NM Application Suite

NM Application Suite
English
Instructions for Use
NM Application Suite
Extended Brilliance Workspace NM 1.0
PHI
NM Application Suite
INSTRUCTIONS FOR USE
Release 1.0
Philips Healthcare
4535 604 78081 Rev A
English
PAI
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Philips Healthcare has taken care to ensure the accuracy of this document. However, Philips Healthcare assumes no liability for errors or
omissions and reserves the right to make changes without further notice to any products herein to improve reliability, function, or
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ACCESSTM, ADAC®, ALLEGRO®, ARGUS®, AtlasTM, AutoQUANT®, AutoSPECT®, AutoSPECT®Plus, CardiaQ®, CardioMD®,
CardioTM, CardioTM 60, CardioTracTM, CCTTM, ColliMATETM, CPET®, ENsphere®, EPICTM, ExSPECTTM, EZXTM, FlexLOGICTM,
ForteTM, GEMINITM, GENESYS®, GlobalQ®, InStill®, InteLOGICTM, JETSphereTM, JETStream®, MCD/ACTM, MidasTM,
MOSAICTM, P3IMRT®, P3MD®, PegasysTM, PINNACLE3®, PIXELAR®, PrecedenceTM, SENTRYTM, ShadowTM, SKYLight®,
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Prescription Device Statement
Caution: Federal law restricts this device to sale by or on the order of a physician (or properly licensed practitioner).
Disclaimer
Neither Philips Healthcare, its parent, nor any of its worldwide affiliates shall be liable or obligated in any manner in respect of bodily
injury and/or property damage from the use of the system/software if such is not in strict compliance with instructions and safety
precautions contained in the relevant operating manuals and in all supplements thereto, in all product labels, and according to all terms
of warranty and sale of the system, or if any change not authorized by Philips Healthcare is made to the software operating the system.
CE Marking
Manufacturer:
Philips Medical Systems (Cleveland), Inc.
3860 North First Street
San Jose, California 95134
European Authorized Representative:
Philips Medical Systems Nederland B.V.
PMS Quality & Regulatory Affairs
Veenpluis 4-6
5684 PC Best
The Netherlands
NM Application Suite Instructions for Use
Document number 4535 604 78081 Rev A
© 2009 Koninklijke Philips Electronics N.V., 3860 North First Street, San Jose, CA 95134, USA
Printed in the United States of America
Philips Healthcare
NM Application Suite is CE Marked to the Medical Device Directive 93/42/EEC.
Contents
1
Introduction ......................................................................................................... 1
1.1
1.2
1.3
2
General Information ............................................................................................. 5
2.1
2.2
2.3
2.4
2.5
2.7
3.2
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Getting Online Help ................................................................................................. 6
Getting Remote Help from Philips ............................................................................ 6
Loading Files ............................................................................................................. 6
Using the Control Panel ............................................................................................ 8
2.4.1
Using the Patient Selector .......................................................................... 10
2.4.2
Using the Workflow .................................................................................. 10
2.4.3
Using the Data Managers........................................................................... 16
2.4.4
Using the Global Image Tools ................................................................... 46
Drawing ROIs ......................................................................................................... 59
2.5.1
Editing ROIs ............................................................................................. 61
2.5.2
Reusing ROIs ............................................................................................ 61
2.5.3
Changing the Edge Detection Type ........................................................... 61
2.5.4
Using Isocontours ...................................................................................... 62
2.5.5
Drawing Other ROI Shapes....................................................................... 62
2.5.6
Other ROI-related Tasks ........................................................................... 62
2.5.7
Creating a Custom ROI............................................................................. 63
Using Viewers .......................................................................................................... 63
2.6.1
Viewer Components .................................................................................. 64
2.6.2
Linking Viewers......................................................................................... 65
2.6.3
Moving and Resizing Viewers .................................................................... 65
2.6.4
Using a Curve Viewer ................................................................................ 66
Using Layouts .......................................................................................................... 66
2.7.1
Editing Layouts.......................................................................................... 69
2.7.2
Editing Layouts in AutoSPECT Pro .......................................................... 71
AutoSPECT Pro ................................................................................................. 73
3.1
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2.6
3
Intended Use ............................................................................................................. 1
Conventions Used in This Manual ............................................................................ 1
Overview ................................................................................................................... 2
1.3.1
Intended Users............................................................................................. 2
The AC Map Workstep ........................................................................................... 74
3.1.1
Reviewing an AC Map............................................................................... 74
3.1.2
Using CT-AC Data ................................................................................... 75
3.1.3
Using Vantage AC Data............................................................................. 77
3.1.4
Using Chang’s AC ..................................................................................... 79
The Reconstruction Workstep ................................................................................. 79
3.2.1
Start/End ................................................................................................... 81
3.2.2
Zoom......................................................................................................... 81
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3.3
3.4
Cardiac ............................................................................................................. 109
4.1
4.2
4.3
4.4
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MUGA ................................................................................................................. 109
4.1.1
Using MUGA ......................................................................................... 109
4.1.2
Results..................................................................................................... 110
4.1.3
Preferences .............................................................................................. 111
First Pass ............................................................................................................... 111
4.2.1
Using First Pass ....................................................................................... 111
4.2.2
Results..................................................................................................... 112
4.2.3
Preferences .............................................................................................. 112
Shunt .................................................................................................................... 113
4.3.1
Using Shunt ............................................................................................ 113
4.3.2
Results..................................................................................................... 113
4.3.3
Preferences .............................................................................................. 113
Review Layouts ..................................................................................................... 114
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3.2.3
Method ..................................................................................................... 81
3.2.4
Bound ....................................................................................................... 83
3.2.5
Iterations ................................................................................................... 83
3.2.6
Matrix Size ................................................................................................ 83
3.2.7
Subsets ...................................................................................................... 84
3.2.8
Start .......................................................................................................... 84
3.2.9
Attenuation Correction ............................................................................. 84
3.2.10 Scatter Correction ..................................................................................... 84
3.2.11 Decay Correction ...................................................................................... 86
3.2.12 Motion Correction .................................................................................... 86
3.2.13 Axis Correction ......................................................................................... 87
3.2.14 Filter ......................................................................................................... 87
3.2.15 Y Axis........................................................................................................ 88
3.2.16 Cutoff ....................................................................................................... 89
3.2.17 Order ........................................................................................................ 89
3.2.18 Comparing Parameters .............................................................................. 90
3.2.19 Using Manual Motion Correction............................................................. 90
3.2.20 Analyzing Sinograms and Cyclograms ....................................................... 95
The Reorientation Workstep ................................................................................... 98
3.3.1
Reorienting Datasets ............................................................................... 100
Setting Preferences for AutoSPECT Pro ................................................................ 101
3.4.1
General Preferences ................................................................................. 103
3.4.2
Preferences for the Setup Workstep ......................................................... 103
3.4.3
Preferences for the ACMap Workstep ..................................................... 104
3.4.4
Preferences for the Reconstruction Workstep .......................................... 104
3.4.5
Preferences for the Reorientation Workstep............................................. 105
3.4.6
Preferences for the Review Workstep....................................................... 105
3.4.7
Saving and Applying Preferences ............................................................. 105
3.4.8
AutoSPECT Pro Default Protocols ......................................................... 106
5
Whole Body ...................................................................................................... 115
5.1
5.2
5.3
5.4
5.5
5.6
6
Lung .................................................................................................................. 119
6.1
6.2
6.3
6.4
6.5
7
Using Three Phase Analysis ................................................................................... 115
Results for Three Phase Analysis ............................................................................ 115
Parameters for Three Phase Analysis ...................................................................... 116
Using Ileosacrum Ratio Computation ................................................................... 116
Results for Ileosacrum Ratio Computation ............................................................ 116
Review Layouts ...................................................................................................... 117
Using Lung ............................................................................................................ 119
Washout Results .................................................................................................... 119
Ventilation Results ................................................................................................ 120
Perfusion Results ................................................................................................... 120
Review Layouts ...................................................................................................... 120
Renal ................................................................................................................. 123
Using ROIs in Renal ............................................................................................. 124
Supplying Inputs for Renal .................................................................................... 125
Renal Results ......................................................................................................... 125
Preferences ............................................................................................................. 125
Review Layouts ...................................................................................................... 126
Simple Renogram .................................................................................................. 126
7.6.1
Using Simple Renogram .......................................................................... 126
7.6.2
Results ..................................................................................................... 127
7.7 Pre Post Lasix ........................................................................................................ 127
7.7.1
Using Pre Post Lasix ................................................................................ 127
7.7.2
Results ..................................................................................................... 128
7.8 Post Renogram Lasix ............................................................................................. 129
7.8.1
Using Post Renogram Lasix ..................................................................... 129
7.8.2
Results ..................................................................................................... 129
7.9 GFR Gates ............................................................................................................. 130
7.9.1
Using GFR Gates..................................................................................... 130
7.9.2
Results ..................................................................................................... 130
7.10 ERPF Schlegel ....................................................................................................... 131
7.10.1 Using ERPF Schlegel ............................................................................... 131
7.10.2 Results ..................................................................................................... 131
7.11 ERPF Schlegel with Void ....................................................................................... 132
7.11.1 Using ERPF Schlegel with Void............................................................... 132
7.11.2 Results ..................................................................................................... 132
7.12 ERPF MAG 3 ........................................................................................................ 133
7.12.1 Using ERPF MAG 3................................................................................ 133
7.12.2 Results ..................................................................................................... 134
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7.1
7.2
7.3
7.4
7.5
7.6
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7.13 Deconvolution ...................................................................................................... 134
7.13.1 Using Renal Deconvolution .................................................................... 134
7.13.2 Results..................................................................................................... 135
7.14 DMSA Static Ratio ............................................................................................... 135
7.14.1 Results..................................................................................................... 135
7.15 Hilson Index ......................................................................................................... 136
7.15.1 Using Hilson Index ................................................................................. 136
7.15.2 Results..................................................................................................... 136
7.16 Patlak .................................................................................................................... 137
7.16.1 Using Patlak ............................................................................................ 137
7.16.2 Results..................................................................................................... 137
7.17 Cortical Analysis ................................................................................................... 138
7.17.1 Using Cortical Analysis ........................................................................... 138
7.17.2 Results..................................................................................................... 138
7.18 Split T 1/2 ............................................................................................................ 138
7.18.1 Using Split T1/2 ..................................................................................... 139
7.18.2 Results..................................................................................................... 139
Endocrine .......................................................................................................... 141
8.1
8.2
8.3
9
Esophagus ......................................................................................................... 145
9.1
9.2
9.3
9.4
10
Using Esophagus ................................................................................................... 145
Esophagus ............................................................................................................. 145
9.2.1
Using Esophagus ..................................................................................... 145
9.2.2
Esophagus Results ................................................................................... 145
9.2.3
Preferences .............................................................................................. 146
Gastro-Esophagus Reflux ...................................................................................... 146
9.3.1
Using Gastro-Esophagus Reflux .............................................................. 146
9.3.2
Gastro-Esophagus Reflux Results............................................................. 146
9.3.3
Preferences .............................................................................................. 147
Review Layouts ..................................................................................................... 147
Gastro Intestinal ............................................................................................... 149
10.1
10.2
10.3
10.4
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Thyroid ................................................................................................................. 141
8.1.1
Using Thyroid......................................................................................... 141
8.1.2
Results..................................................................................................... 142
Parathyroid ........................................................................................................... 143
8.2.1
Using Parathyroid ................................................................................... 143
8.2.2
Subtraction Results.................................................................................. 143
Review Layouts ..................................................................................................... 143
Using Gastric Emptying ........................................................................................ 149
Results ................................................................................................................... 149
Preferences ............................................................................................................ 150
Review Layouts ..................................................................................................... 151
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11
Hepatobiliary .................................................................................................... 153
11.1
11.2
11.3
11.4
11.5
11.6
Using GallBladder ................................................................................................. 153
Results for GallBladder .......................................................................................... 154
Preferences for GallBladder .................................................................................... 155
Results for GBEF Static Analysis ........................................................................... 155
Preferences for GBEF Static Analysis ..................................................................... 155
Review Layouts ...................................................................................................... 156
12
General Review ................................................................................................ 157
13
QC Tools .......................................................................................................... 159
13.1
13.2
13.3
13.4
14
Using QC Tools .................................................................................................... 159
UFOV and CFOV Results Tabs ............................................................................ 160
Using the QC Tools Toolbar ................................................................................. 161
Saving Results ........................................................................................................ 161
13.4.1 Saving to a Text File ................................................................................ 161
13.4.2 Saving as Secondary Capture.................................................................... 162
13.4.3 Saving to Film ......................................................................................... 162
Astonish Reconstruction .................................................................................. 163
14.1 When to Use Astonish ........................................................................................... 163
14.2 Using Astonish Reconstruction .............................................................................. 164
14.2.1 Filtering and Noise .................................................................................. 164
14.2.2 Iterations and Subsets .............................................................................. 165
14.2.3 Applying Other Corrections .................................................................... 166
14.3 Further Reading ..................................................................................................... 166
14.3.1 Information on OSEM reconstruction..................................................... 166
14.3.2 Information on resolution recovery.......................................................... 167
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Backing Up and Restoring Data ....................................................................... 169
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15.1 Backing Up Data ................................................................................................... 169
15.2 Restoring Data ....................................................................................................... 169
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N M A p p l i c a t i on S u i te
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1
Introduction
The NM Application Suite is processing software designed to streamline
Nuclear Medicine workflow to meet productivity demands of NM
imaging departments. It includes a comprehensive suite of planar, SPECT
and QA applications and provides users with the ability to make a “play
list” of protocols on the fly and access the tools when needed, where
needed.
1.1
Intended Use
The NM Application Suite is a nuclear medicine image display and
processing application suite that provides software applications used to
process, analyze, and display medical images and data. The results
obtained may be used as a tool, by a nuclear physician, in determining the
diagnosis of patient disease conditions in various organs, tissues, and other
anatomical structures. The data processed may be derived from any
nuclear medicine gamma camera. The NM Application Suite should only
be operated by qualified healthcare professionals trained in the use of
nuclear medicine equipment.
1.2
Conventions Used in This Manual
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This manual uses the following conventions:
NM Application Suite
Release 1.0
•
WARNING: Messages that alert you to conditions that may result in
death or serious injury.
•
CAUTION: Messages that alert you to conditions that may result in
one or more of the following:
–
Minor or moderate injury to you or the patient
–
Damage to the equipment or other property
–
Data loss
•
IMPORTANT: Vital information that describes how to properly
install, configure, or use the system.
•
Note: Additional information that may help explain an action or
procedure
•
The following items appear in a unique style in the text:
–
<Enter> Press the Enter key on the keyboard.
–
<Return> Press the Return key on the keyboard.
In tro du ctio n
1
1.3
Overview
•
1.3
–
Screen elements and system controls (menu items, buttons,
switches, etc.). For example, Save.
–
Computer messages displayed on the screen. For example,
Reboot After Installation.
All host names, IP addresses, and Ethernet addresses displayed in these
procedures are examples only. Before entering host names, IP
addresses, or Ethernet addresses, check the existing network configuration to make sure that you do not duplicate any existing entries.
Overview
The NM Application Suite is a Windows-based nuclear medicine
processing workstation that functions seamlessly out of the box with
JETStream acquisition. The product's design and features improve
operator and department workflow by allowing workflow distribution of
technologist and physician activities to workspots distributed within
nuclear medicine departments in hospitals, cardiology offices, imaging
centers and remote locations. This includes the application suite running
on the Extended Brilliance Workspace system. The NM Application Suite
can also communicate with competitor cameras and workstations and
interfaces seamlessly with multi-modality data and PACS. The NM
Application Suite offers a complete, robust nuclear medicine workstation
that meets the needs of customers in all geographies.
Extended Brilliance Workspace (EBW) is the Philips CT and PET/CT
processing workstation solution. EBW is Windows based and uses high
performance hardware for handling large CT datasets.
The Medical Imaging Platform (MIP) is a set of standardised Philips-wide
Windows-based software assets that are being used to form the basis of
next generation imaging applications.
NOTE:
If you load third-party software onto the workstation it may
decrease system performance.
1.3.1
Intended Users
NM Technologists will perform acquisition and processing of image data
generated from a gamma camera. Their experience can range from
beginning nuclear medicine student to multiple years of experience. The
system must therefore be simple to use and understand for the
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The NM Application Suite uses the EBW as a platform to integrate
SPECT, PET and CT applications onto a single desktop for our Hybrid
Imaging customers (using Precedence and BrightView XCT). In addition,
the NM Application Suite leverages several of the resources provided by
EBW such as patient management, printing, archival networking, and an
application bridge to maximize throughput and quality.
Overview
1.3
inexperienced user, yet flexible enough to accommodate the experienced
user. Use of the system by inexperienced users may or may not be under
the supervision of fully-trained personnel.
Physicians will perform processing, post-processing, display/review and
interpretation of nuclear medicine images acquired from a gamma camera.
Experience can range from 1st year medical student, resident to board
certified Nuclear Medicine physician. The system must therefore be
simple to use and understand for the inexperienced user, yet flexible
enough to accommodate the experienced user. Use of the system by
inexperienced users may or may not be under the supervision of
fully-trained personnel.
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Physicists will perform processing, post processing, display/review for
acceptance testing and QC of Nuclear Medicine images acquired from a
gamma camera. These users require analysis tools, such as manual regions
of interest, statistics inspection, and curve generation beyond the standard
tools found in clinical applications.
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Introduction
3
Overview
4
I n tro d u c t io n
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1.3
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General Information
This section describes features that are available for all applications.
The layout of the NM Application Suite consists, broadly speaking, of two
areas:
4535 604 78081 Rev A
Figure 1 NM Application Suite layout
1.
Control Panel
2.
Viewing area
The Control Panel contains all the tools necessary to use the applications.
See the section on “Using the Control Panel” on page 8 for details.
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The viewing area consists of viewers that contain study images, results,
curves, and any other visual information presented by an application. See
the section on “Using Viewers” on page 63 for details about viewers. It also
has a strip at the top that contains DICOM information from the study. If
you right-click in the viewing area, a menu appears that provides access to
many of the tools available in the Control Panel.
In the DICOM strip, you can select the information to display by
right-clicking and selecting a field from the pop-up menu. Some of these
may be hidden when you use the Deidentify feature in the Utilities
manager.
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2.1
Getting Online Help
2.1
Getting Online Help
As with other EBW applications, online help is available by clicking the
Help button at the top of the EBW window. This displays the Philips
splash page with some buttons at the top. Select your application’s manual
in the drop-down menu under the Operation Manual button, and then
click Operation Manual to open the file.
2.2
Getting Remote Help from Philips
For some problems, you may need to provide Philips Healthcare with
remote access to your system. You can do this using the EBW Remote
Service feature:
1. In EBW, click Help.
2. In the next screen, click Remote Service.
3. In the Remote Access dialog, select View Only or Remote Control
Sharing, as required, and click Start.
This begins the remote session.
4. To end a session, click Disable, near the upper right of the screen.
2.3
Loading Files
When you load studies into the NM Application Suite, you can choose to
load them through EBW’s Review or Analysis menus. Loading a study
through the Review menu opens it in the selected application in the
Review (last) workstep, allowing you to view all the datasets. However, you
can still select the Setup workstep and proceed through all the worksteps
to reprocess the study.
If you go to the Setup workstep, the Review workstep is not
available unless you load the buckets and process the study.
Loading through the Analysis menu opens it in the selected application’s
workflow, allowing you to start processing.
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NOTE:
Loading Files
2.3
Figure 2 Location of EBW Review and Analysis menus
4535 604 78081 Rev A
In both cases, the process is to select one or more studies in the EBW
Patient Directory and then select one of the applications from the Review
or Analysis pull-down menus. Both menus contain these NM Application
Suite applications:
•
NM Application Suite: This opens the Review application, allowing
you to review all the data before making any edits.
•
NM Cardiac: This includes methods for MUGA, First Pass, and
Shunt.
•
NM Whole Body: This includes methods for Three Phase Analysis
and Ileosacrum Ratio.
•
NM Renal: This includes methods for Renogram, ERPF MAG3,
Lasix, Patlak, and others.
•
NM Lung: This includes methods for Washout, Ventilation, and
Perfusion.
•
NM Endocrine: This includes methods for Thyroid and Parathyroid.
•
NM Hepatobiliary: This includes methods for Gallbladder (Hepatic
Duct, Common Bile Duct, Duodenum, and Background) and GBEF
Static Analysis.
•
NM Gastric Emptying: This includes methods for Liquid and Solid.
•
NM Esophagus: This includes methods for Gastro-Esophagus Reflux
and Esophagus.
•
AutoSPECT Pro: This includes methods for Cardiac, Vantage, Thallium, Astonish, Brain, Bone, and others.
Philips Healthcare
NOTE: You can load multiple patients, but as the number increases,
performance may suffer, depending on factors such as file size, number of
series, etc.
See the NM Application Suite Reference Manual for information on
minimum loading requirements for specific applications.
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2.4
Using the Control Panel
When a study loads, the NM Application Suite tries to match the study
information to some matching criteria. If a match is found, the study
loads into the Define Regions workstep, allowing you to start drawing
ROIs immediately. If it fails, it loads into the Setup step, allowing you to
assign data to the correct buckets manually before proceeding to the
Define Regions workstep. For information on setting up match criteria,
see the section on “Editing Auto Matches” on page 14.
2.4
Using the Control Panel
Philips Healthcare
The Control Panel is where most of the work in the NM Application Suite
takes place. There are four areas of the Control Panel:
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Using the Control Panel
4535 604 78081 Rev A
Figure 3
1.
2.4
Control Panel
Patient Selector: If you have loaded multiple patients, you can use this
drop-down menu to select one. See the section on “Loading Files” on
page 6 for details.
When you select a study using the drop-down menu, the workstep
information for the current study is preserved. For example, if you are on the
Review Results workstep in a study, then select a different study, if you use
the pull-down menu to go back to the first study you automatically return to
the Review Results workstep. You do not need to reselect data and redraw
ROIs.
2. Workflow Navigator: This allows you to navigate among the worksteps,
and perform work and choose tools that are specific to a workstep.
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2.4
Using the Control Panel
Here you can load datasets, draw ROIs, review results, etc. See the
section on “Using the Workflow” on page 10 for details.
3.
Data Managers: These allow you to choose activities that are unrelated
to a workstep, for example setting preferences, performing image
manipulation, selecting an application, etc. See the section on “Using
the Data Managers” on page 16 for details.
4.
Global Image Tools: This is where you can choose among tools that are
common across applications, like saving, printing, changing the colormap,
etc. See the section on “Using the Global Image Tools” on page 46
for details.
You can minimize and maximize the Control Panel using the pushpin icon
in the top right of the panel.
Figure 4 Control Panel pushpin
When it is minimized, you still have access to the workstep buttons.
You can reapply the current preference by clicking Restart, at the bottom
of the Control Panel. You might do this to reload the study and reset all
ROIs.
To exit the NM Application Suite, click Exit at the bottom of the Control
Panel.
Use the View Status Bar button to display the status bar. The status bar
appears at the bottom of the viewing area, and contains information
pertaining to the current workstep. You can drag the top of the status bar
to make it bigger, allowing you to see multiple lines.
2.4.1
Using the Patient Selector
The Patient Selector allows you to select a new patient to display. If you
loaded multiple patients into the NM Application Suite, you can use the
drop-down menu to select a patient to work on.
2.4.2
Using the Workflow
There are three buttons that control the workflow:
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Figure 5 Status bar
Using the Control Panel
Figure 6
2.4
Workflow buttons
1.
Next and Previous buttons
2.
Workstep list
•
The left and right arrows at the sides (#1 in the image above) go to the
next or previous workstep.
•
The small down arrow at the bottom of the workstep name (#2 above)
provides a pull-down list of all the worksteps, allowing you to go
directly to any available workstep.
Use the buttons to navigate through the worksteps. The basic workflow is
described immediately below; a more detailed description follows.
•
Load data into an application: Click an application icon in EBW; the
default preferences are loaded (but you can reselect another set manually later).
•
Define Regions: If automatching succeeds, draw ROIs; if not, manually load the data buckets, then proceed to Define Regions.
NOTE:
The workflow for AutoSPECT Pro is slightly different at this point. In
that application, instead of defining regions and reviewing results, you
perform reconstruction and reorientation (and possibly AC map generation).
See the chapter on AutoSPECT Pro for details.
•
Review results: After drawing the ROIs, review the processed results.
Be sure to verify any automatically generated results in an
application. You are responsible for ensuring that the results are consistent
with your clinical expectations.
•
Review the processed images.
Reviewing Data
When you load data into the NM Application Suite application (as
opposed to a dedicated application such as Renal, Cardiac, etc.), it is
displayed in the Review application, allowing you to see all the data before
loading it into an application. Depending on the study type, various
layouts are available in which to view the data. You can use the full
functionality of the Control Panel without loading the data into another
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Using the Control Panel
application. This means that you can perform image processing functions
with the ICMT or apply color maps, for example. For more on the Review
application, see the section on “General Review” on page 157.
NOTE:
Studies are loaded in the Review application only when you select
the NM Application Suite icon in the EBW Patient Browser. If you select
another application instead, the study opens in the Define Regions
workstep if automatching succeeds, or the Setup workstep if it fails.
Setup Workstep (Loading Data)
If the data meets the application’s default preference’s automatching
criteria, the datasets are automatically assigned to data buckets, and the
application proceeds to the Define Regions workstep. If not, you can load
the data manually by using the drop-down list of datasets at the right of
the data bucket (#2 in the image below).
Figure 7
1.
Expected data indicator
2.
Assign data to bucket
Data buckets
Expected data are indicated by an exclamation point (#1 in the image
above). If you do not load the expected data, some operations or results
may not be available.
If you load data manually, be sure to load the data into the correct
buckets. If you load the wrong data, the results will be incorrect.
There is a Custom Display container at the bottom of the list. This
contains 25 buckets. You can use these for data that may not be part of the
dataset proper, such as images created with the ICMT, for example. As
with the other buckets, datasets can be automatically assigned based on
automatching criteria. If no buckets are loaded, the Custom Display
layout will not be available in the application.
The drop-down list of datasets provides information about what data can
be loaded into the current bucket (refer to the figure below):
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NOTE:
Using the Control Panel
Figure 8
1.
An allowed dataset
2.
Currently loaded dataset
3.
Unavailable dataset
4.
Clear Bucket
2.4
Loading data
•
Data that are available to load are not shaded.
•
The currently loaded dataset is lightly shaded.
•
Unavailable data is darkly shaded.
To unload a bucket (remove the dataset), click Clear Bucket (#4 above).
Define Regions Workstep
In this step, you are prompted to draw all ROIs that are required by the
current preference. For details on drawing ROIs, see the section on
“Drawing ROIs” on page 59.
Review Results Workstep
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After processing the data based on the ROIs, one or more results layouts
are available in the Review Results workstep. They appear in a list under
the workstep name. Use the Next button to proceed through them in
order. Each application may have unique results. See the chapters on the
individual applications for details.
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Depending on the layout you are using, some viewers may not be included
in the results display. To see if there are any hidden viewports, click the
Show Hidden Viewers tool in the Utilities manager in the Image Tools.
This contains a list of all the viewers that are hidden. If you need to display
a hidden viewer, you can either add it to the first viewer in the layout as a
new tab, or create a new layout that has a tiled space for it, and save the
layout in a Preference. For details on adding tiles to a layout, see the
section on “Editing Layouts” on page 69. For details on creating and
editing a layout, see the section on “Creating and Editing Preferences” on
page 43.
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Using the Control Panel
Review Workstep
The last step allows you to review the processed data in multiple layouts,
which depend on the type of study loaded.
Editing Auto Matches
You can use the Data Matcher to edit matching criteria for a data bucket.
To use the Data Matcher, you define expressions to use for various
DICOM attributes, and then combine those expressions using logical
operators. You can also combine operations. Each expression and each
operation is on a separate line in the dialog.
NOTE:
Unless you are familiar with the syntax and construction of regular
expressions, do not attempt to create a new filter from scratch. Just edit
existing filters.
1. In the Preferences Data Manager, click the green Filter bucket data
button to open the Data Matcher.
Filter bucket data button
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Figure 9
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The Data Matcher window appears:
Figure 10 The Data Matcher window
1
Add expression
2
3
Delete Expression
Composite expression
2. In the list of buckets on the left, click the bucket to change.
NOTE:
Use the Reset button at any time to reset the bucket’s expression to
its original default values. To cancel, click the Close button.
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3. Use the DICOM pull-down menu to select the DICOM attribute to
match.
4. Click the ‘+’ icon (Add expression) near the top right of the window to
add the expression to the list.
The expression appears in a new line at the bottom of the list. Click a line
to display it in the window at the bottom in the form of a search expression.
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To delete an expression, click the line and click the ‘x’ icon (Delete Expression) near the top right of the window.
