syngo MR E11 Operator Manual Scanning and postprocessing Answers for life.

Transcription

1 syngo MR E11 Operator Manual Scanning and postprocessing Answers for life.

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3 syngo MR E11 Operator Manual Scanning and postprocessing

4 Legend Indicates a hint Is used to provide information on how to avoid operating errors or information emphasizing important details Indicates the solution of a problem Is used to provide troubleshooting information or answers to frequently asked questions Indicates a list item Indicates a prerequisite Is used for a condition that has to be fulfilled before starting a particular operation Indicates a one-step operation Indicates steps within operating sequences Italic Is used for references and for table or figure titles Is used to identify a link to related information as well as previous or next steps Bold Blue Courier Courier Menu > Menu Item <variable> Is used to identify window titles, menu items, function names, buttons, and keys, for example, the Save button Is used to emphasize particularly important sections of the text Is used for on-screen output of the system including code-related elements or commands Is used to identify inputs you need to provide Is used for the navigation to a certain submenu entry Is used to identify variables or parameters, for example, within a string CAUTION Used with the safety alert symbol, indicates a hazardous situation which, if not avoided, could result in minor or moderate injury or material damage. CAUTION consists of the following elements: Information about the nature of a hazardous situation Consequences of not avoiding a hazardous situation Methods of avoiding a hazardous situation 4 Scanning and postprocessing Operator Manual

5 Legend WARNING Indicates a hazardous situation which, if not avoided, could result in death or serious injury. WARNING consists of the following elements: Information about the nature of a hazardous situation Consequences of not avoiding a hazardous situation Methods of avoiding a hazardous situation syngo MR E11 5

6 Legend 6 Scanning and postprocessing Operator Manual

7 Table of contents 1 Introduction Layout of the operator manual The current operator manual Intended use Authorized operating personnel Definitions of different persons 23 2 Safety General safety information General information regarding the operating system, network security, display as well as system resources Basics: Multi monitor operation Basics: Ending a work session Service functions: Service session Service functions: Remote service access Saving and exchanging data: Configuring the data transfer D: Working in 3D Pixel Lens D Fusion: SUV operation D Multi monitor operation: Dataset registration D Multi monitor operation: 3D Series list Structured Report Viewer Administration MR safety information MR safety instructions Open source software included 37 syngo MR E11 7

8 Table of contents 3 Frequent tasks and tools Frequent tasks General information 40 Coordinate system Frequent image processing tasks 44 Selecting images 44 Selecting images explicitly 44 Windowing images 45 Zooming and panning Frequent data selection tasks 49 Searching for patient data 49 Filtering data 50 Sorting data 51 Searching for and retrieving patient data from storage media 51 Using the Patient Search function on remote network nodes Frequent system management tasks 55 Starting the system 55 Shutting down the system 56 Restarting the system 56 Restarting syngo MR Frequently used tools Keyboard shortcuts 57 General 57 Parameter cards 58 Inline Display UI explanation 60 Exam task card 60 Toolbar of the Exam task card 62 Toolbar of the program control 63 The Protocol info line 64 Program Card 65 Wait queue 66 Protocol icons 67 Series icons in the program step 68 Icons in the status bar 69 Protocol markers in the wait queue 69 8 Scanning and postprocessing Operator Manual

9 Table of contents 4 Preparing an examination Patient registration General information 72 Patient registration Task 74 Registering a patient at your scanner 74 Registering a patient from the database 75 Preregistering patients 75 Registering the patient to continue the examination UI explanation 76 Patient registration dialog window 76 Patient registration confirmation pages 77 syngo MR E11 9

10 Table of contents 4.2 Composing a measurement program General information 79 Follow-up examinations 79 PhoenixZIP 79 Automatic adjustment 80 AutoAlign 81 Study split 82 Image numbering 82 Study information 83 Measurement of large examination regions Assembling the measurement program 84 Selecting a measurement program or program step 84 Reconstructing protocols from images (Phoenix) 85 Performing follow-up examinations 87 Inserting a measurement pause 87 Changing the sequence of pauses/ program steps 87 Deleting a program step Editing study information 88 Changing Body Part Examined 89 Changing procedure steps 90 Changing image comments Preparing protocols 92 Propagating numbering settings 92 Setting the protocol properties 92 Configuring automatic adjustment 93 Activating coil memory and automatic coil selection 93 Creating a Set-n-Go protocol 94 Setting automatic composing of images from Set-n-Go protocols 95 Creating a Composing group 96 Setting TimCT measurements Preparing pauses 98 Setting the pause properties 98 Setting breathhold pauses 98 Setting pauses for dynamic protocols Saving programs or protocols 100 Saving the queue as a new program UI explanation Scanning and postprocessing Operator Manual

11 Table of contents Step Properties General 101 Step Properties Voice Commands 102 Step Properties Execution 103 Step Properties Image Management 105 Step Properties Auto Load 106 Step Properties Copy References 107 Step Properties Preview 111 Step Properties Pause 112 Modality performed procedure step Table positioning General information Tasks 114 Moving the table to the isocenter 114 Moving the table by a certain distance UI explanation 114 Table positioning Performing an examination Measuring and loading reference images General information 120 Introduction 120 Prerequisites for reference images 120 Dependencies between the table position, reference image, and protocol Tasks 125 Loading reference images manually 125 Loading series into the segments 127 Finding the best-suited reference image 128 Navigating in stamp segments 129 Changing the layout of stamp segments 129 Removing images from the image area 130 syngo MR E11 11

12 Table of contents 5.2 Planning the examination volume General information 131 Slice positioning 131 Slices / slabs 131 Saturation regions 133 Navigator objects 135 Geometry parameters Tasks 136 Selecting graphic objects 136 Panning graphic objects 136 Rotating graphic objects 138 Aligning graphic objects 140 Moving Dot Engine specific objects 141 Adding slice or slab group 142 Creating radial slices 143 Adding saturation regions 143 Graphically changing object properties 144 Deleting graphic objects 147 Transferring the position of reference images to slices/slabs UI explanation 148 Position toolbar 148 Tim Planning toolbar 150 Display of slices 151 Saturation regions 154 Navigator objects 155 Dot Engine specific objects 156 Orientation aids 157 TimCT measurement area 159 Set-n-Go measurement Scanning and postprocessing Operator Manual

13 Table of contents 5.3 Scanning General information 161 Performing a routine examination 161 Adapting the measurement parameters 163 General information (SAR and stimulation) 164 General information - Physio / Triggering Routine scanning tasks 170 Editing parameters of subsequent protocols 170 Resolving parameters conflicts 171 Repeating measurements 171 Measuring an open protocol multiple times 172 Terminating a measurement 172 Skipping a program step 173 Positioning the table with parameters of the parameter cards 173 Defining a new center position 173 Avoiding SAR limit exceeded 174 Increasing SAR tolerance 174 Avoiding stimulation limit exceeded 175 Increasing db/dt tolerance 176 Adapting the adjustment volume 176 Transferring parameters from previously measured protocol 177 Copying measurement parameters 177 Copying parameters from an image in the GSP segment 178 Copying image position (Inline display) 178 Playing back voice output Special scanning tasks 179 Performing measurements with countdown 179 Using Physiological Triggering 180 Breathhold scanning 180 AutoAlign scanning UI explanation 183 Exam paused 183 Physiological display 184 SAR information Prediction 185 syngo MR E11 13

14 Table of contents SARLimit(s) exceeded! 187 Stimulation monitor Information 189 Stimulation monitor Recommendations 189 Voice output patient settings Viewing and editing images during examinations General information 192 Scroll sequence 192 Movie display 193 Inline display Tasks 195 Defining the sort scheme 195 Measuring pixel coordinates, distances, and angles 196 Starting the movie display UI explanation 197 Movie control 197 Movie properties 200 Inline display Postprocessing and reporting Standard evaluation methods General information 206 Viewing task card 207 2D evaluation 207 Pixel lens 207 Position display Tasks 212 Loading multiple studies or patients in the Viewing task card 212 Annotating images 213 Rotating and flipping 214 Using the interactive movie 214 Measuring the distances 214 Measuring angles 215 Evaluating regions (ROIs) 215 Measuring position and grayscale values with the Pixel Lens 217 Starting the offline position display UI explanation 219 Position display dialog window Scanning and postprocessing Operator Manual

15 Table of contents 6.2 syngo MR E11 syngo 3D Loading images to 3D Loading images via the Patient Browser Loading images from the Viewing task card Loading images via the 3D Series List Closing patients Moving through the volume Shifting with the mouse Setting the image orientation Using standard views Controlling the in-plane orientation Activating the orthogonal view Moving a cut line Rotating a cut line Rotating a VOI Generating series of images Setting the reference image Generating parallel ranges Generating radial ranges Generating curved images Generating curved ranges Storing images Saving images and series quickly Storing with the dialog box 3D: Save As Filming images Transferring images Transferring images to the Viewing task card Changing the display mode Switching to MPR with changeable slice thickness (MPR Thick) Switching to Shaded Surface Display (SSD) Changing thresholds for SSD Setting the light source Defining the MIP slice thickness (MIP Thin) Defining a VRT slice thickness (VRT Thin) Setting a visibility mask

16 Table of contents Using Free View 242 Activating Free View 242 Common interactions 243 Using the clip planes 243 Using the clipbox Extracting a VOI 245 Using the VOI clipbox 246 Changing the size in clipbox mode 246 Moving the clipbox 246 Using the VOI Punch Mode Using 3D Editor 249 Calling up the Object Editor 249 Creating a 3D object with threshold 250 Using the Undo function 251 Using the Update function 251 Using Region Growing 251 Cutting out structures 252 Using the Morphological Operations Using Fusion Function 254 Loading image data sets 255 Aligning image series 256 Displaying overlaid images side by side 260 Displaying overlaid images in Fusion mode 261 Editing the Fusion image 262 Saving results for non 3D Applications Using Fly Through 265 Starting Fly Through 265 Changing the display mode 266 Changing Fly View volume settings 267 Modifying viewing distance 267 Moving in the Fly segment 268 Using auto navigation 268 Performing Fly volume click 269 Defining the path or flight along a path Working with two monitors 271 Loading one data set 272 Loading two data sets simultaneously 272 Using the two-monitor display 272 Performing a manual registration Scanning and postprocessing Operator Manual

17 Table of contents 6.3 Saving and exporting images General information 274 Important information for storing and sending data 274 Data Import 275 Rules for saving, exporting, and filming Tasks 276 Storing images and reference images 276 Transferring images to other task cards 277 Filming, sending, and exporting images 277 Storing data on storage media 278 Exporting to a USB device 281 Exporting to a Network share 282 Sending data via the network 283 Importing data from storage disks 284 Importing data from the hard disk 284 Importing data from a USB device UI explanation Reporting General information 286 General information on reporting 286 Completion status of a report Tasks 288 Creating reports 288 Editing reports 288 Printing a report 288 Sending a report 289 Exporting reports UI explanation 290 Report icons in the Patient Browser 290 Report editor 292 syngo MR E11 17

18 Table of contents 6.5 Filming Transferring images to Filming 294 Filming images with Window 1 and Window Selecting images and sheets 294 Selecting film sheets 295 Selecting an entire film job Editing film jobs 296 Changing the layout 296 Windowing images 297 Copying and moving images or film sheets 297 Deleting images or film sheets 297 Deleting images except every n-th image 298 Showing or hiding image text and graphics 298 Selecting another camera Exposing on film 300 Exposing a film sheet 300 Exposing a film job Associating layouts to a study, series, or protocol 300 Assigning a film layout 301 Canceling a film layout assignment 302 Deleting a layout Scanning and postprocessing Operator Manual

19 Table of contents 6.6 Composing images General information 302 Important notes for Composing 302 Important notes for evaluation 303 Prerequisites for image selection 304 Notes for reconstruction 305 Loading composed images 307 Scoliosis angle according to Cobb 308 Kyphosis angles of vertebrae 308 Deviation of the spine from the vertical 309 Difference in height Tasks 310 Composing images 310 Aligning images 311 Drawing the scoliosis angle 312 Drawing kyphosis angles 312 Measuring vertical alignment 313 Drawing the difference in height 313 Saving composed images UI explanation 316 Composing task card 316 Text information in images 317 Displays in images 318 Indication of composed images 319 View subtask card 319 Manual subtask card 321 Adjust subtask card 322 Tools subtask card Dynamic analysis General information 324 Prerequisites for dynamic analysis 324 Functions Tasks 331 Starting analysis 331 Adding images during the analysis UI explanation 333 Function dialog windows 333 Scaling dialog window 338 Evaluation check dialog window 338 Calculation status window 339 syngo MR E11 19

20 Table of contents 6.8 Filtering, correcting, converting images General information 341 Editing images with image filters 341 General information on distortion correction 341 General information on RGB conversion of images Tasks 344 Filtering images 344 Using 2D distortion correction 345 Using 3D distortion correction 345 Resetting 2D distortion correction 345 Converting images to RGB UI explanation 346 Offline Image Filter Parameter dialog window Appendix Warning messages UI explanation 350 Stimulation monitor - Warning! 350 Stimulation monitor - Stimulation limit exceeded! 350 SED Warning 351 Warning: Examination interrupted! 352 Warning: Examination interrupted! Scanning and postprocessing Operator Manual

21 Introduction 1 1 Introduction In order to operate the MR system accurately and safely, the operating personnel must have the necessary expertise as well as knowledge of the complete operator manual. The operator manual must be read carefully prior to using the MR system. 1.1 Layout of the operator manual Your complete operator manual is split up into several volumes to improve readability. Each of these individual operator manuals covers a specific topic: Hardware components (system, coils, etc.) Software (measurement, evaluation, etc.) Another element of the complete operator manual is the information provided for the system owner of the MR system. The extent of the respective operator manual depends on the system configuration used and may vary. All components of the complete operator manual may include safety information that needs to be adhered to. The operator manuals for hardware and software address the authorized user. Basic knowledge in operating PCs and software is a prerequisite. 1.2 The current operator manual This manual may include descriptions covering standard as well as optional hardware and software. Contact your Siemens Sales Organization with respect to the hardware and software available for your system. The description of an option does not infer a legal requirement to provide it. syngo MR E11 21

22 1 Introduction The graphics, figures, and medical images used in this operator manual are examples only. The actual display and design of these may be slightly different on your system. Male and female patients are referred to as the patient for the sake of simplicity. 1.3 Intended use Your MAGNETOM MR system is indicated for use as a magnetic resonance diagnostic device (MRDD) that produces transverse, sagittal, coronal and oblique cross sectional images, spectroscopic images and/or spectra, and that displays the internal structure and/or function of the head, body, or extremities. Other physical parameters derived from the images and/or spectra may also be produced. Depending on the region of interest, contrast agents may be used. These images and/or spectra and the physical parameters derived from the images and/or spectra when interpreted by a trained physician yield information that may assist in diagnosis. Your MAGNETOM MR system may also be used for imaging during interventional procedures when performed with MR compatible devices such as in-room displays and MR Safe biopsy needles. The MAGNETOM MR system is not a device with measuring function as defined in the Medical Device Directive (MDD). Quantitative measured values obtained are for informational purposes and cannot be used as the only basis for diagnosis. For the USA only: Federal law restricts this device to sale, distribution and use by or on the order of a physician. Your MR system is a medical device for human use only! 22 Scanning and postprocessing Operator Manual

23 Introduction Authorized operating personnel The MAGNETOM MR system must be operated according to the intended use and only by qualified persons with the necessary knowledge in accordance with country-specific regulations, e.g. physicians, trained radiological technicians or technologists, subsequent to the necessary user training. This user training must include basics in MR technology as well as safe handling of MR systems. The user must be familiar with potential hazard and safety guidelines the same way the user is familiar with emergency and rescue scenarios. In addition, the user has to have read and understood the contents of the operator manual. Please contact Siemens Service for more information on available training options and suggested duration and frequency of such training Definitions of different persons Term used User/Operator/ Operating personnel System owner MR worker Explanation Person who operates the system or software, takes care of the patient or reads images Typically physicians, trained radiological technicians, or technologists Person who is responsible for the MR environment. This includes legal requirements, emergency plans, employee information and qualifications, as well as maintenance/repair. Person who works within the controlled access area or MR environment User/Operator as well as further personnel (for example, cleaning staff, facility manager, service personnel) syngo MR E11 23

24 1 Introduction Term used Siemens Service/service personnel Explanation Group of specially trained persons who are authorized by Siemens to perform certain maintenance activities References to Siemens Service include service personnel authorized by Siemens. 24 Scanning and postprocessing Operator Manual

25 Safety 2 2 Safety 2.1 General safety information MR safety information 34 syngo MR E11 25

26 2 Safety General safety information General information regarding the operating system, network security, display as well as system resources Caution The operating system may not support all characters for the received DICOM document. The display of the name e.g. the patient name may be incomplete or misleading. syngo will not change the used characters (e.g. minority characters) even if it cannot display them. Use other attributes for identification if possible. Caution Impermissible or faulty manipulations/ changes of the software or hardware or connection of the system to a network. Unauthorized access, damage to the equipment. Make sure all necessary precautions with respect to the existing level of security are considered when adding a functionality or altering the shipped configuration. You are not permitted to open or remove the housing of the equipment or to install third-party software. Caution Using syngo directly on a public or private network may lead to insufficient system performance. Degradation of system performance possible or unexpected system behavior. Only use syngo in a secure and load-adapted network. 26 Scanning and postprocessing Operator Manual

27 Safety 2 Caution Insufficient memory or disk space may lead to an instable or blocking system. System is not available in emergency cases. Do not ignore the storage capacity warning icons. Do not ignore the warning message Basics: Multi monitor operation Caution When working with several monitors, the patient name displayed in the folder of a task card belongs only to this task card. Any other visible task card may contain data from another patient. Wrong diagnosis is possible. Use patient demographics displayed in the image text for clear identification Basics: Ending a work session Caution Switching off the computer in Stand-by mode or without shutting down. Loss of data, data corruption or system damage possible. Shut down the computer before switching off. syngo MR E11 27

28 2 Safety Caution Switch user, shut down, logoff or restart without saving data. Possible loss of unsaved changes. Save data before switching user, shutting down or restarting the system Service functions: Service session Caution Service session (e.g. with limited access) running in parallel to data acquisition. Popup windows may appear and cause confusion. Always close service UI when work is done, don t minimize it Service functions: Remote service access Caution Terminating remote service without consultation with the service engineers. Terminating the remote service ends all service processes and may cause system malfunctions. Always coordinate termination with the service engineer before terminating remote service. 28 Scanning and postprocessing Operator Manual

29 Safety Saving and exchanging data: Configuring the data transfer Caution Lossy compression is selected for data transfer. Image quality of the lossy compressed images may be no longer adequate for diagnostic purpose. Do not use the lossy JPEG compression for sending data to a report or primary diagnosis workstation. Do not use the lossy JPEG compression for archiving. Note: Application of lossy compression will be indicated in image text except if No Text is switched on D: Working in 3D Caution Measurements in projected images. False diagnostics possible. Do not use measurements in projected images for diagnostic purposes Pixel Lens Caution Use of pixel lens in the Viewer and in the 3D card. The pixel lens may display different values. Be aware of differences in pixel lens measurements. The pixel lens measurement in the Viewer considers a rectangle around the clicked point, whereas measurement in the 3D card considers a cube surrounding the clicked point. syngo MR E11 29

30 2 Safety D Fusion: SUV operation Caution Image with earliest acquisition date and time is not included in the SUV calculation. Incorrect SUV calculation. The SUV calculation is based on the earliest acquisition date and time in the selected and loaded data set. Make sure that the first image is included in the data set for correct calculation D Multi monitor operation: Dataset registration Caution Automatic registration for compare layout is not sufficient. Insufficient diagnosis basis. Check registration and use manual registration functionality to re-adjust registration if automatic registration is not sufficient D Multi monitor operation: 3D Series list Caution Unintentional loading of series of different patients in 3D Compare Mode. Possible mix-up of patient series and incorrect diagnosis. Do not load data of different patients in 3D Compare Mode. 30 Scanning and postprocessing Operator Manual

31 Safety Structured Report Viewer Caution If there is no specific style sheet available locally for display of a SR document, then the generic style sheet is applied instead. Not all information might be present or displayed correctly as a consequence, especially when private attributes are included in the structured reports. In the display of the report and in exported documents it will be indicated that only a generic mechanism has been applied. Caution The image quality of images which are viewed within the Structured Report viewer might not be sufficient for reading purposes. A false diagnosis might occur. Do not base your diagnosis on images which were only displayed in the Structured Report viewer application. Caution When opening a SR document for further processing, an old version of a structured report document is accidentally opened. Existing processing results within the latest version of the document might get lost because the currently opened document can now be saved as latest version. When opening and editing a structured report document, always assure that you use the latest version. The version information is recognizable within the syngo browser. syngo MR E11 31

32 2 Safety Administration Caution Inaccessible system. User access may be prevented due to forgotten or unknown accounts or passwords, or wrong setup (for example, in case of an emergency). Do not forget to define a general user account for emergency access and assign it to a group and a role both called Emergency Access. Define a local user account for emergency. The password for this account should never expire. Do not allow any user to change the password for this account. The users shall contact you immediately in case of problems. Recommendations: - set the following attributes for emergency accounts: password never expires and user is not allowed to set password. - define local accounts for emergency 32 Scanning and postprocessing Operator Manual

33 Safety 2 Caution Behavior of secured systems. The hospital s security policy also effects the behavior of the syngo system in certain cases (for example. password strength requirements, enabled empty passwords, or locking of an account after a specific number of failed logins). Establish a user model for your hospital and verify it before the security system is activated. Establish a proper procedure for emergency access. Note that if you enable an empty password for the emergency account, this is enabled for all other users as well. Nethertheless, instruct the users to use good passwords. Always back up your system before enabling the security system and before any major changes. Inform all users about any changes and settings. They should contact you or any other administrator immediately in case of problems. It is recommended not to remove the predefined privileges of the administrative accounts because otherwise the administrator may not be able to solve system problems like disk is full (Bypass and archiving audit trail needed) or no license available (Bypass and change password for remote service needed). At least user management privilege should be granted. (Remark: system privileges assigned to build-in groups will not be removed without explicit user confirmation.) syngo MR E11 33

34 2 Safety Caution Limited access to system. After activating the security system, access is limited to only the defined users. Make sure you have read and completed all preparatory steps. Back up your complete system as done after installation before activating the security system. 2.2 MR safety information In this chapter you will find all the general safety instructions for the software manuals. Further safety instructions can be found in the descriptions of the individual applications MR safety instructions Caution Missing or incorrect display of small anatomical structures as a result of motion correction! Incorrect diagnosis and omitted treatment due to false negative diagnosis. Incorrect diagnosis and unnecessary biopsies due to false positive diagnosis. For diagnosis, always use the original image in addition to the corrected image. 34 Scanning and postprocessing Operator Manual

35 Safety 2 Caution Use of inappropriate protocol settings! Wrong diagnosis due to insufficient quality of the parameter values Ensure that the quality of the parameter values are sufficient. Therefore use only Siemens protocols. Caution Evaluated parameter values are only estimated! Wrong diagnosis As the given protocol settings are preconfigured but not standardized always consider that the evaluated parameter values are only estimated. Therefore you are responsible for the interpretation of such estimated results. Caution Use of subtracted or motion corrected images for diagnosis! Fine anatomical structures are lost Image quality is compromised or vessel shape is changed Incorrect diagnosis Always use both, the postprocessed and the original images for diagnostic purposes. syngo MR E11 35

36 2 Safety Warning Unapproved software! System error Only use software authorized by Siemens. Never copy or install unauthorized software onto the MR system. Do not install additional software on the system. The new software could replace existing system files and adversely affect the ability of the system to acquire data. Caution Inaccurate display of temperature changes when using temperature sensitive sequences! Incorrect diagnosis, wrong therapy planning Consider the measurement inaccuracy of this method (also refer to relevant literature). Ensure that the patient does not move during the acquisition of images (also assess anatomical images), and check for sufficiently high SNR. Consider carefully the temporal and spatial resolution when planning the therapy. Perform preliminary examinations for analyzing the tissue (e.g. in case of fat myoma), as temperature sensitive sequences use fat suppression by default. 36 Scanning and postprocessing Operator Manual

37 Safety 2 Advances in MR technology over the recent years have led to more and more calculated results and derived images. Since those results and images typically use multiple input images, naturally not all effects of each source image will be fully propagated to the final result image. It is therefore recommended to refer to the original data for a detailed diagnosis and to verify clinical findings observed in derived images. If image quality problems are encountered, you should contact your local Siemens Service for analysis Open source software included The software delivery volume includes a separate Open Source DVD. This DVD contains the Open Source software packages as well as the associated licensing information installed in this product. For additional information, please read the following files on DVD: release-notes.pdf release-notes-linux.pdf syngo MR E11 37

38 2 Safety 38 Scanning and postprocessing Operator Manual

39 Frequent tasks and tools 3 3 Frequent tasks and tools 3.1 Frequent tasks Frequently used tools 57 syngo MR E11 39

40 3 Frequent tasks and tools Frequent tasks General information Coordinate system The software syngo MR and its predecessor software Numaris (including Numaris 3.5) use different patient coordinate systems. Keep this information in mind, especially when you diagnose Numaris-acquired MR images with syngo MR. If you have any questions about converting the different coordinate systems, please contact your applications specialist. The whole body patient coordinate system Beginning with software version syngo MR B13, all measurements provide their table position (TP) and slice position (SP) in the Whole Body Patient Coordinate System. Origin: The origin of the Whole Body Patient Coordinate System is located at the magnet isocenter during the first measurement of a new series block (the first table position). In practical applications, this is usually the location marked with the laser light localizer prior to starting a new study. Slice position (SP): Beginning with software version syngo MR B13, the slice position (SP) for all measurements is shown relative to the origin of the Whole Body Patient Coordinate System of the current series block. Coordinate system for Numaris 3 and Numaris 3.5 (+FAL) Slice positions as seen from the magnet isocenter into the direction of Feet, Anterior and Left are positive. 40 Scanning and postprocessing Operator Manual

41 Frequent tasks and tools (1) Coronal Anterior (A) Coronal Posterior (P) (2) Sagittal Left (L) Sagittal Right (R) (3) Transverse Feet (F) Transverse Head (H) MR images based on this patient-oriented coordinate system are only converted when you export them into a DICOM format. Coordinate system for syngo MR (DICOM standard, +LPH) Slice positions as seen from the magnet isocenter in the direction of Left, Posterior and Head are positive. syngo MR E11 41

42 3 Frequent tasks and tools + - (1) Coronal Posterior (P) Coronal Anterior (A) (2) Sagittal Left (L) Sagittal Right (R) (3) Transverse Head (H) Transverse Feet (F) Overview of the slice position movement: The direction of the slice position changes as it moves from minus to plus. Direction of slice positions Numaris 3 and Numaris 3.5 syngo MR +FAL +LPH If the slice position ascends, the slices move toward the positive coordinates: Numaris 3 and Numaris 3.5: The transverse slice moves in the direction of the feet (F). The coronal slice moves in the anterior (A) direction. The sagittal slice moves in the left (L) direction. 42 Scanning and postprocessing Operator Manual

43 Frequent tasks and tools 3 syngo MR: The transverse slice moves in the direction of the head (H). The coronal slice moves in the posterior (P) direction. The sagittal slice moves in the left (L) direction. Coordinate system for the Whole Body Patient syngo MR E11 In syngo MR, position information in the PCS is shown in the form of the following abbreviations: L=Left, R=Right, A=Anterior, P=Posterior, H=Head, F=Feet. They replace the algebraic signs + or - used in previous Numaris versions. Computation method for determining a slice position: The slice is tilted by 15 and offset by 50 mm from the magnet isocenter. 43

44 3 Frequent tasks and tools (1) Starting table position (TP=0). Origin of the Whole Body Patient Coordinate System (2) Current table position (TP=F350) The table positions are computed from the vertical vector from the origin of the Whole Body Patient Coordinate System to the measurement slice: (350+50)*cos 15 = 386 TP: F350 SP: F Frequent image processing tasks Selecting images Selecting a single image Click an image to select it. or Use the arrow keys of the keyboard to change the current selection. Selecting images explicitly Hold the Ctrl key down and click individual images (multi-select). 44 Scanning and postprocessing Operator Manual

45 Frequent tasks and tools 3 or Hold the Shift key down to select several consecutive images. Selecting images up to the end of series Selecting complete series 1 Select a single image. 2 Select Edit > Select On Succeeding from the main menu. 1 Select an image from each required series individually. 2 Select Edit > Select Series from the main menu. With Select On Succeeding, you have to select the first image of each required series to select all series completely. Deselecting images Hold the Ctrl key pressed and click individually selected images again. or Select Edit > Deselect All from the main menu or select a single image. If none of the segments has a blue border, one or more images are selected in the background. Windowing images Setting the scope of selection Select Image > Windowing On Succeeding to be able to process all images up to the end of the series. syngo MR E11 45

46 3 Frequent tasks and tools or Select the series first if you want to window all images of a series. An explicit selection of images overrides Windowing On Succeeding. Assigning predefined window settings 1 Select the images you want to window. 2 Select Image > Windowing and select a window setting from the submenu. You can modify the predefined window settings in the NUMARIS/4 Configuration Panel. For more information, refer to: Basic Functionalities. 3 Use the corresponding keys of the symbol keypad for fine adjustment of the window settings. Windowing with the mouse 1 Move the mouse up or down in an image with the center mouse button pressed to change the window center. 2 Move the mouse right or left to change the window width with the middle mouse button pressed. Restoring window values Saving window values only Select Image > Home Window to undo your changes. Select Image > Save Window Values to undo your changes. The current window values are saved for the selected images. Zooming and panning Zooming and panning with the mouse 1 Click the Zoom/Pan icon. 2 Drag the mouse cursor up or down at the edge of the segment to zoom the image. 46 Scanning and postprocessing Operator Manual

47 Frequent tasks and tools 3 3 Drag the mouse cursor within the center part of the segment to pan the image. 4 Click the Zoom/Pan icon to deactivate the Zoom/Pan function of the left mouse button. Restoring the zoom factor 1 Click the Home Zoom/Pan icon. The last saved zoom factor of the images in the database is restored. or Select Image > Zoom Factor... in the main menu. The Zoom Factor dialog box is displayed. 2 Enter a predetermined zoom factor. syngo MR E11 47

48 3 Frequent tasks and tools Using the Blow up mode MR only: The description applies only to 3D and 3D Vessel View. In other applications, different functions are started with a double-click. 1 Double-click a segment to activate the Blow up view. 2 Double-click the Blow up view again to return to the initial layout of the chosen segment. 48 Scanning and postprocessing Operator Manual

49 Frequent tasks and tools Frequent data selection tasks Searching for patient data 1 Scroll through the list of patients using the scroll bar until you find the required patient. 2 Click the patient entry in the navigation area to view the information levels stored for this patient. All the studies of this patient are displayed in the content area. If View > Image Stamps is activated, all data objects are displayed as image stamps on the image/data level. 3 Click a study in the navigation area to select it and to view all the associated series. 4 Click a series in the navigation area to select it and to obtain an overview of all the images in the content area. syngo MR E11 49

50 3 Frequent tasks and tools 5 Click an image in the content area to select it. Filtering data 1 Select a filter using the Filter menu or the tool bar (if configured). 2 Click the Not Archived icon. Only the data which are not stored are displayed. 3 Click the Not Printed icon. Only the data which are not yet printed are displayed. 4 Click the Not Sent icon. Only the data which are not yet sent to the network are displayed. 5 Click the Not Marked icon. Only the data which are not marked are displayed. 6 Click the Marked icon. Only marked data are displayed. If you do not find the specific patient data in a search, make sure that no filter is activated. Creating filter criteria Call up the Filter Specification dialog box to create your own filter criteria by selecting Options > Filter Settings from the main menu. These user-defined filters are placed in the Filter menu as additional menu entries. Deactivating the filter Select Filter > Off from the main menu. or Click the Not Filtered icon. All the data are displayed unfiltered. 50 Scanning and postprocessing Operator Manual

