Physician’s Quick Reference Guide - syngo.via VB60

syngo.via MM Oncology Physician’s Quick Reference Guide VB60 Contents: Scrolling Pg 2 Windowing Pg 2 Pan/Zoom Pg 3 Settings and Configuration Pg 3 Changing Layouts Pg 4 Resetting the Layout Pg 4 SUV Measurements Pg 4 Molecular Tumour Volume and Total Lesion Glycolysis Pg 5 Deauville Score Pg 6 Manipulating Image Fusion Pg 6 Viewing Different Datasets Pg 6 Multi – Timepoint Viewing Pg 7 Alignment Between Timepoints Pg 7 Creating Savescreens Pg 7 Initial Layout Configuration Pg 8 Lesion Scout Pg 8 Closing A Patient Pg 9 Importing Data Pg 10 Shortcuts Pg 11 Page 1 of 12 SIEMENS Healthineers' Effective Date: 23/04/2024 I QR700008487 Unrestricted © Siemens Healthcare Pty Ltd. 2024 syngo.via Physician’s Quick Reference Guide VB60 Scrolling To scroll through the images, click and hold the right mouse button, then drag up and down (fast navigation with skipping, toggle U for skip on/off); OR Scroll the mouse wheel (best for slower navigation); OR Grab the reference lines on the images and drag up/down/left/right. Ensure to click more centrally on the reference lines (inside the arrows on the orange line of the shown image) as clicking on the reference lines toward the outer edge of the image segment will rotate the images. Windowing For PET/SPECT images press the mouse wheel down on an image segment containing PET/SPECT data. Drag up and down to adjust the threshold. The background can be adjusted by hovering the mouse over the windowing watermark at the centre bottom of the image and using the sliding scale bar. If it is a fused image, move the mouse cursor to the right side of the image 6.3 0-3 SUV F5 segment then press down on the mouse 0-5 SUV F6 wheel to adjust the threshold, or use the 0-7 SUV F7 windowing slider bar as described. The 10cm alpha blending can also be adjusted here 0-8 SUV F8 SUy Parameters Units as desired. F 415s, XYZ Gauss2.00 0-10 SUV : ??? mm 0-15 SUV T PET Color LUT Alternatively, hover over the bottom right 0-Max SUV B PET Presets corner menu of the image segment, select AC CT TAP IV, Volume Scaled Reset Windowing PET Presets, then select one of the predefined presets (eg 0-7 SUV means a background of 0 and a threshold of 7). These can be adjusted as desired by clicking on the Configuration icon. For CT Images, the windowing can also be adjusted by pressing down on the mouse wheel and dragging up/down to adjust the window centre and left/right to adjust the window width. If the image is a fused image, move the mouse cursor to the left side of the image segment then press down on the mouse wheel to adjust the CT window. CT Window presets are available by hovering over the bottom right corner menu of an image segment, select CT Presets and select the desired predefined CT window. Alternatively, the default Hot Keys are: CT Color LUT F5 – Soft Tissue Soft-Tissue F5 CT Presets F6 – Lung Lung F6 Reset Windowing F7 – Bone Bone F7 F8 – Liver Liver F8 Angio These hot keys can be reconfigured as desired. Colon Brain Head-Neck Page 2 of 12 SIEMENS Healthineers Effective Date: 23/04/2024 I QR700008487 Unrestricted © Siemens Healthcare Pty Ltd. 2024 syngo.via Physician’s Quick Reference Guide VB60 Pan/Zoom The Pan and Zoom function should be the activated tool by default, however if you have selected another tool, to get back to the Pan/Zoom functionality, hover over the menu at the top left of the image segment and select Pan/Zoom, select Hot Key Z, or simply press the Esc button. To Pan, hover the cursor toward the middle of the image segment – the cursor will look like the mouse pointer with two crossed arrows – then left mouse click, hold, and drag the mouse around to move the image as desired. To Zoom, hover the cursor toward the outer edges of the image segment – the cursor will look like the mouse cursor with two overlapping boxes – then left mouse click, hold, and drag to resize the image as desired. Settings and Configuration Configuration within VB60 can be performed anywhere you see a cogwheel. From the Patient Browser, in the top right corner, the cog wheel will open the Configuration Panel. From here you can adjust the Monitor Configuration, Image Text Size, and customise Image Text Display, among other things. SIEMENS teolthineers Configuration Panel Viand Appearance Configuration Panel Size of Font Configuration Monitor Configuration When customising Image Text, ensure you have selected the correct Modality for the Image Text Display, e.g. CT, PT, Fused. Make sure to click Apply between making changes to each modality. Workflow