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© 2013 Invivo Corporation All Rights Reserved DS-3.1-425-009-00

VERSION 3.1 QUICK REFERENCE

Technical Support(USA) 1-877-INVIVO-1

1-877-468-4861International _____________

Manufactured for:Invivo Corporation3545 SW 47th AvenueGainesville, FL 32608USA For Support:Call: 1-877-INVIVO-1 (1-877-468-4861)Mon-Fri 8AM-8PM Eastern Timee-mail: [email protected]

Manufacturer:MeVis Medical Solutions AGCaroline-Herschel-Str. 1D-28359 BremenGermany

This quick reference guide is intended to provide an overview of the main functionality of DynaSuite Neuro 3.1. Before using this product make sure to read the complete Instructions for User and the User Guide.

References:DSN-3.1-425-001 DynaSuite Neuro User GuideDS-3.1-425-002 DynaSuite Neuro Information for Use

Section 1: General Overview.................................................................................................................................................................... 1Section 1.1: Logging In ...................................................................................................................................................................... 1Section 1.2: System Overview/Support ............................................................................................................................................ 1Section 1.3: Troubleshooting ............................................................................................................................................................. 1

Section 2: Functions, Toolbars and User Interface (UI) ............................................................................................................................. 2Section 2.1: Functions ....................................................................................................................................................................... 2Section 2.2: Screen Layout................................................................................................................................................................ 4Section 2.3: Tools .............................................................................................................................................................................. 5Section 2.4: Drag and Drop Images ................................................................................................................................................. 8

Section 3: Study Overview and Workflow ................................................................................................................................................ 9Section 3.1: Study Overview Panel ................................................................................................................................................... 9Section 3.2: Access Anywhere Patient Selection ............................................................................................................................. 10Section 3.3: Typical Workflow .........................................................................................................................................................11

Section 4: Quality Checks ....................................................................................................................................................................... 14Section 4.1: Registration Check ....................................................................................................................................................... 14Section 4.2: 3D Check .................................................................................................................................................................... 15Section 4.3: Vessel Check ............................................................................................................................................................... 16Section 4.4: Diffusion Check ........................................................................................................................................................... 17Section 4.5: fMRI Check ................................................................................................................................................................. 18

Section 5: Study Review .......................................................................................................................................................................... 19Section 5.1: fMRI Review ................................................................................................................................................................ 19Section 5.2: Diffusion Review .......................................................................................................................................................... 20Section 5.3: Dynamic Review .......................................................................................................................................................... 21Section 5.4: Smart Fusion Review ................................................................................................................................................... 22

Section 6: Reprocessing fMRI Studies ..................................................................................................................................................... 24Section 7: Surgical Planning and Therapy System Export ....................................................................................................................... 25Section 8: Result Series Creation ............................................................................................................................................................. 26Section 9: Key Terms ................................................................................................................................................................................27

DynaSuite Neuro Table of Contents

Figure 1.1

Web: www.invivocorp.com

General Overview

Section 1.1: Logging InReference Figure 1.1Workspace (default): dynasuiteUser Name (default): dynasuitePassword (default): dynasuiteIf login fails on a Client Workstation, check that the server system is powered on.

Section 1.2: System Overview/SupportDynaSuite is a digital imaging workstation with an extensive set of tools for performing dynamic analysis and fusion of images using MRI (Magnetic Resonance Imaging) patient examination data. To use the system at full potential, it is helpful to review some key terms (Section 9), and understand their applications.

In order to become familiar with the user interface and DynaSuite workspace, refer to Sections 2 and 3.

IMPORTANT: Always archive your studies before transferring them to DynaSuite. DynaSuite is not intended to serve as an archive device.

Once a study is marked COMPLETE on DynaSuite it will remain on the Worklist Directory for a limited time (default two weeks) before being automatically removed.

Section 1: General Overview

For SupportCall: 1-877-INVIVO-1 (1-877-468-4861)

Or e-mail: [email protected]

Section 1.3: TroubleshootingIf an error message is encountered or DynaSuite is unresponsive:

1. Press Ctrl + Shift + Esc, select the Applications Tab, select “DynaSuite”, Left Click “End Task”

2. Restart DynaSuite3. If the workstation exhibits similar behavior, restart the

workstation.4. If the issue persists, when prompted to send error message to

Invivo, select “Send Report”

Loading Patient Studies:1. Patient Studies can be transferred directly from the modality or

can be sent from PACS via a network connection.

