Getting Started with Corridor4DM Quick Start Tutorial

This video presents getting started with 4D MA nuclear cardiac quantification, review and reporting application. Here we give a brief demonstration of four DMS clinical workflow for cardiac, SPECT and reporting, as well as an overview of four DMS. Other features. To begin, first launch a patient data set into 40 M by right clicking on the study name and select open with a dropdown appears. Select 40M to launch that data set into 40 M. Patient review takes place within the displays on the main canvas. Use the buttons in the workflow panel, top down for standard clinical review the panel to the immediate right contains data set information relevant to the workflow screen displayed available tools in the toolbar. Assist with processing and interpretation as needed for global controls of 4D M, such as save and quit, use the control panel. For DM, automatically displays the appropriate workflow depending on the study type of the patient loaded. SPECT studies from Siemens. Ivo and in TiVo to slice cameras, automatically launched the SPECT workflow in 40 M to begin your SPECT assessment. First, evaluate the quality of the raw data for all datasets by viewing that Elmo viewports for extra cardiac activity, breast attenuation and patient motion. Additionally, ensure all sinograms an Lina grams are smooth with no breaks or misalignments which indicate patient motion in either the X or Y direction. Once all raw datasets have been evaluated for adequate image quality, select the next screen for image processing. For DM automatically quantify's left ventricular ejection fraction. Transient ischemic dilation, commonly referred to as TD and many other values as part of this process for DM, estimates the orientation contours. An basil limits based on the data set acquisition. To review these estimates for optimal placement. Three initial steps are taken. First verify orientation by confirming the HLA apex of all datasets is pointing towards 12:00 o'clock. And the VIA Apex is pointing towards three o'clock. Second, ensure the contours are correctly outlining the endo and epicardial surface is of the left ventricle. Should either the orientation or contours need adjustments. Enter manual mode. 3rd Verify the Basel limits are correctly placed at the base of the left ventricle, as these impact the functional estimates such as left ventricular ejection fraction and TID. If any adjustments are made, click save and begin your interpretation on the next screen. Here you are visually evaluating the tracer uptake by the heart walls at both stress and rest. Begin by visually comparing the row of stress slices to the row of rest slices. The difference in intensity at stress. An rest results from a difference in the amount of uptake, which indicates a defect should any corresponding rest to stress slices not be aligned, simply click and drag the slice in the desired direction. Note the TID value displayed in the data set information panel. The TID quantification assesses the blood supply reaching the innermost layer of the left ventricle. When lower blood flow exists at stress compared to rest, the TID value becomes elevated. Proceed to the images plus quant screen to compare your visual interpretation of perfusion with polar Maps and segmental score quantifications. Visually compared the rows of stress slices to the corresponding stress polar Maps and the rest slices to the corresponding rest polar Maps to correlate consistent tracer uptake. Low intensity an black areas indicate below normal perfusion. Polar Maps depict perfusion in the main vascular territories of the left ventricle of your patients. Data set compared to normal patient datasets. The first row of polar Maps is called perfusion blackout Maps in the order of stress, rest and reverse ability on the reverse ability map. A white crosshatch pattern represents a greater than 10% difference in uptake between stress an rest indicating the potential for reversibility. The polar Maps in the bottom row are called segmental perfusion score Maps. These divide the left ventricle into 17 segments and compare each to a normal patient database on a zero to four scale with 0 being normal tracer uptake. Assess diagnostic risk using the regional scores and prognostic risk using the global scores. If you do not agree with the scores in comparison to the slices or blackout Maps, you can adjust any segment left Click to increase right Click to decrease. Once perfusion interpretation is complete, move on to the function plus quantification screen to evaluate the functional strength of the left ventricle. Begin your review by visually assessing the gated slices. Sidney through the cardiac cycle observed the intensity change from frame to frame to evaluate wall motion and wall thickening. Correlate your assessment with the gated wall motion Maps. Motion of the heart measured in