Display and Behaviour Configuration Customise Image Text Configuration CR Page 3 of 12 SIEMENS Healthineers Effective Date: 23/04/2024 I QR700008487 Unrestricted © Siemens Healthcare Pty Ltd. 2024 syngo.via Physician’s Quick Reference Guide VB60 MM Oncology Reading Changing Layouts 30 Reading :: Private Layouts The layout gallery is in the MM Oncology Reading step. Click the icon and choose your desired layout. Hold the Ctrl key while clicking to open the layout in Now Layout its default settings, otherwise your current windowing and LUT are maintained upon switching layouts. Right click on any layout to set it as the default. Public Layouts Layouts with the suffix nTP refer to multiple timepoint layouts. For example, Hybrid Hybnd 3TP mybad 2TP 41P 2TP will display images from two different timepoints, usually the current study and a prior. >> Advanced Close Layouts are separated into public and private galleries. User created layouts are available in the private gallery at the top. Commonly used layouts from the public gallery can be dragged and dropped into the private gallery for easier access. Users with Clinical Administrator rights can drag and drop their Private layouts into the Public gallery to make them available for all users. Resetting the Layout T Text A on_ ]Clip Box 3MBqKG Time Right click within any image segment and select Reset Layout /1964 Fit to Segment RREN' TAP IV ROI Circle 141 I PET TAP Corrected 120s M4 Presentation. This will return the layout to its default image type, 6/2018 3D Reference Point 0:43 PM orientation, windowing, and LUT settings. -1436.3 Distance Line is Marker RECIST/WHO + VOI Isocontour R FUSION Solid Lung Lesion Segmentation min VOI Sphere 512 Lesion Auto Zoom Filter: ??? mm. Paste Contour Paste Bounding Paste As Target Volumhis .......... Reset Layout Presentation on_11_Brest, 3Mb Insert and Propagat SUV Measurements In a PET or Fused Image segment hover over the upper right Dotance Line ROI CircleO hand corner menu and select RECIST/WHO + VOI Isocontour (Hot Key – Alt H) from the menu. You will then be able to draw LIVOI1 PT Max: 11.27 SUV-bw Arrows Peak: 9.80 SUV-bw / Size: 11am3 a 3D VOI around a lesion. Left click, hold, and drag a circle TLG: 78.03 SUV-bw xicm3 Volume (MTV): 11.58 cm VOUSphere around the lesion, then release the mouse button. The system Thresh: 4.51 SUV-bw/ 40% Text T will then create an isocontour within this boundary around the Propagate Markers FECISTIMHO . VO area of interest. A box will appear beside this region containing Sid Lung Lesen Segmentation Lesion Scout the SUV information. To change the threshold value, hover Start Lung CAD over the Region icon at the centre bottom of the image cell. Statt Virtual Planar Reconstruction Spine No Label This will bring up the slider bar. Adjust as desired. The information displayed, as well as the default thresholding within the VOI, can be configured within MM Oncology Settings. O 1.32 SUV-bw 3.29 40 %6 100 Page 4 of 12 SIEMENS Healthineers' Effective Date: 23/04/2024 I QR700008487 Unrestricted © Siemens Healthcare Pty Ltd. 2024 syngo.via Physician’s Quick Reference Guide VB60 The default thresholding value MM Oncology Vision 11 Brest, IMRoKG Tima CHLIBRERT Vicino 11 Brest 3ManKG Time can be set by clicking on the Configuration Printe Laptats Configuration icon in MM Lang CAO Oncology Reading, select Laron Measurements then scroll down to configure the desired settings. You can select either % - of Local Max or Absolute ---- ------- Threshold. Set the desired ------------------------ default threshold, then click OK. Finidings Navigator ---------- Distance Line EA03 HORIZON 167MBq Cape PROI Circle EA03 HORIZON_167MBq O 1/22/1965, F. 51Y BicPixel Lens JRRENT | CURRENT WB 3.0 131s 3 [3] | PET WB Marker IT To select the information displayed for the created 18/2017 | 7/18/2017 Arrow 04:07 AM | 11:05:35 AM isocontour or Finding, hover over the top right A116.1 | SP A116.1 Angle 4. corner menu of a PET/SPECT/FUSED image VOI Sphere Text T segment, right click on VOI Sphere or RECIST/WHO PR FUSION Propagate Markers + Isocontour and select VOI Isocontour Properties. min RECIST/WHO + VOI C 2 VOI Isocontour Properties socontour Solid Lung Lesion 2'512 Filter: ??? mm Send To Context Menu 300 T Lesion Scout 40 Start Lung CAD VOI Isocontour Properties Start Virtual Planar X Reconstruction Spine/Rib Label Display the following evaluations on PET/SPECT data: V Max (Maximum) Max.eq (Maximum Equivalent) Peak (Highest Average 1cm3 Sphere) Peak.eq (Highest Average 1cm3 Sphere Equivalent) Select