Sagittal reference segment - Left to right or right to left (2) Coronal reference segment - Anterior-posterior or posterior-anterior (3) Axial reference segment - Feet to head or head to feet (4) Volume segment - Depending on the predefined layout, another display type is set in the volume segment. 15 Workbook | syngo.via Quick Guide for MM Oncology 1.2.4. Basic Operation of the Viewer 1.2.4.1. Mouse Interactions Notes The right mouse button allows you to navigate; the left mouse button lets you use the selected tool. The middle mouse button/scroll wheel is used for windowing or scrolling. Modifier keys such as the Alt key or the Ctrl key enable you to perform more functions with the mouse: Uses the currently selected tool By default, Zoom/Pan is activated for 2D images and for 3D images. On double-click, the segment is enlarged (blow up) or reduced again. Opens the context menu Windows the selected image, when you press the mouse wheel: Move the mouse up / down to decrease / increase the brightness Move the mouse to the right / left to decrease / increase the contrast Ctrl + Windows the selected images: Move the mouse up / down to decrease / increase the brightness Move the mouse to the right / left to decrease / increase the contrast Keep the mouse button pressed to scroll through original (stack or stripe) or calculated 2D images (MPR, MIP Thin, VRT Thin, MPR/MPR). Rotates a VRT/MIP volume in the selected segments 16 Workbook | syngo.via Quick Guide for MM Oncology Use the scroll wheel to scroll through images of the selected segments Notes Use the scroll wheel to scroll through time points or data groups of 2D images Alt + Scrolls through time points or data groups of 2D images Alt + Rotates MPR images and 2D images 1.2.4.2. Keyboard Interactions Navigation Keys in 2D Arrow keys Scrolls through the images up/down Arrow keys Scrolls through the images in stripe of stacks lay- up/down outs Ctrl + Arrow Jumps to the next segment key Alt + Arrow Scrolls through data groups, if available key Home/End Jumps to the first/last image in a stack Navigation Keys in 3D Arrow key Rotates a 3D volume Scrolls through a slice or slab Ctrl + Arrow Jumps to the next segment key 17 Workbook | syngo.via Quick Guide for MM Oncology Function Keys Notes F1 Opens the Online Help (with information belong- ing to the situation/workflow) Shift + F5-F8 Depending on the configuration for the specific modality: Applies windowing presets Applies color LUT presets F9 Toggles between alpha values within a fused seg- ment (MPR/MPR). 0% - currently applied alpha value - 100% F10 Inverts the color or grayscale values (color LUT) for the images in the selected segments F11 Maximizes the image area. Pressing again toggles back. Shortcut Keys to Acess Tools and Functions Standard Shortcut Keys A Sends send all images of a stack from the image area to the film sheet. Alt Allows you to move evidence objects even if a (press and tool is currently active. hold) Ctrl + A Selects all segments Ctrl + Alt + A Closes the work item and sends the results of the current session to the configured archive C Activates the ROI Circle tool D Activates the Distance Line tool 18 Workbook | syngo.via Quick Guide for MM Oncology Notes E Sends the currently selected image from the image area to the film sheet. F Creates a clinical finding and lists it in the Find- ings Navigator G Hides or shows graphical objects H Hides or shows reference lines Ctrl + G Selects all graphical objects Activates the Scroll tool Shift + 1 Activates or deactivates the performance mode in the scrolling without skipping mode Scrolling performance is improved due to image compression L Activates the Pixel Lens tool Alt + L Starts and stops the Layout Editing mode M Activates the Marker tool Activates the Rotate tool O P Activates the Punch function to draw and punch only one contour (quick punch mode) Q Removes the Clip box and Clip Plane in the selected segments R Activates the 3D Reference Point tool Alt + R Opens the Report Editor S Creates a snapshot finding out of the selected segments and lists it in the Findings Navigator Ctrl + Alt + S Closes the work item without archiving T Hides or shows the image text 19 Workbook | syngo.via Quick Guide for MM Oncology Notes U Enables or disables scrolling without skipping when using the right mouse button. If you scroll with skipping enabled, an indicator is displayed in the segment. V Activates the VOI Sphere tool W Activates the Windowing tool Y Enables or disables Synchronization functions Activates the Zoom/Pan tool N Spacebar Activates the Movie tool Starts and stops a movie Ctrl + Shift + A Activates fast correction of alignment Esc Deactivates the current tool For volume restriction with planes: .Hides the handles of the planes .Hides the planes Del Removes the selected item/overlay Ctrl + C Copies the selected object to the clipboard Ctrl + X Cuts the selected objects Ctrl + V Pastes an object from the clipboard Alt + Tab Lets you select another primary window or appli- cation Selects multiple objects Ctrl + 20 Workbook | syngo.via Quick Guide for MM Oncology Notes Selects multiple objects in sequence Shift + (Ctrl + Z) This shortcut key is currently not supported. Use the Undo icon. (Ctrl + Y ) This shortcut key is currently not supported. Use the Redo icon. 1.2.4.3. Corner Menus The corner menus provide tools for image preparation, optimization, evaluation, and property settings. They are placed in the corners of each segment, grouped by functionality. The tools displayed in the corner menus depend on the current workflow step and image type. Image manipulation tools (- Page 106 Orientation tools), (- Page 107 Tools to mask out structures), Top left corner (- Page 106 Registration Tools (Fusion)), menu (- Page 109 Tools for restricting the volume), (- Page 110 Tools to create new series), (- Page 94 Scrolling tools), (- Page 97 Opti- mization and preparation tools), and (- Page 94 Windowing tools). Measurement and marking tools (- Page 101 Measurement tools) and (- Page 100 Annotation tools). Top right cor- ner menu Window settings and modality-specific presets (- Page 94 Windowing tools). Bottom right corner menu 21 Workbook | syngo.via Quick Guide for MM Oncology 1.2.3.4. Layout For each workflow, specific layouts are defined. The layout that is applied when you open data for processing or viewing only depends on the active workflow step. syngo.via provides a number of predefined layouts. You can also modify existing and create new layouts. Layout Gallery 3D Viewing Layout Gallery Administrator Public Layouts MPR MPR VRT Standard MPR VRT Head 2 When you click the Layout Gallery icon in the Case Navigator, all layouts that are available for the current workflow step are displayed. Predefined Layouts (1) List of users (only visible for administrators) The administrator can select the private layouts from any user of the site. The administrator can drag these layouts to the public layouts. The name of the user is defined as follows: _. Notes 22 Workbook | syngo.via Quick Guide for MM Oncology (2) Private layouts Notes Collection of your own personal layouts. You can create, modify, and delete your own private layouts. For administrators, this section contains the private layouts of the user selected in the List of users. Note: If you have no Private layouts section, you are not allowed to create private layouts. For more information, please contact your administrator. (3) Public layouts Collection of layouts that have been predefined by a clinical administrator for your entire institution. Only administrators are allowed to edit public layouts. (4) Siemens layouts (only visible for administrators) Collection of layouts provided by Siemens. These layouts may be updated when syngo.via is updated or upgraded. Note that the layouts provided by Siemens cannot be deleted or modified. 