51 Frequent tasks and tools 3 Sorting data 1 Select a data level in the navigation area to display its elements in the content area. 2 Open the Sort menu and click one of the sorting criteria stated. If the selected sort order cannot be applied, the following default order is automatically used: Patient Name Study Description Series Number Instance Number 3 Select Sort > Reverse Order to reverse the order of selected data level. Searching for and retrieving patient data from storage media 1 Click the icon of a data medium in the navigation area to display all the patient data stored there. Select View > Source to hide or display storage media individually in the navigation area. 2 Search for, and select patient and examination data by clicking through the data levels in the navigation area. 3 Click the Import icon to import the selected data into your local database. You can only process data stored in the local database. syngo MR E11 51

52 3 Frequent tasks and tools Using the Patient Search function on remote network nodes With Patient Search and Search Selected, you can retrieve patient and examination data from workstations and long-term storage systems that are working with other DICOM program systems or previous syngo program versions. These systems are not displayed in the navigation area. For information about DICOM structures and features, read the current DICOM conformance statement. 1 Select Patient > Search in the main menu. The Patient Search dialog box is displayed. (1) Input fields for search criteria (2) Search details area 52 Scanning and postprocessing Operator Manual

53 Frequent tasks and tools 3 (3) Information area (4) Series details list (5) Buttons (6) Status bar 2 In the Node selection list, select the network node where the data being searched for is located. 3 Enter the last name or ID of the patient being searched for (the wildcard * is supported). or Enter the study details, series details, or body parts in the search details area of the Patient Search dialog box. 4 Click the Search button to start the search. All patients and studies that were found are displayed in the information area. 5 Click a study if you want to have the corresponding series displayed. The series are displayed in the series details list. 6 Select a series in the series details list and click the Image List button. The Image Search Results dialog box is opened. syngo MR E11 53

54 3 Frequent tasks and tools 7 Select one or more patients, studies, or series from the information or search output area of the Patient Search dialog box. Select instances from the Image Search Results dialog box. 8 Click the Import button. The selected data is copied from the network node to your workstation and displayed in the navigation and content area of the Patient Browser. Saving and loading search attributes 1 In the Type New Query Name selection list, enter a name for the search that you want to save. 2 Click the Save button to save the search. 3 From the Type New Query Name selection list, select the search that you want to load. To delete a saved query, you can select in the Type New Query Name selection list and click the Delete button. 54 Scanning and postprocessing Operator Manual

55 Frequent tasks and tools Frequent system management tasks Starting the system During switch-on, no preliminary examination steps can be performed at the MR system. 1 Turn the key switch at the alarm box to the right. 2 Press the SYSTEM ON button. The System On LED lights up. The MR system is switched on. The computer system boots automatically. Without user administration With user administration If booting problems are suspected, check the booting status first by clicking the scanner icon before taking further measures (rebooting the host etc.). After booting the system succesfully, the software starts at the syngo Acquisition Workplace. If the User administration (HIPAA) option is installed, the Login User dialog window opens. 1 Enter your user name and password. 2 Click OK. syngo MR E11 55

56 3 Frequent tasks and tools The syngo MR Workplace is switched on separately. Shutting down the system Shutting down the entire system entails shutdown of the syngo Acquisition Workplace, the MR scanner, and the MARS processor. System Shutdown via End Session 1 Select System > End Session. The End Session dialog window opens. 2 Click Shutdown System. System Shutdown via System Manager 1 Select System > Control. The System Manager dialog window opens. 2 Open the Host subtask card (refer to Operator Manual - System and data management). 3 Click Shutdown All. 4 To shut off the system, confirm the safety query with Yes. Once you have closed down all programs and the operating system, you must switch off the components of the measurement system via the alarm box. That way you ensure that the MARS processor boots up when you start the system (refer to Operator Manual - MR System). Restarting the system An error in the operating system requires a restart of the syngo Acquisition Workplace. Restarting the system via End Session 1 Select System > End Session. The End Session dialog window opens. 2 Click Restart System. Restarting the system via System Manager 1 Select System > Control. The System Manager dialog window opens. 2 Open the Host subtask card. 56 Scanning and postprocessing Operator Manual

57 Frequent tasks and tools 3 3 Click Reboot. 4 To shut off the syngo Acquisition Workplace, confirm the safety query with Yes. The syngo MR program and the operating system are shut down and started again. Restarting syngo MR An error in syngo MR requires a restart. The program can be shut down and restarted separately. Restarting syngo MR via End Session 1 Select System > End Session. The End Session dialog window opens. 2 Click Restart Application. Restarting syngo MR via System Manager 1 Select System > Control. The System Manager dialog window opens. 2 Open the Host subtask card. 3 Click Restart syngo MR. The program syngo MR shuts down and restarts. The operating system is not shut down. 3.2 Frequently used tools Keyboard shortcuts General Action Keyboard operation Copy Ctrl + C Cut Ctrl + X Paste Ctrl + V Delete selected object or text Del syngo MR E11 57

58 3 Frequent tasks and tools Action Start next measurement (Continue) Keyboard operation F12 Depending on workflow status or active dialogs, Continue may apply to multiple functions simultaneously. In this case Continue is automatically assigned to the function with the highest priority: Start the breathhold measurement (Scan Breathhold function of the Inline Display) End the current measurement and start the next one in the queue (Stop & Continue function of the Inline Display) Close the Exam paused dialog window during measurements with/ without contrast agent and perform the next measurement (Continue of the program scheduler) Go to the next control element within the task card Go to the previous control element within the task card Switch task card Tab Shift + Tab Ctrl + Tab Parameter cards Action Go to the next parameter card Go to the previous parameter card Go to the next parameter subtask card Go to the previous subtask card Go to the next parameter Go to the previous parameter Increase numerical value Decrease numerical value Keyboard operation Ctrl + right arrow key Ctrl + left arrow key Ctrl + Shift + right arrow key Ctrl + Shift + left arrow key Tab Shift + Tab Up arrow key Down arrow key 58 Scanning and postprocessing Operator Manual

59 Frequent tasks and tools 3 Action Accept numerical value Keyboard operation Enter or Tab (go to the next parameter) Scroll to next parameter in the parameter set Up arrow or right arrow key Scroll to previous parameter in the parameter set Down arrow key or left arrow key Activate/deactivate checkbox Enter or Space bar Expand/collapse selection list Select entry from selection list Enter Up/down/right/left arrow key or Home to first input or End to the last input Apply entry from selection list Enter or Esc or Tab (go to the next parameter) Select button (e.g. for coil selection) Enter or Space bar Inline Display The following shortcuts are applicable when the mouse focus is on the Inline Display. Action Go to the next icon (set focus) Go to the previous icon (set focus) Keyboard operation Tab Shift + Tab syngo MR E11 59

60 3 Frequent tasks and tools Action Apply function of the icon with focus Keyboard operation Enter or Space bar Operating the Stop & Continue icon with the keyboard allows concentrating on the image display without caring about the position of the mouse UI explanation Exam task card 60 Scanning and postprocessing Operator Manual

61 Frequent tasks and tools (1) 3 Displays reference images in each segment. The reference images are used to position graphic measurement objects (slices, slabs). (2) Displays previously measured images in the stamp segments. Each stamp segment represents a series. Stamp segments do not allow graphic slice positioning. While you can window images in stamp segments, you cannot zoom or pan them. (3) Displays the program control and information on the current patient data. ( Page 63 Toolbar of the program control) (4) Displays the wait queue. ( Page 66 Wait queue) (5) Displays information regarding the open protocol. ( Page 64 The Protocol info line) (6) Displays the toolbar with buttons for editing and controlling the measurement. ( Page 62 Toolbar of the Exam task card) (7) Details view: The parameter cards of the current protocol are displayed. ( Page 65 Program Card) syngo MR E11 61

62 3 Frequent tasks and tools (8) Dot view: A user guidance or most important parameters of the current protocol are displayed. Toolbar of the Exam task card Opens the Position toolbar. ( Page 148 Position toolbar) Starts the Inline Display. At the first call-up, the Inline Display appears at the position of the left GSP segment. Afterwards, the Inline Display displays the last position. ( Page 202 Inline display) Opens the Table positioning dialog window. ( Page 114 Table positioning) Opens the Physiological display. ( Page 184 Physiological display) Displays the Parameter Card or the Dot Cockpit (Operator Manual - Dot Cockpit). This split button is extended (flyout) via the arrow for accessing both options. Opens the SAR information dialog window. The fill level and percentages displayed on the icon indicate to what degree the estimated highest SAR value of the measurement approximates the critical SAR limit. ( Page 185 SAR information Prediction) Switches between Dot view and Details view. 62 Scanning and postprocessing Operator Manual

63 Frequent tasks and tools 3 Toolbar of the program control Opens the Patient View of a Dot Engine examination. Toggles the protocol marker presented in the queue between Image Comment, Body Part Examined and Studies. Opens the Apply Contrast Agent dialog window. Opens the protocol. Duplicates the protocol and starts scanning. Cancel Applies changes. Recycle bin for deleting program steps via drag & drop. Stops the measurement. Pauses the measurement. Starts the measurement. Skips the measurement. syngo MR E11 63

64 3 Frequent tasks and tools The Protocol info line The protocol info line is located directly above the parameter card stack. (1) Total measurement time of the protocol with current settings (2) Abbreviation for the positioning mode of the protocol (see Parameters and Image text documentation for further details). (3) PAT acceleration factor When PAT is switched on, the product of both acceleration factors PE and 3D is shown. (4) Acquired voxel size for current parameter settings Tooltip shows the reconstructed voxel size. (5) Relative signal-to-noise ratio (SNR) (6) Sequence type 64 Scanning and postprocessing Operator Manual

65 Frequent tasks and tools 3 Program Card (1) Defines the examination region. (2) Displays available examinations for the selected region. (3) Displays the selected measurement program. (4) Displays available measurement programs for the selected examination. (5) Displays the program steps for the selected measurement program. syngo MR E11 65

66 3 Frequent tasks and tools Wait queue (1) Completed measurement (2) Canceled or skipped measurement (3) Measurement in progress (4) Open protocol (5) Element not yet executed in queue (6) Series icon (7) Selected protocol (8) Display of the measurement time of the protocol (9) Display of the remaining overall measurement time 66 Scanning and postprocessing Operator Manual

67 Frequent tasks and tools 3 Protocol icons For protocols: Planning of the protocol is necessary. For example, the protocol needs to be opened and user interactions need to be performed. For decision steps: Forced decision. Queue will halt and open decision step before it continues with following protocols The protocol has to be started manually. The protocol has to be started manually and can be measured multiple times in sequence. The protocol is a Set-n-Go protocol or a step within a Setn-Go protocol. The Set-n-Go protocol has to be started manually. The measurement was canceled or skipped. Image inline functionality is selected for this protocol. For pauses: Contrast agent pause For protocols: Contrast agent has been administered Before or after measuring a protocol, a patient instruction is automatically inserted. Before or after measuring a protocol, a patient instruction needs to be given manually. The protocol is linked to an automatic patient instruction which does not have a voice output. The symbol is shown following a corresponding system message. The protocol is the source of a copy reference. syngo MR E11 67

68 3 Frequent tasks and tools The protocol is the target of a copy reference. The number shows the source of the copy reference. The protocol is the target of a copy reference and parameter conflicts occured during updating the copy reference. The protocol is the target of a copy reference which is ineffective due to an error. Selection list to make a decision (Decision steps) Indicates the successful computation of the AutoAlign references. AutoAlign verification symbol. Estimated measurement time of the program step The remaining measurement time of a running protocol is depicted graphically. Busy indicator. Indicates that a step-specific task is being processed. For protocols that are measured multiple times (Multi- Load-Start protocols) and for Set-n-Go protocols, individual step numbers are generated for each measurement consisting of the original protocol number followed by an ascending decimal number. Series icons in the program step Reconstruction of the series has started. During the measurement, only one series was generated. All images of this series were fully reconstructed. 68 Scanning and postprocessing Operator Manual

69 Frequent tasks and tools 3 A number of images of the first series were reconstructed. During the measurement, several series were generated. All series were completely reconstructed. During the measurement, several series were generated. Only some of the images were reconstructed. Icons in the status bar There is at least one system error. Measurements are not possible until the error is corrected. The previous measurement has at least one acquisition error. The error does not affect subsequent measurements. By starting a new measurement, all errors in the previous measurement are reset. There are no acquisition errors. There are no errors after reconstruction. Errors were reported that occurred sometime between image reconstruction or post-processing and image storage to the database. Indicates that Dynamic Analysis is in progress. Indicates that image is filtered. Protocol markers in the wait queue Indicates an image comment. When the mouse pointer is placed over a protocol marker, the comment if existing is displayed. ( Page 91 Changing image comments) syngo MR E11 69

70 3 Frequent tasks and tools Indicates Body Region Examined. ( Page 89 Changing Body Part Examined) Indicates a procedure step. The procedure step is automatically assigned during patient registration. When the mouse pointer is placed over the protocol marker, the assigned procedures (with accession number) of the program step are displayed. ( Page 90 Changing procedure steps) 70 Scanning and postprocessing Operator Manual

71 Preparing an examination 4 4 Preparing an examination 4.1 Patient registration Composing a measurement program Table positioning 114 syngo MR E11 71

72 4 Preparing an examination Patient registration General information Patient registration When the Security Package is activated, you can register a patient only if you are authorized. With the InvokeRegistration, you can open the registration form and perform registration. Missing or contradictory patient data You can open the Exam task card only if the height, weight, sex, age, and position of the patient are entered, and all entries for the studies are consistent. In case of inconsistencies, the weight of a patient registered in the RIS can only be changed by re-registering the patient: Register the patient from the worklist without starting a measurement, search the patient in the local database, register a new study, and enter the correct weight. Re-link the re-registered patient to the worklist request by entering the accession number. Caution Incorrect input of patient-related data! Wrong identification and marking Verify that the patient name has been entered correctly. Prior to the MR examination, correct the data for patient orientation, especially if the patient is to be repositioned during the examination. 72 Scanning and postprocessing Operator Manual

73 Preparing an examination 4 Caution The internal identification of patient data, e.g., studies, series, and images, uses the system time for generation of the patient identification. If it is necessary to turn the system clock back duplicate identified may be created. Data may be assigned to wrong patient. If it is necessary to turn the system clock back for synchronization purposes, wait until the previous clock setting has been passed before creating new patient data. Caution The operating system may not support all characters for the received DICOM document. The display of the name e.g. the patient name may be incomplete or misleading. syngo will not change the used characters (e.g. minority characters) even if it cannot display them. Use other attributes for identification if possible. Caution When working with several monitors, the patient name displayed in the folder of a task card belongs only to this task card. Any other visible task card may contain data from another patient. Wrong diagnosis is possible. Use patient demographics displayed in the image text for clear identification. syngo MR E11 73

74 4 Preparing an examination Caution Automatic registration for compare layout is not sufficient. Insufficient diagnosis basis. Check registration and use manual registration functionality to re-adjust registration if automatic registration is not sufficient Task Registering a patient at your scanner 1 Press the Patient Registration key on the symbol keypad (Num 0). The Patient Registration dialog window opens. 2 As a minimum, fill out the compulsory fields (e.g. Last Name, Patient ID) displayed in bold. If the patient is already registered, search for the patient with the Search button. 3 Click the Exam button. The confirmation page is displayed. 4 Change the values in the undimmed input fields and selection lists, according to the examination. 5 Confirm the changes with Confirm. The patient is registered. If you do not enter a patient ID, the system automatically assigns a unique identification code derived from the date, time, abbreviation for daylight-saving or standard time, and the identification number of your system. 74 Scanning and postprocessing Operator Manual

75 Preparing an examination 4 Registering a patient from the database Patient Browser with registered patients is open 1 Select the required patient from the scheduler of the Patient Browser and double-click on the entry. The Patient Registration dialog window opens. 2 Check and, if necessary, change the values in the undimmed input fields and selection lists. 3 Click the Exam button. The confirmation page is displayed. 4 Change the values in the undimmed input fields and selection lists according to the examination. 5 Confirm the changes with Confirm. The patient is registered. Preregistering patients If you preregister a new patient, you can later call the patient from the Patient Browser when performing the examination. 1 Press the Patient Registration key on the symbol keypad (Num 0). The Patient Registration dialog window opens. 2 As a minimum, fill out the compulsory fields (e.g. Last Name, Patient ID) displayed in bold. 3 Click the Preregister button. The patient is preregistered in the scheduler of the Patient Browser. Registering the patient to continue the examination During registration, you can link a new examination with an already existing study (e.g. from the previous day). 1 Open the Patient Browser. 2 Select the study of the patient in the local database. 3 Press the Patient Registration key on the symbol keypad (Num 0). Most data are already set by linking the study with the previous day. syngo MR E11 75

76 4 Preparing an examination 4 Enter missing examination data. 5 Apply data for the examination. The system does not create a new study. The images measured are added to the study selected during registration UI explanation Patient registration dialog window Patient > Registration (1) Defines the patient data (compulsory fields in bold) (2) Defines additional data of the physicians 76 Scanning and postprocessing Operator Manual

77 Preparing an examination 4 (3) Control buttons (4) Defines data concerning the examination (compulsory fields in bold) (5) Defines additional data of the hospital Patient registration confirmation pages Depending on the study (e.g. single/multi study) different confirmation pages are displayed. Patient > Registration > Exam syngo MR E11 77

78 4 Preparing an examination (1) Displays the safety-relevant patient information. First Level Mode SAR Switches the examination to the First Level mode ( Page 174 Increasing SAR tolerance). First Level Mode Stimulation (2) Increases the db/dt tolerance ( Page 176 Increasing db/dt tolerance). Displays general medical information. Only available if the patient was registered via HIS/RIS. (3) Defines the measurement program. Frequent Shows a filtered examination tree. Patient was registered via HIS/RIS: The most frequently used examinations for the requested procedure are displayed. Patient was registered locally: The most frequently used examinations of local registrations are displayed. All Programs Shows the whole examination tree. Load Program to Queue (4) Automatically loads the measurement program to the wait queue after registration confirmation. Defines the study-specific information. Study Part Defines the assignment of individual studies to requested procedures in case of a multi study examination. 78 Scanning and postprocessing Operator Manual

79 Preparing an examination 4 Study Description Sets the name of the study in the Patient Browser. Add Study Comment Adds a study comment, which is additionally copied to the image comment. The image comment is usually configured in the image text. Multiple fields for assigning studies to requested procedures are displayed only if the examination consists of more than one study. (5) Assigns the Body Part Examined and laterality information to program steps. 4.2 Composing a measurement program General information Follow-up examinations If you want to perform a follow-up examination for a patient, you reconstruct it from the examination by using PhoenixZIPs ( Page 79 PhoenixZIP). Manual loading of PhoenixZIPs from the PACS and manual entry of PhoenixZIPs into the program control is necessary to perform the follow-up. PhoenixZIP The PhoenixZIP or the Phoenix Evidence Document (PED) is a structured report in the DICOM format. PhoenixZIP is used for the efficient storage and transport of protocol information. It ensures optimal follow-up examinations within the workflows of hospitals. Information carrier PhoenixZIP: PhoenixZIP plays a central role in the reconstruction of examinations. syngo MR E11 79

80 4 Preparing an examination When initiating a new examination, a PhoenixZIP is automatically generated once per protocol and stored together with the measurement results as soon as the last image reconstruction of the measurement has been completed. For Set-n-Go protocols, one PhoenixZIP per Set-n-Go-protocol is generated. PhoenixZIP: contains important information used to perform followup examinations. Protocol-specific information: PhoenixZIP contains all protocol data of the measurement protocols and protocol properties required to reconstruct an examination accurately. For example: Modality Performed procedure step System type Software version Field strength Protocol name Name of sequence FoV read FoV phase Acquisition time Echo time Repetition time Flip angle Number of slices Image type of the images measured Automatic adjustment Adjustment is important to obtain high-quality images. 80 Scanning and postprocessing Operator Manual

81 Preparing an examination 4 Adjustment is configured on the System Adjustments parameter card. The MR system automatically adjusts prior to each protocol. Reuse of adjustment results: To avoid performing a complete adjustment each time, the system uses the adjustment results of a previously measured protocol. Usually the results can be applied only if the following parameters of the two protocols remain unchanged: Table position Coil elements used Shim mode (Standard / Advanced /Tune-up) Adjustment volume Adjustment results are only valid within an examination. Dependency on coil elements can be avoided by selecting Adjust with body coil on the System Adjustments parameter card. Dependency on the adjustment volume can be avoided by using the shim mode Tune-Up without water suppression. Adjustment tolerances: During measurements with a changed table position, adjustment values of similar table positions may be used by determining adjustment tolerances in place of new adjustment values. The adjustment tolerance depends on the adjustment type on the MR system and/or individual sequences. However, it is automatically limited by both patient safety and the image quality desired. Adjustment volume: An adjustment volume is defined for each protocol. Most adjustments are referenced to this volume, which you can change as required. AutoAlign AutoAlign is the method for automatic positioning and alignment of slices for an MR examination. AutoAlign provides alignment algorithms for different anatomical regions, for example: syngo MR E11 81

82 4 Preparing an examination Head Spine Knee Refer to Operator Manual System and data management. Study split Multiple examination requirements planned in the HIS/RIS system (e.g., head and cervical spine) can be performed in one session. For each requested procedure, a study is created. Advantages of several studies: Direct allocation of the individual studies in the documentation and billing Easier distribution of the studies to the reporting radiologist (reporting stations) The assignment of studies to requested procedures in the patient registration can be changed during the examination ( Page 90 Changing procedure steps) and after the examination (refer to Operator Manual System and data management), if neccessary. Image numbering Numbering is determined by the orientation and position of the images and performed according to slice groups. It is independent of the slice positioning, excitation sequence, and number of concatenations in multi-slice measurements. Numbering rules: Primary order The images are divided into sagittal, coronal, and transverse groups according to their main orientation. Secondary order The slices are numbered according to their position in ascending or descending order. After the measurement, you may view the numbering of the reconstructed images in the Position Display of the Viewing task card, in the image area of the Viewing task card or in the Patient Browser. 82 Scanning and postprocessing Operator Manual

83 Preparing an examination 4 Study information There are different types of study information: Procedure Step/Study Body Part Examined Image comment A study may contain several different procedure steps, body parts examined and image comments. Procedure Step/Study: If your system is connected to an RIS, you can obtain work requests via the HIS in the form of procedure steps for your MR system. During patient registration, a note regarding the procedure step is created in the queue. The information for the procedure step is now available for further processing within the hospital (refer to MPPS in the Operator Manual - System and Data Management). Procedure steps are used for study splitting ( Page 82 Study split), ( Page 90 Changing procedure steps). Body Part Examined: With the body part instruction range, the images to be measured are provided with information regarding the body part. This information is visible and editable in the Patient Browser. It can be evaluated, for example, via a hospital information system. The body part to be examined is defined during patient registration. You can change the presettings for the examination region in the wait queue ( Page 89 Changing Body Part Examined). Image comment is saved with the image in the image database. Image comments appear as image text in the series. Measurement of large examination regions To avoid image distortions, the examination regions should be as close to the isocenter as possible. In this region, the magnetic field lines run in parallel. syngo MR E11 83

84 4 Preparing an examination Set-n-Go measurement: With Set-n-Go measurements, large examination regions are divided into several sections that each fit in the MAGNETOM isocenter. The table is moved to the optimum position (MAGNETOM isocenter) according to isocenter protocols. The images resulting from each measurement step are used to compose an overall image. TimCT measurement: During TimCT measurements, the table moves continuously. This way, large examination regions are measured in their entirety Assembling the measurement program Selecting a measurement program or program step It is possible to insert program steps or to add complete programs to the queue, even if they are from other body regions. ( Page 87 Changing the sequence of pauses/program steps) Prepare all head and knee protocols in the Dot Cockpit with an AutoAlign reference. If you measure such a protocol without AutoAlign scout, the reference is ignored automatically. Patient is registered 1 Click this icon to open the Program Card. 84 Scanning and postprocessing Operator Manual

85 Preparing an examination 4 2 Select the SIEMENS or the Customer exam database.. 3 Open the program tree to display the desired measurement programs (regions > exams > programs). If you do not find a suitable measurement program, you can assemble individual programs in the Dot Cockpit and transfer them to the wait queue (Operator Manual - Dot Cockpit). 4 Select a measurement program to display the contained program steps in the right area of the Program Card. 5 To transfer complete measurement programs, select them in the program tree and click this icon or drag & drop them into the wait queue. or To transfer individual program steps, drag & drop them from the Program Card into the wait queue. If the selected measurement program is a Dot Engine, you can only transfer the complete measurement program. Reconstructing protocols from images (Phoenix) You can reconstruct protocols from previously measured images. syngo MR E11 85

86 4 Preparing an examination Patient is registered Drag an image or series into the wait queue of the program control. The resulting protocol is appended at the end of the queue. For Set-n-Go protocols: The corresponding step is reconstructed from an image. The complete protocol is reconstructed from a series. If you reconstruct protocols from images measured with a different software version or that come from another MAGNETOM, the system performs an additional conversion step. 86 Scanning and postprocessing Operator Manual

87 Preparing an examination 4 Performing follow-up examinations Patient Browser is selected Scheduler is open Requested follow-up exam is selected If you do not have the required PhoenixZIP series on your system, you import it from the archive. 1 Mark the PhoenixZIP series and drag it to the program control with the mouse. The follow-up examination is reconstructed. If protocol conversion is necessary, a dialog which informs you that the protocols have to be converted appears prior to reconstruction. 2 Perform conversion and continue with the reconstruction by clicking OK. Inserting a measurement pause You insert a pause, for example, to administer contrast medium or to provide the patient with instructions. Patient is registered Select Append Pause from the context menu of the wait queue. The pause is appended to the end of the wait queue, and the Step Properties - Pause dialog window opens. ( Page 112 Step Properties Pause) Changing the sequence of pauses/program steps You can only modify the order in the part of the queue that has not been measured so far. Wait queue contains program steps Moving a program step syngo MR E11 Select one or multiple program steps and drag & drop them to the desired position within the wait queue. 87

88 4 Preparing an examination Cutting/Copying and inserting a program step 1 Select one or multiple program steps. 2 Select Cut from the context menu of the selected steps. or Select Copy from the context menu of the selected steps. 3 Select the program step in front of which you want to insert the cut program steps. 4 Select Paste from the context menu of the selected step. If no program step is selected in the wait queue prior to pasting, the program steps will be appended at the end of the queue. Deleting a program step You can delete individual steps or all program steps in the queue. Wait queue contains program steps Deleting individual program steps 1 Select one or multiple program steps. 2 Select Delete from the context menu of the selected steps. or Drag the selected steps into the recycle bin icon on the lower left side of the queue. Deleting all program steps Select Clear all from the context menu of the wait queue Editing study information In the wait queue, additional study information for the program steps can be displayed and modified using protocol markers. 88 Scanning and postprocessing Operator Manual

89 Preparing an examination 4 Select the scope of the protocol markers to be presented in the queue in the selection list of the upper program control area. The entry Standard shows the default view of the queue. Changing Body Part Examined When you select your measurement program, you automatically set the Body Part Examined of the program steps. If you want to change the body part examined during the examination, you can change the region set. The scope Body Part Examined is set for the protocol markers 1 Select the program steps to be modified (single or multi selection possible). 2 Click the region name in the protocol marker. The Body Part Examined dialog window opens. 3 Select a body part from the selection list. To edit, supplement, or reduce the list of selectable body parts, click the Manage button. 4 If necessary, select the laterality. 5 Click OK. syngo MR E11 89

90 4 Preparing an examination Changing procedure steps The procedure step ensures that all series and consumables of a study are available in the hospital information system for further editing. Every program step in the wait queue is assigned to one or more requested procedure steps according to the settings made during patient registration. This assignment can be changed in the corresponding protocol markers. Patient is registered The scope MPPS is set for the protocol markers Changing procedure step assignment 1 Select the program steps to be modified (single or multi selection possible). 2 Open the selection list of a protocol marker and edit the assignment by checking/unchecking the requested procedures. Every program step has to be assigned to at least one procedure. Editing procedure steps 1 Right-click the respective protocol marker. 2 Select MPPS Properties from the context menu. The Modality Performed Procedure Step dialog window opens. ( Page 113 Modality performed procedure step) 3 Enter the designation used for billing purposes in the Description field. 4 Record all services to be included for billing. Closing or terminating procedure steps 1 Right-click the respective protocol marker. 2 Select MPPS Properties from the context menu. The Modality Performed Procedure Step dialog window opens. ( Page 113 Modality performed procedure step) 90 Scanning and postprocessing Operator Manual

91 Preparing an examination 4 3 Click Completed to complete the procedure step. Further actions such as image calculations are no longer recorded for this procedure step. or Click Discontinued to cancel the procedure step. When you register or deregister a patient, you are not informed that the procedure step is incomplete. Changing image comments It is possible to add comments to program steps and modify them. Comments appear as image text in the series. If no image comment is entered in the program control, the comments entered in the patient registration are applied. You can change image comments for program steps that are not yet processed. The scope Image Comment is set for the protocol markers 1 Select the program steps to be modified (single or multi selection possible). syngo MR E11 91

92 4 Preparing an examination 2 Click the text field of the protocol marker and enter or edit the image comment Preparing protocols Propagating numbering settings You can propagate the image numbering set for consecutive protocols with similar table positions. When you activate the Inherit Image numbering setting of the Queue menu, the settings for image numbering via protocols are inherited as soon as they are opened for editing. However, this applies only to consecutive protocols with similar table positions. 1 Select a protocol. 2 Select Queue > Inherit Image Numbering. 3 Open a protocol with a similar table position. When you open the protocol, it automatically accepts the settings for image numbering of the previously processed and completed predecessor protocols. Setting the protocol properties 1 Select the pending protocol from the queue. 2 Select Properties from the context menu. The Step Properties dialog window opens. 3 Set the protocol properties as required. ( Page 101 Step Properties General) ( Page 102 Step Properties Voice Commands) ( Page 103 Step Properties Execution) ( Page 105 Step Properties Image Management) ( Page 106 Step Properties Auto Load) ( Page 107 Step Properties Copy References) 92 Scanning and postprocessing Operator Manual

93 Preparing an examination 4 4 To apply the changes, click OK. Configuring automatic adjustment Normally, the parameters should not be modified. All system adjustment settings made on the System parameter card only apply to the protocol currently open. 1 Open the required protocol in the wait queue. The parameters of the protocol are shown. 2 Select the System Adjustments parameter card (see Parameters and Image Text documentation). 3 Edit the automatic adjustment parameters. Activating coil memory and automatic coil selection Using the Coil memory or the Auto Coil select functions eliminates the need for manual coil selection tasks within the current protocol. Activating/deactivating Coil memory or Auto Coil select may be overruled by the protocol settings in the System - Miscellaneous parameter card. This is particularly relevant if coil elements will be selected manually. Coil memory To switch on coil memory, select Queue > Coil memory on the Exam task card. The coil selection from a previous protocol that was measured with the same or a similar table position is applied automatically. Automatic coil selection The Auto Coil Select icon indicates whether automatic coil selection is activated. To switch on automatic coil selection, select Queue > Auto Coil select on the Exam task card. All surrounding coils are selected automatically. syngo MR E11 93

