VIEWER. Version 4.0. Software User Guide Revision 1.0. Copyright 2018, Brainlab AG Germany. All rights reserved.

VIEWER Version 4.0 Software User Guide Revision 1.0 Copyright 2018, Brainlab AG Germany. All rights reserved.

TABLE OF CONTENTS TABLE OF CONTENTS 1 GENERAL INFORMATION...5 1.1 Contact Data...5 1.2 Legal Information...6 1.3 Symbols...8 1.4 Using the System...9 1.5 Compatibility with Medical Devices and Software...10 1.6 Training and Documentation...12 1.7 Technical Requirements for Viewer on a PC...14 1.8 Technical Requirements for Viewer Through a Web Browser...15 2 SOFTWARE OVERVIEW...17 2.1 Getting Started...17 2.2 Layouts...19 2.3 Viewing Data...24 3 USING VIEWER...31 3.1 Reconstruction Views...31 3.2 Redefining Patient Orientation...34 3.3 Measurement Functions...36 3.3.1 Measuring Distance...37 3.3.2 Measuring Diameters...38 3.3.3 Measuring Angles...39 3.3.4 Measuring Open Angles...40 3.3.5 Additional Measuring Functions...41 3.3.6 Calibrating...42 3.4 3D Options...43 3.4.1 Editing 3D Visualizations...45 3.4.2 3D Stereoscopic Volume Renderings...47 3.5 Comparison...48 Software User Guide Rev. 1.0 Viewer Ver. 4.0 3

TABLE OF CONTENTS 4 Software User Guide Rev. 1.0 Viewer Ver. 4.0

GENERAL INFORMATION 1 GENERAL INFORMATION 1.1 Contact Data Support If you cannot find information you need in this guide, or if you have questions or problems, contact Brainlab support: Region Telephone and Fax Email United States, Canada, Central and South America Tel: +1 800 597 5911 Fax: +1 708 409 1619 us.support@brainlab.com Brazil Tel: (0800) 892 1217 brazil.support@brainlab.com UK Tel: +44 1223 755 333 Spain Tel: +34 900 649 115 France and French-speaking regions Africa, Asia, Australia, Europe Japan Tel: +33 800 676 030 Tel: +49 89 991568 1044 Fax: +49 89 991568 811 Tel: +81 3 3769 6900 Fax: +81 3 3769 6901 support@brainlab.com Expected Service Life Software updates and field support are offered for five years of service for this product. Feedback Despite careful review, this user guide may contain errors. Please contact us at user.guides@brainlab.com if you have improvement suggestions. Manufacturer Brainlab AG Olof-Palme-Str. 9 81829 Munich Germany Software User Guide Rev. 1.0 Viewer Ver. 4.0 5

Legal Information 1.2 Legal Information Copyright This guide contains proprietary information protected by copyright. No part of this guide may be reproduced or translated without express written permission of Brainlab. Brainlab Trademarks Brainlab is a trademark of Brainlab AG. ihelp is a trademark of Brainlab AG. Non-Brainlab Trademarks Microsoft, Windows, ActiveX, Edge and Internet Explorer are trademarks of Microsoft Corporation, registered in the US and other countries. Mozilla Firefox is a trademark of Mozilla Foundation, registered in the US and other countries. MacOS, Safari and ipad are trademarks of Apple Inc., registered in the US and other countries. Android is a trademark of Google Inc., registered in the US and other countries. Patent Information This product may be covered by one or more patents or pending patent applications. For details, see: www.brainlab.com/patent. Integrated Third-Party Software This software is based in part on the following work. The full license and copyright notice can be found at the links below: Independent JPEG Group. (https://github.com/uclouvain/openjpeg/blob/master/license) OpenJPEG (https://github.com/uclouvain/openjpeg/blob/master/license) libjpeg-turbo (https://github.com/libjpeg-turbo/libjpeg-turbo/blob/master/license.md) libtiff 4.0.4 beta (http://www.libtiff.org/misc.html) Xerces-C++, developed by the Apache Software Foundation (https://xerces.apache.org/ xercesc/) This product uses jquery.nicescroll. For a full description of copyrights, disclaimers and license see https://github.com/inuyaksa/jquery.nicescroll/blob/master/mit.license This product uses Durandal. For a full description of copyrights, disclaimers and license see https://raw.githubusercontent.com/bluespire/durandal/master/license.txt Additional Acknowledgments Stepanov and McJones, "Elements of Programming" license Copyright (c) 2009 Alexander Stepanov and Paul McJones Permission to use, copy, modify, distribute and sell this software and its documentation for any purpose is hereby granted without fee, provided that the above copyright notice appear in all copies and that both that copyright notice and this permission notice appear in supporting documentation. The authors make no representations about the suitability of this software for any purpose. It is provided "as is" without express or implied warranty. Algorithms from Elements of Programming by Alexander Stepanov and Paul McJones Addison- Wesley Professional, 2009 SGI C++ Standard Template Library license: Copyright (c) 1994 Hewlett-Packard Company 6 Software User Guide Rev. 1.0 Viewer Ver. 4.0