millimeters, is plotted on the first map and scores on a scale of 0 to 4 from normal to aneurysmal on the second. The wall thickening polar Maps displayed the count increase during systole compared to diastole. Measured in percent, these scores are based on a scale of zero to three from normal to severe. These scores will auto transfer to the patient report, correlate your findings with the volume curve to assess the squeezing strength of the left ventricle and primary functional values. The deeper the curve, the higher the ejection fraction the EF and vice versa. This important value indicates the percentage of blood pumped out of the left ventricle with each contraction. Once functional review is complete. View the MPI summary screen. All primary information is displayed here. To review for consistency as well as to affirm your assessment of your patients cardiac health. Compare and review perfusion an function objects and make any segmental score changes as desired. Knowing that these will automatically transfer to the patients report. Additionally, evaluate the 3D renderings which displayed the blackout polar Maps as a 3D object to visually correlate wall motion, wall thickening and perfusion. Look to the data set information panel for key quantifications, including the FT ID and some scores to review and finalize the report. Click the reporting button in the control panel. Your patience report displays with available patient information and for DM quantifications, automatically populating. Note that the fields throughout the reporting module in red indicate that the report anticipates an entry to view 2 pages of data boxes at the same time. Turn off the report preview function by clicking on the preview button located in the upper right corner. Enter the patient height and weight to automatically calculate PSA an BMI. Refering and interpreting physicians must be identified using the dropdown menu to add a physician who is not pre configured during setup. Click other and entered the positions name. To complete patient information, click medical history. Enter study indications by clicking the white data box for each category. Primary categories must be filled secondary or optional to help provide a comprehensive assessment, click within each box. For options. Enter information using voice recognition software, free text or by selecting within the dropdowns. If the patient has a prior study, toggle exist to display additional data boxes regarding that study. Once all patient information is complete, click stress test. To begin entering, study specific information. Select the correct stress test type and relevant data boxes will appear. Enter stress test details and the adequacy of stress using the white data boxes. These will automatically update the stress test protocol and findings when Autotext is turned on to edit either protocol or findings, simply click the box and type. For EKG specific findings, click EKG. The resting EKG status selected activates relevant data boxes. Select normal to automatically populate normal values manually. Adjust these as needed when abnormal is selected for the stress EKG status, the data boxes appear red. Click in each box to activate a predefined list of options or enter values by free text or voice recognition software. When auto text is turned on, stress EKG findings will automatically update based on the values entered. Once complete, enter image ING information on the next screen. Begin by entering the radiotracer injection time for stress and then rest. Notice how the imaging protocol data automatically updates and the acquisition parameters automatically populate. Edit Any fields requiring modification to review and modify position interpretations. Click to the next screen. Left ventricular perfusion and function. Quantifications from 4D M automatically populates core Maps and other areas in the report from these values. Impression sentence is our automatically generated review all values and impression sentences for agreement with your assessment across all screens as needed for SPECT studies. Fill ablex RV Maps or present for physicians who wish to enter their assessment and include with the patients report. Depending upon physician preference, auto text can be turned off to support the full dictation of your interpretations into the dialog boxes. Once you are satisfied with your assessment, click preview to read through the report. Enter overall study quality. Clicking in the required fields of the miscellaneous screen. The overall screen facilitates the review and editing of the various interpretations. Click the finalized icon in the upper right toolbar, which will allow you to save in the desired format and location the finalized button electronically signs the report and requires the unique password of the interpreting physician. This password can be set up in the administration module. To access this