1.2.3.5. Time Points In syngo.via, studies and series can be defined as different time points depending on the workflow assignment and the scheduled examination: Current time point Contains the studies or series that are scheduled to be read by you today. The current time point must not necessarily contain the most recently acquired data. You always load data displayed as the current time point when you start a workflow. In addition, data from multiple prior and later time points can be loaded. Later time points Contain recent studies or series that have been acquired after the studies or series of the current time point. Prior time points Contain data from examinations that have been performed in the past and are used for comparison with studies or series of the current time point. 23 Workbook | syngo.via Quick Guide for MM Oncology 1.2.3.6. Series Navigator Notes Using the Series Navigator, you can switch the time points which are pre-defined in layouts. When you load additional data, the Series Navigator sorts it into time point groups according to the time points on which the images where taken (study date and time). Data from a later time point is displayed above data of the current time point. Data can be dragged and dropped into Viewer segments from the Series Navigator. Data Groups Add Study Later Timepoint Contain items that have Later 01 been acquired after the current timpoint ! CR. 3/25/2008 HG Current Timepoint Current Contain items that are scheduled to be read today. XA, 3/22/2008 Unknown study description Kont .- 3 Prior Timepoint › Kont .- 1 Contains items that have been performed in the past Prior 01 and are used in comparison to current. ! CR, 3/21/2008 Thorax 24 Workbook | syngo.via Quick Guide for MM Oncology 1.3. Basic Functions to Read Images 1.3.1. Layout Tools 1.3.2. Scrolling Tools Workflow steps Top left corner menu Expands the layout gallery Activates the left mouse button for scrolling Here you can select a layout, create a new lay- Top left corner menu > Scroll Layout Gallery out, or save changes to the current layout. Scroll Scrolls automatically through series, 3D vol- In the layout gallery, click the >>Advanced button to access more umes, or data groups functions: Movie Top left corner menu > Movie Opens the Layout Creator Here you can define the number of monitors New and segments for a new layout. 1.3.2. Windowing Tools Activates the editing mode for layouts In this mode, you can manipulate the size of Top left corner menu Edit the currently displayed segments. Keyboard shortcut: Alt + L Changes width and center values This tool is also available in the Common Tools Note: Windowing is always available by press- area. Windowing ing and dragging the middle mouse button (scroll wheel). In the images of most modalities the window Saves changes in the selected layout is defined by width and center. In PET, NM, or SPECT images the window is defined by the position of the lower and Save upper window limit (bottom and top). Saves the selected layout as a new layout Top left corner menu > Windowing E Save As Bottom right corner menu Common Tools area Resets the window values (width and center) to the values the image was displayed with Resets time points which you have applied after initial loading from the Series Navigator to the time points Home Windowing that are defined in the layout Bottom right corner menu > Home win- Reset Time Points dowing Activates the editing mode for layouts Lets you apply color LUTs (look-up tables) In this mode, you can manipulate the size of from a list Edit Layout the currently displayed segments. For images from different modalities, corre- Keyboard shortcut: Alt + L Color LUT sponding default color LUTs are available. Bottom right corner menu > Color LUT Lets you apply windowing preset values from a list Presets Bottom right corner menu > Presets Notes 25 Workbook | syngo.via Quick Guide for MM Oncology 1.3.3. Synchronization Tools Notes Common Tools area Groups selected segments so that you can work with them synchronously Synch For the Zoom and Navigation options note the following: Depending on the workflow, data sets need to be in the same frame of ref- erence or there is a spatial alignment of the images (for example for images from differ- ent time points). During synchronization the following indica- tors are displayed in the segments: D : Synchronization successful CD: Synchronization not possible Allows you to adjust the spatial alignment within synchronized segments Align Keyboard shortcut: Crtl + Shift Allows you to adjust the spatial alignment within synchronized segments of different time points Align Timepoints Keyboard shortcut: Crtl + Shift + A Only the registration between time points is modified. The registration within each time point is not affected. Top left corner menu Allows you to activate and deactivate the cor- related cursor mode. Correlated Cur- If activated, a synchronized cursor is dis- sors played in all segments. Top left corner menu > Correlated Cursors 26 Workbook | syngo.via Quick Guide for MM Oncology 1.3.4. Optimization and Preparation Tools Optimization Top left corner menu Rotates a 2D image or a 3D volume Top left corner menu > Rotate Notes Rotate Alt + right mouse button RA Flips images left or right Top left corner menu > Flip Horizontal Flip Horizontal R Flips images up or down Top left corner menu > Flip Vertical Flip Vertical Zoom/Pan Top left corner menu Zooms and pans continuously with the mouse Zoom/Pan Top left corner menu > Zoom/Pan Alt + left mouse button Resizes the images in the segment so that they are entirely visible in the segment Fit to Segment Top left corner menu > Fit to Segment Displays the selected images in their original resolution as acquired (acquisition size) Fit to Acquisition Using this resolution, all objects drawn on Size images, such as ROIs and graphic objects, are displayed in an optimal way. Top left corner menu > Fit to Acquisition Size AutoViews Bottom right corner menu Navigates to a location of interest and gets the views oriented in a clinically meaningful way. AutoViews Bottom right corner menu > AutoViews Home Position Top left corner menu Resets the following viewing parameters to the values that were initially displayed in the segment: Home Position Orientation Zoom/pan values Viewing direction Alignment in the segment (in-plane rota- tion) Image position(for slice and slab images) Top left corner menu > Home Position Size Direct manipulation drag & drop Switch / rearrange segments You can arrange available series according to your needs. You can drag a series from the Series Navigator to an empty segment to add the series to the display. You can also drag a series to a segment that already contains a series to replace the cur- rently displayed one. 27 Workbook | syngo.via Quick Guide for MM Oncology 1.3.5. Hiding/Showing Overlays Tools Notes Common Tools area Toggles between full or customized image text or hides the image text Full Text Keyboard shortcut: T Custom Text Shows or hides graphical objects Keyboard shortcut: G Hide Graphics Shows or hides reference lines. Keyboard shortcut: H Hide Lines 1.3.6. Annotation Tools Top right corner menu Draws arrows onto an image and allows text annotations Arrow Top right corner menu > Arrow Marks a position onto an image and allows text annotations Marker Top right corner menu > Marker Allows text annotations Top right corner menu > Text Text 28 Workbook | syngo.via Quick Guide for MM Oncology 1.3.7. Measurement Tools Top right corner menu Measures the length of a line Evaluates statistical values for a freely drawn Available for 2D, MPR, MPR Thick, MIP Thin, egion Distance Line MinIP Thin, and MPR/MPR images ROI Freehand Available for 2D, MPR, MPR Thick, MIP Thin, With Distance Line Properties, you can spec- MinIP Thin, and MPR/MPR images (Fusion) ify to turn the display of evaluation results on With ROI Properties, you can specify to turn or off. It can be accessed by clicking the the display of evaluation results on or off. It wrench icon. can be accessed by clicking the wrench icon. Top right corner menu > Distance Line Top right corner menu > ROI Freehand Measures the lengths of connected lines Evaluates statistical values for a polygonal Available for 2D, MPR, MPR Thick, MIP Thin, region Distance Polyline MinIP Thin, and MPR/MPR images With Poly Line Properties, you can specify to ROI Polygonal Available for 2D, MPR, MPR Thick, MIP Thin, MinIP Thin, and MPR/MPR images turn the display of evaluation results on or With ROI Properties, you can specify to turn off. It can be accessed