MI Cardiology Application Corridor4DM 2025

SIEMENS Healthineers What’s New in Corridor4DM 2025 Template Effective Date: 26 Mar 2025 | QR700020784 1 This training material is based on the medical device INVIA Corridor4DM 2025. Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Disclaimer SIEMENS Healthineers syngo.via Q Scanner AI-Rad Companion V syngo.via Syngo Carbon View&GO Space Please keep in mind that the user interface may differ slightly from what is shown in this Job Aid. The actual usage of the tool may differ slightly on the different host systems, for example on syngo.via, Syngo Carbon Space, syngo.via View&GO, AI-Rad Companion or on the scanner. The tool functionality defined in this Job Aid is applicable to any of the Siemens Healthineers products in which you find this tool. Template Effective Date: 26 Mar 2025 | QR700020784 2 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Corridor4DM 2025 – What’s New Job Aid SIEMENS Healthineers Table of contents New Features and Enhancements Summary — Overview of all updates 4 Normals Databases Update — Rubidium-82 (FBP, IR, TOF), F-18 Flurpiridaz 5 General Enhancements: 10 E 4DM Volumetric ROI Quantification 11 Copy & Paste ROI Functionality — Streamlined ROI management 12 Inflammatory Results Table Enhancements — SUV Mean (Max), COV CORRIDOR4DM 13 SUV Quantification Enhancements — Color bar, polar map, GE SPECT 14 Total Perfusion Deficit (TPD) Enhancements — MPI summary updates 15 Dataset Information Updates — BMI, editable injected activity 16 New PET Surface Algorithm — Synchronized surfaces across datasets 17 SCU/SCP Data Transfer Enhancements — Efficient result transfer 18 Multi-Monitor Display Support — Up to four screens supported 19 CT Enhancements: 20 CT Viewer Enhancements — Reference lines for localization 21 Calcium Scoring Enhancements — Vessel/valve ID, reporting 22 PET-CFR: 25 PET-CFR & iMFR — iMFR overview, mapping, diagnostic support 26 Fusion & Reserve Screen Enhancements — Cine, motion correction 30 Time Activity Curve (TAC) Enhancements — Customization, modeling 32 INVIA Amyloidosis Workflow: 34 Amyloidosis Workflow — Workflow overview and reporting templates 3 35 Template Effective Date: 26 Mar 2025 | QR700020784 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Overview – What´s New in Corridor4DM 2025 SIEMENS Healthineers New Features and Enhancements are included in V-FPZ/All 4DM's Validated Corridor4DM 2025: Flurpiridaz Normal Database • Validated Flurpiridaz Flow Quantification 21 Model and database • New Rubidium databases Validated Dynamic Renaud JM, et al. Under • Volumetric ROI Motion Correction Journal Review • New Amyloidosis Workflow available with Tc-99m DPD and I-124 Evuzamitide tracers • Integrated Myocardial Flow Reserve MFR Prognosis [Death] 4DM's iMFR, MBF & (iMFR) MFR Quantification • Enhancements for SUV Quantification • Total Perfusion Deficit enhancements • Validated Residual Calcium Scoring enhancements • Algorithm (MC Str): Subtraction for Reporting enhancements INVIA F-18 FPZ ROI 1:1/1 Rapid Imaging Protocol • Multi-Monitor-Display Residual Subtracted You will learn more in the following sections. Template Effective Date: 26 Mar 2025 | QR700020784 4 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 SIEMENS Healthineers Normals Databases Update Template Effective Date: 26 Mar 2025 | QR700020784 5 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Normals Databases Update SIEMENS Healthineers To perform quantification comparison to normals databases 2 PET-CT 100 100 for supine PET images taken using Rubidium (Rb-82) 3 4 V-CFR/NH3/ROI/AII radiopharmaceutical reconstructed with either FBP, IR, or MI Processing 4DM PET, 001, 004-014,RB82 (PET Abnorn V-CFR/RB82/ROI/AII Time of Flight methods: Database:V-CFR/NH3/ROI/AII V-DIFF12 Fusion Protocol: V-DIFF21 1 Existing Rb82 DB is updated to FBP. Reserve V-FDGU75,10 • AC Images RadPharm: N-13 Ammonia V-FPZ/AIl 3 Gender: Composite 2 New Rb82 DBs for IR and TOF added. AC Images + Quant Corrections: Any Any Any Composite V-MBF/R/NH3/ROI/F • Recon Arc: RAO-LPO V-MBF/R/NH3/ROI/M AC Func + Quant Dataset Type: Dynamic V-MBF/R/RB82/ROI/F Flow Model Name: V-MBF/R/RB82/ROI/M INVIA N-13 ROI 1:1 To perform quantification comparison to normals databases Dyssynchrony Manufacturer: Any V-MBF/S/NH3/ROI/F for supine PET images taken using F-18 Flurpiridaz Model: Any V-MBF/S/NH3/ROI/M radiopharmaceuticals: MPI Summary Created: 2/13/2017 11:01:26 V-MBF/S/RB82/ROI/F Modified: 3/10/2017 11:35:35 V-MBF/S/RB82/ROI/M CT Viewer V-NH3/AII 3 • Validated Flurpiridaz Normal Database has been Datasets in Database (27) V-REVER added. V-FPZ/All Ca Scoring (1) (2) (4) V-Rb82/FBP/F 16 V-Rb82/FBP/M 1 2 DB Editor V-Rb82/IR/AIl 2 V-Rb82/TOF/All 21 Template Effective Date: 26 Mar 2025 | QR700020784 6 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Normals Databases Update *Rubidium-82 (IR) SIEMENS Healthineers REFERENCE GUIDE E 4DM Normals Databases - RB-82 Rubidium-82 (IR) SPECT Imaging Protocol Radiopharmaceutical Rb-82 Database Description Administration IV Acquisition Protocol 1 Day Rest/Stress A Male and Female (Composite) normals database was created ECG Gating Acceptance Window, Gating Not applicable for perfusion quantification based on Rubidium-82 3D PET image Frames data specific to iterative reconstruction with point spread Orientation Supine function modeling, scatter correction, and CT attenuation Acquisitions Duration 7 minutes correction. The databases were created from patients with low- NM Camera Make/Model Siemens Biograph mCT likelihood of coronary artery disease. The imaging protocols for Stress Testing Parameters which these databases apply are: Stress Protocol Regadenoson Rubidium-82 3D PET Protocol with IR reconstruction Reconstruction Parameters Patient position: Supine Reconstruction Method TrueX (HD-PET) 3 Iterations, 24 Subsets Filter 7.0 mm Gaussian Database Name Corrections CTAC, Scatter Correction Male and Female V-Rb82/IR/All Matrix size 128 x 128, Zoom 2 Pixel size (mm) 3.18 mm Patient Demographics Composite (Mean) Age 50 Database Properties Weight 226.6 lbs. Male and Female (Composite) Height 68 