5. Type the string to match in the text box and use the pull-down menu to
set the following:
• Equals - The expression is true if it matches the string exactly.
• Contains - The expression is true if it contains the string anywhere in it.
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• Not Equals - The expression is true if it does not match the string
exactly.
6. To combine two lines, select the lines using Shift-click to add a line. Then
use the Combine pull-down menu to set the operator for the expression:
• AND - An expression is true if both elements (this one and the one to
which it is being added) are true.
• OR - An expression is true if either element (this one and the one to
which it is being added) is true.
• NOT - An expression is true if this element (this one and the one to
which it is being added) is not true.
Click the ‘+’ icon (Add expression) to add the new line.
7. To add more attributes or lines, repeat the process.
You can create multiple filters within the window; only one will be applied
at any time.
8. Select an expression to use and click Save; the saved expression is
highlighted in green.
9. Click Close to close the window.
2.4.3
Using the Data Managers
•
Object Browser: This allows you to view the available datasets when
you are in an application. See the section “Object Browser” on page 16
for details.
•
Viewer Tools: This contains tools you can use in the image viewers,
like pan, zoom, cine controls, etc. See “Viewer Tools” on page 17 for
details.
•
Application Palette: This contains links to all the applications,
allowing you to select an application or switch between applications.
You can switch at any time, in any application. When you switch, the
state of the current application is not saved; it is equivalent to exiting
the application and starting a new one.
•
ICMT (Image Curve Manipulation Tool): This provides access to the
ICMT. See “Image and Curve Manipulation” on page 25 for details.
•
Preferences: This allows you to configure, create, and manage preferences. See “Creating and Editing Preferences” on page 43 for details.
Object Browser
The Object Browser is a simple tool that provides a list of the current
datasets when you are in an application. However, right-clicking on a
dataset allows you to get DICOM information for it, add a viewer to a
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There are five Data Managers. They organize activities in these categories:
Using the Control Panel
2.4
layout (in 2D applications), or select a layout to display datasets (in
AutoSPECT Pro). You might want to add a viewer, for example, to create
a second version of an image to experiment with and compare to the
original. The list of layouts in AutoSPECT Pro allows you to control how
the data is displayed at the time of selection.
To add a viewer in 2D applications:
1. Click a viewer tab to select a container to hold the new viewer.
2. In the Object Browser, right-click on the image to add.
3. Select Add from the menu. The new viewer is added to the container
that has the currently selected viewer.
To display datasets in a layout in AutoSPECT Pro:
1. In the Object Browser, left-click to select data (using Shift or Ctrl to
add to the selection).
2. Right-click on one of the selections and select a layout from the list.
NOTE:
Only layouts that can accommodate all the selected data are listed.
To get DICOM information for a dataset, right-click on it and select
Dicom Information from the menu. This displays a window with the
most useful DICOM fields and their values. To get the full DICOM
information, you must use the EBW Patient Directory or the EBW
Subselection feature.
Viewer Tools
This manager provides tools that affect the viewers. The following is a
complete list of the tools available in the manager.
NOTE: The tools that are available depend on the viewer that is selected
and the type of dataset it contains. Not all tools are available for all
viewers and datasets.
Tool
Description
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Play/Stop - This starts and stops a cine. Use the entry boxes to set the start
and end frames
Sync Cine in Viewers - This starts running the cines in all viewers at frame
1, so they all run in sync.
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Change Frame Rate - This sets the frame rate of a cine in frames per second (fps). Use the slider to increase or decrease. The range is 1 - 100 fps.
Movie Mode - This determines how a cine behaves. Cyclical Forward
repeatedly runs the cine forward. Cyclical Backward repeatedly runs the
cine backward. Bounce runs the cine alternately forward and backward.
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Tool
Description
Change bin/time number and Change gated/dynamic slice - For gated
tomo datasets these toggle between sliders to select bins or slices.
Scroll - For cine datasets, this scrolls through the images in order. Use any of
the options in the table below to scroll through a series.
Deselecting the Scroll menu item only affects the click-drag scroll
method, not the arrow keys, scroll wheel, etc.
NOTE:
Select Phase - For multiphase studies, use this pull-aside menu to select the
phase to display.
Astonish - Planar Astonish is an image restoration process (a special type of
filter) to enhance the image resolution for a planar image by using the Blind
Deconvolution technique. Image restoration is a process to remove or minimize known degradations in an image. There are three settings: Sharp,
Sharper, and Sharpest. These correspond to 3, 5, and 10 iterations,
respectively. For details on Astonish, see the appendix, “Astonish Reconstruction” on page 163.
It is not recommended to use planar Astonish with projection
data. Resolution recovery for SPECT data should be done with Astonish
in AutoSPECT PRO.
NOTE:
Hide/Show ROI - This toggles the display of ROIs.
Triangulation - This allows you to use the location of a cursor in one view
to alter other views. Triangulation is available for applications that display multiplanar views of the same image set (TRANS/SAG/COR, for example). When
you click on an image, a crosshair appears. Dragging the crosshair changes the
other views according to where the cursor is.
Orientation - This specifies the orientation of the image.
Select Visual Type - For volumes, this allows you to select a view of the
volume data.
Normalize to Series - This normalizes all frames based on the minimum
and maximum pixel value that is found in all frames of a series (the entire volume for a volume dataset or the entire set of frames for a dynamic dataset).
Use the normalization functions carefully because they can have
dramatically different effects, depending on the dataset. When the counts
are generally low in some frame in a series, if you normalize the frame
using Normalize to each Frame, it (and every other frame) looks like it
has a full range of counts. This means that you may not be able to make
a useful comparison between it and other frames. Using Normalize to
Series preserves the relationship.
NOTE:
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Normalize to Frame - This normalizes each individual frame based on its
own minimum and maximum pixel value. See the note below.
Using the Control Panel
Tool
2.4
Description
Define Tiling - This allows you to set the number of (sequential) images in a
viewer. The maximum is 4x4 tiles.
Previous Page - This displays the previous frame in a cine.
Next Page - This displays the next frame in a cine.
Here are the options for the Scroll feature above:
Scroll forward
Scroll backward
Click-drag down
Click-drag up
Right arrow key
Left arrow key
Page Down key
Page Up key
Scroll mouse wheel backward
Scroll mouse wheel forward
End key (scrolls forward to last frame)
Home key (scrolls back to first frame)
Context Image Tools
Right-clicking in a viewport when it is selected provides access to a menu
with some combination of the following tools, depending on what type of
viewport is active.
NOTE:
Tool
To select a viewport, Ctrl-click it.
Description
Scroll - For cine datasets, this scrolls through the images in order. Use any of the
options in the table below to scroll through a series.
Deselecting the Scroll menu item only affects the click-drag scroll
method, not the arrow keys, scroll wheel, etc.
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Pan - This moves the image within the viewer. The image follows the motion of
the mouse.
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Zoom- This increases and decreases the apparent size of the image. Drag the
mouse up to enlarge the image, down to shrink it.
Graylevel - This adjusts the brightness and background, allowing you to normalize
a dataset. Hold down the left mouse button and drag it vertically to adjust the
brightness in the selected viewer, and horizontally to adjust the background. See
the section on “Using the Image Control Bar (ICB)” on page 47 for details.
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Tool
Description
Position - This allows you to move through the slices of a 3D volume.
Roll - This allows you to rotate a 3D image around the axis that is perpendicular
to the cursor direction.
Rotate - This allows you to rotate a 3D image around the axis that points into the
screen.
Bin Selection - For gated tomo datasets, you can use this pull-aside menu to
select the bin to display.
Previous Page - This displays the previous frame in a cine.
Next Page - This displays the next frame in a cine.
Define Tiling - This allows you to set the number of (sequential) images in a
viewer. The maximum is 4x4 tiles.
Colormap Tools - This pull-aside menu allows you to select a colormap from a
list, an intensity correction from a list, and the next and previous colormap and
intensity.
[no icon]
Previous Intensity - This applies the previous item in the intensity list.
[no icon]
Next Intensity - This applies the next intensity map in the list.
Invert Graylevel - This inverts the pixel values on the underlying image, so
darker areas become lighter, and lighter areas become darker. Depending on the
colormap applied to the image, you may see a different effect.
NOTE:
This is not available in AutoSPECT Pro.
Contrast Stretch - This resets the grayscale values of only the pixels in the viewport such that the lowest pixel value becomes 0 and the highest becomes 255. The
rest of the pixels are scaled appropriately. This is most useful when you are
zoomed into an image far enough to have some pixels beyond the edges of the
viewport.
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Histogram Windowing - This resets the viewer contrast level to a reasonable
value for data that does not have SUV values calculated. Use this tool to make a
quick contrast adjustment when the values are far off normal.
Using the Control Panel
Tool
2.4
Description
Text Box - This allows you to type text on the image. To use it, click in the viewer
and type. You can then move it by dragging, and set its properties (see “Applying
Properties Changes to an Object” on page 59 for details). Right-clicking on it displays a menu of options you can use for the object. You can append the text, and
by deleting text from the end backwards, you can replace text. This text is not
saved; to preserve it you must create a secondary capture. To create text you can
save, you must create a Viewer Label (see below). This does not work for 3D
images in the MPR Fusion layout.
CAUTION: When you add annotations, be careful not to accidentally cover
some patient information. If you do, you could misidentify a patient, potentially causing misdiagnosis.
Arrow + TextBox - This is like the Text Box above, but it creates an arrow with
text attached to it. To use it, click in the viewer where the arrowhead should be,
then click to set the other end of the arrow. Now you can type the text. You can
move it by dragging, and set its properties. Right-clicking on it displays a menu of
options you can use for the object. This does not work for 3D images in the MPR
Fusion layout.
CAUTION: When you add annotations, be careful not to accidentally cover
some patient information. If you do, you could misidentify a patient, potentially causing misdiagnosis.
Measure - This pull-aside menu provides tools for making measurements on an
image. These tools are also available in the Utilities section of the Global Image
Tools. See the section on “Making Measurements” on page 52 for details.
NOTE:
This does not work for 3D images in the MPR Fusion layout.
Astonish - Planar Astonish is an image restoration process (a special type of filter) to enhance the image resolution for a planar image by using the Blind Deconvolution technique. Image restoration is a process to remove or minimize known
degradations in an image. There are three settings you can use: Sharp, Sharper,
and Sharpest. These correspond to 3, 5, and 10 iterations, respectively. For
details on Astonish, see the appendix, “Astonish Reconstruction” on page 163.
It is not recommended to use planar Astonish with projection data.
Resolution recovery for SPECT data should be done with Astonish in
AutoSPECT PRO.
NOTE:
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Movie Control - This toggles the display of the movie controls, which allow you
to stop and start a cine, and to set the frame rate.
Orientation Markers - This toggles the display of single-letter orientation labels
appropriate to the viewer type (Left-Right, Anterior-Posterior, etc.).
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Paste - This pastes a saved ROI created using a Measurement tool.
Viewer Label - This displays the Viewer Label Editor. See the section on “Using
the Viewer Label Editor” below for details.
Normalize to Frame - This normalizes to the maximum pixel value in the superior half of the pixel data space in each frame. See the note below.
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Using the Control Panel
Tool
Description
Normalize to Series - This normalizes the image using the hottest pixel in the
entire slice volume (for volume datasets) or series (for dynamic datasets).
Use the normalization functions carefully because they can have
dramatically different effects, depending on the dataset. When the counts are
generally low in some frame in a series, if you normalize the frame using
Normalize to each Frame, it (and every other frame) looks like it has a full
range of counts. This means that you may not be able to make a useful
comparison between it and other frames. Using Normalize to Series preserves
the relationship.
NOTE:
Select Visual Type - For volumes, this allows you to select a view of the volume
data.
[various
icons]
[Rendering Modes] - This allows you to select a rendering mode from the pop-up
list. See the section below on “Rendering Modes.”
Threshold - For 3D volumes rendered using the ISO Surface, this adjusts the
number of Hounsfield Units above which to create a rendered surface.
Switch Image Orientation - This sets the orientation of the image. Select the
appropriate orientation from the list.
[various
icons]
[Volume type] - This allows you to select how much of a volume to display: a single
slice; small, medium, or large slab; or the entire volume.
Select Overlay - This toggles the active status of the top image (making it active
for setting the colormap, for example). This is available only for fusion studies.
Select Underlay - This toggles the active status of the bottom image (making it
active for setting the colormap, for example). This is available only for fusion studies.
Sum - This displays a composite image in which each pixel is the sum of the corresponding pixel in all the images.
[no icon]
Max - This displays a composite image in which each pixel is the max of the corresponding pixel in all the images.
[no icon]
Isocontour - This displays a pop-up menu of all the isocontour ROIs in the image,
and a slider to control the sensitivity of the edge detection of the object. The
slider settings for the ROIs are saved as part of a Preference.
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[no icon]
Here are the options for the Scroll feature above:
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Scroll forward
Scroll backward
Click-drag down
Click-drag up
Right arrow key
Left arrow key
Page Down key
Page Up key
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Scroll forward
Scroll backward
Scroll mouse wheel backward
Scroll mouse wheel forward
End key (scrolls forward to last frame)
Home key (scrolls back to first frame)
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Using the Movie Controls
The Movie tool displays a panel at the bottom of the viewport with these
features:
Figure 11 Movie controls
Play/Pause
2. Change Frame Rate - This slider controls the speed at which the cine
1.
plays (1-100 frames per second)
Using the Viewer Label Editor
Clicking Viewer Label displays a panel at the bottom of the viewport with
these features:
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Figure 12
Viewer label editor
1.
Text - Type label text here.
2.
Location - You can either enter coordinates in the X and Y boxes or
drag the label directly in the viewer. When you drag, the location values
update automatically.
3.
Create - Click this to place the label in the viewer.
4.
Update - Click this to apply any edited values to the selected label.
5.
Label list - This is a list of all the labels in the active viewer.
6.
Delete - This deletes the selected label.
7.
All Frames - Checking this displays the label on all frames of a cine.
An easy way to use the Viewer Label Editor is to just click Create, and
then edit and move the new label directly on-screen by typing in the label
box or dragging it. You can edit and move an existing label similarly.
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Using the Control Panel
Labels are also available as Preferences. In the Preference Editor, you can
click on the Labels tab and see labels for all images, sorted by workstep.
You can edit the text and location within the editor. For more on creating
and editing Preferences, see the section on “Creating and Editing
Preferences” on page 43.
•
MaxIP - For each pixel in the output image a ray is cast through the
volume. At equally-spaced discrete sampling positions, the value is
(tri-linearly) interpolated from the nearest volume samples/voxels. The
output image pixel is assigned the maximum value sampled by the ray.
This creates a 2D image of the brightest voxels.
•
MinIP - This is the same as MaxIP, except each output image pixel is
assigned the minimum value sampled by the ray.
•
Average - This is the same as MaxIP, except each output image pixel
is assigned the average value sampled by the ray.
•
Summed Intensity - For each pixel in the output image a ray is cast
through the volume. At equally-spaced discrete sampling positions, the
value is (tri-linearly) interpolated from the nearest volume
samples/voxels. The output image pixel is assigned the sum of all
values sampled by the ray.
•
Shaded Opacity Blend - For each pixel in the output image a ray is cast
through the volume. At equally-spaced discrete sampling positions, the
value is (tri-linearly) interpolated from the nearest volume
samples/voxels. Each value along the ray is assigned a (RGBA) color by
applying a color and opacity map. A color map transforms a scalar
value to an RGB color. An opacity map transforms a scalar value to an
opacity value. Each of the color values for the sampling positions are
then composited together. Phong shading is applied and the final color
value assigned to the output image pixel.
•
Opacity Blend - This is the same as Shaded Opacity Blend, but
without the shading.
•
ISO Surface - The surface representing constant value within the
volume.
Using the Application Palette
The Application Palette allows you to select an application with which to
view a study. You can switch to any application, however if the study is not
compatible with the application you cannot load any of the data. Since
this Manager is always available, you can switch applications at any time.
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Rendering Modes
Using the Control Panel
Figure 13
2.4
Application Palette
Image and Curve Manipulation
The Image and Curve Manipulation Tool (ICMT) allows you to perform
processing operations on images and on generated curves. These
operations can include (but are not limited to) image math, filtering,
correction, and curve generation. You can perform multiple processing
functions without having to store the processed image in the database and
then recall the image to perform the next function.
The ICMT can manipulate the following image types:
•
Static
•
Dynamic
•
SPECT
•
Gated SPECT
•
Total Body
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Generated result datasets are DICOM 3.0 compliant, and do not
overwrite existing data.
Whenever you create a new result to be used in another application,
be sure to follow these guidelines:
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NOTE:
•
Always visually verify the dataset for artifacts, erroneous results, or any
non-conformity.
•
Always verify the dataset against the minimum dataset requirements
for the application.
IMPORTANT:
Be sure to experiment with different values when performing
operations on an image (math, filters, correction, etc.) to get the results
you need. Do not count on any default to create an image that meets your
specific needs.
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Using the Control Panel
Using the ICMT
•
Image Crop: This allows you to create an image that is a subset of
another image. See the section on “Image Crop” on page 27 for details.
•
Image Filter: This provides four common filters to use on images:
Laplacian, Spatial 3x3, Spatial 5x5, and Spatial Temporal. See the
section on “Image Filter” on page 27 for details.
•
Image Math: This provides the four basic math operations (+, –, x, /)
for both image math and constant math. Nth Root and Clipping is
also included. See the section on “Performing Operations on Images”
on page 28 for details.
•
Frame: This provides five functions that operate on frames: Append,
Compress, Extract, Image Mask, and Matrix Convert. See the section
on “Manipulating Frames” on page 30 for details.
•
Image Orient: This provides tools for reorienting an image by rotating
or flipping it, and by reversing the frame index. See the section on
“Image Orient” on page 34 for details.
•
Astonish: This provides functions to support Planar Astonish as a
deconvolution image processing algorithm for optimized resolution
recovery on non-gated planar static, planar dynamic, planar total
body, and tomographic projection data sets. See the section on
“Astonish” on page 35 for details.
•
Attenuation Correction: This provides Chang’s-based edge detection
based on the isotope used. See the section on “Attenuation Correction” on page 36 for details.
•
Motion Correction: This provides functions for performing manual
motion correction. See the section on “Motion Correction” on page
37 for details.
•
Create Curve: This provides tools for creating curves and calculating
ratios based on ROIs. See the section on “Create Curve” on page 39
for details.
•
Volume Knitting: This allows you to stitch reconstructed tomograms
together to create a larger volume. See the section on “Volume Knitting” on page 42 for details.
To use a panel, click on its arrow button:
Figure 14
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Button to open an ICMT panel
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The ICMT has 10 panels that allow you to perform different sorts of
operations:
Using the Control Panel
2.4
The Status Bar at the bottom of the viewing area displays information
relating to the operation to be performed, for example, “Select a region
size,” or “Image type is not compatible with this operation.” Check this
box for quick instructions or related information.
Figure 15 Status Bar (lower right)
NOTE:
Some ICMT panels use ROIs as inputs. You cannot use ROIs drawn
in the Define Regions workstep as input. You must draw new ROIs using the
Measurements feature in the Utilities Data Manager or in a viewport’s
context menu.
In the ICMT, image names may not match what you see in a viewer or the
EBW Patient Browser. This happens when there are multiple datasets with
the same Object Name (for example “LAT”). The Object Name is taken
from the Image ID. The ICM Tool then uses the name as a base string and
appends a number. So you could see names like “LAT,” “LAT-1,”
“LAT-2,” etc. More technically, for multiple images below the same series,
the series PIIM object is constructed once and is reused for all the
subsequent images having the same Series Instance UID.
Image Crop
NOTE:
This feature only works for whole body, static, dynamic, and tomo
datasets.
1. Open the Image Crop panel using its arrow button.
2. Select a dataset from the Image pull-down menu.
3. Click Open Image (
).
A crop box with the dimensions of the Crop Size appears.
4. If necessary, change the crop size using the Crop Size pull-down menu.
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5. Position the crop box by dragging it. Be sure to drag the lines that define
the box, not the interior of the box.
6. Type a name for the result file in the Result text box.
7. Click Create (
).
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The result appears in a new tab in the current viewport.
Image Filter
The filtering process is similar for static and dynamic images. Filtering is
accomplished by assigning each pixel in an image, one at a time, a new
count value. The new count value is determined by the specific filter
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weighting arrangement applied to the image. In other words, each pixel is
multiplied by a number that is determined by the pixel’s position relative
to the center pixel.
The products of these multiplications are added together, but only the
pixel in the center is assigned the resulting “weighted average” count value.
The filter is then moved and the process repeated, until every pixel in the
image has been treated as the center and assigned a new, weighted average
count value.
For details on each filter’s coefficients and weighting arrangement, see the
section on “Filters” in the NM Application Suite Reference Manual.
NOTE:
Filtering an 8-bit deep image will convert it to a 16-bit deep image.
1. Open the Image Filter panel using its arrow button.
2. Select a dataset from the Image pull-down menu.
3. Select a Method.
There are four filters available:
• Laplacian
• Spatial (3x3)
• Spatial (5x5)
• Spatial Temporal
4. Type a name for the result file in the Result text box field.
5. Click Create (
).
The result appears in a new tab in the current viewport.
Performing Operations on Images
•
Two static
•
Two dynamics
•
One static and one dynamic
When operating on two dynamic images, both images must have the same
number of frames; the operation is applied between corresponding frames.
In subtraction, for example, frame 1 of the second image set is subtracted
from frame 1 of the first image set, frame 2 of the second image set is
subtracted from frame 2 of the first image set, and so on, through all the
frames of the two dynamic image sets.
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Use the Image Math panel to perform image math. Arithmetic operations
can be applied to these datasets:
Using the Control Panel
2.4
If one image is dynamic and the other is static, then the operation is
applied between each frame of the dynamic image and the static image.
The resulting image is a dynamic image with the same number of frames
as the dynamic image.
You can operate on images with different matrix depths, but not on
images with different matrix sizes. For example, an image with a matrix
depth of 8 and an image with a matrix depth of 16 can be added together,
however, the resulting image has a matrix depth of 16. On the other hand,
an image with a matrix size of 64 x 64 cannot be added to an image with a
matrix size of 128 x 128. The Matrix Convert function can be used to
convert an image to a specified matrix size.
Some image operations may produce results that at first may seem
unexpected. For example, when multiplying an image, the max value for
the image may change. This can happen if some pixels become saturated
(reach a value of 32,767) as a result of the multiplication. In this case, each
of the saturated pixels will have the maximum value.
In Math operations, all header information from the source image is
copied to the new result, so, for example, if you save the result image to
the database you will not see the current date as the exam date.
When performing image math, you must select an Operation and possibly
the Type of information to operate on.
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Operations:
•
Add: This adds the second operand to the image.
•
Subtract: This subtracts the second operand from image.
•
Multiply: This multiplies image by the second operand.
•
Divide: This divides the image by the second operand
•
Clip: This allows you to set a threshold or clip value by checking Clip
Above or Clip Below. To threshold, type a value in the text box. To
clip, type a value in the text box and check Set to 0. The difference is
that Set to 0 sets values beyond the one in the text box to 0 instead of
to the value in the text box. The value can be a number or a percentage,
so you can type “1100” or “50%”, for example. The percentage is
calculated based on the image max. (The image minimum and
maximum appear for reference below the text box.)
•
Nth Root: This takes the Nth root of the image using a value for N
that you set in the Nth Root box.
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Types of information:
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•
Image: The values of the pixels in a second image that you select (using
the Image 2 list) are used for the second operand.
•
Constant Value: The value you type in (using the Value box) is used
for the second operand. The value can be a number or a percentage, so
you can type “1100” or “50%”, for example. The percentage is calcu-
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lated based on the Image max value. (The image minimum and
maximum appear for reference above the Result box.)
•
•
Image Statistics: The method you choose from the Method menu is
used for the second operand:
–
Minimum calculates the minimum pixel value (in all frames).
–
Average calculates the mean pixel value (using the sum of all the
frames’ means).
–
Maximum calculates the maximum pixel value (in all frames).
ROI Statistics: This allows you to select an ROI from the list in From
ROI, and use its statistics as an operand. As in Image Statistics, you can
select the Method (Minimum, Average, or Maximum). For
multi-frame images, check Frame By Frame to apply the Method to
each frame (rather than to all frames at once) to create the equivalent
result frame.
NOTE:
You must use one or more ROIs created using the Measurement
tools to use ROI Statistics, not ROIs drawn as part of the Define Regions
workstep. Also, the list of available ROIs in the From ROI list consists of all
ROIs for the image currently displayed in the Image menu, even if there are
multiple instances of the image, in different containers.
The basic procedure for using the Image Math panel is:
1. Open the Image Math panel using its arrow button.
2. Select a dataset from the Image pull-down menu.
3. Use the controls described above as appropriate.
4. Type a name for the result file in the Result text box field.
5. Click Create (
).
Manipulating Frames
Image Frame allows you to manipulate frames by appending,
compressing, extracting, masking, and converting the matrix.
Use Frame Append to add frames from additional acquired phases or
statics to create a single continuous dataset. Images to be appended must
have the same matrix size.
NOTE:
You can only append static or dynamic images.
You can also append static images to dynamic datasets. In this case, the
static images are appended to the last phase of the dynamic dataset. Also,
for statics, the frame interval is the average of all the intervals.
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Frame Append
Using the Control Panel
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You can append two or more static images to create a single-phase
dynamic dataset, or two dynamic images to create a multi-phase dynamic
dataset. Each phase maintains its original time per frame information. You
can also append static images to the end of a dynamic dataset. In this case,
the static images inherit the image rate of the dynamic dataset.
NOTE: Images are appended using the time normalization method. For
static images, each frame interval is the average of all frame intervals.
The maximum pixel and total counts of each appended image are scaled
up or down to match the image rate.
NOTE: If you create a dynamic dataset from static images for use in the
ICMT Motion Correction tool, you must save the data and exit the
application before performing motion correction.
1. Open the Image Frame panel using its arrow button.
2. Select a dataset from the Image pull-down menu.
3. Select Frame Append from the Image Frame icon’s pull-down menu.
4. Select a dataset to append from the Image 2 list.
5. Type a name for the result file in the Result text box.
6. Click Create (
).
Frame Compress
Use Frame Compress to reduce the number of frames in a dynamic image
set. This divides the original frames into small groups, each containing an
equal number of frames, which you specify. The frames in each group are
then added into one frame. If the number you specified does not divide
evenly into the number of frames of the original dataset, the remaining
frames are discarded.
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For example, if the number of frames of the original data is 16, and the
number you specify is 2, then every two frames are added together to
create an 8-frame dynamic image. But if the number of frames of the
original data is 16, and you specified 3, then the result is a 5-frame
dynamic image, and the sixteenth frame of the original dataset is
discarded.
For multiphase datasets, the number of frames available to compress is the
number of frames in the smallest dataset. You cannot compress static or
whole body datasets.
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NOTE: In some cases, when multiple frames of a 16-bit image are added
together, a condition called “rollover” occurs. Rollover occurs when the
pixel value exceeds 216 -1, thus rolling over to a pixel value of 0. This causes
the resulting image to have black holes where rollover occurred. If this is
not the desired effect, scale down the pixel values by multiplying the image
by a small value (such as 0.05).
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One situation where you might use Frame Compress is when you want to
combine a fast phase dynamic with a slow phase dynamic. In a case like
this, you could compress the first phase of 180 frames of 1 sec to 9 frames
of 20 sec in order to then combine them with a second at 20 sec/frame.
The resulting dataset is a single phase dynamic, since the frame rates of the
2 dynamics are now the same.
For gated tomo or reconstructed gated tomo data, you cannot select the
number of frames to compress: all bins are compressed, yielding just a
tomo or reconstructed tomo (ungated) dataset. In this case the controls are
replaced by the text “Compress All Bins.”
1. Open the Image Frame panel using its arrow button.
2. Select a dataset from the Image pull-down menu.
3. Select Frame Compress from the Image Frame icon’s pull-down
menu.
4. Set the Compress By Factor by typing a number or using the arrow
buttons to increase or decrease the number.
Frames are compressed in groups (see the illustration below). Setting
the Compress By Factor to 5 compresses 5 frames at a time. By
default, each frame is in exactly one group of compressed frames.
However, you can create an overlap or skip frames using the Offset
feature. This specifies the number of frames to skip, starting from the
first frame in a group, before starting a new group.
For gated planar datasets, you can either compress all bins to one bin,
or compress by a factor of 8. So if you have 24 bins, you can compress
to 1 bin or to 3.
NOTE:
If you need to use an Offset that is different from the default (which is
the same as the Compress By Factor value), use the arrow buttons to
increase or decrease the existing number.