by clicking the wrench the display of evaluation results on or off. It icon. can be accessed by clicking the wrench icon. Top right corner menu > Distance Polyline Top right corner menu > ROI Polygonal Measures an angle between two lines Evaluates statistical values for a spherical or Available for 2D, MPR, MPR Thick, MIP Thin, an ellipsoidal volume Angle MinIP Thin, and MPR/MPR images VOI Sphere Available for MPR, MPR Thick, MIP Thin, MinlP Top right corner menu > Angle Thin, and MPR/MPR images (fusion) With VOI Properties, you can specify to turn the display of evaluation results on or off. It Determines the pixel value at a current posi- can be accessed by clicking the wrench icon. tion of a pixel or a voxel Top right corner menu > VOI Sphere Pixel Lens Available for 2D, MPR, MPR Thick, MIP, MIP Thin, MinIP Thin, and MPR/MPR images With Pixel Lens Properties, you can specify Evaluates statistical values for a volume you the size of the pixel lens. It can be accessed have defined drawing freehand contours by clicking the wrench icon. VOI Freehand Available for MPR, MPR thick, MIP Thin, or Top right corner menu > Pixel Lens MinIP Thin images With VOI Properties, you can specify to turn the display of evaluation results on or off. It Evaluates statistical values for a circular or can be accessed by clicking the wrench icon. elliptical region Top right corner menu > VOI Freehand ROI Circle Available for 2D, MPR, MPR Thick, MIP Thin, MinIP Thin, and MPR/MPR images With ROI Properties, you can specify to turn the display of evaluation results on or off. It can be accessed by clicking the wrench icon. Top right corner menu > ROI Circle Notes 29 Workbook | syngo.via Quick Guide for MM Oncology 1.3.8. Display Types Displays 2D images Notes Bottom left corner menu > 2D 2D Displays MPR images Bottom left corner menu > MPR MPR Displays MPR Thick images With MPR Thick Properties, the properties MPR Thick for this display type can be adapted. It can be accessed by clicking the wrench icon. Bottom left corner menu > MPR Thick Displays fused MPR/MPR images With MPR/MPR Properties, the properties for MPR/MPR this display type can be adapted. It can be accessed by clicking the wrench icon. Bottom left corner menu > MPR/MPR Displays MIP images Bottom left corner menu > MIP MIP Displays MIP Thin images With MIP Thin Properties, the properties for MIP Thin this display type can be adapted. It can be accessed by clicking the wrench icon. Bottom left corner menu > MIP Thin Displays MinIP Thin images With MinIP Thin Properties, the properties MinIP Thin for this display type can be adapted. It can be accessed by clicking the wrench icon. Bottom left corner menu > MinIP Thin Displays VRT images With VRT Gallery, VRT Presets can be selected VRT and modified. It can be accessed by clicking the wrench icon. Bottom left corner menu > VRT Displays VRT Thin images With VRT Gallery, VRT Presets can be selected VRT Thin and modified and with VRT Thin Properies, the properties for this display type can be adapted. They can be accessed by clicking the wrench icon. Bottom left corner menu > VRT Thin Opens the VRT Gallery dialog box and lets you select and modify VRT presets. VRT Gallery Right-click on VRT/VRT Thin and choose VRT Gallery. 30 Workbook | syngo.via Quick Guide for MM Oncology 1.3.9. Registration Tools Notes Allows you to manually align fused base ser- ies and overlay series to match them as Visual alignment closely as possible. Available when MPR/MPR has been activated. Top left corner menu > Visual alignment Fused base series and overlay series are auto aligned automatically. Automatic Regis- Available when MPR/MPR has been activated. tration Top left corner menu > Automatic Registra- tion 1.3.10. Orientation Tools Allows you to navigate quickly to the same coordinates of a patient in different series and views of series 3D Reference Point To define a pathology as new center within a segment press ALT while clicking it. Top left corner menu > 3D Reference Point Allows you to lock and unlock the 90 degree orientation of reference lines in a orthogo- nally synchronized segment. Lock Reference Lines Top left corner menu > Lock Reference Lines 31 Workbook | syngo.via Quick Guide for MM Oncology 1.3.11. Masking Tools Masks out bone structures auto An algorithm is automatically applied Bone Removal depending on the body region. Notes Auto Available for VRT and MIP images Top left corner menu > Bone Removal Auto Masks out bone structures The applied algorithm is optimized for head Bone Removal or neck regions. Head Available for VRT and MIP images Top left corner menu > Bone Removal Head Masks out bone structures The applied algorithm is optimized for thorax Bone Removal or abdomen regions. Body Available for VRT and MIP images Top left corner menu > Bone Removal Body Masks out bone structures The applied algorithm is optimized for Bone Removal extremities. Leg Available for VRT and MIP images Top left corner menu > Bone Removal Leg Allows you to refine bone removal algorithm results Edit Bone You can mask out bone structures or display Removal non-bone structures again. Available for VRT and MIP images Top left corner menu > Edit Bone Removal Allows you to define the transparency of bone structures Bone Opacity Available for VRT and MIP images Top left corner menu > Bone Opacity Allows you to remove irrelevant structures resulting from patient tables or head holders Table Removal Available for VRT and MIP images Top left corner menu > Table Removal Allows you to interactively segment struc- tures such as vessels, bones or organs. Region Growing Available for VRT, MPR and MPR thick images Top left corner menu > Region Growing Allows you to use several masking layers to show or hide the masked structures. Anatomy Visual- Available for VRT, MIP, MPR and MPR thick izer images Top left corner menu > Anatomy Visualizer 32 Workbook | syngo.via Quick Guide for MM Oncology 1.3.12. Volume Restriction Tools Top left corner menu Punches out an area of the volume (by keep- ing the inner or the outer part for reconstruc- tion) Notes Punch With Reset Visibility Mask, the visibility mask can be reset. It can be accessed by clicking the wrench icon. Top left corner menu > Punch Hides the volume behind a cutting plane With Show Clip Plane Graphics, the clip Clip Plane plane graphics can be turned on or off and with Change Orientation, the clip plane ori- entation can be changed. They can be accessed by clicking the wrench icon. Top left corner menu > Clip Plane Only shows the volume inside a slab With Slab Thickness, the initial slab thickness Clip Plane Slab can be changed and with Change Orienta- tion, the clip plane orientation can be changed. They can be accessed by clicking the wrench icon. Top left corner menu > Clip Plane Slab Restricts the volume to a cuboid With Clip Box Graphics, the clip box graphics Clip Box can be turned on or off. It can be accessed by clicking the wrench icon. Top left corner menu > Clip Box 1.3.13. Creation of New Series Tools Top left corner menu Allows you to select a range tool Top left corner menu > Ranges Tools Ranges Tools Allows you to define parallel slices of the vol- ume for reconstruction Parallel Ranges Top left corner menu > Ranges Tools > Par- allel Ranges * Allows you to define slices of the volume for reconstruction that are arranged around a pivot Radial Sliced Ranges Top left corner menu > Ranges Tools > Radial Sliced Ranges Allows you to define radial views of the vol- ume for reconstruction Radial Ranges Top left corner menu > Ranges Tools > Radial Ranges Allows you to define parallel curved slices of the volume for reconstruction Curved Ranges Top left corner menu > Ranges Tools > Curved Ranges 33 Workbook | syngo.via Quick Guide for MM Oncology 2. MM Oncology Engine 2.1. Purpose of MM Oncology Engine Notes MM Oncology is a general workflow for reading oncology data, that is, it is not specific to any particular disease or data type. It includes specific preparation and evaluation tools. When you start the workflow, alignment algorithms and other calculations are performed during pre-processing depending on the configuration. 