GENERAL INFORMATION Permission to use, copy, modify, distribute and sell this software and its documentation for any purpose is hereby granted without fee, provided that the above copyright notice appear in all copies and that both that copyright notice and this permission notice appear in supporting documentation. Hewlett-Packard Company makes no representations about the suitability of this software for any purpose. It is provided "as is" without express or implied warranty. Copyright (c) 1996 Silicon Graphics Computer Systems, Inc. Permission to use, copy, modify, distribute and sell this software and its documentation for any purpose is hereby granted without fee, provided that the above copyright notice appear in all copies and that both that copyright notice and this permission notice appear in supporting documentation. Silicon Graphics makes no representations about the suitability of this software for any purpose. It is provided "as is" without express or implied warranty. CE Label The CE label indicates that the Brainlab product complies with the essential requirements of Council Directive 93/42/EEC (the MDD ). Viewer is a Class Im product according to the rules established by the MDD. NOTE: The validity of the CE label can only be confirmed for products manufactured by Brainlab. Sales in US US federal law restricts this device to sale by or on the order of a physician. Software User Guide Rev. 1.0 Viewer Ver. 4.0 7

Symbols 1.3 Symbols Warnings Warning Warnings are indicated by triangular warning symbols. They contain safety-critical information regarding possible injury, death or other serious consequences associated with device use or misuse. Cautions Cautions are indicated by circular caution symbols. They contain important information regarding potential device malfunctions, device failure, damage to device or damage to property. Notes NOTE: Notes are formatted in italic type and indicate additional useful hints. 8 Software User Guide Rev. 1.0 Viewer Ver. 4.0

GENERAL INFORMATION 1.4 Using the System Intended Use Viewer is a software device for display of medical images and other healthcare data. It includes functions for image review, image manipulation, basic measurements and 3D visualization (MPR reconstructions and 3D volume rendering). It is not intended for primary image diagnosis or the review of mammographic images. Viewer does not have any specific indications for use. Intended User The intended users are medical professionals, such as doctors and their staff. Place of Use The place of use is determined to be indoors, normally in a hospital or clinical setting. User Profiles The device is generally used by medical professionals such as doctors, their assistants or nursing staff which are in need of displaying medical (DICOM) images and other healthcare data for nondiagnostic purposes. Patient Population The device is software which allows viewing of DICOM data. Hence there is no specific patient population. Plausibility Review Warning Before patient treatment, review the plausibility of all information input to and output from the system. Responsibility Warning This system solely provides assistance to the physician and does not substitute or replace the physician's experience and/or responsibility during its use. It must always be possible for the user to proceed without the assistance of the system. Only trained medical personnel may operate system components and accessory instrumentation. Software User Guide Rev. 1.0 Viewer Ver. 4.0 9