module, click the icon in the lower left corner. Three items in admin are required to be set up prior to completing a report. Your hospitals name an logo. The interpreting physicians name Signature, an password, and the path for storing the final report. Refer to the reporting users guide which is accessed by clicking on the Help icon in the upper right toolbar. For more detailed assistance in setting up these and other items in four DM administration. In addition to cardiac SPECT review and reporting for DM provides workflows and report templates for all other core molecular imaging protocol visit in Via's Prospects Center for Instructional Guides on these features. Gated blood Pool provides an analysis of the amount of blood pooling in the heart chambers at different times of an average cardiac cycle. This protocol is used to determine how blood is settling, which can indicate if the hardest working optimally or is under strain. Including hybrid CT with SPECT studies adds anatomical review for improved patient assessment in TiVo 6 and 16. Slice scanners obtain such patient studies using for DM hybrid. Siti obtained calcium scores aligned separate nuclear and see T studies view any CT only scan or simply attenuation, correct SPECT or PET studies. Review pet studies from Siemens bio. Graph line of scanners using four DM including rubidium ammonia and FTG acquisition protocols. Pet Review and Reporting offers the same, comprehensive and specific tools available for SPECT imaging. Additionally, the CFR option for PET enables the measurement of absolute flow and reserve a newer imaging technique where four DM has been a leader, further improving the tools available to cardiologists for improved patient care. On site training from a 40M product specialist is provided for all customers purchasing for DM who are located in the USA and Canada. Experience has shown that site specific configuration and training optimizes the use of for DM and the related patient care. For all other countries, such configuration and training is conducted via Webex. Thank you for your interest in 4D M. Please contact four DM at in viasolutions.com for any requests. We look forward to working with you.

SPECT, 001; 004-001, ID GSR (Ischemic2) , 52 yrs, Male History Chest Pain Symptoms OttEr Symptorrs Ottr•r Symptorns )tner Symptorns )ther Symptoms stress/EKG Stress/EKG CT Eov: 99 Pain Thin Asian PET.CfR SPEC' Gaps ID GSA ! Medical History (GStr-Rst) (GStr.Rst) NWPT NM/PT Unkrxn•n Q' quant Values v/ Quant Values Post Stress ESV: 100 Rst Black 100 100 SPECT 80 yo Female 60 yo Female 57 yo Female 52 yo 52 yo Male 52 52 0 Male 70yo Male , 52 yrs, Male 52 yrs, Male 70 yo 62 yo Male 62 yo yo Female o Male 40M GS.'R 40M PET. 001, 004-014,RB82 (PET Abnormal) 40M spa-CT, 001, 004-001110 GS.'R 40M Gaps. DOI. 40M PET CFR. 004-016, Rd82•CFR 40M 001, GSR 40M 001, 004-018,GBps.'LA0 40M 001, GS.'R 40M 001. GS.'R (Ischemic2) 40M PET. 001. 004-014,RB82 (PET Abnormal) 40M Gaps, 001. 004-0WGBps.'1_A0 40M spa-CT. 001, 004-001, 10 GS.'R 40M SPECT.CT, 001, (Casc) PET CFR, 004-016, RB82•CFR PET CFR, 004-016, PET CFR, 007, 004-016, RB82•CFR PET 001, 004-014,RB82 (PET Abnormal) Gaps, 001. PET 002, (HFPO Prep) Gaps, 001, SPECT.CT, 001, GSIR•casc (Casc) 001, GS.'R Padent Demographics 001, (Casc) 001, GSIR•casc (Casc) 00401 10 GS.'R 004.m1,10 GS.'R 10 GS.'R GS.'R Wdkatjons - DaW Native Alaska Native 40M SPECT, 001; 004-001 ,SR 40M SPECT, 001; 004-001,1D GSR , 40M SPECT, 001; 004-001,1D GSR , 52 yrs, Male 40M SPECT, 001; 004-001,1D GS/R , 40M SPECT, 001; 004-001,1D GSR 40M SPECT, 001; GSR , 40M SPECT, 001; 004-001,1D GSR (Ischemic2) 40M SPECT, 001; 004-001 GSR 40M SPECT, 001; 004-001 GSR , 52 yrs, Male 40M 001, 004-001, 10 GS.'R 40M SPECT, 001; 004-001,1D GS/R (Ischemic2) ! Stress Test 52 yo Male , 52 yrs, Male 52 yrs, Male 52 yos, Male QA Interpretations 03/13/1954 NWPT IngntÉnt GSA 52 yo Male , 52 yrs, Male 40M SPECT, 001, 40M SPECT, 001, 004-001, ID Iale GStr GStr 2 GStr 10 GStr 4 GStr 11 GStr I G Str Frame G Str Frame 4 GStr Frame 14 GStr 7 GStr Frame 4 Frame 8 Frame 9 16 40M SPECT, 001; 004-001,1D GS/R (Ischemic2) , 52 yrs, Male 40M SPECT, 001; 004-001,1D GS/R (Ischemic2) Imaging Info Patient Info Pabient Info J Demographics , 52 yrs, Male Time Time Activ Curves ESV: ES QA Lin ogram Sin ogram Lin ! LV Perfusion Gstress TC-Gated [FBPI Gstress TC•Gated (Primary 11 Gstress TC•Gated (Primary Ung 16 Native Hawaiian I Native Hawaiian I Other 124 Motion Protocol Gated Stress Tc-99m Sestamiöi / Static Gated Stress Tc-99m Sestamöi ; Static Rest Tc-99m Tetrotosmin GStr Frame: 40 Gstress TC.Gated [FdP1 Gstress TC.Gated [Fan Gstress TC c;stross TC [Fan Gstross TC TC MPI Summary Transverse Patient Browser 004-001, ID GS/R (Ischemic2) SPECT, 001, 004-001,1D GS/R (Ischemic2) 4DM SPECT, 001, 004-001,1D GS/R (Ischemic2) Transverse 09 07 02 n Sep 21 20) 20 40M SPECT, 001, 004-001,1D GS/R (Ischemic2) 40M SPECT, 001, 004-001, ID GS/R (Ischemic2) 4DM SPECT, 001, GS/R (Ischemic2) 4DM SPECT GS/R (Ischemic2) Wall 0-9 ZO sep zo sep ED perfusion Native I Alaska Native Q WNaves Wan Motion ! EKG GStr 13 GStr Frame: 1 GStr Frat-re 4 normal v/ Quant Values Quant Values (GStr.Rst) (GStr.Rst) Stress Test (GStr.Rst) Function Overall ! Overall NW/PT Gstress T Demographics ! Stress Test LV perfusion RV perfusion EKG Medical History Arnbulatcxy preliminary v' Quant Values v"' Quant Values 'O New Physician @ normal 16 16 Fr. 10 11 52 Arrtry•thrrias Arrtrythrrias QRS MormokUy QRS Tomo QA MPR Gstress TC [FBPI 03/13/1954 GStr Frarne: 1 1 GStr Frarne: U Edit Adequæy or or TC-Gated Tc.