Voxar 3D ColonMetrix Reference Guide
The software described in this document is furnished under a license, and may be used or copied only according to the terms of such license. Toshiba means, Toshiba Medical Visualization Systems Europe, Limited, a private limited company (company number SC341779) registered in the United Kingdom, having an office at Bonnington Bond, 2 Anderson Place, Suites 7 and 8, EH6 5NP, United Kingdom. Toshiba assumes no responsibility for the use or reliability of software that is not supplied by Toshiba or of hardware used in connection with Toshiba-supplied software. The Software License and Limited Warranty are contracts between Toshiba and the purchaser which will use the software. Any descriptive information in this document about software is subject to change by Toshiba in its sole discretion without notice, and should not be considered as a commitment by Toshiba. Toshiba assumes no responsibility for any errors that may appear in this document. Copyright 2009 Toshiba Medical Visualization Systems Europe, Limited. All rights reserved All trademarks and registered trademarks are the property of their respective owners. Voxar 3D ColonMetrix Reference Guide (TMVSE000074-00) January 2009.
Contents Chapter 1 Introduction 5 About this document... 5 About Voxar 3D ColonMetrix... 5 About the Voxar 3D ColonMetrix user interface... 6 About the viewing modes... 7 Notes...12 Chapter 2 Overview of tools 13 2D tools...13 3D tools...14 Display tools...14 Notes...15 Chapter 3 Common tasks 17 Read images...17 Specify the center-line...19 Select a viewing mode...20 Pan a view...20 Rotate a VOI...20 Zoom a view...21 Change the window and level of an MPR view...21 Cine a plane in an MPR view...22 Start and stop the 3D flythrough...22 Change the Field of View...23 3
Contents Create a flythrough movie and export it as an AVI...24 Mark findings...25 Capture a view...30 Delete a capture...30 Maximize a view...30 Display the localizer view in the Dissected viewing mode...31 Check Computer Assisted Reporting (CAR) results...32 Create a report...34 Using the mouse wheel and right mouse button...34 Finish a reading session...35 Notes...36 Chapter 4 User scenarios 37 Index 55 4
Chapter 1 Introduction About this document This document introduces the main features of Voxar 3D ColonMetrix, and describes how to use these features in a typical scenario. Caution: Before using ColonMetrix, you must read the safety and regulatory information in the Voxar 3D online Help. About Voxar 3D ColonMetrix Voxar 3D ColonMetrix is a clinical application that helps you identify and report findings in CT colonography examinations. It allows you to: Store and organize CT and Secondary Capture images in DICOM format Display and manipulate CT images using a variety of views: MPR (Multi-planar Reformatting) views that display a volume generated from a set of images, and allow you to view any plane within that volume 3D views that display a volume in three-dimensions Dissected view that displays an unfolded 2D representation of the 3D volume Mark findings, and describe them with notes, measurements, and captures Create reports for patients and physicians, and store them as DICOM images Use Computer Assisted Reporting (CAR) to provide assistance when reporting findings 5
Chapter 1: Introduction About the Voxar 3D ColonMetrix user interface The Voxar 3D ColonMetrix user interface allows you to manipulate images using a variety of views and tools. Viewing mode tabs Toolbar Viewing area Findings area Viewing area Generates volumes from your images, and displays those volumes in MPR (Multi-planar Reformatting), 3D and endoscopic views. Viewing mode tabs Allows you to select viewing modes, which change the content of the viewing area and toolbar so that you can perform specific tasks. Toolbar Contains tools and controls for viewing and manipulating the volume in the views. 6
About the viewing modes Findings area Allows you to create and view markers, specify marker details, accept or reject Computer Assisted Reporting (CAR) results, and create a report of your findings including captures and notes. About the viewing modes The application provides the following viewing modes: Review mode Displays the volume from a prone scan and/or supine scan. Each volume is displayed as an MPR and a 3D view: Before reading a study, this mode allows you to: Check the colon has been accurately segmented in the 3D view Review and edit the center-line of the colon 7
Chapter 1: Introduction After reading a study, this mode allows you to review the location of recorded findings before finishing and archiving: If a single supine or prone scan is selected for viewing, Review mode allows you to review the location of findings recorded in that scan If a supine and prone scan are selected for viewing, Review mode allows you to review and compare the location of findings recorded in the two scans Compare mode Allows you to compare the volume from a supine scan with the volume from a prone scan. It displays each volume as an MPR view and endoscopic view. 8