5. If necessary, adjust the Offset.
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Figure 16 Using Compress By Factor and Offset
Using the Control Panel
2.4
6. If Compress By Factor is 5 and Offset is 5, compression is performed
on frames 1-5, then frames 1-5 are skipped before starting a new
group, 6-10; then the first 5 frames of the new group are skipped
before starting another group, and so on. If Compress By Factor is 5
and Offset is 2, compression is performed on frames 1-5, then the
first two frames are skipped and a new group of 5 starts on frame 3,
then the first two frames of the new group are skipped and a new
group of 5 starts on frame 5, and so on. Similarly, increasing the
Offset to 7 would create a gap of 2 frames after every 5. (See the
figure above.)
7. Type a name for the result file in the Result text box.
8. Click Create (
).
The result appears in a new tab in the current viewport.
Extracting Frames
Use Frame Extract to remove a frame or range of frames from a dynamic
image. The new dataset is the extracted frame(s).
NOTE:
You can extract frames from tomo, gated, dynamic, or reconstructed
tomo datasets.
NOTE: To extract frames from a tomo dataset, it must be a 360° tomo with
64 or 128 projections. To create a 180° tomo you can just extract half the
frames. If you extract frames in the middle of a projection, you cannot save
them as a new tomo, but you could create a static from them. To extract
frames from a gated tomo dataset you must compress all the bins first
(using the Frame Compress feature).
1. Open the Image Frame panel using its arrow button.
2. Select Frame Extract from the Image Frame icon’s pull-down menu.
3. Select a dataset from the Image pull-down menu.
4. For multiphase datasets, select a Phase to extract.
NOTE:
For multiphase datasets, you cannot extract across phases.
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5. Type the number of the start frame in the Extract Frame From box or use
the arrow buttons to increase or decrease the existing number.
6. Type the number of frames to extract in the Count box or use the arrow
buttons to increase or decrease the existing number.
7. Type a name for the result file in the Result text box.
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8. Click Create (
).
The result appears in a new tab in the current viewport.
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Matrix Conversion
Use Matrix Convert to convert an image frame from one matrix size to
another. This function is intended for use in situations where data has
been acquired in a matrix size that is incompatible with a desired
processing function. All images are automatically converted to a depth of
16; 16-bit deep images cannot be converted to 8-bit deep images. Total
counts of the new image are within 5% of the original image.
1. Open the Frame panel using its arrow button.
2. Select a dataset from the Image pull-down menu.
3. Select Matrix Convert from the Image Frame icon drop-down menu.
4. Select a matrix size from the Convert to drop-down menu.
5. To avoid averaging counts when converting, click Preserve Total Counts.
This preserves the counts in each pixel.
6. Type a name for the result file in the Result text box.
7. Click Create (
).
The result appears in a new tab in the current viewport.
Image Mask
Use the Mask feature to set pixels inside or outside an ROI to 0.
1. Open the Image Frame panel using its arrow button.
2. Select a dataset from the Image pull-down menu.
3. Draw an ROI to use as a mask (use one of the Measurement tools in the
context menu available when you right-click on an image).
4. Click Mask In to set pixels inside the ROI to 0; click Mask Out to set
pixels outside the ROI to 0.
5. Select the ROI to use as the mask from the From ROI list.
6. Type a name for the result file in the Result text box.
7. Click Create (
).
Image Orient
For an image, you can rotate and flip to change the orientation; for a cine,
you can reverse the order of the frames. This feature works on all datasets
except for reconstructed gated tomo datasets.
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The result appears in a new tab in the current viewport.
Using the Control Panel
2.4
NOTE:
The Image Tools Data Manager contains tools to rotate and flip
images. The difference between those tools and the ones in this panel is
that the former only change the display; the ones in this panel create new
image data, which you can then save.
1. Open the Image Orient panel using its arrow button.
2. Select a dataset from the Image pull-down menu.
3. Select an orientation from the Rotation menu.
NOTE:
The Reverse Frame Index menu item reverses the order of a set of
frames.
4. Type a name for the result file in the Result text box.
5. Click Create (
).
The result appears in a new tab in the current viewport.
Astonish
Astonish is an image restoration process (a special type of filter) to
enhance the image resolution for a planar image by using the Blind
Deconvolution technique. Image restoration is a process to remove or
minimize known degradations in an image.
You can use any data except for volume and tomo.
The default radioisotope is the one used to generate the image, but you
can override it. The default isotopes are:
Au-195m
Co-57
Co-58
Co-60
Cu- 62
F-18
Fe-59
Ga-67
Ga-68
I-123
I-125
I-131
In-111
Kr-79
Kr-81m
MO-99
Tc-99m
Tl-201
Xe-127
Xe-133
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1. Open the Astonish panel using its arrow button.
2. Select a dataset from the Image pull-down menu.
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If the image has radioisotope, collimator, and pixel size information in
the header, the Radioisotope, Collimator, and Pixel Size fields are
filled in automatically (the Collimator and Pixel Size fields are for
display only, not input).
3. If the Radioisotope field is not filled in, select a radioisotope from the
pull-down list.
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4. Set the number of Iterations.
The higher the Iterations value is, the sharper the image becomes.
However, at some point artifacts (noise) may start to appear. Be careful
to strike a balance between sharpness and avoiding artifacts.
5. Type a name for the result file in the Result text box.
6. Click Create (
).
The result appears in a new tab in the current viewport.
Attenuation Correction
You can use Attenuation Correction on an image to compensate for the
absorption and scattering that occurs in count information as it passes
from inside the body to the detector. The attenuation correction method
used is Chang's Attenuation Method.
NOTE:
Attenuation correction is only appropriate for transverse images,
and operates only on reconstructed tomo datasets.
The algorithm estimates the attenuation at any point by computing
(e–µd), where µ is the amount of attenuation per cm, and d is the distance
from any point to the edge of the body in cm. This is a post reconstruction
correction algorithm.
For transverse brain images, edge detection is automatic. For other
transverse reconstructed images, for example cardiac, you can manually
define ROIs and then apply the attenuation correction.
Attenuation Correction requires the following data:
•
Transverse images in 64 x 64 or 128 x 128 matrices
•
An attenuation coefficient based on the radionuclide used (automatically extracted from the patient header)
•
A pixel calibration factor (automatically extracted from the patient
header)
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Isotope
Energy (keV)
Coefficient
Au-195m
262
0.1
Co-57
122
0.12
Ga-67
90,184, 297
0.12
I-123
159
0.12
I-131
364
0.1
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The attenuation coefficient is determined by the radioisotope used to
generate the image, but you can override that value. The default
attenuation coefficients are:
Release 1.0
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Isotope
Energy (keV)
Coefficient
In-111
173, 240
0.12
Tc-99m
140
0.12
Tl-201
80,167
0.14
Xe-133
81
0.14
2.4
1. Open the Attenuation Correction panel using its arrow button.
2. Select an image from the Image menu, then click Open (
).
3. Click Identically in all Frames to draw an ROI the same size in all
frames; click Individually Frame by Frame to draw an ROI in each
frame based on edge detection within that frame.
4. Resize and readjust the ellipses, if necessary.
5. If the isotope is wrong, select the correct one from the Isotope
pull-down menu.
The default Coefficient is filled in according to the selected Isotope.
If you need to redo the edge detection, click Reset.
6. Type a name for the result file in the Result text box.
7. Click Create (
).
The result appears in a new tab in the current viewport.
References
1. Budinger TF, Gullberg RT, Nuesman RH: 1979. Emission computer
tomography. Image Reconstruction from Projections: Implementation
and Applications, ed G. T. Herman, Springer-Verlag.
2. Budinger TF, Gullberg RT: 1981. The use of filtering methods to
compensate for constant attenuation single-photon emission computer
tomography. IEEE, Transactions in Biomedical Engineering
BME-28:42-157.
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3. Chang LT: 1978. A method for attenuation correction in radionuclide
computer tomography. IEEE, Transactions in Nuclear Science
NW-25:638-643.
Motion Correction
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Use Motion Correction to adjust the positions of the loaded images to
correct for patient motion. When you open a dataset for motion
correction, you see a splash display so you can interactively browse the
images in the study. You can only motion correct gated planar and
dynamic datasets.
You can have the system calculate corrected positions automatically, or you
can manually correct images yourself.
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1. Open the Motion Correction panel using its arrow button.
2. Select a dataset from the Image pull-down menu.
3. Click Open (
).
The dataset opens as a splash display in a new viewer.
4. Click a Correction Method.
NOTE:
Marker boxes are not used to locate significant image areas; they are
just for reference. You could use the measurement tools to draw reference
objects as well.
5. In the Markers section, click the button representing the number of
markers to use.
Figure 17 A marker box
6. Drag any of the marker boxes and center them on significant areas
within the image.
7. Adjust their size to constrain the area in which the software looks for
the image markers.
8. Scroll through all the images and make sure that the marker boxes
enclose the significant area in each image. If they do not, resize the
image.
9. If there are image markers you do not want to appear in the preview,
check Blank Regions.
10. To avoid accidently moving or resizing markers once they are in place,
click Lock Markers.
12. If you have moved any images and want to reset them to their original
positions, click Reset. This resets all adjusted images simultaneously.
You can only reset the markers and images on the original image, not
on a Result image.
13. Type a name for the result file in the Result text box.
14. Click Create (
).
Depending on the placement of the marker boxes, the motion correction algorithm may produce artifacts. The only way to fix an artifact
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11. Examine the frames. If you selected Manual, you can adjust them by
dragging or typing values in the X and Y fields in Frame Offset by
Axis.
Using the Control Panel
2.4
problem is to try placing the marker boxes differently and redoing the
correction.
The result appears in a new tab in the current viewport.
Create Curve
You can use the Create Curve panel to create curves and ratios for ROIs,
and to export an ROI to an Excel file. Curves appear in a new viewer.
When a curve viewer is active, the ICMT Data Manager has panels that
allow you to perform operations on curves instead of images.
To switch from the curve functions to the image functions, click on the
tab of an image viewer. Clicking on the tab of a curve viewer switches
back.
IMPORTANT:
You cannot use ROIs created in the Define Regions workstep.
You can only use ROIs you draw using the Measurements tool, available in
the Utilities Data Manager or the right-click context menu.
You can create ROIs at any time, not just when the Create Curve panel is
active.
NOTE: If you create a curve from a multiphase dataset, it displays frame
data, not time data. This means that the x axis displays frame numbers,
not time increments.
ROIs you create appear in the ROI pull-down menu.
1. If you do not already have an ROI, create one using one of the
Measurement tools available in the Utilities Data Manager or context
menu.
2. Select an ROI using the ROI dropdown box, or click Select All to select all
the ROIs.
Select All selects all ROIs in all containers. However, it usually only makes
sense to create curves for ROIs in one viewer. For this reason, be sure the
ROIs you have are all confined to one viewer.
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3. Select a method from the Method drop-down menu. The methods are:
• Min plots the minimum pixel value for each frame.
• Mean plots the mean pixel value for each frame.
• Max plots the maximum pixel value for each frame.
• Sum plots the total pixel values for each frame.
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4. Click Export ROI if you would like to export the ROI information to a
comma-separated (.csv) Excel file. Using the Save As dialog, this exports
only the selected ROI.
5. Click Create (
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6. In the Curve field, type a name for the curve to be plotted. This is the
label for the curve that appears in the plot.
7. In the Result field, type a new name for the plot or select an existing plot
from the pull-down menu. This is the name that appears in the resulting
viewer’s tab.
A new viewer appears with the curves in it, and the ICMT panel changes
to display a new set of four panels. See the following sections for more on
these.
•
Curve Filter: This provides four ways to interpolate points on a curve:
Smooth Filter (3- and 5-point), Linear Fit, and Exponential Fit.
•
Curve Math: This provides the four basic math operations (+, –, x, /)
for both image math and constant math. You can also use this to
display a selected curve’s information from a subset of its frames.
•
Curve Decay Correction: This allows you to perform decay correction
based on the isotope used in the study.
•
Curve Properties: This allows you to export curve information,
change the curve line color, and delete curves.
NOTE:
If a dataset has time information, you can change the X axis of the
plot to display minutes, seconds, milliseconds, or frames. Use the mouse
scroll wheel to cycle through the choices.
Interpolating Curve Points (Curve Filter)
Use this panel to interpolate points on a curve.
1. With a curve viewer active, click the Curve Filter arrow button in the
ICMT panel.
2. Select a curve using the Curve list.
3. Select a Method:
• Smooth (5 point) Filter
• Smooth (3 point) Filter
• Exponential fit
4. In the Result Curve field, type a name for the curve to be plotted or use
the drop-down button. This curve label appears in the plot.
5. In the Plot field, type a new name for the plot or select an existing plot
from the drop-down menu. This is the name that appears in the resulting
viewer’s tab.
6. Click the Create icon.
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• Linear Fit
Using the Control Panel
2.4
Performing Math Operations on Curves
When performing curve math, select an operation and optionally a second
operand. The operations are:
•
Add to Curve: This adds the second operand to the curve.
•
Subtract from Curve: This subtracts the second operand from the
curve.
•
Multiply Curve: This multiplies the curve by the second operand.
•
Divide Curve: This divides the curve by the second operand.
•
Extract from Curve: This displays a selected curve’s information from
a subset of its frames.
Operand Types are:
•
Second Operand is Curve: The values of the pixels in a second curve
that you select are used for the second operand.
•
Second Operand is Constant Value: A value you type in is used for the
second operand.
To preform curve math:
1. With a curve viewer active, open the Curve Math panel using its
arrow button.
2. Select a curve from the Curve 1 drop-down menu.
3. Select an Operation and an Operand from the pull-down lists.
4. Select a second curve from the Curve 2 menu.
5. In the Curve field, type a name for the curve to be plotted or use the
drop-down menu. This curve label appears in the plot.
6. In the Plot field, type a new name for the plot or select an existing
plot from the drop-down menu. This is the name that appears in the
resulting viewer’s tab.
7. Click Create.
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The result appears in a new tab in the current viewport.
Decay Correction on Curves
Decay Correction allows you to perform decay correction based on the
isotope (and its half-life) used in the study.
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The default radioisotope is the one used to generate the image, but you
can override it. The default isotopes are:
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Au-195m
Co-57
Co-58
Co-60
Cu- 62
F-18
Fe-59
Ga-67
Ga-68
I-123
I-125
I-131
In-111
Kr-79
Kr-81m
MO-99
Tc-99m
Tl-201
Xe-127
Xe-133
Yb-169
1. With a curve viewer active, open the Decay Correction panel using its
arrow button.
2. Select a curve from the Curve drop-down menu.
3. Select a radioisotope from the Radioisotope drop-down menu.
4. In the lower Curve field, type a name for the curve to be plotted or use the
drop-down menu. This curve label appears in the plot.
5. In the Plot field, type a new name for the plot or select an existing plot
from the drop-down menu. This is the name that appears in the resulting
viewer’s tab.
6. Click Create.
The result appears in a new tab in the current viewport.
Curve Properties
•
To display statistics, select a curve in the Curve list and click Statistics.
A panel appears at the bottom of the image, and contains counts,
times, slope, etc.
•
To change the line color, select a curve in the Curve list and click Line
Color. This brings up the Windows color picker. Select a color and
click OK.
•
To export curve values, select a curve in the Curve list and click Export
Curve. This brings up the Windows Save dialog. Use the dialog to
name and locate the saved file.
NOTE:
•
Saved curve files are in the .csv (comma-separated values) format.
To remove a curve, select a curve in the Curve list and click Remove.
Volume Knitting
You can use the Volume Knitting panel to stitch together multiple
reconstructed tomographic volumes into a single output tomographic
volume. For example, you could use this if you acquired multiple single
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Curve Properties allows you to export curve information, change a curve’s
line color, and delete curves.
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field of view (FOV) tomograms, reconstructed them and then wanted to
create a single reconstructed tomogram with all of the FOVs knitted
together.
NOTE:
This panel is only available in AutoSPECT Pro.
1. Use the Segment menus to load the images to be knitted.
You can view the image by clicking on its Open button (
).
2. Specify SPECT or CT using the radio buttons.
3. Type a name for the result in the Result box (or leave the default).
4. Click Create (
).
Creating and Editing Preferences
This section describes creating and editing preferences for all applications
except AutoSPECT Pro and the Review application. For information on
setting preferences for AutoSPECT Pro see the section on “Setting
Preferences for AutoSPECT Pro” on page 101. The Review application
does not have any Preferences.
You can create a Preference from scratch or create one using an existing
Preference as a starting point. You can also update an active Preference
with a single click. In all cases, you begin by modifying layouts, ROIs, and
any application-specific parameters. Then you can create, modify, or
update the Preference. For information on editing layouts, see the section
on “Editing Layouts” on page 69.
Use these controls for Preferences:
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Figure 18 Preference function buttons
1.
Create preference
2.
Open Preference Editor
3.
Update to Current and Save
4.
Show Factory
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Use the Show Factory checkbox to toggle the display of the default factory
Preferences. The rest of the buttons are discussed in the following sections.
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Figure 19
1.
User Preferences
2.
Factory Preferences
3.
Preference tabs
Preference Editor
For new Preferences, there is a Custom Display Method. Using this in a
Preference allows you to add up to 25 images to be displayed in the
Custom Display layout in the Review workstep. (And if you use
AutoMatching, the buckets can be filled automatically.) If you create a
new Preference with only the Custom Display Method, the workflow will
jump from the Setup workstep directly to the Review workstep, with no
region definition or results worksteps.
This allows you to create a Preference that is set up to display the bucketed
data in very specific ways. For example, you could set the number of
viewers and their sizes, add viewer labels, and set the colormaps so that
whatever you load is displayed consistently each time without having to
process anything.
In most cases, you will probably only need to make variants of existing
Preferences.
1. Apply the Preference to use as the starting point, or base Preference.
2. Make changes to layouts, ROIs, and application inputs as necessary.
For information on changing layouts, see the section on “Editing Layouts”
on page 69.
3. Select the Preferences Data Manager.
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Creating a Preference Based on an Existing One
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4. Click Open Preference Editor.
The Preference Editor window opens.
5. Make other changes in the Preference Editor as necessary.
6. Type a name for the preference in the Save As box.
7. Click Save.
Creating a New Preference
It is easier to create a Preference by starting with an existing one and
editing it, but you can also create one from scratch.
NOTE:
When you create a new Preference, the layouts may not match
those in the Factory equivalent of the Preference.
1. Select the Preferences Data Manager.
2. Click Create Preference.
The Preferences Editor window opens (see Figure 19).
3. Check one or more methods in the list.
4. Click Proceed.
5. Make changes to the Organs tab as needed by selecting an ROI, changing
its color, selection type, or drawing type.
6. Make changes to the Parameters tab as needed by editing the parameters.
7. Type a name for the Preference in the Save As box.
8. Click Save.
9. Click Close to close the window.
10. Apply the new Preference using the Apply layout button ( ).
11. Make additional changes to the workflow layouts as appropriate.
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For information on changing layouts, see the section on “Editing Layouts”
on page 69.
12. In the Preferences Data Manager, click Update to Current and Save.
Quick Update
1. Make the necessary changes to the workflow ROIs, layouts, and inputs.
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For information on changing layouts, see the section on “Editing Layouts”
on page 69.
2. Select the Preferences Data Manager.
3. Click Update to Current and Save.
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Using the Global Image Tools
There are two types of tools that are available in all applications. They
organize activities in these categories:
•
Image Tools: This provides basic image-related tools you can use in all
applications. See the section on “Using the Image Tools” for details.
•
Utilities: This contains miscellaneous tools, for example, ones that
create tiles, control the display of data on images, and show hidden
viewers. See the section on “Using Utilities” for details.
Using the Image Tools
The following tools are available in the Image Tools manager:
Tool
Description
Image Control Bar (ICB)- This allows you to control dynamic range, colormaps,
intensity, and pixel values. See the section below for details.
Contrast Stretch - This resets the grayscale values of only the pixels in the
viewport such that the lowest pixel value becomes 0 and the highest becomes
255. The rest of the pixels are scaled appropriately. This is most useful when
you are zoomed into an image far enough to have some pixels beyond the edges
of the viewport.
Histogram Windowing - This resets the viewer contrast level to a reasonable value for data that does not have SUV values calculated. Use this tool to
make a quick contrast adjustment when the values are far off normal.
Invert Gray Level - This inverts the pixel values on the underlying image, so
darker areas become lighter, and lighter areas become darker. Depending on
the colormap applied to the image, you may see a different effect. This is not
available in AutoSPECT Pro.
Using this reverses the effect of some of the colormap editor controls.
See below for details.
NOTE:
Pan - This moves the image within the viewer. The image follows the motion of
the mouse.
Zoom- This increases and decreases the apparent size of the image. Drag the
mouse up to enlarge the image, down to shrink it.
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Flip - This flips the image about the horizontal axis.
Mirror - This flips the image about the vertical axis.
Rotate Clockwise - This rotates the image 90°.
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Tool
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Description
Rotate Counter-Clockwise - This rotates the image -90°.
Select All Viewers - When this is Off, changes in the Image Control Bar (see
below) apply to all image viewers (not curves, results, etc.). When this is On,
changes apply only to viewers that are selected. By default, all image viewers are
selected. Selected viewers have L-shaped borders in the corners. Ctrl-click a
viewer to deselect or reselect it.
Alpha Blending - For fusion studies (SPECT/CT, PET/CT, etc.), this controls
the visibility of the two images. Dragging the mouse horizontally affects one
image, and dragging it vertically affects the other. This is available only for fusion
studies.
Reset Image Viewing Settings - This undoes changes to all viewers made
using the other Image Tools, resetting the viewers to the state they were in
when the workstep began. This is true for all tools except Roll and Rotate,
available in the right-click context menu.
Save - This has two options: Save and Secondary Capture. See “Saving
Data” below for details.
Film Display - This captures the entire viewing area for film. Click on the
Film button at the top of the window to use the film functions. See the chapter
on “FilmView” in Volume 1 of the Extended Brilliance Workspace manual for
details on this.
CAUTION: Ensure that any hardcopy output that is to be used for interpretation is of diagnostic quality (printed on Codonics printers, for example).
Non-diagnostic output may lead to misinterpretation. An example of
non-diagnostic output is a JPEG file printed on a Windows printer.
Report Display - This captures the entire viewing area for a report. Click on
the Report button at the top of the window to use the reporting functions.
See the chapter on “Report” in Volume 2 of the Extended Brilliance Workspace
manual for details on this.
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CAUTION: Ensure that any hardcopy output that is to be used for interpretation is of diagnostic quality (printed on Codonics printers, for example).
Non-diagnostic output may lead to misinterpretation. An example of
non-diagnostic output is a JPEG file printed on a Windows printer.
Using the Image Control Bar (ICB)
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The ICB allows you to control color maps, intensity, pixel values, and
upper and lower levels for an image. For fusion studies, there are two
ICBs. In this case, the top one is for the overlay image, and the bottom
one for the underlay image (usually the SPECT image). Use the following
features to control image colors and dynamic range:
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Figure 20 ICB controls
•
•
1.
Sliders
2.
Drop-down menu for Color Map, Intensity, and Pixel Values
Sliders: These adjust the background and brightness (dynamic range)
of all images that use the current color palette. All numbers are pixel
values.
–
The left (lower) slider controls the background, or lower threshold
of the color map, below which pixel values are displayed as one
color corresponding to the lowest value in the color table.
Lowering this enhances the low-count image areas.
–
The right (upper) slider controls the brightness, or upper
threshold, above which pixel values are displayed as one color
corresponding to the highest value in the color table.
–
You can adjust the background and brightness together by dragging the section of the line between the numbers.
Color Map: This is available in the drop-down menu at the right end
of the color bar. Select a color map from the choices in the menu.
CAUTION:
If you create your own colormaps you should be familiar with
digital image processing. Incorrect colormaps may lead to misdiagnosis. It is
your responsibility to verify and validate the colormaps you create or edit.
Philips is not responsible or liable for user-created colormaps. Philips
Healthcare does not guarantee the accuracy of any edited or user-created
colormap.
Intensity: The Intensity cycle field changes the intensity of the
displayed image. It is available in the drop-down menu at the right end
of the color bar. The intensity and associated functions are listed in the
table below.
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•
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Weight
Function
Log3
y = e1/2.3
Log2
y = e1/2.0
Log1
y = e1/1.5
Linear
y=x
Exp1
y = e1.5
Exp2
y = e2.0
2.4
Use Log1, Log2, or Log3 when you want to enhance the lower count
portions of an image. Use Exp1 or Exp2 when you want to enhance
the higher count portions of an image.
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Figure 21
•
1.
Intensity Factor
2.
Counts
3.
Log
4.
Linear
5.
Exp
Intensity functions
Pixel Values: This is available in the drop-down menu at the right end
of the color bar. Select an upper bound for the slider range from the
choices in the menu. The range is from 128 to 65536. The default is
based on the pixel values in the current image.
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Saving Data
The Save utility has two options: Save and Secondary Capture.
When you use Save, the Save Image dialog appears:
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Figure 22
Save Image dialog for 2D applications
Figure 23
Save Image dialog for AutoSPECT Pro
1. To save an image, check its box and optionally edit its name by
clicking on it and typing.
2. For AutoSPECT Pro, additionally select the tab for the settings used
in the current Preference, the Thickness for the Transverse and
Oblique data, and type a Technologist Name.
NOTE:
You cannot set Thickness for Sagittal or Coronal data.
3. Click Save to save the images to the EBW Patient Directory. (Be sure
to refresh the browser to see the new images.)
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When you use the Secondary Capture Utility, the Save Secondary
Capture Dialog appears.
1. Use the Save As pull-down menu to select an image format.
•
Single-Frame Secondary Capture
•
JPEG
•
Multi-Frame Secondary Capture
•
AVI
2. Type a Description and choose the appropriate settings.
3. For multi-frame and AVI formats, you can check Frame and specify
the Start and End frames, and the number of frames to Skip.
4. For gated formats, you can check Bin and specify the Start and End
bins, and the number of bins to Skip.
5. Check RGB to save color images, or Grayscale for grayscale images.
6. Click Save to save the images to the EBW Patient Directory. (Be sure
to refresh the browser to see the new images.)
CAUTION:
Do not use captured images or saved screens for diagnostic use.
They may not include all the information necessary for a diagnosis. For this
reason, they are only for reference, or inclusion in documents such as
reports and presentations.
Using Utilities
You can use the following tools to control the layout of the viewers:
Tool
Description
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Text Box - This allows you to type text on the image. To use it, click in the viewer
and type. You can then move it by dragging, and set its properties (see “Applying
Properties Changes to an Object” on page 59 for details). You can append the text,
and by deleting text from the end backwards, you can replace text. Right-clicking on
it displays a menu of options you can use for the object. This text is not saved; to
preserve it you must create a secondary capture. To create text you can save, you
must create a Viewer Label, available in a viewer’s context menu. You cannot use this
on MIP images.
CAUTION: When you add annotations, be careful not to accidentally cover some
patient information. If you do, you could misidentify a patient, potentially
causing misdiagnosis.
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Arrow + TextBox - This is like the Text Box above, but it creates an arrow with
text attached to it. To use it, click in the viewer where the arrowhead should be,
then click to set the other end of the arrow. Now you can type the text. You can
move it by dragging, and set its properties. Right-clicking on it displays a menu of
options you can use for the object. You cannot use this on MIP images.
CAUTION: When you add annotations, be careful not to accidentally cover some
patient information. If you do, you could misidentify a patient, potentially
causing misdiagnosis.
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Tool
Description
Measurements - This is a list of measurement tools. See “Making Measurements”
below for details.
NOTE:
You cannot use this on MIP images.
Image Information - This toggles the display of various image overlays. See “Information Display (Image Information)” below for details.
Annotation Editor - This displays a dialog box that allows you to create and edit
text annotations on images. See the section below on “Creating Annotation Templates” for details.
Create Tiles - This tiles the viewing area, allowing you to add space for more viewers, for example. The viewers always fill the space in the viewer area. This means
that if you reduce the number of viewers, the remaining viewers will grow to fill the
space.
Show Hidden Viewers - If you have closed a viewer in the current layout, it will be in
this list. To display it again, select it from the list.
Deidentify - This toggles the display of patient information on all images in the
viewing area.
Making Measurements
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•
Duplicate - This creates a copy of the selected object in a different
color.
•
Properties - This displays the Display Properties panel at the bottom
of the viewer, which allows you to change properties of the selected
object, such as color, size, transparency, etc. See “Applying Properties
Changes to an Object” on page 59 for details.
•
Copy - This copies the selected object. To paste, click Paste on the
toolbar. If you paste in the same viewer, the object is pasted on top of
the original, from where you can move it. If you paste it in a different
viewer it is pasted in an equivalent position, taking into account
anatomical features in the image.
•
Delete - This deletes the object.
•
Cut - This removes the object but keeps it in memory, available for
pasting.
•
Text Label - This allows you to add text to the shape. Click where you
want the text to appear, and type the text. You can move a text label
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There are many tools you can use to take measurements or draw ROI
objects in a dataset. All the objects created by the tools have some
properties in common, and they are available in the menu that appears
when you right-click on the object:
Using the Control Panel
2.4
lighted, and displays a line connecting it to the object it is associated
with.