ßated Gstress 0T Stress LAO-Gated Gstress TC-Gated Gstress TC.Gated Gstress TC-Gated IFBPI ED Frame Stress Test Perfusion zoo Filter: None 4DM SPECT, 001, 004-001,1ID GS/R (Ischemic2) 4DM SPECT , 001, 004-001, ID GS/R (Ischemic2) normal sinus rhythm Derncwaphics Chest Pain Wan Motion Wall Motion Scores 5 Slices uoVor.68ml, 91 repolarizatlcn TC99m 4DM SPECT, 001, 004-001,1D GS/R (Ischemic2) 4DM SPECTI 001, 004-001,1D GS/R (Ischemic2) 40M SPECT, 001; 004-001,1D GS/R (Ischemic2) ObservatkY11 ER ER None Horne TOO'S ml-voltage QRS Paüent Info P atient Info Paüient Info Patient Info Imaging Info pa6ient Info Pabent Info -99m Patient Dem paUent patient Dem L RV Perfusion Read (4) Read SS 23 none LV Permsion LV Perfusion RV RV Surmwy Perms"' n the R" RN Risk F&tors Risk ! LV Perfusion ! RV Perfusion Test NWPT Data Ung Gstress T Auto Str—s RV Functmn Str—s LV Functm NWPT Imaging Protocxol Data NWPT Imaging Protcxol Data NWPT Imaqinq Protocol Data Normal Score Rot EKG stat'S Rest EKG status Stress Test Stress Stress RV GStr Frame: 8 GStr Rest status Auto-Text Motm w processing 15:36:19 C) sinus rhythm GStr Pert u Clear ESV: EOV; sss: ESV: 31 ESV: as ESV: 25 SSS: 16 svs: 16 31 RBC vitro RBC in vitro Patmt Overall ! RV Function ! RV Perfusion (GStr-Rst) ! Stress Test EKG EKG 15:36:19 Excellent Excellent 4M s E 16 Fr, supine, FBP 16 supine, FBP Study D a Doel 'S ED Frame Medical History Tomo QA Sin ogram 40M SPECT, 001, 004-001, ID GS/R (Ischemic2) GStr Frame: Ung Framne: Ung Gstress TC•Gated (Primary 11 Gstress TC-Gated [Primary Il Frurne: Ung Frarne: 16 Frame: Ung Frarne: Ung ! Demographics Demographics DetTMaphics Demt_HaraphIcS NM/PT ImaÄ Prot(xol Data Auto-Text - Day Test normal Unkrxn•n Rate: — paUent pavent Extaü -gess Stress a normal response Stress ST resgu)nse was Si depression -gess Stress normal response Stress ST was 1 -gess normal Stress n" a normal Stress ST was 1 Stress a normal response Stress ST resgu)nse was Si depression ! LV Perfusion S i depression Stress Suess nao a vesponse Sress ST response was Saess Suess a Stress ST response nas Suress Stress a vesponse ST was Stress Stress a vesponse ST was 1 ST *pression Stress nao a 'esponse ST was 1 ST *pression * pression RV FINDING s Mass; CO; Esc; 37.0 37.0 (100%) CO; CO 60 CO: CO: 60 CO; 60 C O; 60 CO 6.0min CO C 0 6.0 1100%) 000%) Gstress Filter. None Ungated Tc-99m Sestamibi Tc.99m Sestamibi fi Medical Tc-99m Stress Test Sun-unary 09-Mar.2007 15:36:19 09-Mar-2007 15:36:19 Wall Rate Gated Rest EKG Rest Stress EKG ! LV Perfusion Data 15:36:19 ! RV Perfusion 16 Fr, supine, FBP in the lateral. and leads in the lateral. Stress Imaging was not pelormed_ Rest imaging was not perlormed. Stress imaging was pefformed; 381 mCi ot Tc-99m Sestamibi were injected intravenously aner the termination of regadenoson Rest Imaging was perlormed witn the patient in the supine position approximately 124 minutes following the intravenous injection ot Stress imaging was not Rest imaging was not pellormed. '"rmal '"mal i the and the and stress and stress Rej Rej 0.0 55 ml. Tc .99m Reason tor Terrninatül Reason Terrninatül Processing for Terrrmatm Timing ! History Mah ! Medical History Medical History J Medical History ! Medical Histo•ry LV blot I-uspant EDV: 99 ml (52 Regk)nal Wall Thkkerü" Filter: None Un ated Un ated Stress RV Function Filter: None Filter: None U ated U ated Motm Perfusion-Blackout In supine position approximately 124 Tunules tne Intravenous Injection or FDG.Viabi1ity by Date, Oescniption and by Oate Cescnpton and by Date, Oescnpton and Mass: Adequæy of Stress sss: sss: 16 atrial flutter 01 r r u rx Patient Info Imaging Info Paüient Info Stress Test First Cardiæ Evert History Evert History RV Perfusbn Surrynary 16 Fr, Supine, FBP 16 Fr, supine, FBP 16 Fr, Supine Infusion. The hear was imaged with the patient in the supine position approximately 37 minutes post-injectiom Rest imaging was not -ne t•selne resting EKG Bas normal RV LV O Abnorma Ischemia Stress Test Surnrnary 52 12 Auto-Texl Free Text k)0d Pod Wall Thkkening no: Test Test Type Fnarmacologlc Stress RV Functbn Regbonal Wall Motm Regk)nal Wall Motm inteqyeted Stress/EKG Quant Values ( ) Rest EKG Rest EKG Status Stress "as judgeC to a pressure Stress ST response Bas o: AC • Normal ESV: 31 ml ESV: 31 55 no: 