all the properties you want displayed, then click Mean (Average) Mean.eq (Average Equivalent) OK. SD (Standard Deviation) SD.eq (Standard Deviation Equivalent) Min (Minimum) V TLG (Total Lesion Glycolysis) / Total Activity (Mean x MTV) / Volume (MTV) (Molecular Tumor Volume) V Thresh (Threshold of VOI Max) Deauville Score 1 Please review results as the system only evaluates Deauville scores from 2 to 5. OK Cancel Molecular Tumour Burden (MTV) and Total Lesion Glycolysis (TLG) Burden You can configure the VOI Isocontour property settings to display the volume (MTV) and the TLG of a lesion (see above). The values of the MTV and/or TLG will then be displayed for each individual volume that you create. To get a total tumour burden, click on the Findings Details icon in the Findings Navigator – the MTV and TLG Findings Navigator burdens will be displayed in the popup box on the Series Details Name Value Sour. L4VON1 20.7 MM O O tab. Page 5 of 12 SIEMENS Healthineers' Effective Date: 23/04/2024 I QR700008487 Unrestricted © Siemens Healthcare Pty Ltd. 2024 syngo.via Physician’s Quick Reference Guide VB60 Deauville Scoring H After configuring VOI properties to display the Deauville Score (see above), draw a VOI Isocontour around a lesion – a box will appear at L1VOI1 PT the bottom of the image segment prompting you Max: 11.27 SUV-bw Peak: 9.80 SUV-bw / Size: 1 cm3 to place an automated Liver and Aorta region RTLG: 78.03 SUV-bw x cm3 (just click on the Liver and Aorta icons). Navigate Volume (MTV): 11.58 cm3 Thresh: 4.51 SUV-bw / 4 back to the lesion and the Deauville Score will be Deauville Score: ??? displayed. All lesions will now display a Deauville i Deauville Score: Place Liver region Score, until this feature is configured off. Liver Region Aorta Region Manipulating Image Fusion Zoom/Pan H Hover over the upper left corner menu of the fused 3D Reference Point image segment, select the down arrow beside D- Windowing Automatic Registration and select Visual Correlated Cursors Alignment. Now left click and hold on the image El Movie and the PET data will move independently of the Visual Alignment CT. A wheel will also appear and when you hover Automatic Registration over this, you will notice the mouse cursor will Reset Alignment change to look like a circle with arrows. Left click and hold on the wheel and you will be able to Scanner Alignment Visual Alignment rotate the PET image. The rotation wheel can be moved by clicking and dragging the button in the centre of the wheel, this will change the axis of rotation of the PET image. Adjust as desired then hover over the top left corner menu in the fused image segment and deselect the registration tool, or simply press the Esc button. If you are unhappy with your image registration you can revert to the syngo.via registration by selecting Automatic registration or Reset Alignment. Viewing Different Datasets CT PET, 7/18/2017 PETAPETCT_WholeBody (Adult) PET-CT 1 The image datasets that are currently being displayed in the image segments will appear highlighted blue in the Series menu. To view a different dataset, the PET NAC for example, left mouse click and hold on this dataset and drag it over another image segment CT WB 3.0 131s 3 PET WB [4] containing PET data and release the mouse button. PET WE Uncorrected Page 6 of 12 SIEMENS Healthineers Effective Date: 23/04/2024 I QR700008487 Unrestricted © Siemens Healthcare Pty Ltd. 2024 syngo.via Physician’s Quick Reference Guide VB60 Multi – TimePoint Viewing If the patient has had previous PET studies the system can be configured to launch these prior studies with the current study. To view these together, change the layout within the layout gallery to 2TP Hybrid, or your desired layout option. If the prior study cannot be seen in the Series Navigator, select Add Study in the top right of screen, select the desired studies from the popup window and select Load Data. If there are multiple previous studies, you can select nTP Hybrid layout display (where n = number of studies available) or select the 2TP layout and cycle through the prior studies by pressing Alt T. Alignment Between Timepoints When comparing two timepoint studies, syngo.via will attempt an automatic registration of the two datasets. If you wish to Align dign Timepoints adjust the automatic registration attempt, select Align from the Tool BE Lock Navigation Tools menu, then select Align Timepoints, and click to activate the tool. Grey crosshairs will appear on the screen and the Lynch Align 11 -Text Hid Hide Lines Graphic Timepol timepoints