in. Date Created 16-Mar-2023 17:17:39 BMI 34.1 Date Last Modified 12-Apr-2023 09:50:30 BSA 2.0 Manufacturer Any Model Any Total Datasets in Database 80 Total Mean 84.4 + 7.9 (45.5:95.8) Total StDv 6.6 +/- 0.8 (5.2:11.0) Template Effective Date: 26 Mar 2025 | QR700020784 7 *Invia Reference Guide HS_2025-31A-NormalsDatabases Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Normals Databases Update- *Rubidium-82 (TOF) SIEMENS Healthineers REFERENCE GUIDE Normals Databases - RB-82 Rubidium-82 (TOF) Database Description SPECT Imaging Protocol Rb-82 A Male and Female (Composite) normals database was created for Radiopharmaceutical Administration IV perfusion quantification bases on Rubidium-82 3D PET image data specific to iterative reconstruction with point-spread function and time-of-flight Acquisition Protocol 1 Day Rest/Stress modeling, scatter correction, and CT attenuation correction. The databases ECG Gating Acceptance Window, Gating Not applicable were created from patients with low-likelihood of coronary artery disease. Frames The imaging protocols for which these databases apply are: Orientation Supine Rubidium-82 3D PET Protocol with TOF reconstruction Acquisitions Duration 7 minutes Patient position: Supine NM Camera Make/Model Siemens Biograph mCT Stress Testing Parameters Database Name Stress Protocol Regadenoson Male and Female V-Rb82/TOF/AIl Reconstruction Parameters Reconstruction Method UltraHD-PET 3 Iterations, 21 Subsets Patient Demographics Composite (Mean) Filter 7.0 mm Gaussian Age 50 Corrections CTAC, Scatter Correction Matrix size 128 x 128, Zoom 2 Weight 226.6 lbs. Pixel size (mm) 3.18 mm Height 68 in. BMI 34.1 Database Properties BSA 2.0 Male and Female (Composite) Date Created 16-Mar-2023 17:16:07 Date Last Modified 12-Apr-2023 09:50:52 Manufacturer Any Model Any Total Datasets in Database 80 Total Mean 85.2 + 7.3 (49.7:94.6) Total StDv 6.3 + 1.1 (4.6:13.0) Template Effective Date: 26 Mar 2025 | QR700020784 8 *Invia Reference Guide HS_2025-31A-NormalsDatabases Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Normals Databases Update *F-18 Flurpiridaz SIEMENS Healthineers REFERENCE GUIDE Normals Databases - F-18 Flurpiridaz E 4DM F-18 Flurpiridaz Database Description PET Imaging Protocol Radiopharmaceutical F-18-Flurpiridaz Administration IV A Male and Female (Composite) normals database was created for perfusion quantification based on F-18-Flurpiridaz PET image data with Acquisition Protocol 1 Day Rest/Stress scatter correction, and CT attenuation correction. The databases were ECG Gating Acceptance Window, Gating Not applicable created from patients with low likelihood of coronary artery disease as Frames determined based on maximum stenosis < 20% on quantitative coronary Orientation Supine angiography, and no previous PCI, CHF, stroke or ACS. The imaging Acquisitions Duration 15 minutes protocols for which these databases apply are: NM Camera Make/Model Various Stress Testing Parameters . F-18-Flurpiridaz with FBP or IR reconstruction Stress Protocol Regadenoson . Patient position: supine Reconstruction Parameters Reconstruction Method FBP, IR Database Name Filter Various Male and Female V-FPZ/AI Corrections CTAC, Randoms, Scatter, Dead- Patient Demographics Composite (Mean) Time, Decay Age 59 Matrix size 128x128 Weight Not available Pixel size (mm) 2.14 to 4.00 mm Height Not available BMI 33.9 Database Properties BSA Not available Male and Female (Composite) Date Created 09-May-2019 06:58:19 Date Last Modified 22-Jun-2023 13:49:14 Manufacturer Any Model Any Total Datasets in Database 25 Total Mean 81.7 + 9.8 (30.6:94.5) Total StDv 7.3 + 1.4 (4.3:14.1) Template Effective Date: 26 Mar 2025 | QR700020784 9 *Invia Reference Guide HS_2025-31A-NormalsDatabases Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 SIEMENS Healthineers General Enhancements Template Effective Date: 26 Mar 2025 | QR700020784 10 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Fusion Screen Volumetric ROI (VOI) SIEMENS Healthineers Quantifications Volumetric ROI (VOI) quantifications has been added on the Fusion Screen to assess cardiac 1 amyloidosis & sarcoidosis with PET & SPECT SUV Fusion more accurately. 2 1 Volumetric ROI quantifications can be Amyloidosis O NM Viewer 4DM PYP, 001, 004-001, Abnormal PYP VOI Mala /Ot ma 70 in 100 lhe vol activated from the Dataset Layout tool. This is Object (PT) Tomo QA Transverse Cardiac Amyloid [xSPECT Transverse the default layout for the Amyloidosis and Processing 19-Apr-2023 10:08:00 Volume Size: 256 × 256, 129 slices Fusion Pixel Size (mm): Inflammatory workflows. 1.95 x 1.95 x 1.95 Images None 30 PDF Viewer 2 The Four Panel with VOI table is used to Target (CT) 3.0 B30s PYP ACI provide the volumetric ROI quantifications. 19-Apr-2023 10:26:15 Volume Size: 512 x 512, 178 slices Pixel Size (mm): 0.98 x 0.98 x 1.50 Corona MPR 3 In the Volumetric ROI Result table, the max None Transformation Panel Cardiac Metabolic Volume (CMV) and max X(Trans) Y(Trans) Cardiac Metabolic Activity (CMA) values help Z(Trans X(Rot) you assess the uptake in myocardium. They Y(Rot) Z(Rot) 3 provide an estimate of cardiac impact from Volumetric ROI Results tracer uptake in the heart at least 50% above Sagitta Region Units Mean StDv Max Volume the blood pool activity. Higher CMV and CMA Blood pool SUV 1.57 0.29 2.44 3.78 ml Heart SUV 3.15 .74 7.76 1022.49 ml values are believed to relate to higher Reporting amounts of amyloid in the heart. CMV and Screen Capture Threshold CMV CMA CMA values of 0 indicate a normal study. This XML Export 2.35 625.13 ml 2671.16 g Help review helps determine the semi-quantitative grade for the report. Template Effective Date: 26 Mar 2025 | QR700020784 11 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Copy and Paste Rois ROI functionality SIEMENS Healthineers 1 3 Amyloidosis Copy and Paste Rois ROI functionality has been NM Viewer 4DM PYP, 001, 004-001, Abnormal FTP 1 added on the Fusion Screen and the Viewer Tomo QA PYP 180 AMYLOID X-SPECT/CT 1 HOUR [Advanced] V+ Screen. MI Processing 16 Fusion 3 Images 1 • Draw an elliptical, freehand, rectangular, PDF Viewer or polygon ROI’s by selecting one from the ROI Menu tool. 2 • Right click on the ROI opens the ROI menu. Select Copy ROI then move the 4/19/202: 54 (ct) 256 × 256 x 64 2.40 am cursor to the area you want to paste the PYP AMYLOID STATICS 1HOUR 4 ROI and right click Paste ROI. This creates E Stats in Table 1: 168.73 + 35.90 CNTS 100 an identically sized ROI. X Ratio(1/2)= 2.01+0.57 2: 83.90 + 15.63 CNTS ROI Label: 2 Undo Add ROI Units: CNTS CNTS Redo Sum: 282615 140454 3 • Selecting the ratio tool generates the Pixels: |1675 1674 Delete ROI Max: 259 ratio uptake. 