2.2. Image Requirements MM Oncology supports certain data types when opening the application. The initial screen layout depends on the types of data loaded. The following scan data types and combinations of them are possible: • Computed-tomography (CT) • Multi-phase • Dual Energy (DE) • 3D Magnet-resonance tomography (MR) • Positron emission tomography (PET) • Single-photon emission computed tomography (SPECT) • xSPECT (Symbia Intevo) • Combined PET/CT scans and SPECT/CT scans acquired using a hybrid scanner • Combinations of PET, CT, SPECT and MR acquired on separate scanners • Dynamic PET • Gated PET and CT data. The data has been acquired in tandem with a gating device and reconstructed into multiple volumes that correspond to physical phases. 2.2. Loading Patient Data into the Viewer 1. In the Result list of the Patient Browser, select the corresponding study. 2. To open the study with the assigned workflow, you may double click or RM click and select the Open icon. When you open a study that has no workflow assigned, a default workflow is assigned and the workflow is started. or – – To assign another workflow to the study before opening, RM click the Open with icon and select the appropriate workflow. The Patient tab is opened, the workflow is started, and the images are loaded into the Viewer. If you re-open a workflow, the workflow will be displayed in the previous user’s view. Ensure that the segments are displaying the data you expect. 34 Workbook | syngo.via Quick Guide for MM Oncology 2.3. MM Oncology Tools and Shortcuts Icon Description Available in Keyboard shortcut Case Corner Con- Mini Navi- menu text tool- Notes gator menu bar CT Presets F5 (> Page 114 Applying Lower F6 right windowing pre- F7 sets) F8 PET Presets (> Page 114 Applying Lower windowing pre- right sets) CT Color LUT Shift + F5 and PET Color LUT Lower Lower Shift + F6 right right Shift + F7 Shift + F8 Edit Table ( Page 73 Removing Upper left Yes the patient table manually) Icon Description Available in Keyboard shortcut Case Corner Con- Mini Navi- menu text tool- gator menu bar Automatically applying auto punch (> Page - Yes 73 Removing the patient table manually) Perform Punch (> Page 73 Removing Yes the patient table manually) Reset to Initial State (> Page Yes 74 Resetting table removal) Units (> Page Lower 78 Selecting right SUV units) Automatically Place PERCIST Liver Refer- ence Regions (> Page Yes 80 Placing the liver refer- ence region) 35 Workbook | syngo.via Quick Guide for MM Oncology Icon Description Available in Keyboard shortcut Case Corner Con Mini Navi- menu text tool- gator menu bar Notes Automatically Place PERCIST Aorta Refer- ence Regions (> Page Yes 80 Placing the aorta refer- ence region) Visual Align- ment ( Page Upper 68 Perform- left ing visual align- ment) Automatic Registration auto (-> Page 67 Aligning fused segments automatically) Upper (> Page left 67 Aligning separate seg- ments or time points automat- ically) Reset Align- ment ( Page Upper 64 Resetting left alignment) Icon Description Available in Keyboard shortcut Case Corner Con- Mini Navi- menu text tool- gator menu bar Automatically applying auto punch ( Page Yes 73 Removing the patient table manually) Perform Punch (> Page 73 Removing Yes the patient table manually) Reset to Initial State ( Page Yes 74 Resetting table removal) Units (- Page Lower 78 Selecting right SUV units) Automatically Place PERCIST Liver Refer- ence Regions Yes (> Page 80 Placing the liver refer- ence region) 36 Workbook | syngo.via Quick Guide for MM Oncology Icon Description Available in Keyboard shortcut Case Corner Con- Mini Navi- menu text tool- gator menu bar Notes Scanner Align- ment (> Page Upper 64 Setting left scanner align- ments) Global View (-> Page Lower 69 Switching left to global view) Result View (> Page Lower 69 Switching left to result view) Edit Result View (> Page Upper 70 Editing left result view) Reset Result View (> Page Upper 71 Resetting left result view) ROI Circle (-> Page 83 Evaluating Upper right C regions of inter- est (ROI) circles) Icon Description Available in Keyboard shortcut Case Corner Con- Mini Navi- menu text tool- gator menu bar Dual Energy ROI Circle (> Page 83 Evaluating Upper DE regions of right interest (ROI) circles) Pixel Lens ( Page Upper L 84 Using the right pixel lens) VOI Sphere (> Page 100 Creating Upper PET Segmenta- right - tion using the Threshold) RECIST/WHO Ruler (- Page Yes Upper right - Alt + Q 90 Perform- ing RECIST measurements) Lung Lesion Segmentation (> Page Yes Upper 91 Segment- right - Alt + 1 ing lesions in CT data) 37 Workbook | syngo.via Quick Guide for MM Oncology Icon Description Available in Keyboard shortcut Notes Case Corner Con- Mini Navi- menu text tool- gator menu bar Liver Lesion Segmentation (> Page Upper Alt + 2 91 Segment- Yes right ing lesions in CT data) Lymph Node Segmentation (> Page Yes Upper Alt + 3 91 Segment- right ing lesions in CT data) Generic Seg- mentation (> Page Yes Upper 91 Segment- right Alt+ ing lesions in CT data) Evaluate a lesion with RECIST/WHO + VOI isocontour Yes Uppe ( Page right Alt + H 99 Perform- ing hybrid measurement) Icon Description Available in Keyboard shortcut Case Corner Con- Mini Navi- menu text tool- gator menu bar Show/Hide Lung CAD results (> Page Yes 103 Displaying syngo.CT Lung CAD findings) Start Lung CAD (> Page 104 Starting Upper and stopping right syngo.CT Lung CAD) Correct seg- mentation (-> Page 96 Correcting Yes CT segmenta- tion) Undo Edit (> Page - Yes 97 Undoing the last step) Delete seg- mentation (> Page - 97 Deleting - Yes CT segmenta- tion) 38 Workbook | syngo.via Quick Guide for MM Oncology Icon Description Available in Keyboard shortcut Case Corner Notes Con- Mini Navi- menu text tool- gator menu bar Hide Selected Measurement (-> Page 97 Showing Yes or hiding a CT measurement) Edit Finding (-> Page 130 Opening the Measure- Yes Alt + E ment Details window) Lesion Auto Zoom (- Page Yes Alt + Z 109 Zooming in a lesion automatically) Marker (-> Page 128 Setting - Upper right - M review mark- ers) Color Coding % (-> Page 119 Trending across time Yes points for a selected region of interest) Icon Description Available in Keyboard shortcut Case Corner Con- Mini Navi- menu text tool- gator menu bar Trending Graph (- Page 119 Trending across time Yes points for a selected region of interest) Wrench (> Page 139 Opening Yes the Configura- tion dialog box) 39 Workbook | syngo.via Quick Guide for MM Oncology 2.4. Layouts Notes Data Presentation in layout Hybrid Shows anatomical and functional images. Single Shows one data set per monitor. Dual Shows two data sets per monitor. Multi Shows several data sets per monitor. Different time point layouts, for example, CT multi Shows data at different time points and contrast 2TP, or CT Lung 2TP phases. (-> Page 50 Layout with two time points) Additionally, there are various other layouts avail- Shows specific image types or CT images in vari- able, for example, CT MPR VRT, or CT Multi+VRT ous presentations. 2.5. 3D Reading Workflow Step 2.5.1. Image Alignment 2.5.1.1. Reasons for Performing Image Alignment Motion Correction You can compare studies where a patient has moved or is differently positioned. The patient’s positioning between studies is rarely the same, even when imaging with a single device. Different Acquisition Protocols You can take images using different acquisition protocols. This process of taking several sets of images with different protocols often takes time, and the patient may be differently positioned between studies. Image alignment can be used to compare the different effects of the protocols. Regions of Interest (ROI) W You can perform image alignment on ROIs. Image alignment supports an accurate location of an area of interest, such as a tumor, and improves the comparison of this area of interest over time. 2.5.1.2. Visual Alignment 1. Click the fused segment. 40 Workbook | syngo.via Quick Guide for MM Oncology 2. From the upper left corner menu, choose the Visual Alignment icon. The visual alignment wheel appears on the image. Notes 3. Move the cursor over the circle and drag to rotate the circle. You can rotate the overlay. 4. Move the cursor so that it is not over the circle. Click and drag to translate the overlay. 