HYBRID VIEWER. HERMES Data Analysis Applications. Hand book CD500.3_P31V 2.0C-2.1C. Template: T

Transcription

1 HERMES Data Analysis Applications HYBRID VIEWER Hand book Document Revision Date: Document Number: Version: C-2.1C Canada Health Template: T Website: HERMES Medical Solutions AB

2 HYBRID VIEWER 2(120) The software described in this manual and the software itself is copyrighted and all rights are reserved by HERMES Medical Solutions. Neither the software nor the manual may be copied or in any other way reproduced without prior consent in writing from HERMES Medical Solutions who reserve the right to make changes and improvements to the software and the manual at any time. HERMES Medical Solutions takes no responsibility for loss of data. HERMES Medical Solutions takes no responsibility for any results and diagnoses derived from using the program described or from information in this manual. The users of the software are solely responsible for its use and for the resulting diagnoses. HERMES Workstation, BRASS, CSTomo, FUGA, GOLD, HLINK, HOSEM, HQUAL, HWWW, JaRVIS, MultiModality, Neuropath, NudVoxel, NudSegment, OptiArc, PERFIT, QMS, REN, SPETS, TCS, Hybrid Viewer, Hybrid Recon, TeleHERMES, OnLine HERMES, Smart HERMES, HERMES OnLineReporting and HERMES Locum are Trademarks of HERMES Medical Solutions AB. Solaris, MySQL are registered trademarks owned by Oracle Corporation. UNIX is a registered trademark of UNIX System Laboratories. SPARCstation is a registered trademark of SPARC International, Inc. Postscript is a registered trademark of Adobe Systems Incorporated. Microsoft, MSDOS, Windows are registered trademarks of Microsoft Corporation. Intel and Pentium are registered trademarks of Intel Corporation. HERMES Medical Solutions welcomes feedback from readers of this manual. Please report any errors in content or typography and suggestions for improvements by . info@hermesmedical.com CD500.1_P31V

3 HYBRID VIEWER 3(120) Table of Contents ABOUT THIS MANUAL... 6 Intended use... 7 Intended user... 7 Compatibility... 7 System requirements... 7 LOADING A STUDY... 9 PROTOCOLS Layout Protocols User Protocols QUICK START TOOLS SUMMARY KEYBOARD SHORTCUTS TOOLS DESCRIPTION Triangulation Scroll Zoom/Pan Lookup Table Measure Annotate Arrow Quick ROI ROI/VOI Synchronization Filter Profile... 66

4 HYBRID VIEWER 4(120) Saving Reports Print Patient Information (PET only) Bookmarks Loading/Saving User Properties Modules MIP/Cine Layers Visibility Orientation Cardiac Display Options Overlay Options Import/Export Options ADDITIONAL FUNCTIONS Saving Studies Saving Movies Scaling Planar Static and Whole Body Images Displaying Prints and Planar Images CLINICAL EXAMPLES Single PET/CT or SPECT/CT Two PET-CT studies Serial PET-CT Studies TROUBLESHOOTING OPTIONAL MODULES Lung Perfusion and Ventilation Module Nuclear Medicine Module Cardiac Module APPENDICES SUV Values Calculations for the Lung Module MANUFACTURER

5 HYBRID VIEWER 5(120)

6 HYBRID VIEWER 6(120) ABOUT THIS MANUAL This manual is valid for the application Hybrid Viewer with part number P31, version 2.0. This manual is designed to be easy to navigate around. You can use the chapter headings listed in the left hand navigation panel to move quickly to any section of the manual. Most of the information is presented in the form of tables. User operations described in the manual have been color coded as follows: BLUE LEFT MOUSE BUTTON RED RIGHT MOUSE BUTTON GREEN KEYBOARD This manual contains the following sections: Loading a study Quick Start a table listing the basic operations needed to get you started. Tools summary a table listing all the Tools available in the application, with the icons and keyboard shortcuts used to access them Shortcuts a table listing all the available keyboard shortcuts Tools Description- tables listing the functions available for each tool. Each functional description table is followed by a blue table listing the options which can be configured for this tool in the user protocols. Clinical layout examples

7 HYBRID VIEWER 7(120) Intended use The Hybrid Viewer application is intended to provide display/visualization, quantification, and multidimensional review of the biodistribution of radio nuclides in the body using planar and tomographic images. Intended user The user may be an experienced physician, medical physicist, nurse or other operator who has been trained by an authorized distributor or by Hermes Medical Solutions. Compatibility The Hybrid Viewer version 1.4 is compatible with following applications: Part number Name Version P5 Gold 2 and 4.2 P6 Dicom 4.0 System requirements Following system requirements are recommended for use of Hybrid Viewer version 1.4c. Manufacturer Part number Product specification Workstation DELL 1 T5500 CPU, One Intel Core i3-540 (Dual Core, 3.06 GHz, 4MB Cache) 2 RAM, 2GB DDR3 non-ecc Memory (1333MHz, 2x1GB) Operating system, Microsoft Windows 7 32 bit 3 Graphics card Gainward GeForce GTX MB PhysX Or Manufacturer Part number Product name Workstation DELL 1 T1500 CPU, One Intel Xeon E5507 (Quad Core, 2.26 GHz, 4MB Cache, 4.80 GT/s Intel QPI) 1 RAM, 2GB DDR3 1333MHz ECC-UDIMM (2x1GB) Operating system, Microsoft Windows 7 32 bit 3 Graphics card Gainward GeForce GT240 1GB PhysX CUDA 1 DELL, T5500 are either registered trademarks or trademarks of DELL in the United States and/or other countries 2 One Intel, Intel, Intel Core are either registered trademarks or trademarks of Intel Corporation in the United States and/or other countries 3 Microsoft, Windows are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries. 4 Gainward are either registered trademarks or trademarks of Gaiward in Germany and/or other countries.

8 HYBRID VIEWER 8(120) Display Size Resolution 24 inch Wide 1920 x 1200 pixels

9 HYBRID VIEWER 9(120) LOADING A STUDY A study can be loaded into HybridViewer from different types of patient browsers: HERMES GOLD HERMES Fast Launch PACS (e.g Agfa) RIS (e.g.carestream) The illustration shows 3 ways in which the HybridViewer can be started from GOLD3, once the study or series within a study have been selected. The order in which studies are selected in the patient browser does not matter. The layout protocol will ensure that series from different dates are grouped into the correct studies. The layout protocol also determines whether the older or newer study is displayed on the top or bottom of the screen for a single screen protocol or on the left or right screen for a dual screen protocol.

