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Carestream Vue PACS MR Diffusion User Manual

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Clinical Collaboration Platform
Vue PACS
MR Diffusion and MR Perfusion
User Guide
Part # AE9362
2017-05-17
Vue PACS MR Perfusion User Guide
Unrestricted Internal Use
AE9362 C
Uncontrolled unless otherwise indicated
Page: 1 of 43
Vue PACS MR Perfusion User Guide - AE9362.docx

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Summary of Contents for Carestream Vue PACS MR Diffusion

  • Page 1 Clinical Collaboration Platform Vue PACS MR Diffusion and MR Perfusion User Guide Part # AE9362 2017-05-17 Vue PACS MR Perfusion User Guide Unrestricted Internal Use AE9362 C Uncontrolled unless otherwise indicated Page: 1 of 43 Vue PACS MR Perfusion User Guide - AE9362.docx...

  • Page 2: Table Of Contents

    Table of Contents Acronym list ............................. 6 Introduction ............................9 Application Workflow ........................11 Loading the Study .......................... 12 Initial Display ..........................14 Basic Image Manipulation ..................... 14 Tool Ribbon ........................... 14 Viewing Diffusion Series ........................ 16 DWI Images ........................... 16 DTI Images ..........................
  • Page 3 Carestream Health, Inc. shall not be liable for any loss or damage, including consequential or special damages, resulting from the use of this information, even if loss or damage is caused by Carestream Health, Inc.'s negligence or other fault.
  • Page 4 Unauthorized personnel must be prevented from accessing the system. • If the system does not operate properly, or if it fails to respond to the controls described in this manual, contact the nearest Carestream Health, Inc. field service office to report the incident and await further instructions. •...
  • Page 5 INDICATIONS FOR USE The CARESTREAM Vue PACS is an image management system whose intended use is to provide completely scalable local and wide area PACS solutions for hospital and related institutions/sites, which will archive, distribute, retrieve and display images and data from all hospital modalities and information systems.

  • Page 6: Acronym List

    Compact disc Clinical Document Architecture Contrast Frame Number CORBA Common Object Request Broker Architecture COTS Commercial Off the Shelf Software Carestream Carestream Health cSVD Circular Singular Value Decomposition Cerebrovascular accident DBMS Database Management System Distinguished Encoding Rules DICOM Digital Imaging and Communications in Medicine...
  • Page 7 Acronym Meaning Health Level Seven International HTTP Hypertext Transfer Protocol HTTPS Hypertext Transfer Protocol over TLS Integrating the Healthcare Enterprise Internet Information Services Image Processing Intrusion Prevention System MR Leakage Map Key Object Key Object Selection LDAP Lightweight Directory Access Protocol Lookup Table Middle Cerebral Artery Mean Diffusivity...
  • Page 8 Acronym Meaning Remote Management Services Region of Interest Service Class Provider Service Class User Service Object Pair Structured Query Language Structured Report SRSA Secure Remote Service Access Secure Sockets Layer sSVD Standard Singular Value Decomposition Standard Uptake Value Singular Value Decomposition TCP/IP Transmission Control Protocol/Internet Protocol Time Interval Difference...

  • Page 9: Introduction

    2. Introduction The MR Diffusion and MR Perfusion modules are clinical tools for evaluating water diffusion and blood perfusion parameters in the brain. The applications use as input a collection of images produced by a Magnetic Resonance (MR) scanner. Diffusion Weighted Imaging (DWI) MR and Diffusion Tensor Imaging (DTI) MR series are used for calculating the rate and direction of water diffusion in the brain, while DSC series serve to calculate blood flow, blood volume, and permeability.
  • Page 10 • TMAX • Calculation of a k2 permeability map • Corrected maps based on the k2 maps For further details on the diffusion and perfusion maps, see Section 5 Viewing Diffusion Series and Section 6.3 Working with Perfusion Maps. • Ability to add ROIs •...

  • Page 11: Application Workflow

    3. Application Workflow An MR study may include diffusion series, perfusion series, or both diffusion and perfusion series. For the diffusion series, the following steps are performed: 1. Automatic calculation of the brain mask—Executed automatically by the application while allowing manual corrections by the user. 2.

  • Page 12: Loading The Study

    4. Loading the Study To load an MR perfusion study – 1. In the Vue PACS client, highlight the study in the Archive Explorer. 2. Select one of the following from the right-click menu: • Load To > Perfusion Stroke: The “Perfusion Stroke”...
  • Page 13 • Load To > Perfusion Lesion (applicable for any study containing Diffusion groups): The “Diffusion” application is intended for any study that contains a Diffusion group, and it loads that group only. Furthermore, only Diffusion maps will be calculated. Vue PACS MR Perfusion User Guide Unrestricted Internal Use AE9362 C Uncontrolled unless otherwise indicated...