2 149 Copy ROI Min: 60 44 Mean: 168.73 83.90 Copy All ROIs Median: 172 82 4 • Selecting Stats in Table shows the ROI Reporting Paste ROI Variance: 1289.15 244.27 StDv: 35.90 15.63 statistics. Screen Capture Highlight Area Area: 9628.71 9622.97 XML Export 4/19/2023 Pan ROI X/Y Ratio: 2.01+0.57 10:00:45 2.55 1) 256 x 256 x 1 2.40 mm Help Stats in Table Template Effective Date: 26 Mar 2025 | QR700020784 12 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Enhancement Inflammatory Results SIEMENS Healthineers Enhancement for Inflammatory Result Table Inflammatory 2, 004-024,RB82+FDG (HFPD Prep) Female (57 yo, 66 in, 190 lbs) 1 SUV Mean (Max): SA HLA MPR Gives the mean and maximum SUV value MPR MPR with Coefficient of Variation (COV) for each wall and globally. These metrics support a more detailed and quantitative assessment of inflammatory activity. SUV = 1.6 + 0.0 ( 1.7 ) SUV = 1.6 + 0.0 (1.7) Perfusion-Normalized Perfusion-Blackout SUV SUV-Blackout REST Rb GATED REST Rb GATED GATED FDG AC GATED FDG AO 100% 100% 10.0 SUV 10.0 SUV 78 8 78 79 85 13 0 1.7 O 94 87 1 0% 2.0 15 81.9 5 0.0 SUV 2.3 (4.6) 0.0 SUV 34 Region Perf Blackout Perf Def-Sev SUV Mean (Max) - COV SUV Blackout Relative SUV Threshold ANT 8 % 3.1 SD 2.3 (4.0) SUV - 0.22 34 % (12 g) 2.4 LAT 0 % 0.0 SD 3.3 (4.6) SUV - 0.19 94 % (34 g) INF 0 % 0.0 SD 2.0 (3.0) SUV - 0.19 15 % (5 g) SEP 13 % 3.0 SD 1.7 (2.0) SUV - 0.07 0 % (0 g) APX TOT 0 % 0.0 SD 2.1 (2.5) SUV - 0.13 14 % (1 g) 5 % 3.0 SD 2.3 (4.6) SUV - 0.32 34 % (53 g) Derived Region Normal Scar Inflammatory Mixed ANT 57 % 8 % 34 % 0 % LAT 6 % 0 % 94 % 0 % INF 85 % 0 % 15 % 0 % SEP 87 % 13 % 0 % 0 % APX 86 % 0 % 14 % TOT 61 % 0 % 5 % 34 % 0 % Template Effective Date: 26 Mar 2025 | QR700020784 13 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Enhancements for SUV Quantification SIEMENS Healthineers PET-CFR NH3 PAT Cool W Processing Cool Male (66 yi Object (PT) Gray Scale AC Sages Gray-Exp Transverse PET NH3 RE Gray-Inverted MPR . AC Fune . Quant 29 May 2005 Green Volume Size 256 x 256, 8 Heart Dyssynotony Pixel Size (IT Hot Body 1.34 x 1.34 x Hot Metal V-NH3/AH LineW MicroDelta Hot Metal Enhancements for SUV Quantification Rainbow Target (C) Red Polar TA 0.6 Spectrum 1 2004 Spectrum 10Step to facilitate visualization and interpretation of Size Step 10 Fusion SUV Scaling Blue data. Ca Horing Transformation Panel Coo SC Viewer X(Trans) 20.68 Y(Trans) 3.22 Gray Scale Z(Trans) 28.28 1 • The Colorbar Menu includes a visual X(Rot) 10.00 Gray-Exp Y(Rot) 0.00 color bar for standardized SUV. ZIRO .11.17 Gray-Inverted (45.31. 216.55. - 203 30 ) Volumetric ROI Results Green Region Units Mean StDv Max Volume Heart 2 SUV quantification value can now be Blood pool SUV 2.15 0.08 2.36 1.83 ml • Heart SUV 7.01 2.44 11.36 219.05 ml Hot Body Reporting displayed on the Polar Maps page also Hot Metal for SPECT data. LineW MicroDelta Hot Metal Raw Rainbow GE SPECT Data SUV Quantification has 53 Mi Norm Severity Red been included. 2 Det-Sev Spectrum Blackout DB Mean Spectrum 10Step DB StDv Step10 Thresholds 2 Thermal SUV 1 Warm Metal STATIG PDG AC RUSTRUSTATKIN SUV Scaling Template Effective Date: 26 Mar 2025 | QR700020784 14 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Enhancements Total Perfusion Deficit SIEMENS Healthineers Total Perfusion Deficit calculation TPD values are now available on the MPI summary page via the Quant Map Menu. SPECT-CT 100 4 O 100 Raw SD Male (62 yo, 68 in, 175 lbs) Tomo QA 4DM SPECT-CT, 001, 004-003,1D GS/R+CaSc (CaSc) Norm GSTRESS TC [FBP] Str Severity MI Processing 22-May-2007 13:21:37 Def-Sev Single Score provides a unified score that Static, Supine, FBP • 15.0 mCi Tc-99m Sestamibi Blackout Fusion UgVol: 79 ml, TID: -- SSS: 11 SDS: 9 DB Mean combines both defect extent and severity, V2-GSRD/TC/NC/M DB StDv Images Thresholds calculated at the pixel-by-pixel level. C Images TPD mages + Quant Rst AC Images + Quant 1 • Both regional and global TPD scores are Func + Quant O Dyssynchrony available, enhancing the clinical value and MPI Summary REST TC [FBP] 22-May-2007 15:11:54 Static, Supine, FBP interpretability of perfusion imaging. T Viewer 30.0 mCi Tc-99m Tetrofosmin Perfusion-Total Perfusion Deficit UgVol: 73 ml, TID: -- SRS: 2 GSTRESS TC [FBP] REST TC [FBP] Reversibility Ca Scoring V2-GSRD/TC/NC/M 8.9 Enhanced evaluation of disease state. 0.0 8.9 • 0.0 27.8 0.0 0.0 0.0 0.0 2.1 0.0 0.0 0.0 27.8 0.0 0.0 B 0.0 10.0 0.0 0.0 10 8 0.0 19. 14.5 0.0 0.0 0.0 • TPD (Total Perfusion Deficit) displays the 0.0 0.0 O. 19. 0.0 14.5 0.0 0.0 0.0 severity weighted extent (0 to 100%) for Reversibility 0.0 16.64 0.0 0.11 0.0 16.54 22-May-2007 13:21:37 V-REVER abnormal areas as determined by SSS SRS SDS LO comparison to a Normals database. O 0 O O Reporting O Screen Capture O 0 O o 0 O O XML Export Help Perf: 0: Normal 1: Mild 2: Moderate 3: Severe 4: Absent Preferences Auto |Summed | None Ungated TPD Revers 17 Seg Calcium Template Effective Date: 26 Mar 2025 | QR700020784 15 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Enhancements – Dataset Information SIEMENS Healthineers Amyloidosis • BMI in Demographics Section includes Body BSA (m2): 2.13 BMI (kg/m2): 27.01 NM Viewer 4DM PYP, 001, 004-001, Abnormal PYP Mass Index in patient demographics. Aids in Tomo QA PYP 180 AMYLOID X-SPECT/CT 1 HOUR [Advanced] Weight (lb): 199.20 Units dose optimization & result interpretation. MI Processing 24 Height (in): 72.01 O English IS Ability to update the injected activity in the PDF Viewer Dataset Information • -Reporting Dataset Information Window via the Default Patient Name: 4DM PYP, 001 BSA (m2): BMI (kg/m2): 27.01 Information tab on NM viewer tab or the or Patient ID: 004-001, Abnormal PYP Units Weight (Ib): SI Birth Date: 17 Jan 1942 Height (in): 72.01 MI Processing screens has been included. English Row 1 4/19/2023 Panel 1 Panel 2 10:08:00 Description: PYP 180 AMYLOID X-SPECT/CT 1 H ... PYP 180 AMYLOID X-SPECT/CT 1 H ... 