About the viewing modes Dissected mode Generates dissected (unfolded) views of the colon that allow you to view the volume from a supine and prone scan, mark findings or review markers. Note: It is not possible to make measurements in Dissected mode. The gray area at the edge of each image contains repeated information from the opposite edge of the image. This overlap ensures there is no loss of any surface feature information at the edge of the dissected image. 9
Chapter 1: Introduction Prone mode Allows you to view the volume from a prone scan in four views three orthogonal MPR views and an endoscopic view: 10
About the viewing modes Supine mode Allows you to view the volume from a supine scan in four views three orthogonal MPR views and an endoscopic view: 11
Chapter 1: Introduction Notes 12
Chapter 2 Overview of tools 2D tools Icon Function Description Cine Cine through images Pan Pan images left, right, up and down Zoom Zoom images Change window and level Oblique MPR go to point MPR look at Adjust center-line Link tools Change the window and level Rotate standard MPR images into oblique MPR images Reposition the camera within the colon in the MPR views Change the camera angle in the MPR views Draw or modify the center-line Link prone and supine views so they cine, pan and zoom simultaneously 13
Chapter 2: Overview of tools 3D tools Icon Function Description Targeted/Endoscopic mode Rotate Rotate around point Pan Switch between Targeted Review and Endoscopic mode Rotate the 3D image The camera view remains focused on one object and rotates around it Pan images left, right, up and down Change Field of View Increase or decrease the Field of View (camera viewing angle) Display tools Icon Function Show/Hide MPR crosshairs Show/Hide camera location in views Show/Hide center-line on MPR views Show/Hide center-line on 3D view Show/Hide the localizer view in Dissected viewing mode 14
Notes Notes 15
Chapter 2: Overview of tools 16
Chapter 3 Common tasks This chapter describes tasks that are regularly performed in Voxar 3D ColonMetrix. Read images 1 If you are in a viewing mode or clinical application, click the Exit button. 2 If you have created a report during the current reading session, do one of the following: To archive the report, click the Finish and Archive button To finish the reading session without archiving the report, click the Discard and Finish button 3 On the Archive tab of the Study Browser, select a study, then select the series that contain the images you want to read. You can read the following combinations of series: One prone series One supine series One prone and one supine series To select more than one series, click the first item, hold down the CTRL key, then click the other item. 17
Chapter 3: Common tasks 4 If you want to select a series from a different study, hold down the CTRL key and select the study, then select the series. This is useful for situations where the prone and supine series for a patient are in separate studies. Note: You can only select images from different studies if the studies have the same Patient Name and Study Date. 5 Click the ColonMetrix button. 6 If the Refine Series dialog box is displayed, specify the images required, then click the View button. Note: For information about how to read images with a PACS, contact your PACS vendor. 18
Specify the center-line Specify the center-line The center-line is used to generate the dissected view and the flight path for the 3D flythrough in the endoscopic views. When loading images, ColonMetrix automatically calculates the center-line of the colon. The center-line is represented by a yellow line with yellow circles on the start and end points. Center-line in a 3D view Center-line in an MPR view Automatic generation of the center-line may fail due to collapsed loops, fluid filled loops and complete strictures. If ColonMetrix is unable to generate a center-line through the entire colon, right-click on a view past the obstruction where the center-line should continue. For example: Right-click 19
Chapter 3: Common tasks Select a viewing mode Click the viewing mode tabs to switch between the Review, Compare, Dissected, Supine and Prone viewing modes. For more information about the ColonMetrix viewing modes, see About the viewing modes on page 7. Pan a view Select the Pan tool, then click and drag on the view. Alternatively, you can pan an MPR view by holding down the mouse wheel and dragging on the view. Rotate a VOI Select the 3D Rotate tool, then drag on the view. Note: When you start ColonMetrix, this is the default 3D tool. To rotate the VOI to display a particular orientation, click the arrow to the right of the 3D Rotate button and select the required orientation from the menu. 20