10 HYBRID VIEWER 10(120) PROTOCOLS The application uses two types of protocol layout protocols and user protocols. Layout Protocols These protocols are designed by Hermes staff and include the following: The layout of each of the pages displayed by clicking on the tabs on the right hand side of the screen The number of pages you can display The number of screens used User Protocols These protocols can be configured by the user within the Tools menu of the application. Details of the choices for these protocols are shown in the blue tables later in this manual. The user protocol userdefault is loaded automatically. If you would like to use a different user protocol there are 2 possibilities. Load the protocol using the Tools/Load Properties menu item in the application after it has started Load the protocol automatically from the patient browser. Hermes staff can configure this for you.

11 HYBRID VIEWER 11(120) QUICK START Change display CLICK on tab on right hand side or Type. to step forward, to step backward through tabs or Type 1, 2, 3 etc to change tab Change CT window/level F1-F12 on keyboard Change color table RIGHT CLICK on color bar and select color table

12 HYBRID VIEWER 12(120) Change thresholds CLICK on lines on color bar and drag to new position Play movie CLICK on Play Play time movie of tomographic gated or dynamic study CLICK on Gate option CLICK on Play Scroll through slices Mouse wheel or Scroll mode or Move sliders below images or Use double arrows or Use Keyboard Left/Right arrows move one slice at a time Up/Down arrows move 3 slices at a time

13 HYBRID VIEWER 13(120) Triangulate CLICK on images Display/remove text overlay O on keyboard Zoom an image full screen Quick Print (no need to use Print window) DOUBLE CLICK over an image or RIGHT CLICK over image and select Full Screen CLICK on QuickPrint icon (creates a print for each screen) or RIGHT CLICK over image Screen Quick Print (prints current screen) Print (manual) CLICK on Print icon or P on keyboard RIGHT CLICK over image Send View to print Send Screen to print Drag an individual image into print window by CLICKING over the image and DRAGGING into the Print Window Drag the whole screen display into print window by CLICKING anywhere in the grey space below the tabs and DRAGGING the small box into the Print Window Annotate CLICK on annotate icon Scroll through time frames of tomographic gated or dynamic study CLICK on Gate option Mouse wheel or Use double arrows Note: Scroll mode, slider and keyboard all scroll through slices not through time when Gate option is set

14 HYBRID VIEWER 14(120) Sum frames of tomographic gated or dynamic study CLICK Gate option Off Set First and Last Frame to be summed CLICK on Sum Display single or multiple prints or images CLICK on this button to display a single image or print CLICK on the arrows to move through the images CLICK on this button to display multiple images or prints Save a study after masking, manually moving etc RIGHT CLICK over any image in the study and choose Save Patient Save a clipped study With ROI tool open, RIGHT CLICK over a clipping ROI and choose Export -> Clip and Save Patient

15 HYBRID VIEWER 15(120) TOOLS SUMMARY The tools in the application can be selected by clicking on an icon along the top of the application, using a keyboard shortcut or right clicking over an image and choosing an option in the Tools menu. OPERATION ICON KEYBOARD SHORTCUT OPERATION ICON KEYBOARD SHORTCUT TRIANGULATION T SYNCHRONIZATION SCROLL S FILTER ZOOM Z PROFILE PAN N REPORT LOOK UP TABLE L PRINT P MEASURE M QUICK PRINT NGLE K PATIENT INFORMATION (PET) ANNOTATE W BOOKMARKS ARROW D SHORTCUTS ROI/VOI MANUAL QUICK ROI Q QUIT

16 HYBRID VIEWER 16(120) KEYBOARD SHORTCUTS OPERATION ICON KEYBOARD SHORTCUT OPERATION ICON KEYBOARD SHORTCUT GENERAL LOOKUP TABLE SETTINGS Change tabs 1,2,3 ETC Lookup table mode L < and > keys Print mode P Change thresholds (in LUT mode) CLICK-DRAG LEFT MOUSE BUTTON UP/DOWN OR Remove overlay text O Change windows and levels F1-F12 LEFT/RIGHT Image slice slider on/off V Change absolute scaling maximum F1-F6 Step forward through tabs Step backward through tabs., Invert color table I Remove/add color table in image display B FUSION MEASUREMENT/ANGLE MODE Fusion on/off (on fused images) F Line measurement mode M View second study (on fused images) G Angle measurement mode K Toggle between original CT colors and alpha blending when fusion slider is moved H TRIANGULATION SCROLL

17 HYBRID VIEWER 17(120) Triangulation mode T Scroll mode on S Remove crosshairs C Scroll faster SHIFT-SCROLL Change crosshair type SHIFT-C Sroll one frame forward or backward Scroll 3 slices at once < and > Arrown up and dow ZOOM ANNOTATION Zoom mode Z Annotate mode W Zoom +/- DRAG CTRL-DRAG (TRIANGULATION MODE) Arrow mode Reset zoom SPACEBAR Delete DELETE KEY D Pan mode N Pan Reset pan Zoom image full screen DRAG SHIFT-DRAG (TRIANGULATION MODE) SPACEBAR DOUBLE CLICK (TRIANGULATION MODE) QUICK ROI/ROI REPORT Quick ROI mode Q Report mode

18 HYBRID VIEWER 18(120) Change Quick ROI circle size Show/Hide ROI contours on image Change size of the ROI Show/Hide ROI contours on image SHIFT-Q R 1,2,3. R

19 HYBRID VIEWER 19(120) TOOLS DESCRIPTION Triangulation MODE OPERATION HOW ANY mode Cursor on/off C on keyboard Change cursor type SHIFT/C on keyboard or RIGHT CLICK Change cross type TRIANGULATION mode Show cursor at triangulation point RIGHT CLICK 3D cursor ON

20 HYBRID VIEWER 20(120) Do not show cursor RIGHT CLICK 3D cursor OFF Zoom an image to full screen RIGHT CLICK or DOUBLE CLICK Full Screen