94 4 Preparing an examination The maximum number of coils is limited by the number of system channels. For large measurement regions on systems with a low number of channels, it is possible that automatic coil selection does not yield the optimal results. Creating a Set-n-Go protocol Set-n-Go protocols are created from the regular FIX or ISO protocols (Positioning mode = FIX or ISO). The set-n-go checkbox on the Geometry Tim Planning Suite parameter card is activated 1 Select and open the required protocol in the program control. 2 Click this icon in the Tim Planning UI. The protocol is copied. The Set-n-Go protocol now consists of two steps, each containing the same sequence. Distortion correction is a prerequisite for Set-n-Go protocols. The Distort. Corr. parameter is automatically set to 2D. In the Set-n-Go protocol, you can change the majority of the step protocol properties independent of the other measurement steps. ( Page 101 Step Properties General) ( Page 102 Step Properties Voice Commands) ( Page 103 Step Properties Execution) ( Page 105 Step Properties Image Management) ( Page 106 Step Properties Auto Load) ( Page 107 Step Properties Copy References) 94 Scanning and postprocessing Operator Manual

95 Preparing an examination Adding a step 4 1 Select the step you want to copy in the Step selection list. 2 Select Protocol > Add Subprotocol. The selected measurement step is copied and appended at the end of the step list. Deleting a step The slices of the Step added are positioned according to the value in the Overlap dialog window. 1 Select a step in the Step selection list. 2 Click next to the selection list. The step is deleted. Setting the step parameters If only one measurement step is left, the protocol automatically changes to a single step protocol. 1 Select the step you want to edit in the Step selection list. 2 Define the measurement parameters of the step. ( Page 163 Adapting the measurement parameters) The modification of the step parameters does not affect the parameters of the other steps. Setting automatic composing of images from Set-n-Go protocols Set-n-Go protocols are open 1 Select the Tim Planning Suite parameter card. 2 Select the desired distortion correction in the Distortion Corr. selection list (2D or 3D). 3 Activate the Inline Composing checkbox. syngo MR E11 Inline Composing is only possible with distortion correction. 95

96 4 Preparing an examination 4 From the Composing Function selection list, choose the method for composing images. As soon as the Set-n-Go protocol is measured, a composed image is created from the images of the measurement step. Creating a Composing group You can compile multiple protocols into composing groups to examine large regions. The images from protocols of a group automatically create composed images. This function simplifies the planning of examinations which require measurements at different table positions. Note the limitations on using composed images. In contrast to Set-n-Go protocols, you cannot open and plan Composing groups together. The prerequisites for Inline Composing must be fulfilled. ( Page 302 General information) Allocating the protocol to a group 1 Select the desired protocol from the program control. 2 Activate the Inline Composing checkbox on the Inline Composing parameter card. If the Inline Composing checkbox is activated, the Distortion Corr. parameter is also activated 3 From the Composing Function selection list, select the method for composing images. 4 From the Composing Group selection list, select the composing group to which the protocol is to be assigned. The protocol is now part of the selected composing group. 96 Scanning and postprocessing Operator Manual

97 Preparing an examination 4 Closing the group Only if the last protocol of a Composing Group has the Last Step status, is the system able to compose the images into an overall image. 1 Open the last protocol of the Composing Group. 2 Activate the Last Step checkbox. The post-processing icons of this group are not crossed out anymore. If the composing group was not completed with the Last Step status, the Composing check dialog window appears at the beginning of the measurement. In this dialog window, you can set the status with Set last step for the current protocol or start the measurement anyhow with Continue. Setting TimCT measurements If the adjustment data for table move are only partially or not at all available, adjustment is performed automatically prior to the measurement. Setting additional adjustment 1 Open the Geometry TimCT parameter card. 2 Activate the Perform CTM adjustments checkbox. After the TimCT localizer measurement, additional adjustment is performed across the entire range of table movement (see Parameters and Image Text documentation for more information). Setting TimCT-specific parameters 1 Open the Geometry TimCT parameter card. 2 Define the parameters as required (see Parameters and Image Text documentation for more information). The settings of the TimCT-specific parameters are applied to all slice groups of the examination region. syngo MR E11 97

98 4 Preparing an examination Preparing pauses Setting the pause properties 1 Select Edit Properties from the context menu of the pause step to open the Step Properties - Pause dialog. ( Page 112 Step Properties Pause) You can only edit pause properties of pauses which have not yet been executed. 2 Click OK. Setting breathhold pauses With this method you define the pause time between the breathhold commands. The pause time is set in the Step Properties Voice Commands dialog or during the examination in the Patient View. The protocol is a breathhold protocol Concatenations are set on the Physio PACE parameter card 1 Select the protocol. 2 Open the Step Properties dialog with Properties from the context menu. 3 Define the pause time with Pause in the Use local settings area of the Voice Commands tab. Use this setting if you do not want to override the pause time during the examination with the settings of the Patient View. 4 Select the voice commands before and after the measurement on the Voice Commands tab. 5 Make sure that the parameter Pause after meas. on the Contrast Dynamic parameter card is not set. Otherwise the pause time will be ignored and the pause time is defined as described: ( Page 99 Setting pauses for dynamic protocols) 98 Scanning and postprocessing Operator Manual

99 Preparing an examination 4 (1) Breathhold protocols start with a pause (2) Automatic voice command (3) Acquisition a) Concatenation 1 b) Concatenation 2 (4) Pause between the automatic voice commands Setting pauses for dynamic protocols With this method you define the pause time between the measurements. This is typically used for dynamic Angio examinations. The protocol is a breathhold protocol The number of Measurements set on the Contrast Dynamic parameter card is greater than 1 1 Select the protocol. 2 Define individual pauses between measurements with Pause after meas. on the Contrast Dynamic parameter card. 3 Open the Step Properties dialog with Properties from the context menu. 4 Select the voice commands before and after the measurement on the Voice Commands tab. If the voice commands take too long for the defined pause time, the user is informed before the measurement starts. syngo MR E11 99

100 4 Preparing an examination (1) Dynamic protocols start with a pause (2) Automatic voice command (3) Acquisition a) Measurement 1 b) Measurement 2 (4) System checks that total time of automatic voice commands and pause set in the Step Properties Voice Commands dialog does not exceed Pause after meas. set on the Contrast Dynamic parameter card Saving programs or protocols Saving the queue as a new program You can save a modified measurement program as a new program. Wait queue of the program control contains protocols 1 Select Save as from the context menu of the wait queue. The Save Program As dialog window opens. 2 Perform the required settings. Please refer to Operator Manual - Dot Cockpit for further information. 100 Scanning and postprocessing Operator Manual

101 Preparing an examination UI explanation Step Properties General (1) Defines a unique protocol name. The name of the protocol is used as a series description for the images acquired with this protocol. It is shown, for example, in the Patient Browser. (2) Describes the protocol. When you put the mouse pointer on a protocol entry in the program control, the protocol designation and description are shown temporarily. syngo MR E11 101

102 4 Preparing an examination (3) Defines study information. Step Properties Voice Commands Voice outputs are patient instructions that occur mainly at measurements with breathholds. (1) No voice output will be played back. (2) Voice output will be played back according to the following settings: Option Voice commands Comment Defines whether the voice commands are played back automatically or manually. 102 Scanning and postprocessing Operator Manual

103 Preparing an examination 4 Option Before scan Comment Defines the individual voice commands to be played back After scan Pause Defines the duration of the pause between the voice commands. If no voice command is selected, this option defines the duration of the pause between the breathholds. (3) The Dot settings of the Patient View are used. The parameters are displayed read-only. Step Properties Execution (1) Activates automatic start of the measurement without further preparation. syngo MR E11 103

104 4 Preparing an examination Localizers are usually started automatically without being checked. (2) Defines manual start of the measurement. Option Single measurement Comment Identifies protocols that allow for only one manual start-up. Repeated measurement Auto Start Identifies protocols that allow for multiple loading and measurements. Prior to each new measurement, a dialog window allowing you to start the protocol is displayed. Suitable for measurements with countdown. When clicking the Start button on the Exam paused dialog window, the measurement starts immediately after the countdown has expired. Note: When automatic voice commands are selected, the duration of the voice command is part of the countdown. If you have recorded a voice output on your system, you can perform this type of examination without manual start-up. (3) Defines image reconstruction at a higher priority. Reconstruction is performed parallel to the measurement and not appended at the end. The reconstruction of the images parallel to the measurement is limited to a certain raw data volume. The next measurement is started only when all current raw data have been reconstructed. 104 Scanning and postprocessing Operator Manual

105 Preparing an examination 4 (4) Activates automatic opening/closing of the inline display when the protocol is measured/the measurement is completed. Step Properties Image Management (1) Loads images automatically into the Viewing task card. If you reconstruct more than 400 images for a protocol, automatic loading into Viewing is no longer possible. (2) Prevents automatic DICOM transfer of images from the current protocol. syngo MR E11 105

106 4 Preparing an examination (3) Creates a position display for every measured series. The selection list defines the reference images to be used. If you activate the Load images to viewer checkbox, the position display of the series is automatically loaded into Viewing. Step Properties Auto Load (1) Loads the measured images automatically into the stamp segments. (2) Loads the measured images automatically into a GSP segment of the Exam task card. The selection list defines the required GSP segment. 106 Scanning and postprocessing Operator Manual

107 Preparing an examination 4 Step Properties Copy References (1) Activates the Copy References function and defines the source protocol step. For Dot Engines: Copy References cannot be set across strategies. It is recommended activating Copy References only in Simulation Mode of the Dot Cockpit. syngo MR E11 107

108 4 Preparing an examination (2) Parameter group Center of slice groups & Saturators Parameters Coil element selection (without matrix mode) Slice/slab groups Position, orientation and rotation Sat. regions Position, orientation and thickness Navigators Position, orientation, rotation, extension in phase-encoding and readout direction, thickness Slices and sat. regions Coil element selection (without matrix mode) Slice thickness Slice/slab groups Number of slices/slab groups Number of slices/slabs per group Position, orientation, rotation, distance factor Sat. regions Number, position, orientation and thickness of sat. regions, Number, thickness and gap of parallel/tracking sat. regions sat. mode Navigators Position, orientation, rotation, extension in phase-encoding and readout direction, thickness 108 Scanning and postprocessing Operator Manual

109 Preparing an examination 4 Parameter group Slices Parameters Coil element selection (without matrix mode) Image numbering Slice thickness Slice/slab groups Number of slices/slab groups Number of slices/slabs per group Position, orientation, rotation, distance factor Navigators Position, orientation, rotation, extension in phase-encoding and readout direction, thickness Saturation Sat. regions Position, orientation, position and thickness Parallel/tracking sat. regions Number, thickness and gap Saturation mode syngo MR E11 109

110 4 Preparing an examination Parameter group Measurement parameters Parameters Coil element selection (without matrix mode) Image numbering FoV slice FoV readout FoV phase Basic resolution, phase resolution, slice resolution phase oversampling, slice oversampling slice thickness Radial views, radial interleaves, BLADE coverage Slice/slab groups Number of slices/slab groups Number of slices/slabs Position, orientation, rotation, distance factor, phase-encoding direction Sat. regions Number, position, orientation and thickness of sat. regions, Number, thickness and gap of parallel/tracking sat. regions Sat. mode VOI for Spectroscopy Interpolation resolution for CSI Navigators Position, orientation, rotation, extension in phase-encoding and readout direction, thickness Adjustment volume Shim mode Position, orientation, rotation and extension of the adjustment volume Everything Table position All parameters including the sequence Table position of the protocol 110 Scanning and postprocessing Operator Manual

111 Preparing an examination 4 Parameter group Navigators Parameters Position, orientation, rotation, extension in phase-encoding and readout directions, thickness A multi-selection of protocols can be copied, unless it contains decision steps or Dot-Engine-specific workflow steps. (3) Copies phase-encoding direction. The phase-encoding direction of navigators cannot be overwritten. (4) Copies all steps of the protocol to the target protocol of a Set-n-Go protocol. (5) Applies the setting of the Last Step parameter (thus it is applied to the target protocol for Inline Composing). (6) Copies all steps to the target Set-n-Go protocol. Step Properties Preview Refer to Operator Manual Dot Cockpit. syngo MR E11 111

112 4 Preparing an examination Step Properties Pause (1) Defines the name of the pause. The name should describe the purpose of the pause. (2) Provides an entry field for an optional comment. (3) Activates the Contrast agent selection field and the Catalog button. (4) Defines the required contrast agent. Catalog Opens the Contrast Agent Catalog dialog window for selection of the required contrast agent. 112 Scanning and postprocessing Operator Manual

113 Preparing an examination 4 Modality performed procedure step (1) Defines the designation used for billing purposes. (2) Terminates the procedure step, e.g. if the examination cannot be executed as planned. (3) Closes the procedure step. syngo MR E11 113

114 4 Preparing an examination Table positioning General information You can control the patient table movement by using either the control panel next to the magnet bore or the software at the syngo Acquisition Workplace in the control room. If you register a patient after the table was positioned, the Dot Display and the Table positioning dialog show the wrong table position. When the first measurement is started, the correct table position will be shown Tasks Moving the table to the isocenter 1 Position the laser light localizer on the examination area. 2 Move the table and the patient to the isocenter of the examination with this icon. Moving the table by a certain distance You may position the patient table with millimeter precision in the Table Positioning dialog window. 1 Enter the distance by which you want to move the patient table in the Move table by field. 2 Move the patient table into or out of the magnet by the distance specified with these buttons UI explanation Table positioning View > Table Positioning 114 Scanning and postprocessing Operator Manual

115 Preparing an examination 4 (1) Displays the distance between the magnet isocenter and the slice marked (by light localizer). (2) Moves the patient table precisely into the center of the measurement field. Center of measurement field Position of the last measurement Position marked by the light localizer Condition The marked position and the position of the last measurement are not identical. The table is at the position identified by the light barrier. A measurement has not yet been performed. - or - The marked position and the position of the last measurement are not identical. The table is at the position of the last measurement. syngo MR E11 115

116 4 Preparing an examination Center of measurement field Measurement plane of the head coil Isocenter without light localizer Condition The marked position and the position of the last measurement are not identical. The measurement or identification with the light localizer was not performed. Some protocols provide isocenter positioning of the patient (assigned on the scanner) without laser light marker for a fast start of the measurement. Note: This automatic patient positioning is only provided for the following patients: Female: cm Male: cm When you press this button during the examination workflow, the table is alternately moved between the last measurement position (first click) and the zero point of the examination (next click). (3) Moves the patient table into/out of the magnet by the distance specified. (4) Stops table movement. (5) Cancels table stop. (6) Moves the patient table completely out of the magnet. 116 Scanning and postprocessing Operator Manual

117 Preparing an examination 4 Never move the table to home (requires confirmation) or change coils (invalidates adjustments) after the Exam paused dialog is shown for automatically starting protocols. Both events will independently prevent the measurement from being started. Do not lower the table when you want to continue the examination! When the table is lowered, the examination is considered complete. The system assumes that you now want to register and examine the next patient. All reference images are removed from the image area. (7) Switches on the ventilation in the magnet bore (click again to increase/decrease) (8) Switches on the lighting in the magnet bore (click again to increase/decrease) syngo MR E11 117

118 4 Preparing an examination 118 Scanning and postprocessing Operator Manual

119 Performing an examination 5 5 Performing an examination 5.1 Measuring and loading reference images Planning the examination volume Scanning Viewing and editing images during examinations 192 syngo MR E11 119

120 5 Performing an examination Measuring and loading reference images General information Introduction To perform the examination, you need to have full access rights. Detailed information regarding all security settings in syngo are included in the syngo Security Package brochure. Reference images from localizer: The localizer is the first program step. The reference images are displayed in the image area of the Exam task card once the localizer measurement and image calculation have been completed. Automatically loading images: According to the protocol properties, the measured images are loaded automatically Into a GSP segment of the Exam task card and/or Into the stamp segments where each stamp represents a series. ( Page 106 Step Properties Auto Load) Prerequisites for reference images Unsuitable images: The following images cannot be used as reference images: Mosaic images Secondary capture images (e.g. alpha images of the BOLD evaluation) 120 Scanning and postprocessing Operator Manual

121 Performing an examination 5 Curved cuts of the 3D evaluation Distortion-corrected images with too much distortion (image type DIS2D* or DIS3D*) Table position: Depending on how the table position of the protocol is determined, the prerequisites to be met by the reference images differ. Positioning mode of protocol Fixed table position Positioning mode = FIX Table position of reference image Positioning mode = REF Isocentric protocols Positioning mode = ISO Reference images Non distortion-corrected images (image type ND) with identical table position Distortion-corrected images (image type DIS2D/ DIS3D) with random table position Non distortion-corrected images (image type ND) with identical table position Distortion-corrected images (image type DIS2D/ DIS3D) with identical table position All distortion-corrected images (image type DIS2D or DIS3D). See Parameters and Image Text documentation. Dependencies between the table position, reference image, and protocol You can plan your measurements on non-distortion-corrected (image type ND) and distortion-corrected reference images (image type DIS2D or DIS3D). syngo MR E11 121

122 5 Performing an examination When you use non-distortion-corrected reference images (image type ND), the table position of the protocol has to match the table position of the reference images. Therefore you can use a FIX protocol with an identical table position or a REF protocol with an automatic propagation of the table position. For distortion-corrected reference images (image type DIS2D or DIS3D), you can plan protocols with freely selectable positioning modes (REF, FIX or ISO). The table position of the protocol does not have to agree with the reference images. Isocenter measurements can only be planned for distortioncorrected reference images (protocol with ISO positioning mode). In these protocols, the table position is automatically determined by the system so that the common center of all positioned slices is located as completely as possible in the magnet isocenter during a later measurement. To this end, the relationship between the table positions of the reference images and the protocol parameters of the table position must be known. Reference images while opening a protocol: Depending on the Positioning mode of the protocol to be opened, the effects with respect to the reference images displayed and the table position of the protocol are different. FIX Protocol REF Protocol ISO Protocol Open protocol with loaded reference images The table position of the protocol remains unchanged. Suitable reference images are sought. The protocol takes the table position of the reference image selected. Reference images remain unchanged. DIS images are loaded: Reference images remain unchanged. ND images are loaded: Reference images are unloaded. The table position of the protocol remains unchanged. 122 Scanning and postprocessing Operator Manual

123 Performing an examination 5 FIX Protocol REF Protocol ISO Protocol Open protocol without loaded reference images The table position of the protocol remains unchanged. The current hardware table position is propagated to the protocol. The table position of the protocol remains unchanged. Suitable reference images are sought. Suitable reference images are sought. Suitable reference images are sought. Load reference images while the protocol is open: The image type of the reference images to be loaded has varying effects on the table position of the respective protocol. FIX Protocol REF Protocol ISO Protocol DIS images with other table positions are loaded DIS images are loaded. The table position of the protocol remains unchanged. DIS images are loaded. The protocol takes the table position of the reference image. DIS images are loaded. The table position of the protocol remains unchanged. ND images with other table positions are loaded ND images are loaded. The protocol takes the table position of the reference image. ND images are loaded. The protocol takes the table position of the reference image. ND images are canceled. ISO protocols cannot be planned with ND images. Composed images are loaded Composed images are loaded. Composed images are loaded. Composed images are loaded. The table position of the protocol remains unchanged. The table position of the protocol remains unchanged. The table position of the protocol remains unchanged. Composed images can only be loaded simultaneously with DIS images as reference images. Navigate in reference images: Depending on the Positioning mode of the protocol, navigation with Series+/- differs due to the reference images. syngo MR E11 123

124 5 Performing an examination FIX Protocol REF Protocol ISO Protocol DIS Reference Image Freely-selectable navigation between all DIS series at all table positions. The table position of the protocol remains unchanged. Freely-selectable navigation between all DIS series at all table positions. The protocol takes the respective table position of the reference image. Freely-selectable navigation between all DIS series at all table positions. The table position of the protocol remains unchanged. ND reference images of the same table position Freely-selectable navigation between all ND series with identical table positions. Freely-selectable navigation between all ND series with identical table positions. Not applicable The table position of the protocol remains unchanged. The table position of the protocol remains unchanged. Manually change the table position of the protocol: Depending on the Positioning Mode of the protocol, manual changes in table position may differ. FIX Protocol REF Protocol ISO Protocol Change table position while DIS images are loaded Reference images remain unchanged. Protocol shifts to the newly entered table position. Table position cannot be edited. Reference images remain unchanged. Protocol shifts to the newly entered table position. Change table position while ND images are loaded The system looks for suitable reference images for the new table position. Table position cannot be edited. Not applicable Protocol shifts to the newly entered table position. 124 Scanning and postprocessing Operator Manual

125 Performing an examination 5 FIX Protocol REF Protocol ISO Protocol Change table position when no images are loaded The system looks for suitable reference images for the new table position. Table position cannot be edited. Protocol shifts to the newly entered table position. Protocol shifts to the newly entered table position. When you change a table position via Copy Parameter in a REF protocol or via a copy reference, the REF protocol is set to FIX. Change the mode of the protocol: Depending on the Positioning mode of the protocol, changes in the Positioning mode occur. FIX Protocol REF Protocol ISO Protocol Changing the Positioning mode Previously ISO or REF: Switch to FIX without affecting the protocol table position or the reference images. Previously ISO or FIX: The protocol takes the table position of the reference image. Previously FIX or REF: The isocentric table position is calculated. The slice positions remain constant Tasks Loading reference images manually You can use images from already measured protocols for graphic slice positioning. Try to avoid loading large data series or the system may slow down. syngo MR E11 125

126 5 Performing an examination To plan isocenter protocols and Set-n-Go protocols, the reference images must be distortion-corrected (image type DIS2D or DIS3D). For this purpose, the Distort. Corr. filter on the Resolution Common parameter card of the localizer must be set to 2D or 3D. Images are part of the current examination All images are part of the same series block Distortion correction matches with current protocol ( Page 341 General information on distortion correction) Table position matches with current protocol Loading a series from the program control 1 Select a protocol in the program control that has been processed either in part or in full. 2 Double-click the series icon. or If several series were generated for a measurement, single-click the multiple series icon and select the desired series by double-clicking the corresponding icon in the popup window. The series is loaded into the image area of the Exam task card. 126 Scanning and postprocessing Operator Manual

127 Performing an examination 5 Loading a series from the Patient Browser 1 Open the Patient Browser. 2 Select the images or series in the Patient Browser. 3 Use the mouse and drag the images or series into one of the reference image segments. Loading series into the segments If images are not loaded automatically into the segments, you can load them manually. Whether or not series are loaded automatically into a segment depends on the protocol properties or the configuration of the Dot add-in. syngo MR E11 127

128 5 Performing an examination Images are reconstructed Drag the series to the desired segments. You can change the layout of the series in the stamp segments as requested. If the destination segment is not empty, the previous series is replaced. Finding the best-suited reference image The Nearest function is used, e.g. in spectroscopy, to find the reference image best suited to the area of interest. 1 Select the required reference image in the loaded reference image series. 2 Select the graphic object. 3 If the graphic object has the same orientation as the reference image, select Tools > Copy Image Position. 128 Scanning and postprocessing Operator Manual

129 Performing an examination 5 4 Select Scroll > Nearest. The reference images with the planes nearest the position of the selected graphic object are automatically displayed in the other two segments. Navigating in stamp segments You can load any number of series into the stamp segments. A maximum of 12 series is displayed. Shifting all series by one segment To shift all series by one position to the left or right, click the respective arrow key in the outer left segment. Shifting series by 12 segments Press the Image up or Image down key. All series shift 12 segments up or down. Previously visible series are hidden. Jumping to the first/last series Scrolling from image to image in the stamp segment Use the Home or End key to jump to the first or last series. As in a large image segment, you can scroll from image to image. Press the appropriate key on the symbol keypad. When you keep the key pressed, the images are shown as a movie. Changing the layout of stamp segments You can remove series from the stamp segments and repeat the measurement. Load the new series automatically or manually back into the stamp segments. Removing stamp segments The Patient Browser is not affected by removing series via stamp segments. syngo MR E11 129

130 5 Performing an examination 1 Select the requested stamp segments. When you select stamp segments, the entire series is selected automatically. 2 Select Remove Segment from the context menu. Inserting an empty stamp segment 1 Select the segment in front of which you want to insert an empty segment. 2 Select Insert Segment from the context menu. Removing images from the image area Removing images from all segments Removing images from reference image segments Changing the distortion correction of reference images To remove images from all segments: Select Edit > Clear All Segments. To remove images from the reference image segments: Select Edit > Clear Graphic Segments. You can subsequently change the distortion correction of reference images. Thus the distortion correction of the entire series is changed. Requirements with respect to distortion correction of the reference images depend on the type of the protocol loaded. ( Page 341 General information on distortion correction) 1 Mark the reference image segment or stamp segment for the series where you want to change distortion correction. 2 Select Evaluation > Distortion 2D Correction or Distortion 3D Correction or Inverse Distortion 2D Correction. If the image type is suitable for the current protocol, the images of this series are loaded automatically as reference images. 130 Scanning and postprocessing Operator Manual

131 Performing an examination Planning the examination volume General information Slice positioning The measured reference images determine the position, extent, and orientation of the examined region. When opening a protocol, these settings are shown as graphic objects in the reference images: Slices or slabs from which images will be reconstructed later Saturation regions for avoiding motion artifacts Navigator objects when the protocol is based on a navigator sequence Slice boxes, ROIs, Markers as positioning aids in Dot Engines. Using the tools for positioning slices, the graphic objects of the protocol are adapted to the anatomy of the patient. Caution Use of mosaic images for displaying the slice position! Incorrect diagnosis due to erroneous display of slice position and/or angle Do not use mosaic images for displaying the slice position. Examination region: Slices should be positioned as close to the MAGNETOM isocenter as possible. In this region, the magnetic field lines run in parallel, ensuring optimum image quality. Distortions can occur outside of the isocenter. You can divide protocols with large examination regions into several protocols that fit fully in the MAGNETOM isocenter. ISO protocols automatically calculate the optimum table position and move the table to the MAGNETOM isocenter during the measurement. Slices / slabs Slices and slice groups: syngo MR E11 131

132 5 Performing an examination (1) Slice thickness (2) Slice distance (3) Phase FoV (4) Read FoV Slabs and slab groups: (1) Effective slice thickness (2) Read FoV (3) Phase FoV (4) Slab thickness Field of view (FoV): The field of view is defined by its length and width. The length and width correspond to the read-out and phaseencoding directions in the magnetic field. Thickness and distance: 132 Scanning and postprocessing Operator Manual

133 Performing an examination 5 Distance factor > 0% Distance factor = 0% Distance factor < 0% Saturation regions A saturation region is a volume where the MR signal is suppressed by an RF saturation pulse. Regular and parallel saturation regions: Regular saturation regions are numbered and may be positioned freely. Parallel or tracking saturation regions are always linked to a slice or slab group. Regular saturation region Parallel saturation region Asymmetric saturation regions: A special form of the regular saturation region is the asymmetric saturation region. This is a saturation region with a sharp edge that allows the saturation region to be positioned closer to the anatomy of interest. The sharp edge is indicated by the white line. syngo MR E11 133

134 5 Performing an examination Standard saturation region Asymmetric saturation region Tracking saturation regions: A tracking sat region is associated with and parallel to the slices of a slice or slab group. They can be on either side of the group. The tracking sat region passes through the slice/ slab group in either the ascending or descending direction. Orientation of the slice group Order of RF excitation Sat name Sagittal preferred Ascending Tracking R -> L Sagittal preferred Descending Tracking L -> R Coronal preferred Ascending Tracking A -> P Coronal preferred Descending Tracking P -> A Transverse preferred Ascending Tracking F -> H Transverse preferred Descending Tracking H -> F During acquisition, the saturation region tracks the most recently measured slice. The distance between the saturation region and this particular slice is the same as at the beginning of the measurement (distance to the first slice of the slice or slab group). 134 Scanning and postprocessing Operator Manual

135 Performing an examination 5 Navigator objects Navigator objects are used in special navigator sequences e.g. to record the movement of the diaphragm and uptake of contrast media, and to trigger the signal that starts the measurement. Navigator types: Left: Navigator pen (infinitely long pen); right: Navigator cuboid (finite cuboid volume) (1) Base size phase (normalized direction) (2) Base size read (phase-encoding direction) (3) Thickness (navigator direction) Compared to the cuboids, the pens are of infinite extent in the navigator direction. A two-dimensional excitation profile may be defined within the base area. This excitation profile is defined by the sequence. Depending on the application, it may have a rectangular, trapezoidal, or elliptical contour. Geometry parameters For graphical slice positioning, the most important geometry parameters are: Base resolution Phase resolution Slice resolution FoV readout and FoV phase Phase-encoding direction syngo MR E11 135

136 5 Performing an examination Phase oversampling Slice oversampling Tasks Selecting graphic objects Protocol is open Graphic objects are displayed in the reference images Click the center, a border line, or another element of the graphic object. The selected graphic object is highlighted by a different color. To select a graphic object which is close to the current selection, zooming the image and/or clicking a distant part of the target graphic object may be necessary to enable successful selection. Panning graphic objects Slice groups, slab groups, and saturation regions can be grouped in order to move them together with Tools > Coupled Graphics On. Protocol is open Graphic objects are displayed in the reference images Graphic object is selected Moving an object with the mouse 1 Click and hold the pivot handle with the mouse and drag the object to the desired position. The object position is updated on all reference images. If the pivot handle of an object is not visible in the reference image, proceed as follows: 2 Press Shift and keep the key pressed. 136 Scanning and postprocessing Operator Manual

137 Performing an examination 5 3 Drag the intersecting line to the desired position. Parallel and tracking saturation regions can be moved together only with slices or slabs that they have been assigned to. Moving slice group by half the slice distance 1 To move in the positive slice-selection direction, select Protocol > Gap filling +. 2 To move in negative direction, select Protocol > Gap filling. With manual breathhold measurements, you can pan the slice group in several steps so that some slices are congruent before and after panning. Moving slice group by group thickness 1 To move in the positive slice-selection direction, select Protocol > Stack +. 2 To move in the negative direction, select Protocol > Stack. Panning the slice group by its thickness is especially suitable for multiple breathhold measurements. Moving center of object in the reference plane 1 Select the reference image to be used as the reference plane. 2 Select Protocol > Shift to Image Plane. The center of the graphic object is moved into the reference plane and, if necessary, into the visible area of the image. You cannot use this function for saturation regions or for slice and slab groups located parallel to the reference image. Shifting the image in the Z direction In distortion-corrected reference images (image type DIS2D or DIS3D), you can move the graphic objects of the open protocol in the Z direction of the patient coordinate system (patient table movement direction). 1 Select the reference image to be used as the reference. 2 Select Protocol > Shift to Segment Center. syngo MR E11 137

138 5 Performing an examination All graphic objects of the protocol are moved in the Z direction. The position and orientation of the objects to one another are retained. The protocol has the table position of the reference image. Moving the FoV with overlapping You can move the FoV overlapping the entire length of the patient coordinate system in the Z direction. Sagittal and coronal slices are moved in the readout or phaseencoding direction. Transverse slices are moved perpendicular to the slice plane. This way, you can plan multiple protocols whose FoVs overlap so that the resulting images can be reconstructed into a complete image. 1 If necessary, use the Protocol > Overlap... to set the value for the overlapping required. 2 Mark the FoV you want to move. 3 Select Protocol > FoV + or FoV. Rotating graphic objects When you rotate slices whose center is not in the plane of rotation (oblique and double-oblique intersections), the center of the slice moves as you rotate the slice. Slice groups, slab groups and saturation regions can be grouped in order to move them together with Tools > Coupled Graphics On. Protocol is open Graphic objects are displayed in the reference images Graphic object is selected Rotating around object center 1 Move the mouse pointer to a location of the object where it takes this particular shape. 2 Click and hold the left mouse button at this position and rotate the object in the desired direction. 138 Scanning and postprocessing Operator Manual