Zoom a view Zoom a view Select the Zoom tool, then drag on the view drag up to zoom in and drag down to zoom out. Note: You can only zoom a 3D view in Review mode. Alternatively, you can: Zoom a 3D view by moving the pointer over the view and rotating the mouse wheel Zoom an MPR view by moving the pointer over the view, then holding the the CTRL key and rotating the mouse wheel To apply other zoom options for the MPR views, click the arrow to the right of the Zoom button and select an option from the menu. Change the window and level of an MPR view Select the Window/Level tool. Then, drag on the MPR view: Drag up and down to decrease and increase the window level respectively Drag left and right to decrease and increase the window width respectively 21
Chapter 3: Common tasks To change the window and level of the MPR views using presets, click the arrow to the right of the Window and Level button and select the required preset from the menu. Cine a plane in an MPR view Select the Cine tool, then drag up or down on an MPR view. Alternatively, you can cine an MPR view by moving the pointer over the view, then rotating the mouse wheel. Start and stop the 3D flythrough In Compare, Supine, or Prone mode, click the Fly button on a 3D view to start the flythrough. When performing a 3D flythrough the Fly button changes to Stop Flying. Click the Stop Flying button to stop the flythrough. Alternatively, click the middle mouse button on a 3D view to start and stop the automatic flythrough. Move the mouse pointer over the Fly button to display the flythrough configuration options. This allows you to change the flythrough speed and direction. To manually flythrough, rotate the mouse wheel. Note: A combination of anatomy, center-line position and scan acquisition may prevent you from being able to visualize the whole colon during the 3D flythrough. 22
Change the Field of View To get a better visualization of the whole colon, it is recommended that you also review the dissected and MPR views. Change the Field of View Drag the FOV slider to increase or decrease the Field Of View (camera viewing angle). The following table shows how different Fields of View specify how much of the volume is displayed: Field of View Amount of Volume displayed 23
Chapter 3: Common tasks Create a flythrough movie and export it as an AVI On the Report tab, define the Position, Direction, Parameters, and whether gravity is applied to the flythrough movie, then click Save Flythrough Movie. Click the Report button to switch to the Reading Manager. Select the thumbnail that contains the captures associated with the movie, then click the Export as non-dicom images button. Enter the File name for the flythrough movie, change the Save as type to AVI Movie Files, then click OK. 24
Mark findings Mark findings In Compare, Supine, Prone and Dissected modes, you can place markers on the views to record findings for reporting purposes. Each marker has three standard properties: Index number a unique number that identifies the marker Image set the image set that contains the marker, supine or prone Image the image in the image set where the marker is placed In addition, you can specify the following properties: Type the type of finding indicated by the marker: Pedunculated Polyp, Sessile Polyp, Flat Polyp, Mass, Cancer, Unspecified lesion or Extracolonic finding Confidence your confidence with the marker type decision: Questionable, Probable, or Definite Location the anatomical location of the marker in the colon, for example, splenic flexure You can also write notes related to markers, measure lines related to markers, capture views related to markers, and merge supine and prone markers. Add a marker On the Markers tab in the Findings area, click the Create button then click the finding in a view. This adds a marker to all the views, and an entry for the marker is displayed on the Markers tab. Alternatively, you can add a marker by pressing CTRL and clicking the left mouse button over the view. 25
Chapter 3: Common tasks To review the MPR, 3D and dissected views linked to the marker, click its entry on the Markers tab. Deselect an active marker After adding a marker, any measurements you make are associated with that marker until you deselect it or add a new marker. To deselect an active marker, click the Select None button. Delete a marker On the Markers tab, click the entry for the marker you want to delete, then click the Delete button. You can select more than one marker: To select a range of markers, click the first marker in the range, hold down the SHIFT key, then click the last marker in the range To select markers that are not in a range, click the first marker, hold down the CTRL key, then click the other markers 26