2. Studies can also be imported from external sources such as a CD, DVD, or USB drive using the patient browser.

Section 2: Functions, Toolbars and User Interface (UI)

Access Anywhere – Study AccessDynaSuite 3.1 has an Access Anywhere client-server option to allow you access studies from any location where you have adequate computer hardware and network bandwidth. Certain functions, such as patient study selection, will vary from standalone workstation operation and are detailed in this guide.

Section 2.1: Functions

Fusion AnywhereDynaSuite 3.1 provides you with the ability to combine images and results in any preconfi gured hanging in any combination you choose. Images and results are organized by type and can be added from the “Images” list from the right hand side panel. Any image or result from the list can be dragged and dropped into any viewport. In Smart Fusion, certain results, such as fMRI activations and vessels can be dropped into the 3D vieport for a 3D rendering of the results.

Overlays are added by drag and drop or removed by opening the image panel with the arrow in the lower left corner of the viewport, right clicking on the overlay to be removed, and selecting “delete”.

With the image panel open, opacifi cation of the selected overlay can also be modifi ed with the slider(s) at the bottom of the panel or it can be hidden by clicking on the “eye”.

Functions, Toolbars and User Interface (UI)

Tools AnywhereTools associated with the selected image or overlay are presented in the control panel. Regions-of-interest (ROIs) can be drawn in any viewport and results for that ROI will correspond to the selected or “active” overlay or image. The heading of the Control Panel indicates the image or overlay the results are associated with.

A right click of the mouse in any viewport will bring up the “Pie Menu”. The Pie Menu provides local tools for the viewport you are working in. It will also select tools pertinent to the active image or overlay in that viewport. For example, if an fMRI overlay is active, the fMRI Probe Tool will be in the Pie Menu.

Additional tool selections are available by clicking on the down arrow of the Pie Menu.

Section 2.1: Functions (continued)

Section 2.2: Screen Layout

Work Area Viewports

SidePanel

ControlPanel

ImageSelectionPanel

Global Toolbar (See Figure 2.1 on next page)

Section 2.3: Tools

Global Toolbar

Figure 2.1Patient browser

Full screen

Defer/complete

Reset View

Synchronization tools

Image stacking tools

Window level tools

ROI tools

Print options Viewport setup

ADSReceiving queue Processing queue

Date & time information CPU usage indicator

Transfer

Local Tools

• Add an image or overlay to a viewport – drag and drop from the image list in the right hand side panel

• Activate an overlay or image – left click on the image or overlay in the viewport

• Selected overlay or image name will be bold• Tools and data associated with the active image or

overlay will appear in the Control Panel• View image or overlay controls – select the “up” arrowhead in

the viewport’s image management tool in the lower left of the viewport (Figure 2.2)

• Image or overlay on/off control will appear to the left of each layer

• Opacifi cation control will appear at the bottom of the Images panel

Image Panel

Figure 2.2

Section 2.3: Tools (continued)

• Right click in the viewport of interest• Left click the downward arrowhead to expand selections• Follow arrow head to lowest level for a given function• Move cursor to desired tool and left click to execute

Local Tools

Pie Menu

Figure 2.3 Figure 2.4

Section 2.3: Tools (continued)

Section 2.4: Drag and Drop Images

“Images” in the section on the right are organized by image and results type. Any image or result can be dragged and dropped into a 2D viewport in any hanging. Some results, such as fMRI activations and vessels can be dropped in the 3D viewport in the Smart Fusion application as well. Images and results from this section are co-registered and will be synchronized for scrolling. If an anatomical image is dropped into a viewport which contains a gray scale anatomical image underlay, the new image will appear in color to diff erentiate it from the underlay.

To replace the current underlay with a new anatomical image, drag the new image over the image list for the current underlay until it highlights, then release.

Some processed images from the “Other Images” list from the left Study Panel may also be dragged and dropped into an inspector. These images may or may not be co-registered with the rest of the study. If they are not, an icon will appear next to the image to indicate lack of synchronization.

Images SectionOther Images Section

Study Overview and Workfl ow

GUI (graphical user interface) area on left for listing and selecting studies and applications:

Worklists (Level 1) Icons representing groups of studies. Double Click on study type to

view the study list.

Studies (Level 2) Overview of individual exams with image icons, patient name and

exam date. Single Click on patient name to open the case, view reports and view specifi c hangings of images and data.

Studies, Applications and Images (Level 3) Overview of hanging protocols for open study. Single Click on the

applications` title to view it.