21 HYBRID VIEWER 21(120) User Protocol Options(Tools -> Triangulation) PROPERTY OPTIONS Active cross type Tick options required Tab connect live Color ON - Scroll tabs together OFF- Scroll tabs independently Color of cross Transparency Intensity of cross- 0% is full intensity Cross Visible Not visible Full Screen Position The position of the full screen mode images (right click or double click), can be set for a multi-monitor configuration. Current Cross Cross type which appears at startup

22 HYBRID VIEWER 22(120) Scroll MODE OPERATION HOW ANY mode Scroll Roll mouse wheel over any image or DRAG slider bar below images Scroll faster SHIFT KEY while scrolling SCROLL mode Scroll CLICK & DRAG forwards & backwards Scroll faster SHIFT KEY while scrolling Zoom/Pan MODE OPERATION HOW ANY mode Zoom up + ON KEYBOARD Zoom down Reset - ON KEYBOARD SPACEBAR TRIANGULATION mode Zoom up CTRL-CLICK & DRAG forwards Zoom down Pan up/down/left/right CTRL-CLICK & DRAG backwards SHIFT-CLICK & DRAG in direction required Reset SPACEBAR ZOOM mode Zoom up CLICK & DRAG forwards

23 HYBRID VIEWER 23(120) Zoom down Reset CLICK & DRAG backwards SPACEBAR PAN mode Pan up/down/left/right CLICK & DRAG in direction required Reset SPACEBAR User Protocol Options (Tools -> Zoom/Pan) PROPERTY OPTIONS Zoom, Pan and Reset All independent (T, C and S operate independently) All linked (T,C and S operate together) Coronal and sagittal linked (T operates independently, C and S together) Initial Zooms Set for each study type

24 HYBRID VIEWER 24(120) Lookup Table MODE OPERATION HOW ANY MODE Change windows/levels F1 F12 on keyboard ADJUST color bar sliders beside images Change thresholds ADJUST color bar sliders Change maximum value for absolute scaling F1-F6 on keyboard Change color table RIGHT CLICK on color bar and select required table Change fusion color table RIGHT CLICK on fusion color table bar Add/remove fusion (fused images) Adjust fusion overlay transparency F on keyboard DRAG fusion slider from left to right CT unchanged when using fusion slider H on keyboard Display second study (fused images) G on keyboard Change color table mode or Gamma setting DOUBLE CLICK on color bar

25 HYBRID VIEWER 25(120) Freeze range when in Absolute mode Allows to adjust 2 different images at different % LUT MODE Raise upper threshold/window setting CLICK & DRAG forward Select image to freeze then CLICK on the lock bellow it Lower upper threshold/window setting CLICK & DRAG backward Raise lower threshold/level setting CLICK & DRAG right Lower lower threshold/level setting CLICK & DRAG left Raise fusion color upper threshold (on fused images) CLICK & DRAG forward Lower fusion color upper threshold CLICK & DRAG backward Raise fusion color lower threshold CLICK & DRAG right Lower fusion color lower threshold CLICK & DRAG left

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27 HYBRID VIEWER 27(120) Notes When dragging the mouse to change thresholds, release the mouse button before moving the mouse along a different axis. Changing and the upper and lower thresholds will change the SUV maximum and minimum scaling of a PET study. Clicking and dragging over an image displayed in fusion mode, will change the fusion color thresholds only and not the settings of the underlying image. User Protocol Options(Tools-> Color table) PROPERTY Default scaling mode for each modality CR,MR,PT,OT OPTIONS Window/level Absolute Relative SUV Additional default scaling mode for different NM study types Absolute Relative Unmark Planars at Start Tick this option to have all planar images unselected at start up. Connect color tab By T-C-S (color table changes only apply to a single tab) By volume (color table changes apply to all tabs)

28 HYBRID VIEWER 28(120) Fusion Base Blending Alpha 100% If set to 100%, the original colors for the CT are used instead of blending them with alpha. The H shortcut option changes this setting Color tables for each modality and fusion SUV type Weight BSA LBM BMI SUV min, max and default value

29 HYBRID VIEWER 29(120) Display Bq/cc Display pixels values in Bq/cc over images Window/level for keyboard shortcuts F1- F12 Default W/L setting Read W/L from header Save W/L in header Set Window and Level to values specified in header if they exist Save current Window and level settings if the study is saved from this application

30 HYBRID VIEWER 30(120) Relative min & max scaling Absolute % of max scaling for keyboard shortcuts F1-F6 Default absolute scaling setting

31 HYBRID VIEWER 31(120) Measure MODE OPERATION HOW MEASURE mode Add tape measurement line CLICK AND DRAG to endpoint Add fixed measurement line DOUBLE CLICK on the first point and drag to endpoint Adjust length of line or cross CLICK at either end of the line and DRAG to new position Move a line Rotate line or cross CLICK anywhere on the line except the ends and DRAG to new position Press the CTRL key CLICK on either end of the measurement and DRAG Adjust position of cross CLICK on the center of the cross and DRAG Move one axis of a cross CLICK anywhere on the line except the ends or center point and DRAG Delete a line or cross Move mouse over the measurement line or cross and press DEL on keyboard or RIGHT CLICK Delete Change between line to cross RIGHT CLICK Line or cross

32 HYBRID VIEWER 32(120) User Protocol Options(Tools -> Measure) PROPERTY OPTIONS Font & size of text Color of line and text Line width Default line type Line Cross

33 HYBRID VIEWER 33(120) Annotate MODE OPERATION HOW ANNOTATION MODE Annotate an image with text CLICK over the image at the position the text should start TYPE text Press ENTER when text is complete Adjust position of existing text CLICK over text to be moved until a hand appears CLICK & DRAG to new location Add predefined annotation to an image RIGHT CLICK Predefined Annotations CLICK on text in list and DRAG to as many locations as required Store text in predefined annotation list RIGHT CLICK Predefined Annotations ENTER TEXT CLICK on Add Annotation

34 HYBRID VIEWER 34(120) Delete text from annotations list CLICK over text in list Press DELETE on the keyboard Delete text Move the mouse over the text until a hand appears Press DELETE on the keyboard or RIGHT CLICK DELETE Delete all text RIGHT CLICK DELETE ALL Notes Annotation cannot be extended beyond the border of an image frame.