256 x 256 x 64 Study Date: 19-Apr-2023 19-Apr-2023 PYP AMYLOID STATICS 1HC Study Time: 10:08:00 10:08:00 1: 168.73 + 35.90 CNTS Ratio(1/2)= 2.01+0.57 Protocol Rst Rst 2: 83.90 + 15.63 CNTS Inje cted Activity (mCi): 31.0 31.0 Injection Time: 08 50 00 108 50 00 Ragiopharmaceutical: To-99m PYP To-99m PYP Energy window (Kev):| 123 - 150 129 - 150 Radiation Dose (mSv): 6.83 6.83 Reporting Image Size: 256 x 256, 64 Slices, 1 Frames 256 x 256, 64 Slices, 1 Frames Screen Capture Pixel Size (mm): 2.40 x 2.40 2.40 x 2.40 XML Export 0 1 66 4/19/2023 Min / Max Pixel: 0 /71 10:00:45 Min / Max Intensity: 0 / 66 CNTS (QS=1) 0 /71 CNTS (QS=1) Help 256 x 256 x 1 Orientation: Supine Supine Preferannac Manufacturer: SIEMENS NM SIEMENS NM Template Effective Date: 26 Mar 2025 | QR700020784 16 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 New PET Surface Algorithm SIEMENS Healthineers 1 The Algorithms preferences page provides now 1 Surface Algorithm the new surface algorithm Synchronize Surfaces Iterative Alignment: Centering Only, Max Iterations: 5 Frame: Summed for PET Protocols. v2016+ Algorithm Static 50 Constrain Axial Length 2 ~Synchronize Surfaces for PET Protocols 2 Synchronize Surfaces for PET protocols, when Image Sampling: Recon Pixel Size checked, left ventricular surfaces for all datasets from a given acquisition are synchronized to optimize the processing workflow. Basal Plane Motion Min 5 mm Max 20 mm Valve Plane Algorithm: Septal Wall - Mid Membranous Septum Functional Estimates ~ Apply Harmonic Fit to Volume Curve ~ Compute Diastolic Function Parameters Polar Map Algorithm Volume Normalization Slice Normalization Template Effective Date: 26 Mar 2025 | QR700020784 17 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Enhancements Data Transfer SIEMENS Healthineers New SCU/SCP Interface in Save and Screen Capture to ensure 1 Screen Capture X 1 efficient data transfer, streamlining workflow and reducing Site Local Site Name - 100 Template None data loss. Facilitates seamless interoperability with PACS and Storage Location Print other imaging systems. Save to Image Database 2 O Store to Local File File Name Itsclient\C\Temp\SPECT_CT_05202025_1441.dcm 2 Sending Results to a SCP Connection: Region to Capture Type of Capture Canvas Color Click on the Save tool to display the Save window. Full Screen Static Image Movie O Black O Image Window and Dataset Information O DICOM SSC . DICOM MFSC . White Image Window Only JPEG WMV For Storage Location use the check toggles to determine where TIFF PNG 2 results will be sent. Database is the default selection and will send results to the database where the study was loaded. × 2 d Save 3 Sending Screen Captures to an SCP Connection: DICOM Results Click on the Screen Capture button to display the Screen Capture window. Result Format Composite Result State Preliminary For Image Repositories, use the check toggles to determine where Storage Location < Database WI SCP PACS screen captures will be sent. Reporting Database is the default selection and will send screen captures to 3 the database where the study was loaded. Barcon Capture XML Export Help Template Effective Date: 26 Mar 2025 | QR700020784 18 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Multi-Monitor-Display SIEMENS Healthineers To improve workflow efficiency, display 4DM application screens in up to four separate windows for patient study review. Using multi-monitor displays optimizes clinical review and results in less time spent navigating 4DM. Upon initial installation, if 2+ monitors are detected, 4DM automatically configures 4DM for dual (2) monitor display. 4 1 Under the Screen Setup section, the User User Specific Settings: Displays option shows the number of Molecular Imaging Workflows Screen Layout M MPI AC MPI M CTAC MPI displays automatically detected by 4DM. SPECT Viability PET Viability Apply Colorbars -Screen Setup 2 1 Active Screens 2 2 To change the number display screens Image Display Displays 3 Edit Reset utilized, select the Reset which activates Global Settings: Screen Name Dataset Layout Screen Template Display Initial the Edit button. Algorithms Tomo QA All NVIA Defined 1 4 MI Processing All INVIA Defined 1 3 Use the Displays drop-down to select the number of monitors. Manually enter Displays × Reporting coordinates if desired. If any changes are 3 Screen Capture Displays Auto made, click Save (blue floppy disk icon) to # left top width height save the display and any coordinates XML Export 1 3840 -252 1664 1069 changes. 2 0 1920 1040 O Help 3 1920 O 1920 1040 4 The display setting sequence can also be Preferences changed via the Display drop-down. This is user specific and can be activated via User Management. Template Effective Date: 26 Mar 2025 | QR700020784 19 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 SIEMENS Healthineers CT Enhancements Template Effective Date: 26 Mar 2025 | QR700020784 20 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Enhancements CT Viewer SIEMENS Healthineers 1 CT Viewer Enhancements for the CT Viewer Transverse Transverse MPR MIP 1 20 mm Reference lines are now present within the Coronal and Sagittal 3-CT viewports to translate through the volume to improve definition of location of findings. ........... F Coronal MPR A 0.49, -209.51 1601.10) Sagittal MPR Regions of Interest Region Units Min Max Mean StDv Area Template Effective Date: 26 Mar 2025 | QR700020784 21 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Enhancements Calcium Scoring SIEMENS Healthineers SPECT-CT -160 240 -160 240 MPR MIP Thin MIP Tomo QA 4DM SPECT-CT, 001, 004-003,1D GS/R+CaSc (CaSc) Male (62 yo, 68 in, 175 lbs) Enhancements for Calcium Scoring CaScore 3.0 B35s 55% MI Processing 22-May-2007 13:41:09 Transverse Transverse 0.98 x 0.98 × 2.50 MPR Fusion kV: 130 5 Slices eff.mAs: 55 Filter: 1 