1B 2 mCl ot Tc-99m Tetrotosmin. Stress imaging was perlormed: 381 rnCi ot Tc99m Sestan-ibi were Injected Intravenous aner the 7.1 ntegxeted Resting EKG is not abe to be for ischenia Resting EKG is not abe to be for ischania SMS Gstress stress 'EKG stress/EKG stress.'EKG CT A mid and A the and ! L.V Function ! Function ! RV Function ! LV Function 1 mCi Tc-99m Tetrorosmim Stress imaging was 38.1 Tc-99m Sestan-ibi were injected intravenously aner tne GSR stress UJnknown Unkrww•n termination of regadenoson infusion. The heart was imnaged with the patient in the supine position approximatery 37 minutes post- blot 16 16 15 Hecht: Sinogram Sin ogram SA (Apex—Base) right axis deviation Tc-99m Sestamibi EDV: 99 Stress was Judged to be sub-maximal Stress had a normal blood pressure Stress ST response was Gstress TC-Gated [Primary Gstress TC•Gated (Primary 11 Wall Wall Thickening Wall Wall Normal SSS:16 SDS: 16 ot Stress ot S or inrusm The was witn in supine »proxrnatety 37 minutes or inrusm The was in supine »proxrnatety 37 minutes Irrreased EDV: 99 ml (52 HR Septa I Demographics Day 57 17 NatWe Ala"a Native Nathe NatWve v' Stress Test v/ Slress lest ! Stress Test Stress Test stress EKG Stress/EKG Stress EKG ! Stress Tent Stress TC Stress.EKG Test red«ed Series Seriess Results Stress was Judged to be Stress nad a normal blood pressure response Stress ST response was 1 amr sinus bradhycardia depression sGREST TC [FBPI Str Funjection 15:36:19 40M nut haw sottsare *ense Key. To a license. seM request to Reversibility 17 zones EMracardiac Stu'y Qualty Sunnwy Sany Quary 7.1 (35 results, 34011 PM) sGREST TC [FBP] PM) T.ne Oaseline resting EKG was normal, Gloöal.•1Jnlfor1T Mass: 148 g, CO: 6.0 ESV: 31 ml(17 mVm*) Anterior Quant Gated Blood Pool EDV: 97 ml (51 EDV: 97 ml (51 mVm*) EDV: 99 ml (52 mvmZ) Camera: Syrnbia T2 EDV: 99 ml (52 mVm*) Camera: Symnbia T2 ! RV Function W Function Interpretations SPECT Severes stress r«overy NV Text Rest ! NM,'PT sGREST [FBPI Stress Agent 09-Mar-2007 Rest EKG Findings Rate RVH Auto-Text Stress Test Findings SPECT.CT D9-Mar-2DD7 15:37:06 Clear h ages R-R: 35%@659 Wall Motion (mild?)' positive) in the inferior and lateral leads during stress and recovery PerfusmBlackout Perfusmn.Blackout Stress to ST STS CT ST ST ST ! EKG ) junctional rhythm EKG 1.29 UgV01: 55 ml, inviasolutions.com/ProspectCenter 55 ml, 55 ml. Processing Rej Beats: 0.0 16 Fr, Supine , Supine Normal None 1 of Quant V' EKG septa' Uninterpretatk Interpretations Medical History ESV: 31 ESV: 33 ml (18 ESV: 31 ml (17 mVm2) ESV: 31 ml (17 ESV: a Heads: 2 in al LCX 310 RV Summary Summary LV Sumnary LV Summary MP Summary Stms LV Sumnary RV Sumrnary LV Sumnury LV Surnnury interrreted stress EKG status stress EKG status sss: 16 ugvor. 55 ml, TID: of Fum Assessrrpnt Base S PROTOCOL: STRESS PROTOCOL: - S PROTOCOL for 68.00 169.001 Reason tor Reason tor Ter Regacenoscn r«overy oNy r«overy ony in Imaging Info ugvoe 55 ml, -29 258 25 8 Tc-99m Sestarnüli Tc-99m Sestamib)i Gstress TC (FBPI Tc-99m Sestamibi m Sestamibi 119 sGREST TC [FBPI Arrtnnatcxy Arrtnnatuy Quant Values CT Findings Ung, Supine, FBP Ung. Su _18e, FBP Images + Quant + Quant 10 LV PERFUSION ts consuucteu your junctional rhythm Inputs In section 21 cot 100 100 min:sec [ nin:sec Stress Test Protocol Sign in to continue to 4DM Administration. Wall Thickeninq Wan Thickeninq Auto-Text min:sec MC str Wall Thickeninq Scores Global Abnormal suggesuve o: multi-vessel Auto-Text 92.4 Vmin Func Quant FTrysEian: Qua*y 100 Func 4DM SPECT, 002 SPECT, 002 GStr GStr Sinogram VI-GSRDTC:NCT.' Notmal Not sGREST TC [Primary 11 Imaging Info Stress TC EKG is to be mterpreted EKG is to be EKG is to be txhania V NM/PT ! NWPT ! NM/PT NM/PT Camera: Symt)ja T2 era: Symbia T2 left ansterior fascicular block Was Stress LV Was LV Stress LV Wall LV Wall Siemens Healthineers are neither the provider nor legal ischemia iscnemia Observatm I ER MC_Rst MC Rst Mak Mak• Observation ER Func + Quant I UgV01•. 55 ml, TID:— Following pharmacologic stre Mass: 1436 g, CO: 5.6 Vmin 09-Mar.2007 14:04:53 Mass: 148 g, CO: 6.0 vmmn Mass: 148 g, CO: 6.0 Vmin Mass: 148 g, CO: 6.0 vmm sass: Mass: 14 0:6.0 Vmin O: 6.0 Vmin Septal Beats: 37.0 (100%) Beats: 37.0 ectopic atrial rhythm Images + Quant Func Quant CtBt Cfctmnfereme CtBt Cfctmfereme CtBt Crctrnfereme inferior in Pain Irnages + Qua. Irnages + Quant frnages + Quant ! RV Perfusion Qu t Additional Tc-99m Sestamibi Show Event H i Slow Pre-test Pain Show Base State Stress EKG Findngs Auto-Text Summary RV Summary STRESS TEST Adequacy of stress: AV gee Gstress TC r ne patient was Infused Intravenous'y regaaenoson at 0.08 m,g/ml tor a total aurauion o' 10 seconds. A total regaaenoson dose ot r ne patient was Intravenousry regaaenoson at m,g/ml tor a total duration or 10 seconds. A total regaaenoson dose ot r ne patient was Infused Intravenous'y regaaenoson at 008 mg/ml tor a total aurauon or 10 seconds. A total regaaenoson dose ot 4DM Gstress TC-Gated [Primary Gstress TC-Gated [FBPI Gstress TC-Gated [FBPI Gstress TC-Gated Gstress for a total duration of 10 seconds. A total regadenoson dose of tor a total duration of 10 seconds. A total regaaenoson dose of Camera Heads: 2 Difascicular block Difascicular Oifascicular Nock Nom-el projection Perfusion-Blackout Flow ( Flow Nu sss: 16 ED ES ESV: ES ED ES VLA ED VLA ES HLA ! NM/PT ! NM/P no: Clear Ung, Supine UgV01•. 