35 HYBRID VIEWER 35(120) User Protocol Options(Tools -> Annotation) Font & size of text Color of arrows and text Annotation Visible Hidden

36 HYBRID VIEWER 36(120) Arrow MODE OPERATION HOW Arrow mode Annotate an image with an arrow. CLICK over the image at the position the arrow should start DRAG to the end position Adjust position or length of existing arrow Delete arrow and redraw Delete an arrow Move the mouse over the arrow until a hand appears Press DELETE on the keyboard RIGHT CLICK DELETE Delete all arrows RIGHT CLICK DELETE ALL

37 HYBRID VIEWER 37(120) Quick ROI MODE OPERATION HOW Quick ROI mode Draw ROI or VOI QUICK ROI CIRCLE Position circle Move mouse over any image except the MIP Change diameter of circle SHIFT-Q or RIGHT CLICK Quick Roi Circle Diameter QUICK ROI FREEHAND Draw a new freehand Quick ROI or replace an existing ROI CLICK and draw QUICK ROI SEED Draw a seed ROI CLICK, move mouse and then release mouse to finish ROI QUICK ROI THRESHOLD Set threshold CLICK on icon CLICK on threshold icon, set single or multiple elements, set threshold level Draw a threshold ROI DOUBLE CLICK over centre of lesion 3D QUICK VOI SPHERE

38 HYBRID VIEWER 38(120) Change diameter of sphere SHIFT-Q or RIGHT CLICK 3D Quick Voi Sphere Diameter 3D QUICK VOI THRESHOLD Set threshold CLICK on icon CLICK on threshold icon Set single or multiple threshold Set threshold level Draw a threshold VOI DOUBLE CLICK over centre of lesion 3D PEAK SUV IN 1.00CM 3 Position 1.00cm 3 VOI Move small circle over volume of interest in any plane. The peak SUV is the mean SUV of the voxels within the 1.00cm 3 VOI. Change Quick ROI mode RIGHT CLICK Print Quick ROI or VOI with image and statistics

39 HYBRID VIEWER 39(120) RIGHT CLICK Send View to Print (current image) Send Screen to Print (whole screen) Screen Quick Print (no need for Print window) Notes A Quick ROI in circle or freehand mode will remain in place while scrolling through a set of slices. The statistics will be updated for each slice. Send to Print will only show a single slice. Sometimes when drawing a QUICK ROI or VOI, a point or a square can appear within the ROI. The point represents the max pixel value of the ROI or VOI. The square represents the max 3D SUV within the VOI.

40 HYBRID VIEWER 40(120) User Protocol Options(Tools-> Quick Roi/Voi) Mode Quick Roi Circle Quick Roi Freehand Quick Roi Threshold Quick Roi Seed 3D Voi Ellipsoid 3D Voi Threshold 3D Peak Suv in 1.0cm 3 Diameter of circle Position of text 10 pixels 20 pixels 30 pixels 50 pixels Bottom left Near cursor Triangulate in Quick Roi mode Values displayed Color of circle & text Font of text Average Min Max SUV Peak

41 HYBRID VIEWER 41(120) ROI/VOI Individual Roi Operations OPERATION HOW Select ROI type CLICK on required icon Draw a ROI DRAW ROI on image Draw a seed ROI CLICK & DRAG to define seed region. Release mouse to finish the contour Threshold ROI Draw a threshold ROI CLICK on a lesion to define threshold roi around it. See other options bellow for Thresold ROI Draw a threshold ROI with SUV value CHECK SUV radio button and define a value. All values above this value will be included in the ROI Define a threshold ROI using a percentage of max relative to the previous region CHECK relative to max radio button and define a % value. This will draw a threshold ROI with 70% of the max value of the previously defined ROI.

42 HYBRID VIEWER 42(120) CLICK on center nearest to mouse position to set the % of max to a specific portion of a ROI Draw a threshold ROI with absolute value CLICK on absolute radio button to define a threshold ROI using Counts or other units. CLICK on cold spot radio button to define the threshold ROI around all values bellow the defined absolute value. Draw Threshold on multiple elements This will define a threshold ROI around all element above the defined value in a slice Close a freehand ROI CHECK the multiple elements box in threshold menu. RELEASE MOUSE Close a polygonal ROI DOUBLE CLICK Copy, move, resize, edit,delete, mask or export a ROI or VOI RIGHT CLICK over a ROI or VOI on an image

43 HYBRID VIEWER 43(120) Rename a ROI CLICK over ROI in ROI window RIGHT CLICK Rename Enter new ROI name Delete a ROI RIGHT CLICK inside ROI on image Delete Roi or CLICK over ROI in ROI window RIGHT CLICK Delete Paste a copied ROI or VOI to another series CLICK ROI or VOI in ROI window RIGHT CLICK

44 HYBRID VIEWER 44(120) Paste a copied ROI RIGHT CLICK over image Paste ROI Paste a mirrored copy of a copied ROI Mask inside a ROI or VOI RIGHT CLICK over image Paste ROI Mirrored RIGHT CLICK over a ROI or VOI on an image Select Apply ROI or VOI Mask Insert ROIs between Duplicate ROIs between drawn ROIs

45 HYBRID VIEWER 45(120) Note: ROIs must be drawn from low slice number to high slice number Create a VOI from one or more ROIs RIGHT CLICK one or more ROIs in the same plane in ROI window Constrain with a ROI. Tick the Constraint option to constrain a VOI within a ROI through all slices in this plane. Can also be used to select a volume, constrained by the ROI, for automatic registration. This can be used for one volume only. Individual Voi Operations

46 HYBRID VIEWER 46(120) OPERATION HOW Draw a VOI CLICK ON VOI button in ROI window Choose Single or Multiple Elements (Multiple available for SUV threshold only) Choose Absolute or SUV and set threshold values Set Relative to Max to set a threshold relative to the maximum within the VOI defined by SUV or Absolute Threshold. For example, an initial VOI is created with a threshold of SUV=4 and the maximum voxel value within that VOI is 18. This value is multiplied by the percentage set in Relative to Max (50%), so the new threshold value is 18x0.50=9. This value is used for the final VOI, which is grown either from the max voxel position or, if Contour nearest to Max is ticked, from the position of the mouse when double clicked. The latter option is mostly used for complex, nested VOIs. DOUBLE CLICK on the center of the volume of interest Fusion This determines the transparency of the VOI on the orthogonal views. When the slider is to the left,the VOI is not seen and to the right the VOI is a solid color. Draw a sphere or box View VOI statistics CLICK ON button in ROI window Set diameter or edge length DOUBLE CLICK on the center of the required volume Displayed in ROI tool window