1 • The results table now includes Images Heart Rate: -- dedicated Vessel/Valve C Images Images + Quant evaluation and Vessel/Valve name AC Images + Quant buttons, allowing for clearer Func + Quant Dyssynchrony IF identification of calcified structures. MPI Summary Corona MPR CT Viewer 2 • Reset All and No Calcium Deposit Ca Scorin DB Editor buttons are now available to delete quickly the quantification if needed. A 2 1 F Sagittal MPR Vessel Lesions Volume (mm3) Agatston Score Vessel/Valve Lesions Volume (mm3) Agatston Score LM 0.0 AAO 0 0.0 LAD 367.2 182 DAG 0.0 LCX 0 0.0 AV 0.0 RCA 128.7 162 MV 0 0.0 Reporting Total 495.9 644 TV 0.0 Screen Capture PV 0.0 XML Export The observed calcium score of 644 is above the 90th percentile. For a patient with the following criteria (62 yo, Caucasian, male) the percentile calcium Help score values are 25th: 0, 50th: 42, 75th: 207, 90th: 568. Preferences Auto 130 HU Template Effective Date: 26 Mar 2025 | QR700020784 22 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Enhancements Calcium Scoring SIEMENS Healthineers 1 • Vessel/Valve identifies the four heart valves (AV=Atrial, MV=Mitral, TV=Tricuspid, PV=Pulmonary) and two Aorta branches (AAo = Ascending Aorta, DAo=Descending Aorta), each as its own color-coded button. 2 • Click on the Vessel/Valve name to activate the corresponding color to be manually assigned to areas of calcium deposits. 3 • Reset will bring the vessel/valve score back to zero allowing the user to re-quantify. 4 • No Calcium Deposit will set the measurements for that vessel/valve to zero. 3 4 Vessel Lesions Volume (mm2) Agatston Score 1 Vessel/Valve Lesions Volume (mm2) Agatston Score LM 0.0 AAO LAD 2 367.2 482 DAO LCX 0.0 AV 2 RCA 186.0 200 MV Total 553.1 682 TV PV The observed calcium score of 682 is above the 90th percentile. For a patient with the following criteria (62 yo, Caucasian, male) the percentile calcium score values are 25th: 0, 50th: 42, 75th: 207, 90th: 568. Template Effective Date: 26 Mar 2025 | QR700020784 23 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Calcium Scoring Reporting SIEMENS Healthineers New enhancements have been added 4 MPI with CT (GSt ... | CT Findings Report: Preliminary to the Calcium Scoring Reporting Patient Info CT Incidental Findings Demographics Incidental Results O Normal Uninterpretable Not Done Findings section, expanding the scope V Medical History Abnorma Not interpreted Unknown PERFUSION FINDINGS Stress/EKG of reporting and interpretation: Stress Test CT Incidental Findings Free Text Normal Stress Images EKG Imaging Info Qualitative Calcium Scoring NM/PT 1 Calcium Scoring Findings Rest Images • CT Interpretation Results Quantitative Results Results: Interpretations In 2 Interpretable mm3 Agatston Score Overall Study Quality: Good V Quant Values Unable to quantify / estimate CAC due to Extra Cardiac Activity: Normal LM 0.0 0 Study Artifacts: None Users can now LV Perfusion Not interpreted RV Perfusion Not Done LAD 367.2 482 LV Myocardial Perfusion Defects: (1) Large sized, moderate severity, apical, anterior, septal, and anteroseptal, completely reversible defect consistent with document qualitative LV Function 1 Unknown LCX ischemia in the territory typical of the mid and distal LAD. 0.0 0 RV Function Scan Significance: Scan significance was abnormal and indicates a high risk for hard cardiac events. assessments of calcium Amyloidosis Qualitative Results RCA 128.7 162 Stress/RestLV Volume Ratio: 1.09, Normal LV PERFUSION QUANTITATIVE RESULTS V CT Findings None - Use quantitative results Total 495.9 644 presence and distribution, No visible CAC Coronary Territory Stress Extent Rest Extent Ischemic Extent Summary Mild visible CAC (estimated Agatston score < 100) AAO 0.0 0 LAD 39% 7% 39% complementing quantitative / Miscellaneous Moderate visible CAC (estimated Agatston score 100 - 400) LCI 15% 0% 15% Severe visible CAC (estimated Agatston score > 400) DAo 0.0 0 RCA 6% 1% 6% Overall % of LV 23% 7% 23% measurements for a more AV 0.0 0 Summed Stress Score = Fmco MV 0 Summed Rest Score = Summed Difference Score = comprehensive evaluation. TV 0.0 0 LV FUNCTION FINDINGS AND INTERPRETATION PV 0.0 Stress 2 • Study Quality Indicators: Ejection Fraction 62% ED Volume, EDv Index 125 ml, 64.8 ml'm2 Allows users to capture the ES Volume, ESv Index 47 ml, 24.4 mlm2 CaSc Regional Findings Auto-Text Cardiac Output 3.981/min overall quality of the study, The total coronary artery calcium score is 644, with calcifications noted in the LAD and RCA arteries. Myocardial Mass 163 g Summed WTHK Score Summed WMOT Score providing valuable context LV Global Function: Normal LV Volume: Normal for interpreting results and CaSc Summary Findings Auto-Text LV Regional Function: Mild hypokinesis in the anterior segment(s) consistent with perfusion abnormalities. The coronary artery calcium score indicates a severe extent of coronary atherosclerosis. The observed calcium score of 644 is above the RV FINDINGS AND INTERPRETATION 90th percentile. For a patient with the following criteria (62 yo, Caucasian, male) the percentile calcium score values are 25th: 0, 50th: 42, RV Perfusion: Normal supporting consistent 75th: 207, 90th: 568. RV Volume: Normal reporting standards. Template Effective Date: 26 Mar 2025 | QR700020784 24 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 SIEMENS Healthineers PET-CFR Template Effective Date: 26 Mar 2025 | QR700020784 25 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Integrated Myocardial Flow Reserve (iMFR) SIEMENS Healthineers with integrated Diagnostic Support Window PET-CFR 100 O What is iMFR? MI Processing MI_Cardio_Rb82_dyn_1, _MI_Cardio_Rb82_dyn_1 Male (68 yo, ?? in, 194 lbs) PET 12f5s_6f10s_4f20s_4 ... SA HLA TVLA Time Activity Curves Fusion 23-Mar-2009 13:10:25 Summed, Supine, IR: SC:CTAC 50.0 mCi Rb-82 AC Images UgVol: 54 ml, TID: -- SSS: 4 S Integrated myocardial flow reserve (iMFR) AC Images + Quant V-MBF/S/RB82/ROI/M Summed MC PET 12f5s_6f1. builds upon the insights physicians obtain from AC Funo + Quant 23-Mar-2009 13:12:25 (kBq/ml) Static, Supine, IR:SC:CTAC 50.0 mCi Rb-82 Dyssynchrony UgVol: 54 ml, TID: 1.08 SSS: 