•
Properties - This brings up the Properties dialog for the shape (see
“Applying Properties Changes to an Object” for more).
•
Duplicate - This creates a copy of the selected object on top of the
object. This means that it looks like nothing has happened. However,
you can then move the copy to separate the two.
Additionally, some measurement tools allow you to create other objects
related to the tool. For example, if you have two points selected, you can
create a line that uses the points. These secondary objects have the same
properties and menu choices as the tools of the same name: when you
right-click on the line, the menu for a line appears.
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Depending on the object, you may also see these options:
•
Area - This calculates the area of an enclosed shape.
•
Perimeter - This calculates the length of the edge of an enclosed shape
(not the area of the shape).
•
Length - For lines, this displays the line length.
•
Mean Pixel Value - This displays the mean pixel value of all the pixels
on the object’s line.
•
Maximum Pixel Value - This displays the value of the brightest pixel
on the line.
•
Minimum Pixel Value - This displays the value of the dimmest pixel
on the line.
•
Total Value - This displays the value of the sum of all the pixels along
a line.
•
Pixel Value Standard Deviation - This displays the standard deviation
of the values of the selected pixels.
•
Histogram - This displays a histogram of the pixels in an ROI.
•
Profile - For lines, this displays a graph that describes the pixel value
at each pixel on the line.
•
Mirror Polyline On Point - This mirrors the ROI about a point that
you define by clicking.
•
Mirror Polyline On Line - This mirrors the ROI about a line that you
define by clicking twice to define the endpoints.
If you select two ROIs that enclose an area (circle, box, etc.), right-clicking
on one of them allows you to select ROI Ratio from the menu. This
displays the mean, min, max, and sum values for the two areas.
NOTE:
You cannot draw on a cine in progress. You must stop the cine
before drawing.
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The following table describes all the measurement tools.
Tool
Description
Point - This creates a point. Click to create the point. If you drag the point, the values
update continuously.
Line - This draws a line between two points. Click on the starting point, then on the
end point.
Angle - This allows you to draw two joined lines, which can be placed along two
image features to measure the angle between them. Click on the starting point for the
first line. Drag the cursor to define the line, and click again to set the vertex of the
angle. Move the cursor to the end point of the second line and click to complete the
angle.
Open Angle - This allows you to draw two separate lines, which can be placed along
two image features to measure the angle between them. Click where you want to start
drawing your first line. Click at the end point of the first line to end the line. Click
where you want to start drawing your second line. Move the cursor to the end point
of the second line and click to complete the angle.
Polyline - Draws a line with corners at set points. Click at the starting point of your
line. Drag the mouse to the point where you want to change the line’s direction. Click
to set a corner. Draw other line segments in the same way. Double click at the end
point of the line.
Smoothed Polyline - Draws a line with curves at set points. Click at the starting
point of your line. Drag the mouse to the point where you want to change the line’s
direction. Click to set a curve. Draw other line segments in the same way. Double click
at the end point of the line.
Circle - This allows you to draw a circle. To use, click to set a starting point for the
circle. Drag the mouse until the circle is the correct size. Click again to complete the
circle.
Ellipse - This allows you to draw an ellipse. Click-drag to create the major axis of the
ellipse. When the axis line reaches the right length, release the mouse. Move the cursor perpendicular to the first line until the ellipse is the desired size, and click to set
the ellipse.
Rectangle - This allows you to draw a rectangle. Click-drag to draw one side of the
rectangle. Move the cursor perpendicular to the line to expand the rectangle. Click to
complete the rectangle. You can rotate or resize the rectangle by selecting it, clicking
on a handle on the rectangle’s corner, and dragging that corner to a new location. The
entire rectangle will rotate or change size.
Polygon - This allows you to draw a multi-point polygon. Click to set a starting point.
Drag the cursor to create a side, and click to set a corner. Double-click to set the final
corner and complete the polygon.
Smooth Polygon - This allows you to draw a multi-point polygon with curved corners. Click to set a starting point. Drag the cursor to create a segment, and click to set
a corner. Double-click to set the final corner and complete the polygon.
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Box - This allows you to draw a box. Click to set a starting point for the box. Drag
the mouse until the box is the correct size and shape. Click again to complete the box.
Using the Control Panel
Tool
2.4
Description
Closed Contour - This allows you to draw a curved contour. Click to set a starting
point for the curve. As you drag the cursor, a line appears along the its path. Click
again to complete the shape. Closed contours can be edited by selecting the contour
and drawing a path that starts and ends on the contour. The new path replaces the
contour segment between those points.
If you draw a contour that loops over itself, the area inside any loop is
ignored in reporting or calculating pixel values in the contour.
NOTE:
Information Display (Image Information)
This provides menus that control various kinds of annotations on the
image. There are annotation templates that control which DICOM fields
appear on images. These are set for Minimal, Normal, and Extended. You
can edit the templates using the Annotation Template Editor. For more on
this, see the section below on “Creating Annotation Templates”.
Tool
Description
Normal - This displays a medium amount of patient information.
Minimal - This displays a small amount of patient information.
Extended - This displays all available DICOM annotation information.
None - This removes all DICOM annotation information.
Rulers - This toggles the display of rulers.
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Grid - This toggles the display of a grid centered on the image.
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Color Scale - This toggles the display of a color scale on the right side of
the image.
Creating Annotation Templates
You can customize the text annotation on images using the Annotation
Template Editor, changing such features as the text’s color, font, position,
and so on. To open the Annotation Template Editor, click Annotation
Editor.
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CAUTION: When adjusting or creating annotations, be sure not to obscure
key patient information. If patient information is obscured, misdiagnosis
may result.
Figure 24
Annotation Template Editor
•
Whether the image is original data or derived (which usually means a
processed image)
•
Whether the image is a primary image or a secondary capture
•
The image type (gated, tomo, etc.)
•
Whether the image is an emission or transmission image
•
The modality of the image (PET, SPECT, etc.)
•
The amount of annotation set by the Image Information control in the
Utilities Data Manager (this is not a property of the image, but something you set in the application)
You can set values for all of these criteria, in addition to adding or deleting
text and changing its properties.
To change the annotation used for a particular type of image, you must
first know what kind it is. To find out:
1. Select the image in the lower list in the EBW patient directory.
2. Right-click and select View Dicom Info from the menu. This displays
the DICOM Information window.
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When a viewer displays an image, the annotation on the image is
determined by six criteria:
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2.4
3. Find the Image Type field (0008:0008). This field has information on
the first four of the bullets above.
4. Find the Modality field (0008:0060). This is the fifth bullet above.
Now you can set the correct values in the Annotation Template Editor:
1. Set the first five values: the DICOM Modality field corresponds to
the Modality pull-down menu (see the figure below); the DICOM
Image Type fields correspond to Value 1, Value 2, Value 3, and
Value 4.
Figure 25 DICOM field values
1.
Modality: 0008:0060
2.
Value 1: 0008:0008 (first value)
3.
Value 2: 0008:0008 (second value)
4.
Value 3: 0008:0008 (third value)
5.
Value 4: 0008:0008 (fourth value)
NOTE:
The Modality determines the attributes that appear in the list on the
left. For combined modalities, attributes that are unique to one modality are
color coded. Use the legend at the bottom to identify them.
Use the Reset button in the upper right at any time to undo changes.
2. Select the annotation level using the Annotation pull-down menu at
the top of the window; check Set Level As Default to have images use
the Annotation level as the default.
3. Set the Render Mode if the annotation should apply to specific
display options.
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4. Select a color for annotations, as necessary, by clicking the Color For
All Annotations checkbox and selecting a color from the drop-down
menu.
5. To add an annotation, drag it from the list on the left to the image
area; to remove an annotation, drag it from the image area to the list.
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6. Position the annotation in the image. The image area is divided into a
3x3 grid (you can see this in Figure 24). To move an annotation into
another area, drag and drop it into the area.
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Using the Control Panel
7. To edit an annotation’s text properties, double-click on the
annotation in the image area. This displays some controls on the right
side of the window:
Figure 26
1.
Display Name
2.
Delimiter
3.
Justification
4.
Font
5.
Color
6.
Viewer Cell
7.
Both
8.
Underlay
9.
Overlay
Annotation text properties
8. Type a new Display Name, as necessary.
9. For annotations that use two attributes on the same row (the Matrix
annotation, for example), type a Delimiter character or string to use
to separate the strings.
10. Change the Justification, Font, and Color as necessary. The color
overrides any color set by the Color For All Annotations control.
12. For a fusion image, select whether annotations appear on the Overlay,
Underlay, or Both by using the For Fusion, Show controls.
13. Click OK to confirm the changes, or Cancel to ignore them.
To load the factory default for the current settings, click the Load button
in the upper right.
To remove changes you have made to a template, click Undo Changes.
Click OK to cancel.
Click Save to save the annotation.
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11. For dynamic images, check Viewer Cell to have the annotations
appear only on the first frame instead of on every frame.
Drawing ROIs
2.5
Click Delete Template to delete the template.
Applying Properties Changes to an Object
The Properties panel allows you to control the appearance of
measurement ROIs and text.
1. Right-click on the ROI and select Properties from the menu.
If the viewer is too narrow to show the full Properties panel, you may be
able to resize the viewer until it fits.
2. Use the Text properties and Graphic properties tabs to make changes to
the properties as needed.
NOTE:
The text properties apply only to the ROI name, not any statistics
that may be showing.
3. To use the settings on all objects of the type selected, check Set as
Defaults. To include the current selection, check Apply for selection as
well.
4. Click Apply.
Not all properties apply to every object.
5. To close the Properties panel, click the close button in the upper right
corner of the panel.
2.5
Drawing ROIs
Ordinarily, you draw ROIs in the Define Regions workstep. But you can
also draw them on any image using the Measurements tool available in the
right-click context menu or in the Utilities Data Manager. For more on
this tool, see the section on “Making Measurements” on page 52.
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In the Define Regions workstep, ROIs are drawn in three ways:
•
Some ROIs may be drawn automatically as the workstep initiates.
•
You can manually draw ROIs, and manually redraw ROIs that were
created automatically.
•
Some ROIs may allow you to use an automatic Detect Region feature
to create the ROI without having to draw it manually.
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The most common procedure for drawing ROIs is to find the image on
which to create the ROI (the one with an instruction on it), choose a
drawing tool to use, draw the ROI, and proceed to draw all the required
ROIs similarly.
The drawing tools work intuitively, though the Closed Contour tool bears
some explanation. To use this tool, click and drag in the window. When
you release the mouse button, a line segment automatically connects the
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Drawing ROIs
point where you started to the point where the cursor is when you release
the button. This means that the cursor does not necessarily need to
describe a complete shape, since you can complete a shape by releasing the
mouse button.
The software helps you know what ROI to draw in three ways:
•
The cursor may become a pencil in the window in which to do the
drawing.
•
An instruction appears in the window (for example, “Draw Gall
Bladder”).
•
A pencil may appear in the ROI control of the ROI to be drawn.
To redraw an ROI, click on the Draw Region eraser icon of the ROI
control you want to redraw (#3 in Figure 28). This removes the ROI.
Then redraw it.
To delete all manually drawn ROIs, click Redraw Regions (#3 in Figure
27). This also toggles the display of manually drawn regions.
Figure 27 Global ROI controls
1.
Add User Defined Region
Load Templates
3.
Redraw Regions
4.
Detect All Regions
5.
Set ROI Type for all regions
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2.
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Figure 28
2.5.1
2.5
ROI drawing controls
1.
Select ROI Color
2.
Detection Type
3.
Draw Region
4.
Detect Region
5.
Set ROI Type for this region
Editing ROIs
To edit an ROI, first select it. If it is a geometrical shape, use the anchor
points to resize it; if it is a Closed Contour, start drawing on the line where
you need to edit.
If you need to edit an ROI that is inside another ROI, select the outside
ROI and move it to a different location on the image where it does not
overlap the ROI you wish to edit. Edit the ROI and then return the other
ROI to its original position.
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2.5.2
Reusing ROIs
You can create ROIs that you can reuse whenever you run the application.
You might use this to create an ROI for a study that will be performed
again later on the same patient, for example. You can create templates
from any ROIs.
To create a template, right-click on an ROI and select Save as template.
To use saved templates, click Load Templates (#2 in Figure 27). This
draws all the templates you have created.
2.5.3
Changing the Edge Detection Type
There are four edge detection types available in the Detection Type
pull-down menu (#2 in Figure 28):
•
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2.5.4
Drawing ROIs
•
Isocontour: This draws an ellipse, which you can move and resize to
enclose an ROI. For details see “Using Isocontours” below. This is not
available for all regions.
•
Automatic: This creates an isocontour with no hints from a preliminary ellipse, as the Isocontour type has. As soon as you select this, edge
detection is performed, as long as all required ROIs are present. If the
required ROIs are not present, nothing happens until they are. This is
generally for creating background ROIs. This is not available for all
regions.
•
Template: If there is a template set for a region, it loads automatically
if this is selected.
Using Isocontours
The Isocontour tool draws an ellipse, which you can move and resize to
enclose an ROI. To move the ellipse, drag it; to resize it, use the handles to
change the shape.
To create an isocontour within the ellipse, click the Detect Region icon
(#4 in Figure 28).
To draw all isocontours at once, click Detect All Regions (#4 in Figure
27). This also toggles the display of the isocontours. Clicking it alternately
draws them and hides them.
2.5.5
Drawing Other ROI Shapes
2.5.6
•
Box
•
Rectangle
•
Polygon
•
Closed Contour
•
Circle
•
Ellipse
•
Smoothed Polygon
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You can use any of the ROI tools to draw ROIs. Select a shape from the
ROI type pull-down list (#5 in the figures above):
Other ROI-related Tasks
Other ROI-related tasks you can perform are:
•
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Move an ROI: click and drag the ROI’s outline.
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NOTE:
If the ROI is small and has many control points, it may be difficult to
grab a portion of the outline with no control points. If this is the case, zoom
in. This will make everything larger, including the space between control
points.
2.5.7
•
Change the color of an ROI: click the arrow on the ROI’s color swatch
(#1 in Figure 28) and pick a new color from the pulldown menu.
•
Create a custom ROI (#1 in Figure 27); see “Creating a Custom ROI”
on page 63 below for details.
Creating a Custom ROI
You can use custom ROIs to create regions to analyze that are not provided
by default.
1. Click Add User Defined Region (#1 in Figure 27).
A new ROI control is added at the bottom of the ROI list.
2. Type a name for the ROI in the text field.
3. Set the color using the color swatch pulldown menu.
4. Set the visibility of the ROI: a check mark in the checkbox shows the ROI;
unchecking the box hides the ROI.
2.6
Using Viewers
The NM Application Suite viewers allow you to view medical image data
using optimized default protocols and frequently used viewing protocols,
based on image modality and image types.
A viewer is a tabbed window that displays a single dataset. There are
different types of viewers to display different kinds of datasets (static,
gated, orthogonal, etc.).
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When data is loaded, the software uses certain criteria to decide which
viewer to use to display the data. Certain tools are available in a context
menu available with a right-click for each type of viewer. Viewers are
combined into layouts, which can contain multiple viewers and types.
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2.6.1
Using Viewers
Viewer Components
Figure 29 Viewer components
A viewer has five main components:
1. Tab(s)
2. Title Bar
3. Hide button
4. Minimize/Maximize button
5. Image area
You can use the tab to reposition the viewer or to switch between images if
they are stacked. See the section below on “Moving and Resizing Viewers”
for more on this. When a viewer has multiple tabs, the tab for the active
image display is highlighted.
2. Title bar
You can maximize and restore the viewer by double clicking on the title
bar.
3. Hide button
Use the Hide button to remove a viewer from the layout. To show a viewer
again, use the Show Hidden Viewers button in the Utilities Global Tool.
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1. Tab(s)
The viewer tab displays some information that is relevant to the contents
of the viewer. This could be the layout name, the bucket name that the
dataset was loaded in, the dataset name, etc., or a combination of these. A
tool tip for the tab contains additional information.
Using Viewers
2.6
4. Minimize/Maximize button
Click Minimize/Maximize to enlarge a viewer or to return the image to its
original size.
NOTE:
You can also double-click on the viewer’s title bar to resize the viewer.
5. Image area
The image area of the viewer contains the image. Also, if you right-click in
the image area, a menu appears with a set of tools that depends on the type
of viewer. See the section on “Context Image Tools” on page 19 for details.
The image area contains any annotations present, such as patient name,
date of birth, etc., and in the lower left, values for brightness and
background, abbreviated LL (Lower Level) and UL (Upper Level). These
are the values under the Image Control Bar in the Image Tools Global
Tool.
2.6.2
Linking Viewers
Figure 30 Viewer brackets, controlling viewer on the left
2.6.3
Moving and Resizing Viewers
You can move a viewer by clicking on its tab and dragging. You can move
a viewer to two places: an empty area of the layout (an area with no
viewers), or to the title bar of another viewer, where it becomes another
tab.
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You can select multiple viewers so they respond together to tools that
affect a viewer. These tools are the ones in the context menu available
when you right-click in the viewer and their duplicates in the Data
Managers. To select a viewer, Ctrl-click in its image area; add or subtract
viewers by Ctrl-clicking in them. One viewer is the controlling viewer.
This is indicated by blue brackets in the corners. Any actions performed in
the controlling viewer are duplicated in the linked viewers. Linked viewers
have white brackets.
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When you drag a viewer, the cursor includes a small square. The square
contains a black ‘+’ when the cursor is in an area where you can drop the
viewer, and a red ‘x’ when it is not.
If you drop the viewer in an empty area, the viewer is resized to fit in the
area. If you drop it on the toolbar of another viewer, the viewers stack.
When viewers are stacked, clicking on a tab brings that viewer to the front.
Viewers are laid out on a grid. You can resize a viewer, but only by resizing
the section of grid that it occupies. This means that other viewers may
change shape as well. To resize a viewer, drag one of its edges. For more on
changing a layout to adjust viewers, see the section on “Editing Layouts”
on page 69.
2.6.4
Using a Curve Viewer
In the Review Results workstep, curve viewers have unique functions that
are not available in other viewers. These are available when you right-click
in a curve viewer.
Y Axis To Domain Range - This redraws the graph so the Y axis
minimum value is 0.
AutoScale Y - This redraws the graph so the Y axis minimum is the min
value instead of 0.
Time Axis To Domain Range - This redraws the graph so the X axis
minimum value is 0.
AutoScale X - This redraws the graph so the X axis minimum is the min
value instead of 0.
Export To Spreadsheet - Selecting this brings up a save dialog allowing
you to save the values in a comma-separated list (.csv file).
Axis In Sec - Selecting this displays the time axis in seconds.
Axis In Min - Selecting this displays the time axis in minutes.
Show Grids - When this is checked, a grid is drawn under the curves.
Using Layouts
A layout consists of one or more viewers, of any type. When a study loads
in the Review application (the default for many studies), all the images
appear in a default layout appropriate to the data that is loaded.
You can select a different layout after the images load. The layouts are
designed to be clinically appropriate to facilitate review. However, you can
edit a layout so it addresses specific needs, and save it as part of a
Preference. For more on this, see the section on “Creating and Editing
Preferences” on page 43.
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Using Layouts
2.7
NOTE: A layout’s viewports try to maximize the size of images during
loading. However, the success of this attempt depends on a number of
factors, such as the image size, aspect ratio, matrix size, brightness, and
viewport size, and so on. For this reason, image sizes may vary.
If you have loaded a study in the viewer, you can select a layout that
provides a set of viewers that displays the data to its best advantage. See the
list of layouts below to decide which one suits your purposes. The
available layouts depend on the type of study that is loaded.
NOTE:
When you load a multiphase dynamic dataset, the image contrast
and window are assigned based on the image that contains the maximum
pixel value. A dynamic phase viewport can appear empty. Use Contrast
Stretch and Histogram Windowing to make more of the pixels visible.
To switch to a different layout, click on one of the choices under the
workflow controls. Layouts you have viewed have a check mark on the
left.
Layouts that are available for the current data have a light background;
unavailable layouts have a dark background. The layouts that are available
depend on the data that is present. Layouts called “SC images” display
secondary capture images.
Figure 31
Examples of available and unavailable layouts
1.
Visited layout
2.
Current layout
3.
Unavailable layouts
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The Custom Display layout is available at the bottom of the list of factory
layouts in the Review workstep for all applications except for AutoSPECT
Pro and the General Review application. It displays up to 25 datasets in a
study (depending on what is loaded in the Custom Display buckets), not
just the data needed to run the application.
NOTE: When loading whole body data pairs, you may need to pay
attention to the DICOM Instance Number. For a single pair, the
application displays them correctly no matter how you load the datasets.
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The following layouts are available in the Review application. See the
sections on individual applications for other application-specific layouts.
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NM Exam Overview
•
Planar Viewing Protocols
•
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•
Whole Body Horizontal Display
•
Whole Body with Spots Display
•
Spots Display
•
Whole Body Intensity Compare
•
All Dynamic Display
•
All Dynamic with Spots
•
NM Planar comparison – side by side
•
NM Planar comparison - fusion
•
Gated Planar Display
•
Secondary Captures Overview
•
SPECT and SPECT/CT Viewing Protocols
•
One View
•
One View Comparison (2 volumes)
•
SPECT 3 View
•
SPECT 3 View Composite (projection)
•
SPECT 3 View Raw Composite
•
SPECT 3 View Composite (3D MIP)
•
SPECT 3 View Comparison
•
SPECT 3 View Comparison Composite (projection)
•
Orthogonal2D View
•
CT Series Display
•
DX Series Display
•
Xray Series Display
•
PET Series Display
•
MR Series Display
•
US Series Display
•
MPR 2D Fusion Display (side-by-side)
•
MPR 2D Fusion Display
•
NM SPECT comparison – side by side
•
Multi-Segment Fusion display
•
Whole body Fusion display
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Editing Layouts
A layout consists of viewers in a grid of tiles. If you change the size or
shape of a tile, since the total grid area is fixed, usually it will necessarily
affect the size or shape of at least one other tile. However, you can change
the number of tiles in the grid, which creates larger or smaller tiles for the
viewers to fit into. What this means is that editing a layout is often a
tradeoff between the sizes and shapes of the tiles (viewers) in the layout.
NOTE:
The tiles in a grid are not independent rectangles. They are merely
the space between the grid lines. So when you adjust a tile, you adjust grid
lines, which affects adjacent tiles.
To change the number of tiles in a layout, click Create tiles in the Utilities
Data Manager and select a tile layout.
If a layout does not display the data optimally for your needs, you have
two choices. If you can change a default layout so it is more useful, you
can just edit that and save the changes as part of the Preference or as a new
Preference. But if you need multiple new layouts, you can create new ones
using the Save Layout As button. You can start from an existing layout or
from the Custom Display layout, which is available at the bottom of the
list of layouts in the Review workstep for all applications except for
AutoSPECT Pro and the General Review application.
Figure 32
Custom Display layout and Save Layout As button
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The Custom Display layout contains up to 25 datasets in a study, not just
the data needed to run the application. This means you could create a
comprehensive layout or set of layouts, or remove some viewers so you see
only the data you want.
To create a new layout:
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1. Select a layout to edit (factory layout, user layout, or Custom Display
layout).
2. Make changes to the layout by removing and resizing viewers,
changing the number of tiles, changing colormaps, etc.
3. Click Save Layout As and type a name for the layout.
The new layout is added at the bottom of the list.
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4. If you made changes to the way buckets are automatched, test the
layout by exiting the application and running it again.
To edit a saved layout, make the changes and then use Save Layout As
to resave the layout using the same name.
To delete a saved custom layout, right click on the list entry and click the
Delete menu item.
NOTE:
You cannot delete the layout that is currently active: you must first
select another layout.
In making changes to a layout you can:
•
Rearrange viewers in the tiles
•
Resize the tiles
Additionally, in all applications except for AutoSPECT Pro, you can:
•
Hide viewers (leaving empty tiles)
•
Change the number of tiles in the grid
NOTE:
A viewer always completely fills a tile. So when you change the size
or shape of a tile, you change the size or shape of the tile’s viewer
accordingly.
To rearrange viewers, drag a viewer to an open tile. You may have to create
an open tile by temporarily stacking two viewers. To stack viewers, drag
the tab of one onto the title bar of another.
To resize a tile, drag one of its edges. Dragging a side edge changes the
width of the tile, as well as that of the adjacent tile; dragging a top or
bottom edge changes the size of the whole row of tiles, as well as the
adjacent row.
NOTE:
You can resize tiles while they contain viewers.
To hide a viewer, click the viewer’s Hide icon in the title bar. To show a
hidden viewer, use the Show Hidden Viewers tool in the Utilities tab.
To change the number of tiles in the grid, use the Create Tiles tool in the
Utilities tab. If you need fewer tiles in a single row (to allow for wider
viewers), you can resize a tile on the end so both its edges are at the edge of
the viewing area, making it a zero-width tile. However, if you do this, be
aware that the now-invisible end tile may get populated with a viewer,
which will be a zero-width viewer. If this happens, resize the tile, move the
viewer, and size the tile back again.
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Figure 33 Title bar Hide control
Using Layouts
2.7.2
2.7
Editing Layouts in AutoSPECT Pro
AutoSPECT Pro handles layouts slightly differently from the other
applications. First, you can only edit layouts in the Review workstep. After
editing a layout, click Save under the list of layouts and type a name for
the new layout.
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To delete a layout, launch the Preference Editor and check Delete
Protocol. When you save the Preference, the layout is deleted.
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AutoSPECT Pro
AutoSPECT Pro is a fast and accurate application that allows you to
automatically or manually reconstruct one or more SPECT, gated SPECT,
Total Body SPECT, Vantage SPECT, or SPECT-CT projection datasets.
SPECT datasets that you can manually reconstruct include cardiac, bone,
brain, liver, and other SPECT datasets.
When reconstructing data, you can view three instances of the data and
change filter settings on each one for comparison.
NOTE:
Vantage is the trade name for the Philips nonuniform attenuation
correction option using a gadolinium transmission line source.
NOTE: In this manual, “CT-AC” indicates that CT is used for attenuation
correction. “AC” indicates generic attenuation correction.
For Brightview XCT data, CT images are paired with projection data. The
result is that when SPECT data is loaded, the CT data is automatically
placed in the AC map bucket. If you have edited the DICOM
information for the CT images (for example, the Series Description), the
pairing is broken. When the data is no longer paired, it is handled the
same way as data from machines that do not support pairing, which is
often the case: automatching is attempted. If automatching fails, you can
bucket data manually.
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The AutoSPECT Pro workflow differs from that of the other applications.
It has the standard Setup workstep to start the process, and the Review
workstep at the end. However, instead of the Define Regions and Results
worksteps, AutoSPECT Pro has the following:
•
AC Map Generation: This workstep is available when you load the
appropriate data. It allows you to create or inspect an AC map for
processing.
•
Reconstruction: This allows you to reconstruct unprocessed datasets,
including SPECT, gated SPECT, and Total Body SPECT datasets.
•
Reorientation: This allows you to reorient transverse datasets. For
cardiac studies, short axis, horizontal long axis, and vertical long axis
datasets are automatically generated from the reoriented transverse
datasets, and displayed. For all studies, you can use this workstep to
manually reorient the reconstructed dataset.
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When a dataset loads in the Setup workstep, its energy window is checked
against a default for the radioisotope used. If the window is absent or
differs from the default, a dialog appears allowing you to select an isotope,
use the default, or use the settings from the source image.
NOTE: All worksteps appear in the workstep list, but whether you can use
one may depend on the data and preference selected.
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The AC Map Workstep
NOTE:
Images that are 256x256 pose special issues. First, this size is not
supported for gated datasets. For other datasets, processing can take a
long time due to memory demands. Additionally, for 256x256 Total Body
SPECT data, you should process segments separately and knit them
afterward, rather than using the AutoSPECT Pro AutoKnitting feature.
One possible SPECT/CT workflow might include processing in
AutoSPECT Pro, viewing fusion displays, and loading the results to
AutoQuant. To ensure that this sort of workflow is possible, always start
with the original CT data and not a preexisting ACMap (for example, one
created in JETStream Workspace).
If the CT data is not available, the workflow may not complete correctly.
However, you could still use a preexisting ACMap to perform attenuation
correction of the SPECT data.
3.1
The AC Map Workstep
This workstep is available for some Preferences if the right data is loaded.
It has four layouts, determined by the input data and Preference selected:
•
A QC layout for reviewing an existing AC map using a CT-AC or
Vantage preference
•
CT-AC layout: This is available if you have loaded a CT image using
one of the CT-AC preferences.
•
Vantage AC layout: This is available for Vantage data if you have also
loaded transmission projection data using one of the Vantage preferences.
•
Chang’s AC layout: This is available for any SPECT image using a
Chang’s AC preference.