Section 3: Study Overview and Workfl ow

Worklists (Level 1) Studies (Level 2)

Studies, Applications and Images (Level 3)

Section 3.1: Study Overview Panel

Patients in the worklist will have a solid line around the image icon if the study has been pre-fetched to the client workstation or a dotted line if it hasn’t. Right click on the patient from the worklist that has not been pre-fetched will bring up the menu shown in Figure 3.1. On fast networks, selecting the “Open” option will provide the best performance. For slower networks “Prefetch” will allow you to download the study in advance of opening it for better review performance.

Section 3.2: Access Anywhere Patient Selection

Figure 3.1

Section 3.3: Typical Workfl ow

Open Study

Quality Checks(pages 14-18)

fMRI Review(page 19)

• Registration Check• 3D Check• Vessel Check• Diff usion Check• Motion Check• Reprocess any fMRI series with unique

timing (page 24)

• View each fMRI map• Adjust fMRI thresholds• Create 2D ROIs• Analyze ROI statistics• View fMRI timecourse graphs• Add annotations

Continued on next page

Diff usion Review(page 20)

• View anatomic comparison image• View DWI image• View FA map• View ADC map• View DTI colormap• Draw ROIs - compare quantitative values• Add annotations

Continued on next page

Section 3.3: Typical Workfl ow (continued)

Dynamic Review(page 21)

• View anatomic comparison image• View rCBV map• View rCBF map• View MTT map• View TTP map• Draw ROIs - compare quantitative values• View curves• View leakage map• Add annotations

Create Result Series

Section 3.3: Typical Workfl ow (continued)

Smart Fusion Review(page 22)

Complete Case & Close Study

• View vessels• View diff usion maps• Adjust the map overlay opacity• Create fi ber tracks• View fi ber tract security margins• View fMRI maps• Change overlay colors• View dynamic maps• Change the opacity of the 3D rendering• Manipulate the clip planes

Export DICOM images to PACS(page 26)

Export to surgical navigation(page 25)

Section 4: Quality ChecksSection 4.1: Registration Check

In any hanging, dragging a processed image into an inspector or selecting an overlay already present, will enable the tools for that overlay. The “Registration Check” tool allows the user to confi rm or adjust the registration of the selected overlay to the high resolution pre-contrast 3DT1 image set.

• Drag and drop the desired processed image into the vieport• Select the “Registration Check” button from the control panel• Use the default overlay type or select the “Checkerboard” mode• To window level the overlay hold the right mouse button and drag

vertically on the viewport• Select the tool of choice from the top tool bar at the top for the left

mouse function (e.g. rotate to rotate the overlay)• Press and hold left mouse button in the inspector and drag to move,

rotate, change W/L or scroll• Center mouse button default is overlay pan movement• New settings can be saved or the registration can be reset to the

default using the buttons in the lower right

Figure 4.1

Quality Checks

Section 4.2: 3D Check

In any hanging, the 3DT1 no contrast image may be checked for skull stripping quality.

• Select the 3DT1 image from any viewport• Select the “3D Check” button from the control panel• For major corrections the “threshold” in the lower left can be

adjusted• For local adjustments select the “Marker” tool from the top

tool bar and begin on the sagittal image with the 5 “+” signs• Left click on the colored area to remove a section• Left click on an open area to add a section• Scroll through the slices and repeat – note that the algorithm will

correct in 3D so it’s generally not necessary to do each slice• The “Update 3D View” button can be used to see the impact

of your changes on the 3D rendering• Changes can be saved or discarded using the tool bar in the

lower right

Figure 4.2

Section 4.3: Vessel Check

Figure 4.3

If both a pre and post contrast 3D T1 image have been acquired for a study, the Vessels quality may be checked from any hanging.

• Select the Vessels overlay from any viewport or drag and drop the “Vessels” image from the image section into a viewport

• Select the “Vessels Check” button from the control panel• The “threshold” in the lower left can be adjusted to aff ect the

skull stripping and the “Marker” tool can be used to edit the green areas or those with no color. Operation is the same as described in section 4.2

• For local adjustments to vessels select the “Marker” tool from the global tool bar and begin on the sagittal image with the 5 “+” signs• Left click on the green colored area to remove a section of

unwanted vessels• Scroll through the slices and repeat – note that the algorithm will

correct in 3D so it’s generally not necessary to do each slice• The “Update 3D View” button can be used to see the impact

of your changes on the 3D rendering• Changes can be saved or discarded using the control panel in

the lower right

Section 4.4: Diff usion Check

The Diff usion Check tool provides an air suppression threshold that helps suppress noise outside the cortex for improved tracktography.