will scroll and pan independently. When you are happy with the registration, deselect the Align tool. To revert to Edit Snapshot Print Export Unda Redo Layout Image Image syngo.via automatic registration of timepoints, press Ctrl on the keyboard and select a segment from each timepoint, then hover over the top left corner menu of an image segment and select Reset Alignment. Creating Snapshots/Layout Snapshots The Snapshot icon is found in the Tools menu. A Snapshot will capture an active single image segment, whereas Layout Tools Snapshot Snapshot will capture all the image segments on the screen with Synch Layout Snapshot de Lines the active segment. Snapshots will appear in the Findings Timepol ... Snapshot to Finding Navigator and in the Series Navigator under Results MM Oncology Reading. These can be reviewed by double clicking. To Edit Snapchiot Print Export Undo Bedo Image delete individual Snapshots, you must use the Findings Navigator, right click and delete. To delete all Savescreens, right click on the Results MM Oncology Reading and delete. Generally, but depending on configuration, all snapshots will transfer to PACS upon closing a study with Save and Send. Page 7 of 12 SIEMENS Healthineers' Effective Date: 23/04/2024 I QR700008487 Unrestricted © Siemens Healthcare Pty Ltd. 2024 syngo.via Physician’s Quick Reference Guide VB60 Initial Layout Configuration It is possible to configure the system to launch a default layout based on preference or the number of available timepoints and the study type. Click on the Configuration icon in the MM Oncology Reading bar, then select Initial Layouts. Click on the + and set rules based on the number of timepoints and/or the study description. The asterisk symbol represents a ‘wildcard’ and can be used to soften or omit the condition. The asterisk position determines whether the referenced word/phrase must be at the beginning or end of the description. Place asterisks either end of the word/prase to indicate that this word/phrase can fall anywhere within the description, e.g. Lung VQ* indicates that the study description must begin with ‘Lung VQ.’ *VQ Scan indicates that the study description must end with ‘VQ scan.’ *VQ* indicates that the study description must contain ‘VQ’ somewhere within it. MM Oncology Configuration MM Oncology Reading o Calculation Visualization Indiet Layouts Meisterpens Lung CAD Trendiog Lesion Scout REOST 1.1 State Tinspeine Aisignment Cejost Antigunant Condition initial Layout PET; study Onerijoan + Assign Initial Layout Findings Navigator For Patient with Thepointts): Name Sour 1.78 UND For a study it no tules match ine y Desde Las Shuty Description (Asgrwrent object) Assignment Condition) use this layout OK Cancel Hybrid Lesion Scout Lesion Scout is designed to find all Configuration lesions within the image segment to Calculation Visualization Initial Layouts Measurements Lung CAD Trending Lesion Scout Archiving save you time creating these regions Choose a preset configuration: Sample Preset yourself. This tool is especially helpful Selection Criteria when there are multiple lesions present Select all foci with SUV Max greater than Manual Threshold Auto ID with value of 2.5 4 SUV within the patient. This tool can be Automatically analyze and suggest physiological Segmentation Criteria areas for exclusion from burden calculation. found in the top right corner menu of a Segment foci with % Local Max with value of 40 9 Supported for [18F]-FDG radiopharmaceutical only. Please ensure all foci are reviewed before accepting. PET or Fused image segment. Once the Discard segmentations MI less than 0.5 ¢ tool has been activated, a box will greater than 0.5 ¢ ml appear at the bottom of the image cell Segmentation Color Configuration and you will be prompted to place an Excluded Included Green Orange automatic liver and aorta region by OK Cancel clicking on these icons. Syngo.via will then automatically calculate and highlight all areas within the image segment that fulfil the designated criteria, as configured in the Lesion Scout settings, found in the MM Oncology Reading Configuration menu. You can then scroll through the image and use the toggle function to convert something to be included or excluded, as desired. Page 8 of 12 SIEMENS Healthineers' Effective Date: 23/04/2024 I QR700008487 Unrestricted © Siemens Healthcare Pty Ltd. 2024 syngo.via Physician’s Quick Reference Guide VB60 MEA03_HORIZON_167MBq Cape PET-CT Centre MEA03_HORIZON_167MBq *11/22/1965, F. 51Y Biograph Horizon CURRENT | CURRENT CT WB 3.0 131s 3 [3] | PET