139 Performing an examination 5 The object is rotated around its center. The rotational axis is now perpendicular to the reference image. Rotating projection area 1 Keep the Ctrl key pressed. 2 Position the mouse pointer on the contour line of the object. The mouse pointer changes shape for rotation. 3 Click and hold the left mouse button at this position and rotate the object in the desired direction. Rotating regular sat regions and navigator pens 1 Click a position in the object to serve as the center of rotation. The center (pivot) is displayed at the position closest to where you clicked. 2 Click the object with the mouse button away from the center and rotate the object in the desired direction. The object rotates around its center. Parallel and tracking saturation regions can be rotated only with the slices or slabs assigned to them. Swapping phase-encoding direction of the object The phase-encoding direction of the object can change as it is rotated. It is possible to swap the direction. 1 Select the object. 2 Select Protocol > Swap Phase. The field of view of the selected object rotates by 90. The phaseencoding and readout directions are swapped. You cannot use this function for saturation regions. Rotating slice and slab groups by 90 1 Select the group. 2 Select Protocol > Turn Group. syngo MR E11 139

140 5 Performing an examination The intersections are rotated by 90. The center of the group remains unchanged. Aligning graphic objects Protocol is open Graphic objects are displayed in the reference images Aligning objects at a right angle to the reference plane 1 Select the object to be aligned. 2 Select Protocol > Perpendicular The selected object is aligned. Slices or slab groups are shifted with their center into the reference plane. When you align a navigator at an angle of 45, it is aligned parallel instead of perpendicular to the reference plane. The navigator orientation is then in the image plane. If no object is selected, Perpendicular affects all oblique slices, slice boxes, and slab groups. Oblique saturation regions or navigators are not aligned in this case. Aligning slice or slab groups perpendicular to one another 1 Select the object to be aligned. 2 Select Protocol > Orthogonal. The group is aligned and its center is moved to the reference group. Aligning all slice groups parallel to one another 1 Mark the slice group parallel to which all other slice groups are to be aligned. 2 Select the Protocol > Align Parallel. All slice groups of a protocol or all steps of a Set-n-Go protocol are aligned parallel to one another in the slice-selection direction. This function is only available with a Tim Planning Suite. Aligning the FoV 1 Mark the FoV to which the others should be aligned and positioned. 2 Select Protocol > Align FoV. 140 Scanning and postprocessing Operator Manual

141 Performing an examination 5 The FoV of all steps of a Set-n-Go protocol are aligned with overlap. The slices are moved in the readout or phase-encoding direction. You can set the overlap value with Protocol > Overlap... This function is only available with a Tim Planning Suite. Moving Dot Engine specific objects Dot Engine protocols may have some specific objects like Markers, ROIs or Slice boxes. Protocol is open Protocol is part of a Dot Engine Moving an object within a segment 1 Click the object. The cursor changes shape. 2 Drag the object to the required position. Moving an object from one segment to another 1 Click the object. The object is copied. The cursor changes shape. You can leave the positioning mode and modify the image and graphical objects while the Dot Engine object is copied. This icon shows that a Dot Engine object is on the clipboard and still has to be positioned. Clicking this icon activates the positioning mode. 2 Paste the object by clicking on the required position in the required segment. syngo MR E11 141

142 5 Performing an examination Adding slice or slab group Protocol is open Graphic objects are displayed in the reference images Adding a slice or slab group If you selected a group prior to adding, the characteristics of this reference group are propagated to the new group. If no other group was selected prior to adding, the new group has one slice and/or one slab and the center of the reference plane. Select Protocol > Add Slice (Slab) Group. Positioning via mouse click 1 Click this icon in the Position Toolbar. The slice or slab group drawing mode is activated. The cursor changes shape. 2 Click where the center of the new group should be located in the reference image. The new slice/slab group is drawn in. Its center is in the image plane of the reference image. Adding in the 3 point mode 1 Select Edit > Deselect All to ensure that no group is selected. If a group is selected, this group is aligned with the three points. 2 Click this icon in the Position Toolbar. The 3 point mode is activated. The cursor changes shape. 3 Set three points in the reference images via mouse click. Until the third point is set, you can move the first and second points with the mouse or delete them by clicking again. You can also scroll through the reference images or load new reference images. 142 Scanning and postprocessing Operator Manual

143 Performing an examination 5 The new group is displayed in the reference images. The center slice or slab of this group is defined by the three points in the plane. Creating radial slices Radial slices replace all slices, slice groups, slabs, and slab groups of the current protocol. Protocol is open Graphic objects are displayed in the reference images 1 Select a slice group from which the radial slices are to be created. 2 Select Add-On > Create Radial Slices... The Create Radial Slices dialog window is shown. 3 Specify the number or the angle of the slices to one another. The corresponding value is calculated automatically. 4 Select the rotational axis. 5 Click OK. The radial slices are generated on the basis of the selected slice group. Adding saturation regions Protocol is open Graphic objects are displayed in the reference images syngo MR E11 143

144 5 Performing an examination Positioning a regular saturation region 1 Select Tools > Create Sat.. The mode for drawing regular saturation regions is activated. The cursor changes shape. 2 Click where you want to insert the new saturation region in the reference image. The saturation region is located perpendicular to the reference image and runs in the vertical direction. The thickness of the region is calculated using standard protocol parameters. Positioning sat region in the center of the segment 1 Select a reference image. 2 Select Protocol > Add Sat. The saturation region is located perpendicular to the reference image and runs in the vertical direction. The thickness of the region is calculated using standard protocol parameters. Graphically changing object properties The following alternative modes are available with regard to the initial mode: Initial mode Changing the slice (slab) thickness Changing the number of slices (slabs) Changing the slice (slab) distance Changing slice oversampling Changing the field of view Changing phase oversampling Alternative mode (ALT key pressed) Changing the number of slices (slabs) Changing the slice (slab) thickness Changing the number of slices (slabs) Changing the slice (slab) thickness Changing phase oversampling Changing the field of view Protocol is open Graphic objects are displayed in the reference images 144 Scanning and postprocessing Operator Manual

145 Performing an examination 5 Changing the thickness of slices/slabs 1 Select Tools > Extent Mode > Extent Thickness. 2 To increase the thickness, use the mouse to drag the Extent handle away from the group. 3 To decrease the thickness, drag the Extent handle to the center of the group. Changing the slice thickness also changes the distance between slices since the distance factor remains constant. Changing the number of slices/ slabs 1 Select Tools > Extent Mode > Extent Slices (Slabs). 2 To increase the number of the slices/slabs, drag the Extent handle away from the group. 3 To reduce the number, drag the Extent handle into the center of the group. When the maximum number of slices (determined by other protocol parameters, e.g. TR) is reached, the group is displayed with bold lines. Changing the distance between slices/slabs 1 Select Tools > Extent Mode > Extent Distance. 2 To increase the distance of the slices/slabs, drag the Extent handle away from the group. 3 To reduce the distance, drag the Extent handle into the center of the group. Change slice oversampling (3D measurements) 1 Select Tools > Extent Mode > Extent Slice Oversampling. 2 To increase slice oversampling, drag the Extent handle away from the group. 3 To reduce slice oversampling, drag the Extent handle into the center of the group. Changing the field of view (FoV) 1 Select the slice or slab group whose FoV you want to change. 2 Drag the FoV handle into the required direction. syngo MR E11 145

146 5 Performing an examination When you drag the FoV handle into the readout direction, the mouse pointer changes into this shape. When you drag the FoV handle into the phase-encoding direction, the mouse pointer changes into this shape. In the phase-encoding direction, you can increase the FoV to a square. You can reduce the FoV independent of the readout direction. An increase (decrease) of the FoV in the readout direction means an increase (decrease) in the phase-encoding direction since the ratio of the length in both directions remains constant. Changing phase oversampling 1 Select Tools > Extent Mode > Extent Phase Oversampling On. 2 Select the slice or slab group. 3 To increase phase oversampling of the selected slice or slab group, drag the FoV handle in the phase-encoding direction. 4 To decrease phase oversampling, drag the FoV handle in the opposite direction. Changes in phase oversampling have a symmetric effect on the slice or slab group. The size and the center of the FoV remain constant. Changing regular sat regions Changing parallel and tracking saturation regions You can change the orientation or thickness of sat regions with the mouse. The procedure is the same as for positioning slices and slab groups. 1 To change the thickness of a parallel sat region, use the mouse to drag the Extent handle not facing the slice and/or slab group in the desired direction. To shift the complete sat region, press the Shift key while changing the slice thickness of the sat region. 146 Scanning and postprocessing Operator Manual

147 Performing an examination 5 2 To change the distance of a parallel sat region, use the mouse to drag the Extent handle facing the slice and/or slab group in the desired direction. With parallel saturation regions, modifying the slice thickness and the distance to the slice/ slab group always affects both saturation regions symmetrically. Deleting graphic objects Protocol is open Graphic objects are displayed in the reference images Deleting a selected object 1 Select the object you would like to delete. 2 Press the Del key on the keyboard. The selected object is deleted and another object is selected. If deletion causes the slices or slabs to fall below the minimum number required by the protocol, the object is not deleted but the number of slices or slabs is reduced to the minimum. If you delete the last slice group of a step, the entire step is deleted. When a Set-n-Go protocol contains only one step with only one slice group, you cannot delete this slice group. Deleting all objects Select Protocol > Delete All Graphics. All objects of the protocol are deleted except for the minimum number of slice/slab groups defined in the protocol. Only parallel saturation regions are retained. Transferring the position of reference images to slices/slabs Protocol is open Graphic objects are displayed in the reference images Transferring position and orientation of reference image to slice/slab group 1 Select the required reference image. 2 Select the slice or slab group whose position you want to change. 3 Select Tools > Copy Image Position. syngo MR E11 147

148 5 Performing an examination The center of the group is moved into the plane of the selected reference image. The shift is perpendicular to the plane of the reference image. The orientation of the group is adjusted to that of the reference image. If no group is selected, the position of the reference image is transferred to the first group of the protocol. Transferring copied image position to additional slice/slab groups 1 Select the requested slice or slab group. 2 Select Tools > Paste Image Position. The copied image position is transferred to additional slice and/or slab groups UI explanation Position toolbar View > Position Toolbar (1) Activates the mode for changing a graphic object. (2) Activates the mode for enlarging/reducing or moving the reference image. (3) Activates the slice or slab group drawing mode. 148 Scanning and postprocessing Operator Manual

149 Performing an examination 5 (4) Activates the saturation region drawing mode. (5) Activates the 3-point mode for drawing slice or slab group. (6) Deletes the graphic object. (7) Displays the reference image as a line (line mode). (8) Displays the reference image as a rectangle (box mode). (9) Displays the image in package mode. In package mode, the individual slices of a slice group are hidden to provide a better overview. (10) Activates the mode for changing the thickness of the slices or slabs of a group. (11) Activates the mode for changing the number of slices or slabs of a group. (12) Activates the mode for changing the distance between slices or slabs of a group. (13) Activates the mode for changing the extent of slice oversampling. (14) Activates the mode for changing the extent of phase oversampling. (15) Shows or hides reference lines. syngo MR E11 149

150 5 Performing an examination (16) Activates or deactivates the coil elements. (17) Shows or hides the adjustment volume. (18) Shows image text. Tim Planning toolbar (1) Moves slice group by group thickness in negative/positive direction. (2) Activates coupled graphics. (3) Adds a step to the Set-n-Go protocol. (4) Moves the FoV with overlapping in negative/positive direction. (5) Aligns all slice groups of a protocol or all steps of a Set-n-Go protocol parallel to one another. (6) Aligns the FoV of all steps of a Set-n-Go protocol with overlap. 150 Scanning and postprocessing Operator Manual

151 Performing an examination 5 Display of slices Perpendicular cut A solid intersecting line shows that the graphic object is located vertical to the reference image (1). Single-oblique intersection A dotted intersecting line shows that the graphic object is located single-oblique or double-oblique to the reference image (1). With single-oblique intersections, one side of the field of view (FoV) is located parallel to the intersecting line. The projection also maps a side area of the slice group. Double-oblique intersection With a double-oblique intersection, neither of the two sides of the field of view (FoV) runs parallel to the common intersecting line with the reference image. Accordingly, two side areas are displayed on the projection area, providing a spatial impression. Slice oversampling (50%) in box mode View > Graphics > Hide Slice Oversampling Slice oversampling is also used to prevent aliasing artifacts. The measured area along the slice selection direction is expanded symmetrically on both sides of the FoV. syngo MR E11 151

152 5 Performing an examination Intersection lines (in this case, sagittal slices in a transverse image) The graphic object intersects the reference image at an angle 30. Projection area (in this case, sagittal slices in a sagittal image) The graphic object intersects the reference image at a shallow angle ( 30 ) and, therefore, is projected on the reference image. In a graphic object located parallel to the reference image, the projection area corresponds exactly to the dimensions of the field of view (FoV). If several graphic objects intersect the image at a shallow angle, only the projection area of the selected object is displayed. Hidden slices With oblique intersections, not all intersections of a slice or slab group intersect the reference image. Slices located completely in front or after the reference image are not drawn in. 152 Scanning and postprocessing Operator Manual

153 Performing an examination 5 Slice group without intersecting the reference image The projection area of the slice group is not visible. The edge is shown as a dotted line. Intersection in line mode View > Graphics > Line Mode On In line mode, the intersection through the reference image is displayed as a line. The center line of the intersection area is shown. Intersection in box mode In box mode, the intersection through the reference image is displayed as a rectangle. The actual intersection surface is shown and therefore the anatomical region covered by the slice. syngo MR E11 153

154 5 Performing an examination Slice group in package mode View > Graphics > Package mode On In package mode, individual slices of a slice group are hidden. For the entire group, only the outline of the intersection is displayed. The inner lines show the thickness of the individual slices and/or individual slabs. Slice or slab groups are automatically displayed in the package mode when the elements of the group overlap and are closely located to one another (depending on the magnification set for the reference image). Saturation regions Saturation regions that intersect the reference image are displayed as crosshatched bars. (1) Selected saturation region. The bar is highlighted. Handles are displayed. (2) Unselected saturation region. Asymmetric saturation region. The white line indicates the sharp edge of the saturation region. 154 Scanning and postprocessing Operator Manual

155 Performing an examination 5 Tracking saturation region (1) Displays the handle for changing the sat thickness. (2) Displays the handle for changing the distance from the slice/ slab group. (3) Displays the standard vector (arrows between the slice group and ascending or descending sat region show). Navigator objects The navigator objects are shown with projection lines. Object Comment Non-selected navigator cuboids are displayed in turquoise. Non-selected navigator pens are displayed in blue. Selected navigator objects are displayed in yellow and include handles. If the navigator does not have a common intersection with the reference image, the projection lines are shown as dashed lines. syngo MR E11 155

156 5 Performing an examination Object Comment If the navigator does have a common intersection with the reference image, the projection lines are shown as continuous lines. In this case, dashed lines indicate the intersection area. Next to the navigator object, the following arrows can be displayed: Object Comment Dot Engine specific objects Marker The arrow without lines shows the direction of base vector 2 (phase-encoding direction). The arrow with the dotted lines points in the direction of the navigator. This display allows you to recognize special situations. The arrow for navigator direction points away from the viewer. The navigator direction continues into the image plane. The arrow for navigator direction points towards the viewer. The navigator direction runs out of the image plane. The arrow for the direction of base vector 2 is not shown if the angle between the reference image and base vector 2 lies between 45 and Scanning and postprocessing Operator Manual

157 Performing an examination 5 ROI Slice box Cuboid Orientation aids Coils and coil elements that are selected (2) or not selected (1) for the examination View > Coil Positions On Only coils with a known table position are displayed. These are either coils with fixed table positions or coils whose position was determined dynamically via application adjustments. Coil elements are only displayed on sagittal or coronal reference images. syngo MR E11 157

158 5 Performing an examination Adjustment volume in the reference image. View > Adjust Volume On Table position (blue line) of the ISO protocol View > Protocol Table Position On Shadow lines View > Graphics > Shadow On Shadows improve the visibility of graphic objects in light images. Reference line View > Reference Lines On Reference lines show the positions of other reference images and facilitate spatial orientation. 158 Scanning and postprocessing Operator Manual

159 Performing an examination 5 Object outside of the isocenter A warning icon indicates that the planned slice, slab, or FoV is too far outside the MAGNETOM isocenter. The corresponding objects are highlighted in red. Such measurements result in strong image distortions, even after 2D or 3D distortion correction. They cannot be used as reference images for slice planning or position display and are labeled with image type DIS2D* or DIS3D*. TimCT measurement area (1) Handle to extend the TimCT area (2) General measuring range (area enclosed by solid magenta line) (3) Table position at the end of the measurement (dashed blue line) (4) Measuring range when selecting a variable resolution e.g. area of an increased resolution (dashed magenta line) (5) FoV read (area enclosed by solid yellow line) (6) Direction of movement of the patient table (7) Table position at the start of the measurement (solid blue line) The table positions are in the isocenter of the magnet. The table position prior to the measurement can be displayed or hidden. syngo MR E11 159

160 5 Performing an examination Set-n-Go measurement (1) Active measurement step (2) Object of active measurement steps (3) Passive measurements steps (4) Objects of passive measurement steps Saturators and Navigators of passive measurement steps are not displayed. 160 Scanning and postprocessing Operator Manual

161 Performing an examination Scanning General information Performing a routine examination After exam-related preparations, you acquire a localizer and graphically plan the slice or slab groups in the reference images. You modify the measurement parameters as required. ( Page 170 Routine scanning tasks) Never move the table to home (requires confirmation) or change coils (invalidates adjustments) after the Exam paused dialog is shown for automatically starting protocols. Both events will independently prevent the measurement from being started. Routine course of measurement: As soon as you have modified and closed the first protocol, the system starts with the measurement of this protocol. If the next protocol is suitable for this task, it is subsequently measured. Utilize measurement times: During the measurement, you can do one of the following: Edit the unmeasured program steps in the program control, Complete the parameters of pending protocols and plan the examination sequence, View, evaluate, comment on, or film the images of a previously measured series. Stop an examination: If the measurement procedure is interrupted (e.g. by patient movement) or all necessary images are measured, you can end the measurement without affecting the remaining program sequence. Repeat and Rerun measurements: You can repeat protocols at any time in the following way: syngo MR E11 161

162 5 Performing an examination Repeat a selected protocol (Repeat). Open and adapt a selected protocol before repeating (Repeat & Open). Rerun the whole queue after the selected protocol (Rerun from here). Manually start measurements: For kinematic examinations, you can run protocols any number of times. For this purpose, you start a protocol manually and repeat it until all required measurements have been performed. Some breathhold measurements are also started manually. The protocol is loaded into the MR system and waits until you provide a manual start command. Automatic breathhold measurements: Breathhold measurements with automatic AudioVoice commands start automatically. Contrast agent AudioVoice commands: For an examination with contrast agent, plan a number of pauses in the measurement program for contrast examination. ( Page 112 Step Properties Pause) Alternatively, you can perform contrast medium examinations using multiple measurements. ( Page 172 Measuring an open protocol multiple times) Measurements with patient instructions: Before and after measurements, patient instructions in different languages can be added automatically via protocols. You can manually play back voiceovers. ( Page 178 Playing back voice output) Measurements with manual voice commands: Before and after each breathhold measurement, the user can give manual voice commands. The system waits until the user clicks the Continue button of the program scheduler after each voice command. For manual voice commands, the pre sound, post sound, pause, and patient language parameters are ignored. Automatic positioning suggestion: Using AutoAlign Head, AutoAlign Knee or AutoAlign Spine, the MR system performs automatic and reproducible slice positioning for head, knee or spine examinations independent of the patient position. 162 Scanning and postprocessing Operator Manual

163 Performing an examination 5 Jobs: If your MR system is connected to a HIS (hospital information system), you can receive jobs for your MR system from the HIS via the network. When you register a patient, a reference to the job is created in the form of steps that appear as a procedure step in the queue. All services rendered are automatically entered in the job. The information of the procedure step is now available for further processing in the hospital. ( Page 82 Study split), (for MPPS refer to Operator Manual - System and data management) Conflict management: Before and after measurements, inconsistencies can occur between the measurement program and the actual settings at the MR system. The MR system detects and informs you about these inconsistencies. Plan n Go: For Dot Engines the auto-open behavior in a queue is as follows: If a queue step is closed, the next step which needs user interaction (working man symbol) opens automatically. Adapting the measurement parameters For graphic slice positioning, you usually only need to check the parameters of the Routine parameter card. There you can change the field of view (FoV) and other frequently adjusted settings. For protocols with a dot add-in, only selected parameters are shown in the Dot view. Via the button on the bottom of the toolbar, the user can switch to the Details view, from where all parameter cards can be accessed. In case of special questions and special anatomical conditions, you can adjust the measurement parameters of the Contrast, Resolution, and Geometry parameter cards. Copying parameters: You can copy parameter groups from protocol to protocol. This saves time during the parameter entry and the completion of the protocols. Value ranges: The value ranges of a few parameters are limited by the technical possibilities of your MR system. Certain parameters depend on other measurement parameters. In this case, a change in one parameter value will require changes in other measurement parameters as well. The limits are shown in the lower half of the parameter card. syngo MR E11 163

164 5 Performing an examination Scan Assistant: If you exceed the Soft Limits, the Scan Assistant dialog window appears. It informs you about the adaptation of other measurement parameters. You can confirm your parameter change including the necessary adaptations or undo your parameter change. The Scan Assistant dialog window must be closed before you can adapt another protocol. General information (SAR and stimulation) Monitoring of physiological effects Physiological effects in the patient may occur during MR examinations. These effects are caused by radio-frequency fields or by magnetic fields varying over time. The MR system software automatically monitors the SAR and db/dt limits. Correct automatic monitoring presumes compliance with the prescribed sequence of operations. Different operating modes can be set to limit physiological effects. Detailed information regarding patient safety (especially regarding positioning) can be found in the Safety section of the System manual. Specific absorption rate (SAR) Part of the electromagnetic radiation is absorbed by the patient's body tissue and converted into heat. The RF output absorbed per kg body weight is known as Specific Absorption Rate (SAR). It is expressed in W/kg. If the SAR exceeds the thermal regulation capacity of the patient, his/her body temperature will rise. SAR limits: The specific absorption rate is established and monitored for such aspects as Whole-body, partial body and local RF exposition. If one of the values exceeds 100%, the respective SAR limit value is already exceeded. The limits are set in accordance with requirements defined in IEC and requirements from national regulations. 164 Scanning and postprocessing Operator Manual

165 Performing an examination 5 The SAR limit values are also a function of the ambient temperature. At a room temperature of > 25 C, the permitted SAR limits are decreased. We recommend setting the temperature of the examination room to 21 C since a higher ambient temperature may lead to lower SAR limits. Automatism to avoid SAR limit exceeding: If SAR limits are exceeded, the system automatically tries to adapt the protocol by utilizing the tolerances (if configured on the Sequence - Assistent parameter card) of the protocol. Specific energy dose (SED) The specific energy dose is the value of the accumulated whole body SAR throughout the entire examination. It is expressed in J/kg (= Ws/ kg). Although while observing all SAR limits, with very long and high average SAR examinations, tissue damages may occur espcially with patients with restricted thermal regulation. SED limits and thresholds: The SED limit is set to J/kg. This is equivalent to a continous SAR level of 2 W/kg for 2 hours or 4 W/kg for 1 hour. A warning threshold of 6000 J/kg is defined by Siemens risk management, equivalent to a continous SAR level of 2 W/kg for 50 minutes or 4 W/kg for 25 minutes. Below this threshold, all persons with normal thermal regulation are considered safe. Above this threshold, depending on the applied SAR and the individual patient's condition, the patient may suffer physiological stress or may even experience tissue damage. To avoid these problems, please adapt the examination duration to the above described times for normal and fist level modes. Stimulation (db/dt) Stimulation due to varying magnetic fields: Electrical currents affect the patient during the examination. They are induced through temporal changes in the magnetic flux induced by the gradient coils. This is expressed mathematically as db/dt. Peripheral nerve stimulation may result. Indications are prickling, tickling, or slight muscle spasms in various body regions. syngo MR E11 165

166 5 Performing an examination Stimulation limits:unlike in SAR monitoring, patient data such as age, weight, and size are not used for the stimulation models. With respect to stimulation monitoring, a protocol in the same slice orientation may either be run for all or none of the patients. Stimulation models: Stimulation monitoring is based on stimulation models. SAFE model The threshold values and stimulation limits are determined by semi-empirical procedures that take the results of extensive clinical trials into consideration. Only very few patients will experience stimulation at the threshold. At the stimulation limit, the probability of stimulation is 50%. db/dt model The legally defined db/dt restrictions are included in the calculation of the threshold values and stimulation limits. Stimulation monitoring according to the SAFE model is performed on a regular basis. Depending on country-specific guidelines, the db/dt model may also be applied. Operating modes The SAR and stimulation monitoring can be operated in two modes which are set during patient registration: Normal mode: In the Normal mode, SAR and db/dt limits are set to low values. Warming of the patient is kept to a minimum and stimulation can be excluded. Normal mode is the default operating mode. Controlled operating mode: In the First level mode, SAR and db/dt limits are set to higher values. Increased SAR values may cause the patient to experience notable heat increases. Increased db/dt values may cause the patient to experience slight peripheral nerve stimulation. 166 Scanning and postprocessing Operator Manual

167 Performing an examination 5 General information - Physio / Triggering Introduction Physiological movements in the body, e.g. heart beat or respiration, can cause motion artifacts. Such artifacts are recognizable in the image as e.g. noise or blurring. You can avoid these motion artifacts by synchronizing physiological signals (ECG signal, pulse, respiration) with the measurements. Physiologically-triggered measurements also create cine studies of cyclic motion, such as the function of a heart valve. Measurement procedure: Two measurement methods are currently used, namely triggering or retrospective gating. Triggering involves using a characteristic position in the physiological signal curve as the trigger for acquisition. Triggering is possible using ECG signals, pulse signals, respiratory signals, and external trigger signals. Retrospective gating involves retrospectively correlating the acquired image data with the curve of a physiological signal. Retrospective gating can be applied using ECG signals, pulse signals, and external trigger signals. Operating elements: The Physiological Display window enables you to observe the physiological signal curve and to select the desired triggering procedure. You can also check long-term statistical values. The special parameters for triggering or retrogating measurement methods are set on the Physio parameter card. Triggering and gating methods ECG triggering is especially useful for thoracic and cardiac measurements to avoid image blurring caused by the heartbeat during standard measurements. The ECG Signal shows the action potential of the heart in the form of a curve. The individual curve phases correspond to the respective contraction or relaxation phases of the heart. The R-wave in the QRS complex is used as the trigger point for the measurement. syngo MR E11 167

168 5 Performing an examination The signal curve for ECG triggering (1) System acquisition window (2) Measurement acquisition window (3) Average interval (average cycle) (4) Delay time (delay trigger) (5) Standard deviation of the average cycle Retrospective gating: Some special sequences enable retrospective gating. The measurement runs without triggering. The acquired image data are retroactively sorted according to cardiac phases. In contrast to triggering, retrospective gating allows you to measure all cardiac phases including the late diastole. Retrospective gating can be applied to ECG signal curves, pulse signal curves, and external trigger signal curves. The 1st Signal/Mode selection list on the Signal 1 subtask card contains the following additional entries: ECG/Retro Pulse/Retro Ext/Retro 168 Scanning and postprocessing Operator Manual

169 Performing an examination 5 Respiratory triggering is used to avoid motion artifacts caused by breathing. (1) Expiration (2) Inspiration Pulse triggering is used for suppressing motion and flow artifacts caused by pulsating blood or CSF. (1) First pulse wave (2) Second pulse wave (3) Diastolic blood pressure (4) Systolic blood pressure The first pulse wave (premature pulse wave) is used for triggering. This wave corresponds to the systolic blood pressure. External trigger signal: An external signal is used for functional measurements to trigger measurements of the stimulated series. The external digital trigger signal is supplied via the connection at the column cover of the table. The rising edge of the signal is used to start the measurement. syngo MR E11 169

170 5 Performing an examination Routine scanning tasks Editing parameters of subsequent protocols Measurements are in progress Opening a protocol in the wait queue Double-click the required protocol in the queue. The measurement parameters of the protocol are shown in the parameter card stack. In case of a protocol with dot add-in, only selected parameters are shown on the parameter tab of the Dot view. With a dot add-in, the focus is to guide the user. It is usually not necessary to change the protocol parameters. To view all parameters, the user can switch to the Details View. The Positioning mode of the protocol affects the reference images and the table position of the protocol. ( Page 121 Dependencies between the table position, reference image, and protocol) Editing the protocol 1 Define the parameters according to requirements. 2 Close the protocol and apply the changes with Apply. The protocol is complete and executable. Applying changes before opening next protocol When you open the next protocol without having closed the previous one, the Apply Changes dialog window appears. 170 Scanning and postprocessing Operator Manual

171 Performing an examination 5 1 If you want to open the protocol again prior to performing it, deactivate the Make step complete checkbox. 2 Apply or refuse the changes with Yes or No. The protocol closes. The next protocol opens. Resolving parameters conflicts For the following reasons, parameter conflicts can occur during copying: At least one of the parameters was not or only partially copied. At least one other parameter has to be adjusted to copy the parameters of the selected group (e.g. number of links). Apply Changes dialog window is displayed Accept the proposed adjustments with OK. The target protocol is updated. The dialog window closes. Repeating measurements When repeating program steps individually, it may be necessary to measure the entire queue again. Measurement is in progress Repeating a single protocol 1 Select a protocol from the queue. or Select an image of the protocol. 2 Repeat the protocol without changes with Repeat from the context menu. or Open the protocol for parameter adaptions before repeating with Repeat & Open from the context menu. The protocol is repeated as soon as possible. Repeating multiple protocols 1 Select the protocols you want to repeat. 2 Select Append from the context menu. syngo MR E11 171

172 5 Performing an examination The program steps are copied and appended to the end of the queue. Rerunning part of the queue 1 Select the program step from where you want to rerun the queue. 2 Rerun the part of the queue with Rerun from here from the context menu. or To rerun the part of the queue with a different strategy, select Rerun from here with from the context menu, modify the settings in the Patient View, and start the measurement with Apply. The function Rerun from here with is only available for Dot Engines. The running step is not affected. The selected protocol and all subsequent program steps are rerun. Measuring an open protocol multiple times Measurements which are repeated with slightly changed protocol parameters, e.g. cardio and angio applications, can be performed with the open protocol. Therefore it is not necessary to close the protocols and open them again after each change of parameters. Protocol is open 1 Change the parameters as required. 2 Click this icon. A copy of the open protocol is generated and inserted in the queue above the open protocol. The original protocol remains open and can be repeated multiple times. Terminating a measurement Under special circumstances, a measurement can be terminated. The next measurement starts immediately. Scanning of the protocol is in progress Click this icon. The measurement stops immediately. The protocol is identified as terminated. 172 Scanning and postprocessing Operator Manual

173 Performing an examination 5 You can also interrupt a measurement in the examination room by using the STOP button at the intercom. Skipping a program step Protocol is opened for processing in the wait queue Click this icon. The skipped program step is identified as terminated. Positioning the table with parameters of the parameter cards 1 Select the parameter card System - Miscellaneous. 2 Determine the table position on the Positioning mode selection list. 3 Determine the direction and distance of the table position under Table position. Defining a new center position Select Patient > Reset Table Position. The table position is reset to zero. The current table position is defined as the center position. Subsequently the queue is ready again. You can start a new series block. All images planned in the graphic segments and all series icons in the program control are removed from already measured protocols. If indicated by the property dialog window, all protocols ready for measurement are reset to incomplete. They have to be planned again. syngo MR E11 173