55 ml, TID: - UgV01: 5 UgV01: 55 ml, TID): - UgV01: 55 ml, TID: - UgV01: 55 ml, TIC): - Rej Beats: 0.0 55 ml, TID): - Gstress TC-Gated [Primary Il stress EKG status Qualiy Artifæts 99 4DM Reporting User's Guide multitocal atrial tachycardia Algorithm (MC str): INVIA Rb.82 ROI Algorithm (MC str): Rb.82 Algorithm (MC str): Ape 99 69 / ER O .4 mg was injected Intravenously. 04 mg was injected intravenously. Func + Quant sSs; 16 SSs; sss: 16 up Clear 16 SOS; If, V2.GSRCVTC/NC/M EF Qualitative manufacturer of this video. Any claims and statements made in other - PDF 1 Function Function HR (bpm): 92.4 lbpm): 92.4 Interpretations Interpretation s UgVol•. 58 ml, TID•. 1.29 UgV01: 58 ml, TID: 1.29 Str ! Miscellaneous STRESS DYNAMIC TOF STRESS TOF STRESS DYNAMIC STRESS STATIC AC with TOF STREST STATIC AC with TOF Incatenl IS Row a Acquisitnn Date Acquismtnn Date RV Perfusbn Impression Stress EKG Status Stress Test Stress EKG Correctnns Posmn Auto-Text sss: 16 Tc-99m Tetrofosmin Lin ogram Sin ogram Count Histogram R-R: 35%@659 Sstress Gstress Gstress TC Stress Gstress T nonscpciOc IVCD 4DM SPECT, 002 Algorithm (MC INVIA Algorithm (MC Rst): INVIA Rb-82 Lottie Algorithm (MC Rst): INVIARW82ROl Lottie Algorithm (MC Rst): INVIA Lottie Images ED Frame ES Frame Frame EF Image ESV (ml) EDV (ml) 31 EDV' (ml) ESV (ml) 30 Hybrid-CT Coronal AV REST Rb STATIC AC aoncnna[ Tneres aoncrma[ s aoncrna[ s STATIC FOG AC Regmal R.' vs normal ! EKG CT Auto-Text Acc Beats: 37.0 (100 Acc Beats: 370 (100%) LV 1 RV Function None v' Quant Values Quant Values v/ Quant Values hMizoMaI Ambulatay Arnbulat«y bnages • Quant Images + Quant crest or Camera: Symbia T2 Reason tor your Inputs m or Inc + Quant lateral In 'm LV I RV Function •313/1954, M Inferior Func + Quant stress EKG V2.GSRDiTC/NC/M V2.GSRCVTC/NC/M V2-GSRDrTCJNC,M SSS:16 SDS: 16 incomplete RBBB V2-GSRDÆTC/NC/M was a for a for 99 29 QRS Morphobgy 69 ! Overall this video and any content shown in the video are under the LV Findngs Sumrnary Perfus Tc Login Information Stress/EKG Stress Secmd ! LV perfusion LV Perlusm LV PerlusKn MPI s in the and mid s in and mid ER ES RV Survnary Reports. RTF RV FiMings Sumnrnary RV Fimngs Sumrnary LV St" LV LV LV LV Siess LV LVfumt& St" LV LVfumt& Global Results Global Siess LV Auto-Texl St" LV Rej Beats: 0.0 C)pen Open with Stress EKG Fir-Klngs Stress EKG Firxmgs Stress EKG Firxmlngs Auto-Text SIEMENS ! LV Perfusion ! LV ! L.V Perfusion ! Perfusio ! LV perfusion LV LV Perfusion RV Clear r.crmal s.nus Provoked t" exert• or diMress Proned t" exert• or aress Prmoked or •Wress Prowked t" exert• or diMress Prowked exen• or eress or diMress o1 Stress gl Camera; camera; Camera: sgmL SPECT Workflow none 50 too % so regaaenoson at 008 'or a total duration or 10 seconds A regacenoson dose regaaenoson at 008 'or a regadenoson at 008 'or a total duration or 10 seconds A total regacenoson dose regaaenoson at 008 'or a total duration or 10 seconds A total regacenoson dose Summary Study Referral Data Reporting Status saved to LV 1 RV Function Str—s RV Functmn regaaenoson at a a Camera Heads: 2 Other was LV LV Interpretations Imaging Info 20-May-20æ d(Mn EKG is to 4 13 Training C] RBBB (EDV/S) 4 13 4 13 SSs; 16 SOS; 16 SSs; SOS; 16 SRS: o SRS; 8 SSs; SRS; o SRS; 0 SOS; 16 Gstress TC (FBPI Gstress TC-Gated Stress Test Gstress Gstress TC Gstress TC (FgP1 Stress TKG rc sGREST TC sGReS1 rc 1 691 RB3B 26 to 169.00 In 99m as RV ! RV 4DM 'WIA LLC. kg/rnA2 rnA2 R-R: 35%@659 Options co CO Stress normal, RV normal) Stress was RV normal, Stress was RV normal: RV normal Stress was ' normal on patient was at 0.08 mgiml a total duration Of 10 seconds, A total regadenoson dose Of 16 perfusion View as Real-Only with Vew as Read-only with with Flow (ml,'mWg) U RV Perluson ! LV ! I.V Perfusion ! LV Perfusion ! RV ! w ! L.V Perfusion ! RV Perfus ! RV Pertusion RV ! IV Function Launching SPECT wc Gstress TC-Gated (FBPI Flow (ml,'min/g) Flow (ml,'miWVg) 09.wr.20071 LV myocardial pefluslcn was abnormal. Global Stress LV tunctlon i.