Discovery CT750 HD
0459
Discovery CT750 HD
Operator Manual, English
5308208-1EN
Revision: 2
2008 General Electric Company
All rights reserved.
Revision History
REV
DATE
09-08
10-08
i-1
Table of Contents
Revision History............................................................................................................................. i-1
Chapter 3: Safety
Introduction............................................................................................................................................3-1
What Do I Need to Know About....................................................................................................3-3
Warning Labels and Symbols................................................................................................3-3
General Safety Guidelines .......................................................................................................3-7
Radiation Safety...........................................................................................................................3-9
Authorized Users .................................................................................................................3-9
General Radiation Safety.............................................................................................. 3-10
Scans Acquired at the Same Tomographic Plane ............................................ 3-10
CTDIvol .................................................................................................................................. 3-12
X-Ray Tubes........................................................................................................................ 3-13
Electrical Safety......................................................................................................................... 3-13
Mechanical Safety.................................................................................................................... 3-14
General Mechanical Safety ......................................................................................... 3-14
Patient Positioning........................................................................................................... 3-15
Volume Shuttle .................................................................................................................. 3-19
Laser Safety ................................................................................................................................ 3-20
Reconstructed Image Orientation.................................................................................... 3-21
Data Safety.................................................................................................................................. 3-22
Application Specific Safety Topics.................................................................................... 3-24
Helical Scanning ............................................................................................................... 3-24
Cardiac Imaging ............................................................................................................... 3-25
Patient Preparation ......................................................................................................... 3-27
Lung Algorithm.................................................................................................................. 3-28
Autoscan .............................................................................................................................. 3-28
SmartStep Safety ............................................................................................................. 3-28
TOC-1
TOC-2
TOC-3
TOC-4
TOC-5
Chapter 9: SmartPrep
Introduction............................................................................................................................................9-1
What Do I Need to Know About....................................................................................................9-2
SmartPrep.......................................................................................................................................9-2
Setting SmartPrep Parameters.............................................................................................9-2
Scanning the Baseline Phase.................................................................................................9-2
Scanning the Monitor Phase..................................................................................................9-2
Scanning the Scan Phase........................................................................................................9-3
How Do I...................................................................................................................................................9-4
Set the SmartPrep Parameters .............................................................................................9-5
Scan the Baseline Phase..........................................................................................................9-9
Scan the Monitor Phase ........................................................................................................ 9-11
Scan the Scan Phase .............................................................................................................. 9-13
TOC-6
TOC-7
TOC-8
TOC-9
TOC-10
TOC-11
TOC-12
TOC-13
TOC-14
TOC-15
TOC-16
TOC-17
TOC-18
TOC-19
TOC-20
TOC-21
Product Manufacturer
Chapter 1
Product Manufacturer
This chapter lists the manufacturer of the Discovery CT750 HD product. The manufacturer
listed is authorized to CE mark the product listed.
Table 1-1 Discovery CT750 HD Product Manufacturer
Model Name
Discovery CT750 HD
Manufacturer (*)
Manufacturing Site
GE Medical Systems, LLC *
Manufacturer Address
3000, N. Grandview Blvd.
Waukesha, WI - 53188, USA
1-1
Chapter 2
Prerequisite Skills
This guide is not intended to teach imaging. It is necessary for you to have sufficient
knowledge to competently perform the various diagnostic imaging procedures within your
modality. This knowledge is gained through a variety of educational methods including
clinical working experience, hospital based programs, and as part of many college and
university programs.
Chapter Format
Each chapter contains a consistent format. This consistency provides uniformity for content
delivery and a better learning environment for you. Listed below are the components for
each chapter.
2-1
Introduction
The Introduction provides a short introduction to the chapter and a list of tasks to be
presented.
How Do I...
The How Do I... section provides the detailed steps necessary to complete a given task.
These detailed steps not only provide the steps to complete a task, but also provide
additional information, as needed, related to a step.
Each task also includes a Quick Steps table. This Quick Steps table is intended to be used as
a quick reference by the experienced technologist and provides only the steps necessary to
complete a task. Be sure to read the detailed steps before using this table.
Description
Click
Right-click
Middle-click
2-2
Description
Double-click
Triple-click
Table 2-2 Conventions for Menus, Buttons, Text Boxes, and Keyboard Keys
Example
Describes
Select
Press Enter
Click [Viewer]
Click
prior)
(Exam
2-3
Safety Notices
The following safety notices are used to emphasize certain safety instructions. This guide
uses the international symbol along with the danger, warning, or caution message. This
section also describes the purpose of a Note.
DANGER:
WARNING: Warning is used to identify conditions or actions for which a specific hazard
is known to exist which may cause severe personal injury, death, or
substantial property damage if the instructions are ignored.
CAUTION:
NOTE: A Note provides additional information that is helpful to you. It may emphasize certain
information regarding special tools or techniques, items to check before proceeding,
or factors to consider about a concept or task.
2-4
Safety
Chapter 3
Safety
Introduction
This chapter provides information about safety precautions and procedures. It is important
for you to read and understand the contents of this chapter so the correct precautions and
procedures are followed.
This manual should be kept near the console for easy access.
If necessary, additional training is available from a GE Applications Specialist. Contact your
institutions GE sales representative for additional information about further safety and
operational training.
TheDiscovery CT750 HD scanner complies with IEC 60601-1 and UL 60601-1.
The system is classified as a Class I, IPX0 equipment, not suitable for use in the presence of
a flammable anesthetic mixture with oxygen or nitrous oxide. It is rated for continuous
operation with intermittent loading. No sterilization is applied. The patient table cradle is
considered a Type B applied part.
The Discovery CT750 HD Computed Tomography X-ray system is intended to produce
cross-sectional images of the body by computer reconstruction of x-ray transmission data
taken at different angles and planes, including Axial, Cine, Helical (Volumetric), Cardiac,
Spectral, and Gated acquisitions for all ages. These images may be obtained either with or
without contrast. This device may include signal analysis and display equipment, patient
and equipment supports, components and accessories.
This device may include data and image processing to produce images in a variety of
trans-axial and reformatted planes. Further the images can be post processed to produce
additional imaging planes or analysis results.
The Discovery CT750 HD CT Scanner System is indicated for head, whole body, cardiac
and vascular X-ray Computed Tomography applications.
The device output is a valuable medical tool for the diagnosis of disease, trauma, or
abnormality and for planning, guiding, and monitoring therapy.
3-1
Safety
If the spectral imaging option is included on the system, the system can acquire CT images
using different kV levels of the same anatomical region of a patient in a single rotation from
a single source. The differences in the energy dependence of the attenuation coefficient of
the different materials provide information about the chemical composition of body
materials. This approach enables images to be generated at energies selected from the
available spectrum to visualize and analyze information about anatomical and pathological
structures.
CAUTION:
3-2
Safety
Radiation Safety
Electrical Safety
Mechanical Safety
Laser Safety
Data Safety
Accuracy of Measurements
Accessories
Environmental Concerns
DANGER:
The most severe label describes conditions or actions which result in a specific
hazard. You will cause severe or fatal personal injury, or substantial property
damage if you ignore these instructions.
WARNING: This label identifies conditions or actions which result in a specific hazard.
You will cause severe personal injury, or substantial property damage if you
ignore these instructions.
3-3
Safety
CAUTION:
This label applies to conditions or actions that have potential hazard. You may
cause minor injury or property damage if you ignore these instructions.
This chapter uses the international symbol or icon along with the danger, warning or caution
message.
Table 3-1 IEC Standards
Symbol
IEC Standard
Alternating current
ON / Power
Input Power
Output Power
Type B Equipment
3-4
Safety
Symbol
3-5
Safety
Figure 3-3 The following warning labels are located on the table
WARNING: This x-ray unit may be dangerous to patient and operator unless safe
exposure factors, operating instructions and maintenance schedules are
observed. To be used by authorized personnel only.
3-6
Safety
This product was designed and manufactured to ensure maximum safety of operation.
It should be operated and maintained in strict compliance with the safety precautions,
warnings and operating instructions contained herein, and in any other documentation
specific to the product.
The system has been designed to meet all the safety requirements applicable to medical
equipment. However, anyone attempting to operate the system must be fully aware of
potential safety hazards.
The owner should make certain that only properly trained, fully qualified personnel are
authorized to operate the equipment. A list of authorized operators should be
maintained.
This manual should be kept at hand, studied carefully and reviewed periodically by the
authorized operators.
Become familiar with the functional hardware so that you can recognize serious
problems. Do not use the scanner if it appears damaged or fails. Wait for qualified
personnel to correct the problem.
If the product does not operate properly or if it fails to respond to the controls as
described in this manual, the operator should:
First ensure the safety of the patient.
Next ensure the protection of the equipment.
Evacuate the area as quickly as possible in any potentially unsafe situation.
Follow the safety precautions and procedures as specified in this manual.
Immediately contact the local service office, report the incident and await further
instructions.
The images and calculations provided by this system are intended as tools for the
competent user. They are explicitly not to be regarded as a sole incontrovertible basis for
clinical diagnosis. Users are encouraged to study the literature and reach their own
professional conclusions regarding the clinical utility of the system.
Understand the product specifications, system accuracy, and stability limitations. These
limitations must be considered before making any decision based on quantitative
values. In case of doubt, please consult your sales representative.
Make sure all covers are in place before you use the equipment. The covers protect you
and your patient from moving parts or electrical shock. The covers also protect the
equipment.
NOTE: Only qualified Service personnel should service the system with the covers off.
3-7
Safety
Do not block the ventilation ports of the electronic equipment. Always maintain at least
6 inches (15 cm) clearance around the ventilation ports to prevent overheating and
damage to the electronic hardware.
Watch for the electromagnetic compatibility from other hardware. For more
information, refer to the Electromagnetic Compatibility section in Technical Reference
Manual, under the General Safety Guidelines.
WARNING: This system is intended for use by healthcare professionals only. This system
may cause radio interference or may disrupt the operation of nearby
equipment. It may be necessary to take mitigation measures, such as
reorienting or relocating the system or shielding the location.
WARNING: CT Scans may cause interference with implanted or externally worn electronic
medical devices such as pacemakers, defibrillators, neuro stimulators and
drug infusion pumps. The interference could cause operational changes or
malfunction of the electronic medical device.
Recommendations prior to scanning:
If practical try to move external devices out of the scan range.
Ask patients with neurostimulators to shut off the device temporarily while the scan
is performed.
Minimize the x-ray exposure to the electronic medical device.
Use the lowest possible x-ray tube current consistent with obtaining the required
image quality.
Do not scan directly over the electronic device for more than a few seconds.
NOTE: For procedures such as CT Perfusion or CT Interventional scans that require scanning
over the electronic medical device for more than a few seconds, attending staff
should be ready to take emergency measures to treat adverse reactions if they occur.
Recommendations after scanning
Have the patient turn the device back on if it had been turned off prior to scanning.
Have the patient check the device for proper functioning, even if the device was
turned off.
Advise patients to contact their healthcare provider as soon as possible if they
suspect their device is not functioning properly after a CT scan.
3-8
Safety
NOTE: Recommendations from FDA Preliminary Public Health Notification: Possible
Malfunction of Electronic Medical Devices Caused by Computed Tomography (CT)
Scanning date July 14, 2008.
Radiation Safety
WARNING: Improperly used X-Ray equipment may cause injury. Read and understand
the instructions in this book before you attempt to operate this equipment.
If you fail to follow safe X-Ray practices or ignore the advice presented in the
manual, you and your patient risk exposure to hazardous radiation.
CAUTION:
Authorized Users
This equipment incorporates a high degree of protection against X-Ray radiation outside the
useful beam. But this equipment can not substitute the essential requirement that every
user must take adequate precautions to prevent the possibility of any person carelessly,
unwisely, or unknowingly exposing themselves or others to radiation.
Everyone having anything to do with X-Ray equipment must receive proper training and
become fully acquainted with the recommendations of the National Council on Radiation
Protection and Measurements and the International Commission on Radiation Protection.
NCRP reports are available from:
NCRP Publications
7910 Woodmont Avenue
Room 1016
Bethesda, Maryland 20814
WARNING: Everyone having anything to do with X-Ray equipment must take adequate
steps to insure protection against injury.
3-9
Safety
All persons authorized to use the equipment must understand the dangers posed by X-Ray
exposure so that they can prevent any injury or damage that may result from such
exposure. GE Medical Systems urges you to use protective materials and devices to prevent
any injury or damage from X-Ray exposure.
WARNING: Never scan a patient with unauthorized personnel in the scan room. Warn
visitors and patients about potential for harm if they fail to follow
instructions.
WARNING: Never calibrate, test the scanner, or warm the tube with patients or personnel
present in the scan room.
Stay behind a lead screen or lead glass shield during each X-Ray exposure.
Use technique factors prescribed by the radiologist or diagnostician. Use a dose that
produces the best diagnostic results with the least X-Ray exposure.
Amber indicator lights on the gantry display panel, and rear of the gantry, illuminate
during X-Ray exposure.
CAUTION:
3-10
Safety
A warning message (Figure 3-5) is posted when [Confirm] is selected for the following scan
types:
SmartStep
SmartPrep Baseline and Monitor scans
Cine scans
Axial scans with zero table increment (interval)
VolumeShuttle (axial)
Volume Helical Shuttle
Figure 3-5 Warning Message when scanning on the same tomographic plane: Axial, Cine
and Helical
Figure 3-6 Warning Message when scanning on the same tomographic plane: Volume
Helical Shuttle
3-11
Safety
Figure 3-7 Warning Message when scanning on the same tomographic plane: Volume
(axial) Shuttle
After reading the message, if you wish to continue with the scan, click [Continue].
CTDIvol
As you setup the scan parameters from the view/edit screen, the Dose Information area at
the upper right of the scan monitor contains updated dose information. This dose
information is based on a measurement of the CTDI or CT Dose Index, which is the current
standard for CT dosimetry and performance. By using a measurement called CTDIvol, a
single value is provided to estimate the relative dose for an exam.
The CTDIvol is a weighted average measurement in a reference phantom. This dose is
expressed in milliGrays. For additional information on specific CTDIvol doses and their
calculations, refer to your Technical Reference manual.
The DLP or Dose Length Product is the product of the CTDIvol and the scan length for a
group of scans. This number can be summed over the entire exam to give an estimate of the
total dose. The value is expressed in milliGray centimeters.
The Projected Series DLP shows the DLP that would result from scanning the current group
or groups.
The Accumulated Exam DLP displays the total exam DLP up to the current point in time.
Scout dose is not included in the DLP totals since standards for reporting scout dose are not
yet defined. Scout dose is generally a very small part of the exam.
The dose information updates when technique values such as kV, mA, scan time, slice
thickness, and scan field of view are changed.
Dose information is saved as screen save image in Series 999 upon End Exam and Series
997 contains the DICOM Dose Structured Report.
3-12
Safety
CAUTION:
Using accessories which are not GE options might affect dose and image
quality.
X-Ray Tubes
The scanner uses cooling and reconstruction algorithms specifically designed for GE X-Ray
tubes.
You risk three dangers when you do not use GE X-Ray tubes.
A non GE tube could overheat and explode if the cooling delays do not meet its design
requirements.
The images could exhibit reduced performance or artifacts if your x-ray tube fails to
conform with GE tube performance specifications.
Radiation leakage may exceed GE specifications when a non GE X-Ray tube is installed
in the scanner.
CAUTION:
Electrical Safety
DANGER:
ELECTRICAL SHOCK HAZARD. Avoid all contact with any electrical conductor.
Do not remove or open system covers or plugs. Internal circuits use high
voltage capable of causing serious injury.
An electrical hazard may exist if any light, monitor or visual indicator stays
on after the system is shut down. To prevent possible injury, turn off the
main power supply wall switch, and contact your service office immediately.
3-13
Safety
DANGER:
DANGER:
ELECTRICAL FIRE. Conductive fluids that seep into the active circuit
components of the system may cause short circuits that can result in
electrical fires. Therefore, do not place any liquid or food on any part of the
system.
To avoid electrical shocks or burns caused by the use of wrong type of fire
extinguisher, make sure that only fire extinguishers approved for use on
electrical fires are used.
Surplus length of power cords or other cables from mobile accessory units that may be
used with some patient scanning should be stored in safe and isolated areas, such as
individually in a figure eight at the base of stationary equipment. This discourages signal
interference and protects cables from damage due to traffic.
Mechanical Safety
General Mechanical Safety
Check for any obstruction around the equipment before attempting to move the table
and gantry. When performing table or gantry motions, always monitor the progress of
the motion.
Be especially careful when tilting the gantry or moving the table when the cradle
extender or head holder is in place to avoid driving these accessories into the gantry
covers.
The (Cradle Unlatch Indicator) is illuminated in green when the cradle is
unlocked. An unlocked cradle could potentially move unexpectedly.
The (Interference) light illuminates when the cradle has reached a travel limit or
encountered interference.
If the table reaches one of the limits while actively pressing the controls, the limit light
will turn off when the controls are released.
3-14
Safety
Clear an interference by changing the gantry tilt, moving the cradle, or adjusting the
table height.
WARNING: Do not use the table base as a foot rest. You could entrap and injure your foot
while lowering the table. Do not place your hands between the table base and
the table side panels.
WARNING: Do not place your hands inside the gantry opening when tilting the gantry.
The gantry can pinch or crush your hands!
Patient Positioning
DANGER:
Do Not Place a Patient on the Table Weighing More Than the Upper Limit Of
500 Pounds. This Could Cause the Table to Fail and the Patient Could Fall.
CAUTION:
Temporal sampling may be degraded due to changes in timing for the table
to move from location to location if proper positioning methods are not
followed. Make sure that the patient is securely positioned on the table and
their arms are not allowed to drag on the table or allow clothing, sheets or
blankets to get caught causing a table move problem.
CAUTION:
WARNING: Temporal interval for images exceeds 3.2 seconds. Use of this data for
processing of CT Perfusion maps may contain errors in the functional
information.
Temporal sampling for data acquired for use in CT Perfusion should not exceed 3.2 seconds
between data points for optimal results. As the temporal resolution increases an error in the
statistical accuracy of the information may be introduced.
3-15
Safety
CAUTION:
When using the external laser alignment light for patient positioning
purposes, be aware that the patient's elevation may be slightly lower with the
cradle extended than with the cradle fully retracted. This is because the cradle
may bend slightly under a patient's weight. This difference should be taken
into consideration for applications where patient position information is
critical, such as radiation therapy planning. To minimize these affects, after
using the external laser alignment system to position the patient, advance
the patient to the CT scan plane. Turn on the CT alignment lights to determine
if they line up with the markers on the patient. If necessary, compensate for
the bend in the cradle by elevating the table. When the CT alignment lights
line up with the markers, set the landmark for the scan using the Internal laser
alignment light.
Please refer to X-Y Table Accuracy Procedure to assess the X-Y table accuracy
of your system.
CAUTION:
When using patient positioning accessories, make sure there are no areas,
which might cause a pinch point or interfere with patient tubing or IV.
CAUTION:
When using patient positioning accessories that are not GE options, make
sure there are no areas that might cause a pinch point or interfere with
patient tubing or IV.
CAUTION:
WARNING: None of the accessories support the full weight of a patient. If you sit, stand,
or otherwise apply excessive pressure to these devices, they break or come
off the cradle and may cause an injury.
3-16
Safety
CAUTION:
Check to make sure the power injector has enough IV tubing to allow free
movement of the cradle. Make sure the unit itself does not interfere with table
travel.
Ensure excess tubing length is secured to the table top. DO NOT loop
additional IV tubing in the patient's fingers.
CAUTION:
The patient positioning straps provided with the system do not support the
full weight of the patient. Patient positioning straps should be used to aid in
patient positioning and are not meant to fully restrain the patient.
CAUTION:
Check the length of all patient health lines (IV tubing, oxygen line, etc.) and make sure
they accommodate cradle travel. Position these lines so they cannot catch on anything
within the patient vicinity or between the table and gantry during cradle travel or gantry
tilt.
The concentrated weight of short, heavy patients can cause the cradle to make contact
with the gantry.
Make sure you do not drive the cradle into the gantry cover.
Make sure you do not pinch the patient's skin or extremities between the cradle and
the gantry.
Avoid any patient contact with the gantry during tilt or cradle movement (manual or
software driven).
Return the gantry tilt to the 0 degree upright position, latch the cradle, and adjust the
table to a comfortable height for patient loading and unloading.
Latch the cradle before you load or unload the patient (the Cradle Unlatch indicator
illuminates when the cradle is unlatched).
Physically assist all patients on and off the table and into position on the cradle.
3-17
Safety
WARNING: To Prevent Pinching or Crushing of the Patient Watch the Patient and
Equipment Carefully at All Times During Gantry Tilt or Table Movement. If
Unwanted Motion Occurs or Motion Does Not Stop, Press the Emergency Stop
Switches on the Console or Gantry.
Check the accessory attachment plate fixed to the end of the cradle. Repair or replace if
loose or damaged.
Use the cradle extender to support the patient's head or feet during a scan.
CAUTION:
If the table is lowered with anything in the red X area as indicated above, the
table could be damaged along with the equipment or object under the table.
CAUTION:
The foot pedals at the base of the table for loading and unloading patients
are always active. Care should be taken not to activate the foot pedals once
the patient has been positioned on the cradle and an exam started.
WARNING: The head holder may crack, possibly injuring the patient's head or neck, if the
patient tries to brace himself or herself on the head holder during positioning.
The head holder and cradle extender are only designed to support 75 pounds
(34kg). Ask the patient to move up into the head holder or manually help the
patient into position.
To move the patient out of the gantry in an emergency, the cradle can be manually
withdrawn by applying a minimum of 60 lbs (267 N) of force.
3-18
Safety
CAUTION:
CAUTION:
Use of any cradle extension accessories such as the table extension, head
holder, coronal head holder, and phantom holder are not accounted for in the
table gantry interference matrix. Therefore, additional care needs to be taken
to closely monitor any table up/down, in/out or gantry tilt movement to avoid
contact of the extended accessory with the gantry.
Volume Shuttle
CAUTION:
NOTE: For Volume Helical Shuttle a message will be posted in the Real Time Information
Area and an Attention pop-up will be posted with the following messages:
"Table travel did not meet expected time for pass(es) during acquisition."
Additional information on the errors seen can be found in the GE System Log.
3-19
Safety
Figure 3-9 Message at End Exam for exams containing Volume Helical Shuttle
Laser Safety
A laser alignment light system is available in order to accurately define the patient scan
region.
CAUTION:
THE DETECTOR AND DAS ROTATE TO POSITION THE ALIGNMENT LIGHTS OVER
THE LASER PORTS.
- Keep your hands away from the gantry opening.
- Make sure the gantry side covers are in place.
CAUTION:
3-20
Safety
The indicator on the gantry display panel lights when you turn ON the alignment lights.
Warning labels regarding laser safety are provided on the gantry, as described in the
Warning Labels and Symbols section.
CAUTION:
P
Head First Supine
R
A
Head First Prone
P
L
L
P
Feet First Supine
R
A
Feet First Prone
The patient position information stored in the image header correctly reflects the orientation
(RAS) information for the patient. Viewing applications will correctly reflect Right (R), Left (L),
Anterior (A) and Posterior (P) of the patient.
The reconstructed image orientation may differ from preferred anatomical viewing
presentation in which the patient's Right is on the viewers Left and patient's Left is on the
viewers Right. For example when the patient is scanned Head First and Prone the patientss
Left is on the viewers Left and the patients Right is on the viewers Right. The image
presentation will need to be modified to display preferred anatomical viewing. Some
viewing stations may not have the capability to flip the image presentation, but if the
capability exists, you must use display tools such as Flip to change the presentation of the
image.
3-21
Safety
Some remote viewing stations may have the capability to set default viewing protocols, this
is another tool that can be used to set an anatomical viewing presentation.
Post processing applications such as Direct MPR, Reformat and Volume Viewer
automatically orient images in anatomical viewing orientation. These applications create
axial images in anatomical viewing presentation. Please see Auto Applications (Option) for
more information. The system also provides the capability to create Gray Scale Presentation
State Objects (GSPS) to flip the image orientation.
Flip/Rotate in recon can be used to generate images where right/left or anterior/posterior
are flipped or where both R/L and A/P have been flipped to meet desired image display
preference. An Attention pop-up is displayed at Confirm for series where Flip/Rotate in recon
is selected. Attention: This scan prescription utilizes one of the reconstruction based image
flip and/or rotate options. Please ensure that this prescribed image orientation is displayed
appropriately on all remote viewing devices.
Figure 3-11 Flip Warning Message
Data Safety
To ensure data safety:
Verify and record the patient's identification before starting a scan.
Observe and record the patient's orientation, position and anatomical landmarks
before starting a scan. Ensure that the patient is positioned within the scan
parameters.
Maintain system image quality by performing Daily QA and other maintenance.
Connectivity - Always verify that the data transferred to another system has been correctly
received.
3-22
Safety
WARNING: The system posts a warning message when expected disk space required to
store scan data from the prescribed exam is insufficient.
WARNING: The system posts a warning message when expected image space required
to store images from prescribed reconstruction is insufficient.
WARNING: The system posts a warning message when data was interpolated to generate
images.
WARNING: The system posts a warning message if there is a failure during the archive
of patient data.
WARNING: The system posts a warning message if there is a failure during the network
of patient image data.
WARNING: The system posts a warning message when a scan is aborted due to a failure
in the acquisition chain.
WARNING: The system posts a warning message when the system has low disk space.
This is due to a partition on the system disk getting too full. Removing images
will not help. Contact service to help with recovery. If you reboot the system
and see the message asking if you want to run storelog, select the option to
remove the logs.
3-23
Safety
WARNING: Helical scanning has the inherent ability to produce artifacts when scanning
highly sloped anatomy (e.g. pediatric or adult heads). Factors which worsen
this effect are: faster table speeds, thicker image thickness, and gantry tilt.
In some cases these artifacts could be mistaken for a hemorrhage near the
cranium, or a thickening of the skull.
To reduce the occurrence of these artifacts you may prescribe slower table
speeds and/or thinner slices (such as 2.5mm) during helical scans near the
vertex of a pediatric or adult head.
WARNING: For helical scans, the Segment Recon Mode in Retrospective Recon may be
used to assess if there is an artifact or not. If questions still arise, then re-scan
the area with a two second Axial scan.
WARNING: It has been documented in radiology literature that an artifact may occur in
the chest that bears the double margin of the great vessels, which emulates
a dissection of the vessel during 0. 4- 1.0 second scans. This can occur in axial
or helical scans. If you have scanned axially with a 0. 4- 1.0 second rotation
time and observe this phenomenon, re-scan the area with a 2 second axial
scan to verify if it is artifact or patient pathology. Segment recon mode for
helical and cine acquisitions may be used in Retro recon to also assess if the
areas is artifact or pathology.
3-24
Safety
Cardiac Imaging
Additional Cautions are included in the Cardiac Imaging Discovery CT750 HD chapter.
CAUTION:
A patient with any of the conditions listed below may require additional
attention. If patients are scanned with these conditions, the software may not
be able to detect the R-Peaks and the images therefore may be produced as
ungated segment images.
- Patients with multiple pre-contractions or extra systole (e.g. PVC, PAC)
- Patients with persistent or extreme arrhythmia
- Patients with bi-ventricular lead (dual chamber) pacemakers
CAUTION:
CAUTION:
The heart rate displayed on CT console is a 3-cycle average. You must review
the actual waveform pattern to determine ECG trace clarity, trigger location
and if any cycle to cycle variability or masked arrhythmias may be present in
order to adapt set up and conditions prior to proceeding with the scan
acquisition.
CAUTION:
Cardiac helical scan modes of SnapShot Segment, Burst, and Burst Plus are
optimized for specific heart rate ranges. Select the appropriate scan mode
for each patient's heart rate pattern. If the incorrect mode is selected,
temporal resolution may be insufficient and degraded image quality could
result.
3-25
Safety
CAUTION:
SnapShot Pulse scan mode for coronary artery imaging is intended to be used
for patients with stable heart rates of 65 beats per minute or less. It is not
recommended to scan a patient with heart rates that are unstable or above
65 BPM with SnapShot Pulse as the temporal resolution may be inadequate
for freezing the motion of the heart and the increase the interscan delay
between exposures could lead to degraded image quality. Alternate imaging
modes of cardiac helical should be considered if optimal conditions for
SnapShot Pulse are not met. Cardiac helical modes should be considered if
patient does not meet the criteria for SnapShot Pulse.
CAUTION:
SnapShot Pulse should not be used for studies where function or full
multiphase analysis is needed. Settings may limit the cardiac phases
available to one or a few neighboring phases impacting the ability to analyze
heart motion or review cardiac phase locations outside the prescribed phase.
CAUTION:
CAUTION:
AutomA and ECG Modulation are not valid with SnapShot Pulse acquisitions
due to prospective control of x-ray over the scan volume. Only Manual mA
values can be prescribed.
3-26
Safety
Patient Preparation
CAUTION:
Ensure the ECG patches are not past expiration date and that the gel on the
pads is still moist for proper conduction of the ECG signal for successful
gating.
It is important to explain to the patient the events that will occur during the acquisition
of the contrast enhanced cardiac data. Make sure to explain the warm feeling that may
occur during the injection of the contrast material.
Use hyperventilation technique for all the series in a cardiac exam. Practice the
hyperventilation instructions with the patient prior to scanning.
During the practice breath hold, make sure to watch the ECG trigger monitor to
determine the average heart rate, minimum heart rate, and ECG pattern during the
breath hold.
Position the patient's arm over the patient's head so they are comfortable and will not
move during the acquisition of data.
CAUTION:
If, during the scan, the heart rate drops significantly lower than the prescribed
heart rate, there is a potential for gaps in the gated image location. To avoid
image location gaps, a non-gated image is reconstructed for the period where
the patient heart rate dropped below the expected or confirmed heart rate
at the start of the exam. A non-gated image may have more motion and may
not be reconstructed at the prescribed phase.
CAUTION:
There is a possibility that the ECG signal may not be detected by the scanner
due to improper lead placements, or a lead falling off during the scan. It is
important to place new leads on the patient before the scan. Make sure the
leads are attached properly, and use only GE recommended ECG leads.
It is important to confirm ECG trace clarity before the scan.
CAUTION:
The heart rate displayed on the CT console is a 3-cycle average. You must
review the actual waveform pattern to determine ECG trace clarity, trigger
locations, and if any cycle to cycle variability or masked arrhythmias may be
present in order to adapt set up and conditions prior to proceeding with the
scan acquisition.
3-27
Safety
CAUTION:
CAUTION:
Lung Algorithm
The Lung algorithm setting provides edge enhancement between structures with large
density differences, such as calcium and air, resulting in a sharper lung field when
compared to Standard algorithm.
For best image quality, prescribe a 5 mm scan thickness when you plan to use the Lung
algorithm. If you plan to prescribe a High Resolution Lung study with 3.75, 2.5, or
1.25 mm, use the Bone algorithm.
The Lung setting enhances the contrast of small objects. For best viewing and film
quality, select a window width of 1000 to 1500 and a window level of -500 to -600.
The Lung algorithm setting increases the CT number values at the edge of high contrast
objects. If you plan to take CT number measurements of vessels or nodules in the lung,
please check and compare your results with Standard algorithm images. (ROI and
Histogram functions use CT numbers.)
Remember: The edge enhancement provided by the Lung setting may not be
appropriate in some clinical cases. Please take individual viewing preferences into
account when you choose the Lung setting.
Autoscan
Press and release [Move to Scan] on the console to advance the cradle if AutoScan is
disabled.
If you select Auto Scan during one group Rx, it remains ON for every group in that series.
SmartStep Safety
The SmartStep option adds several components to the scan room. These are the In-Room
Monitor, Hand Held Control for table movement as well as image review, and the X-Ray
Control Foot switch.
3-28
Safety
Each of the SmartStep components is connected to the system by a cable. When using the
system, ensure that the cables cannot catch on anything when the gantry or table is moved.
Table Float
During the scan the Clinician has the option to float the table between scans. When the
Table Float mode is selected, the table is unlatched and can be moved freely by anyone at
the bedside.
WARNING: Unintended table motion may cause a serious injury. Table may be bumped
or jarred during an interventional procedure. Care must be taken when
performing interventional procedures in the float mode. It is the clinician's
responsibility to ensure that they have control of the table when in this mode
of operation. Table must not be left unattended when in the float mode.
Ensure that the table is latched before leaving the table side.
SmartStep Scanning
SmartStep scanning allows multiple scans at one location for interventional procedures. The
system allows up to 90 seconds of scanning in one place. After 90 seconds, the operator
must prescribe a new scan to continue. The accumulated scan time from a procedure is
displayed in the In-Room Monitor.
CAUTION:
CAUTION:
CAUTION:
The foot pedal is active if the system is in the "Prepped" state. Care should be
taken not to step on the foot pedal and make an unwanted exposure.
Clinician's working in the scan room should wear appropriate protective clothing. Lead
aprons, groin and thyroid protection, as well as protective eye wear are available through
the GE Accessories Catalog.
3-29
Safety
WARNING: When scanning for interventional (biopsy) studies the scan mode, image
thickness, number of images per rotation and the display layout used affect
the display of the images. It is recommended to use the Biopsy Mode provided
on the system. If manually prescribing biopsy scans, Axial 1i scan mode or
Helical scan mode with a slice thickness greater than 2.5 mm must be used.
Do not use Cine scan mode for interventional (Biopsy) imaging. Do not use an
Auto view layout with more than one Auto View image viewport.
Refer to Select a Multiple Image Display in the Image Display Viewing Area chapter
of the Learning and Reference Guide for more information on how to set up the
desired viewing options.
CAUTION:
The continuous AutoView layout format should not be used for display of
images during an interventional study because it does not allow for quick
review of images in a free viewport.
Choose one of the following for the best auto view layouts.
Figure 3-12 Auto View Layouts
3-30
Safety
CAUTION:
The manual cradle release feature is intended for emergency egress and small
movements. In rare instances, if the cradle release is used to move a patient
out of the gantry, instead of using the table control buttons as specified in
the operator manual, a discrepancy of up to 6mm between the numerical
display on the gantry and the actual position of the table can be introduced.
Accuracy of Measurements
Measure Distance for Axial, Helical, and Cine Images
Measure error using the straight line distance graphic is less than two times the image pixel
size.
CAUTION:
Note that the measurements are accurate only if the trace segments are
longer than the slice interval.
For measurements of anatomy in the "X" direction that are at ISO center ("Y"):
The measure error using the straight line distance graphic is less than 5 % of the
measured distance plus 2 mm.
For measurements of anatomy in the "X" direction that are NOT at ISO ("Y"):
The measure error using the straight line distance graphic is less than 5 % of the
measured distance plus 2 mm plus 3 % of measured distance per centimeter from
ISO.
3-31
Safety
Figure 3-13 Scout Scan Plane
Measure Angle
Measurement accuracy using the angle graphic is equal to the displayed angle value +/- 10
degrees for an angle measured between segments which are five times larger than the
image pixel size. Accuracy improves as the length of the segments increases.
ROI
Area measurement accuracy using a region of interest graphic (rectangle, smooth curve,
ellipse or free draw) is equal to the displayed area +/- the circumference of the region
multiplied by (image pixel size)2/2. Mean and standard deviation values for the intensity of
3-32
Safety
the pixels in the region are also affected by this accuracy. If the ROI is rotated, the area
measurement can vary up to 5%. Region of interest statistics are based on the pixels INSIDE
the graphic defining the region.
If each axial pixel represents 0.5mm of anatomy, then the reformat plane thickness
equals 0.5mm.
If pixel size equals 0.9766mm (500mm/512), then the reformat plane represents a slice
of anatomy about one millimeter thick.
Posture
Correct posture is very important. To ensure correct posture while sitting at your operator
console, follow these basic steps:
1. Face the monitors and keyboard without twisting your body.
2. Sit comfortably erect with the small of your back well supported.
3. Position your forearms parallel to the floor, with your wrists straight.
4. Position the screen so that your eyes are nearly level with the top of the screen.
5. Keep both feet flat on the footrest, with your thighs parallel to the floor.
If you cannot comfortably maintain this position while working at your operator console, you
should make the necessary adjustments to your operator console environment.
Equipment Adjustments
Chair
Adjusting the fit and height of your chair is very important for comfort. Follow these basic
guidelines:
1. Fit the backrest snugly against your back. People with shorter legs might need a back
cushion.
2. Set your chair height to position your forearms parallel with the floor when your hands
are placed on the keyboard. If your feet dangle, you need a footrest.
3-33
Safety
Keyboard
Keyboard height is also important. When typing:
Your wrists should be as straight as possible.
Your forearms should be parallel to the floor.
Your hands and fingers should float over the keys or mouse.
Screen
With your head straight, your eyes should be looking directly at the top of the screen.
You should look at the screen straight-on, not at an angle from the side, top or bottom.
Glare from the screen can disrupt your viewing and cause eyestrain. Do not face a
window, and position the screen at right angles to bright light sources.
Comfort
Comfort at your operator console indicates you've set up your work area correctly. However
even a well-designed area needs frequent adjustment, especially for different users. Take
the time when positioning yourself at your operator console to ensure your comfort.
It is also recommended that if you use the operator console for extended periods of use
(several hours at a time), that you take short breaks to get away from your operator console
and perform simple stretching exercises to reduce the chance of fatigue.
Other considerations:
Keep the patient in view at all times.
Never leave the patient unattended.
Stay alert to your patient's condition.
Use the speakers and microphones on the table, gantry, and console to stay in
constant communication, even while you sit at the console.
Follow the exam procedures explained in the Chapters 13 and 14 of the Learning and
Reference Manual. Carefully enter patient information and position before
proceeding.
CAUTION:
3-34
Safety
Accessories
WARNING: None of the accessories support the full weight of a patient. If you sit, stand,
or otherwise apply excessive pressure to these devices, they break or come
off the cradle and may cause injury. Note if an accessory breaks, use caution
when picking it up and do not continue to use.
WARNING: Accessories like arm boards and catheter bag holders are not secured to
gantry and may interfere with gantry if not positioned properly.
Use only GE approved equipment together with this system.
With each use check all accessories for damage and remove them from service if
damaged or cracked.
GE Approved Accessories
Table 3-2 Approved Accessories
Type
Cardiac Trigger Monitors
Respiratory Monitor
Partial UPS
Manufacturer
IVY 3150 - B
IVY 3100 - B with ethernet
Varian 1.7
Powerware 9355
Powerware 9330
Seagate FreeAgent
MOD Drive
Sony SMO-F551
Opticon 6125
Hand Held 3800
Modem
Mult-Tech ZBA
Video Splitter
InLine IN3254
Monitor
NEC 1990Sxi
The placement of the IVY cardiac trigger monitor should be on the monitor stand. The
monitor should not be placed on the CT table. It should be positioned so that it is not
touching the CT table or gantry when it is in use.
3-35
Safety
IV Pole Safety
Care should be taken in the amount of weight and ensuring that the pole is tightened prior
to use.
CAUTION:
The IV pole may bend when excessive weight is placed on the pole. Ensure no
more than 4.5 kg or 10 lb. is placed on the IV pole.
CAUTION:
Ensure that the IV pole extension collar is tightened prior to use to avoid the
pole height to move on it's own.
CAUTION:
The maximum allowable weight on the table tray is 9kg or 19.8 lbs
CAUTION:
Objects that may be susceptible to tipping should be strapped down with the
Velcro strap provided.
CAUTION:
To Latch an accessory:
Align the accessory tongue with the pocket at the end of the cradle.
Keep fingers clear of the cradle.
Push the tongue all the way into the pocket until it latches into place.
Rubber shims may have been installed on the head holder or foot extender to give it
a tighter fit. Please take care when latching the accessory to make sure that it is
completely latched. Push the latch forward until you hear a click. Verify that the latch
is fully latched.
3-36
Safety
To Unlatch an accessory:
Pinch the two L-shaped parts together and pull the accessory out of the cradle.
An alternate method is to apply a light force to the catch in the direction to pull the
accessory out of the cradle.
Proper operation:
Keep the accessory "tongue" and cradle pocket clean and free of fluids and debris.
Keep the latch and cradle pocket area clear of sheets, drapes, pads or any item that
could interfere with proper latching and cause damage.
Positioning
Positioning patient anatomy over the area where the head holder or cradle extension
attaches to the cradle may produce images where the contrast be between 2
adjacent rotations is different. Make sure the area of interest especially the head in
properly positioned in the head holder or on the cradle extension.
CAUTION:
Due to access limitations on the left side of the gantry, some procedures may
be affected when ancillary equipment is used. Assess the placement of the
equipment needed for the procedure before the placement of the patient on
the table. Access around the left side of the gantry may also be affected.
3-37
Safety
Emergency Devices
The system has two types of Emergency buttons:
1. Emergency Stop- when pressed, all table and gantry motions are halted, generation of
X-rays is stopped, laser alignment lights are turned off. The system aborts any data
acquisition in progress, and attempts to save all data acquired prior to the abort. Use
the Emergency Stop button for patient related emergencies.
2. System Emergency Off Button- when pressed, the power to all system components is
removed, stopping all table and gantry motion and generation of X-rays. The system
aborts any acquisitions in progress, and data obtained prior to the abort can become
corrupt or lost. Use the System Emergency OFF button for catastrophic emergencies,
such as fire or earthquake.
CAUTION:
If you press the Emergency Stop or Emergency OFF buttons during a scan, the
system will abort the data acquisition.
Emergency Stop
NOTE: Every operator should take a few minutes to locate the Emergency Stops on his or
her system before he or she scans the first patient.
The system has five Emergency Stop buttons:
One on each control panel on the front of the gantry (Figure 3-14).
3-38
Safety
Figure 3-14 Front of gantry Emergency Stop Buttons
Press an Emergency Stop button in the event of a patient related emergency or if the cradle,
table or gantry starts to move unexpectedly.
Once an Emergency Stop button is pressed, the Reset gantry key, on the gantry control
panel, flashes about once every two seconds.
Press the Reset gantry key to restore power to the gantry and table.
When Emergency Stop is applied, the moving cradle and tilting gantry may overrun by less
than 10 mm and less than 0.5 degrees respectively.
3-39
Safety
Press PAUSE SCAN to pause scanning after the current scan completes.
During an exam, the system pauses between scans if you Press any button on the
control panel other than the alignment lights. It stops X-Ray if you Press the same
button(s) during a scan.
Emergency Egress
System operation may be stopped due to power failure or a safety event (something coming
into contact with the collision sensors), or the system may be halted by the operator in
response to emergency conditions.
The Cradle unlatch button should only be used in two situations.
1. In Emergency Egress situations.
2. When using the SmartStep scan type.
3-40
Safety
To safely remove the patient:
1. Press the Cradle Release gantry key or the Emergency Stop button (Figure 3-14) to
disengage the clutch
2. Pull the cradle to its out position, using the Cradle Lip or Cradle Handle (Figure 3-14).
3. Assist the patient off the table.
3-41
Safety
CAUTION:
Equipment used in a clinical setting must be cleaned and free of any blood and other
infectious substances.
Customers are responsible for the sanitary condition of the equipment. The
suggested equipment clean-up procedure for cleaning any fluids or matter
discovered in accessible areas or inside under direction of service are as follows:
Wear personal protective equipment.
Wear proper Nitrile gloves.
Before cleanup take note of sharp corners or objects that could cut the gloves. If
gloves tear, remove, wash hands thoroughly and re-glove.
Use cloth or paper towels along with cleaner, taking care not to splash.
Sanitize the area using common bleach diluted 10:1 or an Approved Cleaning
Agent listed in the Maintenance and Cleaning section. Clean any tools that come
in contact with body fluid.
Since viruses require moisture to remain active, dry the entire area.
When confident the area is clean and dry, place cleaning materials in a red
biohazard bag.
Remove gloves, turning them inside out, and put gloves in the biohazard plastic
bag. Seal and give the bag to appropriate personnel for disposal.
Environmental Concerns
This symbol indicates that the waste of electrical and electronic equipment
must not be disposed of as unsorted municipal waste and must be collected
separately. Please contact an authorized representative of the manufacturer for
information concerning the decommissioning of your equipment.
3-42
Safety
(Hg)
(Cd)
(Cr(VI))
(PBB)
(PBDE)
Operator Console
Gantry
LCD Monitor
Patient Table
3-43
Safety
Component Name
(Hg)
(Cd)
(Cr(VI))
(PBB)
(PBDE)
WARNING: Do not discard the X-Ray Tube Assembly among industrial waste or domestic
garbage.
WARNING: A damaged X-ray Tube Assembly should not be dispatched through the
national postal service.
The X-Ray Tube Assembly contains the following potentially hazardous materials:
Lead: Lead salts are toxic and their ingestion may cause serious problems. The
manipulation/ handling of lead is subject to regulations.
Oil: Univolt 54 and Crosstrans 206 mineral oil are not toxic, but the prevailing
environmental regulations should be observed for their disposal or recuperation. For
example, it is forbidden to dispose of these oils in the wastewater or sewage system
or in the natural environment.
3-44
Safety
Your local GEMS field service will advise you on the suitable means of disposal.
The X-Ray Tube Assembly to be discarded should be forwarded to the GEMS Service
network, and it will be disposed of in a GEMS recycling center.
Precautions
Take all the necessary precautions for the personnel handling the recovery or destruction of
X-Ray Tube Assemblies, and in particular against the risks due to lead.
These personnel must be informed of the danger involved and of the necessity to observe
the safety measures.
3-45
Chapter 4
4-1
Pediatric Protocols
4-2
120 kV
head filter
body filter
2.20
relative dose
2.00
1.80
1.60
1.40
1.20
1.00
0.80
15
20
25
30
35
4-3
CTDI phantom
Ped Head
Ped Body
Small Head
16 cm Phantom
Head
Small Body
Medium Body
Large Body
Cardiac Small
32 cm Phantom
Cardiac Medium
Cardiac Large
4-4
Scan signal-to-noise
Limit the highest quality images requiring the highest radiation dose to very specific
indications such as angiography or visualizing small subtle lesions. Studies with higher noise
may be just as diagnostic and require lower dose.
4-5
Lower kVp
Consider decreasing the kilovoltage to 80 or 100kVp for smaller patients. Significant
decreases in dose can be achieved with lower kVp selections, but decreases in kVp should
not be done without increasing the mA to maintain noise levels and contrast to noise ratios.
Lower kV selections also increase HU values so the window width for viewing images will
need to be increased to maintain a similar appearance. Since lower kVp selections lower
x-ray penetration, it is important to not use low kV selections on too large of a patient, which
can potentially result in compromised image quality. Work with your radiologist and medical
physicist to establish low kV protocols and patient size limits. Table 4-2 and Table 4-4 can be
used as guide for making adjustments to mAs for changes in kV in a protocol.
Table 4-2 kV and mAs Adjustment Factors
KV Adjustment Factor
kV
80
100
120
140
Factor
0.3
0.6
1.0
1.4
4-6
80 kv
100 kv
45.0
120 kv
140 kv
40.0
35.0
30.0
25.0
0
100
200
300
400
500
600
700
800
900
mAs
To assure sufficient x-ray penetration, this chart is intended as a relative guide to the
maximum patient diameter that can be scanned based on a kV and mAs selection. It does
not indicate, a recommended technique factor (that is generally higher) since the technique
factor also depends on the image quality needed for the diagnostic task.
AutomA
If using AutomA, proper patient centering is critical. Double check and verify the table
height is centered to the patient. Raise or lower the table as needed before taking the
scouts. After the scouts are taken and prescription is done, verify the mA table calculations
before confirming the scan. Make sure minimum mA and maximum mA values are set
appropriately. See section on AutomA for more detail.
Increase Pitch
Increasing pitch will decrease the amount of radiation needed to cover the region indicated,
usually without compromising the diagnostic quality of the scan. Increasing pitch from 1.0
to 1.375:1 decreases dose by a factor of about 27%.
4-7
Acq.