  • Page 14: Initial Display

    Right-click anywhere in the image display area to select image manipulation activities, such as windowing, zooming, panning, and others. For a description of all image manipulation tools available in the Vue PACS application, see the CARESTREAM Vue PACS help. Use the mouse wheel to scroll through the series images.
  • Page 15 Description Settings—Adjust settings related to the algorithm, maps, clinical parameters, input state, ischemic regions, and tables. Open a Report—Opens an automatically generated report containing all the measurements and graphs performed by the user. Show/Hide Brain Mask—Show/hide brain mask. You can also add brain mask manually as well as erase added brain mask coloring.

  • Page 16: Viewing Diffusion Series

    6. Viewing Diffusion Series The system calculates water diffusivity and displays a set of maps summarizing the calculated values. The windowing menu, displayed by right-clicking the windowing annotation, allows you to apply various maps and change the windowing scale to minimum and maximum values. Use the windowing menu to display values that are beyond the values of the bar.

  • Page 17: Dti Images

    If you are working with two monitors side by side, you can use a dual-monitor layout. Click Toggle Dual Monitor in the Layout ribbon. The display is adapted to the dual-monitor environment. The slider at the bottom of the original series represents values of gradient factor b (sec/mm2). Use the slider to show the data at the different b-values.
  • Page 18 Vue PACS MR Perfusion User Guide Unrestricted Internal Use AE9362 C Uncontrolled unless otherwise indicated Page: 18 of 43 Vue PACS MR Perfusion User Guide - AE9362.docx...
  • Page 19 If you are working with two monitors side by side, you can use a dual-monitor layout. Click Toggle Dual Monitor in the Layout ribbon. The display is adapted to the dual-monitor environment. Note that the dual-monitor display shows more maps than the single-monitor display. The following illustrations show the dual-monitor layout on landscape and portrait monitors.

  • Page 20: Using The Brain Mask Correction Tool

    Maps Based on the various diffusivity measures, the system generates a diffusion tensor and calculates the tensor’s eigenvalues λ1, λ 2, λ 3 (λ 1 > λ 2 > λ 3) and eigenvectors V1, V2, V3 respectively. The following maps are shown: Maps reflecting isotropic diffusivity •...

  • Page 21: Erasing Brain Mask

    6.3.3 Erasing Brain Mask To erase added brain mask marking – 1. Click Erase Brain Mask in the drop-down menu of the Show/Hide Brain Mask icon. 2. Click the left mouse button at the point where you wish to start erasing brain mask which you added manually.

  • Page 22: Perfusion Series

    7. Perfusion Series When a perfusion series is loaded, the perfusion input data is displayed first, and then you continue to map calculation. 7.1 Initial Layout The initial layout includes: • The calculated TMIN images • The original series data •...
  • Page 23 Vue PACS MR Perfusion User Guide Unrestricted Internal Use AE9362 C Uncontrolled unless otherwise indicated Page: 23 of 43 Vue PACS MR Perfusion User Guide - AE9362.docx...
  • Page 24 If you are working with two monitors side by side, you can use a dual-monitor layout. Click Toggle Dual Monitor in the Layout ribbon. The display is adapted to the dual-monitor environment. Note that the dual-monitor display shows more maps than the single-monitor display. If the study includes both diffusion and perfusion series, the images of the diffusion series are displayed on the monitor on the right-hand side.

  • Page 25: Calculating Perfusion Input Values

    7.2 Calculating Perfusion Input Values When you initially load the study, the application automatically calculates values that serve as a basis for the perfusion calculation. You can manually correct the results to improve your reading accuracy. 7.2.1 Identifying the AIF and VOF The application automatically segments arteries and veins to identify candidate AIF and VOF curves that are to be used for the analysis NOTE: The artery and vein marks do not necessarily appear on the same slice.
  • Page 26 Segmentation and Show/Hide VOF Segmentation icons in the Perfusion ribbon are enabled when the Segmentation option is selected in the Input State settings (See Section 8 Using Settings) 7.2.3.1 Displaying Artery and Vein Segmentations To display all segmented arteries on the images, click Show/Hide AIF Segmentation in the Correction Tools section of the Perfusion ribbon.

  • Page 27: Using The Brain Mask Correction Tool

    7.2.4 Using the Brain Mask Correction Tool You can display and hide the brain mask in the input images. Additionally, you can correct the displayed brain mask by manually adding to the brain mask display as well as erasing the addition. 7.2.4.1 Displaying the Brain Mask To display the brain mask, click the brain mask icon...