174 5 Performing an examination Avoiding SAR limit exceeded The SAR Limit(s) Exceeded! window only opens in the following case: Although utilizing the tolerances of the protocol, the system cannot observe the SAR Limits. SAR Limit(s) Exceeded! window has opened Changing the measurement parameters The SAR Limit(s) Exceeded! window provides you with recommendations on how to avoid exceeding the SAR limit. The proposed changes apply to one parameter (TR, slices, or flip angle), assuming that the other two parameters are not to be changed. If an option is dimmed, no change proposal is available for that particular measurement parameter. When all options are dimmed, you have to select different protocols. 1 Select a change proposal. 2 Click OK. The proposed changes are applied. The measurement starts automatically. Skipping a measurement You can skip measurements for which exceeding SAR limits have been determined. Click Cancel. The protocol is marked as canceled in the queue. The next protocol is loaded. Increasing SAR tolerance The patient can experience notable heat increases due to increased SAR values. Patient is registered Wait queue of the program control contains protocols 1 Select Options > SAR Information... The SAR Information dialog window opens. 2 Set the operating mode for the next measurement to First Level. 174 Scanning and postprocessing Operator Manual

175 Performing an examination 5 The SAR limits are set to a higher value. In First Level mode, change options can be inactive for the following reasons: No changes are required. The system cannot make recommendations. To enable measurements in First Level mode, change parameters directly in the protocol. Avoiding stimulation limit exceeded The Stimulation Monitor - Stimulation Limit Exceeded! window only opens in the following case: The sequence will exceed the stimulation limits. This is independent of the type of the applied monitoring model SAFE or db/dt. Stimulation Monitor - Stimulation Limit Exceeded! window has opened Changing the measurement parameters 1 Click Calculate to request suitable protocol change proposals. The Stimulation monitor - Recommendations dialog window opens. 2 Select a change proposal. 3 Click OK. The proposed changes are applied. The measurement starts automatically. Skipping a measurement You can skip measurements for which exceeding stimulation limits have been determined. Click Cancel in the Stimulation Monitor - Stimulation Limit Exceeded! window or Skip in the Stimulation monitor - Recommendations dialog window. The protocol is marked as canceled in the queue. The next protocol is loaded. syngo MR E11 175

176 5 Performing an examination Increasing db/dt tolerance The patient can experience slight peripheral nerve stimulation due to increased db/dt values. Patient is registered Current measurement exceeds the stimulation threshold The Stimulation Monitor - Warning! dialog window opens. Start the measurement despite possible stimulations with OK. The db/dt limits are set to a higher value. The abbreviation SP appears in the status bar. Adapting the adjustment volume The adjustment volume is defined for each protocol for tuning the transmitter and receiver. The default setting of the adjustment volume depends on the slices and slabs. In most cases, an orthogonal cuboid encloses the slices or slabs to be measured. For spectroscopy protocols, the default setting corresponds to the adjustment volume of the VOI. For protocols that do not require shim adjustment measurements (e.g. Tune-Up mode) or water suppression adjustments, use a fixed adjustment volume. Adjustment procedures are not necessary after slice positioning. 1 During graphic slice positioning, click this icon on the Position Toolbar. The adjustment volume is shown as a green rectangle in each reference image. 176 Scanning and postprocessing Operator Manual

177 Performing an examination 5 2 Adjust the volume graphically or numerically. Transferring parameters from previously measured protocol Measurements are in progress Target protocol is open 1 Double-click the previously measured protocol in the queue. The protocol parameters are displayed in a dialog window. They can only be viewed, not edited. 2 Copy the parameters from the previously measured protocol to the target protocol. ( Page 177 Copying measurement parameters) Copying measurement parameters 1 Double-click the target protocol in the wait queue. 2 Select the source protocol. 3 Select Copy Parameters from the context menu. The Copy Parameters dialog window opens. 4 Select the parameter group you want to copy from the source protocol. 5 If necessary, activate the displayed checkbox(es). ( Page 107 Step Properties Copy References) 6 Click OK. syngo MR E11 177

178 5 Performing an examination Copying parameters from an image in the GSP segment Measurements are in progress GSP segment contains an image for the protocol waiting in the queue 1 Select Copy Parameters from the context menu of the respective GSP segment. The Copy Parameters dialog window opens. 2 Copy the parameters from the previously measured protocol to the target protocol. ( Page 177 Copying measurement parameters) Copying image position (Inline display) Inline Display is started Protocol is opened in the program control 1 Select a graphic object in the protocol. 2 Click this icon. The slice position and orientation of the current image in the Inline Display are transferred to the selected object. If no graphic object was selected, the position and orientation are transferred to the first slice group of the protocol. Transferring image position with drag & drop Click the lower left corner of the image (drag & drop area) and drag it to a GSP Segment. Playing back voice output Voice outputs provide the patients with instructions in the examination room. 178 Scanning and postprocessing Operator Manual

179 Performing an examination 5 Patient is registered 1 Select Voice Output Patient Settings in the context menu of the information/tool bar of the program control (above the wait queue). The Voice Output Configuration dialog window opens. ( Page 190 Voice output patient settings) 2 Select the language from the selection list. 3 Select the required patient instruction. If the required patient instruction is not listed, you can record it yourself (refer to Operator Manual - System and data management). 4 Click this icon. The selected voice output is played back. 5 Use the slider to adapt the volume of the voice output Special scanning tasks Performing measurements with countdown Wait for user to start is set in Step Properties Execution Exam paused dialog window opens after completing protocol adjustment ( Page 183 Exam paused) 1 Enter the planned length of a pause in seconds in the Countdown field. 2 Click Start. The countdown starts. syngo MR E11 179

180 5 Performing an examination Using Physiological Triggering Sensors are positioned Quality and volume of the trigger signal is good Measurement program is designed for physiological triggering Physiological triggered protocol is open 1 Select View > Physiolog. Display. The Physiological Display dialog window opens. ( Page 184 Physiological display) 2 Set the parameters and observe the physiological signals. 3 Open the Physio Signal 1 parameter card. 4 Set the desired triggering procedure in the 1st Signal/Mode selection list. 5 If necessary, set the Average cycle manually or by clicking Captured cycle. 6 Click Apply in the program control. Parameter settings are transferred to the MR system. The protocol is complete and starts automatically. Breathhold scanning Navigator signals are not recorded during the measurement. Only afterward is the navigator signal measured and displayed again. The position of the diaphragm during the first measurement is displayed as a yellow line. Protocol is a multi breathhold protocol Pauses and voice commands are defined ( Page 98 Setting breathhold pauses) Inline Display is open Protocol is started 1 Position the navigator on the diaphragm. The position of the diaphragm (navigator signal) is displayed as a function of time in the Inline Display. 180 Scanning and postprocessing Operator Manual

181 Performing an examination 5 2 Monitor the respiratory curve in the Inline Display. 3 If necessary, apply the breathhold command. 4 If measurement does not start automatically, start it with this icon. 5 If necessary, inform the patient to breathe again after the measurement. The patient should breathe normally for a while. 6 Repeat these steps until measurement is completed. AutoAlign scanning An AutoAlign program starts with an AutoAlign scout protocol. It is followed by multiple clinical AutoAlign protocols using the computed AutoAlign results. syngo MR E11 181

182 5 Performing an examination Measurement supports AutoAlign AutoAlign Localizer is measured If the system has not recognized one or more AutoAlign references with sufficient accuracy, the respective protocols in the queue are marked with this verification symbol. In addition, the warning symbol is displayed at the AA Scout step. A brief error description pops up when placing the mouse cursor at the icon. The user has to open these protocols, edit them if required, and re-assign them to the examination using the Apply button. 1 To view the status of the calculated references, select Queue > AutoAlign Info Dialog in the main menu. 2 In the reference images, ensure that slices are positioned correctly. 3 Start scanning with Apply. 182 Scanning and postprocessing Operator Manual

183 Performing an examination UI explanation Exam paused Contrast examinations often require a precisely timed measurement sequence, especially following contrast agent administration. Never move the table to home (requires confirmation) or change coils (invalidates adjustments) after the Exam paused dialog is shown for automatically starting protocols. Both events will independently prevent the measurement from being started. (1) Defines a countdown. If the countdown has expired, the countdown continues in the minus area. For Angio Dot Engines, the countdown is predefined and the measurement starts automatically as soon as the countdown has expired. syngo MR E11 183

184 5 Performing an examination (2) Displays the time since the beginning of the first measurement of the current multiple measurements. (3) Displays the time beginning with the end of the previous measurement. Physiological display (1) Displays the time domains of the measurement (not available for All ECG mode). Gray Green Dark green Red Indicates the delay time. Indicates the measurement interval and/or measurement acquisition window. Indicates the measurement pause e.g. sending saturation pulses. Indicates timeout. With display rate Fast, no time domains are shown. With display rate Slow, time domains are shown if the selected signal is a respiratory signal or an external signal. (2) Defines how many signal tracks are displayed. 184 Scanning and postprocessing Operator Manual

185 Performing an examination 5 (3) Sets the triggering method. Procedures VCG/standard ECG I only ECG II only ECG III only Comment Both ECG channels are used to determine the trigger pulse (default setting). Only ECG channel 1 is used to determine the trigger pulse. Only ECG channel 2 is used to determine the trigger pulse. Only ECG channel 3 is used to determine the trigger pulse. You cannot change trigger procedures during the measurement. (4) / (5) Selects the displayed signal. SAR information Prediction Options > SAR Information... syngo MR E11 185

186 5 Performing an examination (1) Sets the SAR operating mode. ( Page 174 Avoiding SAR limit exceeded) (2) Shows relative SAR and B1+rms values. Relative value is the relation of the actual value to the corresponding limit. B1+rms is the root mean square value of the MR effective component of the B1 field (B1+). B1+ hereby is the average value of the total axial, central slab of up to a few centimeters thickness. Please note that the table lists all patient safety-related information. There are additional internal component protections. The SAR icon shows the maximum of all relative values. ( Page 62 Toolbar of the Exam task card) 186 Scanning and postprocessing Operator Manual

187 Performing an examination 5 (3) Shows detailed information about the item selected in area (2). In this example, B1+rms has been selected. The absolute value of the selected item is displayed above the green bar, and the corresponding limit is displayed below at the right end of the green bar. If the SAR value is outside the green range, the permissible limit value has been exceeded for the operating mode currently selected. SARLimit(s) exceeded! Message when protocol exceeds SAR limit syngo MR E11 187

188 5 Performing an examination (1) Displays the ambient temperature measured inside the bore. ( Page 164 Specific absorption rate (SAR)) (2) Sets the SAR operating mode. ( Page 174 Avoiding SAR limit exceeded) 188 Scanning and postprocessing Operator Manual

189 Performing an examination 5 (3) Suggested changes to reduce SAR. Stimulation monitor Information Options > Stimulation Info... (1) Shows safety factors for the stimulation prediction. (2) Shows maximal approximation of the stimulation limit (in%). (3) Indicates exceedance of the stimulation threshold. Stimulation monitor Recommendations Stimulation Monitor Stimulation Limit Exceeded! dialog window > Calculate syngo MR E11 189

190 5 Performing an examination (1) Current parameters and suggested changes to reduce stimulation (2) Changes gradient mode. As a result, changes are made to TE, TR, and the measurement time. Changes are active if the Change Gradient Mode checkbox is activated. Voice output patient settings Voice Output Patient Settings in the context menu of the information/tool bar of the program control (above the wait queue) 190 Scanning and postprocessing Operator Manual

191 Performing an examination 5 (1) Sets the language of the patient via selection list (2) Selects the patient instructions If an instruction is not available in the selected language, the speaker symbol and the duration time are not displayed. (3) Starts and stops playback of the selected instructions (4) Sets the volume of the voice output via slider. For Dot Engines, the patient language can also be set in the Patient View. syngo MR E11 191

192 5 Performing an examination Viewing and editing images during examinations General information Scroll sequence Scroll between series: If multiple series are loaded into an image segment, you can scroll between series. The series number defines the order of the series. It depends on the date and time of reconstruction. The order of the series cannot be modified. Scroll within series: You can define the order of the images within a series. You can select from various default sort options in the menu. You can also define your own sort scheme for the order of images. The sort scheme also determines the order of images for movie display. ( Page 193 Movie display) Sort Scheme: Name Sorting scheme Application range Anatomical SP»TT»TA»NR Standard sort, localizer, anatomical examinations, multislice/multi-phase measurements (grouped according to phases), multi-slice real-time measurements Triggered MO»TT»TD»SP Multi-slice/single phase measurements or multi-slice/multiphase measurements (when a slice package is anatomically viewed at a defined trigger time). Perfusion and diffusion multi-slice measurements Chronological MO»TA»SP»NR Sorting by time of acquisition (TA), images with the same TA are sorted by SP, images with the same TA and SP are sorted by NR. As numbered NR»SP Sorting according to image number (NR). Images with the same NR are sorted according to SP. As loaded Sorted by load order Abbreviation: 192 Scanning and postprocessing Operator Manual

193 Performing an examination 5 Abbreviation MO Example Sorting according to main orientation sag cor tra SP Sorting according to a) main orientation sag cor tra, b) allocation to a 3D group, c) depending on the main orientation, the portion of the center vector of the group in the sequence tra cor sag, d) the portion of the center vector of the slice corresponding to the main orientation (within the 3D group) in the sequence tra cor sag TT TA TE TD BV NR Sorting according to trigger time Sorting according to acquisition time Sorting according to echo time Sorting according to time after delay (perfusion or diffusion time) Sorting according to b-value Sorting according to image numbers - Sorting according to load order. This criterion does not allow any subcriteria. Movie display During a measurement or measurement pause, you can start the movie display, check the quality of the images being acquired, and gather preliminary diagnostic information. A large image segment is used for the movie display. You can perform additional measurements or repeat them while the movie is running. Groups are formed for the movie display to provide a better overview within series. Groups within a series: Movies display the images of one group. However, it is possible to jump from group to group. One series one group: A series is treated as one group if all images in the series differ according to the same sorting criterion. The sort scheme also determines the order of images for movie display. syngo MR E11 193

194 5 Performing an examination Example: Single-slice multi-phase series (cardiac imaging) Sorting SP >> TT >> TA. All images of the initial series have the same slice position. However, they have different trigger times. One series multiple groups: A series is divided into several groups if the current display mode contains images in consecutive order that can be differentiated only when using the secondary search criteria. Example: Multi-slice multi-phase series (cardiac imaging) Sorting SP >> TT >> TA. This series is divided into n groups, because it contains images of n different slice positions and trigger times. The first group contains all images with slice position 1 and different trigger times. The second group contains all images with slice position 2 and different trigger times. Inline display Inline Display is used for the following applications: To view and control the reconstructed images during the measurement in progress To localize the requested slice positioning and slice orientation of a real-time protocol To trace the contrast agent signal in a CARE Bolus measurement before starting the high-resolution protocol To trace the navigator signal (respiratory curve) To start and pause a multiple breath-hold measurement for some sequence types, e.g. TimCT Oncology To trace the t-test for BOLD measurements on the EPI mosaic images To filter the display of BOLD images (except for Mosaic BOLD images) of a certain slice For TimCT Oncology measurements, to filter the reconstructed images or a projection progress image Automatic start: 194 Scanning and postprocessing Operator Manual

195 Performing an examination 5 The display includes only images that are loaded automatically from image reconstruction. It is not possible to load images into Inline Display and then to scroll back to previously displayed images. Inline Display opens automatically when a protocol with the Auto open inline display property is about to run in the job list. Inline Display opens at its last position. You can set the position to the first image segment by double-clicking into the Inline Display. Image display shows the images in sequence, similar to a fast slide show. If image reconstruction provides the images very quickly, only the most up-to-date images are displayed. If the slices are measured with interleaving, Inline Display is empty. The images are reconstructed after data acquisition Tasks Defining the sort scheme Images are loaded Using Siemens sort scheme 1 Select Scroll > Display Order. 2 Select a sort scheme. Defining own sort scheme 1 Select Scroll > Display Order > User Defined. The Image Display Order dialog window opens. 2 Select the sort criteria. syngo MR E11 195

196 5 Performing an examination Use three different sort criteria. If the first sort criterion Load Order is selected, other sort criteria are not necessary. The selection lists are inactive. 3 Click OK. Measuring pixel coordinates, distances, and angles Reference images are loaded Measuring the pixel coordinates 1 Select Image > Modify Graphics. 2 Click the area of interest in the image and keep the mouse button pressed. The coordinates of the position of the mouse pointer in the whole body patient coordinate system are displayed. Measuring the distance between images 1 Select Image > Modify Graphics. 2 Click the image and hold the mouse button down. 3 Move the mouse pointer to the starting point. 4 To start measuring the distance, press the Shift key. The coordinates and the distance disappear when you release the mouse button. 5 To display the distance line, release the mouse button. 6 Release the Shift key. 7 Move the mouse pointer to the end point. The distance to the first point is displayed below the coordinates. 8 To end measuring the distance, release the mouse button. The display of the coordinates and the distance disappears. Measuring angles 1 Select Image > Modify Graphics. 2 Press and hold the mouse button. 3 Measure the distance from the apex of the angle and any point along the first leg. 196 Scanning and postprocessing Operator Manual

197 Performing an examination 5 4 Press Ctrl and move the mouse to a point at the second leg. 5 Release the Ctrl key when the second side is visible. The angle is displayed below the coordinates and the distance. 6 To end measuring angles, release the mouse button. The display of the coordinates, distance, and angle disappears. Starting the movie display Select Scroll > Movie > Movie Control. The Movie Control dialog window opens. Starting in LOOP mode Click this icon. The movie display starts in the LOOP mode. After the last image of the series, the first image is displayed again, etc. Starting in Yo-Yo mode Click this icon. The movie display starts in the Yo-Yo mode. The direction of movie display is changed after the last image. The second to last image is displayed, etc UI explanation Movie control Scroll > Movie > Movie Control syngo MR E11 197

198 5 Performing an examination (1) Starts movie display in the Yo-Yo mode. The direction of movie display is changed after the last image. The second to last image is displayed, etc. (2) Shows the current sort order. (3) Opens the Movie Properties dialog window. (4) Displays the index of the current image / total number of images. (5) Starts real-time mode. If you manually change the speed in real-time mode, real-time mode automatically stops. (6) Skips images in the real-time mode. (7) Sets and shows the speed. LED display 198 Scanning and postprocessing Operator Manual

199 Performing an examination 5 Color Status Stopped or paused Running, all images are displayed. Running, the Skip images option is enabled and at least two images are skipped. Running, the Skip images option is disabled, the current speed is lower than the currently set one. (8) / (15) Running or paused status Scrolls from group to group and moves from the group of series A to the first group of series B. Stopped status Scrolls from series to series. (9) / (14) Scrolls by one image in the running or paused status. (10) / (13) Sets start / end marker to limit range. (11) Reverses display order (in paused status only). (12) Displays the position of the current image in the series. syngo MR E11 199

200 5 Performing an examination Movie properties (1) Sets the real-time mode. (2) Sets a time frame for real-time mode. (3) Defines the number for inline movie segment. (4) Sets the sort scheme. (5) Sets the Display Order. 200 Scanning and postprocessing Operator Manual

201 Performing an examination 5 (6) Switches the Image Text on/off. For optimal movie quality, we recommend hiding this additional information. (7) Switches the Reference Lines on/off. With the reference lines switched on, the current image in the movie segment is displayed through a reference line in the other image segment and continuously updated in the running or paused status. (8) Activates the positioning graphics. With the positioning graphics activated, all GSP objects and all orientation aids selected via the menu are shown in the movie segment in the running or paused status. (9) Sets the default parameter set. Store Saves parameter sets so that they are available when you start the system again. Restore Sets the default parameters. syngo MR E11 201

202 5 Performing an examination Inline display (1) Displays the number of the program step. (2) Toolbar of the Inline display: Option Comment Saves images automatically. For interactive scanning in real-time mode, you have to switch off automatic image storage. Saves an individual image. Pauses the Inline display. Ends the current measurement and starts the next one in the queue (Stop & Continue). 202 Scanning and postprocessing Operator Manual

203 Performing an examination Option 5 Comment Starts the breathhold measurement (Scan Breathhold). For TimCT Oncology measurements only: Moves the table for a breathhold and stops. Navigator signals are not recorded during the measurement. During the first measurement, the position of the diaphragm is displayed as a yellow line. You can also start the measurement using the start measurement icon in the toolbar of the program control. ( Page 63 Toolbar of the program control) For TimCT Oncology measurements only: Moves the table to the end position (without breathhold pauses). A further click on the button stops the TimCT Onco measurement. Activates the display filter. The slice number of the images to be displayed can be entered into the input field to the right of this icon. For TimCT measurements, you can display either the reconstructed images or a projection progress image. The slice number field is not available in this case. Copies the position and orientation of the currently displayed image into the open protocol and into the buffer. syngo MR E11 203

204 5 Performing an examination 204 Scanning and postprocessing Operator Manual

205 Postprocessing and reporting 6 6 Postprocessing and reporting syngo MR E Standard evaluation methods syngo 3D Saving and exporting images Reporting Filming Composing images Dynamic analysis Filtering, correcting, converting images

206 6 Postprocessing and reporting Standard evaluation methods General information Important information on diagnosis: Caution Measurements in projected images. False diagnostics possible. Do not use measurements in projected images for diagnostic purposes. A standard monitor without calibration is not suitable for diagnostic purposes. Please consider the initial acceptance testing for image display devices and the follow-up service for constancy testing on a regular base, as offered by Siemens service. Rotate and flip images: Orientation labels are rotated and flipped together with the image. Any annotations and graphics you enter are deleted when you rotate or flip an image. Save images: Caution Modifications in medical images are not saved automatically in the same way as image comment. Additionally, in case of a user switch where the new user has no adequate access rights, modifications of the image text may also be lost. Image modifications may be lost. Use Patient > Save as in order to save the image with modifications as a new image. 206 Scanning and postprocessing Operator Manual

207 Postprocessing and reporting 6 Viewing task card On the Viewing task card, you can view the results of an examination and evaluate it or prepare it for diagnostics. You can also use the Viewing task card to compare image material of different examinations and, depending on the configuration, of different patients. You can first load the images using the Patient Browser or from the 3D task card into the Viewing task card. Here you can select one of various ways of arranging the image material and displaying it in the clearest way for your diagnostic problem. You can then save the processed and evaluated images, print them, expose them on film, or send them to other locations in your network. 2D evaluation To evaluate result images in the Viewing task card, you can measure distances and angles, and evaluate Regions Of Interest (ROIs). ROIs (Regions Of Interest) are used to mark anomalies in the images and evaluate the gray scale within these regions statistically. ROIs can be circular, rectangular, or freehand regions. You can also measure the length of a structure, i.e. a blood vessel, by drawing the shape with a freehand line (Tools > Freehand Distance). You can end this line with a double-click Pixel lens The Pixel Lens displays the average value of gray scales of a small 5 5 pixel area. In syngo MR, the patient coordinates are displayed together with this value. The displayed coordinates refer to the Whole Body patient coordinate system. The zero point of the coordinate system is at the table position located in the magnet isocenter during the first measurement of a series block. In practice, this is the position marked by the light localizer prior to the beginning of a new MR examination. ( Page 40 Coordinate system) syngo MR E11 207

208 6 Postprocessing and reporting Prerequisites for coordinate display: The patient coordinates are displayed only if the reference image meets the following conditions: The image is a Siemens MR image The image is not a mosaic image The image has a defined DICOM image plane Restrictions: The images used have to belong to the same series block. The result images may contain distortion artifacts as a result of the non-linearity of the gradient field inside the magnet. Image distortion artifacts in the visible image are not corrected by the coordinates displayed. The patient coordinate is displayed only if the inaccuracy of the specified image coordinates lies within a 7-mm tolerance margin. For Composing images, only the transverse part of the Pixel Lens coordinates is shown in the image. The user is responsible for using the correct (mutually compatible) images for comparing the Pixel Lens coordinates. Caution Coordinate data when using the pixel lens function! Incorrect diagnosis Use the pixel lens function only in the center of MR images. Do not use the pixel lens function to compare coordinates between images with distortion correction and those without. Reference the coordinates of the pixel lens function only to the table position in the lower right of the image. Do not copy Pixel Lens markers from image to image! If a Pixel Lens marker is copied, it does not appear at the identical patient coordinate in the images it appears at the same distance to the upper left corner of the images! 208 Scanning and postprocessing Operator Manual

209 Postprocessing and reporting 6 Do NOT use the Pixel Lens when multiple images are selected! If several images are selected, the Pixel Lens marker does not appear at the identical patient coordinate in the images it appears at the same distance to the upper left corner of the images! Please note the inaccuracies that may be displayed when using this application. Examples: Example 1 You search for the patient coordinates from the transverse image on the left in the second, sagittal image on the right. syngo MR E11 209

210 6 Postprocessing and reporting Example 2 You compare two sagittal images that belong to the same series block but have a different FOV. The first image shows only parts of the lumbar vertebrae, the second image shows the entire length of the lumbar vertebrae. Example 3 You compare two sagittal images of the same series block, but at different table positions. The first image shows the upper section, the second image shows the lower section of the cervical spine. TP 0 TP F15 Position display For series containing a large number of images, it is useful to display the position of images in an overview. The cut lines for acquired images are calculated with the original reference images or other suitable images. The position display shows the cut lines of acquired images in images belonging to a new series. Two variants are available for position display: Offline position display Inline position display 210 Scanning and postprocessing Operator Manual

211 Postprocessing and reporting 6 You can display single images, complete series, or several series offline in the position display. You can configure the display and the labeling of the cut lines yourself. For computing position display, you need to have full access rights to the data to be evaluated. Detailed information regarding all security settings in syngo are included in the syngo Security Package brochure. Definition of terms: Term Description Data image Displays the position line of an image Data series Series containing the data image Reference image Image on which the position line of a data image is displayed Reference series Series containing the reference image Offline Position Display Position display on the Viewing task card Inline Position Display Position display in the Exam task card Prerequisites: General remarks The images are MR images only. The images are not Secondary Capture images (e.g. Alpha images). The images have an image plane. The images are not mosaic images. The images are part of the current examination of the current patient. Images from software versions prior to syngo MR B15 The images must have the same frame of reference. Reference images may not be distortion corrected. syngo MR E11 211

212 6 Postprocessing and reporting Images from software versions beginning with syngo MR B15 The images must have the same frame of reference. Beginning with syngo MR B15, the type of distortion correction is part of the FoR. The images are part of the same series block. The images are of type ND, DIS2D or DIS3D. For reference images of type ND, all images were measured at the same table position. These conditions do not apply to reference images of type DIS2D and DIS3D. Type DIS2D*images cannot be used as reference images for position display. The new position display series: Calculating the position display generates a new series. It includes reference images for which at least one cut line can be calculated and displayed. Name of the new series:the name of the new series consists of PosDisp, the series number set in square brackets, plus the name of the first data series. Example: PosDisp: [2] t1_se_sag Number of the new series: The number of the new series is the highest series number assigned thus far +1. If a series number has not yet been assigned, e.g. after system installation, the PosDisp series will be given the number Automatic data transfer: Usually your MR system configuration saves all new reconstructed images to specific network nodes. You can exclude PosDisp images from automatic data transfer (Evaluation > Position Display > Disable Auto Transfer) with the actual setting saved. It even remains when you restart your MR system Tasks Loading multiple studies or patients in the Viewing task card With Multi View, you can have multiple patients displayed simultaneously in the Viewing task card. 212 Scanning and postprocessing Operator Manual

213 Postprocessing and reporting 6 Patients with different patient IDs, but otherwise identical data, are handled as different patients by the system. Viewing task card is open Patient Browser is open 1 Click the Multi View icon on the View subtask card to activate this display mode. 2 Use drag & drop to load multiple studies or patients (multi study layout). 3 Drop each patient in a different study view. Annotating images Inserting predefined text You can enter 20 predefined texts or freely formulated texts on the Composing task card. You can change the texts at any time. Composing task card is open Images are loaded 1 Open the Annotation dialog window with this icon on the Tools subtask card. The Annotation dialog window opens. 2 Select a predefined text from the list. Inserting free text annotation Viewing, Composing, Tissue 4D or Vessel View task card is open Images are loaded 1 Click this icon to enter a text. 2 Click the required position in the image to insert the text. 3 Enter the text you want to insert. Changing text 1 Double-click the entry you want to change in the Annotation dialog window. The Edit Annotation Text dialog window opens. 2 Overwrite the text as required and click OK to apply the new text. syngo MR E11 213

214 6 Postprocessing and reporting Positioning text Click the text and move it to the desired position. Rotating and flipping Orientation labels are rotated and flipped together with the image. Any annotations and graphics you enter are deleted when you rotate or flip an image. Viewing task card is open 1 Select the images that you want to edit. 2 Select Images > Rotate. 3 Select Images > Flip Horizontally or Flip Vertically. Using the interactive movie Viewing task card is open 1 Click the Interactive Movie icon on the View subtask card. 2 Hold the left mouse button down in the image and move the mouse up or down to play the movie forward or backward. 3 Click the Interactive Movie icon again to terminate the Movie mode. Measuring the distances For distance measurements, the geometric accuracy of the measurement system in the isocenter is ±0.1 mm. If you change the imaging parameters (for example, window, reconstruction parameter, FoV), it may influence the image impression. It can have effects on the start-points and end-points of distance measurements you selected. 1 Click the Distance icon of the Tools subtask card. 2 Drag out a line between two points in the image while holding down the left mouse button to display the distance in the image. 214 Scanning and postprocessing Operator Manual

215 Postprocessing and reporting 6 The information displayed is configurable. Measuring angles 1 Click the Angle icon to activate angle measurement. 2 First drag out one line while holding the left mouse button down. The line represents the first leg of the angle. 3 Draw another line for the second leg. The angle size is displayed in the image. You must pull each line toward the origin of the angle or away from the origin of the angle. Otherwise the complementary angle with respect to 180 is calculated. Evaluating regions (ROIs) 1 Click the Circle or Rectangle icon on the Tools subtask card. syngo MR E11 215

216 6 Postprocessing and reporting 2 Click the image and draw the ROI (rectangle or circle). 3 Release the mouse button. or Click the Freehand ROI icon. 4 Drag the mouse around your region of interest, and double-click the end point. You can also draw the region point to point by clicking with the mouse at each change of direction (polygon definition). A statistical evaluation of the ROI is displayed. (1) Evaluated gray scale range (2) Highest and lowest gray scale value (3) Mean value and standard deviation (4) Area of the ROI in cm 2 (5) Number of pixels in the ROI If the loaded series contains images with different resolutions, different values may result when calculating the area of an ROI. 216 Scanning and postprocessing Operator Manual

217 Postprocessing and reporting 6 You can configure the data displayed via the NUMARIS/4 Configuration Panel. Measuring position and grayscale values with the Pixel Lens When the Pixel Lens is activated, the values of the current mouse pointer position are displayed. When images are saved, the Pixel Lens markers in the images are saved as superimposed graphics. Viewing task card or 3D task card is open Only one image is selected Click this icon. The cursor changes shape. The grayscale value is shown in the first line. The second line shows patient coordinates. Inserting a marker at a fixed position You can also call up the pixel values in an image. 1 Activate the Pixel Lens function. 2 Click the pixel of interest with the left mouse button. The pixel is marked with a small circle. If the image is loaded in Viewing, the grayscale value is shown in the first line. The second line shows patient coordinates. If the image is loaded in the 3D task card, only the grayscale value is displayed. The circular marker of the Pixel Lens does not match the area measured to determine the grayscale value. It has a constant size and is independent of the zoom factor of the image. The gray scale value is always determined by a 5 5 pixel area. syngo MR E11 217

218 6 Postprocessing and reporting Selecting and moving the marker 1 Deactivate the Pixel Lens function. 2 Move the mouse pointer to the marking. The arrow cross is displayed in enlarged format. 3 Press and hold the mouse button and move the marking with the mouse to the required position. The grayscale value and patient coordinates are updated. Deleting a marker 1 Click the marker to select it. The marker changes shape. 2 Press Del. The marker of the Pixel Lens is deleted. Starting the offline position display The sequence used for selecting images automatically determines the images used as data images or reference images. The calculations for reference series must be completed prior to calculating the slice position for series. Position display of series (example) All images of one or more series are displayed in the position display. 1 Load the transverse series to the Viewing task card. 2 Place the input focus on an image from this series. 3 On the Patient subtask card, click this icon. The position display is calculated. The cut lines with the reference images are calculated and displayed for all images of the data series. The new PosDisp series contains the sagittal and coronal reference images, each with the cut lines. Position display of a selection (example) A coronal and a transverse series are loaded into the Viewing task card. The cut lines of selected coronal images are displayed in the transverse images. 1 Explicitly select the coronal images of interest. 2 Select an image from the transverse series. 218 Scanning and postprocessing Operator Manual