For SPECT cardiac studies acquired from BrightView XCT systems
using a 1-segment protocol, the CT FOV is 14.4 cm in the axial direction.
For patients with large hearts, to ensure the robustness of attenuation
correction, 3D scatter correction, and Astonish resolution recovery, the
attenuation maps are automatically extended by ~20 mm at both ends in
the axial direction by duplicating the original end slices of the attenuation
map. Hence, the effective axial map FOV is ~18.4 cm.
3.1.1
Reviewing an AC Map
If you provide an AC map as input to AutoSPECT Pro, the AC Map
workstep displays the map in a splash format so you can review it.
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NOTE:
The AC Map Workstep
3.1.2
3.1
Using CT-AC Data
If you are processing a CT-AC dataset, a new data manager for performing
registration tasks becomes available. Use the controls below in the
Registration data manager to register the SPECT image relative to the CT
image.
Figure 34 CT-AC layout controls
1.
Tool
Translation Offset
2.
Rotation Angle
3.
Translation Increment
4.
Rotation Increment
Description
Translate: This allows you to manually translate the SPECT image in any of the
three orthogonal views by dragging the image. You can also use the Translation
Offset parameters to specify offset values in X, Y, and Z.
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Incremental Translate: This allows you to translate the SPECT image in increments specified by the Translation Increment control (and set as defaults: see
“Preferences for the ACMap Workstep” on page 104). To translate, click on the
image. The image is divided into triangular quadrants defined by an imaginary X
drawn from corner to corner (see Figure 35). Clicking in a quadrant moves the
image in the direction of that quadrant (for example, clicking in the left quadrant
moves the image left). You can also use the Translation Offset parameters to
specify offset values in X, Y, and Z.
Rotate: This allows you to manually rotate the SPECT image by dragging it in any
of the three orthogonal views. You can also use the Rotation Angle parameters to
specify rotation values in X, Y, and Z.
Philips Healthcare
Incremental Rotate: This allows you to rotate the SPECT image in increments
specified by the Rotation Increment control (and set as defaults: see “Preferences
for the ACMap Workstep” on page 104). To rotate, click on the image. The image
is divided in half by an imaginary vertical line. Clicking on the right half rotates the
image clockwise; clicking on the left half rotates it counterclockwise. You can also
use the Rotation Angle parameters to specify rotation values in X, Y, and Z.
Reset: This puts the SPECT image in the position and orientation it was in when
the workstep began.
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The AC Map Workstep
Tool
Description
Center: This centers the SPECT image on the CT image. If you have made any
adjustments to the position or orientation of the SPECT image, they are overridden.
Undo: This undoes the previous operation. Successive clicks undo each operation you performed, in order.
Redo: If you have used Undo, this redoes the previous operation. Successive
clicks redo each operation you performed, in order.
Figure 35 Triangular quadrants used in incremental translation
If you have a dataset acquired with the Philips fiducial markers (used as a
QC tool for Precedence and BrightView XCT, for example), more controls
become available:
1.
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Find Markers
2.
Register
3.
Hide Markers
4.
Mean Distance
•
Find Markers: This searches for markers and indicates their positions
with a cross.
•
Register: This registers the images based on markers that were found.
•
Hide Markers: This toggles the display of the crosses.
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Figure 36 ACMap workstep controls with fiducial marker functions
The AC Map Workstep
•
3.1.3
3.1
Mean Distance: This is the average of the distance between all the
fiducial markers in the SPECT image and the corresponding markers
in the CT image for all markers that were found.
Using Vantage AC Data
If you are using Vantage AC data, you can perform transmission
reconstruction using some of the same controls available in the
Reconstruction workstep, but with different options.
Method (FBP)
This is a standard filtered back project reconstruction. When this is
selected, you must also set the following controls:
Control
Values
Filters
Butterworth (Off, Smoothing, Analytic)
Cutoff
0.1 - 2.0
Order
0.0 - 10.0
Bound
On or Off
Filter
Filter defaults to Butterworth. This is a low pass filter that smooths an
image. You can control the smoothness by modifying the cutoff and order.
It also has properties to ensure that the filter is applied consistently to files
acquired with 64 x 64, 128 x 128, and 256 x 256 matrices.
Additionally, you can determine the smoothing applied to the
reconstructed transverse dataset:
Off
No smoothing is applied to the reconstructed or projection dataset.
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Smoothing
A 3 x 3 spatial filter is applied to each slice of the reconstructed dataset.
Analytic
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A filter based on the settings in the Filter, Cutoff, and Order fields is
applied to the reconstructed dataset. The Analytic filter is a
three-dimensional filter that smooths the reconstructed dataset in the x-,
y-, and z-axis. Filtering along the x-axis and y-axis smooths the counts
within each slice. Filtering along the z-axis smooths the counts from slice
to slice.
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Cutoff
This reduces or eliminates the effects of high frequency information by
applying a frequency cutoff value.
When using filters to enhance nuclear medicine images, organs or areas of
uniform counts are converted to low frequency signals, and lesions with
sharp edges or background noise are converted to high frequency signals.
Reducing the cutoff value smooths the image by eliminating the high
frequency signals. Increasing the cutoff value sharpens the image by
retaining the high frequency signals. However, both the lower and higher
frequencies are attenuated.
Drag the slider or type a value to set the cutoff value (the range is 0.1 to
2.00).
IMPORTANT:
The Cutoff and Order fields can be modified when a filter uses
these fields, but they are grayed out when they are not in use by the filter.
Order
This modifies the exponent that determines the rate that a filter attenuates
a signal. The filter order modifies the region where a filter goes from
passing information to attenuating information. Decreasing the order
widens the transition band, that decreases the attenuation rate of high
frequency signals. Increasing the order narrows the transition band, that
increases the attenuation rate of high frequency signals.
The range is 0.0 to 10.0. To increase or decrease the Order value, enter a
value in the field or drag the slider.
Bound
Check this to determine the body contour and reconstruct the data within
that contour. Uncheck it to reconstruct all of the data within the
field-of-view.
Method (Bayesian)
When Bayesian is selected, you must also set the following controls:
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Control
Values
Iterations
12
Start
Uniform
Truncation Correction
On or Off
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The Bayesian method uses a gradient iterative reconstruction method that
assumes that the values within soft tissue will have a uniform attenuation
coefficient. The output of this algorithm is significantly smoother and
more accurate than the FBP result. This is the recommended method for
performing transmission reconstruction.
The Reconstruction Workstep
3.2
Iterations
This control is only enabled if the selected method is Bayesian Iterative.
The number of iterations depends on your data and preferences. Philips
recommends 12 iterations.
Start
The initial estimate used by the iterative algorithm can be either a FBP
image or an image with a uniform pixel value.
•
FBP requires fewer iterations, and is recommended.
•
Uniform starts with equalized pixel values and requires approximately
five additional iterations to converge.
Truncation Correction
This is only available when the Bayesian Iterative method is selected.
Enabling this applies a symmetry prior to correcting for truncation present
when the patient is larger than the camera field of view. This method is
identical to the regular BITGA method when no truncation is present.
(BITGA, or Bayesian Iterative Transmission Gradient Algorithm, uses a
prior function that preferentially weights the current attenuation
coefficient estimate at each pixel toward the value for soft-tissue region.)
The only reason not to use truncation correction is if there are artifacts
present in the reconstructed transmission image.
3.1.4
Using Chang’s AC
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If you are using Chang’s AC, you can draw an ROI and then use these
controls:
3.2
•
Identically in all Frames: This uses the ROI in the same size and position in all frames.
•
Individually Frame by Frame: This adjusts the ROI to the frame
contents on every frame.
•
Isotope: This dropdown menu allows you to select the isotope used in
the study.
•
Coefficient: This allows you to type in an attenuation coefficient
value.
•
Reset: This resets the ROIs to their state when the workstep began.
The Reconstruction Workstep
The Reconstruction workstep (Figure 37) contains one or two sets
(depending on the data loaded) of the following:
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The Reconstruction Workstep
•
Viewports that display projection data with or without motion correction, filtered projection data, and a reconstructed slice.
•
Zoom controls that allow you to specify the zoom factor applied.
•
Method controls that determine the reconstruction method used and
any corrections to apply.
•
Correction controls to apply to the data.
•
Filter controls that determine the filter settings used to reconstruct the
selected datasets.
•
Limit parameters to specify the reconstruction range.
Figure 37 A Reconstruction layout
To use the Reconstruction page, first adjust the start and end slice of the
dataset. For cardiac datasets, these are set by the software, but you can
adjust them to improve the results. You can either drag the reconstruction
limit lines with the mouse or type values into the Start and End fields.
After adjusting the slices, use the controls described in the following
sections.
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The reconstruction methods, controls, and suggested parameters depend
on the dataset type selected for processing. However, some of the controls
and recommended settings are the same for all datasets.
The Reconstruction Workstep
3.2
CAUTION: Visually verify the reconstruction results before saving to ensure
images are reconstructed properly. Improperly reconstructed images may
result in misdiagnosis.
3.2.1
Start/End
Start and End display the start slice and end slice of the reconstructed
transverse dataset. You can change the values by dragging the
reconstruction limit lines or by typing values into the fields.
NOTE:
If you have multiple reconstructions of the same data, adjusting the
slice limits for one reconstruction setting automatically adjusts them for all
other settings. Similarly, if you have concurrent data (for example, gated
and summed, dual isotope, etc.), adjusting the slice limits for one
automatically adjusts them for the other.
3.2.2
Zoom
Zoom allows you to apply a zoom factor to the reconstructed datasets.
AutoSPECT Pro applies the zoom factor to the reconstructed transverse
dataset. Short axis, horizontal long axis, and vertical long axis datasets
created from this transverse dataset are reconstructed using the same zoom
factor.
NOTE:
Zoom is disabled for all methods except FBP.
Checking Zoom displays a box on the reconstructed slice. The box shows
the image area corresponding to the zoom value. You can drag the box to
reposition it on the image. Drag the zoom slider or type a value to set the
zoom factor (the range is 1.0 to 3.0).
3.2.3
Method
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AutoSPECT Pro provides four methods for reconstructing the transverse
data.
•
Standard FBP - Filtered Backprojection: Reconstruction is performed
by backprojecting with a ramp filter.
•
Iterative MLEM - Maximum Likelihood Expectation Maximization:
Reconstruction is performed in an iterative fashion, with updates
based upon a comparison of the estimation to the measured projection
data. This method reduces streak artifacts found in FBP reconstructions.
NOTE:
MLEM only supports attenuation correction for Tc-99m and Tl-201.
To use AC for other data, use OSEM or Astonish instead.
•
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The Reconstruction Workstep
are used in each iteration. This method offers faster reconstruction
than MLEM with similar accuracy.
•
Astonish - If you have the Astonish option enabled, you can select this
method. Astonish uses Ordered Subsets Expectation Maximization
with resolution recovery to reconstruct the dataset. Resolution
recovery compensates for detector and collimator performance as a
function of radius from the detector to the center of the image. It uses
a deconvolution method based on measured collimator parameters
that are stored in a configuration file. It also includes noise control that
is independent of the number of iterations and subsets used. For more
information on Astonish, see the “Astonish Reconstruction” on page
163 appendix.
NOTE:
Vantage data that is labeled “_EMSCR” has already had resolution
recovery applied. It is inappropriate to apply Astonish to this data, so it is
not available for “_EMSCR” data.
After changing the method, review the available controls to be sure they
are set as you intended. Refer to the table below for specific information
about the controls.
Control
FBP
MLEM
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Astonish
Bound
On or Off
Start
FBP or Uniform
Uniform
Uniform
Iterations
12 is recommended - then
evaluate the
image (range is
1- 60)
2 is recommended - then
evaluate the
image (range is
1- 60)
4 is recommended - then
evaluate the
image (range is
1- 60)
16
16
Hanning, None
Subsets
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OSEM
Filter
None, Butterworth, Gaussian, Hamming,
Hanning, Parzen
Butterworth
Butterworth
Y-Axis
Off, Smoothing,
Analytic, Prefilter
Off, Smoothing,
Analytic
Analytic
Cutoff
0.1 - 2.0
0.1 - 2.0
0.1 - 2.0
Order
0.0 - 10.0
0.0 - 10.0
0.0 - 10.0
Start and End
First and Last
Slice Numbers
First and Last
Slice Numbers
First and Last
Slice Numbers
Matrix
Same as input
matrix, 64, 128,
256
Zoom
1.0 - 3.0
0.1 - 2.0
First and Last
Slice Numbers
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The controls available for each method are listed in the table below.
The Reconstruction Workstep
Control
FBP
Attenuation
Correction
MLEM
OSEM
Astonish
On or Off
On or Off
On or Off
On or Off
On or Off
Scatter Correction
3.2.4
3.2
Decay Correction
On or Off
On or Off
On or Off
On or Off
Number of
Detectors
Single, Dual, Triple
(auto-selected
based on image
header)
Single, Dual, Triple
(auto-selected
based on image
header)
Single, Dual, Triple
(auto-selected
based on image
header)
Single, Dual, Triple
(auto-selected
based on image
header)
Axis Correction
-5.0 - +5.0
Motion Correction
On or Off
On or Off
On or Off
On or Off
Motion Correction method
Auto, Manual
Auto, Manual
Auto, Manual
Auto, Manual
Changs AC
On or Off
Bound
This control is only enabled if the selected method is Iterative MLEM.
Checking this determines the body contour and reconstructs the data
within that contour. If it is unchecked, all of the data within the
field-of-view is reconstructed.
Iterations
This control is only enabled if the selected method is Iterative MLEM,
3D OSEM, or Astonish. The number of iterations depends on your data
and preferences. The number of iterations is also affected by the initial
estimation used. If FBP is used, 10 to 15 iterations are usually adequate.
The effect of this control on an image involves a tradeoff. Generally,
higher values yield a sharper image, but at the expense of increased noise.
The range is 1-60.
3.2.6
Matrix Size
The Matrix Size menu is only available when the method is FBP. Matrix
allows you to specify the matrix size of the saved reconstructed datasets.
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3.2.5
The X1 option creates a reconstructed dataset that contains the same
matrix size as the input dataset. Selecting 64, 128, or 256 creates a saved
reconstructed dataset that contains the specified matrix size.
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IMPORTANT: Reconstructed datasets using a 256 matrix sizes can become
very large, and may be incompatible with some software (AutoQuant, for
example).
3.2.7
Subsets
This control is only enabled if the selected method is 3D OSEM or
Astonish. The number of subsets depends on your preferences, and the
number of projections in the loaded dataset. The number of projections
divided by the number of subsets should be a whole number. For instance,
if there are 64 projections, there could be 64, 32, 16, 8, 4 or 2 subsets. For
120 projections, there could be 120, 60, 40, 30, 15, 10, 5, 3, or 2 subsets.
Requesting more subsets does not extend the reconstruction time, but
requesting more iterations does. If you enter an invalid number of subsets,
your value is replaced by the nearest valid value. Using the full number of
projections as the number of subsets is not recommended. Philips
recommends using a subsets value that is close to the number of
projections divided by 4. Using 1 subset is valid, but this is essentially the
same as using Iterative MLEM reconstruction, and does not take
advantage of the ordered subsets algorithm.
3.2.8
Start
This control is only enabled if the selected method is Iterative MLEM (it
is set to Uniform for OSEM and Astonish). The initial estimate used by
the iterative algorithm can be either a FBP image or an image with a
uniform pixel value.
3.2.9
•
FBP requires fewer iterations, and is recommended.
•
Uniform starts with equalized pixel values and requires approximately
five additional iterations to converge.
Attenuation Correction
IMPORTANT:
Do not neglect to check this option for Vantage datasets, or
attenuation correction will not be applied.
3.2.10
Scatter Correction
If you are processing a CT-AC or Vantage dataset, or using a saved
attenuation map with OSEM or Astonish as the reconstruction method,
you can check this to apply scatter correction during reconstruction.
Scatter correction is based upon an estimated slab model. See References 7
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If you are processing a Vantage or CT-AC dataset or using a Changs AC
preference, check this to apply attenuation correction to the reconstructed
dataset.
The Reconstruction Workstep
3.2
and 9 in the NM Application Suite Reference Manual for a full description
and validation of the method. Scatter correction can reduce the impact of
detecting scattered photons from hot organs near the organ of interest.
Scatter correction is only available when OSEM or Astonish is the
reconstruction method, and when Attenuation Correction is ON. In
general, Philips recommends using scatter correction whenever you
perform OSEM or Astonish with Attenuation Correction. If you want to
do Attenuation Correction only, without scatter correction, Philips
recommends using Iterative MLEM with Attenuation Correction.
NOTE: Vantage data that is labeled “-EMSCR” has already had scatter
correction performed. It is inappropriate to apply AutoSPECT scatter
correction to this data, so the scatter control is disabled if “-EMSCR” data
is loaded.
Scatter Correction uses a pre-calculated estimation (a kernel) of the scatter
expected from a point source in water, which is stored on your hard drive.
These kernels are specific to the isotope used, the energy window, and the
pixel size. You can only perform scatter correction for combinations of
parameters for which a kernel exists. The current release of AutoSPECT
Pro supports scatter correction for seven isotopes; the following
combinations of parameters are supported:
Window 1
settings
Window 2
settings
Window 3
settings
Supported
Zoom Factors
Tc-99m
15 or 20% @
140 keV
NONE
NONE
All zooms
Tl-201
15 or 20% @ 72
keV
15 or 20% @ 167
keV (or NONE)
NONE
All zooms
In-111
15 or 20% @
173 keV
15 or 20% @ 245
keV
NONE
All zooms
Ga-67
15 or 20% @ 92
keV
15 or 20% @ 185
keV
15 or 20%
@ 300 keV
(or NONE)
All zooms
I-123
15 or 20% @
159 keV
NONE
NONE
All zooms
I-131
15 or 20% @
364 keV
NONE
NONE
All zooms
Lu-177
15 or 20% @
113 keV
15 or 20% @ 208
keV (or NONE)
NONE
All zooms
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Isotope
Using scatter correction in AutoSPECT may add several minutes to
your reconstruction times, especially for isotopes with multiple scatter
windows (e.g., Ga-67).
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The Reconstruction Workstep
Decay Correction
Check this to apply decay correction to the projection dataset prior to
reconstruction. This automatically pulls isotope information from the
projection dataset.
The Detector is automatically determined based on the dataset’s header
information. However, if you need to change it, select Single, Dual, or
Triple, depending on how the dataset was acquired.
IMPORTANT:
Because of DICOM issues on some systems, the number of
detectors may be misidentified. Be sure to always check this field and
change it if necessary.
3.2.12
Motion Correction
If Motion is checked in a Preference and it is set to Automatic, motion
correction will happen with no intervention. However, if AutoProceed is
off for Reconstruction, automatic motion correction happens when you
enter the Reconstruction workstep, so you see the corrected images when
the application pauses at the Reconstruction workstep. Also, if Motion is
set to Manual but AutoProceed is on, Manual will override the
autoproceed and the study will pause at the Reconstruction workstep in
the motion correction layout.
If you are in the Reconstruction workstep you can still perform automatic
motion correction. To do this, Motion must be checked and set to
Automatic. As soon as both of these conditions are met, motion
correction is performed.
•
Automatic Motion Correction: Use this for Cardiac datasets to have
the AutoSPECT Pro algorithm automatically locate the heart, evaluate
it for motion artifacts, and make the appropriate adjustments.
Selecting this automatically selects Auto as the mode, and performs the
automatic corrections. The motion corrected projection image will
cine in the upper viewport. Review the images in cine mode to determine if motion correction has been successfully applied. The heart
should remain at the same level for all projections—no sudden jumps
should occur.
•
Manual Motion Correction: Use this for non-cardiac datasets, and for
cardiac datasets where the automatic motion correction induces artifacts. To perform manual motion correction, see the section below on
“Using Manual Motion Correction” on page 90.
If a Gated dataset is selected, any correction made to a Summed file is
automatically made to the corresponding Unsummed file.
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There are two ways to perform and review motion correction:
The Reconstruction Workstep
3.2
NOTE: If you check Motion after making manual corrections, AutoSPECT
Pro replaces the manual corrections with automatic corrections. To use
automatic motion correction, the Motion box must be checked in addition
to Automatic being selected.
3.2.13
Axis Correction
Axis applies an axis of rotation correction or center of rotation (COR) to
the reconstructed datasets. Check Axis to enable the option. Then enter
the amount of correction. This correction is only necessary for older
Philips/ADAC cameras. It is not necessary if the camera includes this
information in the acquired data as the newer Philips cameras do:
Skylight, Forte, BrightView, and Precedence, for example.
NOTE:
3.2.14
This is only available when the selected Method is Standard FBP.
Filter
Filter allows you to select the filter applied to the data during
reconstruction.
When the reconstruction method is FBP, each filter modifies a ramp filter
to smooth or enhance image details.
When the reconstruction method is MLEM or OSEM, the filter is applied
after reconstruction. When the reconstruction method is Astonish, the
filter is applied to the projections before and during reconstruction.
Depending on the reconstruction method, the Filter menu contains
combinations of the following options:
None
No filter modifies the ramp filter applied to the data during
reconstruction. This may produce sharp but noisy images.
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Butterworth
This filter is available only with the FBP, MLEM, and OSEM methods,
not Astonish. The Butterworth filter is a low pass filter that smooths an
image. You can control the smoothness by modifying the cutoff and order.
It also has properties to ensure that the filter is applied consistently to files
acquired with 64 x 64, 128 x 128, and 256 x 256 matrices.
Gaussian
This filter is available only with the FBP method. The Gaussian filter is a
frequency filter based on an exponential function that takes the form: F(x)
= a*exp(-b), where a and b are based on the mean and standard deviation.
This equation is referred to in statistics as “normal” or “bell” curve.
Because of its exponential drop-off, it also behaves well in filtering.
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An advantage of the Gaussian filter is that it can become almost any kind
of filter (low pass, high pass, or band pass) and it can have a gradual or
sharp cutoff. The shape of the filter is controlled by the cutoff frequency
and the filter order. It also has properties to ensure that the filter is applied
consistently to files acquired with 64 x 64, 128 x 128, and 256 x 256
matrices.
The cutoff frequency is entered as a percentage of the Nyquist frequency.
The Nyquist frequency is the highest possible frequency in the image. The
resolution limit is set by the linear sampling distance. Therefore, the cutoff
frequency can range from 0.0 to 1.0. A cutoff frequency of 0.5 represents
50% or 1/2 of the Nyquist frequency.
The filter order specifies the steepness of the cutoff. In general, the higher
the filter order, the steeper the cutoff. A steep cutoff is necessary to
eliminate structures that may overlap in frequency. For example, if you
have high frequency data and high frequency noise, a sharp cutoff helps
isolate the data. Otherwise, a gradual cutoff is more desirable.
Choice of filter parameters is dependent on the nature of the data,
personal preference of the user, counting statistics and camera
performance.
Hamming
This filter is available only with the FBP method. It is a modified Hanning
window with a more abrupt cutoff at the high frequency limit.
Hanning
This filter is available only with the FBP and Astonish methods. It is a low
pass filter that smooths an image. Its falloff, which controls the
attenuation of the high frequencies, is determined by the cos2.
Parzen
This filter is available only with the FBP method. It is a low-pass filter that
smoothes an image using a linear falloff.
3.2.15
Y Axis
Off
No smoothing is applied to the reconstructed or projection dataset.
Smoothing
This filter is available only with the FBP, MLEM methods. A 3 x 3 spatial
filter is applied to each slice of the reconstructed dataset.
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This menu is unlabeled, but is next to the Filters menu.
The Reconstruction Workstep
3.2
Analytic
This filter is available only with the FBP, MLEM, and OSEM methods. A
filter based on the settings in the Filter, Cutoff, and Order fields is applied
to the reconstructed dataset. The Analytic filter is a three-dimensional
filter that smooths the reconstructed dataset in the x-, y-, and z-axis.
Filtering along the x-axis and y-axis smooths the counts within each slice.
Filtering along the z-axis smooths the counts from slice to slice.
Prefilter
This is a smoothing filter used before reconstruction. This filter is used
only with the Standard FBP method.
3.2.16
Cutoff
This reduces or eliminates the effects of high frequency information by
applying a frequency cutoff value.
When using filters to enhance nuclear medicine images, organs or areas of
uniform counts are converted to low frequency signals, and lesions with
sharp edges or background noise are converted to high frequency signals.
Reducing the cutoff value smooths the image by eliminating the high
frequency signals. Increasing the cutoff value sharpens the image by
retaining the high frequency signals. However, both the lower and higher
frequencies are attenuated.
Generally, too low a cutoff value produces over-smoothed data, possibly
disguising a lesion. Too high a cutoff value produces noisy images which
appear patchy. The filter choice must reflect both the frequency context of
the noise and the frequency context of the organ in the image.
Drag the slider or type a value to set the cutoff value (the range is 0.1 to
2.00).
The Cutoff and Order fields can be modified when a filter uses
these fields, but they are grayed out when they are not in use by the filter.
3.2.17
Order
The Order value, used in the Butterworth and Gaussian filter functions,
modifies the exponent that determines the rate that a filter attenuates a
signal. The filter order modifies the transitional band (the region where a
filter goes from passing information to attenuating information).
Decreasing the order widens the transition band, which decreases the
attenuation rate of high frequency signals, and can decrease the
smoothing. Increasing the order narrows the transition band, which
increases the attenuation rate of high frequency signals, and can increase
the smoothing. So the higher the filter order, the narrower the transition
band and the steeper the drop-off.
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The value ranges from 0.0 to 10.0. To increase or decrease the Order
value, enter a value in the field or drag the slider.
3.2.18
Comparing Parameters
You can compare parameter settings using the Compare page. This
displays three copies of a slice, and all the controls available for the data.
The parameter values on the Reconstruction page are used for the middle
slice; for comparison, the top slice has slightly lower values, and the
bottom slice has slightly higher values. You can adjust any of the values to
create a more meaningful comparison. When you are done adjusting the
copies, click Apply for the one that you want to save. For studies with
multiple datasets, click Apply once for each dataset. Click the
Reconstruction button to go back to the Reconstruction page. The
reconstructed slice will reflect the changes you made, and the controls will
retain the settings you made.
3.2.19
Using Manual Motion Correction
Use the Motion Correction feature to analyze and correct for patient
motion that may have occurred during an acquisition or to verify that
motion artifacts have been corrected when automated motion correction is
applied.
Perform motion correction on summed emission data only. This feature is
not available for transmission data, and should be used for review purposes
only for unsummed (gated) data. Unsummed data is automatically
summed when loaded, and you can motion correct that. The motion
corrected values are automatically applied to the unsummed data as well,
and view it using a layout for the gated data.
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The Motion Correction panel displays the original and corrected
projection dataset with sliders and horizontal reference bars, a sinogram or
cyclogram of the original projection and corrected dataset, a motion
graph, and the current slice:
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Figure 38 Motion correction page
1.
Horizontal reference bars
2.
Motion correction sliders
3.
Motion graph of slices
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Here are the controls for Motion Correction:
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Figure 39 Motion correction controls
1.
Motion correction arrows
2.
Reset
3.
Show/Hide Markers
4.
Enhance
5.
Sinogram/Cyclogram
6.
Mask
See the next section for information on sinograms and cyclograms. Use the
controls below to perform motion correction.
CAUTION: Review the motion corrected projection datasets in cine mode to
ensure that motion has been corrected for accuracy. Improperly applied
motion correction may create artifacts resulting in misdiagnosis.
Correct X, Y
This allows you to apply automatic motion correction changes to the X
and Y axes individually. By default, only Correct Y is checked.
Show/Hide Markers
This toggles the display of the hash marks and coordinates in the
Corrected viewport.
Use this to display the pixel count differences between frames. Image
brightness is proportional to the amount of inter-projection movement
present. When displayed with cine on, the areas of motion artifacts are
accentuated.
Sinogram/Cyclogram
By default, a sinogram is displayed when the Motion Correction page
appears. A sinogram assists in identifying vertical motion, whereas a
cyclogram assists in identifying horizontal motion. You can toggle between
a sinogram and a cyclogram using this button (this control is also available
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Enhance
The Reconstruction Workstep
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when you right-click on a sinogram image). They both update as you
make adjustments to an image. For more on sinograms and cyclograms,
see the next section, “Analyzing Sinograms and Cyclograms” on page 95.
Mask
This allows you to specify the region of interest in a dataset (this button is
also available when you right-click on a mask image). Drag the crosshairs
in the center to move the mask; drag the small circles to resize the mask.
Figure 40 Mask controls
1. Move
2. Resize
Detector
Select the detector type (Single, Dual, Triple) used during acquisition
from the Detector pulldown menu. See the note in the next section for
information about applying manual motion correction to Dual-Head
data.
This is automatically detected when the information is available in
the patient header. However, be sure to review this setting to verify that it
matches the acquisition, and change it if necessary.