Compatibility with Medical Devices and Software 1.5 Compatibility with Medical Devices and Software Compatible Brainlab Medical Software Only Brainlab medical software specified by Brainlab may be installed and used with the system. Contact Brainlab support for clarification regarding compatibility with Brainlab medical software. Non-Brainlab Software Only authorized Brainlab employees may install software on the Brainlab system. Do not install or remove any software applications. DICOM Conformance DICOM conformance statements can be found on the Brainlab website at: www.brainlab.com/ dicom. Medical Electrical Systems For information regarding the configuration of medical electrical systems, see the relevant System User Guide and Technical User Guide. Updates Warning Updates to the operating system (hotfixes) or third-party software should be performed outside clinical hours and in a test environment to verify correct operation of the Brainlab system. Brainlab monitors the released Windows hotfixes and will know, for some updates, if problems can be expected. Contact Brainlab support if any problems to operating system hotfixes are encountered. Virus Scanning and Malware Brainlab recommends protecting the system with state-of-the-art anti-virus software. Be aware that some malware protection software (e.g., virus scanner) settings can negatively affect system performance. For example, if real-time scans are performed and each file access is monitored, then loading and saving patient data may be slow. Brainlab recommends disabling real-time scans and performing virus scans during non-clinical hours. Warning Ensure that your anti-virus software does not modify any Brainlab directories, specifically: C:\Brainlab, D:\Brainlab, F:\Brainlab, etc. C:\PatientData, D:\PatientData, F:\PatientData, etc. Warning Do not download or install updates during treatment planning. Contact Brainlab support for further information regarding any of these issues. Microsoft Security Updates for Windows and Driver Updates Brainlab allows the installation of security patches only. Do not install service packs and optional updates. Verify your settings to ensure updates are downloaded and installed correctly and at a suitable time. Do not update drivers on Brainlab platforms. 10 Software User Guide Rev. 1.0 Viewer Ver. 4.0

GENERAL INFORMATION See the Brainlab website for more information about settings and a list of Microsoft Security Updates blocked by Brainlab support. Address: www.brainlab.com/updates Password: WindowsUpdates!89 Software User Guide Rev. 1.0 Viewer Ver. 4.0 11

Training and Documentation 1.6 Training and Documentation Brainlab Training Before using the system, Brainlab recommends that all users should participate in a training program held by a Brainlab representative to ensure safe and appropriate use. Supervised Support Before using the system for surgical procedures where computer-aided navigation is considered critical, perform a sufficient number of complete procedures together with a Brainlab representative. Responsibility Warning This system solely provides assistance to the surgeon and does not substitute or replace the surgeon's experience and/or responsibility during its use. It must always be possible for the user to proceed without the assistance of the system. Only trained medical personnel may operate system components and accessory instrumentation. Extended OR Time Brainlab Navigation Systems are sensitive technical equipment. Depending upon OR setup, patient positioning, calculation durations and complexity, surgery duration using navigation may vary. It is up to the user to decide whether a potential prolongation is acceptable for the respective patient and treatment. Reading User Guides This guide describes complex medical software or medical devices that must be used with care. It is therefore important that all users of the system, instrument or software: Read this guide carefully before handling the equipment Have access to this guide at all times Available User Guides NOTE: Available user guides vary depending upon the Brainlab product. If you have questions regarding the user guides you received, please contact Brainlab support. User Guide Software User Guides Hardware User Guides Instrument User Guides Cleaning, Disinfection and Sterilization Guide System User Guide Technical User Guide Contents Overview of treatment planning and image-guided navigation Description of OR system setup Detailed software instructions Detailed information on radiotherapy and surgical hardware, typically defined as large complex instruments Detailed instructions on instrument handling Details on cleaning, disinfecting and sterilizing instruments Detailed information on system setup Detailed technical information on the system, including specifications and compliances 12 Software User Guide Rev. 1.0 Viewer Ver. 4.0

GENERAL INFORMATION User Guide System and Technical User Guide Contents Combines the contents of the System User Guide and the Technical User Guide. Software User Guide Rev. 1.0 Viewer Ver. 4.0 13

Technical Requirements for Viewer on a PC 1.7 Technical Requirements for Viewer on a PC Viewer Hardware Requirements Graphics: DirectX 11 compatible with 512 MB graphics memory Display resolution: 1280x1024 Processor: 4 physical cores RAM: 4 GB Additional 3D Stereo Viewing Requirements RAM: 8 GB Passive 3D stereo display Polarized glasses 14 Software User Guide Rev. 1.0 Viewer Ver. 4.0

GENERAL INFORMATION 1.8 Technical Requirements for Viewer Through a Web Browser General Computer with network connection, sufficient screen resolution (see hardware below), and mouse. Tablet with network access and sufficient screen resolution (see hardware below). Software OS\Browser Internet Explorer Edge* Firefox* Chrome* Safari* Windows 7 11 N/A OK OK N/A Windows 8 11 N/A OK OK N/A Windows 10 11 Edge OK OK N/A MAC OS N/A N/A N/A N/A OK ios N/A N/A N/A N/A OK Android N/A N/A N/A OK N/A * Ensure you are using the latest version of your browser. Hardware 2GB RAM recommended Screen resolution: 1024x768 or higher Mouse with scroll wheel recommended when using a computer Network Network connection speed: - At least 10 Mbps. The network connection must be stable. You may need to restart the application if the network connection is unstable. - Latency max: 200 ms Access required to the server via port 80 and 443 (http and https). Software User Guide Rev. 1.0 Viewer Ver. 4.0 15