219 Postprocessing and reporting 6 3 On the Patient subtask card, click this icon. The position display is calculated. The new PosDisp series contains all images of the transverse series for which cut lines of the selected coronal images exist. Position display of several series (example) A coronal, a transverse, and a sagittal series are loaded into the Viewing task card. The cut lines of all transverse and sagittal images are displayed in the coronal images. 1 Explicitly select a transverse and a sagittal image. 2 Select an image from the coronal series. 3 On the Patient subtask card, click this icon. The position display is calculated. The new PosDisp series contains all images of the coronal series including the cut lines of the transverse and sagittal images UI explanation Position display dialog window Evaluation > Position Display > Settings syngo MR E11 219

220 6 Postprocessing and reporting (1) All All cut lines are displayed. First/Last Only the first and last cut lines of a parallel line group are displayed. Automatic Cut lines that are too close to one another are automatically hidden. Overlapping cut line labels are avoided. The system automatically switches from First/last to Automatic as soon as the first and last cut line of a group cannot be calculated. Other line groups remain unaffected. (2) These icons determine the preferred position for the cut line annotations in the PosDisp image. (3) None No cut lines are labeled. First/Last Only the first and last cut lines from each parallel and equidistant line group are labeled. All All cut lines are labeled. Automatic All cut lines are labeled as long as they do not overlap. Individual annotations are hidden if they do overlap. Every Only every nth cut line is labeled. Sorting is based on image number and starts at Scanning and postprocessing Operator Manual

221 Postprocessing and reporting syngo 3D The result of an MR examination is a sequence of images through a solid volume. By combining two-dimensional images, it is possible to obtain a three-dimensional display of the region of interest. In this three-dimensional display, you can work just like in a threedimensional model. The basic software supports you in: Generating new images Cutting out individual regions Extracting or masking out structures for a precise diagnosis Applying a wide range of evaluation functions for special diagnostic problems syngo 3D provides you some alternative procedures for working with three-dimensional images. You decide with what method you want to begin as soon as you load images into the 3D task card. On the 3D task card, you then prepare your image material with the selected method, or you start another image processing procedure Loading images to 3D The following criteria must be fulfilled for displaying a selection of images: All images must originate from one patient and from one study. The number of images that you can process depends on the availability of an enhanced graphics card, and on configuration. All images must have the same x/y coordinates and FoV (Field of View). For clinical application information and recommended scan protocols, refer to the application-specific operator manuals. Loading images via the Patient Browser 1 Call up the Patient Browser by selecting Patient > Browser... from the main menu. syngo MR E11 221

222 6 Postprocessing and reporting 2 Select one series or at least three images in the Patient Browser. 3 Click the 3D MPR icon to start image processing as multiplanar reconstruction (MPR). In addition to the multiplanar reconstruction (MPR) described here, you can switch over at any time to: Maximum intensity projection (MIP) Surface shaded display (SSD) Volume rendering technique (VRT) For more information, refer to: ( Page 237 Changing the display mode) Loading images from the Viewing task card 1 Select at least three images or the series that you want to process. 2 Click the 3D MPR icon to start image processing as MPR. If you explicitly select no images in the Viewing task card, the entire content of the opened patient folder is transferred. That means all images of the patient are transferred. Loading images via the 3D Series List Caution If you load large data sets, the image pixel data will be downsampled. The image quality may be insufficient. Be aware of reduced image quality if indicated in image display. 222 Scanning and postprocessing Operator Manual

223 Postprocessing and reporting 6 The 3D Series List dialog box is displayed if: The series you transferred is not suitable for 3D display You selected more than one series for processing (1) Patient data (2) Series suitable for 3D display (valid list) (3) Series unsuitable for 3D display (invalid list) Double-click a valid series that you want to examine, or select the series, and click the Select button. Select Patient > Open Series List... to open the 3D Series List and access other series that you marked for examination. Closing patients Click the Close Patient icon in the lower part of the control area to close all currently displayed images. All images are closed and removed from the 3D task card Moving through the volume You can move slice by slice forwards or backwards through the volume. The other segments are updated simultaneously. syngo MR E11 223

224 6 Postprocessing and reporting Shifting with the mouse Shifting with the mouse is an interactive equivalent to scrolling via the dog-ear. 1 Click in the segment you want to scroll. 2 Activate the parallel shift function using the SmartSelect menu. The shape of the mouse cursor indicates the action performed. 3 To move slowly through the volume, press the mouse key and drag slightly upwards. 4 To move faster through the volume, drag the mouse cursor further upwards. 5 To move the image plane out of the volume, drag the mouse cursor downwards Setting the image orientation Using standard views The standard views are used as a starting point for processing images. 224 Scanning and postprocessing Operator Manual

225 Postprocessing and reporting 6 (1) Sagittal view: Left to Right or Right to Left (2) Transversal view: cranio-caudal or caudo-cranial (head-feet or feet-head) (3) Coronal view: anterior-posterior or posterior-anterior (frontback or back-front) 1 Select one of the three image segments in the image area of the 3D task card. 2 Click the relevant icon of the Orientation subtask card. Controlling the in-plane orientation Click the Orientation Control icon in the upper control area to enable the orientation control. If the images are mainly sagittal or coronal, the head is displayed at the top. If the images are mainly transversal, the images are displayed anterior at the top. syngo MR E11 225

226 6 Postprocessing and reporting You can return to the standard view from any other view by clicking the Default Orientation icon. Activating the orthogonal view To display slices along the main axis of an organ for example, the heart you set the view in the reference image. Click the Ortho Sync icon in the upper part of the control area. Moving a cut line The reference lines indicate the position of two slice planes which are displayed in the two other segments. You can recognize which image corresponds to which cut line by the color of the reference lines and the frame around the segments. The arrows indicate the viewing direction from which you view a plane. Click a reference line in an image and move it holding the left mouse button down to shift the cut line. The corresponding slice plane is displayed in one of the other segments. or Use the dog-ears to move the slice forwards or backwards. Rotating a cut line By rotating the cut lines, you create oblique planes (only one line is oblique) or double-oblique planes (both lines are oblique). Dotted lines indicate planes that are not perpendicular to the view displayed. An orientation cube is displayed on all images. It indicates the anatomical orientation of the reconstructed image. 226 Scanning and postprocessing Operator Manual

227 Postprocessing and reporting 6 1 Click the Free Mode icon to activate free mode. 2 Click the line with the left mouse button and hold the mouse button pressed. 3 Rotate the line around the central point. 4 Click the active Free Mode icon to freeze the angle. Rotating a VOI 1 Click the Rotate Images icon on the upper part of the control area. The mouse pointer changes shape. 2 Tilt the VOI by moving the mouse up or down. 3 Rotate the VOI by moving the mouse to the left or right. While you are rotating the VOI, the image is displayed with reduced quality. 4 Combine rotating and tilting by moving the mouse diagonally. 5 Spin the VOI by moving the mouse along the border of the segment, keeping the left mouse button pressed. syngo MR E11 227

228 6 Postprocessing and reporting Generating series of images Caution The zoom factor for reference image display is selected such that the complete volume can be displayed. This preselected zoom factor influences the spatial resolution for reconstruction. The spatial resolution may be lower than the spatial resolution of the original images. Reduced image quality (lower resolution) due to default zoom level. Center the relevant area and select a suitable zoom factor before starting calculation of ranges or resampling. Setting the reference image 1 Set up a view you require in one of the segments as the basis of further processing. 2 Click that segment to select this view as the reference image. The selected reference image is displayed with a thick border. Generating parallel ranges By using the Parallel Ranges icon, you create a series of images parallel to a selected reference line. In this mode, you can generate a parallel series of tomographic images at equal distance and with equal slice thickness. 1 Click the Parallel Ranges icon on the Settings subtask card. The 3D: Parallel Ranges dialog box is displayed. 228 Scanning and postprocessing Operator Manual

229 Postprocessing and reporting 6 You can move the dialog box 3D: Parallel Ranges if it obscures the output segment (lower right segment). 2 Enter the number and the thickness of images to be generated and confirm with the Enter key. 3 Enter the distance between the images and confirm the setting with the Enter key. or Move the starting or end line graphically in the reference image. With the following icons you can generate a series whose intersection planes are horizontal or vertical in the center of the reference image. 4 Click the Horizontal Ranges icon. syngo MR E11 229

230 6 Postprocessing and reporting or Click the Vertical Ranges icon. 5 Click the Swap Range Order icon to reverse the existing image numbering of the series. 6 Click the Constant Number of Images icon to keep the number of images constant when resizing the range. 7 Move the mouse cursor to the center line. 8 Move the reference line to reposition the entire range. 9 Rotate the reference line if you want to rotate the entire range. 10 Click the Start button. The series of parallel images is displayed in the lower right segment. 11 Save your new series if the new series is as you require it. ( Page 235 Storing images) Generating radial ranges In order to view a range from different angles, you generate radial tomographic images. In this way, you simulate step-by-step rotation around a reference axis. 1 Click the Radial Ranges icon on the Settings subtask card. The 3D: Radial Ranges dialog box is displayed. 230 Scanning and postprocessing Operator Manual

231 Postprocessing and reporting 6 2 Enter the number of images to be generated and confirm with the Enter key. 3 Enter the angle between the images and confirm the setting with the Enter key. or Rotate the starting line, the center line, or the end line around the point of rotation. 4 Move the entire range by moving the point of rotation. 5 Click the Swap Range Order icon to reverse the existing image numbering of the series. 6 Click the Constant Number of Images icon, and drag the start or end line of the graphic range object to another position. syngo MR E11 231

232 6 Postprocessing and reporting The cutting lines are distributed between start and end line. The distance between the images is automatically adapted so that a whole number of images can be calculated. 7 Click the Start button. The series of radial images is reconstructed in the lower right segment. 8 Save your new series if the new series is as you require it. ( Page 235 Storing images) Generating curved images With this option, you can draw a cut line with any curvature inside the MPR image. This cut will be reconstructed and displayed in the output segment. Caution Using non planar slice images for diagnostic purposes. Wrong diagnosis. Be careful when interpreting orientation labels. Keep the shape of the curved cut and its orientation in the volume in mind. 1 Select the segment that contains your reference image. 2 Click the Curved Mode icon on the Settings subtask card. The program changes to the drawing mode and the cursor changes shape. 232 Scanning and postprocessing Operator Manual

233 Postprocessing and reporting 6 3 Draw the cut line by clicking each point along the requested path with the left mouse button. or Draw a freehand line by pulling the curve while keeping the left mouse button pressed. 4 Finish the line by double-clicking. 5 Save your new series if you are satisfied with it. ( Page 235 Storing images) If you are not satisfied with the new reconstructed representation yet, you can vary the cut lines in the working segment. 6 To display further parts of the cut line, move its starting point in the reference image (working segment) by dragging the arrow along the curve with the mouse. 7 Move the whole line, keeping the left mouse button pressed. Generating curved ranges With this option, you generate a series of curved cut images that are parallel to one another and are a defined distance apart. Caution Using non planar slice images for diagnostic purposes. Wrong diagnosis. Be careful when interpreting orientation labels. Keep the shape of the curved cut and its orientation in the volume in mind. syngo MR E11 233

234 6 Postprocessing and reporting 1 Select a segment. 2 Click the Curved Ranges icon on the Settings subtask card. The dialog box 3D: Curved Ranges is displayed. 3 Draw a reference line by holding the left mouse button pressed. 4 Double-click to finish drawing. In the selected reference segment, the positions of the parallel curved tomographic images are shown graphically. 5 Enter the number and the thickness of the images to be generated and confirm with the Enter key. 6 Enter the distance between the images and confirm the setting with the Enter key. 7 Click the Swap Range Order icon to reverse the existing image numbering of the series. 8 Click the Constant Number of Images icon, and drag the start or end line of the graphic range object to another position. The distance between the cut images changes accordingly (is increased or decreased). The number of images remains the same. 9 Move the entire range by clicking the reference line and moving the mouse with the left mouse button pressed. 234 Scanning and postprocessing Operator Manual

235 Postprocessing and reporting Storing images You can have the new series stored automatically during reconstruction. Click the Enable auto-save option on the Ranges subtask card in the 3D Configuration dialog box. Saving images and series quickly 1 Select the desired image or any visualization in the output segment. 2 Click the Save icon. When stored for the first time, a new series is saved in the local database with the name of the evaluation type (MPR, MIP etc.). Storing with the dialog box 3D: Save As 1 Select the desired image or any visualization in the output segment. 2 Click the Save As icon. The 3D: Save As dialog box opens. syngo MR E11 235

236 6 Postprocessing and reporting 3 Enter the name of the physician to whom you want to provide the series of a patient into the Reading Physician field. 4 Enter a comment text in the Comment input field if necessary. 5 Click the Save all images in one series option to save all single images generated from a set of volume data in one series. or Click the Group all images by type option if you want to save images with different output types in your database sorted by the output type. 6 Enter a series name or select a name from the selection list. 7 Confirm the settings with the OK button. All selected images are stored in the new series. The next images you generate or save are appended to the selected series. They are saved under this series name with the name of the evaluation type Filming images 1 Select the desired segment. 236 Scanning and postprocessing Operator Manual

237 Postprocessing and reporting 6 2 Click the Copy To Film Sheet icon of the control area. or Press the Copy To Film Sheet key on the symbol keypad Transferring images You can process selected images by going on to 2D processing or evaluation, or you can transfer the images to other locations in your clinic network. Transferring images to the Viewing task card Click the Save and Load to Viewing icon Changing the display mode The system allows you to switch from MPR to MPR Thick, MIP, MIP Thin, SSD, VRT,or VRT Thin whenever you want. You also can switch to MinIP via selecting Type > MinIP in the main menu. If you want to switch over all segments, you must select and switch over each one separately, one after the other. Switching to MPR with changeable slice thickness (MPR Thick) 1 Click the segment whose output type you want to change. 2 Click the MPR Thick icon on the Type subtask card. The value for MPR image thickness is displayed in the lower left corner of the image. syngo MR E11 237

238 6 Postprocessing and reporting Changing the MPR thickness 1 Right-click the MPR Thick icon. The dialog box 3D: MPR Thick is displayed. 2 Enter an image thickness (in mm) in the dialog box 3D: MPR Thick. 3 Click the Set as default button to set the entered image thickness value as default. 4 Confirm with the OK button. or Click the Default button to use the preset image thickness. Switching to Shaded Surface Display (SSD) 1 Select an image as the reference image. 2 Click the SSD icon on the Type subtask card. You can also transfer the images directly from the Patient Browser or the Viewing task card by selecting Applications > 3D > SSD. Changing thresholds for SSD The system provides default settings for the threshold values for surface extraction but you can alter them individually. 1 Right-click the SSD icon on the Type subtask card. The 3D: SSD Definition dialog box is displayed. 238 Scanning and postprocessing Operator Manual

239 Postprocessing and reporting 6 2 Enter new threshold values in the input fields. 3 Check the values by pressing the Enter key. or Move the slider with the left mouse button to the right or to the left to increase or reduce the threshold value. or Select your predefined threshold value pairs from the list Presets. The new threshold values are immediately applied in the Low value or High value fields. 4 Click the High Quality button as soon as you have found the desired threshold values. 5 Close the dialog box 3D: SSD Definition if you are satisfied with your evaluations. The SSD display is now recalculated. As soon as the procedure is complete, you see a new SSD image which you can freely rotate. Setting the light source 1 Click the Open Light Source icon inside the 3D: SSD Definition dialog box to get a better display of the surface condition of anatomical structures. 2 Select one of your predefined settings or use the sliders to set the desired values. 3 Confirm your settings with the OK button. syngo MR E11 239

240 6 Postprocessing and reporting Restoring light source settings Click the Reset Light Source Direction icon to restore the original direction of the arrow. Defining the MIP slice thickness (MIP Thin) MR only: When a volume data set containing wideband noise is rendered using MIP, the resultant MIP image can show chessboard or stripe-like artifacts when viewed along one of the volume axes. To reduce these artifacts, select Type > MIP Ultra Quality from the drop-down menu. 1 Select a reference segment and scroll through the slice until you reach the desired position. 2 Click the MIP Thin icon on the Type subtask card. The value for MIP image thickness is displayed in the lower left corner of the image. Changing the MIP thickness 1 Right-click the MIP Thin icon on the Type subtask card. The 3D: MIP Thin dialog box is displayed. 2 Enter the image thickness. 3 Click the Set as default button to set the entered image thickness value as default. 4 Confirm with the OK button. 240 Scanning and postprocessing Operator Manual

241 Postprocessing and reporting 6 or Click the Default button to use the default value for MIP image thickness. Generating series of MIP Thin images The selected setting is applied to all subsequent MIP Thin reconstructions. You can also generate different series of tomographic slice images by using your MIP Thin images. For more information, refer to: ( Page 228 Generating series of images) Defining a VRT slice thickness (VRT Thin) 1 Select a reference segment and change the display of the image until it meets your requirements. 2 Click the VRT Thin icon on the Type subtask card. Changing the VRT slice thickness 1 Right-click the VRT Thin icon on the Type subtask card. The 3D: VRT Thin dialog box is displayed. 2 Enter the image thickness. 3 Click the Set as default button to set the entered image thickness value as default. 4 Confirm with the OK button. syngo MR E11 241

242 6 Postprocessing and reporting or Click the Default button to use the default value for the image thickness. The selected setting is applied to all subsequent VRT Thin reconstructions. Setting a visibility mask The visibility mask consists of all masks already created for a data set with VOI Punch mode or 3D Editor. For more information, refer to: ( Page 245 Extracting a VOI), ( Page 249 Using 3D Editor). Existing masks are indicated by Manip (manipulated) in the upper left area of the image text. If one of the modes VOI Punch or 3D Editor is active, the visibility mask is automatically switched on. The Visibility Mask icon is dimmed. After terminating the mode, the mask remains switched on and the icon is undimmed. Click the Visibility Mask icon on the Type subtask card. The visibility mask is applied, and images are shown with masked out structures. If you load the image, existing masks are applied automatically Using Free View Using the Free View function, you can isolate a part of the data set volume. For that purpose, use clip planes and the clipbox, and in that way hide the area you do not require. Activating Free View Click the Free View icon in the Settings subtask card. In the lower right segment, the volume is displayed in Free View. 242 Scanning and postprocessing Operator Manual

243 Postprocessing and reporting 6 (1) Clipbox (white border lines) (2) Clip Plane (red border lines) (3) Clip Plane Slab Mode icon The clipbox is displayed if you clicked the VOI clipbox icon. For more information, refer to: ( Page 245 Using the clipbox). Common interactions You can change the volume display in different ways: By rotating the volume By zooming and panning the volume For more information, refer to: ( Page 46 Zooming and panning), ( Page 214 Rotating and flipping). Using the clip planes You can change the position and reciprocal distance of the clip planes. syngo MR E11 243

244 6 Postprocessing and reporting Select Edit from the main menu and deselect Hide Clip Plane Graphics to display the clip plane. Rotating clip planes Rotating objects Select Orientation > Rotate Clip Plane from the main menu to rotate the clip plane. Select rotate object from the SmartSelect menu to rotate the object. Pushing/pulling clip planes Using the Push/Pull Clip Plane function, you can manipulate the clip plane and objects in different ways: You can push or pull the clip planes by moving the mouse over the clip plane s inner area. You can rotate the clip planes by moving the mouse close to the clip plane s border. You can rotate the object by moving the mouse outside the clip plane. 1 Select Orientation > Push/Pull Clip Plane from the main menu. 2 Select the active mode by moving the mouse cursor with the left mouse button pressed down. Zooming/panning an object Changing the clip plane distance Select zoom / pan from the SmartSelect menu to zoom and pan the object. You can determine the thickness of the volume displayed by entering a value for the clip plane distance. 1 Right-click the Free View icon on the Settings subtask card. The 3D: Clip Plane Definition dialog box opens. 244 Scanning and postprocessing Operator Manual

245 Postprocessing and reporting 6 2 Enter a value for the clip plane distance. 3 Confirm with the OK button. Switching between clip planes Click the Clip Plane Slab Mode icon in the free view segment to toggle between one or two clip planes. Using the clipbox You can change the position and size of the clipbox. If you start the Clipbox mode and the Free View mode is active, the Free Clipbox mode is used. 1 Click the VOI Clipbox icon on the Settings subtask card. The clipbox graphics is displayed in the free view segment. 2 Move the mouse cursor over the center of the clipbox side until the border frame of the clipbox side becomes highlighted in blue. 3 Drag the mouse cursor keeping the left mouse button pressed in order to shift the side of the clipbox You cannot perform clip plane and clipbox interaction simultaneously. Extracting a VOI With a volume of interest (VOI), you extract a volume of diagnostic interest to you thus limiting the volume to be reconstructed to a partial volume. You can extract a VOI in the following ways: Position and delimit a cuboid VOI (VOI Clipbox) Draw a freehand VOI (VOI Punch Mode) syngo MR E11 The views in the reference segments are perpendicular to one another, but they might not be perpendicular to the patient coordinate system. You can change these views at any time. For more information, refer to: ( Page 224 Using standard views). 245

246 6 Postprocessing and reporting Using the VOI clipbox 1 Click the VOI Clipbox icon on the Settings subtask card. The entire data set with the default VOI delimitation appears in the output segment. The rectangle shows the preset delimitation of the VOI. 2 Select Settings > VOI Reset Clipbox from the main menu if you want to reset the size of the clipbox to the initial values. The reset is applied to all segments simultaneously. If you start the Clipbox mode without being in Free mode, the rectangular clipbox mode is used. Changing the size in clipbox mode Click a boundary line of the clipbox and move the grab handle while holding the mouse button down. Moving the clipbox 1 Place the mouse cursor on the edge of the selected VOI to change its position. 2 Move the VOI while holding down the left mouse button. Using the VOI Punch Mode Click the VOI Punch Mode icon on the Settings subtask card. The dialog box 3D: VOI Punch Mode appears in the output segment. Here you will find all the icons that you need for VOI editing. 246 Scanning and postprocessing Operator Manual

247 Postprocessing and reporting 6 When extracting VOIs, you can combine the output types MIP and SSD in different segments to extract and reveal the volume of interest more clearly. Drawing a freehand line 1 Click the Draw Contour icon in the 3D: VOI Punch Mode dialog box. 2 Position the individual curve points in the selected segment with the left mouse button. or Draw a continuous line, keeping the left mouse button pressed. 3 Complete your line with a double-click. The starting and end point of the line are connected. Punching a freehand VOI Click the Keep Inside icon. syngo MR E11 247

248 6 Postprocessing and reporting The area outside the boundary is cut off. or Click the Remove Inside icon. The enclosed area is cut off. Deleting a freehand line 1 Click the line to select it. 2 Press the Delete key on your keyboard. You can also delete a line by clicking the Draw Contour icon again. Undoing deletion Click the Undo Last icon in the 3D: VOI Punch Mode dialog box. 248 Scanning and postprocessing Operator Manual

249 Postprocessing and reporting 6 With Undo Last, you can restore areas that you accidentally deleted. Rejecting all steps Click the Reset All icon in the 3D: VOI Punch Mode dialog box. Closing the VOI mode After performing the VOI Punch mode, the punch mask is automatically saved under the name 3D VOI Punch within the series 3D Application Data. Click the Close button in the 3D: VOI Punch Mode dialog box. or Click the VOI Punch Mode icon on the Settings subtask card. Now, every time you switch to MIP or SSD display and if you activate the Visibility Mask, the effective VOI is displayed. If you close the VOI mode after undoing all processing steps, the punch object 3D VOI Punch is deleted Using 3D Editor The 3D Editor provides tools for marking and isolating structures of interest semi-automatically in three-dimensional space. These structures are referred to as objects. The object is applied automatically when loading the images next time. Calling up the Object Editor Select Settings > Editor Region Growing to call up the 3D: Object Editor. The 3D: Object Editor is opened in Region Growing mode. syngo MR E11 249

250 6 Postprocessing and reporting (1) Tool bar (2) Object list (3) Mode-specific tools (here: tools for thresholding) (4) General buttons Creating a 3D object with threshold 1 Select the threshold value suitable for your object. 2 Fine-tune the threshold values with the slider or the spin box. 3 Click the Add to Object icon to start reconstruction of the object. The reconstructed object appears in the result segment. The created object is listed as New object in the object list. 4 Click the New Object icon to create further objects. 250 Scanning and postprocessing Operator Manual

251 Postprocessing and reporting 6 Using the Undo function If the entries you made are incorrect, you can undo the last task, for example, Add to Object. Click the Undo Last icon. Using the Update function Click the Update Masking icon after image manipulation to apply the changes of your object editing and to update the display. Using Region Growing 1 Select an object in the object list. 2 Click the Set Seed Point icon in the Region Growing window area. 3 Click the relevant points in the working segment (upper right) to set seed points. You can set any number of seed points, drag them to different positions, and delete them via the Delete key on your keyboard. 4 Click the Draw Blocker icon to prevent the filling of certain parts of an object by the Region Growing function. The image in the upper right segment switches to MIP display. 5 Use the MIP to draw a boundary line across the image area you want to define as a separator. 6 Double-click to end drawing the blocker. 7 Click the Replace Object icon to start reconstruction of the object. syngo MR E11 251

252 6 Postprocessing and reporting The edited object appears in the result segment. Cutting out structures With the Object Punching mode, you can cut freely definable areas out of an object. 1 Click the Object Punching icon. (1) Draw Contour (2) Keep Inside (3) Remove Inside 252 Scanning and postprocessing Operator Manual

253 Postprocessing and reporting 6 2 Click the Draw Contour icon to draw a cut line. 3 Set the starting point of your contour with a mouse click and set further contour points with the mouse. 4 Click the Keep Inside icon to delete structures outside the contour. or Click the Remove Inside icon to remove structures inside the contour. Using the Morphological Operations You apply morphological operations to remove edge areas in the representation by eroding and dilating. Click the Morphological Operations icon. The tools for the Morphological Operations are displayed in the 3D: Object Editor. (1) Erode Object (2) Dilate Object syngo MR E11 253

254 6 Postprocessing and reporting Eroding an object 1 In the spin box, enter the surface thickness by which the object is to be eroded. 2 Click the Erode Object icon. The eroded object appears in the result segment. Dilating an object 1 In the spin box, enter the voxel size by which the object is to be dilated. 2 Click the Dilate Object icon. The object is displayed with the relevant areas in the result segment Using Fusion Function The Fusion function allows you to combine the results of different acquisition techniques or acquisitions performed at different times by overlaying them. Fusion evaluation requires two volume data sets: The reference series serves as an anchor for subsequent overlaying of the two image data sets. The model series is aligned spatially on the reference series. Both image series should cover approximately the same examination range. Caution Using fused images for diagnosis. Incorrect diagnosis. Do not use fused images for diagnosis if the history of manipulations is not well known. 254 Scanning and postprocessing Operator Manual

255 Postprocessing and reporting 6 Caution The resolution of the fused range series is reduced. Image quality is not sufficient for diagnosis. The resolution of fused range series is calculated as described below: 1) When Always resample with original resolution is unchecked (default configuration), the resolution of the fused range series is same as the resolution of the reference series (series loaded first). 2) When Always resample with original resolution is checked, the higher resolution between the reference and model series is used for the fused range series irrespective of the loading order. Loading image data sets Caution Unintentional loading of series sets of different patients in Fusion Mode. Mix-up of patients and incorrect diagnosis. Do not load data of different patients in Fusion Mode. 1 Select the series you want to use as reference images in the navigation or content area of the Patient Browser. 2 Click the 3D MPR icon on the tool bar of the Patient Browser. 3 Select the series you want to use as model images in the Patient Browser. 4 Click the Fusion icon on the tool bar of the Patient Browser. The images of the loaded reference and model series are displayed as overlays in the first three segments. syngo MR E11 255

256 6 Postprocessing and reporting (1) Image area: three orthogonal views of the loaded images (2) Control area: icons for editing and displaying images Aligning image series As soon as you have loaded the image series for processing with Fusion, you can align them in orientation and rotation. Using the registration matrix: You can save intermediate steps or the final result of a Fusion registration by saving the corresponding registration matrix. You can also assign the initial or the default matrix. The next time you load two series, the last used matrix is automatically applied. 256 Scanning and postprocessing Operator Manual

257 Postprocessing and reporting 6 Click the Registration icon in the Image subtask card. The 3D: Fusion Registration dialog box opens. Using the alignment with landmarks Both loaded image series are made to match using suitable reference points (distinguished structures). 1 Click the Landmarks icon in the 3D: Fusion Registration dialog box. The functions of Landmarks are displayed. syngo MR E11 257

258 6 Postprocessing and reporting Using visual alignment (1) Buttons for setting and editing reference points (2) List of reference points 2 In one of the reference segments, move the crosshair to the desired reference position. 3 Define the associated reference point on the model side and apply the reference pair with Add. 4 Repeat both steps for at least two additional reference points. 1 Click the Visual Alignment icon in the 3D: Fusion Registration dialog box. 2 Use the direction and rotation arrows to visually align the model series with the reference series. You can also use the mouse to adjust the model series to the reference series. Using surface matching With Surface Matching, you align the model images with the reference images on the basis of threshold values corresponding to a specific tissue structure. 1 Click the Surface Matching icon in the dialog box 3D: Fusion Registration. The functions of Surface Matching are displayed. 258 Scanning and postprocessing Operator Manual

259 Postprocessing and reporting 6 The reference series is displayed in the two left segments and the model series in the two right segments of the image area. 2 Enter threshold values and click the Register button. As soon as you start overlaying, the Register button changes into Define. After registration has finished (or was stopped), Define can be clicked to go back to threshold definition mode. Using automatic registration With Automatic Registration, the model series is automatically aligned with the reference series. You can choose between Precise registration and Fast registration. It is important to roughly align the model series in the segments with the reference series. syngo MR E11 259

260 6 Postprocessing and reporting 1 Click the Automatic Registration icon in the dialog box 3D: Fusion Registration. The functions of the Automatic Registration are displayed. 2 Select Precise registration or Fast registration. 3 Click the Register button. The two image series are now recalculated to match and successively aligned with each other. Applying overlaying Click the OK button to merge the reference and the model series into a single data set. Displaying overlaid images side by side 1 Click the Side by Side icon on the Image subtask card. The left image area is used to display the reference images and the right area for the model images. 260 Scanning and postprocessing Operator Manual

261 Postprocessing and reporting 6 2 Use the coupled mouse pointers to compare the data sets synchronously. Displaying overlaid images in Fusion mode 1 Click the Fused MPR icon on the Type subtask card to switch to fusion mode. The two image data sets are displayed in different colors. The overlaid image data set is displayed as it is for Visual Alignment in three orthogonal views. syngo MR E11 261

262 6 Postprocessing and reporting 2 Select a segment and click the required display mode if you want to change the display mode. ( Page 237 Changing the display mode) Editing the Fusion image Select Fusion > Fusion Definition from the main menu. The 3D: Fusion Definition MPR is displayed. 262 Scanning and postprocessing Operator Manual

263 Postprocessing and reporting Mixing Ratio 6 Pull the slider with the left mouse button in the direction of the data set whose intensity you want to increase. Using the Color Lookup Table Select the color representation you want in the selection list for the reference or model data set (LUT=Lookup table). Changing Window Values Move the the slider or the edge of the slide to change brightness (C = center value) and contrast (W = width value). Masking With nuclear medicine images, you can move the Window Value slider beyond the limits of the range displayed in the dialog box. Click the Advanced >> button to display the masking section and define individual visibility thresholds for the reference and for the model series. Saving results for non 3D Applications You can save 3D Fusion results for common viewing applications, such as the syngo Viewing or MagicView. These viewers are used to compare the original with the fused images. syngo MR E11 263