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NOTE:
In all cases, you can use Single to correct any data, even if it was acquired
with two or three heads. The program can use the information about the
correct number of heads to speed up and simplify motion correction, but
it can successfully motion correct each frame individually if Single is
selected.
Manually Correcting for Motion
To manually correct for motion, you need to step through each slice in the
reference viewport, move the image up or down or side to side as needed
to align the images, and reconstruct the image for motion correction.
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IMPORTANT: To minimize the number of slices you need to correct, examine
the entire dataset for motion and note the slices where correction is
needed. Determine the minimum number of slices you can correct to align
the entire study. For example, if slices one and two are offset from all other
slices, correct the first two slices relative to the last.
NOTE:
When applying manual motion correction to dual-head data, the
software enforces the following rules:
•
For Dual- and Triple-Head datasets, corrections in the Y direction that
are applied to the Nth projection image of one detector head are also
applied to the Nth projection image of the other detector head. For
example, if you correct frame 6 of a 64 frame dual head study by an
amount 0.5 pixels, NM Application Suite will also correct frame 38 (6
+ 32) by an amount 0.5 pixels.
•
For Dual-Head datasets that are acquired in the relative 180 degree
configuration, an additional rule is enforced (but not for the 90 degree
configuration). Corrections in the X direction that are applied to the
Nth projection image of one detector are applied in the opposite direction to the Nth projection of the other detector. For example, if you
correct frame 6 of a 64 frame dual head study by an amount 0.5,
Autospect will also correct frame 38 (6 + 32) by an amount -0.5 pixels.
•
For Triple-Head data, corrections in the X direction on one head must
take into account the angles of the other heads when calculating
corrections for them. This means that, for example, correcting by 0.5
pixels on one head may mean correcting by 0.25 on another, and by
-0.25 on the other.
For the following procedure, refer to Figure 38 above. To manually correct
a dataset for motion:
1. Analyze the sinogram, cyclogram, or the cine display of the projection
dataset to determine if the study contains a motion artifact.
2. In the Original Data viewport (labelled at the bottom of the
viewport), align the three horizontal reference bars with a constant
point of reference. This automatically adjusts the reference bars in the
Motion Corrected Data viewport. For example, in a cardiac study,
align the top reference bar with the superior ventricular surface, the
bottom reference bar with the inferior ventricular surface and the
middle reference bar with the mid-ventricular cavity.
You can use the reference lines as a visual cue when determining
whether the patient has moved. It may help to Ctrl-click the viewport
and use the cine controls in the Viewer Tools manager.
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To accentuate motion artifacts, click on Enhance and analyze the cine
display of the projection dataset. With Enhance enabled, the pixel
count difference between frames is displayed. Therefore, regions of
increased motion are displayed as brighter regions.
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3.2
3. Step through the projections using the arrow keys on the keyboard.
You can also use the mouse wheel to step through the projections.
Analyze the image as you step through the projections until you reach
the image needing correction.
4. Align the image in the Corrected viewport with the reference bars, as
necessary.
To do this, do one of the following:
•
Click on the motion correction arrows (see the figure above) to move
the image vertically or horizontally 0.1 pixel per click.
NOTE:
Click the RESET button (see the figure above) to return to the
original settings of the currently active frame.
•
Drag the motion correction sliders (the yellow hash marks) in the
Corrected viewport to move the image vertically or horizontally.
NOTE:
The pixel values appear in the upper right corner of the
Corrected viewport.
As you move the images a bar appears in the Graph viewport (see the
figure above). These bars give a visual representation of where the slices
are motion-corrected, how far they have been corrected, and in what
direction.
IMPORTANT: Do not press Correct when manually correcting for motion. If
you press Correct after manually moving the data, your entries will be
overwritten by the automatic motion control.
When the image is reconstructed the motion correction changes are
applied.
3.2.20
Analyzing Sinograms and Cyclograms
Understanding Sinograms
To create a sinogram, a single row of pixel values in each projection image
forms a row of pixel values in the sinogram (Figure 41). For example, to
create a sinogram displaying the data used to create the Nth slice in a
reconstructed dataset, the count values contained in the Nth row of each
projection image would be assigned to the corresponding row in the
sinogram. The count values contained in the Nth row of Image 1 form the
first row of the sinogram. The count values contained in the Nth row of
Image 2 form the second row of the sinogram. The number of rows in the
sinogram equals the number of projections in the SPECT dataset. The
number of images in the sinogram dataset equals the number of slices in
the reconstructed dataset.
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AutoSPECT Pro allows you to create sinograms and cyclograms to analyze
motion artifacts in SPECT studies.
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Figure 41 Sinogram generation
1. Image 1
2. Image 2
3. Image 3
4. Nth slice
5. Row N from Image 1
6. Row N from Image 2
7. Row N from Image 3
Analyzing Sinograms
1. If the cyclogram is displayed, click on Toggle Cyclogram in the Motion
Correction window to switch from the cyclogram display to the sinogram
display.
2. Display the sinogram from the desired slice.
The viewport for the original SPECT dataset displays the dataset as a
series of individual projection images. Each projection image contains the
counts acquired by a detector at a specific azimuth. Displaying other
projection images in the SPECT dataset allows you to view the counts
acquired at different azimuths.
However, an image in a sinogram displays the counts from the same row
in all of the projection images that are used to create a single tomographic
slice. Moving the reference line up or down displays sinograms at different
slice levels.
4. Analyze the sinogram for evidence of motion.
Viewing a dataset as a sinogram allows you to easily detect motion artifacts.
A sinogram created from a dataset without motion artifacts appears as a
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3. Drag the reference line in the Reference viewport. The sinogram display is
updated to the current slice.
The Reconstruction Workstep
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smooth spiral, but a sinogram created from a dataset containing motion
artifacts contains horizontal breaks or discontinuities in the spiral (Figure
42).
Figure 42 Sinogram without (left) and with (right) motion artifacts
Understanding Cyclograms
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Cyclograms are similar to sinograms but are generated by selecting a point
in a transverse slice and then concatenating from each projection image
the vertical strip that passes through that point (Figure 43).
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Figure 43
Cyclogram generation
1. Image 1
2. Image 2
3. Image 3
4. Column N from Image 1
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5. Column N from Image 2
6. Column N from Image 3
Analyzing Cyclograms
1. In the Motion Correction window, click on Cyclogram to enable the
cyclogram display.
A transverse sample slice will appear based on the reference line in the original projection image.
2. Drag the reference line in the original viewport.
The sample transverse slice is updated to the current slice corresponding to
the position of the reference line.
3. Use the crosshair in the sample transverse slice to determine the transverse
column to be used to generate the cyclogram. Ensure that the crosshair is
within the correct ROI.
If the crosshair is not within the ROI, right-click and drag the crosshair
within the ROI.
4. Analyze the cyclogram for evidence of motion.
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Cyclograms display evidence of motion similar to sinograms except in the
vertical plane. A cyclogram created from a dataset without motion artifacts
appears as a smooth wavy image, but cyclograms created from datasets
containing motion artifacts contain vertical breaks or discontinuities in
the image (Figure 44).
Figure 44 Cyclogram without (left) and with (right) motion artifacts
3.3
The Reorientation Workstep
The Reorientation workstep (Figure 46) allows you to automatically or
manually reorient SPECT or gated SPECT datasets. When you select the
Reorient workstep, cardiac datasets are automatically processed and
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reoriented. If you are not satisfied with the automatically identified
reorientation, or if the dataset is non-cardiac, you must adjust the limits
manually.
NOTE:
Reoriented data is saved in the ACC format: the apex points to the
right in the vertical long axis, and upward in the horizontal long axis (see
the figure below). Additionally:
•
Short Axis images in the dataset are sliced from apex to base.
•
Vertical Long Axis images in the dataset are displayed from septum to
lateral wall.
•
Horizontal Long Axis images in the dataset are displayed from inferior
to superior.
Figure 45
1.
Cardiac ACC orientation (SAX at left, VLA in middle, HLA at right):
Superior
2.
Inferior
3.
Septal
4.
Lateral
5.
Base
6.
Apex
Perform reorientation on summed emission data only. Changes made to
the reorientation on the unsummed gated data are applied to the Summed
data, and vice-versa. Philips recommends making changes to the
reorientation only on the Summed Emission data page.
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For multiple reconstructions of the same dataset in the same processing
session (for example, with and without attenuation correction), changes
made to the reorientation of one reconstruction are automatically made to
any other reconstruction in the session.
If you have used scatter correction or Astonish for reconstruction,
the transverse slice in the Reorientation page may look different from the
sample Reconstructed Slice image on the Reconstruction page. This is
because calculations for the sample slice do not use the full 2D or 3D
information used for the final reconstruction displayed in the Reorientation
page.
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Figure 46 Reorientation page
Visually verify the reorientation results before saving to ensure
images are reconstructed properly. Improperly reoriented images may
result in misdiagnosis.
3.3.1
Reorienting Datasets
The Reorient workstep (Figure 46) contains Azimuth and Elevation
reference lines that you can drag and rotate. If the Twist option is enabled,
an axial tilt reference line is displayed in the bottom viewport. The
orientation of the reference lines determines the orientation of the
reconstructed datasets.
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Setting Preferences for AutoSPECT Pro
3.4
To manually reorient the organ of interest:
1. Position each reference arrow in the organ of interest: for each viewport,
drag the circle in the middle of the reference arrow to the center of the
organ of interest.
2. Drag an end of a reference arrow to rotate it to align the organ of interest.
Alternatively, type a value in the Azimuth and Elevation boxes at the
bottom.
3. If necessary, check the Twist box at the bottom to display the Twist
reference arrow and adjust that as well.
4. Specify the slices to save by dragging the reference lines on the right side of
each viewport to enclose the organ of interest. Use the Matrix Zoom
control at the bottom to control the apparent size of the image: either drag
the slider or type in a zoom value (the range is 1-3). If you need a specific
pixel size, use the Pixel Size box to type in a value.
NOTE:
You cannot adjust the viewports individually with Zoom.
IMPORTANT: When positioning the reference lines, allow sufficient space
between the lines and the organ so that you do not clip it.
3.4
Data Type
Image Type
Tomo/Emission
Motion Corrected Tomo
Gated Tomo
Gated Motion Corrected Tomo
Gated ReconTomo
(Emission)
Summed Tomo, Motion Corrected summed Tomo, Motion Corrected
gated Tomo, Gated Transverse, Gated Short Axis, Gated Horizontal Long
Axis, and Gated Vertical Long Axis
Recon Tomo (Emission)
Non cardiac: Oblique/Reoriented Transverse, Sagittal, and Coronal
Cardiac: Transverse, Short Axis, Horizontal Long Axis and Vertical Long
Axis
Recon Tomo
(Transmission)
AC Map
Setting Preferences for AutoSPECT Pro
AutoSPECT Pro handles preferences differently from the other
applications in the NM Application Suite. This section describes how to
set preferences in AutoSPECT Pro only, not in any other application.
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You can save the following data and image types:
There are 21 factory preferences for AutoSPECT Pro:
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1 Day
•
2 Day
•
Dual Isotope
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Setting Preferences for AutoSPECT Pro
•
Thallium
•
Astonish Cardiac
•
Vantage Pro
•
Astonish Vantage Pro
•
Astonish Cardiac CT-AC
•
Cardiac CT-AC
•
Bone
•
Astonish Bone
•
TB SPECT
•
General Dual CT-AC
•
General Chang AC
•
General CT-AC
•
Brain
•
Astonish Brain
•
Brain Chang AC
•
Brain CT-AC
•
Cardiac Reorientation
•
Reorientation
To use Preferences, select the Preferences Data Manager. This manager
contains a list of all the AutoSPECT Pro preferences, and some controls at
the bottom:
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1.
Edit Preference
2.
Delete Preference
3.
Apply Preference
4.
Show Factory
Preferences controls
•
To edit a preference, select the preference from the list and click Edit
Preferences. See the sections below for details on editing preferences.
•
To apply a preference, double-click it, or select it and click Apply Preference.
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Figure 47
Setting Preferences for AutoSPECT Pro
3.4.1
3.4
•
To delete a preference, select the preference from the list and click
Delete Preference.
•
To toggle the display of the factory-installed preferences, check the
Show Factory checkbox.
General Preferences
In an AutoSPECT Pro preference, each workstep has its own preference
settings. In addition, you can set some parameters for the preference as a
whole (ones that apply to all worksteps):
•
AutoProceed: This determines whether the workflow automatically
continues through the workstep if all the required input is present. If
this is unchecked, the workflow will always stop at the workstep. If it
is checked, it will stop only if the required input is not present.
NOTE:
AutoProceed is available for all worksteps except the first one, Setup.
You must manually proceed from the Setup step even if AutoProceed is
checked for it in the Preference.
•
Acquisition Matching String: This allows you to set strings for exam
matching based on the DICOM attributes Study Description,
Protocol Name, or Body Part Examined. Separate strings with a
comma. Matching succeeds if any of the DICOM attributes contains
one of the matching strings.
•
CT Window Preset: These translate the values of an image into a
range of gray levels suitable for optimal viewing of the specified organ
or area.
•
SPECT ColorMap: These convert gray levels to colors using different
schemes.
NOTE:
CT images loaded into the AC Map workstep are always displayed in
grayscale.
3.4.2
Preferences for the Setup Workstep
The following controls appear in the Setup workstep.
•
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All other parameters are specific to the worksteps and are described below.
Matching String: Strings you type in here are used to match datasets
and exams that will use the preference. Separate strings with a comma.
Matching succeeds if the value of any of these DICOM attributes
contains one of the matching strings:
–
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For datasets: Study Description, Protocol Name, and Body Part
Examined (organ)
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–
3.4.3
For exams, the matching proceeds in this order: Acquisition
Context, Image ID, Series Description and Image Comment
•
Active: Check this to set whether the bucket appears in the Setup step.
•
Alternate Name: This is an additional string to use with the default
bucket name.
Preferences for the ACMap Workstep
The controls available in this workstep depend on the preference you are
editing. For a Changs AC preference, there are no relevant controls. For a
Vantage preference, the controls are a subset of the Reconstruction
workstep controls (Method, Corrections, Filters, etc.); see the descriptions
in the section on “The Reconstruction Workstep” on page 79 for details.
For most other preferences, the following controls are present:
3.4.4
•
Rotation: This sets the increment by which the SPECT image rotates
when you click on it using the Incremental Rotate tool.
•
Translation: This sets the increment by which the SPECT image
moves when you click on it using the Incremental Translate tool
Preferences for the Reconstruction Workstep
•
Since you can have up to three reconstructions when using the
Compare function, you can set the preferences for each one using the
buttons on the left. Click a button to select it, and set the preferences
described below. Use the checkboxes to specify whether the reconstruction is available.
•
Auto Knitting: Checking this automatically knits loaded segments
during reconstruction. However, for this to work, all segments must
include the full field of view, and they must all use the same reconstruction settings (Method, Iterations, Filter, etc.).
•
Mode: This determines whether there is a single set of reconstruction
and reorientation controls or a dual set.
•
Reconstruction controls: The Reconstruction controls allow you to set
the default settings seen in the workstep: the default Method, Iterations, Filter, whether the Corrections are on or off, etc. For explanations of these, see the sections that describe them.
NOTE: If Motion is checked and set to Manual, this will override the
AutoProceed setting, and the process will stop at the Reconstruction
workstep to allow manual motion correction.
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The following controls appear in the Reconstruction workstep.
Setting Preferences for AutoSPECT Pro
3.4.5
3.4
•
Saving Options: These are the datasets to save. Check a dataset to have
it saved; type a string in the text box to save the dataset with that name
instead of the one displayed.
•
Buckets: This specifies the bucket that is to be a required dataset in the
Setup workstep.
Preferences for the Reorientation Workstep
The following controls appear in the Reconstruction workstep.
3.4.6
•
Oblique Twist: This determines whether Twist is on or off.
•
Matrix Zoom: This specifies a default zoom factor.
Preferences for the Review Workstep
This is a list of all the viewing protocols. Select a Default protocol by
clicking on its radio button. Select the protocols to make available by
using the Active checkboxes. For protocols you have created (listed under
User Viewing Protocols), you can check Delete Protocol, which deletes
the protocol on saving the Preference.
3.4.7
Saving and Applying Preferences
When you are done making changes to a preference, you have the
following options:
Before saving, be sure to verify that you have configured the
options in all the appropriate worksteps.
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IMPORTANT:
•
Save As: This displays a dialog that allows you to save the changes you
have made as a new Preference.
•
Save: This saves the changes you have made to the preference. To save
it as a new preference, type a name in the Preference Name field before
clicking Save.
NOTE:
If you make changes to a factory default Preference and Save it, a
new user Preference is saved with the same name; the factory Preference
remains unchanged. You can also use Save As and save it as a new
Preference.
Save does not apply the changes to the current dataset; for that, use
Save Apply (below).
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Apply: This applies the current settings to the workstep, but does not
save them to the preference.
•
Save Apply: This saves the changes you have made to the preference,
and also applies it to the current dataset.
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•
3.4.8
Close: This closes the Preferences Editor without saving changes.
AutoSPECT Pro Default Protocols
Here are descriptions of all the default protocols used in AutoSPECT Pro.
1 Day
This protocol reconstructs gated and summed STRESS and REST cardiac
studies without attenuation correction. This default uses FBP with
parameters previously established in AutoSPECT Plus for a 1 day
Cardiolite protocol.
2 Day
This protocol reconstructs gated and summed STRESS and REST cardiac
studies without attenuation correction. This default uses FBP with
parameters previously established in AutoSPECT Plus for a 2 day
Cardiolite protocol.
Astonish Cardiac CT-AC
This protocol reconstructs gated and summed STRESS and REST cardiac
studies with and without CT-based attenuation correction. This default
uses Astonish for emission data with parameters suitable for cardiac
studies.
Astonish Cardiac
This protocol reconstructs gated and summed STRESS and REST cardiac
studies without attenuation correction. This default uses Astonish with
parameters determined from clinical studies. See the NM Application Suite
Reference Manual for references.
Astonish Vantage Pro
Bone SPECT Astonish
This protocol reconstructs bone scans, or general SPECT studies, without
attenuation correction. This default uses Astonish with parameters
determined by clinical users.
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This protocol reconstructs gated and summed STRESS and REST cardiac
Vantage studies with and without attenuation correction. This default uses
Bayesian reconstruction for transmission data and Astonish for emission
data with parameters determined from clinical studies. See the NM
Application Suite Reference Manual for references.
Setting Preferences for AutoSPECT Pro
3.4
Bone SPECT
This protocol reconstructs bone scans, or general SPECT studies, without
attenuation correction. This default uses FBP with parameters previously
established in AutoSPECT Plus.
Brain Astonish
This protocol reconstructs brain studies without attenuation correction.
This default uses Astonish with parameters previously established in
AutoSPECT Plus.
Brain Chang AC
This protocol reconstructs brain studies with and without Chang's
attenuation correction. This default uses FBP with brain parameters
previously established in AutoSPECT Plus.
Brain CT-AC
This protocol reconstructs brain studies with and without CT-based
attenuation correction. This default uses OSEM with generic parameters.
Brain Default
This protocol reconstructs brain studies without attenuation correction.
This default uses FBP with parameters previously established in
AutoSPECT Plus.
Cardiac CT-AC
This protocol reconstructs gated and summed STRESS and REST cardiac
studies with and without CT-based attenuation correction. This default
uses OSEM for emission data with parameters previously established in
AutoSPECT Plus.
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Cardiac Vantage Pro
This protocol reconstructs gated and summed STRESS and REST cardiac
Vantage studies with and without attenuation correction. This default uses
Bayesian reconstruction for transmission data and MLEM for emission
data with parameters previously established in AutoSPECT Plus.
Cardiac Reorientation
This protocol reorients previously reconstructed gated and/or ungated
cardiac SPECT volumes.
Dual Isotope
This protocol reconstructs gated and summed STRESS and REST cardiac
studies without attenuation correction. This default uses FBP with
parameters previously established in AutoSPECT Plus for a thallium
REST, technetium STRESS protocol.
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Setting Preferences for AutoSPECT Pro
General Chang AC
This protocol reconstructs general SPECT studies, both with and without
Chang's attenuation correction. This default uses FBP with generic
parameters.
General Dual CT-AC
You can use this for concurrently reconstructing two SPECT data sets
(e.g., ventilation and perfusion studies, dual isotope studies, etc.) both
with and without CT-based attenuation correction. This default uses
OSEM with generic parameters.
General CT-AC
This protocol reconstructs up to 3 TB SPECT segments concurrently
both with and without CT attenuation correction. This default uses
OSEM with generic parameters.
General Reorientation
This protocol reorients previously reconstructed non-cardiac SPECT
volumes.
TB SPECT
This protocol reconstructs up to 6 TB SPECT segments concurrently.
This default uses MLEM with no axial filter to minimize knitting artifacts,
and no attenuation correction.
Thallium
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This protocol reconstructs gated and summed STRESS and REST cardiac
studies without attenuation correction. This default uses FBP with
parameters previously established in AutoSPECT Plus for a thallium
protocol.
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Cardiac
This application allows you to perform gated planar (MUGA) analysis,
first pass analysis, and quantify left-to-right shunts. It has these methods:
•
LV Muga GBP
•
LV Muga C
•
Shunt
•
First Pass
For information on loading requirements, and on calculations and
algorithms used in this application, see the appropriate section in the NM
Application Suite Reference Manual.
4.1
MUGA
MUGA (Multi-Gated Acquisition) allows you to automatically segment
and quantify gated blood pool datasets, and create statistical information
about the cardiac cycle. A Left Ventricle ROI is required for MUGA, but
the Right Ventricle ROI is also selectable as a Method. By default,
bounding boxes are automatically drawn around the ventricles. From these
regions the application determines ED and ES, and generates results using
relevant corrections (for example, background correction).
4.1.1
Using MUGA
In the Define Regions workstep, this application draws a preliminary
bounding box around one or more regions. By default the edge detection
algorithm is GBP Multiple. You must then take these steps to create ROIs:
4535 604 78081 Rev A
1. Move and adjust a bounding box so it encloses the appropriate
ventricle. Drag the line to move the bounding box; drag a handle to
reshape it.
2. Click Detect Region.
Philips Healthcare
This creates an ROI for the ventricle and an ROI for the background.
To start over, click the circle icon again; to draw the ROI by hand,
click the eraser icon.
The ED and ES frames for LV and RV are automatically determined and
the ROIs are automatically drawn. If you would like to change any of
these:
1. In the Cine viewer, go to the correct frame (using the Scroll feature,
for example).
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4.1
MUGA
2. If necessary, redraw the ROI by clicking on its eraser icon and using
the ROI pencil tool.
3. Right-click in the Cine viewer, and use the Set As pop-up menu to
select a label.
In the Review Results workstep, you can use the red timing marker in the
Time Activity viewer to get results values and Regional EFs at a specific
time. Drag the marker to a specific time to view the values; the precise
time appears just above the marker.
CAUTION:
If the count rate is significantly lower in the last few bins of the
study, the Ejection Fraction value and the identification of the ED and ES
frames can be wrong. To avoid this situation, use the timing marker in the
Time Activity viewer to exclude the last bins from the calculations.
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Results
C a rdi a c
•
Cine
•
ED/ES images
•
Phase/Amplitude images, and Phase Histogram
•
Ejection Matrix/Stroke images
•
Ejection Fraction
•
Background Counts
•
Peak Filling Rate
•
Peak Ejection Rate
•
Time to Peak Filling
•
Time to Peak Ejection
•
Filling for 25%, 33%, 50%, and 75%
•
Nominal Interval
•
RR Interval Window
•
Acquired Beats
•
Rejected Beats
•
Skipped Beats
•
Volume Time Activity Curve
•
Regional Ejection Fractions
•
First Derivative Time Activity Curve
Philips Healthcare
4.1.2
NM Application Suite
Release 1.0
First Pass
4.2
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
4.1.3
Preferences
To change the Preferences for this application:
1. Select the Preferences Data Manager.
2. Click Open Preference Editor at the bottom of the Preferences
section (the second icon:
).
3. Make changes in the preferences window using the information in the
table below.
See the section on “Creating and Editing Preferences” on page 43 for
details on editing Preferences.
You can save these parameters as Preferences:
Default
Description
Muga Algorithms
GBP Multiple
This is the algorithm used for edge detection.
View Smoothed Image
True
This determines whether the cine images are
smoothed (using the Fourier algorithm)
Slope
1.0
Slope of the line fit to points in a calibration plot
Intercept
0.0
Y intercept of the line fit to points in a calibration
plot
First Pass
This calculates right or left ventricular ejection fractions from a First Pass
dynamic study. It requires rapid framing rate studies (30-40 sec
acquisitions of 0.03 to 0.04 secs per frame) of the first transit through the
heart to obtain a 16-frame gated study.
4.2.1
Using First Pass
In the Define Regions workstep, after drawing the ROIs, use the timing
markers in the Whole Heart Time Activity curve to specify the time to
analyze.
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4.2
Parameter
In the Review Results workstep, review the frame pairs in the Ventricle
curve. These are the colored lines in the time activity curve. If they need
redefining, follow these steps:
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4.2
First Pass
1. Select Manual from the Frame Pairs Identification Type pull-down
menu.
2. Click on a FramePair radio button to select the pair to define.
3. Drag the red and green timing markers from their default position at
time zero to define the beginning and end frames.
4. Click Add Frame Pair to confirm the settings.
5. Identify other frame pairs similarly.
6. Use the Delete Frame Pair button to delete a pair.
4.2.2
Results
•
Cine display
•
Gated Study display
•
Ejection Fractions for each frame pair
•
Average Ejection Fraction
•
Ventricle Time Activity Curve
•
Splash display
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
4.2.3
Preferences
To change the Preferences for this application:
1. Select the Preferences Data Manager.
2. Click Open Preference Editor at the bottom of the Preferences
section (the second icon:
).
See the section on “Creating and Editing Preferences” on page 43 for
details on editing Preferences.
You can save these parameters as Preferences:
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C a rdi a c
Parameter
Default
Description
Review Compress Factor
1
Number of frames to compress for review data
No. of Frames
6
This determines how many frame pairs to identify in the
Ventricle Time Activity curve in the Results step
NM Application Suite
Release 1.0
Philips Healthcare
3. Make changes in the preferences window using the information in the
table below.
Shunt
4.3
4.3
Shunt
This calculates the pulmonary-to-systemic flow ratio to determine if a left
to right cardiac shunt is present. Given a fast dynamic cardiac study
(usually a 30 sec acquisition of 0.5 secs per frame), Shunt processing
requires fitting of the pulmonary curve with a gamma variate fit,
subtraction of the fit and subsequent fitting of the remaining curve data
with a second gamma fit to determine the pulmonary-to-systemic flow
ratio. Superior Vena Cava quality control time is also computed to
evaluate the bolus quality.
4.3.1
Using Shunt
In the Define Regions workstep, after defining the ROIs, use the timing
markers in the Right Lung Time Activity curve to define the points to use
to fit the gamma curve to the data as closely as possible. The Recirculation
curve is drawn automatically, based on the Right Lung fitted curve. Use
the timing markers in the Recirculation curve to fit its gamma curve as
well.
Results
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4535 604 78081 Rev A
4.3.2
•
Composite image
•
Cine with all ROIs
•
SVC Control Time
•
Pulmonary Transit Time
•
Qp/QS ratio
•
SVC (superior vena cava) Time Activity curve
•
Time Activity curves for right lung, gamma fit, recirculation, and
recirculation fit
•
Splash display
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
4.3.3
Preferences
To change the Preferences for this application:
1. Select the Preferences Data Manager.
2. Click Open Preference Editor at the bottom of the Preferences
section (the second icon:
).
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Release 1.0
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4.4
Review Layouts
3. Make changes in the preferences window using the information in the
table below.
See the section on “Creating and Editing Preferences” on page 43 for
details on editing Preferences.
You can save these parameters as Preferences:
4.4
Parameter
Default
Description
Review Compress Factor
1
Number of frames to compress for review data
Review Layouts
Below are the layouts in the Review workstep:
Muga Dynamic
•
Muga Cine
•
Shunt Dynamic
•
Shunt Splash
•
First Pass Splash
•
First Pass Dynamic
•
Gated FirstPass
•
SC images
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•
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C a rdi a c
NM Application Suite
Release 1.0
5
Whole Body
This application allows you to quantify multiple types of skeletal image
data and review the results. It has these methods:
•
Three Phase Analysis: This calculates count density mean ratios.
•
Ileosacrum Ratio Computation: This calculates the ratio of the Left
and Right Ileosacrum with respect to the Spine (Spine = 100%).
For information on loading requirements, and on calculations and
algorithms used in this application, see the appropriate section in the NM
Application Suite Reference Manual.
5.1
Using Three Phase Analysis
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4535 604 78081 Rev A
As you draw the Numerator/Denominator ROI pairs, the ratio is
displayed in the viewer.