Technical Requirements for Viewer Through a Web Browser 16 Software User Guide Rev. 1.0 Viewer Ver. 4.0

SOFTWARE OVERVIEW 2 SOFTWARE OVERVIEW 2.1 Getting Started General Information Viewer has multiple uses. For example: View medical images and Brainlab treatment plans Compare image sets from multiple studies Perform windowing and measurement functions Opening Viewer Local installation: open Viewer through Content Manager, within Patient Data Manager. This enables you to access patient files and use Brainlab software. Web browser: open Viewer through Origin Server, which enables you to access patient files and use Brainlab software. Using the Patient Selection software, select the patient and desired data for viewing. Refer to the Software User Guide for Patient Data Manager, Origin Server, and Patient Selection for more information. Screen Layout 1 2 Figure 1 The screen layout displays data side by side, allowing the user to compare data. Software User Guide Rev. 1.0 Viewer Ver. 4.0 17

Getting Started No. Area Explanation 1 2 Main menu Selected view Menu of available functions. NOTE: Available functions may vary depending on your license. The image series name and icons are highlighted on the selected view. Main Buttons Press the relevant button to enable the function. Button Function Home: Returns you to your start page. All changes (e.g., selected image set, windowing, trajectories, measurements, cropped boxes, 3D thresholds) are automatically made available for other applications. Data: Opens the menu for hiding/showing data. Patient name and ID: Select to return to patient selection to make changes to the selected patient or data. View: Image viewing options. Measure: Image measurement options (angles, distances, etc.) and annotations. 3D Options: Create 3D visualizations, crop image and select a region of interest. Comparison: show comparison of Brainlab objects when present in the image set. Done: Proceed and save changes. Back: Prompts you to save changes before returning to the previous screen. Select Save to make data available for other applications. Select Discard to discard data. Select Cancel to remain on the Viewer page. 18 Software User Guide Rev. 1.0 Viewer Ver. 4.0

SOFTWARE OVERVIEW 2.2 Layouts General Information 1 2 3 Figure 2 Viewer uses smart layouts, which automatically select the most relevant views based on your data set. To adjust the default layout, data set, and/or object list that is displayed, select Data. No. 1 2 3 Description View area Data selection Layout selection Available Layouts Layout Details Angio: Displays between four and six views containing: 3D reconstructions of vessels and bone/vessels. Availability of 3D views depends on the selected image data ACS, Slice views and angiogram views NOTE: Availability of this layout is license dependent. Cranial: Displays between four and six views containing: A 3D reconstruction of the head using the skin reconstruction or Bone/MR A 3D reconstruction of the head using the smart approach view ACS and Slice views containing one to two image sets NOTE: Availability of this layout is license dependent. Software User Guide Rev. 1.0 Viewer Ver. 4.0 19

Layouts Layout Details Spine: Displays five views containing: A sagittal spine vertabrae view; displaying individual slices Four individual slices as depicted within the sagittal spine vertabrae view NOTE: Availability of this layout is license dependent. Custom: Displays each selected data set side by side in the viewing area. NOTE: Add View is only available using this layout. Angio 2 3 1 Figure 3 4 The Angio view displays up to six data sets simultaneously. No. 1 2 3 4 Description Axial, coronal, sagittal or slice view for a data set Smart Vessels view Content varies depending on available data Content varies depending on available data 20 Software User Guide Rev. 1.0 Viewer Ver. 4.0

SOFTWARE OVERVIEW Cranial 3 4 5 2 1 Figure 4 The Cranial layout contains a maximum of six views from four data sets. The left-hand view port displays a 3D representation of the main data set. Move the slider 2 to adjust the object view. Use the in-view buttons to scroll through the data set. Alternatively, you can use the mouse wheel. No. 1 2 3 Description Smart Bone/MR View Slider used for cropping the 3D reconstruction and viewing internal objects Smart Approach view containing a 3D reconstruction of the head using brain surface vessels and skin 4 Axial, coronal, sagittal or slice view for data set 1 5 Axial, coronal, sagittal or slice view for data set 2 Software User Guide Rev. 1.0 Viewer Ver. 4.0 21