Mark findings Make a measurement For each marker you can make the following measurements: Line measure a straight line on a view To make a line measurement for a marker, click the marker s entry on the Markers tab, then click the Add Line button. On the view, move the pointer to where you want the line measurement to start and click the left mouse button. Then, move the pointer to where you want the line measurement to end and click the left mouse button. Note that when you add a marker, the Add Line tool is selected automatically. Point a Hounsfield Unit (HU) measurement for a specific point To make a point measurement for a marker, click the marker s entry on the Markers tab, then click the Add Point button. On the view, move the pointer to where you want to take the point measurement and click the left mouse button. The measurements are placed in the Measurements area on the Markers tab. Each measurement is given an unique number [Marker number].[measurement number]. For example, the first measurement associated with marker 2 would be displayed as 2.1. The numbers are displayed in the views and the # column in the Measurements area. 27
Chapter 3: Common tasks Merge supine and prone markers If markers in the supine and prone volumes refer to the same finding, you can merge them so they have one entry. On the Markers tab, hold down the CTRL key, click the entries for the two markers, then click the Merge button. Merged markers are labelled with an M : If you want to split a merged marker, click the entry for the merged marker and click Split. This returns it to separate markers in the prone and supine volumes. When splitting markers, all measurements made to the separate markers are retained, but measurements made after the markers were merged are deleted. Note: You cannot merge markers of different types, confidence levels, locations, or those that are already merged. Capture a view related to a marker On the Markers tab, select the entry for the marker. Then select the Capture tool and click the view. The capture is displayed in the Captures area of the Markers tab. The Distance from anus measurement is embedded in the capture. This describes the location of the marker along the center-line from the anus. Note: You cannot take captures of the dissected views. 28
Mark findings Delete a capture related to a marker 1 On the Markers tab, select the entry for the marker. 2 In the Captures area, select the capture to be deleted. To select a range of captures, hold down the SHIFT key and click the first and last capture in the range. To select captures that are not in a range, hold down the CTRL key and click each capture. 3 Click the Delete button. Specify type, confidence and location After adding a marker you can specify its details that is, the finding type, confidence with the decision and the anatomical location. To specify a marker s details, select the marker entry: Use the Type, Confidence and Location boxes to specify the required details. 29
Chapter 3: Common tasks Capture a view To capture a view for a report summary: On the Report tab, select the Capture tool and click the view. The capture is taken and a thumbnail is displayed in Captures area. Note: You cannot take captures of the dissected views. Delete a capture To delete a capture related to a report summary: 1 Click the Report tab. 2 In the Captures area, select the capture to be deleted. To select a range of captures, hold down the SHIFT key and click the first and last capture in the range. To select captures that are not in a range, hold down the CTRL key and click each capture. 3 Click the Delete button. Maximize a view Double-click on a view. To return the view to its previous size and position, double-click the view again. 30
Display the localizer view in the Dissected viewing mode Display the localizer view in the Dissected viewing mode Click the Show/Hide localizer button. The center-line is represented by a yellow line with yellow circles on the start and end points. The red section of the center-line represents the area that is currently being viewed in the dissected view. 31
Chapter 3: Common tasks Check Computer Assisted Reporting (CAR) results Computer Assisted Reporting provides an automated secondary review to provide assistance when reporting findings. The CAR results are calculated without any interruption to your workflow and can be viewed after you have completed your primary reading. You can view the CAR results after all the images in an image set have been analyzed. To view the current progress, click the CAR tab. The sphericity threshold determines how spherical an object must be for it to be included in the CAR results. By increasing the sphericity threshold you may increase specificity for true polyps. By decreasing the sphericity threshold you may increase the overall sensitivity, drawing attention to more irregular shaped objects. To change the threshold, drag the Sphericity Threshold slider. Viewing results On the CAR tab, select the Show the CAR results in the visualizer check box. 32