5. Select Visual Alignment from the menu to accept the changes. This overwrites the custom alignment set. 2.5.1.2. Automatic Alignment Aligning Fused Segments 1. Select an appropriate layout and click on the relevant segment. 2. From the upper left corner menu, select Automatic Registration. auto Aligning Separate Segments 1. Select an appropriate layout, press the Ctrl key and click on the relevant segments of different volumes or the views of the time points accordingly. 2. From the upper left corner menu, select Automatic Registration. The data in the segments is updated to show the automatic alignment result. The result overwrites the custom alignment set. auto 41 Workbook | syngo.via Quick Guide for MM Oncology 2.5.2. Quantification Notes 2.5.2.1. SUV Algorithms Available 2.5.2.1.1. SUV by body weight (SUV-bw) SUV-bw is the most commonly used SUV measure, where bodyweight in grams is used to calculate a SUV-bw in g.ml-1. This excludes the plasma glucose term, which can affect the validity of comparisons made between scans where the plasma glucose concentration is different. This is usually accounted for by the patient fasting before the scan is taken, which brings the glucose concentration within an acceptable range. 2.5.2.1.2. SUV by body surface area (SUV-bsa) This SUV uses an approximation of the body surface area in cm2, to give a SUV-bsa in cm2.ml-1. Body surface area (BSA) is calculated as follows, where BW is body weight (in kg) and H is patient height (in cm): BSA = BW 0.425 × H 0.725 × 71.84 2.5.2.1.3. SUV by lean body mass (SUV-lbm) This value is dependent on the sex of the patient. Lean body mass (LBM) is calculated for males as follows, where BW is body weight (in kg) and H is patient height (in cm): LBMMALE = 1.10 × BW - 128 × (BW⁄ H)2 Lean body mass (LBM) is calculated for females as follows, where BW is body weight (in kg) and H is patient height (in cm): LBMFEMALE = 1.07 × BW - 148 × (BW⁄ H)2 When LBM is used to calculate SUV, the LBM units are converted from kg to g to give a SUV-lbm in g.ml-1. 2.5.3. Changing the SUV Units 1. Click a PET or a PET/CT segment. 2. From the lower right corner menu, choose Units. 3. Select the appropriate unit. The application calculates the maximum SUV. 42 Workbook | syngo.via Quick Guide for MM Oncology 2.5.3.1. Using PERCIST Notes Positron Emission Response Criteria in Solid Tumors (PERCIST) is a standard for follow-up of PET hybrid acquisitions to ensure quantitative comparability between study time-points. Reference regions are placed in each PET series, and compared. Similarly, the acquisition details of series should be compared, to see if the scans are comparable. This involves looking at the dose, timings and scan protocols for each scan. 2.5.3.1.1. Liver Reference Region 1. Select a segment containing attenuation-corrected PET data. This segment can be a fused segment or a MPR segment, but not a 3D segment such as a MIP segment. 2. From the top right corner menu, select Liver Reference Region. 3. The application automatically displays the PERCIST liver reference region. The reference region has a 3 cm diameter. 2.5.3.1.2. Aorta Reference Region 1. Select a segment containing AC PET data. 2. From the top right corner menu, select Aorta Reference Region. The application automatically displays the PERCIST aorta reference region. The aorta reference region is a cylinder with a height of 2 cm and a diameter of 1 cm. 2.5.3.1.3. Manually Adjusting Region 1. If the automatic placement fails, you are notified by a message in the Control Area. The region will be placed in the center of the segment. 2. Click and drag on a region to adjust the placement. 43 Workbook | syngo.via Quick Guide for MM Oncology 2.5.4. Measurements Notes 2.5.4.1. ROI Can be used for evaluation of CT, PET, SPECT and Dual Energy scans. With ROI, You can get SUV in 2D volumetric space on PET and xSPECT scans. 2.5.4.1.1. Evaluating Regions of Interest 1. From the upper right corner menu, choose ROI Circle. The ROI mode starts and the mouse pointer changes its shape. 2. To draw a circle, click and drag the mouse until the circle is of the required size. or – – To draw an ellipse, press and hold the Shift key while drawing. The evaluation results are displayed. L8ROI1 Max: 146.00 HU Mean: -319.05 HU Min: -937.00 HU SD: 332.90 HU Area: 5.02 cm2 2.5.4.2. Pixel Lens You can use the pixel lens tool to determine a value, grayscale value or SUV within a small local region. 1. Select the unit. 2. From the upper right corner menu, choose the Pixel Lens icon. The mouse pointer changes its shape. 3. Move the mouse pointer across the image and click the requested position. The grayscale value is displayed next to the pixel marker and is preceded by the identification tag P. The pixel marker displays the average value around the requested position in the selected unit. 44 Workbook | syngo.via Quick Guide for MM Oncology 2.5.4.3. VOI Isocontour 1. Select a PET, SPECT or Fused Segment with alpha blend ratio set to 50% or greater. 2. From the 3D Reading workflow step, click the RECIST + VOI icon. or – – From the upper right corner menu, choose RECIST/WHO + VOI Isocontour. You have activated the RECIST/WHO + VOI Isocontour tool The mouse pointer changes its shape. 3. Click and drag to draw the VOI. To draw a circular bounding region, click and drag the mouse until the sphere has the desired size. or – – To draw an ellipsoid, press and hold down the Shift key while drawing. 4. If the Measurement Details window does not open automatically, right-click the measurement and choose Edit Measurement from the context menu. The Measurement Details window opens. At the bottom of this window there is a slider to adjust the threshold of the VOI. The threshold maximum is the maximum within the ellipsoid, which is used to limit the extent of the isocontour. Global threshold value may be set across practice, or maybe individually by set per user on a case-by case bases. 5. On a case-by-case basis, click and drag the slider to change the threshold. The VOI shape changes. 6. Access the global or default threshold settings via the Ranch from Case Navigator. 1 SIEMENS 2 MM Oncology MM Oncology Reading PETCT_Flow_3+RespOsted. RectumCa. Edge MLPETCT_Flow_3+Res 18 FOO Ref.: MMM Oncology Biograph 128 Edge F-18 FDO /1/1944. M "1/1/1944. M 3D Reading URRENT CURRENT C_CT 3.0 1301 3 [2] AC_CT 3.0 1of 3 [] Current A01:A1 .- > A01:A1 10/2014 7/10/2014 CT PET, 7/10/2014 :12:48 AM 11:12:48 944 WB IMan.a. FRMna 2 Min.a. FRMn.a. PA201.5 SP R7 D PET-CT 1 " AC_CT 3.0 130f 3 [2] "AC_CT 2.0 1501 3 [5] Lung CAD ACT Once Boare " TrueX+TOF 5 MBg/kg 3121s ... 3 › 8Gates TrueX+TOF 321s5m ... Trending . HDChest 35% TrueX.TOF 322. MM Reading * 3DOSEM+TOF 32153mm (NAC) Additional Data LA] Results MM Reading Results lesuts MM Oncology Reading Lesuts MM Oncology Reading [1209) 7 Findings Navigator PETCT_Flow_3+RespGated, Rectum Ca. Edg Ref.: MMM Oncology MI_PETCT_Flow_3+F 18 FOG 1/1/1944. M Biograph 128 Edge_mCT F-18 FDG Source *1/1/1944. M Value LIVO13 12.6. MM URRENT FueX+TOF 5 Mg/kg 3:21:3mm (AC) CURRENT L1VO12 28.56 ... MM. TrueX-TOF 5 MBgkg 111 ROICi. 85.75 .. MMR A01:F1 -> A01:F1 TUDY 7/10/2014 STUDY 7/10/2014 7/10/2014 :13:18 AM 11:13:18 AM 8 IMAn.a. FRMna. 4 MAna. FRMn.a. P A701.5 SP R7 0 10cm Tools 5 Hoe Lines Graphics Timepoints C 2001 00-200 SF+TOF 321s, XYZ Gauss3.00 6 Q Fiter: ??? mm UND 7. If the threshold setting and shape of the VOI is appropriate, click OK. The VOI is created and saved in the Findings Navigator. Notes 45 Workbook | syngo.via Quick Guide for MM Oncology 2.5.4.4. Copying/Pasting Measurement Objects You can copy regions of interest (ROI) and volumes of interest (VOI). You cannot Notes copy and paste CT segmentation objects. 1. Right-click on a measurement object and choose Copy from the context menu. 2. Right-click on an image segment and select Paste to paste the object. 2.5.4.5. Creating Findings on a Fused Segment 1. Select a fused segment. 2. If you want the finding drawn on the overlay series, change the alpha blend ration to 50% or greater. If you want the finding to be drawn on the base (CT or MRI) series, change the alpha blend to 49% or less. 3. Select the desired tool to draw the contour. Note: The RECIST/WHO + VOI Isocontour tool creates both these measurements. The mouse pointer changes its shape depending on the blend ratio. 