Layouts Spine 3 2 1 Figure 5 3 The Spine layout contains five standard views using one data set. The left-hand view port displays the slice positioning shown in the other views. The alignment can be adjusted by dragging the yellow markers 2. NOTE: When the slices are repositioned the corresponding view is updated. No. 1 2 3 Description Sagittal view of the spine and its vertabrae. Also displayed are the slices shown in the other views. These slices can be repositioned. Slice markers Axial, coronal, sagittal or slice views for the individual slices 22 Software User Guide Rev. 1.0 Viewer Ver. 4.0

SOFTWARE OVERVIEW Custom Figure 6 Custom displays all available data and also allows you to select any view from the list of available reconstruction options using Add View. Software User Guide Rev. 1.0 Viewer Ver. 4.0 23

Viewing Data 2.3 Viewing Data General Information View functions provide basic image manipulation options. Changes are applied to the current data set and its reconstructions. DICOM images must have a squared pixel size. There is no limitation for the matrix size. Orientation A human figure appears in the lower left corner of each view to indicate the orientation of the image. Other relevant orientation indicators appear in each view, including: H (head), F (foot), L (left), R (right), A (anterior) and P (posterior). 2D Orientation Figure 7 This symbol is shown when displaying 2D images. Basic Viewing Buttons The basic viewing buttons are always available in Viewer. Button Function Scroll: Drag to the right or down, to move forward through the set Drag to the left or up, to move backwards through the set NOTE: Alternatively use the arrows in the image to scroll. 24 Software User Guide Rev. 1.0 Viewer Ver. 4.0

SOFTWARE OVERVIEW Button Function Rotate: Rotate the 3D reconstruction Zoom: Drag up to zoom out Drag down to zoom in Pan Pan: Drag the image to the desired position or press the image to center the image at that point. Add View: Opens reconstruction selection. Reconstructions: Opens reconstruction selection. Maximize/Minimize: Maximizes/minimizes the selected image. Close Image: Closes the selected view. Scroll Arrows: Arrows within the view for scrolling through image slices. View Functions Button Function Reset: Resets all slices to the original viewing settings. Linked View: Links multiple image sets on the screen. Software User Guide Rev. 1.0 Viewer Ver. 4.0 25

Viewing Data Button Function Presets: Select CT windowing presets. Windowing: Adjust the brightness (up and down) and contrast (left and right). Slices: Adjust the number of slices displayed. Thickness: Adjust slice thickness. Align: Allows you to adjust the orientation of scan data. Flip: Drag across the image you wish to move: Vertically, to flip the image up/down Horizontally, to flip the image right/left NOTE: Flip is active for 2D (X-rays) only. Screenshot: Takes a screenshot of current screen. NOTE: When you select Done after using View functions, changes are saved for that image set. The next time you open the image set, it opens with the same layout. Presets Figure 8 26 Software User Guide Rev. 1.0 Viewer Ver. 4.0

SOFTWARE OVERVIEW You can choose preset windowing settings for CT image sets which are optimized by Brainlab to display particular structures such as bone, lung or soft tissue. To do this, press Presets to see a list of available optimizations. Thickness 2 3 1 Figure 9 The Thickness function is only available for original slices if the following conditions are met: The slice distance is the same over the whole image set The maximum slice distance is 2 mm The maximum difference between slice distance and slice thickness does not exceed 10% NOTE: Axial, sagittal or coronal reconstructions cannot be averaged. No. 1 2 3 Explanation Slider bar for adjusting slice thickness. The thickness range depends on the distance between slices and cannot exceed a maximum of 6 mm total thickness. The averaged thickness is indicated in the header (in front of AVERAGE). A box indicates the thickness of the averaged area. Software User Guide Rev. 1.0 Viewer Ver. 4.0 27