4 myocardial flow reserve (MFR). MPI Summary O V-Rb82AR/All 120 Time (sec) 240 300 360 Reserve MC Str MRI MC Rst M Global M Global CT Viewer Perfuision Blackout Flow Blackout Flow (ml/minin) Traditional MFR quantification does not iMFR Diagnostic Support Window Algorithm (MC Str): INVIA Rb-82 ROI Lortie Ca Storing PET 1215s_6f10s_4f20s_414 ... Sur X 23-Mar-2009 12:53:45 Algorithm (MC Rst): INVIA Rb-82 ROI Lortie Summed, Supine, IR: SC:CTAC iMFR Prognosis [Death] MFR Diagnosis [Obstructive CAD] Global Results differentiate focal epicardial stenosis from diffuse 50.0 mCi Rb-82 UgVol: 50 ml, TID: -- SRS: 0 Probability of V-MBF/R/RB82/ROI/M Obstructive CAD Mean Flow (ml/min/g) 8 Very High atherosclerosis and microvascular dysfunction. High Summed MC PET 12f5s_6f1 25 MC Str MC Rst MC Str MC Rst Reserve Medium 23-Mar-2009 12:55:45 Low Very Low 85% 84% 2.20 0.96 2.30 Static, Supine, IR:SC:CTAC 50.0 mCi Rb-82 78% 82% 1.93 0.98 1.97 UgVol: 50 ml, TID: -- SRS. O 85% 81% 2.52 0.92 2.75 0 V-Rh82/R/All iMFR distinguishes between the extent of focal Sun 83% 83% 2.20 0.94 2.33 75- indicted Very Low Moderate iMFR Map and diffuse perfusion impairment, markers that Focally Impaired MFR Extent (% ) Diffusely Impaired MFR Extent (%) 100 Normal MFR: 2.54 Comparison 0.5 Mean Focally Impaired MFR Diffusely Impaired MFR: 1.83 enable physicians to better diagnose and treat 23-Mar-2009 13:10:25 Global MFR V-CFR/RB82/ROI/AII Focally Impaired MFR: 1.38 V-REVER The risk figures above focus only on the impact of the specific iMFR parameters plotted. Clinical diagnosis and prognostic assessment requires integrati the patients. of all imaging and clinical data, including information which may significantly increase or decrease risk beyond the iMFR parameters above. x Reversibility Reserve Reserve-Stats Reporting Region Normal Perf Normal Perf Str Defect Str Defect Screen Capture MFR>=2.0 MFR<2.0 MFR>=2.0 MFR<2.0 LAD 83 % (2.41) 16 % (1.85) 0 % (-) 1 % (1.68) LCX XML Export 55 % (2.43) 18 % (1.79) 0 % (-) 27 % (1.36) RCA 100 % (2.77) 0 % (-) 0 % (-) 0 % (-) TOT 80 % (2.54) 12 % (1.83) 0 % (-) 7 % (1.38) Help 0.0 2.3 Template Effective Date: 26 Mar 2025 | QR700020784 26 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Integrated Myocardial Flow Reserve (iMFR) SIEMENS Healthineers How does it work? Stress MPI Blackout MFR LAD 100 iMFR combines two fundamental approaches of cardiac dynamic PET quantification for Ammonia, Rubidium and *Flurpiridaz tracers: • Relative Stress Perfusion: The relative distribution of blood RCA LCX flow within the myocardium based upon the highest area of tracer uptake, to identify impaired perfusion region(s). iMFR No Stress Defect Normal • Myocardial Flow Reserve(MFR): The ratio of absolute MFR 22 myocardial blood flow (MBF) during stress compared to Stress Defect Obstructive Focally absolute MBF at rest- in the identified impaired region(s). MFR <2 Epicardial CAD Impaired No Stress Defect Microvascular Diffusely MFR <2 Diffuse Disease Impaired When combined, these metrics identify regions of the Stress Defect myocardium with normal, focal or diffusely impaired perfusion. MFR 22 Infarct or Artifact *Validated Flurpiridaz Flow Quantification Model has been added. Template Effective Date: 26 Mar 2025 | QR700020784 27 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Integrated Myocardial Flow Reserve (iMFR) SIEMENS Healthineers 1 The iMFR map is created automatically and provides a categorical map 1 iMFR Map derived from the relative perfusion defect maps and the MFR maps. Normal MFR: 2.05 The categories are color coded as follows: Diffusely Impaired MFR: 1.36 Focally Impaired MFR: 0 76 • Green: Areas quantified as normal perfusion with normal reserve (>2,0). This category is referred to as “Normal MFR”. • Red: Areas quantified as abnormal perfusion and abnormal reserve (<=2.0). This category is referred to as “Focally Impaired MFR”. No Stress Defect MFR 22 Normal • Yellow: Areas quantified as normal perfusion with abnormal reserve (<=2.0). This category is referred to as “Diffusely Impaired MFR”. Stress Defect Obstructive Focally Blue: Areas quantified as abnormal perfusion with normal reserve MFR <2 Epicardial CAD Impaired • (>2,0). This category is referred to as “Focally Preserved MFR”. No Stress Defect Microvascular Diffusely MFR <2 Diffuse Disease Impaired Stress Defect 2 The iMFR table provides the regional and global extents of each MFR 22 Infarct or Artifact category as a fraction of the LV. The mean MFR within each indicated region is also given in parentheses. Using the Results Table evaluates the patient scores. 2 Normal Perf Normal Perf Str Defect Str Defect The Results Table shows % of impairment, Regionally & Global(TOT) LAD Region MFR>=2.0 MFR<2.0 MFR>=2.0 MFR<2.0 LAD 0 % (2.03) 90 % (1.31) 0 % 10 % (0.84) LCX LCX 0 % (-) 11 % (1.00) 0 % 89 % (0.74) RCA 8 % (2.05) 91 % (1.49) 0 % 2 % (1.09) RCA TOT 2 % (2.05 70 % (1.36) 0 % 28 % (0.76) Template Effective Date: 26 Mar 2025 | QR700020784 28 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Integrated iMFR Diagnostic Support Window SIEMENS Healthineers • 1 The iMFR Diagnostic Support window can be opened by clicking on the Plot Magnifier icon to review the iMFRs stratification of the patient on the plot. • 2 *Probabilistic models are provided to help identify (a) patients with increased mortality risk, (b) patients with obstructive coronary artery disease and (c) patients with high risk (multi-vessel) disease. • 3 The iMFR prognosis and the iMFR Diagnosis plot are designed similarly with colored bands stratifying the patient´s risk as assed via published clinical validation results. iMFR Map 3 2 3 Normal MFR: 2.05 Diffusely Impaired MFR: 1.36 iMFR Prognosis [Death] Threshold Scale iMFR Diagnosis [Obstructive CAD] Focally Impaired MFR: 0.76 of O Probability of 8 Very Low = 0-20% Obstructive CAD Very High 25 High Low = 20-40% Medium Low Very Low 1 Medium = 40-60% 50 High = 60-80% Predicted Risk 15 Very Low LON Very High = 80-100% Moderata High Diffusely Impaired MFR Extent (%) Very High Focally Impaired MFR Extent (%) 100 2 iMFR Plot Key Global MFR 0.5 Mean Focally Impaired MFR 1.0 1.5 2.0 The Prognosis Plot estimates the risk of mortality Provides a probability estimate for obstructive coronary from all causes within the next 3 to 4 years, artery disease (CAD).Obstructive CAD is characterized including elevated risk of a cardiac event. Significant blockages in the arteries, typically plaque This estimate is derived from the relationship build up on the inner artery walls. This can lead to a between a patient’s global MFR and their diffusely variety of symptoms and an increased risk of a heart impaired iMFR extent. attack or heart failure. Template Effective Date: 26 Mar 2025 | QR700020784 29 *These probabilistic models were based on clinical studies in a large PET registry (details can be provided by INVIA). Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Enhancements PET-CFR SIEMENS Healthineers 1 2 ET-CFR -650 250 100 50 100 Fusion MI Processing MI_Cardio_Rb82_dyn_1, _MI_Cardio_Rb82_dyn_1 -Object (CT) Enhancements for the Fusion Screen Fusion Multiseries Transverse MPR AC Images 08-Aug-2007 10:34:35 Volume Size: AC Images + 512 x 512, 66 slices Quant Pixel Size (mm): • 0.38 x 0.38 x 2.00 1 Incorporates cine functionality for AC Funo & Quant None dynamic imaging to aids in functional Dyssynchrony 1 analysis of cardiac motion and MPI Summary -Target (PT) PET 12f5s_6f10s_4f20s_4 Reserve 23-Mar-2009 12:53:45 perfusion. Volume Size: CT Viewer 168 × 168, 81 slices Pixel Size (mm): 1.85 x 1.85 x 2.03 Ca Scoring Foronal V-Rb82AR/AIl APR 2 2 • Adds frame normalization option for Transformation Panel 1 X(Trans) o dynamic data analysis to improve Y(Trans) temporal analysis of MBF data. Z(Trans) X(Rot) 0 Y(Rot) Z(Rot) 0 Sagittal MPR Reporting Screen Capture XML Export Template Effective Date: 26 Mar 2025 | QR700020784 Help 30 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Enhancements PET-CFR SIEMENS Healthineers Enhancements for the Reserve Screen 1 2 1 Automatic Motion Correction, to improve O S T Reserve alignment and accuracy across time frames yn 1 without manual intervention. SA SA SA 2 Temporal Filter and Spatial Filter on the Reserve Screen tool allows the user to apply a filter for enhancing the image quality of the gated slices. 4 DynStrCTAC Filter: None 3 3 Three short axis lock for input ROI PET 12f5s 6f10s 4f20s 4. SA SA SA HLA VLA 23-Mar-2009 13:10:25 synchronized assessments supports linked Summed, Supine, IR: SC:CTAC 50.0 mCi Rb-82 UgVol: 53 ml, TID: MBF assessment. SSS: 4 SDS: 4 (4) V-Rb82AR/All 4 Modified Reserve Dataset panel to show static dataset information related to relative DynRstCTAC perfusion maps improves correlation of Filter: None PET 1215s 6f10s 4f20s 414 SA SA SA HLA VLA static relative perfusion to MBF. 23-Mar-2009 12:53:45 Summed, Supine, IR: SC:CTAC 50.0 mCi Rb-82 UgVol: 52 ml, TID: -- SRS: 1 Lock control settings for Rate Pressure V-Rb82AR/AII Product RPP & heart-lung axis measurements. Supports consistency & 3 Apply Synchronize ROI Changes ֏ reproducibility. Template Effective Date: 26 Mar 2025 | QR700020784 31 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 PET-CFR Enhancements Time Activity Curves SIEMENS Healthineers Curve Options for the Time Activity Curves enhancements to provide the ability to review MC Str Time Activity Curves 900 800 K1: 0.93 K2: 0.11 FV: 0.22 RV: 0.00 ChiSq: 0.22 the fit of the model through the TAC. 700 K1: 0.87 K2: 0.11 FV: 0.12 RV: 0.00 ChiSq: 1.08 600 K1: 0.84 K2: 0.10 FV: 0.23 RV: 0.00 ChiSq: 0.85 K1: 1,00 K2: 0.12 FV: 0.26 RV: 0.00 ChiSq: 1.09 500 K1/1.04 K2: 0.11 FV: 0.27 RV: 0.00 ChiSq: 1.13 400 K1 0.95\ K2: 0.11 FV: 0.28 RV: 0.00 ChiSq: 1.26 (kBq/ml) 1 • Checkboxes for Time Activity Curve (TAC) selections allow select or deselect 300 200 specific Time Activity Curves for display, adjust visual styles, enable or disable 100 10 15 30 model overlays. 20 25 Frame Index MC Rst Time Activity Curves 900 800 K1: 0.57 K2: 0.05 FV: 0.17 RV: 0.00 ChiSq: 0.21 700 K1: 0.56 K2: 0.05 FV: 0.07 RV: 0.00 ChiSq: 0.70 2 • Right-click the Time Activity Curves to display the Curves Options window and K1: 0.58 K2: 0.06 FV: 0.17 RV: 0.00 ChiSq: 0.91 600 K1 0.56 K2: 0.05 FV: 0.17 RV: 0.00 ChiSq: 1.21 500 further customize the display by selecting any of the following possibilities. K1: 0.58 K2: 0.05 FV: 0.23 RV: 0.00 ChiSq: 2.09 400 K1: 061 K2: 0.07 FV: 0.25 RV: 0.00 ChiSq: 1.27 (kBq/ml) 300 200 Click to toggle between Frame Index and Time 100 10 15 20 25 30 O Frame Index MC Str Time Activity Curves MLV M RV Global BP+Global 700 M LAT M SEP M ANT M INF M APX 600 1 MI Processing Reserve 500 E Curves Options Curves Options 400 Display -Display 300 M Use Linear Scale M Kinetic Model (kBq/ml) 200 Time Normalize Graphs M Use Linear Scale M Use Frame Index Time Normalize Graphs 100 M Sync Y Axis Use Frame Index Sync Y Axis O 2 10. 30 Frame Inde. lick to toggle between Frame Index and Time Template Effective Date: 26 Mar 2025 | QR700020784 32 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 PET-CFR Enhancements Time Activity Curves SIEMENS Healthineers Curve Options: 1 Curves Options 1 • *Kinetic Model: When checked, the kinetic model fitted tissue Display TACs (solid line), the measured tissue TACs (circular markers), Kinetic Model and kinetic model parameters (rate constants K1, K2, K3, Use Linear Scale spillover values FV and RV, and model fit error ChiSq) are displayed. When unchecked, only the measured tissue TACs are Time Normalize Graphs displayed (solid line). Use Frame Index • Use Linear Scale: When unchecked, the vertical axes are Sync Y Axis converted to a log-scale. MC Rst Time Activity Curves • Time Normalize Graphs: When checked, scales the activity 900 concentration in each frame by the frame duration. When 800 K1: 0.57 K2: 0.05 FV: 0.17 RV: 0.00 ChiSq: 0.21 unchecked, no scaling is applied. 700- • Use Frame Index: When checked, graphs the activity 600 500 concentration versus frame index. When unchecked, graphs the 400 (kBq/ml) activity concentration versus time. 300 • Sync Y Axis: Synchronizes the y-axis scales for stress and rest to 200 compare curve peaks more accurately. 