47 HYBRID VIEWER 47(120) View ROI statistics within a VOI Click on + sign beside VOI number

48 HYBRID VIEWER 48(120) Redraw one of the ROIs within a VOI Scroll to slice with where ROI is incorrect RIGHT CLICK inside VOI/ROI on image CLICK and draw new ROI RIGHT CLICK inside new ROI Scroll to a slice which shows the VOI RIGHT CLICK inside VOI Automatically copy ROIs and VOIs drawn on one series to other loaded series CLICK and select the following in the ROI window

49 HYBRID VIEWER 49(120) Merge VOIs Select 2 or more VOIs and choose Merge VOIs Operations on all Rois/Vois OPERATION HOW RIGHT CLICK over a ROI or VOI on an image with the ROI/VOI tool open Print ROIs or VOIs with image and statistics to Print window Note: The Print window layout must be set to 1x2 or 2x1 for the Statistics window to be saved in the Print If images with ROIs/VOIs and statistics have been Exported to Print, as described above, click on the Print icon or type P. The image and statistics windows are saved as one print page with layout 1x2. Print ROI or VOI statistics only to Print window In the ROI window, CLICK on or select Print from File menu

50 HYBRID VIEWER 50(120) Export Statistics directly to Excel (if installed) or to an xls file RIGHT CLICK over a ROI or VOI on an image with the ROI/VOI tool open or In ROI/VOI tool window, CLICK on or select Export Statistics from File menu Select a directory. A file will be saved with filename containing study details and prefix RoiVoi. If Excel is installed it will also open automatically with current statistics.

51 HYBRID VIEWER 51(120) Export Statistics as CSV file In ROI/VOI tool window, select Export Statistics from File menu A print will be automatically created in Gold3 which shows the images on which ROIs/VOIs have been drawn and a CSV text file with type Other will also be saved. This can be viewed with the Open Document application in Gold3. Clip a study within constrained ROIs and save RIGHT CLICK over a ROI on an image with ROI/VOI tool open A new study will be saved which is clipped by the ROI boundaries

52 HYBRID VIEWER 52(120) Export volume to RTP to GOLD3 database and store with CT study RIGHT CLICK over a ROI or VOI on an image or RIGHT CLICK over a ROI or VOI in ROI window CLICK on or select Export to RTP from File menu PRE/POST Option NOTE: this option is part of a licensed package. CLICK on PRE/POST tab at the bottom of ROI or VOI RIGHT CLICK in ROI or VOI menu when in PRE/POST tab to generate an graphic of the ROI values

53 HYBRID VIEWER 53(120) DOCK widget option CLICK on undock to move the ROI widget and make it floatable DRAG next to existing ROI widget to split the widget in 2 and see two sets of ROI or VOI side by side

54 HYBRID VIEWER 54(120) MASK inside ROI or VOI RIGHT CLICK on mask Roi after drawing a ROI to mak Choose which slices to apply the mask onto Press R key to hide the contours of the ROI

55 HYBRID VIEWER 55(120)

56 HYBRID VIEWER 56(120) User Protocol Options(Tools -> Roi../Voi..) Color of ROIs Threshold Automatically copy rois/vois to all datasets ROI/VOI values Default setting used for automatic ROIs and VOIs Relative SUV Tick if Rois and VOis drawn on one series should be automatically copied to all other series Tick values to be displayed in ROI/VOI window Circle Sphere, Cube Tick Fixed for circle ROI to be a circle rather than an ellipse Set default sizes

57 HYBRID VIEWER 57(120) Synchronization Synchronizing studies at load time When more than one series is loaded into HybridViewer, a check is made for the Frame of Reference ID field in the study header. Any series acquired with the same Frame of Reference ID will have been acquired on the same scanner at the same time. The series should also have Image Position coordinates in the header, which allow the images to be correctly positioned relative to each other. A number of scenarios are possible when 2 or more series are loaded. Once the studies have been loaded they will either be locked or unlocked. Locked Triangulation between series is enabled Unlocked Triangulation between series is disabled Study/Series Frame of Reference Question/Answer at load time Locked/Unlocked Sync window 1 Study, > 1 Series Same in both None Locked 1 Study, > 1 Series Absent in 1 or more series Unlocked 1 Study, > 1 Series Absent in 1 or more series Locked

58 HYBRID VIEWER 58(120) 1 Study, > 1 Series different but they should be the same (acquired on a GE Hybrid camera) Locked 2 Studies, 1 or more series in each Different between studies Unlocked 2 Studies, 1 or more series in each Different between studies Locked 2 Studies, 1 or more series in each different but they should be the same (acquired on a GE Hybrid camera) Locked Notes Unless the studies have been previously aligned to each other you should either choose Automatic register studies or Unlock studies.

59 HYBRID VIEWER 59(120) Synchronizing studies after they have been loaded OPERATION HOW Register series and studies CLICK on Manual Register 2 series Manually CLICK on arrows beside selected images or Press-and-hold the SHIFT key then CLICK and DRAG to move the overlaid image relative to the reference image Optionally CLICK on Resample if images have been rotated. This will calculate and display the real interpolated volume. It is not necessary to resample each time a rotation is made, as this will be done anyway when you CLICK on OK.

60 HYBRID VIEWER 60(120) CLICK on OK if the resulting images are acceptable. The studies will be resampled, the Sync window will close and the studies will be locked or CLICK on Cancel to restore images to original position. The Sync window will close and the studies will be unlocked CLICK on Reset to reload the original studies. Register studies Automatically (pre-post sync module only) Modes: Fast Approximation Translation X-Y-Z (translation only) CLICK on Automatic CLICK on the 2 studies or series to be used for synchronization. If 2 studies are to be registered, the second study selected in this window will be moved to fit the first study. If there is a pair of studies in a Reference Group or Groups, it is recommended to select one study in each group only CLICK on Mode required CLICK on Register All Parameters (translation & rotation)

61 HYBRID VIEWER 61(120) CLICK on OK if the resulting images are acceptable. The Sync window will close and the studies will be locked or CLICK on Cancel to restore images to original position. The Sync window will close and the studies will be unlocked CLICK on Reset to reload the original studies.