WB -> AQ1:A1 | AQ1:F1 # PT009649 PET^PETCT_WholeBody (Adult) STUDY 7/18/2017 7/18/2017 | 7/18/2017 11:04:07 AM | 11:05:35 AM 3 IMA n.a. FRM n.a. | 4 IMAn.a. FRM n.a. SP A143.6 | SP A143.6 RefLIV1 PT Max: 3.02 SUV-bw Mean: 2.38 SUV-bw R SD: 0.25 SUV-bw Excluded PERCIST Threshold: 4.07 SUV-bw ncluded 10cm MPR FUSION SL min A AC 2 512'512 EQ Filter: ??? mm a 50.00% 300 5.00 SUV-bw Please review system results 40 T B 0.00 SUV-bw Ulver Fogian Aspian Accept Once happy, select Accept, and findings will be created for all the lesions found that fulfil the criteria. Scroll through the image segment or the Findings Navigator again and delete any findings that should not be included in the calculation. If configured, MTV and TLG will also be calculated with this tool. Closing a Patient Click the Tick button located on the left of the screen. This is Save and Send and will close the patient and send any created series or findings to PACS. Alternatively click on the X at the top of the screen next to the Patient’s name, then choose to Save and Send. Save and Pause will save the current patient as you have left it, but will not send any created series or findings to PACS. Discard Changes will not save any created series or findings, and will not send anything to PACS. MM Oncology Close Patient ? X MM Oncology Reading 3D Reading How would you like to close the patient MEA03_HORIZON_167MBq? RECIST 1.1 Save and Send (Results are stored on the system and sent to your archive [CTRL + ALT + A]) Solid Liver Lymph RECIST on Node Generic Save and Pause (Results are stored on the system [CTRL + ALT + S]) = Lung CAD AEF Once Board Auto Zoom X Discard Changes Trending (Unsaved results will be lost) MM Reading Cancel Page 9 of 12 SIEMENS Healthineers' Effective Date: 23/04/2024 I QR700008487 Unrestricted © Siemens Healthcare Pty Ltd. 2024 syngo.via Physician’s Quick Reference Guide VB60 Importing Data To import patient data from another DICOM node you can right click on the patient and select Search Patient with DICOM Q/R. This will pre-populate the pop-up window with the patient’s information. The user can select the desired node to search for prior studies, select such studies, then click Import. You can also selectively choose individual series to import, to reduce time and save space on the syngo.via server. To import data from file, such as a USB, select the Import icon located in the top right of the Patient Browser page, choose the applicable path, data then select Import. Page 10 of 12 SIEMENS Healthineers' Effective Date: 23/04/2024 I QR700008487 Unrestricted © Siemens Healthcare Pty Ltd. 2024 syngo.via Physician’s Quick Reference Guide VB60 Hot Keys Initial Shortcuts: F1 – Help Menu. F11 – Expand / Collapse Menus. Esc – Deactivates Tool. Z – Pan / Zoom – Pan image with cursor over the middle of the cell; Zoom image with cursor on the outer edge of the cell. Save and Send Tick – Close patient and export all findings to PACS. Windowing CT Windowing – select a CT Segment first: F5 – Soft Tissue. - F6 – Lung. - F7 – Bone. - F8 – Brain. - F10 – Invert Colourscale (CT or MI datasets). - Fused Segment – select a Fused Segment first: F9 – cycle through Fused -> CT -> PET/SPECT Data. - Image Overlay T – Hide / Show Image Text. G – Hide / Show Image Graphics. H – Hide / Show Crosshairs. Snapshot/Layout Snapshot Capture: S – Create a snapshot of active segment. Alt + S – Create a Screen Capture of active screen. Measurements and Tools: R – Turn on Small Crosshairs. D – Distance Measurement. Alt + H – VOI Isocontour. C – ROI Circle. V – VOI Sphere. Shift V – VOI Oval. U – Unskip / Skip images for Slower / Faster Navigation. Spacebar – Starts / Stops Movie ie MIP or Stack scroll. Alt – temporarily disable active tool. Dataset Manipulation: Alt + T – Cycle through Timepoints. Alt + A – Cycle through Bundles. Alt + D – Cycle through Reconstructions. Page 11 of 12 SIEMENS Healthineers' Effective Date: 23/04/2024 I QR700008487 Unrestricted © Siemens Healthcare Pty Ltd. 2024 syngo.via Physician’s Quick Reference Guide VB60 *Images courtesy of Siemens Healthcare - MI Training Course Material Please note that the 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's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. 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. Copyright © Siemens Healthcare Pty Ltd, 2024 Siemens Healthcare Pty Ltd Level 3, 141 Camberwell Rd Hawthorn East, VIC 3123 AUSTRALIA Page 12 of 12 SIEMENS Healthineers' Effective Date: 23/04/2024 I QR700008487 Unrestricted © Siemens Healthcare Pty Ltd. 2024