Viewing Data Selected Data Menu The SELECTED DATA menu allows you to hide/show selected data. 3 45 6 7 8 1 2 Figure 10 No. 1 2 3 4 5 6 7 8 Explanation Select icon to open the SELECTED DATA menu. Data available for viewing (e.g., images, objects, measurements). Select MORE to open data selection page. Select to show data. Select to hide data. Select to expand/condense lists of available data. Displays all available layouts. Select to close the SELECTED DATA menu. Data Properties 1 Figure 11 Data properties are shown in the Data menu. For example, object volume 1 in planned objects. 28 Software User Guide Rev. 1.0 Viewer Ver. 4.0

SOFTWARE OVERVIEW Warning Volume calculation is based on factors such as image quality, image resolution and slice thickness, and may differ from the actual volume of the highlighted object. Slices Function Figure 12 The Slices function allows you to define how many slices are displayed by using a grid to select the desired layout. Linked View Requirements Linked View links multiple image sets. Any actions performed on one set (e.g., scrolling or panning), are also performed on the linked views. To use Linked View, the images/image sets must either: Be part of the same image set or reconstruction, or Be fused (through Brainlab software or the scanner) Maximizing/Minimizing Images 2 1 Figure 13 No. 1 Component Image list Software User Guide Rev. 1.0 Viewer Ver. 4.0 29

Viewing Data No. 2 Component Maximized view NOTE: The maximized image remains in the image list. Maximizing/Minimizing Options Options To maximize an image, press the maximize arrow. To minimize an image, press the minimize arrow. To change the image in the maximized view 2, select an image in the image list 1 or drag an image onto the maximized view to swap. 30 Software User Guide Rev. 1.0 Viewer Ver. 4.0

USING VIEWER 3 USING VIEWER 3.1 Reconstruction Views General Information Viewer allows you to view reconstructions in addition to the already selected images. Reconstruction views are linked to the original image set (i.e., any changes made in one view will be applied to the others). You can view the original image set simultaneously with up to three reconstruction types. Selecting any of the reconstruction icons displays that reconstruction. Reconstruction Selection Select the reconstructions button 1 or Add View 2, to open a selection dialog 3. From here you can open the individual reconstruction options. Reconstruction selection shows symbolic icons for the available views. NOTE: Available reconstructions may vary depending on the selected data format and your license. NOTE: Slice 6 is the original image set, not a reconstruction. 4 5 3 6 2 1 Figure 14 Software User Guide Rev. 1.0 Viewer Ver. 4.0 31

Reconstruction Views No. 1 2 3 4 5 Reconstructions button Add View Reconstruction selection dialog Standard contains a set of more commonly used reconstructions Other contains additional reconstructions How to Select Reconstructions Step 1. Select Add View or the Reconstructions button. The reconstruction selection dialog opens. 2. Choose your view using the symbols. NOTE: Filters can be applied to this view. Ensure no filters are highlighted if you wish to view all options. Liver View Figure 15 The Liver view displays all available image data specific to the liver but also allows you to select any view from the list of available reconstruction options. NOTE: Availability of this layout is license dependent. 32 Software User Guide Rev. 1.0 Viewer Ver. 4.0

USING VIEWER How to Access the Liver View Step 1. Select Add View. 2. Select Basic > Other. 3. Select Other Views > Liver. Software User Guide Rev. 1.0 Viewer Ver. 4.0 33

Redefining Patient Orientation 3.2 Redefining Patient Orientation General Information The Align function allows you to redefine the patient orientation in the image set. For example, if the patient was scanned in the axial (prone or supine) position but with the head tilted, the labeling of the scan data will not match the orientation. You can correct this by aligning the data so that it corresponds to the label in the respective view. NOTE: It is recommended to use reconstructions, rather than the original image slices, when using the Align function. How to Redefine Patient Orientation 1 Figure 16 Step 1. Select Align. 2. Rotate and/or pan the image 1 so that the orientation markers in the view align with the actual patient orientation. Other open views can be used to compare and verify the orientation alignment. Warning Ensure that the patient orientation defined using the Align function matches the actual patient orientation in the image set. How to Swap Positions Step Select and hold down a view, then release the view at the desired location. 34 Software User Guide Rev. 1.0 Viewer Ver. 4.0

USING VIEWER Step The two views swap position. Software User Guide Rev. 1.0 Viewer Ver. 4.0 35

