syngo.via Frontier Coronary Plaque Analysis

This research application allows us to do quantities and associated semantic coronary artery plaque analysis from a standard coronary CTA data set. On the left, I found a data set and I can click on a specific series here on the right. As you know, single via Frontier will open and read only. To open the case, please right click on the selected patient, select open with and then select CT coronary plaque analysis frontier. Once the data set is loaded into frontier, you can see it's very clearly stated that this is not for clinical use. In single via Frontier we only have research applications of kind of workflows and those are only for research. So we search now for the latest version of the coronary plaque analysis. This is version 5.0. And here we also have the version 4031 available, and it might even be that we also have older versions of coronary plaque analysis available. But this is #5. Once you have found the one, you can also get information by clicking on the I button. I explained in another video how you could get information about the different research applications. It works for all the research applications the same throughout Singo via Frontier. I click on the tile of coronary plaque analysis and then the research application starts. Once the research application has started, we get the question if we want to treat this as a coronary study. Not only coronary arteries like we are doing now, but also carotid arteries can be measured with this research application. That's why the system asks for this. I click of course, yes. The status bar is running now. After a little while, the system has automatically made a couple of vessels here in this view. You have the list with vessels over here in the CPT centerline editing option in the control area, as you can see here on the left. And here you have the list with the coronary vessels that the system automatically detected. This takes a little while. But it's worth waiting because the system did quite a nice job. Now we can analyze all those coronary branches, but for this demonstration we will use only one. We can see clearly in this screen here in the CPR we have a well affected left artery descending. How do we proceed? The lad one is already selected. If it is not selected, then you can go over to the area where the center line editing mode is possible and select the vessel over there. After this, we go to the CT plaque editing mode and we can add a plaque. What we can do first is analyze the area over here in a more or less standard way. When we click into the center line of the LED, we see a cross section of the LED over here and it's still not at the area. Here we can analyze if the system has taken the vessel into account. It might be that the threshold settings are not optimal and that you have to set the thresholds manually. You can do this with this slider here below. It's quite small, but you can see that the circle around the vessel becomes larger and smaller as soon as I move this slider. We put the slider really close to the lumen over here. This is the way we can go through the whole vessel. We are interested in this part. We go now to the button add plaque and we click into the area where we want to start to do the measurements. This is a red marker over here that marks the beginning of the Stenotic area that we want to analyze. We click below this area where a green mark is mentioned. As soon as we have done this, the system will analyze this area. You can scroll through this area to see if the system took the outer walls of the vessel into account. Once we're happy with the position, we can click initialize in the cross-sectional image. Where we can go to the CT plaque editing control area where we press the button initialize walls. We see the status bar again, so the system is calculating. Once the system has calculated this area, you will see that the CPR is changing. This research application analyzes the outer walls and the inner walls of the lumen. They can be seen in both the CPR and cross-sectional images. And those are editable. If you want, you can select the inner Wall Edit mode. Or the Outer Wall edit mode. Or you can even ignore the inner wall which is selected. Let's come to an interesting part, and that is the analysis of the plaque that we have here. We have a little list with findings over here where you can see that the system found that the vessel has 480 almost 481 cubic millimeter and a lumen with the volume of about 123. The plaque is actually much thicker and there is a classification of this plaque. From this, which is stated as 100%, more than 48% is calcified. The noncalcified plaques are 86% of the total plaque burden and from this the lipid rich is almost 12 cubic millimeters and the fibrotic is almost 300 cubic millimeters, which is responsible for 83% of this plaque. What we can also mention here is the American Heart Association segmentation. It's a little bit behind here because of the smaller screen that is used. Might be segment 7 because the branches come from here. You can mark this over here. It's a little bit hidden in this view. In the real system, you will see the segments clearly resented. What we can mention is if there's a napkin ring sign there. When we have a complete circular classification in the coronary artery in this case or in the clotted artery, we can mention this here in the report. I don't see this here, but there's only one heavy calcified over here, so there's definitely no napkin ring sign. What is also a nice feature is that we can define what the thresholds are for the respective plaques. So we can define on which hands filled level the calcified plaque starts and where the lipid rich protect areas are. We can do this simply by going over this bar in the histogram and moving the bar to the desired position. And of course the calculation will also be updated instantly. The thresholds are set for a certain tube setting and especially in regards to two KV. This was done with 120 kilovolt. Nowadays we use much lower energies, of course, for cardiac analysis. We can set this manually if you want. We have the whole range from 70 to 150 KV available here and we have also something else that I will talk about a little bit later. We can set their KVV setting according to the KJV setting of the data set that we created. The system does this automatically, but we can do this manually as well. What we can do as well is create our own preset. I change it here a little bit to 212. If you want to store this, I can store this as a certain preset. Once we are happy with the settings, we accept the current settings and we get some information. Again. Because of the small screen, we cannot see all the measurements that are shown. There's a stenosis grade in percentage over here. There is an eccentricity index also over here and we have a remodeling index and a minimum luminal area is also mentioned over here. What we can do is send the results by creating a snapshot. That's a very easy way. But we can also send the results back to Singo via where it is clearly marked that this is not for clinical use and that it is just research results that we have. What is quite nice in this research application is that we can also use dual energy data set. For that you have to select two data sets 1 lower and higher energy of course. And we can use this especially in carotid vessels analysis. And quite often there is a dual energy data set available which we can also put in here. We have here the CPLEX summary which was available coming out of this research application. We can export a report and you can put it somewhere here on the library. I put it here on the desktop of this system. I'm going to press, OK. And later on we will see that we are going to have this data set available on the desktop. We can also export the masks again and put these on the desktop of this PC and we can have a look to the export of the masks afterwards. Then you see another workflow step and it's the pair of vascular analysis. Besides this one, it is possible to do an analysis of the perivascular fat. The analysis recognizes the inflamed vessels which can create a plaque afterwards and might be pose a risk for a clot. Unfortunately, in this version of the research application, we cannot start this here directly. We have to close the research application and start it again and we have to go directly after we selected the vessel to this perivascular analysis. Again. The export of the report goes on the same way. That's more or less the standard in Syngo via frontier. We have the standard functionalities available. In this research application of Syngo via frontier, there's also a help file available. This manual is very useful to read. You can download it here in this area. Views can be reset once I have played around with the settings. Furthermore, I can create a snapshot and send the results out to syngo via. Beside I have the option to turn off the text, so with that I can fully concentrate on the images. And also the center lines can be taken away. Thank you very much for your attention.

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SIEMENS Patient Browser Browse Read (29) More Filters CT Open Print Open with DICOM Expor Results (9 results, 8:48:30 AM) Series Workflow Status Workflow Des ... Patient Name Date of Birth Patient ID Modality CT CaScoring 2015R2130 CT, HS, SEG. FO_TFL_CorCTA_4Stents FO201602 CT, SEG, SR 2015R2102 FO_CorCTA_70kV_TFL, Erlangen 2014R2001 Surfaces CT Cardiac FO_CorCTA_Stent_Bypass-Stenosi ... CT, OT, SEG. Function <9> (50%) FO_CorCTA_Spi_Stents, Erlangen FO_113 AS+CorCTA_Seq_57-62_BPM, C.H .... 2014R0402 DS_CorCTA_Spiral_LAD_Stenosis _... 2012R0995 ces CT Cardiac Instances The selected data opened as read-only 8:48 AM DICOM Sa ... FRO* Results Series Number Series Description Series D 231.14 MB [1] ROI Freehand Coro 71% 760.30 KB 244.37 MB Evidence Documents CT Cardiac Function 1.86 MB Evidende Documents MM Reading Plaque Prototype Persistence Data_NotForCli ... FRO_CineRender_Cardiac10Stents fc33d6c641 Report Data d83ab8a5e0 Segmentations MM Radiomics_NotForClinic ... 72.26 MB SEG Workflows of the selected studies are cancelled 6:31 PM Results (10 results, 6:31:42 PM) Workflow Description FO 94 FRO_AspectScore_1 7079c72c21 FRO_BestContrast_Male 947239fd3e Cardiac_Function_Global_Findings_1 546.00 KB FRO_Cardiac_Plaque_LAD e53021e6d4 2.06 MB SR FRO_CardiacRiskAnalysis_2 7.09 KB FRO_CardicaFunction bd9e54674f 2.40 MB OT 406.40 KB S1 Snapshot Coro 71% 840.53 KB Segmentations Cardiac Function_PreProcessi ... 73.01 MB Ope Open with View as Read-Only with Batch Open Assign Workflow Group Studies Batch Assign Workflow Cancel Workflow Search Patient with DICOM Q/R Send to Archive Add to Demo List ances Remove from Demo List Set Delete Protection state Remove Correction state Start Set Archive state Correct Favorites CT Dental Function MM Radiomics Frontier MM Reading a NotForCli ... CT Cardiac Function otForClinic ... CT Cardiac Functional Analysis Frontier CT Cardiac Planning CT Cardiac Risk Assessment Frontier Set Mark state CT cFFR Frontier Cut Suggested PreProcessi ... CT Chest Pain CT Colon CT Coronary CT Coronary + Ca CT Coronary Plaque Analysis Frontier CT DE + Vascular Size new ae6114cdfd Evidence Documents MM Reading 4 229 Opening selected data using workflow CT Coronary Plaque Analysis Frontier ... Healthineers Not for clinical use Select a prototype Frontier ID: 000001 Go to syngo.via Frontier Prototype Go to syngo.via Frontier Support and Recently Used Cardiac Functional Analysis Coronary Plaque Analysis MR Neuro Perfusion Create and manage patient- Calculation of TMAX perfusion maps for local and global AIF. from single and dual energy CTA Allow 4D motion correction and Expiration date: Sept. 30, 2021 Expiration date: June 30, 2021 3D Printing Best Contrast Loading ... Load, edit and create Emphasises the contrast segmentation objects for 3D Cardiac Risk Assessment cardiac risk by quantifying abdominal fat and pericardial fat. Cinematic Rendering CT and MR datasets DS_CorCTA_Spiral_LAD_Stenosis_F .. * 6/1/1957 M 2012R0995 All prototypes are not intended for clinical use Search Store Discussion Forum Siemens Healthineers CT specific (soft) plaque findings NEW printing This prototype is used to assess 4.3.1 ext Abdomen/Heart Fat Analysis on Creates photorealistic 3D view of Non-Contrast CT Data for Slice CT Pneumonia Analysis CT Skull Unfolding Prototype for the detection and Creates unfolded images of the quantification of abnormalitites skull consistent with pneumonia. DE IronVNC Flow Visualization Quantification of iron content in Evaluates the vessels in CT Neuro Perfusion datasets with respect to time to max enhancement Research Application Starting ... MM Research Frontier Heart CT Centerline Editing CT Plaque Editing Add Plaque DECT Plaque Analysis CT Plaque Summary Perivascular Analysis SCANNER PASTEUR 90 mm 120 KV Vessel: LAD Component Plaque Ratio [%] AHA Segme Lipid Rich Napkin Ri Segment Length [mm]: 29.6 2D Measurements Accept current Min. Luminal Area [mm']: Stenosis Grade [%%]: Remodeling Index: Eccentricity Index: Threshold Presets: 600 800 1000 1200 1400 1600 Rese Tree Prototype mode selection Treat as coronary study? Yes No Plaque Sections ID Branch Create Send Coronary Resut nitialize Vol. [mm3] France - Lumen MRT LAD1 HRA PR Edt Markers CT Centerli Editing Name Index Cente FactoryNan ContourCer LAD_Secondary10 26 Type Index Reset Index Cente FactoryNan- 120 k Coronar LHA VRT ndex Cente FactoryNan LAD Secondarv3 Nam 120 K 120 kV Edit Markers LP Duter Wall HLA mm HU AH BR Wals nan 800 1000 1200 1400 1600 1000 12 800 1000 1200 1400 1600 1000 1200 1400 1600 1000 1200 800 1000 1 Duter Wal 800 1000 1200 1400 1 Initialize 48 67 600 800 AR RA AHL 20 kV LFP rance HTA AHA Segments: Napkin Ring Sign Lipd Rich Help Napkin R - Calcified 100 kV 130 KV 150 kV 80 kV 110 kV RAF Plaque Overall Plaque Burden Calcified Lipid Rich Fibrotic Segment Involvement Score 0/16 Report Browse For Folder Desktop Libraries Network Export Make New Folder Cance > Shows the files, folders, program shortcuts, and other items on the desktop Export Masks Select Result Folder This PC 3D Objects Documents 1200 1400 1600 Radius (mm) FAI FAS FAM RC Mean Diameter Outer Wall: Mean Diameter Inner Wall: Radius (mm) 5.00 cx FA RCA 20 28 ROI Mode: Inner <- > Outer 4 38 A Certificate error MM This site is not secure This might mean that someone's trying to fool you or steal any info you send to the server. You should close this site immediately. Details Pla Type here to search syngo 10.1.1.51 9:08 AM 2 Add notes Layouts 2 Layouts Startup Layout Once you have started the prototype, image registration and mixed im- age computation, in the DE case, followed by fully automatic cardiac pre-processing on the mixed image takes place. In the SE case the data volume is immediately pre-processed. Afterwards, manual user interac- tion is possible through the prototype's graphical user interface as shown below. The steps in the control area, as well as the centrally displayed Ul ele- ment for plaque definition will guide you through the process of creating MM 6 TT Twin CPR Layout In the layout gallery, which is accessible by clicking the "Layout Gallery" button (HH) at the top-right corner of the control area, it is possible to change between the regular layouts ("2MPR + VRT + CPR + CS" and "3MPR + VRT + CPR + CS") and the twin CPR layouts ("CS + TCPR" and "3MPR +VRT + TCPR + CS"). Both are available for sinale screen and for dual screen setups. FCPAV5_0_0/ Basic Coronary Plaque Analysis Workflow 3 Basic Coronary Plaque Analysis Work- flow The prototype must be started within the MM Research Frontier work- flow with appropriate data. The following guides you through the creation of a plaque section step by step. In an SE scenario the steps will be carried out on a single loaded series. In a DE scenario the steps are done on the mixed im- age computed from the two DE input series. Select the vessel of interest, e.g ., "LAD1", from the list of found centerlines in the "CT Centerline Editing" step. View the selected vessel in the curved planar reconstruction (CPR) view and/or in the cross sectional view on the right side using the familiar syngo.via modes of interaction. Create a new plaque section to be analyzed by pressing the "Add Plaque" button in the "CT Plaque Editing" step. The new section will appear in the "Plaque Sections" list in the lower half of the control area. Note that in "CT Plaque Editing" the mode "Edit Markers" is activated now. Place the red top marker and the green bottom marker of the current plaque section by clicking with the left mouse button on appropriate locations in the current centerline in the CPR view. After initial positioning both markers can still be dragged by keep- ing the left mouse button pressed on them. Use the left mouse button to navigate to representative cross sectional views of the newly created plaque section in the CPR view MM 8 On the cross sectional view move either the slider below or keep "Shift" + middle mouse button pressed and move the mouse up and down to change the parameters of the auto-contourer, which will be used for initializing the outer vessel wall, until the dashed contour displayed in the cross sectional view meets your expec- tations. It should align with the outer wall of the coronary vessel. Afterwards click the "Initialize Walls" button in the "CT Plaque Editing" step or the "Initialize" button below the cross sectional view, which will trigger automatic initialization both of the inner and the outer vessel wall of the plaque section. In case you are not satisfied with the course of the inner and outer vessel wall surfaces enable wall editing with "Edit Inner Wall" or "Edit Outer Wall" in the "CT Plaque Editing" step. Now, editing the respective surfaces is possible from the CPR views as well as from the cross sectional view. Note: it is recom- mended to edit the contours on the CPR views. CPR based ed- iting allows much faster corrections than editing in the cross sec- tional view. The different editing modes will be detailed in the section dedicated to this workflow step. Similarly, "Edit Markers" allows changing the proximal start and the distal end of a plaque section. Leaving the three editing modes again triggers compu- tation of the histogram and 3D image masks for plaque compart- ment analysis. In order to rotate the vessel around the centerline in the CPR view you can press the right mouse button and change view by moving the mouse left or right. "Fibrotic" plaque (green), and The available thresholds are dependent on the chosen evalua- tion mode. Currently the following evaluation modes are sup- ported in this prototype: "HU Threshold": this evaluation mode is available both for SE and DE cases. For DE data HU thresholding is per- formed on the mixed image computed from the low and high kV images. "DE Threshold": this evaluation mode is only available for DE cases. Here, thresholding is based on the DEI. "HU/DE Threshold" : this evaluation mode is only availa- ble for DE cases. Its intention is to isolate low attenuation compartments (lipid rich and fibrotic alike) based on HU thresholding on the mixed image in a first step. Then DEI thresholding is used to distinguish between lipid rich and fibrotic tissue within this combined compartment. In this mode, you can switch between the HU and DEI histo- grams and their associated thresholds via the "Show DEI Histogram" check box on the right above the histogram viewer area. The transparency of the compartment overlays can be controlled by the slider under the cross sectional view during compartment analysis. The overlays can be turned on and off with the "Plaque Visibility" button or the "Space" key. (Note: focus has to be either on the viewer areas or the control area for that; change the focus by clicking the left mouse button in the appropriate area). Once the thresholds have been set as you wanted move on to further plaque definition above the histograms. It allows addi- tional characterization of the current plaque section. Define the following qualitative and quantitative characteristics: affected major coronary branch (LAD, RCA, or CX), affected vessel segments according to the American Heart Association (AHA) convention (1-16), and . Turn on "2D Measure Visibility" by clicking the associated button at the top of the control area. All "2D Measurements" now dis- played in the current cross sectional view are specific to this very position of the plaque section under investigation. If this is the cross section where you would like to take these 2D measure- ments click "Accept current" to make the values be part of the Stenosis Grade [%]: Health CT Coror Plaque S 6:33 PM SIEMENS . CT Coronary Plaque Analysis 2D Measure Segment Length [mm]: 10.5 40 mm -100 0 100 200 300 400 500 600 700 800 900 1000 1100 1200 1300 1400 1500 1600 1700 Text 15 4 CLose Patient How would you like to close the patient FRO_Cardiac_Plaque_LAD? Save and Send (Resuilts are stored on the system and sent to your archive [CTRL + ALT + AI) Save and Pause Discard Changes (Unsaved results will be lost) 11 12 Sign Cancel Results (10 results, 6:33:55 PM) FRO_3DPrinting_Heart In progress CT Coronary Plaque A ... 8ca38b5d9a The selected data opened The user must ensure that the Frontier Research Applications and/or the results obtained by their utilization will be used for Research Use only. "Research Use" means the use of a software for research (particularly for basic research) where the software itself is not validated. Research Use does not include market and feasibility studies concerning the software as well as any clinical use of the software, namely its use for any patient- specific examination in connection with the preparation of a diagnosis or therapy planning. The use of a Frontier Research Application in connection with any system cleared as a medical device may affect the medical device clearing of said system. 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