64 X 0.625
32 X 0.625
16 X 0.625
8 X 0.625
4 X 0.625
2 X 0.625
32i
*1.25
0.625
N/A
N/A
N/A
N/A
16i
2.50
1.25
0.625
N/A
N/A
N/A
(mm)
8i
5.00
2.5
1.25
0.625
N/A
N/A
4i
N/A
5
2.50
1.25
N/A
N/A
2i
N/A
N/A
5.00
2.50
1.25
N/A
1i
N/A
N/A
N/A
5.00
2.50
1.25
4-8
Pediatric Protocols
The Pediatric protocol area was designed to help facilitate protocol selection for pediatric
patients by providing age based protocol areas for Head, Orbit and Miscellaneous and color
coding system for Neck, Upper Extremity, Chest, Abdomen, Spine and Pelvis. It is highly
recommended to place and select pediatric protocols from the pediatric selector based on
age, height and weight.
By entering the pediatric patient's weight in the New Patient screen, the system will
automatically select the appropriate color code area for the anatomical area selected.
After the patient information has been entered, click on the <Pediatric> button to bring up
the anatomical selection area. The anatomical areas are indicated by text.
4-9
4-10
Zone
Color
Pink
6 - 7.5
13.2 - 16.5
59.5 - 66.5
Red
7.5 - 9.5
16.5 - 20.9
66.5 - 74
Purple
9.5 -11.5
20.9 - 25.4
74 - 84.5
Yellow
11.5 - 14.5
25.4 - 32.0
84.5 - 97.5
White
14.5 - 18.5
32.0 - 40.8
97.5 - 110
Blue
18.5 - 22.5
40.8 - 49.6
110 - 122
Orange
22.5 - 31.5
49.6 - 69.5
122 - 137
Green
31.5 - 40.5
69.5 - 89.3
137 - 150
Black
40.5 - 55
89.3 - 121.3
--
4-11
4-12
Getting Started
Chapter 5
Getting Started
Introduction
The Getting Started chapter provides you with information about the hardware components
and users conventions, as well as the shutdown and startup procedures of the system. The
chapter is broken into three parts: hardware components, users conventions, and shutdown
and startup. The purpose of this chapter is to provide the necessary background information
about the system that may be important in understanding other topics presented in
subsequent chapters.
This chapter explains the process of shutting down and starting up the system. It provides
step-by-step instructions to learn how to:
5-1
Getting Started
Configure Groups
Add a Local Group
Add a Enterprise Group
Manage a Group
Remove a Group
Change Groups Roles
Use QuickSnap
Use IQ Snap
As stated in the About This Guide chapter, it is necessary for you to have sufficient
knowledge to competently perform the various diagnostic imaging procedures in
Computerized Tomography. This guide is not intended to teach Computerized Tomography.
5-2
Getting Started
Hardware Components
Breath Hold Light.
Internal Gantry Components
Computer (Operator Console)
Monitors
Mouse
Bright Box
Power Distribution Unit (PDU)
Users Conventions
Tool Chest
HIPAA
Understanding users and groups
Understanding groups and privileges
Software Download
OptiDose
Dose Features & Technology *
5-3
Getting Started
Hardware Components
Figure 5-1 Gantry Controls
12
13
14
15
11
5
4
16
17
7
18
9
10
Icon
Function
Description
Prep Delay
Timer
Stop Scan
Scan Start
Cradle In
5-4
Getting Started
No.
Icon
Function
Table Up
Cradle Out
Table Down
Fast Speed
AutoVoice
Demo
(breath-hold
lights are
only used
during CT
scans)
See Figure
5-3.
11
Description
12
Tilt and
Table
Travel
Limits
5-5
Getting Started
No.
Icon
Function
Internal
Landmark
External
Landmark
13
14
Description
5-6
Getting Started
No.
Icon
Function
Laser
Alignment
Light
15
Description
A toggle which when pressed, turns all the laser
alignment lights on or off. These are used to help
establish landmark locations.
CAUTION:
16
17
Table
Collision
Sensor
Indicator /
Reset
Home
18
Gantry Display
The gantry display (Figure 4-4), provides gantry and table status information. The numbers
above and below each indicator or status area on the gantry display figure correspond to
the numbers in Table 5-2.
5-7
Getting Started
Figure 5-2 Gantry Display
1 2 3
Breathe Light
Breath
Light
Hold Your
Laser Light
Indicator
CAUTION:
5-8
Getting Started
Collision
Indicator
Cradle
Unlocked
Indicator
Vertical
Height
Indicator
Horizontal
Cradle
Position
Gantry Tilt
Indicator
Exposure
Indicator
Heart
Indicator
5-9
Getting Started
Lung
Indicator
Description
Performix HD Tube
The anode heat capacity with a Performix HD tube
is 8 million heat units (MHU) and the cooling rate is
1782 kilo heat units per minute (KHU/min).
Performix HD is limited to 100.2 kW.
Gemstone Detector
5-10
Getting Started
Component
Description
Description
5-11
Getting Started
Number
Description
Description
Monitor Connection
5-12
Getting Started
Figure 5-6 Console Rear Plug In Panel
16
1
2
3
12
10
13
11
14
4
5
6
7
15
Name
Description
J31
J30
J29
J28
J27
J26
J25
J24
Printer Connection
J22
10
J4
11
J2
12
J21
13
J5
14
J3
15
J1
16
C83
Power Switch
5-13
Getting Started
CAUTION:
These Receptacles are not for General Use. The power consumption of both
accessories should not exceed 960 Watts.
DANGER:
1
2
3
4
5
5-14
Getting Started
The computer is located at the base of the console and it contains all the hardware
necessary to operate the system and perform image generation.
Xtream FXTM Technology
The operator console issues a PC based computer system running a Linux based operating
system.The system includes system, image and scan data disks and stores up to 250,000
512 images and with 1 terra byte for scan data files which supports approximate 1450
rotations for 1 second Hi Res acquisitions.
GRE Recon
The Global Reconstruction Engine (GRE) hardware provides reconstruction times of up to 16
images per second based on hardware configuration. The faster times enhance the
capabilities of SmartPrep to provide more precise timing in the delivery of contrast material
for a wide variety of examinations.
ASIR Recon
A second recon subsystem is available for reconstruction of Adaptive Statistical Iterative
Recon images. The ASIR recon hardware provides reconstruction times of up to 5 images a
second for Volume mode and up to 15 images a second for slice mode.
Applications on Operator Console (OC)
Common user interface with Advantage Windows for improved productivity. The OC now
supports an expanded list of Advanced Application packages such as Volume Viewer, CT
Perfusion 4- Multi-Organ or Neuro only, Advantage CTC Pro, AutoBone, CardIQ Xpress 2.0
Plus, AVA Xpress, Card EP, and Dentascan.
Volume Viewer is a prerequisite to support , CardEP, Advantage CTC Pro, AutoBone, CardIQ
Xpress 2.0 Plus, and AVA Xpress.
Located on the top of the console table top is a media tower with three drives and a
separate MOD drive.
Table 5-7 Device Descriptions
Device Name
Magnetic Optical
Disk Drive (MOD)
Description
Located at the top of the media tower is the MOD drive used
for image archiving and restoring. The MOD disks are
erasable and re-writable and 1.2 or 2.3 GB media can be
utilized. The MOD can store 1800 (1.2GB) or 6000 (2.3GB)
lossless JPEG compressed 512 x 512 matrix images per side.
Actual number may vary by stored image type.
NOTE: PC based systems only save images files to MOD, scan
data is saved to DVD RAM for these systems.
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Getting Started
Device Name
Description
Digital Video
Disk Read/Write
(DVD-R/W)
Digital Video
Disk-Random
Access Memory
(DVD-RAM)
Connections for
iLinq and service
computer
functions
Computer power
on/off switch
5-16
Getting Started
Table 5-8
Tape Strips
Tape Strips
Located underneath the table are the collision sensor strips. These strips are located in
areas where there is potential for the table to come into contact with foreign objects, such
as a wheel chair or a stretcher. If one of the tape strips is touched, the table and gantry
motion stops immediately. Raise the table and clear the obstruction. You can now continue
moving the table down.
Figure 5-9 Collision Sensor Strips
NOTE: The maximum scan range and gantry tilt depends on the table height. The mark on
the cradle for maximum scannable range is based on the table center at isocenter.
Make sure the patient is positioned within the scannable range and use the Tilt and
Table Travel Limit button on the gantry control panel to check limits.
5-17
Getting Started
CAUTION:
If the table is lowered with anything in the red X area as indicated in Figure
5-10, the table could be damaged along with the equipment or object under
the table.
Figure 5-10
NOTE: Discovery CT750 HD tape switches are only activated when downward motion of
the table elevation encounters an obstruction. They are not activated when touched.
CAUTION:
Use of any cradle extension accessories such as the table extension, head
holder, coronal head holder, and phantom holder are not accounted for in the
table gantry interference matrix. Therefore, additional care needs to be taken
to closely monitor any table up/down, in/out or gantry tilt movement to avoid
contact of the extended accessory with the gantry.
Monitors
There are two monitors for the system (Figure 5-11). The monitor on the left is the Scan
monitor and the monitor on the right is the Display/Image monitor.
Figure 5-11 Monitors
LCD Monitors
5-18
Getting Started
NOTE: If the power is turned off to the monitors by either console off or using the power off
button on the monitor, it takes 15 minutes for the monitors to stabilize to their set
brightness and contrast levels. During this warm-up time, do not make any
adjustments to the brightness or contrast levels.
1. Scan Monitor - The Scan monitor contains the user interface that controls all aspects of
scanning from entering patient information to ending the patient exam. The interface
also includes scan protocol control, scan data manipulation, and system maintenance,
such as tube warm-up and calibrations.
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Getting Started
The numbers on the above picture correlate to the numbered explanations below.
2
3
4
5
6
7
1. Desktops - The desktops can be thought of as a work environment. When a desktop is
open, all the functions related to that desktop are placed on the display/image monitor.
The available desktop selections are:
Exam Rx - To view images as you scan, auto film, manual film, and to apply
measurements and other features to an image.
Image Works - To view other exams, archive, network, remove, manual film, apply
measurements and other features to an image, perform 2D reformations, and
access optional software features.
Learning Solutions - access to electronic based operator information - Learning
and Reference Guide.
iLinq - To gain on-line access to GE Online Center engineers and Answerline
Applications Specialists for the purpose of sending and receiving information
related to the scanner. Within this desktop, you also have access to the ten most
frequently asked questions and a searchable database.
Service - Used mostly by field engineers to save scan and/or voice protocols and
to perform system diagnostics.
Shutdown - To restart the system, shutdown for power cycle of the system, or
User log out for HIPAA
2. Feature Status Area - contains the following areas:
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Getting Started
Date/Time/Image Space - Shows current date, time, and the remaining 512 and
256 matrix image space on the system disk.
Reconstruction - Shows the current or most recent exam, series, and image
reconstruction status. This status includes prospective or retrospective
reconstruction.
On the Xtream and Xtream FX systems, recon shows the exam, series, image range
and percent complete.
Archive - Shows the current or most recent exam, series, and image archive
status. This status includes Save or Restore.
Network - Shows the current or most recent exam, series, and image network
status. This status includes Send or Receive.
Filming - Shows the current or most recent filming status.
Current Message - This area serves two functions. First, when you click on the
area, you can see a list of the system messages. These messages are not
necessarily error messages but can simply be any informational message
generated by the system. The second purpose is to leave messages about the
system for the field engineer by using [Memo]. When you click [Memo], a pop-up
menu appears. Making sure the cursor is in the menu area, you can then type a
message, then click [Save]. The message now is a part of the log files. The field
engineer can look at this message at a later date by viewing the log file via [View
Log]. You can also view the error log through [View Log].
2 10 11 12
9
3 4 5
6 7 8
The numbers on the above picture correlate to the numbered explanations below.
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Getting Started
1. Emergency Stop - In the event of an emergency situation, pressing emergency stop
stops all table and gantry motions, as well as any X-ray exposure in progress.
2. Exposure Indicator - The
exposure is taking place.
NOTE: The Remote Tilt button on the Scan Control Interface Module can be used to return
the gantry to zero once all the prescribed scans for the exam have been acquired.
9. Talk - Pressing
(Talk) and speaking towards the intercom above the
button allows you to communicate with the scan room.
WARNING: Be sure that the Gantry will not touch the patient during Remote Tilt
operation. Pinching or crushing may happen if the Gantry touches the patient.
10.Volume Control (operator to patient) - The (Volume Control Operator Voice
to Patient) dial is located just below the indicator on the front of the keyboard.
This dial controls the volume of the operators voice to the patient. An upward
adjustment of the dial increases the volume while a downward adjustment of
the dial decreases the volume. The dial does have numbers on it to let you
know what volume level you have set.
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Getting Started
11.Volume Control (autovoice to gantry)-The (Volume Control Autovoice to
Gantry) dial is located just below the indicator on the front of the keyboard.
This dial controls the volume of the autovoice to the gantry. An upward
adjustment of the dial increases the volume while a downward adjustment of
the dial decreases the volume. The dial does have numbers on it to let you
know what volume level you have set.
Description
F1
Film Image
F2
Film Screen
F3
Film MID
F4
Print Series
F12
Translated Text
14. Preset Window Width/Window Level Keys - The F5 - F11 function keys are used to
apply the preset WW/WL values stored in User Prefs in Image Works. The keys can be
used to set the WW/WL using the preset values in viewports on ExamRx, in the Viewer
and Mini-Viewer in Image Works and in Reformat.
Table 5-10 Function Keys
F Key
Window/Level
F5
Previous
F6
Abdomen
F7
Head
F8
Lung
F9
Mediastinum
F10
Spine
Translated Text
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F Key
Window/Level
F11
Vertebra W/L
Translated Text
15. Page Up/Page Down - The Page Up and Page Down keys allow you to review the next
and prior images in a viewport or viewports from the Exam Rx or Image Works desktops.
16. Window Width/Window Level Control Keys - You can use these keys to manually
change the WW/WL settings for images in the Exam Rx and Image Works desktops. The
(Up/Down) keys increase/decrease the window level and the
(Left/Right) keys
decrease/increase the window width.
Mouse
The mouse is used extensively to make selections on the scan and display/image monitors.
It is a standard three button computer mouse that is set up to work with the system.
Figure 5-13 Mouse
left
right
middle
The three mouse buttons are referred to as the left, middle, and right mouse buttons. In this
manual, the term "click" refers to pressing and releasing the left mouse button. The term
"double click" refers to quickly clicking and releasing twice on the left mouse button. The
term "triple click" refers to quickly clicking and releasing three times on the left mouse
button.
Most of the selections required during the scan and review process require a single click on
the left mouse button. This is the primary button for selection. The middle mouse button is
used primarily for adjusting window width and window level. The right mouse button is used
infrequently for scrolling images, magnification, and for accessing hidden menus.
NOTE: For specific terminology and mouse descriptions used in this text, refer to Table 2-1
in the About This Guide chapter.
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Bright Box
The Bright Box (Figure 5-14) is a separate piece of hardware that can be utilized to review
images without having to fully utilize the mouse or keyboard. Using the Bright Box allows
someone to review an image or images while someone else utilizes the mouse and
keyboard to set up or continue the scan series.
The Bright Box can be used only in the Exam Rx desktop with any "free" viewport. The term
"free" refers to a viewport that is not utilized for autoview or autofilm. It can be used in the
Autolink viewport, although, when the first image of another series is reconstructed, that
image is displayed in the viewport, taking the place of the series you are currently reviewing.
It is recommended to click the review screen, bottom left viewport, as a "free" viewport.
You can only work in one viewport at a time. Before you begin, you should put the desired
viewport in primary focus, with a double click in the viewport, so it does not affect the other
viewports.
NOTE: To get additional information about primary and secondary viewports, refer to the
Image Display Viewing Area chapter.
Figure 5-14 Bright Box
The numbers on the above picture correlate to the numbered explanations below.
1. Prior Button - Pressing this button displays the prior image in the set. This button is
inactive while in the paging mode.
2. Next Button - Pressing this button displays the next image in the set. This button is
inactive while in the paging mode.
3. Trackball - The trackball has two functions. The first, while not in the paging mode,
adjusts the window width and window level of the image. Moving the trackball to the left
decreases the window width while moving it to the right increases the window width.
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Moving the trackball down decreases the window level while moving it up increases the
window level. While in the paging mode, moving the trackball up pages through the
sequence from beginning to end at a rate dependent on the speed at which you move
the trackball. Moving the trackball down pages through the sequence from end to
beginning at a rate dependent on the speed at which you move the trackball.
4. Paging Button - The paging button is used to page through a sequence of images. Once
the viewport of interest is in primary focus, you can click the paging button twice to
initiate paging. You notice the letter "P" displayed in the lower right of the viewport
indicating the paging mode is active. Once you are in the paging mode, the next/prior
buttons are disabled and the trackball is used for paging through the sequence of
images. While in the paging mode, you can click once on the paging button to switch to
the window width and window level mode. This is designated by a "WL" replacing the "P"
in the lower right of the viewport. The trackball now controls the WW/WL settings.
Clicking the paging button again returns you to the paging mode. To exit the paging
mode, click twice on the paging button. The "P" in the lower right corner of the viewport
disappears indicating you are out of the paging mode.
3
1
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Function
Description
1. Power
2. Gantry Enable
3. Emergency Stop
Users Conventions
The following users conventions are used throughout the user interface. Most of them
apply to the process of scan set up.Functions that are active are highlighted in yellow.
Functions that are not available because another function is open are gray.
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Getting Started
If one function is open and then a second is opened, the first open function is
highlighted with a folded corner, indicating the function is still open and active. The
second open function is the current active function.
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Getting Started
Once a new patient exam has been started and you are setting up the scan parameters
from the view/edit screen, the scan parameters are listed in columns. You can change
parameters within the prescription by clicking the column heading or the parameter
value directly. Changing a prescription through the column heading changes that
parameter for all corresponding rows. To change a parameter in a specific group, click
the desired parameter below the column heading.
Parameter selections that have a raised button appearance, when selected, displays a
pop-up menu prompting you to click or type in the desired parameter.
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When a parameter is highlighted orange, this indicates that a parameter has been
adjusted by the system from the original preset value. Changing one parameter may
affect other parameters. In this case, you may have more than one parameter
highlighted orange. (In this example, the scan type was changed from helical to axial.
The ISD changed, as well as parameters in the recon tab card. You will be able to
continue, however, you should review parameters to make sure they are as needed for
the clinical protocol.)
When a parameter is highlighted red, you cannot continue scanning until a correction is
made. (In this example, the techniques selected for the exam are too much for the
system to handle, so we need to change a parameter to continue.) Once the correction
is made, you can then continue.
When you input an invalid parameter, the system defaults to the closest value possible
and a brief message explaining this change displays in the scan message area. If you
wish to see the message again, click on the parameter that has been changed. (In this
example, 400 mA was input but the system changed the value to 380 mA.)
Tool Chest
The tool chest is located on the right monitor in the upper right corner of the screen on the
Image Works desktop. Many items can be selected from this area.
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Getting Started
Figure 5-16 Tool Chest
1
2
3
4
5
6
7
8
9
10
Table 5-11 Tool Chest
Autovoice Volume
Check Security
Turn On Extended HU
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Getting Started
Quick Snap
CAUTION:
IQ Snap
CAUTION:
10
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Getting Started
HIPAA
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was signed by
President Clinton on July 21, 1996 and has the general objectives to:
Guarantee health insurance coverage of employees.
Reduce health care fraud and abuse.
Introduce/implement administrative simplifications in order to augment
effectiveness and efficiency of the health care system in the United States.
Protect the health information of individuals against access without consent or
authorization.
Administration Simplification regulations of HIPAA have been in effect since early
2001.
GE Medical Systems has a longstanding reputation of providing customizable, clinical
solutions to protect the privacy and security of your organization's unique clinical workflow,
as well as your patient's confidentiality. Our scanner, software and services already
incorporate many of the core HIPAA requirements. We are saved to working with you, our
customer, to provide additional value to help you meet the continuing HIPAA challenge.
Please recognize the intended use of the product when determining how critical any privacy
risk is, relative to patient care and safety. GE is very concerned with providing the best care
to the patients; and in some cases we have determined that patient care is more important
than the risk to privacy. In these cases we take every precaution to minimize the privacy risk.
Security and Privacy are maintained across a Healthcare system. Any product that is placed
into an uncontrolled environment will not be secure and can not protect privacy. As we
design scanners we design them to be implemented in a "Secure Environment". A secure
environment is based on multiple layers of security, a concept known as defense in depth.
For example: a Best Practice that is gaining much attention places firewalls between
departments, as well as at a DMZ, between all extranets, and the external Internet access
point. In this example a radiology firewall may allow DICOM and HL7 traffic through, but no
other protocols. These DICOM and HL7 protocols would be blocked at the DMZ and again at
the Internet Firewall.
HIPAA requires you to log on to the scanner and log off when you are done scanning for a
period of time. If you do not log off the system will log you off and you will have to log back
on.
HIPAA contains the following permissions. You can have Administrator, GE Service,
Standard User, or Limited User. Standard User can perform scanning functions and modify
protocols. Administrator can set up and delete users. Limited users can perform all
scanning functions. GE Service can do all functions. You must have Administrator
permission to add or delete users.
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Getting Started
When you are adding users for local databases, certain rules apply. You must use the
following parameters.
Users/Groups - Lower case letters and numbers only
Users/Groups - Can not start with a number
Users/Groups - No limit on length
Passwords - Must be at least one character long, no NULL
Passwords - Can contain uppercase letters, numbers, and special characters
Administrator and Limited User permissions have different abilities when logging on. The
Administrator permission can add users. The Standard User permission can scan and
modify protocols. The Limited User can only scan. Emergency User login has Limited User
permission.
NOTE: HIPAA is an option that can be turned on or off by your Field Engineer.
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Getting Started
Software Download
Software Download provides the capability for Broadband connected systems with a
Service Contract to automatically down load software updates to the scanner. These
updates can be configured to Auto Install or Manual install.
A pop up indicating that this capability is installed on the system will be displayed for the
first 3 weeks after a software load from cold at every reboot.
Figure 5-17 Automatic Software Update Window
As updates become available a pop up will be displayed informing you of the update.
Figure 5-18 Automatic Software Update download
5-35
Getting Started
OptiDose
For years GE has followed the ALARA principle (As Low As Reasonably Achievable) in helping
our customers optimize dose. GE has provided many tools to help the clinician minimize
dose while achieving clinically diagnostic image quality.
GE CT is a proven leader in delivering dose efficiency in every scanner category. GE has
achieved this position through a "total system" approach.
Here you will learn about just some of the features which contribute to our "total system"
approach. To learn much more about this subject, please ask for our comprehensive
brochure, Dose in Computed Tomography: Basics, Challenges, Solutions (01-7192) located
on our web site at: http://www.gemedicalsystems.com/rad/ct/optidose.html.
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Getting Started
Advanced Artifact Reduction (AAR)
A low-signal magnification tool that allows low-dose protocols to be used in highly
attenuating regions. AAR is automatically enabled as needed.
Advanced Noise Reduction (ANR)
A low-signal correction algorithm that allows low-dose protocols to be used in highly
attenuating regions. ANR is automatically enabled as needed.
HiLight Matrix Detector
The HiLight Matrix Detector material was developed by GE specifically for CT scanning,
offering a 99% absorption efficiency. It also offers the capability of more slices without
increasing dose.
No Post-Patient Collimation
GE uses only pre-patient collimation, providing 44-52% better detector efficiency in
sub-millimeter mode than our competitors.
Tracking Collimator
Developed originally for the LightSpeed systems, the tracking collimator keeps the beam
focused only on the active detector cells, and makes sub-millimeter scanning possible with
high dose efficiency.
Protocol Wizard
Automatically adjusts affected parameters to keep image noise constant, dose optimized
and within specifications of the scanner.
Prospective ECG Gating
Reduces dose in cardiac ECG-gated scanning for cardiac calcium scoring and contrast
enhanced cardiac angiography applications by triggering the X-Ray tube on only during a
specified cardiac phase or phase range for each cardiac cycles throughout the acquisition.
Neuro3D Filters
Noise reduction filters for thin slice acquisitions for applications where data will be
manipulated in 3D modes such as reformat or maximum intensity projections for neuro
applications.
Adaptive Statistical Iterative Recon (ASIR)
ASIR is a noise reduction reconstruction mode that can remove unwanted noise from
images allowing for reduction in dose and improvement in image quality.
NOTE: * Not all features are available on each system.
5-37
Getting Started
Dose Reports
CTDIvol, DLP (Dose Length Product), and Dose Efficiency is displayed during scan
prescription and provides patient dose information to you. The CTDIvol, DLP and Phantom
size used to calculated dose is automatically saved once you select End Exam. The Dose
Report is saved as Series 999. It can be filmed, archived, and networked after the scan is
completed.
A DICOM Structured Dose Report generates a CT Dose Report which can enable tracking of
dose for the patient by the hospital radiation tracking system/RIS/HIS. DICOM SR Dose
Report is saved as part of the patient's exam in Series 997. The DICOM SR Dose Report
cannot currently be opened on the scanner. It can be reviewed and printed using Reporting
Tool on the Advantage Windows workstation or any station that can read a DICOM
Structured Report format.
SmartStep accumulated exposure time is displayed on the Dose Text Page and the DICOM
Structured Dose Report.
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Getting Started
Figure 5-19 Dose Information
Dose Text
Page
Scan Technique
5-39
Getting Started
How Do I...
This section provides the step by step instructions for shutting down and starting up the
system. Specifically, it describes how to:
Configure Groups
Add a Local Group
Add a Enterprise Group
Manage a Group
Remove a Group
Change Groups Roles
Use QuickSnap
Use IQ Snap
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Getting Started
2. From the pop-up attention box, select the option you wish to do if HIPAA is enabled.
Logout User allows enables you to login as a different user.
NOTE: For information on how to Login and Logout, refer to: Login and Logout.
Restart brings the system software all the way down and then automatically reboots
the system.
Shutdown brings the system all the way down to the power off prompt. You can then
turn power off to the system.
3. Click [OK].
4. If you selected Shutdown or Restart a series of menus and messages appear.
If Restart was selected the system automatically restarts the system.
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Getting Started
NOTE: The system has software and hardware installed called SmartID. This software verifies
the tube ID at startup. If the tube ID fails, the following screen appears. You may
continue scanning however, you do need to call your Field Engineer.
If Shutdown was selected, turn off the OC power, if not already off with the power
switch on the front of the console and then turn the power switch on to restart the
system.
Wait two minutes before cycling power on after a power interruption.
5. To power up the system push the power switch on the front of the operator console and
the system will automatically restart.
NOTE: The Discovery CT750 HD system has software and hardware installed called
SmartID. This software verifies the tube ID at startup. If the tube ID fails, the following
screen appears. You may continue scanning however, you do need to call your Field
Engineer.
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5. Click [Logout User].
6. Click [OK].
The system logs you out and waits for the next login.
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Getting Started
2. Click [Utilities].
Figure 5-22
5-46
Getting Started
3. Select EA3 Admin Browser.
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Getting Started
Figure 5-23 Administration Tab
5-48
Getting Started
Figure 5-24 Applications Screen
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Getting Started
timeout is generated, the EA3 logon screen is displayed. This value can be any
positive integer, or it can be 0. If the value is 0, this indicates NO inactivity timeout
(there will never be a timeout event regardless of how much time has elapsed).
Display Last Logon Name - Whether or not to display the username of the last
user that has logged in on the EA3 logon screen.
Administrator Message - Under certain circumstances / error conditions, the
user of EA3 is asked to contact an administrator. This field allows the
administrator to specify contact details for himself / herself and a custom
message.
Emergency Prompt - The text that will be displayed to any user logging in as
emergency. The user is asked to enter information (usually their actual user
name). This text is the text that will appear in that prompt for information.
7. Click [Apply Configuration].
To make a configuration change, make the necessary changes on the fields, and
click the Apply Configuration button. If there was a problem with making the
changes (such as an invalid value or a problem contacting the back-end Servlet) you
will see a message box indicating this error with a description of the error. If the
changes are successful, after the 'Apply Configuration' button is clicked, then you
will see a brief message indicating that the changes were applied in a green label. If
at any time, you want to revert your changes to what is currently saved on the
back-end, you can click the Restore Configuration button. This will undo any
changes that you have made that have not yet been saved by clicking the Apply
Configuration Button. (Once you click the 'Apply Configuration' button and get the
confirmation label, the changes have been applied).
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Getting Started
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Getting Started
Administration component to unlock the user. Note that locking only applies to local
users (enterprise user locking is managed by the enterprise server)
Minimum Password Length - The minimum length of a new password for a user.
Note that if a password is below the minimum password length already, setting this
value will have no effect on the password. For example if your password is 8
characters, and someone changes the minimum password length to 10 characters,
the 8 character password is still ok. However, next time the user changes their
password, they will have to choose a password that is 10 characters or greater. Note
that minimum password length only applies to local users (password length
restrictions for enterprise users are managed by the enterprise server)
Lock Duration (Minutes) - The number of minutes a user stays locked for if they
become locked because of failed login attempts.
Apply Configuration - Use the Apply Configuration button to save changes.
Restore Configuration - Use this button to undo any changes that have not been
saved yet. If there are any errors, you will get a popup box describing the error. If it is
successful, you will see a green label appear with confirmation information.
NOTE: Users can become locked in one of two ways.
The user enters too many incorrect passwords. In this case, the user will be locked
out for a certain amount of time, even with a correct password. Once the time has
elapsed, the user can attempt a login again. An administrator can unlock this user
before the lock duration time has elapsed by un checking Locked under the Local
User tab when a user is selected.
The administrator forcefully locks the user account. In this case, the lock duration
does not apply to a user who was forcefully locked by and administrator. They are
locked until the administration unlocks them.
3. Click [Apply Configurations].
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Remove a User
1. Select User.
2. Click [Remove User].
3. Click [Confirm Removal].
If you do not want to make the change, simply click the Cancel button.
Figure 5-29 Confirm Removal
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Configure Groups
The third tab on the EA3 Administration Component is the Groups tab. On this tab, you can
add local groups, add enterprise groups, remove local groups, remove enterprise groups,
change group roles, and change group memberships.
1. Click [Groups].
Figure 5-32 Groups window
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Getting Started
Configure Groups
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Configure Groups
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5-64
Getting Started
Configure Groups
Manage a Group
You can select a group to be highlighted by clicking on the group's name in either the 'Local
Groups' or the 'Enterprise Groups' list box on the left side. Only one group can be
highlighted at a time, and if you attempt to choose multiple groups, EA3 will automatically
select the top-most group that is selected. Once a group is highlighted, you can make any
necessary modifications to that group.
NOTE: When you first navigate to the Groups tab, EA3 will put the first listed local group
highlighted automatically. If there are no local groups, then EA3 will put the first listed
enterprise group highlighted automatically. if there are no local groups or enterprise
groups, then there will be no group highlighted, and all of the buttons in the center
panel will be disabled until a group is added.
Remove a Group
1. Once a group is highlighted, click [Remove Group].
This brings up a popup panel asking you to confirm the removal of the group.
2. If you want to remove the group, click [Confirm Removal].
If you do not want to remove the group, simply click [Cancel].
Figure 5-35 Remove Group
Add Memberships
1. Once a group is highlighted, click [Add Membership].
This brings up a popup panel that lists all of the users that are eligible to be added to
this group. If there are no users eligible to be added to this group, you will get an error
message box instead of the popup panel. Once you get the popup panel, simply
5-65
Getting Started
select all of the users that you want to add to this group (you can select as many as
you want at one time).
2. Click [Add Membership].
If you do not want to remove the group, simply click [Cancel].
Remove Memberships
1. Once a group is highlighted, click [Remove Membership].
This brings up a popup panel that lists all of the users that are eligible to be removed
from this group. If there are no users eligible to be removed from this group, you will
get an error message box instead of the popup panel. Once you get the popup panel,
simply select all of the users that you want to remove from this group (you can select
as many as you want at one time).
2. Click [Remove Membership].
If you do not want to remove the group, simply click [Cancel].
5-66
Getting Started
5-67
Getting Started
Figure 5-36 Enterprise Tab
The following configurations can be made on the top box of this tab:
Enable Enterprise Authentication - Whether or not Enterprise users should be able
to log in. If this is unchecked, only local EA3 users will be able to log in. If this is
checked, both local users and enterprise EA3 users will be able to log in (although the
local EA3 user database will always be tried first).
Cache Enterprise Users - Whether or not Enterprise users should be cached once
they successfully login. If this is checked, then a local record of an Enterprise user is
kept. If at any time that user attempts to login again, and for some reason the
Enterprise directory server is not available (i.e. network problems), that user will be
granted access if they provide the correct password. If this is unchecked, then an
Enterprise user will be denied access in the case that the Enterprise directory server
cannot be reached. Note that hashed passwords are cached, the actual password is
not cached.
Enterprise Authentication Latency (Seconds) - The amount of time (in seconds) that
the EA3 login process should wait for a response from the Enterprise directory server.
5-68
Getting Started
Often times, there is a network latency when connecting to servers, and it will be
different on different network configurations. If the amount of time is reached
without a response from the directory server, the EA3 login process will return a failed
login. A value of 5 seconds should be enough time to allow a properly configured
directory server to respond, without being too much of an annoyance to the user if
the directory server is down (i.e. they will only have to wait at a maximum 5 seconds
for the login attempt to return).
Applying configuration changes on the Enterprise tab top box are the same as
mentioned before for the Application tab. Use the Apply Configuration button to
commit changes, and the Restore Configuration button to undo any changes that
have not been saved yet. If there are any errors, you will get a popup box describing
the error.
Additionally, the actual connection to the Enterprise directory server can be made on
this tab. You will be modifying properties in the lower two boxes of the Enterprise tab.
5-69
Getting Started
Auto Configuration
1. Click [Auto-detect Server Name].
This attempts to lookup the name of Server Name of the directory server.
In some environments, EA3 can try to auto-detect the Enterprise Directory Server.
This will only work in some environments (i.e. where DNS allows service lookups). This
is just a convenience feature, and will sometimes return with an alert that the
auto-detect could not find the server. It is not an error if that message is displayed,
simply continue with these steps to configure the Server.
2. Enter the Server Name or IP address of the Enterprise directory server that EA3 should
connect to, in the Server Configuration box.
NOTE: The system must be able to resolve any IP address or server name. This means the
system must either have DNS enabled or the system must have static information in
a hosts file (i.e. /etc/hosts).
3. Choose the Authentication type that the directory server supports.
If it is a Microsoft Active Directory Server, most likely you need to choose Kerberos. If it
is a Novell eDirectory Server, most likely you need to choose LDAP If you do not know,
check with the owner of the directory server for information.
If the enterprise server supports SSL connections, check the 'Use SSL' checkbox.
NOTE: If you use LDAP authentication without SSL, passwords will be sent in the clear. This
is not recommended, and the client is alerted if they attempt to configure this way.
With kerberos and non-SSL, the authentication is encrypted, but the LDAP traffic is
not.
4. Click [Test Connection].
This tests to see if the machine can connect to the directory server. If the connection
is successful, you will see a label with a 'CONNECTION OK' text next to the Test
Connection button.
If the connection is not successful, you will see a label with a 'CONNECTION BAD' text
next to the Test Connection button.
If the connection is bad, then there is a problem connecting to the directory server.
Possible problems are wrong IP/server name or the system does not have DNS
running / cannot resolve the IP address / server name.
Once the Test Connection procedure indicates that the connection is good,
5. Select the type of directory server (either Microsoft Active Directory, Novell eDirectory, or
orhter).
5-70
Getting Started
6. Click [Generate Defaults] button.
This should populate the Realm Name, Format, DN, Login Attribute, First Name
Attribute, Last Name Attribute, and Group Attribute fields with default values for that
directory server type.
If the directory type is MSAD, both the realm name and the DN should be populated.
If the directory type is eDirectory, the realm name will be blank. If you are attempting
to configure a directory server that is not MSAD or Novell eDirectory, the
configuration will have to be done manually. You'll need to get the correct LDAP
property information from the owner of the directory server.
If this is a non-MSAD, non-eDirectory server, or is a server with a non-default
configuration, it is possible that you may need to change some properties manually.
See below for a definition of all of the properties that you can configure.
7. Enter a username and password of a user that resides on the directory server.
8. Click [Login].
You will see login result information in the Login Results section on the bottom of the
tab.
This will indicate if the login was successful or not.
Additionally, it will print out the First Name, Last Name, and any group memberships
for the user. You may get a warning if First Name, Last Name, or Group Memberships
were not found.
Getting this warning means 1 of two things:
The LDAP properties are mis-configured (i.e. First Name Attribute, Last Name
Attribute, and/or Group Attribute)
The user doesn't have a First Name, Last Name, or any Group Memberships
configured on the Enterprise directory server.
If you get these warnings, you may want to talk with the owner of the directory server
to make sure you have everything set up correctly.
If the test login succeeded and you are satisfied with the first name, last name, and
group membership information, then your Enterprise directory server is properly
configured.
9. Click [Apply Configuration].
This makes the configuration changes. Just like other tabs in the Administration
component, clicking Restore Configuration will undo any changed made that have
not yet been applied.
5-71
Getting Started
5-72
Getting Started
Manual Configuration
As mentioned before, if you are connecting to a directory server that is not MSAD or Novell
eDirectory, or the directory server you are connecting to has a custom configuration, you
may need manually configure some of the properties. Here are definitions of all of the LDAP
configuration properties and what they do.
Format - This is either set to domain or dn. domain is the 'MSAD' way of doing LDAP
authentication (i.e <userId>@<realm name>). dn is the other way of doing LDAP
authentication, which eDirectory, and most other directory servers use (i.e.
loginAttribute=<userId>,<ldap base dn>). If you are connecting to a non-MSAD
directory server, it's pretty safe to say that you should use dn.
DN - This is the LDAP base DN of the LDAP server to which you are connecting.
Usually this is the fully qualified domain name separated by a bunch of 'DC='. For
example, if the fully qualified domain name of the directory server is 'example.com', it
is likely that the DN will be 'DC=example,DC=com'.
Login Attribute - This is the LDAP attribute that should be used for the unique
identifier of the user. This is what they will use as their user id to login. On MSAD this is
'sAMAccountName, and on eDirectory, it is usually 'cn'. This should be set to whatever
the directory server you are connecting to uses as a unique identifier.
First Name Attribute - This is the LDAP attribute that should be used for the first
name of the user.
Last Name Attribute - This is the LDAP attribute that should be used for the last
name of the user.
Group Attribute - This is the LDAp attribute that should be used to find group
memberships for the user. On MSAD, this is 'memberOf'.
NOTE: EA3 finds all instances of this attribute (not just the first, like it does for other
attributes). So if a user belongs to more than one group, EA3 will find all memberships.
NOTE: Regarding LDAP parameter configurations, EA3 finds the first instance of the
configured attribute for a user, except for Group Membership. So, if you configure the
First Name attribute to be an attribute that is listed multiple times, EA3 will assume
the first one found during an LDAP query is the correct First Name. For Group
Membership, EA3 will find all instances of that attribute.
5-73
Getting Started
Configuration (e.g. after you made some changes and want to revert back and you
haven't pressed 'Restore Configuration' yet.
NOTE: If you make changes on one tab (e.g. Application tab), and do not press Apply
Configuration, and then you navigate to another tab, your changes will be lost. The
next time you navigate to this tab, since the changes were never applied, you will see
the old configuration. So, after making changes on a tab, but before navigating to a
different tab, you must click Apply Configuration. Also, there are sometimes more
than one Apply Configuration button on a given tab, so make sure you click the one
associated with the data you changed (the buttons are grouped with the data they
manage in a bordered panel).
To help the you understand what fields you may have changed, any changed fields are
highlighted with green text / borders, and the Apply Configuration button that must be
pressed in order to commit the changes. Below in Figure 5-37 is demonstrating field
highlighting. You can see that several fields have changed, and you should click the Apply
Configuration button.
Figure 5-37 Highlighted Changes
5-74
Getting Started
Use QuickSnap
QuickSnap provides the ability to collect data for trouble shooting system issues. QuickSnap
is found in the Tool Bar on Image Works desktop.
1. Click [QuickSnap].
This is located on the Image Works Desktop Toolbar.
Figure 5-38 Toolbar
5-75
Getting Started
2. Click [OK].
The pop-up menu goes away when the snap is complete.
3. Make note of the time and date of the QuickSnap for later use in debugging by the
service engineer.
CAUTION:
Do not initiate a QuickSnap if the system is actively collecting data with x-ray
on.
5-76
Getting Started
Use IQ Snap
IQ Snap provides the ability to reserve the scan data files related to images with IQ issues for
further investigation.
CAUTION:
The maximum number of images that can be selected for IQ Snap is 500 images. All the
images need to be in the same series. If there are IQ issues in more than one series, each
series needs to be done separately.
The corresponding scan data files will be reserved for images in the anonymous exam. You
can verify the scan data is reserved by selecting Recon Mgnt; then selecting Release Scan
Data. For Helical, the scan data reserved is for the group or scan the group the images are
related to. For Axial mode, the scan data reserved will be the axial rotation the images are
related to. For Axial mode, you may want to select a group of images on either side of the
image where an IQ issue is seen to make sure enough scan data will be available later.
1. Select the images that you want to reserve the scan data files in the Browser on Image
Works desktop.
2. Make an anonymous series or a set of anonymous images for the series with IQ issues.
If the images selected are not anonymous, a pop-up will appear instructing you to
make the data anonymous.
Figure 5-40
5-77
Getting Started
Figure 5-41 Toolbar
5. Click [OK].
5-78
Getting Started
5-79
Getting Started
Full Mode
Partial Mode
Exam Number
ANON or ANONYMIZED
ANON or ANONYMIZED
Patient ID
ANON or ANONYMIZED
ANON or ANONYMIZED
Patient Name,
ANON or ANONYMIZED
ANON or ANONYMIZED
Exam Description
ANON or ANONYMIZED
Shown
Series Description
ANON or ANONYMIZED
Shown
Birthdate
Removed
Removed
Age
Removed
Removed
Weight
Removed
Removed
Operator Name
Removed
Removed
Site Name
Removed
Shown
Sex
Blank
Blank
Referring Physician
Blank
Blank
Accession Number
Blank
Blank
5-80
Getting Started
Figure 5-43 Full mode
5-81
Getting Started
Figure 5-45 Image examples
5-82
Daily Maintenance
Chapter 6
Daily Maintenance
Introduction
This chapter explains preparing the system for daily use and calibrations. It contains the
step-by-step instructions to help you learn how to:
NOTE: When performing the tube warm-up or calibrations, it is essential that the gantry area
be clear of any objects. Any obstruction in the gantry most likely lead to artifacts in
scanned images.
CAUTION:
For important information regarding safety, please refer to the Safety chapter.
6-1
Daily Maintenance
NOTE: If the detectors are cold due to the A1 Power Panel (Breaker) being off, turn the system
on and wait two hours before performing a tube warm up. This allows the detectors
to return to their operating temperature.
NOTE: Failure to perform tube warm-ups when requested by the system may result in
serious damage to the tube and system.
NOTE: Failure to perform requested tube warm-up will result in reduction of the maximum
mA possible for the exam after a tube warm-up has been cancelled or skipped.
6-2
Daily Maintenance
Figure 6-2
Desired mAs can be achieved by changing rotation time (mAs = mA x rotation time).
6-3
Daily Maintenance
How Do I...
This section provides the step-by-step instructions for warming-up the tube and performing
air calibrations. Specifically, it describes how to:
6-4
Daily Maintenance
The screen changes and the system displays blue colored button features for Tube
Warm-Up and FastCals (air calibrations) in the upper left corner of the screen.
There is also a message area in the upper right corner of the screen.
2. Click [Tube Warm-Up].
The system displays a warning dialog box. This is because the tube cooling
algorithms are established for GE specific tubes. If any other tube is installed, you are
responsible.
NOTE: Refer to the Safety chapter regarding using non-GE-specific tubes.
3. Click [Accept & Run Tube Warm-up] to proceed.
The system displays a message area detailing each slice concerning kV, mA, slice
thickness and exposure duration.
NOTE: Make sure gantry area is clear of all objects and personnel.
4. Press Start Scan on the top of the keyboard.
The system automatically performs all tube warm-up scans.
The system returns to the Daily Prep menu when scans are completed.
5. Click [Quit] or proceed to Fast Calibrations.
Choosing quit ends the Daily Prep screen.
6-5
Daily Maintenance
6-6
Daily Maintenance
6-7
Daily Maintenance
Figure 6-3 Dirty Mylar Attention
6-8
Multi-Detector Information
Chapter 7
Multi-Detector Information
Introduction
This section explains the multiple detector hardware and detector configurations. The
step-by-step instructions to help you learn how to set these factors is located in Building
Protocols. It is important to understand how the detectors work in order to choose the
correct technical factors for the exam.What Do I Need to Know About...section presents the
concepts necessary to understand multi-detector utilization. The concepts you need to
understand are:
Scintillator Material
Hardware Components
Axial Interval
Slice Profiles
7-1
Multi-Detector Information
Scintillator Material
The Gemstone scintillator material is created from garnet gemstones infused with a rare
earth phosphor composition. This new technology creates a material that has reduced after
glow, improved primary speed, high light out put and fast response to enable high resolution
scanning, sub second imaging and fast switching of energies during imaging.
Hardware Components
Changes have been made to several pieces of hardware that make this scanner different
from other scanners you may have used in the past. These changes are:
Collimator
The collimator contains two independently controlled tungsten cams. The rotation of
the cams provides continuously variable beam thickness and Z-axis position. The
collimator, also, contains three bowtie beam filters that filter and shape the beam to
optimize dose and image quality.
Scan Geometry
A shorter scan geometry allows for a 20% mAs reduction from HSA CT/i single slice
axial scan techniques. The gantry aperture is 70 cm. The Focal Spot to Isocenter
distance is 54 cm. The Focal Spot to Detector distance is 95 cm.
Matrix Detector
There are 64 detector cells in the Z direction. The 64 rows are 0.625 mm in the Z
direction. Each signal can be collected from an individual detector row or a
combination of detectors. Up to 64 signals can be taken from 64 detector cells (or
64 slices per rotation of the gantry).
Other Changes
Changes in the DAS, Slip Ring and Scan/Recon Unit have been made. There are also
new reconstruction algorithms for the multi-slice data.
7-2
Multi-Detector Information
1i
2i
4i
8i
16i
32i
64i
2 X 0.625
1.25
N/A
N/A
N/A
N/A
N/A
N/A
4 X 0.625
2.5
1.25
N/A
N/A
N/A
N/A
N/A
8 X 0.625
5.0
2.5
1.25
N/A
N/A
N/A
N/A
16 X 0.625
N/A
5.0
2.5
1.25
0.625
N/A
N/A
32 X 0.625
N/A
N/A
5.0
2.5
1.25
0.625
N/A
64 X 0.625
N/A
N/A
N/A
5.0
2.5
1.25*
0.625*
Beam Collimation or detector coverage allows selection of 1.25 mm, 2.5 mm, 5.0 mm,
10 mm, 20 mm, or 40 mm.
Number of images per rotation are 1i, 2i, 4i,8i, 16i, 32i, or 64iRetro recon choices are the
result of the slice thickness and number of images, i.e. selecting 32 images at 1.25 mm
slice thickness allows retro choices of 0.625 mm, 1.25 mm, 2.5 mm, and 5 mm.
Rotation Speed can be adjusted to optimize acquisition time. Rotation Speeds are 0.4.
0.5, 0.6, 0.7, 0.8, 0.9, 1.0, and 2.0 seconds.
For VolumeShuttle (axial), the number of passes and Coverage Time need to be
completed.
7-3
Multi-Detector Information
The number of detectors combined per signal/channel affects the maximum slice
thickness.
One, two, four, eight, sixteen, thirty-two, or sixty-four slices can be generated per
rotation.
Multi-slice axial imaging is faster than single slice helical scanner using a 1:1 pitch.
Axial Interval
The interval is equal to the number of images per rotation times the detector thickness, i.e.,
in the 32 x 0.625 mode sixty-four images are generated, each 0.625 mm thick for a total
of20 mm of coverage per rotation. The interval per rotation would be 20 mm.
Beam
collimation
System
32 X 0.625
20.0 mm
64
64 X 0.625
40.0 mm
64
7-4
Multi-Detector Information
The following pitches are available for either system:
0.5:1 interleaved helices
0.9:1 interleaved helices
1.375:1 interspaced helices
Interleaved helices minimizes helical artifact, and gives the best detail. Interspaced helices
has more interpolated of data and increased helical artifact when compared to interleaved
mode.