•.as normal. Stress LV volume was normal. Stress LV regional wall IS consuucteo your sGREST TC Reversibility 086058 saved O ncmnal range Ml Rm.. 161.01 PM PM 0309/2007 V2-GSRDJTC/NCM V2-GSRDJTC/NCJM VI-GSRDiTC,'NCWI V2-GSRDffC/NC/M 2-GSFEDTC Gated Wall demonstrated ST ABCS present demonstrated Sinus ST depression. were present. Supine Unkrxnown sole responsibility of the provider, INVIA Solutions. Additionally, RV Stress RV Stress Stress normal normal was Reporting PER 421 PER (EDV/S) 421 PER 421 PER (EDws) 421 is Gstress Cancel on Pain 4 13 ! NM/PT EKG Prkx Test Prü Test Func • Quant Func + Quant v" Quant Values motion was abnormal. Stress LV regional wall thickening was abnormal. incomplete I MG_Rst 64 x 64 x 16 gatch ESV ! RV Function U LV Function ! I.V Function ! LV ! LV Perfusion ! IV RV LV Function LV FUNCTION AND LV AND 4DM PET SARCOID, 002 40M PET SARCOID, 002 Demo 4DM J' terfa Summary MP' Summary Demo Demove ! Demographics Interpretations summary Finalizing the Report Func + Quant Images + Quant ! Medical History ! Stress Test ! NM/PT o essing Quant MP' summary 4DM Interface Stress Hybrid-CT Tomo QA Gated Blood Pool Summary CFR PET Order-mg Physkian Order-mg Physk:ian EKG Integxetmg Physkian Interpreting Physician FBP CT Findings MFR3 MFR3 (EDWS) MFRS MFR3 MFR3 (EDws) MFR3 (E-ows) 100 Images + Quant Rnvthm Rhythm PER (EOMS) PER (Eth'S) PER (Eth'S) 342 PER normal LV 14 Auto-Ten s a hgh LV of rd a LV of rd a hgh LV of C] a hgh LV of a LV of d LV of ! R.V Function ! I.V Function ! RV Function ! LV Perfusion ! LV Function ! L.V Function ! WV Function ! RV Perfusion W L Function ! Function W Function Function RV Function ! L Function LV Function !V Function ED VLA VLA Auto-Text ventricular tachycardia (non-sustained) the training may not be available in all countries and the CT Ses!am101 Chest Pain Synvt«ns Chest Pain Syrnptcms Chest Pain ED ES SyrMorrs Sym'*orrs 16 CT no Gstress TC-Gated Gstress TC-Gated [FBPI Gstress TC.Gated TC-Gated Gstress Stress Test Gstress TC IFgP1 Gstress TC Stress TC TC Stress EKG EDv ! Overall 4DM Features (ms) Ung, FBP Il and indicates a hign risk for harc cardiac events. 661 75 % o .67 Thest Chest (Xcwntererre Pain Referring Physician Physkcian Physkian otner ooe Board CT Findings me •nruseo regacenoson at mgm a total or 10 A re.adenoson o' John Board Certification 004.024 Prep) (HFpo Reversibi lity Summary Chest Circurnrererre Wall Test CHB (ventricularty paced rhythm) ED BP Respmse 66.2 % PET HR (Wn) HR (bpm) BP (mmHg) ung Clear AV Clear 0 4 mg was 71 174 TPER (ms) 174 TPER (ms) TPFR (ms) 174 99 0 Inpctjon Tinne hr min: sec resynchronization paced rhythm Test al Tc-99m Sestamibi Tc-99m Sestamiöi rpER MA Summuy MPI Summary Data (ms) supine, sep content may not be commercially available in all countries. 09 Stress Interpretations 0000 Tc-99m Sestamibi None ES Volurre FkG Test Summary RV Summary MP Summary the distal Septa' segment, There PET SARCOID, 002 Time Activi$' Curve Cleai Clea; Event Risk Summary Rhythm Event R" Event Risk Summary Event R" Sumnury TC.Gated AV AV Bkxk was O A O A search Patient OR Recovery m 07 '19m , m 07 , '19m m 07 '19m , 718:04. m 07 , '19m 718:04. 2.3 (46) 29 89 WPW pre-excitation ORS Morphology QRS ! Overan Accessk)n Nurrt)er Accessk)n Nurrtpr Accessk)n Nurr%er HR (bpm) 11369495 Arrhythmias Arrtr,'tnnuas 88 TOT HR (bpm) 88 1.19 Una, Sumne EOv EDv ED C mg was O mg STRESS DYNAMIC with TOF REST STNATIC with TOF REST DYNAMIC with TOF Clear 50 100% 50 100% EOv; ESV: no: - There is LV wall thickening IS abnormal. There is Sis in the proximal and mid BP RV Sumrnary SSS: 16 SDS: 16 Test v' Miscellaneous !' Miscellaneous ! Miscellaneous -ne stress sinus ST APCs S'..ess ST responsewas 1Smm ST Pre-test CAD Pre-test o' CAD CAD Miscellaneous Tc-99m Sestambi a hard an a hard SuggC-Sln•e was a hign normal Q Waves a hlgn 01 a hign 21 was SRS: o EDV EDV: ESV L I St 4DM v" Quant Values Cahtratnn [Be 57.4 13.1 (87.0) 38 1 none Please contact the provider, INVIA Solutions, for more C eøesson in the lateral. and inregolatera Eads Curing stress am recovery. 24 16 15 18 BP Bnqada syndrome BP (rnrnHg) segment. There mildly reduced thickening in the proximal -rom your inputs in this section. Septa' or Gstress TC sGREST TC Adequæy or 01 Stress Perf Def-Sev SUV Mean (Max) SUV Blackout Func + Quant (HFPO Prep) Prep) Subjective Function SPECI ! Overan Overall ! Overall Proc«fire ID OtEr Interpreters C)tEr Interpreters non-diagnostic sGREST TC Reversibi lity see OSSO:S8 OS:SOS8 Instances Test 31ac events. Quick Start Tutorial MI 86.4 .1-10.1 (100) g. co: CO: Eov: Cancel (Eows) Study Referral Data Clear ED ES HLA ED VLA SRS SDS al and mid anterolateral and inferior segments. 09-Mar-2007 15:37:06 09-Mar.2007 15:36:19 r,crmal repolarizatcn UNIVERSITY OF MICHIGAN Anty•thnas Arrty•thnas US IS "MOT QRS MoqhokUy' QRS MorwhokUy' [O pre-exc LV Summary Clear asystole tation ! LV Function to Auto pre-exc , 4DM PET CFR, 007 4DM PET CFR, 007 PET CFR, 006 PET CFR, 007 1 29 2.2 (3.8) SUV Pert u Excellent SRS; 8 SRS; o PER Ml information. 