264 6 Postprocessing and reporting You have to store 2 or 3 different series of images with the correct position, thickness, and orientation. The first series consists of a 3D range from the reference series. The second series consists of a 3D range from the model series. The third series consists of a 3D range of images fused from the two series. Resampling data Select Fusion > Resample Data from the main menu if you want the data to be resampled. Depending on the configuration, three new series with position, thickness, orientation, and resolution of the reference series are created. They are stored in the Local Database together with the registration matrix. Creating ranges in Fusion mode 1 Click the Parallel Ranges icon on the Settings subtask card. The 3D: Parallel Ranges dialog box opens. 2 Select the output type of the reference series, and set the desired range parameters. 3 Confirm with Start, and save the calculated range. 4 Do the last step without changing the range parameters. 264 Scanning and postprocessing Operator Manual

265 Postprocessing and reporting 6 5 First select the output type of the model series, calculate the range and save it. Do not change the range parameters or the range graphic during these steps Using Fly Through Fly Through is used to visualize cavities, such as the colon, the bronchial system, and arteries from positions within the volume. Starting Fly Through Click the Fly Through icon in the Settings subtask card. The Fly view appears in the segment at the lower right, and the Fly View Volume (FVV) is displayed in the reference segments. syngo MR E11 265

266 6 Postprocessing and reporting (1) Main menu, extended by Fly-specific items (2) Control area for easy call-up of functions (3) Image area, subdivided into four segments (4) Status bar for feedback and error messages Changing the display mode 1 Click the SSD icon on the Type subtask card to enter the SSD mode. 2 Click the VRT icon on the Type subtask card to enter the VRT mode. 266 Scanning and postprocessing Operator Manual

267 Postprocessing and reporting 6 Changing the display mode settings Right-click the SSD icon to change the settings for SSD (fly view). or Right-click the VRT icon to change the settings for VRT (fly view). Changing Fly View volume settings The Fly View Volume (FVV) represents the actual field of view of the virtual camera and determines the area visualized in the Fly segment. You can modify the FVV in the image segments with the mouse. (1) Standing point (2) Viewing point (3) Clipping point 1 Shift the viewing point (2) to move the entire FVV. 2 Shift the standing point (1) or the clipping point (3) to rotate the FVV. 3 Drag the edges of the FVV to increase or reduce the viewing angle. Modifying viewing distance 1 Select Settings > Fly View Volume in the main menu. syngo MR E11 267

268 6 Postprocessing and reporting The 3D: Fly View Volume dialog box opens. 2 Change the distance between standing point and viewing point via the spin box. Moving in the Fly segment 1 Activate the rotate around viewing point, rotate view, push / pull functions via the SmartSelect menu with a right mouse click. 2 Modify the view in the Fly segment while holding the mouse button down. 3 Click the Zoom/Pan icon in the upper part of the control area and drag the image center in the Fly segment to the desired position. 4 Click a position in the Fly view to center this position in the segment center. Using auto navigation During auto navigation the virtual camera moves along a line calculated by the system for this cavity. 1 Via SmartSelect, select and activate the auto navigation mode in the Fly segment. 2 Click and drag the mouse. You control the navigation speed by vertical movements of the mouse. 268 Scanning and postprocessing Operator Manual

269 Postprocessing and reporting 6 You can stop, save images or set path points with the Mark (Numeric: 3) key of your keyboard at any time during auto navigation. Performing Fly volume click 1 Click into the Fly segment to perform an auto navigation to the 3D click point. The 3D click point has the coordinates of the first surface pixel below the clicked position. 2 Click the Home Zoom/Pan icon if you want to return to the initial values. With a rotation and a continuous movement of the FVV, the clicked position becomes the viewing point and is shifted to the middle of the segment. Viewing distance and angle do not change. Defining the path or flight along a path 1 Select Settings > Fly Path Planning... in the main menu. or Right-click the Fly Through icon. syngo MR E11 269

270 6 Postprocessing and reporting The 3D: Fly Path Planning dialog box opens. 2 Click the Insert Point icon of the 3D: Fly Path Planning dialog box to add a new point to the path. 3 Click the Remove Point icon to delete a point of the path. 4 Click the Fly Backwards or Fly Forwards icon if you want to move through the volume along the path. or Use the Position torch to move along the path. 270 Scanning and postprocessing Operator Manual

271 Postprocessing and reporting 6 5 Click the Stop Flying icon to stop the flight. 6 Click the Save Path icon if you want to save the current version of the path. The path is saved. Any existing path is overwritten. You can save only one path. Saving images while flying Click the Saving images while flying icon in the dialog box if you want to save the images automatically during the flight. Deleting path Click the Clear Path icon to delete all points of the path existing. Hiding path Click the Hide Path icon if you want to fade out the path Working with two monitors The 3D Dual Monitor option allows you to use two monitors for displaying images. Fusion is not applicable on a two monitor system, but will use only one monitor. syngo MR E11 271

272 6 Postprocessing and reporting Loading one data set In the Patient Browser, select one series in the Viewing task card. The content of the output segment is displayed in Blow-up mode on the secondary monitor (except for Fly Through). Loading two data sets simultaneously You can use the Compare mode to compare pre- and post-studies, or to compare contrast and non-contrast images. 1 Select two series of one or two patients acquired with the same modality in the Patient Browser, in the Viewing task card, or from the 3D Series List with the Ctrl key. Some image series within the section Valid Series of the 3D Series List are marked with a blue font. You can additionally select them for loading to 3D simultaneously. 2 Load the series to 3D. The Compare mode starts automatically. The more recent data set is displayed on the primary monitor. Using the two-monitor display On the primary monitor, usually three MPR images are displayed; on the secondary monitor, a projected volume image (VRT) is displayed in a large segment. 272 Scanning and postprocessing Operator Manual

273 Postprocessing and reporting 6 The Compare mode allows to display two aligned data sets, one on each monitor. You can use it to compare pre- and post-studies or to compare contrast and native images. Performing a manual registration As soon as two suitable image series have been simultaneously loaded, an automatic registration is performed. The series on the secondary monitor is spatially aligned with the series loaded on the primary monitor. 1 Click the 3D: Compare Mode Registration icon in the Image subtask card. The 3D: Compare Mode Registration dialog box is displayed. The segments are in manual alignment mode. 2 Adjust the images of one data set so that they show the same anatomical or pathological structure of interest as the other data set. For adjusting data sets you can use, for example, dog-ears, reference lines, shift mode, or rotate mode. 3 To save the registration as a matrix to the local database, enter a name in the Registration Matrix entry field, and click the Save Registration icon. syngo MR E11 273

274 6 Postprocessing and reporting 4 To delete a stored matrix, select a name from the Registration Matrix list, and click the Delete icon. You cannot delete the initial matrix. After automatic registration and possible manual corrections of the registration, both data sets are correlated. This means that any action performed on one data set is also performed on the other data set Saving and exporting images General information Important information for storing and sending data Caution Transferring manipulated non-square matrices/viewing segments. Diagnostically relevant areas of images may be lost. When manipulated images are exported or sent to another workstation, the related original images should be sent, as well. It is strongly recommended to base the final diagnosis always on the original images and not on modified or manipulated images. 274 Scanning and postprocessing Operator Manual

275 Postprocessing and reporting 6 Caution Misleading/misinterpretation of the storage commitment flags AC/SC. Storage Commitment means storage to hard disk but this may not fulfill or guarantee regulatory requirements about long term archiving. The committed objects can be deleted by users. As a consequence, loss of data within the required period for retention may occur. Observe the regulatory requirements regarding long term archiving. Caution Systems that do not use storage commitment only report back to the sending system when the data has been fully received (flags A and S). A user or an auto delete mechanism at the sending system might subsequently delete the sent data. However, this response does not imply that the data has already been stored at the receiving system. In the case that the receiving system cannot store the data, the data might irrevocably be lost. Double-check that the data is actually stored on the receiving system. Use storage commitment whenever it is supported by the sending and receiving systems. When a user logs off, unsaved data are lost irretrievably. Always check for unsaved data and save any data you want to keep before logging off. Data Import Data from hard disks, DVD-Rs, or CD-Rs must be imported into the Local Database first before it is possible to load them into a task card. Rules for saving, exporting, and filming The following rules apply for reference images. syngo MR E11 275

276 6 Postprocessing and reporting Graphic slice positioning objects are saved with reference images. They are displayed in the non-selected version (without handles) with shadow lines and monochromatic. Distance lines, angles, etc. are not saved. Objects of graphical slice positioning in reference images cannot be edited in the Viewing task card Tasks Storing images and reference images On the Exam task card, you can group a number of series and save them in a new series. These series must belong to the same series block and have the same frame of reference. 1 Select the series or images explicitly. 2 Select Patient > Save As. 3 Select the Save images in new series option. 4 Change the suggested series name as needed and confirm with OK. The suggested series description is taken from the protocol name supplemented by a prefix and a postfix. If it exceeds 64 characters, it is abbreviated by shortening the protocol name from right to left, the prefix from right to left, and finally the postfix from left to right. Appending images to an existing series You can append individual GSP images to an existing series. 1 Select the GSP images explicitly. 2 Select Patient > Save As. 3 Select the Append images to series option. 4 Select the series where you append the GSP images and click OK. 276 Scanning and postprocessing Operator Manual

277 Postprocessing and reporting 6 The new images of the series have image numbers 5000 and upwards. This enables you to distinguish between old and new images within the series. Appending an image to a reference series You append a GSP image directly to the existing reference series. 1 Select the segment with the desired image. 2 Select Patient > Copy Selection. Transferring images to other task cards You can directly transfer images and series from the Exam task card to other open task cards for post-processing. 1 Explicitly select the images or series on the Exam task card. 2 Drag your selection via drag & drop onto the tab of the other task card. The selected images are transferred to the task card. Filming, sending, and exporting images Copying images to the film sheet You can copy images directly from the task card to the virtual film sheet when editing or after having completed an evaluation. 1 Select the images or series explicitly. 2 Select Patient > Copy to Film Sheet. If you have not explicitly selected an image, the image from the segment with the input focus is copied to the film sheet. Sending images You can send images to other network addresses directly from the Exam task card. 1 Select the images or series explicitly. 2 Select Transfer > Export to. Exporting images You can save images on the hard disk as single files. 1 Select the images or series explicitly. 2 Select Transfer > Export to Off-line. syngo MR E11 277

278 6 Postprocessing and reporting The Export to Off-line dialog window opens. 3 As the destination, enter C:\TEMP and click OK. The images are exported to the target directory. Checking the data transfer You can check and control processing of the export and network jobs: Select Transfer > Local Job Status or Transfer > Network Job Status. A dialog window for checking and controlling the jobs is displayed. Storing data on storage media You can store data on storage media, for example, CD-R, or DVD-R. CD-Rs and DVD-Rs are not suitable for long-term storage. Caution DVD-R Medium used for export/archive may get corrupted or may be not readable with other DVD devices. Loss of data or user perception of loss of data. Configure and use local media only as archive media if the requirements regarding retention and readability are sufficient fulfilled e.g. the media is approved by the manufacturer for archiving. Verify readability of the data on the medium before the data is deleted in the database. 278 Scanning and postprocessing Operator Manual

279 Postprocessing and reporting 6 Caution When you simultaneously export data to a device (like CD-R or DVD-R drive) and try to read data from the same device with external (non syngo based) applications, one job or both jobs can fail (depending on the timing). A loss of data is possible. When data is being written to a drive, any external access at the same time will destroy the current write job and could even damage the storage disk. Data already stored on a multi session disk might also become unreadable. Do not try to access the device with non syngo based applications while it is writing data or reading data. To ensure successful writing or reading, check the Local Job Control to see if there are any write or import jobs in progress. Caution Archiving to media already containing clinical data. Loss of data due to corruption of removable media. Avoid recording on removable media which already contains clinical data. Caution A recording error may make a medium unusable. In multi-session mode, all data previously stored on that medium could be lost, too. If this happens, any archive flags set to this data in the database become invalid. Only delete the data that you have archived on a media from the local database after you have successfully finalized and verified the media. syngo MR E11 279

280 6 Postprocessing and reporting It is recommended to clear all entries in the Local Job Status before transferring data (Transfer > Local Job Status). Patient Browser is open or images are loaded in a task card 1 Select the data that you wish to store. 2 Select Transfer > Export to in the Patient Browser or the task card. The Export To dialog box opens. 3 Select [CD/DVD-Writer] from the selection list of the Export To dialog box. 4 Click the Export button to store the data on the default CD/DVD drive. 5 Enter a unique designation for the CD-R/DVD-R in the dialog box displayed. 6 Click the OK button. Ejecting CD/DVD If you do not wish to finalize the medium yet, eject the CD-R/ DVD-R only by using Eject from after the export is finished and not by using the Eject button on the DVD drive. 280 Scanning and postprocessing Operator Manual

281 Postprocessing and reporting 6 Caution A medium is not finalized. Another system/device may show this medium as empty or defective or the data of the last session is missing. Use Eject with finalize to complete the work on this medium and to ensure that the medium is readable on other systems/ devices. If a medium on which you expected to find data seems to be empty or defective or on which the last data is missing, try to use the original or another syngo system to finalize the medium for further read-only access. 1 Select Transfer > Eject from from the main menu of the Patient Browser. The Eject From dialog box opens. 2 Select [CD/DVD] from the selection list of the Eject From dialog box. 3 Click the Eject button to eject the CD-R/DVD-R from the drive. Exporting to a USB device You can export patient data, images, and reports to an external USB device. Depending on the configuration, data can be exported either by Transfer > Export to Off-line... or Transfer > Export to... menu item. Caution Using USB devices without own power supply. The USB controller can be permanently damaged. Use USB devices as recommended by the manufacturer of the device. syngo MR E11 281

282 6 Postprocessing and reporting Caution Plugging/unplugging USB devices during acquisition can make the system unstable which may affect other processes, such as running acquisition tasks. Loss of data, acquisition process disturbed. Do not plug or unplug USB devices during acquisition tasks or other critical processes. Patient Browser is open or images are loaded in a task card USB device is connected 1 Select the data you want to export. 2 Select Transfer > Export to Off-line... or Transfer > Export to... in the Patient Browser or the task card. The Export to Off-line or the Export to dialog box opens. 3 Select the USB drive from the Path selection list. 4 Click the OK button to store the data on your USB device. Caution Removal of USB device without deactivation via software. Loss of data, damaged operating system, and damage of media possible. Do not immediately unplug a USB device. Always use the software functionality for safe removal before unplugging. 5 Click the USB icon in the status bar or select Transfer > Eject from... in the Patient Browser to eject the USB device. Exporting to a Network share You can export patient data, images, and reports to a Network share. Depending on the configuration, data can be exported either by Transfer > Export to Off-line... or Transfer > Export to... menu item. 282 Scanning and postprocessing Operator Manual

283 Postprocessing and reporting 6 If the currently displayed content of the device is not the latest, you are asked to remount the device before importing or exporting data. You can manually remount the device by doubleclicking the device icon. 1 Select the data you want to export. 2 Select Transfer > Export to Off-line... or Transfer > Export to... in the Patient Browser. The Export to Off-line or the Export to dialog box opens. 3 Select the Network share from the Path selection list. 4 Click the OK button to store the data on your Network share. Sending data via the network During installation, Siemens Service sets up various network connections (for example, Node 1 and Node 2) as standard addresses in the network. Do not configure non-archive nodes as a longtime archive. Patient Browser is open or images are loaded in a task card 1 Select the data you want to send. 2 Select Transfer > Send to in the Patient Browser. The Send To dialog box opens. 3 Select the desired destinations from the selection list of the Send To dialog box. 4 Click the Send button to send the data to the selected node. Select the network connection(s) from a list in the Send To dialog box if you want to send data to: An address other than the standard addresses More than one user in the network simultaneously syngo MR E11 283

284 6 Postprocessing and reporting Importing data from storage disks 1 Insert the disk on which the patient or examination data is stored. 2 Click the corresponding icon of the drive in the navigation area of the Patient Browser and select the required data. 3 Select Transfer > Import. The selected data is copied from the external storage disk to the database and placed at the corresponding position in the database. You can watch the progress of the import process in the Local Job Status dialog box (Transfer > Local Job Status). Importing data from the hard disk You can copy objects for example, images or series from your local hard disk, or from a remote folder into the Local Database. You can only import images in the DICOM format for example, IMA files. 1 Select Transfer > Import From Off-line from the main menu of the Patient Browser. The Import From Off-line dialog box is displayed. 2 Select the required drive and directory from the Path selection list. 3 Select the files you want to import. 4 Click the OK button. The objects are imported into the database and appended to any existing patient data objects or a new patient folder is created. Importing data from a USB device 1 Insert the USB device on which the patient or examination data is stored. 2 Select Transfer > Import from Off-line in the main menu of the Patient Browser. 284 Scanning and postprocessing Operator Manual

285 Postprocessing and reporting 6 When the Import from Off-line dialog box pops up, ensure that the proper Path is selected (USB device). The files saved on the USB device should be displayed. 3 Select the files you want to import. 4 Click the OK button. The selected data is copied from the USB device to the database and placed at the corresponding position in the database UI explanation Patient > Save As (1) Creates a new series. (2) Appends images to an existing series. (3) Name of the created series. (4) Selection list of the existing series. syngo MR E11 285

286 6 Postprocessing and reporting Reporting General information General information on reporting Results of evaluations (images, diagrams, etc.) can be stored as structured reports in DICOM format. Reports can be generated from the Argus, Vessel View, and Mean Curve task cards. You can select, edit, and print reports in the Patient Browser or in the applications where they were created. Additionally, the Patient Browser sends reports via the network. Reports in the Patient Browser are stored on the same level as the measurement or evaluation results. Contents of a report: The following information can be recorded in a report: Data relating to the institute (name, address, ) Demographic patient data Quantitative results of the examination Qualitative results of the examination Summary and conclusions comprising individual diagnoses, values measured, and medical codes Recommendations for further diagnosis or therapy Links to medical images or graphics Links to curve plots Diagnostic codes (not for Vessel View reports): For an effective search and evaluation, encoded texts are integrated into the reports. Special code dictionaries (code catalogs) are used for encoding. syngo MR allows you to select a code catalog for reporting/ diagnostics or for defining your own code catalog. ( Page 292 Report editor) Examples of diagnostic code catalogs: 286 Scanning and postprocessing Operator Manual

287 Postprocessing and reporting 6 SNOMED ( SNM3 and SRT ) ACR Index for Radiological Diagnosis ( ACR ) ICD9 and ICD10 ( I9 and I10 ) ICD9-CM and ICD10-PCS ( I9C and I10P ) Completion status of a report The way the report is saved depends on its completion status. Status Partial Completed or Verified Storage The changes are saved in the current report. Changes are saved in a new version of the report with a new version number. A new version of the report is also created if the report in the database is marked with one of the following statuses: Printed Archived Archived + Verified Archived + Committed Sent Sent + Committed Exported Received Instead of report images, references to the DICOM images are saved. Save the changed report before printing it. If you subsequently close the print preview without saving it in edit mode, all changes to the report are lost. syngo MR E11 287

288 6 Postprocessing and reporting Tasks Creating reports You can create a report as soon as the evaluation results are displayed. Argus, Vessel View or Mean Curve task card is open Create a report with this icon. The Report Editor dialog window opens. The report has the status PARTIAL. Adding data 1 In the first segment of the task card, select the images that you want to add to the report, along with their corresponding evaluation data. 2 Select Patient > Append to Report. The selected data are added to the report. Editing reports Patient Browser is open Editing a report If you edit a report with status COMPLETE, the changes are saved as a new report. It is not possible to save changes to the existing report. 1 Double-click the required report. The Report Editor dialog window opens. 2 Perform your changes on the Report-Editor window. ( Page 292 Report editor) 3 Set the Completion Flag. 4 Click Save to save the changes. Printing a report Report is open 1 Click Print Mode. 288 Scanning and postprocessing Operator Manual

289 Postprocessing and reporting 6 The current report is shown in the Print Preview. You cannot change the report in this dialog window. 2 Click Print in the print preview. The Print dialog window opens. 3 Define the printing settings. 4 Click Print in the print preview. Switching to Edit Mode closes the print preview. Sending a report Patient Browser is open System is connected to a network 1 Select the report 2 Select Transfer > Send to... Reports are sent in the Structured Report DICOM format. Referenced images are not automatically sent with the report. They must be sent separately. A transmitted report has been assigned the COMPLETE status. It is no longer possible to save changes to this report. Changes have to be made in a copy of this report. Exporting reports For data exchange, reports of a patient may be exported to an external data carrier (CD or DVD). An exported report consists of two parts: syngo MR E11 289

290 6 Postprocessing and reporting DICOM component: DICOM data directory with linked report data in DICOM format and displayed on the DICOM Viewer. HTML part: Reports on Xhtml basis and jpg images derived from DICOM data of the respective data directories. Exported report data of a patient can be displayed via the supplied DICOM Viewer or via an Internet browser. Making the report available for export Patient Browser is open 1 Select the report in the Patient Browser. 2 Select Applications > Report Tools > Export HTML to Off-line. The report data is collected in a CDR_Offline_Directory until you burn the data to a data carrier (CD or DVD). Burning the report to CD or DVD Patient Browser is open Select Transfer > Export to Off-line. Burning is started in the single session mode. All data burned to the external medium are automatically deleted in the CDR_Offline_Directory UI explanation Report icons in the Patient Browser Symbol Definition Report icon in the directory structure Report icon in the contents area of the most current version Report icon in the contents area of the oldest version 290 Scanning and postprocessing Operator Manual

291 Postprocessing and reporting 6 Symbol Definition Report icon in the contents area of secondary captures Report icon in the contents area (study selected) syngo MR E11 291

292 6 Postprocessing and reporting Report editor (1) Data from the patient ID 292 Scanning and postprocessing Operator Manual

293 Postprocessing and reporting 6 (2) The Completion Flag indicates the progress of the report. Two functions are available: COMPLETE PARTIAL Once a report has been assigned the COMPLETE status, it must be saved as a new report. It is no longer possible to save changes to the existing report. (3) Defines the name of the author. (4) Information units: Individual diagnoses and diagnostic code (for Argus only). Acquiring diagnoses and comments. Some parts of the report contain input fields for recording additional comments. Instead of empty text input fields, a plus sign is shown in front of the name of the input field. (5) The diagnostic codes (not for Vessel View reports) are organized in catalogs in DICOM format. Argus and Mean Curve reports do not provide any default catalogs. Diagnostic codes can be set under Applications > Report Tools > Report Configuration in the Patient Browser. A diagnostic code catalog has to be preset in the report configuration before a report is edited for the first time. This enables you to define the appropriate code by either selecting it or entering it manually. syngo MR E11 293

294 6 Postprocessing and reporting 6.5 Filming You can expose the images of an examination on film or print them on paper for documentation and reporting Transferring images to Filming 1 First select the images that you want to film in the Patient Browser or on the task cards. 2 Click the Copy to Film Sheet icon. or Push the Copy to Film Sheet key on the symbol keypad (Num Enter). Filming images with Window 1 and Window 2 By performing the following workflow steps you can film images with Window 1 and Window 2, either interleaved or appended. 1 Select Options > Configuration... from the main menu of any task card. 2 Double-click the Filming Layout icon on the NUMARIS/4 Configuration Panel. 3 Activate Copy series (for Double Window) on the Series tab card in the Filming Layout dialog box and confirm with OK. 4 Copy the images from the Patient Browser or Viewing via Copy to Film Sheet icon, main menu, or keyboard key Selecting images and sheets In order to select images and sheets for filming, you can: Select one or more images Select complete series Deselect images 294 Scanning and postprocessing Operator Manual

295 Postprocessing and reporting 6 Selecting film sheets Click the border of the film sheet to select all the images it contains. or Click the border of the first film sheet of your choice holding the Ctrl key down. Page to another film sheet using the dog-ears. Extend your selection by a single film sheet (hold the Ctrl key pushed). or Extend your selection by all the film sheets in between (hold the Shift key pushed). syngo MR E11 295

296 6 Postprocessing and reporting Selecting an entire film job Click the opened film job to select all the film sheets with all images of this job. The folder icon of a selected film job is highlighted (blue). All the images of this job are shown with a continuous blue line border Editing film jobs Changing the layout With the layout of the film sheet, you define the number and size of the segments on a film sheet. To change the size and position of an image within the segment, select Image > Zoom/Pan. 1 Select individual images or a film sheet or select an entire film job. 2 Click the Layout subtask card on the Filming task card into the foreground. 3 Click the icon for a film layout to display the selected images in this format. 4 Select Properties in the context menu for additional layouts, if necessary. or Select a layout from the Layouts selection list in the lower right control area In the Filming Layout Editor you can create new layout divisions for selection. To do so, select Patient > Filming Layout Editor from the main menu and create and edit new layouts according to your needs. After restarting the application, the new layouts are available in the Film Properties dialog and the Layouts selection list. 296 Scanning and postprocessing Operator Manual

297 Postprocessing and reporting Including an Information Segment 6 You can display an information segment as the first image of the series. It contains patient overview and common information. 1 Select Patient > Filming Layout from the main menu 2 Activate the Information Segment checkbox on the Series tab card in the Filming Layout dialog box. You can change the content of the Information Segment with the Image Text Editor. You can open the Image Text Editor by selecting Options > Configuration in the main menu. Then double-click the Image Text Editor icon. Windowing images Refer to ( Page 45 Windowing images). Copying and moving images or film sheets 1 Select the images/film sheets that you want to copy or move. 2 Select Edit > Copy in the main menu. or Select Edit > Cut in the main menu. 3 Select the image in front of which you want to insert the selected images. 4 Insert the images with Edit > Paste in the main menu. If you only want to move images within a film sheet, you can also do that easily by drag & drop. In this case, deselect the Zoom/Pan icon. If you want to add new images from the Patient Browser to a film job, you can do that easily by drag & drop. The images are inserted into the film job in front of the target segment. Deleting images or film sheets 1 Select one or more images or film sheets. 2 Select Edit > Delete in the main menu. syngo MR E11 297

298 6 Postprocessing and reporting or Click the Delete icon or push the Del key on the keyboard. You can also delete images with Film > Clear Document(s) in the main menu. In this case, the segments of the deleted images remain empty. Use Film > Repack afterwards to reorganize the film sheet or the entire film job (gaps are filled again). As long as Film > Repack remains checked, empty segments will be refilled automatically after operations such as drag & drop, Delete, and Cut ( automatic Repack ). Deleting images except every n-th image 1 Right-click the film sheet and select Keep every n-th image from the context menu. 2 In the Keep every n-th image dialog box define the value for the n-th image. Every non n-th image is removed from the film sheet. Showing or hiding image text and graphics 1 Click the All Text icon on the Images subtask card to have all text information about the images filmed. or Click the Customized Text icon to have only part of the text information exposed on film. If you want to set Customized Text, you can call up the Film Properties dialog box with Properties in the context menu. 298 Scanning and postprocessing Operator Manual

299 Postprocessing and reporting 6 or Click the No Text icon to hide all text information in the segments. 2 Click the Show Graphics icon on the Images subtask card to display graphics (e.g. ROIs) and annotations. or Click the Hide Graphics icon to hide graphics and annotations. Selecting another camera 1 Click the Camera subtask card on the Filming task card into the foreground. or Select Film > Change Camera... to call up the Change Camera and Film Size dialog box. 2 Select a camera from the list. This selection list contains all the cameras connected to your system. syngo MR E11 299

300 6 Postprocessing and reporting Exposing on film Exposing a film sheet 1 Select one or more film sheets in the Filming task card. 2 Select Film > Expose Film Sheet to process only the selected film sheets. Exposing a film job Click the Expose Film Task icon as soon as you want to expose one of the film jobs in the queue. You can call up the Film Job Status dialog box by selecting Patient > Film Task Status from the main menu or click the Film Job Status icon on the Filming task card. In the dialog box, you can get information about film jobs that are waiting to be executed in the queues for each camera and printer Associating layouts to a study, series, or protocol In the Filming Study Layout window, you can assign specific layouts to individual studies. Double-click the Filming Study Layout icon on the NUMARIS/4 Configuration Panel. 300 Scanning and postprocessing Operator Manual

301 Postprocessing and reporting 6 Assigning a film layout You can only assign one specific layout to each study, series, or protocol. This layout is then automatically used for filming the corresponding images. You can assign a layout by selecting a study, series, or protocol stored in your system and the layout required and then linking the two. If a layout other than the standard layout is already assigned to a study, series, or protocol, you must first cancel this link before you can assign a new study-specific layout. 1 Select the required film layout from the Film Layouts selection list. 2 Click the + symbol in front of a study to display the series/ protocols associated with it. You can only select entire studies if they are not subdivided into series/protocols. In such cases, the + or symbol in front of the entry is missing. 3 Click a study, series, or protocol to select it. syngo MR E11 301

302 6 Postprocessing and reporting 4 Click the Down arrow button to assign the layout to the selected entry. Canceling a film layout assignment 1 Select the relevant study, series, or protocol in the Studies/Series linked to selected layout list. 2 Click the Up arrow button. Deleting a layout 1 Select a layout that you no longer require from the Film layouts selection list. 2 Click the Delete Layout button. The entry is deleted from the list Composing images General information Important notes for Composing Caution Dislocation during manual MR-image adjustment! Viewing of combined MR images for diagnostic purposes! Incorrect diagnosis Always additionally refer to the original images for diagnostic purposes. 302 Scanning and postprocessing Operator Manual

303 Postprocessing and reporting 6 As the user, you are responsible for accurately selecting original images for reconstruction as well as manual adjustment of the image margins. Reconstructed images differ from original images with respect to image information, especially at the image transitions. For this reason, reconstructed images of bones and vascular structures are not always suitable for diagnosis. When transmitting one or several reconstructed images through the network or on a data medium, please inform the recipients of the above facts. Important notes for evaluation Diagnosis: Before using a composed image to support a diagnosis, visually verify the image transitions using the original images with an appropriate resolution. Independent of how reliable the transitions between individual images may appear, only a physician can ensure diagnostic accuracy using the image margins of the original image for visual inspection. Compare the composed image with the original images using the View > Single with Original function. Distance and angle measurements: Digits appearing after the decimal point in the measurement results are not representative of the accuracy of the measurement taken. When using a measurement to support diagnosis, the physician has to consider all sources of errors. syngo MR E11 303

304 6 Postprocessing and reporting Caution Distance measurements across image boundaries of composed images are error prone. This is an accumulated error depending on the number of original images! Incorrect distance measurement Perform measurements only in the original images, if possible. Use only the original images for diagnostic purposes. Do not use geometrical measurement values as a sole basis for diagnosis. Do not perform measurements across image borders marked as Insufficient match! Mirrored image: Image is mirrored. Confusing left/right leads to incorrect diagnosis! The examiner is responsible for correct application of functions and/or interpretation of the images as well as the consequences resulting from his actions. Minimize the risk of incorrect interpretations by e.g. providing notes/comments. Prerequisites for image selection Criterion Image type Image matrix Pixel spacing Description Only MR images acquired with syngo MR are acceptable. All images of a volume must have the same image matrix. All images of a volume must have the same pixel spacing. Pixel spacing = FoV/image matrix Image layout All images of a volume must form a cuboid. 304 Scanning and postprocessing Operator Manual