Figure 48 Numerator/denominator ROI pair and ratio
5.2
NM Application Suite
Results for Three Phase Analysis
Release 1.0
•
Composite image with ROIs and Ratio
•
Pool & Delayed images, with ROIs and Ratio
W h o l e B od y
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5.3
Parameters for Three Phase Analysis
•
Splash display with ROIs
•
Time Activity curve for Flow Numerator and Denominator
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
5.3
Parameters for Three Phase Analysis
To change the Preferences for this application:
1. Select the Preferences Data Manager.
2. Click Open Preference Editor at the bottom of the Preferences
section (the second icon:
).
3. Make changes in the preferences window using the information in the
table below.
See the section on “Creating and Editing Preferences” on page 43 for
details on editing Preferences.
You can save these parameters as Preferences:
5.4
Parameter
Default
Description
Smooth Curve
False
This determines whether the
results curves are smoothed.
Using Ileosacrum Ratio Computation
If you do not have the required dataset, you can create a substitute by
displaying the Posterior image, adjusting the red limit bars, and using
Extract in the right-click context menu. This allows you to proceed to the
Define Regions workstep and draw ROIs.
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Results for Ileosacrum Ratio Computation
W h o l e B od y
•
Review image with all ROIs
•
Counts in Left, Right, and Spine regions
•
Number of pixels in Left, Right, and Spine regions
•
Normalized counts in Left, Right, and Spine regions
•
Raw (%) for Left and Right compared to Spine
NM Application Suite
Philips Healthcare
5.5
Release 1.0
Review Layouts
•
Normalized (%) for Left and Right compared to Spine
•
L/R Raw Ratio
•
L/R Normalized Ratio
•
IS-Ratio L/R
•
IS-Ratio R/L
•
Left SIJ Index
•
Right SIJ Index
•
All Images
5.6
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
5.6
Review Layouts
Below are the layouts in the Review workstep:
Whole Body Comparison
•
Flow With Statics
•
Static Review
•
Whole Body With Spots
•
Whole Body Display
•
Fusion Display
•
SC images
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•
NM Application Suite
Release 1.0
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Review Layouts
118
W h o l e B od y
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5.6
NM Application Suite
Release 1.0
6
Lung
This application allows you to generate relative pulmonary uptake values
for various pulmonary studies. Depending on the datasets you have
loaded, you can perform analysis for perfusion only, ventilation only, or
washout. Results are provided for upper, middle, and lower vertical
segments in each lung. It has these methods:
•
Perfusion Analysis
•
Ventilation Analysis
•
Washout Analysis
For information on loading requirements, and on calculations and
algorithms used in this application, see the appropriate section in the NM
Application Suite Reference Manual.
6.1
Using Lung
This application draws a bounding box around each lung. To use
automatic edge detection, first adjust each bounding box by dragging its
control points. Then click Detect All Regions.
NOTE: If you have loaded both posterior and anterior images, you can
redraw ROIs separately on each image. However, you must be sure to
select the image first by clicking on it.
6.2
Washout Results
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In the Washout Analysis workstep, as soon as you draw the ROIs, you see
the Results information:
•
Cine with ROIs
•
Static images
•
T1/2 values for each segment in each lung
•
Splash display with ROIs
•
Time Activity curves for each segment in each lung
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
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Release 1.0
Lung
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6.3
Ventilation Results
6.3
Ventilation Results
•
Posterior and Anterior images with ROIs
•
6 viewers for static images in other orientations
•
Posterior: For each lung, counts by segment, in counts and as a
percentage
•
Anterior: For each lung, counts by segment, in counts and as a
percentage
•
Geometric Mean: For each lung, counts by segment, in counts and as
a percentage
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
6.4
Perfusion Results
•
Posterior and Anterior images with ROIs
•
6 viewers for static images in other orientations
•
Posterior: For each lung, counts by segment, in counts and as a
percentage
•
Anterior: For each lung, counts by segment, in counts and as a
percentage
•
Geometric Mean: For each lung, counts by segment, in counts and as
a percentage
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
Review Layouts
Philips Healthcare
6.5
Below are the layouts in the Review workstep:
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Lung
•
Perfusion Ventilation Compare
•
Perfusion Display
•
Ventilation Display
•
Washout Display
NM Application Suite
Release 1.0
Review Layouts
Washout Perfusion Display
•
SC images
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•
6.5
NM Application Suite
Release 1.0
Lung
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Review Layouts
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Lung
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6.5
NM Application Suite
Release 1.0
7
Renal
The Renal application allows you to analyze and display dynamic singleand multi-phase planar renal studies.
IMPORTANT:
The application uses the Pre Injection Syringe and Post
Injection Syringe images, if loaded, to compute the injected dose. Use the
following guidelines when acquiring pre- and post-injection syringe images:
•
Place the syringe on the table 30 cm from the collimator face. Under
the syringe, include all other items typically used between a patient and
the table (e.g., sheet, pad, restraining strap).
•
If the radiopharmaceutical activity of the pre-injection syringe is
greater than 3 mCi, use a syringe shield when acquiring images for
both the pre- and the post-injection syringes. Pre-injection syringe
activity less than 3 mCi does not require shielding.
•
If you typically image patients in the supine position, position the
detector under the table. If you use a different patient position, position the detector accordingly.
•
Acquire a one-minute static image of each syringe, using a 256 x 256
matrix to avoid pixel overflow.
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This application allows you to process and analyze planar renal studies of
1, 2, or 3 phases. You can use this application to:
NM Application Suite
Release 1.0
•
Load and process dynamic images from a renal study for display and
processing. You can limit the set of frames in the loaded dynamic sets
to a consecutive subset of frames for use in processing.
•
Create your own predefined default sets and define the rules for
matching the default sets to study types and protocols (with the appropriate system permissions). By default, the application uses predefined
parameter values based on the protocol name of the selected study.
•
Choose a processing algorithm. Choices include: ERPF (plasma and
camera-based); GFR (plasma and camera-based); Lasix; Transplant;
Gates; Taylor; Oberhausen; Bubeck; Tauxe; and UAB. The application takes the algorithm you choose as a default chosen based on exam
name, and uses the algorithm to determine which ROIs are required.
•
Inspect, define, and modify injection times and doses.
•
Create composite images from the dynamic and use them for defining
ROIs.
•
Define pre- and post-injection syringe images and pre- and post-void
bladder images.
•
Perform automated organ segmentation, including identification of
right and left kidneys, right and left background regions, and aorta as
Renal
123
7.1
Using ROIs in Renal
required by the processing algorithm chosen. You can choose the shape
of the background ROIs.
•
Manually define the required regions and modify any system-generated regions. After reviewing the curve plots of the specified regions,
you can adjust the scale and displayed range of the plots.
•
Perform Patlak corrections.
•
Adjust the time interval for update calculations.
•
Display a differential renogram.
•
Compute and display the Hilson index for a transplant.
•
View post-miction displays as applicable for the selected study.
The application has these methods:
•
Simple Renogram
•
Pre Post Lasix
•
Post Renogram Lasix
•
GFR Gates
•
ERPF Schlegel
•
ERPF Schlegel with Void
•
ERPF: MAG 3
•
Renal Deconvolution
•
DMSA Static Ratio
•
Hilson Index
•
Patlak
•
Cortical Analysis
•
Split T1/2
7.1
Using ROIs in Renal
The Renal application has some unique ROI functionality. While other
applications may allow you to draw ROIs semi-automatically, manually, or
by using a template, Renal also provides completely automatic ROI
definition in some instances. To use this, select the pink area icon in the
ROI pull-down menu for the ROI you need to set.
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Renal
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For information on loading requirements, and on calculations and
algorithms used in this application, see the appropriate section in the NM
Application Suite Reference Manual.
Supplying Inputs for Renal
7.2
In the Define Regions workstep of some Preferences, this application
draws a preliminary bounding box around one or more regions. You must
then take these steps to create ROIs:
1. Move and adjust the bounding boxes so they just enclose the
appropriate areas. Drag a line to move a bounding box; drag a handle
to reshape it.
2. Click the Detect All Regions icon to create isocontours for all the
regions at once.
This creates ROIs for the areas and for any required backgrounds. To start
over, click the Detect All Regions icon again; to draw the ROI by hand,
click the eraser icon (Draw Region) in the ROI control. It turns into a
pencil, indicating that you can draw manually.
7.2
Supplying Inputs for Renal
Some Renal Preferences require inputs in the Define Regions workstep
that affect the results calculations. There are two inputs that are only
displayed in the results, and are not used for calculations. These are
Radionuclide and Radiopharmaceutical. These are read from the
DICOM header if they are present; if not, you can type any value for
them.
7.3
Renal Results
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
Preferences
4535 604 78081 Rev A
7.4
To change the Preferences for this application:
1. Select the Preferences Data Manager.
Philips Healthcare
2. Click Open Preference Editor at the bottom of the Preferences
section (the second icon:
).
3. Make changes in the preferences window using the information in the
table below.
See the section on “Creating and Editing Preferences” on page 43 for
details on editing Preferences.
You can save these parameters for this application:
NM Application Suite
Release 1.0
Renal
125
7.5
Review Layouts
Parameter
Default
Description
Review Compress Factor (Renogram)
1
Number of frames to compress for renogram
review data
Review Compress Factor (Flow)
1
Number of frames to compress for flow
review data
Composite Start Frame
1
First frame of composite image
Composite End Frame
(varies
depending on
the
method)
Last frame of composite image
For more on compression, see the section on “Frame Compress” on page
31.
7.5
Review Layouts
Below are the layouts in the Review workstep:
7.6
•
Renal Dynamic
•
Renal Review
•
Static Review
•
DMSA Static Review
•
SC images
Simple Renogram
7.6.1
Using Simple Renogram
In the Define Regions workstep, you may need to provide values for the
following parameters in the Inputs viewer:
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Renal
•
Radionuclide
•
Radiopharmaceutical
NM Application Suite
Release 1.0
Philips Healthcare
Simple Renogram is primarily used to analyze the acquisition data and
produce statistical information about the function of the kidneys.
Pre Post Lasix
7.6.2
•
Time of Lasix Injection (min)
•
Differential Start Time (min)
•
Differential End Time (min)
•
Residual Activity Time (min)
•
Curves Smoothing Factor
•
Composite image with all ROIs
•
Cine with all ROIs
•
Peak Time (sec) for both kidneys
•
T 1/2 (min) for both kidneys
•
Peak Counts for both kidneys
•
Diff Perfusion (%) for both kidneys
•
Renal Retention (%) for both kidneys
•
Differential Calculation Time (min)
•
Radionuclide
•
Radiopharmaceutical
•
Time of Lasix Injection (min)
•
Splash display
•
Time Activity curve for Flow data for both kidneys and aorta
•
Time Activity curve for Renogram data for both kidneys and bladder
Results
Pre Post Lasix
This method provides renal processing capability (analogous to Pegasys)
by combining the flow and renal portions of the study into a single curve
for processing.
7.7.1
Using Pre Post Lasix
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7.7
7.7
In the Define Regions workstep, you may need to provide values for the
following parameters in the Inputs viewer:
NM Application Suite
Release 1.0
•
Radionuclide
•
Radiopharmaceutical
Renal
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7.7
Pre Post Lasix
•
Time of Lasix Injection (0 for no Lasix)
•
Time of Post Lasix Percent Remaining (min)
•
Differential Start Time (min)
•
Differential End Time (min)
•
Residual Activity Time (min)
•
Curves Smoothing Factor
NOTE:
If Time of Lasix Injection is blank or zero, it will not appear in the
Review Results workstep.
7.7.2
Results
•
Composite image with all ROIs
•
Cine with all ROIs
•
Time Activity curves for Flow data for both kidneys and aorta
•
Time Activity curves for Renogram data for both kidneys and bladder
•
Splash display
•
Peak Time (min)
•
T 1/2 (min)
•
Peak Counts
•
20 Min / Peak Ratio (%)
•
Differential (%)
•
Time To Max (sec)
•
Max Flow Counts
Renogram Results
Flow Image Timings
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Renal
•
Peak Post Lasix (min)
•
T 1/2 From Peak (min)
•
T 1/2 from Lasix (min)
•
PRE-L/10M Clearance (%)
•
PK-L/10M Clearance (%)
•
Aorta Peak Time (sec)
Philips Healthcare
Lasix Clearance Report
NM Application Suite
Release 1.0
Post Renogram Lasix
7.8
•
Differential Time (min)
•
Radionuclide
•
Radiopharmaceutical
•
Time of Lasix Injection (min)
7.8
Post Renogram Lasix
This method uses a post renogram Single Framing Rate Dynamic
(Diuresis) study to create the Post-Lasix T 1/2.
7.8.1
Using Post Renogram Lasix
In the Define Regions workstep, you may need to provide values for the
following parameters in the Inputs viewer:
Radionuclide
•
Radiopharmaceutical
•
Curves Smoothing Factor
•
Time of Lasix Injection (min)
•
Composite image with all ROIs
•
Cine with all ROIs
•
T 1/2 (min) for both kidneys
•
Radionuclide
•
Radiopharmaceutical
•
Time of Lasix Injection (min)
•
Time Activity curve for left kidney Lasix and fit
•
Time Activity curve for right kidney Lasix and fit
•
Splash display
Results
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7.8.2
•
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Release 1.0
Renal
129
7.9
GFR Gates
7.9
GFR Gates
This calculates the total glomerular filtration rate (GFR), individual GFR,
normalized GFR, time to peak, and time to half peak for two-kidney,
single-kidney, and kidney transplant patients.
7.9.1
Using GFR Gates
In the Define Regions workstep, you may need to provide values for the
following parameters in the Inputs viewer:
130
Radionuclide
•
Radiopharmaceutical
•
Patient Weight (lb)
•
Patient Height (in)
•
Pre Dose Multi-Factor
•
Post Dose Multi-Factor
•
Pre-Injection Counts
•
Post-Injection Counts
•
Pre-Injection Time
•
Patient Injection Time
•
Post-Injection Time
•
Total Injected Dose
•
Composite image with all ROIs
•
Cine with all ROIs
•
Depth (cm) for both kidneys
•
Peak Time (sec) for both kidneys
•
T 1/2 (min) for both kidneys
•
Uptake (%) for both kidneys
•
GFR (ml/min) for both kidneys
•
Total GFR (ml/min)
•
Normalized GFR (ml/min)
•
Total Injected Dose (MBq)
Results
Renal
Philips Healthcare
7.9.2
•
NM Application Suite
Release 1.0
ERPF Schlegel
7.10
•
Radionuclide
•
Radiopharmaceutical
•
Splash display
•
Time Activity curves for Flow data for both kidneys and aorta
•
Time Activity curves for Renogram for both kidneys and bladder
7.10
ERPF Schlegel
This method calculates the effective renal plasma flow.
7.10.1
Using ERPF Schlegel
In the Define Regions workstep, you may need to provide values for the
following parameters in the Inputs viewer:
Radionuclide
•
Radiopharmaceutical
•
Patient Weight (lbs)
•
Patient Height (in)
•
Total Injected Dose (MBq)
•
Pre-Injection Counts
•
Post-Injection Counts
•
Composite image including all ROIs
•
Cine including all ROIs
•
Time Activity curve for right and left kidney values, and bladder values
•
Splash display
•
Peak Time (sec) for both kidneys
•
T 1/2 (min) for both kidneys
•
Slope1 (peak - t1/2) for both kidneys
•
Uptake (%) for both kidneys
•
ERPF (ml/min) for both kidneys
Results
Schlegel Results
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7.10.2
•
NM Application Suite
Release 1.0
Renal
131
7.11
ERPF Schlegel with Void
Normal Values
•
Normalized ERPF (ml/min) for both kidneys, and total
•
Total ERPF (ml/min)
•
Normalized ERPF (ml/min)
•
Radionuclide
•
Radiopharmaceutical
Total Values
7.11
ERPF Schlegel with Void
This method calculates the effective renal plasma flow with additional
calculation of dose return and residual urine volume.
7.11.1
Using ERPF Schlegel with Void
7.11.2
132
•
Radionuclide
•
Radiopharmaceutical
•
Patient Weight (lbs)
•
Patient Height (in)
•
Voided Urine Volume (ml)
•
Voided Urine Activity (MBq)
•
Total Injected Dose (MBq)
•
Pre-Injection Counts
•
Post-Injection Counts
•
Composite image including all ROIs
•
Cine including all ROIs
•
Time Activity curve for right and left kidney values, and bladder values
•
Splash display
Results
Renal
NM Application Suite
Release 1.0
Philips Healthcare
In the Define Regions workstep, you may need to provide values for the
following parameters in the Inputs viewer:
ERPF MAG 3
7.12
Schlegel with Void Results
•
Peak Time (sec) for both kidneys
•
T 1/2 (min) for both kidneys
•
Slope1 (peak - t1/2) for both kidneys
•
Uptake (%) for both kidneys
•
ERPF (ml/min) for both kidneys
•
Normalized ERPF (ml/min) for right and left kidneys
•
Total ERPF (ml/min)
•
Normalized ERPF (ml/min)
•
Residual Return (%)
•
Voided Return (%)
•
Predicted Return (%)
•
Normal Return (%)
•
Total Return (%)
•
Radionuclide
•
Radiopharmaceutical
Normal Values
Total Values
Return Values
ERPF MAG 3
The method implements calculation of effective renal plasma flow from
MAG-3.
7.12.1
Using ERPF MAG 3
In the Define Regions workstep, you may need to provide values for the
following parameters in the Inputs viewer:
Philips Healthcare
4535 604 78081 Rev A
7.12
NM Application Suite
Release 1.0
•
Radionuclide
•
Radiopharmaceutical
•
Patient Weight (lbs)
•
Patient Height (in)
Renal
133
7.13
Deconvolution
7.12.2
•
Pre-Injection Counts
•
Post-Injection Counts
•
Pre Dose Multi-Factor
•
Post Dose Multi-Factor
•
Composite image with all ROIs
•
Cine with all ROIs
•
T 1/2 (min) for both kidneys
•
Peak Time (min) for both kidneys
•
Uptake (%) for both kidneys
•
ERPF (ml/min) for both kidneys
•
Total MAG3 Clearance (ml/min)
•
Total ERPF (ml/min)
•
Radionuclide
•
Radiopharmaceutical
•
Time Activity Flow curves for both kidneys
•
Time Activity Renogram curves for both kidneys
•
Splash display
Results
7.13
Deconvolution
This method allows you to generate kidney retention functions with
transit calculation.
Using Renal Deconvolution
In the Define Regions workstep, you may need to provide values for the
following parameters in the Inputs viewer:
134
Renal
•
Radionuclide
•
Radiopharmaceutical
•
Time of Lasix Injection (min)
NM Application Suite
Release 1.0
Philips Healthcare
7.13.1
DMSA Static Ratio
7.13.2
7.14
7.14
Results
•
Composite image with all ROIs
•
Cine with all ROIs
•
Mean Transit Time (min) for both kidneys
•
T80 (min) for both kidneys
•
T20 (min) for both kidneys
•
% Function (%)
•
Peak Time (min) for both kidneys
•
Radionuclide
•
Radiopharmaceutical
•
Time of Lasix Injection (min)
•
Splash display
•
Time Activity background subtracted curves for Renogram data for
both kidneys and blood
•
Time Activity curves for Function data for left and right retention
function
DMSA Static Ratio
This method provides 2 ROI ratio comparison (optionally with
background subtraction) analogous to the Pegasys Global Q
implementation.
Results
Philips Healthcare
4535 604 78081 Rev A
7.14.1
•
Posterior image with ROIs
•
Counts/Total Vol for both kidneys
•
%Diff/Total Vol for both kidneys
•
Counts/Unit Vol for both kidneys
•
%Diff/Unit Vol for both kidneys
•
Geometric Mean Counts for both kidneys
•
Any optional images loaded
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
NM Application Suite
Release 1.0
Renal
135
7.15
Hilson Index
7.15
Hilson Index
The Hilson Index method generates a renal perfusion index based on the
ratio of areas under the kidney curve and the area under the artery curve in
the perfusion phase. It is typically used for kidney transplant management.
7.15.1
Using Hilson Index
After you have drawn the ROIs, you can optionally enter these values in
the Inputs viewer:
136
Radionuclide
•
Radiopharmaceutical
•
Composite image with all ROIs
•
Cine with all ROIs
•
Peak Time (min)
•
T 1/2 (min)
•
Aorta Peak Time (sec)
•
Area Aorta Curve To Peak (cps)
•
Area Renal Curve (cps)
•
Hilson Perfusion Index
•
Peak Counts (cps)
•
Up Slope (cpm)
•
Rise Time (min)
•
20 min / Peak Ratio (%)
•
20 min/ 3 min Ratio (%)
•
EOS (cps)
•
TEOS (min)
•
Total Counts (cps)
•
Total Counts Range (2 to 3 mins) (cps)
•
Radionuclide
•
Radiopharmaceutical
•
Time Activity curve for Perfusion data for aorta and transplant kidney
Results
Renal
Philips Healthcare
7.15.2
•
NM Application Suite
Release 1.0
Patlak
7.16
7.16
•
Time Activity curve for Clearance data for aorta and transplant kidney
•
Splash display
Patlak
This method provides the capability to generate Patlak-Rutland plots and
display separate tissue and vascular background regions together with a
Patlak-Rutland plot (Analogous to the Odyssey Euro Custom Menu)
7.16.1
Using Patlak
In the Define Regions workstep, you may need to provide values for the
following parameters in the Inputs viewer:
Radionuclide
•
Patient Weight (lbs)
•
Time of Lasix Injection (min)
•
Activity Administered (MBq)
•
Composite image with all ROIs
•
Cine with all ROIs
•
Peak Time (sec) for both kidneys
•
Relative Function (%) for both kidneys
•
RF Time Range (sec) for both kidneys
•
Two Minute Uptake (%) for both kidneys
•
Three Minute Uptake (%) for both kidneys
•
20 Min/Peak Ratio (%) for both kidneys
•
Radionuclide
•
Radiopharmaceutical
•
Time of Lasix Injection (min)
•
Splash display
•
Rutland Fit curves for each kidney
•
Time Activity curves for both kidneys and bladder
Results
Philips Healthcare
4535 604 78081 Rev A
7.16.2
•
You can use the timing markers in the Time Activity graph to adjust the fit
curves, which also causes the results values to change.
NM Application Suite
Release 1.0
Renal
137
7.17
Cortical Analysis
7.17
Cortical Analysis
This method computes and displays various results using the Cortical
regions.
7.17.1
Using Cortical Analysis
In the Define Regions workstep, you may need to provide values for the
following parameters in the Inputs viewer:
Radionuclide
•
Radiopharmaceutical
•
Time of Lasix Injection (min)
•
RCA Calculation Time (min)
•
Curves Smoothing Factor
•
Composite image with all ROIs
•
Cine with all ROIs
•
T 1/2 (min) for both cortexes
•
Peak Time (min) for both cortexes
•
Peak Counts for both cortexes
•
Residual Cortical Activity (%)
•
RCA Calculation Time (min)
•
Radionuclide
•
Radiopharmaceutical
•
Time of Lasix Injection (min)
•
Time Activity curve for Renogram data for both cortexes
•
Splash display
Results
7.18
Philips Healthcare
7.17.2
•
Split T 1/2
This method uses a post-renogram single framing rate dynamic to create
separate right and left T 1/2 curves with associated control timing markers
and appropriate curve fitting.
138
Renal
NM Application Suite
Release 1.0
Split T 1/2
7.18.1
7.18
Using Split T1/2
In the Define Regions workstep, you may need to provide values for the
following parameters in the Inputs viewer:
•
Radionuclide
•
Radiopharmaceutical
•
Curves Smoothing Factor
In the Review Results workstep, you can use the timing markers in the
curve viewer to adjust the time range represented by the results values.
Drag the timing markers to update the results.
Results
•
Composite image with all ROIs
•
Cine with all ROIs
•
T 1/2 (min) for both kidneys
•
Radionuclide
•
Radiopharmaceutical
•
Time Activity curve and markers, with fit for left kidney
•
Time Activity curve and markers, with fit for right kidney
•
Splash display
Philips Healthcare
4535 604 78081 Rev A
7.18.2
NM Application Suite
Release 1.0
Renal
139
Split T 1/2
140
Renal
Philips Healthcare
7.18
NM Application Suite
Release 1.0
8
Endocrine
This application allows you to process and review thyroid and parathyroid
imaging studies. Using this application, you can display and analyze both
dual isotope (Tc-Tl) and delayed Mibi parathyroid studies, as well as
thyroid studies, including calculation of differential uptakes. It has these
methods:
•
Parathyroid Subtraction: This subtracts the technetium image from
the normalized thallium image and displays a subtracted image. This
is the Dual Isotope technique.
•
Parathyroid Dual-Phase: This method allows you to compare the
phases in dual-phase data. It is for display only, and has no ROIs or
results.
•
Thyroid: Thyroid uptake is calculated in the total area in up to six
regions of interest. Full and Empty Syringe data from a gamma-camera
image or Dose Calibrator input are used. The size of the thyroid is
calculated in cm2, weight in grams, and volume in cm3.
For information on loading requirements, and on calculations and
algorithms used in this application, see the appropriate section in the NM
Application Suite Reference Manual.
8.1
Thyroid
Thyroid uptake is calculated in the total area in up to six regions of
interest. Full and Empty Syringe data from gamma-camera image or Dose
Calibrator input are taken. Size of the Thyroid is calculated in cm2, weight
in grams and Volume in cm3.
Using Thyroid
4535 604 78081 Rev A
8.1.1
In the Define Regions workstep, you may need to provide values for the
following parameters in the Inputs viewer:
•
Select Radionuclide
Philips Healthcare
Additionally, if the Full or Empty syringe images are not present, you may
need to provide the following parameters, which are used in the
calculation of thyroid's percent uptake:
NM Application Suite
Release 1.0
•
Assayed Dose - Pre Administration (MBq or MCi)
•
Assayed Dose - Post Administration (MBq or MCi)
•
Calibration Factor (cpm/KBq or MCi)
Endocrin e
141
8.1
Thyroid
•
Pre Administration Measurement Time (M/d/yyyy h:mm:ss tt)
•
Post Administration Measurement Time (M/d/yyyy h:mm:ss tt)
•
Thyroid Measurement Time (M/d/yyyy h:mm:ss tt)
Calibration Factor: If Syringe or capsule data is used from a Dose
Calibrator, a calibration factor must be determined to establish the
relation between counts per minute and kiloBequerels (or microCuries).
The calibration factor is determined using a known amount of activity in
MBq (e.g. 37MBq or 1 mCi).
NOTE:
By default, the EBW system is set to use Bq. To change to Ci, open
the EBW Preferences and change it in the PET Preferences Viewing page. If
you use mCi, convert uCi for kBq in this example.
To calculate the Calibration Factor:
1. Assay the capsule (or syringe) in a dose calibrator and record the
result.
2. Acquire a static image of the capsule in a thyroid phantom using the
same collimator and distance from the collimator as that used for a
patient.
3. Load the capsule image in the General Review application by
selecting it and clicking NM Application Suite in the EBW Review
panel.
4. Select a tool from the Measure list (right-click on the image or go to
the Utilities manager).
5. Draw a tight ROI around the capsule.
6. Right-click on the ROI and select Total Value from the menu.
7. Note the number displayed for the ROI and convert it to counts per
minute.
8. Divide the counts per minute by activity as expressed in kiloBequerels
or microCuries (e.g. 37000 kBq or 1000 uCi) to obtain the
calibration factor in cpm/kBq or cpm/uCi.
The calibration factor must be determined again if different
collimators are used or when the gamma camera has been tuned.
8.1.2
142
Results
Endocrine
•
Thyroid image with ROIs
•
Counts (in the thyroid region and any optional regions)
•
Number of Pixels (in the thyroid region and any optional regions)
•
Uptake (%) (in the thyroid region and any optional regions)
NM Application Suite
Release 1.0
Philips Healthcare
NOTE:
Parathyroid
8.2
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
8.2
Parathyroid
The Subtraction method subtracts the thyroid image from the normalized
parathyroid image and displays a subtracted image. This is the Dual
Isotope technique. You can use Mibi and delayed Mibi or Tl and Tc
images.
8.2.1
Using Parathyroid
In the Define Regions workstep, you are required to draw a background
region first, and then the thyroid region. Usually the order is reversed, but
for this application, drawing the background first allows the software to
create a background-subtracted image so that the organ is better defined.
This means that you can draw a more accurate ROI for the thyroid.
If the two images are not aligned and motion correction is required, draw
the ROIs as usual on the Thyroid image. Then drag and adjust the ROI
on the Parathyroid image so the ROI is correctly positioned around the
organ. This will align the images before subtraction.