Measurement Functions 3.3 Measurement Functions General Information The Measure menu provides advanced measurement options. Measurements are applied to the current slice, as well as one slice before and after. Distance, circle and angle measurements are visible in Viewer only. Distance and circle measurement functions are not available on non-calibrated images. NOTE: The quality of distance measurement depends on the resolution of the image set. Measure Buttons Button Function Distance: Measure distance between any two points. Circle: Measure the diameter of a circle overlaying the image. Angle: Measure the angle of any three points on the same plane. Open Angle: Measure the angle between two open planes. Point: Place text labels in the image. NOTE: Points are visible in other software applications as well. See Next: When there is more than one measurement in the selected data, jumps to the slice where the next measurement occurs. Delete: Delete measurement objects. Calibrate: Calibrate the measurement functions in relation to a marker with known dimensions. NOTE: Measurements and points can only be changed when the Measure menu is open. 36 Software User Guide Rev. 1.0 Viewer Ver. 4.0

USING VIEWER 3.3.1 Measuring Distance General Information The Distance function allows you to measure the distance between any two points in the image. How to Measure Distances Figure 17 Step 1. Select Distance. 2. Select anywhere on the image. A line appears on the screen. 3. Reposition the line as needed by selecting and dragging the end points. The distance is calculated and displayed in millimeters between the selected points. Software User Guide Rev. 1.0 Viewer Ver. 4.0 37

Measuring Diameters 3.3.2 Measuring Diameters General Information The Circle function allows you to measure the diameter of a circle overlaying the image. Diameter measurements are applied to the current slice, as well as one slice before and after. How to Measure Diameters Figure 18 Step 1. Select Circle. 2. Select a point in the image to create a circle. The diameter of the circle is calculated and displayed. 3. Reposition the circle as needed by dragging the center. Resize the circle by selecting and dragging the edges. 38 Software User Guide Rev. 1.0 Viewer Ver. 4.0

USING VIEWER 3.3.3 Measuring Angles General Information The Angle function allows you to measure the angle of any three points on the same plane. NOTE: The displayed angle is a 2D measurement. The value is always in relation to the displayed plane. How to Measure Angles Figure 19 Step 1. Select Angle. 2. Select a point in the image. An angle appears on the screen. 3. Reposition the points as needed by selecting and dragging them. The angle between the selected points is calculated and displayed. Software User Guide Rev. 1.0 Viewer Ver. 4.0 39

Measuring Open Angles 3.3.4 Measuring Open Angles General Information The Open Angle function allows you to measure the angle between two planes of interest. How to Measure Open Angles Step 1. Select Open Angle. 2. Select a point in the image. Two lines appear on the screen. 3. Reposition the lines as needed by selecting and dragging the end points. The angle between the lines is calculated and displayed. 40 Software User Guide Rev. 1.0 Viewer Ver. 4.0

USING VIEWER 3.3.5 Additional Measuring Functions Point Button 2 1 To place text labels in an image, select Point, then reposition by dragging to the desired location. Select Annotation 1 to edit the annotation text in the dialog that opens 2. Delete Button To delete measurements, first select Delete, then select the measurement you wish to delete. Software User Guide Rev. 1.0 Viewer Ver. 4.0 41

Calibrating 3.3.6 Calibrating General Information The Calibrate function allows you to calibrate the measurement functions in relation to a known physical marker. How to Calibrate Step 1. 2. Select Calibrate to activate. 3. Reposition and resize the circle to match the size of the marker as prompted. Resize it by pressing and dragging the edges. Select Enter Diameter Here and enter the correct dimensions of your marker into the dialog. 4. Select OK. NOTE: All measurements are recalibrated in relation to the dimensions of the marker. 42 Software User Guide Rev. 1.0 Viewer Ver. 4.0

USING VIEWER 3.4 3D Options General Information The 3D Options toolbar allows you to create and adjust the following features of 3D visualization: Threshold adjustment Image cropping Select ROI (Region of Interest) Figure 20 3D Visualizations When scrolling through a 2D image set, a yellow line or shadow within the 3D visualization represents the location of the currently viewed slice. Within other 2D images, a crosshair represents the intersecting planes. These representations fade when scrolling stops. Trajectories, objects and points are visible within 3D visualizations. Warning The colors appearing in the 3D visualization may not reflect the color of actual tissues. Be aware that 3D visualizations are created based on gray values and therefore surface inaccuracy or artifacts may create inaccuracies in the 3D visualization. Digitally Reconstructed Radiograph (DRR) The DRR preset uses CT data to create an X-ray image approximation. The result is an X-ray-like image, calculated from the selected angle. Maximum Intensity Projection (MIP) MIP is a volume visualization method for 3D data that projects the voxels with the maximum intensity along the viewing direction in the visualization plane. Software User Guide Rev. 1.0 Viewer Ver. 4.0 43