• Select the diff usion image or a color map overlay from any viewport or drag and drop a diff usion image or result from the image section into a viewport

• Select the “Diff usion Check” button from the control panel• The “threshold” in the lower left can be adjusted to aff ect the

amount of noise outside the cortex represented by the colored area of the image

• Adjust the threshold slider or adjust the value with the up/down arrows or by replacing the value directly

• The image will refl ect the changes immediately• Scroll through the slices to insure no “holes” are present in the

color overlay of the brain• Increase the threshold to reduce noise outside the brain• Decrease the threshold to repair “holes” in the brain

• Changes can be saved or discarded using the tool bar in the lower right

Figure 4.4

Section 4.5: fMRI Check

The Motion Check tool allows the user to assess patient movement and determine if it is within acceptable limits.• Select a fMRI series or an activation map overlay from any viewport or drag and drop a fMRI image or result from the image

section into a viewport• Select the “Motion Check…” button from the control panel• The amount of subject translation (movement in the x, y, or z direction) and rotation (around the x ,y, or z axis) is displayed• Screen captures may be taken for archive documentation purposes

Figure 4.5

Section 5.1: fMRI ReviewSection 5: Study Review

The fMRI Review Application allows the user to view source EPI images and interrogate fMRI activation areas on high resolution anatomical images.

• Select fMRI Review from the Applications area on the left

• Select a fMRI series from the Images List, drag and drop it into a viewport, or select from an overlay within the image panel

• The fMRI control panel allows user adjustments to thresholds (t-values), color schemes, and more

• Select the fMRI probe tool from the “Pie Menu” to create ROIs of activation area(s) to be viewed on a time course graphic display

• The current ROI is graphically displayed showing a white curve as the expected hemodynamic response and the yellow curve as the ROI response throughout the time course of the series

• Screen, result series captures, and Report Statistics may be taken for archive documentation purposes

Figure 5.1

Pie Menu

Study Review

Section 5.2: Diff usion Review

• The Diff usion Review Application allows the user to view linked, comparative diff usion images and assess statistical values

• Select Diff usion Review from the Applications section on the left

• DTI Color maps, ADC maps and FA maps are displayed

• The diff usion specifi c control panel allows user adjustments to thresholds

• Select the Freehand ROI tool from the “Pie Menu” to create ROI statistics of FA and ADC values

• Screen, result series captures, and Report Statistics may be taken for archive documentation purposes

Figure 5.2

Pie Menu

Section 5.3: Dynamic Review

• The Dynamic Review Application allows the user to view linked, comparative perfusion images and assess statistical values

• Select Dynamic Review from the Applications section on the left

• Select any type of Dynamic map from the Images section, drag and drop it into a viewport

• The curve inspector shows time intensity changes interactively with the crosshair (white curve), ROIs used for statistics are also displayed as yellow curves throughout the time course of the series

• Screen, result series captures, and Report Statistics may be taken for archive documentation purposes Figure 5.3

Section 5.4: Smart Fusion Review

• The Smart Fusion Review Application allows the user to view linked 2D images in all three planes simultaneously

• Fusion Anywhere: Any image can be dragged and dropped into any viewport. In Smart fusion, certain results, such as fMRI activations and vessels can be dropped into the 3D inspector for a 3D rendering of the results.

• Tools Anywhere: Tools associated with an active image or overlay are presented in the control panel in the lower right corner. ROI results will correspond to the “active” overlay or image shown in the heading of the control panel.

Figure 5.4

Figure 5.5

• Overlays can be added by drag and drop from the Image section or removed by opening the image panel with the arrow in the lower left corner of the viewport, right click on the overlay to be removed, select “delete”

• With the image panel open, opacity thresholds of the selected overlay can be modifi ed with the slider(s) at the bottom of the dialog box or it can be hidden by clicking on the “eye”

• Vessel visualization (drag and drop Vessels from the Images section)

• Fiber Tract representation in 3D can be viewed from any ROI. Include/Exclude functions for modifi cations and security margins for surgical planning may be applied

• Screen captures, result series captures, and Report Statistics may be taken for archive documentation purposes

• Screen and result series captures may be taken for surgical navigation purposes

Section 5.4: Smart Fusion Review (continued)

Section 6: Reprocessing fMRI Studies

When an fMRI study is performed using a non-standard timing sequence the case should be allowed to import and process automatically, and then the specifi c fMRI studies can be reprocessed using correct parameters.1. From the Image List on the left side of the screen, right

click on the series that needs to be reprocessed.2. From the pop-up menu select Apply Advanced

Processing Rule to the Selected Image Set | fMRI Preprocessing (Figure 6.1)

3. The fMRI analysis window will open.4. Set each parameter based on the specifi cs of the current

study.• See the image on the right for details about how to enter the

necessary timing information (Figure 6.2).5. Click the ‘OK’ button to re-process the fMRI

studies.4. When the processing is complete, re-open

the case and view the results.Figure 6.2

Duration of task and rest for fi rst task (in volumes.)