Subtraction Results
Philips Healthcare
4535 604 78081 Rev A
8.2.2
•
The Tl and Tc images side-by-side with the defined region overlaid on
both images; each image also displays the total count at the bottom
•
The subtracted image; use the bar at the bottom to set the Subtraction
Factor (range = 0 - 3)
•
8 subtracted images with subtraction factors of 3.0F, 2.0F, 1.5F, 1.0F,
0.9F, 0.8F, 0.7F, 0.6F
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
8.3
Review Layouts
Below are the layouts in the Review workstep:
•
NM Application Suite
Release 1.0
Parathyroid Side by Side
Endocrine
143
Review Layouts
•
Parathyroid Static Review
•
Thyroid Static Review
•
SC images
Philips Healthcare
8.3
144
Endocrine
NM Application Suite
Release 1.0
9
Esophagus
This application generates a set of time-activity curves for a dynamic
esophageal study, based on an ROI that you define. Typically, it is done on
patients who have difficulty in swallowing, have gastro-esophageal reflux,
or have peristalsis problems. It has these methods:
•
Esophagus
•
Gastro-Esophagus Reflux
For information on loading requirements, and on calculations and
algorithms used in this application, see the appropriate section in the NM
Application Suite Reference Manual.
9.1
Using Esophagus
By default, this application draws a rectangular bounding box with three
sections around the esophagus. You can adjust the box using its control
points, or change the drawing mode to manual to use a different drawing
shape.
9.2
Esophagus
This allows you to get esophageal transit information by segment,
including time activity curves, empty ratio, and peak ratio.
Using Esophagus
In the Review Results workstep, you can use the timing markers in the
curve viewer to adjust the time range represented by the results values.
Drag the timing markers to update the results.
9.2.2
Esophagus Results
Philips Healthcare
4535 604 78081 Rev A
9.2.1
NM Application Suite
Release 1.0
•
Cine with all ROIs
•
Time Activity curve for each of the ROI segments
•
Empty Ratio for each segment and the whole esophagus
•
Peak Ratio for each segment and the whole esophagus
•
Splash display of the images
•
Time Activity curve for the whole
Esoph agus
145
9.3
Gastro-Esophagus Reflux
•
A “condensed” image for each dynamic dataset, in which each column
is the sum across the y-axis of each frame of the dataset; the columns
are presented side-by-side in frame order.
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
9.2.3
Preferences
To change the Preferences for this application:
1. Select the Preferences Data Manager.
2. Click Open Preference Editor at the bottom of the Preferences
section (the second icon:
).
3. Make changes in the preferences window using the information in the
table below.
See the section on “Creating and Editing Preferences” on page 43 for
details on editing Preferences.
You can save these parameters for this application:
9.3
Parameter
Default
Description
Review Compress Factor
1
Compression value for
review data
Gastro-Esophagus Reflux
This allows you to get reflux information, including empty and peak
ratios, and a time activity curve.
Using Gastro-Esophagus Reflux
In the Review Results workstep, you can use the timing markers in the
curve viewer to adjust the time range represented by the results values.
Drag the timing markers to update the results.
9.3.2
146
Gastro-Esophagus Reflux Results
Esophagus
•
Cine with all ROIs
•
Time Activity curve for the whole
•
Splash display of the images
NM Application Suite
Release 1.0
Philips Healthcare
9.3.1
Review Layouts
9.4
•
Empty Ratio
•
Peak Ratio
•
A “condensed” image for each dynamic dataset, in which each column
is the sum across the y-axis of each frame of the dataset; the columns
are presented side-by-side in frame order.
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
9.3.3
Preferences
To change the Preferences for this application:
1. Select the Preferences Data Manager.
2. Click Open Preference Editor at the bottom of the Preferences
section (the second icon:
).
3. Make changes in the preferences window using the information in the
table below.
See the section on “Creating and Editing Preferences” on page 43 for
details on editing Preferences.
You can save these parameters for this application:
9.4
Parameter
Default
Description
Review Compress Factor
1
Number of frames to compress for review data
Review Layouts
•
Splash Display
•
SC images
Philips Healthcare
4535 604 78081 Rev A
Below are the layouts in the Review workstep:
NM Application Suite
Release 1.0
Esophagus
147
Review Layouts
148
Esophagus
Philips Healthcare
9.4
NM Application Suite
Release 1.0
10
Gastro Intestinal
You can use a Linear, Elashoff, or Siegel curve fit method for these
calculations. You can also compute a new series of frames equal to the
geometric mean of corresponding anterior and posterior series (if you have
loaded these series).This application provides data on the clearance time of
stomach contents and calculates the T1/2 for gastric emptying. The
application supports two isotope image sets: Tc for Solid and In111 for
Liquid emptying calculations. A linear fit curve is used for Solid data and
an exponential fit curve for Liquid. When both series are loaded, a new
series of frames equal to the geometric mean is computed. It has these
methods:
•
Solid
•
Liquid
For information on loading requirements, and on calculations and
algorithms used in this application, see the appropriate section in the NM
Application Suite Reference Manual.
10.1
Using Gastric Emptying
In the Setup workstep, you can load multiple dynamic or static datasets.
The application will append datasets according to the time value in the
DICOM header.
In the Review Results workstep, you can use the timing markers in the
curve viewer to adjust the time range represented by the results values.
Drag the timing markers to update the results.
Results
4535 604 78081 Rev A
10.2
Philips Healthcare
Depending on the Preference, the following results are available.
NM Application Suite
Release 1.0
•
Anterior composite image with ROIs
•
Posterior composite image with ROIs
•
Cine loop for Anterior with ROIs overlaid on all images
•
Cine loop for Posterior with ROIs overlaid on all images
•
Splash display for Anterior with ROIs
•
Splash display for Posterior with ROIs
•
Time to Half
G a st ro I n t e s ti n a l
149
10.3
Preferences
•
Time to Peak
•
Retention at 30, 60, 90, 120, and 240 minute lag times
•
End Time Retention
•
Max and Min Line Retentions
•
Time Activity curve for each ROI
•
Time Activity viewer containing the Fit curve and decay corrected
Residual curve
NOTE:
If you have loaded geometric mean data, the Residual curve is
actually the geometric mean curve.
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
10.3
Preferences
To change the Preferences for this application:
1. Select the Preferences Data Manager.
2. Click Open Preference Editor at the bottom of the Preferences
section (the second icon:
).
3. Make changes in the preferences window using the information in the
table below.
See the section on “Creating and Editing Preferences” on page 43 for
details on editing Preferences.
150
G a s t ro In t e s t in a l
Parameter
Default
Description
Review Compress Factor
1
Number of frames to compress for review
data
Smooth Curve
False
This determines whether the Residual
Curve is smoothed.
Solid or Liquid, depending on
the Preference selected Decay Corrected Curve
True
This determines whether the Decay Corrected curve appears in the Time Activity
viewer.
Curve for Calculation
Residual Curve
This determines whether the Fit or Residual curve is used to calculate all the
Results.
NM Application Suite
Release 1.0
Philips Healthcare
You can save these parameters for this application:
Review Layouts
10.4
10.4
Review Layouts
Below are the layouts in the Review workstep:
Gastro Intestinal Dynamic Review
•
Gastro Intestinal Splash
•
Gastro Intestinal Static Review
•
SC Images
Philips Healthcare
4535 604 78081 Rev A
•
NM Application Suite
Release 1.0
G a st ro In t e s t in al
151
Review Layouts
152
G a s t ro In t e s t in a l
Philips Healthcare
10.4
NM Application Suite
Release 1.0
11
Hepatobiliary
This application allows you to perform gall bladder static analysis and gall
bladder dynamic analysis. It has these methods:
•
Gall Bladder: This displays a dynamic series of gallbladder images and
calculates the gallbladder ejection fraction. It involves no further radionuclide injections, but requires a timed cholecystokinin octapeptide
(CCK) infusion part way through the study. You can get results for
these ROIs, which are also selectable as methods for Gall Bladder:
–
Gall Bladder (required)
–
BackGround
–
Hepatic Duct
–
Common Bile Duct
–
Duodenum
•
GBEF Static Analysis: This calculates the percent emptied from the
pre-intervention (CCK) Gallbladder static and up to 12 Post-intervention statics.
•
GBEF Static Analysis: This calculates the percent emptied from the
pre-intervention (CCK) Gallbladder static and up to 12 Post-intervention statics.
For information on loading requirements, and on calculations and
algorithms used in this application, see the appropriate section in the NM
Application Suite Reference Manual.
11.1
Using GallBladder
Philips Healthcare
4535 604 78081 Rev A
In the Define Regions workstep, a splash display is present for reference,
and a Time Activity curve is drawn as soon as all required ROIs are
present. Additionally, you may need to provide values for the following
parameters in the Inputs viewer:
NM Application Suite
Release 1.0
•
Stimulus Info
•
Dosage of CCK
•
Time CCK Infusion Began
•
Duration of CCK infusion
•
Morphine Administered
Hepato biliar y
153
11.2
Results for GallBladder
In the Review Results workstep, you can use the timing markers in the
Gall Bladder curve viewer to adjust the time range represented by the
results values. By default, the green line indicates maximum counts, and
the red line indicates minimum counts. Drag the timing markers to move
them.
11.2
Results for GallBladder
•
Cine loop with all ROIs
•
The Ejection Fraction GBEF (%), based true counts, and on the
timing markers in the time activity curve
•
The Ejection Period GBEP (min) based on the timing markers in the
time activity curve
•
The Ejection Rate GBER (%/min) (time between injection and begin
of emptying) based on the timing markers in the time activity curve
•
Maximum Counts based on the timing markers in the time activity
curve
•
Minimum Counts based on the timing markers in the time activity
curve
•
Dosage of CCK (or morphine, if selected)
•
Time CCK (or morphine, if selected) Infusion Began
•
Duration of CCK (or morphine, if selected) infusion
•
Latent Period GBLP (min)
•
Morphine Administered
•
Time Activity curve for background corrected Gall Bladder
•
Time Activity curve for background corrected Hepatic Duct
•
Time Activity curve for background corrected Common Bile Duct
•
Time Activity curve for background corrected Duodenum
•
Splash Display
If you do not see all the result images in the Review Results workstep, it
may be that one or more viewers are hidden. If you suspect this, try using
the Show Hidden Viewers tool in the Utilities Data Manager. See the
section on “Review Results Workstep” for details.
154
Hepatobiliary
NM Application Suite
Release 1.0
Philips Healthcare
The Gallbladder Ejection Fraction application displays a dynamic series of
gallbladder images and calculates the gallbladder ejection fraction.
Depending on the preference selected, the results include a combination
of the following:
Preferences for GallBladder
11.3
11.3
Preferences for GallBladder
To change the Preferences for this application:
1. Select the Preferences Data Manager.
2. Click Open Preference Editor at the bottom of the Preferences
section (the second icon:
).
3. Make changes in the preferences window using the information in the
table below.
See the section on “Creating and Editing Preferences” on page 43 for
details on editing Preferences.
You can save these parameters for this Preference:
11.4
Parameter
Default
Description
Review Compress Factor
1
Number of frames to compress for review data
Stimulus Info
NoStimulus
This is the type of stimulus used in the study.
Decay Corrected
Curve
Yes
This determines whether the Time Activity curve uses
decay correction data.
Results for GBEF Static Analysis
If multiple Post Stimulus images are loaded:
•
Counts and % Emptied values for PreStimulus
•
Counts and % Emptied values for all Post Stimulus data
11.5
•
PreStimulus counts
•
PostStimulus counts
•
Ejection Fraction value
Preferences for GBEF Static Analysis
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If one Post Stimulus image is loaded:
To change the Preferences for this application:
1. Select the Preferences Data Manager.
2. Click Open Preference Editor at the bottom of the Preferences
section (the second icon:
).
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11.6
Review Layouts
3. Make changes in the preferences window using the information in the
table below.
See the section on “Creating and Editing Preferences” on page 43 for
details on editing Preferences.
You can save these parameters for this Preference:
11.6
Parameter
Default
Description
Review Compress Factor
1
Number of frames to compress for review data
Review Layouts
Below are the layouts in the Review workstep:
GBEF Dynamic Display
•
GBEF Splash Display
•
SC images
•
Static Review
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•
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General Review
When you are in the EBW Patient Directory, if you click the NM
Application Suite button in either the Review or Analysis panel, the
selected studies open in the General Review application. This allows you
to view the contents of a study without loading it into a processing
application. It has no processing capabilities or results, and no preferences.
However, all the functionality of the Control Panel on the left is still
available, including the viewer tools and ICMT, so you can still perform
operations on images. It also provides some display layouts, which vary
according to the data that is loaded:
All Image Display
•
Whole Body Display
•
Whole Body with Spots
•
All Dynamic Display
•
All Dynamic with Spots
•
SPECT 3 View
•
Orthogonal View
•
Fusion Display
•
Series Display
•
Gated Planar
•
Whole Body Intensity Compare
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QC Tools
The QC Tools allow you to calculate the uniformity of an image. The
result is two images, which you can then compare to check for uniformity.
It uses static planar NM DICOM images as input.
NOTE: Although the Application Palette appears as a Data Manager in the
QC Tools application, it is empty. You cannot switch from the QC Tools to
another application.
13.1
Using QC Tools
Before using the QC Tools application, make sure you have an appropriate
QC image, then follow the instructions below:
1. Click to highlight the patient dataset study you want to view.
2. Click on the Analysis icon’s drop-down button.
3. Select the QC Tools icon from the Analysis applications.
The QC Tools window appears.
4. Click on an image in the Pictorial Index (lower left).
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5. The QC Tools application determines and displays the UFOV shape,
however if you want to modify this, use the UFOV Type drop-down.
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13.2
UFOV and CFOV Results Tabs
6. Click OK.
The loaded image, a smoothed version (bottom image), and its UFOV and
CFOV results appear:
Figure 49 QC Tools main window
13.2
UFOV and CFOV Results Tabs
160
Q C To o ls
•
Minimum (Counts and Location)
•
Maximum (Counts and Location)
•
Row Differential Uniformity (Percentage)
•
Column Differential Uniformity (Percentage)
•
Max Row (Difference and Location)
•
Max Column (Difference and Location)
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After an image loads, the center section of the main QC Tools window
displays the following UFOV and CFOV image results:
Release 1.0
Using the QC Tools Toolbar
13.3
13.3
Using the QC Tools Toolbar
Each UFOV and CFOV viewer features a toolbar to customize your
image.
To use the tools in the toolbar, click on the toolbar icon (#1 below). A
toolbar appears on the left with the controls described below.
Figure 50 Viewer window with toolbar (left column)
1.
Toolbar
Select Color Map: Use the drop-down menu to select a color map.
Invert Gray Level: Click to invert the image’s pixel values.
4. Contrast Stretch: This sets the minimum and maximum pixel values to
2.
3.
0 and 255, adjusting the other values accordingly.
5.
13.4
Text Box: Use this icon to add text to your image. Click where you
want the text box to appear, and then type in your text. Click outside
the text box to save it.
Saving Results
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Using the controls below, you can save results to text files, and you can
save the display as a secondary capture or save it to film.
Figure 51 Save (left), Save current display (middle) and Film Display (right)
13.4.1
Saving to a Text File
Use Save to save the results to a text file. This displays the Enter Details
dialog.
1. Some fields in the Results section are filled in by default; edit them if
necessary:
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13.4
Saving Results
•
Collimator
•
Camera
•
Test Conductor
•
Date
•
Pixel Size
•
Detectors
2. Use the Store Results section to specify locations for the Summary
Results and Additional Results.
3. To save the additional results, check Save Additional Results.
4. Type any other information into the Comments section.
5. Click Save Results.
13.4.2
Saving as Secondary Capture
Use Save current display to save a multi-frame secondary capture of your
QC Tools results. This displays the Save Secondary Capture Dialog.
1. Use the Save As pull-down menu to select an image format.
•
Single-Frame Secondary Capture
•
JPEG
•
Multi-Frame Secondary Capture
•
AVI
2. Type a Description and choose the appropriate settings.
3. For multi-frame and AVI formats, you can check Frame and specify
the Start and End frames, and the number of frames to Skip.
4. For gated formats, you can check Bin and specify the Start and End
bins, and the number of bins to Skip.
5. Check RGB to save color images, or Grayscale for grayscale images.
13.4.3
Saving to Film
Use Film Display (see Figure 51 above) to capture multi-image (full study
window) captures. This creates an image that includes both the results
viewer and all image viewers.
NOTE:
You can view and print the image using the EBW Film feature. Refer
to your EBW Instructions for Use for details.
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6. Click Save to save the images to the EBW Patient Directory. (Be sure
to refresh the browser to see the new images.)
14
Astonish Reconstruction
If you have the Astonish license, Astonish appears as one of the
reconstruction methods available.
The Astonish method consists of performing Ordered Subsets Expectation
Maximization with compensation for the blurring effects of your
collimator built into the reconstruction. We frequently refer to this
compensation as Resolution Recovery, because it allows the recovery of
some of the original resolution of the activity distribution. To model the
point spread of the activity distribution at the time of acquisition,
Astonish uses the distance from the detector to the object of interest
recorded as a function of angle by your camera during acquisition, and the
geometric properties of the specific collimator used.
14.1
When to Use Astonish
The accurate modeling performed by Astonish leads to excellent image
quality for all images. Philips recommends using this method for most
nuclear medicine SPECT reconstruction.
Using the Astonish SPECT reconstruction method will enhance the
resolution of your SPECT images, and improve the signal-to-noise ratio.
The improved noise properties and appearance of the background of your
images may change the appearance of the images. You may need to read
several Astonish images in order to become comfortable with the
appearance of these reconstructed images.
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The image below shows a patient study reconstructed according to typical
clinical practice (bottom), and the same study reconstructed with Astonish
(top). The improved resolution results in clearer separation and detail in
the vertebrae. This is especially apparent in fine structures such as the
breastbone.
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14.2
Using Astonish Reconstruction
Figure 52
A comparison of Astonish reconstruction (top) with FBP reconstruction (bottom)
IMPORTANT: When using Astonish reconstruction for Cardiac images, use
an Astonish database for your quantitation. AutoQUANT 7.0 provides an
Astonish database, or you can use its database tools to generate normals
databases specific to your site, your imaging preferences, and Astonish
reconstruction with your preferred parameters (filtering, AC, scatter
correction, etc.).
Using Astonish Reconstruction
You use Astonish in the same way as the other reconstruction methods: by
selecting it from the Reconstruction pull-down menu or by using Astonish
defaults. This section describes how to set reconstruction parameters such
as Filtering, Iterations, and Subsets in order to optimize image quality
when you use Astonish.
14.2.1
Filtering and Noise
With many iterative reconstruction methods, the noise in the
reconstructed image increases with iterations. For this reason, the number
of iterations is kept small to avoid having an overly noisy image. Astonish
incorporates collimator effects so as to prevent this accumulation of noise,
allowing you to use more total iterations while maintaining an acceptable
image.
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14.2
Using Astonish Reconstruction
14.2
However, if your images are noisy to begin with—for instance, for gated
cardiac datasets, rest perfusion imaging, or for general nuclear images
acquired a long time after injection—it is helpful to pre-filter the data
both prior to and during reconstruction. For this reason, Philips provides
you with a Hanning pre-filter to use with Astonish for noisy data.
The two images below show the effect of filtering on an Astonish
reconstructed image. The left image shows a Maximum Intensity
Projection (MIP) display of an Astonish image reconstructed with 4
iterations and 16 subsets, with no pre-filter. The right image shows a
similar display of an image reconstructed with the same parameters, but
after applying a Hanning pre-filter with a cutoff of 1.0. The image has
become smoother without losing the fine detail available as a result of the
Astonish reconstruction.
Figure 53
14.2.2
Astonish reconstruction without Hanning filter (left) and with Hanning filter (right)
Iterations and Subsets
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To take full advantage of the resolution recovery provided with Astonish
SPECT reconstruction, the expectation maximization algorithm must
converge, which requires a large number of updates to the activity
estimation for noisy data. Whereas for MLEM the number of updates is
identical to the number of iterations, for OSEM, the subsets and iterations
are multiplied together to calculate the total number of updates. The
higher this number of updates is, the more likely the software is to have
achieved convergence. Although it is possible to achieve an acceptable
nuclear medicine reconstructed image using 2-3 iterations and 8-16
subsets, even better image quality may be achieved by iterating more. This
may cause processing times to be extended, so your site must determine
the acceptable number of iterations. While there is no maximum number
of iterations, the maximum number of subsets is the number of
projections in the data. Philips recommends starting from a Uniform
estimate and using at least 24 updates for most nuclear medicine data,
which can be achieved by performing 3 iterations with 8 subsets.
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14.3
Further Reading
The two images below show the effect of iteration number on an Astonish
reconstructed image. The left image shows a Maximum Intensity
Projection (MIP) display of an Astonish image reconstructed with 2
iterations and 16 subsets, with no pre-filter. The center image was
reconstructed with 3 iterations, and the far right image with 4 iterations.
More fine detail becomes available with additional iterations, but the
images also become noisier.
Figure 54 Astonish reconstruction with 2 iterations (left), 3 iterations (center), and 4 iterations
(right)
14.2.3
Applying Other Corrections
As with other iterative methods, Astonish allows you to apply attenuation
and scatter correction during reconstruction when transmission data is
used along with the usual emission data. AutoSPECT Pro accepts CT
data, Vantage transmission data, or a previously generated attenuation
map to use in performing these corrections.
14.3
Further Reading
Almquist H, Arheden H, Arvidsson AH, Pahlm O, and Palmer J. Clinical
implication of down-scatter in attenuation-corrected myocardial SPECT. J
Nucl Cardiol 1999; 6:406.
14.3.1
Information on OSEM reconstruction
Hudson HM, Larkin RS: Accelerated image reconstruction using ordered
subsets of projection data. IEEE Trans Med Imag 13, 601-609, 1994.
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To learn more about reconstruction using Resolution Recovery and other
corrections, you may wish to read the following abstracts and papers:
Further Reading
14.3.2
14.3
Information on resolution recovery
Younes RB, Mas J, Pousse A, Hannequin P, Bidet R: Introducing
simultaneous spatial resolution and attenuation correction after scatter
removal in SPECT imaging. Nucl Med Comm 12, 1031-1043, 1991.
Liang Z, Jaszczak R, Coleman R: A 3D model for simultaneous
compensation of nonuniform attenuation and collimation divergence of
SPECT image reconstruction. J Nucl Med 32, 917 (abs), 1991.
Liang Z, Turkington TC, Gillard DR, Jascczak RJ, Coleman RE:
Simultaneous compensation for attenuation, scatter and detector response
for SPECT reconstruction in three dimensions. Phys Med Biol 37,
587-603, 1992.
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Floyd CE Jr, Jaszczak RJ, Manglos SH, Coleman RE: Compensation for
collimator divergence in SPECT using inverse Monte Carlo
reconstruction. IEEE Trans Nucl Med NS-35, 784-787, 1988.
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Backing Up and Restoring Data
You can back up and restore data using the simple EBW BackupRestore
utility. This copies LAN configurations, some system parameters, license
keys, and application files to a folder on the D: drive.
15.1
Backing Up Data
1. Press Windows-e to bring up a Windows Explorer window (the Windows
key is the one with the logo on it, near the Spacebar).
2. Navigate to C:\Pms\System and double-click BackupRestore.
3. In the Backup/Restore dialog, browse for a folder to back up to.
4. Check the items to back up.
5. Click Start Backup.
A backup folder is created with a name that includes the date and time of
the backup, for example “backup_25_Mar_2009_13_25_58.”
The Backup Log dialog displays the files being backed up. When finished,
it displays “END BACKUP.”
6. Close the Backup Log and the application.
15.2
Restoring Data
1. Press Windows-e to bring up a Windows Explorer window (the Windows
key is the one with the logo on it, near the Spacebar).
2. Navigate to C:\Pms\System and double-click BackupRestore.
4535 604 78081 Rev A
3. In the Backup/Restore dialog, click Browse to find the folder to restore.
4. Check the items to restore.
5. Click Start Restore.
The Backup Log dialog displays the files being restored. When finished, it
displays “END RESTORE.”
Philips Healthcare
6. Close the Backup Log and the application.
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Restoring Data
170
Ba ck in g Up an d Re st o r in g Da ta
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15.2
NM Application Suite
Release 1.0
Index
AAA global image tools 46
AC maps 36, 74
ACC format, in AutoSPECT Pro 99
acquiring syringe images
for renal studies 123
annotations 55
annotations, configuring 55
annotations, DICOM, on an image 55
Application Palette 24
applications
AutoSPECT Pro. See also, AutoSPECT Pro 73
Bone 115
Cardiac Planar 109
Endocrine 141
Esophageal 145
Gastric Emptying 149
Hepatobiliary 153
list of 7
Lung 119
QC Tools 159
Renal 123
Review 157
Astonish 35
description 163
using 164
when to use 163
attenuation correction 36, 74
attenuation correction, in AutoSPECT Pro 84
automatching 14
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A
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Release 1.0
AutoSPECT Pro 73
AC Map workstep 74
ACC format 99
attenuation correction 84
axis correction 87
Chang’s AC data 79
CT-AC data 75
cyclograms 95
decay correction 86
editing layouts in 71
motion correction 90
Preferences 101
protocols 106
Reconstruction workstep 79
Reorientation workstep 98
scatter correction 84
sinograms 95
Vantage AC data 77
axis correction, in AutoSPECT Pro 87
B
Background and Brightness adjustments 48
backing up 169
Bone application 115
buckets
matching criteria for 14
C
Cardiac Planar application 109
Chang’s AC data, in AutoSPECT Pro 79
cine controls 23
Color Map 48
context tools 19
Control Panel
location 5
control panel 8
CT-AC data, in AutoSPECT Pro 75
Curve Decay Correction 41
Curve Math 41
Curve Properties 42
curves 39
Custom Display 44, 69
171
D
Data Managers 16
Application Palette 24
ICMT 25
Image Tools 46
Utilities 51
Viewer Tools 17
Data Matcher 14
data, backing up and restoring 169
decay correction 41
decay correction, in AutoSPECT Pro 86
Define Regions workstep 13
deidentifying 55
E
EBW 2
Endocrine application 141
Esophageal application 145
Extended Brilliance Workstation 2
F
K
knitting images 42
L
G
label editor 23
labels 23
layouts
defined 66
editing 69
editing in AutoSPECT Pro 71
loading data 12
loading files 6
Lung application 119
Gastric Emptying application 149
grid, displaying 55
M
files, loading 6
First Pass 111
Frame Append 30
Frame Compress 31
Frame Convert 34
Frame Extract 33
H
Hepatobiliary application 153
I
ICMT 25
Astonish 35
Attenuation Correction 36
Create Curve 39
Curve Decay Correction 41
Curve Math 41
Curve Properties 42
Image Crop 27
Image Filter 27
Image Frame 30
Frame Append 30
Frame Compress 31
172
Frame Convert 34
Frame Extract 33
Mask 34
Image Math 28
Image Orient 34
Motion Correction 37
panels 26
Volume Knitting 42
Image Control Panel 47
Image Crop 27
Image Filter 27
Image Orient 34
Image Tools 46
Image Control Panel 47
images
acquiring for pre- and post-injection syringes 123
intended use 1
Intensity 48
Mask 34
measurments 52
motion correction 37
motion correction, in AutoSPECT Pro 90
movie controls 23
MUGA 109
N
Philips Healthcare
cyclograms, in AutoSPECT Pro 95
NM Application Suite
general information 5
layout 5
O
object properties 59
overview 2
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Release 1.0
P
Parathyroid 143
Patient Selector 10
Preference Editor 45
Preferences
creating 43, 44, 45
editing 43
First Pass 111
MUGA 109
Parathyroid 143
Shunt 113
Thyroid 141
Transit 145
Preferences, in AutoSPECT Pro 101
Properties panel 59
protocols, in AutoSPECT Pro 106
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T
Thyroid 141
tools
contetxt 19
Transit 145
U
QC Tools application 159
Utilities 51
annotations 55
Measurements 52
saving 49
secondary capture 50
tools 51
utilities 51
R
V
reconstruction, in AutoSPECT Pro 79
Renal application 123
reorientation, in AutoSPECT Pro 98
Restart 10
restoring data 169
Review application 157
Review Results workstep 13
Review workstep 14
reviewing data 11
ROI properties 59
ROIs
creating curves 39
creating custom 63
drawing 59
edge detection 61
exporting 39
image math using 28
isocontours 62
predefined shapes 62
reusing 61
rulers, displaying 55
Vantage AC data, in AutoSPECT Pro 77
Viewer Label Editor 23
Viewer Tools 17
viewers
components 64
curve 66
defined 63
moving and resizing 65
using 63
viewing area
location 5
Q
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sinograms, in AutoSPECT Pro 95
status bar 10
syringe images, acquiring
for renal studies 123
W
workflow 10
controls 10
worksteps 10
S
saving 49
saving data 49
scatter correction, in AutoSPECT Pro 84
secondary ca pture 50
secondary captures 51
Setup workstep 12
Shunt 113
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Release 1.0
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