2.5.4.6. RECIST/WHO Measurements RECIST – Response Criteria in Solid Tumors. Uses longest tumor diameter on an axial slice. WHO – World Health Organization. Uses longest and widest perpendicular diameters on an axial slice. These tools employ standard methods for measuring solid tumors to track the progression or treatment response of the tumors. Possible on the following image types: • MPR • MPR Thick • MIP Thin • MinIP Thin 2.5.4.6.1. Changing RECIST Standards When RECIST 1.0 is active, the RECIST of a lymph segmentation is interpreted along the longer diameter. When RECIST 1.1 is active, the RECIST of a lymph segmentation is interpreted along the shorter diameter. In the 3D Reading workflow step: Select RESIST 1.0 or 1.1. This option only works for a 3D segmentation algorithm or a WHO measurement. 2.5.4.6.2. Performing RECIST Measurements 1. Select RECIST standard. 2. Select the segment containing CT or MR data. In a fused segment, set the alpha blend ratio to 0-49% 46 Workbook | syngo.via Quick Guide for MM Oncology 3. In the 3D Reading workflow step, click the RECIST icon or - - Choose the RECIST/WHO Ruler icon from the upper right corner menu. Notes 2.5.4.6.3. Performing WHO Measurements 1. In the 3D Reading workflow step, click the RECIST icon. The mouse pointer changes its shape. 2. To draw a RECIST line, click a start point and drag the mouse pointer to the required end point. or – - To create a RECIST/WHO area, keep the Shift key pressed and draw two orthogonal lines. 2.5.4.7. Automatic CT Segmentation For CT data, you can use the automatic segmentation tools to evaluate lesions. For each lesion type, a different algorithm is used. An HU threshold for a specific anatomy may be set via the configuration ranch from the Case Navigator. Icon Description Location/Keyboard Shortcut Lung lesion segmentation Case Navigator Upper right corner menu Alt+1 Liver lesion segmentation Case Navigator Upper right corner menu Alt+2 Lymph node segmentation Case Navigator Upper right corner menu Alt+3 Generic segmentation Case Navigator Upper right corner menu Alt+4 Available lesion segmentation types 1. Select a CT image segment. 2. Click the appropriate segmentation icon in the 3D Reading workflow step. or – - From the upper right corner menu, choose the segmentation tool. 3. The mouse pointer will change shape. 4. Drag the mouse pointer to draw a line across the lesion. or – - Perform a single click in a lesion if the lesion is small. 47 Workbook | syngo.via Quick Guide for MM Oncology 2.5.4.8. Hybrid CT Segmentation Notes 1. Select a CT segment. 2. Click the appropriate segmentation icon in the 3D Reading workflow step. or – - From the upper right corner menu, choose the segmentation tool. The mouse pointer changes its shape. 3. Drag the mouse pointer to draw a line across the lesion. or – – Perform a single click in a lesion if the lesion is small. Automatic 3D contour defined around the lesion. You can find it in the Findings Navigator. The label consists of an L followed by a consecutive number. L1VOI1 RECIST 1.1 Diam.: 24.9 mm Max. Orth. Diam.: 23.2 mm Volume: 4.055 ml 2.5.4.9. Hybrid Measurement You can use this measurement tool to create bounded isocontours on PET or SPECT data, and RECIST/WHO measurements on CT or MR data. This function is available in a PET or SPECT MPR/MIP Thin segment. It is not available on a MIP segment. From the 3D Reading workflow step, click the RECIST + VOI icon. or – – From the upper right corner menu, select RECIST/WHO + VOI Isocontour. The RECIST/WHO + VOI Isocontour tool is activated. 48 Workbook | syngo.via Quick Guide for MM Oncology 2.5.4.9.1. Isocontour with Spherical or Elliptical Bounding Notes Region 1. Select a MIP/MPR thin segment. 2. Activate the RECIST/WHO + VOI Isocontour tool. 3. Press and hold shift key and drag mouse pointer on PET or SPECT 4. Only drag mouse pointer on CT or MR 2.5.4.9.2. Segmentation Using the Threshold 1. Select a PET segment or fused segment where the alpha blend level is 50% or greater PET. 2. From the 3D Reading workflow step, click the RECIST + VOI icon. or – – From the upper right corner menu, select RECIST/WHO + VOI Isocontour. 3. The mouse pointer changes shape 4. Click and drag to draw the VOI. 2.5.4.10. Creating VOIs Across Time Slices in Dynamic PET Data Any VOI Sphere you draw on one time slice is automatically copied to the other time slices of the loaded study. 1. From the upper right corner menu, select VOI Sphere or VOI Isocontour. 2. Create a VOI. The VOI is automatically copied to the other time slices. 2.5.4.11. Zooming in a Lesion Automatically 1. In the 3D Reading workflow step, click the Auto Zoom icon. 2. Deactivate the function to reset the zoom. 49 Workbook | syngo.via Quick Guide for MM Oncology 2.5.5. Adjusting Windowing Notes 2.5.5.1. Color and Window Adjustment 1. Select PET or NM or Fused segment. 2. Move the mouse over the small window icon at the bottom center of the segment. 3. A window bar will appear. PET or NM Wndow Bar If you have a fused image, you will also have an Alpha Blending slider. Alpha Blending Slider Fused Image Window Bar 4. Move the mouse over the window bar until the pointer changes to a hand. 5. Left mouse click and drag the window center or window width to adjust. 6. Double click on the window bar to set to default. 2.5.5.2. Adjust Alpha Blending 1. Select a fused segment. 2. Press the F9 key to switch from base, overlay and fused displays. 2.5.5.3.1. Applying Windowing Presets and LUTs 1. From the lower right corner menu, choose the Windowing icon. 2. From the menu, choose the required windowing preset or LUT. Units PET Color LUT CT Color LUT PET Presets CT Presets Home Windowing 50 Workbook | syngo.via Quick Guide for MM Oncology 3. Choices for Presets: a. Units Notes b. PET Color LUTs c. CT LUTs d. PET Presets e. CT Presets f. Home Windowing 2.5.5.3.1.1. Hot Keys for Changing Presets CT Segments: F5 to F8 keys, F10 Inverts greyscale values Changing Color LUTs: Shift key and F5 to F8 keys for LUTs Fused Segments: Alt key + F10 to invert the color LUT of the PET or SPECT 2.5.5.3.1.2. Presets Based on SUV 1. Click the PET or SPECT segment. 2. From the lower right corner menu, choose the Windowing icon. 3. Move to PET Presets. Units PET Color LUT CT Color LUT 0-5 % Alt+F5 -- PET Presets 0-10 % Alt+F6 -- CT Presets 0-25 % Alt+F7 -- Home Windowing 0-50 % Alt+F8 0-75 % -= 0-100 % 4. Select the desired SUV preset. 51 Workbook | syngo.via Quick Guide for MM Oncology 2.6. Trending Workflow Step The Trending workflow step provides information about how lesion statistics have changed over time, according to the RECIST standard. Here are the basic steps: Notes 1. In the 3D Reading workflow step, create a region of interest in the current scan. You can create a RECIST measurement (for Tumor Burden). 2. In the 3D Reading workflow step, create corresponding region of interests in the previous scans. 3. In the 3D Reading workflow step, link the region of interests for trending. 2.6.1. Trending Across Time Points for a Selected ROI You must first create a region of interest and then link it. Regions of interest that have been placed in the same anatomical location are linked automatically. 1. Load a current and at least one prior scan into MM Oncology 2. Create regions of interest on current and at least on prior scan. 3. If measurements are not linked automatically, perform the following steps: a. In the 3D Reading workflow step, right click the region and select Edit b. When the Measurement Detail dialog opens, the Select Finding to Link To table displays a list of lesions that have been defined. Select the finding you wish to link to. c. Click OK. 4. The Trending workflow step displays the trending results in the image area (see below) and the summary table with lesion statistics over multiple time points. 