7-5
Multi-Detector Information
Helical Thickness determines the prospective and retrospective image slice thickness.
Pitch / Speed determines the speed of the table per gantry rotation. There are four pitch
selections with associated table speed.
For Volume Helical Shuttle, the number of passes and Coverage Time need to be
completed.
7-6
Multi-Detector Information
updates mA based on changes made to rotation time, scan type, helical pitch, and slice
thickness to maintain equal image noise. There are many considerations for the anatomy
you are scanning. Timing is very important when administering contrast or for long breath
holds. Considerations are the slice thickness, coverage time, how you wish to view the data,
and what artifact can be tolerated. Trade-offs should be made to fit these considerations.
The basic rules are: Interleaved pitches will have less helical artifact especially when slice
thickness is equal to the detector. Interleaved pitches will have better slice profile when
thickness is equal to the detector.
Interspaced to Interleaved = 30% decrease in mAs.
Changing from Full to Plus recon allows a 15-20% decrease in mA.
Slice Profiles
Because the data for a helical image is weighted over more than one rotation, to provide the
best possible image quality the nominal image slice may differ slightly from your selection
dependent on table speed, pitch, and slice selection. The nominal FWHM slice widths are
given in the following table.
Table 7-3 Nominal Slice Thickness - Axial Scan Modes (FWHM in mm)
Aperture
(mm)
1.25
2.50
5.00
40.00
0.77
0.95
2.27
5.22
20.00
0.69
0.98
2.20
5.02
10.00
0.52
1.12
2.35
4.75
5.00
N/A
1.12
2.33
4.79
2.50
N/A
1.07
2.25
N/A
1.25
N/A
1.00
N/A
N/A
Table 7-4 Nominal Slice Thickness - Helical Scan Modes (FWHM in mm)
Aperture
(MM)
40
20
Aperture
(MM)
40
20
7-7
Multi-Detector Information
Aperture
(mm)
0.625
1.25
2.5
40
0.88
1.10
2.38
7-8
Building Protocols
Chapter 8
Building Protocols
Introduction
This chapter explains the process of building, viewing, and editing protocols. It contains the
step-by-step instructions to help you learn how to:
Delete an AutoVoice
Delete a Protocol
NOTE: A protocol must be selected in order to initiate the scanning sequence. Protocols are
used as a basis for routine or established procedures. Once chosen for use, any
protocol may have any factor modified as needed for individual case purposes. While
the individual case is being set up in the New Patient Area, any changes needed may
be made. This changes the protocol for that particular patient only, it does not change
the established protocol. The system comes with several common protocols ready
for you to use. If you wish to change the established protocols, you must follow the
directions outlined in this chapter for editing a protocol.
8-1
Building Protocols
Helical/Axial/Cine
Building Protocols
Using Protocols
Editing Protocols
Viewing Protocols
System Options
AutomA
SmartmA
Pediatric Protocols
Protocol Numbers
Anatomical Selector
IQ Enhance
Copy Forward
Flip/Rotate in Recon
Helical/Axial/Cine
Helical or spiral scanning is a method of acquiring images in a continuous data set. The
x-ray tube and Digital Acquisition System (DAS) expose and rotate continuously through 360
degrees while the patient is passed through the area of exposure at a set rate of movement
(pitch). The information gathered is then reconstructed into images of the prescribed slice
thickness and interval.
Axial scanning is the traditional step and shoot method of acquiring data. The x-ray tube
and DAS expose and rotate one 360 degree loop. The table and patient move a preset
distance (interval) and the process is repeated.
8-2
Building Protocols
Cine is a method of scanning that uses full or partial rotations of the gantry while gathering
input from one location over time. You may set the acquisition in groups expanding the time
to be scanned. This is especially beneficial when determining the function of anatomy and
physiology (i.e., hemangioma).
8-3
Building Protocols
8-4
Building Protocols
Figure 8-3 Axial Shuttle View Edit Screen
8-5
Building Protocols
Prospective multiple reconstructions are not compatible with Volume Helical Shuttle. Retro
Recon is used to reconstruct the desired slices and spacing. A message is displayed at End
Exam if a Volume Helical Shuttle series was included in the exam instructing you to go to
Retro Recon and create any additional reconstructs that might be needed or to reserve the
scan data so it will not be overwritten before reconstructions can be done.
Images for Volume Helical Shuttle are assigned series number of 700 plus the original series
number.
8-6
Building Protocols
Figure 8-4 Volume Helical Shuttle Scan Type Window
8-7
Building Protocols
Figure 8-5 Image Thickness Window
8-8
Building Protocols
Figure 8-7 Volume Helical Shuttle Warning Message at Confirm
8-9
Building Protocols
1.25
2.50
5.00
40.00
0.77
0.95
2.27
5.22
20.00
0.69
0.98
2.20
5.02
10.00
0.52
1.12
2.35
4.75
5.00
N/A
1.12
2.33
4.79
2.50
N/A
1.07
2.25
N/A
8-10
Building Protocols
Aperture
(mm)
1.25
1.25
2.50
5.00
N/A
1.00
N/A
N/A
Table 8-2 Nominal Slice Thickness - Helical Scan Modes (FWHM in mm)
Aperture
(MM)
40
20
Aperture
(MM)
40
20
Aperture
(mm)
0.625
1.25
2.5
40
0.88
1.10
2.38
Building Protocols
The protocols are built using the Protocol Management feature. There are four protocol
selections to choose from: User, GE, Service, and Most Recent. The protocols contain all of
the scan parameters. User protocols can be built in either adult or pediatric models. There is
space for 90 protocols in each of the ten anatomical regions for adult protocols and 90
protocols for each color area of the pediatric protocols. There are nine different weight
classifications in each of the seven color areas plus three additional areas for you to build
pediatric protocols in. You have a total of 6,840 available user selected protocols to build.
Using Protocols
After entering the patient information in New Patient, you have several options for choosing
a protocol. There are four protocol selections to choose from: User, GE, Service, and Most
Recent. Once you choose the area you wish to get the protocol from, then you select an
anatomical area and the protocol you wish to use. Once the protocol is chosen, the
scanning sequence is activated. All parameters for scanning a patient can be set up in a
protocol. This saves you time when prescribing scan parameters for each patient.
8-11
Building Protocols
Editing Protocols
Once a protocol is chosen, any factor in the individual exam may be adjusted without
affecting the established protocol. If an established protocol has a factor or factors you wish
to permanently change, this can be done by clicking the [Protocol Management] button,
selecting the user tab and going to the appropriate area, entering or choosing the desired
value changes, and clicking on the [Accept] button. If your system has been configured for
HIPAA Login, you must have permission to accept any changes in Protocol Management.
Viewing Protocols
To view a protocol click the [Protocol Management] button, User or GE, then select the
appropriate area or protocol. Every series can then be viewed by using the [Next Series]
button. Values may be changed to see effects on other values or other available options.
When finished, the [Cancel] button cancels any possible changes made and closes the
window. It does not cancel the established protocol. The established protocol remains as it
was built.
System Options
There are several option packages that may be purchased and installed on your system
which include setting up various protocols. You need to have some understanding of their
functions if you are to use them in your protocols. These options include: , Prospective
Gating,Cardiac, and Auto Applications. For details on these options refer to the specific
chapters, SmartPrep VariSpeed, Prospective Gating (SmartScore) (Option), SmartStep
(Option),and Auto Applications (Option).
8-12
Building Protocols
AutomA
Background
A significant factor in the quality of a CT image is the amount of x-ray quantum noise
contained in the scan data used to reconstruct the image. Most technologists know how the
choices of x-ray scan technique factors affect image noise. That is, noise decreases with the
inverse square root of the mAs and slice thickness. Noise also decreases approximately
inversely with kVp. For example, increasing the mA from 50 to 400 (a factor of 4) will
decrease quantum noise by a factor of the square root of 8. Quantum noise also increases
with increasing helical pitch; however, the exact relationship is dependent on the details of
the helical reconstruction process.
The most significant factor that influences the quantum noise in the scan data is the x-ray
attenuation of the patient section being scanned. The x-ray attenuation is related to the size
and tissue composition of the patient section. Figure 8-9 shows a distribution of patient
attenuation area values (PAA) for adult abdominal images that ranges from 19 to about 41
with a mean of 27.6 (for this patient sample set). The patient attenuation area (also called
the Patient Attenuation Indicator, PAI)1 is computed for the patient section as the square
root of the product of the sum of raw pixel attenuation values times the pixel area.
Figure 8-9 Adult abdominal patient distribution in terms of average patient attenuation
1.T Toth, Z.Ge, and M. Daley, "The influence of bowtie filter selection, patient size and patient centering on CT
dose and image quality", Poster SU-FF-I42, 2006 AAPM Conference (MedPhy, Vol 33, No.6, June 2006)
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Figure 8-10 Example small patient (PAI = 20) with factor of 5 noise increase (simulated)
For a given fixed scan technique, the quantum noise varies by about a factor of 5 from the
smallest to the largest patients attenuation (PAI range of 17 to 41). Figure 8-10 shows an
example of a five times noise increase simulated for a small patient (20 PAI). With a fixed mA
scan protocol, the technologist must select the mA using a qualitative estimate of the
patient attenuation. This may be accomplished using patients weight, diameter
measurements, body mass index, or just as a qualitative visual classification. Because these
methods provide very rough x-ray attenuation estimates and do not account for
attenuation changes within the patient region being scanned, the technologist must use a
high enough technique margin to avoid the possibility of compromising the diagnostic
quality of the images with too much noise. Since dose is inversely related to the square of
the noise, many patients are likely to be receiving more dose than necessary for the required
diagnostic quality using such manual methods.
Automatic tube current modulation: AutomA is an automatic tube current modulation
feature that can make necessary mA adjustments much more accurately than those
estimated for the patient by you and thereby can obtain a more consistent desired image
noise in spite of the wide range of patients. Since image noise variability is substantially
reduced, a significant overall patient dose reduction is possible with proper scan parameter
selection.
AutomA (Z-axis modulation) adjusts the tube current to maintain a user selected quantum
noise level in the image data. It regulates the noise in the final image to a level desired by
you. AutomA is the CT equivalent of the auto exposure control systems employed for many
years in conventional X-ray systems. The goal of AutomA is to make all images contain
similar x-ray quantum noise independent of patient size and anatomy.
The AutomA tube current modulation is determined from the attenuation and shape of
scout scan projections of the patient just prior to CT exam sequence.
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SmartmA (angular or xy modulation) has a different objective than Z-modulation. It adjusts
the tube current to minimize X-rays over angles that have less importance in reducing the
overall image noise content. In anatomy that is highly asymmetric, such as the shoulders,
x-rays are significantly less attenuated in antero-posterior (AP) direction than in the lateral
direction. Thus, the overwhelming abundance of AP x-rays can be substantially reduced
without a significant effect on overall image noise.
Angular modulation was first introduced on GE single slice scanners in 1994. 1, 2
AutomA Theory
AutomA is an automatic exposure control system that employs Z axis tube current
modulation and is available on all GE Multislice CT scanners. A noise index parameter allows
you to select the amount of X-ray noise that will be present in the reconstructed images.
Using a single patient scout exposure, the CT system computes the required mA to be used
based on the selected noise index setting. The noise index value will approximately equal
the standard deviation in the central region of the image when a uniform phantom (with the
patient's attenuation characteristics) is scanned and reconstructed using the standard
reconstruction algorithm.
Figure 8-11 Example noise variation with fixed mA and mA variation with AutomA with a
Noise Index setting
1. L. Kopka and M. Funke, "Automatically adapted CT tube current: Dose reduction and image quality in phantom
and patient studies," Radiology 197 (P), 292 (1995).
2. D. R. Jacobson, W. D. Foley, S. Metz, and A. L. Peterswen, "Variable milliampere CT: Effect on noise and low contrast detectability," Radiology 210(P), 326 (1996)
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The system determines the tube current using the patient's scout projection data and a set
of empirically determined noise prediction coefficients for a reference technique. The
reference technique is the selected kVp, and an arbitrary a 2.5 mm slice at 100 mAs for an
axial reconstruction using the standard reconstruction algorithm. The scout projections
contain density, size and shape information about the patient. The total projection
attenuation (projection area) contains the patient density and size information and the
amplitude and width of the projection contains the patient shape information. These patient
characteristics determine how much x-ray will reach the detector for a specified technique
and hence predict the image standard deviation due to x-ray noise for the standard
reconstruction algorithm.
To predict the image noise at a given z position for the reference technique, the projection
area and oval ratio are obtained from the patient's scout. The oval ratio is an estimate of the
patient asymmetry that is determined from the amplitude and width of the projection data.
The expected x-ray noise for the reference technique (reference noise) is then calculated as
a function of the projection area and oval ratio from the scout using polynomial coefficients
that were determined by a least squares fit of the noise measurements from a set of
phantoms representing a clinical range of patient sizes and shapes.
Knowing the reference noise and the difference between the reference technique and the
selected prescribed technique, the mA required to obtain the prescribed noise index is
calculated using well know x-ray physics equations. That is, the noise is inversely related to
the square root of the number of photons and the number of photons is proportional to the
slice thickness, slice acquisition time, and mA. In the GE AutomA design, an adjustment
factor for helical pitches is also incorporated in the calculation to account for noise
differences that scale between helical selections and the axial reference technique.
AutomA FAQs
1. What suggestions do you have for a new AutomA user?
If you are not familiar with the concept of noise index (image noise) you can use the
GE default protocols as a starting point or consult the literature until you find the
highest noise index value that provides acceptable diagnostic quality. Experiment by
scanning some phantoms with different noise index values to gain some confidence.
A 30 cm diameter water phantom or a 35 cm diameter low density polyethylene
phantom have an attenuation similar to the average adult abdominal patient (27.6
PA).
Check the mA table on the scan Rx menu to see what mA is actually being used. If
you see that it is frequently at the max mA range, consider increasing the noise index
or increase the max mA limit if it is not at the maximum limit of the x-ray generator.
Each dose step decrease will increases the Noise Index by 5% and reduces the mA in
the mA table about 10%.
If you normally reconstruct images with thin sections for 3D reformatting and thicker
slices for axial viewing it is important to understand that the first prospective
reconstructed slice thickness is used for calculating AutomA. Generally you would
want to set the noise index for the thicker slice images. For example, you might want
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a noise index of 10.0 for 5 mm thick images for viewing but you may also want 0.625
mm slices for 3D reformatting. If you prescribe the 0.625 mm slice recon first
followed by the 5 mm recon, AutomA will calculate the mA needed to obtain an
image noise of 10 for the 0.625 mm slices since it is prescribed first. In this case, to
avoid excessively high mA and high dose, you need to readjust the noise index using
the following approximation;
RxNoiseIndexthin = RxNoiseIndexthick
ViewingSliceThickness
FirstRxSliceThickness
Example:
28.3 = 10
5mm
0.625
2. Why is the standard deviation I measure in the image some times different than the
noise index I selected for the scan?
There are many factors that can account for this. But, first consider that the noise
index setting you make only causes the tube current to be adjusted so that the
system projects a similar X-ray intensity through the patient to the detector. Hence it
regulates the X-ray noise or quantum noise in the scan data. The noise in the image
depends on other factors as well. The selection of reconstruction algorithms,
reconstructed slice thickness selection (if different than your prospective selection),
and the use of image space filters will also change the noise in the image. In addition,
it is very difficult to make standard deviation measurements on patient data since
the standard deviation is affected by small CT number variations of the anatomy and
by patient motion or beam hardening artifacts. Even with uniform phantoms,
standard deviation measurements will produce some variability in measured results
because of the inherent nature of quantum statistics.
Another situation that can cause significant differences between the selected noise
index and the image standard deviation is when very large patients provide
insufficient detector signal. In these cases, electronic noise sources can become the
dominant image noise source instead of X-ray noise. In these cases at various
threshold levels, special projection data dependent filters begin to be applied to help
preserve image quality. The highest kVp is recommended when excessively large
patients are to be scanned.
Another factor is how well the patient is centered in the SFOV. Image noise can
increase significantly if the patient is mis-centered. This occurs because the bow ti
filter projects maximum x-rays intensity at isocenter since this is the region of
maximum attenuation if the patient is centered. If the patient is mis-centered, there
are fewer x-rays projected to the thickest part of the patient, and hence image noise
will increase. The optimum strategy is to find the highest noise index sufficient for the
clinical task and let AutomA select the mA without using significant constraints.
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3. Will I get a dose reduction when I use AutomA?
AutomA will use a dose that depends on the noise index you select and the size of the
patient you are scanning. If, you do not obtain a dose reduction over a population of
patients, you may have selected a lower noise index than you really need and this
results in higher mA values on average than your fixed mA protocols. One strategy to
avoid using more dose is to set the max mA parameter to the same level as your
fixed mA protocols. This will cap the maximum dose to the same level as your fixed
mA protocol. Hence, AutomA will never be allowed to use more dose then you
previously used. However, image noise will increase in regions where the mA is
limited by the max mA selection and the IQ will degrade with increasing patient size.
The optimum strategy is to find the highest noise index sufficient for the clinical task
and let AutomA select the mA without using significant mA limits
4. Why do my images seem noisier when I use AutomA?
AutomA will produce an x-ray intensity to maintain the noise index you select. Thus,
you may need to use a lower noise index. This may be the case if you find that the
average mA for your population of patients is generally lower than your previous
fixed mA protocols. This situation indicates you are using lower dose and hence
higher noise levels would be expected.
Certain patient images may also be noisier than your experience suggests. For
example, your experience tells you to expect significantly lower noise in thin patients
than obese patients. Since AutomA makes the image noise approximately the same
for all patients, you may have to re-learn what to expect. What is most important, is
to find the highest noise index that allows you to make a confident diagnosis for the
clinical problem since this results in the lowest patient dose.
If you desire somewhat lower noise in small patients, you may want to create Small,
Nominal, and Large patient protocols. You can use a slightly lower noise index for the
small patients and a slightly higher noise index for large patients.
A conditional noise limiting strategy you can employ, is to increase the low mA range
parameter. If you find that images are generally not acceptable to you below some
minimum mA value, then you may set this value as the low mA range limit. This will
prevent AutomA from using lower mA values than you desire. Note, however, that this
defeats the purpose of AutomA and causes the image noise to decrease below the
selected noise index and thereby increases the dose.
Yet another possibility for higher noise than you might expect is if you are looking at
multiple reconstructed images that have thinner slices than the prospective scan Rx
slice thickness. AutomA uses prospective slice thickness as a factor when the mA
table is generated. You need to be sure the noise index is set for the first prospective
image based on image thickness you will use for axial image viewing (see FAQ 1). This
caveat applies equally for fixed mA as well as AutomA scanning.
Higher noise images can also occur when patients are not well centered in the scan
field of view. The bowtie filter attenuation increases with distance away from
isocenter. Hence the thickest part of the patient should be approximately centered in
the scan field of view. Otherwise image noise will increase since the patient thickness
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adds to the bowtie filter thickness. This is especially important for highly asymmetric
anatomy such as through the shoulders. Again, this effect is no different with AutomA
than with fixed mA.
Recognize also that there are some obese patients that exceed the capabilities of the
tube and generator to satisfy the selected noise index. This is also no different than
fixed mA scanning. For such obese patients, one strategy is to select a higher kVp
setting when possible.
5. Why is the mA that is annotated on the image sometimes slightly different than the mA I
see in the mA table?
The mA displayed on the image is determined by measuring the generator mA during
the scan and averaging the measured result over the total number of views used to
reconstruct the image. The number of views used to produce the image may be more
than one gantry rotation for a helical scan. Hence the annotated value is a
combination of the mA table values that depends on how many views from each
rotation were used for the image. In addition, the generator is automatically
adjusting the filament current to account for changing conditions during the scan to
keep the mA within the desired tolerance of the commanded mA table. For example,
this is why you may see an mA value of 41 in the image where the mA table indicated
40.
6. I understand that noise in the image changes with reconstruction parameter selections,
but why is the noise sometimes different when I retro reconstruct the same scan data at
a different display field of view?
When you select a reconstruction algorithm, the system may sometimes re-adjust
the actual filter kernel. This readjustment will change the image standard deviation.
This will happen if the display field of view selection exceeds a certain size and is
especially apparent with higher resolution algorithms such as bone and edge. The
change in kernel is required when the DFOV selection makes the pixel size too large
to support the intended spatial resolution. This characteristic is independent of
AutomA.
AutomA Interface
AutomA is selected for a group of scans. When you select AutomA (Figure 8-14), this
enables the feature. The system uses the data collected from the most recent Scout
scanned for the exam.
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When possible, the kVp setting for the scout should be taken using the same kVp that the
axial or helical scan is taken.
Function
Description
Noise Index
Dose Steps
Reset
The Noise Index value displayed is updated automatically as you change the Relative Dose.
The Noise Index change is relative to the Default Noise Index. You can prescribe your own
Noise Index value. The mA range area is used for entering a Min and Max mA value. The Max
mA value sets the clipping mA value. This mA value can also determine the focal spot size.
You need to enter the proper mA value for the focal spot size you wish to use.
Table 8-4
Table 8-5 Table of mA ranges by kV, Focal Spot Size and Scan Mode Type
Scan Mode
Normal
Hi-Res
kV
80
10-620
625-700
100
10-680
685-800
120
10-570
575-835
140
10-490
495-715
80
10-620
625-700
100
10-500
505-750
120
10-420
425-625
140
10-360
365-540
When AutomA is selected, the mA annotation on the view/edit screen is annotated with the
maximum mA in the mA range prescribed for the scan group. See Figure 8-12. You can view
the list of mA values that will be used for each rotation for the acquisition if you select [mA
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Table]. This is a read-only table showing the mA for each rotation or scan separated by
groups. Refer to Figure 8-13. AutomA is automatically turned off and can not be enabled if
the orientation for the series does not match the orientation for the scouts. The calculation
of the mA table is based on the last scout so the series much match the scout. If there is no
scout, AutomA will also be unavailable.
Manual mA
The Manual mA mode allows you to scan without enabling the AutomA mode. You can enter
a mA value for each group prescribed. When building protocols, make sure the Manual mA
value field has a reasonable mA entered in it even if the protocol will use AutomA in case
AutomA is turned off.
The Manual mA mode allows you to scan without enabling the AutomA mode. You can enter
a mA value for each group prescribed.
Figure 8-12 mA Annotation
Max mA Selected
Noise Index
Figure 8-13 mA Table
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Figure 8-14 mA Control Window
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SmartmA
SmartmA is variable mA in the X-Y direction. For each rotation along Z, the system calculates
each X and Y mA value from the ratio of the long and short axis of the patient and is shown
in the SmartmA head and body examples (Figure 8-15).
Figure 8-15 SmartmA Tables
Head Table
Body Table
The low and high mA are calculated from the long and short axis ratio. The SmartmA tables
(Figure 8-15) show examples of low and high mA values per scan.
The noise increase from using SmartmA compared to AutomA is no more than 7 %. The dose
reduction from using SmartmA is approximately 15 %.
Figure 8-16 Dose Tables
AutomA Dose Information
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SmartmA modulates four times during a rotation. Because of this the mA varies four times
during each exposure. The mA ramp up time is about 100 milli-seconds.
Figure 8-17 Modulation Example
Quadrant 1
Quadrant 2
Quadrant 4
Quadrant 3
The images are annotated with a tilde sign (~) marking next to the noise index number
indicating SmartmA was used (Figure 8-18).
Figure 8-18 SmartmA Annotation
AutomA Annotation
SmartmA Annotation
NOTE: Make sure the Manual mA value in a protocol is a reasonable value even if the protocol
will use AutomA or SmartmA in case AutomA is turned off.
You can select SmartmA by clicking on the mA value on the view/edit screen.
NOTE: AutomA must be selected first, then SmartmA is available.
NOTE: AutomA and SmartmA will be disabled if patient orientation does not match the
orientation of the scout. Once the orientation for the series matches the scout,
AutomA and SmartmA can be selected.
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Figure 8-19 AutomA disabled message
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Figure 8-21 SmartmA Control Window
Manual mA
The Manual mA mode allows you to scan without enabling the SmartmA mode. You can
enter a mA value for each group prescribed.
Reference Noise Index
Default or baseline Noise Index for the given protocol. Any changes to Dose Steps, Slice
Thickness or Noise index are referenced to this value. The Reference Noise Index value can
only be prescribed while in protocol management.
Noise Index
The noise level required for the study. As the Noise index increases the required mA
decreases and image noise increases.
Dose Steps
Adjusts Noise Index by steps of 5%. Dose steps can be increased or decreased. Plus values
decrease image noise thus increasing required mA. Minus values increase Noise index, thus
decreasing required mA. A Dose step value of 0 indicates that the prescribed Noise index is
equal to the Reference Noise index for the protocol.
Reset
Reset returns the Reference Noise Index to the GE Target Noise Index default values for the
anatomical area and slice thickness chosen in the protocol. Reset is available while in
Protocol Management.
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Pediatric Protocols
The [Pediatric] button brings up a screen that allows you to select an anatomical area. The
anatomical areas are indicated by text.
Figure 8-22 Pediatric Selector
Once the anatomic area is selected, a window containing rainbow bars appears. This
indicates you are using weight based protocols designed for pediatrics. Choose the color
category for your patient and the protocol list is displayed accordingly. If there is no
weight-specific protocol associated with the selected anatomical area, the Protocol
Category window appears (Figure 8-25). The default weight/color selector will show the
patient weight entered in the patient information screen, or the last weight/color selection (if
no patient information was entered). If you enter a patient weight on the patient information
screen and select a color/weight selector that is not consistent with the entered information,
an error message appears (Figure 8-24) and you must acknowledge that you have chosen a
protocol that does not match the patient size. Selectors on the color/weight bar are labeled
with the zone ranges for weight and length, with the word of the selected color and with the
weight/color zone number as indicated in Table 8-6. Weight-specific protocols are enforced
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for all anatomical areas except head, orbit and miscellaneous. Protocols in the head and
orbit categories are usually defined based on patient age as opposed to patient
weight/height.
Table 8-6 Color Code Table
Zone
Number
Zone
Color
Pink
6 - 7.5
13.2 - 16.5
59.5 - 66.5
Red
7.5 - 9.5
16.5 - 20.9
66.5 - 74
Purple
9.5 -11.5
20.9 - 25.4
74 - 84.5
Yellow
11.5 - 14.5
25.4 - 32.0
84.5 - 97.5
White
14.5 - 18.5
32.0 - 40.8
97.5 - 110
Blue
18.5 - 22.5
40.8 - 49.6
110 - 122
Orange
22.5 - 31.5
49.6 - 69.5
122 - 137
Green
31.5 - 40.5
69.5 - 89.3
137 - 150
Black
40.5 - 55
89.3 - 121.3
--
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Figure 8-23 Color Selector
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Figure 8-25 Protocol Category Window
Protocol Numbers
The protocol numbering systems enable you to easily enter a protocol number in the patient
information screen when you are setting up a scan. The first number indicates the protocol
area you are using. The second number indicates what weight zone you are using. This
shows up on pediatric protocols. The third number indicates which protocol you selected
out of that area. If only two numbers are displayed, this means you are using an adult
protocol and the second number indicates which protocol you selected from that area
(Figure 8-26).
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Figure 8-26 Protocol Numbers
Area Number
Protocol Number
GE Area Numbers
Adults
Peds
21-30
31-40
User Area Numbers
Adults
Peds
1-10
11-20
Anatomical Selector
The Anatomical Selector area lets you decide if you want to
use a GE defined, User defined, Service defined, or a Most
Recent protocol. GE defined protocols are a list of protocols
the factory installs on your system. These protocols have been
used by physicians and radiologists on this type of system and
have worked well. User protocols are a list of protocols that you and your radiologist or
physician have built into your system. These protocols are custom protocols that your
radiologist or physician likes to use. Service protocols are used when your GE Service
Engineer needs to perform routine maintenance on your system. The Most Recent protocol
tab is an area where the parameters from the last 90 exams scanned are stored. Protocols
under GE and Most Recent tabs cannot be modified or deleted, but they can be copied into
the user selector in any of the adult or pediatric anatomical areas.
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ECG Traces can be saved to a CD-Rom using the Save ECG Trace feature in the Tool Bar on
the Image Works desktop. This can be done when the IVY monitor is connected to the
gantry, is also set in Ethernet mode, and the ECG Trace/Viewer option is installed. The ECG
Traces from the last 100 cardiac gated series can be saved to a CD-Rom, and the ECG
Traces from the last 500 cardiac gated series are stored on the CT system.
The ECG traces (waveforms) can be edited using the ECG Editor in Retro Recon, which
provides the capability to remove individual recon windows from one or more heart cycles,
insert, delete or move the R-peak trigger locations, and manually move or reposition a recon
window of one or more heart cycles. This can be useful to make modifications to the ECG
waveform in the event an irregular or unexpected arrhythmia that occurs during the
acquisition.
Figure 8-27 Trace Viewer (waveform display)
IQ Enhance
IQ Enhance is a special reconstruction process which can be prescribed to minimize
artifacts commonly seen in thin slice helical acquisitions. IQ Enhance is compatible with
0.625 mm and 1.25 mm slice thicknesses. Interval for acquisitions with IQ Enhance must be
equal to the slice thickness (0.625 mm or 1.25 mm) or an overlap of 50% (0.312 mm or 0.625
mm). IQ Enhance is selected in the Recon Options pop-up window.
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Reconstruction of ASIR images can be prescribed prospectively for Recon1 or as a
prospective multi-recon (PMR) for Recon 2 or 3 or retrospectively in Retro Recon. If
reconstructing data retrospectively, a New Series should be selected for each reconstruction
of the data with ASIR applied.
ASIR is located on the Recon Tab under Recon Options. ASIR modes are None, Sliceand
Volume. Slice mode can be applied to acquisitions of any slice thicknesswhile Volume mode
can only be applied to Hi-Res acquisitions with 0.626mm slice thickness. Slice mode can be
applied to a range of slices where as Volume mode must be applied to the full range of
slices acquired in the acquisition. Volume mode will have a slower reconstruction
performance but overall better noise reduction quality and some helical artifact reduction
compared to Slice mode. Slice mode will have less impact on reconstruction time but will
have a lesser degree of noise reduction capability compare to Volume mode.
There are several constraints that apply to the acquisition of data where ASIR will be applied:
ASIR is not compatible with Cardiac Noise Reduction Filters (C1, C2, C3) or Neuro 3D
Filters (N1, N2, N3).
Volume mode is not compatible with IQ Enhance.
ASIR is not compatible with the Chest Recon Type.
ASIR is not compatible with any of the real time interactive image modes such as
SmartPrep (base line and monitor images), Biopsy mode, or SmartStep.
Volume mode image interval must equal to slice thickness (0.625) or up to 50%
(0.312mm) overlap.
In Volume mode, the minimum number of slice is 28. If the number of slices is less
than 28, only slice mode will be available. If the number of slices is reduced to less
than 28, the ASIR mode will be changed to Slice.
Volume mode reconstruction is always applied to the entire scan range.
Reconstruction of ASIR images involves defining the level of noise reduction desired for the
parameters used for various applications. Image reconstruction is a blending of the original
images and a percentage of an image with 100% noise reduction. There are 10 blending
levels available which are simply the amount of noise reduction based on the maximum of
the 100% image reconstructed with the original image data. It is expected that confidently
selecting the optimal amount of noise reduction and integrating the reduction in dose
possible will require some adapting on how this reconstruction technique works.
To assist you in reviewing the entire range of noise reduction levels quickly so desired ASIR
level image sets can be created retrospectively and adjustments be made to protocols for
dose reduction, an ASIR Review application can be selected on the Image Works desktop.
The ASIR Review application can be selected on the Image Works desktop for review of the
entire range of noise reduction levels. In ASIR Review, you can quickly determine the desired
ASIR level image sets should be created at and determine modification to protocols for dose
reductions. The ASIR Review application aids in the understanding and establishing the
optimal dose and desired noise level per protocol efficiently for your facility by your
physicians.
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NOTE: Images intended for use in the ASIR Review application must have the same slice
thickness, interval DFOV, R/L centers, A/P centers, scan range and Recon type.
NOTE: The maximum number of images per series that can be loaded into ASIR review is
1500.
NOTE: ASIR Review applications needs two sets of data. One reconstruction needs to be a
non-ASIR series and a series that has 100 % ASIR applied. ASIR Review application
will not accept other ASIR levels for example 50 %.
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Table 8-7 Example of ASIR annotation:
Iterative Recon
Modes
S=Slice
V=Volume
Types
Levels
Example Annotation
10=10 %
20=20 %
30=30 %
40=40 %
50=50 %
60=60 %
70=70 %
80=80 %
90=90 %
100=100 %
S=Statistical
Copy Forward
Copy Forward provides the capability to define a set of parameters to be copied across
series for Recon 1 and into Recon 2 or 3. The Patient Position and Patient Entry can be
copied from the previous scanned series.Copy Forward is enabled in Protocol Management.
Enter a D or d into the Start/End, DFOV, R/L or A/P Center, interval (helical only) or tilt fields.
Fields where Copy Forward has been defined are outlined with a green box. To copy the
Patient Position and Patient Orientation select the Copy Patient Position, Patient Orientation,
and Anatomical Reference button. When the protocol is used in New Patient, the fields
where Copy Forward have been defined will be outlined in green. If copy forward for Patient
Position/Patient Orientation is selected, Copy Pt. Orient. Pt. Position Anat. Ref. will be
highlighted. When Copy Forward is used in PMR 2 or 3 for Start/End location, the system
keeps the range equal to that of Recon 1.
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Figure 8-30 Copy of Orientation Area
Figure 8-31 View Edit screen with Copy Forward selected in green
Flip/Rotate in Recon
The reconstructed orientation of an image can be changed from the default mode in Recon
by selecting one of the flip/rotate options.
Figure 8-32 Recon Option with Flip/Rotate enabled
Selection for Flip/Rotate are None, FLR (Flip Right/Left), FTB ( Flip Top/Bottom) and FLR/FTB
(Flip Right/left and Top/Bottom). The flip option selected is shown on the ViewEdiit screen.
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The default GE CT orientation is based on a view from patient's feet. The reconstructed
image orientation may differ from preferred anatomical viewing presentation where the
patient's Right is on the viewers Left and the patient's Left is on the viewers Right.
Flip/Rotate options are found in Recon Options. The RAS information annotated on the
image is applied according to the Flip R/L, Flip T/B or both Flip R/L and T/B selected for
reconstruction of the image. Annotation indication that Flip/Rotate selection was applied to
the reconstruction is displayed in the upper left corner of the image.
Flip/Rotate options cannot be selected for images being acquired in the decubitus patient
positions.
Upon Confirm, a pop-up message is displayed indicating Flip/Rotate was selected for the
exam to verify that images are displayed properly if sent to remote viewing stations.
Figure 8-33 Flip Message
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The two x-ray energies are acquired in an interleaved fashion by rapidly synchronous
switching of the energy levels. The GSI mode is compatible with helical, axial, or CINE scan
modes. Because the two-energy levels are acquired almost simultaneously, patient or organ
motion related registration issues are eliminated.
The interleaved high- and low- energy views are separated as part of the image
reconstruction operation. The GSI reconstruction algorithm produces two complete highand low- energy sets. The projection-based material decomposition algorithm uses both the
high- and low- energy data to create material density and/or monochromatic images. The
material density pairs consist of iodine and water, calcium and iodine.
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How Do I...
This section provides the step-by-step instructions for building, viewing, or editing protocols.
Specifically, it describes how to:
Delete an AutoVoice
Delete a Protocol
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NOTE: There is space for 90 protocols in each of the Adult anatomical areas. In the Pediatric
anatomical areas, there is space for 90 protocols each in Head, Neck and
Miscellaneous. For the seven color coded Pediatric anatomical areas, there is space
for 90 protocols in each of the nine different weight classifications. You have a total
of 6,840 available user selected protocols to build. If you wish to create, edit, or view
protocols in the pediatric selector, click [PEDIATRIC]. To return to the adult protocols,
click on the adult model.
3. Click [User].
This is used to build custom protocols for your site.
4. Select an anatomical region.
A space for up to 90 protocols opens (there may be existing protocols listed).
You can click the arrow up or down to view a list of 15 protocols at a time.
You can use the scroll bar to move quickly through all 90 protocols.
5. Click [New] or [Edit].
Select [New] if you have not built this protocol before.
Select [Edit] if you are making changes to an existing protocol.
6. Select an open area in the list and enter the name of protocol.
Any name may be used. It is helpful if you choose a name that reflects what the
protocol is meant to be used for (e.g., Routine Head, Trauma Spine, Chest/Abd/Pelvis).
If the protocol being built is to be the default (most commonly used) protocol, click
[Set As Default]. Only one protocol in each list can be set as the default.
NOTE: Default protocols can not be set in the pediatric color coded areas.
7. Select the type of series to be built from the window that appears.
In most cases, a scout series is built first because this allows for more precise
scanning. A scout must be programmed first if it is to be displayed automatically with
Show Localizer.
Auto mA and Smart mA require a scout to be acquired in order to generate a mA
table.
8. Click [OK].
9. Set the proper patient position.
Place the mouse cursor at the head or foot of the model and click once to change
orientation. Place the mouse cursor over the abdomen area or the base of the table
and click once to rotate model 90 degrees.
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Figure 8-34 Patient Position
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12. Set Scout Parameters.
NOTE: Scout Parameters include Scout Image number, Start and End Locations to set the
length of the scout, technique factors of kVp and mA, scout plane, AutoVoice and use
of the Window Width/Level feature. Selecting an individual cell under a parameter
column allows you to adjust only the factor in that group. Selecting the parameter
column from the top row highlights all of the factors directly below the selected
column and allows you to adjust that factor in all of the images.
The number of scouts may be added to or deleted by selecting the scout number and
using the [Add Scout] or [Delete Scout] buttons.
Start Loc./ End Loc. are to set the amount of anatomical coverage needed for the
scout. The S designation stands for superior (toward the head) from the center point.
The I designation stands for inferior (toward the feet) from the center point,
regardless if the patient is oriented head first or feet first to the gantry.
Technique Factors for scout images are set low because scouts are normally used for
planning purposes only. 120kV and a low mA are common factors.
Scout Plane designates what type of scout is being acquired. Zero designates an AP
(supine) or PA (prone) scout. Ninety designates a lateral scout.
AutoVoice is used if you want the system to give the patient breathing instructions
while the scouts are acquired.
Click [AutoVoice] and a window appears.
Click the desired pre-recorded message.
Select Pre Set Delay if desired.
NOTE: The Auto Voice language displayed at the time the systems is booted up is the
defaulted language set by your Field Engineer initially.
If the Auto Voice Language is changed to use one of the preset autovoice
multi-language messages, the system will return to the default language once you
have clicked on [End Exam].
Scout WW/WL is used to set the desired window levels of the scout when it displays
in the localizer.
Auto Transfer by Series automatically transfers the series to the selected
destination.
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Figure 8-35 Scout Window
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15. Set Scan Parameters.
NOTE: The Scan Parameters include Patient Position, Anatomical Reference point,
AutoFilm Setup, AutoStore, AutoTransfer, Show Localizer, and Series Description.
The data acquired for all other series is different than data acquired for scout images.
This means that features such as Patient Position and AutoVoice must be set or
activated again for this series.
If you want to copy the scanned patient orientation and position for the Scout to the
next series in a protocol, select [Copy Orientation].
Set the proper patient position by placing the cursor at the head or feet of the model
and click to change the head first/feet first orientation. Place the cursor over the
abdominal area of the model and click to rotate the model in 90 degree increments.
Click [Anatomical Reference] and a window appears where you can choose one of
the preset center points or designate with a two letter abbreviation your center or 0
point. This should be set the same as your scout images.
Click [AutoFilm Setup] and a window appears where you may establish how the
filming is going to be set up.
NOTE: refer to the Set the Film Parameters for Automatic Filming task for more details.
Set Auto Store/AutoTransfer. If these features were set for the scout image, they are
automatically set for this series. If they were not selected for the scout series, they
may be activated in this series and the scout image(s) are included in the
storage/transfer. Click [AutoStore] and it automatically sends the image data to the
system storage device. Click [AutoTransfer] and a window appears. Click the IP
address to which the images are to be sent, click [OK].
Click [Show Localizer]. This will display a scout image on the display monitor in a 1 on
1 format with graphic representation of the start and end locations as well as
displaying a line for each image that is reconstructed. This allows for graphically
adjusting the protocol (adding or deleting slices).
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16. Set Technical parameters.
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NOTE: If your scanner has Volume (axial) Shuttle or Volume Helical Shuttle option installed,
the Scan Types will include Shuttle mode.
Helical Scan Type support Volume Helical Shuttle mode, a helical acquisition mode
which moves back and forth (shuttles) across scan range for wider coverage for 4D
CTA or body perfusion imaging.
Helical scan type is used most frequently for a wide range of exam types.
Cine mode is used when one location needs to be scanned over a period of time such
as for a hemangioma.
Start and End Locations are set in millimeters superior to, and/or inferior from, the
anatomical reference point. The locations designate the points of anatomy to be
scanned. If specific numbers are known, select the correct button (Start or End) and
enter the value. The numbers must be preceded by the correct designation of S for
superior (towards the head) from the centering point, or I for Inferior (towards the
feet). The easiest way to set Start and/or End Locations is to graphically adjust
them. The slices are represented as a group of lines on the scout image. The start
location is demonstrated with a solid square in the middle of a line. The end location
is demonstrated by an open square box in the middle of a line.
To adjust, click and drag the appropriate square to the desired location. When the
mouse is released, the system automatically updates the value to the nearest
0.25 mm in the start or end location, depending on which value was adjusted. If
the entire group of lines is to be adjusted, click and drag the X annotation in the
center of the lines to move all the lines together.
+ and - may be used as a substitute for S and I. S equals + and I equals D or d can be used in the Start/End locations to copy the locations from the
previous scan.
The Number of Images is determined by the combination of Start and End Location,
Slice Thickness, and Image Interval and set automatically by the system.
If a specific number of images are needed, select that cell and enter the desired
value. The system automatically adjusts the End Location for you and highlight
the End Location area in orange to let you know a change was made to the
parameters.
For shuttle acquisitions, the number of passed or Coverage Time needs to be
entered.
To set the slice thickness and speed, click [Thick/Speed] and a window appears.
Choose a slice thickness of 0.625 mm, 1.25 mm, 2.5 mm, 3.75 mm, or 5.0 mm. For
axial scans, you choose between 1i, 2i, 4i, 8, 16i, 32i, or 64i depending on system
configuration. For helical, you choose between 32 row (20 mm beam) 32 row
(40 mm beam)or 64 row (40 mm beam) modes depending on system
configuration.
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NOTE: For details on the different modes, refer to the Multi-Detector Information chapter for
your system.
The Image Interval is for helical scans only and is automatically set to match the
slice thickness by the system. This is known as contiguous (back to back) scans. If an
overlap or spacing (skip) is desired, click the image interval cell and enter the correct
value.
D or d can be used in the Image Interval field to copy the locations from the
previous scan.
NOTE: If any of the values in Start/End Location, Number of Images, Slice Thickness, or Image
Interval are changed from the original value, the system automatically adjusts any
necessary values to maintain the scan. For example, if the number of images is
decreased, the system automatically adjusts the end location. The system highlights
any adjusted value in orange and changes any necessary graphic representations
on the scout. Refer to the Getting Started chapter for details.
The Gantry Tilt can be set manually or graphically to a maximum of 30 degrees in
half degree increments. The most common way to set the tilt is graphically. On a
lateral scout, you see circular handles on the Start and End locations.
Click and drag the circle to adjust the lines on the scout to the desired tilt. If a
specific tilt is wanted, select the feature button and enter the desired value.
C may be used in the Tilt field. Typing C enters the current gantry tilt in degrees.
D or d may be used to copy the tilt value from the prior series.
NOTE: Maximum degree of tilt depends on the height of the table and interaction with
interference (collision) matrix. Use the Tilt/Table Travel button on the gantry keypad
to observe the min/max values for gantry tilt and table travel for the current
landmark.
The SFOV choices for Discovery CT750 HD are Ped Head, Small Head, Head, and
Ped Body, Small Body, Medium Body, Large Body, Cardiac Small, Cardiac Medium,
Cardiac Large. The Ped Head, Small Head, Head are 32 cm in diameter with special
processing to correct for beam hardening effects. Ped Body is a diameter of 32cm.
Ped Head and Ped Body have a 30 kW limit. Small Body is 32 cm in diameter, Medium
Body, Cardiac Small (32 cm), Cardiac Medium (36 cm), Cardiac Large and Large Body
are 50 cm in diameter.
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To set the kVp, select [kV] and a window appears. The kVp values of 80, 100, 120, and
140 are displayed. Select the desired factor or cancel and the window closes. The
most common kV factor used for routine scanning is 120kV.
To set the mA, click [mA]. Any mA value in increments of 5 starting at 10 and going to
800 mA for 100 kW systems may be entered in Manual mA. AutomA can be selected
to provide consistent image quality.
To use AutomA, enter the AutomA values. Refer to AutomA for more information.
As with any x-ray exposure, mA x time is the mAs value. Appropriate exposure
values must be used to maintain image quality.
Select [SmartmA] if you wish to use this. A scout must exist and the orientation for
the series must match to be able to enable AutomA or SmartmA. For more
information on SmartmA refer to: SmartmA.
The Total Exposure Time is automatically set by the system and is determined by the
number of images and type of scan. This setting can only be changed by resetting
one of the other factors. The Total Exposure Time is useful for determining
breath-hold times, and contrast injection timing. If the scan type is helical, the
displayed Total Exposure Time is exactly what is shown. The Total Exposure Time lists
the x-ray on time only and does not reflect any ISD applied. When calculating
breath-hold times for axial scans, the ISD for each scan must be added to the
Exposure Time displayed to reflect the total amount of time the patient would need
to hold his/her breath.
The Prep Group feature is used to establish how long the system waits before turning
the x-ray on for a given group of scans. This delay can be used during initial contrast
injection, timing of auto voice instructions, or a delay to wait for structures to fill with
contrast.
To set the Prep Group, click the [Prep Group] parameter column or cell and enter
the appropriate value in seconds. The system starts to acquire the images after
the [Start Scan] button is selected and the Prep Group Delay counts down. It is
important to start the injection at the same time as starting the scan to insure
accuracy of when the IV bolus arrives in the appropriate anatomy. The valid
ranges for Prep Group delays are: 1st group 0- 300 seconds, group delay for axial
is 1-600 seconds and helical is 5-600 seconds.
When the scan type selected is Axial, the feature ISD (Interscan Delay) is available.
To set the ISD, click the ISD parameter column or cell and enter the appropriate
value in seconds. This feature allows time for the table to move the correct
amount of millimeters set for the Image Interval. It can also be used to help with
tube cooling by increasing the value, extending the time between exposures
allowing the heat units to dissipate. Typically, the ISD is set at 1 second so the
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exam is done as fast as possible. The valid range for ISD is 1-300 seconds. If
Helical or Cine scan type are selected, this feature is not available.
Breath-Hold is the setting for how long the patient must hold his/her breath for each
exposure.To set the breath-hold, click the [Breath-Hold] parameter column or cell
and enter the appropriate value in seconds. Breath-Hold and Breathe Time can be
used in conjunction in order to cluster scans within a group. The valid range for
Breath-Hold is N (None) or 0-60 seconds.
The Breathe Time is the setting to allow the patient to breathe normally between
breath holds.
To set the Breathe Time, click the [Breathe Time] parameter column or cell and
enter the appropriate value in seconds. If there is IV contrast being injected, it is
important to consider the appropriate length of this delay and its effect on patient
comfort. Breath-Hold and Breathe Time can be used in conjunction in order to
cluster scans within a group. The valid range for Breathe Time is N (None) or 0-60
seconds.
The Voice/Light/Timer feature is used so that the system will automatically give the
breathing instructions to the patient according to the Breath Hold, Breathe Time, and
Total Exposure Time. If the Total Exposure Time is less than the Breath Hold time, the
system uses only the time needed for the exposure. The Light and Timer features will
be visible on the gantry if these two features are selected for use. For more
information on the Voice/Light/Timer feature, see Set Timing Parameters. If the
Voice/Light/Timer feature was selected for the scout series, it must be selected for the
axial series as well.
