syngo.via CT Cardiac Planning

syngo.via® CT Cardiac Planning syngo.via CT Cardiac Planning is a full-featured, semi-automatic workflow designed to aid in the diagnostic evaluation of cardiac anatomy - specifically the aortic valve and annulus plane – in pre-procedure planning of TAVI interventions. 1. From the Patient Worklist, load an appropriate data set into the CT Cardiac Planning Workflow: • If the examination has been correctly mapped, double click to load • If manual mapping is required, right-click the examination and select Open With > CT Cardiac Planning 2. Use the Phase Navigator to review different phases in a multi-phase 80% 256 * 256 cardiac data set. Select a phase directly from the list, use the mouse 10% 256 * 256 20% 256 * 256 (scroll wheel + ALT, or drag left/right + RMB) or up/down arrows to 35% 256 * 256 step through consecutive phases. The cine mode will automatically 45% 256 * 256 50% 256 * 256 navigate through all available cardiac phases. The automatic loading 55% 256 * 256 60% 256 * 256 strategy utilizes Best Systole/20% R – R, or that phase which is clos- 65% 256 * 256 est. 70% 256 * 256 71% BestDiast 512 * 512 75% 256 * 256 80% 256 * 256 3. The Case Navigator provides many tools which are useful in per- CT Cardiac Planning + forming a general evaluation of the heart. Heart Isolation and Blood Pool Removal are performed as preprocessing steps. Dese- CT Cardiac Planning lect the icon(s) to view the complete anatomy. Isolate Remove Heart Blood Cardiac Aortic Mitral Planes Valve Valve • Heart Isolation automatically isolates the heart from the surrounding tissues and structures • Blood Pool Removal extracts the remaining blood from the heart chambers. Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 5/3/2017| HOOD05162002591584 Healthineers Job Aid | syngo.via CT Cardiac Planning Effective Date: 5/3/2017| HOOD05162002591584 4. To better assess the aortic and mitral valves, MPR views can be aligned with the cardiac or valve planes. • In the Case Navigator, enable the Cardiac Planes icon. Cardiac Planes • syngo.via calculates the orientation of the standard cardiac planes on the best systolic phase or that phase closest to 20%. • In the Case Navigator, enable the Aortic Valve Plane or Mitral Valve Plane icon Aortic Valve • syngo.via calculates the orientation in alignment with the selected valve Mitral Valve 5. The Aortic Valve workflow step automatically identifies the right, left, and non-coronary cusp hinge points. It also automatically pre-processes the annulus plane and provides minimum, maximum, pe- rimeter, and effective diameters of the aortic annulus with the centerline. Aortic Valve Annulus Plane Right Left Dual Ostium Ostium Ostia Show Redefine Reset Points Points Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 5/3/2017| HOOD05162002591584 Healthineers Page 2 of 8 Job Aid | syngo.via CT Cardiac Planning Effective Date: 5/3/2017| HOOD05162002591584 6. The Therapy Connect workflow step generates a series of VRT images in 5 degree incre- ments that rotate parallel to the annular plane. The corresponding C-arm angulations are included in the DICOM header for later use in the interventional cardiology lab (requires a Siemens syngo X Workplace). Therapy Connect CorCTA 0.75 B26f 10-80% +C SP R92.9 Create Views MPR LAO 87 CRAN 44 7. The Rapid Results workflow step automates and standardizes the post-processing steps associated with many CT examinations. It reduces the time needed to document cases and improves the repro- ducibility among users. In Cardiac Planning, Rapid Results provides a default protocol for producing measurements associated with pre-procedural TAVI planning. These steps are fully customizable in the Protocol Configurator. Rapid Results Protocol Configurator ? X Protocol TAVI Planning New Rename Copy Delete Protocol TAVI Planning Step Configuration Measurement Form Configuration Current Protocol Available Steps Select Layout System Actions Il Verify annulus plane User Actions Bookmark Segment (CPR) K Fill Form Annulus Size LVOT Size Sinus of Valsalva Size Step 1/12 Select Layout STJ Size Protocol Properties Available at the acquisition workplace for association with reconstructions Minimize OK Apply Cancel Import Export Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 5/3/2017| HOOD05162002591584 Healthineers Page 3 of 8 Job Aid | syngo.via CT Cardiac Planning Effective Date: 5/3/2017| HOOD05162002591584 Step 1/12 Select Layout • Step 1 – Select an alternate layout, if desired. • Press Play to begin the guided measurement protocol K Step 2/12 Verify annulus plane • Step 2 – Verify the Annulus Plane. The hinge points can be adjusted/edited if necessary – i click the Redefine Points icon on the Aortic Valve workflow step as described in the Step 2/12: Verify annulus plane x Guidance Dialog box. Please verify the correct identification of the aortic annulus plane. Click the Redefine Points icon in the Aortic Valve blind to change the position of the hinge points if necessary. Press Play to continue. Do not show again Close • Step 3 – Automated step in which the resulting MPR Curved images are Bookmarked. Aorta Aorta Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 5/3/2017| HOOD05162002591584 Healthineers Page 4 of 8 Job Aid | syngo.via CT Cardiac Planning Effective Date: 5/3/2017| HOOD05162002591584 • Step 4 – Navigate to the annulus plane and verify Step 4/12 Annulus Size the contour in the cross-sectional segment and create a finding to document the annulus dimen- Step 4/12: Annulus Size sions. x Please navigate to the annulus plane and verify the contour in the cross-sectional segment. Create a finding to measure the annulus dimensions. + Do not show again Close • Step 5 – Navigate to the left ventricular outflow Step 5/12 LVOT Size tract (about 5mm below the annulus plane). Verify the contour in the cross-sectional segment and create a finding to document the LVOT di- Step 5/12: LVOT Size X mensions. Please navigate to the left ventricular outflow tract, about 5 mm below the annulus plane. Verify the contour in the cross-sectional segment and create a finding to measure the dimensions of the LVOT. Do not show again + Close • Step 6 – Navigate to the widest portion of the Sinus Step 6/12 Sinus of Valsalva Size of Valsalva. Verify the contour in the cross-sec- tional segment and create a finding to docu- Step 6/12: Sinus of Valsalva Size X ment the size. Please navigate to the widest portion of the sinus of Valsalva and verify the contour in the cross-sectional segment. + Create a finding to measure the size. Do not show again Close Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 5/3/2017| HOOD05162002591584 Healthineers Page 5 of 8 Job Aid | syngo.via CT Cardiac Planning Effective Date: 5/3/2017| HOOD05162002591584 • Step 7 – Navigate to the sinotubular junction (STJ). Step 7/12 STJ Size Verify the contour in the cross-sectional segment i and create a finding to document the dimensions. Step 7/12: STJ Size x i Please navigate to the sinotubular junction and verify the contour in the cross-sectional segment. Create a finding to measure the + size. Do not show again Close • Step 8 – Navigate into the ascending aorta (about 4 Step 8/12 Ascending Aorta Size cm above the annulus plane). Verify the contour in the cross-sectional segment. If no automatic con- Step 8/12: Ascending Aorta Size x tour is present, create one manually by right-click- ing in the segment and selecting Edit Contours. Navigate into the ascending aorta. Create a finding to document the measurements. Verify the contour in the cross-section. Create a manual contour by right-clicking on the segment and selecting Edit Contours if needed. Create a + finding to measure the size. Do not show again Close • Step 9 – Automated step in which the resulting MPR image in Segment 2 is Bookmarked. Annulus HA vD: 30.5 mm Herz 0.6 B26f 60% SP A270.9 R 5cm MPR A 1000 CAUD 4 Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 5/3/2017| HOOD05162002591584 Healthineers Page 6 of 8 Job Aid | syngo.via CT Cardiac Planning Effective Date: 5/3/2017| HOOD05162002591584 • Step 10 – Navigate to an MPR view that displays both Step 10/12 Coronary Ostia Plane coronary ostia and the annulus plane. You can click on the Dual Ostia icon in the Aortic Valve workflow Step 10/12: Coronary Ostia Plane × step to display this quickly. Press Play to continue. Please navigate to an MPR view displaying both coronary ostia and the annulus plane. You can click on the Dual Ostia icon in the Aortic Valve blind to do this. Press Play to continue. Do not show again Close • Step 11 – Measure the distance between the right coronary ostium and the annulus plane. If you used Step 11/12 RCO Height i the Dual Ostia icon the horizontal line represents the annulus plane. Step 11/12: RCO Height x Please measure the distance between the right coronary ostium and the annulus plane. If you used the Dual Ostia functionality, the horizontal reference line coincides with the annulus plane. Do not show again Close • Step 12 – Measure the distance between the left Step 12/12 LCO Height coronary ostium and the annulus plane. If you used the Dual Ostia icon the horizontal line rep- resents the annulus plane. Step 12/12: LCO Height X Please measure the distance between the left coronary ostium and the annulus plane. If you used the Dual Ostia functionality, the horizontal reference line coincides with the annulus plane. Do not show again Close Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 5/3/2017| HOOD05162002591584 Healthineers Page 7 of 8 Job Aid | syngo.via CT Cardiac Planning Effective Date: 5/3/2017| HOOD05162002591584 Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH 2020 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84-0 siemens-healthineers.com Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 5/3/2017| HOOD05162002591584 Healthineers Page 8 of 8