62 HYBRID VIEWER 62(120) Register studies Semi- Automatically (pre-post sync module only) CLICK on Semi-Automatic button CLICK on the 2 studies or series to be registered Navigate through slices until a landmark is displayed on both series Triangulate on the same landmark on both series CLICK on the closed lock to lock the studies. The Sync window will close and the studies will be locked To unlock the studies again, CLICK on the Sync button then CLICK on the open lock to unlock the studies CLICK on Reset to reload the original studies.

63 HYBRID VIEWER 63(120) Save co-registered studies CLICK on Save button Enter text labels User Protocol Options(Tools-> Synchronization) Default synchronization mode as program starts Ask Split References (split studies into different reference groups even if they have the same FOR UID) Unlock Already Aligned (assumes the studies are aligned even though the FOR UIDs differ) Automatic Register

64 HYBRID VIEWER 64(120) Automatic mode (default mode if automatic chosen at start up or in Sync window) Fast Registration using a single mid volume coronal image Translation only Full (translation and rotation) Modality NM/CT/PT/MR. If there is more than 1 series in a study e.g. PET and CT, this setting determines which will be used when automatic registration takes place at start up and when more than one study is selected in a group in the Sync window Range Parameters Initial search ranges for automatic registration default values should not normally need to be changed

65 HYBRID VIEWER 65(120) Filter OPERATION HOW Filter an image CLICK on the study or studies to be filtered Select the type and characteristics of filter from filter menu CLICK on Filter Undo filter Save filtered volume to GOLD3 database, with FILTERED prefixing the Process label field. CLICK on Reset CLICK on Save

66 HYBRID VIEWER 66(120) Profile OPERATION HOW Draw a profile through an image Select type of profile from drop down menu Automatic is constrained to 0 and 90 degrees Freehand is unconstrained angle. Select width of profile CLICK and drag profile through an image

67 HYBRID VIEWER 67(120) Display profile Save an image with profile and profile display in Print Window Tick profile to be displayed CLICK on Print icon in Profile window Save profile values in an Excel format file Display profile values in Excel (Excel must be installed) Increase /decrease width of an already drawn profile Delete profiles CLICK on Excel button in Profile window Navigate to a directory and enter a name. CLICK on Excel button in Profile window CLICK on OK CLICK on profile on image until a hand appears Select Increase/decrease width RIGHT CLICK on profile on image until a hand appears Delete or RIGHT CLICK over profile in profile window Delete Options Select Bq/cc or SUV for y axis for profiles on PET studies.

68 HYBRID VIEWER 68(120) User Protocol Options(Tools -> Profile) Color of profiles

69 HYBRID VIEWER 69(120) Saving Reports OPERATION HOW Create a Report Select Report directory and report template from drop down menus. CLICK on Launch Report Any prints which have been saved will be automatically appended to the Word document and patient details in the report will be replaced according to the Report options configured in Tools. CLICK on Save to Gold to save the Word document into Gold. CLICK on Save Final PDF to save a PDF format copy in Gold.

70 HYBRID VIEWER 70(120) User Protocol Options(Tools->Reporting) The fields specified here should match those in the Report template see example template below. The Root template directory specifies the main directory for storing reports. It can have sub-directories for different categories of reports. Each sub directory should contain a Report template document.

71 HYBRID VIEWER 71(120)

72 HYBRID VIEWER 72(120) Print MODE OPERATION HOW Any mode Print all screens directly without using Print window Saves print as a DICOM file and optionally sends to HERMES and any DICOM node such as PACS CLICK on Quick Print icon Print single screen directly without using Print window RIGHT CLICK over the image Screen Quick Print Store an image in print window RIGHT CLICK over the image Send View to Print or CLICK on print icon (or P ON KEYBOARD) CLICK anywhere over an image and DRAG the small box into the right hand space in the print window

73 HYBRID VIEWER 73(120) Store contents of single display tab in Print window RIGHT CLICK over the image Send Screen to Print or CLICK on print icon (or P ON KEYBOARD) CLICK anywhere in the area beneath the tabs and DRAG the small box into the right hand space in the print window Print mode Delete all prints listed in the Print window

74 HYBRID VIEWER 74(120) Delete a single print in the queue RIGHT CLICK over the print label DELETE Rename print label Change print label to predefined option RIGHT CLICK over image label RENAME TYPE new label Complete label by typing ENTER RIGHT CLICK over image label Predefined Annotations Drag predefined annotation over label field Create a new image. This is only needed if prints are already stored and you would like to change the layout for the next print, or if you have changed the layout for an existing print but would like the next image to go into a new print. Change print layout The layout can be changed for prints already listed. Select the print and then change the layout.

75 HYBRID VIEWER 75(120) Annotate prints Save print as DICOM file and optionally send to HERMES and any DICOM node such as PACS See section on ANNOTATION with text and ARROWS CLICK on this icon or Select Export to Dicom from File menu in the Print window Save print as PNG file to GOLD3 database CLICK on this icon or Select Export png + txt from File menu Save print as PNG on local file system CLICK on this icon or Select Save to File from File menu. Produce hardcopy of prints in queue to local printer CLICK on this icon

76 HYBRID VIEWER 76(120) or Select Print from the File menu Add print to current Report CLICK on this icon User Protocol Options(Tools-> Print) Print Header Tick items required in print header Add a logo Navigate to logo file

77 HYBRID VIEWER 77(120) Patient Information (PET only) OPERATION HOW Display patient information Click on the Patient Information icon Change patient information Edit information then click on Apply. SUV values will be updated if necessary according to new information

78 HYBRID VIEWER 78(120) Bookmarks OPERATION HOW Display Bookmark window CLICK on the Bookmark icon Save Bookmark information Select File / Export Results file Bookmark contents are saved in an XML file in WORKING Load a previously saved Bookmark file Select original patient study or studies and associated XML file(s) Display loaded Bookmark information Open Bookmark window CLICK on item to display. The images will be updated to display selected object.