3D Options Presets Available presets vary depending on data type: Data Type Standard Other CT without contrast Skin DRR Bone CT with contrast Skin MIP CT Contrast (bone and vessels) MR Skin MIP Vessels N/A Rotational angiography Bone MIP Vessels N/A PET/SPECT MIP MIP MIP N/A Bone/Vessels, Skin/Bone/ Vessels and MIP Bone, Skin/Bone and DRR Objects View The objects view shows all selected voxel objects, trajectories and fiber objects. 44 Software User Guide Rev. 1.0 Viewer Ver. 4.0

USING VIEWER 3.4.1 Editing 3D Visualizations General Information You can edit and amend the 3D visualization parameters using: Threshold Crop Select ROI Reset 3D How to Adjust Threshold Step 1. Select Threshold. 2. Drag to adjust the threshold: Drag to the left or up, to increase Drag to the right or down, to decrease How to Crop an Image Step 1. Select Crop. The crop frame appears in the image set. 2. Adjust the crop frame so that it surrounds the section of the image you wish to keep. To adjust frame size, drag the frame edges or the round markers located within the frame. To rotate the frame, press an edge and drag the frame. Release the edge, then press it again to rotate the frame in a different direction. NOTE: The area outside of the crop frame is no longer visible. How to Select an ROI Step 1. Select Select ROI. 2. Drag diagonally over the chosen area. A selection frame is created based upon the diagonal. 3. Release the hold. The software selects the ROI and zooms in on it. Software User Guide Rev. 1.0 Viewer Ver. 4.0 45

Editing 3D Visualizations How to Use Reset 3D Step Reset 3D: Resets all changes that have been made with the selected feature. If no features are selected, pressing Reset 3D returns the 3D view to the original calculation. 46 Software User Guide Rev. 1.0 Viewer Ver. 4.0

USING VIEWER 3.4.2 3D Stereoscopic Volume Renderings General Information This feature allows you to view 3D volume renderings in stereoscopic 3D on a 3D display. To start 3D stereoscopic viewing, select the icon in Content Manager 1, and select the 3D display 2. 1 2 3D Stereoscopic Buttons When accessing Viewer remotely using iplan Net or Origin Server, additional buttons are available in the 3D Options menu. Button Function 3D Stereo: Enable/disable 3D stereoscopic viewing. Swap Left/Right: Swaps volume rendering for left and right eye. NOTE: Select Swap Left/Right in order to check that you are viewing in full 3D. Software User Guide Rev. 1.0 Viewer Ver. 4.0 47

Comparison 3.5 Comparison Comparison View You can perform a comparison if your image sets contain voxel objects that were created using SmartBrush. Figure 21 Select Load Data under Comparison. Viewer searches for more voxel objects of this object type and loads the corresponding image sets and shows them in a chronological order. 48 Software User Guide Rev. 1.0 Viewer Ver. 4.0

INDEX INDEX Numerics 3D stereoscopic viewing...47 3D viewing...47 3D visualizations... 43 crop...45 ROI... 45 threshold...45 3D volume rendering... 43 A add view... 24 align...25,26 B brightness...26 C CE label...7 close... 24 contrast...26 cropping...45 D distance measurement... 37 DRR...43 F flip...25,26 I image layout... 35 image orientation...24 indications for use... 9 L labels... 41 linked view...25 P pan... 24,25 point button...41 presets...25 3D visualizations...44 threshold adjustment... 45 R reconstruction selection...31 reconstructions... 24 reset... 25 ROI 3D visualization... 45 rotate... 24,25 S screenshot...25 scroll... 24 slices... 25,26 support numbers... 5 swapping views... 35 symbols... 8 T text labels... 41 thickness... 25 three-dimensional volume rendering... 43 threshold presets...45 W windowing...25 Z zoom...24,25 M maximize... 24 maximizing images...29 measurements angles... 39 calibration... 42 delete...41 diameter...38 distances... 37 labels... 41 open angles...40 minimize... 24 minimizing images...29 MIP... 43 Software User Guide Rev. 1.0 Viewer Ver. 4.0 49

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