17. Set Recon Parameters.
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NOTE: The Recon Parameters include DFOV, Right/Left Center (R/L), Anterior/Posterior
Center (A/P), Recon Type (algorithm), Matrix Size, Recon Mode, and Auto Applications.
The DFOV allows you to target a particular piece of anatomy for display on the
screen. The smallest DFOV is 5.0 cm. The maximum DFOV is always the same as the
selected SFOV.
The DFOV choices for a Discovery CT750 HD are: Ped Head (5 cm - 32 cm), Small
Head (5 cm - 32 cm), Head (5 cm - 32 cm), Ped Body (5 cm - 32 cm), Small Body (5 cm
- 50 cm), Medium Body (5 cm - 50 cm), Large Body (5 cm - 50 cm), Cardiac Small (5 cm
- 32 cm), Cardiac Medium (5 cm - 50 cm), and Cardiac Large (5 cm - 50 cm).
To set the DFOV value, click the [DFOV] parameter column or cell and enter a
specific value. The DFOV may also be set graphically by using the diamond
handles on the Show Localizer Image. Click and drag the diamonds to expand or
contract the DFOV. The system automatically updates the value in the feature
area.
D or d may be used to copy the DFOV from the previously scanned series.
The R/L Center allows you to offset the center of the image for display. This is useful
if the patient is not positioned normally or if an offset structure such as the spine or
kidney is what you want centered. The maximum offset for R/L Center is one half the
SFOV from isocenter selected (e.g. Head SFOV is 32cm so maximum offset R/L is
16cm or 160mm).
To set the R/L Center, click the [R/L] parameter column or cell and enter a value in
millimeters starting with the correct designation of R or L. The range of values can
be from 0 to one-half the SFOV. Typically, you would not want the offset to exceed
one-half the DFOV or the resulting image does not show a right or left marker, it
does show markers as R-R or L-L. The R/L Center may also be set graphically by
using the X annotation on the AP scout image reference lines. Hold down the Shift
key first, then click and drag the X to center over the area of interest.
+ and - may be substituted for R and L. R equals + and L equals -.
D or d may be used to copy the R/L value from the prior series.
The A/P Center works the same way as the Right/Left Center using the lateral scout
image. The maximum offset for A/P Center is one half the SFOV from isocenter
selected (e.g. Head SFOV is 32cm so maximum offset A/P is 16cm or 160mm).
+ and - may be substituted for A and P. A equals + and P equals -.
D or d may be used to copy the A/P value from the previously scanned series.
The Recon Type sets the algorithm for reconstruction of the images.
To set the Recon Type, click the [Recon Type] parameter column or cell and a
window appears.
Select the appropriate algorithm. This sets the algorithm for the primary or first
reconstruction. The algorithms going from left to right increase spatial resolution
and decrease low contrast detect ability. The Bone Plus algorithm can be used for
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any study that normally used bone algorithm but is very useful in cases where the
Edge algorithm was used. This is because the Bone Plus algorithm has no
reconstruction penalty and is very close in standard deviation to Edge. The Chest
algorithm provides soft tissue resolution and contrast when viewing the images in
a soft tissue/mediastinal window width and window level and high resolution of
the lung tissue when viewing the images in a lung window width and window
level.
If Hi Res mode has been enabled, additional algorithms are available. They are
HD Standard, HD Detail, HD Bone, HD Edge, and HD Bone Plus for non cardiac
imaging. For cardiac imaging, the additional algorithms are HD Standard, HD
Standard Plus, HD Detail, HD Detail Plus and HD Edge.
These algorithms provide higher resolution when matched with data acquired in
Hi Res mode compared to the basic algorithms.
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NOTE: The system allows you to program up to three reconstructions of data and Cardiac
phases from one exposure. To set up the other reconstructions and phases (if needed),
click [Show Recon 2] and enter appropriate values in the parameter columns or cells.
The [Show Recon 3] button is now available if needed.
If you want to transfer Recon 2 and Recon 3 to another workstation, you can select
[Series Auto Transfer].
All three recons can be sent to a different place than set in the exam level transfer.
A Host window will pop-up.
Up to four locations can be selected.
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Recon Options window contains Recon Mode, Window Width and Window Level
settings, Cardiac Filters for noise reduction if scan type is set for Cardiac Helical or
Cardiac Cine, Flip/Rotate selection, and ASIR mode selection.
NOTE: Window Width and Window Level values entered in the Recon Option window is also
added to film Set 1 in the Auto Film Tab Card.
Window width/Level can be defined for the different groups on the Recon Tab.
If Helical scan type is selected, IQ Enhance will be available if the slice thickness is
0.625 mm or 1.25 mm and the interval for these slice thicknesses is equal to the slice
thickness (0.625 or 1.25) or one half the slice thickness (0.312 or 0.625).
Adaptive Statistical Iterative Reconstruction (ASIR) is where you can select the
desired noise reduction in your images. Click [Slice] or [Volume] and then select the
desired blending level. For more information, refer to Adaptive Statistical Iterative
Reconstruction (ASIR) (Option) covered earlier in this chapter.
Flip/Rotate is where you specify that image presentation be flipped/rotated from
system normal default presentation in recon opposed to apply to image in display.
If Cardiac scan type is selected, cardiac noise reduction filters C1, C2, C3 can be
selected to reduce noise in the images for SnapShot Segment, SnapShot Burst,
SnapShot Burst Plus, or SnapShot Pulse acquisitions.
The Auto Apps feature allows you to build 3D models with Direct 3D or to create thick
slice axials from thin data sets without image reconstruction while the scan is in
progress. If you have Direct Multi-Planar Reconstructions (DMPR) installed, it can be
used to create axial, sagittal, and coronal slices from thin data sets.Neuro 3D Filter
allows provides noise reduction filters Low/N1, Med/N2, High/N3 to reduce noise in
images while maintaining image quality. The 3D models from Direct 3D,reformatted
images from DMPRand filtered images from Neuro 3D Filter maybe filmed and saved.
For details, refer to the Auto Applications (Option) chapter.
18. Set the filming parameters.
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NOTE: The Filming Parameters include AutoFilm (On/Off), Frame Format, Interval, Flip,
Window Width, Window Level, Mag. Factor, Rotate, User Annotation, Filter, and GSE
(Gray Scale Enhancement).
The AutoFilm feature must be turned on if the system is to display and film images in
the AutoFilm Viewport on the Display Monitor. The system defaults to off, so in
building new protocols or editing existing protocols it must be turned on.
To turn AutoFilm on, click [AutoFilm] then click the [AutoFilm] parameter column
or cell, and click [YES].
NOTE: If the selection is left in the Off position, images have to be filmed manually. Refer to
the Manually Filming Images chapter.
The Frame Format sets how many images are placed in each frame of the film
composer. You have the option of choosing 1 on 1, 2 on 1 (vertical and horizontal), or
4 on 1 formatting. Any option chosen is used for the entire film series, there is no
option to change format once the filming starts.
The Interval is used to tell the system which images is to be filmed. For every image
reconstructed to be filmed, enter 1. For every other image, enter 2. For every third
image, enter 3 and so on. The range is 1-5.
The Flip feature allows you to flip images Top/Bottom, Left/Right or both. This is
helpful when a patient is scanned in a prone or hanging head (i.e., supine coronal)
position.
To set Flip, click the [Flip] parameter column or cell and a window appears from
which you can choose the appropriate option.
The Window Width allows you to set the width level for filming. The image appears in
the AutoFilm viewport with this setting. It may be used or adjusted in the filming
viewport.
To set the Window Width, click the [Width 1] parameter column or cell and enter
the value desired. This setting is also stored in the image header for transfer to a
network receiving station. The range is 3072.
If you have the Expanded CT Number Range enabled, the range is 32767.
The Window Level allows you to set the window level for filming. The image appears
in the AutoFilm Viewport with this setting. It may be used or adjusted in the filming
viewport.
To set the Window Level, click the [Level 1] parameter column or cell and enter
the desired value. This setting is also stored in the image header for transfer to a
network receiving station. The range is 3072.
If you have the Expanded CT Number Range enabled, the range is 32767.
NOTE: The system image display supports pixels with a range of -32,767 to 32,767.
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NOTE: For information on expanded CT number range, refer to: Enable Extended CT Number
Range or Disable Extended CT Number Range.
The Magnification Factor (Mag. Factor) allows you to establish a preset
magnification for each image for filming. The range is 0.5-2 (in 0.1 increments e.g.
1.1/1.2/1.3).
To set the Mag. Factor, click the [Mag. Factor] parameter column or cell and enter
the desired value.
The Rotate feature allows you to rotate images Right/Right or Right/left. This is
helpful if the patient is scanned in a decubitus position.
To set Rotate, click the [Rotate] parameter column or cell and a window appears
where you can choose the appropriate option.
The User Annotation (User Anno) feature allows you to place annotation(s) on each
image in a film series. This annotation appears in the middle of the cell above the
image. This is helpful to denote delayed studies or other unusual film sequences. It is
commonly used on spine studies to denote vertebral levels.
To set User Annotation, click the [User Annotation] parameter column or cell and a
window appears in which you can enter appropriate text.
The Filters feature allows you to use edge enhancement filters (to sharpen images)
or smoothing filters (to soften images) on every image in a film series.
To set Filters, click the [Filters] parameters column or cell and a window appears
where you can choose the appropriate option.
NOTE: For more information on filters and their use, refer to the Image Manipulations
chapter.
The Gray Scale Enhancement [GSE] feature allows you to change the gray scale
curve to enhance areas of low contrast such as the gray/white matter interface in
brain tissue, on every image in a film series.
To set the GSE click [GSE] parameter column or cell and a window appears from
which you can choose the appropriate option.
19. Use Additional Feature Buttons.
NOTE: These features cannot be built as a portion of a protocol. They can be used when
actually scanning a patient.
The Add Group feature allows you to insert another set of images following the prior
group with all of the same factors, except for Start/End location within the same
series. The start location of the new group automatically set contiguous to the end of
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the prior group. The end location is determined by the number of slices, slice
thickness, and image interval.
To add additional groups, click [Add Group] and the new group is inserted. Every
click inserts another group.
The Split Current Group feature allows you to split a selected group into separate
groups. This is helpful for tube cooling issues or breath-holds.
To split a group, you must first highlight which group you wish to split by clicking
on the first box (with image numbers) at the start of the group. It highlights in a
bright blue color.
Click [Split Current Group] and a window appears from which you may choose to
split between selected slices or by location.
The Delete Selected Group feature allows you to remove an entire group from the
series.
To delete a group, you must first highlight the group to be deleted by clicking on
the first box (with image numbers) at the start of the group. It highlights in a bright
blue color.
Then click [Delete Selected Group] and the highlighted group is deleted.
The Smart Prep feature can be built into a protocol. Smart Prep is an excellent tool
for monitoring the peak enhancement of IV contrast injections. For details on the
SmartPrep option, refer to the SmartPrep chapter.
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Click and hold [Record] until you are ready to begin your message. Normally, you are
recording a pre-message first, e.g., Take in a breath and hold it. When you release
the mouse button, the recording starts as indicated by the clock to the right of the
[Record] button. Begin your message right away. Speak clearly toward the
microphone located on the computer keyboard. Click [Stop] as soon as you finish
speaking. The total time of the message is displayed in the clock. If you make a
mistake, simply click [Stop] and then repeat these steps.
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NOTE: It is very important to try to start and stop the recording as quickly as possible to
avoid adding time to the beginning or end of a message.
5. Click [Pre-Message].
Select the [Pre-Message] button next to the name you just entered. This highlights
the feature in blue.
6. Click [Save Message].
This enters the message to the system and enters the time in the Pre-Message Area.
7. Click [Record] and begin Post-Message.
Repeat the steps to record a message for post instructions (e.g. Breathe normally).
8. Click [Post- Message].
This highlights the area in blue.
9. Click [Save Message].
This enters the message to the system and enters the time in the Post-Message area.
NOTE: If you wish to hear any recorded message, click on the selections Pre- or Postmessage to highlight it in blue. Go to the lower right corner of the screen to the
Message Management area and click play.
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3. Click [English-Male] and select the desired primary language from the AutoVoice
Language Selection window.
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Delete an AutoVoice
It may be necessary to remove old or unwanted messages from the system as employees
change or as different languages are required.
1. From the scan monitor, click [Protocol Management].
A window appears with the choices of AutoVoice or Protocol Management.
2. Click [AutoVoice].
The AutoVoice menu appears with three pre-recorded voice messages and any that
have been saved to the system.
NOTE: The three pre-recorded messages cannot be deleted.
3. Select the title of the message to be deleted.
This highlights the selection in blue.
4. Click [Delete Set].
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6. Select the anatomical selector you wish to paste to.
You can only paste to User protocol selector. The [Paste] button is not available for
the GE or Most Recent selectors.
7. Select the area you wish to paste to.
8. Click [Paste].
The protocol is now copied to this area.
You can now use or edit this protocol.
NOTE: If you copy a protocol from the Most Recent area, check features like; Smart Prep,
Show Localizer, and other choices are good choices for the protocol.
9. To change the name of the protocol, click on the protocol to be renamed.
10. Enter the new name.
The protocol is renamed.
11. Click [Done] to exit.
8-68
Building Protocols
8-69
Building Protocols
Delete a Protocol
Use this procedure to delete a protocol from your user defined list. This allows you to keep
your protocol list current by deleting any unnecessary protocols.
1. From the scan monitor, click [Protocol Management].
8-70
Building Protocols
8-71
Building Protocols
8-72
Building Protocols
Figure 8-37 ECG Viewer
8-73
SmartPrep
Chapter 9
SmartPrep
Introduction
This chapter explains SmartPrep. It contains the step-by-step instructions to help you learn
how to:
9-1
SmartPrep
SmartPrep
SmartPrep
SmartPrep is a standard option. It is a feature that allows intermittent monitoring of IV
Contrast enhancement in one particular section of anatomy that is in the area of interest.
The contrast flow is monitored by Low-Dose scans until the contrast enhancement reaches
the preferred point and the operator initiates the scan prescription.
If SmartPrep is enabled for a series, the system cancels the AutoView display for any images
in the recon queue when the SmartPrep series is started. These images are selected from
the browser for review once they have been reconstructed. Only images from the series with
SmartPrep and those after the SmartPrep series are displayed in AutoView viewport.
9-2
SmartPrep
9-3
SmartPrep
How Do I...
This section provides the step-by-step instructions for Utilizing SmartPrep. Specifically, it
describes how to:
9-4
SmartPrep
This puts the scout image for your scan in the display monitor with a single line
annotated on the image.
9-5
SmartPrep
4. Set the Monitor Location.
This may be done graphically by clicking and dragging the red X on the line in the
scout image to the desired location.
The location can also be entered in the Monitor Location area once you have
determined the specific value. The value must have an S or I designation. (refer to
Report the Cursor Location and the Pixel Value on how to get value using cursor).
+ and - may be substituted for S and I. S equals + and I equals -.
NOTE: This location is very important as this is where the monitoring images are scanned
and where the ROI(s) are placed.
5. Enter the mA.
The system defaults to a low mA value.
To change the value select the mA area and enter the desired setting. You want to
use low mA to keep heat units to a minimum. The usual range is around 40 mA for
most studies.
6. Enter the Diagnostic Delay.
This value allows time for the table to move into the Scan Phase Start Location and to
ready the system for the Scan phase. This is generally set to minimum values
possible for arterial studies and 10 or greater seconds for venous/routine studies.
The Diagnostic Delay can be entered explicitly or the system can automatically
calculate the minimum value.
The Diagnostic Delay is entered in seconds. The range is 3-60 seconds in 0.1 second
increments.
For Explicit Manual entry of the Diagnostic Delay, the delay time selected needs to
meet clinical needs and include time for the initial breathing instructions to the
patient. Or, an AutoVoice Pre-Message can be selected. Selecting an AutoVoice
Pre-Message to be played prior to scanning in some case may increase the
Diagnostic Delay value to allow the message to be played.
When Auto Minimum Delay is selected, the diagnostic delay time is set automatically
to the minimum time possible.
The minimum delay possible is updated to adjust for table movement between the
Monitor location and the Scan Phase. If Scan Location is changed after the
SmartPrep Pop-up window is closed, the Diagnostic Delay time is automatically
updated to the minimum time possible when Auto Minimum Delay is on and if the
value for the Diagnostic Delay is less than the minimum value entered.
The value for the prescribed Diagnostic Delay is displayed in the attention message
pop-up at Confirm.
9-6
SmartPrep
Figure 9-1 Auto Minimum Diagnostic delay OFF message
The Diagnostic Delay time is displayed in Prep Group for Group1 in Timing Tab along
with SP indication that SmartPrep is enabled.
Figure 9-3
7. If desired, select a Pre-Auto Voice Message to be played during the transition from
Monitor to Scan Phase.
The number for the AutoVoice to be played when AutoVoice Pre-Message is enable is
displayed on the button. The AutoVoice Message is selected on Timing Tab in Voice
Lights Timer.
9-7
SmartPrep
Figure 9-4
NOTE: If an AutoVoice Pre-Message is not enabled and the patient is required to hold their
breath for the acquisition once the scan phase is initiated, the operator must give the
first breathing instruction to the patient. The system automatically gives all other
instructions if AutoVoice has been set for the study.
When an AutoVoice Pre-Message is selected, review the Diagnostic Delay value to
make sure it is acceptable, as the delay value may have been extended to support
playing of the Pre Message.
8. Click [Continue] or [Cancel].
Selecting [Accept] confirms any changes to the SmartPrep parameters and returns
you to the view/edit screen.
Selecting [Cancel] returns you to the view/edit screen and closes the pop up window.
It does not cancel SmartPrep Rx.
After setting the scan Rx, on the view/edit screen click [SmartPrep Rx].
From the pop up window click [Off].
Click [Show Localizer].
Set the Monitor Location.
Enter the mA.
Enter the Diagnostic Delay.
If desired, select a Pre-Auto Voice Message to be played during the transition from
Monitor to Scan Phase.
8. Click [Continue] or [Cancel].
9-8
SmartPrep
The value for the prescribed Diagnostic Delay displayed in the attention message
pop-up at Confirm.
3. Click [Continue].
The system displays the Scan Progress screen. The display shows the dynaplan for all
three phases, Baseline, Monitor, and Scan.
9-9
SmartPrep
4. On the keyboard press [Move to Scan].
This takes the table to the Monitoring Location.
5. On the keyboard press [Start Scan].
This acquires the baseline image at the monitoring location.
When the image is reconstructed, you see a one on one display of the image on the
display monitor. To the left of the image is six SmartPrep display features available to
use on the image. These features are Zoom (2x), Display Normal, Ellipse ROI, Hide
Graphics (toggle to hide/show graphics), Erase, Explicit Mag (range 0.5-2.0).
6. Place Ellipse ROI in an area of interest.
You can now put up to three ROIs on an area of interest by selecting the Ellipse ROI
feature from the SmartPrep display area. For example, if you are interested in
evaluating the liver parenchyma, put the ROI in the liver so that it is not touching any
vessels. If you are interested in evaluating a vessel, put the ROI on the vessel of
interest.
9-10
SmartPrep
2. On the keyboard press [Start Scan] and start the injection of IV contrast at the same time.
The system waits the time set in the Monitoring Delay area and then begin acquiring
images at the time set for the inter-scan delay (ISD).
NOTE: There is a maximum of 40 monitoring images available.
3. On the Display Monitor watch the four on one display for the monitoring activities.
The upper left quadrant shows the baseline image with the ROI(s).
The upper right quadrant shows the real time monitoring image as it reconstructs
along with the ROI(s).
The lower left quadrant shows a real time enhancement threshold graph comparing
the ROIs of each monitoring scan versus the time from the start of the monitoring
delay.
9-11
SmartPrep
NOTE: On the graph is a horizontal line denoted by a T. This represents the numeric
enhancement threshold that was entered from the SmartPrep prescription. If an ROI
was not placed on the baseline image this line does not appear.
The lower right quadrant shows, in real time, the time that each monitoring scan was
acquired based on the beginning of the monitoring delay as well as showing the ROI
values for each scan.
The lower right quadrant also displays an elapsed time clock. This displays, in real
time, the time from when Start Scan was selected for the monitor phase until the
Scan Phase icon was selected. This is the inject to scan delay for this series of scans.
4. When the desired enhancement threshold is achieved click [Scan Phase].
The table moves to the scan prescription start location and, based on the Diagnostic
Delay selected, the scan prescription is started.
When the line representing the ROI of interest is close to or on the line denoting the
preset enhancement threshold value, you may click [Scan Phase] to initiate the scan
prescription.
You can also click [Scan Phase] based on your observation of the real time
monitoring images, if those images show adequate contrast in the area of interest.
NOTE: If all forty monitoring scans have been utilized it is necessary to use the Move To Scan
and Start Scan buttons on the keyboard to place the table in position and initiate the
scan prescription.
9-12
SmartPrep
The table moves to the scan prescription start location and, based on the Diagnostic
Delay selected, the scan prescription is started.
The real time updating of information in the quadrants is stopped.
A screen save image of the quadrant is captured by the system for later review if
needed.
NOTE: The system places the baseline image, the monitoring images and the screen save
image with the exam in the browser. These images are denoted as series 200
prospective and screen save images. If an additional baseline image was acquired
these images are in series 201.
NOTE: If an AutoVoice Pre-Message is not enabled, the initial breathing instructions to the
patient for the start of the exam scan prescription must be delivered by the operator
during the Diagnostic Delay. The system then provides the rest of the breathing
instructions if Auto Voice has been selected.
9-13
VariSpeed
Chapter 10
VariSpeed
Introduction
This chapter explains the choices available in the option known as VariSpeed. VariSpeed
allows the system to operate at new sub-second rotation speeds. This chapter contains
step-by-step instructions to help you learn how to:
Use VariSpeed
10-1
VariSpeed
VariSpeed
VariSpeed
VariSpeed is a option that allows the system to operate utilizing various sub-second rotation
times. The rotation times in this package are 0.5 seconds, 0.6 seconds, 0.7 seconds, and 0.9
seconds. The variability of the rotation times gives you the ability to adjust the parameters
for patient size and different applications. For scanning a medium or average sized patient
for an abdominal study, the 0.5 second rotation time provides adequate mAs for image
quality. For a larger patient you may need to use the 0.6 or 0.7 second rotation time. Both
studies would be completed using sub-second rotation times because of the flexibility in
having the various rotation times.
10-2
VariSpeed
How Do I...
This section provides the step-by-step instructions for using VariSpeed. Specifically, it
describes how to:
Use VariSpeed
10-3
VariSpeed
Use VariSpeed
VariSpeed is a purchasable option that allows the system to operate using various
sub-second rotation times. The rotation times in this package are 0.5 seconds, 0.6 seconds,
0.7 seconds, and 0.9 seconds. The variability of the rotation times gives you the ability to
adjust the parameters for patient size and different applications.
1. From the view/edit screen, click [Scan Type].
A pop up window appears.
10-4
Chapter 11
The procedure for using Prospective Gating (SmartScore) in conjunction with calcium
scoring includes the following operator and system actions:
Patient and ECG monitor set up
Cardiac exam prescription and confirmation
Automatic system preparation
Scanning initiation
Image transfer to Advantage Windows workstation
SmartScore on Advantage Windows workstation
The exam prescription is described here. Information on patient set up, ECG monitor set up,
image management, and scoring can be found in the separate SmartScore documentation.
11-1
R to R interval
R to R interval
Images used for Prospective Gating (SmartScore) are acquired during the R to R interval. The
R to R interval is the time between maximum patient heart contractions (R wave peaks). For
example, the R to R interval is 660 milliseconds for a resting heart rate of 90 beats per
minute. See below for more information on the cardiac cycle.
11-2
P-wave
Represents depolarization of the atria and results in contraction or systole of the
atria.
QRS complex
Represents depolarization of the ventricles and results in contraction or systole of the
ventricles.
R-wave is used for triggering because of its strong electrical signal and correlation
of the muscle activity of the heart.
The R-R interval is the time between the peak of one R-wave and the peak of the
next. Each R-R interval represents the length of one cardiac cycle.
T-Wave
Represents re-polarization of the ventricles and results in relaxation or diastole of the
ventricles.
11-3
Ventricular systole extends from the R-peak to the T-Wave when the heart is contracting
and expelling blood.
Ventricular diastole extends from the T-Wave to the R-peak. During diastole, the
ventricles fill with blood.
11-4
How Do I...
This section provides the step-by-step instructions for using Prospective Gating
(SmartScore). Specifically, it describes how to:
11-5
11-6
If the system detects a valid ECG signal, the patients heart rate in Beats Per Minute
(BPM) is displayed on the Gating button. BPM displayed is a 3 cycle average of the
patient's heart rate. The ECG waveform for the patient can be displayed by clicking
on [ECG Trace] after a BPM is displayed.
If the system detects no signal from the ECG monitor, the button turns red and no
BPM value is displayed. In this scenario, reevaluate ECG connections to patient and
monitor to gain ECG signal before continuing.
11-7
11-8
8. On the SmartScore Pro pop up, click [Off] to turn gating on.
9. Review and/or change parameters on the SmartScore Pro pop up screen as necessary.
The R to R interval is displayed in BPM in the R to R Interval field.
The R to R interval is displayed in milliseconds directly below the BPM entry. The
R-to-R interval is updated based on an average over a period of 3 cardiac cycles.
The center R-Peak Delay (%) is defined as a percentage of time between 2
consecutive R-peaks. The default value is 70%, which should be in the diastolic phase
in order to minimize occurrence of cardiac motion. The time, in milliseconds,
displayed directly below the Center R-Peak Delay (%) identifies the amount of time
after the preceding R-peak that aligns with the Trigger Delay percent for the patient's
displayed heart rate.
11-9
Images per R-to-R Interval defines the number of images reconstructed per image
location for each heart cycle. You have a scan at that location that lasts X duration,
and out of that data you reconstruct images at a time interval of either 50 or 100
milliseconds.
b) Select either [1], [3], or [5] from the pop up menu.
The number of images that can be acquired depended upon the R to R Interval of the
patient.
The middle slice of the group is taken at the point of the Trigger Delay. The remaining
images, if more than one, are reconstructed at either 50ms or 100ms intervals before
and after the middle image.
If the point to begin data acquisition is too short for the hardware to start after the R
to R wave, the system skips one beat and begin in the next R to R wave.
10. Click [Accept] on the SmartScore Pro pop up menu to continue with Prospective Gating
(SmartScore) or click [Cancel].
NOTE: It is important to give the patient the same breathing instructions for the scout scans
as are given for the Cine Scan Type acquisition. The patient should be asked to take
several breaths in and out before holding breath while the actual scan is acquired.
This helps provide a more consistent heart rate during the acquisition of the
SmartScore images.
11-10
11-11
Chapter 12
Set Up a Patient
NOTE: The maximum number of images in a series is 3000 for prospective and retrospective
series. How images are put in different series based on how they are reconstructed.
12-1
Scan Preparation
Patient Preparation
Patient Skin Preparation & Electrode Placement
Alternate Electrode Positions for Signal Clarity
12-2
Prior to Scanning
Before initiating a scan, it is extremely important to check the ECG trace on the scanner
console and ECG trigger monitor to make sure the waveform is clean and ECG-gating is
triggering properly. In cardiac imaging, there is a dependency on the patient specific heart
rate as input to ECG gated exam completion.
ECG-gating is considered correct if the R-peak is pronounced and clearly distinguishable
from the remainder of the waveform (i.e. no other elevated segments) and the red trigger
line is shown on the R-peak of the QRS complex on the ECG waveform.
Use the impendence check button on the Ivy Monitor to verify that the electrode placement
and connection with the patient are good.
If these conditions are not met, reposition the electrodes as per recommendations in the
Patient Skin Preparation & Electrode Placement section of this guide.
12-3
The figures below demonstrate varying electrocardiograms (ECG) similar to the waveforms
that could be seen from connecting the leads of the cardiac trigger monitor to the patient
for an ECG-gated CT acquisition. These show an expected normal or typical waveform
(Figure 12-2), a suboptimal noisy waveform (Figure 12-3), a suboptimal elevation in T-Wave
amplitude (Figure 12-4), and an irregular spacing between the R-Peaks creating an
arrhythmia (Figure 12-5).
Figure 12-2 Normal ECG Trace
12-4
If the impendence check fails or if the waveform is noisy as shown in Figure 12-3 above,
please refer to Patient Skin Preparation & Electrode Placement to ensure the optimal
conditions are being met. Additionally, confirm all cables are properly connected and ECG
monitor is positioned away from the table and gantry.
If the waveform has elevated T-waves, as in Figure 1-7, do the following:
Confirm electrode placement, or
Try to place the electrodes more laterally on clavicles or on the arms, or
Use the Alternate Electrode Positions for Signal Clarity in Figure 12-19.
Refer to Patient Skin Preparation & Electrode Placement.
If this does not yield a more normal waveform (Figure 12-2), try changing the measurement
Lead on the ECG monitor from Lead 2 to Lead 1 or Lead 3.
12-5
Cardiac Helical
Cardiac Helical is a low-pitch ECG-gated helical acquisition mode where the pitch value is
set based on the patient's heart rate. The range of pitch values varies based on both the
gantry speed and the scanner configuration. The patient's heart rate must be within the
range of 40 -120 BPM for the system to allow scan confirmation.
NOTE: If Start Scan times out or you need to pause scan and resume, make sure to review
the patient's heart rate before you resume/reconfirm the scan. The heart rate may
have changed from the value you originally confirmed and a different pitch might be
used for the scan. In cardiac scanning, confirm the acquisition only when you are
ready to proceed.
Move to Scan is valid for 180 seconds while Start Scan is only valid for 30 seconds
before it times out.
The pitch selected is based on the patients heart rate on the console at the time that the
"confirm" button is selected on the view/edit screen. Therefore it is very important to be
aware of what the pitch is set to prior to confirming the scan. If you want to use a smaller
pitch other than what the scanner is detecting for the HR, you will need to use the HR
override button located in the gating area. The tables below (Table 12-1) represent the pitch
table overview for the various scanner configurations.
12-6
Gantry Speed
Pitch
0.35
0.16
41-49 BPM
0.35
0.18
50-57 BPM
0.35
0.20
58-65 BPM
0.35
0.22
66-74 BPM
0.35
0.24
0.35
0.20
86-95 BPM
0.35
0.22
96-113 BPM
0.35
0.24
0.35
0.20
NOTE: If the heart rate varies more than 10 BPM, use Heart Rate Override in the CardIQ
SnapShot pop-up and enter the minimum value in the HR Range which covers the
lowest BPM expected to occur during the scan to ensure a low enough pitch is used
for the acquisition.
Table 12-2 Discovery CT750 HD with 0.40 sec./rotation gantry speed (64 slice)
HR Range
Gantry Speed
Pitch
0.40
0.18
43-49 BPM
0.40
0.20
50-59 BPM
0.40
0.23
60-69 BPM
0.40
0.26
0.40
0.20
81-94 BPM
0.40
0.22
0.45
0.20
105+ BPM
0.40
0.20
12-7
CAUTION:
If during the scan the heart rate drops significantly lower than the prescribed
heart rate, there is a potential for gaps in the gated image location. To avoid
image location gaps, a non-gated image is reconstructed for the period where
the patient heart rate dropped below the expected or confirmed heart rate
at the start of the exam. A non-gated image may have more motion and may
not be reconstructed at the prescribed phase.
SnapShot Segment
SnapShot Segment is an acquisition and reconstruction method used to generate
retrospectively ECG-gated images using data from one cardiac cycle in a half-scan
reconstruction technique.
SnapShot Segment image reconstruction is recommended for 64 slice systems with rotation
speed of 0.35 and patient's heart rate that is between 30-74 beats per minute (BPM).
The temporal resolution that results depends on the gantry speed used. For SnapShot
Segment single sector reconstruction, the fastest gantry speed available should be used in
order to optimize the temporal resolution.
Images acquired with SnapShot Segment are annotated SSEG.
12-8
CAUTION:
SnapShot Burst
SnapShot Burst is a reconstruction method used to create retrospectively gated images
from two cardiac cycles within the same phase of the heart cycle. Burst imaging produces
images with improved temporal resolution due to the combining of data from 2 cardiac
cycles.
SnapShot Burst image reconstruction is recommended to be used for patient's whose heart
rate is higher than the SnapShot Segment range listed above. (Please see previous tables for
specific ranges at each scanner configuration.) The temporal resolution will vary depending
on the heart rate and scanner configuration. Please note, SnapShot Burst reconstruction will
optimize temporal resolution across the image set based on the scan acquisition
parameters. Resulting images will be annotated SSB2 indicating that data from 2 cardiac
cycles was used, or SSEG when resulting acquisition parameters yield single sector images.
12-9
Table 12-3 This table provides a description of each function in the CardIQ window.
Function
Descriptions
Heart Rate
Monitoring
This button toggles [On] or [Off]. This button defaults to [On] which allows
the scanner to capture the ECG signal. This needs to be on in order to do a
cardiac scan.
Heart Rate
Override
This button toggles [On] or [Off]. This is defaulted to [Off]. If you click [On],
you can manually enter the patients heart rate which forces the system to
override the detected heart rate and set the pitch to the heart rate you
entered.
NOTE: This is defaulted [On] for SnapShot Burst Plus scanning.
R to R
Interval
This displays the heart rate in beats per minute. This is updated based on
the average of 2 R to R intervals.
R-Peak
Delay
12-10
Descriptions
Heart Rate
Use this to manually enter a patients heart rate for patients whose heart
rates vary during breath holds. You can only enter a value when the Heart
Rate Override button has been toggled [On]. This is a mandatory entry for
SnapShot Burst Plus scanning.
[Accept]
This accepts the parameters that you entered and returns you to the view
edit screen.
[Cancel]
SnapShot Pulse
SnapShot Pulse is a prospectively ECG-gated Low-Dose acquisition mode to acquire
contrast enhanced cardiac images at a specific cardiac phase or phase range.
SnapShot Pulse requires the 0.35 second gantry speed, 100 kW generator, and 64 slice
patient scanning option be installed. SnapShot pulse is not available on 32 slice
configurations.
In a SnapShot Pulse acquisition, x-ray is on for the specified phase plus padding compared
to retrospectively ECG-gated cardiac helical scan where x-ray is on for the entire length of
the scan (Figure 12-7).
Figure 12-7 Cardiac gated helical and SnapShot Pulse acquisitions
SnapShot Pulse is an axial step and shoot mode used to acquire images during a specified
phase of the heart cycle with padding. Padding provides additional phase information to
account for variations in heart rate by adding time before and after the center phase of the
acquisition (e.g. adding 100 mSec before and after the 75% phase thus providing additional
phase information).
Figure 12-8 demonstrates SS-Pulse acquisition acquired during one heart cycle (complete
R-R interval).
12-11
SnapShot Pulse requires that 0.35 second gantry speed, 100.2 kW generator and 64 slice
patient scanning options be installed.
Padding is prescribed in the range of 0 - 200 milliseconds, and is added to both sides of the
center of the acquisition. Padding defaults to the value listed in the heart rate Dependent
Padding Lookup Table unless overridden. You may prescribe the desired amount of padding
if different than default. Click [Gating] to display the SnapShot Pulse pop-up. Click [Padding
Override] and enter desired millisecond padding. Maximum dose savings can be
accomplished by reducing padding value for patients with stable heart rates. The default
padding is set to cover 10% of the patient's R-to-R interval. This default value is set to
ensure adequate phase coverage for over 90% of patients. The patients heart rate may
become slower during the breath hold. You may want to increase the amount of padding
entered to accommodate this variability in the patient's heart rate.
Table 12-4 Heart Rate Dependent Padding Lookup Table
Heart Rate (HR) Dependent Padding
HR Range
30-39
175
40-49
150
50-59
125
>59
100
12-12
Table 12-5 This table provides a description of each function in the SnapShot Pulse window.
Function
Cardiac
Gating
Padding
Override
Descriptions
This button toggles [On] or [Off]. This button defaults to [On] which allows
the scanner to capture the ECG signal. This needs to be on in order to do a
cardiac scan.
This button toggles [On] or [Off]. It is defaulted to [Off] and can be used to
adjust the amount of overscan or padding around the center phase
NOTE: This is defaulted [On] for SnapShot Pulse scanning.
R to R
Interval
This displays the heart rate in beats per minute. This is updated based on
the average of two R to R intervals.
Center
R-Peak
Delay
12-13
Descriptions
Dynamic
Padding
(mSec)
[Accept]
This accepts the parameters that you entered and returns you to the view
edit screen.
[Cancel]
CAUTION:
SnapShot Pulse should not be used for studies where function or full
multiphase analysis is needed. Settings may limit the cardiac phases
available to one or a few neighboring phases impacting the ability to analyze
heart motion or review cardiac phase locations outside the prescribed phase.
12-14
WARNING: SnapShot Pulse scan mode should only be used for patients with stable heart
rates of 65 beats per minute (BPM) or less. It is not recommended to scan a
patient with heart rates that are unstable or above 65 BPM with this mode as
the temporal resolution may be inadequate for freezing the motion of the
heart and the increase in the interscan delay could lead to suboptimal image
quality. Alternate imaging modes such as cardiac helical should be
considered if the optimal conditions for SnapShot Pulse are not met.
CAUTION:
CAUTION:
Cardiac helical scan modes of SnapShot Segment, Burst, and Burst Plus are
optimized for specific heart rate ranges. Select the appropriate scan mode
for each patient's heart rate pattern. If the incorrect mode is selected,
temporal resolution may be insufficient and degraded image quality could
result.
CAUTION:
A patient with any of the conditions listed below may require additional
attention. If patients are scanned with these conditions, the software may not
be able to detect the R-Peaks and the images therefore may be produced as
ungated segment images.
- Patients with multiple pre-contractions or extra systole (e.g. PVC, PAC)
- Patients with persistent or extreme arrhythmia
- Patients with bi-ventricular lead (dual chamber) pacemakers
12-15
CAUTION:
NOTE: The images for cardiac gated acquisitions do not begin reconstruction until all the
data for the scan have been acquired.
Hi Res Mode
The Hi Res Mode is compatible with all the cardiac sequences. Hi Res Mode enables higher
resolution scanning for imaging cardiac structures. There are five Hi Res reconstruction
algorithms - HD Standard, HD Standard Plus, HD Detail, HD Detail Plus, HD Bone and HD
Edge. HD Detail or HD Detail Plus maybe useful when imaging patients with stents.
The ECG Trace must be displayed on the console. If you do not see a trace, do not
attempt to scan any cardiac gated studies.
In order to be able to edit an ECG Trace in the ECG Viewer in Retro Recon, the system
must save the trace. If you do not see a trace in retro recon, contact service to verify the
system is saving ECG Traces. Without a saved ECG Trace, images may be reconstructed
as ungated.
P-wave
Represents depolarization of the atria and results in contraction or systole of the
atria.
QRS complex
Represents depolarization of the ventricles and results in contraction or systole of the
ventricles.
R-wave is used for triggering because of its strong electrical signal and correlation
of the muscle activity of the heart.
12-16
T-Wave
Represents repolarization of the ventricles and results in relaxation or diastole of the
ventricles.
Ventricular systole extends from the R-Peak to the T-Wave when the heart is contracting
and expelling blood.
Ventricular diastole extends from the T-Wave to the next R-Peak. During diastole, the
ventricles fill with blood.
CAUTION:
There is a possibility that the ECG signal may not be detected by the scanner
due to improper lead placements or a lead falling off during the scan. It is
important to place new leads on the patient before the scan. Make sure the
leads are attached properly.
CAUTION:
Ensure the ECG patches are not past expiration date and that the gel on the
pads is still moist for proper conduction of the ECG signal for successful gating
12-17
CAUTION:
12-18
Pitch
Pitch is the ratio of table travel per rotation divided by the detector Z collimation. With
cardiac scans, the movement of the cradle and the x-ray tube needs to be in sync with the
heart rate to avoid any gaps in the image data set. As the patients heart rate increases, the
pitch increases for SnapShot Segment and Burst Mode. If the patients heart rate decreases,
the pitch decreases. This is why it is very important to understand the heart rate of the
patient during a breath hold so the appropriate pitch is selected.
Phase Location
The cardiac phase is defined as a point or period in time in the cardiac cycle. The location of
the cardiac phase is defined in a percentage of how far it is between R-Peaks (% R-Peak
Delay).
% R-Peak Value
The percent R-peak parameter controls the cardiac phase location of a given reconstruction
(Figure 12-13). It refers to the center of the reconstruction window in terms of a percentage
distance between any two successive R-Peaks given from the ECG.
Figure 12-13 % R-Peak Value
Reconstruction Window
12-19
ECG Modulated mA
ECG Modulation is a dose reduction feature that allows the user to specify a minimum and
maximum mA Range which is varied across the patient's cardiac cycle (R-to-R interval. A
phase percent range is specified for the Full mA range. ECG Modulation is only available in
cardiac helical modes (SnapShot Segment, SnapShot Burst and SnapShot Burst Plus).
NOTE: This feature is not applicable for the prospectively gated SnapShot Pulse scan mode.
In a stable heart rate this can lead to clinically relevant dose reduction for the patient by
implementing "full mA" for the useful portion of the cardiac cycle where images are to be
reconstructed and a reduced mA for the remainder of the cardiac cycle.
Figure 12-14 Full mA
Full mA
Recon
Recon
Recon
ECG
mA
12-20
NOTE: For Heart Rates < 65 BPM, we recommend full mA range from 70 % to 80 %. For heart
rates > 65, we recommend full mA range from 40-80 %.
ECG modulated mA when used with lower heart rates provides the best dose saving
opportunities. As heart rates increase the potential for dose savings decreases. Additionally,
an increase in the Max mA phase range settings, the potential for dose savings will
decrease. Once the heart rate exceeds 100BPM, the maximum phase range capability for
ECG Modulation is 40-80%. Additionally, the best dose savings for heart rates above
12-21
Scan Preparation
For single barrel injector's: Load with 80-100cc of contrast. (Please note: the total
volume and strength of contrast used is the site's discretion).
For dual barrel injector's: Load contrast syringe with 70-90cc of 300 to 350 strength
contrast media. (Please note: the total volume and strength of contrast used is the
site's discretion). Also load saline syringe with 50cc Saline.
Explain test to patient and have them sign a consent form if required at your site.
Have the patient lie supine on the table feet first.
Start IV line; make sure to explain the effects of the contrast to the patient. Even if the
patient has had a contrast injection before, reinforce how they will feel during the
scan. This step is CRITICAL as this will help minimize the patient's anxiety during the
injection of the contrast. Reassure them that what they will feel during the injection is
normal and they should try to remain relaxed during the scan.
Turn on the ECG machine, and ensure good connection to gantry and leads. To
confirm a good connection, check the upper right display area of the monitor, Figure
12-17.
Check that the Heart icon is illuminated on the gantry display.
12-22
If you do not have a good connection, check to make sure that the cable connecting
the ECG machine to the backside of the Gantry is plugged in properly, and the same
cable is connected to the ECG Machine. In case of low signal, please check electrode
placement and chose alternate position if needed. If there is "noise" within the ECG
wave, it is recommended that you DO NOT SCAN, until this condition is corrected.
Perform an impedance check to make sure that there is no issue with electrode
conductivity with the patient. If the impedance is good, the value for the lead will be
listed in green on the monitor. If the value is below the acceptable level, the value is
shown in red. If the impedance checks do not pass, re-prep and replace any of the
electrodes that do not pass.
Make sure excess IV tubing and excess ECG cable length is properly placed and
secured. Movement of the lead wires during scanning can degrade the gating signal.
To ensure patient safety and avoid disruption of the gating signal, any IV tubing and
the ECG cable length need to be secured properly.
Prior to the scan, have the patient practice the breathing instructions that will be
given during the exam. The scan time for the contrast enhanced cardiac gated
acquisition should be around 5-8 seconds to cover the entire heart. Recommended
breathing instructions include having the patient take a couple of breaths in and out
before holding their breath in order to increase their oxygen levels. Typical procedure
is to instruct the patient to take in one breath, blow it out, then take in another
breath, blow it out, then take in one more breath and hold their breath don't breathe.
Have the patient hold their breath for 20-30 seconds and then inform the patient to
breathe normally. Make sure to watch the ECG monitor during the breathing
instructions and take note of the patient's heart rate while they are holding their
breath. A patient's heart rate usually stabilizes a few seconds after they begin
holding their breath. Monitoring the heart rate during the breathing instructions
12-23
Patient Preparation
Patient preparation is extremely important step in the production of gated cardiac images
due to the dependency on the patient's heart rate input via ECG monitor during the
acquisition of data. The procedure should be explained completely before the exam is
started. Inform the patient of the breathing instructions that you are giving and practice the
breathing instructions before the scan. Review the potential effects the patient may
experience as the contrast is being injected. Inform the patient of the four phases in the
exam and explain what will happen in each phase. This helps the patient understand what
to expect, what is expected of them and remain calm throughout the exam.
This keeps the heart rate at a normal rhythm if the patient is comfortable with what is
happening. If the heart rate changes drastically during the scan, the image quality is
compromised.
The heart rate stabilizes 2-7 seconds after a breath hold. To help alleviate issues at the
beginning of the scan, have the patients start to hold their breath 3-5 seconds prior to x-ray
On.
The key to success in cardiac imaging is a stable heart rate, ideally the heart rate variation
should be within 5 BPM during a scan. Patients with heart rate variations of 10 BPM or
greater should not be scanned.
12-24
RA
US - White
EU - Red
LA
US - Black
EU - Yellow
LL
US - Red
EU - Green
NOTE: Lead placement on the clavicles needs to be done with the arms over the head in
position to be used for scanning.
12-25
Electrodes may be placed farther out on the arms or in this alternate position.
Use the impendence check on the IVY monitor to ensure the electrode connection is good,
after the patient has been positioned as needed for the cardiac study. If the impendence
check fails, remove electrodes and prep the patient again and replace with fresh electrodes.
Recheck impendence after preparing the patient.
Check to ensure the electrodes are not the wrong type, expired, dried out, or old.
The electrodes need to be radiotranslucent with a fresh gel pad (not dried out) to maintain
good electrical contact with the skin surface during table movement. Do not use patient
monitoring electrodes that may be available from other departments in your facility as
these are not suitable for short term ECG triggering. Patient Monitoring electrodes are not
suitable for ECG triggering. Recommended electrodes are listed below.
NOTE: The GE recommended electrodes are Dyna/Trace1500 by ConMed.
If a different type of electrode is used, there is a risk of errors in gating which could lead to
difficulties in gaining effective diagnosis from the cardiac exams or could even lead to
non-diagnostic results.
12-26
Scout Scan
First, you acquire two scouts with the patient in the feet first supine position at 90 and 180
degrees. Refer to Table 12-6 for the parameters.
Table 12-6 Scout Parameters
Action
Parameters
Gating
On
Start Location
S60
End Location
I300
mA
40
kV
120
Auto Voice
Localizer Scan
Second, a series needs to be done to localize the heart to identify the level where the
coronary arteries originate and the base of the heart. (A Smart Score - coronary artery
calcium scoring - series can be done in place of the localizer scan.)
Table 12-7 Localizer Parameters
Action
Parameters
Gating
On
Scan Type
Helical
Rotation Time
0.4
Rotation Length
Full
Start Location
End Location
Apex of heart
Number of images
40
12-27
Parameters
Thickness/Speed
5 mm
Pitch
Interval
5 mm
Gantry Tilt
SFOV
Small or Large
kV
120
mA
Prep Delay
ISD
N/A
Breath Hold
Breathe Time
DFOV
25 cm
Recon Type
Standard
Parameters
Gating
On
Scan Type
Cine
Rotation Time
Rotation Length
Segment
Start Location
End Location
Apex of heart
Number of images
Thickness/Speed
12-28
Parameters
Pitch
N/A
Interval
20 mm
Gantry Tilt
SFOV
Large
kV
120
Prep Delay
0 seconds
If using autovoice, prep delay will adjust to the length
of the message.
ISD
1.3 seconds
Breath Hold
Breathe Time
DFOV
25 cm
Do not change. This DFOV is required to post process
in SmartView.
Recon Type
Standard
Reconstructions
Segment
Trigger Delay
70 %
12-29
Parameters
Gating
On
Scan Type
Axial
Rotation Time
1.0 second
Rotation Length
Full
Number of images
12-15
Thickness/Speed
Pitch
N/A
Interval
Gantry Tilt
SFOV
kV
120
mA
50
Prep Delay
5 seconds
ISD
1.0 second
Breath Hold
Breathe Time
DFOV
25 cm
Suggested Volume/Rate
Recon Type
Standard
12-30
Cardiac
SnapShot Segment
(Helical)
Parameters
30-74 BPM
Gating
On
On
On
On
Scan Type
SnapShot Pulse
(Cine)
SnapShot Segment
(Helical)
SnapShot Burst
(Helical)
SnapShot Burst
Plus (Helical)
Rotation
Time
0.35 seconds
0.35 seconds
0.35 seconds
0.35 or 0.37
seconds
Rotation
Length
Cine Segment
Cardiac Segment
Cardiac Segment
Cardiac Segment
Start
Location*
End Location
Thickness
0.625 mm
0.625 mm
0.625 mm
0.625 mm
Pitch
N/A
This is
automatically
selected by the
scanner based on
the heart rate.
Automatic
This is
automatically
selected by the
scanner based on
the heart rate
entered in Heart
Rate Override.
Interval
0.625 mm
0.625 mm
0.625 mm
0.625 mm
Gantry Tilt
SFOV
Cardiac Small
Cardiac Large
Cardiac Small
Cardiac Large
Cardiac Small
Cardiac Large
Cardiac Small
Cardiac Large
kV
120
120
120
120
mA
210-300
210-300
210-300
210-300
Action
Cardiac
SnapShot Burst
(Helical)
Parameters
75-113 BPM
Cardiac
SnapShot Burst
Plus (Helical)
Parameters
> 114 BPM
12-31
Action
(Continued)
Cardiac
SnapShot Pulse
(Cine) Parameters
< - 65 BPM
Cardiac
SnapShot Segment
(Helical)
Parameters
30-74 BPM
Cardiac
SnapShot Burst
(Helical)
Parameters
75-113 BPM
Cardiac
SnapShot Burst
Plus (Helical)
Parameters
> 114 BPM
Prep Delay
20 seconds is the
Default.
Replace with the
value determined
from Test Bolus
doing MIROI
calculation for
peak contrast
enhancement to
optimize Prep
Delay value for this
patient dependent
parameter.
20 seconds is the
Default.
Replace with the
value determined
from Test Bolus
doing MIROI
calculation for
peak contrast
enhancement to
optimize Prep
Delay value for this
patient dependent
parameter.
20 seconds is the
Default.
Replace with the
value determined
from Test Bolus
doing MIROI
calculation for
peak contrast
enhancement to
optimize Prep
Delay value for this
patient dependent
parameter.
20 seconds is the
Default.
Replace with the
value determined
from Test Bolus
doing MIROI
calculation for
peak contrast
enhancement to
optimize Prep
Delay value for this
patient dependent
parameter.
Breath Hold
3 to 5 seconds
before x-ray starts
and continue thru
scan completion.
Typically <10
seconds.
3 to 5 seconds
before x-ray starts
and continue thru
scan completion.
Typically <10
seconds.
3 to 5 seconds
before x-ray starts
and continue thru
scan completion.
Typically <10
seconds.
3 to 5 seconds
before x-ray starts
and continue thru
scan completion.
Typically <10
seconds.
Voice Lights
Timer
Recon Option
SS-40
SS-40
SS-40
SS-40
DFOV
25 cm (adjustable)
25 cm (adjustable)
25 cm (adjustable)
25 cm (adjustable)
Algorithm
Stnd
Stnd
Stnd
Stnd
Suggested
Volume/Rate
75-100 cc at 5cc
per second
75-100 cc at 5cc
per second
75-100 cc at 5cc
per second
75-100 cc at 5cc
per second
12-32
Cardiac
SnapShot Segment
(Helical)
Parameters
30-74 BPM
Gating
On
On
On
On
Scan Type
SnapShot Pulse
(Cine)
Hi Res ON
SnapShot Segment
(Helical)
Hi Res ON
SnapShot Burst
(Helical)
Hi Res ON
SnapShot Burst
Plus (Helical)
Hi Res ON
Rotation
Time
0.35 seconds
0.35 seconds
0.35 seconds
0.35 or 0.37
seconds
Rotation
Length
Cine Segment
Cardiac Segment
Cardiac Segment
Cardiac Segment
Start
Location*
End Location
Thickness
0.625 mm
0.625 mm
0.625 mm
0.625 mm
Pitch
N/A
This is
automatically
selected by the
scanner based on
the heart rate.
Automatic
This is
automatically
selected by the
scanner based on
the heart rate
entered in Heart
Rate Override.
Interval
0.625 mm
0.625 mm
0.625 mm
0.625 mm
Gantry Tilt
SFOV
Cardiac Small
Cardiac Large
Cardiac Small
Cardiac Large
Cardiac Small
Cardiac Large
Cardiac Small
Cardiac Large
kV
120
120
120
120
mA
350-500
350-500
350-500
350-500
Action
Cardiac
SnapShot Burst
(Helical)
Parameters
75-113 BPM
Cardiac
SnapShot Burst
Plus (Helical)
Parameters
> 114 BPM
12-33
Action
(Continued)
Cardiac
SnapShot Pulse
(Cine) Parameters
< - 65 BPM
Cardiac
SnapShot Segment
(Helical)
Parameters
30-74 BPM
Cardiac
SnapShot Burst
(Helical)
Parameters
75-113 BPM
Cardiac
SnapShot Burst
Plus (Helical)
Parameters
> 114 BPM
Prep Delay
20 seconds is the
Default.
Replace with the
value determined
from Test Bolus
doing MIROI
calculation for
peak contrast
enhancement to
optimize Prep
Delay value for this
patient dependent
parameter.
20 seconds is the
Default.
Replace with the
value determined
from Test Bolus
doing MIROI
calculation for
peak contrast
enhancement to
optimize Prep
Delay value for this
patient dependent
parameter.
20 seconds is the
Default.
Replace with the
value determined
from Test Bolus
doing MIROI
calculation for
peak contrast
enhancement to
optimize Prep
Delay value for this
patient dependent
parameter.
20 seconds is the
Default.
Replace with the
value determined
from Test Bolus
doing MIROI
calculation for
peak contrast
enhancement to
optimize Prep
Delay value for this
patient dependent
parameter.
Breath Hold
3 to 5 seconds
before x-ray starts
and continue thru
scan completion.
Typically <10
seconds.
3 to 5 seconds
before x-ray starts
and continue thru
scan completion.
Typically <10
seconds.
3 to 5 seconds
before x-ray starts
and continue thru
scan completion.
Typically <10
seconds.
3 to 5 seconds
before x-ray starts
and continue thru
scan completion.
Typically <10
seconds.
Voice Lights
Timer
Recon Option
VS-40
VS-40
VS-40
VS-40
DFOV
25 cm (adjustable)
25 cm (adjustable)
25 cm (adjustable)
25 cm (adjustable)
Algorithm
HD Stnd
HD Stnd
HD Stnd
HD Stnd
Suggested
Volume/Rate
75-100 cc at 5cc
per second
75-100 cc at 5cc
per second
75-100 cc at 5cc
per second
75-100 cc at 5cc
per second
NOTE: * Start location will need to be adjusted higher for patients who have by-pass graphs.
12-34
When retro reconstructing a multi phase (MP) data set to the acquired slice thickness the
series numbers are as follows if the original series number is 4.
If images are Retro Reconstructed with a thicker slice, the series number has an additional
50 added on.
12-35
7
8
9
Function
1
HR Range
Display
12-36
Function
2
Heart Rate
Curve
Trigger
Location
Save
Restore
Measure
Zoom In
Zoom Out
12-37
Adjust/Move Triggers
The following instructions outline methods the user can employ to perform edits or
adjustments to the ECG trigger locations in the Retro Recon with ECG Viewer option
installed. Edits to the trigger information may not be needed for the majority of exams or for
routine use. Edits to the waveform may enable you to override the systems performance
and to reconstruct images using the edited trigger information. The series description for
series reconstructed with edited trigger points is annotated with ECG+ in order to know that
your interpretation of the trigger information was utilized.
Most edits can be made by right clicking with the mouse on the ECG Viewer display and
accessing the right click menu, or by the left click and drag operation.
Figure 12-21 Move Trigger Location
Old
Position
New
Position
Clicking on the R-Peak-trigger and dragging it to the desired position on the trace can move
triggers. R-Peak-triggers can be moved for the x-ray on range of recorded R-Peak-triggers
(x-ray on time).
NOTE: SnapShot Pulse acquisitions have limited X-ray on during the cardiac cycle, which
limit the flexibility to adjust trigger locations. The X-ray on window cannot be
repositioned after the scan is complete. Cardiac Helical (SnapShot Segment,
SnapShot Burst, SnapShot Burst Plus) acquisitions have continuous X-ray on period
throughout the scan duration. They have a higher degree of flexibility to adjust the
trigger points.
12-38
4
Table 12-13 Right Click Options
Right Click
1. Insert Trigger
2. Delete Trigger
3. Invert Trace
4. Undo
12-39
Insert Triggers
Figure 12-23 Insert Trigger
12-40
Delete Triggers
Figure 12-24 Delete a Trigger
Invert a Trace
Figure 12-25 Invert a Trace
Inversion of the trace about the
baseline can be done when the
application is in the default edit
mode.
The trace can be inverted
repeatedly by clicking the invert
button.
You are allowed to edit triggers on
the inverted waveform and save
the triggers.
Inverted waveform are not saved.
12-41
Measure Mode
Figure 12-26 Measure Mode
12-42
This enables you to adjust magnification setting of the ECG Trace can be enabled by clicking
on the [Zoom In] or [Zoom Out] buttons.
When the [Zoom In] button is clicked, you can zoom in by a fixed amount in the x direction
only. The [Zoom In] button can be clicked several times until the zoom in maximum is
reached of 5 times the size of the original trace.
When the [Zoom Out] button is clicked, you can zoom out by a fixed amount in the x
direction only. The [Zoom Out] button can be clicked several times until the [Zoom Out]
maximum is reached. The trace is loaded in the maximum zoomed out state.
The scale of the plot is set such that the selected region fills up the entire trace viewport.
You can scroll to any other part of the trace at the selected zoom level.
You can perform all editing of the trace at the selected zoom level.
12-43
How Do I...
This section provides the step-by-step instructions for cardiac imaging acquisitions.
Specifically, it describes how to:
Set Up a Patient
12-44
Set Up a Patient
Before bringing the patient in the scan room, make sure that you have everything ready. The
ECG monitor should be plugged in and connected to the gantry with the leads plugged into
the monitor. Have a supply of fresh unexpired ECG electrodes available. Make sure that the
cardiac protocol is built and ready to use. Have the injector loaded with contrast.
NOTE: Use electrodes made with silver/silver chloride (Ag/AgCl) gel on the pad. Do not use
other additional gels. We recommend using the electrodes that are shipped with the
system.
NOTE: The GE recommended electrodes are Dyna/Trace1500 by ConMed.
It is recommended to have the patient fast for ~4 hours prior to their appointment
due to the introduction of contrast media in this examination.
In addition the patient should be advised not to consume any caffeine containing
substances for 12 hours prior to the examination. These could raise the heart rate. An
example is coffee.
In order to keep the heart rate as low as possible the patient should also be advised
not to engage in any cardiovascular exercise prior to the examination.
Administration of Beta Blockers and/or Sublingual Nitroglycerin Spray can be used at
the sites discretion.
The key to cardiac imaging is a Stable Heart Rate, ideally less than 5 BPM variation,
but no more than 10 BPM variation for the most successful exams.
Explain the exam to the patient.
1. Load the injector.
For single barrel injector's: Load with 80-100cc of contrast.
NOTE: The total volume and strength of contrast used is the site's discretion.
For dual barrel injector's: Load contrast syringe with 70-90cc of 300 to 350 strength
contrast media.
NOTE: The total volume and strength of contrast used is the site's discretion. Also, load saline
syringe with 50cc Saline. Explain the exam to the patient.
2. Position the patient supine feet first on the cradle.
3. Start an IV line for the contrast injection.
4. Prepare the patient for lead placement.
a) Place arms above patients head.
b) Gently scrub the location with cotton gauze until the skin is a healthy pink.
Do not use alcohol.
c) If necessary, shave a four-square-inch area.
12-45
Electrodes may be placed farther out on the arms or in this alternate position.
12-46
If you do not have a good connection, check to make sure that the cable
connecting the ECG machine to the backside of the Gantry is plugged in properly,
and the same cable is connected to the ECG Machine. In case of low signal, please
check electrode placement and chose alternate position if needed. If there is
"noise" within the ECG wave, it is recommended that you DO NOT SCAN, until this
condition is corrected.
7. Perform an impedance check to make sure that there is no issue with electrode
conductivity with the patient.
If the impedance is good, the value for the lead will be listed in green on the monitor.
If the value is below the acceptable level, the value is shown in red.
If the impedance check does not pass, re-prep and replace any of the electrodes that
do not pass.
12-47
12-48
12-49
Scout Scans
This series is scanned to localize the area that you need for scanning the cardiac series. This
description assumes you have selected the appropriate protocol based on the heart rate for
SnapShot Segment, SnapShot Burst, or SnapShot Burst Plus.
1. Landmark the patient at the sternal notch.
2. Click [New Patient] and enter the patient information.
3. Select the Cardiac protocol and accept it.
4. To verify that the scanner is receiving the ECG signal, click [Gating Off] on the view/edit
screen.
Figure 12-31
If the system detects a valid ECG signal, the patient's heart rate average in Beats Per
Minute (BPM) is displayed on the gating button. On the Console, the BPM is a 3 cycle
average of the R-R interval. On the ECG Monitor, the BPM value displayed is a 3 cycle
average for the IVY 3150-B or 3100-B with Ethernet.
12-50
If the system detects no signal from the ECG monitor, the button turns red and no
BPM value is displayed.
12-51
Localizer Scan
This series is used to find your starting and ending locations for the heart.
1. Click [Next Series] from the protocol.
2. Click [Show Localizer] and position the scans so you scan from approximately one inch
below the carina to the apex of the heart.
NOTE: Pay close attention to where the position of the scan is taken. It should cover the
complete heart.
3. Set up Low-Dose helical scan parameters.
120kV, 0.4 sec., 60 mA (100mAfor large patients) 1.375:1 pitch 55 table speed.
4. Click [Accept].
5. Click [Confirm].
6. Give the patient the same breathing instruction that you have practiced with.
7. Press Move to scan.
8. Press Start Scan.
12-52
12-53
12-54
2. Click [Show Localizer] and position the scans so you scan from approximately one inch
below the carina to the apex of the heart.
NOTE: Pay close attention to where the position of the scan is taken. It should cover the
complete heart. Be careful not to overscan the area
3. Click [Gating] and the CardIQ SnapShot window opens for Cardiac Helical acquisition or
the SnapShot Pulse window opens for Cardiac Cine acquisitions.
12-55
The auto detect mode is the default pitch selection method for SnapShot Segment
and SnapShot Burst and automatically set the pitch based on the patient's heart rate
when the scan is confirmed. If you have found that the heart rate is different during
the breath holds, you should enable Heart Rate Override and manually enter a heart
rate value to the minimum hear rate for the HR Range that contains the observed
value. The pitch chart tables in Table 12-15 and Table 12-15 represent an overview of
the pitches available for the various scanner configurations.
12-56
Use the default Dynamic Padding value or prescribe a padding value to account for
variation in heart rate during the scan. Padding is prescribed in milliseconds and is
added to either side of the center of the half-scan acquisition window. Turn the
Padding Override button to [On] to enable the Dynamic Padding field to accept
manual entries. The following, Table 12-14, lists the default and recommended
padding values for various heart rate ranges. The range for padding is from 0 to 200
msec.
Table 12-14
Heart Rate (HR) Dependent Padding
HR Range
30-39
175
40-49
150
50-59
125
60->
100
12-57
12-58
Gantry Speed
Recon/Scan Mode
Pitch
30-40 BPM
0.35
0.16
41-49 BPM
0.35
0.18
49-57 BPM
0.35
0.20
58-65 BPM
0.35
0.22
66-74 BPM
0.35
0.24
75-85 BPM
0.35
0.20
86-95 BPM
0.35
0.22
96-113 BPM
0.35
0.24
114+ BPM
0.35
0.20
Table 12-16 Pitch Chart for Discovery CT750 HD 64 slice with 0.4 second gantry rotation
speed
Discovery CT750 HD 64 with maximum 0.40 sec./rotation gantry speed
HR Range
Gantry Speed
Recon/Scan Mode
Pitch
30-42 BPM
0.40
0.18
43-49 BPM
0.40
0.20
50-59 BPM
0.40
0.23
60-69 BPM
0.40
0.26
70-80 BPM
0.40
0.20
81-94 BPM
0.40
0.22
95-104 BPM
0.40
0.20
105+ BPM
0.40
0.20
12-59
12-60
Phase Entry allows you to change the percentage of R-to-R interval by entering in a
start and end phase and the phase increment. The recommended reconstruction
12-61
Lists common
phases available for
reconstruction
This area displays
the phase ranges
covered for each
scan location in the
SnapShot Pulse
scan series.
Multiple scan
locations are
required to cover
the heart and each
may cover a unique
phase range if
heart rate
variations occur.
NOTE: You can only enter start and end phases within the acquired phase range displayed
in the SnapShot Pulse window.
3. Adjust the trigger points in the ECG waveform using R-Peak Editor in the ECG Viewer
window as needed.
For more information, refer to SEGM (Ungated segmented image reconstruction).
12-62
12-63
A message appears.
12-64
12-65
Adjust/Move Triggers
The following instructions outline methods the user can employ to perform edits or
adjustments to the ECG trigger locations in the Retro Recon with ECG Viewer option
installed. Edits to the trigger information may not be needed for the majority of exams or for
routine use. Edits to the waveform may enable you to override the systems performance
and to reconstruct images using the edited trigger information. The series description for
series reconstructed with edited trigger points is annotated with ECG+ in order to know that
your interpretation of the trigger information was utilized.
Most edits can be made by right clicking with the mouse on the ECG Viewer display and
accessing the right click menu, or by the left click and drag operation.
1. From the scan monitor, click [Retro Recon].
The Retro Recon list select screen appears. All images with available scan data are
listed.
2. From the Retro Recon list select screen, select the appropriate patient, exam, and series.
The most recently scanned examination are at the top of the list.
The Retro Recon view/edit page appears, showing all of the scan parameters
available for retro reconstruction.
3. Click [Select Series].
4. Click on [New Series Number] as needed.
5. Click [Retro] for all groups or click [Y] for an individual group.
If you select [Retro], a pop up window appears. Choose [Yes] or [No]. You may also
click on the individual group and toggle between [Y] and [N].
The system assumes all available data is to be reconstructed. If there are multiple
groups, you must determine which group(s) has data you wish to reconstruct.
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Insert Triggers
This is done to normalize a heart cycle.
NOTE: Due to the prospectively gated nature of SnapShot Pulse scans, retro-recon is limited
to the data acquired during the scan. Therefore, inserting, adjusting or deleting
R-peak triggers in SnapShot Pulse acquisitions may not improve the gating
effectiveness for the scan.
1. From the scan monitor, click [Retro Recon].
The Retro Recon list select screen appears. All images with available scan data are
listed.
2. From the Retro Recon list select screen, select the appropriate patient, exam, and series.
The most recently scanned examination are at the top of the list.
The Retro Recon view/edit page appears, showing all of the scan parameters
available for retro reconstruction.
3. Click [Select Series].
4. Click on [New Series Number] as needed.
5. Click [Retro] for all groups or click [Y] for an individual group.
If you select [Retro], a pop up window appears. Choose [Yes] or [No]. You may also
click on the individual group and toggle between [Y] and [N].
The system assumes all available data is to be reconstructed. If there are multiple
groups, you must determine which group(s) has data you wish to reconstruct.
Figure 12-38 Retro Recon Window
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Delete a Trigger
This is used to remove an extra trigger.
NOTE: Due to the prospectively gated nature of SnapShot Pulse scans, retro-recon is limited
to the data acquired during the scan. Therefore, deleting triggers in SnapShot Pulse
cases may not improve the gating response for these types of acquisitions.
1. From the scan monitor, click [Retro Recon].
The Retro Recon list select screen appears. All images with available scan data are
listed.
2. From the Retro Recon list select screen, select the appropriate patient, exam, and series.
The most recently scanned examination are at the top of the list.
The Retro Recon view/edit page appears, showing all of the scan parameters
available for retro reconstruction.
3. Click [Select Series].
4. Click on [New Series Number] as needed.
5. Click [Retro] for all groups or click [Y] for an individual group.
If you select [Retro], a pop up window appears. Choose [Yes] or [No]. You may also
click on the individual group and toggle between [Y] and [N].
The system assumes all available data is to be reconstructed. If there are multiple
groups, you must determine which group(s) has data you wish to reconstruct.
Figure 12-40 Retro Recon Window
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Invert a Trace
Use this when you need to invert the ECG trace.
1. From the scan monitor, click [Retro Recon].
The Retro Recon list select screen appears. All images with available scan data are
listed.
2. From the Retro Recon list select screen, select the appropriate patient, exam, and series.
The most recently scanned examination are at the top of the list.
The Retro Recon view/edit page appears, showing all of the scan parameters
available for retro reconstruction.
3. Click [Select Series].
4. Click on [New Series Number] as needed.
5. Click [Retro] for all groups or click [Y] for an individual group.
If you select [Retro], a pop up window appears. Choose [Yes] or [No]. You may also
click on the individual group and toggle between [Y] and [N].
The system assumes all available data is to be reconstructed. If there are multiple
groups, you must determine which group(s) has data you wish to reconstruct.
Figure 12-42 Retro Recon Window
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12-81
The Retro Recon list select screen appears. All images with available scan data are
listed.
2. From the Retro Recon list select screen, select the appropriate patient, exam, and series.
The most recently scanned examination are at the top of the list.
The Retro Recon view/edit page appears, showing all of the scan parameters
available for retro reconstruction.
3. Click [Select Series].
4. Click on [New Series Number] as needed.
5. Click [Retro] for all groups or click [Y] for an individual group.
If you select [Retro], a pop up window appears. Choose [Yes] or [No]. You may also
click on the individual group and toggle between [Y] and [N].
The system assumes all available data is to be reconstructed. If there are multiple
groups, you must determine which group(s) has data you wish to reconstruct.
Figure 12-44 Retro Recon Window
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The Retro Recon list select screen appears. All images with available scan data are
listed.
2. From the Retro Recon list select screen, select the appropriate patient, exam, and series.
The most recently scanned examination are at the top of the list.
The Retro Recon view/edit page appears, showing all of the scan parameters
available for retro reconstruction.
3. Click [Select Series].
4. Click on [New Series Number] as needed.
5. Click [Retro] for all groups or click [Y] for an individual group.
If you select [Retro], a pop up window appears. Choose [Yes] or [No]. You may also
click on the individual group and toggle between [Y] and [N].
The system assumes all available data is to be reconstructed. If there are multiple
groups, you must determine which group(s) has data you wish to reconstruct.
Figure 12-46 Retro Recon Window
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The Retro Recon list select screen appears. All images with available scan data are
listed.
2. From the Retro Recon list select screen, select the appropriate patient, exam, and series.
The most recently scanned examination are at the top of the list.
The Retro Recon view/edit page appears, showing all of the scan parameters
available for retro reconstruction.
3. Click [Select Series].
4. Click on [New Series Number] as needed.
5. Click [Retro] for all groups or click [Y] for an individual group.
If you select [Retro], a pop up window appears. Choose [Yes] or [No]. You may also
click on the individual group and toggle between [Y] and [N].
The system assumes all available data is to be reconstructed. If there are multiple
groups, you must determine which group(s) has data you wish to reconstruct.
Figure 12-48 Retro Recon Window
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Chapter 13
13-1
Neuro 3D Filter
13-2
Icon
Description
Start New
Combine
Current
Off
Single Step
Protocols
13-3
Icon
Description
This allows you to define camera, formats, and start
options for filming reformatted images to the Direct film
Composer.
Filming Setup
Auto Batch
NOTE: You will not have the ability to set the localizer lines
on the reference image.
Allows you to set up a protocol so the system will
automatically archive reformatted images to the default
archive device selected for the system after they are
created.
Auto Store
13-4
Icon
Description
Allows you to set up a protocol so the system will network
the formatted images to desired network location. Up to
four remote hosts can be selected. Use [Apply All] to copy
selected list of host to all the protocols prescribed.
Auto Transfer
13-5
Page Turner
13-6
DMPR Icon
13-7
6 7 8
10 11
12
Icon
Minimize
Zoom
Description
Clicking on this icon to minimize the review
controller around the image viewport.
This allows you to fit your images in the
viewport by making the images larger or
smaller as needed. Once you have made an
image larger or smaller, all of the images in the
series are displayed in the same adjusted size.
NOTE: This is a right mouse key function.
Pan/Roam
13-8
Icon
Description
Display Normal
Render Mode
Measurements
Screen Save
Screen Lock
Loop
Rock
10
11
13-9
12
Icon
Scroll Images
Description
Clicking and dragging up and down on the
middle of the slider. The images will scroll within
the series.
Click and drag on the outside bar of the slider
to change the slice thickness of the images
being displayed.
NOTE: The right screen display can toggle between DMPR and 2D display. The focus outline
around the DMPR or Layout buttons will indicate the display which is currently active.
To toggle back to DMPR, click on [Continue Direct MPR Review].
Figure 13-5 Continue Direct MPR Review
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13-11
Neuro 3D Filter
Neuro 3D Filter is a noise reduction filter optimized for thin slice data that is intended for
post processing in Reformat to create Average and MIP images, Volume Rendering and 3D
models for Neurological studies such as Circle of Willis, Carotids, Sinuses, Orbits, Mandible
and helical Brain. The Neuro 3D Filter can be used to reduce noise in images or reduce dose
while maintaining image quality. It may be possible to reduce dose by 10-30% and maintain
acceptable image noise level and image quality depending on the level of filtering selected.
Neuro 3D Filter removes noise from the image while preserving image resolution.
Retrospectively, Neuro 3D Filter is selected in the Browser on Image Works desktop. There
are three levels: Low, Medium and High. Images processed using Low are saved in a series
that is the original series number plus 30. Images processed using Medium are saved in a
series that is the original series number plus 40. Images processed using High are saved in a
series that is the original series number plus 50.
Neuro 3D Filter is only compatible with series that have a single group without repeated
image locations. It is not possible to select a subset of a series. A message will be displayed if
the series is not compatible with Neuro 3D Filter. Neuro 3D Filter is not compatible with ASIR.
Figure 13-7 Incompatibility Message
13-12
How Do I...
This section provides the step-by-step instructions for performing Auto Applications.
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13-14
13-15
13-16
13-17
Quick Steps: Set the Direct MPR Parameters in the Scan Prescription
1. Click on the Recon Tab.
2. Click [Off] in the Auto Apps column.
3. Click [DMPR].
4. Click [OK].
5. Click [Start New] to start a new DirectMPR session.
6. Click [Unused].
7. Click Next and Prior arrows to review all protocols in the list.
8. Click on the reformat protocols you wish to select.
9. Click [OK].
10. Click [Setup] to select the film composer format for filming.
11. Click [OK].
12. Click [Off] under Filming.
13. Click [Off] under Auto Batch.
14. Click [Off] under Auto Store.
15. Click [Off] under Auto Transfer.
16. Click [OK].
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13-19
Chapter 14
Performed Procedure
Step (PPS) (Option)
Introduction
This chapter explains how to use the Performed Procedure Step (PPS) option. It contains the
step-by-step instructions to help you learn how to:
14-1
14-2
How Do I...
This section provides the step-by-step instructions for utilizing the Performed Procedure
Step (PPS) feature. Specifically, it describes how to:
14-3
14-4
Chapter 15
15-1
Exam Split
Virtual Mode
Hard Mode
Exam Split
Provides you with the capability to "split" a series of patient images into separate groups.
These new smaller image groups can be networked to desired reading stations for multiple
"reads" and multiple billings on select patient exams.
Using the Exam Split option will allow for split images from a single acquisition and assign
them to a Requested Procedure ID or accession number retrospectively. On the ImageWorks
desktop using Exam Split, all the images of the scan will be loaded. Using left mouse key to
select the first image and shift, left mouse key simultaneously to choose the last image to
be sent to a specific exam procedure.
At scan time all Patient records that you wish to have available to split to must be selected
from the Patient Schedule when selecting New Patient. Your system will be configured in
one of two modes for Exam Split. The mode configured is dependent on the capabilities of
the system you are sending images to review.
Exam Split requires that the Connect Pro option be installed.
Virtual Mode
Your remote station must support Performed Procedure Step (PPS) and Gray Scale
Presentation State (GSPS). Images will be Auto Transferred to the Remote station. In Exam
Split ranges of images will be assigned to each accession number or procedure code and a
Gray Scale Presentation State (GSPS) object will be created and transferred when selected.
Hard Mode
Hard Exam Split will create a new series of images for each accession number or procedure
code ranges of images are assigned to. For this reason images will not be Auto Transferred
to the Remote Station.
Your GE Field Engineer will configure your site for the mode of Exam Split based on input
from your sites IT and PACS administration.
15-2
Comment Area
15-3
How Do I...
This section provides the step-by-step instructions for utilizing the Exam Split (Option).
Specifically, it describes how to:
15-4
15-5
7. Select desired Requested Procedure ID or Accession Number from the available list
which reflects the procedures selected from Patient Schedule for New Patient.
This is from the list of exams registered to this patient from ConnectPro.
15-6
HES Mode
9. Adjust the Window Level if needed.
Set the window/level for the images using the mouse or W/L preference buttons.
10. Click [Add].
The images will be added to the procedure list.
11. Hilight the procedure or procedures you wish to send and click [Send].
Repeat until you have sent all procedures you have images added to.
The images are transferred to the desired host.
If the system is configured for VES, a GSPS object is sent to the remote station. If HES
mode is configured, a new series of images will be sent to the remote hosts.
You can select more than one procedure if you are sending them to the same
destination.
You can select the Browser to exit Exam Split before the images have completed
transferring. A pop up message will display after the transfer is complete.
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15-8
15-9
15-10
SmartStep (Option)
Chapter 16
SmartStep (Option)
Introduction
SmartStep is a mode of scanning designed for interventional procedures. The Radiologist or
Physician usually inserts a needle or catheters into a patient and then need to see images
showing the position of the catheter or needle.
This chapter explains the SmartStep imaging process. It contains the step-by-step
instructions to help you learn how to:
16-1
SmartStep (Option)
SmartStep
SmartStep Display
SmartStep
SmartStep is a mode of scanning designed to be use by the Radiologist or Physician during
interventional procedures. The SmartStep is accomplished by using the integrated Hand
Held Controller (HHC) and foot switch.
The available slice thicknesses of SmartStep are: 2.5 mmand 5 mm. These are created from
using a 4X detector configuration. Detector rows one and two create image one. In the case
of 2.5 slice thickness, detector rows one, two, three, and four create image one. Detector
rows three, four, five and six create image two. Detector rows five, six, seven and eight
create image three. The configuration for 2.5 mm slice thickness is the 8 - 0.625 5 mm beam
collimation. The configuration for 5 mm slice thickness is the 16 - 0.625 10 mm beam
collimation. detector configuration.
Only the 0.8 second and 1 second full rotation scan times are available for SmartStep on
Discovery CT750 HD. All algorithms are available for reconstructions.
16-2
SmartStep (Option)
NOTE: Other desktops are unavailable during SmartStep.
16-3
SmartStep (Option)
Figure 16-1 Hand Held Controller
Alignment Light
Prep
Move to Start Location
Cradle Move In
Bump In
Bump Out
Disabled
Cradle Release
Change Focus
Next Image
Prior Image
W/L Toggle
Button
Description
Prepares the system for x-ray acquisitions.
16-4
SmartStep (Option)
Button Name
Alignment Light
Move to Start
Location
Button
Description (Continued)
This button Enables the laser positioning lights.
Cradle Move In
Bump In
Bump Out
Disabled
Cradle Release
Change Focus
Next Image
16-5
SmartStep (Option)
Button Name
Button
Description (Continued)
Prior Image
W/L Toggle
SmartStep Display
SmartStep display provides three viewports for interventional images on the top of the
display window with a free viewport at the bottom of the display window. The free viewport
allows you to choose any image to be displayed by clicking on [List/Select]. The three
interventional viewports automatically update each time an exposure is made with the foot
pedal.
Figure 16-2 SmartStep window
First Image
Second Image
Third Image
Free Viewport
NOTE: Images in the interventional viewport are displayed superior to inferior in location.
NOTE: If images are not available after a step, the viewport will be blank. Use Prior image
on the Hand Held Control and then press Next image to display the missing images.
16-6
SmartStep (Option)
The Remaining time indicates how much time you have left in this series before you have to
go back to the View/Edit screen and click [Confirm] again. The Accumulative time indicates
how much time the patient has been exposed to radiation. This time will keep updating as
long as you stay in the same exam. Once you end the exam, the accumulative time resets to
zero.
NOTE: The total accumulated exposure time for all SmartStep scan groups and Series will
be displayed on the Dose Text page.
CAUTION:
16-7
SmartStep (Option)
How Do I...
This section provides the step-by-step instructions for using the SmartStep scan mode.
Specifically, it describes how to:
16-8
SmartStep (Option)
16-9
SmartStep (Option)
5. Prepare the patient and supplies for the procedure.
Have your biopsy tray and other supplies ready for the Physician or Radiologist.
Prepare the patient for the procedure by creating a sterile area and explaining the
breathing instructions.
16-10
SmartStep (Option)
2. Click [SmartStep].
3. Click [Scan Type] and select [0.8 sec] or [1.0 sec].
You can choose between the 0.8 second full rotation or the 1.0 second full rotation
4. Click [Start Location] and enter the initial image location where you want to start.
5. Click [Slice Thickness] and select the desired slice thickness.
You can choose between 2.5 mm, or 5.0 mm.
16-11
SmartStep (Option)
7. Click [SFOV] and enter the desired scan field of view.
8. Click [kV] and select the desired kV.
9. Click [mA] and select or enter the desired mA.
10. Click [Exposure Time] and enter the maximum exposure time.
This is a time that is entered before you have to reset the timer.
11. Click [Bump Distance] and enter the distance you want the cradle to bump in or out.
The default Bump Distance is half of the selected slice thickness.
12. Enter the display parameters for DFOV, R/L Center, A/P Center, and Recon Type.
All algorithms are available. If Edge is selected, the time to display the interventional
images will be increased.
13. Click [Confirm].
A warning message appears.
16-12
SmartStep (Option)
Select SmartStep from the Dynaplan screen or by clicking [Create New Series].
Click [SmartStep].
Click [Scan Type] and select [0.8 sec] or [1.0 sec].
Click [Start Location] and enter the initial image location where you want to start.
Click [Slice Thickness] and select the desired slice thickness.
Click [Gantry Tilt] and enter the desired tilt.
Click [SFOV] and enter the desired scan field of view.
Click [kV] and select the desired kV.
Click [mA] and select or enter the desired mA.
Click [Exposure Time] and enter the maximum exposure time.
Click [Bump Distance] and enter the distance you want the cradle to bump in or out.
Enter the display parameters for DFOV, R/L Center, A/P Center, and Recon Type.
Click [Confirm].
Click [Continue].
16-13
SmartStep (Option)
Once the Prep button has been pressed or clicked, the screen will update to PREP IN
PROGRESS.
2. The system is ready for scans when the READY TO SCAN message indicator appears.
16-14
SmartStep (Option)
3. Step on the foot pedal to make an exposure in the SmartStep scanning mode.
The XRAY ON message indicator appears.
NOTE: After each rotation, you must release foot peddle before you scan again.
5. Repeat steps 1-4 as many times as necessary while scanning in the SmartStep mode.
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SmartStep (Option)
16-16
SmartStep (Option)
16-17
SmartStep (Option)
16-18
SmartStep (Option)
16-19
SmartStep (Option)
3. Enter the desired window width and level for all six locations.
NOTE: Keep the mouse inside the text box while typing the parameter.
4. Click [Save as defaults] to save the values entered.
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SmartStep (Option)
16-21
Scheduling Patients
Chapter 17
Scheduling Patients
Introduction
This chapter explains how to schedule patients. It contains the step-by-step instructions to
help you learn how to:
17-1
Scheduling Patients
Patient Schedule
Connect Pro
Patient Schedule
Patient Schedule is a feature which allows patient information and exam protocols to be
pre-programmed in advance of patient arrival. At scan time, you can either select from the
created list, enter the patient ID number, enter the Accession number or use the optional Bar
Code Reader to call up patient information. Patient information can be easily added or
deleted from this list.
Connect Pro
Connect Pro is a purchasable option which retrieves critical patient information from your
HIS/RIS using a DICOM connection and sends it to your scanner. Connect Pro pulls
information from HIS/RIS and put it into Patient Schedule.
Connect Pro can also be customized to fit your departments needs by using "filters" to pull
only the information in which you are interested.
Connect Pro can collect more than just the standard demographic information about your
patients. It can also collect other information, such as allergies, pregnancy status, medical
alerts, or any other information about your patient.
17-2
Scheduling Patients
How Do I...
This section provides the step-by-step instructions to utilize the Schedule Patient feature.
Specifically, it describes how to:
17-3
Scheduling Patients
2. Aim the Bar Code Reader at the bar code for either Accession number or Patient ID on
the patient requisition.
The patient information is pulled from the Patient Schedule list and automatically fill
into the fields on the Patient Information screen.
Table 17-1 Patient Information
Field Name
Parameters
Accession Number
Up to 16 characters
Patient ID
Up to 16 characters
Patient Name
Up to 32 characters
Sex
M (Male) or F (Female)
Birthdate
Age
Weight
Kgs or Pounds
Reference Physician
Up to 32 characters
Radiologist
Up to 32 characters
Operator
Up to 3 characters
History
Up to 60 characters
Exam Description
Up to 22 characters
Protocol Number
Up to 5 characters
Req. Proc. ID
Up to 16 characters
Date
Time
17-4
Scheduling Patients
17-5
Scheduling Patients
NOTE: When entering the Patient ID, if more than one record with the same Patient ID is
found in the Patient schedule list a dialog displays notifying you of this. Be sure when
selecting the patient record that you have selected the correct entry for the scan
being performed. To avoid having multiple Patient Records with the same Patient ID
make sure to set the Delete Completed Exams preference to zero. This will assure that
only new records are in the Patient Schedule list.
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Scheduling Patients
2. Click [Update].
3. Under Get Patient List For:, click [This System], [All CT Systems], or [All Systems].
This System pulls the patient schedule for the current scanner you are on.
All CT Systems pulls the patient schedule for all of the CT systems on the HIS/RIS
connection.
All Systems pulls the patient schedule for all the systems on the HIS/RIS connection.
4. Select a Date Range.
Type in a From and To date. Be sure to follow the correct month/day/year format.
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Scheduling Patients
5. If desired, type the Requested Proc. ID or Accession Number information into the
correct fields.
This is an additional way to pull patient information.
6. If desired, type the patients name information into the correct field.
This is a quick way to search for a patients name.
7. If desired, type the patients ID information into the correct field.
8. Click [Continue Update] to continue or [Cancel Update] to cancel without saving any
new selections.
17-8
Scheduling Patients
The Patient Schedule information screen appears (it looks similar to the New Patient
screen).
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Scheduling Patients
17-10
Scheduling Patients
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Scheduling Patients
2. Click [Preferences].
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Scheduling Patients
4. Set the number of days to delete exams.
Type in the number of days after which you would like the scanner to delete the
completed exams.
The number must be between 0-30.
A completed record is not added to the Patient Schedule list if number of days is set
to 0.
The system default is 3.
NOTE: It is important to set the Delete Completed Exams to zero when Patient Information
is updated from the HIS/RIS. This assures that Completed Accession numbers are
not inadvertently selected for scanning a second time causing Patient reconciliation
issues on the PACS system.
5. With the Connect Pro option, click [Yes] or [No] to Update Schedule Automatically.
Selecting Yes updates the schedule when you click Patient Schedule.
It updates based on the parameters selected in Update.
6. With the Connect Pro option, click [Yes] or [No] to Show Update Parameters.
Selecting Yes shows the Update screen every time the system starts to automatically
update.
This allows you to edit the Update parameters, if desired.
7. With the Connect Pro option, click [Yes] or [No] for Use Study UID?
Selecting Yes uses a study instance UID (Unique Identifier) from HIS/RIS.
By selecting No, the scanner assigns the study instance UID (Unique Identifier) to the
exam.
8. With the Connect Pro option, click [Yes] or [No] for Edit Modality Worklist?
Selecting [No] prevents you from editing any patient information from HIS/RIS.
Selecting [Yes] allows you to edit any patient information from HIS/RIS.
9. Click [OK] to accept entries, or [Cancel] to cancel out without accepting entries.
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Scheduling Patients
NOTE: Preferences are not maintained between system software loads. Please update the
preferences after a software load has occurred.
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Scheduling Patients
17-15
Scheduling Patients
17-16
Scheduling Patients
17-17
Scheduling Patients
6. Click [Enter] to begin.
NOTE: From the New Patient screen, you can also type in the patient ID, Accession number
or use the optional Bar Code Reader to select a patient. Make sure you have the
correct field selected for your entry.
17-18
Scheduling Patients
The schedule list appears and the far right column is labeled Status.
17-19
Scheduling Patients
17-20
Scheduling Patients
3. Click [View More Info].
17-21
Biopsy Mode
Chapter 18
Biopsy Mode
Introduction
This chapter explains how to use the biopsy mode. The biopsy mode improves the efficiency
of setting up and acquiring slices during a biopsy.
This chapter contains the step-by-step instructions to help you learn how to:
18-1
Biopsy Mode
Biopsy Mode
Biopsy Mode
The Biopsy Mode or Biopsy Rx improves the efficiency of setting up and acquiring slices
during a biopsy. All of the parameters required are available on one menu. You are able to
choose which direction the scanner acquires images from a centering point as well as how
many images to acquire. You can change slice thickness and/or interval. You can enter a
specific location for a slice and a gantry tilt, if required.
NOTE: AutomA is turned off when Biopsy Mode is entered. Review the Manual mA value
prescribed.
18-2
Biopsy Mode
How Do I...
This section provides the step-by-step instructions for using the biopsy mode. Specifically, it
describes how to:
18-3
Biopsy Mode
WARNING: When scanning for interventional (biopsy) studies the scan mode, image
thickness, number of images per rotation and the display layout used affect
the display of the images. It is recommended to use the Biopsy Mode provided
on the system. If manually prescribing biopsy scans, Axial 1i scan mode or
Helical scan mode with a slice thickness greater than 2.5 mm must be used.
Do not use Cine scan mode for interventional (Biopsy) imaging. Do not use an
Auto view layout with more than one Auto View image viewport.
Refer to Select a Multiple Image Display for more information on how to set up the
desired viewing options.
1. From the view/edit screen, click [Biopsy Rx].
18-4
Biopsy Mode
A pop up window appears containing all of the Biopsy Rx Parameters.
18-5
Biopsy Mode
7. Enter the Image Interval.
Image Interval is for helical scans only.This sets the distance between images.
Commonly for a biopsy, the interval is set to the same value as the slice thickness or
with minimal overlap.
8. Click [Confirm Biopsy Rx] or [Cancel].
Confirm Biopsy Rx activates the scan sequence to acquire images. Cancel cancels
the Biopsy Rx window and does not acquire images.
NOTE: The Biopsy Rx button is also available from the Dynaplan screen. All of the steps
remain the same. It is very useful to utilize this button, especially if a series of biopsy
images have been acquired previously. This is because the biopsy images remains in
the same series number and there is no need to return to the view/edit screen.
NOTE: Biopsy Images are not AutoFilmed. If a previous scan group had AutoFilm on, it is now
turned off. Any subsequent scans done has to turn AutoFilm back on.
NOTE: Check the mA prescribed. AutomA is automatically turned off in Biospy Mode. Review
the mA value to ensure it is appropriate for the type of scan being performed. Return
to the view/edit screen and adjust mA as needed.
18-6
Chapter 19
Clinical table lateral motion verification procedure for PET-CT RT and CT-RT
Set Up
Procedure
Analysis of Results
Clinical table elevation adjustment verification procedure for PET-CT RT and CT-RT
Procedure
Analysis
19-1
19-2
19-3
Requirements
One metric ruler (minimum 1.0 mm resolution)
RT tabletop
100 pounds of standard weights (25 pounds plates recommended)
Figure 19-1 Metric ruler aligned with laser on top of cradle top
Set Up Procedure
1. Install RT flat top on cradle.
2. If a PET/CT system, move table base to CT position.
3. Set elevation at 150 mm below ISO.
NOTE: When reading the metric scale, it is important to read to 0.5 mm.
19-4
19-5
19-6
Results
Table 19-1 Use the chart below to record the results
Measurement Location
_____________________
Weight
_____________________
Room 1
_____________________ (mm)
Scan Plan 1
_____________________ (mm)
Room 2
_____________________ (mm)
Room 3
_____________________ (mm)
Scan Plane 2
_____________________ (mm)
Room 4
_____________________ (mm)
Room 5
_____________________ (mm)
Scan Plane 3
_____________________ (mm)
Room 6
_____________________ (mm)
19-7
19-8
H2
Weight
100 pounds
Room 1
0.0 mm
Scan Plan 1
-1.5 mm
Room 2
-3.5 mm
Room 3
-3.5 mm
Scan Plane 2
-2.5 mm
Room 4
-4.5 mm
Room 5
-4.5 mm
Scan Plane 3
-4.0 mm
Room 6
-5.5 mm
1. From "Room 6", it can be seen that the initial cradle lateral shift was 5.5mm, therefore if
the cradle were not cycled prior to scanning, the offset at the scan plane relative to the
room lasers could be this large.
2. After one cycle (extend between 890 mm to 850 mm, then retract) the offset at the scan
plane improves by 3.5mm (in this case) and therefore the actual offset is 2.0 mm
(5.5-3.5).
NOTE: One cycle equals a cradle in and out motion.
Some systems may only require one cycle, others may require three cycles.
3. After 2 cycles the offset at the scan plane improves by 4.5mm (in this case) and therefore
the actual offset is 1.0 mm (5.5-4.5).
4. Depending upon the desired level of offset, this method can be used to determine the
number of cycles needed.
19-9
19-10
Requirements
Medtec CT Simulation Laser QA device phantom or equivalent device (Figure 19-3,
requires 2 IPPS Lok-Bars)
RT tabletop
100 pounds of standard weights (25 pounds plates recommended)
Figure 19-3 LEFT - MedTec RT alignment device - RIGHT: CT orthogonal reformat image of
laser QA device (abdomen window level).
19-11
19-12
19-13
Results
NOTE: Post adjustment QA distance represents the accuracy of table vertical position
achievable with the workflow recommended in section one.
19-14
_____________________ (mm)
_____________________ (mm)
_____________________ (mm)
_____________________ (mm)
19-15
Chapter 20
Selecting a Protocol
20-1
Positioning Patients
Using Protocols
Using Contrast
Preset Descriptions
Positioning Patients
Before placing patients in scanner, each day the accessories that may be used during the
day while scanning should be inspected such as the head holder, table extension, patient
positioning sponges and straps to make sure they are in good working condition. Positioning
pads and straps should be inspected and cleaned to prevent possibility of artifacts being
introduced due to foreign matter such as contrast on the surfaces of these items. Do not use
accessories that maybe broken or torn. Make sure patients are comfortable as possible on
the table or in the head holder. Use positioning spongers and pads along with positioning
straps to aid in the positioning of the patient to help them hold the position needed to
complete the exam. If patients are comfortable, they will be able cooperate and hold still
during the exam. If arm support or catheter bag hanger is used make sure they are placed
securely on the table to support the arm or hold the catheter bag. Monitor the location of
the arm support or catheter bag holder to prevent any collisions with the gantry.Make sure
any sheets, blankets and patient clothing or gowns are not allowed to get caught as the
table is moving. Use the positioning straps to help contain these items so they are not loose
or hanging off the cradle.Make sure to explain the procedure to the patient so they
understand what is going to happen and what to expect. This will reduce incidences of
patient moving because they are surprised by the position they are put in the gantry or the
movement of the table.
Using Protocols
All parameters for scanning a patient can be set up in a protocol. This saves the technologist
time when prescribing scan parameters for each patient. When a new patient is to be
scanned, the technologist types in the patient information and chooses a protocol. The
protocol may be adjusted on a per patient basis without permanently altering the original
set of parameters. Once the parameters are set and the prescription is confirmed, scanning
can begin.
NOTE: For information on building protocols, refer to the Building Protocols chapter.
20-2
Using Contrast
When IV contrast is to be used, make sure the injector or syringes of contrast are set up
before performing the localizer (scout) scan. The contrast (syringe) icon on the lower right
corner of the view/edit screen must be selected. When the icon is selected, there is a +C
annotation on the images next to the image number, indicating that IV contrast was used
for that exam.
20-3
Preset Descriptions
The New Patient Screen has four different Preset selection that you can choose from. These
areas allow you to enter frequently used Physician, Radiologist, Operator initials, and Exam
Descriptions. This is a feature to expedite data entry.
You can Add, Delete and change the information in these areas. It is possible to Sort the
entries for the presets.
20-4
How Do I...
This section provides the step-by-step instructions for Setting Up A Patient And Completing
A Localizer (Scout) Scan. Specifically, it describes how to:
Selecting a Protocol
20-5
The Patient Information screen appears automatically displaying the new Exam
Number.
NOTE: The system assigns the exam number automatically. The maximum Exam number
for patient scanning is 49,999. The exam number will need to be reset by your Field
Engineer when the system reaches the maximum number.
Table 20-1 Patient Information
Field Name
Parameters
Accession Number
Up to 16 characters
Patient ID*
Up to 16 characters
Patient Name*
Up to 32 characters
Sex
M (Male) or F (Female)
Birthdate
Age
Weight
Kgs or Pounds
Height
Reference Physician*
Up to 32 characters
Radiologist
Up to 32 characters
Operator
Up to 3 characters
History
Up to 60 characters
Exam Description
Up to 22 characters
20-6
Parameters
Protocol Number
Up to 5 characters
Req. Proc. ID
Up to 16 characters
Date
Time
NOTE: * If this information was entered from a RIS system, these areas support up to 64
characters. If the patient is edited or manually entered then the character limits are
described in the table above.
Figure 20-1 Patient Information Screen.
2. From the Patient Information area, enter data into the appropriate fields.
You must enter the Patient ID to continue. The Protocol Selection area does not
become active until the Patient ID is entered.
When you are typing the patients name, for DICOM users, you have to type the last
name, first name, and middle initial with a "^" between names and initials.
20-7
CAUTION:
Make sure that you keep the mouse over the New Patient screen when typing.
Once you have entered data into a field, you can press Enter to go to the next text
box or you can click in the text box you wish to input data.
3. Click the preset buttons and select the desired information. Or, click on the field and
enter desired information.
Information is listed in the order it is entered with last entry displayed at the top of
the list.
If you click Referring Physician, Radiologist, Operator, or Exam Description, a
preset menu will appear allowing you to select which preset you wish to use.
To change a name from the list, click Referring Physician, Radiologist, Operator, or
Exam Description, select the name, enter new information, and click [Change].
To add a name to the list, click Referring Physician, Radiologist, Operator, or Exam
Description, type the name and click [Add].
To delete a name from the list, click Referring Physician, Radiologist, Operator, or
Exam Description, select the name and click [Delete].
To sort the list items for Exam Description, click [Sort]. The sort sequence is 1, 10,
100 to 9, 99, A to Z, a to z (Figure 20-2).
These Presets are saved across software loads from Save System State.
The maximum number of entries in the preset areas are 100.
20-8
4. When all of the desired patient information is completed, select the desired protocol
from the Anatomical Selector area.
You can select a protocol by either selecting a default protocol or by choosing a
specific body part, then selecting the protocol.
20-9
20-10
CAUTION:
The patient positioning straps provided with the system do not support the
full weight of the patient. Patient positioning straps should be used to aid in
patient positioning and are not meant to fully restrain the patient.
3. Press the buttons on the gantry to raise the table up and in.
Always make sure that nothing is close to the table that may interfere with table
movement.
4. Position the laser lights so that they are lined up with the desired anatomical reference
and centered to the desired anatomy.
NOTE: A poorly positioned and centered patient can impact the mA values calculated for
AutomA/SmartmA.
CAUTION:
Make sure that you instruct the patient to look away from the laser lights. The
laser beam used for positioning can cause eye injury.
Do not position the patient with the laser lights in their eyes.
NOTE: Landmark setting for Patient Position Sensitive Study Types. When using the external
laser alignment light for patient positioning purposes, be aware that the patients
elevation may be slightly lower with the cradle extended than with the cradle fully
retracted. This is because the cradle may bend slightly under a patients weight.
NOTE: If the patient is not fully in the head holder, light and dark images may be seen at ends
of the beam collimation between two rotations especially if the gantry is tilted. Make
sure to fully position the patient's head in the head holder.
20-11
If you do not press the landmark button, confirm remains gray (unselectable) until the
landmark button has been pressed.
Attach the head holder or foot extender to the end of the cradle towards the gantry.
Lay the patient on the table.
Press the buttons on the gantry to raise the table up and in.
Position the laser lights so that they are lined up with the desired anatomical reference
and centered to the desired anatomy.
5. Press the desired landmark button (Required).
20-12
Selecting a Protocol
Selecting a protocol saves you a lot of time while maintaining a quality exam. It keeps exams
consistent because the exam is done the same way each time.
1. On the left monitor, place the mouse over the area that you want to scan and click on it.
A list of all the protocols that you built in this area of the protocol manager appears.
2. From the list, select the protocol that you want to use by clicking on it.
20-13
20-14
If the button is red that means no signal has been detected by the system. The
system pops up a message instructing you to check the connection. Check to make
sure all of the ECG leads are connected to the patient and that power is on to the
monitor. Click [OK] to close the message box when you have checked everything. If
the gating check button is light blue you can proceed.
NOTE: For more information about gating and instructions on prescribing an exam that
includes gating measurements, refer to Prospective Gating (SmartScore) (Option) or
Cardiac Imaging Discovery CT750 HD chapter.
20-15
20-16
20-17
Chapter 21
Adjusting Graphic Rx
Repeat a Series
21-1
Adjusting a Protocol
Adjusting a Protocol
Once a specific protocol is selected from the protocol manager, any of the parameters may
be modified on a per patient basis. This can be done without permanently altering the
original protocol.
21-2
21-3
How Do I...
This section provides the step-by-step instructions for setting up the scan series.
Specifically, it describes how to:
Adjusting Graphic Rx
Repeat a Series
21-4
21-5
NOTE: For more information on these scan types, rotation, and lengths, refer to Building
Protocols.
21-6
21-7
21-8
21-9
21-10
Adjusting Graphic Rx
Adjusting the scan series graphically is the fastest way to set up for a scan series. If your
protocol is set up correctly, you do not have to make many changes; just adjust the lines
representing the series and confirm.
NOTE: Restart Show Loc in the Tool Bar can be used to restart Graphic Rx in the situation
where the Scout image has been reconstructed but does not appear in Show
Localizer.
NOTE: If the scout scan is still not shown in Show Localizer after selecting Restart Show Loc,
use the crosshair cursor on the scout to explicitly define the start/end location and
offsets.
1. Click [Show Localizer].
2. This shows the scout with the graphic lines for you to adjust.While holding the shift key
down, click and drag the center red X to position the lines over the anatomy you wish to
cover.
This allows you to move the lines up and down on a lateral scout, as well as from side
to side on a AP scout. By moving the lines, you are adjusting the start and end
location, and the RAS (Right, Anterior, and Superior) coordinates.
3. Click and drag the solid box to the starting position.
This changes the starting point.
4. Click and drag the empty box to the ending position.
This changes the ending point.
If you hold the shift key down and drag either the solid or empty box, it adjusts both
the starting and ending locations at the same time.
5. Click and drag the diamond key to set the display field of view.
If you hold the shift key down and drag on the diamond key, it adjusts both sides of
the lines.
6. Click and drag the circle to adjust the tilt if needed.
If you tilt and change your mind, hold the shift key down and click on the circle. This
returns the tilt parameter to 0 degrees.
7. Select [Show] or [Hide] from the control panel.
If Hide Slices is visible then graphic mode is to show a line for each image reconned.
Hide Slices is the default at system boot up. Once you change the mode, it will
remain through all exams until you do a system restart or shutdown.
If Show Slices visible then graphic mode is to show a transparent area of coverage,
no lines displayed for slices.
21-11
21-12
21-13
NOTE: The Auto Voice language displayed at the time the systems is booted up is the
defaulted language set by your Field Engineer initially.
If the Auto Voice language is changed for the current exam, the system will return to
the default language once you have clicked End Exam.
You can record an additional 17 voice instructions. For more information on Auto
Voice, refer to the Record a Personalized AutoVoice section of this guide.
You can choose to select AutoVoice preset delay. For more information refer to:
Change Preset Delay for AutoVoice
You can choose to select Breathing lights and/or a timer.
21-14
A pale yellow color window with a "N" indicates the breathing lights are selected only.
No auto voice is selected.
A pale yellow color window with a "T" in it indicates that the breathing lights are
selected with a countdown timer.
A pale yellow color window with a number and a "T" indicates that auto voice,
breathing lights, and the countdown timer are selected.
Figure 21-5
A blue color window with a number indicates that auto voice only is selected. No
breathing lights or delays will come on.
21-15
Here is an example of the preview screen. In the beginning, you can see that there is
a 45 second prep delay, followed by a axial cluster of six scans. At the end of the axial
cluster, there is a 10 second breathe time and the helical clusters begin.
If your exams preview graph exceeds the width of the screen, you can use the scroll
keys at the bottom of the screen.
8. To get out of the preview mode and start scanning, click Confirm.
If you want to go back to view edit and make changes, click [View Edit].
21-16
21-17
21-18
21-19
21-20
IQ Enhance is a recon mode which can minimize helical artifacts seen in helical thin
slice images. Image Enhance is compatible with 0.625 and 1.25 mm slice thicknesses.
Intervals must be set equal to the slice thickness (0.625 or 1.25) or half the slice
thickness (0.312 or 0.625). IQ Enhance annotation is added to the left side of the
image.
An E is added to the annotation on the left side of the image to indicate IQ
Enhance was enabled.
NOTE: For Head and Ped Head only Plus mode is allowed prospectively for 0.625 and 1.25mm
slice thickness, but Helical Pitch of 1.375:1 or 1.75. Full mode is enabled with IQ
Enhance for scans with 0.625 mm and 1.25 mm thick from 16 X 0.625 and 16 X 1.25
detectors when the SFOV used is Head or Ped Head, and Helical Pitch of 0.562:1 or
0.938:1.
21-21
NOTE: If D was selected in Protocol Management for Start and End Locations, Interval, DFOV,
A/P Center, R/L Center, the reconstruction are updated automatically to the values
used in the previous series. Recon 2 and/or Recon 3 values are copied from Recon 1.
9. If you want a third reconstruction, click [Show Recon 3], click [Recon Enabled] and click
[Yes].
You are able to change your start and end locations as long as they do not exceed
Recon 1.
You can also change the slice thickness, interval, DFOV, R/L, A/P and Recon Type to a
different value than Recon 1 and turn it on.
21-22
11. Select which Host you wish to network Recon 2 and Recon 3 to.
12. Click [OK].
21-23
21-24
Repeat a Series
Repeat Series now allows you to choose any series that has been scanned. When more than
one series has been scanned, a list of all scanned series will be displayed. Click on the series
that you wish to repeat. If only one series has been scanned, Repeat Series will not display
the Repeat Series pop-up. The state of Show Localizer on or off is remembered by the
system. If Show localizer state is on, it will be automatically displayed when you return to the
ViewEdit screen.
1. Click [Repeat Series].
This is located at the bottom of the View Edit screen.
3. Click [OK].
21-25
21-26
21-27
21-28
Automatic Filming
Chapter 22
Automatic Filming
Introduction
This chapter explains how to perform some basic tasks for auto filming. It contains the
step-by-step instructions to help you learn how to:
22-1
Automatic Filming
Autostart
Image Filters
Autostart
Autostart is a feature used in automatic filming where the filming can be set to start as soon
as images are taken and reconstructed. This is selected in autofilm setup and can be turned
on or off for each film set. The choices of No Autostart, Autostart New Sheet, and
Autostart Same Sheet are available. No Autostart tells the system not to auto start the
filming of the film set. Autostart New Sheet tells the system to auto start the film set using
a new sheet of film. Autostart Same Sheet tells the system to auto start the film set using
the existing sheet of film. If Autofilm is turned ON and No Autostart is selected, then
AutoFilm has to be started manually by you from the AutoFilm viewport. Having Autostart
ON adds to maximum AutoFilm efficiency.
Image Filters
There are several different display enhancement filters available on the system. The Edge
Enhancement filters are useful for filming bone windows, as they sharpens the image. There
are six levels of Edge Enhancement, E1, E21, E2, E22, E23, and E3. E1 applies the least
amount of enhancement and E3 applies the most. When these filters are used, the image is
annotated with E1, E2, E21, E22, E23, or E3.
The Lung Enhancement filter is designed specifically to use when filming lung windows.
When the Lung enhancement filter is applied, the image is annotated with the word Lung.
There are also five Smoothing filters, S1,S11, S2, S22 and S3, which are used when filming
soft tissue windows to decrease the appearance of noise in an image or enhance low
contrast areas. S1 applies the least amount of smoothing and S3 applies the most. When
these filters are used, the images is annotated with S1, S11, S2, S22 or S3.
22-2
Automatic Filming
Enhancement, G1, G2 and G3. G1 applies the least amount of enhancement and G3 applies
the most. When a filter is applied, the images is annotated with G1, G2, or G3 just above the
vertical tick mark scale on the right side of the image.
22-3
Automatic Filming
How Do I...
This section provides the step-by-step instructions for using autofilming. Specifically, it
describes how to:
22-4
Automatic Filming
Referen
ce)
Automatic filming is a feature in which the scanner automatically films an exam. Values for
filming like format, number of copies, W/L, etc., can be set up ahead of time in a protocol by
using the AutoFilm Setup button from the view/edit screen.
22-5
Automatic Filming
22-6
Automatic Filming
If AutoFilm is turned on for the series, but No Autostart was selected from AutoFilm
Setup, Start New Sheet must be used to start autofilming with a new sheet of film
and to apply the settings prescribed in AutoFilm Setup. Filming uses the format which
was selected from AutoFilm Setup.
2. To pause filming during AutoFilm, click [Pause Filming].
This temporarily pauses autofilming, which allows you to adjust the WW/WL or
perform display features such as ROI and measure distance.
22-7
Automatic Filming
3. To restart autofilming after using [Pause Filming], click [Continue Same Sheet].
This continues filming where you left off, on the same sheet of film.
You can also use Continue Same Sheet to start AutoFilm initially, instead of using
Start New Sheet. The only difference is that filming continues on the same sheet of
film that is already on the film composer, instead of using a new one.
Also, this keeps all of the settings used in the previous exam for autofilming.
4. Click [Cancel Film Series] to delete a series from filming.
This would be useful if there was a lot of patient motion and you did not want the
current series to be filmed.
5. Click [Cancel Film Exam] to delete an entire exam from filming.
Click [Start New Sheet] (if no autostart was selected in AutoFilm setup).
To pause filming during AutoFilm, click [Pause Filming].
To restart autofilming after using [Pause Filming], click [Continue Same Sheet].
Click [Cancel Film Series] to delete a series from filming.
Click [Cancel Film Exam] to delete an entire exam from filming.
22-8
Automatic Filming
22-9
Chapter 23
NOTE: In this chapter the feature that is utilized for filming is called a Film Composer and
has the designation of Auto or Manual Film Composer. These features are set as icons
on the display monitor. The icons do not need to be selected for the feature to operate.
It is beneficial in the early use of your system to select these icons and see how they
look when in operation.
23-1
23-2
How Do I...
This section provides the step-by-step instructions for manually filming images. Specifically,
it describes how to:
23-3
Quick Steps: Set Window Width and Window Level Preset Keys
1.
2.
3.
4.
23-4
23-5
23-6
23-7
Managing Images
Chapter 24
Managing Images
Introduction
This chapter explains the process of managing Images. It provides step-by-step instructions
to learn how to:
FTP a Report
View a Report on a PC
24-1
Managing Images
Anonymous Patient
Archive
Network
WorkArounds
Data Export
In the middle of the Feature Status Area is a row of icons. From top to bottom, the icons are
for image reconstruction, archive, network, and filming functions. To the right of these icons
is the current status.
24-2
Managing Images
Archive Status
Text to the right of this icon indicates status of the images being archived.
Network Status
Text to the right of this icon indicates the status of the systems networking functions.
Filming Status
Text to the right of this icon indicates filming status of the images being filmed
Anonymous Patient
There may be times when you would want the name of a patient to be kept confidential. This
is when you want to create an Anonymous Patient. An Anonymous Patient can be created
by exam, series, or even a single image.
A few good reasons for using Anonymous patient would be:
You have scanned a test patient or volunteer and do not want the name displayed.
Anytime you do not want the patients name on films. For example, films that are in a
display or would be put in a show.
Anonymous Patient changes Patient Name, Patient ID, Exam Number, Exam, Description
and Series Description.
Archive
Archive is an off-line filing system for images. The archive feature allows you to save and
restore images to and from a media storage device or remote host. The archive system uses
a Magnetic Optical Disk (MOD) for storage. Images stored on an MOD are "off-line" meaning
that in order to display the images you must first restore them to the system disk. The MOD
is considered a local archive device. Communication from your system to the MOD is in a
DICOM format, so that the MOD listed in the archive window as a DICOM_MOD.
The archive function can read from and write to Maxoptix archive media. This is the
standard drive.
In addition to the Maxoptix MOD, images can be archived to a remote network host
providing the host is a Storage Commitment Class Provider.
Archive verifies the integrity of the data by performing a hardware check in the media drive.
24-3
Managing Images
Network
Networks link image acquisition systems and workstations together. By connecting these
compatible devices, you have the ability to transfer images between your scanner and
workstations and/or other image acquisition systems, quickly and easily.
Common situations for networking are:
In order to understand the networking process, a few key terms are explained below.
Networking Terms
In the chart below you will find some terms that are associated with the process of
networking.
Term
Definition
Remote Host
Transfer
Transmit/Send
Transmit/Receive
24-4
Managing Images
WorkArounds
Images archived on an Advantage Windows system may fail to restore on the
system. Use Network to transfer images from the Advantage Windows to the
scanner.
Even though the Sony MOD drive states that it is a 5.3 gb drive. The archive software
only supports a maximum size of 2.3 gb. 2.3 gb 512 bytes per sector is the preferred
archive media size to utilize on the system.
Archive may fail and slow the system when more than 200 images are queued by
image. To avoid this, try to archive by series if possible.
The system may report that the media is full even though the media has just been
labeled when Save by image is selected. To avoid this, Try selecting a smaller
range of images.
The feature status area or the browser may report an Exam has saved even though
all images have not been saved to MOD. Scroll through the images in the image
window. Highlight the images listed as Archive N and re-save them.
Restoring Exam, Series or images that already exist on the system disk will not post a
message that the images are restored or that they already exist. If you have restored
images, but get no message that they have been restored, verify that they don't
already exist on the system disk.
When the archive media gets close to being full, the system will always look to see if
the exam, series or image can fit on the MOD, if it is desired to have exams
sequentially on a MOD, place a new MOD in the drive when first notified the disk may
be full.
If Label is selected in Archive, finish the Label process; don't select cancel on the
Label pop up. Archive will be non functional, a system reboot will be necessary to
recover.
It's best to resolve any paused queue entry as soon as possible.
To minimize corruption of MODs, it is extremely important the MOD media be
detached and removed from the MOD drive before doing a shutdown or recycling
power to the system.
When restoring from a MOD, it is recommended to write protect the media before
placing it in the drive. If the system is unable to read the media, remove the write
protect and see if the system is able to perform a recovery of the media to access the
data.
If the MOD can not be detached or will not eject from the drive, do a shutdown and
eject the MOD once the message "Hit any key to start the system" is seen. Do not use
the screw to eject the disk.
If you get a time-out message when trying to access the MOD, the MOD drive may no
longer recognized by the system. Perform a shutdown to re-establish
communication between the system and the MOD drive.
24-5
Managing Images
Data Export
Data Export allows you to either store or FTP CT images as JPEG, PNG, AVI, MPEG or MOV
formats. The files can only be burned to a CD-R and only one report can be burned at a time.
Once a CD-R has been burned, you cannot add more reports at a later time. It is not a
rewritable process.
The JPEG, PNG, AVI, MPEG or MOV images can be viewed from a PC or laptop with a
Windows 2000 or XP operating system using Internet Explorer 5.5 or later.
There are two tabs on the Data Export window:
Compose tab allows you to define the compression factor, annotation level, W/L,
Zoom, scroll, and output format for the series you want to export.
Export tab allows you to view a list of all the examinations and series you have in the
Data Export program.
You can compose a series and then export it to either a CD or FTP site at a later
date.
Examinations and series stay in the Export program until they are actively deleted.
Figure 24-1 Data Export Window
24-6
Managing Images
Figure 24-2 Compose Tab
8
2
11
10
5
7
4
#
1
Selection
Description
Selection
Displays patient name, examination and series number, number of images in the series,
file size of the images with current compression selection, and matrix size.
Conversion
Format
Allows you to select the image format for the currently selected data set. Format
choices include: JPEG, PNG, AVI, MPEG, and MOV. AVI, MPEG, and MOV are all movie type
formats. Choose the format that is compatible with the movie player on your PC or
laptop.
Compression
Factor
Only applies to JPEG and MPEGs. The lower the number, the less compression, the
higher the image quality but the larger the file. Image/Sec. is movie play back speed
and therefore it is only applicable for MPEG, AVI or MOV files.
Frame per
Second
Allow you to set how many frame to play per second. This option is only available when
you have selected a MPEG, AVI or MOV conversion format.
Image Range
Selection
Allows you to select the images you want to place in the designated folder. For example,
if you have a multi-phase series selected and all you want is the first phase in the MPEG,
then select the range of images representing phase 1 of your data set. The ability to
select a subset of images from the selected series is particularly important if you are
plan to FTP the files rather than burn a CD.
You can enter a interval to create a movie file of a specific interval of images. The valid
range for the interval is one minus the maximum number of images in the series.
Annotation
Allows you to set the level of annotation for the images: none, full, partial (a subset of
the full annotation) or custom which activates the [Customize] button that allows
specific annotation options.
24-7
Managing Images
#
Selection
Description
Propagate
Allows you to apply the image manipulations (W/L, zoom, scroll) you have performed on
all images forward from the currently displayed image.
Play/Stop
Click the [Play] button to preview the MPEG, AVI, or MOV file. Click the [Stop] button to
quit playing the movie.
Quit
Image Area
Displays the current images by scrolling through them in a cine loop. Use the keyboard
Page Up and Page Down keys to move through the images manually.
NOTE: You must click on the image window and put it in focus before next/prior
will function.
9
Report Name
Appears at the top of the report once you execute the data export. It also appears in the
Export data list. Typically the patients name and type of file are entered as the Report
Name. There can be no spaces or characters other than AlphaNumeric.
Folder Name
The name of the folder to which you want to file the Report Name. From the Export tab,
you can view the data listed within each folder. The data within a folder is sorted by file
type. For example, if you added 10 JPEGs from the T1 series and 20 JPEGs from the T2
series you will see a list of 30 JPEGs in that folder. If you want these JPEGs separated,
you must place them in separate folders.
10
Anonymous
The images added to the report will have the patients name replaced with Anonymous
and the examination number.
10
Save State
Saves the image orientation, w/l values, roam and zoom values of a range of
images that you select.
11
+/- Series
10
Add to Report
Adds the current data set to the report from which you can either burn the information
to a CD-R or FTP it to an IP address. A Data Conversion progress window appears once
you click the [Add to Report] button. Click the [Cancel] button if you want to stop the
data conversion.
24-8
Managing Images
Figure 24-3 Export Tab
24-9
Managing Images
Table 24-2 Export Tab Descriptions
Selection
Description
Report Name
List
Delete Icon
Select an item in any of the list displays (Report, Folder, or Type) and click the Delete icon
to remove the item from the list. Items remain on the list after you Quit Data Export until
they have been deleted through this method.
Folder Name
List
Lists all the folders associated with the report name. Note the file size to make sure you
can FTP the file or store it on a single CD-R.
Move to
Allows you to move the currently highlighted item to a destination of your choice. For
example, you can highlight an item in the Type list and add it to a particular folder in the
Folder list. The size of the data that comprises each folder is listed.
Type Name
List
Lists the item types. If, for example, you added 20 T1 JPEG images to Folder 1 and then
added another 20 T2 JPEG images to Folder 1, the number of JPEGs in folder 1 is 40. The
quantity and size of each data type is listed.
Quit
Report Name
The name of the report that you are going to export. Select the report from the menu.
Comment
Allows you to type in a comment that appears on the report. Do not apply a carriage
return when typing. The text wraps automatically when appropriate for the finished
report.
Conversion
Formats
Select one of the radio buttons to determine the file type. Typically select HTML.
10
[Create CD]
Click [Create CD] to start burning the report to the CD-R that is currently in your systems
CD/DVD drive. The following message appears once the system is ready to write to the
CD-R: CD writing operation cannot be cancelled after start,
Start CD Write Continue?
Click [OK] to continue. Once the write process is active the following prompt appears:
CDWriting is going on ...
When the system has successfully written the CD, the following prompt
appears: CD Writing successfully completed.
[Send FTP]
Click [Send FTP] to open the FTP window. Enter the information for all the text boxes. The
User Name, Password, and IP Address are for the FTP destination site. Selecting Save the
Settings only saves the Target Directory information. There must be a target directory at
the IP address to successfully transfer files.
24-10
Managing Images
NOTE: CD/DVD Interchange feature is available for recording DICOM images onto below
media, but so far CD/DVD Interchange is not be considered as a way for long-term
images storage.
NOTE: Please pay attention to the following declarations about Media requirements and
Operation requirements when you use the CD/DVD Interchange function.
Media Requirements:
Only support single layered CD-R and DVD-R media. No other media types are
supported, including but not limited to DVD-RW.
Also, dual layered CD-R and DVD-R media are not supported.
Only support 650MB single layer CD-R media
Only support 4.7GB single layer DVD-R media
GEHC recommends using the following media brands have been qualified by GEHC
FCT:
Verbatim 4.7GB 4X commercial DVD-R media
Maxell 4.7GB 1X-4X Compatible DVD-R
SONY 650M CD-R
SONY 1X-4X Compatible 4.G media
TDK 4.7GB commercial DVD-R media
Other high quality CD-R and DVD-R media may also work but GEHC FCT has only
qualified the media types listed above.
Operation Requirements:
DVD-R only support single-session write mode, not support multi-session mode, cant
append write data on DVD-R have been burned.
DVD Interchange are NOT INTENDED for archive or backup purposes! These features
make only "temporary copies" for interchange purposes. GEHC requires cartridge
media for archive like MOD or future solutions. GEHC will not "recover" any
interchange media (it should just be burned again if necessary using patient data
restored from authorized/provided archive media).
Advise customer not to write DVD/CD during scan operations.
The first time CD/DVD media is read on a PC, the permissions for Internet Explorer
need to be set to "Allow active content from CDs to run on My Computer". Otherwise,
it will not be possible to read the media in Operation Requirements session.
24-11
Managing Images
Figure 24-4 CD/DVD Interchange Window
2
10
Description
10
24-12
Managing Images
How Do I...
This section provides the step-by-step instructions for Managing Images. Specifically, it
describes how to:
FTP a Report
View a Report on a PC
24-13
Managing Images
24-14
Managing Images
6. Enter the Port number.
For the HiSpeed CT/i, ZX/i, LX/i, FX/i, DX/i, Advantage Windows, and systems the port
number is 4006.
If you are adding a 3rd party workstation or PACS system, your sites Network
Administrator can provide you with the port number.
A port number is only required when using a DICOM protocol.
7. Enter the AE Title.
The AE Title is unique to the device. If the device is an Advantage Windows
workstation or another GE Healthcare system, the AE Title is the same as the Host
name.
8. Enter Comments.
The comment field allows you to input a comment.
24-15
Managing Images
24-16
Managing Images
24-17
Managing Images
24-18
Managing Images
3. Select the Archive Destination.
Select from the list which device you want to use.
To select the default device, simply select the desired host/device, then click [Set
Default Device]. You will then see the default label in parenthesis next to that device.
4. Select Local or Remote.
This will show a list of local or remote devices.
5. Click [OK].
This will enable your selection.
Click [Cancel] to close the pop up window and disregard any changes made.
24-19
Managing Images
24-20
Managing Images
6. Click on the Comment field and enter comments from the keyboard.
Typically, information about the type of images, MOD side, or pertinent information is
entered.
The text in this field will appear at the bottom of the Archive Browser and the
Image Works browser.
The maximum number of characters allowed in this field is 160.
7. Click [Label].
This begins the labeling process.
A confirmation window pops up and asks you to "Please refer to the Operator Manual
for limitations regarding archive media exchange between GE Products".
8. Click [OK].
This will acknowledge the message.
Selecting [Cancel] in the Format Window will abort the labeling process.
24-21
Managing Images
All items selected on the browser for saving are written onto the media in the
selected archive device.
Items being saved cannot be deleted from the system disk until the save process is
complete. This is indicated by the gray Remove menu title on the browser whenever
items being saved are selected.
5. Click [Detach].
To eject the MaxOptics MOD from the MOD drive, it must first be "detached" via
[Detach] in the Archive menu on the browser.
NOTE: If the MaxOptics MOD fails to detach and cannot be ejected, Click on [Shutdown] in
the upper right corner of the right monitor. When you see "OK to power off the system"
message, press the eject button on the MOD drive. The MOD will now eject.
24-22
Managing Images
24-23
Managing Images
24-24
Managing Images
NOTE: You do not have to wait for the restore to be complete before quitting the Archive
browser window.
NOTE: Remember to [Detach] and replace the storage media when you are done restoring
a patients images.
24-25
Managing Images
24-26
Managing Images
5. Click [Local Disk].
This copies the images onto your systems disk.
6. Click [Quit].
This closes the restore window.
7. Click [Eject].
8. To eject the CD/DVD from the CD/DVD drive.
24-27
Managing Images
24-28
Managing Images
5. Click [Add Exam], [Add Series], or [Clear].
24-29
Managing Images
8. The Interchange Media Browser appears.
This shows the selections and progress of storage.
24-30
Managing Images
24-31
Managing Images
means that your system cannot communicate with the selected remote host. To ping
the DICOM host, Click Network > Ping DICOM Host.
6. Click [Network].
You will have to select this again.
7. Click [Send examination], [Send series], or [Send image].
This depends on what is to be sent.
24-32
Managing Images
5. Click [OK].
This will return you to the browser.
6. Click [Network].
A list of choices will appear.
7. Click [Receive].
A remote browser will pop-up showing you what is on the system disk of the station
from which you want to receive exams/series/images.
24-33
Managing Images
8. Click Search > Change Search Parameters.
This feature allows you to apply a filter in order to narrow down your patient list. You
may search by patient name, ID number, exam number, accession number, or exam
date.
24-34
Managing Images
24-35
Managing Images
A window displays a list of entries of network transfers. Entries are listed how the job
was queued for transfer. If by Exam then only the exam number is listed. If by Series
the exam and series are listed. If by Image the exam, series, and image are listed.
4. If you want check for a specific transfer, enter the Exam, Exam and Series or Exam Series
Image in the search field.
Entries are added to the list at the level they were queued for transfer.
24-36
Managing Images
5. A results window is displayed.
24-37
Managing Images
About 3D and Edit Patient, there are a couple of things to remember. If you edit an exam
that has a saved 3D model, the 3D model are deleted from the exam. Also, if you want to edit
an exam, but you have the 3D model selected when you choose Edit Patient, you will not be
able to edit the exam.
1. Click [Image Works].
This is located in the upper left corner of the display monitor.
2. Select the exam number.
From the Image Works browser, highlight the exam to update.
24-38
Managing Images
3. Click [Edit Patient].
This is located on the right side of the browser.
24-39
Managing Images
5. Click [Accept].
This is a warning message to remind you of all the things that will happen.
If any of the things are of concern, click on [Cancel] and resolve the concern before
proceeding.
6. Click [Accept].
This is an additional reminders warning, letting you cancel if you need to.
24-40
Managing Images
NOTE: You must enter at least three characters in the Edited By field to continue.
If you changed a field but wish to change it back to its original value, highlight the
field and click [Reset Selected Value].
If you have edited multiple fields but wish to change them back to their original
values, click [Reset All Original Values].
Click [Cancel] will cancel Edit Patient.
24-41
Managing Images
8. Click [Accept].
The following menu will appear.
9. Click [Accept].
The old exam will now be removed and the new edited exam is created.
As the old exam is being removed and the new exam is being created, a percentage
countdown menu will appear. The closing Application portion of the countdown is
when the Edit Patient feature is being closed and the Patient Information Edit Log is
being updated.
NOTE: After the editing is complete, the new edited exam is listed on the browser. You can
distinguish edited exams from originals by looking at the description area on the
browser. Edited exams will show the letter "e" plus a number identifying how many
times the exam has been edited. "e+1" means the exam has been edited once. Also,
with edited exams, any description for that exam is pushed to the right on the browser
list to make room for the editing information.
24-42
Managing Images
24-43
Managing Images
24-44
Managing Images
5. Click [OK].
This will cause a pop-up window to come up and ask you Are you sure?
6. Click [Yes].
NOTE: It is recommended that you delete images when image space falls below 10,000
images. This will ensure there is room on the system disk to confirm scans and to
install reconstructed images.
24-45
Managing Images
24-46
Managing Images
24-47
Managing Images
12. Click [Quit] to exit the Data Export application.
24-48
Managing Images
24-49
Managing Images
24-50
Managing Images
FTP a Report
1. Click [Data Export] from the Browser list.
2. Click the Export tab.
See Figure 24-3 for more information.
3. Select the desired report from the Export Report Name pull-down menu.
4. Select the desired data set from the Type Name list.
5. Optional: type a message in the Comment text box. Do not press carriage return while
entering your text, the system adjusts the text for the final report.
6. Select a Conversion format, typically html.
7. Click [Send FTP] to send the data to an IP address.
8. Complete all the text boxes on the FTP window and click [OK].
9. Click [OK] to the Successful File transfer prompt.
10. Click [Quit] to exit Data Export.
24-51
Managing Images
View a Report on a PC
1. Place the CDROM in the CD drive of a PC or laptop running Windows 2000 or XP.
The CD launches automatically. If it does automatically start, open the CD by clicking
on your My Computer icon and open your CD drive. Click INDEX to open the file.
The report is opened and displayed from an Internet Browser.
2. Place the cursor over an image and click to magnify the image.
3. Click the Back arrow on your Internet Browser menu bar to return to the report.
4. When finished viewing the report, close your Internet Browser by clicking File > Close
from the menu bar.
5. Remove the CD-ROM from the CD drive and store it.
24-52
Viewing Images
Chapter 25
Viewing Images
Introduction
This chapter explains how to view images. It contains the step-by-step instructions to help
you learn how to:
Compare Exams/Series/Images
25-1
Viewing Images
List/Select
Paging
List/Select
The List/Select function is located in the Exam RX desktop. Selecting this function gives you a
listing of exams and other information about the exams. This list is known as the Browser.
The Browser is broken down into examinations, series, and images. The exam listing
includes the exam number, patient name, date, description of the exam, modality image
format, pps information, and the archive status by exam. The series area lists the series that
comprise the exam. The series number is listed here as well as the scan type, number of
images for that scan type, a description, what modality the images came from, pps
information, and the manufacturer of the system. The image list box contains all the
information related to images that comprise the highlighted series. In the list box, the
images numbers, table location, thickness and spacing, gantry tilt, RAS coordinates, Scan
field of view, Display field of view, Resolution, Matrix size, Mid scan time in seconds, and
Archive status are listed. This function provides a list of all the exams on the system disk for
viewing.
Paging
Paging allows you to rapidly view images at up to 60 frames per second. This function is
good for viewing scans taken at the same location with contrast to track flow or with motion
such as flexing a Elbow. There are two viewing choices in Paging. Temporal displays the
images in a loop from start to end location all the time as paging continues. Spatial goes
from the starting location to the ending location, then from the ending location to the
starting location, and continues the sequence.
25-2
Viewing Images
25-3
Viewing Images
How Do I...
This section provides the step-by-step instructions for Viewing Images. Specifically, it
describes how to:
Compare Exams/Series/Images
25-4
Viewing Images
25-5
Viewing Images
25-6
Viewing Images
Select from the Browser the Exam, Series and Image that you want to page through.
Click [Viewer] or [Mini Viewer].
In [Image Works] you can move from one exam to another by selecting Exam [+] or [-].
You can move from one Series to another by selecting Series [+] or [-].
You can move from one image to another by selecting Image [+] or [-], or Clicking and
Dragging the scroll bar.
25-7
Viewing Images
25-8
Viewing Images
Select from the Browser the Exam, Series and Image that you want to page through.
Click [Viewer] or [Mini Viewer].
Click on the viewport that you want to use for paging.
Click [Paging].
Click and Drag the scroll bar by Start and change the starting image number.
Click and Drag the scroll bar by End and change the ending image number.
Click and Drag the scroll bar by FPS (Frames Per Second) and change the FPS number.
Select Temporal or Spatial.
Click [Go].
Click [Stop].
If you want to page a new series, and you are in the viewer, click [Select Series].
Click [Cancel].
25-9
Viewing Images
Compare Exams/Series/Images
The compare function allows you to compare images from the same series or a different
series from the current exam, or compare another exam to the current one displayed. This
feature is only available in the image works viewer.
Select the first Exam, Series, and Image that you want to compare on the screen.
Click [Viewer].
Click [Compare].
From the Browser, select the second Exam/Series/Image.
Click [Viewer].
Select the Left Series or Right Series Up and Down arrows to move through the image
set.
7. When you are finished comparing the Exams/Series/Images, click [Cancel Compare].
25-10
Viewing Images
25-11
Chapter 26
26-1
Autoview
Auto Link
Primary Viewport
Secondary Viewport
Viewport
Autoview
Auto View is used to automatically display the images on the screen as the images are
reconstructed by the computer. You have a choice between 8 Autoview layouts.
NOTE: If you are in the one on one layout or any of the multiple viewport layouts, you notice
a folded corner, in the top right corner. This allows you to see what is auto filming. It
toggles the screen each time you click on the folded corner. The folded corner is not
available on the autoview layouts that defaults to filming.
Auto Link
While reconstruction is active, and if you have a autoview port selected with auto link, the
lower right viewport automatically displays the first image of the series being currently
reconstructed. The viewport is annotated with "AL" at the bottom right corner of the image
to indicate that Auto Link is active. All display features and next/prior can be used with Auto
Link.
Primary Viewport
A viewport becomes active or receives primary focus by clicking on it. At that point, the
border around the image turns blue. When a viewport has received the primary focus, you
can choose List/Select and choose which exam you want to view. Also, you can window
level, magnify, and preform other image manipulation functions without effecting other
images currently displayed on the screen.
26-2
Secondary Viewport
When you click on another viewport and the border turns blue, the viewport that was
previously in focus receives secondary focus and has a yellow box around it. In effect, these
two viewports are linked together. A change in one of the viewports is reflected in the other
viewport. For example, changing the window width and window level in the primary image
also changes the window width and window level in the secondary focused image. To return
a single viewport in focus, double click on the viewport of interest, or to put all the images in
focus, triple click on a viewport.
Viewport
The screen can be divided into many different viewing areas. These viewing areas are called
Viewports.
26-3
How Do I...
This section provides the step-by-step instructions for Setting up a Viewing Area for Image
Display. Specifically, it describes how to:
26-4
The second one on one display is a 768 x 768 matrix. The image covers 768 x 768 of the
entire display screen, but in effect, the entire screen is used.
Both of these formats can be chosen in either the Autoview Layout and/or the Review
Layout.
26-5
CAUTION:
This format should not be used for display of images during an interventional
study because it does not allow for quick review of images in a free viewport.
26-6
26-7
Quick Steps: Set Viewports for Automatic Display of the Next Series
1.
2.
3.
4.
26-8
26-9
26-10
Chapter 27
27-1
Sorting Examinations
Sorting Images
27-2
Sorting Examinations
When you look at the patient list on the browser, you want to know what examinations have
been completed. If you spend time looking for a patient to view, you may want to organize
your list to help you find examinations quickly. The list can be organized in many different
ways. The most common method is to sort the examinations by date.
Sorting Images
Image organization is very important to the doctor when reviewing the exam. It may be
helpful to find out the order in which each doctor wants to view the images. The most
common method is to sort the images by their number, so the images are displayed in order
that they were acquired.
27-3
27-4
How Do I...
Anchor
This section provides the step-by-step instructions for sorting examinations and sorting
images. Specifically, it describes how to:
27-5
Sort Examinations
Use this procedure when you want to change the order in which the examinations are listed
on your system.
27-6
Sort Images
Use this procedure when you want to change the order in which the images are listed on
your system.
Quick Steps:
1. Select Sort from the display monitor.
2. Select the desired sort option from the Sort list.
27-7
Image Manipulations
Chapter 28
Image Manipulations
Introduction
This chapter explains how to manipulate image data. The chapter is divided into two parts.
The first part lists how to perform all applicable functions from the Exam Rx desktop. The
second part lists how to perform all applicable functions from the Image Works desktop. It
contains the step-by-step instructions to help you learn how to:
In the Exam Rx desktop:
28-1
Image Manipulations
Neuro 3D Filter
28-2
Image Manipulations
with the source images. When the object is viewed, images are presented in the form that
was displayed on the scanner. GSPS object can only be viewed on systems that support
DICOM GSPS objects.
Neuro 3D Filter
Neuro 3D Filter is a noise reduction filter optimized for thin slice data that is intended for
post processing in Reformat to create Average and MIP images, Volume Rendering and 3D
models for Neurological studies such as Circle of Willis, Carotids, Sinuses, Orbits, Mandible
and helical Brain. The Neuro 3D Filter can be used to reduce noise in images or reduce dose
while maintaining image quality. It may be possible to reduce dose by 10-30% and maintain
acceptable image noise level and image quality depending on the level of filtering selected.
Neuro 3D Filter removes noise from the image while preserving image resolution.
Retrospectively, Neuro 3D Filter is selected in the Browser on Image Works desktop. There
are 3 levels: Low, Medium and High. Images processed using Low are saved in a series that
is the original series number plus 30. Images processed using Medium are saved in a series
that is the original series number plus 40. Images processed using High are saved in a series
that is the original series number plus 50.
Neuro 3D Filter is only compatible with series that have a single group without repeated
image locations. It is not possible to select a subset of a series. A message will be displayed if
the series is not compatible with Neuro 3D Filter. Neuro 3D Filter is not compatible with ASIR.
Figure 28-1 Invalid Data set Message
28-3
Image Manipulations
How Do I...
This section provides the step-by-step instructions for manipulating images in the Exam RX
desktop. Specifically, it describes how to:
NOTE: All of these features are also available from the Accelerator Line Commands refer to
Appendix A.
28-4
Image Manipulations
28-5
Image Manipulations
28-6
Image Manipulations
28-7
Image Manipulations
28-8
Image Manipulations
28-9
Image Manipulations
28-10
Image Manipulations
How Do I...
This section provides the step-by-step instructions for manipulating images in the Image
Works Desktop. Specifically, it describes how to:
NOTE: These features can be accessed from either the Viewer or Mini Viewer in the Image
Works desktop, or the Accelerator Line Commands refer to Appendix A.
28-11
Image Manipulations
28-12
Image Manipulations
While in the viewer or mini-viewer, put the image of interest in primary focus.
Click [Image Enhance].
Under Filters, click [E1, E2 or E3] for edge enhancement.
Under Filters, click [Lu] for lung enhancement.
Under Filters, click [S1, S2 or S3] for smoothing.
Click [Display Normal] to turn enhancement off.
28-13
Image Manipulations
While in the viewer or mini-viewer, put the image of interest in primary focus.
Click [Image Enhance].
Under Gray Scale Enhancements, click [G1, G2 or G3].
Click [Display Normal] to turn enhancement off.
28-14
Image Manipulations
28-15
Image Manipulations
While in the viewer or mini-viewer, put the image of interest in primary focus.
Click [Rect. Matte].
Click and drag on the blue crosshair in the upper left corner of the matte to resize it.
Click and drag anywhere outside of the matte to re-position it.
Click [Erase All] to remove the matte.
28-16
Image Manipulations
28-17
Image Manipulations
28-18
Image Manipulations
28-19
Image Addition/Subtraction
Chapter 29
Image Addition/Subtraction
Introduction
This chapter explains how to set up image addition and subtraction. It contains the
step-by-step instructions to help you learn how to:
Use Existing Images to Create a New Image Using Only the Maximum CT Number
Use Existing Images to Create a New Image Using Only the Minimum CT Number
29-1
Image Addition/Subtraction
Image Addition
Image Subtraction
Binding Series
Image Addition
Image Addition is an operation that consists of adding image intensity values pixel by pixel.
This would be useful for adding thin slices together to get a thicker slice.
Image Subtraction
Image Subtraction is an operation that consists of subtracting image intensity values pixel
by pixel. This could be useful to evaluate contrasted vessels. Remember, patient movement
and breathing between the images can affect the quality of the subtraction.
29-2
Image Addition/Subtraction
Binding Series
Binding Series is a new series that can be created which consists of copies of selected
images from one or more existing series. This could be useful if you had images in two
separate series and wanted to have them in one series to perform 3D or Reformat.
NOTE: Save State information is not maintained in the new series generated with Binding
Series.
"Proc" appears in the browser series list type column if the images in the series are the
result of processing pairs of images have identical locations in the patients body.
"Comb" appears in the browser series list type column if the images in the series are the
result of a combination of images have different locations in the patients body.
NOTE: Since "Proc" series contains images resulting from processing pairs of images having
identical locations in the patients body, such series can be used like any other series
of acquisition images, i.e., geometrical measurements, reformatting, 3D
reconstructions, etc.
NOTE: Since "Comb" series contains images resulting from a combination of images having
different locations in the patients body, the absolute anatomical coordinates
accompanying these series (shown both in the browser and on the displayed images)
are not accurate. Only relative geometrical measurements (i.e., distance, angle, or
area) made within a resulting image are accurate.
29-3
Image Addition/Subtraction
How Do I...
This section provides the step-by-step instructions for image addition and subtraction.
Specifically, it describes how to:
Use Existing Images to Create a New Image Using Only the Maximum CT Number
Use Existing Images to Create a New Image Using Only the Minimum CT Number
NOTE: The Add/Sub feature can be accessed through the Image Works desktop from the
browser or from [Image Analysis] in the Viewer or Mini Viewer. The detailed steps in
this chapter assume that [Add/Sub] is accessed from the browser.
29-4
Image Addition/Subtraction
29-5
Image Addition/Subtraction
29-6
Image Addition/Subtraction
29-7
Image Addition/Subtraction
Quick Steps: Use Existing Images to Create a New Image Using Only
the Maximum CT Number
1.
2.
3.
4.
5.
6.
7.
29-8
Image Addition/Subtraction
Quick Steps: Use Existing Images to Create a New Image Using Only
the Minimum CT Number
1.
2.
3.
4.
5.
6.
7.
29-9
Magnifying Images
Chapter 30
Magnifying Images
Introduction
This chapter explains Magnifying Images. It contains the step-by-step instructions to help
you learn how to:
NOTE: Because the features Roam, Zoom and Mag Factor are located in Exam Rx and
Images works. This chapter details their use in each area separately beginning with
Exam Rx.
30-1
Magnifying Images
How Do I...
This section provides the step-by-step instructions for magnifying images in Exam Rx.
Specifically, it describes:
30-2
Magnifying Images
On the display monitor, click on the viewport where the image is located.
On the display monitor, click [Routine Display].
From the pop up window, click [Roam].
Click and drag on the image with the right mouse and place the image in the desired
location.
30-3
Magnifying Images
Quick Steps: Make the Image Smaller or Larger Real Time in Exam Rx
1.
2.
3.
4.
On the display monitor, click on the viewport where the image is located.
On the display monitor, click [Routine Display].
From the pop up window, click [Zoom].
Click and drag the right mouse in the image to set the desired size. The magnification
factor is annotated on each image in the upper right side with the initials MF (Mag
Factor) and the value from 0.5 up to 8.0.
30-4
Magnifying Images
On the display monitor, click in the viewport with the image to be magnified.
From the display monitor, click [Routine Display].
From the pop up window, click [Explicit Magnify].
From the pop up window, select or enter the desired magnification factor.
30-5
Magnifying Images
How Do I...
This section provides the step-by-step instructions for magnifying images in Image Works.
Specifically, it describes:
30-6
Magnifying Images
Quick Steps: Move the Image Around the Screen in Image Works
1.
2.
3.
4.
30-7
Magnifying Images
Quick Steps: Make the Image Smaller or Larger Real Time in Image
Works
1.
2.
3.
4.
30-8
Chapter 31
Measuring Structures
Within an Image
Introduction
This chapter explains how to measure structures within an image. It contains the
step-by-step instructions to help you learn how to:
In Exam Rx:
Overlay a Grid
In Image Works:
NOTE: Most of the features listed here are available for use in the Exam Rx and the Image
works desktops. Because of this, the chapter is divided into two parts. The first part
lists how to perform all applicable functions from the Exam Rx desktop. The second
part lists how to perform all applicable functions from the Image Works desktop.
31-1
Quick Steps: Report the Cursor Location and the Pixel Value
1.
2.
3.
4.
31-2
Perform the test scans at one location with a small bolus of contrast.
Click [Measurements].
Click [MIROI].
For "Image Range" click [All], or type in the range of images desired for monitoring.
For "Scale for HU", click [Absolute] or [Relative].
For "Define Region," select the type of ROI you would like to use (box, ellipse or trace).
Place the selected ROI over region of interest on image.
7. Click [OK].
8. To determine the prep delay needed for the actual exam, look at the peak on the
graph. You need to count the number of images it took get to that peak, the inter-scan
delay between each image, and the mini-prep delay used. Add those three things
together to determine the actual prep delay needed to produce images with
maximum enhancement.
9. Now set up images for the exam as needed, using the prep delay from the MIROI test.
31-3
How Do I...
This section provides the step-by-step instructions for measuring structures within an image
in the Image Works desktop. Specifically, it describes how to:
Add a Grid
31-4
Chapter 32
NOTE: Most of the features listed here are available for use in the Exam Rx and the Image
Works desktops. Because of this, the chapter is divided into two parts. The first part
lists how to perform all applicable functions from the Exam Rx desktop. The second
part lists how to perform all applicable functions from the Image Works desktop.
32-1
Cross-referencing
Screen Save
Accelerator Line
User Preferences
Cross-referencing
Cross-referencing is a feature which is used to correlate scanned locations on the scout.
You may select a scoutview and then choose to display lines on it which represent
previously scanned locations. This is useful to see which anatomy was covered in a
particular exam.
Screen Save
Screen Save is an electronic photograph of an image. Screen Save saves everything that is
on the image in primary focus. This includes any zoom, cursors, measurements, flip, or
annotation. You can use Screen Save to save images when anatomy or pathology has been
measured. The screen saved images are listed on the patient list browser as series number
99, and called SSave for the series type. When a screen saved image is displayed, the
window width and window level can be changed, but information cannot be removed.
Accelerator Line
The Accelerator Line, also known as the Command Line, allows commands to be typed
which can perform certain display functions. Typing these commands can act as a shortcut
to opening additional menus to access a function.
User Preferences
User Preferences is available for use in the Image Works desktop only. It allows you to
choose customized settings for annotation, tick marks, grid, right mouse button use, series
binding, square viewports and window/level presets. You may choose to apply your
selection for the present exam only, or you may choose to save your selection as a default.
32-2
How Do I...
This section provides the step-by-step instructions for using graphics, text pages and
commands in the Exam RX desktop. Specifically, it describes how to:
NOTE: These features can also be accessed from the accelerator line. For more information,
refer to: Accelerator Line Commands.
32-3
32-4
Put the image that you want to type annotation on into primary focus.
Click [Routine Display].
Click [User Annotation].
Place mouse cursor over the image you are typing text onto.
Type the desired text and it appears in the blue box.
Adjust the box and attached arrow as needed.
Click [User Annotation] again to add additional annotation.
Click [Erase] to erase the primary (blue) annotation.
32-5
32-6
32-7
32-8
32-9
Turning
Graphics On
and Off (Hide)
32-10
32-11
How Do I...
This section provides the step-by-step instructions for using graphics, text pages and
commands in the Image Works desktop. Specifically, it describes how to:
NOTE: These features can also be accessed from the accelerator line. For more information,
refer to: Accelerator Line Commands.
NOTE: All of these features can be accessed from the Viewer in the Image Works desktop.
32-12
Put the image that you want to type annotation on into primary focus.
Click (Annotation).
Place the mouse cursor over the active viewport.
Type the desired text and it appears in the blue box.
Once the text is typed, you may click on the blue box and drag it to a different location.
You may also click on the arrow head and drag it to point to a specific structure, or you
can drag it into the box to make it disappear.
6. Click (Annotation) again to add additional annotation.
7. Click (Erase Annotation) to erase the primary (blue) annotation.
32-13
32-14
32-15
32-16
32-17
32-18
32-19
32-20
32-21
32-22
32-23
32-24
Editing
Default
Settings in the
Image Works
Desktop (User
Preferences)
for Tick Marks
32-25
32-26
32-27
Chapter 33
33-1
Suspended Entries
Graphic Retro
WorkArounds
Suspended Entries
Sometimes the system for a variety of reasons may not be able to complete the
reconstruction of a particular image. This data is then automatically placed in a queue,
where you can attempt to reconstruct it again or delete it.
33-2
Graphic Retro
Graphic Retro provides the capability to graphical prescribe your retrospective
reconstructions using an existing axial plane image as a reference image.
The outer blues boxes (seen inside the red squares on Figure 33-2) allow you to change the
size of the circle which represent the DFOV for your reconstruction and the + (seen inside the
yellow square on Figure 33-2) allows you to reposition the circle to define the RL and AP
Centers for your reconstruction.
The red circle indicates the scan field of view. You cannot reconstruct data outside of the red
circle. You can hide the red circle by clicking [Hide SFOV].
If needed you can click on Roam or Zoom, then click and drag the reference image to
desired position or magnify it.
33-3
WorkArounds
Scan File save is not complete even though the Saved File message has been posted.
It takes time to transfer the file from the system to the DVD-RAM and unmount the
DVD-RAM. It can take up to an hour for the file to completely transfer. Do not try to
eject the DVD-RAM until the light has gone out on the DVD-RAM drive.
33-4
How Do I...
This section provides the step-by-step instructions for managing scan data. Specifically, it
describes how to:
33-5
The Retro Recon list select screen appears. All acquisitions with available scan data
are listed.
2. From the Retro Recon list select screen, select the appropriate patient, exam, and series
The most recently scanned examination is at the top of the list.
The Retro Recon view/edit page appears, showing all of the scan parameters
available for retro reconstruction.
3. Click [Select Series].
Figure 33-2 Retro Recon screen
33-6
6. Click [Retro] to select all groups or click [Y] for an individual group.
If you select [Retro], a pop up window appears. Choose [Yes] or [No]. You may also
click on the individual group and toggle between [Y] and [N].
The system assumes all available data is to be reconstructed. If there are multiple
groups, you must determine which group(s) has data you wish to reconstruct.
7. As needed, enter Retro Start and Retro End locations.
The locations must fall within the range of the selected group and must have S or I
designation.
Cine scans use the time range for the start and end locations and do not require the
S or I designations.
8. As needed, click [Image Thickness].
If you select [Image Thickness], a pop up window appears where you can then enter
the thickness. This changes the thickness in all groups. If there is only one group in
which you wish to change the thickness, or only one of multiple groups, you may
select the thickness area for that group.
The original detector configuration at which the patient was scanned affects how
you can change the slice thickness. The thickness in black is available for
reconstruction.
NOTE: For more information on detector configurations, refer to Multi-Detector Information
chapter.
9. As needed, click [Time].
For Cine acquisitions, you can specify a period of time to be reconstructed
retrospectively opposed to the entire scan.
For Volume Helical Shuttle acquisitions, you can select individual passes or a range of
passes to be reconstructed.
33-7
33-8
33-9
33-10
33-11
33-12
The image(s) is listed by Patient ID, Exam, Series and Image number.
The system highlights selection(s).
3. Click [Delete Suspended Entries] or [Unsuspend Entries].
[Delete Suspended Entries] deletes the image(s) without attempting to reconstruct
the data. Use this if you do not wish the image(s) to be reconstructed.
[Unsuspend Entries] retries the reconstruction of the data. If successful, the system
places the image(s) in the correct exam and series.
a) The [Delete Suspended Entries] button has a pop up window to confirm or cancel
deletion. From the Attention Box, click [OK] to delete the selected entry. Click [Cancel]
to close the pop up window only; this does not cancel entry.
33-13
33-14
33-15
33-16
33-17
33-18
33-19
33-20
Reformat
Chapter 34
Reformat
Introduction
The Reformat software is located in the Image Works desktop.
This chapter explains the process of using reformat. It provides step-by-step instructions to
learn how to:
Reformat a Series
Auto Select
Paint on Slice
Attach/Detach Objects
34-1
Reformat
34-2
Reformat
Safety
Intended Use
User Profile
Important Notes
View Types
Render Modes
Advanced Processing
Display Tools
Segment Tools
Film/Save Tools
Contextual Menu
Up ramp VR Adjustments
VR Tools
Surface Rendering
Film/Save Options
Safety
This section reviews important information for the safe and effective use of Volume Viewer.
The user must understand this information completely before using Volume viewer.
34-3
Reformat
Intended Use
Volume Viewer 3.1 is a medical diagnosis software that allows the processing, review,
analysis and communication of 3D reconstructed images and their relationship with
originally acquired images for CT, MR, X-Ray Angio and PET scanning devices. The
combination of acquired images, reconstructed images, annotations and measurements
performed by the clinician are intended to provide to the referring physician clinically
relevant information for diagnosis, surgery and treatment planning.
User Profile
As with any medical imaging process, only qualified personnel should use this equipment.
You must be aware of the limitations of the basic imaging modality and of ensuing image
processing. This includes understanding the limitations of the initial series acquisition, image
processing technology used, and image display methods.
Important Notes
Image reliability
CAUTION:
WARNING: Non GE images acquired can be loaded in Volume Viewer but GE does not
guarantee the quality or reliability of any reconstruction, segmentation or
measurements performed on these images. Non-GE images can easily be
identified by the corresponding image annotation.
Follow the DICOM acquisition parameter guidelines listed in each
application user guide. Consult GE-published DICOM conformance
statement of Volume Viewer which is available on the GE Healthcare
website at
http://www.gehealthcare.com/usen/interoperability/dicom/products/works
tation_dicom.html.
34-4
Reformat
WARNING: The window width and level (W/L) determine how clearly pathologies and
other anatomical structures can be discerned. Incorrect W/L settings may
result in pathologies and other essential anatomical structures not being
displayed correctly. As a single W/L cannot display all features present in an
exam, use several different setting, when necessary to explore all exam data
Volume Rendering
WARNING: When using Volume Rendering, incorrect setting of opacity curve, opacity
threshold, transparency setting when merging VR objects can result in
pathology or essential anatomies not being visible. Always correlate Volume
Rendering images with original images.
Image quality
34-5
Reformat
Segment Tools
WARNING: Before using any segmentation tool (threshold, scalpel, remove & keep object,
AutoSelect, floater filters) always make sure that it will not remove
pathologies or other essential anatomical structures.
WARNING: When using any Segmentation tools (AutoSelect, threshold, Paint on slice,
Quick Paint), check contours to check the reliability of the segmentation.
Make sure the contours match the correct segmentation and volumes Check
segmented volumes match contours.
Measurements
WARNING: Do not use 3D or slab views only to perform any measurements (distance,
angle, Region of Interest, Report Cursor, Area, Volume). Always check
measurement points position and refer to 2D baseline views (acquisition
images or reformatted images of minimal thickness) to confirm
measurements.
CAUTION:
34-6
Reformat
CAUTION:
When filming or saving images for diagnostic purposes, always make sure
the patient name and geometry information is displayed on all views and
match information on reference view.
CAUTION:
When saving images with a new series description, make sure this description
matches the saved images.
Matrix Size
Display Center
Orientation
(The above requirements need to be the same for all images in the set.)
There must be at least four images selected before selecting reformat.
Tilt acquisitions are not supported for right and left decubitus patient orientation.
Spacing must be less than 10 millimeters and the set should include only axial, sagittal
or coronal images.
Different Display Field Of Views (DFOV) and Gantry Tilts can be loaded however you have to
select between different sources of images to view them. The source annotation is located
in the upper left corner of the image (Figure 34-1). You can change between sources by
clicking on the red annotation.
34-7
Reformat
Figure 34-1 source Annotation
34-8
Reformat
Table 34-1 Red Annotation on the Image
1.
Plane or View
type:
Image Location:
DFOV:
Image Roam:
Press left mouse button and move the image within the
viewport.
Slice Thickness:
Window width
and level:
Patient name:
Click and select from the menu to show or hide the patient
name
2.
3.
4.
5.
6.
7.
34-9
Reformat
Description
Filming Keys
Use keys F1 F4 for manual filming with the Manual Film Composer.
The F3 key in conjunction with <Shift> and the F12 key can be used to
place images on the Autofilm composer.
Preset
Window
Width /
Window Level
Keys
Use keys F5 F11 for preset Window Width (WW) / Window Level (WL)
keys.
These presets are equivalent to the presets that are in the Viewer and
Mini-Viewer in Image Works.
Page Up /
Page Down
Keys and
Arrow Keys
Window
Width /
Window Level
Control Keys
Use these keys to change the WW/WL settings for images in the Exam
Rx and Image Works desktops.
The Up/Down arrow keys increase/decrease the window level,
respectively.
The Right/Left arrow keys increase/decrease the window width,
respectively.
Tab Key
SpaceBar
Ctrl Key +
moving the
mouse
Shift + Left
Click
Shift + Left
Click and
Drag
Alt
Alt + + s
View Types
View type can be changed using the Red annotations on the images.
34-10
Reformat
Figure 34-3 View Types
Mode
Description
3D
VR
Axial
Sagittal
A sagittal is a lengthwise plane dividing the body into left and right
portions.
Coronal
34-11
Reformat
Mode
Description
Oblique
Oblique 3D
Curved
Profile
Histogram
X Section
Render Modes
Render modes consist of Volume Rendering, HD MIP, MIP, Min IP, Ray Sum, and Integral (Table
34-3).
Figure 34-5 Render Modes
Description
Exists only if the model was built using volume mode and is used to display the
Volume
Rendering surface of a model.
34-12
Reformat
Mode
HD MIP
Weighted
MIP
MIP
Min IP
Ray Sum
Integral
Description
Displays the model using the High Definition Maximum Intensity Projection mode.
The mode is identical to the MIP mode as described below, except that image
definition is greater but the system speed is slower.
Displays MIP rendering enhancing front voxels and fading voxels in the back
Displays the model using the Maximum Intensity Projection mode. In this mode,
the density of each point on the screen is the maximum density along a line
perpendicular to the screen.
Displays the model using the Minimum Intensity Pixel mode. In this mode, the
density of each point on the screen in the minimum density along a line
perpendicular to the screen.
Displays the model by summing the models intensity along lines perpendicular to
the screen. This mode simulates conventional radiography images.
Displays only the surface of the model, but the density of each surface point is
equal to the sum of densities along a shallow depth below the displayed surface
point.
34-13
Reformat
Figure 34-6 Cut Planes
34-14
Reformat
Figure 34-7 Main Control Panel
34-15
Reformat
Icon
Description
The Image Controls provide the ability to change the function
of the Left Mouse Button to perform basic image
manipulation:
Page through slices
Rotate Volume
Zoom
Pan
Select a Viewport
Adjust Window Width and Level
Image Controls can be also adjusted via right-click
The [Single Oblique Mode] button (on the right) displays a
line cursor in Reformat that is used to define a new plane. Set
the function of one viewport to Oblique. Make another
viewport primary and then click on the [Single Oblique
Mode] button. A solid yellow line appears, which represents
the plane of the Oblique reformat. This line can be tilted to
display the desired anatomy: place the cursor on the solid
yellow line, hold on the left mouse button and drag to tilt the
yellow line to display the desired plane.
The [Multiple Oblique Mode] button (on the left) displays 3
oblique planes defined by 3 adjustable color axis (orange,
green, blue). Adjust any axis to update the 2 other oblique
planes. De-activating the Multiple Oblique mode (click again
on the button) will keep the orientations defined in oblique
viewports.
The Image Controls provide the ability to change the function
of the Left Mouse Button to perform basic image
manipulation:
Page through slices
Rotate Volume
Zoom
Pan
Select a Viewport
Adjust Window Width and Level
The Image Orientation buttons are used to change the plane
of a 3D or Oblique reformat image.
[S] = Superior
[I] = Inferior
[A] = Anterior
[P] = Posterior
[L] = Left
[R] = Right
34-16
Reformat
Icon
Description
Advanced mode gives access to all tools grouped under
tabs.
Click [Display Less Tools] to switch to basic mode
Basic mode where only My Tools palette is displayed.
This palette is customizable and contains most frequently used
tools.
Click [More Tools] to switch to Advanced mode.
My Tools palette is a customizable tools palette.
It is recommended to place in My Tools most frequently used
tools so they are all grouped together and accessible at any
time.
To remove a tool from My Tools palette, drag and drop the
tool outside the palette or right click on the tool and select
[Remove from My Tools].
To add a tool to My Tools palette, go to the tab where is the
tool to add, then drag and drop it to the My Tools palette or
right click on the tool and select [Add to My Tools] (for
example to add annotations preset tool, go to Display Tab)
My Tools tab can be floated anywhere in the interface grabbing
the top part of the tab. It can also be showed and hidden at
mouse location pressing the Space Bar.
Advanced Processing
Advanced Processing Tools are used to refined segmented objects or combine them using
Boolean operations
It is mandatory before using them to perform an initial segmentation with any of the
segmentation tools (threshold, AutoSelect, Paint, scalpel).
Open the [Segment] tab and click [Advanced Processing] to display the Advanced
Processing window.
34-17
Reformat
Figure 34-8 Advanced Processing
1.
Basic image
34-18
Reformat
Description
Boolean operations can be used to combine 3D segmented
objects together.
All objects must originate from the same master volume.
Perform initial segmentation to generate objects to
combine using any segmentation technique (threshold,
AutoSelect, paint)
Display objects to combine in separate views
Isolate views to combine
Set mouse mode to Select mode
Double click to isolate first view of interest
Combine Segmented
objects
2.
34-19
Reformat
Description
Intersection
Keeps only the voxels common to the two selected models.
2.
Combine Segmented
objects
Addition
Keep all of the voxels that exist in either of the two selected
models.
34-20
Reformat
Description
Filter Floaters is used to remove small fragments from a 3D
segmented object based on size (Small, Medium, Large or
user defined).
Click the view of interest and click [Filter Floaters].
3.
Filter Floaters
Click [Filter Size] and select Small, Medium, Large, or User
Defined and click [Apply].
Review Controller
One of the new features of Reformat is the existence of a Review Controller (Figure 34-9),
which allows you an on-view operation of the main controls provided for the software. Table
34-5 describes the functions of each of these controls.
34-21
Reformat
Figure 34-9 Review Controller
11
10
1
4 5
6 7 8 9
14
12
13
Icon
Name
Description
Job Shuttle
Auto Loop
Auto Rock
34-22
Reformat
Number
4
Icon
Name
Description
Report Pixel
5
6
Distance
Tool
Create
Annotation
Scalpel
Enlarge/
Split Views
10
Hide
Controller
11
Scroll to
Select Image
12
Scroll to
Next
Bookmark
Scroll to
Prior
Bookmark
13
34-23
Reformat
Description
Measure Distance
34-24
Reformat
Display Tools
Figure 34-11 Display Tools
Description
Report Cursor - Click the [Report Cursor] button to
display a RAS coordinate and vector ROI for the current
cursor position.
34-25
Reformat
Icon
Description
Annotate - Click the [Annotation] button to display
annotation panel. Many of the options are linked to
measurement tools. For example, the Distance
Annotation allows you to link an annotation with a
measurement, (e.g., Stenosis: xx.x mm).
Click [Annotation] button.
Click Annotation type (simple annotation, linked
annotation, distance).
Click on the image where to deposit the annotation.
Perform measurement if annotation type is a
measure.
Enter text in the text area.
This can be saved as an annotation preset clicking on
[Save as preset]. By default, preset annotations are
saved under current anatomy and current protocol.
Check [Use for other anatomy] and /or [Use for other
protocol] to make them available from all anatomy
and/or all protocols.
Preset Annotations - Allows you to use preset
annotations.
Distance Measurement - Straight and Curved
measurements are selectable from this panel.
Click on the image to deposit the first and last points.
Projection (2D): 2D measurements are planar
projection measurements. When used in 3D images,
measurement will correspond to the projected red
distance in the plane of the screen.
From volume (3D): When using 3D measurements,
endpoints can be positioned at different depth in the
volume. It is necessary to rotate 3D volumes to
check the exact position of endpoints.
Straight-line measurement is selected by default.
Select curve in the [Along] section to make curved
measures, then deposit multiple points on the image
with left click and validate curved line with right click.
Angle Measurement Click on the image to deposit three points
34-26
Reformat
Icon
Description
Area Measurement
Click on the image to deposit points around the region
of interest. Right click to display results.
Volume Measurement
After an object of interest has been segmented, the
volume of this object can be assessed by clicking the
Volume Measurement tool and then by clicking the
viewport where is the segmented object.
Set Color
Select a Color Map or a Custom Color to apply it to all
non-VR viewports. A color map is available to invert
gray levels.
Trace
Click the button to be guided to create a Curved
reformation, a Profile or a XSection.
Rotate / Translate
To rotate and translate image from a specific angle or
distance. In Rotate tab, click in the center of the
sphere to switch to Anterior view.
Use Tumble mode to oscillate around displayed
angle.
When comparing several exams or series, volumes are
automatically linked.
Link/Unlink tool is used to manually adjust registration
of the volumes.
This tool is activated only when multiple volumes are
loaded
MPR/3D
Guides the user through the creation of MPR and 3D
views.
Adjustment of slabs thickness is possible from this
panel as well as selection of
rendering modes such as MIP, Average, MinIP and
Volume Rendering.
34-27
Reformat
Icon
Description
Display options
Allows to setup user display preferences such as:
Cursor shape and Trace type (Polygon, Smooth, Free
hand).
Show/Hide information:
Display slices locations on active viewport.
Display reference image, annotations.
Display exam/series scrolling section on top of the
left panel:
Display or hide ruler for distance references on
viewports.
Select Paging mode.
Contiguous: optimize paging speed when paging
thick slabs.
Continuous: (default) paging through all slices.
Segment Tools
Figure 34-12 Segment Tools
34-28
Reformat
Table 34-8 .Segment Tools
Icon
Name
Description
It is the most frequently used function for CTA and
MRA studies.
Select appropriate tool for the region to segment.
Use [Small Vessels] segmentation tool to
segment vessels under 5 mm.
AutoSelect
Threshold
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Icon
Name
Description
Remove Object
Scalpel
Paint on Slice
Quick Paint
Advanced
Processing
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Figure 34-13
7
4
5
1
2
Description
[Clear]
[Cut Depth]
[Undo]
[Cut Inside]
[Cut Outside]
[Cut on Trace]
[Keep Object]
[Close]
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Film/Save Tools
Figure 34-14 Film/Save Tools
Description
[Batch Film]
Creates Rotation, Loop or Oblique batch images based
on your prescription.
[Movie]
Creates a comprehensive movie including different
rotations, zoom and pan of the volume.
[QTVR]
N/A in Reformat.
[Quick Export]
Exports in a single click a batch of rotations of a 3D
view or a full batch of contiguous images at displayed
thickness for 2D images.
NOTE: Video Export does not work on the Operators
Console.
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Icon
Description
Save Image
Saves clicked image using the current description
Default save format is Screen capture with the
following options:
[Color (VR images)]: saves VR images in Color.
[Color (non-VR images)]: saves non-VR images in
Color.
Due to DICOM format restrictions, Window Level and
Width of color images cannot be modified. It is then
recommended to unselect this option to be able to
perform windowing adjustments when reading saved
images in PACS or other viewers
[Save State]: Saves current status of Volume Viewer
(3D Model, displays, ROIs) at the same time as
saving the image. This Saved State can be used later
on to restored Volume Viewer State.
Check [Save as Reformatted or PJN] to Save images in
this format every time it is possible. Images saved
under these formats contain geometrical information
so that they can be reloaded in a 3D software and
freely windowed. Click the link [when possible] to
display the list of image types that can be saved as
Reformatted and PJN according to DICOM
requirements. [Color] and [Save State] options are not
compatible with Reformatted DICOM format. These
settings cannot apply to images saved as
Reformatted.
Uncheck the option [Save as Reformatted or PJN] to
benefit from [Color] and [Save State] capabilities every
time you save an image.
Save State
Saves current status of Volume Viewer (3D Model,
displays, ROIs) as an additional series of the exam.
Note: A One-Touch protocol entitled Save State will
appear in the Application field providing the ability to
restore Volume Viewer State.
Save/Recall
Opens a clipboard where to drag and drop objects to
store temporarily within current Volume Viewer
session. Drag and drop is only possible when in
[Select] mouse Mode.
Film/Save Options
Click to select save format type and other film options.
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Contextual Menu
Right click on a view to display the contextual menu. The menu will differ according to the
type of viewport. Corresponding keyboard shortcuts, if applicable, are indicated between
brackets.
The contextual menu always contains the items described below (except when on curved
view, where less items are available).
Figure 34-15 Contextual Menu
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Table 34-11 Contextual Menu
Icon
Description
[Save Image] - To save the image as a DICOM image
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Icon
Description
[Lock cursor to trace] use this option to lock the 3D
cursor on the trace. When using shift key to move 3D
cursor, it will move along the trace on all views.
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Figure 34-16 Opacity Curve with the up ramp shape
Up ramp VR Adjustments
To decrease background noise, increase the value of the lower threshold.
To increase visualization of soft tissues structures, decrease the value of the lower
threshold.
Max Opacity can be reduced: structures become more translucent.
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Figure 34-17 Values
VR Tools
VR tools display as soon as a Volume Rendering image is displayed. To display a VR image,
select VR from the top left red View Type image annotation.
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Basic VR
Settings
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Item
Description
Red line: The vertical red line represents the numerical value of the voxel at the
location of the 3d cursor. Moving the 3d cursor on the image will change the
location of the red line in VR Controls.
Histogram displays voxels distribution (number of voxels per voxel value) in the
image. Peaks correspond to voxel values that are highly represented in the
image.
Shifts the Whole Ramp: click the solid blue box on the ramp and drag left or
right. This will change the upper and lower values of the ramp
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Item
Description
Ramp: The VR ramp represents the voxel opacity in the VR images as a function
of the voxel values. It means that voxels with identical value will have the same
opacity. 0% opacity (eye closed) renders voxels transparent and invisible. As
opacity increases, voxels become more and more visible and opaque. 100%
opacity (eye open) renders voxels as visible and opaque.
Solid White Boxes: Opacity threshold values. When using Up ramp shape: -Drag
the lower white box to the right to remove soft tissue from an exam to modify
the maximum opacity of voxels -Click the upper white box at the top of the
ramp and drag up or down to modify the opacity of all visible voxels.
The red box represents the scale of voxel values displayed in the main VR
Control window. Click and drag the box left or right to shift the display. Zoom in
or out with +/- in the upper right corner (see step 14). Right click on the main
control to return to the original zoom.
Color on/off: Check box to activate color. Uncheck the box to display VR in black
& white.
Active color: to select the active color, click the square color button below the
ramp (the triangle above the color gets black). Click the Active Color button to
change the color.
10
Brightness: the amount of light displayed in the model. Type in a value greater
than 100 to increase the light in the model.
11
Color Transition:
Smooth: shaded transition from one color to the next
Step: all voxels inside the value range display the same color. When Step is
selected small white diamonds indicating range borders will display. Grab the
diamonds o adjust precisely range of values that are assigned to each color.
12
13
14
Zoom in or out to modify the range of voxel values displayed in the main VR
Control window.
Surface Rendering
Surface Rendering is similar to Volume Rendering except that it first separates the volume of
Interest (VOI) from the original data set and then it creates the rendered image.
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Figure 34-19 3D Surface Rendering visualization process.
Film/Save Options
To display [Film/Save Options] window, select [Filming Tools] > [Film/Save Options].
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Figure 34-20 Film/Save Options
Description
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Icon
Description
Sets the steps when adjusting FOV with
left/right mouse buttons on DFOV red
annotation. E.g. when setting 130mm, an
original DFOV of 37.5 cm will decrease will
left click to 26 cm, then 13 cm, then 6.5
cm.
Deactivate or activate this button to hide
or show the cursor on the saved or filmed
image.
[Rfmt] allows W/L adjustments,
measurements, and filtering of saved
images.
[SSave] saves in colors and forbids W/L
adjustments of saved images.
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How Do I...
This section provides the step-by-step instructions for creating Reformatted images.
Specifically, it describes how to:
Reformat a Series
Auto Select
Paint on Slice
Attach/Detach Objects
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Reformat a Series
Using this procedure to reformat a series of images into a different plane for viewing and
filming.
1. Select ImageWorks desktop.
2. Select the Exam, Series, and Images that you desire to Reformat.
3. Click Reformat.
A Oblique, Axial, Saggittal, and Coronal are displayed.
4. Change the View Type by selecting the Red Annotation View Type and select the desired
View Type.
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To show the patient name again, click and hold the right button over the red asterisks
and click [Show] to show the patients name.
This affects all quadrants.
5. Edit the Window Width or Window Level numbers.
On any view, place your mouse over the red Window Width or Window Level
numbers. Type the new number and press Enter.
As you type, the number is displayed in a pop-up box. You must press Enter before
the computer accepts the new number.
If you click on the Window Width or Window Level numbers a list of presets appears.
Select the one you desire.
Middle-click the red Window Width or Window Level numbers and drag right to
increase and left to decrease the Window Width or Level.
NOTE: Remember you can always use the middle mouse button to change the window width
and level.
Middle-click and drag from side to side to change the window width.
Middle-click and drag up and down to change the window level.
6. Click on the red annotation of the view type to change to a different view type.
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Auto Select
Once your reformatted images are displayed you can Auto Select anatomy out of your
reformatted images.
1. Click [AutoSelect] to open the AutoSelect window.
2. Click [Small Vessels] or [Any Structure] from the AutoSelect panel.
[Any Structure] better works for large vessel (> 5mm)
[Small Vessel] is optimal for distal or medium to small vessels (< 5mm)
3. Scroll through the axial images at minimum slice thickness.
Check that no vessel of interest has a green contour. If vessels are contoured in
green,.
4. Place 3D cursor on missing vessel (2D view).
5. Click and hold to add the vessel.
6. Repeat steps to complete all missing vessels.
NOTE: [Small Vessels] will only be present in the menu if the workstation is equipped with
CardIQ or Autobone license. Otherwise use [Any Structure].
NOTE: When using [Small Vessels], you can click once on a vessel to track and fill
automatically the vessel.
7. Click [Apply].
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Paint on Slice
The Paint tool is used to define manually a volume of interest which can be isolated from the
original 3D volume.
1. Select the [Segment] tab and click on
icon.
[Edge attraction] refines automatically the drawn contours adjusting them to the
nearby structure edges.
This may speed up the contouring process.
2. In the view, scroll to the first image containing the structure of interest
3. Place the 3D cursor where you want to begin the contour.
4. Press the shift key when the mouse cursor is at the right location.
5. Hold the left mouse button to draw the contours starting from the red cursor.
Release the left mouse button, to close the contour (connect last point to first point).
6. Page through the slices and draw contours in the new slices.
Repeat the process until your reach the last slice containing the structure to contour.
It is not necessary to define contours on every slice.
The contours interpolates to the intermediate slices.
All contours must be defined in the same view type (eg. Axial view). It is not possible
to combine contours from different view type (e.g. Axial and sagittal).
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7. Click [Apply].
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From the Browser, check all of the parameters to make sure that you have a valid
image set.
2. Select the [Exam/Series/Images] that you want to reformat.
You can select an exam and series, and all the images are included if you do not
select any images.
If you want a selected range of images, you have to select the first image that you
want to include, then find the last image in the range, and while holding down the
Shift key, select the last image. You could also click on the first image and drag
through the range of images.
To select specific images, you must hold down the Ctrl key on your keyboard as you
select the images with the left mouse.
You have to select at least four images for reformat to work.
3. Click [Reformat].
4. Click the red annotation in the upper left corner of the viewport and select [Curved].
The images will load into a curved format.
This changes the viewport to a blue color (Figure 34-22).
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Figure 34-22 Curved Reformat Viewport
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From the Browser, check all of the parameters to make sure that you have a valid
image set.
2. Select the [Exam/Series/Images] that you want to reformat.
You can select an exam and series, all the images are included if you do not select
any images.
If you want a selected range of images, you have to select the first image that you
want to include then find the last image in the range and while holding the Shift key
down select the last image. You could also click on the first image and drag through
the range of images.
To select specific images you must hold down the Ctrl key on your keyboard as you
select the images with the left mouse.
You have to select at least four images for reformat to work.
3. Click [Reformat].
4. Select the Profile Layout preset if available.
5. Click the red annotation in the upper left corner of the viewport and select [Profile].
6. Trace the anatomy of interest.
Create a trace on an axial, sagittal, coronal, or oblique view.
You now see the Profile view (Figure 34-23). It gives the intensities of the pixels along
the trace that you created. The horizontal axis of the profile view is the position in
millimeters along the trace and the vertical axis is the pixel intensity value as a
function of that position.
You can move your mouse over the Profile View and press Shift. Notice the pixel
intensity reference line on the graph. This line gives you the pixel intensity from the
location of the 3D cursor.
You can also move the line by clicking and dragging the line itself.
The value for the pixel intensity reference line can be seen at the bottom right of the
white line.
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At the bottom of the profile view are the pixel statistics of the trace. These values
represent the mean and standard deviation.
7. To exit, click [Close].
A pop-up message asks you if you are sure you want to quit.
8. Click [Yes].
This takes you back to the Browser.
Figure 34-23 Profile View
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From the Browser, check all of the parameters to make sure that you have a valid
image set.
2. Select the [Exam/Series/Images] that you want to reformat.
You can select an exam and series, all the images are included if you do not select
any images.
If you want a selected range of images, you have to select the first image that you
want to include, then find the last image in the range, and while holding down the
Shift key, select the last image. You could also click on the first image and drag
through the range of images.
To select specific images, you must hold down the Ctrl key on your keyboard as you
select the images with the left mouse.
You have to select at least four images for Reformat to work.
3. Click [Reformat].
4. Select the Histogram Layout preset if available.
5. Click the red annotation in the upper left corner of the viewport and select [Histogram].
The Volume Histogram then appears giving the statistics of the object in primary
focus (Figure 34-24).
The Vertical Axis displays the percentage of occurrence of the pixel values that are on
the horizontal axis. The horizontal axis displays the pixel value range of the object in
the viewport.
The statistics at the bottom of the histogram are referring to the voxel in the primary
view. The statistics in the upper right are referring to the class of voxel in a specific
area of the object defined by the two dotted green lines on the graph. These lines are
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referred to as the voxel class boundary lines. The solid white line corresponds to the
intensity of the voxel at the 3D cursor location in the object.
Remember, the voxel reference line references the voxel intensity at the 3D cursor.
The voxel class boundary lines reference the minimum and maximum intensities
around the 3D cursor.
6. If you place the mouse cursor on the voxel reference line and either click and hold the
left key or hold the Shift key, the image displays green enhancement.
This represents the range between the voxel class boundary lines. You can change
the range by clicking and dragging one or both of the boundary lines to display the
desired range. If the voxel reference line is not visible, simply place the mouse cursor
anywhere along the horizontal axis and press the Shift key.
The smoothing value is used to calculate the percentage of occurrence in relation to
the voxel intensity values. The default is 10, which means a range of plus or minus 10
is taken around each voxel intensity point on the horizontal axis. The greater the
smoothing value, the greater the smoothing effect on the histogram curve.
7. To exit, click [Close].
A pop-up message asks you if you are sure you want to quit.
8. Click [Yes].
Figure 34-24 Histogram View
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From the Browser, check all of the parameters to make sure that you have a valid
image set.
2. Select the [Exam/Series/Images] that you want to reformat.
You can select an exam and series, all the images are included if you do not select
any images.
If you want a selected range of images, you have to select the first image that you
want to include, then find the last image in the range, and while holding down the
Shift key, select the last image. You could also click on the first image and drag
through the range of images.
To select specific images, you must hold down the Ctrl key on your keyboard as you
select the images with the left mouse.
You have to select at least four images for Reformat to work.
3. Click [Reformat].
4. Select the X Section Layout preset if available.
Click the red annotation in the upper left corner of the viewport and select [X
Section].
5. Create a closed trace around the area of interest.
To create a trace, place the mouse cursor at the starting point and press and hold the
Shift key as you deposit points along the anatomy.
You need to define at least three points.
Make sure that the view is in primary focus.
The Cross Section View appears.
The vertical axis displays the percentage of occurrence of each pixel intensity value
in the traced area. The horizontal axis displays the intensity values in the traced area.
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The statistics at the bottom reference the entire defined area. The pixel class
statistics at the upper right reference a specified area within the defined area.
The pixel class boundary lines (the green dotted lines) represent the minimum and
maximum pixel intensity values that are part of the pixel class statistics.
The pixel reference line (the white line) corresponds to the intensity of the pixel at the
3D cursor location. The numeric value for this line can be seen to the right of the line
just above the horizontal axis. The pixel reference line can be moved by placing the
mouse cursor on the line, then clicking and dragging, or by placing the mouse cursor
on the graph and pressing the Shift key. If you move the 3D cursor on the image, this
moves the pixel reference line also.
The smoothing value is used to calculate the percentage of occurrence in relation to
the pixel intensity values. The default is 10, which means a range of plus or minus 10
is taken around each pixel intensity point on the horizontal axis. The greater the
smoothing value, the greater the smoothing effect on the cross-section curve.
6. To exit, click [Close].
A pop-up message asks you if you are sure you want to quit.
7. Click [Yes].
Figure 34-25 X Section View
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5. Select the axial, sagittal, or coronal image and rotate the yellow line by clicking and
dragging it into the desired position.
6. Change the slice thickness in the oblique viewport to the desire thickness.
Place the mouse cursor over the red thickness annotation and type in the desired
thickness and press Enter.
7. Change the rendering mode.
Place the mouse over the red annotation word MIP and while holding down the right
mouse button, select which mode you desire.
MIP is used most often in CTA models to demonstrate all the voxels that have the
most intensity like calcium.
8. To quit, click [Close].
A pop-up window appears, click [Yes].
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When any ROI tool is selected, and prior to deposit it on the image, preferences for ROI
statistics can be set in lower left menu.
Where to display ROI (a)
Statistics to display (b)
Default ROI size (c)
Figure 34-27 Preference Menu
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3. Click on the desired ROI tool.
Refer to Figure 34-26.
3D Color ROI is available in one color for MR and in multicolor for CT.
4. Click on the desired anatomy to measure.
This deposits a ROI with the measurement displayed at the bottom of the image.
5. Grab a ROI corner and adjust the size to the structure.
Read the statistical data (Hounsfield units for CT) at the bottom of the viewport
(minimum, maximum, average and standard deviation).
6. Right click on a ROI to delete it.
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2. Select [Statistics] tab to display detailed statistics for the current ROI.
Figure 34-29
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Figure 34-31
5. Click [Save] to save settings adjusted in [Configuration] tab as a new Color Map preset.
6. Click [Remove] to delete Color Maps preset.
7. To load a Color Map preset, select the Color Ramp from dropdown list.
WARNING: Default Plaque Color Map preset is provided for information. You must check
and adjust Values and segment names.
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Attach/Detach Objects
1. Click a color to activate it.
2. Click the [Attach Mode] button
This is the last button in Ramp setting.
3. Click [Attach] color at the bottom, center of the VR Controls panel.
4. To adjust opacity of the voxels holding a color, click the colored box at the top of the
ramp and drag up or down.
5. To attach another color, select a color box, click [Attach], and modify its opacity.
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[Spacing between Images]
[Slice Thickness],
Rendering [Mode]
[FOV]
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34-82
Chapter 35
NOTE: The ASIR Review application is NOT intended to create diagnostic images and are
annotated as Not For Diagnosis. Images viewed in this application should only be
used to determine desired noise levels for reconstruction and to assist in developing
protocols with ASIR reconstruction applied. Screen captures or additional
reconstructions at specific levels cannot be made using this tool. Screen captures or
additional reconstructions will need to be created on the console or in other
supported AW applications.
35-1
ASIR Presentations
Viewport Selection
Image Controls
Display Tools
35-2
ASIR Presentations
By default, you will now see 3 sets of axial images displayed in the ASIR Axial Presentation.
The original or non-ASIR series is in the upper left viewport.
The 100 % ASIR series is in the upper right viewport.
The lower viewport contains the ASIR blended images, displayed at the 50% default
noise level.
The noise blending level is annotated on the bottom right side of the ASIR blended viewport.
Other views can be displayed quickly by changing the presentation to ASIR Sagittal, ASIR
Coronal, or ASIR Blended by left clicking on the desired view.
The ASIR Blended presentation displays all 3 views (axial, sagittal, and coronal)
simultaneously in the desired ASIR blending level but does not contain the original non-ASIR
images or 100% blending images as a reference.
35-3
Viewport Selection
The screen is divided into viewports that are selected by clicking the left mouse button (LMB)
anywhere in the viewport. When a viewport is selected it becomes active and is outlined
with a cyan border. To select an individual image in a viewport that contains multiple
images, click the LMB anywhere on the image. The border for that image will turn cyan to
indicate the image selected.
35-4
35-5
Grab the bar with the left mouse and move to blend the image to the desired noise
level. The ASIR annotation displayed will change as levels are adjusted
simultaneously. Additionally, right or left mouse clicking on the red noise level
annotation changes the noise level up or down in 10 % increments per mouse click.
Click and hold the middle mouse button (MMB) on the red noise level annotation will
also interactively change the noise level by moving the mouse side to side. Lastly, a
desired value can also be typed in directly (in 10 % increments) by placing the mouse
over the red noise level annotation and typing in a value, ie. 70 %.
35-6
Grab the bar with the left mouse to scroll through the volume of images. Click on the
up or down arrows to scroll image by image.
Image Controls
Other tools and menus are described below.
Middle mouse: Click and hold will change the Window width and level
Figure 35-5 WW/WL
35-7
Window leveling: Click and drag with the middle mouse button to change Window
width and level. Also, placing the mouse over the window level annotation and type
in the desired value to change.
Place the mouse over the window level annotation and type in desired value.
Window level presets: Click with left mouse on the window level annotation to
display the presets. Click on the desired preset.
Zoom: Right click and drag to zoom the image or type over DFOV active annotation
Roam: Click and drag the RAS coordinates to roam image.
Display Tools
The Display tab is organized into a set of functional buttons:
Report Cursor
ROIs
Copy
Paste
Cut
Annotation
35-8
ROIs
Figure 35-7 ROI Button
The ROI button is used to deposit a region of interest for statistical measurements. To
activate, click on the ROI button and then deposit the cursor on the image by clicking and
dragging until desired size is achieved.
Click the ROI button on the display tab.
Position the cursor on the image where you want the ROI to be deposited.
Click to deposit the insertion point.
Copy ROI
Select the ROI to be copied and click the Copy button. The ROI remains on the image in the
selected state and is replicated on the system clipboard, which is not visible on the desktop.
This replaces previous entries in the clipboard.
Paste ROI
After copying the desired ROI; click on the image on which to paste it and click the Paste
button. Once an ROI has been copies and pasted it is now linked. To unlink the ROI use RMB
and select unlink from pull down menu.
Cut ROI
Select the ROI to be deleted and click the Cut button. The ROI is removed from the image
and placed on the system clipboard, which is not visible on the desktop. This replaces
previous entries in the clipboard.
35-9
Whether cutting or copying annotation, the process for selecting it is the same. Position the
cursor over the desired annotation and click. To make multiple selections, press and hold the
Ctrl key while clicking on each annotation. Annotation that is selected is highlighted.
Cut annotation
Select the annotation to be deleted and click the Cut button. The annotation is removed
from the image and placed on the system clipboard, which is not visible on the desktop. This
replaces previous entries in the clipboard.
Copy annotation
Select the annotation to be copied and click the Copy button. The Annotation remains on
the image in the selected state and is replicated on the system clipboard, which is not visible
on the desktop. This replaces previous entries in the clipboard.
Paste annotation
After cutting or copying the desired annotation, click on the image on which to paste it and
click the Paste button.
Move annotation
Select the annotation then click and drag the annotation to a new location.
The annotation and its vertices are highlighted when selected. Cut, Copy, or Paste.
The Cut, Copy, or Paste buttons are also used for the Report Cursor and ROIs.
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View
Click [View] and check or uncheck the box.
Figure 35-10 View Menu
1
2
3
Table 35-1 View Menu
Number
Name
Function
View
Show/Hide Header
Show Annotation
Help
Click [Help] to display more information about the ASIR Review application, including
the software version number and name.
35-11
How Do I...
This section provides the step-by-step instructions for utilizing the ASIR Review Application.
Specifically, it describes how to:
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35-13
35-14
Chapter 36
36-1
Viewport selection
Preliminary Assessment
Image controls
Window level
Orientation Changes
Display Tools
File Panel
View Panel
Help Panel
36-2
Viewport selection
The screen is divided into viewports that are selected by clicking anywhere in the viewport.
When a viewport is selected it becomes active and is outlined with a cyan border. To select
an individual image in a viewport that contains multiple images, click anywhere on the
image. The border for that image will turn to cyan indicating the image is selected.
36-3
36-4
Preliminary Assessment
The Preliminary Assessment tab is intended to be the first step in the two-step GSI
workflow. This feature performs a multi-planar volumetric review of the GSI exam series
inputs. The primary goal is to quickly assess the acquired reconstructed Spectral
Imaging Material Density (Material Basis) and/or low/high energy image series in a
multi-planar display.
36-5
36-6
36-7
Image controls
Pan and zoom
Pan (move) the images in the viewport by clicking and dragging over the image to the
desired position. Zoom the images by pressing and holding the RMB and dragging the
cursor up and down in the viewport.
Window level
Window level the Gemstone Spectral images by pressing and holding the MMB and
then dragging the cursor up or down and/or right or left in the viewport. For more
precise adjustment, place the cursor over the W/L annotation in the viewport and type in
a new value. Alternatively, click RMB over W/L annotation and select from the list of
presets.
Figure 36-4 , Window Level Image Pull Down Menu
1
2
3
4
5
6
Table 36-1 Window Level Pull Down Menu
Number
Label
Function Key
Abdomen
(F5)
Head
(F6)
Lung
(F7)
Mediastinum
(F8)
Spine
(F9)
Vertebrae
(F10)
36-8
Locate any point of interest in the image by dragging the 3D Cursor in any view.
Figure 36-6 3D Cursor
Name
Description
Enlarge
36-9
Name
Description
Reset W/L
Hide Annotations
Show Annotations
Save Series
Figure 36-8 Status bar indication when saving out Image Series
Orientation Changes
Changes in image orientation are possible from any imaging display viewport in both
the Preliminary Assessment & Material Decomposition Presentations. The following
orientations are available: Axial, Coronal, and Sagittal. Simply select the active
annotation and select desired orientation change from the drop down menu.