Select if the task starts with rest or activation.

Parameters used to model the hemodynamic response. Usually these should not be changed.

For Siemens data collected in Mosaic format you may need to enter ‘FeetToHead’ in order for the EPI images to align correctly with the 3D T1.

Figure 6.1

Reprocessing Studies

Starting time point of the fi rst full block (rest or activation)

Section 7: Surgical Planning and Therapy System Export• DynaSuite Neuro can export results series images to surgical planning systems. These might be systems like Stealth by Medtronic, Intellect

Cranial Navigation System by Stryker, Vector Vision by BrainLab, and Gamma Knife by Leksell.• From the Smart Fusion hanging, right click in any of the 2D image viewports and select Results | Export to Surgical Navigation System

from the Pie Menu. (Figure 7.1)• Select the overlays to be exported. The current image can be exported with any of the currently active overlays for fMRI activations, fi bers,

and vessels by selecting them from the menu illustrated in Figure 7.2.• Select the export destination from the menu.• Click the ‘OK’ button and the results series will be created and exported to the desired destination.

Figure 7.2Figure 7.1

Surgical Planning and Therapy System Export

Section 8: Result Series Creation

Result Series Creation

Resuls series may be created from any viewport in a “what you see is what you get” fashion.

• Right click in the viewport of interest and select Results | Create Result Series... from the pie menu (Figure 8.1).

• Select a Slice Series or a Time Series if appropriate. (Figure 8.2)• Select All slices or select Around current slice and enter the number of images

you want in the Number of images box. (Figure 8.2)• Series Description allows changes to the created series name (Figure 8.2)• Click the ‘OK’ button and the result series will be created and placed in the results

folder at the bottom of the Image section.

Figure 8.2

Figure 8.1

Section 9: Key Terms

Key Terms

ADC maps - Apparent Diffusion Coefficient maps. Color-coded maps that indicate the overall rate of water diffusion in regions of the brain.

Curve Viewport - The Curve Viewport displays an fMRI activation curve for the currently selected ROI or the values of a selected region (CSP or ROI) on a dynamic image map over time.

Dataset - a set of post-processed images.

DICOM - Digital Imaging and Communications in Medicine.

Diffusion - A type of MRI scan that measures the rate and direction of water diffusion in the brain.

DTI - Diffusion Tensor Imaging. An application of diffusion MR where the direction of maximum water diffusion is color-coded.

Dynamic MR (Dynamic Analysis) - An MR imaging sequence that shows changes in contrast over time.

FA maps - fractional anisotropy maps. Color-coded maps that

indicate areas of anisotropic water diffusion in the brain.

fMRI - functional Magnetic Resonance Imaging. A type of 4D MRI scan that looks at brain function over time as opposed to just anatomy.

Hanging (Applications) - customized arrangement of images and associated data, placement of viewports, and settings for window/level and other parameters.

rCBF maps - relative Cerebral Blood Flow maps. Color-coded maps derived from a dynamic MR scan, which indicate the flow of blood in one brain region relative to others. This is not an absolute measurement.

rCBV maps - relative Cerebral Blood Volume maps. Color-coded maps derived from a dynamic MR scan, which indicate the volume of blood in one brain region relative to others. This is not an absolute measurement.

TTP maps - Time To Peak maps. Color-coded maps derived from a dynamic MR.

Viewport (Inspector Window) - a window that displays images and tools in the work area, providing a variety of display options, especially for MRI examinations.

Results Folders - Separate folders containing selected images, curves, and/or histograms and specific saved images. Results Folder(s) will automatically become integrated into the Structured Report.

Tractography (Fiber Tracking) - one application of DTI that used the pattern of water diffusion in the brain to locate and track white matter tracts.

Section 9: Key Terms (continued)

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© 2013 Invivo Corporation All Rights Reserved DS-3.1-425-009-00

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