5. Click the Trending Graph icon to view the trending graph. H Against Baseline: 4/9/2008 RECIST 1.1 L3VOI1 (+5%) L4VOI1 (+31%) L2VOI1 (+6%) RECIST Change - 30 % 30 % + 20 % 20 % Y AV Other L1VOI1 (+1%) .. The image area displays the trending results with the following information: • Baseline of the region of interest (lesion segmentation or RECIST measurements) • Lesion in the respective color, according to the change rate • Legend of the change rate 52 Workbook | syngo.via Quick Guide for MM Oncology Summary Table The summary table displays the following information: Notes • Lesion statistics over time points • Tumor Burden • Currently selected lesion • Displayed values for CT data depend on the measurement type: • RECIST: only RECIST • RECIST/WHO: RECIST, orth. diameter, WHO area • Segmentation: RECIST, orth. diameter, WHO area, volume doubling time (in days), mean HU, standard HU. 2.6.2. Tumor Burden and Hottest Lesion The Trending tool provides information about lesion statistics and how they have changed over time. This can be used to show differences between pre-therapy scans and scans performed after therapy. This helps to assess the status of the disease and the effectiveness of the treatment. 2.6.2.1. Tumor Burden Trending Use Tumor Burden to display the total Tumor Burden for a time point. This is based upon RECIST measurements you create. Tumor Burden is available for CT data. The graph displays the total Tumor Burden at each time point. 1. Create RECIST measurements of CT segmentations in the time points. 2. For each measurement, right click and select Edit Measurement. 3. Make sure that the Target Lesion check box is checked for each VOI that you want to include. 4. Click the Trending Graph icon in the Case Navigator. or - - Click the Findings Details button in the Findings Navigator. Patient Name 3TP Graph of Selected Lesion Modality CT Baseline Prior 01, 27/04/2007 Tumor Burden Metric RECIST 1.1 + Switch of Print Copy Exggiato Hottest Lesions RECIST 1.1 Trend for Tumor Burden % Change Baseline 33.68 120 30.87 100 29.07 80 25.26 60 22.45 19.65 16.84 14.03 11.23 Prior 02 27/04/2007 20 09.200 DIDAMMARTY 53 Workbook | syngo.via Quick Guide for MM Oncology 2.6.2.2. Trending of the Hottest Lesion Hottest Lesion enables you to see the hottest lesion within each time point. Hottest Lesion is available for PET data. Notes 1. Create VOIs in the time point 2. To view the graph with the hottest lesion, select the region of interest in the CURRENT scan. or - - With the current scan displayed on the screen, select the region of interest in the Findings Navigator. 3. In the Findings Navigator, click the Findings Details button Patient Name 3TP Graph of @ Selected Lesion Modality PET Baseline Prior 01, 27/04/2007 . Tumor Burden Metric Peak Snapshot Print Copy Expert to . Hottest Lesions Peak Trend for Hottest Lesions Change Baseline SUV-bw 50 16.61 L2VO11 40 15.50 30 14.39 13.29 12.18 SV012 11.07 -10 9.96 L2VOI3 -20 8.86 Prior 02 28/07/2008 Prior 01 27/04/2007 CURRENT 20/09/2007 www Date 2.7. Documenting Results MM Oncology lists findings in the Findings Navigator. If you select or create a finding, the linked finding in all other segments is highlighted as well. By default, PET and CT findings are displayed in green color, currently selected PET and CT findings are displayed in magenta. This also applies to a selection of linked findings. Additionally, snapshot images are saved for each finding. To review a finding in the image area, click the finding in the Findings Navigator. 2.7.1. Navigating Through Findings 1. In the Findings Navigator, double-click a finding to display it. The finding is displayed in the segment. 2. Click in the segment and press the F3 key to display the next finding, and press the F4 key to display the previous finding. 2.7.2. Setting the Review Markers You can use review markers function to quickly mark structures of interest. 1. From the upper right corner menu, choose Marker. The cursor changes its shape. + 2. In the image, click the structure of interest. A review marker is displayed in the image. The marker label consists of an M followed by a consecutive number. 54 Workbook | syngo.via Quick Guide for MM Oncology 2.7.3. Adding a Free Text Comment 1. Double-click a marker 2. Enter a comment Notes 3. Press the Return key to confirm you entry 2.7.4. Editing a Review Marker 1. Double-click a marker. 2. Enter a comment. 3. Press the Return key to confirm your entry. 2.7.5. Editing and Reviewing Findings 2.7.5.1. Reviewing Findings Made in the Currently Loaded Series Findings are reviewed and edited in their originating workflow step or application. Findings made in the currently loaded series can be reviewed and edited in the current layout or workflow step. 1. In the Findings Navigator, double-click a finding to display it in the image area. or - - Right-click a finding and choose Display in Current Layout from the context menu. 2. Edit the finding in any segment as desired. The Findings Navigator updates accordingly. 2.7.5.2. Reviewing Findings Made in the Other Series Findings made in a series that is currently not loaded but belongs to the same study can be reviewed and edited in its original layout or workflow step. 1. In the Findings Navigator, double-click a finding. or - - Right-click a finding and choose Display in Original Layout from the context menu. The originating workflow step becomes active and the finding is displayed in the original series and layout. 2. Edit the finding. The Findings Navigator updates accordingly. 2.7.5.3. Adding Snapshot Images 1. Select a finding in the Findings Navigator 2. In the Common Tools area, click the Add Snapshots to Active Finding icon. The snapshot is added to the finding. 55 Workbook | syngo.via Quick Guide for MM Oncology 2.7.6. Opening the Findings Details Box Findings Navigator > Findings Details icon Notes 2.7.7. Displaying and Editing Measurement Details 2.7.7.1. Opening the Measurement Details Window MM Oncology opens the dialog box immediately when you have made new measurements within a 30 mm distance of an existing lesion measurement. Otherwise, if you load data from prior time points or later time points for comparison, you can open the Measurement Details window manually and edit the findings. 1. Select a measurement object. Alternatively, if you want to edit linked measurement objects, select only one of the linked measurement objects. 2. Right-click and select Edit. or - - On the mini toolbar of the CT segmentation, select the Edit Finding icon. 3. The Measurement Details dialog box opens. Measurement Details ? X Select a Finding to Link to Name Organ Proximity (mm) L1 0.0 Edit Properties Organ Lesion Disappeared on Study 21/11/2003 Target Lesion OK Cancel 56 Workbook | syngo.via Quick Guide for MM Oncology 2.7.7.1.1. Measurements Link Notes MM Oncology does not link the measurements automatically in case the measurement is ambigous. If two measurements within a 30 mm distance of an existing lesion measurement exist, the Measurement Details dialog box opens automatically requesting you to link the measurements manually. Linking Measurements 1. In the Measurement Details dialog box, in the Select a Finding to Link To area, select a measurement object or a lesion from the list. 2. Click OK. The measurements are now linked. The finding is deleted in the Findings Navigator, in MPRs, and in the VRT, and is replaced by the finding. Any propagated markers for the linked lesion are removed in views where the linked finding was created. 3. For follow-up examinations, first link the findings with the manual marker from the same time point, and then link them with the lung lesion segmentations from the prior data set. or - - If you do not want to link to an existing lesion, select New. Lesions are listed, and there may be more than one finding associated with a lesion. The Findings Navigator lists measurements with lesions being indicated by the finding name in the Findings Navigator list. 2.7.7.1.2. Editing Properties of a Measurement Object 1. In the Measurement Details dialog box, in the Edit Properties area, select the organ affected by the tumor from the Organ menu. The name is displayed in the Select a Finding to Link to list. or - - To add a new organ name, click in the Organ field and type a new name then click the Add Term icon. 2. To delete an item from the Organ menu, select it and click the Remove Term icon to the right of the menu. 3. Select the Lesion Disappeared check box to mark that the lesion is disappeared in a follow-up study. or - - Select the check box if this is a new lesion. 