100 15 20 25 Frame Ind 30 2 • BP + Global TAC has been added to change the appearance of 2 MLV RV Global M BP+Globa the graph. LAT SEP ANT INF APX Template Effective Date: 26 Mar 2025 | QR700020784 33 *Kinetic Model only applies for the Reserve Screen. Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 SIEMENS Healthineers Amyloidosis Workflow Template Effective Date: 26 Mar 2025 | QR700020784 34 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 New Amyloidosis Workflow SIEMENS Healthineers 1 Amyloidosis 0 100 -650 250 Amyloidosis O New Amyloidosis Workflow Overview NM Viewer 4DM PYP, 001, 004-001, Abnormal PYP Default -Object (PT) FDG-Viability Tomo QA Transverse Cardiac Amyloid [x SPECT| + MPR 1 • The new Amyloidosis Workflow allows GBPS PET-CFR MI Processing 19-Apr-2023 10:08:00 Volume Size: qualitative, semi-quantitative, and PET-CT 256 × 256, 129 slices SPECT Fusion Pixel Size (mm): 1.95 x 1.95 x 1.95 quantitative review of both planar and SPECT SPECT-CT Images None SPECT-CFR patient datasets to assist with identification Inflammatory PDF Viewer Amyloidosis of cardiac amyloidosis, particularly ATTR. Target (CT) 3.0 B30s PYP ACI 19-Apr-2023 10:26:15 • Incorporates Tc-99m DPD and I-124 Volume Size: 512 × 512, 178 slices Evuzamitide tracers to enable imaging for Pixel Size (mm): 0.98 x 0.98 x 1.50 amyloidosis, expanding diagnostic None Coronal MPR Transformation Panel capabilities. X(Trans) 0 • The Amyloidosis workflow automatically Y(Trans) Z(Trans) populates when a Nuclear Medicine Planar, 0 X(Rot) 0 ungated tomographic SPECT, or a Y(Rot) 0 2 Z(Rot ) reconstructed tomographic SPECT dataset is O Reporting loaded, that utilizes either Tc-99m PYP, Tc- Sagittal 99m HDP, Tc-99m DPD, or I-124 Evuzamitide. Screen Capture MPR 2 • The Amyloidosis Reporting option is XML Export integrated in the Reporting Tab. Reporting Help To learn more about the workflow, Screen Capture please refer to the Amyloidosis Job Aid. XML Export H. Preferences Help Template Effective Date: 26 Mar 2025 | QR700020784 35 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 Amyloidosis Reporting SIEMENS Healthineers 4DM reporting offers structured templates and Required Datasets Report Templates Workflow Stress Rest Delay FDG CT guidelines for reporting cardiac amyloidosis cases. Ung Gat Dyn Ung Gat Dyn Ung Gat Ung Gat Amyloidosis (Rst) Amyloidosis 1 By selecting reporting in the control panel, the Amyloidosis with CT (Rst) Amyloidosis IL amyloidosis template will be automatically open based on the imaging protocol. Reporting 1 Amyloidos Amyloidosis Report: Finalized 2 In the Amyloidosis and CT Findings sections Patient Info Qualitative Evaluation Not Defined Absent FINDINGS: Demographics Not Interpretable Focal quick-select choices to efficiently populate text Medical History Equivocal O Diffuse Rest Images Stress/EKG Semi-Quantitative Grading Not Defined in the report can be used. Stress Test Grade 0: No myocardial uptake Overall Study Quality: EKG Grade 1: Myocardial uptake < rib uptake 3 Extra Cardiac Activity: Normal Study Artifacts: Motion artifact Imaging Info Grade 2: Myocardial uptake = rib uptake TECHNETIUM UPTAKE: NM/PT Grade 3: Myocardial uptake > rib uptake Qualitative evaluation: Diffuse CT Quantitative Heart / 3 In the Technetium Uptake Section manually Interpretations Contralateral 2.01 Semi-quantitative Grade: Grade 3: Myocardial uptake >> rib uptake Grade 0: no myocardial uptake Quant Values > 1.5 is highly suggestive of TTR amyloidosis Grade 1: myocardial uptake < rib uptake qualitative evaluation of the patient, semi- LV Perfusion < 1.0 is not suggestive of TTR amyloidosis Grade 2: myocardial uptake = rib uptake Grade 3: myocardial uptake > rib uptake 1 - 1.5 is equivocal of TTR amyloidosis RV Perfusion Quantitative heart/lung ratio: 2.01 >1.5 is highly suggestive of TIR amyloidosis quantitative grade and the quantitative LV Function Not Defined <1.0 is not suggestive of TTR amyloidosis 2 Impression 1.0 - 1.5 is equivocal for TIR amyloidosis RV Function There is abnormal myocardial uptake of Tc-99m PYP, consistent with ATTR-type cardiac amyloidosis. heart/contralateral can be entered. Amyloidosis There is no abnormal myocardial uptake of Tc-99m PYP. This scan is not suggestive of ATTR-type CT Findings cardiac amyloidosis. There is equivocal myocardial uptake of Tc-99m PYP. This study neither rules in nor rules out ATTR- Summary type cardiac amyloidosis. Miscellaneous Overall 4 In the Summary notes any input can be entered 4 SUMMARY: manually. There is abnormal myocardial uptake of Tc-99m PYP, consistent with ATTR-type cardiac amyloidosis. CT scan was performed with a Symbia Intevo 16 operating at 110.00 kV. The exposure was 25 effmAs. Contrast was not administered. - REPORTING The study interpretation occurred on 1/28/2025 08:34:51. Status of the report is Finalized. Reporting Physician: Reporting. MD Template Effective Date: 26 Mar 2025 | QR700020784 36 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 SIEMENS Healthineers Siemens Healthineers are neither the provider nor legal manufacturer of this training. Any claims and statements made in this training and any content shown in the training are under the sole responsibility of INVIA Solutions. Additionally, the training may not be available in all countries and the content may not be commercially available in all countries. Please contact INVIA Solutions for more information. Template Effective Date: 26 Mar 2025 | QR700020784 37 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025 SIEMENS Healthineers Please note that this learning material is for training purposes only. For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Please note: Some functions shown in this material are optional and might not be part of your system. Certain products, product-related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration-dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Siemens Healthineers Headquarters Siemens Healthineers AG Siemensstr. 3 91301 Forchheim, Germany Phone: +49 9191 180 siemens-healthineers.com Template Effective Date: 26 Mar 2025 | QR700020784 38 Job Aid Effective Date: 11 Jul 2025 | QR700025627 Published by Siemens Healthineers AG I © Siemens Healthineers, 2025