Check Computer Assisted Reporting (CAR) results Click on a marker entry to review the views linked to the marker. Accepting or rejecting results On the CAR tab, select the Show the CAR results in the visualizer check box. Then, click a marker entry to review the views linked to the marker. Once you have reviewed the result, right click on the marker in the view and select either Accept CAR finding or Reject CAR finding. When you accept a finding, the marker color changes from yellow to blue. Note: You cannot accept or reject CAR findings in Review or Dissected viewing modes. 33
Chapter 3: Common tasks Create a report On the Report tab, click the Generate button. The report information is sent to the Reading Manager as a set of DICOM images. From the Reading Manager you can: Push the report images to a DICOM archive as a set of Secondary Capture images Export the report images E-mail the report images Print the report images If you export, e-mail, or print a report as a file, it contains all the information in the Secondary Captures images and also includes header information such as the name, address and logo of your institution. Using the mouse wheel and right mouse button In Voxar 3D ColonMetrix, you can: Rotate the mouse wheel to zoom a 3D view in Review mode, or cine a 2D view Hold down mouse wheel and drag to pan Click the right mouse button to select tools and change display options 34
Finish a reading session Finish a reading session In Voxar 3D ColonMetrix, click the Exit button. The Reading Manager is displayed, showing the Report tab. The Report tab displays a thumbnail of each capture taken from the current reading session. Thumbnails of captures Image preview Output and print buttons Reading workflow buttons From the Reading Manager, you can restore Live Image captures, export captures, or print captures see the Voxar 3D Reference Guide. However, to finish the reading session and archive all the captures taken during the session, click the Finish and Archive button. Alternatively, click the Discard and Finish button to finish the reading session without archiving captures. 35
Chapter 3: Common tasks Notes 36
Chapter 4 User scenarios This chapter illustrates suggested workflows using the features available within Voxar 3D ColonMetrix. The suggested workflows are: 3D workflow 2D workflow Dissected workflow 37
Chapter 4: User scenarios 3D workflow Read images using ColonMetrix Select the prone and supine series Start ColonMetrix Specify the center-line Check the center-line by rotating a 3D view Right-click If required, modify the center-line Go to the top of the next page Repeat process to specify the center-line of the other 3D view 38
Start 3D flythrough Select the Supine or Prone viewing mode Start the 3D flythrough Stop the flythrough when you identify a finding Mark findings Click the Create button and click on the 3D view to add a marker Click Add Line, then make a line measurement Go to the top of the next page 39
Chapter 4: User scenarios Capture all visible views related to the marker Click the capture button, then click on each view Restart 3D flythrough and mark any other findings. Repeat until you have completed the flythrough in one direction Click the Fly button to start the 3D flythrough If required, stop the flythrough and mark findings Start flythrough in opposite direction Go to the top of the next page 40
Mark findings Click the Create button and click on the view to add a marker Click Add Line, then make a line measurement Capture all visible views related to the marker Click the capture button, then click on each view Repeat process for other viewing mode Select the Supine or Prone viewing mode Start the 3D flythrough If required, mark findings Capture all visible views related to the marker Restart 3D flythrough and mark any other findings Start flythrough in opposite direction If required, mark findings Capture all visible views related to the marker Go to the top of the next page 41
Chapter 4: User scenarios Compare markers Select the Compare viewing mode In the list of markers, double-click the marker entries that you want to compare Double-clicking a marker entry displays its image in the viewing area Accept or Reject CAR findings Select the CAR tab If required, adjust the Sphericity Threshold to display CAR findings Double-click a CAR marker entry to review it Go to the top of the next page Right click on the marker in a view and select either Accept or Reject 42
Create summary Select the Review viewing mode Select the Report tab Take captures of both 3D views and add Notes if required Click Save Report to push the report information to the Reading Manager Go to the top of the next page 43
Chapter 4: User scenarios Create supine and prone flythrough movies Define the Position, Direction, and Parameters Click Save Flythrough Movie If required, repeat for the other Position 44
2D workflow Read images using ColonMetrix Select the prone and supine series Start ColonMetrix Select the Supine viewing mode Go to the top of the next page 45