4. Select the Target Lesion check box to mark a lesion as a target lesion. Each target lesion is included in the patient’s tumor burden. The tumor burden is displayed on the Findings tab of the report editor. 5. Clear the Target Lesion check box to mark a lesion as a non-target lesion. 6. Click OK to save changes. 57 Workbook | syngo.via Quick Guide for MM Oncology 2.7.8. Displaying a Dynamic PET Time Activity Curve Notes A Time Activity Curve is a graph that shows the uptake and washout of a tracer, in a region of interest. This can help to visualize how different quantitative values in the region change over time. 1. Create a VOI on one time slice and copy it to the other time slices. 2. From the Findings Navigator, select the VOI. 3. In the Findings Navigator, click the Findings Details icon. The Time Activity Curve or TAC window opens. A Time Activity Curve is displayed for the selected VOI. 2.7.9. Creating Reports 1. Before creating a report, a procedure has to be loaded in a workflow and findings should be available in the Findings Navigator. 2. In the Findings Navigator, select the findings, which you want to describe in the report. 3. In the Patient Tab list, click the Report Editor icon. 4. Customize your report. 5. To store a report and to schedule it for archiving, click the Save and Send icon. or - - to save the report, just click the Save icon. The report will be saved, but it will not be distributed. or - - In the Close Patient dialog, click the Discard Changes icon to discard all changes and to close the active patient. The report is saved automatically. You can complete the saved report later on. × 6. To end the report editing, click the Close button at the top right of the floating window. 58 Workbook | syngo.via Quick Guide for MM Oncology 2.8. Ending Workflows Notes 2.8.1. Completing a Workflow 1. A workflow is started and the images are loading in the Viewer. 2. Click the Save and Send icon. The workflow is closed and the state of the workflow is set to Completed. V 2.8.2. Saving a Workflow 1. A workflow is started and the images are loading in the Viewer. 2. Click the Save icon. The workflow is closed and the state of the workflow is set to Saved. = 2.8.3. Discarding a Workflow 1. A workflow is started and the images are loading in the Viewer. 2. Click the X icon in the Patient Tab and a Close Patient dialog box appears. 3. Click Discard Changes and confirm the message. The workflow is closed and unsaved results are lost. The state of the workflow remains unchanged. X 59 Workbook | syngo.via Quick Guide for MM Oncology 3. Short Cuts 3.1. syngo.via General Shortcuts This section provides an overview on shortcuts available in all workflows. Basic shortcuts F1 Open Online Help F11 Maximize image area (full screen) on/off Es Deactivate the current tool Alt (press and Deactivate the current tool temporarily and ena- hold) ble Zoom/Pan Del Delete selected item Alt + Tab Switch to another window or application Ctrl + mouse Select multiple objects click Shift + mouse Select multiple objects in sequence click Ctrl + A Select all segments Ctrl + G Select all graphics (in all segments) Ctrl + C Copy selected object Ctrl + X Cut selected object Ctrl + V Paste object Notes 60 Workbook | syngo.via Quick Guide for MM Oncology 3.1.1. Optimization Tools Optimization tools Zoom/Pan images N Zoom/Pan W Adjust Windowing level and width (with left mouse button) Windowing F5 - F8 Apply Windowing Presets Windowing Pre- sets Shift + F5 - Apply Color LUT Presets Shift + F8 Windowing Pre- sets Alt + F5 - Apply Windowing Presets on overlay of fused MPR/MPR Alt + F8 Windowing Pre- sets F9 Toggle Mixing ratio for fused MPR/MPR: 0% => current alpha value => 100% F10 Invert grayscale or color values Invert P Quick punch Punch Remove Clip Box and Clip Plane from selected segments Clip Plane Clip Box Alt + B Switch automatic bone removal on/off (in MM Reading & CT auto Vascular) Bone Removal Auto Notes 61 Workbook | syngo.via Quick Guide for MM Oncology 3.1.2. Navigation Tools Navigation tools R Activate 3D Reference point 3D Reference point O Rotate image (with left mouse button) Rotate Scroll images (with left mouse button) - Scroll U Slice-by-slice scrolling (without skipping) on/off Scroll Shift + 1 Compression mode for slice-by-slice scrolling Scroll Arrow key up / Scroll through images / rotate volume down Arrow key left / Scroll through images in stripe view / dynamic MPR images / right rotate volume Ctrl + Arrow keys Jump to next segment Alt + Arrow keys Scroll through data groups, if available Home / End Jump to first / last image in a stack Spacebar Start/Stop movie immediately Movie Notes 62 Workbook | syngo.via Quick Guide for MM Oncology 3.1.3. Measurement Tools Measurement tools D Measure a straight distance Distance line C Measure a circular ROI ROI Circle L Activate Pixel lens Pixel Lens M Place a marker on point of interest Marker V Measure a spherical VOI VOI Sphere S Create a snapshot for findings (of selected segments) Snapshot to Find- ing - F Create a clinical finding (will be listed in the Findings Naviga- tor) Notes 63 Workbook | syngo.via Quick Guide for MM Oncology 3.1.4. Common Tools Common tools Alt + L Switch the layout editing mode on/off Edit Layout Y Switch synchronization of segments on/off Synchronization Ctrl + Shift + Fast correction of alignment for synchronized images Arrow key up / (between all / between time points). down Alignment Ctrl + Shift + Scroll wheel Alt + R Open the Report Editor FF Report Editor E Send selected image to the film sheet Print Image A Send all images of selected stacks to the film sheet Print Stack Ctrl + Alt + A Close the case, save and send the results (to the archive) Close Patient - Save and send Ctrl + Alt + S Close the case and save results locally Close Patient - Save results Notes 64 Workbook | syngo.via Quick Guide for MM Oncology 3.1.5. Switch Display Type Switch display type 1 Switch to 2D display 2D 2 Switch to MPR MPR 3 Switch to MPR Thick MPR Thick 4 Switch to MIP MIP 5 Switch to MIP Thin MIP Thin 6 Switch to MinIP Thin MinIP Thin 7 Switch to VRT VRT 8 Switch to VRT Thin VRT Thin Notes 65 Workbook | syngo.via Quick Guide for MM Oncology 3.1.6. Patient Browser Shortcuts Shortcuts in Patient Browser Q Ctrl + F Put cursor into the search field Search Ctrl + E Open the Export data dialog box (with selected data) Export data Ctrl + R Start DICOM Query & Retrieve DICOM Query & Retrieve Ctrl + O Open selected data Open 3.2. MM Oncology Shortcuts MM Oncology Windowing and Color LUTS B Switch the windowing functionality between top (only) and bottom (only) levels F9 Toggle alpha blending in fused segment (0%, 100%, Mixed) Single data set and fused data set (base) F5-F8 Windowing presets Windowing Preset Shift + F5-F8 Color LUTS Color LUT F10 Invert color LUT Invert Color LUT Fused data set (overlay) Alt + F5-F8 Windowing presets Notes Windowing Preset 66 MI - PET/CT On account of certain regional limitations of sales rights and service availability, we cannot guarantee that all products included in this brochure are available through the Siemens sales organization worldwide. Availability and packaging may vary by country and is subject to change without prior notice. Some/All of the features and products described herein may not be available in the United States. The information in this document contains general technical descriptions of specifications and options as well as standard and optional features which do not always have to be Local Contact Information present in individual cases. Siemens Medical Solutions USA, Inc. 40 Liberty Blvd. Siemens reserves the right to modify the Malvern, PA 19355-9998 design, packaging, specifications and options USA described herein without prior notice. Please Telephone: +1-888-826-9702 contact your local Siemens sales representative www.usa.siemens.com/healthcare for the most current information. Note: Any technical data contained in this Global Business Unit document may vary within defined tolerances. Siemens Medical Solutions USA, Inc. Original images always lose a certain amount Molecular Imaging of detail when reproduced. 2501 N. 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