  • Page 28: Working With Perfusion Maps

    7.3 Working with Perfusion Maps 7.3.1 Initiating Map Calculation When all the required data is available, the application is ready to perform the perfusion calculations and yield the perfusion maps and table data. To initiate the perfusion calculations, do one of the following: •...
  • Page 29 • k2 map—Shows a measure which is proportional to the rate of contrast material permeability across the capillaries' blood-brain barrier to the extravascular extracellular space (EES). Calculation of the map values is based on the Boxerman-Weisskoff model . (Calculated k2 values are taken into consideration in the calculation of all other perfusion maps.
  • Page 30 In addition to rCBV, rCBF, MTT, TTP and TMAX, the tables also present the following values in the Ischemic region table: • Tissue Index—The percentage of Lesion tissue volume and of Hypoperfusion tissue volume out of the entire ischemic region. •...
  • Page 31 7.3.2.1 Determining the Display You can determine the order of the displayed maps. Right-click the Change Data annotation and click the map you want displayed in each of the display areas. 7.3.2.2 Selecting the Damaged Side Click the drop-down menu of the Select Damaged Brain Side icon to select the damaged hemisphere.

  • Page 32: Displaying A Fused Image

     Select a font and color. 7.3.2.5 Showing/Hiding Graphic Elements Click the drop-down menu of the Hide/Show icon to show or hide the segmentation of the ischemic region on the TMIN images (Show/Hide Ischemic Regions option), or to hide all graphic elements (Hide All Graphics option).

  • Page 33: Selecting A Layout

    8. Selecting a Layout When the Perfusion application is launched, the Application Layout drop-down in the Layout ribbon lists perfusion-specific layouts. For the input display, the menu lists by default a single layout. The layout is adjusted to landscape monitors and to portrait monitors. For the map display, the menu offers you by default two possible layout types: •...

  • Page 34: Using Settings

    9. Using Settings The Perfusion Settings window allows you to change parameters related to the perfusion algorithm, map parameters, clinical parameters, input state, ischemic regions, and tables. To change parameters, click Settings in the Perfusion ribbon. Use the Perfusion Settings window to make your adjustments.
  • Page 35 Setting Description Dropdown listing all the available maps. For each map, you can set parameters relating to that map. rCBV parameters Set rCBV parameters. • Default Windowing—The default windowing range for rCBV maps. • Acceptance Criteria—When enabled, only values within the set range are used in the ROI statistics and the segmentation of the ischemic region.
  • Page 36 Setting Description region. Disable in cases when parts of the brain are mistakenly removed by the ventricle-detection algorithm. Clinical Settings Setting Description Hematocrit Set the hematocrit values. The ratio between the large and small vessel hematocrit values affects the scaling in the rCBV and rCBF maps. Input State Settings Setting Description...
  • Page 37 Diffusion Setting Description Default B-Value Default B-Value—Set the value that is to be used for calculating the eADC and Settings DWI map. B-Value Filter Settings Set the values that appear in the maps. By default, all values are included. Clicking a value excludes it from the selection. Clicking it again re-includes the value.
  • Page 38 Setting Description Hypoperfusion Set Hypoperfusion threshold criteria: Threshold Criteria Use the drop-down menus to define criteria for the maps. Click Add to add the criterion to the criteria list. A voxel is considered Hypoperfusion if it meets all criteria. Note that acceptance criteria are applied as well when enabled. Criteria types include: •...

  • Page 39: Opening A Report

    10. Opening a Report Click Reporting in the Perfusion ribbon to display a perfusion report. The report shows the content of the perfusion tables and graph. NOTE: Only the average curves are included in the report graph. • Click Preview Report to display a version of the report that contains the patient details, including patient name, report date, patient ID, accession number, birth date, referring physician, report date, report status and study reason.

  • Page 40: Exporting The Perfusion Analysis

    11. Exporting the Perfusion Analysis Click Export in the Perfusion ribbon to export the calculated maps and TMIN images, including the ischemic regions segmentation, the center line indication and the added ROIs. The maps are exported in their original plane. The exported images are saved with the study, with each map constituting a separate series.

  • Page 41: Accuracy And Limitations

    12. Accuracy and Limitations • Image quality—The calculation of perfusion parameters is limited by the scan quality. Excessive noise, patient movement or image artifacts in the original images will ultimately have an impact on the perfusion analysis and the calculated maps. The user should inspect original data and verify that the images are of diagnostic quality and that any patient movement has been corrected using the motion correction algorithm.

  • Page 42: References

    13. References 1. Diffusion MRI. (n.d.). Retrieved from Wikipedia: https://en.wikipedia.org/wiki/Diffusion_MRI 2. Fieselmann, A., Kowarschik, M., Ganguly, A., Hornegger, J., & Fahrig, R. (2011). Deconvolution-Based CT and MR Brain Perfusion Measurements: Theoretical Model Revisited and Practical Implementation Details. International Journal of Biomedical Imaging, 2011, 20.
  • Page 43 150 Verona Street Rochester, NY USA, 14608 © Carestream Health, 2017 CARESTREAM is a trademark of Carestream Health. Made in the USA Vue PACS MR Perfusion User Guide Unrestricted Internal Use AE9362 C Uncontrolled unless otherwise indicated Page: 43 of 43...

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