305 Postprocessing and reporting 6 Criterion Database storage Description All images (or series of images) must belong to one study. All images of a volume must come from one series. Series block Slice thickness Distortion correction Slice distance Slice orientation Slice inclination (based on the first volume) All images must be part of the same series block. All images of a volume must have the same slice thickness. The same distortion correction procedure will be/was used for all images. It is not possible to mix already corrected images with uncorrected ones or 2D corrected with 3D corrected images. The images within a volume must have the same slice distance. The images within a volume must have the same slice orientation. If the slices are acquired in the coronal direction (primary direction), only an inclination from coronal to transversal is permitted (max. ±45 ). Inclinations in other directions are not permitted (tolerance max. ±1 ). If the slices are acquired in the sagittal direction (primary direction), only an inclination from sagittal to axial is permitted (max. ±45 ). Inclinations in other directions are not permitted (tolerance max. ±1 ). Images acquired in the axial direction cannot be composed. The prerequisites that have to be identical within a volume according to the list above may differ from volume to volume. Notes for reconstruction Incomplete slices: During distortion correction, areas may be added to the image where no data were measured. Reconstructions with a Spine algorithm do not include incomplete slices. Reconstructions with an Angio algorithm do include incomplete slices. syngo MR E11 305

306 6 Postprocessing and reporting Manual alignment: In cases where transition areas have not been optimally reconstructed by the computer, you can adjust them manually. Original images: Sometimes it is necessary to use the original image information. You can use individual images, or a special display mode, the cut mode (Hard Image Transitions). Resulting data: The spatial deviation of a pixel in the composed image may deviate by max. 10 mm from the resulting slice plane. The resulting slice plane is computed for opposing slabs in such a way that the criteria is maintained as far as possible. MR images are generated if this criterion is met. The composed images may be used to plan additional measurements. If this criterion is not met, SC (Secondary Capture) images are created. SC images may not be used to plan additional measurements. In the image text, they are characterized by the letters SC. Due to the changed criterion for generating MR images, it is possible that a data set, used to compose MR images with syngo MR 2004A, 2004V, 2005E, 2006T, or LEONARDO 2004, only allows you to create SC images with syngo MR B15A. The Composing algorithms: The Spine algorithm is based on the bone structure of the images. Composed images of this kind may be measured and evaluated, e.g. scoliosis, kyphosis, pelvic obliquity. The Angio algorithm is based on the vessel structure in the images. This allows for overall display of the vessels. The Adaptive algorithm is based on elastic matching. It especially corrects B0 induced inhomogeneities in image areas beyond the magnetic homogeneity volume. Alignment: Sometimes the automatic algorithm does not provide optimum results. In this case, you may manually determine the position of the images relative to one another (pixel-by-pixel shifting). 306 Scanning and postprocessing Operator Manual

307 Postprocessing and reporting 6 By changing the reference parameters, the graphics shown in the composed image are no longer valid following manual adjustment. They must be redrawn accordingly. For a stored composed image that was loaded again, the position of individual images can be changed only if the original images are still in the local database. As the user, you are responsible for correct evaluation of the reconstruction and the diagnostic conclusions drawn from it. In the case of a composed image/volume that has been stored and reloaded, you can change the position of single images relative to each other only if: All original images are available The images are not the result of a canceled reconstruction The composed image or the original images were not changed outside Composing or provided with an electronic shutter. Loading composed images The Composing task card is used to view and post-process composite images after reconstruction. You can only load images of one patient into the Composing task card. Images of one series block may only be loaded per load operation (same frame of reference). If you load images of another patient, the current patient is automatically closed, provided that you confirmed the message accordingly. syngo MR E11 307

308 6 Postprocessing and reporting Scoliosis angle according to Cobb This method involves drawing the tangent to the dorsal plate of the upper neutral vertebra and to the basal plate of the lower neutral vertebra. The system uses them to calculate the scoliosis angle: 1 Scoliosis angle N S Neutral vertebra Apical vertebra Scoliosis angle: Schematic representation (Zilch, H.; Weber, U.: Orthopädie mit Repetitorium. Berlin: de Gruyter, 1989 (left)), example (right) Kyphosis angles of vertebrae A kyphosis angle is the angle between a vertebra and the vertical in a lateral acquisition: 308 Scanning and postprocessing Operator Manual

309 Postprocessing and reporting 6 Kyphosis angle: Schematic representation Example Deviation of the spine from the vertical An additional tool for evaluating scoliosis is to determine the deviation of the spine from an imaginary vertical line. syngo MR E11 309

310 6 Postprocessing and reporting Difference in height The system offers a difference in height measurement which can be used for measuring the difference in height between two points Tasks Composing images Select only matching individual series. In practical application, a study always includes additional series/images. This could lead to canceling a complete study during the loading process. You can only compose MIP images that were measured inline. You cannot use MIP images generated with syngo 3D. Reconstruction cannot not be performed if too many images are loaded. Depending on the quantity of images, some of the images that were loaded may have to be unloaded before a new data set can be composed. Composing task card is open Patient Browser is open 1 Select at least two series with different slice positions. Series must match the prerequisites for reconstruction! 2 Drag the selection to the image area of the Composing task card. If the input images are type Inline MIP reconstruction starts automatically. Otherwise, a dialog window for selecting the algorithm opens. 310 Scanning and postprocessing Operator Manual

311 Postprocessing and reporting 6 3 Select the required algorithm from the dialog window and confirm with OK. The reconstruction starts. The composed images are displayed. If volumes are selected that do not overlap, holes will be present during reconstruction. Reconstruction is performed. Missing areas are shown in black in the composed images. If it was not possible to match the image sections correctly (red triangles), or if the image margin was manually corrected (M), a dialog box appears before storing the images. Aligning images Aligning images should be performed in cut mode (View > Blend/Cut mode) because pixel-by-pixel shifting is easier to see in this mode. Composing task card is open Composed images are loaded 1 Select the image in the series you want to pan. 2 Double-click the required position in the overview image (on the right). The position of the image margin to be corrected is shown via an orientation label in the left margin of the detail image (on the left). 3 Move the image with these buttons. You can set the number of pixels per click by Image > Manual Adjustment. This image and all subsequent images are moved relative to the images above the marked image. syngo MR E11 311

312 6 Postprocessing and reporting Drawing the scoliosis angle The accuracy of Cobb angle or kyphosis angle measurements is comparable with measurements made by hand of filmed images. In the case of angle measurements on projection images, the projected plane must be parallel to the angle plane. Composing task card is open Composed images are loaded 1 Select the required image. 2 Click this icon. In the detailed image the cursor changes shape. 3 Drag a line from the starting point to the end point of the first tangent with the mouse. 4 If necessary, move the image area by double-clicking in the overview (new position of the orientation mark). 5 Draw the second tangent in the same way. The tangents are marked according to their position, for example, Cb1, Cb2, etc. The scoliosis angle is drawn in the vicinity of the apical vertebra. Additional tangents can be added in the same way and previously drawn angles can be changed at any time. Drawing kyphosis angles The accuracy of Cobb angle or kyphosis angle measurements is comparable with measurements made by hand of filmed images. 312 Scanning and postprocessing Operator Manual

313 Postprocessing and reporting 6 In the case of angle measurements on projection images, the projected plane must be parallel to the angle plane. Composing task card is open Composed images are loaded 1 Select the required image. 2 Click this icon. In the detailed image the cursor changes shape. 3 Drag a line from the first point to the second point on the vertebra with the mouse. The line is extended. A vertical line and a kyphosis angle are drawn. Measuring vertical alignment Composing task card is open Composed images are loaded 1 Select the required image. 2 Click this icon. In the detailed image the cursor changes shape. 3 Click the image and drag a short line up or down with the mouse. A vertical line is drawn through the entire image. 4 Draw a short line from the desired point toward the vertical line. A plumb line is dropped to the vertical line and the length of the plumb line is shown. Drawing the difference in height Composing task card is open Composed images are loaded 1 Select the required image. syngo MR E11 313

314 6 Postprocessing and reporting 2 Click this icon. In the detailed image the cursor changes shape. 3 Position the mouse pointer on the first reference point. 4 Drag a line from the first reference point to the second reference point with the mouse. The line indicating the difference in height and the actual difference is displayed. Saving composed images Caution Missing identification of critical areas (for example, seams) in composed images (composer)! Incorrect diagnosis When storing composed images, ensure that critical areas (seams) in images corrected manually or in images that have not been optimally reconstructed by the computer are marked. To mark critical areas, confirm in the pop-up window that the composed image does not correspond with the anatomy of the patient. The critical areas are not marked if you select in the pop-up window that the composed image corresponds with the anatomy of the patient. If it was not possible to match the image sections correctly (red triangles), or if the image margin was manually corrected (M), a dialog box is displayed. Confirming the dialog window with Yes removes the red triangles and the note Image sections do not match! or the markers for manual adjustments (M). Confirming the dialog window with No marks the transition areas with black and white stripes. As the user, you are responsible for correct evaluation of the reconstruction and the diagnostic conclusions drawn from it. 314 Scanning and postprocessing Operator Manual

315 Postprocessing and reporting 6 Saving all images When you want to store all composed images of the current volume displayed: Select Patient > Save All As. Saving selected images When you want to save the currently displayed, composed image: 1 Select the requested image of the volume. 2 Select Patient > Save. Only the currently displayed composed image is saved as a new series under the name SPINE, ANGIO, or ADAPTIVE. or 3 Select Patient > Save As. 4 Select the requested save option and the name of the series. 5 Click OK. The composed image currently displayed is saved with all its settings. syngo MR E11 315

316 6 Postprocessing and reporting UI explanation Composing task card (1) Detail image segment: Display of composed image (2) Original image segment: Display of the corresponding original image 316 Scanning and postprocessing Operator Manual

317 Postprocessing and reporting 6 Only in 3 segment mode (3) Overview image segment: Overview of the entire composed image Text information in images View > Image Text On (1) Patient and examination data syngo MR E11 317

318 6 Postprocessing and reporting (2) Image position numbers with orientation mark and identification (3) Examination and image parameters (4) Notes (5) Slice information and window values (6) System-specific information If you film a composed image with the image text and/or graphics switched off, non-matching or manually adjusted transitions between the individual images cannot be identified as such! Displays in images Display Meaning Image position numbers Image position number with orientation mark Image position number identified with Manual Image position number with identification image segments do not match! 318 Scanning and postprocessing Operator Manual

319 Postprocessing and reporting 6 Indication of composed images (1) Current volume * means: At least one image of the current volume was changed. (2) Current image * means: The image currently displayed was changed. (3) Total number of the composed volume loaded * means: At least one image of all volumes loaded was changed. View subtask card Some functions affect the selected image segment (focus) only, in particular in the Single with Original image view; other functions affect all image segments. Function Windowing Reset window values Inverting grayscale values Flip vertically Zoom/Pan Zoom factor 2.0 or Zoom factor 0.5 Acquired image size Determining the area Home Zoom/Pan Only affects the selected image segments x x x x x Affects all image segments x x x x syngo MR E11 319

320 6 Postprocessing and reporting (1) Only the composed image is displayed. (2) Two composed images are displayed next to each other. (3) Switches between Full image display and overview. Full image display Hides the overview Overview (default setting) (4) Displays one or two overviews of the composed images. Switches between soft transitions and hard cuts Usually composed images are shown with soft transitions. For diagnostic purposes, you can use images with hard cuts and display the original image information as well: Image transitions for a saved and reloaded composed image can be changed only if the original images are still available. 320 Scanning and postprocessing Operator Manual

321 Postprocessing and reporting 6 When Soft transition mode is used, there are transition areas between the single images that were interpolated from two images. Although an image in the Soft transition display appears more pleasing to the eye, only original images (single images with original image view or hard transitions) may be used for diagnosing bone and vessel structures. (5) Resets the image to the default setting for zoom and position. (6) Defines that each image pixel is assigned a monitor pixel. You can select further predefined image displays selecting Image > Zoom in by 2.0 or Zoom in by 0.5. (7) The composed image and the original image with the original image information (if available) are displayed. (8) Shows/hides graphic elements (lines, circles). (9) Enlarges and centers the detailed image according to the selection. The image section is shown in the overview image. Manual subtask card syngo MR E11 321

322 6 Postprocessing and reporting (1) Shows the position of the orientation label (2) Normalizes the brightness of the individual image sections for the current composed volume (not possible for images composed with the ANGIO algorithm). During manual correction, Normalize is automatically switched off again. (3) Returns to automatic positioning (4) Shifts the slice to the front or the back. The composed slice images affected are recalculated. Composed slice images that are not affected remain unchanged. (5) Moves images up or down by the set number of pixels. (6) Moves the cut-line (image margin) up or down by the set number of pixels. (7) Moves images to the right or left by the set number of pixels. Adjust subtask card 322 Scanning and postprocessing Operator Manual

323 Postprocessing and reporting 6 (1) WW Sets the window width WC Sets the window center (2) Resets the window values to the values last saved. (3) Mirrors the image (4) Inverts the gray scale values Tools subtask card (1) Draws a circular ROI (2) Draws a circular ROI with a center. You can perform distance measurements with this method. (3) Draws an arrow syngo MR E11 323

324 6 Postprocessing and reporting (4) Shows partial view of the image (5) Measures a distance (6) Draws a freehand ROI (7) Measures an angle Dynamic analysis General information The Dynamic Analysis function provides syngo MR with a number of arithmetic and statistical functions for evaluating dynamic processes and images. Depending on the function, you can evaluate single images, more than one image, one series, or more than one series. The result images are stored in the database. You can view these images via the Viewing task card or use them as initial images for additional evaluations. Dynamic analysis requires full access rights to the patient data. Detailed information regarding user administration is included in the syngo Security Package brochure. Prerequisites for dynamic analysis The following image characteristics are requested: Originating from the same examination Same field of view (FoV) Corresponding matrix size Same slice orientation Same slice position 324 Scanning and postprocessing Operator Manual

325 Postprocessing and reporting 6 Same slice thickness or times (for T1, T2, T2*, and TTest only) Same intensity correction (all corrected or not corrected) Same type of distortion correction (none, 2D, 3D) A corresponding system message is displayed during loading if the selected images do not meet a particular criterion. The distortion correction can be encoded within the frame of reference. A message is displayed indicating that the frame of reference is not different, but that distortion-corrected images have been combined with images that have not been corrected. Functions Addition: Image addition is used to add the grayscale values of images or to add a constant. Adding the grayscale values of images is equivalent to image overlay. You can overlay an image with the result image of a T-image with exceptional anatomical details. Adding a constant shifts the entire grayscale range. You can add: Images from a series with a constant Images within a series Multiple series with the same number of images syngo MR E11 325

326 6 Postprocessing and reporting Subtraction: During subtraction, you subtract the grayscale values of images from other images or subtract a constant. You can subtract: Image from image Image from series Images / series from constants Constants from images / series Series from series During subtraction, you can change the sequence of operands if you want to, e.g. non subtracting image 4 from image 5, but image 5 from image 4. You can swap the following types of subtraction: Constant of image Image x from image y Series x from series y A single series from all other series (the new single series must be selected prior to swapping) Using Exchange shows the new operation in the title bar. Arithm. Mean: By calculating the mean value of the grayscales, you can average large intensity differences in the images. For parallel images with different slice positions, this method is equivalent to an MPR Thick display. With a temporal sequence of images, averaging the images improves the signal-to-noise ratio or reduces image artifacts. All images of the initial series must have the same slice position. 326 Scanning and postprocessing Operator Manual

327 Postprocessing and reporting 6 Diffusion coefficient: The derivative determines the intensity increase (rise) of grayscale values within a series. You can only take the derivative of one series. All images of this series must have the same slice position. As a result of differentiation, the new series has one image less than the original series. The grayscales value in the result images is a direct measure of the tendency of grayscale values to increase or decrease in the initial series. Apparent Diffusion Coefficient (ADC) The Apparent Diffusion Coefficient (ADC) is a measure of the mobility of water molecules between different tissue types. Before you can determine the apparent diffusion coefficients, you must have measurements with various diffusion weightings (b-values). The following section of this manual provides you with additional information regarding diffusion imaging: syngo Perfusion. The grayscale values in the result images correspond to the apparent diffusion coefficients at the respective locations. Special characteristic within series: The series must include at least 2 images for evaluation within a series. The images of a series are combined into groups that have the same slice position and direction of diffusion. An image with b-value = 0 is assigned to all groups. All images of a group must have a different b-value (diffusion weighting). A result image is calculated for each group. Special characteristic across series: As a prerequisite for evaluating between series, each series includes images of all slice positions that have the same b-value. A result image is calculated for each slice position. It is not possible to take different diffusion directions into account. syngo MR E11 327

328 6 Postprocessing and reporting Division: You can divide: An image by a second image A series by an image A series and/or images by a constant A series by a second series You can change the order of the operands, swap the dividend and divisor of the division using Exchange. The new operation is shown in the title bar. During the across series mode, the divisor is shown in a field below the list of operands. By default, the older series is used as the Divisor. Examples: 2 images: Dividing image by image or dividing both images by the constant 2 series with the same number of images: The image of a series is divided by an image of another series or the images of both series are divided by a constant. Several series, at least one series thereof with a single image only: Dividing the images of all other series by a single image of a series Integration: Integrating the grayscale values of a series provides information on enhancement when using contrast agent studies. You can only integrate via the images of a series. All images of this series must have the same slice position. As a result of integration, the new series has one image less than the original series. Logarithm: Calculating the logarithm of the grayscale values eliminates large differences in MR image intensity. Large intensity gradients are common in MR images of the shoulder and the lungs, for example. 328 Scanning and postprocessing Operator Manual

329 Postprocessing and reporting 6 Multiplication: Multiplying the grayscale values by a constant rescales the grayscale values.you can multiply: Images by a constant A series by a constant Two or more series by a constant You can enter a constant during operation mode and select the automatic option under Scaling. If you deselected automatic scaling (option none), all grayscale values above 4095 will be set to this value. The scaling of result images corresponds to the scaling of initial images. Standard deviation: Describes the average deviation of the values from the mean value. This function visualizes image modifications. The grayscale values scatter proportionally to standard deviations which you can determine within a series or between series. The grayscales in the result images correspond to standard deviations. Slope: Determines the slope of the linear regression within a series (a result image) or between series (a result series). The slope of linear regression describes the rate at which the intensity of the grayscale values increases or decreases within a time series. As in the case of differentiation, the different absorption rates of contrast agent in tissue can be visualized. Time series have to contain at least two images. Otherwise, evaluation will not be possible. The intensity of grayscale values in the result images corresponds to the rising slope of the linear regression. The brighter the grayscale value, the greater the slope. syngo MR E11 329

330 6 Postprocessing and reporting T2 T2* images are especially suitable for showing pathological lesions in tissue. To calculate T2/T2* weighted images, you must have images with the same repetition time TR, however, with different echo times TE, which you generated with multi-echo sequences. These images must have the same slice position. You will find a multi-echo protocol in the exam database under the Multi-Echo protocol file (select in the Program Card or Dot Cockpit: Head > Library > Multi-Echo). The result will be a T2/T2* and a T1 weighted image. T1 T1 weighted images are suitable for displaying anatomical structures. The system provides you with two ways of calculating T1 weighted images: For the inversion recovery method, you require two images with different inversion times TI. However, the repetition time TR and the echo time TE are the same. For the saturation recovery method, you require two images with different repetition time TR yet with the same echo time TE. The result is a T1 and a T2-proton density weighted image. Time To Peak The time up to maximum contrast agent uptake can be evaluated with Time To Peak You can either calculate a minimum grayscale value based on T2/T2* weighted EPI images or a maximum grayscale value based on T1 weighted images. The result of Time to Peak evaluation is either an image (when using one slice thickness only) or a series of images (when using different slice positions). The grayscale values on the images correspond to the uptake times starting with the first image. The later tissue absorbs contrast agent, the brighter it appears in the image. For Time to Peak, you decide whether evaluation will be made on the basis of T1 or on the basis of T2/T2* weighted images. 330 Scanning and postprocessing Operator Manual

331 Postprocessing and reporting 6 TTest: This special method is used to evaluate examinations performed with functional neuro imaging. These examinations generally comprise the following series: Stimulated series (functional brain activity, acquired during stimulation) Native series (no functional brain activity, acquired without stimulation) You can perform a TTest calculation once the series are assigned to stimulated or native series. In the resulting image data, high pixel values indicate that the signal waveform in the measured data takes a course similar to the stimulation paradigm. Anatomical information is no longer contained in the data. You can superimpose these images with Anatomy images (e.g. ep2d). See Addition function for more information. If you superimpose TTest images on non-epi images, compare these images with the superimposed EPI images for safety reasons. Image distortion may occur with EPI measurements. TTest evaluation only starts via the Patient Browser. For these evaluations, you need the same number of stimulated and non-stimulated series Tasks Starting analysis Load only MR images into Dynamic Analysis. If you load images from other modalities, e.g. CT or AX images, a message is displayed indicating that these image types are not supported. Viewing task card is open Patient Browser is open Starting analysis 1 Select images or series in the Patient Browser or the Viewing task card. syngo MR E11 331

332 6 Postprocessing and reporting All loaded images or series are included in the operand list of the function dialog window. 2 Select the function required under Evaluation > Dynamic Analysis. Seven frequently used functions (of a total of 15) are displayed on the Eval. subtask card. The function dialog window for the corresponding dynamic analysis opens. 3 Define the analysis settings on the function dialog window. ( Page 333 Function dialog windows) 4 Start the analysis with OK or Enter. As soon as you start the evaluation function, the images selected are loaded into the respective function dialog window. This icon in the status bar indicates that a filtering process is running in the background. Open the Calculation Status dialog window with this icon. ( Page 339 Calculation status window) Adding images during the analysis Dynamic analysis is started Function dialog window for the corresponding dynamic analysis is open Select the images in the Patient Browser and drag them with the mouse to the operand list in the function dialog window. If you add images from a partly loaded series, the respective operand is added. The information in the Image Area is updated and the operand moves to the top of the list. If you want to evaluate just part of a series, select only the required images of the series via the Patient Browser or in the Viewing task card and start the evaluation function. 332 Scanning and postprocessing Operator Manual

333 Postprocessing and reporting UI explanation Function dialog windows Evaluation > Dynamic Analysis >... syngo MR E11 333

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336 6 Postprocessing and reporting (1) List of images used as operands. The column Increment defines every image used for dynamic analysis. For example, 3 defines that every third image of the series is used for Dynamic Analysis. The sequence of the series in the operand list is usually based on the succession used during loading. The series that is loaded first is the first operand, the series after that are the subsequent operands. During Subtraction and Division, the images or series loaded are listed in the temporal sequence of their generation. (2) Sets the image that is used for subtraction or division. (3) Constant Applies to the operation with the constant for each image of the series. Within Series Only the images of the initial series are used as operands for the evaluation function. A result series from the initial series is generated. The result series contains one or several images. Across Series Generates result series from the individual images of the original series by combining the n-th images of the series. If an increment is assigned, the result series contains fewer images. With subtraction, the result series will usually contain the same number of images as the smallest initial series. 336 Scanning and postprocessing Operator Manual

337 Postprocessing and reporting Within series 6 Across series (4) Generates preview images. These test images are used to determine whether you want to evaluate the entire series with these settings. (5) Shows the preview images. (6) Limits the range displayed in the histogram (lower X axis) to the relevant part by defining a lower and an upper threshold. Only the grayscale values within the thresholds will be used for the evaluation (refer to upper X axis). The Scaling button opens the Scaling dialog window. ( Page 338 Scaling dialog window) (7) List of images in Group 1 and Group 2. Number of images in Group 1 and Group 2 must be equal. (8) Sets the number of series in Group 1 and Group 2 to be ignored in the beginning. (9) Sets the number of series in Group 1 and Group 2 to be evaluated. syngo MR E11 337

338 6 Postprocessing and reporting (10) Sets a grayscale threshold. Grayscale values below this threshold are not displayed. Scaling dialog window (1) Minimum lower threshold Maximum (2) upper threshold You can also enter the Offset and Factor function instead of the two threshold values. These two values have a linear relationship to the Minimum and Maximum. Evaluation check dialog window In case of different image position or slice thickness, the Evaluation Check dialog window is displayed. 338 Scanning and postprocessing Operator Manual

339 Postprocessing and reporting 6 Calculation that can be continued despite different slice positions Calculation that cannot be continued due to different slice positions (1) Continues the calculation (if images with the same image position are not necessarily required). (2) Returns to the function dialog window. (3) Returns to the function dialog window without performing the calculation. Calculation status window Status bar > Dynamic Analysis icon syngo MR E11 339

340 6 Postprocessing and reporting (1) Pauses evaluation. You can pause the evaluation at any time. 340 Scanning and postprocessing Operator Manual

341 Postprocessing and reporting 6 If the list contains a job with the status Waiting, it will be started automatically. (2) Resumes evaluation. If another job is activated, this job is enqueued Filtering, correcting, converting images General information Editing images with image filters Use the Offline Image Filter to post-process blurred images or images with strong noise. These are adaptive filters that search for conspicuous structures in the image. Subsequently, the filter checks if they are either random or part of other structures. Filters take into account the local distribution of signal intensity and the course of local tissue structures. The images selected in the Patient Browser or the Viewing task card are used for reconstruction. Siemens provides three default filters and three freely definable filters. It is not possible to postprocess images or series with an Offline Image Filter that have already been processed with another filter. General information on distortion correction Distortion artifacts Geometric distortions (barrel-shapes/pin cushion) may occur at the edge of images with a large FoV or with off-center slices. These image errors can be eliminated using Distortion Correction. syngo MR E11 341

342 6 Postprocessing and reporting Cause: Gradient coils are used to encode spatial information. Under ideal circumstances, the gradient field rises linearly. In reality, however, deviations from linearity may occur at the image margin. Remedies: If you are planning quantitative evaluations of images, it is essential to correct distortion artifacts. Before measuring, switch on the Distortion Corr. filter. The images resulting from this measurement are distortion-corrected Correct the images retroactively by selecting distortion correction in the Patient Browser. A subsequent distortion correction generates a new series. The uncorrected original images are retained and can be used to position slices for additional measurements. Prerequisites for 3D distortion correction Only entire series are selected The series do not contain distortion corrected images The series consists of at least two slices The slices have the same size The slices have the same slice thickness The distance between slices may not exceed the slice thickness if the data were measured with a 2D sequence During 3D distortion correction, not only the voxels from the current slice, but also those in neighboring slices are taken into account. The correction results are more precise, but require a longer reconstruction time. 3D distortion correction may only be used for specific data sets. 342 Scanning and postprocessing Operator Manual

343 Postprocessing and reporting 6 Visualization of image information that was not measured The expansions and compression of original images during distortion correction may create areas in the result images without data acquisitions. These areas are visible as black surfaces. 2D distortion corrections may show black areas along the edges of the result images. The larger the field of view and the larger the distance of the acquired image from the magnet isocenter, the stronger the effect will be. With 3D distortion corrections, the slices along the edge may occasionally show larger black areas with circular or parabola-shaped boundaries. This happens when additional (nonexisting) slices in the original image would have been needed for reconstructing the image areas. Location of 3D slabs in reference to the volume measured (with exaggerated distortion correction) Phenomena with DIS2D Magnification of phenomenon with DIS3D General information on RGB conversion of images syngo-based systems allow you to link images with overlay graphics. These overlay graphics are not based on the DICOM format but rather on a Siemens-own vector format. To display these overlay graphics with a non-syngo-based DICOM Viewer (e.g. PACS), they must be converted into another, pixeloriented image format. syngo MR E11 343

344 6 Postprocessing and reporting Traditional conversion: During traditional conversions, the overlay graphics are converted into DICOM bitmaps. Diagnostic information may get partially lost during this conversion. The following disadvantages are present when displaying these images in standard DICOM viewers: No color support Poor scalability Blurring with small image matrix RGB converter: When converting data into DICOM-conform RGB images, the diagnostic image is retained. Data exchange of secondary capture images in the RGB pixel format is always ensured because most medical systems support RGB images Tasks Filtering images Viewing task card or Patient Browser is open 1 Select series and images in the Patient Browser or Viewing task card. You can preview and edit images in the Viewing task card. 2 Open the Offline Image Filter Parameter dialog window with this icon. 3 Define the filter settings on the Offline Image Filter Parameter dialog window. ( Page 346 Offline Image Filter Parameter dialog window) 4 Start image processing with OK. The dialog window closes. This icon in the status bar indicates that a filtering process is running in the background. Open the Calculation Status dialog window with this icon. ( Page 339 Calculation status window) 344 Scanning and postprocessing Operator Manual

345 Postprocessing and reporting 6 Once the jobs have been processed, the images are displayed on the Viewing task card. Using 2D distortion correction Exam task card or Patient Browser is open 1 Select images in the Patient Browser or Exam task card. 2 Select Evaluation > 2D Distortion Correction. Distortion correction starts. This icon in the status bar indicates that a filtering process is running in background. Open the Calculation Status dialog window with this icon. ( Page 339 Calculation status window) You receive new series as a result of distortion correction. Distortion-corrected images can be recognized by the image type: DIS2D for 2D. Using 3D distortion correction Exam task card or Patient Browser is open 1 Select images in the Patient Browser or Exam task card. 2 Select Evaluation > 3D Distortion Correction. Distortion correction starts. This icon in the status bar indicates that a filtering process is running in background. Open the Calculation Status dialog window with this icon. ( Page 339 Calculation status window) You receive new series as a result of distortion correction. Distortion-corrected images can be recognized by the image type: DIS3D for 3D. Resetting 2D distortion correction Exam task card or Patient Browser is open Select images in the Patient Browser or Exam task card. Starting calculation Select Evaluation > Undo 2D Distortion Correction. Resetting distortion correction starts. syngo MR E11 345

346 6 Postprocessing and reporting This icon in the status bar indicates that a filtering process is running in background. Open the Calculation Status dialog window with this icon. ( Page 339 Calculation status window) Non-distortion corrected images identified with ND are reconstructed retroactively from distortion-corrected images. Converting images to RGB Patient Browser is open 1 Select the images or series. 2 Start the conversion with Applications > DICOM Tools > Save as RGB. The converted images or series are shown as a new image series in the Patient Browser. The names are extended by _RGB. You can use the RGB pixel images of this series for exchanging data with other systems or DICOM viewers UI explanation Offline Image Filter Parameter dialog window (1) Selects the filter. 346 Scanning and postprocessing Operator Manual

347 Postprocessing and reporting 6 (2) In case of customer defined filter: Enter a value for Edge Enhancement between 1 and 5. (3) In case of customer defined filter: Enter a value for Smoothing between 1 and 5. (4) In case of customer defined filter: Stores the settings of the filter. When using a Siemens filter, the values cannot be changed. The actual filter properties are displayed in parentheses after the name: Filter name (edge enhancement/smoothing) syngo MR E11 347

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349 Appendix 7 7 Appendix 7.1 Warning messages 350 syngo MR E11 349

350 7 Appendix Warning messages UI explanation Stimulation monitor - Warning! Protocol exceeds Stimulation threshold (1) Starts the measurement despite possible stimulation. The abbreviation SP appears in the status bar. Stimulation monitor - Stimulation limit exceeded! Protocol exceeds Stimulation limit 350 Scanning and postprocessing Operator Manual

351 Appendix 7 (1) Opens the parameter cards of the step. (2) Opens the Stimulation Monitor - Recommendations dialog window. ( Page 189 Stimulation monitor Recommendations) (3) Skips the current step. SED Warning SED warning limit has been reached syngo MR E11 351

352 7 Appendix (1) Starts the measurement despite possible physiological stress. (2) Stops the examination. For more information, refer to: ( Page 165 Specific energy dose (SED)) Warning: Examination interrupted! Message when SAR limit is exceeded (on other task card than Exam) 352 Scanning and postprocessing Operator Manual

353 Appendix 7 (1) Changes to the Exam task card. Warning: Examination interrupted! Patient table was in home position (1) The checkmark is only evaluated if you confirm with Yes. If you confirm with No, it is obvious that the patient was repositioned or changed. Therefore, registration or repositioning is necessary. We recommend repositioning with the lightmarker. Checkmark is active and Yes is clicked The examination is continued. syngo MR E11 353