79 HYBRID VIEWER 79(120)

80 HYBRID VIEWER 80(120) Loading/Saving User Properties OPERATION HOW Load a user protocol Select Load properties from the Tools menu. Select the required protocol by clicking over it

81 HYBRID VIEWER 81(120) Change a user protocol Load the protocol, change the required properties using the settings in the Tools menu, CLICK on Save Properties and resave the protocol

82 HYBRID VIEWER 82(120) Modules User Protocol Options(Tools-> Modules) Check which modules are authorized and which tools are active Lock mode disables the keyboard and right click context menu.

83 HYBRID VIEWER 83(120) MIP/Cine User Protocol Options(Tools-> MIP/Cine ) Number of MIP Images Set to number of frames required in MIP movie Distance Factor The larger the number, the less will be the contribution to the movie from parts of the object which are further away. A typical value is 1.0. Speed The default playback speed of movies Play at launch Play MIPS, dynamic, planar gated and acquisition studies as a movie at launch

84 HYBRID VIEWER 84(120) Layers Visibility User Protocol Options(Tools-> Layers Visibility) The options ticked will remain in place when a different mode is selected. For example to render annoation visible even when in measurement or ROI mode, tick the annoation option for all study types.

85 HYBRID VIEWER 85(120) Orientation User Protocol Options(Tools-> Orientation) Invert Slice Wheel On Off Change slider direction Change sagittal image orientation Invert slice order numbering Feet to Head Head to Fee Anterior to Posterior Posterior to Anterior Right to Left Left to Right Anterior to Posterior Posterior to Anterior On Off

86 HYBRID VIEWER 86(120) Cardiac Display Options User Protocol Options(Tools-> Cardiac Display Options..) Specify text to be used to identify Rest and Stress studies. The text is read from the Series Description (Process Label) field

87 HYBRID VIEWER 87(120) Overlay Options User Protocol Options(Tools-> Overlay) Choose study type from drop down menu Tick options to be included in image overlay text

88 HYBRID VIEWER 88(120) Color and font of overlay text Note: Honor Right/Left from Ant/Post labels means that right and left labels will be displayed if Ant or POST are stored in the View label of an image Automatic black/white color Tick option to enable application to automatically select black or white overlay text, according to the current color tables

89 HYBRID VIEWER 89(120) Import/Export Options User Protocol Options(Tools-> Import/Export) Bookmark items to store with File/Export Result file

90 HYBRID VIEWER 90(120) ADDITIONAL FUNCTIONS Saving Studies OPERATION HOW Save currently displayed study. This is useful after manual rotation or translation and after masking a study. CLICK and select Save Patient Saving clipped studies Draw a box ROI (normally on coronal or sagittal image) around the section of the body to be retained With ROI tool open, RIGHT CLICK over the ROI and choose Export -> Clip and Save Patient

91 HYBRID VIEWER 91(120) Save Summed Studies (tomographic gated and dynamic studies) CLICK Gate option Off Set First and Last Frame to be summed CLICK on Sum CLICK and select Save Summed Patient

92 HYBRID VIEWER 92(120) Saving Movies OPERATION HOW Save a movie as an AVI file This file can be played in Powerpoint and any movie player CLICK on red button CHOOSE Avi Movie CLICK ON Save Navigate to directory in which to save the file Save a movie to HERMES and optionally also send to any DICOM node such as PACS CHOOSE Dicom Movie CLICK on Save

93 HYBRID VIEWER 93(120) Save a stack of fused slices as AVI or DICOM movie CLICK on red button Set the slice numbers required CLICK ON SAVE AVI OR SAVE DICOM Export movie group This is configured in the protocol at installation to include all required movies Select this option from the File menu

94 HYBRID VIEWER 94(120) Scaling Planar Static and Whole Body Images OPERATION HOW Scale images separately or in groups CLICK and select Mark All or Unmark All TICK or UNTICK boxes beside each image. Scaling will only affect marked images

95 HYBRID VIEWER 95(120) If Groups have been assigned, CLICK and select a group

96 HYBRID VIEWER 96(120) Displaying Prints and Planar Images OPERATION HOW Display single or multiple images or prints CLICK on this button to display a single image or print CLICK on the arrows to move through the images CLICK on this button to display multiple images or prints Reorder images or prints CLICK on Change Selection CLICK and drag images to new locations CLICK on Apply to return to main screen

97 HYBRID VIEWER 97(120) Remove images from main display CLICK and select Disable Create a scaling group. After clicking Apply to return to the main window, images assigned to different groups will be scaled separately by CLICK and select a group CLICK and select Create Group Enter a name CLICK and choose Move To and a group

98 HYBRID VIEWER 98(120) CLINICAL EXAMPLES These examples show some sample layouts for different types of study. Single PET/CT or SPECT/CT FULL TAB Example

99 HYBRID VIEWER 99(120) TCS TAB Example

100 HYBRID VIEWER 100(120) 4 VIEW TAB Example

101 HYBRID VIEWER 101(120) SPLASH TAB Examples PET only

102 HYBRID VIEWER 102(120) SPECT and CT

103 HYBRID VIEWER 103(120) Two PET-CT studies If a 2 Screen protocol is selected the first study will be displayed on the left and the second on the right. If a single screen protocol is selected, some of the tabs show images from both studies. TCS TAB

104 HYBRID VIEWER 104(120) FULL TAB

105 HYBRID VIEWER 105(120) 4 VIEW TAB

106 HYBRID VIEWER 106(120) SPLASH TAB

107 HYBRID VIEWER 107(120) Serial PET-CT Studies CORONAL TAB

108 HYBRID VIEWER 108(120) TROUBLESHOOTING When loading more than one series, one of the series selected is not displayed Check that the MODALITY field is correct for the types of studies which have been loaded and edit if necessary No SUV values displayed for a PET study An item of patient information such as patient weight, or study information such as dose injected, may be missing. Check in the Patient Information page.