99 VLA am quanuxrve du) am quanuarve du) S am quanuxrve du) S C) degree AV block EDv Set Mark state Test Exist Nu ung, supine, FBP €1 ProcÜre Step ID 130 Mid-VLA 66.2+1-16.8 Perfusion-Blackotn Perfusion-Blackout r. ormal 004-016. exists In the mid and distal ante-nor, lateral, Interior, and septal ESV RV myocardial pelluson was normal. Stress RV volume was normal. Stress RV regional wall motion was normal. Stress RV regional ESV (ml) Password: 4DM Prkx Test CT Findings Lmg QTc interval Rest Rst ! LV Perfusion ! LV Function ! IV Function Flow and Reserve (CFR) Excellent Screen Screen Capture Esc: Tc-99m Sestamibi Tc-99m Tetrotosmin Set Delete Protec:tion state Set Delete Protection state 88 O second degree AV block myskim S in ogram Sin ogram L in ogram Table Count Histogram ES perfusion tor Terrrmation Reason Terrninatim Reason Terrninatül sGREST TC [Primary 11 sGREST TC 11 Below the normal range Rest LV e 004.016. Ordemg Physkian Time Activity Curve Time Acüvity Curve Activity C 2.0 (2.9) SUV Results Table Resuns Table SMS 14 % Stroke Volume 39 Interpreting Physician Rererring Rererrirna Ptrysic•an Rerernm toe wall thickening was normal ESC Additional Features Stress Test Findings stress EKGt Findings Payer Auto-Text Gstress Gstress TC IFBPI Gstross TC Free Text sGREST TC IFBPI sGREST TC [FBPI UP Clear SOB : n the ED HLA ES ED VLA ESV ES HLA ES VLA ES VLA GStr supine supine, UgV01: 58 ml, TID: 1.29 UgVol: 58 ml, TID: 1.29 Acquisitnn Date Corrextnns Posmtnn Positnn Auto. Surnnwy Sunnwy Esc: Esv: Set Archive state Normal ED EKG is to be tor Summary RD Rb.ü 'c 'c 94m 'c 99m 99m 11369495 Cert«atm 15364 SDS see see ST depression, borderline (0.5-09mm) LV Sumnary MPI Summary LV Summary PER(EDws) Anadequate 26345 Physician Auto-Text RV FINDING s no: - SSS: 16 SDS: 16 0.0 SD 2.1 076 Filter: None inteqyreted 15364 Blood pressure respq Blood pre* State Q Waves •4/12/1950. M Static Supine 58 ml, TID: 1.29 vanable AV blCKk Camera Camera Heads Camera Heads: camera; Camera; SRS: o MFR3 SI de Scan significance was abnormal and Indicates a high rtsk nard cardiac events. LV dilation was abnormal suggestwe of multi-vessel SRS —fuse 35126 26 perfusion 0.0 SD Sub-maximal SD 2.3 (46) SUV ! Miscellaneous GStr GStr 21 15 Moderately enlargec Gstress TC [Primary Il 58 ml, TID: 1.29 40M 4DM RV LV 90977 Awcpriate Use Criteria Approcxiate 10 Accessnn Nurrtpr 11369495 Free Text Reg 09-Mar-2007 15:37:06 RV is in Reversibility Reserve- Stats stress EKG status 9986 Rtrest EKG status stress EKG status SSS:16 SDS: 16 rpER PET CFR, 006 PET CFR, 005 Filter: None SDS •12,'9'1954, M Gstress [FBPJ ! Overall Pru:edtre ID 119 Inflamma'orv CT Findings C•ture Test 17563 "rw.rrin:sec Blay be awopriate tv-lay be awopriate Clear be awopriate Haws Ung, Supine, FBP SRS Dose Ung, Supine Stress Test Protocol Auto-Text 50 'o so 50 16 too % Unknown Clea; 52 G str ID I-mg QTc *essure normal to see opuons.t,pe rev _Jnknown 1 E6.o Septa I [FBPJ 21 29 29 15 16 15 16 31 30 31 EOV: 63 52 pressure resnnse was ncrma[ Stress Test Gstress TC [Primary Il Gstress TC [Primary 1] 73 Tc-99m Sestamd)i Tc-99m Sestamibi pressure re pressure Gstress TC-Gated [Primary 11 Sstress Stress ST Gstress to ST Rarebi awmocxiate Rarebi awocxiate Wall Wall Show Show N Pert,' stress EKG Stress Test Auto-Text Rtrest EKG Findings Stress Test Findings Summary Ann Michigan (BELL0162) Event Risk Sumrnary ST Response I Interpretatim in h Gstress TC-Gated tor a total duration 10 seconds. A total regaaenoson dose a total aurauon 10 seconds. A total regaaenoson dose of T ne patient was Intravenously regaaenoson at 008 mg/ml for a total aurauon o' 10 seconds. A total regaaenoson dose of 1 'S63 I'S63 17563 use (Rena (Rena Prcxedure Step ID Prcx«lure Step ID 97 % CT CT F"umgs CT F"mgs CT FKumgs CT FKxmgs no: CT Narmal Namal MFR3: N Flow Flow UgV01: 58 ml, TID: 1.29 QTC MFR3: 99 (ml) 29 99 MFR3: ST ResX»nse I Interpretatbn ST Re*nnse I Interpretatbn ST ResX»nse I Interpretatön O mg was injected Intravenously. •E EOM Ap Una, Supine Inpction Time Inpction Tc-99m Tetrotosmin 20 20) IS Inpuls In Section IS Camera Heads: 2 SSS:16 SDS: 16 SSs; 16 SOS; 16 16 Scan significance was abnormal and indicates a nigh nsk tor nard cardiac events. LV dilation was abnormal suggestive of multi-vessel EDV (ml) 31 ESV (ml) 31 @ooo Inswmce ST 64.4 SMS (100) Leads 21 The Observed calcium Of 682 is above TPFR- 31 16 Ischemia. 22 16 Tetrotosmin Quit 1.26 TPER: ! Overall For a patient with following criteria (62 yo, are O, Tc-99m Te trotosmin 55 15 63 % Cahtratnn Camera: Syrnbia T2 182 73 None Radiatnn Dose Radiatm 45 31 Auto sGREST TC [Primary 11 64.4 50th: 42. 75th: 207. 90th: 568. ST response was 1 Smm ST cemesson (miffy positive) In tne Intenor, lateral, ano Interolateral cunng stress and None PER ) 17 174 10 16 Str 16 119 71 16 PFR(EDV/s) 4 13 4 13 820 12.2 (103.' 54 % a 26) 26) gee 17 Se None N One 10 39 SRS: o Camera Heads: 2 Guess S,- ST tne lateral, ana stress anc S,- ST posnnepn tne lateral, ana gressanC Nu r recovery 11 126 11 ng Frame Gating Frame Ung, 15 16 17 13 13.5 (91.1 ED HLA ED HL_A ES HLA Es HLA VLA ED VLA Es VLA ED HLA Awcvriate use Criteria use Criteria AW%Yiate PER 421 PER (EDV/s) 4 21 Gating G me Gay Gaüng Frame None -99m Perfusion-Blackout Mid-VLA Auto Fr 11 Fr:8 None None 16 'o 19 30 Frio 17 se 340 34.0