Figure 36-9 Orientation Drop Down Menu example
1
2
Number
Name
Axial
Sagittal
Description
is an image representing a cross-sectional slice of anatomy
is a lengthwise plane dividing the body into left and right
portions
36-10
Name
Description
Material Basis
Monochromatic
Color Overlay
Effective Z
Material Basis Images Image Pairs that demonstrate material densities. These
types of images are no longer HU images. They are measured in either mg/cc (Water
& Calcium), or 0.1mg/cc (Iodine). The following MD Basis Image Pair Options are
available from active annotation drop down menus:
Water (Iodine)
Water (Calcium)
Iodine (Water)
Iodine (Calcium)
Calcium (Water)
Calcium (Iodine)
36-11
36-12
Display Tools
The Display tab is organized into a set of functional buttons:
Report Cursor
ROIs
Copy
Paste
Cut
Annotation
ROIs
Figure 36-14 ROI Button
The ROI button is used to deposit a region of interest for statistical measurements. To
activate, click on the ROI button and then deposit the cursor on the image by clicking and
dragging until desired size is achieved.
Click the ROI button on the display tab.
Position the cursor on the image where you want the ROI to be deposited.
Click to deposit the insertion point.
36-13
Link/Unlink
Figure 36-15 Link/Unlink Button
The link/unlink button is used to toggle properties on and off between viewports. When the
viewports are linked, an image rendering function, such as W/L, Zoom, or Pan, etc. is applied
to each viewport by default. When unlinked, the functions will apply only to the active
viewport.
36-14
Whether cutting or copying annotation, the process for selecting it is the same. Position the
cursor over the desired annotation and click. To make multiple selections, press and hold the
Ctrl key while clicking on each annotation. Annotation that is selected is highlighted.
Cut annotation
Select the annotation to be deleted and click the Cut button. The annotation is removed
from the image and placed on the system clipboard, which is not visible on the desktop. This
replaces previous entries in the clipboard.
Copy annotation
Select the annotation to be copied and click the Copy button. The Annotation remains on
the image in the selected state and is replicated on the system clipboard, which is not visible
on the desktop. This replaces previous entries in the clipboard.
Paste annotation
After cutting or copying the desired annotation, click on the image on which to paste it and
click the Paste button.
Move annotation
Select the annotation then click and drag the annotation to a new location.
The annotation and its vertices are highlighted when selected. Cut, Copy, or Paste.
Figure 36-17 Cut, copy, and paste icons
The Cut, Copy, or Paste buttons are also used for the Report Cursor and ROIs.
36-15
File Panel
The Display section of the File Panel allows the user to make changes relating to display
preferences and save new settings or reload default display settings.
The Dual Energy section of the File Panel allows the user to make changes relating to
Low/High Monochromatic Energy Levels and save new settings or reload default keV values.
The Materials section of the File Panel allows the user to make changes to the material
density color overlays and save new settings or reload default keV values.
View Panel
The View Menu provides the following functionality:
Table 36-4 View Panel Options
Number
Name
Function
View
Show/Hide Header
Show Annotation
36-16
Help Panel
The Help menu displays more information about the GSI viewer including the version
number and name.
36-17
How Do I...
This section provides the step-by-step instructions for using the Gemstone Spectral Imaging
Viewer (GSI). Specifically, it describes how to:
36-18
3. Select GSI Viewer in the applications box on the left hand side of the screen.
The images will display in the Gemstone Spectral Imaging Viewer application.
Figure 36-20 Exam and series selection
36-19
36-20
Appendix A
A-1
annotation full
af
Restores full annotation to the image displayed.
annotation groups
agp <on/off> <N> -where N is a group number
With this feature, you can selectively turn off or on specific image annotations on the
screen. The N number corresponds to the annotation in the customize setting for annotation
in User Preferences. For example, to turn off right marker, type agp off 10. You can type more
than one number at a time.
annotation none
an
Removes all annotation from the image displayed.
annotation partial
ap
Applies partial annotation to the image displayed as defined by Display Preferences
dialogue box on Exam Rx screen.
filter
fi <filter name> filter names: e1; e2; e21; e22; e23; e3; lung; (for edge enhancement) s1;
s11; s2; s21; s3; (for smoothing filters) and off.
(i.e. fi e1, fi e2, fi e3, fi lung, fi s1, fi s2, fi s3, fi off)
Apply/remove edge enhancement and smoothing filters on selected image(s). Edge
enhancement filter names are, from least sharpening to most: e1, e2, e3, lung; smoothing
filters are named s1, s2, s3. Entering the command fi e1 applies the least image sharpening,;
entering fi lung applies the most.
A-2
grid
grid <on> or <off>
(i.e. grid on, grid off)
Displays or removes a ruled grid on the image.
image
i <image number>
image number: the desired image number from within the displayed series.
(i.e. i 27 or 27)
Displays the specified image (27) of the current series in the selected viewport.
A-3
rotate left
rl
Rotates the image ninety degrees counter-clockwise.
rotate right
rr
Rotates the image ninety degrees clockwise.
tick marks
tm <on> or <off>
(i.e. tm on, tm off)
Displays or removes both horizontal and vertical tick marks (rulers) along the border of the
image.
A-4
Displays or removes vertical tick marks (rulers) only along the border of the image.
window level
wl <desired level>
(i.e. wl 65)
Applies specified window level setting to the display.
window width
ww <desired width>
(i.e. ww 350)
Applies specified window width setting to the display.
zoom zo <factor>
factor: magnification factor
(i.e. zo 1.5)
Magnifies the image by the factor specified. In the above example the image is displayed
one and one half times as large as its display normal size, or 150% larger in appearance.
Exam Rx
angle
ang
Creates an angle type measurement cursor by explicitly describing the end points of the
lines that make up the cursor.
annotation custom
ac
Applies custom annotation to the image displayed as defined by Display Preferences
settings.
A-5
annotation full
af
Restores full annotation to the image displayed.
annotation groups
agp <on/off> <N> -where N is a group number
With this feature, you can selectively turn off or on specific image annotations on the
screen. The N number corresponds to the annotation in the customize setting for annotation
in User Preferences. For example, to turn off right marker, type agp off 10. You can type more
than one number at a time.
annotation none
an
Removes all annotation from the image displayed.
annotation partial
ap
Applies partial annotation to the image displayed as defined by Display Preferences
dialogue box on Exam Rx screen.
blank viewport
blank
Removes image from the selected viewport, similar to a user text page.
A-6
cross reference
xr <series number> <image set>: <interval>
distance
dist
A measure distance line will appear on the screen.
A-7
ellipse
el
Creates an ellipse type measurement cursor.
erase graphics
eg
Removes selected graphics from the selected image.
exam
e <examination number>
A-8
A-9
filter
fi <filter name>
filter names: e1; e2; e21; e22; e23; e3; lung; (for edge enhancement) s1; s11;
s2; s21; s3; (for smoothing filters) and off.
(i.e. fi e1, fi e2, fi e3, fi lung, fi s1, fi s2, fi s3, fi off)
Apply/remove edge enhancement and smoothing filters on selected image(s). Edge
enhancement filter names are, from least sharpening to most: e1, e2, e3, lung; smoothing
filters are named s1, s2, s3. Entering the command fi e1 applies the least image
sharpening,; entering fi lung applies the most.
A-10
grid
grid <on> or <off>
(i.e. grid on, grid off)
Displays or removes a ruled grid on the image.
hide graphics
hg
Hides all graphics on the selected image. The undo function is show graphics.
image
i <image number>
image number: the desired image number from within the displayed series.
(i.e. i 27 or 27)
Displays the specified image (27) of the current series in the selected viewport.
invert video
inv
Reverses the blacks and whites on the image.
A-11
next exam
ne
Displays the first image of the next exam in the selected viewport, next determined by the
sort function applied to the List Select browser.
next series
ns
Displays the first image of the next series from the displayed exam in the selected viewport.
previous exam
pe
Displays the first image of the previous exam in the selected viewport, previous determined
by the sort function applied to the List Select browser.
previous series
ps
Displays first image of the previous series of the displayed exam in the selected viewport.
print series
prs
Opens the print series dialogue box for the selected viewport, which is in turn satisfied by
mouse commands. By specifying options in the print series box, a sequence of images may
be sent automatically to the printer, or current print jobs may be cancelled by the operator.
Desired image parameters must be set before calling the print series command - zoom,
window level, annotations etc. cannot be altered after the print series dialogue box is
opened.
A-12
propagate
prop <range>
rectangle
rect
Creates an rectangle type measurement cursor. Used for ROI.
report pixel
rp
Opens a Report Pixels dialogue box, and displays an ROI box cursor on the image that is
positioned on the area of interest by a left click and drag of the mouse. Size is not adjustable.
Once in position, clicking OK in the dialogue box creates a pixel report consisting of density
values for individual pixels within the area delineated by the box cursor.
rotate left
rl
Rotates the image ninety degrees counter-clockwise.
A-13
rotate right
rr
Rotates the image ninety degrees clockwise.
screen save
scnsave
Captures the selected image exactly as it is displayed, and creates a new image with a
series number of 99 on the system disk that includes all graphics and display factors applied
to the image and/or viewport at the time of capture.
series
s <series number>
series number: the desired series number from within the displayed exam.
(i.e. s 2)
Displays the first image of the specified series (2) of the current exam in the
selected viewport.
series binding
sb <on> <off>
Turns series binding on or off. With series binding on, the next image is defined as the next
image in the entire exam; at the end of any particular series, the next image is the first
image of the next series. At the end of the exam, a next command will loop back to the first
image of the exam. With series binding off, at the end of a particular series, a next
command will loop back to the first image of the current series.
show graphics
sg
Shows, or re-displays all graphics on the selected image which were hidden with the hide
graphics command.
A-14
tick marks
tm <on> or <off>
(i.e. tm on, tm off)
Displays or removes both horizontal and vertical tick marks (rulers) along the border of the
image.
A-15
user annotation
ua
Displays specified text in a user annotation text box on the image.
window level
wl <desired level>
(i.e. wl 65)
Applies specified window level setting to the display.
window width
ww <desired width>
(i.e. ww 350)
Applies specified window width setting to the display.
zoom
zo <factor>
A-16
Image Works
angle
ang
Creates an angle type measurement cursor by explicitly describing the end points of the
lines that make up the cursor.
annotation custom
ac
Applies custom annotation to the image displayed as defined by Display Preferences
dialogue
annotation full
af
Restores full annotation to the image displayed.
annotation groups
agp <on/off> <N> -where N is a group number
With this feature, you can selectively turn off or on specific image annotations on the
screen. The N number corresponds to the annotation in the customize setting for annotation
in User Preferences. For example, to turn off right marker, type agp off 10. You can type more
than one number at a time.
annotation none
an
Removes all annotation from the image displayed.
annotation partial
ap
Applies partial annotation to the image displayed as defined by Display Preferences
dialogue box on Exam Rx screen.
A-17
arrow
arrow <on> or <off>
(i.e. arrow on)
Displays or removes an arrow cursor from a text annotation box for user annotation.
cross reference
xr <series number> <image set>: <interval>
A-18
distance
dist
A measure distance line will appear on the screen.
ellipse
el
Creates an ellipse type measurement cursor.
erase graphics
eg
Removes selected graphics from the selected image.
exam
e <examination number>
examination number: the desired exam number as indicated on the system disk.
(i.e. e 4578)
Displays the first image of the specified exam (4578) in the selected viewport.
A-19
A-20
filter
fi <filter name>
filter names: e1; e2; e3; lung; (for edge enhancement) s1; s2; s3; (for smoothing filters) and off.
(i.e. fi e1, fi e2, fi e3, fi lung, fi s1, fi s2, fi s3, fi off)
Apply/remove edge enhancement and smoothing filters on selected image(s). Edge
enhancement filter names are, from least sharpening to most: e1, e2, e3, lung; smoothing
filters are named s1, s2, s3. Entering the command fi e1 applies the least image
sharpening,; entering fi lung applies the most.
format
fo <rows>< columns>
rows, columns: rows across and columns down the display screen.
(i.e. fo 4 3)
Format the display screen as specified by rows and columns. The above example displays
images across the screen in 4 rows and 3 columns, or common twelve-on-one.
A-21
freehand
freehand
Displays a small solid blue box that can be used to draw a freehand trace for an ROI. You
must click and drag the box to where you would like to start the trace. Then select the blue
box while holding Shift on the keyboard and move the mouse cursor around the screen to
draw the trace.
grid
grid <on> or <off>
(i.e. grid on, grid off)
Displays or removes a ruled grid on the image.
hide graphics
hg
Hides graphics on the selected image. The undo function is show graphics.
image
i <image number>
image number: the desired image number from within the displayed series.
(i.e. i 27 or 27)
Displays the specified image (27) of the current series in the selected viewport.
invert video
inv
Reverses the black and white on the image.
A-22
next exam
ne
Displays the first image of the next exam in the selected viewport, next determined by the
sort function applied to the List Select browser.
next series
ns
Displays the first image of the next series from the displayed exam in the selected viewport.
paging
pa [<start> <end>] [<rate>]
Activates cine paging. For the start and end values, enter the first and last images you want
to page thru. For rate, enter the number of images per second to page through, with the
maximum being 60.
paging interval
pi <interval>
Allows you to set the interval for paging. The pa command must be used prior to setting
paging interval.
A-23
paging mode
pm <spatial/temporal>
Allows you to change the mode for paging. Selecting temporal will display the images in a
loop mode. Spatial will display images in a back and forth mode.
previous exam
pe
Displays the first image of the previous exam in the selected viewport, previous determined
by the sort function applied to the List Select browser.
previous series
ps
Displays first image of the previous series of the displayed exam in the selected viewport.
print page
pp
Sends the entire current display screen to the film composer and sets the film composer
format to that of the current display format.
print series
prs
Opens the print series dialogue box for the selected viewport, which is in turn satisfied by
mouse commands. By specifying options in the print series box, a sequence of images may
be sent automatically to the printer, or current print jobs may be cancelled by the operator.
Desired image parameters must be set before calling the print series command - zoom,
window level, annotations etc. cannot be altered after the print series dialogue box is
opened.
A-24
propagate
prop <range>
quit
quit
Close the Viewer application and return to the Image Works browser.
rectangle
rect
Creates an rectangle type measurement cursor. Used for ROI.
reference image
ri
Puts a reference image on the selected image.
A-25
report cursor
rc
Displays (reports) current mouse cursor location in pixel coordinates, and a single pixel ROI
reading.
report pixel
rp
Opens a Report Pixels dialogue box, and displays an ROI box cursor on the image that is
positioned on the area of interest by a left click and drag of the mouse. Size is not adjustable.
Once in position, clicking OK in the dialogue box creates a pixel report consisting of density
values for individual pixels within the area delineated by the box cursor.
reset
rs
Reset image to initial display parameters.
rotate left
rl
Rotates the image ninety degrees counter-clockwise.
rotate right
rr
Rotates the image ninety degrees clockwise.
A-26
save state
ss [<first image> <last image>]
Saves the image orientation, w/l values, graphics, and filter and gse values of a range of
images that you can set. Typing ss by itself will save settings for the entire series. A Gray
Scale Presentation State Object is also created and saved to the Data base.
screen save
scnsave
Captures the selected image exactly as it is displayed, and creates a new image with series
number of 99 on the system disk that includes all graphics and display factors applied to the
image and/or viewport at the time of capture.
series
s <series number>
series number: the desired series number from within the displayed exam.
(i.e. s 2)
Displays the first image of the specified series (2) of the current exam in the selected
viewport.
series binding
sb <on> <off>
Turns series binding on or off. With series binding on, the next image is defined as the next
image in the entire exam; at the end of any particular series, the next image is the first
image of the next series. At the end of the exam, a next command will loop back to the first
image of the exam. With series binding off, at the end of a particular series, a next
command will loop back to the first image of the current series.
A-27
show graphics
sg
Shows, or re-displays graphics on the selected image which were hidden with the hide
graphics command.
spline
spline
Deposits a small open blue box for creating a trace. Deposit blue box where you want the
trace to start. Then hold down the Shift key on the keyboard and click with the left mouse to
deposit points. All the points will connect to create a trace.
tick marks
tm <on> or <off>
(i.e. tm on, tm off)
Displays or removes both horizontal and vertical tick marks (rulers) along the border of the
image.
A-28
user annotation
ua
Displays a user annotation text box. Place mouse cursor over the box and type desired
annotation.
user preferences
up
Brings up the user preferences pop up window.
window level
wl <desired level>
(i.e. wl 65)
Applies specified window level setting to the display.
A-29
window width
ww <desired width>
(i.e. ww 350)
Applies specified window width setting to the display.
zoom
zo <factor>
A-30
Appendix B
Legacy Precautions
System
Run Shutdown and Restart daily.
The system may fail to start if system disk space needs to be recovered from unused
system files.
The following message will be posted in the Disk Management shell window:
The purpose of storelog is to recover system disk space by archiving and then removing core,
log, and data files that have been saved for their system troubleshooting diagnostic value.
Now they may be taking up too much space for the system to run properly. Removing these
system log files does not add image space, but should allow the application to start.
You are then directed to answer the following questions (be patient for the messages
to display):
Place the mouse cursor inside the black Disk Management window
1. Do you want to save system log files to removable media?
Type n and press the enter key
2. Do you want to remove the system log files?
Type y and press the enter key.
You will then see a message Please be patient, the system is now removing unwanted files.
The system then starts normally.
If the system fails to startup completely, select [Unix Shell] from the tool chest menu
in the upper right of the Scan Monitor place your cursor in the blue shell and type st.
If mouse selections fail, press the Escape key to clear backlogged requests.
The system may not show typed information on the New Patient or Viewedit screen.
The system will update after a short time.
B-1
The system may be slow to respond to keyboard entry and mouse clicks. If the
system fails to respond stop and let the events catch up.
The dynaplan screen may fail to update if Priority Recon is selected during scanning.
If you can no longer type in a field, move the cursor to the field and try clicking the
middle mouse to restore functionality. If this does not work, then a system shutdown
will be required.
The cursor may not move between the left and right screen. Wait a few seconds
without moving the cursor and try again.
Pressing the Space Bar after selecting all fields in New Patient, locks the patient
information fields and all the patient information fields become insensitive. Only the
delete and backspace key will be active.
Press the delete key to recover from this situation.
Entering \ and pressing the Enter key in the New Patient can cause the fields to
become insensitive.
Under heavy system operation, the message Unable to install image in the database
may be seen. Recon for the series will take longer due to unsuccessful install of
images to the database.
To install a SMPTE pattern, BRH or Quality assurance images for viewing, select the
following. Once installed the images will be available for viewing from the Image Works
browser or List Select in Exam RX. Both will be listed as Exam 1000, the patient name will
reflect if it is a QA image or a SMPTE pattern.
1. Click Service Desktop.
2. Click [Diagnostics].
3. Click [Display Processing].
4. Select [Install SMPTE Image].
In general, wait for a screen transition to take place before making another selection.
If the console becomes unresponsive for 2 minutes or more, shutdown the system
using the pink shutdown button and restart the system. If you cannot select the pink
shutdown button, turn off the console power switch, wait 10 seconds, then turn the
console power switch back on. The system should come up normally.
Protocol Management may not be selectable. Check that retro recon is selectable. If it
is not then the system will need to be rebooted.
Pop-up screens and menus may appear on the wrong monitor or may be displayed
split between the two monitors.
Windows such as the Film Composer that normally are restrained to the right or left
monitor can be dragged to the other monitor. Be careful not to get a Film Composer
hidden behind some screen if you move it to the other monitor.
B-2
B-3
Scan
Scan aborts may occur during Axial or Helical scanning. Always be aware of the scan
progress during an Exam and select Resume as soon as it is posted to continue.
Scan may fail to confirm posting a message that not enough image space exists,
even though the image space shown in the Feature Status Area indicates there is
enough space. This is due to the fact that images are stored on the system disk in
more than one partition. Remove consecutive exams to free up image space for
confirm to proceed.
The system does not verify that the Pediatric protocol number typed in the Protocol
number field matches the Patient weight entered on New Patient. When typing in the
protocol number always verify that you are entering the correct protocol for the
weight category desired.
If Direct3D isenabled in DirectVIS under the Recon tab, Add Group will display some
fields as insensitive as it will be combined with the current Direct3D session. Turn
Direct3D off for the added group if you no longer wanted it to be included as part of
the Direct3D session. This will allow changes to any of the acquisition parameters.
Auto mA should not be used with Gating and Cine acquisitions even though it can be
selected. This includes scans that are done for Cardiac Scoring using Cine Segment.
The gating button may turn red when the patient experiences a big jump in heart
rate such as in a PVC. The system usually will recover and read the signal. Sometimes
you may have to toggle the gating button Off/On to get the heart rate signal synched
again. Care should be taken in starting the scan if the patient continues to have
PVCs.
When using the IVY monitor the heart rate posted may jump to over 200 after
confirming a scan and moving the table into the gantry. This may be caused by the
cables from the ECG monitor touching the gantry cover.
Always try to position cables for the ECG monitor away from the gantry.
To terminate an Insite connection on your system. Select [New Patient] a message
will be posted informing you that the scan hardware resource is not available. Wait 3
minutes and select [New Patient] again to begin scanning
In general, if a scan fails and a [Resume] is posted, click [Resume] to continue. Try
[Resume] again if the first [Resume] fails. If a failure still occurs, reset the scanning
hardware through System Resets in the Service desktop. If scan still fails to restart,
shutdown and Restart the system.
Auto Voice may fail to function, especially during system simultaneity. Make sure that
you can hear the Auto Voice to recognize if Auto Voice has quit, manually breathe the
patient when this occurs.
The Show Localizer scout image may fail to display or images may fail to recon and
may become suspended if scanning is started while remove images is in progress. To
avoid this dont remove images while an exam is in progress or scanning is active.
Remove images when the system is idle.
B-4
The Dynaplan screen may report incorrect status (i.e. a scan is removed before it is
actually scanned) when stop scan is selected. The screen will reset correctly after
Resume or back to view edit is selected.
Scan groups will not be contiguous if you switch from 2 or more Helical scan groups
column or row edit and the scan type is changed to Axial. If this change is made, then
verify the Start and End locations of each of your scan groups and adjust if needed.
The Cine time between images may change when other parameters are modified
within a protocol. Check the Cine time between images prior to confirming the scan
to verify it is the value you wish.
Tilt handles will not be visible on the screen if the DFOV is larger than 48. Use a DFOV
smaller than 48 to assure that the tilt handles are visible.
Show Localizer may fail to display the scout image if the Next Series is selected
before the scout images are reconstructed. Wait until the scout images are
reconstructed before selecting Next Series. If Next Series has already been selected,
toggle Show Localizer off and then on again.
Quickly changing desktops when Show Localizer has been selected for the next
series can cause a partial display of the scout in the Graphic Rx window to occur.
If Page Up or Page Down fails to change the displayed Show Localizer.
Try the following in order:
1.Turn Show Localizer button off then on.
2.Move the cursor off the image window and back on to the image to refresh
the screen if both of these fail then verify that you have a valid scout for
Show Localizer.
If an R, L or A, P value is more than half of the Display Field of View in mm. The image
annotation will not annotate R and L or A and P on the images. For example if the
DFOV is 10cm and the R value is 56mm then the image annotation will show R R. Use
a R-L or A-P value which is less than half of the DFOV in mm to avoid this.
A protocol may fail to display. The following message will be posted to the message
line on the lower center of the scan monitor Cant read selected protocol, please
choose another protocol. If this occurs the protocol is corrupt and will need to be
rebuilt. Delete the protocol and rebuild it.
The patient history field may be missing the last 9 characters when all 60 characters
have been entered and the patient record is either selected as a completed exam or
the Patient ID is entered and the system matches a completed exam.
Even weights entered in Patient Schedule may be rounded up to the next odd pound.
This occurs because weights are stored as kilogram units then converted back to
pounds.
During the acquisition of large data sets (1000-1500), there may be Auto film and
reconstruction performance issues. If either stops, check the queues and restart to
continue.
B-5
When selecting the Auto Voice field, the selected Auto Voice will be deselected. You
must reselect the desired Auto Voice message before exiting the Auto Voice screen.
When entering birth dates on the New Patient or Schedule Patient screens the
following rules apply:
2 digit years can only be entered if the birth year is in the current century for the
21st century - for the year 2000 forward.
Birth dates from any other century must be entered as 4 digits for example for the
year 1899 1999 all four digits must be entered.
Birth dates can only be entered for 150 years (Current year minus 150 years).
If InSite is running the Remote Safety test, New Patient will not open. New Patient
can be made available by either:
1.Calling InSite and request they abort the test.
2.Going to the Service Desktop and selecting |CleanUp| option to cancel the
test in progress.
PMR images may fail to recon if disk space is low. To recon the images, remove
images and restart the recon queue in Recon Management.
You may get the message Duplicate Scan Key, if a Scout Scan is aborted within the
first 20 to 75 mm of table travel or if a the prescribed length of the Scout is less than
75 mm. In order to proceed, an End Exam must be done and new exam started.
It may be possible to prescribe a recon range that is outside the recon 1 boundary.
This may occur is the start location is dragged below the recon end location in recon
2 or 3.
If a large number of scan files are reserved and there is a large recon queue, you may
see the message: Duplicate Scan Key unable to allocate scan file. There will be a
Resume at Start Scan. Either wait a few minutes for the recon queue to decrease or
release some of the reserved scan files.
Bands and lines may be seen in scout images if there is a tube spit or the reference
channel is blocked during the acquisition of a scout scan.
A zero interval axial series, if paused, will add another group equal to the remaining
number of images. Make sure to return to the View/Edit screen to delete this group to
avoid acquiring additional images.
Biopsy is not valid for a Thin Twin helical acquisition mode. If Biopsy is selected, the
Biopsy window does not open; however a group is added to the series at an
inadvertent location. Do not select Biopsy mode with Thin Twin helical scan mode.
If the message Can not read Cal Database, select [End Exam] and re-enter patient
information.
The table will take 10 mm to stop if the table is running at 100 mm/sec. when a patient
weighing 450 lbs. is on the table.
B-6
Patient Schedule
Close the preferences screen before switching between Patient Schedule and New
Patient.
The Patient Name, Patient ID, Accession Number and Requested Procedure ID can
only be edited if Allow to Edit MWL is set to yes in the Preference window.
The Patient Schedule button may not display the Work List from the HIS/RIS server if
the network is slow. Try again.
Protocol Management
Protocols, which contained a SmartStep series, cannot be selected or copied from
the Most Recent selector.
There is no default protocol for Pediatric areas Neck, Upper Extremity, Chest,
Abdomen, Spine, Pelvis, and Lower Extremity.
B-7
If the weight of a child is at the cross over point of a weight category, due to rounding
errors the correct weight category might not be selected. Please check the weight
based category selected against the label and the patients weight.
Reconstruction
If images fail to recon the following should be used in order:
Select [Recon Management], [Unsuspend Queue].
If the image still fails to recon
Select [Recon Management], [Restart Queue]
If this still fails Shutdown and reboot the system.
Lung Algorithm
Provides edge enhancement between structures with large density differences, such
as calcium and air.
Enhances the contrast of small objects. For best viewing and film quality, select a
window width of 1000 to 1500 and a window level of -500 to -600.
Increases CT number values at the edge of high contrast objects. When planning to
take CT number measurements of vessels or nodules in the lung, please check and
compare your results with Standard algorithm images. (ROI and Histogram functions
use CT numbers.)
The edge enhancement provided by Lung Algorithm may not be appropriate in some
clinical cases. Please take individual viewing preferences into account when you
choose Lung algorithm.
Image recon may fail and then shutdown.
If images fail to recon the following should be used in order:
Select [Recon Management], [Unsuspend Queue].
If the image still fails to recon
Select [Recon Management], [Restart Queue].
If this still fails Shutdown and reboot the system.
The dynaplan screen may fail to update if Priority Recon is selected during scanning
Retro recon may not be able to get the same image locations as prospective recon.
This is due to rounding in the start and end location. To avoid this mismatch prescribe
start and end locations that are even numbers.
Retro recon may show more images when using PMR than that recond during
prospective recon if Recon 2 or 3 with a slice thickness greater than Recon 1 is used.
This is due to the extra data acquired for recon of the thicker slices.
B-8
Retro recon list service exams from Fast Cal. Do not attempt to recon this data, the
SRU will shut down. These exams are listed with exams numbers that begin with
50,000.
SmartStep series are listed in Retro Recon but cannot be selected.
Archive
An image series of 3,000 images can only fit on one side of a 2.3 gb MOD.
Auto Store will not save the exam if the media size attached is 1.2 gb.
If a 1.2 gb media is used for image archive and the image series is greater than 1,500
images archive will need to be queued by image. Select a range of images 1,500 or
less when archiving to 1.2 gb media.
If greater than 2,000 images are queued to save by image you may see the browser
disappear and reappear. While this is occurring it will be impossible to access the
browser. To avoid this queue less images at a time when saving by image.
Images may fail to save if saving large groups of images. Verify that all desired
images are saved before deleting them from the system disk.
Network
The network queue list will be slow to access. This is typically seen when 200 or more entries
exist.
DentaScan/Add/Subtract
These applications can only load 1,000 images. Hi-light the desired image range of 1,000
images by selecting the first image desired, hold the shift key down and hi-light the last
image desired then select the desired range.
Retro Recon
Two decimal points cannot be entered, i.e. 3.75 for image interval if column edit is
used. Edit each scan group (row) if an interval with 2 decimals is required.
If a 1 rotation 4i or 2i axial scan is prescribed using add group in ViewEdit with a
Superior to Inferior scan direction is retro reconned, the resulting images will be
B-9
reconned Inferior to Superior. The image locations are correct, but the image
numbers will not match the prospective images.
If you delete queued Retro images the image space reserved for those retro recons is
not given back. You will not get the space back until you reboot the system.
Only start Retro Recon when scanning is complete. Do not delete queued retros while
scanning is active, scanning could stop.
If maximum A-P or R-L offset is selected in Retro Recon, one image may fail to
reconstruct. Select an offset that is 0.5mm less than the maximum value allowed.
The start/end locations of a retro reconstruction may be different from Recon 1 and 2
and 3 when a PMR with a thicker slice than Recon 1 is prescribed for the series.
Retro Recon may hang and core. If the Retro recon screen fails to display or queue
retrospective images, retro recon has cored. Reboot the system to recover.
If an R, L or A, P value is more than half of the Display Field of View in mm. The image
annotation will not annotate R and L or A and P on the images. For example if the
DFOV is 10cm and the R value is 56 mm then the image annotation will show R R. Use
a R-L or A-P value which is less than half of the DFOV in mm to avoid this.
It may be possible to confirm a retro recon prescription with an invalid recon start
and end location that results in a recon suspend. To avoid this change image
thickness before changing image locations.
Recon Management
Scout queue entries can be selected in Delete Retro queue entries. Only select Scout
queue entries to delete if you are sure you do not need the scout image
reconstructed.
Before saving or restoring scan data make sure the system is idle and no Archive,
Network or Filming is active. No other features should be accessed until the save or
restore is complete.
Recon Management may hang while trying to display the menu. Finish the current
exam if scanning and shutdown and restart the system to correct the problem.
If you wish to cancel a Save or Restore scan data, the cancel button will cancel only
after the current scan file is saved or restored. A helical scan file contains a large
amount of data even though it is one scan file, that file can take up to 30 minutes or
more to save. You are unable to scan patients while saving or restoring Scan Data.
Make sure that you have ample time to complete the save or restore before
beginning.
Scan data save or restore is active when the dialog message indicating saving or
restoring scan file is displayed.
If saving scan data, after the save is complete select Restore Scan Files to verify the
data is stored.
B-10
CT Colon (Option)
Rotate and translate is missing in the CTC and Virtual Dissection protocols
Dentascan
Do not use Extended CT Number range for images that will be processed in Dentascan. This
application does not support Extended CT Number range.
B-11
BMD
Do not use Extended CT Number range for images that will be processed in BMD on an
Advantage Windows or Mindways system. These applications do not support Extended CT
Number range.
Auto Transfer
A series may fail to Auto Transfer if [Next Series] then [Create New Series] is selected after a
scout scan is prescribed, but not scanned, i.e.; pause and return to view edit is selected.
B-12
B-13
cap locks is on: For example to select Exam 576 Series 2 image 3 type E576 2 3 on
the accelerator line.
Selection of an exam series or image may fail a second time after an exam series or
image is displayed. If the desired exam series or image does not display then select
the desired images from the browser.
Image location seen on the scanner may differ from that seen on an AW 3.1 system
for tilted images. reports the image location as iso-center of the image. AW 3.1
reports image location as the image center for the image. With tilted images there
will be a difference in the location numbers proportional to the off center distance
times the sin of the tilt angle. The image location can be reported as image center on
by using the Report Cursor function.
Plus recon mode is not annotated on the Series Text Page. Refer to the image
annotation for the Plus recon mode annotation.
An active user annotation graphic will not film the box or arrow that is displayed on
the screen.
Exam Rx Display
Display may reset its self after a software problem. You may see display stop or not
accept your mouse input. Wait for a few seconds and display will automatically
reset. You will have to re-display the images you wish to work on.
The MIROI pop up may display but will not function. This will occur if an Auto View or
Cross reference viewport is in primary focus (blue border) MIROI is not in these
viewport types. Place a Free or Auto Link viewport in primary focus and reselect the
MIROI button to continue.
Any Report Pixel or MIROI chart that is not screen saved, but is filmed will show the
Exam Series and Image as 1000/1/1 on the film composer icon if E/S/I is selected.
This is the exam/series/image number the system assigns to this chart display The
patients exam number is listed correctly on the filmed image.
Image selection from the accelerator line will not function if the primary viewport
contains a MIROI plot or Report Pixels chart. Use List Select to display a new image.
Any accelerator commands entered for Series Binding, Annotation levels for display
or filming will be saved as defaults
ExamRx Display may hang. In some cases switching to the Image Works desktop and
back to Exam Rx display may clear the problem. If this doesnt work then perform a
system shutdown and reboot the system.
Display may post the Print Series dialog and hang when switching layouts and using
the trackball. This may lock the cursor. A system power cycle will be needed to
recover.
The Trackball may fail to initialize properly at system reboot. Try rebooting the
system again to recover.
B-14
Images recond with Priority recon are not available in the Auto Link viewport.
Re-display the series to access these images.
MIROI may fail to produce a graph if next prior is selected while doing MIROI.
Re-display the series and begin again.
With paging active (P in the lower left corner of the image) the trackball may adjust
window width and window level in other viewports, verify the image has the correct
window level before filming the image.
The right mouse may fail to roam even when the state is set to roam. A system
shutdown may be required to clear this problem.
Display may crash when selecting a 3D object from the list select browser. When a 3D
object is selected, 3D should be selected from the browser.
Images may not be displayed after a switch between Auto View or Image Review
layouts. This is due to a restart in the display process. Re-display the desired images
in the viewport to continue.
B-15
The primary focus may change if the space bar is selected multiple times when
entering accelerator line commands. Verify that primary focus is on the image
desired.
Filming
Images or Auto Film control buttons may fail to display in the AutoFilm viewport. This
may occur after a switch between desktops. To display the images change to a
different AutoView layout, then switch back to your desired layout.
Dont let the auto film viewport back up with images to be filmed. Start Auto Film as
soon as possible to keep caught up on filming.
Any of the Auto Film control buttons may be activated when the cursor is over the
button and the space bar is selected. Place the cursor in the Auto Film viewport only
when needed to avoid this problem.
Auto Film may fail to film. This may occur when the Auto Film viewport selection
shows active and the Auto Film status shows paused. Toggle the [Pause] button in
the Auto Film viewport and select [Start New Sheet] or [Continue Same Sheet] to
restart filming.
Image settings such as WW WL and flip rotate, zoom, roam are not maintained
across all images when imitating F4 print series from a MID Viewport format. Use a
512 size viewport to initiate F4 Print Series.
Auto Film may stop and the Continue Same Sheet button will be displayed. The
Continue Same Sheet button will be active, but when selected will not restart filming.
B-16
Use Manual Film to complete filming the exam and reboot the system before starting
the next exam
If the F1 key is used to film the Text Page ROI, Exam Text Page and Series Text Page,
the text pages will be filmed to the film composer last selected in the pop-up for text
page. Use the filming selections in the text page screens to film the information
displayed.
The message Film formatting in progress. Please retry. May be seen when filming to
the Manual Film composer when the system is busy with other simultaneous
operations such as recon, network, auto film and scanning. Retry manual filming
when the system is less busy. A system reboot may be required to recover.
Auto Film may fail to display images if recon is having trouble reconstructing the
image or if images have failed to install in the database. This may also occur if a large
exam has not reconstructed all images and scanning is started on a new exam. The
following dialog will be posted if Auto Film cannot display images:
Exam 100
Series 2
Cannot find 10 images
Skip Missing imagesContinueCancel Film Series
You are presented with 3 choices:
1. Skip Missing images will skip the images that Auto Film cannot find. For
example if Auto Film had filmed images 1-10 and you then got the message
that 10 images were missing and selected Skip Missing Images, Auto Film
would then start filming again with image 21.
2. Continue will look for the images again, if they are not found then the dialog
will be posted again. Before selecting continue verify that recon is active, that
the images have been reconstructed, the missing images are not suspended
or paused in the Recon Queue and the images are able to be displayed. If the
images are suspended or paused in the recon queue, then unsuspend or
restart recon to reconstruct the images before selecting Continue.
3. Cancel Film Series will cancel Auto Film for the series currently being Auto
Filmed. The images will then need to be manually filmed.
If you get this dialog because you have begun an exam while the previous exam still
has images to reconstruct, then Select Continue and select Pause Auto Film, resume
Auto Film when the Exam Series and Images from the previous exam have
reconstructed.
When prescribing Mag factor for auto film, scout images if the scout is longer than
500 mm then use a magnification factor less than 1 to display the entire scout.
The manual film composer may display when confirm is selected for scanning if the
composer had been closed by selecting iconify in the upper right corner of the
composer.
B-17
Its best to run Print Series from only one desktop at a time.
Its best to resolve any paused queue entry as soon as possible.
Print Series may pause automatically under heavy system load.
If Anonymous Patient is selected for an exam where Auto Film is in progress, the
system may fail to cross reference the slices on the scout. If Anonymous Patient is
required for series that are still active in Auto Film, wait till Auto Film is complete for
the series before proceeding with Anonymous Patient.
To install a SMPTE pattern select the following. Once installed the images will be
available for viewing from the Image Works browser or List Select in Exam RX. And
will be listed as Exam 1000. The patient Name will be listed as SMPTE.
Click Service Desktop.
Click [Diagnostics].
Click [Display Processing].
Click [Install SMPTE Image].
Full Annotation instead of partial annotation will be filmed when using F3 (Film MID)
in the Image Works desk top when full annotation is selected.
The format built in a protocol may be changed when the protocol is used with a
message that the format was changed due to an invalid format, even though the
format is valid. Verify in Auto Film set up is the format you desire before confirming
scan.
For Multi-Image Display (MID) in AutoFilm, filters, gray scale and orientation
selections are applied only to the image in the upper left viewport. If there are an odd
number of images in the series, the filters, gray scale and image orientation is
applied to the first group only.
Network
images will not transfer if Advantage Net protocols is used. Always use DICOM
protocol to send images.
images cannot be sent to a HiLight Advantage, HiSpeed Advantage or CT
Independent console. These systems do not support DICOM receive.
Some 3rd party workstations may fail to receive scout images. This is due to the
matrix size of the scout image. These stations do not support receiving matrix sizes
greater than 512. Some scouts images have matrix sizes greater than 512. If it is
desired to have the scout image on the workstation, Screen Save the scout and then
transfer the screen save image to the workstation.
If you query a system from a CT/I or Advantage Windows system in Advantage Net,
only Advantage format image exams will be displayed, No exams will be shown.
Always query a system using DICOM protocol.
B-18
Lateral scouts displayed on an AW 3.1 system will initially display with zero rotation;
they should display with a 270-degree rotation. Rotate the image in the left direction
using the rl command on the command line to display the scout in the desired
format.
Images networked to a Advantage Windows 3.1 workstation running software
versions prior to 3.1_07 will display a DFOV less than what is displayed on the
scanner. This is due to the AW not taking in account the pixels under the focus border
of the viewport.
Images networked to a AW 3.1 will have the following annotation missing:
Accession number,
Date of Birth,
4i, 2i or 1i recon mode on Axial, Retro Axial or Axial Reformatted images,
Series type on Retro images,
Table Speed on Helical images,
Images are annotated +C when Oral Contrast is used. View the Series Text Page to
see if IV contrast was used.
CardIQ annotation for BPM and percent of R-R interval and scan type will
displayed as Axial.
The number of images indicated in a series may be incorrect on the remote browser
when a query is made from an AW or CT/I station.
Series types may be listed differently when images are networked to an Advantage
Windows 1.2, 2.0 or 3.1 system than that shown on the system
Exams with Swedish, German or French characters in any Patient Info field will not be
transferred to an Advantage Windows.
When using DICOM protocol, the entered host name must match in spelling and case
sensitive, otherwise a connection error message will be displayed.
Its best to resolve any paused queue entry as soon as possible.
B-19
Image management
Dont let image space fall below 200 images on a single disk system (130,000-image
storage). This will ensure there is room on the system disk to confirm scans and to
install reconstructed images.
Remove images when scanning is idle. This will assure that all images are
reconstructed, displayed and installed into the database.
Exams that contain SmartStep may fail to remove. Reboot the system to remove the
lock on the SmartStep series.
B-20
Appendix C
Operator Messages
Introduction
This appendix lists user messages that are posted to the user interface. These message are
displayed in one or more of the following areas
Figure C-1 Attention pop up dialog
C-1
Figure C-2 Real Time information area of the scan progress screen on the left monitor
Real Time
Information
Area
Figure C-3 OC message bar on the View Edit screen of the left monitor
OC Message Bar
C-2
Figure C-4 Message area of the Feature Status Area on the right monitor
Message Area
Translation
C-3
Operator Message
Translation
C-4
Operator Message
Translation
C-5
Operator Message
Translation
WARNING:
C-6
Operator Message
Translation
WARNING:
C-7
Operator Message
Translation
WARNING:
C-8
Operator Message
Translation
C-9
Operator Message
Translation
C-10
Operator Message
Translation
C-11
Operator Message
Translation
C-12
Operator Message
Translation
C-13
Operator Message
Translation
WARNING:
C-14
Operator Message
Translation
C-15
Numerics
3D Option 34-1
A
Accelerator Line 32-2
Accelerator Line Commands 32-11
Accept Negative Pixels 29-3
Active Annotation 34-48
Add Images Together 29-5
Addition 29-2
Adjust Graphic Rx 21-11
Adjust the Localizer 20-15
Adjusting a Protocol 21-2
AE Title 24-15
Analysis 19-14
Analysis of Results 19-9
Anatomical Selector 8-31
Annotate Image 32-5
Annotate the Scout With Scan Lines 32-4
Anonymous Patient 24-3
Archive 24-3
Archive Device 24-18
Archive Exams/Series/Images 24-22, 24-26,
24-28
Index-1
EKG 12-16
EKG Waveform 11-2
Era Year Entry 20-4
Exam Prescription for Prospective Gating 11-6
Exam Rx 5-20
F
F Keys 23-2
Fast Cals 6-7
Feature Status Area 24-2
Feature status area 5-20
Filming 24-3
Flip/Rotate 28-5
Flip/Rotate in Image Works 28-12
Forward 1 16-18
Full System Calibrations 6-3
G
Gantry
Display 5-7
Gantry controls 5-8
Gating Check 20-15
Get 24-34
Get Alignment Light Location 18-5
Get Examination 24-34
Get Images 24-34
Get Series 24-34
Graphic conventions 2-2
Graphic Rx 21-11
Gray Scale Enhancement 22-2, 28-2
Guidelines For mAs 7-6
H
Hand Held Controller Button Descriptions 16-4
Hardware Components 7-2
HD MIP Render Mode 34-13
Head SFOV 21-9
Helical Pitch and Scan Mode Definitions 7-4
HHC 16-3
Hide or Show Graphics 32-8
Host 24-14
How to 3D Images 34-46
Index-2
I
iLinq 5-20
Image 24-2
Addition 29-2
Matte 28-10
Sharp 28-6
Smooth 28-6
Subtraction 29-2
Image Filters 22-2, 28-2
Image in Image Works
Matte 28-16
Sharp 28-13
Smooth 28-13
Image Magnification 30-5
Image Orientation 28-5
Image Orientation in Image Works 28-12
Image Works 5-20
Make the image smaller or larger 30-8
Move the image around the screen 30-7
Scroll 30-7
Zoom 30-8
Integral Render Mode 34-13
Interscan Delay (ISD) 21-13
Interventional / Biopsy Scanning 3-30
Inverse Video 28-9
IPPS Lok-Bars 19-11
IVY Monitor Recommended 3 Lead Placement
12-25
K
kV 21-9
L
Label an MOD 24-20
Large SFOV 21-9
Lateral Motion Verification 19-2
Limited Access Room Configuration
3-37
Localizer 20-15
Look for Images that are not Reconstructed
M
mA 21-10
Managing Images 24-1
Manual Detect 12-18
Manual Film Composer Parameters 23-5
Manually Add an Image to the AutoFilm
Composer 22-9
Matrix Size 8-54
Matte
ematte 28-10, 28-16
rmatte 28-10, 28-16
Maximum Pixel Value Extraction 29-2
Measure from Point to Point 31-2
MedTec RT alignment device 19-11
Min IP Render Mode 34-13
Minimum Pixel Extraction 29-2
Mini-Viewer 25-2
MIP Render Mode 34-13
Monitors 5-18
Mouse 5-24
Multiple Image Display 26-6
N
Negative Pixels 29-3
Network 24-3, 24-4, 24-14, 24-31, 24-32, 24-33,
24-36
33-13
Index-3
PMR 8-10
Port Number 24-15
Position the Patient 20-11
Power Distribution Unit 5-4
PPS 14-2, 24-4
Prep Delay 21-13
Prepare a storage media for use 24-20
Prerequisite Skills 2-1
Preset Window Width and Window Level Keys
23-4
R
R to R interval 11-2
Ratio Slider Bar 29-3
Raw Data 33-2
Ray Sum Render Mode 34-13
Recommended workflow for RT 19-2
Reference Image 25-11
Reformat
Creating a Histogram View Type 34-58
Creating an X Section View Type 34-61
Releasing Scan Data 33-3
Remote 24-4
Remove Graphics From the Image 32-9
Remove Images from the Reconstruction List
33-17
Index-4
Scan
Baseline Phase 9-9
Monitor Phase 9-11
Scan Phase 9-13
Scan Data 33-2
Scan Parameters 12-26, 21-5
Scan Type 21-5
Scout 20-15
Screen Save 32-2
Scroll Through A Set of Images 25-8
Secondary Viewport 26-10
Select a Protocol 20-13
Select an Archive Device 24-18
Selecting an Image Set 34-66
Send
Exam, Series, Image 24-32
Send images to the Manual Film Composer
23-6
SmartStep 16-1
Backwards 1 16-18
Display 16-6
Display SmartStep Images 16-14, 16-17
Forward 1 16-18
Hand Held Controller (HHC) 16-3
Hand Held Controller Button Descriptions
16-4
SmartStep 16-3
SnapShot Cine Parameter 12-31, 12-33
Sort 27-6
Sorting 27-3
Specify a Zoom Factor 30-5
Start New Sheet 22-7
Startup 5-41
Subtract Images 29-6
Subtraction 29-2
Suspended Entries 33-2
System Options 8-12
T
Timing Bolus Scan for cardiac scanning 12-29
Timing Parameters 21-13
Transfer 24-4
Transfer Exams/Series/Images 24-31
Transmit 24-4
Tube Warm-Up 6-2
Type Text on the Image 32-5
U
Update the Reconstruction List 33-17
Use Performed Procedure Step 14-4, 15-5
Use VariSpeed 10-4
User Interface
Helical 7-6
User Preferences 32-2
Users conventions 5-26, 5-27
Index-5
V
VariSpeed 10-2
Video Reverse 28-9
View Edit 21-5
Viewer 25-2
Viewing Protocols 8-12
W
Window Width and Level Presets 23-2
Y
Yellow Frame 26-10
Index-6