109 HYBRID VIEWER 109(120) The window and level settings for a CT study do not look correct Images are not displayed as expected e.g, planar images, lungs, cardiac Check that the CT is being displayed with Windows/Levels and not with Upper and Lower thresholds. If it is displayed with thresholds, check that the MODALITY field is set to CT. Check under Tools/Modules that the relevant module is enabled

110 HYBRID VIEWER 110(120) OPTIONAL MODULES Lung Perfusion and Ventilation Module This module requires reconstructed ventilation and perfusion scans. It can also optionally display reprojected or acquired static images, if the Nuclear Medicine module is installed. TCS TAB

111 HYBRID VIEWER 111(120) SUBTRACTION & RATIO TAB

112 HYBRID VIEWER 112(120) STATIC IMAGE TAB

113 HYBRID VIEWER 113(120) Nuclear Medicine Module SPLASH, CINE and PRINT TAB Examples

114 HYBRID VIEWER 114(120)

115 HYBRID VIEWER 115(120) Cardiac Module SPLASH Example

116 HYBRID VIEWER 116(120) APPENDICES SUV Values The program will report the SUV value under the mouse pointer, provided the necessary data to calculate it is available. It will also report mean, maximum and minimum SUV values within regions of interest in the Statistics section of the ROI window. The SUV has been used now for 15 years in PET, and but there are a number of factors which can affect it. Up to 30% of the FDG injected is excreted in urine during the first hour. The more excretion in urine, the less uptake there will be in the tumor and the lower the SUV. There is very little FDG uptake in fat. Normally the body consists of 15-20% fat. Since SUV is directly related to weight, scanning an overweight patient results in a lower SUV in tumors. There are large variations in how fast FDG is taken up from the blood stream into tissues. Diabetic patients can have a lot of FDG in the blood stream one hour after the scan, meaning that less tracer will be deposited in the tumor. Uptake in inflammatory tissue is fast and reaches a plateau already after 20 minutes, while uptake in tumor cells is sometimes a slower process and the plateau is reached after 1 hour. This means that uptake due to tumor and inflammation might be indistinguishable with a static scan after 1 hour. Effects on SUV of Image registration/fusion The maximum SUV value of regions of interest may be reduced, compared to the original acquisition, by registering a PET study to another study, as voxels will be repositioned during the registration operation. Comparison with Volume Display When the same study is reported with Volume Display and with HybridViewer there are two differences to be aware of. Both are due to the fact that if both a CT and PET are loaded together into Volume Display, the PET is interpolated to the matrix size of the CT, which is usually 512x512. This can result in the maximum SUV within a region being slightly lower than it is in HybridViewer, as the pixel value will be reduced in the interpolation process. This is not the case in HybridViewer, which reports the correct maximum SUV values. The second difference is in the slice numbering for coronal and sagittal slices, which may not correspond between the two applications. The transverse slice numbers will however always be the same. SUV Peak Value There was a change in the way that the SUV Peak value is calculated between versions 1.4B and 1.4C. 1.4B: SUV Peak is the mean SUV value of voxels contained in a 1 cubic centimeter volume around the hottest voxel in the VOI structure. It could extend beyond the boundaries of the defined volume 1.4C: SUV Peak volume is now the mean SUV value of voxels in the hottest 1 cubic centimeter constrained inside the VOI structure. It cannot extend beyond the boundaries of the defined volume. The change has been made to conform with the definitions given in the publication - From RECIST to PERCIST: Evolving Considerations for PET Response Criteria in Solid Tumors. SUV Calculation Methods SUV Weight Normalization to body Weight where: A = Activity Concentration in Bq/cc (calibrated pixel value)

117 HYBRID VIEWER 117(120) W = Patient weight in kg D = Injected dose in Bq decay corrected to the time of injection SUV BSA Normalization to Body Surface Area where: A = Activity Concentration in Bq/cc (calibrated pixel value) W = Patient weight in kg H = Patient height in cm D = Injected dose in Bq decay corrected to the time of injection BSA = Body Surface Area m 2 BSA = (W x H ) x Ref: Standardized Uptake Values of FDG: Body Surface Area Correction is preferable to Body Weight Correction. SUV LBM Normalization to Lean Body Mass where: A = Activity Concentration in Bq/cc (calibrated pixel value) W = Patient weight in kg H = Patient height in cm D = Injected dose in Bq decay corrected to the time of injection LBM = Lean Body Mass kg ( ) ( ) ( ) ( ) Ref: Re-evaluation of the Standardized Uptake Value for FDG: Variations with Body Weight and Methods for Correction. SUV BMI Normalization to Body Mass Index where: A = Activity Concentration in Bq/cc (calibrated pixel value) W = Patient weight in kg H = Patient height in cm D = Injected dose in Bq decay corrected to the time of injection BMI =

118 HYBRID VIEWER 118(120) Ref: L-1-11C-Tyrosine PET in Patients with Laryngeal Carcinomas: Comparison of Standardized Uptake Value and Protein Synthesis Rate. References 1. John W. Keyes, Jr SUV: Standard Uptake or Silly Useless Value? Journal of Nuclear Medicine; Vol 36; No 10, p Zasadny KR, Wahl RL: Standardized uptake values of normal tissues at PET with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose: Variations of body weight and a method for correction. Radiology;1993;189; DuBois D, DuBois EF. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Medicine. 1916; 17: Gehan EA, Georges SL. Estimation of human body surface area from height and weight. Cancer Chemotherapy Report. 1970; 54; Graham MM, Peterson LM, Hayward RM: Comparison of simplified quantitative analyses of FDG uptake. Nuclear Medicine & Biology;2000;27; From RECIST to PERCIST: Evolving Considerations for PET Response Criteria in Solid Tumors. Wahl et al. Journal of Nuclear Medicine 2009:50:5:122S-150S 7. Standardized Uptake Values of FDG: Body Surface Area Correction is preferable to Body Weight Correction. Kim et al. Journal of Nuclear Medicine: 1994:35:1: Re-evaluation of the Standardized Uptake Value for FDG: Variations with Body Weight and Methods for Correction. Sugawara et al. Radiology : L-1-11C-Tyrosine PET in Patients with Laryngeal Carcinomas: Comparison of Standardized Uptake Value and Protein Synthesis Rate. De Boer et al. Journal of Nuclear Medicine:2003: 44:3: