philips - Lori Y. Woods
English
Instructions for Use
Brilliance Workspace
Portal
4535 674 64511_A
PHILIPS
Contents
1
Introduction ..................................................................................... 1-1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
Philips Medical Systems 4535 674 64511_A
2
Safety ................................................................................................ 2-1
2.1
3
Important safety directions ...................................................................2-1
Security of system and data ............................................................. 3-1
3.1
3.2
4
About the Brilliance Workspace Portal .................................................1-1
About this guide ...................................................................................1-2
Intended use .........................................................................................1-4
Contraindications .................................................................................1-5
Compatibility .......................................................................................1-5
Compliance ..........................................................................................1-6
Training ...............................................................................................1-7
Regulatory controls ...............................................................................3-2
Security issues and guidelines ................................................................3-3
System description ........................................................................... 4-1
4.1
4.2
4.3
4.4
4.5
Brilliance Workspace Portal - Volume 1
What Portal is.......................................................................................4-1
Requirements........................................................................................4-4
Antivirus software .................................................................................4-9
Applications ........................................................................................4-10
Ancillary programs..............................................................................4-11
i
5
Screen resolution and layout ........................................................... 5-1
5.1
6
Portal client application ................................................................... 6-1
6.1
6.2
6.3
6.4
6.5
7
Directory window................................................................................. 7-2
Using storage devices .......................................................................... 7-16
Queue manager .................................................................................. 7-22
Preferences ...................................................................................... 8-1
8.1
8.2
8.3
8.4
8.5
8.6
8.7
8.8
8.9
8.10
8.11
ii
Overview .............................................................................................. 6-1
Portal client application ........................................................................ 6-2
Portal client application login ............................................................... 6-4
Emergency User.................................................................................. 6-10
Shutdown ........................................................................................... 6-12
Directory .......................................................................................... 7-1
7.1
7.2
7.3
8
Low screen resolution ........................................................................... 5-2
Preferences utility ................................................................................. 8-1
Patient Directory .................................................................................. 8-4
Windowing Presets ............................................................................... 8-7
Image Titles.......................................................................................... 8-9
Measurements..................................................................................... 8-12
Save Images ........................................................................................ 8-13
CT Viewer.......................................................................................... 8-15
Segmentation Presets .......................................................................... 8-17
Reporting ........................................................................................... 8-18
Film Header / Footer.......................................................................... 8-19
AVA ................................................................................................... 8-20
Brilliance Workspace Portal - Volume 1
8.12 Licensing.............................................................................................8-21
8.13 User ....................................................................................................8-22
9
Workflow - navigating the software ................................................ 9-1
Workflow bar........................................................................................9-1
Workspace display ................................................................................9-3
Image area.............................................................................................9-4
Control panel........................................................................................9-5
Progress and Message Bar......................................................................9-6
Philips Medical Systems 4535 674 64511_A
9.1
9.2
9.3
9.4
9.5
Brilliance Workspace Portal - Volume 1
iii
1
1.1
Introduction
About the Brilliance Workspace Portal
Provides the local site administrators and service personnel with
functionality required to:
• Monitor Portal usage
• Administer strong password control
• Add/delete users and groups
• Maintain the database
• Manage web access to the server
Philips Medical Systems 4535 674 64511_A
The Workspace Portal can also be operated from the client:
C:\PortalPms\System\ RemotePortalManagement.exe
Philips Brilliance Workspace Portal v2.5 contains two software
applications, Portal Management (administrative) software and Portal
Client software.
The Portal application enables ubiquitous remote access to Extended
Brilliance Workspace 3.5 functionality through networked hospital PCs.
Brilliance Workspace Portal consists of a server, software and client
application.
Server data base is 500 GB compared to ~140 GB on stand alone Extended
Brilliance Workspace.
Note
Portal Management provides system configuration and maintenance
services such as User management and Modality and PACS connectivity.
Brilliance Workspace Portal - Volume 1
Introduction
1- 1
1.2
About this guide
Portal Server provides Storage and Query/Retrieve capabilities for CT
Images to and from CT modalities and PACS.
1.2
About this guide
This manual is intended to assist users and operators in the safe and
effective operation of the equipment described. The “user” is considered to
be the body with authority over the equipment; “operators” are those
persons who actually handle the equipment.
Before attempting to operate the equipment, you must read this manual
thoroughly, paying particular attention to all Warnings, Cautions and
Notes incorporated in it. You must pay special attention to all the
information given and procedures described in the Safety section.
Before attempting to operate any related CT equipment, you must read,
note, and strictly observe all DANGER notices and safety markings on the
CT Imaging System.
Wa r n i n g
Caution
Note
1 -2
Introduction
Directions, which if not followed, could cause fatal or serious injury to an
operator, patient or any other person, or could lead to a misdiagnosis or
mistreatment.
Directions, which if not followed, could cause damage to the equipment
described in this Instructions for Use and/or any other equipment or goods,
and/or cause environmental pollution.
Highlight unusual points as an aid to an operator.
Brilliance Workspace Portal - Volume 1
About this guide
1.2
The documentation for the Brilliance Workspace Portal is supplied in this
volume.
Volume 1 - Instructions for Use (this document)
This volume explains how to use the Brilliance Workspace Portal. It also
contains information about safety, data security, system start-up, software
navigation, accessing patient data and filming.
Volume 2 - Review
This volume explains how to use the various image viewers supplied with
the system. Also included in this volume are instructions on how to use the
reporting option, and how to use graphic tools for annotating studies and
making basic measurements.
Volume 3 - Analysis
This volume explains how to use advanced applications, Advanced Vessel
Analysis with Stent Planning (AVA), Virtual Colonoscopy (VC),
Comprehensive Cardiac Analysis (CCA), Lung Nodule Assessment (LNA),
and Brain Perfusion (BP).
Philips Medical Systems 4535 674 64511_A
Portal Remote Management Application
This volume explains how to use the Portal Management application. The
local site administrators and service personnel are provided the
functionality required to monitor Portal usage, check for errors, add/delete
users and groups and maintain the patient database.
This Document was originally drafted, approved, and supplied by Philips
Medical Systems (Cleveland), Inc. in the English language under the
product part number 4535 674 64511_A .
Brilliance Workspace Portal - Volume 1
Introduction
1- 3
1.3
Intended use
1.3
Intended use
The Philips Brilliance Workspace Portal is intended to be used and
operated only in accordance with the safety procedures and operating
instructions given in this Instructions for Use for the purpose for which it
was designed. The purpose for which the equipment is intended is given
below. However, nothing stated in this Instructions for Use reduces user’s
and operator’s responsibilities for sound clinical judgement and best clinical
procedure.
The Philips Brilliance Workspace Portal is intended for use as a diagnostic
viewing and processing application. The quality of the images depends on
the level and amount of X-ray energy delivered to the tissue during a
separate CT scan. CT imaging displays both high-density tissue, such as
bone, and soft tissue. When interpreted by a trained physician, CT images
yield useful diagnostic information. It is intended for use on the head and
whole body.
Use and operation of this equipment is subject to the law in the
jurisdiction(s) in which the equipment is being used. Both users and
operators must only use and operate the equipment in such ways as do not
conflict with applicable laws, or regulations which have the force of law.
Wa r n i n g
1 -4
Introduction
In the United States, Federal law restricts this device to sale, distribution,
and use by or on the order of a physician.
Brilliance Workspace Portal - Volume 1
Contraindications
1.4
1.4
Contraindications
The Philips Brilliance Workspace Portal should not be used if any part of
the equipment or system is known (or suspected to be) operating
improperly.
1.5
Compatibility
Equipment described in this manual should not be used in combination
with other equipment or components unless such other equipment or
components are recognized as compatible.
Changes and/or additions to the server should only be carried out by
Philips Medical Systems or by third parties expressly authorized by Philips
Medical Systems to do so. Such changes and/or additions must comply
with all applicable laws and regulations that have the force of law within the
jurisdiction(s) concerned, and with best engineering practice.
Philips Medical Systems 4535 674 64511_A
Changes and/or additions to the equipment that are carried out by persons
without the appropriate training and/or using unapproved spare parts may
lead to the PMS warranty being voided. As with all complex technical
equipment, maintenance by persons not appropriately qualified and/or
using unapproved spare parts carries serious risks of damage to the
equipment and of personal injury.
Brilliance Workspace Portal - Volume 1
Introduction
1- 5
1.6
Compliance
1.6
Compliance
The Philips Brilliance Workspace Portal complies with relevant
international and national standards and laws. Information on compliance
is supplied on request by your local PMS representative, or by:
Philips Medical Systems
PO Box 10 000
5680 DA BEST
The Netherlands
Facsimile: +31 40 276 2205
The Philips Brilliance Workspace Portal complies with relevant
international and national laws and standards on EMC (electro-magnetic
compatibility) for this type of equipment when used as intended. Such laws
and standards define both the permissible electromagnetic emission levels
from equipment and its required immunity to electromagnetic interference
from external sources.
California
In compliance with California’s Best Management Practices for Perchlorate
Materials (California Code of Regulations, title 22, division 4.5, chapter
33, article 1), the following warning applies to all Philips Medical Systems
Brilliance CT scanners and workstations due to Panasonic CR (button)
batteries that are mounted on printed circuit boards in various parts of the
system:
Wa r n i n g
1 -6
Introduction
Perchlorate Material – special handling may apply. For more information,
see www.dtsc.ca.gov/hazardouswaste/perchlorate/index.cfm.
Brilliance Workspace Portal - Volume 1
Training
1.7
Vermont
In compliance with the labeling requirements of the Vermont labeling law
V.S.A. 10, Chapter 159, §6621(d) and Section 6-803 of the Vermont Solid
Waste Management Rules, this product consists of devices that may contain
mercury, which must be recycled or disposed of in accordance with local,
state, or federal laws. (Within this system, the backlight lamps in the
monitor contain mercury.)
1.7
Training
Operators of the Philips Brilliance Workspace Portal must have received
adequate training on its safe and effective use before attempting to operate
the equipment described in this Instructions for Use. Users must also
ensure that operators receive adequate training in accordance with local
laws or regulations which have the force of law.
Philips Medical Systems 4535 674 64511_A
If you require further information about training in the use of this
equipment, please contact your local Philips Medical Systems
representative. Alternatively, contact:
Philips Medical Systems
PO Box 10 000
5680 DA BEST
The Netherlands
Facsimile: +31 40 276 2205
Brilliance Workspace Portal - Volume 1
Introduction
1- 7
2
2.1
Safety
Important safety directions
Philips Medical Systems products are all designed to meet stringent safety
standards. However, all medical electrical equipment requires proper
operation and maintenance, particularly with regard to human safety.
It is vital that you follow strictly all safety directions under the heading
Safety and all Warnings and Cautions throughout this Instructions for
Use, to help ensure the safety of both patients and operators.
Philips Medical Systems 4535 674 64511_A
In particular, you must read, understand and know the information
described in this Safety section before using this equipment.
You should also note the following information given in the Introduction
section of this Instructions for Use:
• intended use of the Philips Brilliance Workspace Portal.
• contra-indications
• training for operators of the Brilliance Workspace Portal.
Wa r n i n g
Operation of the equipment or system with improperly-operating or
wrongly-adjusted components could expose the operator or the patient
safety hazards. This could lead to fatal or other serious personal injury.
Wa r n i n g
Do not use the Brilliance Workspace Portal for any application until you
have read, understood and know all the safety information, safety
procedures and emergency procedures contained in this SAFETY section.
Brilliance Workspace Portal - Volume 1
Safety
2- 1
2.1
Important safety directions
Wa r n i n g
Do not use the Brilliance Workspace Portal for any application until you
have received adequate and proper training in its safe and effective
operation. If you are unsure of your ability to operate this equipment safely
and effectively DO NOT USE IT. Operation of this equipment without
proper and adequate training could lead to clinical misdiagnosis.
Wa r n i n g
Do not use the Brilliance Workspace Portal for any purpose other than
those for which it is intended. Operation of the Brilliance Workspace Portal
for unintended purposes, or with incompatible equipment, could lead to
clinical misdiagnosis.
Intended use of the Brilliance Workspace Portal is described under the
heading Intended Use in the Introduction section of this Instructions for
Use. Compatibility is discussed under the heading Compatibility in the
Introduction section of this manual.
2 -2
Safety
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3
Security of system and data
Philips Medical Systems is dedicated to helping you maintain the
confidentiality, integrity, and availability of electronic protected health
information and the hardware and software products that create and
manage these data.
Philips Medical Systems 4535 674 64511_A
Maintaining security of Philips Medical Systems' products should be an
important part of your facility's security-in-depth strategy. You should
implement a comprehensive, multi-layered strategy (including policies,
processes, and technologies) to protect information and systems from
external and internal threats. Your security strategy should follow industrystandard practices, addressing physical security, personnel security,
procedural security, risk management, security policies, and contingency
planning.
The practical implementation of technical security elements varies by site
and may employ a number of technologies, including firewalls, virus
scanning software, authentication technologies, etc.
This chapter provides guidelines to help the operator and owner
understand the possible ways security can be compromised, and then insure
that safeguards are in place to prevent this from happening. For specific
information about security within their institutions, operators and owners
can consult with the following offices at their location:
• Information Systems Security Officer
• Chief Information Officer
• HIPAA Officer (in the U.S.A.)
• Safety Officer
Brilliance Workspace Portal - Volume 1
Security of system and data
3- 1
3.1
Regulatory controls
3.1
Regulatory controls
Protect patient’s health information
One of the most important assets to protect with security measures is the
patient's health related information.
Many governments require maintaining the confidentiality of this
information. Therefore, strict security measures must be taken to guard this
protected information.
(Users in the U.S.A. may find guidelines at
http://www.hhs.gov/ocr/hipaa/.)
Prevent unauthorized device modification
Philips Medical Systems sells highly complex medical devices and systems.
We are required to follow government-regulated quality assurance
procedures to verify and validate modifications to the operation of our
medical devices.
Operators of this medical equipment must permit only Philips-authorized
changes to be made to the servers, either by Philips' personnel or under
Philips' explicit published direction.
Caution
3 -2
Security of system and data
Do not connect any external devices which were not included with the
server of your Brilliance Workspace Portal system.
Brilliance Workspace Portal - Volume 1
Security issues and guidelines
3.2
3.2
Security issues and guidelines
In addition to the patient information and device integrity needs discussed
in the preceding section on regulatory requirements, the following topics,
issues, and guidelines should be understood and addressed by operators and
owners. All content on this page refers to the Brilliance Workspace Portal
server and not the client PCs.
Network security
The Brilliance Workspace Portal must be placed on a secure local computer
network that has protections against viruses and other harmful computer
system intruders. Make sure the equipment is connected to a local network
that uses appropriate protection, such as a firewall and virus scanners.
Remote Service
Philips Medical Systems 4535 674 64541_A
Philips Medical Systems has a global, web-based network for connecting
many of your Philips systems to our advanced service resources. This secure
tunnel approach provides your equipment with a single point of network
access to on-site Philips equipment using Virtual Private Network
technologies. The remote service function is a secure connection through
explicit authorization and authentication control with encryption of all
data.
Antivirus Updates
Virus definition files and updated virus scanning engines are included with
the equipment. Updates of virus definition files and/or corrective software
versions are regularly made available by Philips to address known
vulnerabilities (virus and otherwise).
The system’s antivirus scanner is scheduled to activate during off hours,
while system is typically not in use. (Refer to the section “Antivirus
Software” in the System Description chapter of this volume for details.)
Brilliance Workspace Portal - Volume 1
Security of system and data
3- 3
3.2
Security issues and guidelines
Caution
Under no circumstances should updated virus definition files (or any type of
software) be installed on the Brilliance Workspace Portal by anyone other
than a Philips Field Service Engineer or an authorized Philips agent.
Positioning of display monitors
Unauthorized visual access to protected information can be minimized by
positioning the system’s display monitor so it faces a wall, to prevent
viewing from doorways, hallways and other traffic areas.
Note
Monitor position is a suggestion for use with monitors of client PCs used to
view Brilliance Workspace Portal.
To help in limiting unauthorized visual access, an unattended computer
display automatically goes blank after a set period of time. If there is no
interaction with the application for a preset length of time, the Idle time
out feature logs users off.
User login and logout protections
A consistent user login process (user names and passwords) provides good
security of protected information.
Minimum login standards include:
• Implementing strong passwords. This is the easiest and most effective
method to increase security. Strong passwords consist of at least eight
alphanumeric, mixed case characters, digits and special characters like
'@' or '*'. Never use words that can be found in the dictionary
• Never post or share user names and passwords
• Change passwords periodically
3 -4
Security of system and data
Brilliance Workspace Portal - Volume 1
4
System description
Brilliance Workspace Portal 2.5 (Portal) is a client/server application that
makes remote access to Extended Brilliance Workspace 3.5 functionality
possible through networked hospital PCs and in hospital locations remote
from the Radiology suite such as the emergency room, the operating room
or in a physician's office.
The main functions of Portal 2.5 include extensions to Extended Brilliance
Workspace 3.5 functionality to support use cases not present in Extended
Brilliance Workspace 3.5, such as user login as well as server and user
administration.
Philips Medical Systems 4535 674 64511_A
The two major components of this application are a server and software,
and a client application and software. The server and client application
communicate through a local area network (LAN) or possibly through the
Internet using a VPN connection.
4.1
What Portal is
Portal communicates with imaging systems of different modalities using the
DICOM-3 standard.
• Portal is a Thin Client /Server application that enables widespread
remote access to EBW 3.5 functionality via networked hospital PC’s.
• The Thin Client machine has the Graphical User Interface (GUI) and
displays images while the central Server retrieves and manages images,
and generates images for transmission to the client.
• Memory and CPU intensive operations such as 3D rendering takes
place on the server. Workstation operations can be performed via PC
Brilliance Workspace Portal - Volume 1
System description
4- 1
4.1
What Portal is
with less computing and memory resources than required by a
standalone workstation.
• Unlimited number of clients; multiple users can login simultaneously
and interact with datasets for review and interpretation.
• It’s a Brilliance Workspace anywhere the clinician needs it.
4.1.1
Key features
In Portal v2.5 CT Viewer imaging modalities supports CT. Portal functions
include various image handling features including:
• Archiving
• Viewing
• Manipulation
• Two and three-dimensional processing
• Analysis
• Filming
• Quick Review
• Reading (and burning – if supported by client PC) cd’s and dvd’s
• Unlimited number of clients
• All features and same GUI as CT Viewer in Extended Brilliance
Workspace v3.5
• Save non-DICOM directly to labeled Multimedia viewer in Portal
• Clipboard – copy an image to paste in documents/power points
• Integration with i-Site PACS: launch Portal with the same user login
and same selected data.
• Reporting (Based on TEcontrol)
• Additional applications:
• Advanced Vessel Analysis with Stent Planning (AVA)
• Virtual Colonoscopy (VC)
• Comprehensive Cardiac Analysis (CCA)
4 -2
System description
Brilliance Workspace Portal - Volume 1
What Portal is
4.1
• Lung Nodule Assessment (LNA)
• Brain Perfusion (BP)
Portal 2.5 employs a graphical multi-window, icon and mouse driven user
interface. It is designed to ensure maximum flexibility and intuitive
operation.
Large image sets are efficiently and conveniently reviewed and prepared for
using Extended Brilliance Workspace’s 2D display and manipulation
functions. Basic functions include real-time zooming, panning, windowing
and image viewing. Many viewing functions are included in the basic
functions, including 2D, slab, volumetric images and a basic endo flythrough capability.
4.1.2
Licensing
Philips Medical Systems 4535 674 64511_A
The Brilliance Workspace Portal software system does not support client
side licensing. Server licensing is limited to licenses based on the MAC
address. There is no user or feature specific licensing.
4.1.3
Performance
While the ultimate performance for any specific client depends on network
performance and load, and the number of users simultaneously requesting
computation on the server, the intent of the Portal application is to have
multiple users be able to use the CT viewer with “interactive” performance
over the network.
If no other users are requesting intensive computation from the server, a
single user is able to expect responsiveness consistent with EBW 3.5
Brilliance Workspace Portal - Volume 1
System description
4- 3
4.2
Requirements
4.2
Requirements
•
•
•
•
•
•
4.2.1
Gigabyte connections recommended
Recommended DNS server with reverse DNS capabilities
Recommended VPN access
Recommended domain based network environment
Supports Windows Vista
Dual server that is transparent to the user and handles twice the amount
of images.
Portal server
The Portal Server is connected to the PMS CT scanner and has PACS
connectivity capabilities. The scanner pushes images to the Portal Server
and the server can send and retrieve DICOM images from PACS.
A site can install multiple Portal servers, in which case a user of a Portal
client can connect to a chosen server. Each Portal server acts independently
and is not aware of any other Portal servers.
Memory- and CPU-intensive operations such as 3D rendering take place
on the server.
The Portal server can be accessed by a wide variety of remote users and can
can be placed anywhere in the Radiology IT rooms.
The Portal server is configured by Philips and is dedicated to running the
Portal server software.
Note
4 -4
System description
You must have the same software version as the server.
Brilliance Workspace Portal - Volume 1
Requirements
4.2
System
The server of Brilliance Workspace Portal is based on a Dell server system
and consists the following:
• Server
• Monitor
• Keyboard
• Mouse
• Internal CD-ROM drive
Caution
Never interrupt electric power to the Portal server when it is switched on.
Power down from the administrative application.
On start-up, the Portal client checks the local hardware and software
configuration. The software upgrades. If the hardware configuration does
not meet the minimum requirements for the Portal client a message
displays.
Philips Medical Systems 4535 674 64511_A
Note
Hardware configuration and software requirements of the Portal server are
listed below.
Hardware configuration
•
•
•
•
•
•
Brilliance Workspace Portal - Volume 1
CPU: 4x CPU Dual Core Xeon 7110 M, 3.66 GHz.
RAM: 20 Gb
Video: none
Operating System: Windows server 2003
Disks: 3 x 300 Gb disks in a RAID 5 configuration of 600 Gb
Network cards: 1 Gigabit network adapter
System description
4- 5
4.2
Requirements
Note
Windows Server 2003 OS permits remote login and system administration
through Remote Desktop Administration. Hospital IT should not install any
software on the Portal, such as security and antivirus.
Software
Third party software and security application Mcafee antivirus, (See the
Antivirus software section later in this chapter for more details) is included
in the installation of Portal 2.5. Also, all unused ports and services are
closed on the server for security purposes.
Note
4.2.2
Generally, other than stipulating minimal requirements, Philips does not
have control over the configuration of the client machines.
Portal client application
Portal client software is deployed on a variety of PCs with multiple
Operating System (OS) and hardware configurations. An unlimited
number of clients can be installed and loaded.
4 -6
System description
Brilliance Workspace Portal - Volume 1
Requirements
4.2
Hardware
Below lists the minimal requirements of the client PC.
Components
Required
Recommended
Available memory
512 mb
1024 mb or higher
Processor speed
1024 MHz
2048 MHz or higher
Screen resolution
1024x768 pixel
1280x1024 pixel or higher
Disk Free space on C drive
200 MB
1024 MB or higher
Network speed
100 Mbit
1000 Mbit or higher
Network card
Compatible with the hospital network or a
broadband Internet connection
Software
Components
Required
Recommended
Supported OS
Win XP
Win XP Service pack 2 OR Win 2000 SP4
Philips Medical Systems 4535 674 64511_A
Service pack 1,
Win 2000 SP4
Nero
Not required
If Nero present:write and read CD and DVD
on all platform
If No Nero: WinXp reads and writes CD
Win2000 only reads CD
Brilliance Workspace Portal - Volume 1
Windows account
for initial installation only. Ability to add Portal
administrative access
Software components.
System description
4- 7
4.2
Requirements
MAC Support
• (1) On WinXp running under Mac OS as a virtual machine
• (2) On WinXp running natively on Mac HW using BootCamp (dual
boot Mac or Xp solution from Apple)
4 -8
System description
Brilliance Workspace Portal - Volume 1
Antivirus software
4.3
4.3
Antivirus software
Antivirus software has been installed on the Portal server. The antivirus
check is started automatically, whether a Windows user is logged in on not,
at 2:00 AM (or 3:00 AM depending on time zone and daylight savings). It
can also be started at any time by a Philips service representative.
• If the computer is in the powered on state at 2:00 AM, but a user is not
logged in, the antivirus software runs automatically without displaying
a message.
• If you are logged in to the Extended Brilliance Workspace system when
the antivirus check is ready to start, this message displays: “Waiting to
Start. Virus Scan Will Start in xx:xx”
You can let it start by itself, or you can elect to start it immediately, or you
can elect to skip the virus scan.
While the virus scan is running, the message “Current State: Scanning
Files” displays.
Philips Medical Systems 4535 674 64511_A
Note
You can cancel a virus scan at any time, either before or during its
execution.
• If you log on during a virus check, the check for viruses continues,
showing messages describing its status.
• If no viruses are found, the following message displays: “Current State:
Virus scan complete. No viruses were detected.” The message window
closes automatically after 30 seconds.
• If a virus is found, the following message is displayed: “Virus scan
complete. A virus was detected. Call your service representative.”
• Contact your service representative. You may view the virus log. Click
the “Close this window” button to exit.
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System description
4- 9
4.4
Applications
4.4
Applications
Brilliance Workspace Portal 2.5 handles and displays independent image
viewing and processing applications.
CT Viewer
A comprehensive viewer for fast review of CT data in four
visualization modes:
2D - review original axial images
Slab - review a thin slab image in different orientations
Volume - review full volume images
Endo - review using the flythrough mode.
AVA (Stent)
Advance Vessel Analysis (AVA) offers a set of tools for stent
planning and general vascular analysis. With AVA you can
easily remove bone, then extract vessels and segment them.
VC
Virtual Colonoscopy (VC) enables fast and easy visualization
of colon scans, using acquired CT images.
CCA
Comprehensive Cardiac Analysis (CCA) is used to assess the
state of the coronary arteries and to create a functional
analysis of the heart.
LNA
Lung Nodule Assessment (LNA) assists with the diagnosis of
pulmonary nodules and lesions.
BP
Brain Perfusion (BP) is a blood flow imaging application that
analyzes the uptake of injected contrast in order to
determine perfusion related information about one or more
regions of interest.
4 -1 0
System description
Brilliance Workspace Portal - Volume 1
Ancillary programs
4.5
4.5
Ancillary programs
The following ancillary programs serve the main applications:
Directory
Selects and retrieves images for the applications. Copies to
other devices.
Queue Manager
Displays the order of copying images from one device to
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another and printing films.
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System description
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5
Screen resolution and layout
In Brilliance Workspace Portal there are two variations of resolution, high
resolution, which is 1280 x 1024 and low resolution, which is 1024 x 768.
Because of this there are some screens in the application where you will see
one of two different user interfaces. The user interface is different because
of the different resolutions. Here are the required and recommended
resolutions:
Required - client screen resolution is 1024x768
Recommended - client screen resolution is 1280x1024 or higher
Note
The portal client does not run on any system that has a lower resolution
than 1024 x 768. The portal runs on a resolution higher than 1280 x 1024
though is does not fill the screen.
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There are some screens that do not show differences in display between
high and low resolutions.
Below are examples of screens that display differences between high and low
resolutions in the user interfaces.
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Screen resolution and layout
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5.1
Low screen resolution
5.1
Low screen resolution
To overcome the low screen resolution, some tools are gathered under new
tabs in the toolbox to avoid a crowded toolbox and allow maximum area
possible for viewports.
Note
If you see double arrows in any of the user interfaces, this is an indicator
that there are additional tabs available.
The following images demonstrate the different layouts of some
applications.
AVA
In low screen resolution the volume rendering tools appear under the View
tab.
High Resolution
5 -2
Screen resolution and layout
Low Resolution
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Low screen resolution
5.1
Comprehensive Cardiac
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In low screen resolution the common tools appear under the Common
Tools tab.
High Resolution
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Low Resolution
Screen resolution and layout
5- 3
5.1
Low screen resolution
Film
In low screen resolution the the layouts appear under the Layout tab.
High Resolution
5 -4
Screen resolution and layout
Low Resolution
Brilliance Workspace Portal - Volume 1
6
6.1
Portal client application
Overview
Brilliance Workspace Portal 2.5 is an application with extensions to
Extended Brilliance Workspace 3.5 functionality for users that are remote
from the acquisition site and the Radiology suite. The Portal client
application can be installed on multiple computers. Multiple users can be
logged into the Portal server at any one time. If one user experiences a crash
or is disconnected on the network, the other users are able to continue to
operate.
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Each user has a username and password and are assigned to a group. User
Ids and groups are managed according to hospital policy using the Portal
administration preferences.
In Portal 2.5, in addition to the CT Viewer application, Advanced Vessel
Analysis (AVA) with Stent planning, Brain Perfusion, Comprehensive
Cardiac (CCA), Lung Nodule Assessment, Virtual Colon, and Reporting
are available. The configuration of these packages varies based on the
licenses purchased.
6.1.1
User threshold
• Measured by resources of the server.
• ~10,000 active slices simultaneously – one server configuration
• ~30,000 active slices simultaneously – one server configuration
• ~60,000 active slices simultaneously – dual server configuration
• Clients connect to the Brilliance Workspace Portal via LAN, WAN or
any broadband internet connection through a secure VPN.
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6.2
Portal client application
6.2
Portal client application
The Portal client application works by connecting to the Portal Server (see
Volume 4 Portal Management chapter 5 Portal Server Application for
more information). Though your site can have multiple servers, it is limited
by which portal servers are configured to be seen by that client. Only one
instance of the Portal client application can run on a client system/personal
computer at a time. The limit of concurrent slices is 10,000 to 60,000,
based on the portal configuration.
In the Portal client application you have access to Patient directory and
Queue manager. You can view patient studies in CT Viewer 2D Mode, Slab
Mode, Volume Mode, and Endo Mode, as well as Advanced Vessel Analysis
(AVA) with Stent Planning, Brain Perfusion, Comprehensive Cardiac
(CCA), Lung Nodule Assessment, and Virtual Colon.
Note
If no other users are requesting intensive computation from the server, you,
a single user should expect responsiveness consistent with Extended
Brilliance Workspace 3.5, assuming a 100Mb network.
Thin-client” technology
Portal is thin-client technology which is a small file installed at remote PCs
to access and view information from a dedicated server.
Server does all the “heavy lifting” while remote thin-clients display only
results.
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Portal client application
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Portal client application
6.2.1
6.2
User information
Most people are either a user or administrator of the Portal client
application though some users can be assigned both user and administrator
privileges.
User rules
• Only one portal client application can be installed on a system.
• Only one user can be logged into a system/personal computer at a time.
• All users have the ability to select image compression.
• You can only connect to servers that are running the same version of
software as the client.
• You can change patient details or anonymize a study. Both of these
functions create new studies. The old study is not removed.
• Deletion of data must be done by the portal site administrator.
• You can logoff at anytime.
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• The portal administrator can log you off at anytime.
• Time-out logs you off after a set time of no activity that has been
determined by the portal administrator.
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6.3
Portal client application login
6.3
Portal client application login
At any particular time, a specific user is only allowed to be logged in to one
Portal client application/Portal server.
If you try to login to a second Portal client application or to the same Portal
server, a warning message displays. If you continue to try you are
automatically logged out from the first Portal client application.
When you are in an application and remain idle for a certain amount of
time, predetermined and configurable by your site administrator, a warning
displays. Then, if you do not respond the Portal client application
automatically logs out of the application.
6.3.1
Login screen
The login screen allows you to choose which Portal server you connect to.
The user interface stores information such as IP addresses, for the
previously entered Portal servers. Therefore you, the current user, can select
between Portal servers or enter information for a new Portal server. When a
Portal server is selected or entered, server statistics display to enable you to
assess the current activity load on the server. (see the Server Statistics section
in the Workflow - Navigating the Software chapter for more information).
6.3.2
Launch Brilliance Workspace Portal
1
Double-click on the Run Portal icon to launch the Portal Client Server.
-OR1
6 -4
Portal client application
Through the Windows start menu go to Philips Standard Application,
Extended Workspace Portal, Run Portal.
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Portal client application login
6.3
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• Portal Login screen opens.
Select server/Verify connection
If there is more than one server available either
2
Select desired Server from the dropdown list.
- or -
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3
Click in the Server box, type the IP address
4
Click the verify connection arrow to verify connection to the selected
portal server.
• The verify connection window opens.
5
(Optional) click Show Details to view the detail logs.
Portal client application
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6.3
Portal client application login
Copy to Clipboard allows you to copy and past the log details into any
document.
Note
6 -6
Portal client application
6
Click close once you have verified connection.
• Portal login screen opens.
7
In the User Name and Password fields enter your user name and
password that has been assigned by the Portal Administrator.
8
Select the type of connection you have for proper compression to allow
better performance when outside the main network.
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Portal client application login
6.3
Main Location: Lossless images
Wide Area Network: Lossy 80%
Cable/DSL Modem: Lossy 60%
IDSN/Modem: Lossy 40%
Custom: allows you to set the compression level
Note
Custom is used for Advanced IT or installation purposes. This is used when
there is a need to go through a firewall. When Custom is selected a Custom
properties box opens. It is only necessary to check the Use HTTP proxy if
there is a problem with the connection.
Use HTTP Proxy option
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Use HTTP Proxy becomes available when you log-in as Custom. Use the
checkbox when there are connection issues. This allows Portal to use the
same communication protocol as a Web browser, which can flow through
hospital firewalls/gateways easier than TCP/IP. The drawback is a small
performance hit (10-15%) compared to regular connections.
Note
When using custom if a compression level is selected that is not
recommend for the type of internet connection being used then
performance becomes slower.
Compression
Compression, a digital process that allows data to be stored or transmitted
using a reduced number of bits. It can be lossless or 'lossy'. The simplest
type of lossless compression stores only the data that change from one pixel
to the next.
Compression helps with the performance of the system such and only
affects the viewing of the images. When images are exported
(filmed/saved/reported) they are lossless (100%).
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6.3
Portal client application login
9
Select Login.
• A progress bar appears at the bottom of the portal login screen. One of
the messages indicates that the system is down loading user preferences
from the server. There maybe several other messages that appear. Once
all background processing has been completed the portal then launches.
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Portal client application
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6.3
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• When the application is launched a fixed size borderless startup screen
displays, Portal opens in Directory.
6.3.3
Reconnection
When there is a drop in connection the client is able to reconnect if the
drop does not take more than 30 seconds.
A “disconnection” icon flashes near the icon tray of the desktop. When
connection is reestablish the icon then disappears.
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6.4
Emergency User
6.4
Emergency User
The server reserves a number of images free for an Emergency user. The
number is configured in the server's management utility.
6.4.1
Scenario
If the server's capacity is 30,000 images, and the number reserved for
Emergency is 3,000 - normal use is of 27,000 images only.
• There are 17 users consuming 26,000 slices
• (1000 images are left available for normal use).
• A new user logs on and launches CT Viewer with a 1,200 slice
• (200 more images than the number available for normal use)==>
• A message comes up:
• If you clicks yes, CT Viewer launches
• no users are disconnected yet
• The server now consumes 27,200 slices (26,000+1200) and has a
reserve of 2800 slices.
• If another user launches CT Viewer with a 3,200 (400 more than what
is available).
• A message comes up and you confirm this is an emergency.
• Upon confirmation the server stops one or more users to fulfill this
request.
• Users are disconnected (First In First Out) until there is enough free
images to load the selected study.
• When you are disconnected a message pops up on the screen.
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Portal client application
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Emergency User
6.4
• The application closes and you are returned to the patient directory.
You loose your work since this is an emergency. Your client is still
logged on.
6.4.2
Emergency use case login
In an emergency use case you may need to ensure emergency access to the
system. There may be times when you must be granted access to the system
resources at a higher priority than other current users.
Emergency Support
When you are not able to load a specific case due to limited Portal
resources, the "Emergency" feature allows this load to continue, and
consider it as an emergency request.
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Emergency requests allow access to Portal's emergency reserves. However if
those reserves are still not sufficient for this latest emergency request, other
user(s) may have their work closed by Portal. The work of non-emergency
user(s) is closed first and lastly older emergency users in turn. This order
minimizes the effect on other user(s) work by priority to satisfying the latest
emergency case.
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6.5
Shutdown
6.5
Shutdown
You can logout or exit out of the Portal client application at anytime. The
application also has idle time out and emergency logoff features.
6.5.1
Logout
When you are finished with using the Portal client application, to exit
properly click the Logout button or the exit application button. The
Logout action raises a modal dialog giving you the opportunity to confirm
or cancel the exit action.
If confirmed, you are logged out of the application and returned to the
Portal login screen.
6 -1 2
Portal client application
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Shutdown
6.5.2
6.5
Exit
Close the application at any time by clicking the standard windows close
button. The exit action raises a modal dialog giving you the opportunity to
confirm or cancel the exit action.
If confirmed, exit shuts down the application and returns to the desktop.
6.5.3
Idle time out feature
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If, while using a viewer package of the Portal client application, you are not
interacting with the application, you may be logged out after a predetermined amount of time. The following message appears.
Note
6.5.4
The time limit is set by the portal administrator.
Administrator logoff
An administrator can always log a user off from the Portal Management
application at any time.
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7
Directory
This section details the Directory specifications and explains the screen
layout and features as well as the mouse and keyboard operations. These
options are available while in the Directory:
• Select and retrieve data from local and remote storage devices.
• Load data to the CT Viewer or application.
• Copy images and files from one device to another.
• Send images to film.
• Quickly review images in Quick View.
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• Display the remaining free space on storage devices.
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Directory
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7.1
Directory window
7.1
Directory window
The Directory window consists of these areas:
• Workflow bar
• Tool panel
• Devices area
• Studies (Patient List) area
• Queue Manager
• Series, Files and Reports tabs
• Quick review
• Status area contains the date, time and free space
Note
7 -2
Directory
You can adjust the layout of the directory by clicking on a border and
dragging it to expand or contract the desired region. To reset layout to the
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Directory window
7.1
original state right mouse click over the Quick review and choose Reset
Layout.
Note
On a small screen (1024x768), toolbox shrinks to allow all the functionality.
Recommended resolution is 1280 x 1024.
Each area of the Directory window is explained in detail in the following
sections.
7.1.1
Workflow bar
The Workflow bar across the top of the window guides your activity
sessions. The bar has buttons that become highlighted to guide you as you
work your way through a session.
Buttons
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7.1.2
Buttons color key:
Grayed out - Inactive, orange - Active, bright yellow - Selected.
Directory - Starting in the Directory mode, you are presented with lists of
available patient studies that are located in various storage devices. It also
provides access to various utility functions.
The Directory button is always in the active state, allowing you to access its
functions at any time during operation.
Review - is inactive (grayed out) as long as no study is loaded. Once a study
is loaded into the CT Viewer, the Review button becomes selected (bright
yellow). You can then select various viewing modes and can employ many
tools to examine and refine the views of the study.
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Directory
7- 3
7.1
Directory window
From Review mode, you can move directly to Directory, Analysis (if active),
Film, Report, or Help, and perform any available functions. You can then
resume the Review mode and continue exactly where you left off.
If you launch an analysis application from the directory, or select another
workflow (film or etc.), Review reverts from selected (bright yellow) to
active (orange).
Note
There can only be one patient loaded into the CT Viewer at a time. You can
use the Quick Review to view another patient at the same time if necessary.
Analysis - is inactive (grayed out) as long as no study is loaded. It becomes
selected (bright yellow) when a study is loaded directly into the application
from the CT Viewer or Directory.
From Analysis, you can move directly to Directory, Review (if active), Film,
Report, or Help, and perform any available functions. You can then return
to Analysis exactly where you left off.
If you launch the CT Viewer or select another workflow (film, etc.),
Analysis reverts from selected (bright yellow) to active (orange).
Note
There can only be one Analysis application open at a time. You can have the
same patient loaded into CT Viewer at the same time. If you have dual
monitors, you can have the two applications open side by side.
Film - This button provides access to the FilmView application. You have
direct access to Film at all times. You can film from the Directory.
Report - The Report button allows you to open the report editor. You have
direct access to Report at all times.
Help - Provides access to the on-line Help system.
7 -4
Directory
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7.1.3
7.1
Tool panel
Review
The CT viewer allows you to view patient studies quickly and easily. There
are four viewing modes available 2D, Slab, Volume and Endo. These are
discussed later in individual chapters.
Analysis
In addition to being able to open a study into the CT viewer, you can load
the study directly into an application and begin image processing and
analysis functions.
1
Click the down-arrow next to the application to display a list of
applications. The list varies depending on your purchased options.
2
Click an icon to load a study into the application.
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Advance Vessel Analysis (AVA)
Advance Vessel Analysis (AVA) offers a set of tools for stent planning and
general vascular analysis. With AVA you can easily remove bone, then
extract vessels and segment them. You can also perform measurements such
as intraluminal diameter, cross-sectional lumen area, length and tortuosity
of vessel segments, and the angles of vessels.
CCA
The Comprehensive Cardiac Analysis (CCA) application is used to assess
the state of the coronary arteries and to create a functional analysis of the
heart.
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7.1
Directory window
Archive manager tools
The Directory toolbox provides access to various file-management
functions.
Quick Film - Allows you to send images to Filming from the Directory. If
the sub-selection option is active, decide on the series and/or derived
images before clicking Quick Film.
Copy To - Copies the currently selected items to another device. A dialog
box opens with lists of available Local and Remote archive devices.
Sub-selection - Allows you to select specific images from each series.
Multimedia (file) viewer - Launches the browser of the database containing
captured media (includes jpeg, tiff, avi, bmp, high and low quality movies,
and secondary captures files) that have been previously saved.
Preferences
Allows you to change various configurations of the system (see Preferences
for more information).
Logout
To exit the system, click Logout.
7 -6
Directory
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Directory window
7.1.4
7.1
Devices area
The system displays the selected device in the devices area. To prevent
patient list confusion, only one device may be selected at a time (in this
case, the Local drive).
Device List - Click the down-arrow next to the selected device icon to view
the device list. The list offers local and remote locations. Click on the
device you want to access. If the device is not available, a message displays
to indicate that.
Device functions menu - To access the following functions (which vary
depending on the device), right click on the selected device icon:
• Local - Devices (local + local folders) - Verify connection, free space.
• CD - Eject, verify connection.
• CDR - Eject, verify connection, free space, clear, record, anonymize all
patients.
Note
CD and CDR are only available if computer has a CD burner and reader.
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• Remote Devices - verify connection.
Stop Connection - When connected to a remote device, this button is
active. Click it to end the network connection to a remote device.
Search - Type in specific information to do a search of the device.
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7.1
Directory window
Clear Filter - Resets the local directory filtering function, restoring the
full list of patients.
Refresh - Refreshes the patient list with newly arrived studies.
7.1.5
Patient list
The Patient list displays the studies that are archived on the selected device.
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Directory
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7.1
Sorting - Data are sorted alpha-numerically:
• Click on the column titles to sort the data in the column.
• Click again on the column title to sort in the reverse order.
• Hold the shift key on the keyboard and click on another column title to
create a secondary sort.
Column Display - You can specify which columns should display as standard
items in the patient list.
• Right click on one of the column titles to bring up a list of options.
• Click on the desired items to toggle selection on or off (a check displays
when an item is selected).
In addition to the standard items, these columns can be included:
• Transferred icon (first column on the left) appears when the study has been
successfully archived.
Note
The service engineer has to configure the Transfer option
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Filtering the list
The filter operation limits the patient list by a data field, and/or by the elapsed
time since the study arrived to the device. You can filter the list using the fields
just below the category titles.
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7.1
Directory window
You can filter by various study parameters.
1
Select a category.
2
Beneath the category title, type the filtering text.
For example, type “c” under the Patient Name, to display only studies where
patient names begin with “c.”
The Patient list is sorted immediately as the characters are typed. Time is sorted
by selecting from the drop down list.
The following categories are toggle options. Click below the column header to
change the filter state. The icon changes to represent the new state.
Option
Transferred
Locked
Opened
Filmed
Not transferred
Unlocked
Not Opened
Not Filmed
Lock - prevents deletion of the file.
Transferred - indicates data sent to the archived device.
Opened - indicates at least one image of the study has been loaded into an
application.
Filmed - indicates at least one image has been sent to film.
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Directory
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7.1
Patient list menu
Right click in one of the patient entries to bring up a menu.
• Copy To - duplicates the selected data to another device.
• Delete - is only available to the administrator.
• Quick Review - launches the Quick review feature
• View DICOM Info - displays the DICOM information.
• Lock/Unlock • Change Patient Details - allows you to change patient information. It
creates a new series but does not delete the original series.
Note
Data can only be deleted by the administrator.
• Anonymize - allows you to permanently eliminate the patient name from
the selected study. This creates a new study without removing the old. Only
available under the patient list.
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• View - opens CT viewer
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7.1
Directory window
7.1.6
Series list
The Series list, located beneath the Patient list, allows you to display and select
various series and other image and data files associated with a patient study.
Selecting a Series to view or analyze
1
Click the Series tab, if not selected.
2
Click in the text line of the series you want to access. The selected line is
highlighted in darker blue.
3
Click Viewer or Application to begin viewing or analyzing.
Columns - You can specify which columns display in the Series list by right
clicking on one of the column headings to bring up a selection box. Click on an
option to toggle it on or off (a check indicates the item is on).
Sorting - The Series list can be sorted in the same way as the Patient list,
described earlier.
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7.1
Series list menu
Right click in one of the patient entries to bring up a menu.
• Copy To - duplicates the selected data to another device.
• Delete - is only available to the administrator.
• Quick Review - launches the Quick review feature.
• View DICOM Info - displays the DICOM information. Only available
if one series is selected.
• Select All Images
• Select Every Other
• Select Every, third, forth, fifth
• Change Patient Details - allows you to change patient information. It
creates a new series but does not delete the original series.
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• View - opens CT viewer
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7.1
Directory window
Using the Copy function
1
Select Copy To from the Series list menu. A dialog box displays the available
devices.
2
Select the device (devices) to receive the selected files.
3
Click OK to begin the transfer.
• Click Reset to clear the selected devices without closing the dialog box.
• Click Cancel to close the dialog box.
• The Copy To request can be monitored in the Queue Manager.
• When any of the right mouse functions are selected they only affect the
highlighted series.
Note
Using the Change Patient details function
7 -1 4
Directory
1
Select Change patient details from the Series list menu.
2
The following warning message displays, click OK.
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7.1
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• The Change patient details dialog box displays.
Note
3
Make the desired changes.
4
Click Save. The new series is saved as a new study in the selected directory.
Prior series is not removed.
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7.2
Using storage devices
7.2
Using storage devices
This section discusses the basic procedures needed to use storage devices with
your Brilliance Portal Workspace.
7.2.1
Verifying connection
To verify the status of the connection to a storage device:
1
Click on the device icon with the right mouse button.
2
Select the Verify Connection option from the pop-up menu. A Connection
Status Report displays.
Eject
For CD/CDR, this operation is used to eject the cartridge from the device.
7.2.2
Free space
To find out how much free space is available on a storage device:
Note
7 -1 6
Directory
1
Click on the device icon with the right mouse button.
2
Select the Free Space option from the pop-up menu. A Free Space Summary
Report for the device displays.
The status box in the Directory also displays the amount of free space for the
local folder of the server and the CDR folder.
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Using storage devices
7.2.3
7.2
CD/DVD
If your computer is equipped with a CD/DVD burner the options for
CD/DVD and CDR/DVDR are available in Brilliance Workspace Portal.
Burning capabilities:
• Windows XP = CDs
• Windows XP + Nero = CDs & DVDs
• Windows 2000 = No burning
• Windows 2000 + Nero = CDs
Note
Either the CD or DVD device exists on your computer but not both.
Note
Depending on whether your systems has a CD/DVD burner determines whether
this chapter applies.
How to read the CD/DVD
The same drive is used for burning and reading.
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Note
Note
1
Insert CD/DVD into the drive.
2
Click drop down arrow next to the device.
3
Click on CD/DVD device.
4
Select the studies/series and load into any application or copy to the local
drive.
5
Right click CD button, select eject when complete.
Loading directly to an application takes longer than loading from the local.
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7.2
Using storage devices
Burning a CD/DVD
Caution
Patient health related information recorded on removable media may
become accessible to unauthorized individuals and thus creates a privacy
security risk. See Chapter 3: Security of system and data for more
information.
Caution
The Brilliance system’s CDR/DVDR folder is an intermediate storage
location for files that you want to burn to a CD/DVD disc. During ongoing
system activities, images and data for multiple patients may have been
stored to the CDR/DVDR folder, by you or by other users, for the purpose of
internal (hospital) archiving.
• Before creating a CDR/DVDR disc of patient images, the Brilliance
system’s CDR/DVDR folder must be “cleared” by using the Clear
command.
• Not all files in the CDR/DVDR folder can be seen in the Brilliance system’s
Directory. Only DICOM files are listed in the Directory. Any other files in
the folder, such as TIFFs and JPEGs (which may belong to different
patients), may not be visible and must be cleared before creating a patient
CD/DVD disc.
• Clearing the CDR/DVDR folder by using the Clear command erases ALL
files in the folder. Deleting files using any other method does not insure
removal of ALL patient files from the CDR/DVDR folder.
Note
7 -1 8
Directory
Up to 4.7Gb can be recorded.
Brilliance Workspace Portal - Volume 1
Using storage devices
7.2
Philips Medical Systems 4535 674 64511_A
How to burn a CD/DVD
1 Access the Directory.
2
From the list of patient studies and/or series, select the patient studies
and/or series that you want to record to the patient CD/DVD.
3
From the Directory’s Archive Manager function, click the Copy To
button. All Local and Remote Devices display.
4
Click the CDR/DVDR icon. The selected files are copied to the
CDR/DVDR folder.
5
When the CDR/DVDR folder contains all the files that you want to
record, insert a blank CD/DVD disc into the CD/DVD burner drive.
6
Right-click the CDR/DVDR button. The drop-down menu displays.
7
Click Record.
• The patient CD/DVD is burned, which takes about 7 to 8 minutes.
• Do not disturb the CD/DVD burner while recording is in progress.
8
Right-click the DVDR button when the disk is burned, from the dropdown menu, click the Clear command.
Verify the contents of patient CD/DVD
To verify that the patient CD/DVD contains only files for the intended
patient, perform the following procedure:
Brilliance Workspace Portal - Volume 1
1
Insert the patient CD/DVD into a PC (personal computer).
2
Access the PC’s Directory function (“My Computer”).
3
Access the directory of the CD/DVD drive (usually D:).
4
Examine the list of files that are shown for the CD/DVD. The list
should include only those patient files you placed into the Brilliance
CDR/DVDR folder after you initially “cleared” the folder.
Directory
7- 19
7.2
Using storage devices
Change free space calculation in status area
Free space information in status area displays the free space of the recorder,
normally according to capacity of CDR which is 650Mb. If the DVDR
media is routinely used, the system can be modified to display free space
according to DVDR capacity which is 4.7Gb.
DVDs can be recorded properly without making this change. The capacity
of the inserted media is checked during the recording process, regardless of
the free space settings in status area.
Note
To change status area free space to display DVDR size:
7 -2 0
Directory
1
Click Preferences.
2
Click Patient Directory, from the Preferences tree.
Brilliance Workspace Portal - Volume 1
Using storage devices
Set “Display free space of DVDR according to the following media
type” to DVDR.
Philips Medical Systems 4535 674 64511_A
3
7.2
Brilliance Workspace Portal - Volume 1
Directory
7- 21
7.3
Queue manager
7.3
Queue manager
The Queue Manager is used to monitor transactions, such as image transfer
and printing of films.
The Print Queue is for printing from the Film viewer only, it does not
include printing reports.
Note
Use this procedure to access the Queue Manager.
1
7 -2 2
Directory
In the Queue manager status box, click the Queue Manager button.
The system displays the Queue manager window.
Brilliance Workspace Portal - Volume 1
Queue manager
2
7.3
Use the Queue manager to view and monitor the transfer of files.
These options are available for items in the transfer queue:
Items in the print queue have one of these statuses:
• Active - currently in progress.
• Waiting - waiting in queue.
• Retry - waiting for timeout to start retry.
• Failed - fatal error with no retries on all the transactions for that transfer
request (study).
Philips Medical Systems 4535 674 64511_A
• Only the administrator can use the Retry or Delete functions.
Brilliance Workspace Portal - Volume 1
Directory
7- 23
8
8.1
Preferences
Preferences utility
Preferences is used to access and modify your system’s configuration setup.
In Preferences you can adjust certain definitions of the system to fit your
organizations specific needs.
All applications in Brilliance Workspace Portal are influenced by definitions
made in the preferences utilities. Preferences allows for your system to be
more user friendly.
Philips Medical Systems 4535 674 64511_A
Preferences is launched from Archive Manager in the Directory (Located
right above the date and time). In the Preferences window there is a list of
categories that display on the left side. To browse between categories click
on a category. Once that category opens you can view that window. Only
one category can be opened at a time.
Brilliance Workspace Portal - Volume 1
Preferences
8- 1
8.1
Preferences utility
Preferences has a set of system definitions that you can control for Brilliance
Workspace Portal 2.5. Some of the definitions are application specific and
some are system wide.
Note
Preferences only affect the user system.
The following are the categories that are available in Preferences:
•
•
•
•
•
•
8 -2
Preferences
Patient Directory
Windowing Presets
Image Titles
Measurements
Save Images
CT Viewer
Brilliance Workspace Portal - Volume 1
Preferences utility
•
•
•
•
•
•
8.1
Segmentation Presets
Reporting
Film Header/Footer
AVA
Licensing
User
Buttons
In the lower right side of the window there are three buttons that are
available in all categories within Preferences. They are available once you’ve
completed your preferences selections. The buttons are:
Default - Set the current preset to it’s default values.
OK - Save all changes and exit application.
Cancel - Discard all changes and ends the session.
Philips Medical Systems 4535 674 64511_A
Note
Brilliance Workspace Portal - Volume 1
• Unavailable fields are grayed out or hidden. Archive functions are not
available while Preferences is in use. There are some fields in Preferences
that are only available to Service users, they are also grayed out, though
some fields that are grayed out are not necessarily service specific.
• Some fields do not have a default value and are not changed by the default
button.
Preferences
8- 3
8.2
Patient Directory
8.2
Patient Directory
The Patient Directory category allows you to define the search fields that
appear in the search dialogue and the order they appear.
Note
The Patient Directory changes only effect the Search Dialogue and has no
effect on the Patient Directory Columns.
• Always use Sub Selection - by default, is not selected. If you want to
use sub selection all the time, select the check box.
8 -4
Preferences
Brilliance Workspace Portal - Volume 1
Patient Directory
8.2
• Time and Date settings - allow you to configure the time and date
display to Military or US time and US or International date formats.
• Show free space - indicates the device for which free space is being
displayed in the Directory status box.
• Display free space - allows you to select the Gb (DVD-R) or the Mgb
(CDR) display for viewing free space from the device.
Filters
You can move filters between the Available filter and Selected filters boxes
by using the arrows. All options that appear in the Available filters box
won’t appear in the search dialog. All options that appear in the Selected
Filters box appears in the search dialog.
• Choose the available filters and move to the selected filter box.
• Arrange the filters how you want them to display in the Search
Dialog.
Philips Medical Systems 4535 674 64511_A
Buttons
Move Up / Move Down
You can change the order of the fields in the Selected Filters box by clicking
the Move Up or Move Down buttons.
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Preferences
8- 5
8.2
Patient Directory
Modalities
You determine which modalities that are to appear in the Search Dialog
field.
Buttons
Add Modality / Remove
Click on the Add Group button to open a dialog box in which you can
create a new Modality Group.
To define the search fields:
• Check the modalities that you would like to select in the Search
Dialog.
• If you must add a modality click on Add Group. Name and define
the modality.
• To remove a modality check the box next to modality, click on
Remove Group.
Note
You can only delete newly created modalities. You can not delete any of the
default modalities.
• Click OK.
8 -6
Preferences
Brilliance Workspace Portal - Volume 1
Windowing Presets
8.3
8.3
Windowing Presets
Philips Medical Systems 4535 674 64511_A
In the Windowing Presets category you can set presets for both CT and
MR by clicking on respective tab. For all applications showing images you
can configure windowing presets. Use this preset to access the windowing
levels modification (Name, Center, Width and Keyboard Short cut) for the
system’s preset organs. The Name, Center and Width of each preset can be
changed. To change a field click on the field and type.
Note
Brilliance Workspace Portal - Volume 1
There are a total of 10 keyboard shortcuts available (0-9) but you can build
up to 15 presets.
Preferences
8- 7
8.3
Windowing Presets
Allowed values
• Center: -1024 to 4095
• Width: -1024 to 4095
• Keyboard Shortcuts: 0-9
Note
Name fields can contain any character. Center and Width only can contain
numbers.
Note
When you delete an entry in the Name field, the entries in the Center,
Width, fields are also deleted.
To modify windowing presets:
•
•
•
•
Click on desired tab, CT or MR.
Make modifications; place cursor in the desired field, Center, Width.
Enter the new value(s)
Click OK
To add windowing presets:
• Go to a blank row and enter desired values.
• Click OK
8 -8
Preferences
Brilliance Workspace Portal - Volume 1
Image Titles
8.4
8.4
Image Titles
Image titles can be adjusted on all applications that show images. You can select
what to display as well as the position and order of how the titles display. Image
titles for both CT and MR can be adjusted, click on respective tab.
Philips Medical Systems 4535 674 64511_A
The Image titles window is made up of the Image title listing, Titles preview and
Image titles’s properties.
You can control which titles are shown on images. Titles can also be added or
removed from the image. Image titles are defaults, you can not delete or create
image titles in the Image title listing.
Brilliance Workspace Portal - Volume 1
Preferences
8- 9
8.4
Image Titles
Buttons
Move Up / Move Down
You change the order of Image titles in the listing by using the Move Up or
Move Down buttons.
To arrange the order of Image titles:
•
•
•
•
•
Select Image title.
Determine where on the image you want that title to display.
Click on Move Up or Move Down.
Preview how the title displays in the Titles preview.
Repeat for each title to be included.
Titles preview
Allows you to view how the Image titles that you arrange display on the image,
updates as you make changes.
Image title’s properties
You can define the position of and when a title displays on an image.
Position
This drop down allows you to choose where on the image the selected image
title is placed. Options are:
8 -1 0
Preferences
Brilliance Workspace Portal - Volume 1
Image Titles
8.4
• Header: left, middle, right
• Middle: left, middle, right
• Footer: left, middle, right
Show title
A drop down menu where you can choose when a title displays. Options are:
Always
In medium and large view ports
In large view ports only
Never
Philips Medical Systems 4535 674 64511_A
•
•
•
•
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Preferences
8- 11
8.5
Measurements
8.5
Measurements
Within Measurements you can control the default properties of different
graphic elements. The Measurements window displays fields that you can
modify; the cursor options, line options, ROI options and the default size of
text.
To make modifications to measurements:
• Define Measurements
• Click OK
8 -1 2
Preferences
Brilliance Workspace Portal - Volume 1
Save Images
8.6
8.6
Save Images
Allows you to select the default storage devices that images are saved to when
using the direct save option within the application.
Philips Medical Systems 4535 674 64511_A
The Save Images window displays options for default devices for Direct Saves
and the quality of how JPEG and AVI files are saved.
Default Devices
You can define one or more of the following as the devices for direct save.
• One (or more) of the devices configured in the system.
• The device from which the images were loaded.
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Preferences
8- 13
8.6
Save Images
Choose Devices
Click on the choose devices button to open a list of all devices configured in the
system.
The selected devices are highlighted. Select the device, click OK/Cancel.
Quality of JPEG Image / AVI Movies
You can control the quality of how JPEG and AVI files are saved. The quality is
controlled through the slide bar which has four ticks low, medium, high and
highest.
Note
8 -1 4
Preferences
There are 2 levels of movie qualities High and Low, they each have a range of low
to high. This also sets the speed of the cine for AVI movies.
Brilliance Workspace Portal - Volume 1
CT Viewer
8.7
8.7
CT Viewer
Philips Medical Systems 4535 674 64511_A
With CT Viewer you control the location of reference images inside the batch,
the location of the mini-reference image, appearance of the Preview window and
the batch presets.
The CT Viewer window displays option you can select for Image, Batch
representation and Batch - Preview.
Image
You can define image settings and how it appears in the batch for the following;
image parameters frame, reference image and mini-reference image. To select
options for each click on the arrows in the drop down boxes.
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Preferences
8- 15
8.7
CT Viewer
Batch representation
With batch representation you decided whether the lines representing the batch
should appear on the reference page.
Batch Preview
By checking one of the following output functions; Save, Save As you can
determine whether the preview window opens.
Show Transparency
Effects the transparency of the image in Volume of CT viewer.
8 -1 6
Preferences
Brilliance Workspace Portal - Volume 1
Segmentation Presets
8.8
8.8
Segmentation Presets
The Segmentation Presets category allows you to view, add or modify
segmentation presets, for both CT and MR. You can also view, add or modify
these presets in the Volume mode of the CT Viewer, where they are called
Tissue Presets.
The Segmentation Presets window displays the Name, Center and Width
columns for which each of the presets can be changed.
Philips Medical Systems 4535 674 64511_A
You can modify the Name, Center and Width by clicking in the field and typing
in the value. New presets can be added too. Segmentation Preset values are:
• Center: -1024, 4095
• Width: -1024, 4095
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Preferences
8- 17
8.9
Reporting
8.9
Reporting
The Reporting category launches Template Editor. In Template Editor you can
set default languages, logo configurations and template editor configurations.
For more detailed information about Reporting refer to the General Reporting
chapter.
8 -1 8
Preferences
Brilliance Workspace Portal - Volume 1
Film Header / Footer
8.10
8.10
Film Header / Footer
Philips Medical Systems 4535 674 64511_A
In the Film Header/Footer category you can define what appears in the header
and footer of the film and configure annotations.
Displayed in the Header/Footer window are annotation selections, a view of the
header and footer and properties you can define. You can make the header and
footer wider or narrower.
To make modifications to the properties:
• Select annotations
• Define properties of each annotation
Brilliance Workspace Portal - Volume 1
Preferences
8- 19
8.11
AVA
8.11
AVA
Specific to the AVA application. In the AVA window is an icon that you click on
to launch the utility, Stent protocol editor.
8 -2 0
Preferences
Brilliance Workspace Portal - Volume 1
Licensing
8.12
8.12
Licensing
In licensing you can see which applications are licensed as well as initiate
temporary licensing. In the Licensing window are the listing of the permanent
licenses and the temporary licenses.
Permanent Licenses
Philips Medical Systems 4535 674 64511_A
Displays a list of all permanently licensed applications.
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Preferences
8- 21
8.13
User
8.13
User
In the User category you can enable or disable image compression quality,
change the password, set the user interface for resolution.
8 -2 2
Preferences
Brilliance Workspace Portal - Volume 1
User
8.13.1
8.13
Image Compression Quality
Compression is used for the communication of images from the server to the
client. Only lossless versions of images are saved. If image compression quality is
enabled, images are compressed to reduce network bandwidth consumption and
enhance interactivity at some cost to image quality. If compression is disabled,
this control has no effect.
• There are four choices for image quality. The best choice for quality is lossless,
though it is the slowest.
• All images that are saved/filmed/reported are lossless.
• All images are labeled when copression is used.
Note
Compression is used to improve system performance.
In Portal 2.5 Jpegs are used for lossy compression and zip for lossless.
When using lossless compression (Q=100%), the images that are being
displayed are DICOM. The DICOM ZIP is used only for the network transfer.
Philips Medical Systems 4535 674 64511_A
Jpeg are displayed when lossy (Q<100%), compression is used.
The meaning of the compression index (e.g. 60%) is the index for quality, an
indication of how the resulting picture compares with the original.
• 100% means lossless
• 80% is “near lossless”…
Connection
The following affects the compression:
•
•
•
•
•
Main Location: lossless images
Wide Area Network: Lossy 80%
Cable/DSL Modem: Lossy 60%
IDSN/Modem: Lossy 40%
Custom: allows you to set the compression level
Brilliance Workspace Portal - Volume 1
Preferences
8- 23
8.13
User
Below is the relation between image quality and the compression index:
Q100: 2-3 : 1 (lossless compression)
Q80: 7-10 : 1 (Wide ares network)
Q60: 8 -15 : 1 (Cable modem)
Q40: 12-20 : 1 (ISDN)
Note
3:1 means that a typical 512 Kb CT image becomes 170 Kb; At 20:1 the
image becomes 25 Kb
The ratio changes for a given compression index because the compression
ratio depends on the content o the image - “clean image” with lots of air
background compresses better (have a bigger ratio) than a low dose noisy
image with little air in the background.
The affect on performance depends on the speed of the network. The
slower the network, the more beneficial the compression.
To control compression index
There are three ways to control compression:
Before Login
On the main login page under Connection properties, click the drop down
to select the type of connection you have for proper compression.
8 -2 4
Preferences
Brilliance Workspace Portal - Volume 1
User
8.13
Philips Medical Systems 4535 674 64511_A
Preferences
1
Login
2
Click Preferences
3
Click User under the Preferences directory
4
Change the default settings
5
Under Image compression quality make the changes
Inside the application
Click on the compression icon.
Brilliance Workspace Portal - Volume 1
Preferences
8- 25
8.13.2
Password
You can change your password at any time.
1
Click on the change password button.
• The Change Password Dialogue box opens.
Note
8.13.3
2
Enter the Current Password
3
Enter the New Password.
4
Confirm New Password by entering the new password again.
5
Click OK to change.
Strong passwords are common.
User Interface for Resolution
You can set the resolution to High, Low, and Auto. Auto selects the best
resolution for the screen. The Portal application is designed to work in two
resolutions, Low - 1040 x 768 (minimum) and High -1280 x 1024
(recommended).
9
9.1
Workflow - navigating the software
Workflow bar
The Workflow bar across the top of the window guides your activity
sessions. The bar has buttons that become highlighted to guide you as you
work your way through a session.
9.1.1
Buttons
Buttons color key:
Philips Medical Systems 4535 674 64511_A
Grayed out - Inactive, orange - Active, bright yellow - Selected.
Directory - Starting in the Directory mode, you are presented with lists of
available patient studies that are located in various storage Devices. It also
provides access to various utility functions.
The Directory button is always in the “active state,” allowing you to access
its functions at any time during operation.
Review - is inactive (grayed out) as long as no study is loaded. Once a study
is loaded into the CT Viewer, the Review button becomes selected (bright
yellow). You can then select various viewing modes and can employ many
tools to examine and refine the views of the study.
From Review mode, you can move directly to Directory, Analysis (if active,
Film, Report, or Help, and perform any available functions. You can then
resume the Review mode and continue exactly where you left off.
Brilliance Workspace Portal - Volume 1
Workflow - navigating the software
9- 1
9.1
Workflow bar
If you launch an analysis application from the directory, or select another
workflow (film or etc.), Review reverts from selected (bright yellow) to
active (orange).
Note
There can only be one patient loaded into the CT Viewer at a time. You can
use the Quick Review to view another patient at the same time if necessary.
Analysis - is inactive (grayed out) as long as no study is loaded. It becomes
selected (bright yellow) when a study is loaded directly into the application
from the CT Viewer.
From Analysis, you can move directly to Directory, Review (if active), Film,
Report, or Help, and perform any available functions. You can then return
to Analysis exactly where you left off.
If you launch the CT Viewer or select another workflow (film, etc.),
Analysis reverts from selected (bright yellow) to active (orange).
Note
There can only be one Analysis application open at a time. You can have the
same patient loaded into CT Viewer at the same time. If you have dual
monitors, you can have the two applications open side by side.
Film - This button provides access to the FilmView application. You have
direct access to Film at all times. You can film from the Directory.
Report - The Report button allows you to open the report editor. You have
direct access to Report at all times.
Help - Provides access to the on-line Help system.
9 -2
Workflow - navigating the software
Brilliance Workspace Portal - Volume 1
Workspace display
9.2
9.2
Workspace display
Philips Medical Systems 4535 674 64511_A
The Brilliance Workspace Portal incorporates the Philips Guided FlowTM
productivity features.
The Brilliance Workspace Portal display has four portions:
• Workflow bar and Workflow buttons
• Control Panel
• Image Area
• Message Bar
Brilliance Workspace Portal - Volume 1
Workflow - navigating the software
9- 3
9.3
Image area
9.3
Image area
The Image Area occupies the large portion of the display. Images, graphs,
and other visual information are displayed in the Image Area.
Patient images can be displayed in either multiple formats, or in a single
large image, or in other formats as determined by the application you are
using.
A typical format would be a larger image in the center/left area, and smaller
reference images in a column at the right edge of the area, as shown below.
9 -4
Workflow - navigating the software
Brilliance Workspace Portal - Volume 1
Control panel
9.4
9.4
Control panel
The control panel provides the tools needed to view and control the patient
images. It appears along the left side of the Workspace window.
The system anticipates your workflow. It offers you various choices and,
depending on the choices you make, presents you with further logical steps
and functions.
Philips Medical Systems 4535 674 64511_A
In general, the workflow proceeds from the top of the panel to the bottom.
Let’s follow the flow in the example control panel at left:
1
Prior to being presented this control panel you would have chosen the
CT Viewer.
2
The CT Viewer control panel displays, you then have the option of
selecting one of the four viewing modes: 2D, Slab, Volume, or Endo.
Slab is the default.
3
If you select Slab, the Slab button appears depressed, and the Slab Tools
control panel is presented. You can proceed with your viewing work.
(For example, you can select one of the orthogonal views (axial, coronal,
or sagittal), and adjust the slab thickness.)
4
As you progress in your work, you may select additional functions from
the “tab” menus.
In this example, once you have manipulated the slab views as desired, your
next desired function might be in the Batch or Cine or Clip options.
Clicking on that tab would open a new set of tools for your use.
Brilliance Workspace Portal - Volume 1
5
At the bottom of most control panels is the “Common Tools” area,
from where you perform general functions such as annotate, zoom, and
save images.
6
Finally, you can exit the application (or, if desired, you can cancel all
your work by clicking “Reset.”)
Workflow - navigating the software
9- 5
9.5
Progress and Message Bar
9.5
Progress and Message Bar
The progress bar appears in the viewport during loading. There is a message
bar at the bottom of the screen where system messages are displayed.
Progress bar
Message bar
9 -6
Workflow - navigating the software
Brilliance Workspace Portal - Volume 1
Philips Medical Systems is part of
Royal Philips Electronics
www.medical.philips.com
[email protected]
Manufacturing address:
Philips Medical Systems (Cleveland), Inc.
595 Miner Rd.
Cleveland, OH 44143
U.S.A.
EU Representative:
Philips Medical Systems, Nederland B.V.