Chapter 4: User scenarios Mark findings Select the Cine tool Cine through the MPR view to identify any findings Click the Create button and click on the view to add a marker Right click on the marker to display the finding in the 3D view Right-click Click Add Line, then make a line measurement on the 3D view Go to the top of the next page 46
Select the Prone viewing mode Compare markers Select the Compare viewing mode In the list of markers, double-click the marker entries that you want to compare Double-clicking a marker entry displays its image in the viewing area Go to the top of the next page 47
Chapter 4: User scenarios Check CAR findings Select the CAR tab If required, adjust the Sphericity Threshold to display CAR findings Double-click a CAR marker entry to review it Right click on the marker in a view and select either Accept or Reject Go to the top of the next page 48
Create report Select the Review viewing mode and switch to the Report tab Take captures of both 3D views and add Notes if required Click Save Report to push the report information to the Reading Manager Create supine and prone flythrough movies Define the Position, Direction, and Parameters Click Save Flythrough Movie If required, repeat for the other Position 49
Chapter 4: User scenarios Dissected workflow Read images using ColonMetrix Select the prone and supine series Start ColonMetrix Specify the center-line Check the center-line by rotating a 3D view Right-click If required, modify the center-line Go to the top of the next page Repeat process to specify the center-line of the other 3D view 50
Select the Dissected viewing mode Mark findings Pan through the dissected view to identify findings Click the Create button and click on a view to add a marker Make a measurement in the endoscopic view Right click on the marker in the dissected view, and select Look at in Endoscopic Make a measurement in the endoscopic view Capture all visible views related to the marker Go to the top of the next page Select the Dissected viewing mode and mark any other findings 51
Chapter 4: User scenarios Compare markers Select the Compare viewing mode In the list of markers, double-click the marker entries that you want to compare Double-clicking a marker entry displays its image in the viewing area Check CAR findings Select the CAR tab If required, adjust the Sphericity Threshold to display CAR findings Double-click a CAR marker entry to review it Go to the top of the next page Right click on the marker in a view and select either Accept or Reject 52
Create report Select the Review viewing mode Select the Report tab Take captures of both 3D views and add Notes if required Click Save Report to push the report information to the Reading Manager Go to the top of the next page 53
Chapter 4: User scenarios Create supine and prone flythrough movies Define the Position, Direction, and Parameters Click Save Flythrough Movie If required, repeat for the other Position 54
Index Numerics 2D tools 13 3D tools 14 3D views center-lines of 19 A accepting CAR results 33 adding markers 25 AVI movie, export flythrough as 24 C camera viewing angle. See Field of View captures deleting 30 exporting 35 printing 35 restoring 35 capturing views 30 CAR 32 about 32 accepting or rejecting results 33 sphericity threshold 32 viewing results 32 center-line, specifying 19 cineing planes 22 ColonMetrix application 6 about 5 toolbar 6 user interface 6 viewing mode tabs 6 viewing modes 7 Compare mode 8 completing a reading session 35 Computer Assisted Reporting 32 creating a report 34 D deleting a marker 26 deleting captures for a report summary 30 deselecting a marker 26 display tools 14 Dissected mode 9 displaying the localizer view 31 E Export flythrough as an AVI movie 24 exporting captures 35 F Field of View of a 3D view, changing 23 findings marking 25 specifying type 29 finishing a reading session 35 flythrough changing the direction of 22 changing the speed of 22 starting and stopping 22 I images, reading 17 introduction 5 L line measurements, taking 27 lines, measuring 27 Live Image captures, restoring 35 localizer view 31 55
Index M markers adding 25 deleting 26 deselecting 26 merging 28 splitting 28 taking captures related to 28 marking findings 25 Maximize a view 30 measuring lines for a marker 27 merging markers 28 mouse wheel, using 34 MPR views, center-lines of 19 P panning views 20 planes in MPR views, cineing (ColonMetrix) 22 printing captures 35 Prone mode 10 R reading images 17 reading sessions, finishing 35 rejecting CAR results 33 report summary deleting captures related to 30 taking captures for a 30 reports creating 34 e-mailing 34 exporting 34 printing 34 pushing 34 Review mode 7 right mouse button, using 34 S scenarios 37 sphericity threshold 32 splitting a merged marker 28 Supine mode 11 T Tools overview 13 U user interface 6 user scenarios 37 V viewing area 6 viewing modes about 7 Compare mode 8 Dissected mode 9 Prone mode 10 review mode 7 selecting 20 Supine mode 11 VOIs rotating 20 W window and level of views 21 Z zooming views 21 56
Index 57
Index 58
Part No: TMVSE000074-00