PMS Quality & Regulatory Affairs Europe
Veenpluis 4-6
5684 PC Best
The Netherlands
Copyright address:
Philips Medical Systems Nederland B.V.
Veenpluis 4-6
5684 PC Best
The Netherlands
© Koninklijke Philips Electronics 2007
All rights are reserved. Reproduction or transmission in whole
or in part, in any form or by any means electronic, mechanical or
otherwise, is prohibited without the prior written consent of the
copyright owner.
Dell is a U.S. registered trademark of Dell Computer Corp.
Microsoft is a U.S. registered trademark of Microsoft Corp.
X0197
This Medical Device meets the provisions of the transposition of
the Medical Device Directive 93/42/EEC within the country of
the origin of the Notified Body concerned with the device.
4535 674 64511_A * 11/2007
English
Review
Brilliance Workspace
Portal
4535 674 64521_A
PHILIPS
Contents
1
Introduction ..................................................................................... 1-1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
2
Safety ................................................................................................ 2-1
Philips Medical Systems 4535 674 64521_A
2.1
3
Regulatory controls ...............................................................................3-2
Security issues and guidelines ................................................................3-3
System description ........................................................................... 4-1
4.1
4.2
4.3
4.4
4.5
Brilliance CT - Volume 2
Important safety directions ...................................................................2-1
Security of system and data ............................................................. 3-1
3.1
3.2
4
About the Brilliance Workspace Portal .................................................1-1
About this guide ...................................................................................1-2
Intended use .........................................................................................1-4
Contraindications .................................................................................1-5
Compatibility .......................................................................................1-5
Compliance ..........................................................................................1-6
Training ...............................................................................................1-7
What Portal is.......................................................................................4-1
Requirements........................................................................................4-4
Antivirus software .................................................................................4-9
Applications ........................................................................................4-10
Ancillary programs..............................................................................4-11
i
5
Screen resolution and layout ........................................................... 5-1
6
Viewing mode - CT Viewer .............................................................. 6-1
6.1
6.2
6.3
7
Graphic Tools ................................................................................... 7-1
7.1
How to use the Graphic tools ............................................................... 7-3
8
Quick Review .................................................................................. 8-1
9
CT Viewer - 2D mode ...................................................................... 9-1
9.1
9.2
9.3
9.4
9.5
9.6
9.7
10
Overview .............................................................................................. 9-1
Scrolling and scrollbar........................................................................... 9-2
2D Viewer window............................................................................... 9-3
Tool panel ............................................................................................ 9-4
Compare............................................................................................. 9-16
Combine ............................................................................................ 9-19
Common tools.................................................................................... 9-29
CT Viewer - Slab mode .................................................................. 10-1
10.1
10.2
10.3
10.4
10.5
10.6
10.7
ii
CT Viewer functionality ....................................................................... 6-3
Series tree.............................................................................................. 6-4
Common tools.................................................................................... 6-13
Overview ............................................................................................ 10-1
Slab viewer tools ................................................................................. 10-3
Cine tab............................................................................................ 10-10
View tab ........................................................................................... 10-11
Tissue management .......................................................................... 10-16
Clip tab ............................................................................................ 10-27
Common tools.................................................................................. 10-28
Brilliance CT - Volume 2
11
CT Viewer - Volume mode ............................................................. 11-1
11.1
11.2
11.3
11.4
11.5
11.6
11.7
11.8
12
CT Viewer - Endo mode ................................................................. 12-1
Philips Medical Systems 4535 674 64521_A
12.1
12.2
12.3
12.4
12.5
13
Overview ............................................................................................12-1
Endo Viewer .......................................................................................12-2
Endo viewer tools................................................................................12-5
Eye orientation viewports....................................................................12-8
Common tools..................................................................................12-28
Filming ............................................................................................ 13-1
13.1
13.2
13.3
13.4
13.5
13.6
13.7
13.8
13.9
Brilliance CT - Volume 2
Overview ............................................................................................11-1
Volume viewer window.......................................................................11-2
Batch tab.............................................................................................11-4
Cine tab ..............................................................................................11-6
View tab .............................................................................................11-8
Clip tab.............................................................................................11-25
Tissue tab..........................................................................................11-34
Common tools..................................................................................11-41
Overview ............................................................................................13-1
FilmView startup ................................................................................13-3
Control panel......................................................................................13-5
Sections tab.........................................................................................13-6
Printing ............................................................................................13-12
Send images to the printer ................................................................13-15
Print History.....................................................................................13-17
Layout tab.........................................................................................13-19
Common tools..................................................................................13-23
iii
14
Reporting ....................................................................................... 14-1
14.1
14.2
14.3
14.4
14.5
iv
Overview ............................................................................................ 14-1
Setting Preferences for Reporting........................................................ 14-3
Template Editor ............................................................................... 14-10
Template Editor Viewer ................................................................... 14-18
Report editor .................................................................................... 14-22
Brilliance CT - Volume 2
1
1.1
Introduction
About the Brilliance Workspace Portal
Provides the local site administrators and service personnel with
functionality required to:
• Monitor Portal usage
• Administer strong password control
• Add/delete users and groups
• Maintain the database
• Manage web access to the server
Philips Medical Systems 4535 674 64521_A
The Workspace Portal can also be operated from the client:
C:\PortalPms\System\ RemotePortalManagement.exe
Philips Brilliance Workspace Portal v2.5 contains two software
applications, Portal Management (administrative) software and Portal
Client software.
The Portal application enables ubiquitous remote access to Extended
Brilliance Workspace 3.5 functionality through networked hospital PCs.
Brilliance Workspace Portal consists of a server, software and client
application.
Server data base is 500 GB compared to ~140 GB on stand alone Extended
Brilliance Workspace.
Note
Portal Management provides system configuration and maintenance
services such as User management and Modality and PACS connectivity.
Brilliance Workspace Portal - Volume 2
Introduction
1- 1
1.2
About this guide
Portal Server provides Storage and Query/Retrieve capabilities for CT
Images to and from CT modalities and PACS.
1.2
About this guide
This manual is intended to assist users and operators in the safe and
effective operation of the equipment described. The “user” is considered to
be the body with authority over the equipment; “operators” are those
persons who actually handle the equipment.
Before attempting to operate the equipment, you must read this manual
thoroughly, paying particular attention to all Warnings, Cautions and
Notes incorporated in it. You must pay special attention to all the
information given and procedures described in the Safety section.
Before attempting to operate any related CT equipment, you must read,
note, and strictly observe all DANGER notices and safety markings on the
CT Imaging System.
Wa r n i n g
Caution
Note
1 -2
Introduction
Directions, which if not followed, could cause fatal or serious injury to an
operator, patient or any other person, or could lead to a misdiagnosis or
mistreatment.
Directions, which if not followed, could cause damage to the equipment
described in this Instructions for Use and/or any other equipment or goods,
and/or cause environmental pollution.
Highlight unusual points as an aid to an operator.
Brilliance Workspace Portal - Volume 2
About this guide
1.2
The documentation for the Brilliance Workspace Portal is supplied in this
volume.
Volume 1 - Instructions for Use
This volume explains how to use the Brilliance Workspace Portal. It also
contains information about safety, data security, system start-up, software
navigation, accessing patient data and filming.
Volume 2 - Review (this document)
This volume explains how to use the various image viewers supplied with
the system. Also included in this volume are instructions on how to use the
reporting option, and how to use graphic tools for annotating studies and
making basic measurements.
Volume 3 - Analysis
This volume explains how to use advanced applications, Avanced Vessel
Analysis with Stent Planning (AVA), Virtual Colonoscopy (VC),
Comprehensive Cardiac Analysis (CCA), Lung Nodule Assessment (LNA),
and Brain Perfusion (BP).
Philips Medical Systems 4535 674 64521_A
Portal Remote Management Application
This volume explains how to use the Portal Management application. The
local site administrators and service personnel are provided the
functionality required to monitor Portal usage, check for errors, add/delete
users and groups and maintain the patient database.
This Document was originally drafted, approved, and supplied by Philips
Medical Systems (Cleveland), Inc. in the English language under the
product part number 4535 674 64521_A.
Brilliance Workspace Portal - Volume 2
Introduction
1- 3
1.3
Intended use
1.3
Intended use
The Philips Brilliance Workspace Portal is intended to be used and
operated only in accordance with the safety procedures and operating
instructions given in this Instructions for Use for the purpose for which it
was designed. The purpose for which the equipment is intended is given
below. However, nothing stated in this Instructions for Use reduces user’s
and operator’s responsibilities for sound clinical judgement and best clinical
procedure.
The Philips Brilliance Workspace Portal is intended for use as a diagnostic
viewing and processing application. The quality of the images depends on
the level and amount of X-ray energy delivered to the tissue during a
separate CT scan. CT imaging displays both high-density tissue, such as
bone, and soft tissue. When interpreted by a trained physician, CT images
yield useful diagnostic information. It is intended for use on the head and
whole body.
Use and operation of this equipment is subject to the law in the
jurisdiction(s) in which the equipment is being used. Both users and
operators must only use and operate the equipment in such ways as do not
conflict with applicable laws, or regulations which have the force of law.
Wa r n i n g
1 -4
Introduction
In the United States, Federal law restricts this device to sale, distribution,
and use by or on the order of a physician.
Brilliance Workspace Portal - Volume 2
Contraindications
1.4
1.4
Contraindications
The Philips Brilliance Workspace Portal should not be used if any part of
the equipment or system is known (or suspected to be) operating
improperly.
1.5
Compatibility
Equipment described in this manual should not be used in combination
with other equipment or components unless such other equipment or
components are recognized as compatible.
Changes and/or additions to the server should only be carried out by
Philips Medical Systems or by third parties expressly authorized by Philips
Medical Systems to do so. Such changes and/or additions must comply
with all applicable laws and regulations that have the force of law within the
jurisdiction(s) concerned, and with best engineering practice.
Philips Medical Systems 4535 674 64521_A
Changes and/or additions to the equipment that are carried out by persons
without the appropriate training and/or using unapproved spare parts may
lead to the PMS warranty being voided. As with all complex technical
equipment, maintenance by persons not appropriately qualified and/or
using unapproved spare parts carries serious risks of damage to the
equipment and of personal injury.
Brilliance Workspace Portal - Volume 2
Introduction
1- 5
1.6
Compliance
1.6
Compliance
The Philips Brilliance Workspace Portal complies with relevant
international and national standards and laws. Information on compliance
is supplied on request by your local PMS representative, or by:
Philips Medical Systems
PO Box 10 000
5680 DA BEST
The Netherlands
Facsimile: +31 40 276 2205
The Philips Brilliance Workspace Portal complies with relevant
international and national laws and standards on EMC (electro-magnetic
compatibility) for this type of equipment when used as intended. Such laws
and standards define both the permissible electromagnetic emission levels
from equipment and its required immunity to electromagnetic interference
from external sources.
California
In compliance with California’s Best Management Practices for Perchlorate
Materials (California Code of Regulations, title 22, division 4.5, chapter
33, article 1), the following warning applies to all Philips Medical Systems
Brilliance CT scanners and workstations due to Panasonic CR (button)
batteries that are mounted on printed circuit boards in various parts of the
system:
Wa r n i n g
1 -6
Introduction
Perchlorate Material – special handling may apply. For more information,
see www.dtsc.ca.gov/hazardouswaste/perchlorate/index.cfm.
Brilliance Workspace Portal - Volume 2
Training
1.7
Vermont
In compliance with the labeling requirements of the Vermont labeling law
V.S.A. 10, Chapter 159, §6621(d) and Section 6-803 of the Vermont Solid
Waste Management Rules, this product consists of devices that may contain
mercury, which must be recycled or disposed of in accordance with local,
state, or federal laws. (Within this system, the backlight lamps in the
monitor contain mercury.)
1.7
Training
Operators of the Philips Brilliance Workspace Portal must have received
adequate training on its safe and effective use before attempting to operate
the equipment described in this Instructions for Use. Users must also
ensure that operators receive adequate training in accordance with local
laws or regulations which have the force of law.
Philips Medical Systems 4535 674 64521_A
If you require further information about training in the use of this
equipment, please contact your local Philips Medical Systems
representative. Alternatively, contact:
Philips Medical Systems
PO Box 10 000
5680 DA BEST
The Netherlands
Facsimile: +31 40 276 2205
Brilliance Workspace Portal - Volume 2
Introduction
1- 7
2
2.1
Safety
Important safety directions
Philips Medical Systems products are all designed to meet stringent safety
standards. However, all medical electrical equipment requires proper
operation and maintenance, particularly with regard to human safety.
It is vital that you follow strictly all safety directions under the heading
Safety and all Warnings and Cautions throughout this Instructions for
Use, to help ensure the safety of both patients and operators.
Philips Medical Systems 4535 674 64521_A
In particular, you must read, understand and know the information
described in this Safety section before using this equipment.
You should also note the following information given in the Introduction
section of this Instructions for Use:
• intended use of the Philips Brilliance Workspace Portal.
• contra-indications
• training for operators of the Brilliance Workspace Portal.
Wa r n i n g
Operation of the equipment or system with improperly-operating or
wrongly-adjusted components could expose the operator or the patient
safety hazards. This could lead to fatal or other serious personal injury.
Wa r n i n g
Do not use the Brilliance Workspace Portal for any application until you
have read, understood and know all the safety information, safety
procedures and emergency procedures contained in this SAFETY section.
Brilliance Workspace Portal - Volume 2
Safety
2- 1
2.1
Important safety directions
Wa r n i n g
Do not use the Brilliance Workspace Portal for any application until you
have received adequate and proper training in its safe and effective
operation. If you are unsure of your ability to operate this equipment safely
and effectively DO NOT USE IT. Operation of this equipment without
proper and adequate training could lead to clinical misdiagnosis.
Wa r n i n g
Do not use the Brilliance Workspace Portal for any purpose other than
those for which it is intended. Operation of the Brilliance Workspace Portal
for unintended purposes, or with incompatible equipment, could lead to
clinical misdiagnosis.
Intended use of the Brilliance Workspace Portal is described under the
heading Intended Use in the Introduction section of this Instructions for
Use. Compatibility is discussed under the heading Compatibility in the
Introduction section of this manual.
2 -2
Safety
Brilliance Workspace Portal - Volume 2
3
Security of system and data
Philips Medical Systems is dedicated to helping you maintain the
confidentiality, integrity, and availability of electronic protected health
information and the hardware and software products that create and
manage these data.
Philips Medical Systems 4535 674 64521_A
Maintaining security of Philips Medical Systems' products should be an
important part of your facility's security-in-depth strategy. You should
implement a comprehensive, multi-layered strategy (including policies,
processes, and technologies) to protect information and systems from
external and internal threats. Your security strategy should follow industrystandard practices, addressing physical security, personnel security,
procedural security, risk management, security policies, and contingency
planning.
The practical implementation of technical security elements varies by site
and may employ a number of technologies, including firewalls, virus
scanning software, authentication technologies, etc.
This chapter provides guidelines to help the operator and owner
understand the possible ways security can be compromised, and then insure
that safeguards are in place to prevent this from happening. For specific
information about security within their institutions, operators and owners
can consult with the following offices at their location:
• Information Systems Security Officer
• Chief Information Officer
• HIPAA Officer (in the U.S.A.)
• Safety Officer
Brilliance Workspace Portal - Volume 2
Security of system and data
3- 1
3.1
Regulatory controls
3.1
Regulatory controls
Protect patient’s health information
One of the most important assets to protect with security measures is the
patient's health related information.
Many governments require maintaining the confidentiality of this
information. Therefore, strict security measures must be taken to guard this
protected information.
(Users in the U.S.A. may find guidelines at
http://www.hhs.gov/ocr/hipaa/.)
Prevent unauthorized device modification
Philips Medical Systems sells highly complex medical devices and systems.
We are required to follow government-regulated quality assurance
procedures to verify and validate modifications to the operation of our
medical devices.
Operators of this medical equipment must permit only Philips-authorized
changes to be made to the servers, either by Philips' personnel or under
Philips' explicit published direction.
Caution
3 -2
Security of system and data
Do not connect any external devices which were not included with the
server of your Brilliance Workspace Portal system.
Brilliance Workspace Portal - Volume 2
Security issues and guidelines
3.2
3.2
Security issues and guidelines
In addition to the patient information and device integrity needs discussed
in the preceding section on regulatory requirements, the following topics,
issues, and guidelines should be understood and addressed by operators and
owners. All content on this page refers to the Brilliance Workspace Portal
server and not the client PCs.
Network security
The Brilliance Workspace Portal must be placed on a secure local computer
network that has protections against viruses and other harmful computer
system intruders. Make sure the equipment is connected to a local network
that uses appropriate protection, such as a firewall and virus scanners.
Remote Service
Philips Medical Systems 4535 674 64541_A
Philips Medical Systems has a global, web-based network for connecting
many of your Philips systems to our advanced service resources. This secure
tunnel approach provides your equipment with a single point of network
access to on-site Philips equipment using Virtual Private Network
technologies. The remote service function is a secure connection through
explicit authorization and authentication control with encryption of all
data.
Antivirus Updates
Virus definition files and updated virus scanning engines are included with
the equipment. Updates of virus definition files and/or corrective software
versions are regularly made available by Philips to address known
vulnerabilities (virus and otherwise).
The system’s antivirus scanner is scheduled to activate during off hours,
while system is typically not in use. (Refer to the section “Antivirus
Software” in the System Description chapter of this volume for details.)
Brilliance Workspace Portal - Volume 2
Security of system and data
3- 3
3.2
Security issues and guidelines
Caution
Under no circumstances should updated virus definition files (or any type of
software) be installed on the Brilliance Workspace Portal by anyone other
than a Philips Field Service Engineer or an authorized Philips agent.
Positioning of display monitors
Unauthorized visual access to protected information can be minimized by
positioning the system’s display monitor so it faces a wall, to prevent
viewing from doorways, hallways and other traffic areas.
Note
Monitor position is a suggestion for use with monitors of client PCs used to
view Brilliance Workspace Portal.
To help in limiting unauthorized visual access, an unattended computer
display automatically goes blank after a set period of time. If there is no
interaction with the application for a preset length of time, the Idle time
out feature logs users off.
User login and logout protections
A consistent user login process (user names and passwords) provides good
security of protected information.
Minimum login standards include:
• Implementing strong passwords. This is the easiest and most effective
method to increase security. Strong passwords consist of at least eight
alphanumeric, mixed case characters, digits and special characters like
'@' or '*'. Never use words that can be found in the dictionary
• Never post or share user names and passwords
• Change passwords periodically
3 -4
Security of system and data
Brilliance Workspace Portal - Volume 2
4
System description
Brilliance Workspace Portal 2.5 (Portal) is a client/server application that
makes remote access to Extended Brilliance Workspace 3.5 functionality
possible through networked hospital PCs and in hospital locations remote
from the Radiology suite such as the emergency room, the operating room
or in a physician's office.
The main functions of Portal 2.5 include extensions to Extended Brilliance
Workspace 3.5 functionality to support use cases not present in Extended
Brilliance Workspace 3.5, such as user login as well as server and user
administration.
Philips Medical Systems 4535 674 64521_A
The two major components of this application are a server and software,
and a client application and software. The server and client application
communicate through a local area network (LAN) or possibly through the
Internet using a VPN connection.
4.1
What Portal is
Portal communicates with imaging systems of different modalities using the
DICOM-3 standard.
• Portal is a Thin Client /Server application that enables widespread
remote access to EBW 3.5 functionality via networked hospital PC’s.
• The Thin Client machine has the Graphical User Interface (GUI) and
displays images while the central Server retrieves and manages images,
and generates images for transmission to the client.
• Memory and CPU intensive operations such as 3D rendering takes
place on the server. Workstation operations can be performed via PC
Brilliance Workspace Portal - Volume 2
System description
4- 1
4.1
What Portal is
with less computing and memory resources than required by a
standalone workstation.
• Unlimited number of clients; multiple users can login simultaneously
and interact with datasets for review and interpretation.
• It’s a Brilliance Workspace anywhere the clinician needs it.
4.1.1
Key features
In Portal v2.5 CT Viewer imaging modalities supports CT. Portal functions
include various image handling features including:
• Archiving
• Viewing
• Manipulation
• Two and three-dimensional processing
• Analysis
• Filming
• Quick Review
• Reading (and burning – if supported by client PC) cd’s and dvd’s
• Unlimited number of clients
• All features and same GUI as CT Viewer in Extended Brilliance
Workspace v3.5
• Save non-DICOM directly to labeled Multimedia viewer in Portal
• Clipboard – copy an image to paste in documents/power points
• Integration with i-Site PACS: launch Portal with the same user login
and same selected data.
• Reporting (Based on TEcontrol)
• Additional applications:
• Advanced Vessel Analysis with Stent Planning (AVA)
• Virtual Colonoscopy (VC)
• Comprehensive Cardiac Analysis (CCA)
4 -2
System description
Brilliance Workspace Portal - Volume 2
What Portal is
4.1
• Lung Nodule Assessment (LNA)
• Brain Perfusion (BP).
Portal 2.5 employs a graphical multi-window, icon and mouse driven user
interface. It is designed to ensure maximum flexibility and intuitive
operation.
Large image sets are efficiently and conveniently reviewed and prepared for
using Extended Brilliance Workspace’s 2D display and manipulation
functions. Basic functions include real-time zooming, panning, windowing
and image viewing. Many viewing functions are included in the basic
functions, including 2D, slab, volumetric images and a basic endo flythrough capability.
4.1.2
Licensing
Philips Medical Systems 4535 674 64521_A
The Brilliance Workspace Portal software system does not support client
side licensing. Server licensing is limited to licenses based on the MAC
address. There is no user or feature specific licensing.
4.1.3
Performance
While the ultimate performance for any specific client depends on network
performance and load, and the number of users simultaneously requesting
computation on the server, the intent of the Portal application is to have
multiple users be able to use the CT viewer with “interactive” performance
over the network.
If no other users are requesting intensive computation from the server, a
single user is able to expect responsiveness consistent with EBW 3.5
Brilliance Workspace Portal - Volume 2
System description
4- 3
4.2
Requirements
4.2
Requirements
•
•
•
•
•
•
4.2.1
Gigabyte connections recommended
Recommended DNS server with reverse DNS capabilities
Recommended VPN access
Recommended domain based network environment
Supports Windows Vista
Dual server that is transparent to the user and handles twice the amount
of images.
Portal server
The Portal Server is connected to the PMS CT scanner and has PACS
connectivity capabilities. The scanner pushes images to the Portal Server
and the server can send and retrieve DICOM images from PACS.
A site can install multiple Portal servers, in which case a user of a Portal
client can connect to a chosen server. Each Portal server acts independently
and is not aware of any other Portal servers.
Memory- and CPU-intensive operations such as 3D rendering take place
on the server.
The Portal server can be accessed by a wide variety of remote users and can
can be placed anywhere in the Radiology IT rooms.
The Portal server is configured by Philips and is dedicated to running the
Portal server software.
Note
4 -4
System description
You must have the same software version as the server.
Brilliance Workspace Portal - Volume 2
Requirements
4.2
System
The server of Brilliance Workspace Portal is based on a Dell server system
and consists the following:
• Server
• Monitor
• Keyboard
• Mouse
• Internal CD-ROM drive
Caution
Never interrupt electric power to the Portal server when it is switched on.
Power down from the administrative application.
On start-up, the Portal client checks the local hardware and software
configuration. The software upgrades. If the hardware configuration does
not meet the minimum requirements for the Portal client a message
displays.
Philips Medical Systems 4535 674 64521_A
Note
Hardware configuration and software requirements of the Portal server are
listed below.
Hardware configuration
•
•
•
•
•
•
Brilliance Workspace Portal - Volume 2
CPU: 4x CPU Dual Core Xeon 7110 M, 3.66 GHz.
RAM: 20 Gb
Video: none
Operating System: Windows server 2003
Disks: 3 x 300 Gb disks in a RAID 5 configuration of 600 Gb
Network cards: 1 Gigabit network adapter
System description
4- 5
4.2
Requirements
Note
Windows Server 2003 OS permits remote login and system administration
through Remote Desktop Administration. Hospital IT should not install any
software on the Portal, such as security and antivirus.
Software
Third party software and security application Mcafee antivirus, (See the
Antivirus software section later in this chapter for more details) is included
in the installation of Portal 2.5. Also, all unused ports and services are
closed on the server for security purposes.
Note
4.2.2
Generally, other than stipulating minimal requirements, Philips does not
have control over the configuration of the client machines.
Portal client application
Portal client software is deployed on a variety of PCs with multiple
Operating System (OS) and hardware configurations. An unlimited
number of clients can be installed and loaded.
4 -6
System description
Brilliance Workspace Portal - Volume 2
Requirements
4.2
Hardware
Below lists the minimal requirements of the client PC.
Components
Required
Recommended
Available memory
512 mb
1024 mb or higher
Processor speed
1024 MHz
2048 MHz or higher
Screen resolution
1024x768 pixel
1280x1024 pixel or higher
Disk Free space on C drive
200 MB
1024 MB or higher
Network speed
100 Mbit
1000 Mbit or higher
Network card
Compatible with the hospital network or a
broadband Internet connection
Philips Medical Systems 4535 674 64521_A
Software
Components
Required
Recommended
Supported OS
Win XP
Win XP Service pack 2 OR Win 2000 SP4
Service pack 1,
Win 2000 SP4
Nero
Not required
If Nero present:write and read CD and DVD
on all platform
If No Nero: WinXp reads and writes CD
Win2000 only reads CD
Brilliance Workspace Portal - Volume 2
Windows account
for initial installation only. Ability to add Portal
administrative access
Software components.
System description
4- 7
4.2
Requirements
MAC Support
• (1) On WinXp running under Mac OS as a virtual machine
• (2) On WinXp running natively on Mac HW using BootCamp (dual
boot Mac or Xp solution from Apple)
4 -8
System description
Brilliance Workspace Portal - Volume 2
Antivirus software
4.3
4.3
Antivirus software
Antivirus software has been installed on the Portal server. The antivirus
check is started automatically, whether a Windows user is logged in on not,
at 2:00 AM (or 3:00 AM depending on time zone and daylight savings). It
can also be started at any time by a Philips service representative.
• If the computer is in the powered on state at 2:00 AM, but a user is not
logged in, the antivirus software runs automatically without displaying
a message.
• If you are logged in to the Extended Brilliance Workspace system when
the antivirus check is ready to start, this message displays: “Waiting to
Start. Virus Scan Will Start in xx:xx”
You can let it start by itself, or you can elect to start it immediately, or you
can elect to skip the virus scan.
While the virus scan is running, the message “Current State: Scanning
Files” displays.
Philips Medical Systems 4535 674 64521_A
Note
You can cancel a virus scan at any time, either before or during its
execution.
• If you log on during a virus check, the check for viruses continues,
showing messages describing its status.
• If no viruses are found, the following message displays: “Current State:
Virus scan complete. No viruses were detected.” The message window
closes automatically after 30 seconds.
• If a virus is found, the following message is displayed: “Virus scan
complete. A virus was detected. Call your service representative.”
• Contact your service representative. You may view the virus log. Click
the “Close this window” button to exit.
Brilliance Workspace Portal - Volume 2
System description
4- 9
4.4
Applications
4.4
Applications
Brilliance Workspace Portal 2.5 handles and displays independent image
viewing and processing applications.
CT Viewer
A comprehensive viewer for fast review of CT data in four
visualization modes:
2D - review original axial images
Slab - review a thin slab image in different orientations
Volume - review full volume images
Endo - review using the flythrough mode.
AVA (Stent)
Advance Vessel Analysis (AVA) offers a set of tools for stent
planning and general vascular analysis. With AVA you can
easily remove bone, then extract vessels and segment them.
VC
Virtual Colonoscopy (VC) enables fast and easy visualization
of colon scans, using acquired CT images.
CCA
Comprehensive Cardiac Analysis (CCA) is used to assess the
state of the coronary arteries and to create a functional
analysis of the heart.
LNA
Lung Nodule Assessment (LNA) assists with the diagnosis of
pulmonary nodules and lesions.
BP
Brain Perfusion (BP) is a blood flow imaging application that
analyzes the uptake of injected contrast in order to
determine perfusion related information about one or more
regions of interest.
4 -1 0
System description
Brilliance Workspace Portal - Volume 2
Ancillary programs
4.5
4.5
Ancillary programs
The following ancillary programs serve the main applications:
Directory
Selects and retrieves images for the applications. Copies to
other devices.
Queue Manager
Displays the order of copying images from one device to
Philips Medical Systems 4535 674 64521_A
another and printing films.
Brilliance Workspace Portal - Volume 2
System description
4- 11
5
Screen resolution and layout
In Brilliance Workspace Portal there are two variations of resolution, high
resolution, which is 1280 x 1024 and low resolution, which is 1024 x 768.
Because of this there are some screens in the application where you will see
one of two different user interfaces. The user interface is different because
of the different resolutions. Here are the required and recommended
resolutions:
Required - client screen resolution is 1024x768
Recommended - client screen resolution is 1280x1024 or higher
Note
The portal client does not run on any system that has a lower resolution
than 1024 x 768. The portal runs on a resolution higher than 1280 x 1024
though is does not fill the screen.
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There are some screens that do not show differences in display between
high and low resolutions.
Below are examples of screens that display differences between high and low
resolutions in the user interfaces.
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Screen resolution and layout
5- 1
5.0.1
Low screen resolution
To overcome the low screen resolution, some tools are gathered under new
tabs in the toolbox to avoid a crowded toolbox and allow maximum area
possible for viewports.
Note
If you see double arrows in any of the user interfaces, this is an indicator
that there are additional tabs available.
The following images demonstrate the different layouts of some
applications.
AVA
In low screen resolution the volume rendering tools appear under the View
tab.
High Resolution
5 -2
Screen resolution and layout
Low Resolution
Brilliance Workspace Portal - Volume 2
Comprehensive Cardiac
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In low screen resolution the common tools appear under the Common
Tools tab.
High Resolution
Brilliance Workspace Portal - Volume 2
Low Resolution
Screen resolution and layout
5- 3
Film
In low screen resolution the the layouts appear under the Layout tab.
High Resolution
5 -4
Screen resolution and layout
Low Resolution
Brilliance Workspace Portal - Volume 2
6
Viewing mode - CT Viewer
The Brilliance Workspace Portal is equipped with the CT viewer for
reviewing patient images.
Launching the CT Viewer
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After selecting a study from the Directory, access the CT Viewer by clicking
on the CT Viewer button in the upper-left corner.
CT Viewer
The primary viewer of the Brilliance Workspace Portal is the CT Viewer.
Within the CT Viewer, there are four viewing modes available, 2D, Slab,
Volume, and Endo.
Each viewing mode has its own clinical usages and has specific visualization
tools associated with it. You can freely navigate between all four viewers,
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Viewing mode - CT Viewer
6- 1
depending on the type of study you have opened, and how you want to
view the patient images.
• 2D - for reviewing original axial images. Several advanced image
processing functions are available including sort, compare, and
combine.
• Slab - for reviewing a slab image in different orientations, with the
ability to roll a thin slab around a pivot point. Also available is the
Planar mode, for reviewing the three orthogonal images
simultaneously.
• Volume - for reviewing full volume images using a variety of volume
rendering techniques.
• Endo - for performing a general flythrough of structures filled with
contrast or air, including general vessels, cardiac vessels, the bronchus,
and the colon.
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Brilliance Workspace Portal - Volume 2
CT Viewer functionality
6.1
6.1
CT Viewer functionality
There are functionalities that are common to all applications. They are in
the series tree and the common tools area of the applications. The common
tools or series tree areas and functionalities are, in general, functional in
2D, Slab, Volume, and Endo viewers.
Additional common tool functions may be designed into other applications
and applications, and some functions may vary somewhat from the way
they are described in this chapter. When that is the case, those functions are
described in the pertinent chapters.
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The series tree and common tools areas for all viewers are described in
detail in this chapter. You will be referred back to this chapter for
functionality descriptions from other chapters.
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6.2
Series tree
6.2
Series tree
Note
• The Series tree appears in all applications (including the “volumetric”
modes of Slab, Volume, and Endo) in nearly identical form.
• In the 2D mode description below, differences between the 2D mode and
the other volumetric modes are noted.
The series tree is a user interface control that displays a list of the studies
and series that are loaded into the viewer, and also any other elements (like
batches) that have been created.
The series tree’s elements display in a format similar to the way directories,
folders, and files are shown in the operating system.
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Brilliance Workspace Portal - Volume 2
Series tree
6.2
Each element of the series tree has a small icon to identify the type of
element being listed. These icons include:
Patient
Series
Volume images
Batch
Images
Image Parameters
Surview
Series tree icon variations
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• If the element has been saved, its icon is shown in full color. (Batch
example shown at left.)
• If the element is not currently saved, its icon is shown as faded.
• If the element is not loaded, its icon is “broken” (shown with a
diagonal white line through it).
• If the element is not available, the icon is grayed out.
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6.2
Series tree
Series tree structure
The tree has three hierarchic levels. Each level acts like a folder.
First level - Study folder
The first level is the Study folder and is titled with the Patient Name. It
contains all instances related to the Study as seen in the patient directory.
Click on the Study folder to select all elements beneath the second level
folders but not those in the third level folders.
Click on the (+) symbol to expand and the (-) symbol to shrink all levels
below the Study.
When all the content of the Study folder is selected, the folders get selected.
This is also true for unselected.
Second level - Series folder
The second level is a folder that contains all instances related to that series
and is titled with the Series number and description.
Clicking the series folder selects all elements beneath it but not those in the
third level folders.
Click on the (+) symbol to shrink all levels below the series.
When all the content of the Series folder is selected, the folders get selected.
This is also true for unselected.
6 -6
Note
In the 2D mode, under this level appears all the acquisitions:
• Mixed series are divided into subgroups under the series folder.
• Surview and Image parameters are identified as such in their names.
Note
In the volumetric modes (including Slab, Volume, and Endo) the series level
represents volume data. Each branch includes a different volume.
Viewing mode - CT Viewer
Brilliance Workspace Portal - Volume 2
Series tree
6.2
Second level - batch folder
A batch appears at the same level as the series and is titled with the batch
name. When it is saved, the series number is added before the batch name.
Batches are labeled automatically (Batch 1, Batch 2 etc.…), and referenced
to the original series.
Third level - the elements inside the series/batch folders
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Contains three types of acquisitions, which are indicated by three different
icons:
• Images (and, in volumetric viewers, MPRs and volumes)
• Surview
• Image Parameters
Duplicated series
These are added to the tree according to their content, and identified by
series number and an empty space for description. Duplicated series can be
renamed and can be saved.
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6.2
Series tree
States of an item in the series tree
Temporary (levels 2 and 3) - A batch or duplicated series that is not saved
in the database. These are identified by a faded icon.
Loaded (levels 1 and 2) - Items that are loaded to the memory and can be
shown on screen immediately when asked for. These are identified by a full
color icon.
Unloaded (levels 1 and 2) - Items that require a loading operation when
you ask for review. These are identified by a “broken” icon and only appear
during the loading of a study.
Selection of items in the series tree
Active (levels 2 and 3) - The element on the tree that contains the active
image in the view port. This is identified by a black background behind the
title.
Selected (levels 1, 2 and 3) - Determines the data that is available for
viewing. These are is identified by an azure background under the title.
To select more than one element, hold down the <Ctrl> key and click the
element(s).
Unavailable (levels 1, 2 and 3) - These items are not available to work with
in a particular viewer. These items are grayed out.
Interacting with the series tree
A single left click controls the selection.
• A highlighted item remains highlighted and become active. A nonhighlighted item becomes the only one highlighted (and therefore
active).
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Series tree
6.2
• By default, the first item of the entire selection is active. Changing the
selection does not change the active item, unless the active one is
removed from the selection.
<Ctrl> + Left Click and <Shift>+ Left Click enables multiple selections of
items.
• All included items become highlighted.
A double left click on an item makes that item the only one highlighted
(and therefore active).
A right click on a series results in the following:
• If you right click on an item currently selected, a pop-up menu opens
and the functions are based on the type of folder/level the item is in
• If you right click on a non-selected item, the item becomes active and
the item previously selected becomes inactive and is no longer selected.
A pop-up menu opens and the functions are based on the type of
folder/level the item is in.
Right click menus
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Options that are not available are grayed out.
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6.2
Series tree
Remove
The Remove from application function:
• Removes the entire selected item (highlighted in black) along with the
folder from the series tree.
• Removes only the folder the contents, never the Patient folder (level 1).
• Is available on any level.
• Issues a warning message.
• Issues a different warning message if the item has not been saved.
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Series tree
6.2
Reload
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At the high level main folder, if a study is removed it can be reloaded
through the main folder. The Reload function:
• Is only available on Patient folder (level 1).
• Only appears after data has been removed.
• Restores the item(s) to the state it was in when loaded or created.
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6.2
Series tree
Rename
Rename is only available on items created in the application that are
unsaved.
Expand All / Expand / Collapse on the study level
Expand All:
• Opens all folders, regardless of their selected state.
• Is available on all folder levels.
Expand:
• Opens the items in the selected folder.
• Is only Available on level 1 and level 2 folders.
Collapse:
• Is only available on level 1 and level 2 folders.
• When collapse is requested on a level 1 selection, all folders close,
regardless of their selected state.
• When collapse is requested on a level 2 selection closes the selected
folder.
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Common tools
6.3
6.3
Common tools
At the bottom of the tool panel is the common tools area. These common
tools provide many basic functions, including measuring, saving, filming,
scrolling, panning, zooming, rotating, and windowing. The common tools
for all applications are described in detail in this chapter. References back to
this chapter are made throughout this user documentation for many
common tool descriptions from other chapters.
The common tools are, in general, common to all the viewing modes, and
are shared with many other applications of the Brilliance Workspace Portal.
Additional common tool functions may be designed into other
applications, and some functions may vary somewhat from the way they are
described in this chapter. When that is the case, those functions are
described in the pertinent chapters.
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If a common tool has a special function in 2D, Slab, Volume, or Endo
mode, that function is described in its respective chapter.
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6.3
Common tools
6.3.1
Save and Save As... functions
Save (also called “direct save”)
The Save functions are available from a drop-down menu. Using these
tools, you can perform a quick save to devices predefined in Preferences, in
DICOM format. (Save functions that are unavailable in the 2D mode, such
as Save Tissue and Save Path, are grayed out. If you have defined a batch,
the Save Batch option becomes available.)
Note
• The data is saved to the default device as defined in the Preferences
utility.
• In addition to designating a default device in Preferences, you can also
have the data saved to “the device from which the images were loaded.”
Refer to the Preferences chapter in volume 1 for details about setting
preferences.
As data is being saved, a pop-up message appears indicating the data is
being saved.
Images are saved according to the selection mode in the default format. For
example:
• Original images are saved as DICOM/original
• Combined images are saved as DICOM/derived
• Others are saved as DICOM/SC (secondary capture)
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Common tools
6.3
Save Display
The display is saved in SC (secondary capture) format. It has the
description “Display.”
Save Tissue
Is only available after a tissue has been created. It is saved as derived and is
given a generic name of Tissue: Cleared Tissue in the Directory.
Save Path
The Save Path function is only available after a path has been created. It is
saved as derived and given a generic name of Path: Curve 1 (Curve 2
etc.…).
Save Batch
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The Save Batch function is available when a batch has been created. The
batch is saved in the default format of the image it contains.
Note
Brilliance Workspace Portal - Volume 2
If you do not want to save images or other data according to the current
default settings in Preferences, use the Save As... function.
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6- 15
6.3
Common tools
Save as...
The Save Image(s) As... drop down menu has multiple options for you to
choose from: Save display as…, Save tissue(s) as…, Save path as…, or Save
batch as….
Clicking Save As... opens the dialog box shown below, where you can save
data in either DICOM or Windows formats to a selectable device.
Depending on what you are saving, you may be presented with different
target devices. Ineligible devices are grayed out.
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Common tools
6.3
Image quality, in Save Batch As... function
When you select a save batch function you also get additional choices of the
movie’s quality: JPG image quality, WMV high quality, and WMV low
quality. The quality of the movies is configured in Preferences. (Refer to the
Preferences chapter in volume 1 for details about setting preferences.).
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If you do not exit the application after changing the Save or Save As...
functions, the last selected device along with the local device is selected
when the next Save or Save As... function is selected. A Same Series check
box also appears and is checked by default. This allows you to save images
to the same series that you are working on.
After exiting the application, the Save and Save As... device resets to the
Preferences definition.
Note
Brilliance Workspace Portal - Volume 2
• Local is always selected.
• Your last device selection is saved when the dialog is closed, and becomes
the default along with Local when another save function is selected.
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6.3
Common tools
6.3.2
Film
Film Images (default) - Images are sent to the Film viewer according to the
selection modes.
Film Display - The display is sent to the Film viewer.
Film Batch - This option is enabled when the series tree selection includes a
batch. This is enabled when a batch is created.
Save and film batch - Saves the batch to the device(s) selected and sends the
batch to the Film viewer.
Note
Images sent from 2D mode to Filming are in their original matrix size.
For more information, refer to the Filming chapter in this volume of the
user manual.
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Common tools
6.3.3
6.3
Report
These buttons are grayed out if the report editor isn't installed.
Report Images (default) - Images are sent to the report editor according to
the selection modes.
Report images with
comments - Opens a dialog
box to include comments
with images.
Report display - The display
is sent to the report editor.
Report display with comments - Opens a dialog box to include comments
with display.
Send batch to report - available when a batch is created.
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Refer to the Report chapter in this volume of the user manual for more
information.
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6.3
Common tools
6.3.4
Viewing tools
These tools affect the display of the images. All tools work on the selected
images.
Scroll
Used for rapid viewing of images in the study by dragging in the viewport.
Pan
Used to center the feature of interest in the image frame by dragging the
image in the window.
Zoom
Used to magnify or reduce the size of the image in the display.
Swivel
Swivel is used to manipulate the rotation of volume images. The Swivel
function allows you to follow an anatomy which cannot be seen in its
entirety in one orientation.
Swivel is not active in the 2D mode.
Note
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Viewing mode - CT Viewer
1
Position the rotation center near the middle of the anatomy.
2
Click the Swivel button to enable the swiveling function.
3
Using the left mouse button, swivel the image until the desired image is
obtained.
Brilliance Workspace Portal - Volume 2
Common tools
6.3
Relate
The Relate Scenes function allows you to mark a specific location of
interest on an image. You can then access the Slab, Volume, and Endo
viewers and see that same location automatically marked on the display.
The Relate Viewports function allows you to mark a specific location of
interest and see it on other images in the viewport (for example reference
images and volume images).
Relate Viewports is available only in the Slab, Volume and Endo viewers, not
in 2D mode, where it is grayed out.)
Note
1
Click the down arrow to open the drop down menu.
2
Click the Relate Scenes/ Relate Viewport button.
3
Click the left mouse button in the desired viewport on the desired
location.
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Relate Scene - a circled green crosshair appears over the position.
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6.3
Common tools
4
Switch to Slab, Volume, or Endo views to see the same crosshair
marking this location in the different scenes.
Relate Viewport - a green cross appears over the position.
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Common tools
6.3.5
6.3
Graphics tools
Graphics tools are used for marking, measuring, and commenting on areas
of interest in the images. (Refer to the Graphic Tools chapter in this volume
of the user manual for more information).
6.3.6
Other graphics functions
Titles display
This function removes / displays (turns off and turns on) the scan
information (“titles”) of all images.
The following information cannot be turned off:
• graphic annotations
• position annotations (L\R\H\F\A\P)
• orientation box
• scale (right side)
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Turning off titles display has no affect when saving, filming or reporting
images. All data still appears on those images.
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6.3
Common tools
Grid display
This function displays a grid pattern on the active image.
The default grid spacing is10mm. Click the dropdown arrow to open the
Grid Spacing dialog box. The range of grid spacing is from 1 mm to 50
mm.
Compression
You can change compression inside the application.
• Lossless
• Q80
• Q60
• Q40
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Brilliance Workspace Portal - Volume 2
Common tools
6.3
Enlarge/Restore window
This function enlarges / restores the active image. Click the button once to
enlarge the active window into a single large image. Click again to restore
the image to the original size.
Image scan parameters
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This button opens a window, displaying all available image scan
parameters.
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6.3
Common tools
6.3.7
Image adjustment tools
These functions effect the selected images.
Windowing presets
The Default preset is the window center and width that comes from the
scanner.
You can define the presets in the Preferences utility. (Once changed, the
preset becomes “Modified.”)
Automatic is used to allow the system to select a windowing center and
width based on the anatomy being displayed.
You can also use keyboard shortcuts 0-9 to activate windowing presets.
You can elect to Type in the Center and Width
values.
1
Click Type in. The Windowing dialog opens.
2
Type in the desired Center and Width values.
3
Click OK to change the windowing. The dialog
closes.
Inverse
Click this button to reverse the gray levels of the image. (The result is a
negative image).
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Common tools
6.3
Enhance
The Enhance function allows you to sharpen or smooth the image by
changing the enhancement value.
1
Click the enhance button and drag the left mouse up or down to
change the enhancement value.
2
You can also right mouse click over the viewport and select
Enhancement and Type in from the drop down menu.
This allows you to type in a value in a number range from -0.01
(smooth) to 5.0 (sharp). The value can include up to 2 decimal places.
6.3.8
3
To exit enhancement, select another tool such as scroll or pan.
4
To turn enhancement off select the Type in feature and type in 0.
End CT viewer session
Exit
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This function closes the application. The Directory opens after the viewer
is closed
Reset all
If changes have been made to the image, this function resets the current
scene to its original state when it was loaded into the application.
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7
Graphic Tools
Graphic tools are available throughout the Brilliance Workspace Portal, and
are used during image analysis to mark and measure features on the image.
Line - draws a straight line between any two points on the image. In
addition, several other line shapes are available: freehand, spline, double
line and polyline. After you draw the line, the line’s length is calculated
and displayed
ROI - encloses a region of interest (area) on the image, and measures the
area, average CT value, standard deviation, and effective diameter of the
enclosed pixels and multiple shapes.
Cursor - measures the pixel value of the image, at the point you clicked.
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On 2D images, the XY coordinates of the point are also shown.
Angle - draws two joined lines, which may be placed along two image
features to measure the angle between them.
Arrow - points to a feature on an image. You can also add text with this
tool.
Text - places alphanumeric annotation anywhere on the image.
Remove all graphics - deletes all the existing graphics you created. You
can also delete individual graphics, as described later in this chapter.
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Graphic Tools
7- 1
Setting Graphic tools preferences
You can control some measurement displays for graphics in the Preferences
utility, as shown in the representative display below.
Preferences is accessible from the Archive Manager in the Directory. For
more information on Preferences refer to the Preferences chapter in volume
1 of this user manual.
7 -2
Graphic Tools
Brilliance Workspace Portal - Volume 2
How to use the Graphic tools
7.1
7.1
How to use the Graphic tools
The following sections describe how to use the graphic tools of the
Brilliance Workspace Portal.
7.1.1
Selecting a graphic tool for use
Single click and double click
You can activate the graphic tool you want to use either by using a single
mouse click or a double click.
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The Single click method allows you to draw one graphic at a time.
• Single click on a graphic tool with the right mouse button. The cursor
becomes a pencil.
• You can draw one graphic.
The Double click method allows you to draw multiple instances of a
graphic without having to reselect the graphic tool for each use.
• Double click on a graphic tool with the right mouse button. The cursor
becomes a pencil.
• You can now create more units of the same graphic by pointing to other
places on the image and clicking to start drawing
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Graphic Tools
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7.1
How to use the Graphic tools
7.1.2
Editing a graphic after drawing it
To delete a graphic
• Place the mouse on the graphic - it turns yellow.
• To delete the graphic, either right mouse click and select Delete from
the menu that pops up
--OR-• Use the <Delete> button on the keyboard.
To move a graphic
• Place the mouse on the graphic to make it active. It turns yellow.
• Move the mouse along the graphic until the cursor changes to the Move
symbol.
• Click and drag the graphic to the desired location.
To change shape of a graphic
• Place the mouse on the graphic to make it active. It turns yellow.
• Place the mouse on the control box you want to use to change the
shape. The cursor becomes an arrow head and the white square appears.
• Drag the control box to the desired location and release the mouse.
• Move additional control boxes as needed.
To add additional graphic control boxes, if needed
• Click on the graphic.
• Place the mouse on the graphic where you want to add a control box.
The cursor changes to an arrow with a white square and a plus sign (+).
• Left click to add a new control box.
7 -4
Graphic Tools
Brilliance Workspace Portal - Volume 2
How to use the Graphic tools
7.1
Philips Medical Systems 4535 674 64521_A
To delete a control point (box)
• Click on the graphic.
• Place the mouse over the existing control box that you want to remove.
• Click on the box while holding down the <Ctrl> key.
• The cursor changes to an arrow and a white square with an X over it.
• Click on the box and the box is deleted.
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Graphic Tools
7- 5
7.1
How to use the Graphic tools
7.1.3
Right mouse click submenus
After you have drawn a graphic, there is available a pop-up menu that
allows you to modify it or to display additional information about the
image area covered by the graphic. Below is an example submenu:
In this example:
• You can Show ticks on graphic lines. Ticks give you an on-screen
measuring scale on drawn lines.
• You can Add points (“control boxes”) to an existing line. Having
additional points allows you to make a graphic more precise.
• You can access Graphic properties to alter the width and color of
graphic lines, and the size and color of text displayed in the graphic.
The Graphic functions Cut, Copy, and Delete are available in all graphic tool
submenus, and not shown in the submenu examples included in the rest of
this chapter.
Note
Open a graphics operation submenu
7 -6
Graphic Tools
1
After drawing the graphic, place the mouse cursor on it to change its
color to yellow.
2
Right mouse click. A graphics operation submenu opens.
3
Select from the desired options to apply them to the graphic.
Brilliance Workspace Portal - Volume 2
How to use the Graphic tools
7.1.4
7.1
To draw a line
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Lines are used to measure distances on images in millimeters. Several line
shapes are available:
• Straight line is used to measure the distance between two features on
the image.
• Freehand is used to measure the length of features of any arbitrary
shape. When drawing the freehand line, the line is continued as you
drag the mouse.
• Spline is used to measure the length of features of any arbitrary shape.
Spline lines have rounded edges and points that are represented in the
line by square boxes. When drawing the Spline, the line is continued
wherever you click to set a new point.
• Double line allows you to place two lines on the image for measuring
vessel or organ diameters. The line profile displays for each line
separately. The diameter difference can also be displayed.
• PolyLines have square edged points that are represented in the line by
square boxes. When drawing the PolyLine, the line is continued
wherever you click to set a new point.
Starting to draw a line
• Select the line type by single or double clicking the currently displayed
line tool
-- OR, if the desired line tool is not displayed -• By clicking the line drop down arrow and single or double clicking a
different line type.
Line (straight, freehand or double)
• Place the cursor at the first point. Hold down the left mouse button and
drag the cursor to the end location and release the button.
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Graphic Tools
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7.1
How to use the Graphic tools
Spline or polyline
• Left mouse click at each point along the line you are drawing.
Move a point of a line
• Place the cursor over a box, hold down the left mouse button and drag
to the desired location.
Move an entire line
• Place the mouse over the middle of the line until the Move cursor
appears. Hold down the left mouse button and drag to desired location.
Add point(s) to a line
• Click on the line.
• Place the mouse on the line until the arrow cursor with a plus (+) sign
appears. Left mouse click to add the point.
Note
7 -8
Graphic Tools
If a line is not exact enough, delete it and start again.
Brilliance Workspace Portal - Volume 2
How to use the Graphic tools
7.1
Line graphics submenus
After a line graphic has been completed, point to it with the mouse until the
graphic turns yellow color.
Right mouse click and a submenu appears.
Freehand line
Spline and PolyLine
Double line
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Straight line
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Graphic Tools
7- 9
7.1
How to use the Graphic tools
7.1.5
To draw an ROI (region of interest)
ROIs are used to measure area, average pixel value and standard deviation of
pixel values within a user-defined region-of-interest.
Several ROI shape are available:
• Circle ROI is used to create a circular region.
• Freehand ROI is used to create a region of any user-defined shape by
dragging the mouse to define the shape’s outer edges.
• Ellipse ROI is used to create a region having an elliptical shape.
• Spline ROI is used to create a region of any user-defined shape. (A Spline
ROI has rounded edges.) The spline is defined by pointing to and clicking
around the edges of the region of interest.
• Rectangle ROI is used to a region having a rectangular shape. (To make a
square hold <Shift> while drawing.)
• Polygon ROI is used to create a region of any user-defined shape. (A
Polygon ROI has squared edges.) The polygon is defined by pointing to and
clicking around the edges of the region of interest.
Starting to draw an ROI
• Select the ROI type by single or double clicking the currently displayed ROI
tool
--- OR, if the desired ROI tool is not displayed -• By clicking the ROI drop down arrow and single or double clicking a
different ROI type.
7 -1 0
Graphic Tools
Brilliance Workspace Portal - Volume 2
How to use the Graphic tools
7.1
To draw a Circle, Ellipse, or Rectangle ROI
• Move the mouse to the center of the area to be enclosed by the circle and
hold down the left mouse button.
• Drag the mouse to enclose the desired region and release the mouse button.
To draw a Freehand ROI
• Move the mouse to anywhere on the outer edge of the region to be enclosed
and hold down the left mouse button.
• Drag the mouse around the region and release the mouse button when the
entire region is enclosed.
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To draw a Spline or Polygon ROI
• Move the mouse to anywhere on the outer edge of the region to be enclosed.
• Click and release the left mouse button to place the first point.
• Move the mouse to the next point and click and release to place another
point.
• Place as many points around the region as need to enclose the region.
• Double click on the last point to end the ROI.
ROI measurement parameters
Four ROI measurement parameters are automatically calculated by the Graphics
application after you create an ROI. They are:
• AR (area)
• AV (average)
• ED (effective diameter)
• SD (standard deviation)
Note
ROI measurement parameters display automatically if you activate them in
Preferences. Alternately, you can turn on the measurement parameters display
from the ROI Option submenu, shown on the next page.
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Graphic Tools
7- 11
7.1
How to use the Graphic tools
ROI graphics submenus
After a ROI graphic has been completed, point to it with the mouse until the
graphic turns yellow color. Right mouse click and the applicable submenu
appears.
Circle, Freehand, Spline, and Polygon
Ellipse and Rectangle
ROI measurement options
7 -1 2
Graphic Tools
Brilliance Workspace Portal - Volume 2
How to use the Graphic tools
7.1
Sum (Add) or Subtract ROIs
When one region of interest overlaps another, or is completely enclosed within
another, the sum or difference of the ROIs may be calculated. The Sum or
Subtract functions work with all ROI graphic options.
1
Draw the first ROI.
2
Right mouse click on the first ROI. The ROI submenu displays.
3
From the submenu, select Sum.
• The first ROI graphic drawn must start with the Sum function. If you use
Subtract on the first graphic you draw, you will not get an accurate calculation.
• Each time you draw an ROI you must select either Sum or Subtract after you
draw the ROI graphic.
Note
4
Draw the second ROI.
5
From the ROI submenu, select either Sum or Subtract.
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For each ROI drawn, the AR (area), AV (average), SD (standard deviation),
ED (estimated diameter) measurement information is given.
At the bottom of the image a mathematical equation with the following
values appears, in green:
• ROI: (A+B, for example)
• Tot AR: (total area, mm2)
• Tot Av: (total average)
• Tot Sd: (total standard deviation)
Note
When subtracting, only the total AR is displayed.
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Graphic Tools
7- 13
7.1
How to use the Graphic tools
7.1.6
To draw a Cursor
The Cursor graphic tool is used to measure the CT value of the pixel on which
you place the cursor graphic.
The Cursor graphic tool also measures (but only on the 2D view image) the XY
position coordinates.
To draw a cursor
1
Single or double click the Cursor graphic tool.
2
Move the cursor to a point on the image and click.
• The pixel value shows.
• On 2D views, the value of the XY coordinate displays (if turned on in
Preferences or the submenu).
3
Repeat steps 1 and 2 as necessary.
Cursor graphics submenus
After a Cursor graphic has been completed, point to it with the mouse until the
graphic turns yellow color. Right mouse click and the applicable submenu
appears.
Cursor - 2D viewer
7 -1 4
Graphic Tools
Cursor - Slab viewer
Brilliance Workspace Portal - Volume 2
How to use the Graphic tools
7.1.7
7.1
To draw an Angle
The Angle graphic tool draws two lines that are placed along two image features
to measure the angle, in degrees, between them.
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To draw an angle
1
Single or double click the Angle graphic tool.
2
Move the cursor to the first point on the image and click.
3
With the left mouse button drag the pointer in the desired direction to draw
the first line of the angle and release the mouse button.
4
Drag the mouse to draw the second line of the angle.
5
Click to end drawing.
• The angle value, in degrees displays near the angle vertex.
• Length measurement and ticks can also be displayed, if they are activated.
6
Repeat steps 2-4 as necessary.
Angle graphics submenu
After an Angle graphic has been completed, point to it with the mouse until the
graphic turns yellow color. Right mouse click and the submenu appears.
Angle
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Graphic Tools
7- 15
7.1
How to use the Graphic tools
7.1.8
To draw an Arrow / add Text
Arrows are used to point to features of interest on the image and, if you desire,
type in corresponding text. Text allows you to add textual information
anywhere on the image, without a corresponding arrow.
To create an arrow and add text
1
Single or double click the Arrow graphic tool.
2
Move the cursor near the feature you are marking.
3
Click and drag the mouse to a location where you want the text to begin.
4
Release the mouse. An empty text box opens.
5
If you do not want any text in the box, click outside the box to close it. (Or,
hit <Escape> on the keyboard.)
-- OR --
6
If you want to enter text in the box, type the desired text in the box. When
finished, click outside the text box to end typing.
7
Repeat steps 1-6 as necessary.
To type text
7 -1 6
Graphic Tools
1
Click the drop down arrow on the Arrow graphic tool.
2
Single or double click on the Text tool.
3
Move the cursor to the location on the image where text is to begin and
click. An empty text box opens.
4
Type desired text.
5
When finished typing, click outside the text box to close it.
Brilliance Workspace Portal - Volume 2
How to use the Graphic tools
7.1
Arrow and Text graphics submenus
After an Arrow and/or Text graphic has been completed, point to it with the
mouse until the graphic turns yellow color. Right mouse click and the applicable
submenu appears.
Arrow and no text
7.1.9
Arrow and text
Remove all graphics
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To remove all graphics click on the Remove all graphics icon.
Note
The number of graphics that are actually removed depends on how many images
are selected in the View tab. Selections can be One, Series, Screen, and All, as
shown below.
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Graphic Tools
7- 17
8
Quick Review
Quick Review enables batch 2D functionality, including reporting and
filming, without launching the CT Viewer. It also enables viewing a second
patient during review of a primary patient.
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You can view a variety of image types in the Quick viewer:
• CT Images
• PET Images
• MultiFrame PET images
• SPECT images
• NM Images
• MR Images
• Secondary capture
• Non DICOM files (limited)
• Non DICOM movies
Note
Brilliance Workspace Portal - Volume 2
If the selected images cannot be loaded into Quick Review, the system
displays a message.
Quick Review
8- 1
Launch the Quick Review application
1
From the Directory display, select a patient series you want to review.
2
Click Quick Review to launch the Quick Review application with the
selected series loaded, as shown below.
2D tools
Quick Review opens in the 2D tools mode. Refer to the CT Viewer - 2D
mode chapter for descriptions of the 2D tools.
8 -2
Quick Review
Brilliance Workspace Portal - Volume 2
Series tab
From this tab you can navigate through the list of displayed series. For more
details about this function refer to the “Series tree” section in the
CT Viewer chapter in this volume of the user manual.
Batch tab
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From this tab you can perform basic batch functions for the quick review
images:
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Quick Review
8- 3
Cine tab
From this tab you can perform basic cine functions for the quick review
images:
8 -4
Quick Review
Brilliance Workspace Portal - Volume 2
View tab
From this tab you can change orientation and layouts.
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Note
Wa r n i n g
Brilliance Workspace Portal - Volume 2
The Combine every: function is similar to Combine in CT Viewer - 2D
mode, but it does not perform non-continuous combining of images. To
combine a “from-to position,” perform combine first, then batch.
The combined images should not be used as the sole basis for clinical
diagnosis.
Quick Review
8- 5
Common tools
At the bottom of the Quick Review tool panel is the common tools area.
These common tools provide many basic functions, including saving,
filming, scrolling, panning, zooming, rotating, and windowing.
For more information refer to the “Common tools” section of the
CT Viewer chapter in this volume of the user manual.
Exit the Quick Review application
When you are finished using the Quick Viewer, click the Exit button.
8 -6
Quick Review
Brilliance Workspace Portal - Volume 2
9
CT Viewer - 2D mode
When you first access the CT Viewer, it opens in the default Slab Viewer
mode. To access the 2D mode viewer, click the 2D Viewer button in the
upper left corner of the viewing display.
Note
9.1
Overview
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The primary function of the CT Viewer’s 2D Viewer mode is to review
original axial images as acquired by the scanner.
Basic functions include:
• Scroll bar for rapid viewing of large image sets
• Zoom, pan, and window/level adjustments
• Alternate (view same images with 2 different window/level settings)
• Graphic tools for annotating and measuring
• Grid overlay
Other functions include:
• Copy viewing parameters from one image to others
• Create a Batch (a series of images for filming, reporting and saving)
• Cine, for viewing images in a movie-like mode
Advanced functions include:
• Sort, using DICOM tags
• Compare series side-by-side
• Combine multiple images into one
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CT Viewer - 2D mode
9- 1
9.2
Scrolling and scrollbar
9.2
Scrolling and scrollbar
Scrolling
Scrolling (left mouse drag in the viewport) progresses the images by one
image at a time.
Scrolling with the mouse wheel progresses the images by one image for each
move.
Scrolling with the keyboard arrows progresses the images by one image for
each key press.
<PgUp> and <PgDn> progresses images backwards or forwards by the
number of images in the current layout.
<End> and <Home> progresses and regresses the images to the end and
beginning of the study.
Scrollbar
In a 2D scene, a scrollbar appears on the right side of the image area, with
up and down arrows at each end.
• Clicking on the arrows of the scrollbar progresses the images by one
image per click, for all the layouts.
• Clicking within the scrollbar, but not on the arrows or the bar itself,
causes the next group or previous group of images to display. The
number of images progress by the number that are in the current layout
(that is, the next 9 images are displayed if you are in the 3x3 layout).
• Clicking and holding the left mouse on the scrollbar causes continuous
image scrolling.
9 -2
CT Viewer - 2D mode
Brilliance Workspace Portal - Volume 2
2D Viewer window
9.3
9.3
2D Viewer window
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A typical 2D viewer window is shown below. The 2D viewer allows you to
view axial images in multi-image layouts.
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CT Viewer - 2D mode
9- 3
9.4
Tool panel
9.4
Tool panel
The tool panel of the 2D mode consists of a variety of buttons, boxes, and
tabs that allow you to access the available functions.
The upper third of the panel provides functions for selecting and
manipulating images.
The middle third of the panel provides functions affecting scenes: Series,
Batch, Cine and View functions.
The lower third of the panel consists of the Common Tools. Common
tools provide many basic functions, including saving, filming, reporting,
scrolling, measurements/annotations, panning, zooming, rotating, and
windowing.
9 -4
CT Viewer - 2D mode
Brilliance Workspace Portal - Volume 2
Tool panel
9.4.1
9.4
Orientation and Layout
Orientation and layout allows you to rotate the images on the display and
specify how many images display in the viewport at one time.
Orientation
Flip/Rotate tools - Click the down-arrow to select from four Flip tools:
•
Flip the selected image(s) horizontally, left-to-right.
•
Flip the selected image(s) vertically, top-to-bottom.
•
Rotate the selected image(s) 90 degrees clockwise.
•
Rotates the selected image(s) 90 degrees counterclockwise.
Layout
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Controls how the images display in the viewport. Click the Layout downarrow to select from four image layout arrangements, 1x1, 2x2, 3x3, 4x4,
and Custom.
When changing layouts, the image that was active beforehand stays active
and appears closest to the top left corner as possible, so that no blank
images appear on the screen.
Custom Layouts - In addition to the four standard layouts, you can define
the number of images in the rows and columns.
Brilliance Workspace Portal - Volume 2
1
Click the Custom... button (or use the right-click menu to access
Custom). The Layout dialog box opens:
2
Click the down-arrows to select rows and columns, from 1 to 4.
CT Viewer - 2D mode
9- 5
9.4
Tool panel
9.4.2
Series tab
Series tree
The Series tree appears in all Brilliance Workspace Portal viewers in nearly
identical form.
The series tree is a user interface control that displays a list of the studies
and series that are loaded into the viewer, and also any other elements (like
batches) that have been created.
Small icons in each line (each “element”) of the tree are used to indicate the
element’s status. An icon can indicate whether the element is an image or a
volume.
For more information about this feature, refer to the “Series Tab” section in
the CT Viewer chapter in this volume of the user manual.
9 -6
CT Viewer - 2D mode
Brilliance Workspace Portal - Volume 2
Tool panel
9.4.3
9.4
Batch tab
The Batch function allows you to create a series of sequential 2-D images,
for saving purposes.
There are two batch modes: Image mode and Plan on Surview.
• In the Image mode, you can define a start and end location by
using the first and last image icons, or by typing in the number
of the images you want along with the option to Select every
1,2,3 etc…
• In the Plan on Surview mode, you can define a batch several
different ways; by typing in the numbers, by dragging lines on
the surview, and by scrolling the two reference images to the
start and end locations desired. If you have more than one series
planned from a surview, they can page through them with the previous
and next series arrows, and set batches for each series.
The Surview button is grayed out if there is no surview series
loaded.
Note
Philips Medical Systems 4535 674 64521_A
A parameters frame and/or reference image (if available) can be
added to the batch. The location of these is at the beginning or end, as
determined by the user in Preferences (For more information on
Preferences see the Preferences chapter in volume 1 of this user manual).
Batch Image mode
To prepare a batch of images for saving, reporting or filming:
Brilliance Workspace Portal - Volume 2
1
Scroll to the image you want to be the first image of the batch.
2
Click From. The image number appears in the text box.
3
After the From image has been designated, click and scroll to the image
you want to be the last image of the batch.
4
Click To. The image number appears in the text box.
CT Viewer - 2D mode
9- 7
9.4
Tool panel
-- OR (instead of steps 2, 3, and 4) -5
Click inside the From text box and type in the number of the first
image.
6
Click inside the To text box and type in the number of the last image.
If you do not want every image between the first and last selections to be
part of the batch, change the Select every setting from 1 to any number
between 2 and the last number of the series.
For example, if you select 3, only every third image becomes part of the
batch (1, 4, 7, etc.).
Clear - Clears the current defined batch series.
Parameter Frame - Check the box to add an image of the series (study)
parameters to the Batch.
Reference - Check the Reference box to add a reference image to the Batch.
9 -8
CT Viewer - 2D mode
Brilliance Workspace Portal - Volume 2
Tool panel
9.4
2D Batch Surview
If the study includes a surview, the Surview button shown at left is not
grayed out, allowing you to define a batch using the Surview image.
Philips Medical Systems 4535 674 64521_A
1
Click Surview in the Batch tab. The Batch on Surview window
displays, as shown below.
The main window shows a surview image with a blue graphic box, which
you use to define the surview batch.
The top of box is the first slice in the batch and the bottom of the box is the
last slice in the batch.
To adjust the height of the blue box.
Brilliance Workspace Portal - Volume 2
1
Click the solid green line at the top or bottom.
2
Drag the box to the desired location.
CT Viewer - 2D mode
9- 9
9.4
Tool panel
To move the box up or down:
1
Point to the middle area of box. A cross appears.
2
Drag the box to the desired location.
To reset and re-plan the batch, click Clear Batch.
All graphic tools are available for annotating images.
If more than one series is in the study use the arrows to move to another
series.
You must save the batch before moving to the next series.
Note
Saving and filming batch
A batch created from Image mode can be saved as a permanent series or a
temporary series.
To create a permanent series from a batch:
Define the batch using the From-To method, or the Plan on Surview
method.
2 Click on Save Batch or Save Batch As...
1
The batch is saved as a new series.
To create a temporary series from a batch:
Define the batch using the From-To method, or the Plan on Surview
method.
2 Click on Duplicate.
1
A new temporary series is created; if you exit the viewer it is deleted.
9 -1 0
CT Viewer - 2D mode
Brilliance Workspace Portal - Volume 2
Tool panel
9.4.4
9.4
Cine tab
The Cine function allows you to view (“play”)images in a cine (movie)
mode.
The images shown by Cine can be of the Whole Study or of the defined
Batch.
Whole study - The entire selection in the series tree is played, regardless of
the selection mode, and in their displayed order (including combine and
sort).
If you are in the compare mode, the selected viewports play.
Batch - (The Batch selection is grayed out if no batch was created.) Click
the Batch button to select batch mode. The batch cine display includes the
surview and the parameters frame, if they were created
You can play the cine forward or backward using the arrow buttons, and
you can pause the display.
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Cine speed is measured in frames per second and can be changed before
and during play. Speed range is from 1 to 25 frames per second.
Progress bar
The Progress bar indicator shows cine progress. The bar is interactive: you
can drag the indicator to scroll the images. When you release the indicator,
cine continues.
Manual scrolling
During cine, you can scroll images with the scroll bar, the left mouse
button, and the arrow keys. The cine continues after you stop manual
scrolling.
Brilliance Workspace Portal - Volume 2
CT Viewer - 2D mode
9- 11
9.4
Tool panel
Cine image layout
When you click Play in the CT Viewer - 2D mode, the layout changes to
1x1 (except when in surview\Compare mode).
• When you click Play in compare mode, the layout does not change.
• When you click Play in surview mode, the cine is in the large view port.
If you switch to another layout during play, the play pauses, and then
resumes.
9.4.5
View tab
Selection
Use these tools to select:
• One image
• A series of images
• A screen (the whole window)
• All images loaded in the viewer
Selecting images allow you to
perform the same manipulation on
the image(s) of your choice, such as leafing, panning, zooming, filming, or
saving.
Note
9 -1 2
CT Viewer - 2D mode
• The selected images are enclosed within a orange frame.
• The active image is enclosed within a blue frame. Operations are
performed in real-time on the active image, while the rest of the selection
is updated during pauses.
Brilliance Workspace Portal - Volume 2
Tool panel
9.4
Create temporary series from selection (Duplicate)
The Duplicate function creates a temporary series from the active selection
(the series is highlighted black in the series tree).
The duplicate series icon in the series tree appears faded; a 1 is appended to
the series number. The temporary series can be saved with the Save
function.
1
Use the Selection function to select the images you want to create a new
series from.
2
Click the Duplicate button.
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The selected series are duplicated into a new temporary
series.
The new series:
• contains the images that were selected when the duplicate was
performed, including any sorting and combining
• appears after the original series, both in the viewport and in the series
tree
• in the series tree, becomes selected, as do all the series that contain
images that were duplicated.
You can now activate the Compare mode (described next) to show the
highlighted original series and duplicated series side by side.
The duplicated series has a faded icon in the series tree, indicating that it is
not saved.
Brilliance Workspace Portal - Volume 2
CT Viewer - 2D mode
9- 13
9.4
Tool panel
The Alternate function
The Alternate function allows you to define two different window/level
presets for the same image(s).
Procedure to activate the Alternate function:
9 -1 4
CT Viewer - 2D mode
1
Select the images that you want to view in the Alternate function.
2
Set the window/level as desired.
3
Click the Alternate button.
4
Set the window/level for the Alternate view.
5
To toggle between the two views, click the Alternate button.
Brilliance Workspace Portal - Volume 2
Tool panel
9.4
The Clone function
Use the Clone function to copy the windowing, zoom, pan, enhancement,
and inverse window parameters from one image (the “source”) to one or
more other images (the “target”).
1
Select the images you want to apply the Clone function to.
2
Click the image from which you want to copy the parameters. It
becomes “Active,” with a blue frame. This is the source image.
3
Click Clone. The Clone button appears pressed. This saves the
parameters from the source image.
4
Scroll to the “target” image with the mouse wheel or the scroll bar and
click on the target image.
The parameters that were saved from the source image are applied to the
target image(s), and the Clone button becomes un-pressed.
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To Clone the settings of one image to an entire series:
Note
1
Click on the source image.
2
Click Clone.
3
Change the selection to “Series.”
4
Click on one of the images of the series.
• If you click Clone while it appears pressed, the cloning function is
cancelled.
Clone is based on the Selection mode.
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CT Viewer - 2D mode
9- 15
9.5
Compare
9.5
Compare
The Compare function allows you to perform a side-by-side review of
several selected elements from the series tree.
A duplicated series is automatically created when Compare is selected, if
there is only one series loaded in the viewer. If you have two series, you have
a choice of vertical or horizontal layouts. If more than one series is loaded,
the system formats the screen to fit the number of series loaded.
Note
The series to be compared are the ones highlighted in the series tree,
regardless of the selection mode.
When you select one series and click Compare:
• The series is duplicated (a "twin" series is created).
• Both series are selected and shown side by side in Compare mode.
If you select a series that already has a duplicated (twin), and you click
Compare, it does not duplicate again. Instead, the twin is automatically
selected for the compare mode.
Three selection modes are available in the compare mode:
• Series mode - one series is selected. Click on the series to be scrolled.
• All mode (default) - used to scroll together all of the compared series.
• Image mode - functions in the same was as a series mode.
9 -1 6
CT Viewer - 2D mode
Brilliance Workspace Portal - Volume 2
Compare
9.5.1
9.5
Sorting and combining compared items
The Sort function and the Combine every X function are available and are
performed only within each selected series.
Sort
The Sort function allows you to sort images using DICOM tags.
Note The Sort function is applied to the series that are selected
and shown in the image area.
You can use factory defined sorting options or you can create your own by
choosing Custom from Select sort.
The Sort function presents a dialog box (shown at left) that allows you to
sort by options.
Philips Medical Systems 4535 674 64521_A
You can define the sort direction, ascending or descending. You can
preview, save and delete sort options. Factory defined sorting options are
available or you can create your own by choosing Custom from Select sort.
Brilliance Workspace Portal - Volume 2
1
Click the Sort button. The sorting dialog box appears.
2
Use the Select sort drop down to select
from the factory sorts (shown at right),
or create your own sort with Custom.
3
You can also click in any of the fields in
the Sort by fields and select desired
parameters (as shown at left).
4
Set the desired Priority. The highest
priority is 1; the lowest is 5.
5
Set the direction. The up arrow denoted ascending sort and the down
arrow denotes descending sort.
CT Viewer - 2D mode
9- 17
9.5
Compare
6
Click Preview to perform the sort without closing the dialog, allowing
you to examine the results.
7
Click OK to accept the sort. The dialog closes and all changes that were
done are saved.
This does not save the sort. (Refer to “Save a sort preset,” below.)
Note
-- OR -8
Click Cancel to close the dialog without saving the new sort. The data
remains sorted as it was before the dialog was opened.
Save a sort preset
You can save a preset for sorting and access it later from the Sort dialog box.
To create a new sort preset:
1
Select Custom from the Select sort drop down.
2
Select Sort by, the direction, and the priority.
3
Enter the name in the blank Select sort field.
4
Click Save sort.
Delete sort
Click Delete sort to delete the current preset from the list. The sort presets
are not case dependent (upper-case and lower-case characters are not
distinguished by the sort).
Note
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CT Viewer - 2D mode
Be careful when deleting. Factory sorts can be deleted.
Brilliance Workspace Portal - Volume 2
Combine
9.6
9.6
Combine
Basic Combine function - The basic Combine function combines groups
of original thin “slices” into fewer, thicker “slices” for viewing, filming,
reporting or saving.
Advanced Combine function - The Advanced Combine function allows
you to manipulate the basic combined sets of images by adding them to
each other or subtracting them from each other (within each combined
image set). The primary use is to perform subtraction on contrasted and
non-contrasted studies. You can also have the basic combined images
displayed in a way that shows, in each pixel location, either the minimum
(“Min”) or the maximum (“Max”) value pixel.
Combined images should not be used as the sole basis for clinical diagnosis.
Wa r n i n g
9.6.1
Basic Combine procedure
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The Combine function operates on every image of the loaded series. Images
are combined in the order they appear in the viewport. The series must be
active in the viewport.
The Combine every: field allows you assign to an integer number value for
the number of sequential images you want to combine.
Note
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1
Select the series that you wish to combine from the Series tab.
2
Click the dropdown arrow next to the Combine every: button and
select the desired Combine value. (You can also click in the field and
type in the value and press <Enter>).
3
The series is combined.
Images that remain at the end of the series that are fewer than the integer
value are not combined.
CT Viewer - 2D mode
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9.6
Combine
As an example, if the order of the images that you want to combine is 1, 2,
3, 4, 5, 6, etc., and you select “Combine every: 3,” the result is:
• the new image 1 is created from original images 1, 2, and 3
• the new image 2 is created from original images 4, 5, and 6
• etc.
The word “Combine” is added to the image label in the new combined
images.
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CT Viewer - 2D mode
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Combine
9.6.2
9.6
Advanced combine (overview)
Note
The Advanced Combine button is grayed out for each series until the
“Combine every:” number has been selected.
After you have combined a series of images, the Advanced Combine button
becomes active.
Clicking the Advanced Combine button activates the function. The
Advanced Combine dialog box displays.
Combine Images dialog box
Below are examples of how the Advanced Combine dialog box looks when
it opens, depending on how many images you selected for the Combine
every: parameter.
Combine every: 5
Combine every: 6
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Combine every: 2
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9.6
Combine
When Combine every: is set at 5 or fewer images
By default, when the Combine Images dialog box opens with Combine
every: set at 5 or fewer, the weight fields are active, and you can enter the
desired weight values.
When Combine every: is set at 6 or more images
When you Combine every: 6 or more images, you cannot set the weights.
The weight value is labeled “All,” and the value is grayed out.
Advanced Combine operations
There are three Advanced Combine operations: Sum, Min and Max.
Min (minimum) or Max (maximum) - Select one of these operations to
produce a series of 2D images based on either the minimum or the
maximum value of each of the original pixels that were combined to form
the new images. A Minimum image is a 2D image of the lowest intensity
pixels and a Maximum image is a 2D image of the brightest pixels.
Sum - Select this operation if you want to create a single “added” or
“subtracted” image from each of the combined images in the series.
Weighting of Summed Images
This parameter determines whether an image can be added or subtracted. A
numerically positive weight causes the image to be added. A numerically
negative weight causes the image to be subtracted.
Equal weighting - When the dialog box is first opened (when you are
working with 5 or fewer combined images) the system equally distributes
the weighting among the images. All weight values are numerically positive,
and their sum equals 1.00.
Adding images - When adding images (up to 5), you can assign positive
weight values as desired (between 0 (zero) and +100. A greater weight
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Combine
9.6
causes an image to have greater influence on the final, summed image. A
lesser weight has lesser influence.
Subtracting images - Subtraction is usually used to subtract 2 studies of the
same patient: one study is non-contrasted and the other is contrasted. To
select this subtraction assign weights of +1.00 and -1.00, respectively.
Normalize weights - Normalization is a feature that proportionally adjusts
the weights you assign, so that the resulting images display in the normal
CT scale. (Without normalization, if the sum of the weights you assign is
greater or less than 1.00, the resulting CT values are biased, causing the
image to be darker or lighter than normal.)
Notes
• Normalization SHOULD BE USED when adding series (when all weights
are zero or greater).
• Normalization SHOULD NOT BE USED when subtracting series (when
weights are both positive and negative).
• If the sum of all weights equals 1.00, normalization does not influence the
results.
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Bias - Use the Bias parameter to add a constant CT value to the resulting
images. The default Bias value is 0 (zero). The Bias dropdown list offers
these values: 0, 24, 1000, and1024. You can also type a Bias value between
-1000 and 3095 for CT (or between -4095 and 4095 for MR). Bias can be
changed at any time, before or after you see the results.
Use Preview to perform the Advanced Combine and view the results
without closing the dialog. You can then adjust parameters and perform the
combine as often as desired.
Use OK to close the Advanced Combine dialog and save all settings and
changes you made.
Use Cancel to close the Advanced Combine dialog without saving the
combine results. The data reverts to its state before the dialog was opened.
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CT Viewer - 2D mode
9- 23
9.6
Combine
9.6.3
Advanced combine procedure: subtract images
The following procedure describes how to use the Advanced Combine
function to subtract 2 studies of the same patient, one pre-contrast and one
with contrast.
• Refer to the previous section “Advanced combine (overview)” for details
about the parameters to use for Advanced Combining.
• When subtracting images it is important for the images to have the same
Z location to achieve accurate results. The Z location can be off by a small
amount, but results are not optimum. In steps 8 and 9 below, you are
advised of your options.
Note
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CT Viewer - 2D mode
1
From the Directory, select a study without and with contrast, each
having the same number of images.
2
Load the study to the CT Viewer.
3
Select the 2D Viewer.
4
Click the All selection mode.
5
Make the non-contrast study “active”
by clicking on it in the series tree. It is
be highlighted in black.
6
Click Sort. The Sorting box opens.
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Combine
7
Click the Select sort button. A dropdown list opens.
8
If your Z locations are accurate, select Mixed Series (Z pos.).
9.6
-- OR -9
If your Z locations are off by a small amount, select Mix Series
(Image#).
10 Make sure the pre-contrast series is the first image, then click OK.
11 Set Combine every: to the value 2. The Advanced Combine button
becomes active.
12 Click the Advanced Combine button. The Combine Images dialog
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box showing 2 Weight fields opens.
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9.6
Combine
13 To perform subtraction, change the Weights to 1.00 and -1.00.
14 Uncheck Normalize weights.
15 Adjust Window and Center as desired, and change Bias as desired.
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Combine
9.6
16 Click the Preview to see the result. Below is a subtracted image of the
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study shown above. The bias for this image is set at 1000.
Conclude the Advanced Combine function as follows:
1
Click OK to close the dialog and save all changes that were done.
-- OR --
2
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Click Cancel to close the dialog without saving the combine results.
The data reverts to its state before the dialog was opened.
CT Viewer - 2D mode
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9.6
Combine
9.6.4
Other Combine procedures
To use combined images in a different scene:
You cannot use combined images in other scenes unless you save and load
them from the Directory.
Note
1
Perform the Combine function.
2
Click Duplicate. This creates a temporary series (of the combined
series), which can be viewed in any of the scenes.
To combine 2 series into 1:
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CT Viewer - 2D mode
1
Select the two series in the series tree.
2
Click the All selection mode.
3
Click the Sort button. The Sort
dialog box opens.
4
Select Custom.
5
Set the first priority to Image
number.
6
Click OK. The 2 series are
combined into 1.
Brilliance Workspace Portal - Volume 2
Common tools
9.7
9.7
Common tools
The common tools area provide many basic functions, including
measuring, saving, image selection, panning, zooming, rotating, and
windowing. Common tools are, in general, common to all the CT Viewers,
and are shared with many other applications of Brilliance Workspace
Portal. If a common tool has a special function in the Volume mode, that
function is described in this chapter.
For more information about the Common Tools, refer to the “Common
Tools” section in the CT Viewer chapter in this volume of the user manual.
Relate function - In the 2D Viewer, the Relate
viewports function is grayed out.
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Only Relate scenes is available, allowing you to
mark a point in any axial image and then switch
to another scene (Slab, Volume, or Endo) and
view the related points in other orientations.
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CT Viewer - 2D mode
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10
10.1
CT Viewer - Slab mode
Overview
The CT Viewer - Slab mode allows you to view and rotate slab images. You
can perform some tissue definition functions, and can also create Curved
Planar Reformat (cMPR) images.
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Slab is the default viewer when you open the CT Viewer. Below is the
opening window of the Slab viewer.
Note
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The opening window shows the Slab mode. An alternate viewing mode is
the Planar mode.
CT Viewer - Slab mode
10-1
10.1
Overview
Slab mode - The Slab mode window consists of a slab image in the main
image viewport and two reference orthogonal viewports at the right.
You can view the slab image by rotating it and changing its thickness. You
can set the slab’s rotation center by moving the cross hairs in the reference
images.
The two reference images on the right show orthogonal axis orientations
(regardless of slab rotation in the main image). Color-coded cross hairs in
the reference images indicate the orthogonal axes: axial (red), coronal
(green), and sagittal (blue). Only the axial (red) crosshair can be rotated.
A paddlewheel function allows viewing images radially around a horizontal
axis. (Paddlewheel is not available in Planar.)
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Slab viewer tools
10.2
10.2
Slab viewer tools
Orientation
Use these buttons to select the viewing orientation of
the main viewport: axial, coronal, or sagittal.
Planar mode
Use this mode to view the three orthogonal plane images. The planar mode
is activated by the Planar button which displays the three orthogonal views
in three viewports. There is no “main” or Slab image.
Each image can be manipulated independently, while the axes remain
oriented at 90 degrees to each other.
Crosshairs appear on all 3 planar viewports. They can be moved and
rotated.
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The crosshairs mark rotation center in the Planar mode, around which the
views can be rotated.
Changing the rendering and thickness in one Planar viewport affects all
viewports.
Layout
There are 2 normal layouts and 1 curve layout:
• 1+2 layout - This layout consists of one main image
and 2 reference images.
• 2X2 layout - This layout shows equal size viewports
in 4 quadrants. In these two layouts there is the
option to display the surview image (if it was loaded
with the study) or MPR images.
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CT Viewer - Slab mode
10-3
10.2
Slab viewer tools
To switch any image to another viewport, click and hold the right
mouse button and drag the viewport to the desired position.
To change reference images to Surview images:
1 Right click over any viewport.
2 Select Reference Images from the submenu.
3 Select the Coronal Localizer or Sagittal Localizer.
4 Repeat to change other reference image.
• 1+3 layout - When you activate the Curve mode, a third reference
viewport is added to the layout. This displays the 3 orthogonal views,
with the results of the drawn path in the upper right viewport.
10.2.1
Series tab
Series - The series tree is a user interface control that displays a list of the
studies and series that are loaded into the viewer, and also any other
elements (like batches and parameters) that have been created. More
information about the Series tree is given later in this chapter.
Batch - The Batch function allows you to create a series of sequential slab
images for saving, reporting and filming purposes.
Cine - The Cine function allows you to view (“play”) images in a cine
(movie) mode.
Clip - The Clip function is used to remove unwanted anatomy from the
slab images.
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Slab viewer tools
10.2.2
10.2
Batch tab
The Batch function allows you to create a series of slab images for saving,
reporting, and filming purposes.
You can add a mini image and reference image to the batch, and can add a
Series parameters frame.
To prepare a batch of images
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Note You can create a batch using any of the viewports. For example, to
make a batch of coronal images, click in the coronal viewport, then
follow the procedure below.
1
Scroll to the image you want to be the first image of the batch.
2
Turn off Show crosshair (under the
View tab).
3
Click From (Mark First).
4
After the From image has been designated, scroll to the image you want
to be the last image of the batch.
5
Click To (Mark Last)
-- or (instead of steps2, 3, and 4) --
Brilliance Workspace Portal - Volume 2
6
Click All to select all images. The full volume batch is created, using the
thickness shown in the Batch tab.
7
Clear - Use this button to clear the current defined batch series. Now
you can start defining a new batch.
CT Viewer - Slab mode
10-5
10.2
Slab viewer tools
Additional batch parameters
After defining the range of the batch, you may set additional parameters:
Thickness - You can change the thickness of the slabs in the batch. The
thickness parameter applies only to the active image (the one with the blue
frame).
Note
Reference images are linked, therefore they are all active when selected.
You have three options for changing the slab thickness:
• Type a value in the thickness box.
• Click the up or down arrows in the box. Each click on the arrows
changes the thickness value by the slice increment.
• Hold down the <shift> key, place the cursor on the image, and using
the left mouse button drag up and down.
The default slice increment depends on the slice thickness and number of
images chosen.
Increment - You can change the distance between each image of the batch.
Changing the increment changes the number of images, but not the range
of the batch.
No. Images - You can change the total number of images. Changing the
number of images changes the increment, but not the range of the batch.
Representation of batch on reference image
Note
You can specify whether or not the batch is graphically represented on a
reference image. Refer to the Preferences chapter in volume 1 of this user
manual.
Shown below is an example reference viewport image after the batch has
been created, and after the “number of images” and the “increment”
parameters have been set. Blue lines extend across the image to show the
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Slab viewer tools
10.2
extent of the batch. A text annotation “1” at upper left indicates the start
(“From” location) of this particular batch. Blue tick marks along the left
and right edges mark the locations of the individual batch images.
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Mini Image - After the batch is defined, the +
symbol for Mini Image (and Reference Image) turn
golden. The Mini Image function places a small
image in the lower-right corner of the main image.
Click the golden + symbol. The Mini Image selection window opens,
showing the available reference images. Only one can be selected.
Select one of the images. If you select None., the dialog is closed without
adding a mini image.
Reference - You can include a reference viewport
image in the batch. Click the Reference + symbol.
The same window as in Mini Image is opened. Select
an image or select None.
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CT Viewer - Slab mode
10-7
10.2
Slab viewer tools
Parameters - You can include a study parameters frame, as shown below, in
the batch by clicking the check box.
Save the batch
You can specify whether or not the batch is shown in a preview display
before you actually save it. Refer to the Preferences chapter in volume 1 of
this user manual.
Note
1
Select Save Batch or Save Batch As... from the common tools. (Refer to
the Common Tools section in the CT Viewer - 2D mode chapter for
more details.)
After clicking Save Batch or Save Batch As..., if system Preferences is
set to do so, the system automatically displays the sequence of batch
images in the batch window, and stops on the last frame.
2
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CT Viewer - Slab mode
If the batch is not what was desired, click Cancel.
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Slab viewer tools
10.2
3
If the batch is satisfactory, you may choose to Add to Series Tree by
clicking the check box. This adds the saved batch into the Series tree to
allow you to continue working with it.
4
To perform the final Save Batch step, click Save.
-- OR -If Save As... was selected, the Save Batch As... dialog box opens.
6
Type in label and make selections for image type and location.
7
Click Ok.
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5
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CT Viewer - Slab mode
10-9
10.3
Cine tab
10.3
Cine tab
The Cine function allows you to view (“play”) images in a cine (movie)
mode.
Whole study - The entire selection in the series tree is played, regardless of
the selection mode, and in their displayed order (including combine and
sort).
Batch - (The Batch selection is grayed out if no batch was created.) Click
the Batch button to select batch mode. The batch cine display includes the
surview and the parameters frame, if they were created.
You can play the cine forward or backward in a continuous mode (loop),
and can pause the display.
Cine speed can be changed before or during play. Speed range is from 1 to
25 frames per second.
Progress bar
The Progress bar indicator shows cine progress. The bar is interactive: you
can drag the indicator to scroll the images. When you release the indicator,
cine continues.
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CT Viewer - Slab mode
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View tab
10.4
10.4
View tab
The View tab in the Slab mode defaults to the Average rendering mode,
and appears as shown at left.
Depending on the rendering mode you select, additional parameters may
be displayed in the rendering section of the tab.
The Rendering modes are summarized later in this chapter (and described
in detail in the CT Viewer - Volume mode chapter, in this volume of the
user manual).
Thickness
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The thickness parameter applies only to the active image (the one with the
blue frame).
Note
Reference images are linked, therefore both are active.
You have three options for changing the slab thickness:
• Type a value in the thickness box.
• Click the up or down arrows in the box. Each click on the arrows
changes the thickness value by the slice increment.
• Hold down the <shift> key, place the cursor on the image, and using
the left mouse button drag up and down.
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CT Viewer - Slab mode
10- 11
10.4
View tab
Paddle wheel
The Slab viewer offers both the normal viewing mode and the paddlewheel
mode.
The normal mode allows you scroll and view images that are parallel to
each other (that is, in parallel slices).
The paddle wheel mode allows you to
scroll and view images radially around a
horizontal axis. (The image at right, from
the Paddlewheel Batch function,
demonstrates the paddle wheel effect.)
The location of the line in the volume is
determined by the cross hair on the
reference images.
To use Paddle wheel function
The Paddle wheel function is available
only when the main viewport is the active image and the Planar mode is not
active.
Paddle wheel - Click the Paddle wheel check box.
Scroll the main viewport to navigate through the generated paddle wheel
MPRs. The image rotates around the axis that is set by the crosshair in the
reference images. The reference images remain constant.
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View tab
10.4
Rendering modes
All of the images in the display can be viewed in each of the available
rendering modes. There are six modes of rendering you can choose from:
Average
Average is the default rendering mode. Average renders according to the
average value along the path (ray) through the patient.
MIP (Maximum Intensity Projection)
MIP displays the highest intensity (maximum intensity Hounsfield unit)
voxel along a particular projection through the volume dataset. This creates
a 2D image of the brightest voxels.
VIP (Volume Intensity Projection)
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Volume Intensity Projection, like MIP, displays the highest intensity voxel
along a projection through the volume dataset. Unlike MIP, VIP assigns the
highest intensity, or greatest brightness value, to voxels closest to the eyepoint, while those further away are faded, according to their distance from
the eye-point.
MinIP (Minimum Intensity Projection)
MIP displays a 2D image of the lowest intensity (minimum intensity
Hounsfield unit) voxel along a particular projection through the volume
dataset. These images can demonstrate respiratory airways.
Surface MIP
Surface MIP rendering allows you to generate volume images by detecting
tissue surfaces based on the Distance (display depth) and Threshold
(Hounsfield Units).
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CT Viewer - Slab mode
10- 13
10.4
View tab
When the projection ray hits a voxel having an HU value equal to or larger
than the threshold, an MIP calculation is started for the distance (mm)
specified.
Volume Rendering
Wa r n i n g
The volume image displays the anatomy according to the defined protocol.
Do not use the volume image as the sole basis for a diagnosis.
Volume rendering assigns opacity and color to every voxel according to
rendering protocols for vasculature, soft tissue, and bone. Selected
structures can be rendered opaque, translucent, or invisible, allowing
visualization through and beyond contiguous structures.
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View tab
10.4
Rotation center and crosshair tools
Rotation Center - Click to show the center point (the green X) around
which the volume can be rotated.
Show Crosshair - Click to show the defaulted on crosshairs on the reference
images.
Center Cursor - This function moves the middle of the image to
the rotation center, centering the image around the rotation
center. Change the rotation center as follows:
1
Move mouse over the current rotation center (the green X) in the slab
view. The mouse pointer turns into an arrow cross symbol.
2
Drag the rotation center to the desired region of interest.
3
Click Center Cursor and the slab view centers around the new rotation
center location.
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The rotation or paddle wheel now rotates around this new rotation
center.
Swivel the slab
The Swivel function allows you to follow any anatomy which cannot be
seen in its entirety in one orientation.
Note
Brilliance Workspace Portal - Volume 2
1
Position the rotation center near the middle of the anatomy.
2
Click the Swivel button to enable the swiveling function.
3
Using the left mouse button, swivel the image until the desired image is
obtained.
Swivel does not work when Paddle wheel is selected.
CT Viewer - Slab mode
10- 15
10.5
Tissue management
10.5
Tissue management
Note
The Tissue Management function is also available in the Volume and Endo
viewers. Operation of the function in those viewers is the same as described
below.
The Tissue Management function allows you to control the viewing of the
volume, based on the tissue definitions for the current study that have been
created in the current work session, or that were previously saved from this
and other applications.
Many tissues can be associated with the current study, including:
• Bone removal.
• Sculpting.
• Segmentation of vessels, liver and kidney, airways, as well as volume
tracing (these functions are not available in the Slab mode).
Click the Edit Tissues button (located under the View tab) to open the
Tissue Management dialog, from where you can control tissue activation.
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Tissue management
10.5
The Tissue Management dialog lists all current and all saved tissues.
Label - Each tissue is identified by its name.
Saved - Tissues saved and or loaded from the archive manager are
marked with the Saved icon. If a tissue has not been saved, the icon
is not shown.
Volume - The Volume represents the original volume in the application. In
effect, this is “no tissue,” just the original volume.
Active - A tissue can be activated\deactivated using this check box.
Tissues that are not active have no affect on what is shown in the
view port.
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Each active tissue can influence the volume in two ways: Show and Hide.
Show - When the Show button is clicked, the part of the volume
defined by the tissue is visible on the view port.
Hide - When the Hide button is clicked, the volume defined by the
tissue is subtracted from the volume shown in the view port. (If you hide a
tissue, its rendering parameters are grayed out.)
Note
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• The show and hide buttons are grayed out if the tissue is not “active.”
• When opening the Tissue mode, saved tissues are either shown or hidden,
depending on the mode they were in when the tissue was saved.
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10.5
Tissue management
Tissue selection
Rendering tools only affect the selected tissue. The selected item is
highlighted in violet color. Only one item in the list can be selected at a
time.
By default, Volume is the selected item when the dialog is opened.
The rendering parameters of the selected tissue are shown on the toolbox,
in the rendering area. If the selected item is not active, the rendering
parameters are grayed out.
You can change the volume protocol of the selected tissue with the middle
mouse button.
Note
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CT Viewer - Slab mode
• Sculpting affects only tissues that are currently active.
• Sculpting of tissues does not affect them permanently. “Reset all” returns
the tissues to their previously un-sculpted state.
• Tissues can also be shown (with their classification) in other rendering
modes besides Volume rendering.
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Tissue management
10.5
• A tissue can be seen in all volumetric scenes, regardless of where it was
defined.
• When loading the tissues, only the volume scenes are affected.
• Controlling the tissues is done separately in each scene.
• The rendering of the tissues is the same in all scenes.
Saving tissues
Use the Save Tissue or Save tissue(s) as... function in the Common tools to
save tissues.
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Note that when you save tissues, you are saving all tissues shown on the
display.
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10.5
Tissue management
10.5.1
Curve
Note
• The Curve function is also available in the Volume and Endo scenes.
Operation of the function in those viewers is the same as described below.
• The curve function is not available in the Paddle wheel mode.
The Curve function allows you to draw a curve (or load an existing curve).
A curve is used for two purposes:
• To produce a Curved Planar Reformat (cMPR) image.
• To produce a curved path for the Endo viewer’s fly through function.
Once a curve is saved, it becomes associated with the study and can be
loaded along with the study into other viewers and some applications.
The available layouts in the curve mode are 1+3 and 2x2.
Note
If you are in the 1+2 layout when you enter the Curve mode, the layout
automatically switches to 1+3.
Activate the curve mode
To activate the Curve mode, click the Curve Mode button (under the View
tab).
If a curve has not been created or saved for this study, the tools appear as
follows:
When you click the down arrow, Load Curve becomes enabled if there are
existing curves. When the button is clicked a dialog with the list of curves
appears, allowing you to select a curve for loading.
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CT Viewer - Slab mode
Brilliance Workspace Portal - Volume 2
Tissue management
10.5
To draw a new curve or load an existing curve, click the dropdown arrow.
Select either the Draw Curve or Load Curve function. If there is no saved
curve, the Load Curve selection is grayed out.
Upon entering the Curve mode (if there is an existing curve), the last curve
that was active is shown in the viewports, and the images in the viewports
are shown in the state they were in at the end of the last completed Curve
mode session. The cMPR image is in the same orientation as in the last
session.
Show path is active (checked) by default. Unchecking it hides the curve.
Curve result screen button is grayed out if there is no curve drawn or saved
for the study. The button is shown in full color if a curve exists. When you
click the Results button, the layout changes and shows the cMPR images
produced by the curve.
Note
If you have been drawing a new curve, and you select Load Curve, you are
prompted to save the current curve before loading a new one.
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Load curve
If you select Load Curve, the following dialog appears, showing the list of
all saved curves associated with this study:
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CT Viewer - Slab mode
10- 21
10.5
Tissue management
The available curves for each study are the ones planned on that study. Also
available are the curves planned on another volume, from another
reconstruction of the same scan.
Curves that are created and saved in Brilliance Workspace Portal version 2.5
applications are valid in all CT Viewing modes.
Draw a curve
In the curve drawing mode, you can use any of the view ports to define a
curve. Use the middle mouse button or arrow keys to scroll.
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CT Viewer - Slab mode
1
Click on the Draw curve button. The cursor changes to a pencil.
2
Click the point where you want to draw your curve.
3
Move the mouse to the next location and click to place another point.
4
Repeat the point and click procedure until you are finished drawing the
curve.
5
Double click to end the curve.
6
Click on the Curve results screen button to display the cMPR images.
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Tissue management
10.5
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In the Draw Curve mode, the layout of the display changes as follows:
1
Before you draw, the slab and 2 reference images are shown (image 1,
above). The upper-right viewport is blank.
2
While you are drawing, the cMPR image appears in the upper-right
viewport (image 2, above).
3
While you are drawing, the projection of the curve appears on all the
reference viewports, and is updated in real time.
4
After you click the Curve results screen, the two cMPR images are
shown in the upper-right viewports and the result image is shown in the
lower-right viewport (image 3, above).
How to start a new curve
Use this procedure to draw a new curve, when one already exists.
Brilliance Workspace Portal - Volume 2
1
Click on Draw Curve.
2
On a point that is not near any existing curve point, click on a new
starting point. The old curve is removed and a new one started.
3
Move the mouse to the next desired point (in any viewport) and click.
4
Repeat the point and click procedure until you are finished drawing the
curve.
5
Double-click to end the curve.
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10.5
Tissue management
cMPR image
• Changing the orientation of the images updates the cMPR image.
• The cMPR image grows interactively with each click.
• The cMPR image can be swiveled around the path.
Note
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CT Viewer - Slab mode
• The curve is shown in all viewports.
• All volumetric scenes are in the curve mode simultaneously, and show the
same curve.
• You can rotate the slab image, using Swivel to reveal hidden parts of the
anatomy.
• If you start a new curve without saving the current one, the first curve is
discarded.
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Tissue management
10.5
Edit a curve
You can edit the shape of any curve, whether it has been saved or is new, by
dragging its control points.
As long as the Curve mode is active, the curve can be edited.
Editing can be done in any viewport, including in the Curve Result screen.
• To add a point in the curve, make it active by double clicking on any
control box on the curve. Move the mouse near the curve. The cursor
changes to a plus sign (+) (“add point”). Click the point on the curve
where you want to add a new point.
• To delete a point (the curve must be active), move the mouse over the
curve to the point you want to delete and click on it. Its control point
becomes a bold yellow. Hold down the <Ctrl> key. An X appears next
to the cursor. Click on the point to delete it.
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• To continue (extend) an existing curve, move the mouse over the end
or start of the curve and click to make it active. The move the cursor off
the end until a plus (+) sign appears. Click to place point(s) to extend
the curve.
-- OR -After making the curve active right click and select Extend Curve. Place
points to extend the curve.
• To finish editing a curve, press <Esc> or double-click the left mouse.
You can draw the curve in any of the viewports. After you finish drawing
(double clicking) in one viewport, you can continue on another viewport
by clicking on the end point (the cursor displays a + sign), then clicking on
a nearby area.
You can “extend” a completed curve with the “Extend Curve” function,
available in the right-mouse menu.
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CT Viewer - Slab mode
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10.5
Tissue management
Save a curve
To save a curve select either the Save or Save As... function in the Common
tools (Save is shown at left). Then select either Save Path or Save Path As...
Save path saves the path by a generic name, starting with “Path: Curve 1”.
Save Path As... opens a dialog (shown below) that allows you to type in a
name for the curve, and to select a device.
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CT Viewer - Slab mode
Brilliance Workspace Portal - Volume 2
Clip tab
10.6
10.6
Clip tab
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For more information about the Clip tab refer to the “Clip” section in the
CT Viewer - Volume mode chapter in this volume of the user manual.
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CT Viewer - Slab mode
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10.7
Common tools
10.7
Common tools
The common tools area provides many basic functions, including
measuring, saving, panning, zooming, rotating, and windowing. Common
tools are, in general, common to all the CT Viewers, and are shared with
many other applications of Brilliance Workspace Portal. If a common tool
has a special function in the Slab mode, that function is described in this
chapter.
In Slab images, measurement graphics (such as line and angle) are 2dimensional.
For more information about Common Tools refer to the “Common Tools”
section in the CT Viewer chapter in this volume of the user manual.
Relate in Slab viewer
In the Slab viewer the relate point is positioned in the middle of the slice
thickness.
As a consequence, if a relate point is created on a vessel when the slab
thickness is set to 10 mm (for example), the vessel might not appear in the
reference ports because the vessel may not pass through the middle of the
slab.
To prevent this, you can set the slab to the minimum thickness so that
when you create a relate point over the vessel, the desired vessel appears in
the reference images.
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CT Viewer - Slab mode
Brilliance Workspace Portal - Volume 2
11
11.1
CT Viewer - Volume mode
Overview
The Volume mode is used to display CT scanner data in a full volume
image. The data set can be rendered in various modes, including Volume
rendering, Minimum and Maximum Intensity Projection (MIP and
MinIP), Volume Intensity Projection (VIP), and Surface MIP.
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The Volume viewer opening window is shown below.
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CT Viewer - Volume mode
11-1
11.2
Volume viewer window
11.2
Volume viewer window
Orientation and layout
Orientation - Use these buttons to select the viewing
orientation of the main viewport: axial, coronal, or
sagittal.
Flip - Flip the main image 180 degrees.
Layout - Two layouts are available, 1+3 and 2x2. The
currently active layout is displayed by the icon. Click the
down arrow to select the alternate layout.
In the 1+3 layout, the images consist of the volume
image in the main viewport and the axial, coronal, and
sagittal images from top to bottom in the reference viewports.
The 2x2 layout has the
same views as 1+3, but is
arranged differently, as
shown in the diagrams at
right.
1 1 -2
CT Viewer - Volume mode
Brilliance Workspace Portal - Volume 2
Volume viewer window
11.2.1
11.2
Volume viewer tab menus
Note
• Tab menus (except Series) are described in detail later in this chapter.
• The Series tab is described in detail in the “Series tree” section of the
CT Viewer chapter, in this volume of the user manual.
Series - The series tree is a user interface control that displays a list of the
studies and series that are loaded into the viewer, and also any other
elements (like batches and parameters) that have been created.
Batch - The Batch function allows you to create a series of images for
saving, reporting and filming purposes.
Cine - The Cine function allows you to view (“play”) images in a cine
(movie) mode.
View - The View tab allows you to access various viewing tools and
functions like rendering modes, thickness, protocols, curves and volume
calculations.
Clip - The Clip function is used to remove unwanted anatomy from the
volume, using tools like bone removal, volume tracing, and/or sculpting.
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Tissue - The Tissue function provides a variety of tissue defining tools,
including segmentation, sculpting, bounding boxes, and clipping planes.
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CT Viewer - Volume mode
11-3
11.3
Batch tab
11.3
Batch tab
The Batch function allows you to create a series of volume images for
saving, reporting and filming purposes.
Note
Some of the features of the batch tab change, depending on the active
image (with the blue frame). With active reference images, batch functions
are like those in the Slab viewer, except with no mini or reference images.
From: and To: - To prepare a batch, use the From and To buttons to
indicate the extent of the batch.
Unlike the way Batch operates in CT Viewer - 2D mode, you can click To
more than once in the Volume viewer.
When you do that, any movement of the volume, or change in protocol or
windowing, or change of bounding tools is interpolated between the stops.
Clear - Use the Clear button to clear the currently defined batch.
Quick Batch - This function allows you to create a batch of
the volume, using just a few clicks and parameter entries.
• Click the button that corresponds to the direction you
want the volume to turn. For example, click the leftpointing arrow to create a batch file in which the volume turns
clockwise.
• Degrees - This determines the extent of rotation in degrees.
• No. Im. (number of images) - This determines the number of images to
be included in the batch.
• Parameter Frame - Select this to include a parameter frame at the
beginning of the quick batch, or the end, depending on what is set in
Preferences.
1 1 -4
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Batch tab
11.3
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Save - To save the Quick Batch, use the Save or Save As... function in
Common tools. The Batch preview window that opens after clicking Save is
like the one in CT Viewer - Slab mode, if selected in Preferences.
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CT Viewer - Volume mode
11-5
11.4
Cine tab
11.4
Cine tab
The Cine tools allows you to view (“play”)images in a cine (movie) mode.
The cine can be of the defined batch or of all the images loaded. You can
control the viewing speed, view the images in forward or reverse mode, and
can pause the display. Functions are summarized below.
Whole study - The entire selection in the series tree is played, regardless of
the selection mode, and in their displayed order.
Batch - The batch (grayed out if not defined) is played.
You can play the cine forward or backward, and can pause the display.
Cine speed can be changed before or during play. Speed range is from 1 to
25 frames per second.
Note
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CT Viewer - Volume mode
The Cine plays only on the Active viewport.
Brilliance Workspace Portal - Volume 2
Cine tab
11.4
WMV Movie
In Volume viewer, you can create a movie and save it as an WMV file
without using SnagIt. You can create a movie by using the To: function.
After every change to your image (zoom, pan, windowing, changing
protocol, rotating, etc...) click the To: button.
After all your image manipulations are complete, click the Save batch as...
button.
Note
If the “preview batch” function was selected in Preferences, the batch
preview displays and stop on the last image. Click “Save” if the batch is
satisfactory.
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The following menu appears, allowing you to save the batch as a high
quality or low quality movie.
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CT Viewer - Volume mode
11-7
11.5
View tab
11.5
View tab
The View tab allows you to access various viewing tools and functions like
rendering modes, thickness, protocols, curves and volume calculations.
Thickness [mm]
The thickness parameter is only available in reference
images. It is not available in the volume view.
You have three options for changing the slab thickness:
• Type a value in the thickness box.
• Click the up or down arrows in the box. Each click on the arrows
changes the thickness value by the slice increment.
• Hold down the <shift> key, place the cursor on the image, and using
the left mouse button drag up and down.
1 1 -8
CT Viewer - Volume mode
Brilliance Workspace Portal - Volume 2
View tab
11.5.1
11.5
Rendering modes
There are six rendering modes available in the Volume viewer:
• Average (this rendering mode is not available when the volume image
is the active image)
• MIP
• VIP
• MinIP
• Surface MIP
• Volume rendering
The rendering panel represents the parameters of the active viewports
(viewports with a blue frame). Select the desired mode via the drop-down
arrow.
MIP (maximum intensity projection)
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MIP displays the highest intensity (maximum intensity Hounsfield unit)
voxel along a particular projection through the volume dataset. This creates
a 2D image of the brightest voxels.
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CT Viewer - Volume mode
11-9
11.5
View tab
VIP (volume intensity projection)
Volume Intensity Projection, like MIP, displays the highest intensity voxel
along a projection through the volume dataset. Unlike MIP, the VIP mode
assigns the highest intensity, or greatest brightness value, to voxels closest to
the eye-point, while those farther away are faded according to their distance
from the eye-point.
The Center slider controls location of the ramp over the volume. The
Width slider controls the rapidity of the fade.
MinIP (minimum intensity projection)
MIP displays a 2D image of the lowest
intensity (minimum intensity
Hounsfield unit) voxel along a particular
projection through the volume dataset.
These images can demonstrate respiratory airways.
The threshold is adjustable by typing in the desired value or by clicking the
arrow buttons.
Default threshold is -1000 or -1024 HU, depending on the scan. (This
setting ignores air). The range is -1024 to 3095.
1 1 -1 0
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Brilliance Workspace Portal - Volume 2
View tab
11.5
Surface MIP
Surface MIP rendering allows you to generate volume images by detecting
tissue surfaces based on the Distance (display depth) and Threshold
(Hounsfield Units).
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When the projection ray hits a voxel having an HU value equal to or larger
than the threshold, a MIP calculation is started for the distance (mm)
specified.
Volume rendering
Wa r n i n g
Brilliance Workspace Portal - Volume 2
The volume image displays the anatomy according to the defined protocol.
Do not use the volume image as the sole basis for a diagnosis.
CT Viewer - Volume mode
11- 11
11.5
View tab
Volume rendering assigns opacity
and color to every voxel according
to rendering protocols for
vasculature, soft tissue, and bone.
Selected structures can be
rendered opaque, translucent, or
invisible, allowing visualization
through and beyond contiguous
structures.
Color to Black-and-White - This
monochrome function turns the
colors of the volume image into
grayscale.
Extra fine quality - This function
changes some rendering
parameters to show the image in a
better quality.
Note
It is best to turn this on after all processing is complete, or it slows down the
processing.
Opacity - This text box allows you to change the opacity of the volume
image. You may enter a value or click the up and down arrows.
• The opacity range is from 1 to 95, where 1 is the least (but not
completely) transparent, and 95 is nearly opaque.
• The default opacity and range is determined according to the default
protocol.
1 1 -1 2
CT Viewer - Volume mode
Brilliance Workspace Portal - Volume 2
View tab
11.5.2
11.5
Edit Presets
The Edit Preset function provides tools that allow you to create your own
volume rendering presets. (Refer to the Volume Rendering section earlier in
this chapter for more information.)
Click the down arrow next to Save Preset As to access the Edit Preset
function. The drop down menu offers these selections:
• Edit Preset - Opens the Protocol Editor (described below).
• Save Preset As Default - The active protocol is saved as the default for
the current protocol group.
• Save Preset - Saves the active preset by its current name. A message asks
if you want to overwrite the existing preset.
• Save Preset As - Saves the active preset by a new name. A dialog opens
for typing the new name.
• Rename Preset - Rename the active preset. A dialog opens for typing
the new name.
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• Remove Preset - Deletes the active preset. A message asks you to
confirm the deletion.
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CT Viewer - Volume mode
11- 13
11.5
View tab
Protocol editor dialog
After you click the Edit Preset button, the Protocol Editor opens at the
bottom of the viewport with the current protocol. The protocol’s name
appears in the title of the dialog.
The dialog functions interactively; any change you make in the editor is
immediately reflected in displayed image.
Opacity Curve
Each preset has one continuous opacity curve along the whole CT Values
histogram. (The opacity curve is independent and is not connected to the
color scale.)
1 1 -1 4
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Brilliance Workspace Portal - Volume 2
View tab
11.5
The opacity curve is a line which represents the opacity of the CT values
along it. The highest point (vertically) is 100% opaque and the lowest
point is 100% transparent.
Control points
Control points are small squares that appear along the opacity curve that
are used to manipulate the curve. The rightmost and the leftmost control
points are located at the beginning and at the end of the histogram (-1000
and 3095 HU) and can be moved vertically or horizontally.
Moving control points
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When you move the mouse cursor over a control point, the cursor becomes
a pointing arrow.
• You can move a control point by clicking it and dragging it with the left
mouse button. (A selected control point has a red border.)
• Moving a control point can be done only between the two adjacent
control points.
• Right clicking anywhere on the curve adds a new control point at the
location where you clicked.
• While dragging a control point, a tool-tip appears and shows its current
CT value and opacity (in the example above, the HU is 305 and the
opacity is 0.35 (35%).
Delete a control point
Press the DELETE key to delete the selected control point. The line
between the two adjacent control points becomes joined.
Moving the opacity curve
To move the whole opacity curve, drag any part that is not a control point
with the left mouse button.
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CT Viewer - Volume mode
11- 15
11.5
View tab
The opacity curve can be moved and extended outside the border of the
preset editor along X-axis only and not more than 2000 CT values.
Moving the curve upward/ downward changes the opacity level of the
whole curve.
Color Scale
The color scale appears below the histogram. The color points that appear
below the color scale correspond to the control points in the histogram.
You can add color points by right clicking between two color points.
You can move a color point by clicking it and dragging it with the mouse.
(The mouse cursor changes into a pointing arrow. A selected color point
has a red border.)
Dragging a color point changes the color gradation. (You cannot drag one
color point across another color point.) While dragging a color point, a
tool-tip appears, showing the current CT value of that point.
You can move the entire color scale by dragging it with the left mouse
button.
If you click on the monochrome button located on the control
panel, the color scale becomes grayscale, but the color points keep
their colors.
Press the DELETE key to delete the selected color point. The line between
the two adjacent control points becomes joined.
1 1 -1 6
CT Viewer - Volume mode
Brilliance Workspace Portal - Volume 2
View tab
11.5
Lock mode
Use the lock mode to lock together the opacity curve and the color scale.
When locked together, the color scale moves with control points of the
curve. Every control point on the opacity curve is given the color that is
below it on the color scale.
When you drag the whole curve, the color scale is dragged with it, and vice
versa.
When you drag a color point on the color scale, the control point on the
curve moves with it, and vice versa.
Color palette
Use the color palette to change the volume image, the color bar, the color
button control point and the color scale to the selected color.
The color palette has a round Hue/Saturation color wheel and a gradient
(Value) slider bar. A cursor (the small box) appears on the wheel at the color
of the selected color point.
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To change the color setting:
1
Drag the cursor to the desired Hue/Saturation position.
2
Drag the slider to the desired color Value.
-- OR --
3
Brilliance Workspace Portal - Volume 2
Use the combo boxes to set the Value, Hue, and Saturation.
CT Viewer - Volume mode
11- 17
11.5
View tab
Zoom-Pan Slide bar
The zoom-pan slide bar is located under the histogram.
At each end of the slide bar is a vertical control slider.
To zoom in the histogram (only the width), move the slider towards the
center.
To pan the histogram after zooming, point the cursor anywhere on the bar
between the two vertical sliders and drag it.
Check boxes and options
Log Scale - Shows the CT Values Histogram in logarithmic mode.
Spline - Turns the curve into spline line.
Color Scaler - Show/hide the color curve.
Protocol Name text field - Displays the current protocol's name.
You can create a new protocol by typing in a new name.
OK button - Closes the Protocol Editor, keeping the changes made for
the volume image, but the protocol is not saved.
Cancel button - Closes the Protocol Editor without saving any changes.
The volume image is displayed according to the selected protocol.
1 1 -1 8
CT Viewer - Volume mode
Brilliance Workspace Portal - Volume 2
View tab
11.5
Save Preset changes
If you make changes and have not renamed the protocol, a dialog box
appears to confirm that you want to overwrite the current protocol presets.
To save the current presets with a new name:
1
Type the new name in the text box.
2
Click Save.
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The protocol saves into the current selected protocol’s group.
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CT Viewer - Volume mode
11- 19
11.5
View tab
Lighting editor
The Lighting feature allows you to apply an illumination effect to the
volume image. The Lighting editor allows you to control the lighting
parameters.
Click the Lighting tab to open the lighting editor, shown below.
Use Light - Click this button to activate (and deactivate) the lighting effect
on the volume image according to the parameters currently set in the
lighting editor.
Light 1, Light 2, Light 3 - There are three light sources for which you can
define the Intensity parameter. Click the button(s) to turn each light on or
off.
Note
1 1 -2 0
CT Viewer - Volume mode
• All changes are displayed interactively on the volume image.
• Drag the parameter slide bars and observe the volume image to locate
the light source.
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View tab
11.5
Intensity - The range of intensity is [0:0.1:1]. The default intensity for
Light1 is 1.0. The default intensity for Lights 2 and 3 is 0.0.
Specularity - Specularity is “shininess.” The range of specularity is
[0:0.1:1]. Maximum specularity is 1.0. The default specularity is 1.
Ambience - This slide bar controls the intensity of the ambient light source.
The range of ambient light is [0:0.1:1]. Ambience is turned off at 0.
Ambience at maximum intensity is 1. The default ambience is 0.
Save button - Save your changes to the light parameters of the current
protocol (displayed in the text box), or change the name and save as a new
protocol.
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OK button - Closes the Protocol Editor, keeping any changes you made for
the volume image.
Mouse functions over the volume image (with or without the
presets editor open)
• Pressing the middle mouse button and dragging the mouse is the same
as being in the lock mode.
• Pressing the middle mouse button and dragging the mouse right or left
widens or narrows, respectively, the opacity curve.
• Pressing and dragging the middle mouse button upward or downward
moves the curve to the left or right, showing a different range of HU.
Brilliance Workspace Portal - Volume 2
CT Viewer - Volume mode
11- 21
11.5
View tab
Volume rendering presets
An extensive catalog of VR protocol presets are available for volume
rendering.
Access the catalog by clicking the Show Presets button.
The VR Protocol window appears, as shown at left. A narrow window
displays color icons representing the available rendering protocol presets.
The active protocol has a blue frame around its icon. Click on an icon to
activate the preset. The volume image updates accordingly.
The default group is determined by the scan type
of the current study. In this example the
ABDOMEN group is active.
Clicking the down-arrow next to the protocol group name opens a drop
down menu for selection of other groups. The default protocol is the
Factory default (unless it has been changed).
You may select a different group, if desired. Then, using the scroll bar, you
can view all available presets in that group.
Note
1 1 -2 2
CT Viewer - Volume mode
Saving a protocol saves it to the current protocol group.
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View tab
11.5
Tissues and related functions
Show Transparent - Used to view, in a semi-transparent mode, all
volumetric anatomy that you have removed using various sculpting,
clipping, or tissue functions.
Show Couch (defaulted to Show Couch box is checked) - Allows you to
show or hide the couch.
Wa r n i n g
Verify couch and head holders were correctly removed.
Calculate Volume - Allows you to calculate the volume of a single tissue (or
more than one tissue, if more than one is active).
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Clicking the button changes the volume image so the protocol is at100%
opacity. A blue highlight appears on he reference images. The calculated
volume is of the pixels colored blue on the reference images.
Edit Tissues - Allows you to control the viewing of the volume, based on
the tissue definitions that have been currently created and/or previously
saved from this and other applications. Clicking the Edit tissues button
opens the Tissue management dialog, from where you can control tissue
activation.
Note
Brilliance Workspace Portal - Volume 2
The Tissue management function is identical to the same function in the
CT Viewer - Slab mode. Please refer to the Slab viewer for details.
CT Viewer - Volume mode
11- 23
11.5
View tab
Curve Mode
The Curve mode function allows you to produce a Curved Multi Planar
Reformat (cMPR) image. You can create a new curve for this purpose, or
you can use a saved curve, if one exists. The curve can be drawn on the
volume image and on the reference images.
To activate the Curve mode, click the Curve Mode button.
Note
1 1 -2 4
CT Viewer - Volume mode
The Curve mode function is identical to the same function in the Slab
Viewer. Please refer to the Slab viewer chapter for details.
Brilliance Workspace Portal - Volume 2
Clip tab
11.6
11.6
Clip tab
The Clip functions are used to remove unwanted anatomy from the
volume.
There are three Clip functions, available from a
drop-down list, as shown at right: Target
Volume, Bounding Cube, and Clipping Plane.
Only one of the functions can be used at a
time.
Target Volume
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Target Volume is used for segmenting large, complex volumes, like the
heart and aorta.
Brilliance Workspace Portal - Volume 2
1
Select the Target Volume from the Clip tab. The target volume box
appears in all the viewports.
2
Move the cursor over a line of any box of a reference image. Control
points appear on the box.
3
To move the box, place the cursor between the control points. The
cursor turns into a cross. Left click and drag the cursor and move the
CT Viewer - Volume mode
11- 25
11.6
Clip tab
box to the correct position.
4
To resize the box, place the cursor over one of the control points. Left
click and drag the cursor to resize the box.
5
To rotate the clipped volume (with the box), use the Swivel function on
the volume image.
6
To rotate only the volume, click the Lock/Unlock button. Now when
you drag the volume, the box remains stationary.
7
To hide the lines in the volume viewport that define the target volume,
click the Hide/Show button. (The lines remain in the reference
images.) Click the Hide/Show button again to make the lines reappear.
8
To reset the target volume box to the original orientation when the
mode was activated, click the Reset button.
9
Click the Target Volume button again to exit the mode. The box
disappears and the entire volume image reappears.
Bounding cube
The Bounding cube is used for analyzing small objects, like neuro vessels. It
works like Target Volume and provides a very quick method for focusing in
on an object.
When you turn on the cube, a crosshair appears on the reference images
along with a yellow cube.
The crosshairs and the cube are active graphics. By moving any crosshair,
you move the cube. By moving any edge of any square you change the
cube's total dimensions (it always remains a perfect cube).
Use the bounding cube function as follows:
1 1 -2 6
CT Viewer - Volume mode
1
Select Bounding cube.
2
To move the bounding cube, point to the intersection of any crosshairs
and drag with the mouse, or move the mouse between control points.
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Clip tab
11.6
-- OR -3
Place the cursor between to control points on the cube. The cursor
turns into a cross. Left click and drag the cube to the correct position.
4
To change the size of the cube, move the cursor over a line of any cube.
Control points appear on the cube.
5
Adjust the control points to cause the cube to expand or contract in all
dimensions around the cube’s center.
6
The Lock/Unlock, Hide/Show, and Reset buttons operate as described
in the Target Volume description, earlier.
7
When you lock the bounding cube and swivel the volume, the reference
lines disappear in the reference viewports. Upon reset of the bounding
cube, the reference lines reappear.
8
Click the Bounding Cube button again to exit the mode. The cube
disappears and the entire volume image reappears.
• Part of the bounding cube can be placed outside the volume.
• Scrolling up increases the cube’s dimensions; scrolling down decreases
them.
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Notes
Clipping Planes
The Clipping Plane is a single, moveable, infinite plane that cuts through
(“slices”) the true volume. The clipping plane leaves a volumetric view on
one side of the plane, it removes the volume on the other side of the plane,
and shows a cross-section of the anatomy at the plane.
1
Click Clipping Plane to activate the function.
The clipping plane is defined by a line on the reference images. The
center of the plane is a straight line that appears on the reference
images. No clipping plane lines are visible in the volume view port.
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CT Viewer - Volume mode
11- 27
11.6
Clip tab
The default orientation of the clipping plane is perpendicular to your
display screen.
2
To change the cut part of the volume:
• Rotate the yellow line on the reference images by placing the cursor
on either end of the line until the cursor turns into a rotating arrow.
• Swivel the volume image using the Lock mode.
By default, when you activate the Clipping Plane mode, the Lock
button is ON. This locks the volume, so the clipping plane rotates but
the volume does not rotate.
When Lock is OFF, the volume swivels.
Note
1 1 -2 8
CT Viewer - Volume mode
3
The Reset button resets the clipping plane back to its original position
when the mode was activated.
4
Click the Clipping Plane button again to exit the mode. The plane
disappears and the entire volume image reappears.
Scrolling up moves the plane perpendicular to itself, posterior to the
anatomy. Scrolling down moves the plane perpendicular to itself, anterior to
the anatomy.
Brilliance Workspace Portal - Volume 2
Clip tab
11.6
Bone removal
• Verify bone removal does not affect vessel completeness.
• Bone removal is intended for use with the body, not the head.
Wa r n i n g
Threshold - Bone removal is a threshold-based tool. It defaults to 350HU
(Hounsfield Units).
Bone Removal affects connectivity between objects. When you click on a
point, all areas connected to the object that have a HU value greater than
the threshold are removed. The extent of the removal function depends also
on the volume rendering protocol.
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Procedure
1
Click the Place Seed button. The cursor turns into a pencil.
2
Set the threshold for bone removal.
3
Click on the bone tissue on any image. After a few moments the tissue
is removed.
4
Continue in this manner to remove all the bone tissue.
5
If bone removal does not remove smaller, unattached volumes
completely, the Remove residuals tool may be helpful.
Residual bone volumes are usually around 20 to 30cc - the system
defaults to 20cc. (The cc parameter is used because the size of the
fragments that may remain should be small.)
Verify remove residuals does not affect vessel completeness.
Wa r n i n g
6
Brilliance Workspace Portal - Volume 2
To Save the tissue, use the Save or Save As... function in Common
tools. (Saves to directory).
CT Viewer - Volume mode
11- 29
11.6
Clip tab
7
When the tissue definition is complete click Accept Tissue. (The
original volume comes back and the tissue is stored in Tissue
Management).
Reset - This function returns the image to the original state.
Undo - The last bone removal, residual, volume tracing or sculpting
function that was performed is undone by this function.
11.6.1
Volume tracing
The Volume Tracing function of the Clipping tools helps you isolate
(segment) one or more anatomic structures within the volume image.
Editing the Volume Tracing results
The Fill function adds to the injected soft tissue, filling in any holes within
the volume.
The Expand function allows you to increase the edges of the contrasted
tissue. Each click expands the edge by a one-voxel increment.
The Erode function allows you to decrease the edges of the contrasted
tissue. Each click reduces the edge by a one-voxel increment.
If you over-inject, you can modify the results with the Undo function.
Each click of Undo erases the last voxels that where added to the tissue
during injection.
The Eraser function allows you to remove the contrast from the reference
image by “rubbing” it out.
The Eraser is a sphere whose radius you can set. The Small eraser is 5 pixels;
Medium is 10 pixels; Large is 30 pixels.
1 1 -3 0
CT Viewer - Volume mode
Brilliance Workspace Portal - Volume 2
Clip tab
11.6
Since the eraser is a shape of a sphere, it erases from the volume, not just
the slice you use it on. Be sure to verify the results of the eraser by scrolling
the reference images.
Note
Volume tracing injection parameters
You can vary the Injection Parameters as desired to control the injection.
The Rate parameter adjusts the cubic volume of the injection. The Low
dose is 400 cc; Medium dose is 1500 cc; High dose is 4,000 cc. You can
also type in a rate value of between 1 and 10,000 cc.
The Type parameter adjusts the “viscosity” of the injection. Injection is
fastest at the 1 value and slowest at the 10 value.
Procedure
Verify segmentation correctness. If necessary, correct tracing with
correction tools.
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Wa r n i n g
Brilliance Workspace Portal - Volume 2
1
Manipulate any of the reference images to locate the volume of interest.
2
Alter the Rate and Type parameters if desired.
3
Click the Inject Dye button (also called “contrast”) to activate the
segmentation (also called “injection”) function.
4
5
Point the mouse onto the volume of interest in the reference image.
To inject the contrast, click and hold the left mouse button. The
volume of interest fills. The injected contrast is displayed as a blue
overlay, filling the volume in real time.
6
You can speed up the injection by dragging the mouse to locations
within the volume that are unfilled.
7
Release the left mouse button to stop the injection.
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11.6
Clip tab
8
Allow a moment, then view the results in the volume image viewport.
9
You may continue injecting as necessary.
10 Scroll the images to view more of the volume and continue injecting if
necessary.
11 Show injection overlay turns the blue overlay on and off in the
reference images.
Note
1 1 -3 2
CT Viewer - Volume mode
• You may also perform Volume Tracing on additional volumes, but first use
the Accept function, then name the tissue using the Tissue Management
dialog.
• The entire volume image is displayed after you Accept. You can then
begin another Volume Tracing session on a different volume of interest.
• You must save to the Directory before clicking the Accept tissue button.
Brilliance Workspace Portal - Volume 2
Clip tab
11.6
Sculpting Tool
Manual sculpting tools are available for volume removal.
Three Region of Interest (ROI) sculpting tools are available: Freehand,
Rectangle, and Circle.
The Exclude function removes everything enclosed within the ROI. The
Include function removes everything outside the ROI.
1
Select an ROI sculpting tool. The cursor turns into a pencil.
2
Use the pencil to outline the volume you want to include or exclude
from the tissue on a reference image, so that a boundary is formed
around the tissue.
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If the outcome is not satisfactory - that is, if the resulting Volume of
Interest does not provide sufficient separation of the tissue from its
surroundings - you can use the Undo function and then re-draw the
ROI.
Brilliance Workspace Portal - Volume 2
3
Save the tissue. (You must save to the Directory before clicking the
Accept tissue button.)
4
Click the Accept Tissue button to save to Tissue Management.
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11- 33
11.7
Tissue tab
11.7
Tissue tab
Tissue Segmentation tools
When you select this tab, the highlight feature turns on and the volume
view port shows a blue tissue that corresponds to the highlight.
Reference images are automatically assigned the smallest possible thickness,
which cannot be adjusted.
When you exit the tissue segmentation tab (when another tab is selected)
any unsaved tissue is lost.
On the reference images, tissue that is included in the active tissue is light
blue color, the same color as the active tissue in the volume view port.
Tissue Segmentation can be performed only on the reference viewports.
The Target Volume, bounding cube, or Clipping Planes can be used to
define the area of interest.
Highlight
After a tissue is accepted, its volume rendering protocol can be edited with
the rendering presets function. The highlight is based on the threshold
determined in the Preset drop-down in the Tissue tab.
The factory default for the Bone window is set with center at 1160 and
width at 2048.
1 1 -3 4
CT Viewer - Volume mode
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Tissue tab
11.7
Volume Measurements
The calculated volume of the active tissue (light blue) and the accumulated
tissue (pink) are displayed in the lower right hand corner of the view port.
The volume calculations are shown in the same color as the tissue. If the
tissue type is not present, the volume is not displayed.
Volumes equal to or greater than 5 cc are shown in cubic centimeters.
Volumes less than 5 cc are shown in cubic millimeters.
Bounding Boxes and Clipping Plane
These tools are identical to the same tools in the Clipping tab, described
earlier in this chapter.
Threshold presets
Threshold (highlighting) can be changed by the middle mouse button.
Adjusting the threshold does not effect any accumulated (pink) tissue.
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You can add a preset or edit the preset list in Preferences. (For more
information on Presets refer to the Preferences chapter in volume 1 of this
user manual).
Save As...
You can save tissue segmentation presets that you have created.
Note
Brilliance Workspace Portal - Volume 2
1
Click the drop down arrow next to the preset.
2
Select Save As...
3
The Save As... dialog box opens.
4
Enter the preset name.
5
Click OK to save as a new preset.
The presets that you create and save are saved in Preferences.
CT Viewer - Volume mode
11- 35
When you change the threshold value of a selected preset it is identified as
“Modified.”
Type in …
Allows you to specify the Window and Level for the threshold.
1
Click the drop down arrow next to the preset.
2
Click Type in... The Threshold dialog box opens.
3
Click in each box Type in the desired center and width.
-- OR --
Note
4
Click the up and down arrows to change the values by 50 units for each
click.
5
Click OK to apply your settings. The dialog box closes.
• Apply shows the results but leaves the dialog box open.
• Cancel closes the dialog box.
Seed
Places a seed to mark a specific volume of Interest (VOI).
Note
You cannot use the Seed and Anti Seed together. You must use one or the
other.
Anti seed
Places a seed to remove a specific volume of interest (VOI).
Tissue tab
11.7
Slice by slice sculpting with interpolation
To more accurately define a tissue, you can draw individual sculpting ROIs
on various slices of a stack of images and the ROIs is interpolated across
intervening slices.
(A stack of images consists of all images in one of the orthogonal
orientations: axial, coronal, and sagittal.)
Within the ROIs, only the data that is marked by the threshold is used in the
tissue definition.
Note
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You can draw ROIs on as many slices as you want. The diagrams below
show how interpolation works:
1 Draw the first ROI on, for example, slice 3.
Brilliance Workspace Portal - Volume 2
2
The first ROI is projected through the entire stack.
3
Draw another, larger ROI on slice 6.
4
The system automatically draws interpolated slices between slices 3 and
6, and the ROI you drew on slice 6 is projected onto slice 7and all
following slices.
CT Viewer - Volume mode
11- 37
11.7
Tissue tab
Rules for slice by slice sculpting with interpolation:
• If you draw an ROI on a slice that already has an ROI, the original ROI
is overridden.
• If you use slice by slice sculpting with interpolation, any current
sculpting you have performed (and any previous slice by slice sculpting
with interpolation you have performed) is overridden.
• ROIs that you draw are shown in green.
• ROIs that the system interpolates are shown in purple.
Note
1 1 -3 8
CT Viewer - Volume mode
• You can perform slice by slice sculpting with interpolation on only one
image stack at a time. (An image stack consists of all axial images, or all
coronal images, or sagittal images.)
Brilliance Workspace Portal - Volume 2
Tissue tab
11.7
Slice by slice sculpting
Note
These tools are used to make small adjustments.
You can sculpt the tissue by adding or removing ROIs on a slice-by-slice
basis. Highlight stays on in this mode.
Add Slice by Slice adds into the current tissue anything within the ROI
that you draw.
Remove Slice by Slice removes from the current tissue anything within the
ROI that you draw.
Sculpting
The same manual sculpting tools are available as in the Clip tab. Refer to
the earlier description of this function.
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Sculpting only applies to the active tissue (blue). Accumulated tissue (red)
is not affected
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CT Viewer - Volume mode
11- 39
11.7
Tissue tab
Add to or subtract from accumulator
These two tools are used when creating a tissue. They allow you to edit the
tissue before you accept it.
1
Create a tissue.
2
Click Add to accumulator button.
3
Make any necessary edits using the sculpting tools.
4
Click Add to or Subtract from accumulator.
5
Repeat steps 3 and 4 until tissue is complete.
6
Save the tissue. (You must save to the Directory before clicking the
Accept tissue button.)
7
When the tissue definition is complete, click the Accept Tissue button
to save to Tissue Management. The original volume comes back and
the tissue is stored in Tissue Management.
Fill, expand and erode
These tools are identical to the same tools in the Clipping tab, described
earlier in this chapter.
Reset and Undo
Reset - This function returns the image to the original state.
Undo - The last bone removal, residual, volume tracing or sculpting
function that was performed is undone by this function.
1 1 -4 0
CT Viewer - Volume mode
Brilliance Workspace Portal - Volume 2
Common tools
11.8
11.8
Common tools
The common tools area provide many basic functions, including
measuring, saving, panning, zooming, rotating, and windowing. Common
tools are, in general, common to all the CT Viewers, and are shared with
many other applications of Brilliance Workspace Portal. If a common tool
has a special function in the Volume mode, that function is described in
this chapter.
For more information on Common Tools refer to the “Common Tools”
section in the CT Viewer chapter of this volume of the user manual.
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Note
Wa r n i n g
Brilliance Workspace Portal - Volume 2
The Window field and the Inverse function in the common toolbox are
grayed out.
• When performing distance or angle measurements on the volume
rendered perspective image, the position pointed to must be well defined
in the image.
• The line end-points of your measurement must lie on data points that are
sufficiently opaque so that no ambiguity exists regarding the depth of
these points within the volume. Otherwise, the distance or angle does not
display.
• Conduct volume measurements carefully, taking time to manually verify
each point of reference.
CT Viewer - Volume mode
11- 41
12
12.1
CT Viewer - Endo mode
Overview
The CT Endo viewer is a review function that allows you to perform a
general flythrough of structures filled with contrast or air, including general
vessels, cardiac vessels, the bronchus, and the colon.
You can look for calcium, plaque, occlusions and stenosis in vessels, nodules
in the bronchus and polyps, and occlusions in the colon.
If you find an object you want to examine, you can stop the flythrough and
use the reference viewports to view the object in detail, zooming and
panning as desired.
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Flythrough features
You can flythrough the structure manually, guiding the path with the
mouse. Or, you can create one or more flythrough paths for the Endo
viewer using the Curve function found in the Slab and Volume viewers.
After saving the curve, you can use it in the Endo viewer to automatically
perform the flythrough.
You can fly forward or backward, moving either step-by-step or at a
continuous rate (which is adjustable).
You can stop and restart the flythrough with a single click in the Endo
viewport.
You can create a WMV movie (high quality or low quality) of the
flythrough by creating and saving a batch of the flythrough images.
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CT Viewer - Endo mode
12-1
12.2
Endo Viewer
12.2
Endo Viewer
When you load a study into the Endo viewer, there is a delay while the
application processes the volume. Then the window shown above is
displayed. The default viewing mode is Volume orientation. The alternate
mode is Eye orientation.
To begin using the Endo viewer, drag the middle of the crosshair to the
desired location (for example, a vessel, an airway, or the colon). The center
of the crosshair represents the “eye” (or the camera) from which the endo
image is created.
Locating the structure - In most cases, the application displays the Endo
image from within a contrast or air filled structure, but occasionally the
Endo image appears solid.
1 2 -2
CT Viewer - Endo mode
Brilliance Workspace Portal - Volume 2
Endo Viewer
12.2.1
12.2
Locate the structure of interest
If the endo image appears solid, as shown below, it is usually because of a
mismatch between protocols. The study may include an air filled structure
but a contrast protocol may have been applied, or vice versa.
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To view the volume correctly, you must select the correct protocol icon
from the protocol list.
You can manually position the rotation center of the viewport into the
volume of interest by moving the crosshairs of the reference images. The
application automatically re-evaluates the rendering protocol needed for the
Endo viewport.
• When the crosshair is moved, the system determines if a different
rendering protocol is needed. (Note that this protocol adjustment is not
made within a protocol category. That is, one air protocol is not
replaced by a another air protocol.)
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CT Viewer - Endo mode
12-3
12.2
Endo Viewer
• The system changes the rendering protocol if the intersection of the
crosshair goes from air to contrast or contrast to air.
1 2 -4
CT Viewer - Endo mode
Brilliance Workspace Portal - Volume 2
Endo viewer tools
12.3
12.3
Endo viewer tools
Volume orientation
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This is the standard orientation for performing flythroughs.
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CT Viewer - Endo mode
12-5
12.3
Endo viewer tools
Eye orientation
In this orientation, shown below, a yellow rotation bar gives you more
control over the view, allowing you to move the “camera” as desired.
.
Viewport Images - Endo viewer
(Item numbers refer to the 2 preceding images)
1 2 -6
CT Viewer - Endo mode
Item
Volume Orientation
Eye Orientation
1
Endo
Endo with rotation bar
2
Axial
Axial
3
Coronal
Eye Axial (EA)
4
Sagittal
Eye Reference (ER)
Brilliance Workspace Portal - Volume 2
Endo viewer tools
12.3
Flip
Click the Flip button to rotate the endo image 180 degrees around the
rotation center. The reference images update accordingly. The Flip button
is always enabled, regardless of which viewport is active.
Flipping the viewports has no effect on the direction of navigation travel.
Play Forward always navigates away from you, “into” the display. Play
Backwards always navigates toward you, “out of ” the display.
Layout
In the Volume orientation,
the two available layouts are
1+3 and 2x2. (1+3 is the
default.) Both are diagrammed
at right.
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In the Eye orientation there
are also two layouts, 1+3 and
2x2. Both are diagrammed at
right.
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CT Viewer - Endo mode
12-7
12.4
Eye orientation viewports
12.4
Eye orientation viewports
The Eye Orientation scene contains the:
• Endo (volume) viewport
• Axial viewport
• Eye Axial viewport
• Eye Reference viewport
Two layouts are available, 1+3
and 2x2.
Axial viewport (A)
The axial viewport displays a simple axial MPR image. The center of the
crosshairs represents the Camera's location. You can move the crosshairs to
change the position of the camera.
The yellow arrows show the direction where the camera is looking.
This axial reference image is the same image that appears in the Volume
orientation viewports, described earlier.
Eye Axial viewport (EA)
The viewed axial plane is 4 cm (default) from the Endo viewport rotation
center (camera).
The distance between the Endo viewport rotation center and Eye Axial
plane can be adjusted by using the Eye Axial Reference Line (the horizontal
green line in the Eye Reference viewport).
Center marker - A marker appears at the center of the image. This marker
is the center of the viewport in most cases. However, you can pan the image
so that this is not the case, but when clicking the volume image, the center
of the image (center maker) returns to the center of the viewport. The
1 2 -8
CT Viewer - Endo mode
Brilliance Workspace Portal - Volume 2
Eye orientation viewports
12.4
center marker is not an active graphic and thus can not be moved in
relation to the image (in this viewport).
When the rotation center of the Endo viewport moves, the Eye Axial
viewport moves relative to it.
You can scroll, pan, zoom, and adjust window/level.
Eye Reference viewport (ER)
This viewport contains the Eye Reference arrow and the Eye Axial
Reference line (both green in color). The Eye Reference arrow points along
the line of sight of the Endo viewport.
• The center of this image is rotation center of the Endo viewport.
• The rotation center of this image is the tail (the end without the
arrow head) of the arrow.
The length of the arrow cannot be changed.
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You can pan, zoom, and window this image.
Reference Arrow
When you point to the Eye Reference arrow with the mouse, it turns
yellow, and each end shows a control box.
Move arrow - The arrow is an active graphic and can be dragged with the
mouse to the left, right, up, and down with the body or tail of the arrow.
The position of the arrow is translated (interpreted to new coordinates) in
the Endo viewport.
Head of the arrow - The head of the arrow can be repositioned radially
around the tail of the arrow. When the head is repositioned the Eye Axial
Reference line is updated.
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CT Viewer - Endo mode
12-9
12.4
Eye orientation viewports
The green Axial reference line remains perpendicular to the arrow so that
the Eye Axial image rotates to the plane of the green line.
Double clicking on the Eye Reference Arrow causes the Reference viewport
to adjust itself so that:
• the arrow’s tail is in the center of the viewport
• the head of the arrow is pointed straight up
During navigation of the Endo viewport or adjustment of the crosshairs,
the different Eye views maintain the orientation of the tail of the arrow
centered in the viewport with the arrow's vector pointing straight up.
Eye Axial Reference line
The Eye Axial Reference line is represented by a green line as shown above.
The line shows where the Eye Axial viewport intersects the Eye Reference
viewport. The line is always perpendicular to the Eye Reference arrow.
1 2 -1 0
CT Viewer - Endo mode
Brilliance Workspace Portal - Volume 2
Eye orientation viewports
12.4
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Rotation Bar in Eye Orientation
Control boxes appear on the ends of the rotation bar when the mouse
cursor approaches.
You can grab these handles and rotate the bar around the center of the
Endo viewport.
The center of the rotation bar in the Endo viewport is the rotation center.
Rotating the rotation bar rotates the Eye Reference and Eye Axial images.
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CT Viewer - Endo mode
12- 11
12.4
Eye orientation viewports
12.4.1
Series tab
The series tree is a user interface control that displays a list of the studies
and series that are loaded into the viewer, and also any other elements (like
batches and parameters) that have been created.
For more details about the Series tree refer to the “Series Tab” section of the
2D Viewer chapter in this volume of the user manual.
1 2 -1 2
CT Viewer - Endo mode
Brilliance Workspace Portal - Volume 2
Eye orientation viewports
12.4.2
12.4
Batch tab
The Batch function allows you to create a series of endo images for saving,
reporting, and filming purposes. It also allows you to create a flythrough
path.
Note
Some of the features of the batch tab change, depending on the active
image (with the blue frame). With active reference images, batch functions
are like those in the Slab viewer, except with fewer options.
Define a Batch when no curve is active
If no curve has been made active, the Batch function is available only on the
Endo view port.
In the initial state of the Batch mode the All Curve button is grayed
out, and no Cine functions are available (all Cine buttons are grayed
out).
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Note
1
Click From:. The current image is the start of the batch.
2
Navigate to the desired end of the batch using the scroll function.
3
Click To: A virtual curve is created.
4
Specify the number of images. (You can change the number only after
the batch is created.)
The virtual curve can be saved (Use “Save Path” in the common tools). The
curve is added to the Curve list (which may be accessed with the “Load
curve” button).
Clear - Use the Clear button to clear the currently defined batch.
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CT Viewer - Endo mode
12- 13
12.4
Eye orientation viewports
Define a Batch using the All Curve function
The All curve function allows you to create a batch from a curve you create
by navigating a new path.
1
Navigate along the desired path using the Forward and Backward
arrows in the View tab.
A virtual path is created along the track of the navigation. The All
Curve button becomes enabled in the Batch tab.
2
Click the All curve button.
A batch is created from the entire path of navigation.
Batch functions when there is a curve active
In this state of the Batch function:
• The batch is available on the Endo viewport.
• The All curve button is enabled.
• Cine in the Curve mode scrolls all the viewports in unison along the
active curve.
1 2 -1 4
CT Viewer - Endo mode
Brilliance Workspace Portal - Volume 2
Eye orientation viewports
12.4
Save the Batch
You can have a batch displayed (preview) on the screen before you save it.
This allows you to review it to make sure it displays correctly. Set the batch
preview in Preferences, as described in the Preferences chapter in volume 1
of this user manual.
Note
1
Select Save Batch or Save Batch As... from the common tools. (Refer to
the Common Tools section in the CT Viewer - 2D mode chapter for
more details.)
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After clicking Save Batch or Save Batch As..., if the preview function is
active, the system automatically displays the sequence of batch images
in the batch window, and stops at the last frame.
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CT Viewer - Endo mode
12- 15
12.4
Eye orientation viewports
2
If the batch is not what was desired, click Cancel.
3
If the batch is as desired, you may choose to Add to Series Tree by
clicking the check box. This adds the saved batch into the Series tree to
allow you to continue working with it.
4
To perform the final Save Batch step, click Save.
-- OR --
5
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CT Viewer - Endo mode
If Save Batch As... was selected, the Save Batch As... dialog box opens,
where you can save data to a selectable device, as a Secondary Capture,
one of several graphic file formats, or high or low quality movies.
Brilliance Workspace Portal - Volume 2
Eye orientation viewports
6
12.4
If you want the file to be stored in the Multimedia (File)
Viewer Folder, which is accessible from the Brilliance Portal
Workspace’s Directory page, also click the Multimedia
checkbox.
Save in Multimedia is only available if the file is saved as JPEG, BMP or TIFF.
Note
7
Click OK when finished saving.
Defining a batch of the entire curve
You can use this option on any view port, regardless of the scrolling mode.
1
Click the All curve button. (This operation is similar to "quick batch"
in Slab mode).
The From: and To: buttons become disabled.
2
Specify the number of images.
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Clear batch
Use the Clear batch button.
Reset all
Clicking the Reset button:
• Resets the zoom parameters on all viewports to their defaults.
• Resets any recorded path.
Restores the Endo viewport to its default volume rendering parameter.
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CT Viewer - Endo mode
12- 17
12.4
Eye orientation viewports
12.4.3
Cine tab
The Cine function allows you to view (“play”) patient images in a cine
(movie) mode. You can control the viewing speed, view the images in
forward or reverse mode, and you can pause the display.
You can view a cine two ways:
• You can view a cine of all the patient images that have been loaded.
• You can view a cine of the images in a batch. (The procedure to create a
batch is described in the previous section.)
If no batch exists, the Batch button is grayed out. If a batch has been
defined, the Batch button is active and the batch function is enabled on all
the view ports. The cine (scroll) is along the virtual curve.
When performing Cine batch on one view port, all the other view ports are
updated accordingly.
Centerline - Click this button to cine along the created path.
Batch - Click this button to cine the batch.
You can play the cine forward or backward, and can pause the display.
Cine speed can be changed before or during play. Speed range is from 1 to
25 frames per second.
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CT Viewer - Endo mode
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Eye orientation viewports
12.4.4
12.4
View tab
The View tab in the Endo mode has two sets of rendering parameters
(described later), depending on whether a Reference viewport or the Endo
viewport is active.
Endo (volume) images
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Reference images
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CT Viewer - Endo mode
12- 19
12.4
Eye orientation viewports
Thickness
This function controls the thickness of the reference viewports. (Thickness
is grayed out in the Endo viewport):
• Axial
• Coronal
• Sagittal
• Eye Axial (Eye orientation)
• Eye Reference (Eye orientation)
The thickness can also be changed by
clicking any of the arrows in any view
and dragging them.
Rendering parameters
The rendering parameters available depend on the images in the viewports,
as shown below.
Reference images
Endo (volume) images
Please refer to detailed descriptions of the various rendering parameters in
the CT Viewer - Volume mode chapter in this volume of the user manual.
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CT Viewer - Endo mode
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Eye orientation viewports
12.4
Crosshair
Show Crosshair (default is to show crosshair) makes visible all graphical
overlays (crosshairs, center marks, rotation bar, and arrows).
In the reference images:
• Red crosshairs represent the Axial plane.
• Blue crosshairs represent the Sagittal plane.
• Green crosshairs represent the Coronal plane.
The intersection of the crosshairs is the rotation center of the Volume
orientation viewport.
(Refer to the Eye orientation section in this chapter for descriptions of
markings in the Eye Axial and Eye Reference viewports.)
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Tissue management
This function allows you to view the volume based on the tissue definitions
previously saved from other applications. Clicking the Tissues button
opens the Tissue Management dialog, from where you can control tissue
activation.
Note
The Tissue management function is identical to the same function in the
CT Viewer - Slab mode. Please refer to the Slab viewer chapter for details.
Speed
You can control the speed of navigation by selecting from the drop-down
list: Slow, Medium Slow, Normal, Medium Fast and Fast.
Navigate forward and backward
These arrows control the direction of flythrough. When you are at the start
of the flythrough, you can only go forward. When you go backward, the
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CT Viewer - Endo mode
12- 21
12.4
Eye orientation viewports
camera reverses the flythrough direction, but does not reverse the image
viewing direction.
1 2 -2 2
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Eye orientation viewports
12.4
Relate viewports and Relate scenes
Relate viewports
This function helps to orient yourself in your current Endo viewer screen
only (the Endo “scene”). (Relate scenes, described below, helps you orient
across the other scenes: Volume and Slab.)
In the Relate viewports mode, when you click a location in any viewport on
your display, the location of that pixel is automatically marked on all the
other viewports.
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To use Relate viewports:
1
Turn off the crosshairs (in the View tab)
2
Select Relate viewports.
3
Click on any pixel in any viewport.
4
Cross marks appear on that point (pixel) in all the other viewports. This
point also becomes the new rotation center. (This is true for all Endo
viewer viewports except the Eye orientation image; see note below.)
Relate scenes
This function helps you orient yourself in the other CT viewer scenes.
Note
Brilliance Workspace Portal - Volume 2
Using Relate scenes in other review modes (2D, Slab, and Volume) is a
recommended way to launch into the Endo viewer. Place the Relate onto a
region of interest, then go into the Endo review mode.
CT Viewer - Endo mode
12- 23
12.4
Eye orientation viewports
Eye orientation
The following conditions apply when you are in the Eye orientation mode:
• The camera (identified by crosshairs in the reference viewports)
updates to the location of the relate point.
• In the Endo viewport you can create a relate point with Relate
viewport, but not with Relate scenes.
• In the reference viewports, using Relate causes the tail of the reference
arrow to be placed at the relate point.
• In the Axial reference viewport, using Relate causes the center of
rotation to locate to the relate point, changing the orientation of the
viewport.
Volume Orientation
The following condition applies to the reference viewports when you are in
the Volume orientation mode:
• In the Axial, Coronal, and Sagittal viewports, using Relate viewport
causes the rotation center (located at the intersection of the crosshairs)
to be moved to the relate point.
Both Orientations
The following conditions apply when you are in either the Volume or the
Eye orientation modes:
• In the Endo viewport, using Relate viewport causes the point clicked
on to rotate around the current rotation center into the center of the
Endo viewport, changing the direction you are looking. (Relate scene
does not work in the Endo viewport.)
• Using the Relate scene function from another scene (Slab or Volume)
places the rotation center at the relate point in the Endo scene.
1 2 -2 4
CT Viewer - Endo mode
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Eye orientation viewports
12.4
Scrolling
Scrolling the reference images moves the volume image camera as if you
were scrolling through a slab image.
Scrolling the volume image changes the crosshair's intersection point
(rotation center) on the reference images.
Leaf along centerline
This function is only enabled when a curve is loaded (active).
Note
1
Select Load Curve.
2
Select path from the Curve Selection Dialog box.
3
Click OK.
Now when you scroll, the image moves along the active curve.
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Scrolling in this mode does not affect the rotation center of the scene (the
arrow and rotation bar do not move).
Viewing Angle
The viewing angle is displayed in the lower right corner of the Endo
viewport.
To change the viewing angle:
1
Right click on the Endo viewport. The context menu appears.
2
Select View Angle.
A list of available view angles appears. The selections range from 15 to
120 degrees.
3
Brilliance Workspace Portal - Volume 2
Select the desired View Angle.
CT Viewer - Endo mode
12- 25
12.4
Eye orientation viewports
12.4.5
Flythrough procedures
Flythrough without an active curve
1
Using the cross hairs on the reference images and using image scrolling,
bring the cursor to the desired starting point.
2
Select a speed.
3
Click Forward.
The mouse cursor becomes a double-ended arrow.
1 2 -2 6
CT Viewer - Endo mode
4
Click on the Endo viewport. The flythrough begins.
5
Navigate through the structure by moving the mouse toward the
desired location in the image.
6
To stop the flythrough, left click on the Endo viewport.
7
To resume, click again on the Endo viewport.
8
To exit the flythrough mode, click any common tool.
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Eye orientation viewports
12.4
Flythrough using an active curve
• If a curve exists for this study, the Load Curve button is in full color.
• If no curve has been saved (or created in another view mode, like Slab or
Volume), the Load Curve button is grayed out, and flythrough with an
active curve is not possible.
Note
1
Click Load Curve.
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The list of available curves appears. (If
there is no saved curve available, the
Load Curve button is grayed out.)
2
Select one of the curves and click OK.
3
Select a speed.
4
Click Forward. (The flythrough
always starts at the beginning of the curve.)
5
Click on the Endo viewport. The flythrough begins.
6
To end the flythrough, left click on the Endo viewport.
7
To continue, click again on the Endo viewport.
To start navigating along another curve
1
Stop the flythrough by clicking on the Endo viewport.
2
Click Load Curve to load another curve.
3
Continue as above to fly through an active curve. The flythrough
always starts at the beginning of the new curve.
To switch to manual navigation
Click the Curve Mode button (so it appears unpressed). (This button is
only enabled after the Load Curve button is selected.
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CT Viewer - Endo mode
12- 27
12.5
Common tools
12.5
Common tools
The common tools area provide many basic functions, including
measuring, saving, panning, zooming, rotating, and windowing. Common
tools are, in general, common to all the CT Viewers, and are shared with
many other applications of Brilliance Workspace Portal. If a common tool
has a special function in the Endo mode, that function is described in this
chapter.
For more information on Common Tools see the “Common Tools” section
of the CT Viewer chapter, in this volume of the user manual.
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CT Viewer - Endo mode
Brilliance Workspace Portal - Volume 2
13
13.1
Filming
Overview
The FilmView application is used for viewing, arranging, windowing,
zooming and annotating filmed images from the server prior to sending
them to be printed. All filmed images are stored in the Print History.
Print History holds only the last ten film projects sent to printing. After
more than 10 printed projects are sent to the list, studies are deleted in the
order they were placed into the History, oldest first.
Note
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FilmView can be accessed by the Film button in the workflow bar. Many
FilmView operations are similar to those in the Viewer applications.
Following are some advanced features of the FilmView application:
• The same image can be filmed side by side for comparison with
different zoom and window parameters in the Dual mode.
• Better organization and economy of film can be achieved by filming in
the Multiformat mode.
• Measurements and annotations can be added or deleted from the
images.
Note
Brilliance Workspace Portal - Volume 2
If an image is saved as a secondary capture to filming, measurements are
not possible.
Filming
13-1
13.1
Overview
FilmView functions
The main application functions of FilmView include:
• Multiple patients can be loaded and filmed simultaneously.
Note
Multiple patients cannot be mixed on the same film.
• Multiple Film Sections each with separate film settings. Sections allow
flexibility in grouping multiple images as a single image.
• Easy arrangement of frames on a page
• Overview mode for single view of the whole film section and easy
arrangement of pages
• Support for printing header and footer (a Preferences setting)
• Background printing with print queue monitoring
• Printing on DICOM and Windows printers
1 3 -2
Filming
Brilliance Workspace Portal - Volume 2
FilmView startup
13.2
13.2
FilmView startup
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The illustration below shows part of the FilmView startup window.
In the example above, six film pages are shown. The pages which are
selected in the Layout tab have a yellow border, identifying them as a
“Section.”
One image has a blue border. It is the “Active” image.
FilmView allows you to handle sections as a group for the purpose of
layout, widowing and zooming, etc.
Other FilmView functions are based on the Active image, such as “Page
Break” and “New Page.” These functions are described later in this chapter.
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Filming
13-3
13.2
FilmView startup
Note
1 3 -4
Filming
The tools available in the control panel are also available via a right mouse
click, as shown below.
Brilliance Workspace Portal - Volume 2
Control panel
13.3
13.3.1
13.3
Control panel
Patient Select
Two applications may send images for different patients at the same time.
Only one patient can be displayed at a time. More than one patient may be
loaded and filmed simultaneously. There can be up to ten active patients.
Click the left and right arrows in the Patient Select box to display different
patients, or click the down arrow and select the patient from the list.
Active Studies
The studies in this directory may be reloaded and re-printed.
The active patients always appear in FilmView even after logging off and on
again. FilmView keeps active studies in the drop down.
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To delete a study:
1
Highlight the study.
2
Click All in the Layout selection.
3
Under Edit image, click Delete.
Print history
After all images are printed, the study is moved from the active drop down
area into Print History.
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Filming
13-5
13.4
Sections tab
13.4
Sections tab
Images sent to the film viewer may be grouped into sections.
There can be a number of film sections for each patient. Each film section
can have its own print attributes (e.g. format) and may be treated
differently with respect to layout, windowing, etc.
The Name column lists the section’s name. The Images column lists the
number of images in a sector.
1 3 -6
Filming
Brilliance Workspace Portal - Volume 2
Sections tab
13.4
Section (Series) Break
A Section Break organizes the way consecutive Series can be presented on
the film. The following are modes of the filming application. They control
the placing of a Series on a page.
Continuous - Allows you to place a series in a continuous section with no
breaks.
Next Row - If you have two series in the same row, this function allows you
to move the next series images to another row.
Next Page - Allows you to place a Series onto the following page.
The section breaks are not affected by the layout selections. They are based
on the Series.
Note
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Dual Mode
Dual Mode replicates each image in the active Series and displays it to the
right of the original.
1
Click on an image in the desired series to duplicate it to make it active
(blue border).
2
Click the Dual Mode button.
In Dual Mode, if the page layout has an odd number of columns, then the
last column in a page does not display. It is advised to change page layout to
have an even number of columns before Dual Mode is turned on.
Note
3
Brilliance Workspace Portal - Volume 2
To view two different tissues or anatomical regions, Window and Zoom
each of the groups separately.
Filming
13-7
13.4
Sections tab
To cancel the Dual mode:
1
From the Sections list, select the section that has dual mode turned on.
2
Click the Dual Mode button.
Section
A section can have only one format. Choose one from the options described
below:
Split - Creates a new section, using the active image as the first image in the
new section.
Combine - Allows you to combine sections. This combines the selected
section with the next section.
Reverse - Reverses the order of images within the single section. Last
becomes first and first becomes last.
Sort - Click the Section Sort button to
open the dialog box.
Sort the images in the active section
according to the priority, the Sort by:
parameters, and the sort direction.
Sort protocols can be created and saved for
later use, for filming other studies. The
sort protocols that you create can be
deleted.
There is a Default sort protocol that you
can use. It cannot be deleted.
1 3 -8
Filming
Brilliance Workspace Portal - Volume 2
Sections tab
Note
13.4
Refer to the 2D mode viewer chapter in this volume of the user manual for
detailed instructions about the Sorting function.
Page Break
Insert a page break after the active image.
Remove the page break after the active image.
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Insert Image
You can insert a parameter image before or after the active image. You can
insert a blank image and you can multiformat the selected images.
• Insert a Parameter image after the active image. A parameter image has
the patient information. You can have only one parameter per image.
Click view mode and change the layout to better view the parameter
image.
• Insert a Parameter image before the active image.
Note
When you insert an image parameter page it becomes attached to the
image that it was inserted next to. Therefore whatever function you apply
(cut, delete etc.) to the image also applies to the parameter page.
Insert a Blank image in front of the active image.
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Filming
13-9
13.4
Sections tab
Multi Format image
The Multi Format image function allows
you to select the number of images to
combine as a single image. The result is a
secondary capture image.
1
Select the images to be combined into a
multiformat page.
You can hold down the <Ctrl> key to
select multiple individual images. Hold
down the <Shift> key to select a range
of images.
2
Click the MultiFormat button. The
MultiFormat Selection box opens.
3
Select the desired format.
4
Click OK.
The result is a secondary capture.
Undo multi format image
1 3 -1 0
Filming
1
Click the drop down arrow at the Multi Format button.
2
Click Undo multi format image.
Brilliance Workspace Portal - Volume 2
Sections tab
13.4
Edit Image
You can delete, cut, copy and paste images.
Select the images you want to edit, then click the button for the edit
function you want.
Delete image - Click to delete the image(s) you selected.
Cut image - Click to cut the image(s) you selected. The cut image(s)
remain in the cut/copy buffer and can be pasted.
Copy image - Click to copy the image(s) you selected. The copied image(s)
remain in the cut/copy buffer and can be pasted.
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Paste image - After cutting or copying image(s), select an image in the film
display, following which you want to paste the images that are in the
cut/copy buffer. Then, click to paste the image(s) you cut or copied.
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13- 11
13.5
Printing
13.5
Printing
From the Printers tab you can make a printer active, configure and define
the settings of printers, set default printers and access print history. You can
also print to client-defined Windows printers or a DICOM printer defined
on the server.
Note
Your system administrator can remove the DICOM print privilege.
Note
Configure Printer is grayed out until you select a printer.
Supported Printers
• DICOM - Color and black and white
• Non DICOM network printers
• Non DICOM printers directly connected to your PC.
1 3 -1 2
Filming
Brilliance Workspace Portal - Volume 2
Printing
13.5
Active Printer
The system may be connected to several printers.
To select a different printer than the one currently set for your system:
1
In the Active Printer box select the drop down arrow. This opens the list
of the available printers.
2
Select the desired printer from the list.
Save as Default printer
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Allows you to set the current printer as the default printer. The next time
you start the application, it defaults to the printer you made default.
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Filming
13- 13
13.5
Printing
Configure Printer
Note
• Configure Printer is grayed out until you select a printer.
• The configuration dialog shown below is an example. The actual setting
parameters vary, depending on the printer you select at your location.
This selection brings up a configuration dialog for making the printer
settings. Set the printer as desired.
1 3 -1 4
Filming
Brilliance Workspace Portal - Volume 2
Send images to the printer
13.6
13.6
Send images to the printer
1
Select a printer from the Active Printer drop down menu.
2
Define the Settings for your printer: the number of copies, the paper
size (sheet dimension), and the orientation, for example.
The specific Settings parameters that you can select vary, depending on the
printer you select to send the images to.
Philips Medical Systems 4535 674 64521_A
Note
3
Click the Print button to send the selected filmed images to the printer.
4
-- OR --
5
Click the Print drop down arrow to select and and print a different
image or group of images, as shown in the menu at left.
The filmed image(s) are sent to the printer.
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Filming
13- 15
13.6
Send images to the printer
13.6.1
Print Options
These are the print options available.
• Print Active Image
• Print Page (selected)
• Print Section (selected)
• Print Patient
Note
1 3 -1 6
Filming
If the Print Options button is grayed out, select a printer from Printers tab
to make it Active.
Brilliance Workspace Portal - Volume 2
Print History
13.7
13.7
Print History
The Print History list stores copies of the last ten previously printed patient
studies. If you want to print additional copies of a previously printed
patient, you can access the Print History list and select a patient from the
list.
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Once more than 10 printed projects are sent to the list, studies are deleted
in the order they were placed into the History, oldest first.
Print History list contains the following columns:
• ID - This ID number is generated by the system.
• Name - Shows the name of the patient.
Note
The patient name is marked in the Active Patient list with a * sign.
• Patient Id - Shows the Patient ID number.
• Printer - Shows whether the patient study has been printed.
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Filming
13- 17
13.7
Print History
To retrieve a patient study from the Print History list:
1
Click the Print History button.
2
Select the patient study
3
Click Load.
To delete a patient study from the Print History list:
1 3 -1 8
Filming
1
Select the patient study.
2
Click Delete.
Brilliance Workspace Portal - Volume 2
Layout tab
13.8
13.8
Layout tab
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From the Layout tab you can view, adjust layout, change orientation and do
image selection.
View Mode
There are two layout View modes, Normal and Overview.
• Normal Mode - Displays one film page at a time and displays the film
in the selected page layout.
• Overview Mode - Displays all of the film pages for the patient in the
same window.
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Filming
13- 19
13.8
Layout tab
In both Normal and Overview modes the following actions can be
performed:
• Pages within a section can be cut, copied or pasted.
• Sections can be cut, copied or pasted.
• One or more images within a film section or over multiple pages can be
selected for viewing and manipulations using the Ctrl/Shift keys.
Page Layout
This feature allows you to change the layout of the film.
Custom Layout - From Custom Layout you can choose the number of
rows and columns for the page layout. You can enter a maximum of eight
rows and eight columns. Click OK to apply the page layout.
Orientation
Selected image(s) and/or section(s) can be horizontally and vertically
flipped and rotated clockwise and counter clockwise.
1 3 -2 0
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Brilliance Workspace Portal - Volume 2
Layout tab
13.8
Selection
From the Selection layout mode you can choose which images to
manipulate.
This mode determines which image(s) are selected, not which image is
active.
Note
•
•
•
•
An active image is within the selection.
There can be only one active image.
The Active image within the selection is marked with a blue border.
Selected images are marked with a yellow border.
Select Image - This button allows you to select an image.
Select Page - This button allows you to select a page.
Select Section - This button allows you to select a section.
Philips Medical Systems 4535 674 64521_A
Select All - This button allows you to select all data.
Actions that can be performed in selection mode include:
• orientation
• delete
• cut
• copy
• save
• pan
• zoom
• windowing
• print
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Filming
13- 21
Actions that are performed based on the active image include:
• Annotations
• Page Break (add/remove)
• Insert Parameter Image
• Insert Blank Image
• Print Active Image
• Paste (the active image locates where paste is performed)
• Section break (the active image begins the first image of the new
section).
Common tools
13.9
13.9
Common tools
The common tools area provides many basic functions, including saving,
panning, zooming, and windowing. Common tools are, in general,
common to all the Viewers, and are shared with many other applications of
Brilliance Workspace Portal.
Philips Medical Systems 4535 674 64521_A
For more information on Common Tools see the “Common Tools” section
in the CT Viewer chapter of this volume of the user manual.
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Filming
13- 23
14
14.1
Reporting
Overview
Report Editor is used to create, modify and view reports. The Reporting
feature of the Brilliance Workspace Portal 2.5 allows you to create
customized reports, using pre-formatted templates. This chapter describes
the functionality of the Reporting application, including Template Editor
and Report Editor.
Philips Medical Systems 4535 674 64521_A
A template is a specially designed formatting document that places the
analytical information and images that you send from an application into
an attractive, organized report. Reports can be customized and can be
stored or printed for both internal and external use, and include patient
information, scan information, and images. Reports can be created in eight
languages; you can select a template for your report in the language of your
choice.
Report templates can be created and modified in Template Editor, which
you access through Preferences. (For more information on Preferences refer
to the Preferences chapter in volume 1 of this user manual.) Reports can be
edited, generated, and printed in Report Editor, which you access through
the Report workflow button.
All Brilliance Workspace Portal applications are configured for reporting.
Brilliance Workspace Portal - Volume 2
Reporting
14-1
14.1
Overview
Printing Reports
Any Windows printer that can be connected through the PC’s USB port is
supported for printing reports. Also supported is any Windows printer that
is networked to your PC. (A printer is not supplied by Philips Medical
Systems).
Output
Reports can be saved as PDF files and images can be saved as DICOM files
as well as non-DICOM files, including JPEG and KO (key object) files.
PDF files are fully compatible with and transferable to any PC equipped
with Acrobat Reader software (version 5.0 or greater).
Reports can be sent to PACS systems that are configured to accept
encapsulated PDF files. Files can be saved to the CDR folder for recording
to CD-R disks.
Note
1 4 -2
Reporting
Images in this chapter showing reports and screen displays are selected
from various applications. They may differ from what is displayed on your
Brilliance Portal Workspace, depending on which application you are using.
Brilliance Workspace Portal - Volume 2
Setting Preferences for Reporting
14.2
14.2
Setting Preferences for Reporting
Philips Medical Systems 4535 674 64521_A
Note
The Preferences utility is accessed from the Archive Manager in the
Directory. (For more information about using Preferences refer to the
Preferences chapter in volume 1 of this user manual.)
Above is a representation of the Reporting window of the Preferences
utility. There are three Reporting preferences available:
• Set Default Language - Allows you to set one of the eight available
languages as the default language for your Reports.
• Logo Configuration - Allows you to download your own graphic
image(s) and select one image to appear on the front page of your
reports.
• Template Editor Configuration - Allows you to create new report
templates and to modify user-created templates.
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Reporting
14-3
14.2
Setting Preferences for Reporting
14.2.1
Set default language for reports
From the Preferences display for Reporting you can set the default
language. Preferences is launched from Archive Manager in the Directory.
To set the default language for your templates:
1
Click Preferences.
2
Click Reporting.
3
Click the dropdown arrow to view the available template languages.
4
Click on the language you want to set as default.
5
Click OK. The selected language becomes the default and the display
returns to its previous state.
After setting the default language, when you request templates for use, or
for editing, the selection list displays all templates that exist in the default
language.
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Setting Preferences for Reporting
14.2.2
14.2
Procedure to configure logos
When the Reporting application is shipped from the factory, it has two
Philips logos (shown at left), called the “factory logos.” (These factory logos
can not be deleted.)
You can download your own images to be used as “hospital logos.” You can
set any hospital logo as the default logo, and it is included in every report
you generate until you change the default logo.
Note
A logo is not required in a report. You can omit a logo in your report by not
selecting any image as the default.
Logo file type
Philips Medical Systems 4535 674 64521_A
The file type for hospital logos can be TIFF or JPEG; JPEGs are
recommended. Your organization should standardize the size and pixel
resolution of the image(s) used as logos. This allows the hospital logos to be
interchanged without having to re-size them. Logos can be imported
directly from a CD and do not have to be saved to the C: drive.
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Reporting
14-5
14.2
Setting Preferences for Reporting
Add Logo(s)
To add logo(s) to your logo folder:
1
Click Preferences. (Preferences is launched from the Archive Manager
in the Directory.)
2
Click Reporting.
3
Click Launch Logo Dialog.
The Logo Configuration box opens, as shown below. (From this box in
addition to adding a logo, you can set a default logo, or change to a new
default logo.
4
Click Add Logo.
The Import files dialog opens, as shown below:
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Brilliance Workspace Portal - Volume 2
Philips Medical Systems 4535 674 64521_A
Setting Preferences for Reporting
Brilliance Workspace Portal - Volume 2
14.2
5
Click Browse. The Import files dialog opens, as shown below:
6
Find, select, and open the image file. The image appears in the Add
Logo window, as shown below.
Reporting
14-7
14.2
1 4 -8
Setting Preferences for Reporting
Reporting
7
Enter a Logo Name.
8
Click Add. The logo is added to Logo Configuration.
Brilliance Workspace Portal - Volume 2
Setting Preferences for Reporting
14.2
To set a logo as default:
Click on one of the images in the logo configuration box to use as the
default logo.
2
The selected image is highlighted with a green border.
3
Click Set As Default.
Philips Medical Systems 4535 674 64521_A
1
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Reporting
14-9
14.3
Template Editor
14.3
Template Editor
With Template Editor, you can select a specific application and design
templates, by either editing an existing template (factory template) or
creating a new template. The list of existing templates displays all of the
available language templates you can select from.
You can send data and images from various applications to a database
within the Workspace system. Reporting can then produce displayable and
printable reports, by incorporating the information within a template.
14.3.1
Templates
There are two types of templates; the factory default template that comes
with the system and custom templates which you can create.
Factory templates - Various templates are provided with your system - these
are called “factory” templates. A factory template is one that is supplied as a
standard component of the Brilliance Workspace Portal. Factory templates
are supplied in seven languages in addition to English, and the languages of
the available templates are listed.
You cannot delete or modify a factory template, or change its name.
However, you can use a factory template as the basis of a new template. You
can copy and modify templates using the “Save As...” function, and save
them under a new, unique name.
Custom templates - In addition to using the factory templates supplied
with your system, you can create and save your own template designs.
Default templates - There can be only one default template. A template
marked as default for a specific clinical application is the one that is used to
create a report when you send data/images from that clinical application to
the Reporting application.
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Template Editor
14.3.2
14.3
Template Editor Configuration
Launch Template Editor
Philips Medical Systems 4535 674 64521_A
The Preferences utility is where you begin the process of editing and
creating report templates. (Preferences is launched from the Archive
Manager in the Directory.)
Brilliance Workspace Portal - Volume 2
1
Click Preferences.
2
Click Reporting.
3
Click Launch Template Editor. The Select target applications box
opens.
4
Choose the desired application(s) by clicking each application you want
to choose. You can choose more than one application. Selected
applications turn grey.
5
To deselect an application, click it again.
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14- 11
14.3
Template Editor
6
Click Next. The Report Editor window opens.
7
Select either Edit Template (default) or select Create New Template by
clicking the button next to the selection.
These functions are described on the following pages.
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Template Editor
14.3.3
Edit existing template
Be careful when editing a report in Template Editor. In some parts of the
report, it is possible to change Findings or Patient Information in the
template that could effect data received from an application.
Wa r n i n g
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14.3
Note
Brilliance Workspace Portal - Volume 2
1
Choose a template from the Existing Templates list.
2
Click Next. The template editor opens.
3
Insert options for the following fields:
• DICOM Fields
• Form Fields
• Insert Image Layout
• Insert Section
4
Click the Save button. The Save Report template box opens. Complete
the options.
5
Click Save or Save As...
The system requires you to name your template. You cannot rename a
Factory template.
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14- 13
14.3
Template Editor
14.3.4
Create new template
Create New Template allows you to choose the sections to be included in a
customized report template. The template report is generic; you have to
customize it by inserting your desired sections. There is a listing of available
factory installed sections, which are pre-defined, which you can choose
from to create a new report template. (You can also create your own new
sections that can be saved and used to create customized templates. This
procedure is explained later in this chapter.)
Note
You should use Create a New Template only if there is no Factory Template
that can be edited to satisfy the new report you have in mind.
Create new template using sections
You can create a new template by using factory default selections or using
the Create New Section function.
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Template Editor
14.3
Left panel - Listed here are factory sections that you can choose for creating
new report templates. (Selected sections from the left panel are inserted into
the customized template through the right panel.)
Arrow buttons (left- and right-pointing arrows) - These arrows allow you
to move sections into the right panel (or return them to the left panel) so
that you can build the report template.
Right panel - This panel contains the selections you have selected, to be
included in your custom report. The order of the sections listed in this
panel is the order in which they appear in the report template.
Arrow buttons (up- and down-pointing arrows) - Use these arrows to
determine the order in which the sections appear in your report. Do this by
moving the selected sections up or down into the desired order.
Create new section
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Click the Create new section button to begin building a new section to be
included in the report template.
Brilliance Workspace Portal - Volume 2
1
Click on Create New Section button.
2
Click OK.
3
Create sections by using the tools on the left panel. (This procedure is
explained in the next section, Template Editor Viewer.)
4
Click Save when finished.
5
Click Back to create a new template.
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14- 15
14.3
Template Editor
Create new template
1
Choose the sections to include in the template.
• Use the right/left arrows to place the sections in the box on the right.
2
Arrange the selected sections in the order they are to appear in the
template.
• Use the up/down arrows to the right.
3
After defining all the sections to be included in the report template,
click Next. The Report opens with defined sections.
Be careful when editing a report in Template Editor. In some parts of the
report, it is possible to change Findings or Patient Information in the
template that could effect data received from an application.
Wa r n i n g
Note
4
Make any additional edits by inserting options for the following fields:
• DICOM Fields
• Insert Form Fields
• Insert Image Layout
5
Click the Save button to save the report. The Save Report Template box
opens.
6
Choose the report type and add a Template Name.
7
Click Save or Save As...
Save As... displays only when editing a factory template.
Make the new template the default template
The new template is not automatically the default template. To make it the
default template:
1 4 -1 6
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Template Editor
14.3.5
14.3
1
Click Back.
2
On the list of existing templates, click Set Default Template to make it
the default template.
Set default template
From the list of existing templates you can set one of the templates as
default by selecting a template, then clicking the Set Default Template
button.
14.3.6
Finish editing and/or creating a template
Philips Medical Systems 4535 674 64521_A
When you are done with your work in the Template Editor Configuration
stage, click Next to access the Template Editor Viewer.
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14- 17
14.4
Template Editor Viewer
14.4
Template Editor Viewer
After you select Edit Template or Create a New Template and click Next, a
sample layout of the report template displays on the Report Template
Editor.
The editor allows you to modify the look of the template using the Insert
DICOM Fields, the Insert form fields, the Insert Image Layout, and the
Insert Section. You can also use the tools in the toolbar across the top of the
display.
Tool panel - The tools in this panel allow you to access a variety of options
for creating report templates, including: changing the font, find, print
preview, print, cut, copy, and paste.
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Template Editor Viewer
14.4
You can add any of the fields listed below into a report template.
To add any of these fields, first place the cursor where you want the field(s)
to appear in the report template.
Insert DICOM Fields
• Highlight the field(s) to add.
• Click the yellow + sign.
• Repeat as necessary.
Insert Form Fields (four buttons, from left to right)
Philips Medical Systems 4535 674 64521_A
• Select and insert tables - Select and insert table with dropdown
arrow; choose from a 2, 3, or 4 column table.
• Insert a Check box - Click the insert check box button.
• Add a section heading - Click the section heading button to insert a
section heading.
• Add a text entry form - Creates a text box for typing.
Insert Image Layout
• Choose the desired layout, including size and placement of an image.
• Comments and/or captions can be placed at top, bottom, left or right
of the image.
• Alternately, you can choose image only, with no caption.
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14.4
Template Editor Viewer
Insert Section - Lists predefined sections, and sections that you create.
• Highlight the field(s) to add.
• Click the yellow + sign.
• Repeat as necessary.
Save Button - You can save the report at any time. When you have
completed any changes to the report template, save them. The Save As...
option displays when you are editing factory templates. If you are creating
or editing a custom template, Save displays.
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Reporting
1
Click the Save button. The Save Report Template box opens.
2
Choose report type.
3
Create a report template name.
4
Click Save As The dialog box closes.
Brilliance Workspace Portal - Volume 2
Template Editor Viewer
5
14.4
Click Back if you want to continue making changes.
-- OR --
6
Click Exit to exit the Template Editor.
7
Click OK to exit Preferences.
Right mouse functions
• Default - Displays a check mark if template is set as the default.
• Copy to language - Allows copying of template into a different
available language.
Philips Medical Systems 4535 674 64521_A
• Delete - Is only available for user created templates.
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14- 21
14.5
Report editor
14.5
Report editor
During your work in one of the applications of the Brilliance Workspace
Portal, you have the opportunity to store images and information into a
reporting database. Report Editor allows you to change the look and layout
of the report by editing a draft report. Report Viewer displays an approved
report in PDF format.
You can make edits to reports using the tool bars, the Summary Images
section, and the Tools section to the left of the report.
With the Report Editor you can select the information to be extracted from
the patient’s study into the report.
You can also add additional content such as:
• Patient information
• Scan procedure
• Analysis results
• Sample images
• Diagnosis
• Recommendations
• Comments (added after the report is generated)
Note
1 4 -2 2
Reporting
This information is based on the Report template configuration that was
selected.
Brilliance Workspace Portal - Volume 2
Report editor
14.5.1
14.5
Report editor workflow
•
•
•
•
•
•
Note
Load patient study/series into an application
Perform analysis
Send data to report (see “Send data to report” below)
Open report editor
Make changes to report
Save or Approve report
Remember to save report.
Send data to report
Philips Medical Systems 4535 674 64521_A
Click the Report image(s) button
to send data, images, and comments
to the report. The Report options
are offered in the dropdown menu.
Wa r n i n g
Brilliance Workspace Portal - Volume 2
Be careful when using the Report Editor function. In some parts of the
report, it is possible to change analysis or patient information data received
from an application.
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14- 23
14.5
Report editor
14.5.2
Report editor functions
Report Editor allows you to change the look and layout of your final
reports. (Before you can edit a report, you must have sent data to it.) The
display below shows what the Report Editor looks like when you open it,
representing the report as it looks when printed.
1 4 -2 4
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Report editor
14.5
Reports tab
All reports for the current patient are listed, by application name and date.
Template - Shows the report templates that are available for the displayed
report (the default template displays).
Language - Shows the languages available for the displayed report (the
default language displays).
Note
The language you use for your comments does not have to be the same as
the language of the report template. (See Language, below.)
Note
Make sure to change the Template and the Language before typing in the
report. Otherwise you lose the typed data.
Summary Images tab
Summary images are a preview of the image(s) sent from the clinical
application. These images are also stored in the patient database.
Philips Medical Systems 4535 674 64521_A
Selecting image(s)
• Select an image by clicking on it.
• Selected images have a green border around them.
• To select a range of images, hold <shift> on the keyboard and select
the first and last of a range of images in the Summary images panel.
• To select multiple images, hold <ctrl> on your keyboard and click
every image you want to select.
• To deselect an image click on it.
All images - If All images checked, all of this patient’s
images that have been sent to the report editor from
various clinical applications are displayed.
If All images is not checked, only the images from the current application
are displayed.
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14.5
Report editor
One column - If checked, the images display in one
column.
You can have both All images and One column boxes checked at the same
time.
Scroll bar - Use this bar to move the images up or down in the summary
image viewport.
Summary Images buttons
Titles On/Off - Click this button to turn the image titles on or off. This
function works whether images are selected or not.
Note
If titles are OFF when the image is sent to the report, there is no patient
information on the images of the report.
Add selected images to report (activated when image(s) are selected) Select the image to be added, then click this button.
Add all images to report - Click this button to add all of the images to the
report. The images do not have to be selected.
1 4 -2 6
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Report editor
14.5.3
14.5
Save/Print Images
Note
The Save/Print Images buttons are grayed out if no images are selected.
Save as Key Object Selection
Philips Medical Systems 4535 674 64521_A
Choose the reason for Selection; use drop down arrow for choice of
selections. When you click OK, a new series is created and displayed in the
Series tab of Patient Directory, with modality set as KO.
Note
Brilliance Workspace Portal - Volume 2
At least one image must be selected or made active before the Save/Print
images function becomes active.
Reporting
14- 27
14.5
Report editor
Save Image(s) or Save Image(s) As...
You can save images to the default storage location(s) or to other locations.
Save image(s) saves the image in its original format to the storage
location(s) which were preset in Preferences.
Save image(s) As... allows you select other storage location(s), to change the
file type (ex: JPEG or BMP), and to enter a file name, as follows:
1
From the dropdown menu, select Save image(s) As...
2
Type a name in the Label field.
3
Select the desired file type from the Save As dropdown menu.
4
Click the box(es) showing the desired storage device(s).
You can select as many storage devices as desired. Click again to deselect a device.
1 4 -2 8
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Report editor
5
14.5
If you want the file to be stored in the Multimedia (File)
Viewer Folder, which is accessible from the Brilliance Portal
Workspace’s Directory page, also click the Multimedia
checkbox.
This function is only available when JPEG, BMP or TIFF is selected.
Note
6
Click OK when finished.
Export selected images in TIFF format
Philips Medical Systems 4535 674 64521_A
You can select the specific image(s) that you want to export as TIFF files. If
no images are selected, this button is disabled.
1
Click Export selected images in TIFF format button. The Export Files
window opens.
2
Choose the desired location.
You can Create a New folder, but the target device must be selected first.
Note
Brilliance Workspace Portal - Volume 2
3
Click Create New Folder. Provide a new folder name.
4
Click OK. The image is exported as a TIFF image.
Reporting
14- 29
14.5
Report editor
Print selected images
1
Select images to print.
2
Click the Print selected images button. The printer parameter box
opens.
3
Select the desired printer and the desired printing options.
4
Click OK to print.
To define a printer, refer to your hospital’s IT department.
Note
14.5.4
Tools tab
Change logo
You can choose which hospital logos to display. Logos can be loaded
through the Preferences function or added directly from the browser.
1
Click the Change logo button. The Change Hospital logo window
opens, showing the hospital logos that are available.
2
Choose a logo, or use Add option to add a new logo.
3
Click OK.
Insert page break
Page breaks can be inserted into reports.
1
In Report Editor, place the cursor where you want the page break.
2
Click Insert Page break button. A page break is inserted.
To remove a page break, place the cursor where the page break was
inserted, and press <Delete> on your keyboard.
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Report editor
14.5
Insert table
Tables can be added to the report.
1
In Report Editor, place the cursor where you want to add the table.
2
Click Insert table button to add table to the report. The table
definition box opens.
3
Define the new table parameters:
• Number of rows.
• Number of columns.
4
Click OK.
Do not change the table columns in the finding section of a report. It is
possible that you can delete the entire finding table.
Wa r n i n g
Insert picture
Philips Medical Systems 4535 674 64521_A
This function adds a picture to a report.
Brilliance Workspace Portal - Volume 2
1
In Report Editor place the cursor where you want image on the report.
2
Click the Insert Picture button. The Import Files box opens.
3
Choose a picture from your picture folder.
4
Click OK.
Reporting
14- 31
14.5
Report editor
Other Report Editor functions
There are other viewing, editing, and finishing functions which can be
accessed at any time while working with the Report Editor.
Show thumbnails - The page thumbnails for the report allow you to see
how many pages are in the report. Click the box next to Show thumbnails.
The thumbnails can be turned on or off.
Click a page in the thumbnail to view that page of the report in the main
viewport.
1 4 -3 2
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Report editor
14.5
Signing Physicians
You can add, edit, or delete a physician’s name here. Enter the reporting
physician’s name.
To Add a new physician:
1
Right mouse click over the Signing Physician box.
2
Choose Add new physician. A text box opens.
3
Type in physician’s name.
After a physician’s name has been added, the Edit physician and Delete
physician options become availible.
Philips Medical Systems 4535 674 64521_A
Saving, copying, printing, and closing a report
Save report – Click this button to save the report. When you save, the
report goes to the Directory, in the Patient’s folder, under the Report tab as
a draft report.
Note
A report that is still in the draft stage can be edited again. After a report has
been approved, it cannot be edited.
Approve report – After reviewing the report, you may approve it. Click the
Approve report button. You are asked “Are you sure you want to approve
this report?” Click “Yes” if you approve.
Note
Brilliance Workspace Portal - Volume 2
• After a report is approved, it cannot be edited.
• After a report is approved, the “Copy As PDF...” function becomes
accessible.
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14.5
Report editor
Copy PDF report to filesystem (only available after approval) – A copy of
the report in PDF format can be sent to the filesystem, where you can
browse folders and choose where you want to save the report.
Copy PDF report to CD ROM - A copy of the report can be saved on a
CD (if your PC is equipped with a CD-ROM burner).
Copy report as DICOM PDF - The PDF report can be saved on Local
Devices or Remote Devices. When you select this function, this dialog box
opens:
1
Choose the desired device.
2
Click OK.
Print report
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1
Click the Print report button. The Windows print dialog opens.
2
Make any necessary changes to the printer options.
3
Click OK to send the report to the printer
Brilliance Workspace Portal - Volume 2
Report editor
14.5
Close report
Click the Close report button to exit from the Reporting application.
If you have not saved the report, a message displays asking if you want to
save the report.
Philips Medical Systems 4535 674 64521_A
Note
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14- 35
Philips Medical Systems is part of
Royal Philips Electronics
www.medical.philips.com
[email protected]
Manufacturing address:
Philips Medical Systems (Cleveland), Inc.
595 Miner Rd.
Cleveland, OH 44143
U.S.A.
EU Representative:
Philips Medical Systems, Nederland B.V.
PMS Quality & Regulatory Affairs Europe
Veenpluis 4-6
5684 PC Best
The Netherlands
Copyright address:
Philips Medical Systems Nederland B.V.
Veenpluis 4-6
5684 PC Best
The Netherlands
© Koninklijke Philips Electronics 2007
All rights are reserved. Reproduction or transmission in whole
or in part, in any form or by any means electronic, mechanical or
otherwise, is prohibited without the prior written consent of the
copyright owner.
Dell is a U.S. registered trademark of Dell Computer Corp.
Microsoft is a U.S. registered trademark of Microsoft Corp.
X0197
This Medical Device meets the provisions of the transposition of
the Medical Device Directive 93/42/EEC within the country of
the origin of the Notified Body concerned with the device.
4535 674 64521_A * 11/2007
English
Analysis
Brilliance Workspace
Portal
4535 674 64531_A
PHILIPS
Contents
1
Introduction ..................................................................................... 1-1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
2
Safety ................................................................................................ 2-1
Philips Medical Systems 4535 674 64531_A
2.1
3
Regulatory controls ...............................................................................3-2
Security issues and guidelines ................................................................3-3
System description ........................................................................... 4-1
4.1
4.2
4.3
4.4
4.5
Brilliance CT - Volume 3
Important safety directions ...................................................................2-1
Security of system and data ............................................................. 3-1
3.1
3.2
4
About the Brilliance Workspace Portal .................................................1-1
About this guide ...................................................................................1-2
Intended use .........................................................................................1-4
Contraindications .................................................................................1-5
Compatibility .......................................................................................1-5
Compliance ..........................................................................................1-6
Training ...............................................................................................1-7
What Portal is.......................................................................................4-1
Requirements........................................................................................4-4
Antivirus software .................................................................................4-9
Applications ........................................................................................4-10
Ancillary programs..............................................................................4-11
i
5
Screen resolution and layout ........................................................... 5-1
5.1
6
Advanced vessel analysis .................................................................. 6-1
6.1
6.2
6.3
6.4
6.5
6.6
6.7
6.8
6.9
6.10
7
Overview .............................................................................................. 7-1
Define stage .......................................................................................... 7-3
Navigate stage..................................................................................... 7-11
Virtual colonoscopy images................................................................. 7-16
Compare stage .................................................................................... 7-29
Common tools.................................................................................... 7-32
Comprehensive Cardiac Analysis (CCA) ......................................... 8-1
8.1
8.2
8.3
ii
Overview .............................................................................................. 6-1
AVA window ........................................................................................ 6-3
Tool panel ............................................................................................ 6-5
Bone Removal stage .............................................................................. 6-7
Vessel extraction (centerline calculation)............................................. 6-27
Measurements..................................................................................... 6-34
Report (option)................................................................................... 6-39
Stent Planning .................................................................................... 6-41
Stent Planning Protocol Editor ........................................................... 6-52
Common tools.................................................................................... 6-61
Virtual colonoscopy ......................................................................... 7-1
7.1
7.2
7.3
7.4
7.5
7.6
8
Low screen resolution ........................................................................... 5-2
Overview .............................................................................................. 8-1
General tools ........................................................................................ 8-5
Heart Review ...................................................................................... 8-10
Brilliance CT - Volume 3
Philips Medical Systems 4535 674 64531_A
8.4
8.5
8.6
8.7
8.8
8.9
8.10
8.11
8.12
8.13
8.14
8.15
8.16
8.17
8.18
8.19
8.20
9
Lung Nodule Assessment ................................................................. 9-1
9.1
9.2
9.3
9.4
9.5
9.6
9.7
9.8
Brilliance CT - Volume 3
Heart Segmentation ............................................................................8-27
Coronaries ..........................................................................................8-34
3D-QCA ............................................................................................8-65
Overview of the tool panels.................................................................8-68
Overview of the 3D-QCA display .......................................................8-69
Viewports in the 3D-QCA application ...............................................8-70
Using Contours to measure stenosis....................................................8-81
Using Calipers to measure stenosis ......................................................8-90
Stenosis calculations............................................................................8-94
Saving, reporting and filming..............................................................8-96
Functional Analysis .............................................................................8-99
Functional Analysis opening window ................................................8-103
Functional Analysis procedure ..........................................................8-105
Finalize the results.............................................................................8-113
Wall Analysis maps ...........................................................................8-118
Visualization tools.............................................................................8-125
View Valves ......................................................................................8-128
Overview ..............................................................................................9-1
Recommended scanning parameters for LNA .......................................9-4
LNA workflow stages and results...........................................................9-6
Loading the initial LNA study ..............................................................9-9
LNA opening window ........................................................................9-10
Using the CAD option........................................................................9-18
Saving the nodule detection results .....................................................9-22
Nodule Matching stage .......................................................................9-23
iii
9.9 Assessment of the Lung Nodules......................................................... 9-28
9.10 The Computer Aided Detection option.............................................. 9-33
10
Brain Perfusion .............................................................................. 10-1
10.1
10.2
10.3
10.4
10.5
10.6
iv
Overview ............................................................................................ 10-1
Scan procedure ................................................................................... 10-2
Start Brain Perfusion .......................................................................... 10-4
Work Stages........................................................................................ 10-5
Perfusion Maps................................................................................. 10-11
Common tools.................................................................................. 10-27
Brilliance CT - Volume 3
1
1.1
Introduction
About the Brilliance Workspace Portal
Provides the local site administrators and service personnel with
functionality required to:
• Monitor Portal usage
• Administer strong password control
• Add/delete users and groups
• Maintain the database
• Manage web access to the server
Philips Medical Systems 4535 674 64531_A
The Workspace Portal can also be operated from the client:
C:\PortalPms\System\ RemotePortalManagement.exe
Philips Brilliance Workspace Portal v2.5 contains two software
applications, Portal Management (administrative) software and Portal
Client software.
The Portal application enables ubiquitous remote access to Extended
Brilliance Workspace 3.5 functionality through networked hospital PCs.
Brilliance Workspace Portal consists of a server, software and client
application.
Server data base is 500 GB compared to ~140 GB on stand alone Extended
Brilliance Workspace.
Note
Portal Management provides system configuration and maintenance
services such as User management and Modality and PACS connectivity.
Brilliance Workspace Portal - Volume 3
Introduction
1- 1
1.2
About this guide
Portal Server provides Storage and Query/Retrieve capabilities for CT
Images to and from CT modalities and PACS.
1.2
About this guide
This manual is intended to assist users and operators in the safe and
effective operation of the equipment described. The “user” is considered to
be the body with authority over the equipment; “operators” are those
persons who actually handle the equipment.
Before attempting to operate the equipment, you must read this manual
thoroughly, paying particular attention to all Warnings, Cautions and
Notes incorporated in it. You must pay special attention to all the
information given and procedures described in the Safety section.
Before attempting to operate any related CT equipment, you must read,
note, and strictly observe all DANGER notices and safety markings on the
CT Imaging System.
Wa r n i n g
Caution
Note
1 -2
Introduction
Directions, which if not followed, could cause fatal or serious injury to an
operator, patient or any other person, or could lead to a misdiagnosis or
mistreatment.
Directions, which if not followed, could cause damage to the equipment
described in this Instructions for Use and/or any other equipment or goods,
and/or cause environmental pollution.
Highlight unusual points as an aid to an operator.
Brilliance Workspace Portal - Volume 3
About this guide
1.2
The documentation for the Brilliance Workspace Portal is supplied in this
volume.
Volume 1 - Instructions for Use (this document)
This volume explains how to use the Brilliance Workspace Portal. It also
contains information about safety, data security, system start-up, software
navigation, accessing patient data and filming.
Volume 2 - Review
This volume explains how to use the various image viewers supplied with
the system. Also included in this volume are instructions on how to use the
reporting option, and how to use graphic tools for annotating studies and
making basic measurements.
Volume 3 - Analysis
This volume explains how to use advanced applications, Advanced Vessel
Analysis with Stent Planning (AVA), Virtual Colonoscopy (VC),
Comprehensive Cardiac Analysis (CCA), Lung Nodule Assessment (LNA),
and Brain Perfusion (BP).
Philips Medical Systems 4535 674 64531_A
Portal Remote Management Application
This volume explains how to use the Portal Management application. The
local site administrators and service personnel are provided the
functionality required to monitor Portal usage, check for errors, add/delete
users and groups and maintain the patient database.
This Document was originally drafted, approved, and supplied by Philips
Medical Systems (Cleveland), Inc. in the English language under the
product part number 4535 674 64511_A .
Brilliance Workspace Portal - Volume 3
Introduction
1- 3
1.3
Intended use
1.3
Intended use
The Philips Brilliance Workspace Portal is intended to be used and
operated only in accordance with the safety procedures and operating
instructions given in this Instructions for Use for the purpose for which it
was designed. The purpose for which the equipment is intended is given
below. However, nothing stated in this Instructions for Use reduces user’s
and operator’s responsibilities for sound clinical judgement and best clinical
procedure.
The Philips Brilliance Workspace Portal is intended for use as a diagnostic
viewing and processing application. The quality of the images depends on
the level and amount of X-ray energy delivered to the tissue during a
separate CT scan. CT imaging displays both high-density tissue, such as
bone, and soft tissue. When interpreted by a trained physician, CT images
yield useful diagnostic information. It is intended for use on the head and
whole body.
Use and operation of this equipment is subject to the law in the
jurisdiction(s) in which the equipment is being used. Both users and
operators must only use and operate the equipment in such ways as do not
conflict with applicable laws, or regulations which have the force of law.
Wa r n i n g
1 -4
Introduction
In the United States, Federal law restricts this device to sale, distribution,
and use by or on the order of a physician.
Brilliance Workspace Portal - Volume 3
Contraindications
1.4
1.4
Contraindications
The Philips Brilliance Workspace Portal should not be used if any part of
the equipment or system is known (or suspected to be) operating
improperly.
1.5
Compatibility
Equipment described in this manual should not be used in combination
with other equipment or components unless such other equipment or
components are recognized as compatible.
Changes and/or additions to the server should only be carried out by
Philips Medical Systems or by third parties expressly authorized by Philips
Medical Systems to do so. Such changes and/or additions must comply
with all applicable laws and regulations that have the force of law within the
jurisdiction(s) concerned, and with best engineering practice.
Philips Medical Systems 4535 674 64531_A
Changes and/or additions to the equipment that are carried out by persons
without the appropriate training and/or using unapproved spare parts may
lead to the PMS warranty being voided. As with all complex technical
equipment, maintenance by persons not appropriately qualified and/or
using unapproved spare parts carries serious risks of damage to the
equipment and of personal injury.
Brilliance Workspace Portal - Volume 3
Introduction
1- 5
1.6
Compliance
1.6
Compliance
The Philips Brilliance Workspace Portal complies with relevant
international and national standards and laws. Information on compliance
is supplied on request by your local PMS representative, or by:
Philips Medical Systems
PO Box 10 000
5680 DA BEST
The Netherlands
Facsimile: +31 40 276 2205
The Philips Brilliance Workspace Portal complies with relevant
international and national laws and standards on EMC (electro-magnetic
compatibility) for this type of equipment when used as intended. Such laws
and standards define both the permissible electromagnetic emission levels
from equipment and its required immunity to electromagnetic interference
from external sources.
California
In compliance with California’s Best Management Practices for Perchlorate
Materials (California Code of Regulations, title 22, division 4.5, chapter
33, article 1), the following warning applies to all Philips Medical Systems
Brilliance CT scanners and workstations due to Panasonic CR (button)
batteries that are mounted on printed circuit boards in various parts of the
system:
Wa r n i n g
1 -6
Introduction
Perchlorate Material – special handling may apply. For more information,
see www.dtsc.ca.gov/hazardouswaste/perchlorate/index.cfm.
Brilliance Workspace Portal - Volume 3
Training
1.7
Vermont
In compliance with the labeling requirements of the Vermont labeling law
V.S.A. 10, Chapter 159, §6621(d) and Section 6-803 of the Vermont Solid
Waste Management Rules, this product consists of devices that may contain
mercury, which must be recycled or disposed of in accordance with local,
state, or federal laws. (Within this system, the backlight lamps in the
monitor contain mercury.)
1.7
Training
Operators of the Philips Brilliance Workspace Portal must have received
adequate training on its safe and effective use before attempting to operate
the equipment described in this Instructions for Use. Users must also
ensure that operators receive adequate training in accordance with local
laws or regulations which have the force of law.
Philips Medical Systems 4535 674 64531_A
If you require further information about training in the use of this
equipment, please contact your local Philips Medical Systems
representative. Alternatively, contact:
Philips Medical Systems
PO Box 10 000
5680 DA BEST
The Netherlands
Facsimile: +31 40 276 2205
Brilliance Workspace Portal - Volume 3
Introduction
1- 7
2
2.1
Safety
Important safety directions
Philips Medical Systems products are all designed to meet stringent safety
standards. However, all medical electrical equipment requires proper
operation and maintenance, particularly with regard to human safety.
It is vital that you follow strictly all safety directions under the heading
Safety and all Warnings and Cautions throughout this Instructions for
Use, to help ensure the safety of both patients and operators.
Philips Medical Systems 4535 674 64531_A
In particular, you must read, understand and know the information
described in this Safety section before using this equipment.
You should also note the following information given in the Introduction
section of this Instructions for Use:
• intended use of the Philips Brilliance Workspace Portal.
• contra-indications
• training for operators of the Brilliance Workspace Portal.
Wa r n i n g
Operation of the equipment or system with improperly-operating or
wrongly-adjusted components could expose the operator or the patient
safety hazards. This could lead to fatal or other serious personal injury.
Wa r n i n g
Do not use the Brilliance Workspace Portal for any application until you
have read, understood and know all the safety information, safety
procedures and emergency procedures contained in this SAFETY section.
Brilliance Workspace Portal - Volume 3
Safety
2- 1
2.1
Important safety directions
Wa r n i n g
Do not use the Brilliance Workspace Portal for any application until you
have received adequate and proper training in its safe and effective
operation. If you are unsure of your ability to operate this equipment safely
and effectively DO NOT USE IT. Operation of this equipment without
proper and adequate training could lead to clinical misdiagnosis.
Wa r n i n g
Do not use the Brilliance Workspace Portal for any purpose other than
those for which it is intended. Operation of the Brilliance Workspace Portal
for unintended purposes, or with incompatible equipment, could lead to
clinical misdiagnosis.
Intended use of the Brilliance Workspace Portal is described under the
heading Intended Use in the Introduction section of this Instructions for
Use. Compatibility is discussed under the heading Compatibility in the
Introduction section of this manual.
2 -2
Safety
Brilliance Workspace Portal - Volume 3
3
Security of system and data
Philips Medical Systems is dedicated to helping you maintain the
confidentiality, integrity, and availability of electronic protected health
information and the hardware and software products that create and
manage these data.
Philips Medical Systems 4535 674 64531_A
Maintaining security of Philips Medical Systems' products should be an
important part of your facility's security-in-depth strategy. You should
implement a comprehensive, multi-layered strategy (including policies,
processes, and technologies) to protect information and systems from
external and internal threats. Your security strategy should follow industrystandard practices, addressing physical security, personnel security,
procedural security, risk management, security policies, and contingency
planning.
The practical implementation of technical security elements varies by site
and may employ a number of technologies, including firewalls, virus
scanning software, authentication technologies, etc.
This chapter provides guidelines to help the operator and owner
understand the possible ways security can be compromised, and then insure
that safeguards are in place to prevent this from happening. For specific
information about security within their institutions, operators and owners
can consult with the following offices at their location:
• Information Systems Security Officer
• Chief Information Officer
• HIPAA Officer (in the U.S.A.)
• Safety Officer
Brilliance Workspace Portal - Volume 3
Security of system and data
3- 1
3.1
Regulatory controls
3.1
Regulatory controls
Protect patient’s health information
One of the most important assets to protect with security measures is the
patient's health related information.
Many governments require maintaining the confidentiality of this
information. Therefore, strict security measures must be taken to guard this
protected information.
(Users in the U.S.A. may find guidelines at
http://www.hhs.gov/ocr/hipaa/.)
Prevent unauthorized device modification
Philips Medical Systems sells highly complex medical devices and systems.
We are required to follow government-regulated quality assurance
procedures to verify and validate modifications to the operation of our
medical devices.
Operators of this medical equipment must permit only Philips-authorized
changes to be made to the servers, either by Philips' personnel or under
Philips' explicit published direction.
Caution
3 -2
Security of system and data
Do not connect any external devices which were not included with the
server of your Brilliance Workspace Portal system.
Brilliance Workspace Portal - Volume 3
Security issues and guidelines
3.2
3.2
Security issues and guidelines
In addition to the patient information and device integrity needs discussed
in the preceding section on regulatory requirements, the following topics,
issues, and guidelines should be understood and addressed by operators and
owners. All content on this page refers to the Brilliance Workspace Portal
server and not the client PCs.
Network security
The Brilliance Workspace Portal must be placed on a secure local computer
network that has protections against viruses and other harmful computer
system intruders. Make sure the equipment is connected to a local network
that uses appropriate protection, such as a firewall and virus scanners.
Remote Service
Philips Medical Systems 4535 674 64531_A
Philips Medical Systems has a global, web-based network for connecting
many of your Philips systems to our advanced service resources. This secure
tunnel approach provides your equipment with a single point of network
access to on-site Philips equipment using Virtual Private Network
technologies. The remote service function is a secure connection through
explicit authorization and authentication control with encryption of all
data.
Antivirus Updates
Virus definition files and updated virus scanning engines are included with
the equipment. Updates of virus definition files and/or corrective software
versions are regularly made available by Philips to address known
vulnerabilities (virus and otherwise).
The system’s antivirus scanner is scheduled to activate during off hours,
while system is typically not in use. (Refer to the section “Antivirus
Software” in the System Description chapter of this volume for details.)
Brilliance Workspace Portal - Volume 3
Security of system and data
3- 3
3.2
Security issues and guidelines
Caution
Under no circumstances should updated virus definition files (or any type of
software) be installed on the Brilliance Workspace Portal by anyone other
than a Philips Field Service Engineer or an authorized Philips agent.
Positioning of display monitors
Unauthorized visual access to protected information can be minimized by
positioning the system’s display monitor so it faces a wall, to prevent
viewing from doorways, hallways and other traffic areas.
Note
Monitor position is a suggestion for use with monitors of client PCs used to
view Brilliance Workspace Portal.
To help in limiting unauthorized visual access, an unattended computer
display automatically goes blank after a set period of time. If there is no
interaction with the application for a preset length of time, the Idle time
out feature logs users off.
User login and logout protections
A consistent user login process (user names and passwords) provides good
security of protected information.
Minimum login standards include:
• Implementing strong passwords. This is the easiest and most effective
method to increase security. Strong passwords consist of at least eight
alphanumeric, mixed case characters, digits and special characters like
'@' or '*'. Never use words that can be found in the dictionary
• Never post or share user names and passwords
• Change passwords periodically
3 -4
Security of system and data
Brilliance Workspace Portal - Volume 3
4
System description
Brilliance Workspace Portal 2.5 (Portal) is a client/server application that
makes remote access to Extended Brilliance Workspace 3.5 functionality
possible through networked hospital PCs and in hospital locations remote
from the Radiology suite such as the emergency room, the operating room
or in a physician's office.
The main functions of Portal 2.5 include extensions to Extended Brilliance
Workspace 3.5 functionality to support use cases not present in Extended
Brilliance Workspace 3.5, such as user login as well as server and user
administration.
Philips Medical Systems 4535 674 64531_A
The two major components of this application are a server and software,
and a client application and software. The server and client application
communicate through a local area network (LAN) or possibly through the
Internet using a VPN connection.
4.1
What Portal is
Portal communicates with imaging systems of different modalities using the
DICOM-3 standard.
• Portal is a Thin Client /Server application that enables widespread
remote access to EBW 3.5 functionality via networked hospital PC’s.
• The Thin Client machine has the Graphical User Interface (GUI) and
displays images while the central Server retrieves and manages images,
and generates images for transmission to the client.
• Memory and CPU intensive operations such as 3D rendering takes
place on the server. Workstation operations can be performed via PC
Brilliance Workspace Portal - Volume 3
System description
4- 1
4.1
What Portal is
with less computing and memory resources than required by a
standalone workstation.
• Unlimited number of clients; multiple users can login simultaneously
and interact with datasets for review and interpretation.
• It’s a Brilliance Workspace anywhere the clinician needs it.
4.1.1
Key features
In Portal v2.5 CT Viewer imaging modalities supports CT. Portal functions
include various image handling features including:
• Archiving
• Viewing
• Manipulation
• Two and three-dimensional processing
• Analysis
• Filming
• Quick Review
• Reading (and burning – if supported by client PC) cd’s and dvd’s
• Unlimited number of clients
• All features and same GUI as CT Viewer in Extended Brilliance
Workspace v3.5
• Save non-DICOM directly to labeled Multimedia viewer in Portal
• Clipboard – copy an image to paste in documents/power points
• Integration with i-Site PACS: launch Portal with the same user login
and same selected data.
• Reporting (Based on TEcontrol)
• Additional applications:
• Advanced Vessel Analysis with Stent Planning (AVA)
• Virtual Colonoscopy (VC)
• Comprehensive Cardiac Analysis (CCA)
4 -2
System description
Brilliance Workspace Portal - Volume 3
What Portal is
4.1
• Lung Nodule Assessment (LNA)
• Brain Perfusion (BP)
Portal 2.5 employs a graphical multi-window, icon and mouse driven user
interface. It is designed to ensure maximum flexibility and intuitive
operation.
Large image sets are efficiently and conveniently reviewed and prepared for
using Extended Brilliance Workspace’s 2D display and manipulation
functions. Basic functions include real-time zooming, panning, windowing
and image viewing. Many viewing functions are included in the basic
functions, including 2D, slab, volumetric images and a basic endo flythrough capability.
4.1.2
Licensing
Philips Medical Systems 4535 674 64531_A
The Brilliance Workspace Portal software system does not support client
side licensing. Server licensing is limited to licenses based on the MAC
address. There is no user or feature specific licensing.
4.1.3
Performance
While the ultimate performance for any specific client depends on network
performance and load, and the number of users simultaneously requesting
computation on the server, the intent of the Portal application is to have
multiple users be able to use the CT viewer with “interactive” performance
over the network.
If no other users are requesting intensive computation from the server, a
single user is able to expect responsiveness consistent with EBW 3.5
Brilliance Workspace Portal - Volume 3
System description
4- 3
4.2
Requirements
4.2
Requirements
•
•
•
•
•
•
4.2.1
Gigabyte connections recommended
Recommended DNS server with reverse DNS capabilities
Recommended VPN access
Recommended domain based network environment
Supports Windows Vista
Dual server that is transparent to the user and handles twice the amount
of images.
Portal server
The Portal Server is connected to the PMS CT scanner and has PACS
connectivity capabilities. The scanner pushes images to the Portal Server
and the server can send and retrieve DICOM images from PACS.
A site can install multiple Portal servers, in which case a user of a Portal
client can connect to a chosen server. Each Portal server acts independently
and is not aware of any other Portal servers.
Memory- and CPU-intensive operations such as 3D rendering take place
on the server.
The Portal server can be accessed by a wide variety of remote users and can
can be placed anywhere in the Radiology IT rooms.
The Portal server is configured by Philips and is dedicated to running the
Portal server software.
Note
4 -4
System description
You must have the same software version as the server.
Brilliance Workspace Portal - Volume 3
Requirements
4.2
System
The server of Brilliance Workspace Portal is based on a Dell server system
and consists the following:
• Server
• Monitor
• Keyboard
• Mouse
• Internal CD-ROM drive
Caution
Never interrupt electric power to the Portal server when it is switched on.
Power down from the administrative application.
On start-up, the Portal client checks the local hardware and software
configuration. The software upgrades. If the hardware configuration does
not meet the minimum requirements for the Portal client a message
displays.
Philips Medical Systems 4535 674 64531_A
Note
Hardware configuration and software requirements of the Portal server are
listed below.
Hardware configuration
•
•
•
•
•
•
Brilliance Workspace Portal - Volume 3
CPU: 4x CPU Dual Core Xeon 7110 M, 3.66 GHz.
RAM: 20 Gb
Video: none
Operating System: Windows server 2003
Disks: 3 x 300 Gb disks in a RAID 5 configuration of 600 Gb
Network cards: 1 Gigabit network adapter
System description
4- 5
4.2
Requirements
Note
Windows Server 2003 OS permits remote login and system administration
through Remote Desktop Administration. Hospital IT should not install any
software on the Portal, such as security and antivirus.
Software
Third party software and security application Mcafee antivirus, (See the
Antivirus software section later in this chapter for more details) is included
in the installation of Portal 2.5. Also, all unused ports and services are
closed on the server for security purposes.
Note
4.2.2
Generally, other than stipulating minimal requirements, Philips does not
have control over the configuration of the client machines.
Portal client application
Portal client software is deployed on a variety of PCs with multiple
Operating System (OS) and hardware configurations. An unlimited
number of clients can be installed and loaded.
4 -6
System description
Brilliance Workspace Portal - Volume 3
Requirements
4.2
Hardware
Below lists the minimal requirements of the client PC.
Components
Required
Recommended
Available memory
512 mb
1024 mb or higher
Processor speed
1024 MHz
2048 MHz or higher
Screen resolution
1024x768 pixel
1280x1024 pixel or higher
Disk Free space on C drive
200 MB
1024 MB or higher
Network speed
100 Mbit
1000 Mbit or higher
Network card
Compatible with the hospital network or a
broadband Internet connection
Software
Components
Required
Recommended
Supported OS
Win XP
Win XP Service pack 2 OR Win 2000 SP4
Philips Medical Systems 4535 674 64531_A
Service pack 1,
Win 2000 SP4
Nero
Not required
If Nero present:write and read CD and DVD
on all platform
If No Nero: WinXp reads and writes CD
Win2000 only reads CD
Brilliance Workspace Portal - Volume 3
Windows account
for initial installation only. Ability to add Portal
administrative access
Software components.
System description
4- 7
4.2
Requirements
MAC Support
• (1) On WinXp running under Mac OS as a virtual machine
• (2) On WinXp running natively on Mac HW using BootCamp (dual
boot Mac or Xp solution from Apple)
4 -8
System description
Brilliance Workspace Portal - Volume 3
Antivirus software
4.3
4.3
Antivirus software
Antivirus software has been installed on the Portal server. The antivirus
check is started automatically, whether a Windows user is logged in on not,
at 2:00 AM (or 3:00 AM depending on time zone and daylight savings). It
can also be started at any time by a Philips service representative.
• If the computer is in the powered on state at 2:00 AM, but a user is not
logged in, the antivirus software runs automatically without displaying
a message.
• If you are logged in to the Extended Brilliance Workspace system when
the antivirus check is ready to start, this message displays: “Waiting to
Start. Virus Scan Will Start in xx:xx”
You can let it start by itself, or you can elect to start it immediately, or you
can elect to skip the virus scan.
While the virus scan is running, the message “Current State: Scanning
Files” displays.
Philips Medical Systems 4535 674 64531_A
Note
You can cancel a virus scan at any time, either before or during its
execution.
• If you log on during a virus check, the check for viruses continues,
showing messages describing its status.
• If no viruses are found, the following message displays: “Current State:
Virus scan complete. No viruses were detected.” The message window
closes automatically after 30 seconds.
• If a virus is found, the following message is displayed: “Virus scan
complete. A virus was detected. Call your service representative.”
• Contact your service representative. You may view the virus log. Click
the “Close this window” button to exit.
Brilliance Workspace Portal - Volume 3
System description
4- 9
4.4
Applications
4.4
Applications
Brilliance Workspace Portal 2.5 handles and displays independent image
viewing and processing applications.
CT Viewer
A comprehensive viewer for fast review of CT data in four
visualization modes:
2D - review original axial images
Slab - review a thin slab image in different orientations
Volume - review full volume images
Endo - review using the flythrough mode.
AVA (Stent)
Advance Vessel Analysis (AVA) offers a set of tools for stent
planning and general vascular analysis. With AVA you can
easily remove bone, then extract vessels and segment them.
VC
Virtual Colonoscopy (VC) enables fast and easy visualization
of colon scans, using acquired CT images.
CCA
Comprehensive Cardiac Analysis (CCA) is used to assess the
state of the coronary arteries and to create a functional
analysis of the heart.
LNA
Lung Nodule Assessment (LNA) assists with the diagnosis of
pulmonary nodules and lesions.
BP
Brain Perfusion (BP) is a blood flow imaging application that
analyzes the uptake of injected contrast in order to
determine perfusion related information about one or more
regions of interest.
4 -1 0
System description
Brilliance Workspace Portal - Volume 3
Ancillary programs
4.5
4.5
Ancillary programs
The following ancillary programs serve the main applications:
Directory
Selects and retrieves images for the applications. Copies to
other devices.
Queue Manager
Displays the order of copying images from one device to
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another and printing films.
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System description
4- 11
5
Screen resolution and layout
In Brilliance Workspace Portal there are two variations of resolution, high
resolution, which is 1280 x 1024 and low resolution, which is 1024 x 768.
Because of this there are some screens in the application where you will see
one of two different user interfaces. The user interface is different because
of the different resolutions. Here are the required and recommended
resolutions:
Required - client screen resolution is 1024x768
Recommended - client screen resolution is 1280x1024 or higher
Note
The portal client does not run on any system that has a lower resolution
than 1024 x 768. The portal runs on a resolution higher than 1280 x 1024
though is does not fill the screen.
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There are some screens that do not show differences in display between
high and low resolutions.
Below are examples of screens that display differences between high and low
resolutions in the user interfaces.
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Screen resolution and layout
5- 1
5.1
Low screen resolution
5.1
Low screen resolution
To overcome the low screen resolution, some tools are gathered under new
tabs in the toolbox to avoid a crowded toolbox and allow maximum area
possible for viewports.
Note
If you see double arrows in any of the user interfaces, this is an indicator
that there are additional tabs available.
The following images demonstrate the different layouts of some
applications.
AVA
In low screen resolution the volume rendering tools appear under the View
tab.
High Resolution
5 -2
Screen resolution and layout
Low Resolution
Brilliance Workspace Portal - Volume 3
Low screen resolution
5.1
Comprehensive Cardiac
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In low screen resolution the common tools appear under the Common
Tools tab.
High Resolution
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Low Resolution
Screen resolution and layout
5- 3
5.1
Low screen resolution
Film
In low screen resolution the layouts appear under the Layout tab.
High Resolution
5 -4
Screen resolution and layout
Low Resolution
Brilliance Workspace Portal - Volume 3
Overview
6
6.1
6.1
Advanced vessel analysis
Overview
Advance Vessel Analysis (AVA) offers a set of tools for general vascular
analysis. With AVA you can easily remove bone, then extract vessels and
segment them. You can also perform measurements such as intra-luminal
diameter, cross-sectional lumen area, length and tortuosity of vessel
segments, and the angles of vessels.
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Various review modes may be used, such as Volume Rendering, Maximum
Intensity Projection, Volume Intensity Projection, axial/coronal/sagittal
orientation, and straighten view with cross-sections. You can delineate
aneurysms, view the presence of mural calcification and lining mural
thrombus, branch vessels (iliofemoral arterial runoff circulation), and iliac.
Cautions
Brilliance Workspace Portal - Volume 3
• Always use the original CT images to correlate existing pathology and/or
anatomical study.
• Advanced Vessel Analysis should not be used as the SOLE
incontrovertible basis for clinical diagnosis.
• Verify that Bone Removal does not remove vessel segments.
• Bone Removal may be used on skull bone (but is not optimized for it).
• Verify that Remove Residuals does not remove vessel segments.
• Verify the accuracy of the centerline curves on the screen and correct
them manually when required.
• Verify the accuracy of the cross-sectional lines on the screen and correct
them manually when required.
Advanced vessel analysis
6- 1
6.1
Overview
The volume image displays the anatomy according to the defined protocol.
Do not use the volume image as the sole basis for a diagnosis.
Caution
6.1.1
Clinical Benefits of Advanced Vessel Analysis
•
•
•
•
•
•
•
•
•
•
•
•
6 -2
Advanced vessel analysis
Advanced visualization
Volume rendering and bone removal
Automated centerline tracking
Determine a true longitudinal dimension between selected crosssectionals of the subrenal aorta and the iliac vessels proximal to the iliac
bifurcation
Obtain angulation and volume measurements
Vessel diagnosis aid
Stenosis quantification and aneurysm assessment
Determine presence and severity (percentage) of stenosis aneurysm
Measurements
• Measure length and dimension of stenosis
• Measure area and mean intraluminal diameters
Cross-section diameter and area
Vessel segment length and angle
Stent graft placement - AVA can provide the valuable information
when assessing suitability for stent graft placement.
Brilliance Workspace Portal - Volume 3
AVA window
6.2
6.2
AVA window
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The typical AVA display consists of the tool panel along the left side, a large
image viewport area in the middle and 3 reference viewports on the right.
The central main viewport contains a 3D volume rendering. The 3
reference viewports on the right have Axial, Coronal, and Sagittal 2D views.
The main viewport may have MIP or Volume Intensity Projection views
and, depending on the stage in the workflow, the reference viewports may
have cross-sectional or MPR views. Any of the viewports can be enlarged to
fill the entire image area, using the Enlarge button, or you may use the
left-mouse click. Double click left to enable, enlarge and disable.
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Advanced vessel analysis
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6.2
AVA window
6.2.1
Screen resolution
When the screen resolution is low (laptop), the toolbox shortens. The tools
in the upper part (thickness and rendering) go into a new tab called View.
When the resolution is set to the recommended there is no View tab.
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Advanced vessel analysis
Brilliance Workspace Portal - Volume 3
Tool panel
6.3
6.3
Tool panel
The AVA application opens with the tool panel shown at left, with the
Bone Removal stage active and the Clip Tools window open.
Analysis toolbox
At the top of the tool panel is the analysis toolbox, which provides access to
a set of guided workflow steps.
The order of steps in the workflow are:
• Bone Removal
• Vessel extraction
• Measurements
• Stent Planning
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Click on the down-arrow to select from the list of workflow steps, or click
on the left or right arrows to move backward or forward one step.
Note
While following the workflow steps, you can go back to a previous step
without discarding any work performed in the current step. However,
making changes in a previous stage (for example, returning to vessel
extraction from the measurements stage, then editing vessel contours)
affects the work done previously.
Note
Measurement stage and Stent Planning remain grayed out until a vessel has
been selected in the vessel extraction workflow.
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6.3
Tool panel
Orientation, Layout and rendering tools
Orientation - Use these buttons to select the viewing orientation of the
main viewport: axial, coronal, or sagittal.
Flip - Flip the main image 180 degrees.
Layout - Two layouts are available, 1+3 and 2x2. The currently active
layout is displayed by the icon. Click the down arrow to select the
alternate layout.
In the 1+3 layout, the images consist of the volume image in the main
viewport and the axial, coronal and sagittal images from top to bottom
in the reference viewports.
The 2 + 2 layout has the same
views as 1 + 3, but is arranged
differently, as shown in the
diagrams at right.
Common tools
At the bottom of the AVA tool panel are the common tools used by many
of applications for saving, filming, reporting, image manipulation, graphic
annotations, etc.
Please refer to the CT Viewer - 2D mode chapter and Graphics chapter in
volume 2 for details.
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Bone Removal stage
6.4
6.4
Bone Removal stage
The Bone Removal stage of AVA contains a variety of tools used to reveal
the vessel(s) of interest. Defines each manipulation that you do to the
image.
6.4.1
Batch
The Batch function allows you to create a series of slab images for saving
and filming purposes. The Batch tools are used to define a batch of full
volume images in different orientations in order to create a live movie.
In AVA, two of the Batch and Cine functions are different than in other
applications:
• From marks your first stations
• To marks your next station
• Quick Batch provides a rotating cine function
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Note
Some of the features of the batch tab changes, depending on the active
image (with the blue frame). With active reference images, batch functions
are similar to those in the Slab viewer, except with fewer options.
From - Defines the starting image of the batch. This is the default when
you enter Batch.
To - Defines the end image of the batch.
When you do that, any movement of the volume, or change in protocol or
windowing, or change of bounding tools are interpolated between the
stops.
Clear - use to clear the currently defined batch.
Quick Batch - This function allows you to create a batch of the volume
using just a few clicks and parameter entries.
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Bone Removal stage
• Click the button that corresponds to the direction you want the volume
to turn. For example, click the left-pointing arrow to create a batch file
in which the volume turns clockwise.
• Degrees - This determines the extent of rotation in degrees.
• No. Im. (number of images) - This determines the number of images to
be included in the batch.
• Parameter Frame - Select this to include a parameter frame at the
beginning of the quick batch.
You can save, send to report and film a Quick Batch by using the Save, Save
As, Report and Film functions in Common tools.
Save image(s) - Click on the save icon to save images as Dicom series. By
clicking on the dropdown arrow you have additional save options including
Save display, Save tissue(s), Save Centerline and Save batch.
Save image(s) as - Click on the Save image(s) as icon to save images as
JPEG, BMP or TIFF files saved under the file tab under directory. A dialog
box opens where you can save the batch as DICOM series. By clicking on
the dropdown arrow you have additional save options including Save
display as, Save tissue(s) as, Save Centerline as and Save batch as.
Note
The Batch preview window that opens after clicking Save as is like the one in
CT Viewer - Slab mode. Only opens if defined in Preferences.
By clicking on the dropdown arrow you have additional save options
including Save display as, Save tissue(s) as, Save Centerline as and Save
batch as.
Report - Sends the batch to the report editor; send the whole display to the
report by clicking on arrow beside report icon and selecting report display.
Film - Sends the batch to the Filming application.
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Bone Removal stage
6.4.2
6.4
Cine
The Cine tools allow you to view (“play”)images in a cine (movie) mode.
The cine can be of the defined batch or of all the images loaded.You can
control the viewing speed, view the images in forward or reverse mode, and
can pause the display. Functions are summarized below.
Whole study - The entire selection in the series tree is played regardless of
the selection mode and in their displayed order.
Batch - This option is available if the From and To functions were used.
You can play the cine forward or backward, and can pause the display.
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Cine speed can be changed before or during play. Speed range is from 0.1
to 25 frames per second.
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AVI Movie
In AVA, you can create a movie. You can turn on the protocol and change
it. You can change the zoom and pan, and change the trim box while
making the movie. Right-click the Save As button and select Save batch as
to bring up the following menu, which allows you to save the batch as an
AVI movie:
6 -1 0
Note
Movie speed is controlled from the “Save As” Preference menu, accessible
from the Directory.
Note
If you have selected show batch preview before saving, a different screen
comes up first.
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Bone Removal stage
6.4.3
6.4
Clipping tools
The Clip functions are used to remove unwanted anatomy from the
volume.
There are three Clip functions, which are
available from a drop-down list, as shown at
right: Target Volume, Bounding Cube and
Clipping Plane.
Only one of the functions can be used at a
time.
Target Volume
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Target Volume is used for segmenting large, complex volumes like the heart
and aorta.
Procedure
To change size or location of the image use control points on the bounding
cube to move up or down, left or right and resize.
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Bone Removal stage
1
Select Target Volume. The cubical target volume box appears in all the
viewports.
2
Move the cursor near the box in one of the reference images. Control
points appear on the box.
3
To move the box, place the cursor between the control points. The
cursor turns into a cross. Left click and drag the cursor and move the
box to the correct position.
4
To resize the box, place the cursor next to one of the control points. Left
click and drag the cursor to resize the box.
5
To rotate the clipped volume (with the box), use the Swivel function on
the volume image.
6
To rotate only the volume, click the Lock button. Now when you drag
the volume, the box remains stationary.
7
To hide the lines in the volume viewport that define the target volume,
click the Hide/Show button. (The lines remain in the reference
images.) Click the Hide/Show button again to make the lines reappear.
8
To reset the target volume to the original orientation when the mode
was activated, click the Reset button.
9
Click the Target Volume button again to exit the mode. The box
disappears and the entire volume image reappears.
Bounding cube
The Bounding cube is used for analyzing small objects, like neuro vessels. It
provides a very quick method for focusing in on an object.
When you turn on the cube, a cross hair appears on the reference images,
and around it appears yellow squares representing the cube.
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6.4
The cross hairs and the squares are active graphics. By moving any cross
hair, you move the cube. By moving any edge of any square you change the
cube's total dimensions (it always remains a perfect cube).
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Use the bounding cube function as follows:
1 Select Bounding cube.
• Bounding cubes appear on the axial, sagittal, and coronal reference
images.
2 To move the bounding cube, place your mouse over the cube in the
reference image when the cross appears, then click and drag.
3 To change the size of the cube, approach any of the squares with the
mouse, and the square becomes active, with control points in the
corners.
4 Adjust the control points to cause the cube to expand or contract in all
dimensions around the cube’s center.
5 The Lock, Hide/Show, and Reset buttons operate as described in the
Target Volume description, earlier.
6 When you lock the bounding cube and swivel the volume, the
bounding box does not display in the reference view ports. Upon reset
of the bounding cube, the reference lines reappear.
7 Click the Bounding Cube button again to exit the mode. The cube
disappears and the entire volume image reappears.
Clipping Planes
The Clipping Plane is a single, moveable, infinite plane that cuts through
(“slices”) the true volume. The clipping plane leaves a volumetric view on
one side of the plane, it removes the volume on the other side of the plane,
and shows a cross-section of the anatomy at the plane.
1 Click Clipping Plane to activate the function.
The clipping plane is defined by a line on the reference images. No
clipping plane lines are visible in the volume view port.
The default orientation of the clipping plane is perpendicular to your
display screen.
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Bone Removal stage
2
To change the cut part of the volume:
• Rotate the yellow line on the reference images.
-OR• Swivel the volume image in the Lock mode.
By default, when you activate the Clipping Plane mode, the Lock
button is ON. This locks the volume, so the clipping plane rotates but
the volume does not rotate.
When Lock is OFF, the volume swivels around the plane.
The Hide/Show and Reset buttons operate as described in the Target
Volume description, earlier.
4 Click the Clipping Plane button again to exit the mode. The plane
disappears and the entire volume image reappears.
3
Note
When the clipping plane is active the scroll button is enabled for the volume
view. Scrolling up moves the plane perpendicular to itself into the visible
volume. Scrolling down moves the plane perpendicular to itself away from
the visible volume.
Bone removal
Wa r n i n g
• Verify bone removal does not affect vessel completeness.
• Bone removal is intended for use with the body, not the head.
Threshold - Bone removal is a threshold-based tool. It defaults to 350HU
(Hounsfield Units).
Bone Removal affects connectivity between objects. When you click on a
point, all areas connected to the object that have an HU value greater than
the threshold are removed. The extent of the removal function depends also
on the volume rendering protocol.
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Bone Removal stage
6.4
The bone removal procedure is as follows:
1
Click Place Seed. The cursor turns into a pencil.
2
Set the threshold for bone removal.
3
Click on the bone tissue on any image. Wait a few moments and the
tissue is removed.
4
Continue in this manner to remove all the bone tissue.
5
If bone removal does not remove smaller, unattached volumes
completely, the Remove residuals tool may be helpful.
Residual bone volumes are usually around 20 to 30cc - the system
defaults to 20cc. (The cc parameter is used because the size of the
fragments that may remain should be small.)
Click Reset and the images return to the state they were in before any
sculpting or bone removal was performed.
Verify remove residuals does not affect vessel completeness.
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Wa r n i n g
6
When the tissue definition is complete click Accept Tissue.
7
To Save the tissue, use the Save function in Common
tools.
In Bone removal you can use either the Reset or Undo
functions.
• Reset returns image back to original.
• Undo returns image in steps, residuals first.
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Bone Removal stage
Volume tracing
The Volume Tracing function of the Clipping tools helps you isolate
(segment) one or more anatomic structures within the volume image.
Verify segmentation correctness. If necessary, correct tracing with
correction tools.
Wa r n i n g
1
Manipulate any of the reference images to locate the volume of interest.
2
Alter the Rate and Type parameters if desired (described later)
3
Click the Inject Dye button to activate the segmentation (also called
“injection”) function.
4
Point the mouse onto the volume of interest in a reference image.
5
To inject the contrast, click and hold the left mouse button. The
volume of interest fills. The injected contrast is displayed as a blue
overlay, filling the volume in real time.
6
You can speed up the injection by dragging the mouse to locations
within the volume that are unfilled.
7
Release the left mouse button to stop the injection.
8
Allow a moment, then view the results in the volume image viewport.
9
You may continue injecting as necessary.
10 Scroll the images to view more of the volume and continue injecting if
necessary.
11 Show overlay turns the blue overlay on and off in the reference images.
Note
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Advanced vessel analysis
• You may also perform Volume Tracing on additional volumes, but first use
the Accept function.
• The entire volume image is displayed after you Accept. You can then
begin another Volume Tracing session on a different volume of interest.
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Bone Removal stage
6.4
Editing the Volume Tracing results
If you over-inject, you can modify the results with the Undo function.
Each click of Undo erases the last voxels that where added to the tissue
during injection.
The Fill function adds to the injected soft tissue, filling in any holes within
the volume.
The Expand function allows you to increase the edges of the contrasted
tissue. Each click expands the edge by a one-voxel increment.
The Erode function allows you to decrease the edges of the contrasted
tissue. Each click reduces the edge by a one-voxel increment.
The Eraser function allows you to remove the contrast from the reference
image by “rubbing” it out.
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The Eraser is a sphere whose radius you can set. The Small eraser is 5 pixels
radius; Medium is 10 pixels; Large is 30 pixels. Scroll the reference images
with the mouse wheel. Observe the results of the Eraser in the volume
image.
Note
Since the eraser is a shape of a sphere, it erases from the volume, not just
the slice you use it on. Be sure to verify the results of the eraser by scrolling
the reference images.
Volume tracing injection parameters
You can vary the Injection Parameters as desired to control the injection.
The Rate parameter adjusts the cubic volume of the injection. The Low
dose is 400 cc; Medium dose is 1500 cc; High dose is 4,000 cc.
The Type parameter adjusts the “viscosity” of the injection. Injection is
fastest at the 1 value and slowest at the 10 value.
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Bone Removal stage
6.4.4
Skull removal
Caution
Note
The Skull Removal function should not be used as the only incontrovertible
basis for clinical diagnosis. Diagnosis should be performed using the original
images, CMPR and curved MPR images.
Skull removal is only active if a carotid study with the small FOV has been
loaded.
The Skull removal option uses the “seeding” technique to segment vessels
and remove the skull bone. (If your system is not enabled for this optional
function, all the buttons in the Skull removal tab is grayed out.)
Click the Skull Removal tab to activate the function. After a delay while the
system processes data, the viewports appear as shown below. You can now
start the vessel seeding.
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6.4
User guide lines
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• A thin layer of residual bone around the carotid siphon may appear similar
to calcium along vessel in the Volume Rendering and MIP views.
• For optimal saccular aneurysm visualization, the algorithm requires
placement of a seed point at the farthest location within the aneurysm.
• The algorithm forces a connection between seed points. Therefore, it
finds a path even through a 100% occlusion.
• The algorithm does not include soft plaques or calcium deposits within
the contour boundaries.
• Strong dental artifacting may impair the accuracy of the algorithm
results.
Skull Removal placement of seeds
1 Load case to AVA
2 Select Skull Removal
3 Place seeds in the internal Right Carotid/Left Carotid and in the Right
Vertebral/Left Vertebral
4 Select Process
5 Go to Clip
6 Change residuals to 1
7 Click residuals button
The brain mask needs at least 3 cm of brain to be included in order for
algorithm to track carotids. Otherwise, the system once you click accept
returns to the Directory. A Good rule of thumb have the technologist scan
through the top of Sella turcica, if carotids are the only area of interest.
Note
Brilliance Workspace Portal - Volume 3
Zoom, Pan and adjust Window Width and Center until you can see the flow
of contrast in the vessel. Then place a seed in the area where contrast is
visible. It helps the algorithm to determine the correct centerline.
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6.4
Bone Removal stage
Recommended seed locations
Shown below are the recommended locations in the skull for placing seeds.
When seeding the vessel always work in one direction: start from the neck
and work up or start from the top and work down to the neck.
Note
Note
1
Find the first point to begin seeding. Use the Relate and Enlarge
functions to aid in finding the point to start seeding.
2
Click the Place Seeds button.
3
Click where appropriate on any of the three reference images (axial,
coronal, sagittal) to place a seed.
• At the minimum, you must place at least three seeds in each of the left
and right carotid vessels.
• When you place a seed, a labeling dialog pops-up. After three seeds, the
color of the label changes.
The context menu opens with these options:
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4
6.4
Click on one of the options to select it.
• Seed move is automatic.
• To delete a seed, right mouse click and select Delete.
The vessel list shows the number of seeds placed for each
vessel.
You can use the Undo button to remove seeds.
The Run Skull Removal button is enabled after you have placed at least
3 seeds in each of the carotid vessels.
5
Click Run Skull Removal. The Skull removal algorithm calculates and
removes the skull. During the calculation a progress message appears in
the status bar.
After placing vessel seeds (skull tab), and clicking Run Skull Removal the
3D model of the segmented tissue appears in the main view port. A center
line appears along each segmented vessel. Verify the correctness of the skull
removal and vessel tracking.
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Finishing Skull removal
After completing the optional Skull Removal function, and finishing the
Bone Removal work stage, you may proceed to the Vessel Extraction work
stage.
The vessels segmented in Skull removal is extracted and appears in the table
in the Vessel Extraction work stage.
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Bone Removal stage
6.4.5
View tools
Volume tools has two looks/functions depending on volume or reference
images active.
Thickness [mm]
The thickness is adjusted via a text box with up and down arrows. Each
click on the arrows change the threshold value by the default slice spacing.
You can also use the <Shift>+left mouse drag function to change the
thickness. Drag up to increase the thickness, drag down to decrease it.
You can also use the keyboard’s left and right arrow keys to change
thickness.
Render
Rendering is used for volume and MPR images. There are five rendering
modes available:
• Volume rendering
• MIP
• VIP
• MinIP
• Surface MIP
For more information on the rendering modes refer to Volume 2 Review.
The rendering panel represents the parameters of the active viewports
(viewports with a blue frame). Select the desired mode via the drop-down
arrow.
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6.4
Volume rendering
Wa r n i n g
The volume image displays the anatomy according to the defined protocol.
Do not use the volume image as the sole basis for a diagnosis.
Volume rendering assigns opacity
and color to every voxel according
to rendering protocols for
vasculature, soft tissue, and bone.
Selected structures can be
rendered opaque, translucent, or
invisible, allowing visualization
through and beyond contiguous
structures.
Philips Medical Systems 4535 674 64531_A
Refer to CT Viewer Volume
chapter for more information on
these rendering modes
• MIP
• VIP
• MinIP
• Surface MIP
Color to Black-and-White
This monochrome function turns the colors of the volume image into
grayscale.
High quality
This function changes some rendering parameters to show the image in a
better quality.
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Bone Removal stage
Opacity
This text box allows you to change the opacity of the volume image. You
may enter a value or click the up and down arrows. Sharper images take
longer to process. Activate when complete for processing.
• The default opacity is determined according to the default protocol.
• The opacity range is from 1 to 95, where 1 is the least (but not
completely) transparent, and 95 is nearly opaque.
Volume rendering presets
An extensive catalog of presets are available for volume rendering.
Show preset icons
Access the catalog by clicking the Show Presets button.
VR Protocol
The VR Protocol window opens. A narrow window display color icons
representing the available rendering presets. The active protocol has a blue
frame around its icon. Click on an icon to activate the preset. The volume
image updates accordingly.
The default group is determined by the scan type
of the current study. In this example at left, the
ABDOMEN group is active.
Clicking the down-arrow next to the protocol group name drops down a
selection of other groups. The default protocol is the Factory default (unless
it has been changed).
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You may select a different group, if desired. Then, using the scrollbar, you
can view all available presets in that group.
Note
Saving a protocol saves it to the current group.
Show Center Lines
Enabled after vessel extraction.
Show Transparent
Used to view, in a semi-transparent mode, all volumetric anatomy that you
have removed using various sculpting, clipping or tissue functions.
Show Couch
Allows you to show or hide the couch.
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Note
In the Bone Removal stage show couch must be turned off.
Calculate volume
Allows you to calculate the volume of a single tissue (or more than one
tissue, if more than one is active).
Clicking the button changes the volume image so the protocol is 100%
opacity. A blue highlight appears on the reference image. The calculated
volume is of the pixels colored blue on the reference images.
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6.4
Bone Removal stage
Edit tissue
Wa r n i n g
Verify couch and head holders were correctly removed.
Allows you to control the viewing of the volume based on the tissue
definitions that have been currently created and/or previously saved from
this and other applications. Clicking the Edit tissues button opens the
Tissue management dialog, from where you can control tissue activation.
Note
Tissue management functions the same as in CT Viewer - Slab mode. Refer
to the Slab viewer for details.
Note
Name the tissue using Tissue Management.
Save/Save as Tissue
Save tissues that you created. Loaded tissues need to be activated in the
TMD.
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Vessel extraction (centerline calculation)
6.5
6.5
Vessel extraction (centerline calculation)
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The Vessel Extraction stage is used for extracting the vessel path, either
automatically or manually.
• The automatic method uses the Centerline Calculation algorithm of
“weighted shortest path.”
• The manual method employs “simple line smoothing.”
The Vessel Extraction display is shown above. Depending on the extent of
the workflow, the central main viewport displays either 3D volume
rendering, slab, MIP, or MPR views.
The three reference viewports on the right usually display the Axial,
Coronal, and Sagittal views. When editing a centerline or contour, CrossSectional / Panoramic / Perpendicular views are displayed.
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6.5
Vessel extraction (centerline calculation)
6.5.1
Vessel Options
Place seeds
1
2
click place seed icon with left mouse click
go to viewport to place a starting seed (#1)
Extract
Use Auto Track Sequence to place two seeds or less
Use Auto Track Tree to place three seeds
Use Manual Track to place more than four seeds
Edit
Place the cursor near a control point, it turns from green to orange. If you
do a right mouse click on the control point while in edit mode delete
becomes available.
To delete or rename a vessel
1 Choose a vessel name from the context list
2 Right click on the vessel name in the vessel list
• Delete Vessel
• Rename Vessel
• Cancel
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Vessel extraction (centerline calculation)
6.5.2
6.5
Place the centerline
Place the centerline after you have done pre-processing.
Pick a vessel from the vessel list
1
2
Click on a vessel from the list.
Enter the new vessel name. The vessel is added to the vessel list.
Place two points in the vessel
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This must be done for a centerline start and end.
1
Click the Place Seeds button.
2
Place a start point by clicking in the vessel in any image viewport: the
main volume rendered image, or any of the reference images. This
point is marked A.
3
Place a second point (it could be the end point) in the vessel. This point
is marked B.
4
After two points are marked, the system enables the Auto
Track Sequence button, and you may click it to have the
system generate the path.
5
Alternately, if the vessel is tortuous, you may mark additional
points along the vessel, by using the Auto Track Tree icon.
6
After four points are marked, the system enables the Manual
Track button, and you may click it for manual centerline
calculation.
The right-hand viewports are set to one cross-sectional and two panoramic
MPR, parallel and perpendicular to each other.
Note
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You can switch between panoramic MPR and slab MIP using the rightmouse shortcut only.
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6.5
Vessel extraction (centerline calculation)
The centerline is traced on the main volume rendered image and on the
two panoramic MPR views.
Caution
Verify the correctness of the centerline curve on screen and correct
manually when required.
The Display Contours function is found under view. It shows the contours
on the cross-section reference view and displays the measurements of the
contour. The location of the displayed contour is a reference perpendicular
line on the center line.
Note
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Advanced vessel analysis
• The centerline can be edited in this stage.
• To correct the center line use the edit tools.
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Vessel extraction (centerline calculation)
6.5.3
6.5
Extracting aorta and iliacs
Be sure to verify the correctness of the extracted vessels.
Wa r n i n g
You may also extract the Aorta and two iliacs.
1
Pick “Aorta & Iliacs” from the Vessel context menu.
The context menu opens after placing seeds
and extracting centerline(s).
Note
Click the Seed button.
Place a start point on the aorta (preferably
above the renal arteries) by clicking in the
vessel in any image viewport.
4 Place a second and third point (marked B
and C) at the common iliacs (right and left,
in no particular order).
5 After three points are marked, the system
enables the Auto Track Sequence button -click it to have the system generate the
paths.
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2
3
Note
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Aorta can be tracked using two points. Aorta and Iliac uses three points.
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6.5
Vessel extraction (centerline calculation)
6.5.4
Label Vessels
After selecting one of the ‘Track’ buttons, a labeling dialog opens.
There are predefined names
• Aorta
• R. Renal
• L. Renal
• Aorta & R.Iliac
• Aorta & L.Iliac
• Celiac
• SMA
• Rt. Carotid
• Lt. Carotid
• Delete Vessel
• OK
• Cancel
When you select a a name, the dialog closes.
You can type in a name: type & click <Enter> or ‘OK’
The following functions are found under the right mouse click while in the
vessel list.
Delete Vessel - you can remove the
vessel.
Rename Vessel - you can change the
name of the vessel
Cancel - closes the dialog without labeling
The centerline being named is displayed in red in the image.
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Vessel extraction (centerline calculation)
6.5.5
6.5
Correct the centerline or add a new vessel
To correct manually, use the edit mode tool to edit and move the entire
centerline, or to move, add, or delete a point.
Note
• If you are changing the bifurcation point, be sure to observe in both
reference images (90 degrees turned from each other) that the height and
center are in the correct position.
• The spacing between the cross-sectional images is fixed by the AVA
application. The spacing is vessel-dependent, between 1.0mm and 2.5mm,
and is not user configurable.
Edit Vessel
•
•
•
•
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Note
Control points appear on the cMPRs and on the Volume image.
The centerline cursor on the cross sectional is movable
‘Add point’ option is available at Rt.click at the edge of the centerline
<Ctrl>+mouse click on a control point to delete it
Add points only work if you delete a point.
For Aorta & Iliacs
• The bifurcation point is marked with a big green square.
• To edit the point: move the square, and click auto ‘Track tree’ again
Note
Brilliance Workspace Portal - Volume 3
If you add a new vessel, the procedure starts again, and the three right-hand
viewports reset to axial, coronal, and sagittal.
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6.6
Measurements
6.6
Measurements
The Measurements stage of AVA allows you to perform general
measurements to gather data about vessels, such as cross-sectional area and
diameter, vessel length, stenosis estimation, and thrombus estimation.
The Measurements viewport is arranged as follows:
• Upper left - MPR with vessel Centerline and two lines locating the
Characteristic and Reference cross-sectionals. (Same image is at
lower-right of Vessel Extraction display.)
• Upper right - two parts: the vessel “strip” image with the
measurements data table below it.
• Lower left - the reference cross-section
• Lower right - the characteristic cross-section
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Measurements
6.6
Straightened MPR Image (upper-right) - This image can be rotated about
the line through center of the image, or you can switch to a new MPR view
perpendicular to the first.
Cross-sectional Contours - On each cross-sectional contour you can use
the editing tools to edit the contour. All the cross-sectional calculations are
done in the background. The results of the calculations are posted in the
data table.
Caution
Verify the correctness of the cross-sectional contours on the screen and
correct them manually when required.
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Text Section - The text section includes the two cross-sectional results
(diameter and area of each one, length measurement, difference diameter
and area) as well as the current user calculation result.
•
•
•
•
•
•
•
•
•
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Reference contour effective diameter
Reference contour area
Reference contour position
Characteristic contour effective diameter
Characteristic contour area
Characteristic contour position
Percentage of difference by diameter
Percentage of difference by area
Distance between the cross-sectionals
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6.6
Measurements
6.6.1
Vessel Tab
The vessel tab contains a list of the extracted vessels for setting the active
vessel, and several ROI creating and editing tools, including some of the QCTA and stenosis calculation tools. You can select a vessel from the list
inside the stage
Edit
Display Contours
Edge finder action - Used for drawing new contours. This tool calculates
average density difference between a point marked in the center of the
vessel and points marked outside the vessel. A contour is then drawn along
the equal density line at half the density difference.
Flexi Contour action - This tool calculates edge points on rays drawn
between a point marked in the center of the vessel and points marked
outside the vessel. A contour is drawn to connect the edge points using the
user-defined rays.
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Measurements
6.6.2
6.6
View Tab
Thickness
There are several methods available for changing the slab’s thickness:
• Type a value in the thickness box.
• Use the up or down arrows at the box.
• Click the Leaf&Select button. Then holding down the <shift> key,
click and drag the mouse left or right.
To change slab thickness in minimal increments use the left and right
arrows on the keyboard.
Render
Allows you to select from four Rendering techniques: Average, MIP, VIP
and MinIP. Each technique brings its own editing tools.
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Show Center Line
Shows the centerline in panoramic view once the “Generate Automatic
Path” button is pressed. (By default, the Centerline is not shown.) Verify
the correctness of the centerline.
Show Contours
Shows the contours on the cross-section reference view and displays the
measurements of the contour. The location of the displayed contour is a
reference perpendicular line on the center line.
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6.6
Measurements
Apply Color Map
Helps to visually distinguish between the contrast and the soft plaque.
Color Map in AVA
Note
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Advanced vessel analysis
Pathology
Range (HU)
Color
Lipid plaque
-40 to 60
Blue
Intermediate plaque
60 to 115
Green
Blood (contrast)
115 to 350
Red
Calcified plaque
350 to 735
White
Ranges are suggested, as described in the literature. The color scale shifts
when you window the image (with the middle mouse button).
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Report (option)
6.7
6.7
Report (option)
The Report function in AVA allows you send images and parameters to the
report scrapbook from the measurements screens. Add results to Report’
and ‘Clear from Report’ are available in the common toolbox. (Refer to the
Reporting chapter in Volume 1 for information on how to create a report
using the data you send from this AVA application.)
6.7.1
Report functions specific to AVA
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Add to report
Risk Factors and clinical history
The first time you Add anything to the scrapbook, the Risk Factors dialog
box displays. Use this feature to send any desired annotation regarding the
patient.
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6.7
Report (option)
Clear results from report
Clicking this button removes all images and data previously sent to the
Report scrapbook.
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Stent Planning
6.8
6.8.1
6.8
Stent Planning
Overview
Use Stent Planning to help provide quantitative information that assists you
in the design of better stents and other interventional devices. The Stent
Planning stage allows you to perform a set of measurements to be used for
planning your stent. The measurements include various diameters, areas,
lengths, and angles. You are advised with hints at each step as to what the
next step should be. At any step you can add your own measurement
definition to the list of predefined measurements. For each calculation the
appropriate number of cross-sections appear on the vessel.
You must do Vessel Extraction before you can perform Stent Planning.
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Note
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6.8
Stent Planning
6.8.2
Window
When you open the Stent Planning stage it opens to the following window.
Upper left viewport
Contains the MPR image with vessel centerline and the cross sectional lines
representing the locations of the stent measurements. (The MPR image is
the same image as the middle image on the right side of Vessel Extraction
display.) The selected diameter measurement is colored red. The diameter
measurement location is displayed in the cross sectional image on the upper
right image. If a length measurement is selected from the list, all associated
diameter measurements are highlighted red.
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Stent Planning
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Upper right viewport
Contains the reference cross section image.
Lower half viewport
Contains the strip image of the vessel, with a graphical representation above
it showing lumen areas and distances along the centerline
CPR image (upper-left)
The same image as the middle-right image in the Vessel Extraction stage.
Strip Image
You can rotate the strip and can scroll the cross-sectionals by moving the
cuts on MPR images or the strip, or by scrolling through the cross section
image.
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Note
Brilliance Workspace Portal - Volume 3
• You can scroll through the cross section image, though in doing so the
selected stent diameter moves as well. The link between the cross section
view contour and the stent diameter position is not breakable.
• You can change the rendering and thickness using the tool panel on the
left.
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6.8
Stent Planning
6.8.3
View tab
Note
The view tab is only visible with certain resolutions.
View is the default tab when you open Stent Planning. For information on
Thickness, Render, Show Center Line, Show Contours and Apply Color
Map see page 6-37.
Show All Measurements
Allows you to ides all inactive diameter lines. When you uncheck this it
causes only the active measurement (Diameter/length/angle) to show.
Active Diameters are the ones last modified or chosen within the list.
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Stent Planning
6.8
Show Data table
When you click on the Show Data table icon a table with the diameter
name, type and values opens in the upper right viewport. You can use the
scroll bars on the right to go up and down the table.
Note
Only the visible part of the table is saved/filmed.
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Stent Planning Measurement Data
Brilliance Workspace Portal - Volume 3
D1
Diameter of proximal neck (mm)
L1
Length of proximal neck (mm)
D2
Diameter of distal end of proximal
A2
Area of distal end of proximal neck
D3
Diameter of aneurism (mm)
L2
Length of stent (mm)
An1
Angle of stent body (degrees)
D4
Diameter of proximal end of distal
A4
Area of proximal end of distal neck
L3
Length of distal neck (mm)
D5
Diameter of distal end of distal
A5
Area of distal end of distal neck
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6.8
Stent Planning
6.8.4
Vessel tab
By using the drop down arrow you can choose the stent graft protocol you
want to work with. There are five factory protocols that you can choose
from according to the stent graft needed. There are two types of stent
grafts, regular type (Aorta) and the type for cases with bifurcation (i.e.
Aorta and Iliacs).
You can make your own protocols using the stent protocol editor (See
Stent Planning Protocol Editor, on page 6-52 for more information). On
the Vessel tab, the image on the right is a schematic diagram of the stent
graft currently in use. The list on the left contains the measurements
needed for the planning of the stent.
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Stent Planning
6.8
Add Measurement
Other measurements may be required for the stent you are planning to use.
If so, you can create them as follows:
1 Click the Add Measurement button. The dialog box shown
at left displays.
2 Click in the Name box to type in the measurement name.
3 Click in the Type box to select the measurement type from the drop
down list.
4 Click in the Description box to type a description of the measurement.
5 Click OK.
Note
To reset the current measurement, click the Reset button. Only the
selected and added new measurements may be deleted (removed from the
list and image display). The default measurements, defined by the protocol,
cannot be removed.
Delete Measurement
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Use to remove an unwanted measurement that was previously added.
Note
Default measurements that were defined in the Stent protocol editor
cannot be deleted.
For information on EdgeFinderAction and FlexiContourAction see
page 6-36.
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6.8
Stent Planning
6.8.5
Edit the diameter location or measured area
The contours and centerline are not editable in the Stent Planning stage.
Note
Select one of the measurements by clicking on the Diameter in the list,
CPR, or straightened CPR. The measurement line turns red.
2 Move the cursor and select the cross section view (top right).
3 Drag up or down with the left mouse. The measurement and the
viewed cross section move in unison.
1
Adding or creating a new stent protocol is done via the Preferences function
in the Directory. See the procedure in the next section of this chapter.
Note
4
To edit the diameters, click one of the diameter’s (Dmin or Dmax)
control points at either end of the diameter line and drag to a new
position.
The Dmin and Dmax diameters are colored blue and orange,
corresponding to the colors for the cross section diameter lines.
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Stent Planning
6.8.6
6.8
Cross-sections for stent planning
By a common convention, five cross-sections are defined for stent planning
measurements:
• Proximal part of proximal neck (D1)
• Distal part of proximal neck (D2)
• Aneurism (D3)
• Proximal part of distal neck (D4)
• Distal part of distal neck (D5)
Once you locate the five cross-sections, AVA calculates their areas and
diameters, as well as calculate distances between them and make pertinent
angular measurements.
You may edit the cross-sections contours using the manual editing tools.
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Caution
Brilliance Workspace Portal - Volume 3
Verify the correctness of the placement of the cross sectionals for the
measurements. Verify the measurements themselves (area, diameter,
length and angle) as well as the correctness of the centerline and cross
sectional contours. Make appropriate corrections manually when required.
You may use the manual editing tools or Flexi Contour and Edge Finder of
the Q-CTA tools to edit and correct contours over the cross-sectional cuts.
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6.8
Stent Planning
6.8.7
Locating and defining cross-sections
To aid in making and recording measurements, a dynamic image is
displayed, showing a schematic diagram of a stent. (The Aorta schematic is
shown at left; a different schematic is displayed for Aorta & Iliacs, shown
on next page)
The measurements are listed in the order they are expected to be carried
out. The current measurement is highlighted in red on the schematic
diagram.
1 Click the D1 box (diameter of proximal neck).
2 The D1 line appears highlighted red in the CPR images. The contour
for D1 appears in the cross section image. Move the pointer up to the
line and the pointer turns into a pencil.
3 With the pencil pointer, move the D1 line to the location of the
proximal neck on the strip image. (Alternately, scroll the images in the
upper-left quadrant to move the D1 line.)
4 Continue as above with D2, D3, D4, and D5. You can Add
Measurements if needed, as described earlier.
5 When done, you can proceed to the Report function.v
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Stent Planning
6.8
Aorta & Iliacs Stent Planning Measurements
AAA Stent Planning Regions
D1
Proximal part of proximal neck
D2
Distal part of proximal neck
D3
Aneurism
D4
Right common iliac attachment
D5
Left common iliac attachment
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AAA Stent Graft
D1
Diameter of proximal neck
L1
Length of proximal neck (mm)
D2
Diameter of distal end of
A2
Area of distal end of proximal
D3
Diameter of aneurism (mm)
L2
Length of stent (mm)
An1
Angulation of aortic neck
D4
Diameter of distal right iliac
D5
Diameter of distal left iliac
L3, L4
Length from aortic bifurcation
to the internal right/left artery
An2,An3
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Angulation of right/left iliac
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6.9
Stent Planning Protocol Editor
6.9
Stent Planning Protocol Editor
The Protocol Editor of the Advanced Vessel Analysis application allows you
to create new stent protocols. All factory protocols are available in the
editor.
Prior to getting started you need:
• a graphic image, in electronic file form, of the stent protocol you are
creating
• the manufacturer's stent data sheet. Use to specify measurements,
other data, and your questions into the protocol you are creating.
If a new stent protocol is created on a client under a specific user name and
password only that user has access to the new stent protocol. If there are
multiple users they should create the same stent under their own user
names.
Note
6.9.1
Open Stent Protocol Editor
1
2
3
From the Directory window, click Preference.
Select AVA from the directory on the left.
Click
to open the Stent Protocol Editor.
Access Protocol Editor
The protocol editor consists of four work stages; Protocol, Image,
Measurement and Questions. Each of these stages is accessed from the
drop-down menu. Click the forward arrow in the function menu to move
to the next stage.
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Stent Planning Protocol Editor
6.9
Protocol work stage
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In the Protocol work stage you can create new stents.
New
To create a New stent
1 Click New
2 Fill in the Protocol Name
• The name of the protocol and can be changed.
3 Fill in the Description
• a brief description of the protocol.
Click the check box next to the statement “This is a Stent for the Aorta and
Iliancs”
Check the box if the stent is to be used for Aorta and Iliac. This indicates
that a bifurcation is needed.
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6.9
Stent Planning Protocol Editor
Import
Use to import protocols.
Export
Use to export protocols to an output device.
Protocol Editor Window
Lists existing factory protocols and the new protocols that you create.
• AAA Stent
• AneuRx Stent Graft
• Excluder
• Powerlink
• Stent General
Click on an existing protocol and all of its data fills the Protocol Editor data
fields.
Note
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Advanced vessel analysis
You can modify any of the existing parameters using the same general
procedures that are described for creating a new protocol.
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Stent Planning Protocol Editor
6.9
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Image work stage
1
Click the name of the image file you are creating.
2
From the menu on the left, click the name of the image file that
corresponds to the protocol you are creating.
If the image you want has not been loaded. It does not appear in the list of
available images.
Note
3
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To move to the Measurements Stage click the forward arrow in the
function menu.
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6.9
Stent Planning Protocol Editor
Measurement work stage
Diameter
To place a line on the image:
1 Click the Diameter button
2 Place the mouse on the image.
3 A line automatically draws on the image. The diameter is automatically
named (D1).
4 You can enter a description in the Description field of the Parameters
view.
Active measurement line is red; inactive lines are blue.
Note
5
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Advanced vessel analysis
You can position the diameter line anywhere on the image by dragging
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Stent Planning Protocol Editor
6.9
it. Use either end of the diameter line to adjust its length or rotation.
6 To create another diameter line, left mouse click on the Diameter and
drag into the image.
Bifurcation
To place a line on the image:
1 Click the Bifurcation button
2 Drag the mouse into the image.
• A line is automatically drawn on the image. The diameter is
automatically named (D Bi).
3 You can enter a description in the Description field of the Parameters
window.
If using an Aorta and Iliac Stent, you must place a bifurcation diameter on
the image.
Note
Only one bifurcation can be placed - after placing the line the button
becomes be grayed out.
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Note
Length
1 Click the Length button to specify a length measurement.
2 You are prompted to "Click on 2 diameter lines" to indicate the start
and end points of the measurement.
Tortuosity
1 Click the Tortuosity button to specify a tortuosity measurement.
2 You are prompted to "Click on 2 diameter lines".
Angle
1 Click the Angle button to specify an angle measurement.
2 You are prompted to "Click on 3 diameter lines."
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6.9
Stent Planning Protocol Editor
Measurements Summary
All existing measurements parameters are listed here. Drag the bar on the
right to scroll up and down to view the complete list. When you click on a
list item it turns red on the image so you can identify it.
Note
Multiple lines turn red when you click on the Angle, Tortuosity, or Length
parameter.
List Order
By using the Up or Down buttons you can change the order of the
Measurements Summary List. Arrange the list in the same order you want
the measurements to be presented in the AVA application.
Orientation
This field only applies to Aorta and Iliac stents. Selections are Common,
Left and Right.
Note
Measurements below the bifurcation should be identified as Right or Left,
thus placing them on the right or left iliac.
Measured Values
To have all the listed parameters display in the in the AVA Stent Planning
strip image in the lower viewport click all four check boxes.
Control Points
You can define control points for the stent in relation to any diameter
location. Control points can be placed above or below the diameter using
millimeter dimensions.
Use the Add and Remove buttons to include or eliminate control points.
Click the forward arrow in the function menu.
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Stent Planning Protocol Editor
6.9
Questions work stage
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Stent manufacturers usually present a series of questions to be answered
when ordering a stent.
Enter these questions into the Protocol and indicate the possible answers
specified by the manufacturer. These questions and answers are included in
the report that can be generated from the AVA Stent Planning function.
Question button
Click the Question button to start a new question. The questions are
automatically numbered and added to the list in the Questions Summary.
Note
Brilliance Workspace Portal - Volume 3
Click any question in the summary list to review it.
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6.9
Stent Planning Protocol Editor
Question panel
The new question number appears in the field at the top of the Question
panel.
Type in the manufacturer's question in the text box below the question
number.
Answer panel
Type in the manufacturer's permissible answers in the Answer boxes that
are listed.
Note
If you do not enter an answer, the question section has a blank text field,
where you can insert free text.
For AVA user
Single Answer - Select this to limit the your response to one choice only.
Multiple Answer - permits several answers to a question, as allowed by the
manufacturer.
Allow Other - permits a different form of answer.
Save and Exit
When you are finished editing and proofreading the protocol, click the
Save button from any window.
After saving the protocol, click the Exit button to return to Directory.
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Common tools
6.10
6.10
Common tools
The common graphic tools area provides many basic functions including
saving, panning, zooming, and windowing. Common tools are, in general,
common to all the CT Viewers and are shared with many other
applications of Brilliance Workspace Portal.
Add\Clear from report are available in the common toolbox under Report.
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For more information on Common tools, see page 5-11 of Volume 2.
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Overview
7
7.1
7.1
Virtual colonoscopy
Overview
The Virtual Colonoscopy application enables fast and easy visualization of
colon scans, using acquired CT images.
Caution
Note
The Virtual Colonoscopy application is not equivalent to conventional
invasive colonoscopy.
The computer assisted reader (CAR) for polyps and the electronic cleansing
function are pending FDA clearance and are not commercially available in
the United States.
Philips Medical Systems 4535 674 64531_A
Work stages
Three work stages are provided in Virtual Colonoscopy:
• Define stage - Upon loading a study, the application automatically
segments the air-filled colon. A center line is calculated and displayed.
• A Cleansing function is optionally available to remove oral contrast if
any is present in the bowel. The function reduces artifacts and
presents an image with true anatomic display of all structures with a
smooth, accurate transition at the air-fluid interface. Cleansing can
potentially improve polyp detection where lesions are under fluid, or
rule out lesions where residual stool could mimic a polyp.
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Virtual colonoscopy
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7.1
Overview
• Navigate stage - The navigate stage provides a variety of visualization
functions:
• A scroll bar allows you to quickly visualize the entire colon along the
center line.
• A center line navigation feature allows you to fly through the colon in
cine fashion, continuously or step-by-step.
• An interactive navigation feature allows you to fly through the colon
by steering the view using your mouse on the image.
• A colon polyp computer aided reader (CAR) is optionally available to
support the radiologist in the detection and analysis of intracolonic
polyps. When enabled, polyp-like elevated tissue regions are
highlighted and displayed as the user scrolls through the images.
Candidates can be confirmed as lesions with a simple “accept” button.
• Compare stage - The third stage, Compare, allows you the ability to
compare up to two views of the patient such as supine, pione and
decubitus views for quick correlation.
Note
7 -2
Virtual colonoscopy
To perform the Compare function, both cases must be loaded at the same
time, when the application is started.
Brilliance Workspace Portal - Volume 3
Define stage
Define stage
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7.2
7.2
After selecting colonoscopy studies from the Directory activate the Virtual
Colonoscopy application.
There is a delay before you see the opening display (shown above). During
colon segmentation, the application is looking for air-filled structures
according to specific Hounsfield Unit values.
Status messages are shown at the bottom of screen, including “Loading
operation completed successfully,” Verify the correctness of the center line,”
and “Making final image. Please wait.”
The application automatically segments the air-filled colon. A center line is
calculated and displays starting and end points.
Structures identified as the colon are colored translucent tan; other air-filled
structures are colored translucent white.
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Virtual colonoscopy
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7.2
Define stage
7.2.1
View tab
Volume tools are available for use on the view tab and allows you to control
the display of the volume image. Use Volume tools to refine the image.
Thickness - Adjusted by using the up and down arrows. Each click
increases the threshold value by the default slice spacing.
Note: Thickness is only enabled in the reference viewports.
Render Modes- allow you to select from four Volume
rendering techniques: MIP, MinIP, Volume Intensity
Projection, and Volume Rendering. Each technique
brings its own editing tools.
Note
Render mode changes depending on the volume render or reference
viewports selected.
Color to BW - Changes color to black and white image.
High Quality - Displays high quality images as they appear on film.
This feature changes the rendering parameter to improve the overall
image quality of the Volume Rendered image
Opacity - Allows you to change the opacity of the volume image. You
can enter a value or click the up and down arrows.
• The opacity range is from 1 to 95, where 1 is the least (but not
completely) transparent, and 95 is nearly opaque.
• The default opacity is determined according to the default protocol.
Save presets as - Saves the active preset by a new name. A dialog opens
for typing the new name.
Show preset - Activates the preset window.
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Define stage
7.2
Show cleansing
Note
The electronic cleansing function is pending FDA clearance and is not
commercially available in the United States.
Note
Cleansing is a purchasable option on the Portal
During automatic segmentation if the application detects high-density
contrast in the colon, it removed the contrast before displaying the final
image. The Cleansing check symbol is in full color if the algorithm detected
HU that range from 200 - 2500. Two Reason the check symbols is grayed
out:
• No fecal tagging is detected.
• Cleaning has not been purchased.
Cleansing function
Cleansing may be automatically applied during segmentation.
Philips Medical Systems 4535 674 64531_A
At left is a reference coronal view showing contrast in the colon. The
contrast was removed to produce the volume image shown in the opening
display on the previous page.
If no contrast is detected, the cleansing function remains inactive as
indicated by the grayed-out.
If, during automatic segmentation, the application detects high density
contrast in the colon, it removes the contrast before displaying the final
image.
You can turn cleansing on or off by unchecking the box.
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Virtual colonoscopy
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7.2
Define stage
Note
The cleansing function is never applied to the Volume viewport.
The images below are:
• without cleansing (at left)
• with cleansing (at right)
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Define stage
7.2
Leaf along centerline
Allows you to navigate along the inside of the colon where the centerline is
generated. To view anatomy outside the colon for incidental, uncheck Leaf
along centerline and use the left mouse to scroll. Your current location is
indicated in all reference images by a green cursor.
Opaque Colon
3D Colon Map (Overview)
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A translucent or Opaque Color rendered image of the color that helps you
orient yourself to partial views presented in other viewports on the display.
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Virtual colonoscopy
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7.2
Define stage
7.2.2
Edit tab
Tools to define
Colon A and B point
The segmentation algorithm suggests the beginning (rectum) and end
(cecum) points of the segment being segmented (points A and B). If
necessary, you can move the points on the volume image. By pointing at the
A and B on the volume image, they change their color to yellow indicating
that they can now be moved.
You can swivel the image and turn it to sagittal orientation to help verify
the location of the points.
If you move the A or B point you must select recalculate center line
Note
Tools to define colon and centerline
In some cases the colon is segmented as a single complete structure. In
other cases, the colon is segmented in several parts, depending the
contiguity of the air-filled structures.
If more than one colon segment is produced, you may have to manually
identify the missing parts and connect them.
Accept/Reject Segment - Click this button then click in the image to
activate a section: the section turns tan. Click again to deactivate the
section: the section turns white.
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Virtual colonoscopy
1
Click on Accept/Reject Segment.
• The cursor turns to a pencil.
2
Place the pencil end on the segment you wish to add.
3
Left Mouse Click to add segment.
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Define stage
4
7.2
A Centerline is automatically done.
Recalculate Centerline - Click this button to indicate that the active
segment is part of the colon. A centerline is calculated between points A
and B of the active segment.
Each segment that you identify and accept as part of the colon is joined
together along the same centerline.
Add Seed Point - You can calculate a center line between multiple
points when automatic segmentation has failed or isn't satisfactory.
Click the Add seed points button, then place as many seeds as desired
on the colon.
6 Make sure you move point B to be between A and C.
7 Click the Accept segment button.
5
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Delete Segment - Click this button and the active segment disappears
from the image.
Hide remaining segments - Click this button after you have identified
and accepted all segments of the colon. The active segment remains in
the image, while all the others disappear.
Undo last operation - Click this button to undo your last segmentation
action.
Note
Brilliance Workspace Portal - Volume 3
The Axial direction is inferior-to-superior.
Virtual colonoscopy
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7.2
Define stage
Opaque Colon - Click this button to change the rendering from
translucent to opaque.
Note
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Virtual colonoscopy
Click the forward arrow to move to the Navigate stage.
Brilliance Workspace Portal - Volume 3
Navigate stage
7.3
7.3
Navigate stage
In this stage you can examine the virtual colon and search for and view
suspected colon polyps. Various image types are available for viewing, as
well as various display arrangements (layouts), including cine mode.
An automatic reading function (CAR) is optionally available that assists
you with searching for polyps.
Philips Medical Systems 4535 674 64531_A
Upon examining the colon both manually and automatically, you can mark
your “Findings” in a list and send the results as images and text to the
Reporting function.
Note
Brilliance Workspace Portal - Volume 3
A message at the bottom of the screen indicates the number of remaining
white segments which were not used during the segmentation of the
centerline. This number varies depending on insufflation of the colon into
the small bowel.
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7.3
Navigate stage
The navigate stage provides a variety of visualization functions:
• A scroll bar at the top of the Navigate display allows you to quickly
visualize the entire colon along the center line.
• A center line navigation feature allows you to fly through the colon in
cine fashion, continuously or step-by-step.
• A colon polyp computer aided reader (CAR) is optionally available to
support the radiologist in the detection and analysis of intracolonic
polyps. When enabled, polyp-like elevated tissue regions are
highlighted and displayed as the user scrolls through the images.
In this stage you can examine the virtual colon and search for and view
suspected colon polyps. Various image types are available for viewing, as
well as various display arrangements (layouts).
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Navigate stage
7.3
Colonoscopy images
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Many viewing modes are available for visualization of the colon. In
addition to orthogonal views, you can use these view modes:
• 3D Colon Map (also called “Overview”) - A translucent or surface
rendered image of the colon that helps you orient yourself to partial
views presented in other viewports on the display.
• Endo - An endoscopic view of the colon.
• Split - A view of the colon (perpendicular to the center line), splitting
the colon in half to show the far wall.
• Filet - A view that cuts a tubular section of the colon longitudinally and
stretches it onto a 420-degree image. (The 30-degree overlap on top
and bottom guarantees full viewing coverage.) The filet image is
designed for fast visual examination of the colon, providing superior
visualization over either Endo or Split.
• Layouts - You can choose to view multiple images in various
arrangements, combining 3D Colon Map, Endo or Split, Filet, and
several conventional image formats.
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7.3
Navigate stage
7.3.1
Layout of navigate display viewports
Note
You can Enlarge any of the images in any of the layouts.
The opening display defaults to the layout used. (user dependant no default
factory.) The layout in the screen shot above are the mixed layout, which
includes the viewports described below:
Viewport 1 - Default view is Filet. Orientation of view is with the end of
the colon toward the right, toward the cecum (point B). The green vertical
lines at the center of the viewport correspond to the center of the blue
highlight in viewport 3 and to the cross-sectional view in viewport 4.
Viewport 2 - Default view is Endo. Direction of view is toward the end of
the colon, toward the cecum (point B).
Viewport 3 - Default view is 3D Colon Map. A blue highlight along the
centerline corresponds to the horizontal dimension of the Filet viewport.
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Navigate stage
7.3
Viewport 4 - Default view is Cross-sectional, perpendicular to the
centerline. The centerline is identified by the green crosshair.
Viewport 5 - Default view is Axial. The centerline is identified by the green
crosshair.
Layouts
Layout selections allow you choose various image arrangements for the
flythrough. The different layouts are provided to suit user preferences.
Mixed - In the upper half of the image area are the Filet
and the Endo views. In the lower half are the 3D Colon
Map, the cross section, and the axial images.
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Standard - This is the default layout. In the upper half
of the image area are the Endo and 3D Colon Map
views. In the lower half are the axial, coronal, and
sagittal images. There is no filet view.
Filet - In the upper half of the image area is the Long
Filet view. In the lower half are the 3D Colon Map, the
cross section, and Endo images.
Endo-Axial - In the fourth layout, the upper half
consists of the Axial and Endo views. In the lower half
are the sagittal, coronal and 3D Colon Map images.
Note
Brilliance Workspace Portal - Volume 3
For information on the Series or View tabs refer to the CT Viewer chapter
in Volume 1.
Virtual colonoscopy
7- 15
7.4
Virtual colonoscopy images
7.4
Virtual colonoscopy images
Note
7.4.1
You can adjust display parameters of the Filet, Endo, and Split images using
the Navigation Features tools, described later.
3D Colon Map Image
A translucent 3D image is provided in all Navigation viewports, showing
the colon with its red center line. A positioning correlation to the filet
image is provided by a blue highlight arrow along the center line. This blue
highlight matches the length of the colon being displayed in the Filet
viewport.
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Virtual colonoscopy images
7.4.2
7.4
Filet image
Filet View Measurement
• Mixed Layout measures four centimeters
• Filet Layout measures 14 centimeters
• 420 degree view with a 30 degree overlap
Philips Medical Systems 4535 674 64531_A
Filet View now displays with grey shaded areas at the top and bottom of the
image. This is your area of overlap. The Filet is displayed with a 420-degree
view of the colon for inspection. The overlap shown is 30-degree top and
bottom. Solid green line represents the midpoint of the filet.
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Virtual colonoscopy
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7.4
Virtual colonoscopy images
The Filet image is intended specifically for fast visual examination of the
colon, and provides superior visualization over other methods.
The Filet image gives a virtual dissection projection that, in effect, is like
cutting a section of the colon open longitudinally and spreading from top
to bottom in the viewport so that the entire wall circumference of the colon
can be seen in one view.
The Filet view is formed with an overlap of 30-degrees at the top and
bottom, yielding a 420-degree image. (The overlap guarantees full viewing
coverage.)
The overlap is marked by shaded portions at top and bottom of the
viewport.
The Filet image is created using a novel visualization technique called the
perspective-filet view. This is designed to show as much of the entire colon
wall as possible from any point along the centerline. It overcomes the
“blind spots” sometimes created when all of the projection rays are
perpendicular to the centerline.
The illustration below is a simple diagram of the perspective technique.
By tilting the projection rays as a function of the distance from the central
location, the view adds perspective to the previously flat view. This allows
the user to see the antegrade and retrograde sides of the folds without
having to manipulate the view at all.
This technique produces some display distortions, both horizontal and
vertical. Horizontal distortion is pronounced at the left and right regions of
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Virtual colonoscopy images
7.4
the image, where parts of the colon wall that are not “visible” with the
perspective technique are black. (Scrolling and/or navigating reveals hidden
areas at left and right.)
Below is another image that demonstrates distortion in the filet image.
What appears to be a domed structure is actually a flat pool of oral contrast
(which may be removed by the Cleansing function).
Endo image
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The 3-D endo-luminal view of the colon is visualized when the (virtual)
camera is oriented parallel to the centerline passing through the colon.
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Virtual colonoscopy
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7.4
Virtual colonoscopy images
Cross section image
The cross-sectional view of the colon is formed by a plane cutting through
it at right angle to the centerline.
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Virtual colonoscopy images
7.4
Split image
The Split image is the 180° view of the colon, visualized when the eye point
is at the centerline, oriented towards the colon mucosa.
3D Colon map
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The 3D Colon map provides a transparent view of the virtually segmented
colon of the patient.
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Virtual colonoscopy
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7.4
Virtual colonoscopy images
7.4.3
Findings tab
Findings and CAR
Note
The computer assisted reader (CAR) for polyps function are pending FDA
clearance and are not commercially available in the United States.
The Findings function allows the radiologist to search for, visualize, and
mark polyps that may exist in the colon images.
The Computer Aided Reading (CAR) option is available for assisting in
polyp detection.
The radiologist may choose whether or not to use the CAR option during
the Findings procedure. When Show CAR results is activated, all findings
found by CAR are marked with an overlay. The overlay is cyan blue when
suggested by CAR, and purple when accepted by the radiologist.
7 -2 2
Wa r n i n g
CAR must be used only as an adjunct procedure to the radiologist’s primary
reading of a study. Final diagnosis and identification of lesions is the
responsibility of the radiologist
Wa r n i n g
The Computer Aided Reading application should not be used as the SOLE
basis for clinical diagnosis.
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Virtual colonoscopy images
7.4
Navigation for making findings
Select the layout. (Filet mode, with its large image, provides the best
polyp visibility.)
2
Set the Speed. A good speed is 10 to 20 mm per sec.
3
When ready, click the forward arrow to begin the flythrough mode.
4
The flythrough begins.
5
When you see an area you want to examine, click the Pause button, or
left mouse click anywhere in a viewport to stop the flythrough.
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Virtual colonoscopy
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7.4
Virtual colonoscopy images
7.4.4
Examination of possible findings
Use and manipulate the various images and layouts to examine a suspected
polyp. The Eye-axial image (which is eye axial to the Endo image) is
especially helpful.
When the display is in the “Use CAR” mode, polyps proposed by the
system are marked with a cyan blue overlay, as shown below.
Note
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Virtual colonoscopy
To properly examine a CAR-suggested polyp, activate the “Hide Findings”
button to remove the CAR overlay.
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Virtual colonoscopy images
7.4
Show cleansing
Upon entering the Navigation stage, all images (including endo, filet, split,
the cross sections, axial, coronal, and sagittal) are cleansed (the contrast is
removed).
Wa r n i n g
Verify the correctness of the cleansing function by clicking the Show
Cleansing checkbox. Click it again to revert to the cleansed images.
To mark a possible polyp, click the Mark button, then click its location on
the image.
Accept or reject polyps
The current marked polyp is considered “active” and can be accepted or
rejected. Only one polyp or possible polyp can be active at a time. You can
return to marked polyps later for activation, additional examination, and
subsequent acceptance or rejection.
Philips Medical Systems 4535 674 64531_A
To accept a marked polyp (thus making it a “Finding”), click on the polyp
then click the Accept button. The polyp is placed into the Findings list.
When you accept a polyp suggested by CAR, it turns dark blue.
Findings appear in blue only on the filet and endo images.
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Virtual colonoscopy
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7.4
Virtual colonoscopy images
Colon Computer Assisted Reader (CAR)
The Findings function allows the radiologist to search for, visualize, and
mark polyps that may exist in colon images. The Colon Computer Assisted
Reader also known as CAR is available for assisting in polyp detection.
Colon Computer Assisted Reader is a purchasable option. If the option has
not been purchased, it does not appear in the Findings box.
Note
CAR procedure
1
Click the Use CAR check box.
2
This brings up a message box.
3
Click the Accept button.
4
This takes a few seconds.
The message bar at the bottom of the page, CAR displays the number of
polyps found in the study.
5
Scroll through the colon until you come to your first possible polyp,
which displays in blue.
To evaluate area of interest:
6
Use cross sectional images to evaluate the CAR finding.
7
When a polyp is detected by CAR, the application annotates the area
with a crosshair and measurement data which id displayed in the
message bar at the bottom of the screen.
• Information displayed includes the X and Y coordinates, Slice
Number, and Distance from Point "A".
8
Choose to Confirm or Reject the findings.
Reject - Click this button to reject an active marked polyp. If the polyp
was already in the Findings list, it is removed.
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Virtual colonoscopy images
7.4
Findings list - Opens a dialog where you can change the measurements
(except the volume measurement).
If CAR was used Min/Max Diameter and Volume appear in the list
Note
Shape - Depending on the measurements of the finding, the
application suggests a polyp shape of sessile, flat, pedunculated or
undefined. You can change the suggested shape from the drop-down
list.
Segment - From the Segment drop-down list you can identify where
the polyp is located: Rectum, Sigmoid Colon, Descending Colon,
Transverse Colon, Ascending Colon or Cecum.
Repeat steps 1-8 for all CAR findings.
Note
Philips Medical Systems 4535 674 64531_A
If you choose to accept the findings another set of measurement data now
appears on the image. They include:
• Maximum Diameter of the polyp
• Minimum Diameter of the polyp
• Volume of the polyp
• Distance from point A
• Average HU of the polyp
9
Brilliance Workspace Portal - Volume 3
To add your findings to the report:
• Click on Report image
• Select sent results to report.
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7.4
Virtual colonoscopy images
7.4.5
Features tab
The Features allow you to set the parameters that control the way various
images are shown in the viewports.
Image type: Filet/Endo, affects the other parameters.
Adjust CAR Performance
1 Click Features
2 Click on CAR settings.
• This brings up the Colon CAR
Settings dialog box.
Adjust the CAR performance using
two variable parameters:
• Minimum Size
• Filter Sensitivity.
Minimum Size slider bar can set the
minimum diameter of the elevated tissue
regions that are highlighted. Three
diameter settings are available: 3mm,
6mm, and 10mm. The default setting is
6mm, which means that no elevated tissue
region smaller than 6mm in diameter is highlighted.
Filter Sensitivity allows control of the relative sensitivity of the CAR
function. Low sensitivity numbers like 1 and 2 are very conservative and
only highlight structures that have a high likelihood of being an elevated
tissue region. High sensitivity numbers like 4 and 5 identify a higher
number of elevated tissue regions, but may identify more false positive
tissue regions. The default Filter Sensitivity setting is 3, which is an
appropriate trade off between sensitivity and false positives.
You can now set your own default settings.
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Compare stage
7.5
7.5
Compare stage
The Compare stage allows you to compare two patient positions at the
same time for faster correlation and to reduce reading time.
Note
To perform the Compare function, both cases must be loaded at the same
time, when the application is started.
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When you enter the Compare stage, the following window displays:
Information on the tools panel is covered in previous sections starting
with Tools to define, on page 7-8.
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Virtual colonoscopy
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7.5
Compare stage
7.5.1
To change viewport
1
2
3
4
5
Right mouse click in the upper viewport.
Select Filet.
Right mouse click in lower viewport.
Select Replace to.
Select from list.
.
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Compare stage
7.5.2
7.5
Compare procedure
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The image area of the opening window displays one case on the left and
one on the right.
Note
Brilliance Workspace Portal - Volume 3
1
Right mouse click on the bottom images to bring up a menu where you
can select the reference views to be 3D Colon Map, cross section, or
Axial.
2
To change from Endo to Filet view right mouse click select.
3
To change lower viewports right mouse, select replace to, select from
the list.
4
When you see that you are in the same anatomical position in both
cases, click the Lock checkbox. Now all navigation can done together in
both cases so you can perform the comparison analyses.
The “Mark Finding” function can be used in either the “Locked” or
“Unlocked” mode.
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7.6
Common tools
7.6
Common tools
The common graphic tools area provides many basic functions including
saving, panning, zooming, and windowing. Common tools are, in general,
common to all the CT Viewers and are shared with many other
applications of Brilliance Workspace Portal.
Add\Clear from report are available in the common toolbox under Report.
For more information on Common tools, see page 5-11 of Volume 2.
Enlarge/Restore
This button changes the active image viewport into a single large image,
eliminating the reference images. Restore brings the screen back to
original. This button is on the tool panel and the same operation can be
done by double clicking on the viewport.
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8
8.1
Comprehensive Cardiac Analysis (CCA)
Overview
The Comprehensive Cardiac Analysis (CCA) application is used to assess
the state of the coronary arteries and to create a functional analysis of the
heart.
This application was verified using only cases from Philips scanners. If you
load cases from another manufacturer there may be difference in
application behavior.
Note
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Automatic segmentation
When you first load a heart study, the application performs a full
segmentation procedure. The entire organ is segmented at one time based
on a pre-defined model. The segmentation model consists of ventricles,
atria, muscle, fat, aorta, and coronary arteries.
Each time a study is loaded, the system performs a new auto segmentation.
Auto segmentation data is not automatically saved when the study is closed.
You must save the segmentation manually.
Note
The different classes are then color-coded. You may highlight the various
segments as desired and examine the correctness of the segmentation.
The aortic root and the coronary arteries are analyzed automatically by the
application. A tree of artery centerlines is generated, allowing you to pick
individual arteries and name them.
Curved planar reformations and a series of cross-sectional images allow you
to inspect an entire artery and estimate the size of stenosis along the artery.
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Comprehensive Cardiac Analysis (CCA)
8- 1
8.1
Overview
8.1.1
Application workflow
The CCA application consists of the following workflow stages:
Heart Review allows you to review the original axial images for each of the
loaded phases while waiting for the automatic segmentation to complete.
Heart Review can begin as soon as images are loaded into the application.
Various tools enable oblique reformations and/or slab MIPs to be rapidly
obtained and manipulated. If you have loaded the ECG file, the ECG
signal can be displayed, which correlates the images with points along the
signal.
Heart Segmentation allows you to view details of the segmentation, make
manual corrections, save the segmentation, and apply a new segmentation
algorithm.
Coronaries allows you to view the heart anatomy—the aorta, the aortic
valves, and the arteries—in high detail. Arteries can be reformed into
straightened views, and the heart can be viewed in the full volume-rendered
mode, including rotations, curved planes and cine.
3D - QCA (Three dimensional Q C Allows you to perform quantitative
measurements concerning the coronary arteries such as percent stenosis and
cross-sectional area, based on either automatic lumen contouring or manual
methods.
Functional Analysis allows you to analyze a variety of heart functions:
including left ventricle volumes, ejection fraction, stroke volume, and
cardiac output. You can also use this function to visualize the mitral and
aortic valve planes. Color maps display the values of regional functional
parameters for each part of the left ventricle, such as wall thickness, wall
motion, and thickening.
Open a study
Note
8 -2
For procedures on loading the study and activating the CCA application,
see the Directory chapter in volume 1.
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Overview
8.1
When selecting and loading a study keep the following in mind:
• If you intend to use the Functional Analysis work stage, be sure to load
a number of phases.
• Only 10 or fewer phases (4400 images) may be loaded.
• Loading the ECG file with the study will facilitate reviewing the
images.
• If a coronary data file was created and saved, load the file with the
series.
• If the coronary file is loaded, re-segmenting the heart will not delete the
current coronary file.
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Sequence of automatic segmentation
When the study is opened, the CCA application automatically performs
several segmentation steps. Each step is described in the message line:
• Analyzing Files
• Loading Images
• Learning Heart Structure
• Defining Coronary Tree
• Calculating Functional
• Ready
Note
The steps of segmentation are repeated for every phase.
When “Ready” is announced, you can move to the Heart Segmentation
work stage.
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8.1
Overview
Note
You have the option of stopping the segmentation by clicking the STOP
button in the center of the message line. You cannot continue segmentation
after it has been stopped. You must repeat the procedure. To restart the
segmentation, hit the Reset All button or reload the images into the
application.
Navigation
Use the arrow buttons in the upper left of each window to navigate through
the CCA workflow stages.
Note
8 -4
• In the workspace, only one step is shown at a time.
• At first, the only enabled step is Heart Review. Subsequent steps become
available after automatic segmentation has completed and the message
bar displays the message “Ready.”
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General tools
8.2
8.2
General tools
The tools at the bottom of the tool panel can be used in all of the workflow
stages of CCA. Each tool is detailed below.
Enlarge/Reduce - allows you to enlarge a specific viewport. This tool
expands the selected viewport to fit the entire viewing area. Click the
tool again to return to the original view.
Relate - places a cursor in the same location in different viewports.
Undo - allows you to undo the last graphical change made to the image.
Redo - repeats the change removed with the Undo command (not used
in Heart Review).
Exit -
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Reset All -
8.2.1
Other tools
Window-level
Window-level (or windowing) is a linear mapping of 2D image data to
available gray levels.
The center value is identified by the letter “C” in the corner of the
viewport. It is measured as a CT value (-1000 to 3095 or -1024 to 3071,
depending on the scanner used).
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General tools
The window width value is identified by “W” in the corner of the viewport.
The mapping is common to all 2D views (except the straightened MPR
image in the Coronary assessment stage).
To change the window-level:
1
Press and hold the middle mouse button inside a 2D image.
2
Drag the mouse left and right to change the width.
3
Drag it up and down to change the center.
The window-level values on the viewport will also change accordingly.
Windowing presets - Click Modified to see a drop down a list of Window
presets, which allow you to quickly set the Center and Width:
• P.F.
• Brain
• IAC
• Spine
• Bone
• Lung
• Abdomen
• Liver
Using the mouse for Windowing - You can also adjust the window Center
and Width by clicking and dragging the middle mouse button. Vertical
dragging changes windowing Center and horizontal dragging changes
windowing Width.
Titles off - Turn the image titles off and on. If turned off, they come back
on when the image is filmed or saved.
Exit - Exit the CCA application.
Reset All - For resetting the study’s images to the state they were in upon
loading, and restarting the segmentation.
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General tools
8.2
Magic Glass
The Magic glass feature is available via the right click menu (or the Magic
Glass button) in all CCA worksteps. It displays a moveable, mini-window
(3 cm default) which can be set with its own windowing, image
enhancement and rendering parameters. This feature allows you to enhance
visualization and assessment of certain elements of the image, such as
calcium and stents, while maintaining optimal viewing parameters for the
main viewport. The magic glass can be easily moved, expanded, reduced, or
hidden to best suit your needs:
• To move the Magic glass window, click inside the area and drag to the
desired location.
• To reduce or expand the size of the window, drag the red border.
• To change the viewing parameters in the active Magic glass window, use
the common tools.
• To change the viewing parameters outside the active Magic glass
window, click outside the window and use the common tools.
Note
You cannot change thickness in the Magic glass window.
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The right click menu for the Magic glass provides additional options which
allow you to hide or show the window; move the window to a specific
viewport; select a preset windowing or zoom setting; define the windowing
and zoom presets; or save a Magic glass protocol for future use. These
options vary depending on the selected CCA stage.
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8.2
General tools
Keyboard shortcuts
8 -8
Key
Function
A
Axial orientation
S
Sagittal orientation
C
Coronal orientation
D
Flip orientation
F
Film image
R
Report image(s)
<1>/<2>/.../<0>
Windowing presets (according to preferences)
<Shift>+<1>, <2>
Rendering modes
T
Titles off/on
I
Image parameters
M
Maximize/minimize the active viewport
<+>/<->
Increase/decrease zoom factor
X
Rotation center mode (slab) cursor displays in middle of viewport
Page Up/Down
Scroll
Arrow Up/Down
Incremental scroll (functions like middle mouse button)
Arrow Left/Right
Change thickness
Home/End
Scroll to beginning/end
<Ctrl>+any tool
Pan
<Alt>+Pan
Horizontally restricted pan
<Ctrl>+Pan
Vertically restricted pan
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General tools
8.2
Mouse functions
Function
Middle wheel scroll
Scroll
Right/left drag
Swivel/Roll
Left+middle drag
Pan
Right +middle drag
Zoom
Middle wheel drag up/down
Windowing center
Middle wheel drag left/right
Windowing width
<Shift>+Left drag up/down
Change thickness
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Mouse Button
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8.3
Heart Review
8.3
Heart Review
After you load the heart study, the application performs an automatic
segmentation process. When the auto segmentation process is complete, the
Heart Review window is shown (see Heart review window, see page 8-16).
Heart Review allows you to review the results of the auto segmentation using
various viewing tools and functions.
You can view the ECG signal in conjunction with the heart images. The ECG
signal helps you correlate the image with points along the signal.
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8.3.1
8.3
Common tools
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Common tools are available for use in all of the workflow stages of CCA. They
are briefly described once here and referenced in later sections. For detailed
information on any of these tools, see Volume 2.
• Save, Report, and Film tools
• Leaf, Zoom, Pan, and Swivel/Roll tools
• Graphics tools (These tools are not described here. See the Graphic Tools
chapter in volume 2.)
• Show/Hide titles
• Compression Quality
• Modified
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Saving Image
The Save Image feature saves the selected image as a derived image in the local
directory.
The image description varies with the orientation of the image:
• Axial orientation is described as Axial.
• Reference orientation is described as MPR.
Note
Tools with right click options include a small marker in the lower right corner of
the button.
Note
• Derived images may not be loaded in conjunction with a phase series into the
Comprehensive Cardiac Analysis application, but may be loaded into other
applications.
• Saved images, reports, and DICOM data are saved in the Local directory.
Note
• You can save images this way:
• Original – clinical image on which you can perform measurements and window
changes.
• Secondary Capture – a snapshot of the image which does not allow performing
any operations on it. If you want to save an image with segmentation overlays
or Magic Glass on, you must use Secondary Capture.
Save application data
After the segmentation, coronary artery centerlines and LV contours (if desired)
have been defined, they can be saved as a separate file.
• Right-click on the Save Image button to drop-down the Save Coronary
button.
The saved file contains DICOM data of all the artery centerlines that have been
created.
When the file is again opened together with the respective image series, the
defined coronaries appear without further need to re-define them.
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Heart Review
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Reporting
To access Reporting functions right click the Save Image to Report button to
drop-down the reporting buttons.
See the “General Reporting” chapter in Volume 2 for a complete description
and instructions for use of the General Reporting feature.
Note
Filming
Click Film to send the selected image to the Film application.
Only the selected image is sent to Film each time Film is clicked.
Note
For a complete description of the Film application Filming chapter in Volume
1.
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Image viewing tools
Click Leaf and Select to activate leafing (the fast viewing of images in the
study). Clicking this button deselects any selected graphics, zoom, and pan
buttons, thus enabling selection of images.
To leaf through images of the study:
Click Leaf and Select to activate leafing.
• To leaf forward, drag the mouse down.
• To leaf in the reverse direction, towards the first image, drag the mouse up.
• To display the images one-by-one, drag the mouse slowly.
• To leaf quickly through the images, drag the mouse rapidly.
1
You can also leaf through the images with the mouse wheel.
To pan 2D viewports, click Pan. Click on the image. Drag the mouse to pan the
image.
To zoom a 2D image or a 3D viewport, click Zoom. Point inside the viewport
and drag the mouse down to enlarge the image, or up to reduce the image.
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The small red cross is your pivot point, and you can swivel your image around
until you see the entire artery.
The rotation of the 3D image, which is centered on the small red cross, can be
moved. (See Re-center about how to change the rotation center.)
Note
You can use keyboard shortcuts for smoother operation:
• Press <Ctrl> with any other tool to pan the image.
• Press <Shift> with any other tool to change the image thickness.
Note
For 2D images, you cannot pan before you zoom.
Graphic tools
The Graphic tools are used for marking and annotating images and for making
basic measurements.
See the Graphics chapter in Volume 2 for complete descriptions and
instructions for using these tools.
Note
Move graphic element and Rotate graphic element are not active in the CCA
application.
Heart Review workflow
Basic options
These options are available in the Heart Review workstep:
• Review images through all the phases.
• Examine the ECG signal using the ECG viewer.
• Choose between two layouts, 1+3 or 2+2 at any time.
• Use the Center cursor as a center of rotation.
• Change the center to rotate the axial image around an area of interest.
• Use the Re-center function to change the center of rotation.
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• If an ECG file was loaded with the phase series, you can examine the ECG
signal concurrently with the images. A vertical green line on the wave marks
the position of the currently viewed slab image.
• To enlarge the smaller reference views for viewing in a single large
viewport, you can use the Enlarge function.
• You can rotate the view using visible axis lines.
• A red line in the smaller reference images is synchronized with the slab
image. You can drag the red line to any location and the slab view will
scroll concurrently.
• You can view multiple phases. To view the images of a phase, click the
phase tabs at the top of the layout.
Heart Reviewing tools mentioned here are described later in this chapter.
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Note
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Heart review window
Two layouts are available in the Heart Review mode, the 1 + 3 layout and the 2
+ 2 layout. The image above shows the 1 + 3 (default) layout. It consists of these
areas:
main image viewport
reference viewports
tool panel
phase tabs
message line
The main image viewport shows a large axial slab image. The most superior
image of the series appears as default.
2 The three reference viewports shows, from top to bottom, axial, sagittal,
and coronal images. The red line in the reference images is synchronized
with the current slab image. Drag these lines to any location and the slab
1
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view in the large viewport will change accordingly.
3 The tool panel shows the Workflow selection menu at the top, the image
control tools in the middle, and the common tools at the bottom.
4 The phase tabs are shown along the top of the image viewports. When
multiple phases are loaded, click on the tabs to view and manipulate
multiple phases and to move easily between them.
• Right click on a phase tab to remove it (must be done before proceeding to
the next workflow step).
• Click the Multiphase tab to view all phases simultaneously.
5 The message line along the bottom of the image viewports shows text
messages describing the current status of the active workflow stage.
In the 2 + 2 layout, the upper viewports show sagittal and coronal images (left
and right, respectively). The bottom viewports show an axial image on the left
and the selected orientation on the right.
Layout options
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These options are available for setting the layout of the CCA window:
Click this button to display the 1+3 layout.
Click this button to display the 2+2 layout.
Click this button to save the current layout as the default layout when the
Comprehensive Cardiac Analysis application is opened the next time.
Setting the active viewport
The active viewport is bordered in red. All other viewports have a green border.
Click any viewport to select it.
Some operations apply only to the selected viewport, like Add to report, or
Cine.
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Right click options
In the 1 + 3 layout (in addition to having the scroll, pan, and zoom functions),
you can swivel, center, and enlarge the images.
In the 1+3 layout, the swap function is enabled for the 3D image and curved MPR
image, via the right click menu.
Note
In the 2 + 2 layout (in addition to having the scroll, pan, zoom and enlarge
functions), you can move and rotate the crosshair.
Use the Move Crosshair function to drag the crosshair up, down, left or right.
When you move the crosshair, the anatomy in the reference views also adjusts to
display the corresponding anatomy.
Use the Rotate Crosshair function to rotate the crosshair within the threedimensional slab image, as shown in the image below.
8 -1 8
1
Right click over a reference image.
2
Select Rotate Crosshair. The cursor changes to Rotate (shown in the Upper
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right viewport below).
3
Move the cursor to one of the green lines in the reference image. These lines
represent the three planes of the slab view: axial, coronal, and sagittal.
4
Left click and drag the line. The new angle of the green lines changes the
orientation of the respective plane in the slab view image.
Orientation tools
Use these buttons to choose between general and cardiac axes.
• For general axes you can change the viewing orientation of the selected
image to Axial, Coronal, or Sagittal.
• For cardiac axes, you can change the viewing orientation of the selected
image to short axis, horizontal long axis or vertical long axis.
To select an image, click in its viewport. The viewport becomes framed in a red
outline to indicate that it is the selected viewport.
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Heart Review
Re-center cursor allows you to freely center the image at the position of the
rotation cursor.
Reset Center & Axis resets the position of the cursor to the center of the
scan volume and returns the axis to be axial\short (depending on whether it
is general or cardiac).
The rotation center serves several purposes:
• It is a reference point when changing orientation.
• It can be moved to the center with the Re-center button.
• It serves as the center of axes for rolling/swiveling. When rotating or
swiveling the image, the new position is the new 3D center.
Use this procedure to recenter the image:
8 -2 0
1
Place the cursor over the small red X in the slab mode viewport. The cursor
becomes a cross.
2
Using the mouse, drag the small red cross to any location.
3
Click Re-center to center the image on the new position of the red cross.
The axes adjust accordingly.
4
To undo the changes to the center and axes, click Reset Center & Axis.
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Rendering tools
Average rendering - The Average rendering mode renders according to the
average CT value.
MIP rendering - The Maximum Intensity Projection (MIP) rendering mode
displays two-dimensional projections from sets of CT slices. In MIP, the
brightness of a displayed pixel is determined by the maximum CT number
along a path (ray) through patient.
The MIP mode enhances features with high intensity even if they are inside the
3D model. In MIP, an anatomical feature is enhanced if it meets these
conditions:
• it is the brightest or has the maximum intensity in the line of sight
• there are no brighter features before it or behind it that obstruct your view
MIP mode is recommended for viewing contrast-filled arteries within a tissue
volume and for revealing calcifications, since they have very high CT values.
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The default image in Heart Review is the axial slab image. It is an advanced
rendering mode designed for fast image scrolling.
Enhance image allows you to sharpen or smooth the image. Click on the area
and drag up or down to enhance.
Note
Too much enhancement can cause artifacts in an image.
Inverse window allows you to invert the black and white values.
The Thickness box allows you to reformat the original default image into
thicker slabs to help reduce noise and produce fewer slices for faster review. You
can change the thickness of the slab by typing a value in the Thickness box or by
using the up or down arrows in the box.
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Change thickness in reference image
1
Move the cursor up to the carrot marks in the reference image.
2
Drag the cursor up to increase the thickness.
3
Drag the cursor down to decrease the thickness.
All images and the Thickness text box value are synchronized with the change.
Other reviewing tools
Enlarge/Restore toggles between the two states with each click:
• The Enlarge button changes the selected image viewport into a single large
image, eliminating the reference viewports.
• The Restore button changes the window back to the original format.
Note
8 -2 2
The Enlarge feature is valid only for views other than orthogonal cuts and the
straightened curved MPR view.
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8.3.2
8.3
Hints
General workflow instructions are provided in the Hints function.
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Click the Hints button to access help files.
8.3.3
Batch & Cine
Batch tools allow you to define a batch of full volume images in different
orientations in order to create a live movie. (These tools function the same as
they do in the Cardiac Viewer - Volume mode. Refer to the details about these
tools in the Cardiac Viewer - Slab tools chapter.)
Note
Before creating a batch definition, define the volume rendering protocol and
clipping.
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Heart Review
From - defines the first image of the batch. Can be defined on volume image
only (not on 2D images).
To - defines the last image of the batch. Can be defined on volume image
only (not on 2D images).
Clear - clears the first and last definitions.
Step size - defines the incremental step between the images in the batch.
No. images - enables you to define the number of frames between the first
and last images. Step size and number of frames are related and affect each
other.
Save - opens a dialog box which enables you to save the batch either as
DICOM series, JPG pictures or AVI movies. You can also select the device
to which the file should be saved as well as the viewports to be included in
the save function.
Report - sends images to the Reporting scrapbook.
Film - sends the batch to the Filming application.
Cine - allows you to create cine views from a previously created batch, a
location mode or a time mode of the active viewport.
Batch Location Mode Time Mode -
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Cine Speed represents the average heart rate in the default mode. However,
you can control the viewing speed; view the images in forward or reverse
mode; and pause the display. You can then cine and save, report, or film
them as a batch.
Note
8.3.4
• Saved AVI and JPG files can be accessed using the Files tab in the Directory.
• You cannot save the Time Mode cine using batch saving tools. to save the file,
select Save Cine from the Save right click menu in Common Tools. You must
play the cine before this option is available.
ECG monitor
The Show ECG Monitor function shows the ECG signal in graphic
form along the bottom of the Heart Review window.
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Note
• The ECG Monitor function is enabled only if the study series was loaded with
its corresponding ECG file.
• The ECG Monitor function is available only in the Heart Review mode.
• The ECG display closes automatically when you leave the Heart Review mode.
Click Show ECG Monitor to examine the ECG signal.
Note
The display’s starting point is 5 seconds before the scan started. The ending
point is 5 seconds after the scan ended.
The ECG signal is colored red for the duration of the scan (that is, the period
that radiation is applied).
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Heart Review
The ECG viewport is synchronized with the other viewports: as you scroll
through the images, a green line correlates the displayed viewport images to the
ECG signal.
The green line (indicated by the arrow in the display above) marks the position
of the currently viewed slab image (or the position of the relate cursor on images
that are non-axial planes).
On the right of the ECG viewport, the instantaneous heart rate and R-R
interval are shown, as well as the mean heart rate over the scan and the number
of heart beats.
To measure time along the ECG signal:
1
2
Click the Caliper button.
Click and drag from any starting point along the graph, and release the
mouse button at the desired stopping point.
The time between the start and end points displays.
To view the heart rate graph:
1
Click Heart Rate.
The heart rate graph shows the change in heart rate over time during the
scan. The graph is synchronized with the image display. The vertical brown
line displays the heart rate corresponding to the displayed image.
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8.4
Heart Segmentation
Heart Segmentation is the process of identifying structures in the original image
data and building 3D models of various parts of the anatomy.
The Heart Segmentation stage allows you to view details of the automatic
segmentation that occurred following loading of the study, and make manual
corrections as needed.
The process segments the heart’s chambers, muscle, fat, coronary arteries, and
the ascending aorta.
Segmentation enables rapid analysis of the coronary arteries and cardiac
function (after the images have been loaded into the viewer).
Segmentation forms the basis for generating subsequent views and for
calculations in the Functional Analysis work stage.
8.4.1
Common Tools
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See Common tools, see page 8-11 for more information.
8.4.2
Hints
See Hints, see page 8-23 for more information.
8.4.3
Segmentation tools
The initial Segmentation window consists of an axial image in the main
viewport and the two orthogonal images in the reference viewports. In the
reference images, the red line corresponds to the slice being displayed in the
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main image, and the green line corresponds to the location of the other
orthogonal view.
The images are color-mapped based on the results of the auto segmentation:
• Yellow: fat
• Red: blood, chambers
• Blue: aorta, coronaries
• Green: muscle, coronary tree
Wa r n i n g
8 -2 8
Verify the accuracy of the heart segmentation. If necessary, manually correct the
segmentation using the Coronary correction and Chamber segmentation tools.
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8.4
Basic segmentation procedure
Review the segmentation
Look for good coronary segmentation, which produces the accurate artery
centerlines necessary for the Coronaries work stage.
At the left is an example series of coronary segmentation images. Scroll with the
left mouse button, or roll the middle mouse wheel to scroll through the axial
images.
After reviewing the results of the automatic segmentation, if necessary perform
the following:
Add additional parts of artery portions that were not segmented.
2
Remove incorrectly segmented tissue from the coronary tissue.
3
Redo the segmentation.
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8.4.4
Segmentation tools
Overlays
The overlays list defines the main segmentation classes (which are displayed as
color maps) for the coronaries, muscle, fat and blood.
Any combination of segmentations can be selected by checking or unchecking
the box to the left of the name. You may activate and display class color overlays
as follows:
• Clear the check box to hide the associated color overlay.
• Click All to display all the color overlays.
• Click None hide all the color overlays.
• Click Coronaries to hide all the color overlays except the Coronaries.
Corrections to Heart Segmentation
This section describes the changes that can be done to the heart segmentation.
When you have completed your changes, you can save them for future use with
the corresponding study.
1 Ensure that all the coronaries are blue.
If corrections are necessary, continue the following procedure to correct any
part of the coronary tree that is not blue.
2 Click Add Coronary.
3 Roll the middle mouse wheel to scroll through the axial images.
4 Click on any coronary that was not colored blue by the automatic
segmentation process to create a new seed point.
You can click on any image to add seed points.
5
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To undo the last correction, click Undo. Each Undo removes the last
change.
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Erase coronary parts
1
Scroll through the images.
2
To remove tissue from the coronary tissue, use the Erase option. Right click
on the button to select from three eraser sizes.
3
Click on the blue area to be removed from the coronary tissue until the blue
color is removed.
4
To undo the erasure, click Undo. Each Undo click removes the previous
change.
Save segmentation
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Note
8.4.5
1
Right click on the Save icon.
2
Select Save segmentation from the drop down list.
3
The system saves the segmentation with the study. You can load the
segmentation along with the study when you select the saved file and the
series from the Directory.
Be sure to use the Save Vessel feature if you want the same vessel segmentation
to appear the next time you open the study.
Advanced chambers segmentation
If the segmentation is incorrect, or if the coronaries were not segmented at all,
you can redo the segmentation process using Advanced Chambers
Segmentation, which employs a different algorithm to segment the coronaries.
Use the Advanced Segmentation tools to access these features:
• Chambers performs the chamber segmentation only. The segmentation
progress can be monitored on the status bar.
• Coronary Tree & Chambers performs a complete segmentation (the
chambers and coronary tree).
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8.4
Heart Segmentation
This function should only be selected if the aortic root was not segmented
correctly.
Note
The system automatically segments the current phase. Click All Phases to
segment all available phases.
1
Select the desired segmentation option to re-segment.
2
Click Redo Segmentation.
3
The system displays a warning. Confirm your selection by clicking OK.
The system displays the status of the segmentation in the status bar.
• Undo cannot reverse the Complete Re-segment step.
• To redo the segmentation using the default algorithm, click Reset All. This will
reload the study images.
• If a coronary file was loaded with the series, Reset All will not reload the
coronary file. Your can return to this coronary definition after trying the resegmentation option by closing and then reopening the application.
Note
Add seed
You can assist the segmentation process by manually placing 1-3 of the
following anatomical seeds:
• Pulmonary valve
• Mitral valve
• Apex
Use this procedure to add seeds:
1 Click the Add Seed button. The Add Seed panel displays.
8 -3 2
2
Check the Pulmonary Valve option.
3
Click Seed.
4
Click on the desired location on the image.
5
Click the desired locations on the Mitral Valve and Apex.
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Click Close.
7
Click the Re-do segmentation button.
This option can be used before any advanced segmentation as well as with the
advanced segmentation.
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Note
6
8.4
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8.5
Coronaries
After you have completed the Heart Segmentation stage, click in the Workflow
menu to access the Coronary Assessment stage (also called the “Coronaries”
stage).
The Coronary Assessment stage allows you to view the heart anatomy - the
aorta, the aortic valves, and the arteries - in high detail. Arteries can be reformed
into straightened views, and the heart can be viewed in the full volume rendered
mode, including rotations, curved planes and cine display.
8.5.1
Common Tools
See Common tools, see page 8-11 for more information.
8.5.2
Hints
See Hints, see page 8-23 for more information.
8.5.3
Basic coronaries procedure
1
Verify the completeness of coronary segmentation.
2
Identify and name all coronary centerlines.
3
Correct any problems that exist in the segmented coronaries and centerlines.
You may perform steps 2 and 3 in any order, depending on the study.
Note
8 -3 4
4
Manually define any unsegmented coronaries.
5
Analyze coronaries.
6
Generate a report.
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You can use keyboard shortcuts for smoother operation.
• press <Ctrl> in the axial image to pan
• press <Shift> with any other tool to rotate the image
Note
Activate viewports
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When first starting the Coronaries work stage, the only images that appear are
the volumetric image (also called volume rendered; also called Heart) in the
upper-right viewport and the axial image in the lower-right viewport.
You must select a segmented arteries centerline to activate the remaining
viewports.
1
Move the cursor over the volumetric image. The centerlines of the
segmented arteries display in yellow as you move over them.
2
Click on a centerline. The line turns red, and all remaining viewports
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become activated, showing the full Coronaries opening window, shown on
the next page.
Note
The text “Unnamed” will appear next to the centerline. You can name the
centerline as described later.
Coronaries window
A volumetric image is in the upper-right viewport. The bottom right viewport
contains an axial image. A curved planar reformed image (along the selected
artery centerline) appears at the upper left.
The bottom left viewport displays a vertical straightened image of the selected
artery, with five adjacent cross-sectional images:
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• The center cross-sectional image corresponds to the red line in the
straightened artery image.
• The left two cross-sectional images correspond to the left two green lines in
the straightened artery image.
• The right two images correspond to the right two green lines in the
straightened artery image.
To view a reference image in the main viewport, right click the reference image
and select Swap.
Note
8.5.4
Vessel tools
Use the vessel tools to name a vessel, delete a vessel name (a right mouse
option), edit the vessel centerline, and continue the vessel centerline.
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Name vessel
The Name vessel function is used to name or rename a selected vessel path.
1 Move the cursor over the volumetric image. As the cursor moves over a
segmented vessel the vessel centerline becomes yellow.
2
Click on a centerline to select it. Any centerline can be labeled or renamed.
The centerline turns red. The straightened view and curved MPR views are
generated.
3
Name the selected vessel using one of these methods:
• Right click on the vessel centerline, and select the desired name from the
list.
• Select a vessel name from the vessel list, and click Name vessel.
• Type an appropriate name in the text box at the top of the vessel list, and
click Name vessel.
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The new vessel is saved. A heart symbol appears next to the vessel name.
• The name is displayed in bolded text, which means the vessel has been
identified and named.
• The heart symbol means the vessel is the currently selected vessel.
Note
4
Move the cursor over the vessel to display the vessel centerline and name.
5
Double click to display the selected vessel. Once identified, a single click
refreshes the window.
Delete vessel name
1
Click on the vessel to select it.
2
Activate Delete mode using one of these methods:
• Click the Delete vessel button.
• Right click and select Delete.
The name of the vessel changes to “Unnamed.” The vessel name in the
vessel list is no longer associated with any vessel.
3
• The old name remains in the Vessel list and may be reused to name another
vessel.
• If the vessel name was imported with a coronary vessel file, the name cannot
be removed.
Note
4
Note
8 -3 8
Rename the vessel (see Name vessel, see page 8-37).
To exit the Delete vessel mode, click the button again.
In most of the CCA functions, exit the current mode by re-clicking the button.
The button will no longer appear depressed.
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Edit centerline path
The centerline of each segmented coronary is viewed in the volumetric view and
a Curved planar reformed view. The automatically defined path will, in most
cases, pass though the centerline of the vessel, but if not, you may use the Edit
Centerline tools to make adjustments to the path.
In the Edit Centerline mode, control points appear along the centerline path on
both the Curved planar reformed and the volumetric views. You can change the
position of each point by dragging it to the correct position.
Use this procedure to re-define the path of a segmented vessel:
Pass the cursor over any segmented vessel in a Curved planar reformed or
volumetric view. A yellow cursor appears.
1
2
Click on the centerline to select it. The centerline turns red.
3
Right click over the Curved planar reformed image to select Edit centerline
(or select the Edit centerline tool).
Control points appear along the centerline.
• You can edit any point by dragging it to the correct location, using either a
Curved planar reformed view or the cross-sectional cut.
• To undo the last change made to the centerline click Undo. Each Undo
removes the previous change.
• To add a control point, double-click the desired location on the centerline.
• To remove a segment from the centerline, drag a control point to overlap
another control point farther along the centerline. The looped segment
disappears.
• You can right click on the Edit centerline to access the Flip centerline
option. This option flips the image so that the aortic root appears at the
bottom of the image.
5 To end the edit function, click Edit Centerline again.
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4
Note
If you want the vessel to appear exactly as you have redefined it when the study is
next opened, use the Save Application data feature.
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Continue segmented coronary paths
In the default Continue vessel mode, vertices are added after the vessel end.
You can right click the Continue vessel icon to edit the proximal or distal portion
of the vessel.
Note
1
Select the vessel to be continued.
The center line turns red, the axial image changes to the location the click
was made, and the Curved planar reformed and straightened vessel images
appear.
2
Click Continue vessel. The axial image displays the segmented vessels as
purple areas.
To rotate the image while remaining in Selected Vessel mode, press <Shift> and
drag the cursor.
Note
3
Scroll with the mouse wheel through the axial images.
4
Click on the continuation of the artery (purple colored tissue) that does not
have a centerline mark to continue the vessel.
The red centerline extends and the Curved planar reformed image updates
to display the extended vessel.
5
Remember to start from the most proximal image and work out to the more
distal images.
To undo the last change made to the centerline click Undo. Each Undo removes
the previous change.
Note
6
8 -4 0
Click the end point on the axial image to continue the vessel.
When the vessel extension is complete, click Continue Vessel to exit the edit
mode.
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Define new vessel path automatically
This function automatically segments a new vessel with a single click on the
volumetric or axial image.
1
Click Automatic Vessel Path. (The Cancel button becomes available.)
2
Click on the vessel path you wish to define more distally than proximally.
(The Save and Edit buttons are now available, with the Edit button active.)
The system calculates and displays a new centerline.
If the system is unable to define a vessel, a centerline does not appear and, in the
status bar, the message “Vessel not found” is shown.
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Note
3
If the desired centerline appears, click Save. The New Vessel Name box
appears.
4
Name the vessel using one of these methods:
• Select a name from the list.
• Type in a name in the text box. Click Name to accept the name.
• Click Cancel to leave the new vessel unnamed.
5
Edit the centerline if necessary.
Define new vessel path manually
Note
You may perform this procedure on the volume or axial image.
You can use this function to perform two tasks:
• define a new vessel path (default)
• join two disjointed segments (right click to select connect broken path
option)
Define the vessel path by marking control points along the path. Add enough
points to follow the vessel’s curvature. If you are defining a path for an
unsegmented part of a vessel be sure to overlap the existing parts.
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Use this method to create a path:
1 Click the Manual Vessel Path button, or right click on the button to access
the Connect Broken Segments option. A network of green lines appears on
the volumetric image showing all potential coronary segments that were
marked as green during the auto segmentation process.
• You can rotate the volumetric image using <shift> with the left mouse
button.
• You can now either create a new path, continue a current path or join
disconnected segments by adding points on either the volumetric image or
the axial image.
• A red cross marks the location of a new point on both the axial and
volumetric images.
2
To continue adding path points, click along the vessel path.
• The Curved planar reformed image of the defined path appears as you add
points.
• As the path gets longer the Curved planar reformed image zooms out to
include the entire defined path.
3
To connect broken segments, rotate the 3D image.
• Click at the end of the proximal segment.
• Continue adding points until you can mark the start of the distal segment.
• In the axial image use the mouse wheel to scroll.
• Points are added to the path’s end—be sure to track the vessel path forward.
(This is best determined using the volumetric image.)
Note
4
Use the Edit Centerline function to correct the centerline if necessary.
Note
5
8 -4 2
To end the path, click Save. The New Coronary Name dialog box appears.
Name the vessel using one of these methods:
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• Type in a name in the text box. Click Name to accept it.
• Click Cancel to leave the new vessel unnamed.
The new vessel is saved and the new vessel name appears in the vessel list in
bolded text. A heart symbol appears next to the vessel name.
Define vessel path
1
Right click on the volumetric image to select Define vessel path. All existing
centerlines become visible and green.
2
Click once at the start of the path to be redefined and click again at the end
of the path. (Anatomically, the path direction is from the apex to the base of
the heart.)
To rotate the image while remaining in Select Vessel mode, press Shift and drag
the cursor.
Note
3
You must name the vessel in order to save the new vessel.
Note
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If the centerlines can be joined, a unified red centerline appears. The Curved
planar reformed views of the centerline also appear.
4
Name the vessel.
The new vessel is saved. A heart symbol appears next to the vessel name and
the name is bolded.
Show centerline
When Show Centerline is checked, the centerline is shown. When un-checked,
the centerline is not shown, and the Edit Centerline function is disabled.
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Highlight Vessel
When Highlight Vessel is checked, the system displays a blue highlight on the
selected vessel in the axial view.
Right mouse options
Right click over the desired image to display its corresponding menu.
Volumetric image
•
•
•
•
•
•
•
•
•
•
Note
8 -4 4
Roll, pan, zoom
View (Coronary tree, Heart, Outline, All, MIP)
Orientation (Axial, Coronal, Sagittal, Reset, and Cardiac Views)
Define vessel path
Edit centerline
Swap
Cuts (Cut plane, Slab, Lock plane, Sculpt)
Detail
Enlarge
Magic glass on
To rotate the image without exiting the currently used function, press Shift, and
drag the cursor.
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Curved Planar Reformed image
•
•
•
•
•
•
Scroll, pan, zoom, swivel
Show cursor
Show centerline
Edit centerline
Swap
Enlarge
Axial image
•
•
•
•
•
•
Scroll, swivel, pan, zoom
Show cursor
Define path
Swap
Enlarge
Magic glass on
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Straightened and cross-sectional images
•
•
•
•
•
•
•
Measure stenosis
Measure length
Profile
Virtual IVUS
Edit centerline
Zoom (general)
Zoom x2
Other mouse functions (including middle wheel)
• Curved planar reformat image: roll mouse wheel to adjust thickness; left
mouse drag scrolls cross-sectional, axial and straightened images, and the
cursor (X) moves.
• Straightened image: left mouse drag up and down rotates vessel on its axis.
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• Axial image: mouse wheel scrolls through images.
• Straightened and cross-sectional images: press and drag mouse wheel to
adjust window/level
• Curved planar reformat and axial images: press and drag mouse wheel up
and down to adjust window/center; press and drag mouse wheel left and
right to adjust window/level.
Evaluate straightened coronary vessels
Click on a centerline. The straightened vessel and Curved planar reformat image
(for that centerline) display.
You can view the entire length of the coronary using one of these methods:
• Drag the Curved planar reformat relate-cursor along the entire length of the
curved planar reformat vessel.
The cross-sectional and straightened images update to display the sections
on either side of the cursor.
• Drag on the volumetric or axial images.
All images update.
The cursor on the axial and Curved planar reformat images also moves along
the vessel.
• Use the slide bar to view the length of the straightened vessel.
IVUS images
The Virtual IVUS is a volumetric image of the vessel lumen, wall, and plaque.
Use this procedure to display the IVUS image in the middle cross section.
8 -4 6
1
Right click on the straightened Curved planar reformed image.
2
Select Virtual IVUS.
3
You can adjust the protocol for the Virtual Ivus by selecting Show\Hide
protocols from the Visualization Tools.
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The IVUS view should not be used as the SOLE basis for clinical diagnosis.
Caution
Relate cursor
To use the Relate cursor option, click the Relate button. the system displays
a green cursor.
2 Click on the Curved planar reformat image. The green cursor now displays
on the volume and axial images.
3 To view the relate position on the volume and axial images, click on one of
the images. The system displays the green cursor on volume and axial images
but not on the Curved planar reformat image.
4 To hide Relate cursor click the 'Relate cursor' button.
1
8.5.5
Visualization tools
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The visualization tools include options for layout, rendering and cutting the
images.
Layout
1 + 5 image layout
The 1 plus 5 image layout is the default layout. It is described earlier in the
chapter.
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2 + 2 image layout
This layout shows a Curved planar reformed image (upper-left) and a
volumetric image (upper-right). There is a straightened vessel image with the
five cross-sectional images (lower-left) and an axial image (lower-right).
Show normal CMPR - Once the coronaries are defined and the volumetric
image is less important, a second perpendicular Curved planar reformed image
may be shown in the upper right viewport.
1
Right click in the upper right viewport.
2
Select Show normal CMPR.
Save as default
Click this button to save the current layout as the default layout when the
Comprehensive Cardiac Analysis application is opened in the future.
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Rendering Tools
Volume Rendering - This mode enables fast and easy visualization of volume
structures using acquired CT images. Ready-made protocols for various clinical
procedures allow you to obtain views of the structures with single-click
operations.
The viewing effect of volume rendering is to show semi-transparent tissues
which partially hide other tissues. This can be used, for example, to make a fatty
tissue more transparent, in order to allow seeing the muscle underneath it.
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MIP - This rendering mode displays ray-traced Maximum Intensity Projection
images. MIP displays two dimensional projections of the highest intensity
(brightness) pixels in a three dimensional volume of interest.
Heart is the default rendering mode. Click the down-arrow to select from all
available preset renderings:
• [Coronary] tree
• Heart [volume rendered image]
• Outline
• 2D map
• Globe - 3D map
• Globe - sphere
• All
Note
• Coronaries must be identified and named before all available renderings can
be selected.
• 2D map, Globe - 3D map, and Globe - sphere are grayed out until three
arteries are identified.
• MIP must be selected in order for some renderings to be displayed, as
indicated in the rendering descriptions starting on the next page.
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Coronary tree - This view shows all arteries connected to the aorta. It may be
viewed in volume rendered or MIP mode.
Heart - This view shows a volumetric view of the heart. You can also get a MIP
view of the whole heart.
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Outline - This view shows the heart with blood in the cavities removed. Only
viewable as MIP.
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2D map - This view shows a 2D Cartesian display of the heart’s surface.
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Globe - 3D map - This view shows a MIP image of the heart’s surface based on
the coronary centerlines, in true anatomical orientation of the heart.
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Global sphere - This view shows a 3D map mapped onto a sphere. It is only
viewable as MIP.
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All - This view shows all data included from the scan, and can be visualized in
volume rendering or MIP mode.
Protocol presets
Use Protocols to map CT values with colors to show various features
based on their transparency and opacity. This function can make any
tissue (based on its H.U. values) more transparent. For example, fatty
tissues can be made transparent, allowing better visualization of the
heart muscles behind them.
Preset protocols allow you use factory protocols. Protocol editing allows
you to create new protocols.
Load a protocol
1
8 -5 4
Click Show/Hide Protocol Presets button to open a saved Protocol Preset
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dialog box.
2
Click the right-arrow button to view the larger dialog box.
• Single click a protocol mini image to access its parameters.
• Double click a protocol mini image to apply the protocol to the
volumetric image.
3
When you are finished with protocols, click the Show/Hide button again
(or the X in the upper right corner) to hide the Protocol Preset dialog box.
Editing protocol presets
The Protocol Preset dialog box contains presets and tools to modify the
rendering parameters.
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Control points
A rectangular area contains small triangles that are control points for generating
and interacting with the mapping.
• The horizontal position of a control point inside the area represents the
point’s CT value.
• The vertical position of the control point represents the point’s opacity level.
Full transparency is achieved at the lowest edge of the area and full opacity is
at highest edge of the area.
Creating a control point - Double click inside the rectangle to create a new
control point.
Color - Each control point can be a different color. All the values between the
control points are calculated for color and opacity by linear interpolation.
Click the down-arrow at the color-setting button to show the color selection
matrix for a range of CT values.
You can change the range of CT values, or FOV, by clicking on an anchor at the
lower left and right corners and dragging it left or right. The value displays
beneath the anchor.
Classification parameters dialog box
The parameters of the protocol consist of this information:
• the range of CT numbers on the histogram scale (-1000 to 3095 or -1024 to
3071, depending on the scanner used)
• an opacity curve (values from 0 to 255)
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To define the protocol, you manipulate a polygon-shaped curve to adjust color
settings and opacity values. (The points of the opacity curve are formed by the
triangle symbols in the rectangular area.) Each point can be moved along the
CT values axis. The height of a point determines the opacity value at that point.
Manipulating the opacity curves
An opacity curve consists of a number of control points, each of which can be
manipulated separately. In addition, two square black control points at the
baseline allow manipulating the entire curve.
Note
When a control point is selected, its triangle color changes from white to black.
Moving a control point
To move a control point, point the mouse inside the small triangle.
• Drag left and to change the control point’s CT value
• Drag up and down to change its opacity level.
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Note
Be sure to click inside the triangle, otherwise all the control points will move.
Moving all control points
1 To change the CT value of all control points, click anywhere inside the
rectangular area (but not in a control point).
2 Drag left and right.
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Deleting a control point
1 To delete a control point, click inside its triangle to select it.
2 Press Delete on the keyboard.
Changing the CT number range
• To change the range of CT values from the mapping that is shown in the
rectangular area, use the small square anchors in the lower part of the
rectangular area.
• To to lower the minimum value for the range, drag the left anchor to the
left.
• Drag it to the right to increase the minimum value for the range.
• The number near the anchor will change as you drag the mouse to reflect
the new value set.
• To change the upper value for the range, repeat the above procedure using
the right anchor.
Assigning colors
Each vertex may be assigned a different color. The colors between the control
points are interpolated and the color bar shows the resulting color table. If no
color is assigned to a vertex it is defined as white.
To assign a color to a vertex:
1 Select the control point.
2 Click the Color button. The dialog box appears.
3 Select the color either by clicking on the desired color in the color palette, or
by adjusting the RGB and intensity components using the sliders.
Load / save protocols
Protocols may be loaded from protocol files and protocols may be saved.
To load a protocol file from disk:
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1
Click Load to open a file selection dialog.
2
Select the protocol file in the dialog.
3
Click Open.
8.5
To save the current protocol:
1
Click Save. The save protocol dialog box opens.
2
Type a name for the file.
3
Click Save.
You can save any protocol as the default protocol by right clicking on the save
icon.
Note
Other visualization tools
Cut tools
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The system offers a way to cut the volumetric model to reveal inner details or to
remove unwanted features from the model display.
You can have either a single cutting plane, or a set of two parallel planes that
create a slab.
You can also lock the current cut to allow moving and rotating the slab.
Enable a cut
1
Click one of the Cut buttons. The selected cut view is shown in the Rotate
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Cut mode (example below).
Rotate & move cut
After selecting a cut you may rotate the cutting plane, as follows:
1
Make sure you are in the Roll mode (right mouse).
2
Drag the left mouse button inside the viewport to rotate the plane.
Move the cutting plane
8 -6 0
1
Right click to open a menu.
2
Select Pan.
3
Click inside the viewport.
4
Drag the cut plane up and down to move forward or backward through the
volume.
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Create a slab view
Click the Slab Cut button to create a slab view. The orientation and position of
the slab is the same as for the cut.
Rotate & move slab
To rotate or move the slab use the same methods as described for a cut.
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Note
The center of rotation is the relate cursor. See Recenter image, earlier, for
details.
Change the slab width
Drag the middle mouse button up and down to change the slab width.
Lock cut
Click Lock Cut Volume after the desired slab or plane has been defined.
Manipulations such as rotate and pan now act on the entire volume with the
plane or slab locked in position.
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8.5
Coronaries
Sculpting
This function can be useful in removing an area from the segmented tissue.
To remove an area with the Sculpting tool:
1 Right click on the image.
2 From the menu, select the desired cut or sculpting option.
• The Include function removes everything not enclosed within the area.
• The Exclude function removes everything enclosed within the enclosed
area.
3
Left click to set a starting point.
Drag the cursor to draw an outline around the area to be removed from the
tissue.
• To undo parts of the outline, press Backspace on the keyboard as needed.
4
5
Note
To end the drawn outline, click on the last point of the outline. The
outlined area is removed from the tissue viewed.
Use the Undo button to re-render the viewport.
Viewing perspective
Classic angiographic views are available. To change the image perspective, click
the Cardiac View down arrow and select from the list:
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Coronaries
•
•
•
•
•
•
•
•
Note
8.5
RAO 30
AP
LAO 60
LAO 60 Cranial 20
Left Lateral
LAO 45 Caudal 15
RAO 45
RAO 120 Cranial 10
The angles display in the lower right of the 3D viewport. This display updates to
show the orientation of the 3D image.
Since this image takes more time to produce than a regular image, there is a
delay before the full detail image displays.
Note
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8.5.6
See General tools, see page 8-5, for details about saving, filming, and creating
Reports.
Batch & Cine
The Batch and Cine tools vary slightly in the Coronary assessment workstep.
Batch
Use the Batch tools to create a rotational batch of the volumetric, curved MPR
and straightened vessel images (any combination). Rotation is around the vessel
centerline (for the Curved MPR and straightened vessel images) or around the
heart center (for the volumetric image).
Note
The curved MPR rotation is always around the cursor. The cursor always jumps
to the center of the screen when you click rotate.
To view the whole vessel place the cursor at the middle of the vessel. You have
these viewing options:
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Coronaries
•
•
•
•
Create rotational batch counter clockwise
Create rotational batch clockwise
Clear selection
Rotation can be defined using the degrees and number of images combo
boxes. Default: 360 degrees, 20 images.
• Save, Film, Report Batch options are the same as in Heart Review.
Cine
Cine options are the same as in Heart Review with the exception of Location
mode option which is not relevant here.
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3D-QCA
8.6
8.6
3D-QCA
The 3D-QCA application (Three Dimensional Quantitative Coronary
Assessment) is the 4th stage of the Comprehensive Cardiac Analysis application.
The 3D-QCA provides viewing and measuring tools that allow you to perform
dimensional and quantitative measurements of the coronary arteries.
Two measuring methods - Contour and Caliper
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Contour method - The 3D-QCA application automatically contours the
coronary arteries that were segmented and named in the Coronaries stage of the
CCA application. These contours overlay the active artery in both curved and
straightened MPR views. First you have to verify the correctness of the
automatic contours and edit if needed. Then, after you visually identify a
stenosis, you will place stenosis and reference line markers on key vessel
locations to define the extent of the stenosis.
Caliper method - This is the manual method of marking the stenotic area of an
artery. Three pairs of caliper-like parallel lines are shown on images of the
straightened MPR arterial image. With the left mouse, you position the calipers
on key vessel locations and, with the middle mouse, adjust the calipers to
delineate the extent of the stenosis.
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8.6
3D-QCA
What you can measure with 3D-QCA
•
•
•
•
Diameter and area of stenosis and reference locations
Length of stenosis
Percent of stenosis
Plot of the area, diameter, effective diameter and minimum diameter along
the vessel
Images available in 3D-QCA
• Volume rendered image
• Curved reformatted image (cMPR)
• Straightened MPR image
• Cross section images of vessel
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3D-QCA
8.6.1
8.6
Steps you need to take before starting 3D-QCA
• Before you start the 3D-QCA stage you must identify and name at least one
coronary vessel in the Coronaries stage of the workflow.
• 3D-QCA is only available for the vessels that were identified in the Coronaries
stage.
• The 3D-QCA selection is grayed out in the workflow menu if an extracted
vessel is not active.
Notes
6
Select the patient study and load it into the Comprehensive Cardiac
Analysis application (CCA).
7
Select Heart Segmentation from the workflow bar after processing is
completed and after the “Ready” message appears in the progress bar at the
bottom of the screen.
8
Review the automatic Heart Segmentation of the coronary arteries to verify
the correctness of segmentation.
9
Select Coronaries from the workflow bar, identify the coronaries artery tree.
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10 The contours produced in 3D-QCA are only as accurate as the centerlines
extracted in the Coronaries stage. Examine the centerlines and correct them
if needed.
11 Right click on the “Save Images” icon and choose “Save Application Data”
to save the centerlines of the coronary artery tree created in the Coronaries
stage along with the segmentation. You can reload the original images and
the centerline (which includes the segmentation) from the Directory the
next time you review the case.
12 Select 3D-QCA from the workflow bar. The 3D-QCA window opens, as
shown on the next page. The active vessel from the Coronary stage will now
become the active vessel in 3D-QCA.
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8.7
Overview of the tool panels
8.7
Overview of the tool panels
Measurement tools - This is the default tool panel when you open 3D-QCA.
One tool, the Vessels list, is carried over from the Coronaries work stage.
New tools for the 3D-QCA application include the Measurement Tools and the
Show Lumen Lines. Within Measurement Tools box, you can:
• choose between the Contours and Calipers measuring modes from the
drop down box
• turn off the Measurements table display with a button click
• turn off one or the other of the Proximal and Distal Reference Lines.
Details will be described in the following procedures as they are used.
Visualization tools and Common tools - The visualization tools and common
tools in 3D-QCA are identical to those in the other CCA work stages.
Note:
8 -6 8
If a button has a little black triangle in the lower right hand corner, a right mouse
click reveals more buttons.
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Overview of the 3D-QCA display
Overview of the 3D-QCA display
Note
The appearance of your Brilliance Workspace Portal display may not look the
same as shown in this user manual. This is because the Portal is designed to
operate on systems with varying display resolutions. However, all controls,
viewports, and functions are available in all systems.
Note
3D-QCA opens with the Measurements Tools selected, and defaults to the
Contours mode.
• The Contours mode is described after this overview.
• The Calipers mode is described later in this 3D-QCA procedure.
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8.8
8.8
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8.9
Viewports in the 3D-QCA application
8.9
Viewports in the 3D-QCA application
Many types of images are provided in the 3D-QCA window to help you identify
and examine the patient study for stenoses.
In this description of the 3D-QCA application, all illustrations
Note
will show the 2+2 layout. The 1+3 layout is available from the
Common tools.
cMPR
Curved MPR image showing the selected artery with centerline and lumen lines.
VR
Volume rendered image of the heart.
sMPR
Straightened MPR image of artery. (Plots of arterial data are optionally available.)
+++
tbl / Ax
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Cross section images of artery (3 sections in contours mode, with contours ON).
Table of measurements. (An axial image is optionally available.)
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Viewports in the 3D-QCA application
8.9.1
8.9
cMPR image
The active vessel from the Coronary stage becomes the active vessel in
3D-QCA, and shows the centerline, which was created in previous workflow
steps in the Coronaries stage. (You can bring up other defined vessels from the
Vessels list.)
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In the Contours mode, the arterial lumen lines are displayed. The red + mark
on the centerline corresponds to the red star mark (or red line) in all the other
viewports.
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Viewports in the 3D-QCA application
Magic Glass
The Magic Glass displays a moveable mini-window which can be set with its
own windowing, zooming, image enhancement and rendering parameters.
The Magic glass feature is available for the cMPR and all other image viewports
(except cross sections) via the Magic Glass button in the tool panel, or from the
right click menu.
In the cross-section images you can access the Magic
Glass function by activating it on the sMPR viewport
and then choose the “Move to Cross Sections” in the
right click menu of the Magic Glass.
Right click in the Magic Glass mini-window for the
menu of Magic Glass parameters.
Refer to the “General tools” section early in the CCA
procedure for details about using Magic Glass.
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Viewports in the 3D-QCA application
8.9.2
8.9
Volume rendered image
The volume rendered image in the upper right viewport can be rotated freely in
all axes. You can make any coronary vessel that was defined in the Coronaries
stage active by clicking on it in the volume rendered image.
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Other Volume Rendering modes
Use the right mouse menu in the VR viewport or the Rendering drop down list
in the Visualization tab to select other renderings.
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Viewports in the 3D-QCA application
Show/Hide protocols - Also from the Visualization tab, you can choose from
various rendering protocols.
Note
8 -7 4
1
Click the Show/Hide protocols
button. A protocol selection box
displays, offering mini images of
available rendering protocols. (An
arrow button allows you to increase
the number of mini images
displayed.)
2
Click the icon of the desired
protocol.
For details about using and editing rendering protocols, go to the Coronaries
stage> Visualization tools> Rendering tools> Load a protocol and Editing
Protocol presets.
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Viewports in the 3D-QCA application
8.9.3
8.9
Straightened MPR image
This viewport displays a straightened MPR image of the selected vessel. (A slide
bar is used for viewing longer images.) The straightened MPR image can be
rotated around its centerline to help visualize the artery.
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Contours mode - In the Contours mode, the vessel contour lines are shown,
along with 3 reference lines.
• a Red line marks stenosis location
• a Yellow line marks the proximal reference location
• a Green line marks the distal reference location
Calipers mode - In this mode, two of the three caliper tools are available. The
caliper connected to the red line are used to mark the stenosis location. The
other caliper marks the reference location. (The third caliper is in a cross section
view.) Clicking on a caliper activates it, turing it green.
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Viewports in the 3D-QCA application
Profile graph (Contours mode only)
Another tool to help you examine a stenosis is the Profile graph, which, when
activated, is displayed in the straightened MPR viewport.
The Profile is a graph that corresponds to the CT numbers across the
straightened MPR image at the point where the red stenosis locator line
perpendicularly crosses the centerline of the vessel.
The profile graph is updated in real time as you move the red locator line along
the artery.
Details on using the Profile function are provided in the “Using Contours to
measure stenosis” procedure later in this section.
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Viewports in the 3D-QCA application
8.9.4
8.9
Cross section images
This viewport displays either 3 or 5 cross sectional images of the selected artery,
depending on the measuring mode.
• In the Contour mode, 3 sections are shown, with contour lines. The
images correspond to the reference lines in the straightened MPR image.
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• In the Calipers mode, 5 sections are shown, with the middle section being
the active frame. (More details are in the Calipers section, near the end of
this procedure.)
IVUS view - In both Contours and Calipers, you can have the middle cross
section frame displays a virtual IVUS view (Interventional Vascular
UltraSound). Right mouse click in any cross section frame or the straightened
MPR and select Virtual IVUS from the right mouse menu.
The Virtual IVUS is a volumetric image of the artery lumen, wall, and plaque. It
is color coded as follows:
• blood appears black
• normal artery wall is yellow
• calcium is white
Note
The IVUS view should not be used as the SOLE basis for clinical diagnosis.
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8.9
Viewports in the 3D-QCA application
8.9.5
Plot
In the Contours mode only, you can view a continuous plot (graph) of the
artery’s diameter and area at each point along the centerline. This is helpful
when you wish to closely determine the extent of a stenosis.
The Plot function is activated / deactivated from the right click menu in the
straightened MPR viewport. Various plot types are available.
Also, you can save the plot information in a data file to a location of your choice
in your PC/network system.
Details on using the Plot function are provided in the “Using Contours to
measure stenosis” procedure later in this section.
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Viewports in the 3D-QCA application
8.9.6
8.9
Measurements table
The Table of Measurements is displayed by default when you open the
3D-QCA application. (You may choose to display an axial image of the heart in
this viewport, as described later.)
As you move reference lines (or adjust calipers in Calipers mode), the table
continuously displays the calculations of diameter, area and percent stenosis.
Details about how the application calculates the table data are provided at the
end of this procedure.
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Physicians and researchers may choose to save the data in an ASCII file, which
can be copied to Excel or Word.
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8.9
Viewports in the 3D-QCA application
8.9.7
Optional axial image
Instead of the Measurements table, you can display an axial image of the heart
with the active artery identified by purple highlighting.
Close the Show/Hide Measurements Table button in the tool bar to hide the
table and make the axial image appear
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Using Contours to measure stenosis
8.10
8.10
Using Contours to measure stenosis
When using the Contours method of dimensioning the stenosis, you will
position three reference lines in key locations on the straightened MPR
viewport.
When you are finished, the Measurements table automatically makes
calculations and lists data useful for stent planning.
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Below is a diagram of the stenosis parameters that make up the definition of the
stenosis.
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8.10
Using Contours to measure stenosis
8.10.1
Working with the straightened MPR image
After you have examined the study for stenoses using the various image
viewports and tools, and have found a stenosis you wish to measure, your
primary tool for assessment will be the straightened MPR image.
In this viewport lumen lines are shown on the vessel, along with red, yellow and
green reference lines, each of which will be positioned to define the extent of the
stenosis. (A slide bar is used for viewing longer images.)
By default, the yellow Proximal reference line and the green Distal reference line
are both turned on when you open the 3D-QCA application. You can turn one
of the lines off, as desired, using the check boxes in the Measurements tools.
1
8 -8 2
Be sure to rotate the straightened MPR view to assure that you have
correctly identified the area of stenosis. (Be aware that the vessel segment
just before artery branch can look like stenosis.) Click and drag the left
mouse button upwards and/or downwards in the straightened MPR view to
rotate the artery.
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Using Contours to measure stenosis
2
3
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With the mouse cursor, drag the red lesion line to the location where the
vessel is most stenotic.
When you move the red lesion line, both the yellow and green reference lines
move also.
Note
Note
8.10
With the mouse cursor, drag the yellow reference line to the proximal
location closest to the lesion where the artery is of normal size.
When you move either the yellow or the green reference line, they move
independently of each other.
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Using Contours to measure stenosis
4
With the mouse cursor, drag the green reference line to the distal location
closest to the lesion where the artery is of normal size.
The distance between the yellow reference line and the green reference line is
displayed in the upper left hand corner of the straightened MPR image as
the Ref.Length dimension.
5
Notice that the data in the Measurements table will update each time you
change the position of the lesion line and the two reference lines.
The table displays the diameter and area values of the reference location(s)
and the lesion, and gives the percent of stenosis based on the diameter and
area.
Note
8 -8 4
Refer to the end of this section for information on how the above calculations are
determined.
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Using Contours to measure stenosis
6
8.10
Right mouse click in the Table viewport allows accessing the “Save to Ascii”
command. You can save the data file to a location of your choice in your
PC/network system, including the Windows desktop.
Editing the contours on the cross sections
You can zoom the cross section images (up to 6 magnification) and edit the
contours and the lumen lines to achieve more precise stenosis data.
Click the Zoom button in the Common Tools, or select Zoom from the
right click menu.
2
Drag upwards in the cross section image frame to increase the image size.
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1
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Using Contours to measure stenosis
3
Click on the Change shape button in the Common Tools tab.
4
Drag the control boxes of the lumen lines as needed to accurately
position the contours on the lumen walls.
Helpful Hint:
There are 10 levels of Undo and 1 level of Redo when you are editing
contours and lumen lines.
8 -8 6
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Using Contours to measure stenosis
8.10
Using the Plot function
The Plot function shows dimensions
of the artery in graphical form along a
line, from the origin to the end of the
tracked artery.
You can use the plot function to help
you be more precise in the placement
of the stenosis and reference lines.
1
Right mouse click on the
straightened MPR view.
2
Select Plot from the right mouse
menu.
3
Select a plot type from the list. The selected plot will have a check mark
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.The plot appears in the bottom half of the sMPR viewport.
4
Position the red reference line onto the lowest stenosis point, the yellow
reference line onto the highest preceding point, and the green reference line
onto the highest point directly following the stenosis.
5
To turn off Plot, access the right mouse menu, click on Plot to uncheck it.
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Using Contours to measure stenosis
Using the Profile function
The Profile displays a graph that corresponds to the CT numbers across the
straightened MPR image at the point where the red stenosis locator line
perpendicularly crosses the centerline of the vessel.
8 -8 8
1
Right mouse click in the straightened MPR or any cross section
viewport. In the drop down menu click Reference lines, then click
Profile.
2
The Profile line updates as you move the red line along the straightened
MPR image.
3
To turn off Profile, right mouse click in the viewport, select Reference
Lines, and uncheck Profile.
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Using Contours to measure stenosis
8.10
Measuring lengths of vessels
In addition to obtaining the vessel lengths that are automatically calculated by
3D-QCA, you can obtain your own length measurements anywhere along the
straightened MPR and cMPR arteries.
1
In the Common tools, click the Line button.
2
Place the mouse cursor over the area of interest in either the cMPR or
straightened MPR viewport. The cursor turns into a pencil.
3
Point to the beginning location of the length you want to measure.
4
Hold down the left mouse button and drag the mouse to the end location.
5
Release the mouse button. The line you draw appears on the image, along
with its length.
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In the cMPR viewport (at right, below), the diameter of the vessel at its start
and end points is also shown.
6
To delete a drawn line and its data, click the Delete graphic element button,
then click each graphic you want to delete.
-- OR --
7
You can delete all lines and data simultaneously by right clicking the Delete
button to bring up the large X, and clicking it.
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8.11
Using Calipers to measure stenosis
8.11
Using Calipers to measure stenosis
The Caliper method of stenosis measurement provides caliper-like tools for
measuring the following arterial diameters:
• the Reference diameter of the blood vessel
• the Stenosis diameter
• the Cross section diameter of the stenosis
From these three measurements, the system will perform the same calculations
as the Contours mode and display them in a table of Measurements, including
the following:
• the percent stenosis, which is derived from the Reference and Stenosis
diameter measurements.
• an estimation of the percent stenosis, which is a refined value of the
stenosis, derived from the cross section dimension. (The percent stenosis is
important when measuring an eccentric stenosis.)
Note
8 -9 0
Refer to the Contours section earlier in this description of the 3D-QCA work
stage for details about examining the study for stenoses.
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Using Calipers to measure stenosis
8.11
Using the Calipers function
Begin this procedure after you have examined the study and identified a stenosis
of interest.
1
In the Measurement tools, select Calipers from the drop down menu.
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The straightened MPR display becomes configured as shown below. The
three caliper tools are positioned in their starting, default locations.
2
Click on the Reference caliper (A in the diagram) to activate it. The caliper
turns green. (An active caliper is green; inactive calipers are blue.)
3
With the left mouse, drag the Reference caliper to a
part of the artery having a “normal” external
diameter.
4
Using the mouse wheel, adjust the spacing of the
Reference caliper so that the two caliper lines fit the
greatest diameter of the artery.
5
Next, click the Stenosis caliper (B on the diagram) to activate it. The caliper
turns green.
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Using Calipers to measure stenosis
6
With the left mouse, drag the Stenosis caliper to the region of
stenosis.
7
Using the mouse wheel, adjust the spacing of the Stenosis
caliper so that the two caliper lines fit the smallest diameter of
the stenosis.
8
Next, click the Cross section caliper on the middle cross sectional image (C
on the diagram) to activate it. The caliper turns green.
9
While observing the middle cross section image and
with the mouse cursor in the scroll mode, point into
the straightened MPR viewport and drag the mouse
up and/or down in the viewport to rotate the vessel.
The Cross section calipers will rotate around the vessel
centerline (the red point in the image). Position the
Cross section calipers so that you can accurately
measure the stenosis cross section.
10 Using the mouse wheel, adjust the Cross section caliper so that the two
caliper lines fit the diameter of the stenosis.
The measurements of the stenosis as derived from the Caliper method of
measurement appear on the Measurements table, as shown on the next page.
8 -9 2
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Using Calipers to measure stenosis
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8.12
Stenosis calculations
8.12
Stenosis calculations
Reference diameter calculation (Contours mode)
Note
8 -9 4
• If only one of the reference lines (proximal or distal) is active, the reference
diameter is the diameter at the location of the reference line.
• If both the proximal and distal reference lines are active, the reference
diameter is the weighted average of the two diameters, as shown below.
Comprehensive Cardiac Analysis (CCA)
Ddist
diameter, distal reference
Dprox
diameter, proximal reference
d1
distance between location of stenosis and
location of proximal reference
d2
distance between location of stenosis and
location of distal reference
Brilliance Workspace Portal - Volume 3
Stenosis calculations
8.12
Reference area calculation (Contours mode)
Note
• If only one of the reference lines (proximal or distal) is active, the reference
area is the area at the location of the reference line.
• If both the proximal and distal reference lines are active, the reference area is
the weighted average of the two areas, as shown below.
Adist
area, distal reference
Aprox
area, proximal reference
d1
distance between location of stenosis and
location of proximal reference
d2
distance between location of stenosis and
location of distal reference
Dref
reference diameter
Dsten
stenosis diameter
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% Stenosis calculation
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8.13
Saving, reporting and filming
8.13
8.13.1
Saving, reporting and filming
Saving your work
Save Image
The Save Image function saves an image to the device identified as the “Direct
save” storage device in the Preferences utility. (Refer to the “Preferences” chapter
in Volume 1 of this user manual for more information.) If desired, you may
select a different save device from the Save To dialog box.
8 -9 6
1
From the Common tools, click the Save Image button. The Save to dialog
opens.
2
Type in a different name than the one provided, if desired.
3
In the Save Device: field, you may select a different device than the default
device, if desired.
4
Click OK to save the image.
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Saving, reporting and filming
8.13
Save Application Data
You can save the lumen contours that 3D-QCA created (including any changes
that you may have made) with the Save Application Data function.
1
From the Common tools tab, right click the Save Images button.
2
Click the Save Application Data button that drops down.
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The Add Description... dialog box opens.
3
Type in a description label.
4
Click OK.
After you have saved the application data, you can reload the original images
and the saved 3D-QCA contours from the Directory the next time you review
the case.
8.13.2
Sending your results to Reporting
Note
The Report function is an optional feature of Brilliance Workspace Portal. The
Report button is grayed out if the Report Editor is not installed on your system.
The Reporting function of the Brilliance Workspace Portal allows you to create
customized reports from the analytical information and images that you send to
Reporting from this application.
The instructions below describe how to send information and images to the
Reporting application. (Refer to the “Reporting” chapter in volume 2 of this
user manual for detailed instructions about finalizing reports.)
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8.13
Saving, reporting and filming
Three Report functions are available under the Report button. (Right mouse
click the Report button for the other two):
Send image to report - This is the default button. To send an image, make the
image active by clicking in its viewport; the frame turns red. Now click the Send
image to report button. To send more images, make them active and click the
button again. The images accumulate in the Report Editor.
Add Findings to report - When you click this button, two Findings pages will
appear, “Add to Report,” and “Risk Factors and Clinical History.” Fill in the
appropriate information fields, and click OK when done. The Findings will be
sent to the Report application.
Delete all Findings - Click this button to delete
8.13.3
Filming
An image currently on the 3D-QCA display may be sent to the FilmView
application. Images are filmed one-by-one.
8 -9 8
1
Click in the image you want to film. The image becomes active and is
outlined in red.
2
From the Common tools tab, click the Film image button. The image is
sent to the FilmView application.
3
Repeat steps 1 and 2 to send additional images to film.
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Functional Analysis
8.14
8.14
Functional Analysis
The Functional Analysis application is the 5th stage of the Comprehensive
Cardiac Analysis application.
Obtaining accurate results from Functional Analysis depends on correct
segmentation of the heart and the correct alignment of the heart axes.
You should carefully review the Heart Segmentation stage before accessing
Functional Analysis. If necessary, you may need to perform the Advanced
Segmentation function of the chambers and coronaries of all the phases, in
Heart Segmentation stage.
After verifying segmentation, you may skip the Coronaries stage and the 3DQCA stage, and directly enter Functional Analysis if desired, and perform
Functional Analysis operations, such as Ejection Fraction, if that is all that is
needed.
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Caution
• Verify that the appropriate phases are loaded.
• Verify the correctness of Heart Segmentation.
• Verify the correctness of the LV, long axis and short axis contours.
Overview
The Functional Analysis stage of Comprehensive Cardiac Analysis allows you to
analyze a variety of heart functions, including:
• left ventricle volume
• ejection fraction
• stroke volume
• cardiac output
• left ventricle wall mass, motion, and thickening
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Functional Analysis
8.14.1
Can I perform Functional Analysis with only one phase?
If only one phase is available, a partial analysis may be performed.
Procedure: One-phase study
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1
Verify long axis orientation, apex and valve plane location on the loaded
phase for 4, 3, and 2 chamber view along with short axis.
2
Review the calculated results for the left ventricular volume in the Results
graph. The calculation is based on the Short Axis contours.
3
Evaluate Aortic and Mitral valve planes using Rendering options under
Visualization Tools.
4
Evaluate the 3D anatomy using the Cut Tools.
5
Review the wall thickness with Polar Map views.
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Functional Analysis
8.14.2
8.14
Glossary of Functional Analysis terms
LV
Left Ventricle
Phase
A portion of the heart cycle, expressed as a percent (%), where 0% is
the End-Diastole phase.
ES
End-Systole - the end of the pumping (ejecting) phase of the left
ventricle; occurs at the end of the T-wave on an ECG. Usually occurs
about 40%.
ED
End-Diastole - the end of the filling phase of the left ventricle; this occurs
just before a contraction. Usually occurs about 0%.
SV
Stroke Volume - the difference between end-diastolic and end-systolic
volumes of blood ejected with each beat.
EF
Ejection Fraction - the fraction of blood pumped out of the (left)
ventricle with each heart beat. The EF = the stroke volume divided by
the end-diastolic volume, expressed as a percent (%).
CO
Cardiac Output - The amount of blood that is pumped by the heart per
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unit time, measured in milliliters per minute (ml/min).
ED volume
The volume at ED phase of the heart - the biggest volume of the heart
during the heart cycle.
ES volume
The volume at ES phase of the heart - the smallest volume of the heart
during the heart cycle.
Echocardiogram
An echocardiogram (often called "echo") is a graphic outline of the
heart's movement. During this test ultrasound waves provide pictures of
the heart's valves and chambers.
Apex
The conical tip of the heart which is usually its most caudal point.
Base
That part of the heart that lies opposite the apex, formed mainly by the
left atrium but to a small extent by the posterior part of the right
atrium; it is directed backward and to the right and is separated from the
vertebral column by the esophagus and aorta.
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Functional Analysis
Mitral valve
The valve between the left atrium and the left ventricle of the heart.
Aortic valve
The valve separating the aorta from the left ventricle of the heart.
Valve plane
Valve plane in the context of Cardiac Axes is the Mitral valve plane.
Long axis
A cut along the long axis of the heart. The long axis is defined as the axis
passing through the middle of the left ventricle - through the apex and
the mitral valve.
Short axis
A cut along the short plane of the heart, orthogonal to the long axis.
Allows you to see a cut of the left and right ventricles.
Wall mass
Myocardial mass.
Wall thickness
Myocardial wall thickness in the radial direction (in short axis plane).
Wall motion
A measure of regional myocardial function.
(Adapted from M. Catherine M. Otto, Textbook of Clinical Echocardiography,
2nd Edition, W.B. Sanders Company, Philadelphia, PA, 2000, ISBN-72167669-3.)
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Functional Analysis opening window
8.15
Functional Analysis opening window
Note
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8.15
The appearance of your Brilliance Workspace Portal display may not look the
same as shown in this user manual. This is because the Portal is designed to
operate on systems with varying display resolutions. However, all controls,
viewports, and functions are available in all systems.
The opening window of the Functional Analysis stage is described on the next
page.
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Functional Analysis opening window
The opening window of the Functional Analysis stage consists of the following
viewports:
Viewport 1
A large volume rendered image forms the main image viewport.
Viewport 2
The phase tabs are shown along the top edge of the image viewports.
Click on the tabs to switch easily between images of the different phases.
Viewport 3, 4, 5
The three reference viewports along the bottom show cardiac axial
images through the LV axes, typical of echo cardiographic planes. From
left to right they are 4 chamber, 3 chamber, and 2 chamber images
Viewport 6
The short axis image is shown in the middle right
Mouse options on the viewports
• Volume view of heart: right click options are roll, pan, zoom, view,
orientation, cuts, enlarge and show magic glass.
• 2, 3, and 4-chamber views: right click options are scroll, pan, zoom, enlarge
and show magic glass.
• Middle mouse dragging left-right and up-down changes:
• for volume image - the protocol
• for 2D images - the width and center of the window
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Functional Analysis procedure
8.16
8.16.1
8.16
Functional Analysis procedure
Functional Analysis tools
The Functional Analysis tools are the default tools when Functional Analysis
opens. Common tools and Visualization tools are described later in this section.
Review Results - This function opens the Results
mode in which you can review the functional
analysis results, such as blood volume data and
Polar maps.
EF - This button opens a dialog to set the ED and ES phases, allowing you to
calculate the Ejection Fraction.
Correct Axes - This function allows you to correct the axes and set the apex and
valve plane correctly.
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Reset - Resets the cardiac axes (which are used for calculating the
contours) to its original location. This function is only relevant if
you have performed any change in “Correct Axes” mode.
Correct Contours - This function allows you to correct the myocardial contours
on the short axis images.
Short Image Creation - Use the Short (Axis)
Image Creation parameters to change the number
and thickness (width) of the short axis images.
These parameters are used in the calculations for
the Polar Maps and all other functional
parameters. These default parameters, selected for
good analytical results, may be modified if needed.
Wall Analysis - This function opens a drop down list with all the Polar Maps
options.
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Functional Analysis procedure
8.16.2
Procedure to establish the ED and ES phases
When you start Functional Analysis, the following conditions exist:
• The default mode is Review Results (the button
is selected).
• The EF (Ejection Fraction) button is active.
• The Numerical Results viewport in the upper right corner is partially
populated with preliminary data, and the graph is approximate.
• None of the Phase tab tags are identified as ED or ES.
To establish the ED and ES phases:
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1
Click the EF button.
2
The ED and ES phases become established, and the Phase tab tags will
indicate which phase is ED (usually 0%) and which is ES (usually 30% or
40%).
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Functional Analysis procedure
8.16.3
8.16
Procedure to correct the Long Axis (when needed)
Click Correct Axes to open a window that allows you to re-orient (correct)
the long axis.
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1
Viewport 1
The top right viewport displays the short axes view. Three colored lines
indicate the planes of the 2-chamber, 3-chamber, and 4 chamber echo views
(red, green, and blue, respectively). These axes are 60 degrees apart.
Viewports
These are the 2-chamber, 3-chamber, and 4-chamber (respectively) echo
2, 3, and 4
views. The vertical green reference line in each of these viewports represents
the calculated long axis. The dotted purple horizontal line in each echo view
designates the valve plane. The V-shaped dotted purple line designates the
apex of the heart.
2
Click the ED phase tab. (The Long axis can only be corrected in the ED
phase.)
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Functional Analysis procedure
3
If necessary, first correct the apex location on the short axis image.
4
Move the pointer cursor to a green line (the long axis). The pointer will
change to either a Rotate cursor at the edges of the line, or to a Move cursor,
when it is closer to the center of the line.
5
Dragging the left mouse cursor causes the image to either rotate or pan
relative to the fixed green line.
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Functional Analysis procedure
8.16.4
8.16
Procedure to correct the valve plane and apex plane
(when needed)
For all loaded phases, check the position of the base and apex planes, and correct
as needed. (The long axis maintains the same position and orientation for all
phases.)
Make sure to define the valve plane separately for ED and ES, as this plane moves
caudally during systole. Failure to do so may result in an underestimation of EF.
Note
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.
1
Correct the apex by dragging the V-shaped dotted purple line to the correct
position.
2
If necessary, correct the Mitral valve plane base by dragging straight purple
dotted line to the correct position.
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8.16
Functional Analysis procedure
8.16.5
Procedure to Re-establish the ED and ES phases
Perform this procedure after correcting the apex plane and the Mitral valve
plane.
8 -1 1 0
1
Slightly rotate the long axis in the ED phase, offsetting it from its current
position.
2
Functional Analysis will then proceed to correct your offset.
3
During the correction, an intended function will also automatically occur:
the apex and valve positions on all other phases will interpolate to locate
between ED and ES.
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Functional Analysis procedure
8.16.6
8.16
Procedure to Correct Contours, when needed
This function allows you to correct the chamber wall contours.
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1
To begin, select Correct Contours. The view changes to 3x3 layout with
inner and outer contour lines. The image below shows the main viewport in
edit mode.
• Yellow = Endocardium contour
• Pink = Epicardium contour
2
You have three contouring options:
• Click Edit contour to manually alter the contour. Edit by selecting control
points and dragging them to the correct positions.
• Click Delete contour to remove the contour lines.
• Click Add contour to manually draw new contours. When manually
adding contours, the first contour will be the yellow endocardium
contour. The second contour will be the epicardium contour.
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Functional Analysis procedure
3
• Be sure to save the contours when finished.
• To save contours, right click the Save icon in common tools, and
select Save Application Data.
• These contours are different than the contours produced in
3D-QCA.
Note
4
8 -1 1 2
To enlarge an image for easier editing, from the right click menu select
Enlarge.
Proceed to the Finalize the results function, on the next page.
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Finalize the results
8.17
8.17
Finalize the results
When you are ready to finalize the Functional Analysis results, the Numerical
Results viewport will be displaying partial data only.
The viewport contains some volume and wall mass data and the preliminary LV
volume graph. It is not fully populated with the rest of the data until the
Ejection Fraction is calculated.
The results at this point are useful as an initial impression. If better initial results
are desired, you should perform the Advanced Segmentation function of the
chambers and coronaries of all the phases, in the Heart Segmentation stage
before opening the Functional Analysis stage.
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Note
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8.17
Finalize the results
8.17.1
Calculate the Ejection Fraction
The EF button is grayed out if only one phase has been loaded. The Ejection
Fraction cannot be calculated with only one phase.
Note
1
To begin calculating the final Functional Analysis data, click Review
Results.
2
Click the EF button. The Phase Set dialog box appears, with the current ED
and ES values.
You cannot click the EF button more than once. Once the Stroke Volume,
Ejection Fraction, and Cardiac output are calculated, they will not change.
Note
3
If you are satisfied with the ED and ES phases that were set in the
“Procedure to re-establish the ED and ES phases,” click OK.
-- OR --
4
If you want to change the ED and/or ES phase, click the arrow and select
the new phase. (The dropdown list selection included each of the phases
that were loaded.)
5
Click OK.
The Functional Analysis calculations are performed. The latest calculations
are now shown in the Numerical Results graph, shown on the next page.
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Finalize the results
8.17
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.
As blood is ejected from the LV, the volume decreases to its minimum,
which is the ES volume. As the blood fills the LV, the volume increases to its
maximum, which is the ED volume.
The graph displays the change over time of the left ventricle volume (ml).
The horizontal scale uses the cardiac phase (%) as the reference time unit.
The numerical calculations yield the Ejection fraction (EF), stroke volume
(SV), cardiac output (CO), wall mass, ED volume and ES volume.
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8.17
Finalize the results
8.17.2
Procedure to set new ED and/or ES phase tags, if needed
In the Numerical Results viewport, two green vertical lines drop from the points
of maximum and minimum LV volume to the phase coordinate line at the
bottom of the graph. These were the phases that were automatically tagged as
ED and ES respectively.
The ED and ES phases should be validated and, if necessary, corrected as
follows:
1
Right click on the phase tab you want to set as the new ED or ES phase.
A pop-up menu appears with these choices:
• Set as ED
• Set as ES
• (Delete phase is only active in Heart Review stage. To delete a phase, you
need to return to the Heart Review stage.)
2
Make your choice, and the previously defined ED or ES tag is cancelled, and
the newly defined phase is tagged instead.
A recalculation is performed on some data, and the results of your changed
ED or ES setting appears in the graph.
3
Note
8 -1 1 6
Repeat steps 1 and 2 to set a different ES or ED phase tag, if needed.
Your newly set phases are used in all calculations.
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Finalize the results
8.17.3
8.17
Comparing phases
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Click the ED/ES phase tab in the upper left corner of the display (see the arrow
in the graphic below) to compare ES\ED phases. The screen has 9 regions:
Viewports
These are the ED and ES short axis views. You can scroll to any height along the LV
1 and 2
long axis, from the apex to the base.
Viewport 3
This is the LV volume graph. You can also display the Polar Maps using the right click
menu in this viewport.
Note
Viewports
These viewports show images of the ED phase, with (from left to right) the 2-
4, 5, and 6
chamber view, the 3-chamber view, and the 4-chamber view.
Viewports
These viewports show images of the ES phase, with (from left to right) the 2-
7, 8, and 9
chamber view, the 3-chamber view, and the 4-chamber view.
Cine is not available in any of the above viewports.
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8.18
Wall Analysis maps
8.18
Wall Analysis maps
The Wall Analysis function presents color-scaled Polar Maps to show the
functional parameters for each segment of the left ventricle.
Polar maps are based on the American Heart Association’s standardized
recommendation for the orientation of the heart, angle selection and names for
cardiac planes and number of myocardial segments.
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Wall Analysis maps
8.18
Polar map - regional
The regional map is divided into the standard 16 LV segmentation, with results
values within each region.
Note
• The default map is the regional polar map.
• Polar maps update when contours are corrected.
Polar map - detailed
The detailed map corresponds to the short axis views, where the inner circle
near the center of the polar map image represents the left ventricular apex and
the outer circle represents left ventricular base.
The colors within a circle represent attributes of the part of the left ventricle that
corresponds to the same polar position of the matched short axis cut.
Polar Map - detailed
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Polar Map - Regional
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Wall Analysis maps
8.18.1
Access the Wall Analysis function
1
Click the Wall Analysis down-arrow to access a list of available map types.
-- OR --
2
Right click in the viewport to access the list. Right click on the side menu.
3
Click the map name on the list to select the desired Wall Analysis
presentation.
To switch between regional and detailed modes of polar map representation:
1
Click Detailed from the right click menu.
-- OR --
2
Select Detailed from the Wall Analysis menu.
3
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Wall Analysis maps
8.18
ED wall thickness
Detailed
Regional
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ED thickness - This map represents the left ventricular wall thickness of the
loaded cardiac phase with the largest ventricular volume and smallest wall
thickness.
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8.18
Wall Analysis maps
ES wall thickness
Detailed
Regional
ES Wall thickness - This map represents the left ventricular wall thickness of the
loaded cardiac phase with the smallest ventricular volume and largest wall
thickness.
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Wall Analysis maps
8.18
Thickening
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The Thickening map represents the percent change in wall thickness between
the two extreme phases in the cardiac cycle, ES and ED, or between a phase
where the muscle is most contracted and a phase where it is most relaxed. The
change is measured in percent relative to the ED wall thickness.
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Wall Analysis maps
Motion
Detailed
Regional
The Motion map represents the change in the endocardial wall position
between two extreme phases in the cardiac cycle, ES and ED, or between a
phase where the muscle is most contracted and a phase where it is most relaxed.
The change is the 3D radial distance between the center position of the
endocardium at ED and its position at ES in the specified direction, and is
measured in millimeters. The values will be positive if the wall motion is
inwards and negative if it is outwards.
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Visualization tools
8.19
8.19
Visualization tools
Rendering tools
For detailed instructions on using the rendering tools refer to the Rendering
Tools in the Coronaries work stage, earlier in this chapter.
The Magic Glass displays a moveable mini-window which can be set
with its own windowing, zooming, image enhancement and
rendering parameters. Refer to the Magic Glass procedure in the 3DQCA section of the CCA application for more information.
Show/Hide protocols - You can choose from various volume
rendering protocols. When you click the Show/Hide protocols
button, a protocol selection box displays, offering mini images of
available rendering protocols.
Philips Medical Systems 4535 674 64531_A
For details about using and editing rendering protocols, go to the Coronaries
stage> Visualization tools> Rendering tools> Load a protocol and Editing
Protocol presets.
Cut tools
The system offers a way to cut the volumetric
model to reveal inner details or to remove
unwanted features from the model display.
You can have either a single cutting plane, or a
set of two parallel planes that create a slab.
You can also lock the current cut to allow moving and rotating the slab.
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8.19
Visualization tools
Cine
Use the Cine function to view simulated heart motion.
• Cine only functions when more than one phase is loaded.
• The best heart motion can be observed when all 10 phases are loaded.
Note
Cine can be activated in the chamber views (4, 3, and 2 in the diagram), the
Short Axis view and any volume view. You can Enlarge any viewport from the
right mouse menu.
• In the short and long axis views Cine enables you to evaluate regional
myocardial contraction or function,
• In the volume view you can manipulate the heart model as it pumps, that
is, you can rotate, move or cut the model while in cine mode.
• In Correct Contours mode, you can play a cine of the nine short axis
images together.
Right click on the Save button in the Common Tools and select Save Cine to
save the Cine of the chamber views and the Short axis views.
Start/stop cine
1
Select the viewport.
2
Click Play in the Cine box.
For long/short axis views, the cine starts immediately. For the volume view, a
dialogue shows the progress of the preparation phase before the cine starts.
Most viewing functions, such as window, center width, zooming, and
scrolling, are available also in cine mode.
8 -1 2 6
3
Click Stop to stop Cine.
4
Change the speed of play by dragging the Cine Speed bar in the Cine box.
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Visualization tools
8.19
Common tools
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The Common tools complement in the Functional Analysis stage are similar to
those in many other applications of Brilliance Workspace Portal. Refer to the
“Common tools” section of the CT Viewer chapter of volume 2 of this user
manual for detailed descriptions of the tools.
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8.20
View Valves
8.20
View Valves
1
Click the Valves button in the Visualization Rendering tools to view the
heart valves. A menu appears that includes these valve choices:
• Aortic Valve shows the cut along the plane through the aortic valve.
• Mitral Valve shows the cut along the plane through the Mitral valve.
2
Click Hollow to change rendering to a hollow black and white image.
(Click Show/Hide protocols to select other protocols.)
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View Valves
8.20
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You can use the Cut tools to manipulate the image.
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9
9.1
Lung Nodule Assessment
Overview
The Lung Nodule Assessment (LNA) application assists the radiologist
with the detection and quantification of pulmonary nodules and lesions. If
a follow-up study of the patient has been acquired, the two studies can be
compared and the growth of nodules can be tracked over time.
The LNA application features include nodule identification using single
click segmentation, nodule volume calculation, and an optional Lung
Nodule Computer Aided Detection (CAD) feature.
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Lung CAD option
Philips Lung Nodule CAD Software Option is a Computer Aided
Detection (CAD) software option designed to assist radiologists in the
detection of solid pulmonary nodules during review of multidetector CT
(MDCT) scans of the chest. It is intended to be used as an adjunct by the
radiologist to identify regions of interest following the initial reading of the
study. Upon further assessment of each CAD-suggested region, the
radiologist may either accept the CAD result as a nodule, or reject it.
Wa r n i n g
The Lung Nodule CAD option is under evaluation. It should not be used as
the SOLE incontrovertible basis for clinical diagnosis.
Wa r n i n g
In the United States, Federal law restricts this device to sale, distribution,
and use by or on the order of a physician.
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Lung Nodule Assessment
9- 1
9.1
Overview
9.1.1
Contraindications
There are no known contraindications for the use of this device.
9.1.2
9 -2
Lung Nodule CAD option warnings and precautions
Wa r n i n g
Before using the CAD option, review the entire study and use your own
radiological interpretation to identify and mark your findings. The CAD
option does not detect all pulmonary nodules. You may miss nodules if you
do not review the entire study before using the CAD option.
Wa r n i n g
Do not change your initial interpretation based on the results of the CAD
option. Since the CAD option does not detect all pulmonary nodules,
changing your initial interpretation may result in misdiagnosis.
Wa r n i n g
Use the CAD option only as an adjunct for detecting lung nodules. Use your
own independent interpretation to distinguish between true nodules and
false positives.
Wa r n i n g
The CAD option also detects structures that are not true nodules (false
positives). Use your radiological interpretation to reject false positives that
may lead to misdiagnosis.
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Philips Medical Systems 4535 674 64531_A
Overview
9.1
Wa r n i n g
Do not use the CAD option to detect the following: ground-glass opacities,
part-solid nodules, and pulmonary parenchymal abnormalities that do not
represent solid nodules. The CAD option does not reliably detect these
abnormalities, which may cause misdiagnosis.
Wa r n i n g
Do not use the CAD option for patients with diffuse interstitial lung disease
or extensive granulomatous disease. Using the CAD option for these
patients may reduce detection performance.
Wa r n i n g
Do not use the CAD option for patients with prior thoracotomy or
radiation therapy involving lung parenchyma. Using the CAD option for
these patients may reduce detection performance.
Wa r n i n g
Use the CAD option only on CT images that were acquired with the
recommended scan protocol parameters presented later in this section.
Wa r n i n g
Using the CAD option on images that were acquired with nonrecommended parameters may reduce detection performance, which may
cause misdiagnosis.
Wa r n i n g
Do not use the CAD option on CT images that exhibit patient motion, such
as exams not performed during a single breath-hold period. Patient motion
may contribute to false positive readings, which may cause misdiagnosis.
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9.2
Recommended scanning parameters for LNA
9.2
Recommended scanning parameters for LNA
When using the Lung Nodule Assessment optional clinical application
there are recommended parameters that should be used to insure accurate
and reproducible results.
It is recommended that the default Brilliance CT Lung acquisition protocol
be used. It is named “Lung Nodule” and is one of the Thorax protocols.
If the radiologist prefers different parameters based on preference or clinical
indication, certain guidelines should be followed if the case is intended to
be processed with the LNA application. In these instances, if guidelines
cannot be met, it is suggested to perform a second reconstruction from raw
data with the recommended parameters for use in the Lung Nodule
Assessment package.
Scanning
Guidelines to follow
Parameter
if default Lung Nodule protocol is not used
Resolution
Standard resolution
Filter
Filter C
• The B filter can be used
• Never use the D or Y filter
• Do not add any additional enhancements
Slice thickness
Slice thickness 3mm or less with a 50% overlap
• The slice thickness is related to the size of the nodule. If the
nodule is small then the thinnest slice thickness available
should be used to make volumetric measurements
• There are several factors that can effect the segmentation of
the nodule:
• Scan parameters (slice thickness, filters)
• Nature of the nodule (shape, homogeneity)
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Recommended scanning parameters for LNA
• If the recommended parameters are not used the accuracy of the results
cannot be assured.
• When performing follow-up studies it is important to use the same
parameters as the original case to get consistent volumetric comparison
between current and previous studies.
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Caution
9.2
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9.3
LNA workflow stages and results
9.3
LNA workflow stages and results
Lung Nodule Assessment consists of three workflow stages:
Nodule Detection
This is the initial work stage for a single patient study. It is used to:
• explore the study in order to find nodules
• use Lung Nodule CAD as an adjunct detection process (if your
Brilliance Workspace Portal is equipped with the option)
• select and segment nodules
• edit the segmentation
After segmenting nodules you can generate a report that includes
calculations of the nodule size and volume.
Nodule Matching
This is an additional work stage to perform if you have already completed
an initial LNA patient study, and are now performing a follow-up LNA
procedure.
You will start by loading both patient studies, the initial and the follow-up,
and then use the Nodule Matching stage to compare the two studies and
assess changes over time. The two studies are shown in the same window
for simultaneous visual comparison. After you have matched nodules
between the studies, you can generate a report that includes calculations of
nodule volume changes and projected doubling time.
Assessment
The final stage is Assessment. This stage is used for both the initial study
and for follow-up studies. A statistical table is presented showing the
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LNA workflow stages and results
9.3
identified nodules, with nodule data such as volume, effective diameter,
and Hounsfield units, as well as calculations of growth and doubling time.
Reporting and Saving
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At any time during analysis, you can send images to Report. In the
Assessment stage, you can also save and film the table, and save the
identified nodules to a file.
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9.3
LNA workflow stages and results
9.3.1
Information Output
After nodules have been examined and accepted by the radiologist, the
Assessment stage presents a table of information about each nodule:
Nodule
Description
Parameter
Volume +/- error
3
(mm )
The volume error estimation is calculated by assuming there is a half of a voxel error on
the surface. Thus, it is half of the volume of the surface voxels. For large nodules, this is a
reasonable measure, but for small nodules, it could be relatively large due to the large
surface to body ratio.
The error in volume calculation is related to the fact that the border of the nodule may
not cover a full voxel. In that case the volume of the nodule is calculated by counting the
voxels in the contour but around the surface boundary there are a lot of voxels that do
not completely form a part of the contour and these voxels contribute to the error in the
volume calculation.
ED (mm)
This is the Effective Diameter and it is calculated by considering the nodule as a sphere.
This means that if the nodule was a sphere with the calculated volume the Effective
Diameter would be the diameter of the sphere.
Max area (mm2)
This is the area within the contour for the largest slice of the nodule in 2-D.
Max D(mm)
This is the Maximum Diameter of the nodule.
HU mean/max/min
These are mean, max, and min Hounsfield Unit values within the segmented nodule.
% Growth
The percentage the nodule has grown from the prior scan.
Doubling (days)
The doubling days of a nodule is computed using the
two volumes of that nodule and the time internal
between the two studies. The doubling time is
calculated assuming exponential doubling time
(assuming the growth follow exponential curve). It is calculated using the formula above.
Where:
is the time interval between the two studies.
V2 is the volume of the second study (the later study)
V1 is the volume of the first study (the former study)
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Loading the initial LNA study
9.4
9.4
Loading the initial LNA study
1
If you were performing a follow-up procedure, you would load two studies at
this time. In the example above, it would be the “Original” and “Follow-up”
study. For the single-study procedure that follows, however, only one study,
the “Original,” is loaded. The follow-up procedure is described in the
“Nodule Matching” section of this chapter.
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Note
2
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From the Directory of the Brilliance Workspace Portal, locate the LNA
study you want to work with, as shown below. (For details about
loading a study, refer to the “Directory” chapter in volume 1 of this user
manual.)
Also from the Directory, under the
Analysis tab, select Lung Nodules. The
LNA study loads and appear in the
LNA opening window, shown on the
next page.
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9.5
LNA opening window
9.5
LNA opening window
Note
The appearance of your Brilliance Workspace Portal display may not look
the same as shown in this user manual. This is because the Portal is
designed to operate on systems with varying display resolutions. However,
all controls, viewports, and functions are available in all systems.
When you load a single study into the Lung Nodule Assessment
application, it defaults to the Nodule Detection work stage.
Axial Slab - The main viewport displays a 5mm thick axial Slab image,
shown in the default Lung window protocol. This is the image for you to
use to examine for nodules. It can be zoomed and panned, and you can
change the thickness. On this image “mark” the suspected nodule(s).
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Reference images, Coronal and Sagittal - These reference images appear on
the window’s right side. After nodules are marked and accepted, these
images visually indicate the locations of the nodules by surrounding each of
them with a bounding box and a nodule number.
MIP image - In the MIP image in the lower-right, the lungs are shown
with a green line dividing the upper and lower lung segments. This line is
an active graphic and can be adjusted up or down: click on the line (it
changes to red) and drag it to the desired location. This line is used for
reporting purposes to indicate whether the lesion is in the upper or lower
portion of the lung. Usually, you would move the line if it is not in the
middle of the patient’s lungs, for example, if the patient had a resection and
only has a partial lung.
Volume and MIP images of the active lesion - The lower-middle and
lower-left viewports initially contain no images if a nodule is not yet
selected. After you mark a lesion, it is segmented as a volume rendered
image at left and a MIP image at right.
Note
Some nodules may not be segmentable.
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Tool panel arrangement
The arrangement of the tools in LNA may be different than is depicted in
the following procedures. This is because display resolutions vary from one
user’s Portal system to the next.
The tool panel also contains the Common Tools array. These tools are
common to all Brilliance Workspace Portal applications. For more
information about Common Tools refer to the “Common Tools” section in
the CT Viewer chapter in volume 2 of the user manual.
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9.5
LNA opening window
9.5.1
Nodule detection
Various viewing techniques and tools are provided to assist in your image
viewing and nodule detecting process.
Orientation
You can select from three viewing orientations, Axial, Coronal, and Sagittal.
You can use the orientation buttons (as shown at left), the keyboard
shortcuts (A, C, or S), or select from the right mouse menu (right click in
any viewport and select from the menu’s Orientation list.)
Slice thickness
The slice thickness can be controlled for the slab image and reference
images. The minimum slice thickness depends on the scan parameters and
the maximum slice thickness is 200mm.
Change the thickness only for image viewing. When performing nodule
segmentation, keep the image at the original default slice thickness (5mm).
Note
1
Click on the image whose thickness you want to change; its border
turns blue.
2
Click the up and down arrows to change the thickness one increment at
a time.
-- OR --
3
Click in the box and type in the desired slice thickness. If you type in a
number that is below the minimum slice thickness, it automatically
defaults to the minimum thickness.
-- OR --
4
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Click the desired viewport; hold the <Shift> key down and left mouse
click and drag to the desired thickness.
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9.5
-- OR -5
Click and drag the arrows on any of the reference images. The red line
affects the axial image. The green and blue lines affect both the coronal
and sagittal images.
Rendering modes
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The Rendering modes function the same as in the Volume Viewer
application. For information about rendering modes, refer to the
“Rendering modes” section in the Volume Viewer chapter in volume 2 of
this user manual.
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9.5
LNA opening window
9.5.2
Marking nodules
Mark nodule - The Mark nodule tool is always available. When your
inspection indicates the existence of a nodule:
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1
Click the Mark nodule button to make it active. A pencilshaped cursor appears.
2
Click the pencil pointer on the nodule. A blue bounding
box appears around the nodule to bring attention to it.
3
An identification number is automatically assigned and
the nodule is automatically accepted, named “Lesion 1,
Lesion 2,...” and added to the Detection list.
• A bounding box also appears around the nodule in both
reference viewports, and also on the MIP image in the
lower right corner.
• A volume rendered image of the nodule appears in the bottom left
viewport, with a MIP image in the bottom middle viewport.
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4
When your inspection finds another nodule, click on the Mark nodule
button again to mark another nodule.
5
Repeat this process as needed until all nodules have been detected.
Show Lesions (also available in Nodule Matching stage) - This function
controls the bounding box around a marked lesion, and is ON by default.
When you uncheck it, the bounding box is removed.
Rotation Center (also available in Nodule Matching stage) - The Rotation
center is an X mark around which an image can be rotated.
• If a marked nodule is selected, when you check the
Rotation center box, the rotation center becomes fixed
onto that nodule.
• If no nodule has been selected, when you check the
Rotation center box, the rotation center defaults to the
middle of the image and you are able to move it (left click and drag) to
any location in the image.
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Center cursor (also available in Nodule Matching stage) - Click on this
button to move the rotation center cursor to the center of the viewport.
Show axial inspection (also available in Nodule Matching stage) Clicking this button activates the nodule inspection function. The
slice-by-slice editing tool becomes available, if needed.
In the axial inspection mode, various views allow you to inspect how well
the automatic segmentation defined the nodule.
• The selected nodule in the main viewport has a pink overlay shown
on it.
• The Volume and MIP images in the lower left and lower middle
viewports display the nodule.
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9.5
LNA opening window
9.5.3
Correcting (editing) nodule segmentation
• If your system is not equipped with the Lung CAD option, you should
perform the corrective editing procedure below.
• If you do have the CAD option, you may skip this procedure and proceed
to “Using the CAD option,” which follows. Then, return to this procedure
and perform corrective editing on all nodules: those found in the initial
reading, and those found and accepted through the CAD option.
Note
In the Show axial inspection mode, be sure to review each nodule for
correct segmentation. A pink overlay appears on the segmented nodules
and the editing tools becomes available.
The Add slice by slice and Remove slice by slice buttons are used to access
the segmentation correction function. You use these functions to add or
remove nodule segmentation by drawing Freehand ROIs on each slice
where the nodule is visible.
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1
Locate the nodule you want to edit.
2
Use the Scroll, Pan, and Zoom functions (in Common tools) to obtain
the best views of the nodule.
3
Select the Add slice by slice or Remove slice by slice functions as
needed. The pencil cursor appears.
4
Hold down the left mouse and drag the pencil to draw a freehand ROI
around the area you want to modify.
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9.5
Release the mouse button and the system recalculates the segmentation,
and either add to or subtract from the nodule overlay, as you selected.
The pink overlay is updated.
5
To turn OFF the editing tool, select any other tool, such as Scroll.
Note
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Continue correcting the nodule segmentation by scrolling to adjacent
slices and repeating steps 1 through 4 as needed.
When you are satisfied that all nodules are properly segmented, you
should save the nodules and the images using the Save and Save as...
procedures, as described after “Using the CAD option” procedure.
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9.6
Using the CAD option
9.6
Using the CAD option
The Lung Nodule CAD (computer aided detection) software option can
assist the radiologist in the detection of solid pulmonary nodules. It is
intended to be used as an adjunct method to identify regions of interest
following the initial reading of the study. Upon further assessment of each
CAD-suggested region, the CAD result may be accepted as a nodule, or
rejected.
If your Brilliance Workspace Portal system is equipped with the CAD
option, the CAD software reviews the patient study in the background
while it is being loaded into the LNA application.
CAD searches the lung tissue for nodules between 4mm and 30 mm in size
and catalogs its results until after the radiologist has made the initial
readings.
Upon request, CAD displays its results in the form of a numbered list of
possible nodules accompanied by several image viewports highlighting the
locations of the suggested nodules.
The radiologist can then examine the CAD-suggested nodules and accept
or reject them. Accepted nodules are added to the list of nodules found
during the radiologist’s initial reading.
Show CAD results
When you are ready to view the CAD results, click Show CAD results. A
Warning message displays:
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Using the CAD option
9.6
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When you select Show CAD results, the nodules suggested by CAD are
surrounded by pink bounding boxes in the Slab image and the reference
images. Nodules that were found both in the initial review and the CAD
software have coinciding blue and pink bounding boxes.
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9.6
Using the CAD option
Accept and Reject nodules
In the Show CAD results mode, the Accept nodule and Reject nodule
tools become available.
The Nodule list shows the CAD-suggested nodules preceded by a pink
bullet symbol. Nodules that were found in the initial review (shown as
Lesions) are listed after the CAD nodules.
As shown above, a selected CAD nodule activates both the Accept and
Reject buttons, but a selected Lesion can only be rejected.
Note
1
Click each CAD-suggested nodule to review it.
The selected nodule is shown in the Slab and reference viewports. The
pink bounding box turns red.
Some nodules may not be segmentable. A message stating that
segmentation failed appears at the bottom of the display.
Note
2
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After inspecting the CAD nodule, either accept it or reject it.
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Using the CAD option
9.6
The Nodule list updates. CAD-suggested nodules become renamed as
Lesions. A pink bullet precedes such nodules, identifying them as
having originated as a CAD nodule.
When you are satisfied that all nodules are properly segmented, you
should save the nodules and the images using the Save and Save as...
procedures, as described in the next procedure.
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9.7
Saving the nodule detection results
9.7
Saving the nodule detection results
After you complete the procedures to find and mark nodules, and after
editing their segmentation, be sure to save the images and nodules.
Save image(s) and Save nodule(s)
These functions, available in Common tools, allow you to save image(s)
and nodule(s) to the Local device (identified as the “Direct save” storage
device in the Preferences utility.)
Save image(s) as... and Save nodule(s) as...I
If desired, you may save image(s) and nodule(s) to different devices than the
default device.
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1
From the Common tools tab, click the Save As... button of your
choice. The Save As... dialog opens.
2
Type in a desired name in the Label field.
3
The Save Device: location defaults to Local, or you may select any
device that is available in your system.
4
Click OK to save.
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Nodule Matching stage
9.8
9.8
Nodule Matching stage
The Nodule Matching work stage is used when you are doing a follow-up
study to an original study you have already processed with Nodule
Detection and saved.
Loading the initial and follow-up studies
1
From the Directory of the Brilliance Workspace Portal, locate the
original and follow-up studies you want to work with, as shown below.
2
Hold down the <Ctrl> key on the keyboard and click both studies to
highlight them.
3
In the Series folder, select the Original study and the saved nodules to
highlight them also.
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9.8.1
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9.8
Nodule Matching stage
4
From the Directory, under the Analysis tab, select Lung Nodules.
A message displays, requiring you to verify the two studies.
5
Click OK if you have selected the correct studies.
Both studies load.
The Follow-up study loads into the Nodule Detection application and
is identified as the Primary study.
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6
Perform the Nodule Detection procedure described earlier in this
chapter to detect, mark, and save nodules in the Follow-up study.
Then return here to perform the balance of the Nodule Matching
procedure.
7
Select the Nodule Matching stage from the workflow dropdown or
click the right arrow button to move to the Matching stage.
8
The Nodule Matching workflow stage opens, as shown on the next
page.
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Nodule Matching stage
9.8
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The Nodule Matching stage opens with the Primary study in the top of
the display and the Secondary study at the bottom half.
The Set Series tab in the tool panel shows the study dates of the two
studies. The older study is named the Secondary, and the newer study is
named the Primary. (Refer to the arrows in the display above.)
Caution
Brilliance Workspace Portal - Volume 3
The Portal system allows you reverse the naming of the Primary and
Secondary studies. If you do switch the names, be sure to verify the
correctness of the findings.
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9.8
Nodule Matching stage
9
In the tool panel, click the Match tab to open the 2-column list of the
nodules in the Primary and Secondary studies.
10 While observing the display viewports of both studies, individually
click the lesions on both sides of the list.
11 When matching nodules are found, click the Match button.
A green bounding appears around the matched lesions in
both studies. The individual lesion names are removed from
the Primary and Secondary list and the new name “Matched Lesions X”
is added below the 2-column list.
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9.8
12 Repeat steps 10 and 11, matching lesions between the two studies, until
all lesions that can be matched are matched.
Note
There maybe lesions that have no matches.
After you have completed your matching process, save the nodules
using the Save Nodule(s) or Save nodule(s) as… functions. (Refer to
the “Saving the nodule detection results” section earlier in this chapter
for instructions.)
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Proceed to the next section in this manual, “Assessment of the Lung
Nodules” to finish the Lung Nodule Assessment process.
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9.9
Assessment of the Lung Nodules
9.9
Assessment of the Lung Nodules
This is the last stage of the Lung Nodule Assessment application. The
function of the Assessment stage is to present the following nodule data in
table form:
• Volume +/- error (mm3)
• Effective diameter (mm)
• Maximum area (mm2)
• Maximum diameter (mm)
• Minimum, maximum and mean Hounsfield values
• Percent of Growth (of matching nodules in follow-up study)
• Doubling days (of matching nodules in follow-up study)
Use with either Single study or Follow-up study
The Assessment stage operates in the same way whether you are working
with a Single study or a Follow-up study. The difference between them is
that in the Single study mode there are no calculations performed for the
Percent Growth and Doubling (days).
After finishing a Single study Nodule Detection stage or a Follow-up
Nodule Matching stage, select Assessment from the workflow dropdown or
click the forward arrow.
The Assessment window opens with a single study or two studies (followup mode.) Both windows are shown on the next page.
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Assessment of the Lung Nodules
Lung Nodule Assessment windows
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9.9.1
9.9
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9.9
Assessment of the Lung Nodules
9.9.2
Lung Nodule Assessment table
Single study
Follow-up study
Note
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1
Click on the lesion you want displayed in the image viewport.
2
Verify that the information on the Assessment table is correct.
You can click on a lesion in the assessment table and if it has a matching
lesion it automatically highlights along with the nodule that was clicked.
This does not update the images in the viewport.
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Assessment of the Lung Nodules
Saving Assessment table data to Report
1
In the Common tools area, click on the Report dropdown arrow.
2
Click Send results to report.
3
The Patient History and Follow Up dialog box opens.
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9.9.3
9.9
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9.9
Assessment of the Lung Nodules
4
Fill in Patient History data.
5
Click OK to send the data and images to the report.
There are 3 images sent for every accepted nodule; slab image of the
nodule, volume image and the MIP image of the nodule are sent to the
report.
6
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Click the Report button at the top of the screen to review the patient's
report and finalize it before approving and saving the report.
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The Computer Aided Detection option
9.10
The Computer Aided Detection option
9.10.1
Device description - Indications for use
9.10
The Lung Nodule CAD option is a computer-aided detection (CAD)
system intended to detect and mark regions of interest (ROI) located in CT
images. It determines which ROIs to mark based on features associated
with solid pulmonary nodules, which could represent early-stage lung
cancer.
The device is intended for use as an aid for image evaluation, only after the
radiologist has performed an initial interpretation of the diagnostic images
and it improves the radiologist's ability to detect lung nodules. It assists the
radiologist in minimizing observational oversights.
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The Lung Nodule CAD option can accurately detect nodules as small as 4
mm with high sensitivity. The CAD program allows readers to find
additional nodules, thus improving reader sensitivity.
9.10.2
Lung Nodule CAD option scanning parameters /
specifications
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Scanners
Philips or other vendor multislice CT scanners
Detector rows
4 or more
Scan area
The entire thorax should be in scan area but it is not required
Exposure
up to 365 mAs
Voltage
120 kV
Slice width
0.9 (submillimeter) to 3 mm
Slice overlap
0 - 50% overlap
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9.10
The Computer Aided Detection option
Number of images
Up to 1,200
Contrast
Intravenous contrast is optional
The above parameters need to be met for optimal image reconstruction.
Additionally, good imaging practices for lung/chest studies need to be
followed, as outlined in the scanner instructions for use.
Functional Components
The Philips Lung Nodule CAD option is part of the Lung Nodule
Assessment (LNA - K023785) application, a part of the post processing
system called Extended Brilliance Workspace (EBW). The image processing
system (EBW) provides a software environment for standard and optional
image analysis applications. The LNA application assists with the diagnosis
of pulmonary nodules and lesions. It allows manual identification of
nodules, which are then segmented (Physician initiated Semi-Automatic
Segmentation) to determine volumes and permit comparison with previous
studies. The Lung Nodule CAD option can be invoked following manual
image review to identify additional nodules for consideration. Analysis and
reporting features are included for clinical presentation and saving
information to removable media or transferring to PACS archive.
Philips Lung Nodule CAD is implemented through a two-step process
consisting of nodule detection and nodule segmentation
• nodule detection delivers a list of potential nodule candidates;
• nodule segmentation delivers a segmentation of the nodule, which is
mainly used to estimate various nodule parameters
Nodule detection
The nodule detection scheme consists of 4 principal parts:
• segmentation of the lung;
• determination of seed points from two-dimensional (2D) analysis of
slice images;
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The Computer Aided Detection option
9.10
• computation of three-dimensional (3D) features and metrics;
• and finally reduction of the candidate list by filtering each candidate
on its features and metrics and the application of simple accept/reject
rules.
Nodule segmentation
The nodule segmentation delivers a labeled image and computes the
maximum diameter, area, volume, and volume-equivalent diameter for all
the segmented nodules. This information is used in the interactive display
of segmented nodules in the LNA application.
Workflow
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Following patient scanning the lung series is loaded into the Lung Nodule
Assessment (LNA) application. The radiologist then reviews the series,
marks and evaluates nodules using nodule detection tools. Once manual
nodule detection and assessment is complete the radiologist can implement
the Lung Nodule CAD option. The radiologist clicks on the CAD icon to
generate a list of candidates for review; then continues with the LNA
activities for each candidate. Finally, the accepted candidates are saved and a
report can be generated.
CAD results
The Lung Nodule CAD option runs in the background when a lung series
is loaded into LNA, and it identifies candidates that measure between 4
mm and 30 mm in maximum diameter. Results of the Lung Nodule CAD
are listed as candidates for sequential review and displayed with a marked
ROI on the CT image. This facilitates review and acceptance/rejection of
the candidates.
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9.10.3
Clinical studies
Clinical Study Overview and Objectives
The clinical studies performed by Philips Medical Systems have evaluated
the safety and effectiveness of the Philips Lung nodule CAD software. The
studies were performed on retrospective data collected from four clinical
sites in the U.S. The study involves CT scan cases from 110 subjects that
were evaluated with Philips Lung Nodule CAD software, installed on an
Extended Brilliance Workspace system running version 2.x software. Each
subject's scan was divided into four quadrants for analysis. One subject's
case was omitted from statistical analysis because the expert panel and a
number of the blinded readers had technical problems loading the case into
the LNA application.
The objective of this clinical study was to investigate the clinical utility of
Philips Lung Nodule CAD software. The study demonstrates the usefulness
of the device in identifying lung nodules, thereby assisting the clinician in
finding nodules that might otherwise have been missed and increasing the
likelihood of earlier diagnosis.
Study Process and Population
Primary data collection during the clinical trial transpired according to the
following process:
• Subject Selection - All subjects who have a CT chest scan are
considered as candidates for assessment of this technique.
• Inclusion Criteria - The subject has completed a successful, good
quality CT chest exam. The subject has been referred for a clinically
indicated CT exam.
• Exclusion Criteria - Any subject that has one of the following
conditions should not participate in the study:
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• collapsed lung
• fibrosis
• post lung surgery
Four (4) investigative sites contributed 110 subject cases to the trial:
Hematology &
Oncology Assoc.,
Little Rock, AR
Indiana
University
Medical Center,
Indianapolis, IN
Fletcher Allen
Winthrop
Healthcare,
University Hospital,
Burlington, VT
Mineola, NY
Number of
patients
52
30
13
15
Average Age
61
60.3
50.4 (n-12)*
53.1
Male
21
40%
12
40%
10
77%
3
20%
Female
31
60%
18
60%
3
23%
12
80%
47
90%
20
67%
12
92%
15
100%
5
10%
10
33%
1
8%
0
0%
Number of CT
Philips Medical Systems 4535 674 64531_A
acquisitions with
contrast agent
Number of CT
acquisitions with
no contrast
*One case was excluded from statistical analyses due to problems correctly loading the case
Each of the subject scans in the trial is divided into 4 lung quadrants. This
permits more refined nodule localization.
9.10.4
Radiologist Interpretations
An expert panel of three radiologists was employed in the clinical trial to
review each case for the purposes of establishing "truth," which in this case
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means identifying and classifying lung nodules into one of two categories:
actionable or not-actionable.
Each lung quadrant was labelled "actionable" if and only if it contains at
least one "actionable finding." Otherwise, the lung quadrant was labelled as
"not actionable."
Each case was reviewed by three expert radiologists independently identifying all solid nodules (ground glass opacities were not included) to
determine whether they were actionable or not-actionable.
A. Each actionable nodule with a diameter in the range 4-30 mm was
identified by slice number and quadrant; and was characterized as either
classic or not-classic on the report form.
B. For quadrants containing one or more actionable nodules, the diameter
of the largest actionable nodule was recorded.
Results of the independent review were evaluated for consensus. Consensus
was not reached for every subject or quadrant. Cases without unanimous
consensus were re-read by the expert panel; each expert received the
previous independent results of the three expert readers. This improved
consensus results on the quadrants and subjects.
In the second phase of the study ten blinded readers (other radiologists)
reviewed each of the cases - first without Philips Lung Nodule CAD and
then with Philips Lung Nodule CAD. Data was collected to measure the
improvement in performance with Philips Lung Nodule CAD, which was
demonstrated using ROC analysis. The information provided on the report
form by each blinded reader without and with Philips Lung Nodule CAD
included:
A. The number of actionable nodules with diameters in the range 4-30 mm
by lung quadrant
B. A quadrant action ability rating (QAR) within the interval [0,100] for
each lung quadrant
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• A rating of 100 indicates that the radiologist is absolutely certain that
at least one nodule in the quadrant is actionable
• A rating of 50 indicates that while the radiologist declares at least one
nodule in the quadrant to be actionable, the radiologist is quite
uncertain as to whether or not the nodule should be declared
actionable
• A rating of 49 indicates that while the radiologist declares the
quadrant to be free of actionable nodules, the radiologist is quite
uncertain as to whether or not at least one nodule should be declared
actionable
• A rating of 0 indicates that the radiologist is absolutely certain the
quadrant is free of actionable nodules
Data Tabulation
The following data were derived for each subject from the case report form
data collected above:
Philips Medical Systems 4535 674 64531_A
Expert Panel Data
A. Quadrant Actionability Index (QAI): The QAI for each lung quadrant
is equal to the proportion of expert radiologists that declared the
quadrant to be actionable.
B. Subject Actionability Index (SAI): The SAI for a subject is the
proportion of expert radiologists that declared at least one lung quadrant
for this subject to be actionable.
C. Quadrant Consensus Indicator (QCI): The QCI for a lung quadrant
was set equal to one if the expert panel reached consensus for the lung
quadrant (QAI=0 or QAI=1); otherwise, the QCI was set to zero.
D. Subject Consensus Indicator (SCI): The SCI for a subject was set equal
to one if the expert panel reached consensus for all four lung quadrants
belonging to the subject (QCI=1 for all four quadrants); otherwise, the
SCI was set to zero.
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Blinded Reader Data
A. Quadrant Positive Indicator (QPI): The QPI for each reader-quadrant
combination was set to one if the reader's actionability rating for the
quadrant was greater than or equal to a threshold value; otherwise, the
QPI was set to zero.
• For operating point analyses, the threshold value was set to 50
• For ROC curve analyses, all possible threshold values were examined
B. Subject Positive Indicator (SPI): The SPI for each reader-subject
combination was set to one if the reader declared one or more of the
subject's quadrants to be positive (that is, if one or more of the QPI
values for this reader-subject combination was equal to one); otherwise,
the SPI was set to zero.
• For operating point analyses, the threshold value was set to 50
• For ROC curve analyses, all possible threshold values were examined
C. Subject Actionability Rating (SAR): The SAR for each reader-subject
combination was set equal to the maximum of the QAR values for the
subject's four lung quadrants.
Evaluation of Data and Statistical Analysis
There were 110 subjects included in the clinical trial. One subject was
excluded from all statistical analyses because the expert panel and a number
of the blinded readers had problems correctly loading the case. The results
of the expert panel reviews of the 436 lung quadrants belonging to these
subjects are summarized in Table 1.
The expert panel reached consensus on 348 quadrants, 260 of which were
unanimously declared to be not-actionable and 88 of which were
unanimously declared to be actionable.
The results of the expert panel reviews at the subject level are summarized
in Table 2.
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Table 1: Summary of Expert Panel Results for Quadrants
Proportion of Expert Readers that Declared Quadrant to
be Actionable (Quadrant Actionability Index - QAI)
Number of
Quadrants
0/3
1/3
2/3
260
60
28
3/3
88
Total
436
Table 2: Summary of Expert Panel Results for Subjects
Proportion of Expert Readers that Declared Subject to be
Actionable (Subject Actionability Index - SAI)
Number of
Subjects
0/3
1/3
2/3
19
19
10
3/3
61
Total
109
The expert panel reached consensus on 80 subjects, 19 of which were
unanimously declared to be not-actionable and 61 of which were
unanimously declared to be actionable.
Philips Medical Systems 4535 674 64531_A
The unit of analysis for the primary efficacy analyses performed was the
lung quadrant following the region-of-interest approach proposed by
Obuchowski et al (2000) and further discussed in the context of lung
nodule diagnosis by Dodd et al (2004). Supplementary analyses were
performed at the subject level in order to present a comprehensive set of
efficacy results. With regard to the expert panel results, primary analyses
were performed for the subset of quadrants or subjects for which the experts
reached a consensus (QCI=1 or SCI=1). Supplementary analyses were
performed for all subjects or quadrants. As a result of these divisions, the
following four data sets were employed for statistical analysis purposes:
• Consensus Quadrants - Data at the lung quadrant level for the 348
quadrants for which the expert panel reached consensus (QCI = 1)
• All Quadrants - Data at the lung quadrant level for all 436 quadrants
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• Consensus Subjects - Data at the subject level for the 80 subjects for
which the expert panel reached consensus (SCI = 1)
• All Subjects - Data at the subject level for all 109 subjects
Statistical Analysis Results
The results of five types of statistical analyses are reported in the following
subsections. The five types of analyses are:
• Analyses for consensus quadrants
• Analyses for consensus subjects
• Analyses for all quadrants
• Analyses for all subjects
• Stand-alone analyses
Claims of clinical efficacy are based primarily on the analysis results for
consensus quadrants.
Statistical Analysis Results for Consensus Quadrants
Figure 2 contains average receiver operating characteristic (ROC) curves for
all blinded readers combined for two modes, without Philips Lung Nodule
CAD and with Philips Lung Nodule CAD. As reported in Table 3, the
increase in area under the ROC curve due to Philips Lung Nodule CAD is
1.9% with a 95% confidence interval of (0.8%, 8.0%). The confidence
interval was produced by a bootstrap analysis employing 10000 bootstrap
samples. Because the lower bound of the confidence interval is greater than
zero, this analysis demonstrates the clinical efficacy of CAD for assisting
physicians with the task of identifying actionable lung nodules in CT scans.
Increases in area under the ROC curve for each reader are reported in Table
4. Notably, for all readers, the area under the ROC curve with Philips Lung
Nodule CAD is greater than or equal to the area under the ROC curve
without Philips Lung Nodule CAD. The performance improvements are
particularly significant for Readers 1, 4, 8 and 9.
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The results for increase in area under the ROC curve by reader were
subjected to a variance component analysis to assess between-reader
variability. The resulting variance component estimates are reported in
Table 5. The variance component due to blinded readers is statistically
significant at the 5% significance level implying that it is likely that the
magnitude of assistance provided by Philips Lung Nodule CAD varies from
reader to reader.
Philips Medical Systems 4535 674 64531_A
Figure 2: Average ROC Curves Without and With Philips Lung module CAD
Table 3: ROC Curve Analysis Results for 348 Consensus Quadrants
Performance
Measure
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Point Estimate
95% Bootstrap
Number of
Confidence
Bootstrap
Interval
Samples
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AURC Without
CAD
86.7%
(76.6%, 90.6%)
10000
AURC With CAD
88.7%
(80.9%, 93.8%)
10000
AURC Increase
1.9%
(0.8%, 8.0%)
10000
Due to CAD
(AURC - area under the ROC curve)
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Table 4: ROC Curve Analysis Results by Reader for 348 Consensus Quadrants
Reader
Number
AURC
Without
CAD
AURC
With CAD
AURC
Increase
Due to CAD
95% Confidence
Interval for
AURC Increase
Due to CAD
1
78.9%
83.2%
4.2%
(-1.1%, 13.0%)
2
94.6%
94.6%
0.0%
(0.0%, 0.0%)
3
82.1%
82.6%
0.5%
(-0.5%, 0.0%)
4
80.0%
84.2%
4.2%
(1.3%, 18.3%)
5
83.9%
84.1%
0.2%
(0.0%, 8.8%)
6
89.6%
90.0%
0.5%
(-1.5%, 7.2%)
7
93.3%
93.5%
0.2%
(-2.3%, 0.0%)
8
89.6%
93.4%
3.8%
(-0.7%, 14.6%)
9
81.9%
87.1%
5.2%
(2.3%, 21.4%)
10
93.4%
94.1%
0.7%
(0.0%, 8.8%)
Philips Medical Systems 4535 674 64531_A
Table 5: Variance Components for Increase in AURC
Variance Component
Variance Component
Due to Blinded Readers
Due to Subjects
0.00165 (64%)
0.00092 (36%)
Total Variance
0.00257
In Table 6, experience levels are tabulated for two groups of blinded readers,
the four readers for which Philips Lung Nodule CAD appears to have
provided significant assistance (Blinded Readers 1, 4, 8 and 9) and the
complementary group of six blinded readers. It is interesting to note that all
three "very experienced" readers are part of the group for which
performance improvements due to Philips Lung Nodule CAD were not
significant. However, the total number of readers is insufficient to assign
any level of statistical significance to this interesting result.
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Table 6: Experience Level of Blinded Readers by Improvement Group
Significant Improvement
Number
Due to Philips Lung
of Blinded
Experience Level
Nodule CAD
Readers
Minimal
Moderate
Very
No
6
1
2
3
Yes *
4
1
3
0
* Readers 1, 4, 8 and 9
Table 7 contains the results of operating point analyses performed for
consensus quadrants. For the operating point analyses, the binary quadrant
diagnoses (actionable, not-actionable) of the blinded readers were
employed. Point estimates and confidence intervals are reported for
sensitivity (SENS) and specificity (SPEC) in both modes of operation
(without CAD and with CAD) as well as for the sensitivity increase due to
CAD and the specificity decrease due to CAD. The sensitivity increase due
to CAD is estimated to be 4.5% with a 95% confidence interval of (2.1%,
17.4%). The specificity decrease due to CAD is estimated to be 0.8% with
a 95% confidence interval of (0.1%, 3.1%).
Table 7: Operating Point Analysis Results for 348 Consensus Quadrants
Performance Measure
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Point
Estimate
95% Bootstrap
Number of
Confidence
Bootstrap
Interval
Samples
SENS Without CAD
68.5%
(46.5%, 78.5%)
10000
SENS With CAD
73.1%
(55.5%, 86.2%)
10000
SENS Increase Due to CAD
4.5%
(2.1%, 17.4%)
10000
SPEC Without CAD
94.5%
(90.8%, 98.6%)
10000
SPEC With CAD
93.7%
(89.5%, 97.6%)
10000
SPEC Decrease Due to CAD
0.8%
(0.1%, 3.1%)
10000
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Statistical Analysis Results for Consensus Subjects
The ROC curve and operating point analyses performed for consensus
quadrants and all readers combined were also performed for consensus
subjects. As reported in Table 8, the increase in area under the ROC curve
due to Philips Lung Nodule CAD is 0.5% with a 95% confidence interval
of (-0.6%, 1.7%). While the point estimate indicates that there was an
average increase in performance at the subject level due to CAD, the
confidence interval indicates that the number of subjects involved is
insufficient to declare a statistically significant benefit at the subject level.
As noted in Dodd et al. (2004), anticipation of this situation at the subject
level is precisely the motivation for planning to perform primary efficacy
analyses at the quadrant level, where additional statistical power is
attainable.
Table 8: ROC Curve Analysis Results for 80 Consensus Subjects
Philips Medical Systems 4535 674 64531_A
Performance Measure
Point
Estimate
95% Bootstrap
Number of
Confidence
Bootstrap
Interval
Samples
AURC Without CAD
91.8%
(86.7%, 95.6%)
10000
AURC With CAD
92.4%
(87.4%, 96.1%)
10000
AURC Increase Due to CAD
0.5%
(-0.6%, 1.7%)
10000
Table 9 contains the results of operating point analyses performed for
consensus subjects. For the operating point analyses, the binary subject
diagnoses (actionable, not-actionable) of the blinded readers were used. A
subject was considered to have been declared actionable by a blinded reader
if and only if one or more of the subject's quadrants was declared to be
actionable by the blinded reader. Point estimates and confidence intervals
are reported for sensitivity (SENS) and specificity (SPEC) in both modes of
operation (without CAD and with CAD) as well as for the sensitivity
increase due to CAD and the specificity decrease due to CAD. The
sensitivity increase due to CAD is estimated to be 2.3% with a 95%
confidence interval of (0.5%, 5.0%). The specificity decrease due to CAD
is estimated to be 1.6% with a 95% confidence interval of (0.0%, 5.7%).
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Table 9: Operating Point Analysis Results for 80 Consensus Subjects
Performance Measure
Point
Estimate
95% Bootstrap
Number of
Confidence
Bootstrap
Interval
Samples
SENS Without CAD
76.6%
(64.8%, 86.6%)
10000
SENS With CAD
78.9%
(67.0%, 88.9%)
10000
SENS Increase Due to CAD
2.3%
(0.5%, 5.0%)
10000
SPEC Without CAD
91.6%
(81.4%, 98.4%)
10000
SPEC With CAD
90.0%
(79.5%, 97.5%)
10000
SPEC Decrease Due to CAD
1.6%
(0.0%, 5.7%)
10000
Statistical Analysis Results for All Quadrants
The ROC curve and operating point analyses performed for consensus
quadrants and all readers combined were also performed for all quadrants.
In order to perform these analyses, quadrants for which the expert panel
failed to reach consensus where randomly assigned to the actionable and
not-actionable classes (see Section 4.1.2). Table 10 contains the results of
the ROC curve analyses. 95% prediction intervals are reported for area
under the ROC curve (AURC) in both modes (without CAD and with
CAD) as well as for the increase in the area under the ROC curve due to
CAD. The prediction interval for the increase in area under the ROC curve
due to CAD is (1.9%, 3.2%).
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Table 10: ROC Curve Analysis Results for All 436 Quadrants
Number of
Performance Measure
95% Prediction Interval*
AURC Without CAD
(71.3%, 74.6%)
10000
AURC With CAD
(73.8%, 77.2%)
10000
AURC Increase Due to CAD
(1.9%, 3.2%)
10000
Randomizations
*With respect the process of randomly assigning non-consensus quadrants to the actionable and
not-actionable classes
Table 11 contains the results of the operating point analyses. 95%
prediction intervals are reported for sensitivity (SENS) and specificity
(SPEC) in both modes of operation (without CAD and with CAD) as well
as for the sensitivity increase due to CAD and the specificity decrease due to
CAD. The prediction interval for sensitivity increase due to CAD is (6.0%,
8.1%) while the prediction interval for specificity decrease due to CAD is
(1.4%, 2.1%).
Table 11: Operating Point Analysis Results for All 436 Quadrants
95% Prediction
Number of
Interval *
Randomizations
SENS Without CAD
(41.0%, 45.8%)
10000
SENS With CAD
(47.9%, 53.1%)
10000
SENS Increase Due to CAD
(6.0%, 8.1%)
10000
SPEC Without CAD
(93.4%, 94.6%)
10000
SPEC With CAD
(91.6%, 92.9%)
10000
SPEC Decrease Due to CAD
(1.4%, 2.1%)
10000
Philips Medical Systems 4535 674 64531_A
Performance Measure
* With respect the process of randomly assigning non-consensus quadrants to the actionable and
not-actionable classes
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Statistical Analysis Results for All Subjects
The ROC curve and operating point analyses performed for consensus
subjects and all readers combined were also performed for all subjects. In
order to perform these analyses, subjects for which the expert panel failed to
reach consensus where randomly assigned to the actionable and notactionable classes. Table 12 contains the results of the ROC curve analyses.
95% prediction intervals are reported for area under the ROC curve
(AURC) in both modes (without CAD and with CAD) as well as for the
increase in the area under the ROC curve due to CAD. The prediction
interval for the increase in area under the ROC curve due to CAD is (0.3%, 0.7%).
Table 12: ROC Curve Analysis Results for All 109 Subjects
Number of
Performance Measure
95% Prediction Interval *
AURC Without CAD
(80.8%, 83.9%)
10000
AURC With CAD
(81.0%, 84.1%)
10000
AURC Increase Due to CAD
(-0.3%, 0.7%)
10000
Randomizations
* With respect the process of randomly assigning non-consensus quadrants to the actionable and
not-actionable classes
Table 13 contains the results of the operating point analyses. 95%
prediction intervals are reported for sensitivity (SENS) and specificity
(SPEC) in both modes of operation (without CAD and with CAD) as well
as for the sensitivity increase due to CAD and the specificity decrease due to
CAD. The prediction interval for sensitivity increase due to CAD is (1.9%,
2.6%) while the prediction interval for specificity decrease due to CAD is
(1.7%, 3.1%).
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Table 13: Operating Point Analysis Results for All 109 Subjects
Number of
Performance Measure
95% Prediction Interval *
SENS Without CAD
(66.4%, 69.0%)
10000
SENS With CAD
(68.7%, 71.2%)
10000
SENS Increase Due to CAD
(1.9%, 2.6%)
10000
SPEC Without CAD
(81.5%, 85.4%)
10000
SPEC With CAD
(79.1%, 83.0%)
10000
SPEC Decrease Due to CAD
(1.7%, 3.1%)
10000
Randomizations
* With respect the process of randomly assigning non-consensus quadrants to the actionable and
not-actionable classes
Stand-Alone Analysis Results
Philips Medical Systems 4535 674 64531_A
The sensitivity of Philips Lung Nodule CAD as a stand-alone nodule
detection tool is reported in Table 14 for both consensus nodules and all
nodules. The corresponding 95% confidence intervals for sensitivity were
obtained by bootstrap resampling of subjects with 10000 bootstraps
replications. In Tables 15, 16, and 17, the standalone sensitivity of Philips
Lung Nodule CAD is reported as a function of the classic nature of the
nodules, contrast use, and slice thickness. There is some indication that
standalone sensitivity is higher for classic nodules than for non-classic
nodules and that sensitivity increases with decreasing slice thickness.
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Table 14: Stand-Alone Sensitivity of Philips Lung Nodule CAD
Number of
Point
Nodules
Estimate
Detected by
for
CAD
Sensitivity
91
54
59.3%
(47.0%, 71.0%)
285
104
36.5%
(29.5%, 43.4%)
Number
Nodule Group
of
Nodules
Consensus
Nodules
All
Nodules
95% Confidence
Interval for
Sensitivity
Table 15: Stand-Alone Sensitivity as a Function of the Classic Nature of Nodules
Nodule
Number of
Group
Nodules
Consensus
Nodules
All
Nodules
91
285
Not Classic = 0, Classic = 1
0
0.33
0.50
0.67
1
44.4%
31.6%
63.9%
77.8%
(4/9)
(6/19)
23/36)
(21/27)
19.7%
31.6%
43.5%
63.9%
50.0%
(25/127)
(6/19)
(10/23)
(23/36)
(40/80)
Table 16: Stand-Alone Sensitivity as a Function of the Contrast Use
Nodule Group
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Contrast Used?
Number of
Nodules
Consensus Nodules
91
All Nodules
285
No
Yes
75.0%
57.8%
(48/83)
(6/8)
38.9%
(14/36)
36.1%
(90/249)
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Table 17: Stand-Alone Sensitivity as a Function of the Slice Thickness
Nodule
Number of
Group
Nodules
Consensus
Nodules
All
Nodules
91
285
Slice Thickness (mm)
0.9
1
1.25
2
2.5
3
80.8%
50.0%
66.7%
66.7%
33.3%
51.0%
(21/26)
(1/2)
(2/3)
(2/3)
(2/6)
(26/51)
45.5%
30.4%
50.0%
60.0%
18.8%
31.9%
(40/88)
(7/23)
(2/4)
(6/10)
(3/16)
46/144)
Philips Medical Systems 4535 674 64531_A
The average number of false positive Philips Lung Nodule CAD findings
per subject is reported in Table 18 for both not-actionable and actionable
subjects. The corresponding 95% confidence intervals for average numbers
of false positive findings per subject were obtained by bootstrap resampling
of subjects with 10000 bootstraps replications. In Tables 19 and 20, the
average numbers of false positive findings per subject is reported as a
function of contrast use and slice thickness. There is some indication that
the number of false positive findings is higher for actionable subjects and
that the number of false positive findings increases with decreasing slice
thickness.
Table 18: Average Number of False Positive CAD Findings Per Subject
Subject
Group
Not
Actionable
Actionable
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Average Number
95% Confidence Interval
of False Positive
for Average Number of
CAD Findings
False Positive CAD
Per Subject
Findings Per Subject
22
5.6
(4.1, 7.0)
87
8.0
(6.6, 9.6)
Number
of
Subjects
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Table 19: Average Number of False Positive CAD Findings per Subject as a Function
of the Contrast Use
Contrast Used?
Number of
Subject Group
Subjects
Not Actionable
22
Actionable
87
No
Yes
6.3
5.3
(n=16)
(n=6)
7.8
(n=79)
9.6
(n=8)
Table 20: Average Number of False Positive CAD Findings Per Subject as a Function
of the Slice Thickness
Subject
Number of
Group
Subjects
Not
Actionable
Actionable
9.10.5
22
87
Slice Thickness (mm)
0.9
1
1.25
2
2.5
3
7.0
3.6
6.0
5.5
(n=7)
(n=5)
(n=2)
(n=8)
9.3
11.4
12.0
8.5
9.2
6.4
(n=22)
(n=10)
(n=1)
(n=2)
(n=5)
(n=47)
Conclusions Drawn From Studies
The Philips Lung Nodule CAD clinical trial outcome indicates that use of
the Philips Lung Nodule CAD feature results in a statistically significant
improvement in the clinician's ability to identify actionable lung nodules.
This conclusion is based on ROC curve analyses performed for clinical trial
data recorded at the lung quadrant level employing quadrants for which the
expert panel reached consensus with respect to the presence of actionable
nodules. Further statistical analysis of the quadrant level data implies that
the improvement due to Philips Lung Nodule CAD may vary from one
clinician to another. The clinical trial data provide anecdotal evidence that
Philips Lung Nodule CAD may provide greater benefits to less experienced
9 -5 4
Lung Nodule Assessment
Brilliance Workspace Portal - Volume 3
The Computer Aided Detection option
9.10
clinicians; however, no statistical significant can be attributed to this
anecdotal conclusion. Analyses performed for all lung quadrants
characterize the level of variability that might be expected in performance
results if the expert panel were forced to consensus for all quadrants. A
small amount of variability is evident while the overall results are consistent
with the statistical analyses performed for consensus quadrants only.
Philips Medical Systems 4535 674 64531_A
All analyses performed for data recorded at the quadrant level were also
performed for data aggregated at the subject level. As was expected, the
subject level performance analyses indicate that, on average, use of the
Philips Lung Nodule CAD feature results in improvement in the clinician's
ability to identify actionable subjects. However, the smaller sample sizes
associated with the subject level clinical trial data preclude assignment of
statistical significance to this subject level conclusion.
Finally, clinical trail results were provided for the Philips Lung Nodule
CAD feature as a stand-alone lung CT scan evaluation tool. These results
are provided for information purposes only since the Philips Lung Nodule
CAD software is not being proposed for use in this mode. The stand-alone
analysis results for Philips Lung Nodule CAD indicate that sensitivity is
higher for classic nodules than for non-classic nodules, sensitivity increases
with decreasing slice thickness, the number of false positive findings is
higher for actionable subjects, and that the number of false positive
findings increases with decreasing slice thickness.
9.10.6
References
Beiden SV, Wagner RF, Campbell G (2000). Components-of-variance
models and multiple-bootstrap experiments: An alternative method for
random-effects, receiver operating characteristic analysis. Acad Radiol
2000; 7:341-349.
Dodd LE, Wagner RF, Armato SG, McNitt-Gray MF, Beiden S, Chan H,
Gur D, McLennan G, Metz CE, Petrick N, Sahiner B, Sayre J (2004).
Assessment methodologies and statistical issues for computer-aided
Brilliance Workspace Portal - Volume 3
Lung Nodule Assessment
9- 55
9.10
The Computer Aided Detection option
diagnosis of lung nodules in computed tomography: Contemporary
research topics relevant to the Lung Image Database Consortium. Acad
Radiol 2004; 11:462-475.
Obuchowski NA, Lieber ML, Powell KA (2000). Data analysis for
detection and localization of multiple abnormalities with application to
mammography. Acad Radiol 2000; 7:516-525.
9.10.7
Panel Recommendations
In accordance with the provisions of section 515(c)(2) of the act, as
amended by the Safe Medical Devices Act of 1990, the PMA was not
referred to the Radiological Devices Panel (an FDA advisory committee)
for review and recommendation - the information in this PMA
substantially duplicates information previously reviewed by this panel.
9.10.8
CDRH Decision
CDRH issued an approval order on <DATE>.
9.10.9
Approval Specifications
Direction for use:
Hazards to Health from Use of the Device:
See the Device Labelling.
See Indication, Contraindications, Warnings,
Precautions and Adverse Events in the labelling.
Post-approval Requirements and Restrictions:
9 -5 6
Lung Nodule Assessment
See the approval order.
Brilliance Workspace Portal - Volume 3
10
10.1
Brain Perfusion
Overview
Brain Perfusion is a blood flow imaging application that analyzes the uptake
of injected contrast in order to determine perfusion-related information
about one or more regions of interest.
Intravenous contrast is injected into the patient and the region is scanned
repeatedly for a period of time. The Hounsfield unit enhancement is
tracked for each voxel over time to produce tissue specific time-density
curves.
Philips Medical Systems 4535 674 64531_A
Measurements made from the time-density curves and user-selected input
regions are used to create various parametric perfusion images. Also,
statistical data and calculations are provided in several tables.
Brilliance Workspace Portal - Volume 3
Brain Perfusion
10-1
10.2
Scan procedure
10.2
Scan procedure
Contrast flow and volume parameters vary by institution. Consult your
Radiologist prior to setting up or changing any injection protocols in your
department.
Note
1
Place patient on the table
2
Start an IV using an appropriate size IV catheter (18/20 gauge)
3
Center patient for head scan by placing the lateral laser on the EAM
4
Perform a routine non-contrast study of the head
Suggested routine head scanning protocols:
5
Click on Plan Scan
6
Click on Insert Scan
7
From the Exam Protocol Exam Group - Select Head
8
Exam Protocols - Select Brain Perfusion
9
Suggested Brain Perfusion Protocols:
Plan the desired perfusion location
10 Arm the injector with contrast
11 Start Scanner and Injector at the same time
12 End Exam
Note
1 0 -2
Brain Perfusion
The scan takes 40 - 60 seconds.
Brilliance Workspace Portal - Volume 3
Scan procedure
A proper scanning procedure is essential for obtaining meaningful perfusion
images. Special care must be taken to ensure that:
• The scan duration is sufficient to cover a pre-contrast period as well as the
entire first pass of the injected contrast bolus. (Recommended: minimum
30 second scan duration.)
• The scans are spaced no more than 2.5 seconds apart. (Recommended:
1.0 second temporal spacing.)
• If the temporal resolution of the scans is greater than 2.5 seconds,
quantitative perfusion measurements are not provided. The color maps
and numeric values represent relative differences only.
• The contrast injection is sufficiently rapid in order to provide reasonable
enhancement in white matter (4 – 5 HU enhancement) while preserving a
narrow bolus. (Recommended: injection of 4 - 5 cc per second contrast for
10 seconds.)
• Failure to meet these requirements results in the creation of unreliable
perfusion images.
Philips Medical Systems 4535 674 64531_A
Wa r n i n g s
10.2
Brilliance Workspace Portal - Volume 3
Brain Perfusion
10-3
10.3
Start Brain Perfusion
10.3
Start Brain Perfusion
Access the Brain Perfusion application
• Occurs automatically when application opens.
• Filtering and registration are done automatically upon loading.
Note
1 0 -4
Brain Perfusion
1
Start from the Directory of the Workflow.
2
Select the desired study from the directory of the device where it is
located.
3
Select the Brain Perfusion icon from the application icon chart, shown
at left. The application opens to the following window:
4
Left mouse click to scroll through the images.
Brilliance Workspace Portal - Volume 3
Work Stages
10.4
10.4
Work Stages
In the Brain Perfusion application there are two work stages, Vessel
Definition and Perfusion Maps. Prior to performing a Vessel Definition
you must verify the correctness of the cerebral mask.
10.4.1
Vessel Definition
Philips Medical Systems 4535 674 64531_A
Includes tools to define artery and vein ROIs. Shown below is the Vessel
Definition window after vessels have been defined.
Brilliance Workspace Portal - Volume 3
Brain Perfusion
10-5
10.4
Work Stages
To define and artery and vein
1
2
3
Set mirror line
Position artery and vein
Move to the next stage
Vessel tab
Includes tools to define Artery and Vein ROIs, Draw Artery Input and
Draw Vein Input.
Draw Artery Input:
When selecting a reference vessel, you can click this drop down to select
either Draw Artery ROI or Draw Artery Point.
• If you select Draw Artery ROI, encircle the area containing the artery
you want to use. (The recommended artery is the anterior cerebral
artery.) The application searches for the single pixel within the ROI
having the maximum enhancement, and marks it as the reference vessel
with a red cross-hair and labels it “Artery.”
• If you select Draw Artery Point, use the cursor to select a single point
in an artery or vein of interest.
Note
There is no Undo, so if the marked artery is not the one you wanted, you
must redraw an ROI.
Draw Vein Input:
Click this drop down to select either Draw Vein ROI or Draw Vein Point.
Encircle the vein of interest with the elliptical ROI function. (The
recommended vein is the superior sagittal sinus.) The application searches
the area for the single pixel within the ROI having the maximum
enhancement, and marks it with a blue cross-hair and labels it “Vein.”
1 0 -6
Brain Perfusion
Brilliance Workspace Portal - Volume 3
Work Stages
Note
10.4
Both the artery and the vein must be marked before a perfusion image is
generated.
Reference Vessel Statistics
The color-coded table beneath the vessel definition image shows the
enhancement value and the TTP (time-to-peak) of the selected vessels. The
artery should enhance before the vein; this can be verified by observing that
the artery has a smaller TTP than the vein.
Artery and Vein Activity
This color-coded chart beneath the vessel definition image shows the
contrast wash-in and wash-out curves, with points marking each
acquisition along time.
Philips Medical Systems 4535 674 64531_A
Wa r n i n g
If either or both of the wash-in and wash-out curves are partial (that is, they
do not show an up-slope and a down-slope), the scan is incomplete, and the
data may be unreliable.
Mask tab
Allows modification of cerebral mask. This is a troubleshooting function,
and is typically used after you have completed the Perfusion Maps stage and
have found that the desired maps have not been created. This may be
caused by the application having mistakenly included in its calculations
other volumes in the head besides the brain.
Wa r n i n g
Brilliance Workspace Portal - Volume 3
Turn on Brain Mask to verify skull removal correctness. Correct mask
threshold or manually redraw mask.
Brain Perfusion
10-7
10.4
Work Stages
Show Brain Mask
When this check box is checked it is used to control brain mask. Click in
the show brain mask check box. A green-dot masking field overlays on the
image showing the volume that is being identified as the brain. If the green
dots appear outside the brain cavity, or if large portions of the brain cavity
are not covered, click Draw Mask to create a freehand ROI by tracing the
skull bone.
High Threshold
Default value is 100
Low Threshold
Default value is 15
Draw Mask
Click on the icon. Left mouse click and hold to trace around the areas of
the entire outer part of the brain. Once the mask is drawn, it is based on
threshold values that warrant what appears in the mask. When done, use
the left mouse click to scroll through all images; examine the green-dot
mask and verify correct definition of the brain volume.
Value tab
You can make modifications of the hematocrit factor.
Hematocrit Factor
The hematocrit factor is the ratio of red blood cells to the total volume of
blood. The factor is used to convert contrast enhancement (in HU) to CBV
(in ml/100g of tissue).
1 0 -8
Brain Perfusion
Brilliance Workspace Portal - Volume 3
Work Stages
10.4
The default Hematocrit factor is 0.45. Do not change the default value
unless you have measured the patient’s factor and it is different from the
default value.
Cine tab
Cine tools allow a real time viewer that automatically scrolls through axial
images in a continuous loop.
Note
When image type tMIP is selected, Cine is disabled.
Philips Medical Systems 4535 674 64531_A
View tab
Show mirror line
The mirror line is an active annotation. Click this button and the mirror
line exhibits handles at the middle and both ends. With the left mouse
button, drag the handles so that the mirror line bisects the brain into right
and left hemispheres. Show Mirror Line allows you to turn the mirror line
on and off.
Note
Mirror line adjustment can only be performed in the vessel definition stage.
Note
The mirror line must be placed in the middle part of the brain. It is active
when yellow with two control boxes at each end. To move the entire line,
place the cursor in the middle of the line. Boxes appear at the end of the
green line when the mouse cursor is placed.
Brilliance Workspace Portal - Volume 3
Brain Perfusion
10-9
10.4
Work Stages
Image Type
Axial or tMIP Images - A tMIP image is a maximum intensity projection
(across the time domain) for each z-axis location. This provides an ideal
way to view arteries and veins in the same image, unaffected by time.
Note
When image type tMIP is selected, Cine is disabled.
Axial image on left, tMIP image on right
Note
1 0 -1 0
Brain Perfusion
Verify the cerebral mask before defining the artery and vein ROIs.
Brilliance Workspace Portal - Volume 3
Perfusion Maps
10.5
10.5
Perfusion Maps
When you are finished with the Vessel Definition work stage, click the right
arrow in the work stage tool bar to begin the Perfusion Maps work stage.
Shown below is the Perfusion Maps window after most analysis steps have
been performed.
Philips Medical Systems 4535 674 64531_A
After the application performs its calculations, perfusion maps and colormapped images are displayed.
Brilliance Workspace Portal - Volume 3
Brain Perfusion
10- 11
10.5
Perfusion Maps
The Perfusion Maps window consists of the following areas:
• The Tool Panel, along the left side.
• The CT images with Summary Map, in the upper-left image quadrant.
• The Perfusion Images, in the upper-right quadrant.
• The ROI Statistics and Increased MTT Area Statistics tables, in the
lower-left quadrant.
• The Tissue and Vessel curves in the lower-right quadrant.
10.5.1
Summary maps
Left
By selecting the left summary map displays the left centerline of the brain.
B on the left side of the brain
None
By selecting Summary maps does not show any maps.
Right
By selecting the right summary map displays the right centerline of the
brain.
To start, identify the Map Display Side that is associated with a perfusion
abnormality.
1 0 -1 2
Brain Perfusion
Brilliance Workspace Portal - Volume 3
Perfusion Maps
10.5
Philips Medical Systems 4535 674 64531_A
The following image is from the Summary Maps viewport.
The map is color-coded as follows:
SUMMARY MAP - COLOR CODES
GREEN and RED
Total area of reduced blood flow
GREEN
Reduced blood flow with normal blood volume
RED
Reduced blood flow with reduced blood volume
The summary map shows the relationship between areas of reduced blood
flow and areas of reduced blood volume. It summarizes information from
all four perfusion images into a single depiction.
Brilliance Workspace Portal - Volume 3
Brain Perfusion
10- 13
10.5
Perfusion Maps
10.5.2
Statistical tables
On the lower-left side in the Perfusion Maps work stage are the ROI
Statistics for slice 6 and the Increased MTT Area Statistics tables which
show the Perfusion statistics.
Note
Slice number changes as you scroll through images.
Note
MTT Statistics table only appears when summary maps are enabled.
ROI Statistics for slice 1
If you have drawn Tissue ROIs, their statistics are shown in this table.
ROI # displays the ROI number.
CBV (ml/100g) is the function integral of the tissue normalized by the
function integral of the selected vein
1 0 -1 4
Brain Perfusion
Brilliance Workspace Portal - Volume 3
Perfusion Maps
10.5
CBF (ml/100g/min) equals the CBV divided by the MTT
MTT (s) is the mean-transit-time of the transfer function (equals the
deconvolution of tissue signal with the selected arterial signal)
TTP(s) is the time-to-peak from the fitted function
Note
After ROI has been drawn, to delete use Remove All Graphics.
Note
The image graphics, the artery/vein (time-intensity) curves, and the
perfusion parameters in the ROI Statistics table are related by
corresponding colors and numbers.
Increased MTT Area Statistics
This table presents data about reduced Cerebral Blood Flow by slice
number.
Slice#
Philips Medical Systems 4535 674 64531_A
Normal CBV (mm2) is the area within the reduced-flow region that has
normal levels of blood volume; its percentage of the entire cerebral tissue
area is calculated and displayed in the next column. (This is the green area
in the summary maps.)
(%)
Reduced CBV (mm2) is the area within the reduced-flow region that has
reduced levels of blood volume; its percentage of the entire cerebral tissue
area is calculated and displayed in the next column. (This is the red area in
the summary maps.)
(%)
Index is calculated by dividing the area with reduced BF and normal BV
(area marked with green), by the total area of reduced BF (area colored
green-plus-red).
Brilliance Workspace Portal - Volume 3
Brain Perfusion
10- 15
10.5
Perfusion Maps
10.5.3
Perfusion Images
Perfusion images display in the upper right corner. You can view all four
maps at once, or view each map individually.
Note
Values above the scale are red. Values below the scale are black.
Color Mapping - As an aid to viewing, you can adjust the color mapping of
the perfusion and time values. Drag the middle mouse button inside the
image frame to adjust the color mapping. The corresponding color bar
shows the maximum and minimum values displayed.
Use the middle mouse button (windowing) to change the color scale range.
Cerebral Blood Volume (CBV) - Cerebral blood volume is calculated by
the ratio of two areas: the area under a tissue time density curve and the
area under a purely vascular region (either the user-supplied artery or vein)
normalized by the hematocrit value. The CBV calculation is based on the
partial volume effect.
1 0 -1 6
Brain Perfusion
Brilliance Workspace Portal - Volume 3
Perfusion Maps
10.5
Mean Transit Time (MTT): Mean transit time is calculated by deconvolving a tissue time density curve and the user-supplied arterial time
density curve. The MTT is the width of the deconvoluted transfer
function.
Cerebral Blood Flow (CBF): CBF is calculated by dividing the CBV by the
MTT.
Time To Peak Enhancement (TTP) is a display of the time it takes for the
peak enhancement to be reached at each x, y location.
10.5.4
Batch tab
Slices
All - Create batch from all locations
Current - Create batch from current location only
Philips Medical Systems 4535 674 64531_A
Available Perfusion Images
Make selection from the images listed below of the images that are to be
added to the batch.
• CBV - Cerebral Blood Volume
• MTT - Mean Transit Time
• tMIP - time Maximum Intensity Projection
• CBF - Cerebral Blood Flow
• TTP - Time To Peak
• Reduced CBF and CBV (Summary Maps)
Brilliance Workspace Portal - Volume 3
Brain Perfusion
10- 17
10.5
Perfusion Maps
Available Data Tables and Graphs
•
•
•
•
•
•
10.5.5
ROI Statistics
Increased MTT
Graph
Reference Vessel Statistics
Reduced CBF Area Statistics
Time and Vessel curves
Batch tools
For more information on how to use the Batch tools refer to Chapter 5 of
Volume 2 Review.
1 0 -1 8
Brain Perfusion
Brilliance Workspace Portal - Volume 3
Perfusion Maps
10.5.6
10.5
Threshold tab
Remove Vessels
You can remove vessels after creating the perfusion maps.
Note
The vessels should be removed before making any ROI measurements.
Click Remove vessels to eliminate pixels from the calculation and from the
color perfusion images. Removed pixels are colored black (zero value).
These same pixels can also be removed from the CBF, MTT, and TTP
images.
Vessel Threshold
To more accurately calculate the perfusion, you can set the Vessel
Threshold value so that the flow in larger vessels is not included in the
statistical calculation. The threshold is expressed as a pixel value in the CBV
image.
Philips Medical Systems 4535 674 64531_A
Note
The vessel threshold of 9 is the default value. Depending on the case, you
may need to adjust this value if the results are not as expected. This may be
caused by too many vessels removed or too many vessels remaining after
Vessel Removal. (Click Set to default to return to the default value.).
The threshold value 9 means that any pixel with the value 9 ml/100g and
greater in the CBV image is not displayed on the perfusion maps or
included in the ROI measurements.
Brilliance Workspace Portal - Volume 3
Brain Perfusion
10- 19
10.5
Perfusion Maps
Visual effect of vessel removal
Shown below is an MTT image before (left) and after (right) the threshold
was lowered to better show the CBF image.
The color map displayed on the image can be adjusted for a better
depiction of blood flow levels by dragging the middle mouse button up and
down within the perfusion image.
You can define the threshold values for the Summary Map using Increased
MTT (mean transit time) and Reduced CBV (cerebral blood volume).
Increased MTT
Adjusting this value affects the area depicted as Green or Red on the
Summary Map. In the example below, the 1.50 threshold value means that
all areas exhibiting mean transit time that increased by 50% (or more)
1 0 -2 0
Brain Perfusion
Brilliance Workspace Portal - Volume 3
Perfusion Maps
10.5
Philips Medical Systems 4535 674 64531_A
when compared to the contralateral hemisphere is shown as either Green or
Red, depending on the CBV value.
Reduced CBV
Adjusting this value determines whether tissue identified as having a
prolonged MTT is depicted in Red or Green in the Summary Map. All
tissue with a prolonged MTT and a CBV below the Reduced CBV
threshold are colored red. All tissue with a prolonged MTT and a CBV
above the Reduced CBV threshold are colored green.
Note
Brilliance Workspace Portal - Volume 3
The CBV threshold affects only tissue that has already been marked as
"abnormal" by the MTT threshold. For the example given.
• Green: prolonged MTT increase by 50%, CBV above 2.0 ml/100g
• Red: prolonged MTT increase by 50%, CBV below 2.0 ml/100g
Brain Perfusion
10- 21
10.5
Perfusion Maps
Save as Default
Save the current parameters as default. Use to change factory default
settings to user defined settings.
Restore Factory
Use to remove user defined settings and to restore parameters to the factory
default values.
10.5.7
Tissue tab
Mirror all tissue ROIs
This is set as default. When checkbox is checked, any drawn ROI is
automatically copied to the other side of the brain.
Example: When you draw an ROI, the ROI is automatically populated on
the opposite side of the brain.
1 0 -2 2
Brain Perfusion
Brilliance Workspace Portal - Volume 3
Perfusion Maps
10.5
Draw ROI tools
The ROI tools are activated for the Perfusion Maps work stage.
Note
You can draw additional ROIs without leaving this stage. (Maximum of 10
ROI’s).
Ellipse - Use the elliptical and freehand ROIs to draw areas for which you
want statistical information. ROIs can be drawn on any image in the
Perfusion Maps stage. Each ROI is automatically assigned a unique color
and number, and ROI statistics are displayed.
Cursor - This defines a pixel-sized ROI for reading statistics from a single
location.
Freehand - Allows you to mark the area of features of any arbitrary shape.
The area inside the ROI is considered as mask and is dyed in green
Philips Medical Systems 4535 674 64531_A
Mirror ROI
Use this tool to duplicate an ROI from one hemisphere to the other
hemisphere. Click this button, then click on a handle of the ROI you want
to mirror. The duplication is mirrored across the Mirror line.
Brilliance Workspace Portal - Volume 3
Brain Perfusion
10- 23
10.5
Perfusion Maps
10.5.8
View tab
Show Mirror Line
For more information on Show mirror line, see page 10-9.
Show Artery/Vein curves
In the lower-right side, a graph depicts the time and density curves of the
selected artery (red), vein (blue), and any user-drawn tissue ROIs.
Tissue ROIs included in the graph are identified by their color codes and
numbers. Because the graph is scaled to the peak of the largest curve (in this
case the vein), the ROI peaks may be indiscernible.
1 0 -2 4
Brain Perfusion
Brilliance Workspace Portal - Volume 3
Philips Medical Systems 4535 674 64531_A
Perfusion Maps
10.5
Show Tissue ROIs
When this checkbox is checked, it controls whether any defined ROIs
display.+
To eliminate the artery and vein curves, un-check Show Artery/Vein
Curves. Now, only the tissue ROI curves are displayed, and the graph
rescales accordingly, as shown above.
Note
Show tissue ROI is only activated when an ROI has been drawn.
Image Type
For more information on Image Type, see page 10-10.
Brilliance Workspace Portal - Volume 3
Brain Perfusion
10- 25
10.5
Perfusion Maps
10.5.9
Images tab
Perfusion map type
Perfusion Images
For more information on Perfusion Images, see page 10-16.
1 0 -2 6
Brain Perfusion
Brilliance Workspace Portal - Volume 3
Common tools
10.6
10.6
Common tools
The common graphic tools area provides many basic functions including
saving, panning, zooming, and windowing. Common tools are, in general,
common to all the CT Viewers and are shared with many other
applications of Brilliance Workspace Portal.
Philips Medical Systems 4535 674 64531_A
For more information on Common tools, see page 5-11 of Volume 2.
Brilliance Workspace Portal - Volume 3
Brain Perfusion
10- 27
Philips Medical Systems is part of
Royal Philips Electronics
www.medical.philips.com
[email protected]
Manufacturing address:
Philips Medical Systems (Cleveland), Inc.
595 Miner Rd.
Cleveland, OH 44143
U.S.A.
EU Representative:
Philips Medical Systems, Nederland B.V.
PMS Quality & Regulatory Affairs Europe
Veenpluis 4-6
5684 PC Best
The Netherlands
Copyright address:
Philips Medical Systems Nederland B.V.
Veenpluis 4-6
5684 PC Best
The Netherlands
© Koninklijke Philips Electronics 2007
All rights are reserved. Reproduction or transmission in whole
or in part, in any form or by any means electronic, mechanical or
otherwise, is prohibited without the prior written consent of the
copyright owner.
Dell is a U.S. registered trademark of Dell Computer Corp.
Microsoft is a U.S. registered trademark of Microsoft Corp.
X0197
This Medical Device meets the provisions of the transposition of
the Medical Device Directive 93/42/EEC within the country of
the origin of the Notified Body concerned with the device.
4535 674 64531_A * 11/2007
English
Portal Remote Management Application
Brilliance Workspace
Portal
4535 674 64541_A
PHILIPS
Contents
1
Introduction ..................................................................................... 1-1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
Philips Medical Systems 4535 674 64541_A
2
Safety ................................................................................................ 2-1
2.1
3
Important safety directions ...................................................................2-1
Security of system and data ............................................................. 3-1
3.1
3.2
4
About the Brilliance Workspace Portal .................................................1-1
About this guide ...................................................................................1-2
Intended use .........................................................................................1-4
Contraindications .................................................................................1-5
Compatibility .......................................................................................1-5
Compliance ..........................................................................................1-6
Training ...............................................................................................1-7
Regulatory controls ...............................................................................3-2
Security issues and guidelines ................................................................3-3
System description ........................................................................... 4-1
4.1
4.2
4.3
4.4
4.5
Brilliance Workspace Portal - Volume 4
What Portal is.......................................................................................4-1
Requirements........................................................................................4-4
Antivirus software .................................................................................4-9
Applications ........................................................................................4-10
Ancillary programs..............................................................................4-11
Contents
i
5
Screen resolution and layout ........................................................... 5-1
5.1
6
Portal Management .......................................................................... 6-1
6.1
6.2
6.3
7
Overview .............................................................................................. 8-1
Users tab............................................................................................... 8-1
Groups tab ........................................................................................... 8-6
Administration ................................................................................. 9-1
9.1
9.2
9.3
9.4
10
Overview .............................................................................................. 7-1
Users statistics....................................................................................... 7-3
Users ................................................................................................ 8-1
8.1
8.2
8.3
9
Overview .............................................................................................. 6-1
Portal server.......................................................................................... 6-3
Starting portal management client ........................................................ 6-5
Status ............................................................................................... 7-1
7.1
7.2
8
Low screen resolution ........................................................................... 5-2
Overview .............................................................................................. 9-1
Configuration tab................................................................................. 9-2
Tools tab .............................................................................................. 9-4
License tab.......................................................................................... 9-12
Directory ........................................................................................ 10-1
10.1 Overview ............................................................................................ 10-1
10.2 Tool bar ............................................................................................. 10-2
10.3 Main viewport .................................................................................... 10-3
ii
Contents
Brilliance Workspace Portal - Volume 4
1
1.1
Introduction
About the Brilliance Workspace Portal
Provides the local site administrators and service personnel with
functionality required to:
• Monitor Portal usage
• Administer strong password control
• Add/delete users and groups
• Maintain the database
• Manage web access to the server
Philips Medical Systems 4535 674 64541_A
The Workspace Portal can also be operated from the client:
C:\PortalPms\System\ RemotePortalManagement.exe
Philips Brilliance Workspace Portal v2.5 contains two software
applications, Portal Management (administrative) software and Portal
Client software.
The Portal application enables ubiquitous remote access to Extended
Brilliance Workspace 3.5 functionality through networked hospital PCs.
Brilliance Workspace Portal consists of a server, software and client
application.
Server data base is 500 GB compared to ~140 GB on stand alone Extended
Brilliance Workspace.
Note
Portal Management provides system configuration and maintenance
services such as User management and Modality and PACS connectivity.
Brilliance Workspace Portal - Volume 4
Introduction
1- 1
1.2
About this guide
Portal Server provides Storage and Query/Retrieve capabilities for CT
Images to and from CT modalities and PACS.
1.2
About this guide
This manual is intended to assist users and operators in the safe and
effective operation of the equipment described. The “user” is considered to
be the body with authority over the equipment; “operators” are those
persons who actually handle the equipment.
Before attempting to operate the equipment, you must read this manual
thoroughly, paying particular attention to all Warnings, Cautions and
Notes incorporated in it. You must pay special attention to all the
information given and procedures described in the Safety section.
Before attempting to operate any related CT equipment, you must read,
note, and strictly observe all DANGER notices and safety markings on the
CT Imaging System.
Wa r n i n g
Caution
Note
1 -2
Introduction
Directions, which if not followed, could cause fatal or serious injury to an
operator, patient or any other person, or could lead to a misdiagnosis or
mistreatment.
Directions, which if not followed, could cause damage to the equipment
described in this Instructions for Use and/or any other equipment or goods,
and/or cause environmental pollution.
Highlight unusual points as an aid to an operator.
Brilliance Workspace Portal - Volume 4
About this guide
1.2
The documentation for the Brilliance Workspace Portal is supplied in this
volume.
Volume 1 - Instructions for Use
This volume explains how to use the Brilliance Workspace Portal. It also
contains information about safety, data security, system start-up, software
navigation, accessing patient data and filming.
Volume 2 - Review
This volume explains how to use the various image viewers supplied with
the system. Also included in this volume are instructions on how to use the
reporting option, and how to use graphic tools for annotating studies and
making basic measurements.
Volume 3 - Analysis
This volume explains how to use advanced applications, Avanced Vessel
Analysis with Stent Planning (AVA), Virtual Colonoscopy (VC),
Comprehensive Cardiac Analysis (CCA), Lung Nodule Assessment (LNA),
and Brain Perfusion (BP).
Philips Medical Systems 4535 674 64541_A
Portal Remote Management Application (this document)
This volume explains how to use the Portal Management application. The
local site administrators and service personnel are provided the
functionality required to monitor Portal usage, check for errors, add/delete
users and groups and maintain the patient database.
This Portal Remote Management Application was originally drafted,
approved, and supplied by Philips Medical Systems (Cleveland), Inc. in the
English language under the product part number 4535 674 64541_A.
Brilliance Workspace Portal - Volume 4
Introduction
1- 3
1.3
Intended use
1.3
Intended use
The Philips Brilliance Workspace Portal is intended to be used and
operated only in accordance with the safety procedures and operating
instructions given in this Instructions for Use for the purpose for which it
was designed. The purpose for which the equipment is intended is given
below. However, nothing stated in this Instructions for Use reduces user’s
and operator’s responsibilities for sound clinical judgement and best clinical
procedure.
The Philips Brilliance Workspace Portal is intended for use as a diagnostic
viewing and processing application. The quality of the images depends on
the level and amount of X-ray energy delivered to the tissue during a
separate CT scan. CT imaging displays both high-density tissue, such as
bone, and soft tissue. When interpreted by a trained physician, CT images
yield useful diagnostic information. It is intended for use on the head and
whole body.
Use and operation of this equipment is subject to the law in the
jurisdiction(s) in which the equipment is being used. Both users and
operators must only use and operate the equipment in such ways as do not
conflict with applicable laws, or regulations which have the force of law.
Wa r n i n g
1 -4
Introduction
In the United States, Federal law restricts this device to sale, distribution,
and use by or on the order of a physician.
Brilliance Workspace Portal - Volume 4
Contraindications
1.4
1.4
Contraindications
The Philips Brilliance Workspace Portal should not be used if any part of
the equipment or system is known (or suspected to be) operating
improperly.
1.5
Compatibility
Equipment described in this manual should not be used in combination
with other equipment or components unless such other equipment or
components are recognized as compatible.
Changes and/or additions to the server should only be carried out by
Philips Medical Systems or by third parties expressly authorized by Philips
Medical Systems to do so. Such changes and/or additions must comply
with all applicable laws and regulations that have the force of law within the
jurisdiction(s) concerned, and with best engineering practice.
Philips Medical Systems 4535 674 64541_A
Changes and/or additions to the equipment that are carried out by persons
without the appropriate training and/or using unapproved spare parts may
lead to the PMS warranty being voided. As with all complex technical
equipment, maintenance by persons not appropriately qualified and/or
using unapproved spare parts carries serious risks of damage to the
equipment and of personal injury.
Brilliance Workspace Portal - Volume 4
Introduction
1- 5
1.6
Compliance
1.6
Compliance
The Philips Brilliance Workspace Portal complies with relevant
international and national standards and laws. Information on compliance
is supplied on request by your local PMS representative, or by:
Philips Medical Systems
PO Box 10 000
5680 DA BEST
The Netherlands
Facsimile: +31 40 276 2205
The Philips Brilliance Workspace Portal complies with relevant
international and national laws and standards on EMC (electro-magnetic
compatibility) for this type of equipment when used as intended. Such laws
and standards define both the permissible electromagnetic emission levels
from equipment and its required immunity to electromagnetic interference
from external sources.
California
In compliance with California’s Best Management Practices for Perchlorate
Materials (California Code of Regulations, title 22, division 4.5, chapter
33, article 1), the following warning applies to all Philips Medical Systems
Brilliance CT scanners and workstations due to Panasonic CR (button)
batteries that are mounted on printed circuit boards in various parts of the
system:
Wa r n i n g
1 -6
Introduction
Perchlorate Material – special handling may apply. For more information,
see www.dtsc.ca.gov/hazardouswaste/perchlorate/index.cfm.
Brilliance Workspace Portal - Volume 4
Training
1.7
Vermont
In compliance with the labeling requirements of the Vermont labeling law
V.S.A. 10, Chapter 159, §6621(d) and Section 6-803 of the Vermont Solid
Waste Management Rules, this product consists of devices that may contain
mercury, which must be recycled or disposed of in accordance with local,
state, or federal laws. (Within this system, the backlight lamps in the
monitor contain mercury.)
1.7
Training
Operators of the Philips Brilliance Workspace Portal must have received
adequate training on its safe and effective use before attempting to operate
the equipment described in this Instructions for Use. Users must also
ensure that operators receive adequate training in accordance with local
laws or regulations which have the force of law.
Philips Medical Systems 4535 674 64541_A
If you require further information about training in the use of this
equipment, please contact your local Philips Medical Systems
representative. Alternatively, contact:
Philips Medical Systems
PO Box 10 000
5680 DA BEST
The Netherlands
Facsimile: +31 40 276 2205
Brilliance Workspace Portal - Volume 4
Introduction
1- 7
2
2.1
Safety
Important safety directions
Philips Medical Systems products are all designed to meet stringent safety
standards. However, all medical electrical equipment requires proper
operation and maintenance, particularly with regard to human safety.
It is vital that you follow strictly all safety directions under the heading
Safety and all Warnings and Cautions throughout this Instructions for
Use, to help ensure the safety of both patients and operators.
Philips Medical Systems 4535 674 64541_A
In particular, you must read, understand and know the information
described in this Safety section before using this equipment.
You should also note the following information given in the Introduction
section of this Instructions for Use:
• intended use of the Philips Brilliance Workspace Portal.
• contra-indications
• training for operators of the Brilliance Workspace Portal.
Wa r n i n g
Operation of the equipment or system with improperly-operating or
wrongly-adjusted components could expose the operator or the patient
safety hazards. This could lead to fatal or other serious personal injury.
Wa r n i n g
Do not use the Brilliance Workspace Portal for any application until you
have read, understood and know all the safety information, safety
procedures and emergency procedures contained in this SAFETY section.
Brilliance Workspace Portal - Volume 4
Safety
2- 1
2.1
Important safety directions
Wa r n i n g
Do not use the Brilliance Workspace Portal for any application until you
have received adequate and proper training in its safe and effective
operation. If you are unsure of your ability to operate this equipment safely
and effectively DO NOT USE IT. Operation of this equipment without
proper and adequate training could lead to clinical misdiagnosis.
Wa r n i n g
Do not use the Brilliance Workspace Portal for any purpose other than
those for which it is intended. Operation of the Brilliance Workspace Portal
for unintended purposes, or with incompatible equipment, could lead to
clinical misdiagnosis.
Intended use of the Brilliance Workspace Portal is described under the
heading Intended Use in the Introduction section of this Instructions for
Use. Compatibility is discussed under the heading Compatibility in the
Introduction section of this manual.
2 -2
Safety
Brilliance Workspace Portal - Volume 4
3
Security of system and data
Philips Medical Systems is dedicated to helping you maintain the
confidentiality, integrity, and availability of electronic protected health
information and the hardware and software products that create and
manage these data.
Philips Medical Systems 4535 674 64541_A
Maintaining security of Philips Medical Systems' products should be an
important part of your facility's security-in-depth strategy. You should
implement a comprehensive, multi-layered strategy (including policies,
processes, and technologies) to protect information and systems from
external and internal threats. Your security strategy should follow industrystandard practices, addressing physical security, personnel security,
procedural security, risk management, security policies, and contingency
planning.
The practical implementation of technical security elements varies by site
and may employ a number of technologies, including firewalls, virus
scanning software, authentication technologies, etc.
This chapter provides guidelines to help the operator and owner
understand the possible ways security can be compromised, and then insure
that safeguards are in place to prevent this from happening. For specific
information about security within their institutions, operators and owners
can consult with the following offices at their location:
• Information Systems Security Officer
• Chief Information Officer
• HIPAA Officer (in the U.S.A.)
• Safety Officer
Brilliance Workspace Portal - Volume 4
Security of system and data
3- 1
3.1
Regulatory controls
3.1
Regulatory controls
Protect patient’s health information
One of the most important assets to protect with security measures is the
patient's health related information.
Many governments require maintaining the confidentiality of this
information. Therefore, strict security measures must be taken to guard this
protected information.
(Users in the U.S.A. may find guidelines at
http://www.hhs.gov/ocr/hipaa/.)
Prevent unauthorized device modification
Philips Medical Systems sells highly complex medical devices and systems.
We are required to follow government-regulated quality assurance
procedures to verify and validate modifications to the operation of our
medical devices.
Operators of this medical equipment must permit only Philips-authorized
changes to be made to the servers, either by Philips' personnel or under
Philips' explicit published direction.
Caution
3 -2
Security of system and data
Do not connect any external devices which were not included with the
server of your Brilliance Workspace Portal system.
Brilliance Workspace Portal - Volume 4
Security issues and guidelines
3.2
3.2
Security issues and guidelines
In addition to the patient information and device integrity needs discussed
in the preceding section on regulatory requirements, the following topics,
issues, and guidelines should be understood and addressed by operators and
owners. All content on this page refers to the Brilliance Workspace Portal
server and not the client PCs.
Network security
The Brilliance Workspace Portal must be placed on a secure local computer
network that has protections against viruses and other harmful computer
system intruders. Make sure the equipment is connected to a local network
that uses appropriate protection, such as a firewall and virus scanners.
Remote Service
Philips Medical Systems 4535 674 64541_A
Philips Medical Systems has a global, web-based network for connecting
many of your Philips systems to our advanced service resources. This secure
tunnel approach provides your equipment with a single point of network
access to on-site Philips equipment using Virtual Private Network
technologies. The remote service function is a secure connection through
explicit authorization and authentication control with encryption of all
data.
Antivirus Updates
Virus definition files and updated virus scanning engines are included with
the equipment. Updates of virus definition files and/or corrective software
versions are regularly made available by Philips to address known
vulnerabilities (virus and otherwise).
The system’s antivirus scanner is scheduled to activate during off hours,
while system is typically not in use. (Refer to the section “Antivirus
Software” in the System Description chapter of this volume for details.)
Brilliance Workspace Portal - Volume 4
Security of system and data
3- 3
3.2
Security issues and guidelines
Caution
Under no circumstances should updated virus definition files (or any type of
software) be installed on the Brilliance Workspace Portal by anyone other
than a Philips Field Service Engineer or an authorized Philips agent.
Positioning of display monitors
Unauthorized visual access to protected information can be minimized by
positioning the system’s display monitor so it faces a wall, to prevent
viewing from doorways, hallways and other traffic areas.
Note
Monitor position is a suggestion for use with monitors of client PCs used to
view Brilliance Workspace Portal.
To help in limiting unauthorized visual access, an unattended computer
display automatically goes blank after a set period of time. If there is no
interaction with the application for a preset length of time, the Idle time
out feature logs users off.
User login and logout protections
A consistent user login process (user names and passwords) provides good
security of protected information.
Minimum login standards include:
• Implementing strong passwords. This is the easiest and most effective
method to increase security. Strong passwords consist of at least eight
alphanumeric, mixed case characters, digits and special characters like
'@' or '*'. Never use words that can be found in the dictionary
• Never post or share user names and passwords
• Change passwords periodically
3 -4
Security of system and data
Brilliance Workspace Portal - Volume 4
4
System description
Brilliance Workspace Portal 2.5 (Portal) is a client/server application that
makes remote access to Extended Brilliance Workspace 3.5 functionality
possible through networked hospital PCs and in hospital locations remote
from the Radiology suite such as the emergency room, the operating room
or in a physician's office.
The main functions of Portal 2.5 include extensions to Extended Brilliance
Workspace 3.5 functionality to support use cases not present in Extended
Brilliance Workspace 3.5, such as user login as well as server and user
administration.
Philips Medical Systems 4535 674 64541_A
The two major components of this application are a server and software,
and a client application and software. The server and client application
communicate through a local area network (LAN) or possibly through the
Internet using a VPN connection.
4.1
What Portal is
Portal communicates with imaging systems of different modalities using the
DICOM-3 standard.
• Portal is a Thin Client /Server application that enables widespread
remote access to EBW 3.5 functionality via networked hospital PC’s.
• The Thin Client machine has the Graphical User Interface (GUI) and
displays images while the central Server retrieves and manages images,
and generates images for transmission to the client.
• Memory and CPU intensive operations such as 3D rendering takes
place on the server. Workstation operations can be performed via PC
Brilliance Workspace Portal - Volume 2
System description
4- 1
4.1
What Portal is
with less computing and memory resources than required by a
standalone workstation.
• Unlimited number of clients; multiple users can login simultaneously
and interact with datasets for review and interpretation.
• It’s a Brilliance Workspace anywhere the clinician needs it.
4.1.1
Key features
In Portal v2.5 CT Viewer imaging modalities supports CT. Portal functions
include various image handling features including:
• Archiving
• Viewing
• Manipulation
• Two and three-dimensional processing
• Analysis
• Filming
• Quick Review
• Reading (and burning – if supported by client PC) cd’s and dvd’s
• Unlimited number of clients
• All features and same GUI as CT Viewer in Extended Brilliance
Workspace v3.5
• Save non-DICOM directly to labeled Multimedia viewer in Portal
• Clipboard – copy an image to paste in documents/power points
• Integration with i-Site PACS: launch Portal with the same user login
and same selected data.
• Reporting (Based on TEcontrol)
• Additional applications:
• Advanced Vessel Analysis with Stent Planning (AVA)
• Virtual Colonoscopy (VC)
• Comprehensive Cardiac Analysis (CCA)
4 -2
System description
Brilliance Workspace Portal - Volume 2
What Portal is
4.1
• Lung Nodule Assessment (LNA)
• Brain Perfusion (BP).
Portal 2.5 employs a graphical multi-window, icon and mouse driven user
interface. It is designed to ensure maximum flexibility and intuitive
operation.
Large image sets are efficiently and conveniently reviewed and prepared for
using Extended Brilliance Workspace’s 2D display and manipulation
functions. Basic functions include real-time zooming, panning, windowing
and image viewing. Many viewing functions are included in the basic
functions, including 2D, slab, volumetric images and a basic endo flythrough capability.
4.1.2
Licensing
Philips Medical Systems 4535 674 64541_A
The Brilliance Workspace Portal software system does not support client
side licensing. Server licensing is limited to licenses based on the MAC
address. There is no user or feature specific licensing.
4.1.3
Performance
While the ultimate performance for any specific client depends on network
performance and load, and the number of users simultaneously requesting
computation on the server, the intent of the Portal application is to have
multiple users be able to use the CT viewer with “interactive” performance
over the network.
If no other users are requesting intensive computation from the server, a
single user is able to expect responsiveness consistent with EBW 3.5
Brilliance Workspace Portal - Volume 2
System description
4- 3
4.2
Requirements
4.2
Requirements
•
•
•
•
•
•
4.2.1
Gigabyte connections recommended
Recommended DNS server with reverse DNS capabilities
Recommended VPN access
Recommended domain based network environment
Supports Windows Vista
Dual server that is transparent to the user and handles twice the amount
of images.
Portal server
The Portal Server is connected to the PMS CT scanner and has PACS
connectivity capabilities. The scanner pushes images to the Portal Server
and the server can send and retrieve DICOM images from PACS.
A site can install multiple Portal servers, in which case a user of a Portal
client can connect to a chosen server. Each Portal server acts independently
and is not aware of any other Portal servers.
Memory- and CPU-intensive operations such as 3D rendering take place
on the server.
The Portal server can be accessed by a wide variety of remote users and can
can be placed anywhere in the Radiology IT rooms.
The Portal server is configured by Philips and is dedicated to running the
Portal server software.
Note
4 -4
System description
You must have the same software version as the server.
Brilliance Workspace Portal - Volume 2
Requirements
4.2
System
The server of Brilliance Workspace Portal is based on a Dell server system
and consists the following:
• Server
• Monitor
• Keyboard
• Mouse
• Internal CD-ROM drive
Caution
Never interrupt electric power to the Portal server when it is switched on.
Power down from the administrative application.
On start-up, the Portal client checks the local hardware and software
configuration. The software upgrades. If the hardware configuration does
not meet the minimum requirements for the Portal client a message
displays.
Philips Medical Systems 4535 674 64541_A
Note
Hardware configuration and software requirements of the Portal server are
listed below.
Hardware configuration
•
•
•
•
•
•
Brilliance Workspace Portal - Volume 2
CPU: 4x CPU Dual Core Xeon 7110 M, 3.66 GHz.
RAM: 20 Gb
Video: none
Operating System: Windows server 2003
Disks: 3 x 300 Gb disks in a RAID 5 configuration of 600 Gb
Network cards: 1 Gigabit network adapter
System description
4- 5
4.2
Requirements
Note
Windows Server 2003 OS permits remote login and system administration
through Remote Desktop Administration. Hospital IT should not install any
software on the Portal, such as security and antivirus.
Software
Third party software and security application Mcafee antivirus, (See the
Antivirus software section later in this chapter for more details) is included
in the installation of Portal 2.5. Also, all unused ports and services are
closed on the server for security purposes.
Note
4.2.2
Generally, other than stipulating minimal requirements, Philips does not
have control over the configuration of the client machines.
Portal client application
Portal client software is deployed on a variety of PCs with multiple
Operating System (OS) and hardware configurations. An unlimited
number of clients can be installed and loaded.
4 -6
System description
Brilliance Workspace Portal - Volume 2
Requirements
4.2
Hardware
Below lists the minimal requirements of the client PC.
Components
Required
Recommended
Available memory
512 mb
1024 mb or higher
Processor speed
1024 MHz
2048 MHz or higher
Screen resolution
1024x768 pixel
1280x1024 pixel or higher
Disk Free space on C drive
200 MB
1024 MB or higher
Network speed
100 Mbit
1000 Mbit or higher
Network card
Compatible with the hospital network or a
broadband Internet connection
Philips Medical Systems 4535 674 64541_A
Software
Components
Required
Recommended
Supported OS
Win XP
Win XP Service pack 2 OR Win 2000 SP4
Service pack 1,
Win 2000 SP4
Nero
Not required
If Nero present:write and read CD and DVD
on all platform
If No Nero: WinXp reads and writes CD
Win2000 only reads CD
Brilliance Workspace Portal - Volume 2
Windows account
for initial installation only. Ability to add Portal
administrative access
Software components.
System description
4- 7
4.2
Requirements
MAC Support
• (1) On WinXp running under Mac OS as a virtual machine
• (2) On WinXp running natively on Mac HW using BootCamp (dual
boot Mac or Xp solution from Apple)
4 -8
System description
Brilliance Workspace Portal - Volume 2
Antivirus software
4.3
4.3
Antivirus software
Antivirus software has been installed on the Portal server. The antivirus
check is started automatically, whether a Windows user is logged in on not,
at 2:00 AM (or 3:00 AM depending on time zone and daylight savings). It
can also be started at any time by a Philips service representative.
• If the computer is in the powered on state at 2:00 AM, but a user is not
logged in, the antivirus software runs automatically without displaying
a message.
• If you are logged in to the Extended Brilliance Workspace system when
the antivirus check is ready to start, this message displays: “Waiting to
Start. Virus Scan Will Start in xx:xx”
You can let it start by itself, or you can elect to start it immediately, or you
can elect to skip the virus scan.
While the virus scan is running, the message “Current State: Scanning
Files” displays.
Philips Medical Systems 4535 674 64541_A
Note
You can cancel a virus scan at any time, either before or during its
execution.
• If you log on during a virus check, the check for viruses continues,
showing messages describing its status.
• If no viruses are found, the following message displays: “Current State:
Virus scan complete. No viruses were detected.” The message window
closes automatically after 30 seconds.
• If a virus is found, the following message is displayed: “Virus scan
complete. A virus was detected. Call your service representative.”
• Contact your service representative. You may view the virus log. Click
the “Close this window” button to exit.
Brilliance Workspace Portal - Volume 2
System description
4- 9
4.4
Applications
4.4
Applications
Brilliance Workspace Portal 2.5 handles and displays independent image
viewing and processing applications.
CT Viewer
A comprehensive viewer for fast review of CT data in four
visualization modes:
2D - review original axial images
Slab - review a thin slab image in different orientations
Volume - review full volume images
Endo - review using the flythrough mode.
AVA (Stent)
Advance Vessel Analysis (AVA) offers a set of tools for stent
planning and general vascular analysis. With AVA you can
easily remove bone, then extract vessels and segment them.
VC
Virtual Colonoscopy (VC) enables fast and easy visualization
of colon scans, using acquired CT images.
CCA
Comprehensive Cardiac Analysis (CCA) is used to assess the
state of the coronary arteries and to create a functional
analysis of the heart.
LNA
Lung Nodule Assessment (LNA) assists with the diagnosis of
pulmonary nodules and lesions.
BP
Brain Perfusion (BP) is a blood flow imaging application that
analyzes the uptake of injected contrast in order to
determine perfusion related information about one or more
regions of interest.
4 -1 0
System description
Brilliance Workspace Portal - Volume 2
Ancillary programs
4.5
4.5
Ancillary programs
The following ancillary programs serve the main applications:
Directory
Selects and retrieves images for the applications. Copies to
other devices.
Queue Manager
Displays the order of copying images from one device to
Philips Medical Systems 4535 674 64541_A
another and printing films.
Brilliance Workspace Portal - Volume 2
System description
4- 11
5
Screen resolution and layout
In Brilliance Workspace Portal there are two variations of resolution, high
resolution, which is 1280 x 1024 and low resolution, which is 1024 x 768.
Because of this there are some screens in the application where one of two
different user interfaces is shown. The user interface is different because of
the different resolutions. Here are the required and recommended
resolutions:
Required - client screen resolution is 1024x768
Recommended - client screen resolution is 1280x1024 or higher
Note
The portal client does not run on any system that has a lower resolution
than 1024 x 768. The portal runs on a resolution higher than 1280 x 1024
though is does not fill the screen.
Philips Medical Systems 4535 674 64541_A
There are some screens that do not show differences in display between
high and low resolutions.
Below are examples of screens that display differences between high and low
resolutions in the user interfaces.
Brilliance Workspace Portal - Volume 1
Screen resolution and layout
5- 1
5.1
Low screen resolution
5.1
Low screen resolution
To overcome the low screen resolution, some tools are gathered under new
tabs in the toolbox to avoid a crowded toolbox and allow maximum area
possible for viewports.
Note
If you see double arrows in any of the user interfaces, this is an indicator
that there are additional tabs available.
The following images demonstrate the different layouts of some
applications.
AVA
In low screen resolution the volume rendering tools appear under the View
tab.
High Resolution
5 -2
Screen resolution and layout
Low Resolution
Brilliance Workspace Portal - Volume 1
Low screen resolution
5.1
Comprehensive Cardiac
Philips Medical Systems 4535 674 64541_A
In low screen resolution the common tools appear under the Common
Tools tab.
High Resolution
Brilliance Workspace Portal - Volume 1
Low Resolution
Screen resolution and layout
5- 3
5.1
Low screen resolution
Film
In low screen resolution the layouts appear under the Layout tab.
High Resolution
5 -4
Screen resolution and layout
Low Resolution
Brilliance Workspace Portal - Volume 1
Overview
6
6.1
6.1
Portal Management
Overview
The Portal Management application allows users with administrative
permissions to:
•
•
•
•
Configure
Apply license parameters
Display the various viewers
Control user accounts for all Portal users
• passwords
• permissions
The local site administrator has access to certain functions of Portal
management through this administrative interface.
Philips Medical Systems 4535 674 64541_A
The web-based Remote Management applet provides the local site
administrators and service personnel the functionality required to monitor
Brilliance Workspace Portal v 2.5 usage, check for errors, add and delete
users and groups, and maintain the patient database.
Within this application the local site administrators and service personnel
are provided with functionality required to:
• Monitor Portal usage
• Strong password control
• Add/delete users and groups
• Maintain the database
Operated also from the client:
C:\PortalPms\System\RemotePortalManagement.exe
Brilliance Workspace Portal - Volume 4
Portal Management
6- 1
6.1
Overview
The Portal management application opens with the Server Statistics tab of
the Status section.
The application sections include: Status, Users, Administration, and
Directory. Each section is explained in subsequent chapters.
6 -2
Portal Management
Brilliance Workspace Portal - Volume 4
Portal server
6.2
6.2
Portal server
The Portal server is deployed as a set of Windows services that start
automatically when the server machine is booted. General system
administration for the server can be run through Windows Remote
Desktop Administration.
Your site can have multiple servers. You can select a Portal server
connection when you log onto a client.
Multiple users can be connected to the Portal server at any one time. Each
client connected to the Portal server operates independently. For example, if
one client is disconnected from the server, or the client computer crashes,
the other users are not effected. Users can only select servers which are
running the same version of software as the Portal client application.
Philips Medical Systems 4535 674 64541_A
All user ids and passwords are stored on the server in an encrypted format
that can only be viewed by privileged administrators through the
administration preferences interface. All communication of user ids and
passwords is encrypted. Strong password rules are controlled by your site
administrator.
Note
Brilliance Workspace Portal - Volume 4
There is no limit on the number of users who can be connected to a Portal
server (it is limited by available resources).
Portal Management
6- 3
6.2
Portal server
6.2.1
Configure portal server
The local site administrator can perform the following available functions:
• View the list of users logged in
• Logoff a specific user
• View the log files
• Configure the LAN
• Configure the number of slices (resources) to reserve for the emergency
user.
• Configure the amount of time that elapses before an idle client shuts
down and is disconnected.
• Delete images in the database.
• Rebuild the database
• Import images
• View server statistics
• Lock the server for maintenance operations
Portal server installation and upgrades
On installation, a default administrator user is created. Two permanent user
ids are created for Philips service personnel. The user database (and user
preferences) is maintained across future software updates and upgrades.
6 -4
Portal Management
Brilliance Workspace Portal - Volume 4
Starting portal management client
6.3
6.3
Starting portal management client
On the server, the Portal Management Client icon is labeled "Portal
Admin," on the client, there is no icon, unless you create one. The file
location is "C:\PortalPms\System\RemotePortalManagement.exe."
To start Portal Management client:
Double click on the Portal Management desktop icon.
Portal Management opens.
2
Enter your user name and password in the Portal Management - Login
box.
3
Click OK.
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Portal Management
6- 5
7
7.1
Status
Overview
This section displays the statistics of server and users.
7.1.1
Server statistics
Philips Medical Systems 4535 674 64541_A
You can see information about the server.
Brilliance Workspace Portal - Volume 4
Status
7- 1
7.1
Overview
Portal server status
The following information about the server is listed:
• Name
• Version
• Memory
• Processor
• Number of Users logged in
• Normal slices usage
• Emergency slice usage
Client login locking status
This section of the tab informs you whether Client login is locked or not.
If the Lock button is visible, then the message reads, “Client login is not
locked. All the portal clients may login to the server.”
1
Click the Lock button to prevent client login.
2
Click the Unlock button to allow client login.
The message reads:
Client login is locked by administrator on station [name of the server]
since [time and date]
3
Click Refresh to update the screen with the most current server
information.
License status
License status includes the application name and its status.
As you can see in the example screen (pervious page), the applications
Portal Service and Remoting Service are both valid.
7 -2
Status
Brilliance Workspace Portal - Volume 4
Users statistics
7.2
7.2
Users statistics
Philips Medical Systems 4535 674 64541_A
The Users Statistics tab allows you to:
• View the current lists of groups and users.
• Perform Logoff of a user.
Most people fit in one of the two groups, user or administrator. Some users
can be assigned both user and administrator privileges. An administrator
has additional privileges, for example they can run the Portal
Administrative application and log users off in an emergency situation.
Brilliance Workspace Portal - Volume 4
Status
7- 3
7.2
Users statistics
In the Users Statistics tab, you can view the list of users, which also includes
their computer and total log time. You can also log a user off in an
emergency.
Emergency log off procedure
7 -4
Status
1
Click on the user to log off.
2
Click the Log off button to log a user off
3
Click the Refresh button to refresh the screen.
Brilliance Workspace Portal - Volume 4
8
8.1
Users
Overview
Through the Users section the local site administrator has access to make
changes to the registered users of Portal.
Philips Medical Systems 4535 674 64541_A
8.2
Users tab
With the Users tab you can add new users, modify the information for
current user, or delete users and all associated user information. The Users
tab displays the following information about the registered users of Portal.
• User Name
• Role
• Last Name
• First Name
• Group Membership
Brilliance Workspace Portal - Volume 4
Users
8- 1
8.2
Users tab
8 -2
Users
Brilliance Workspace Portal - Volume 4
Users tab
8.2
Add new user
Click the New button on right side, the New User box opens
2
Fill in the fields (Username, Password, Confirm Password, First Name,
Last Name, Role, and select the appropriate group memberships
(Administrators, Users, TemporaryPacsUsers).
3
Click Ok, a new user is created.
Philips Medical Systems 4535 674 64541_A
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Users
8- 3
8.2
Users tab
Modify user information
8 -4
Users
1
Highlight the user name you want to modify.
2
Click the Modify button on the right side, the Modify User box opens.
3
Modify information fields (Password, Confirm Password, First Name,
Last Name, Role) and group memberships (Administrators, Users,
TemporaryPacsUsers) where appropriate.
4
Click Ok.
Brilliance Workspace Portal - Volume 4
Users tab
8.2
Delete a user
Highlight the user name to be removed.
2
Click the Delete button on the right side, the Delete User
Confirmation box opens.
3
Click Yes to delete the user.
You can not delete the last remaining administrator.
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Note
1
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Users
8- 5
8.3
Groups tab
8.3
Groups tab
You can add new groups, modify the information of a current registered
group, or delete groups and all their associated information. The Groups
tab displays the following information about the groups that are established
users of Portal:
• Name
• Permissions
8 -6
Users
Brilliance Workspace Portal - Volume 4
Groups tab
8.3
Philips Medical Systems 4535 674 64541_A
Add new group
Brilliance Workspace Portal - Volume 4
1
Click the New button, the New Group box opens.
2
Fill in the name field.
3
Select the new group’s permissions (User Management, Portal Login,
Print DICOM Films, Change Password).
4
Click Ok.
Users
8- 7
8.3
Groups tab
Modify group
1
Highlight the group to be change.
2
Click the Modify button, the Modify Group box opens.
3
Modify the permission (User Management, Portal Login, Print
DICOM Films, Change Password).
4
Click Ok.
The group name cannot be modified, only deleted.
Note
Delete group
8 -8
Users
1
Highlight the group to delete.
2
Click the Delete button, the Delete Group Confirmation box opens.
3
Click Yes to delete the group.
Brilliance Workspace Portal - Volume 4
9
9.1
Administration
Overview
The Administration section is where the local site administrator establishes
the features and functions of Portal server, including:
• General configuration
• Login Password Rules
• Advanced settings
• Portal Services settings
• Client Log Viewer
• Server Log Viewer
Philips Medical Systems 4535 674 64541_A
• Server LAN configuration
• Licenses and their validity
Brilliance Workspace Portal - Volume 4
Administration
9- 1
9.2
Configuration tab
9.2
Configuration tab
The local site administrator can make changes to the portal name, establish
the time frame for idle time out, reserve slice count for ER use, establish
login password rules, and manage the advanced settings.
General
Here is where you define portal name, set default client idle time out and
establish reserved slice count for emergency user here.
• Portal Name: Establish the portal name.
9 -2
Administration
Brilliance Workspace Portal - Volume 4
Configuration tab
9.2
• Default Client Idle Time out (minutes): Enter the number of minutes
that elapses before the system times out when not in use. This happens
per user not per system. This is a system wide configuration setting.
• Reserved Slice Count for Emergency User: Enter the amount of
resources to be available for emergency users. If a user logs on and all
other system resources are busy, the user is prompted to determine if it
is an “emergency” case. If you select yes, you get access to the reserve
amount. Only if the reserve amount is exhausted, a user might be
kicked off.
Login Password Rules
Here is where you establish minimum length, minimum digits count,
minimum special characters count, and minimum uppercase count. The
number range for each is 0-100. Strong passwords are common. You
establish the rules for strong passwords and can be set or change them.
• Minimum Length: Minimum number of combined characters (alpha,
digits, and special characters) in a password.
Philips Medical Systems 4535 674 64541_A
• Minimum Digits Count: Minimum number of digits (0-9) that must
be in a password.
• Minimum Special Characters Count: Minimum number of special
characters ([email protected]#$%^&) that must be in a password.
• Minimum Uppercase Count: Minimum number of uppercase
characters that must be in a password.
Advanced
Here, you can allow or disallow PACS users and enable password expiration
and password expiration warnings.
• Allow Temporary PACS Users: Select to allow temporary PACS users.
Brilliance Workspace Portal - Volume 4
Administration
9- 3
9.3
Tools tab
• Enable password expiration: Select to allow passwords to expire.
If password expiration is enabled:
• Maximum Password Age (days): Enter the maximum number of
days before the password expires.
• Display expiration warning (days): Enter the number of days before
password expiration that you want the expiration warning to display.
9.3
Tools tab
Provides access to common maintenance and configuration operations. The
local site administrator has access to the Portal services and Tools functions.
9 -4
Administration
Brilliance Workspace Portal - Volume 4
Tools tab
9.3
Portal services
You can re-start Portal here.
During backups of software updates a stop of the server software may be
required.
To restart the application:
• Click the Restart... button.
Philips Medical Systems 4535 674 64541_A
Notes
Brilliance Workspace Portal - Volume 4
• If the Portal server is stopped, all the clients are logged off automatically
and an appropriate message displays on the screen.
• If the Portal server software is stopped then certain tools like Lan
configuration and Administrative Patient Directory do not work properly.
Administration
9- 5
9.3
Tools tab
Tools
Here, you can view the client log, the server log, and the server LAN
configuration. The client log viewer functionality is only available when
running from a Portal client.
Client log viewer
1
9 -6
Administration
Click Client Log Viewer; the log file list box opens.
Brilliance Workspace Portal - Volume 4
Tools tab
2
9.3
Click on the log file of interest and then click OK to view the file with
the file viewer, or Cancel to return to the Tools tab.
Philips Medical Systems 4535 674 64541_A
• There is a sort field at the top of the Date, Text, and Source columns.
Enter a date, text, or source in the appropriate field; the list displays
the files sorted to the date, text, or source entered.
• Exiting this window returns you to the Tools tab.
3
Brilliance Workspace Portal - Volume 4
Double click on the file of interest, the MessageDetails viewer opens:
Administration
9- 7
9.3
Tools tab
• With the MessageDetails viewer controls, you can close the details
viewer, copy the details, or move forward or backward through the
data files without closing and reopening the viewer.
4
Click Copy to copy the file details.
5
Click < Previous and Next > to move back and forth through the list,
viewing file details, without closing and reopening the viewer.
6
Click Close to return to the file list viewer.
Server log viewer
9 -8
Administration
1
Click Server Log Viewer; the log list box opens.
2
Highlight the log file of interest. Click OK to view the file with the file
viewer, or Cancel to return to the Tools tab.
Brilliance Workspace Portal - Volume 4
Tools tab
9.3
• There is a sort field at the top of the Date, Text, and Source columns.
Enter a date, text, or source in the appropriate field; the list displays
the files sorted to the date, text, or source entered.
Philips Medical Systems 4535 674 64541_A
• Exiting this window returns you to the Tools tab.
3
Brilliance Workspace Portal - Volume 4
Double click on the file of interest, the MessageDetails viewer opens;
Administration
9- 9
9.3
Tools tab
• With the MessageDetails viewer controls, you can close the details
viewer, copy the details, or move forward or backward through the
data files without closing and reopening the viewer.
Note
4
Click Copy to copy the file details.
5
Click < Previous and Next > to move back and forth through the list,
viewing file details, without closing and reopening the viewer.
6
Click Close to return to the file list viewer.
Do not rename patient data or rebuild database while other users are
logged on to Portal. Ensure all other users are logged off.
Server LAN config
The LAN configuration tool is intended to be used by the IT support
personnel at the site. It allows for the setup connectivity to other devices in
the network and the configuration of the local database.
When you click the Server LAN config button, the following message
opens:
9 -1 0
Administration
Brilliance Workspace Portal - Volume 4
Philips Medical Systems 4535 674 64541_A
Tools tab
Brilliance Workspace Portal - Volume 4
1
Click the Server Lan Config... button.
2
The following window opens.
3
Click Exit to close the window.
Administration
9.3
9- 11
9.4
License tab
9.4
License tab
The License tab displays a list of all your permanently licensed applications.
9 -1 2
Administration
Brilliance Workspace Portal - Volume 4
10
10.1
Directory
Overview
Philips Medical Systems 4535 674 64541_A
There are three sections in the Directory screen:
• Tool bar
• Main viewport
• Reference viewports
Brilliance Workspace Portal - Volume 4
Directory
10-1
10.2
Tool bar
10.2
Tool bar
The tool bar includes:
Database: Click the dropdown arrow and select the database you want to
view from the database list.
Copy To...:Select data, then click the button to transfer the selected data.
Select the device from the popup menu that is to receive the data.
Delete: Click this button to delete the selected data.When you select a
study or series and click on the Delete button, the following confirmation
messages opens, respectively.
1 0 -2
Directory
Brilliance Workspace Portal - Volume 4
Main viewport
10.3
Rebuild Database icon: Click to rebuild the selected database.When you
click the rebuild icon, the following rebuild confirmation message opens.
10.3
Main viewport
Main viewport headings include:
• Patient Name
• Date
• ID
• # of Images
• Accession No.
• # of Series
Philips Medical Systems 4535 674 64541_A
The Series, Files, and Reports tabs are in the lower half of the directory
window.
Series tab
The Series tab displays the number of series, or says “empty”
(number/empty). The table columns include:
• Series ID
• Protocol
Brilliance Workspace Portal - Volume 4
• # of Images
• Description
• Modality
Directory
10-3
10.3
Main viewport
• When you select a series, a slice view is displayed to the right of the
tabs.
Files tab
The Files tab displays the number of files, or says “empty” (number/empty).
The table columns include:
• Reference File ID
• Image Type
• Description
Reports tab
The Reports tab displays the number of reports, or says “empty”
(number/empty). The table columns include:
• Report Status
• Report Type
• Time
Right mouse click functions
• View DICOM Info
• Copy to
• Delete
1 0 -4
Directory
Brilliance Workspace Portal - Volume 4
Philips Medical Systems is part of
Royal Philips Electronics
www.medical.philips.com
[email protected]
Manufacturing address:
Philips Medical Systems (Cleveland), Inc.
595 Miner Rd.
Cleveland, OH 44143
U.S.A.
EU Representative:
Philips Medical Systems, Nederland B.V.
PMS Quality & Regulatory Affairs Europe
Veenpluis 4-6
5684 PC Best
The Netherlands
Copyright address:
Philips Medical Systems Nederland B.V.
Veenpluis 4-6
5684 PC Best
The Netherlands
© Koninklijke Philips Electronics 2007
All rights are reserved. Reproduction or transmission in whole
or in part, in any form or by any means electronic, mechanical or
otherwise, is prohibited without the prior written consent of the
copyright owner.
Dell is a U.S. registered trademark of Dell Computer Corp.
Microsoft is a U.S. registered trademark of Microsoft Corp.
X0197
This Medical Device meets the provisions of the transposition of
the Medical Device Directive 93/42/EEC within the country of
the origin of the Notified Body concerned with the device.
4535 674 64541_A * 11/2007
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