HEAD (Craniosynostosis)

- Spin and Flip of skull in AP view

- Flip of skull in LAT view

- Change transparency between 8-15 to show suture line better and do the same batch rotations. Send all 6 batch rotations to PACS.

- Use the “Adds Charge” 3D modifier

06/20/2016

CTA Head-COWIndication: Aneurysm, Stroke, AVM, etc.

Include: Circle of Willis- Anterior and Posterior Communicating Artery, Middle Cerebral Arteries, Posterior Cerebral Arteries.

Internal Carotid Arteries, Basilar Artery and Vertebral Artery.

Make batch rotations in both VR and MIP, spin and flip in step size of 12.

Send all batch rotations to PACS.

06/20/2016

Vitrea Perfusion

1. Start Vitrea (double click on Vitrea Core icon) Click on the patient’s name on the work list.

a. Under the Applications tab double click on Brain Perfusion to load the images into the protocol or you can load images by clicking on the Series tab and Hold down CTRL and click on all four of the dynamic series (they should all have the same number of images) and right click and select load in Advanced Viewer. Select Brain Perfusion CT from the protocol list, Click on 2D Perfusion.

b. Scroll through all four images and insure that there’s no motion. If motion is seen then click on the motion correction icon (located under perfusion Analysis/Series Verification). You may need to window/ level the image to see more clearly (window level tool is under analysis tab, top left).

c. Use slide bar under the graph to scroll images through time. d. View all four images through time to see where the red dot and blue dot

have been placed. The red dot indicates where contrast is first seen in an artery. The blue dot should be in the densest vein at peak venous flow. (Window/level to be sure that the dots are in contrast and not bone).

e. If correction is needed, select Crshair (+Hu) icon (in the upper left analysis tab) and Click where the artery or vein should be, then click on either artery or vein icon to move dot to that location. When you are happy with the artery and vein selections, click on the Compute icon.

2. Select Snap (camera icon under the analysis tab) then click anywhere in the images to save your work “just in case”).

3. Change color scheme in MTT (Mean Transit Time box/ lower right box) by clicking on the small box under the color bar on that image. Blue should then be at the top of the color bar and red at the bottom.

4. Right click anywhere on images and select Batch Collage.5. Click on Report tab.6. Export the Collage images to stentor, by clicking on the images and then

click export and select Stentor and click Export. 7. Open stentor to insure that all images have transferred.

06/20/2016

CTA Neck-CarotidIndications: Carotid stenosis, Vertebral artery dissection, Vascular disease, Stroke, etc..

Include: Aortic arch, Brachiocephalic artery, Right and Left subclavian arteries, Right and Left common and internal carotid arteries, start of right and left external carotid arteries.

Make batch rotations in VR at step size of 12. (Spins)

Vessel Probe Right and Left internal carotid arteries (show vessel box must be selected)

- Change vessel name (Right Carotid or Left Carotid)- Use lesion tool with LUMEN and WALL selected (click and drag lesion tool

down vessel)- Position VESSEL PROBE view so that the region of stenosis (RED/PINK

arrows) is at the BLUE mid-point and correlates to axial images. - TIP: make sure to check the centerline (right click on image and select

edit centerline) to insure accuracy- Snap shot each side and send to PACS

Then Include: Vertebral Arteries from area of origin to Basilar Artery.

Make batch rotations in VR, MIP, and VR with Semi Transparent bone at step size of 12. (Spins)

Send all Batch rotation images and the two Snapshots to PACS.

SUMMARY:

- 1 Spin VR with carotids only- 1 Spin VR with carotids and vertebrals- 1 Spin MIP and Semi Transparent Bone with carotids and vertebrals- 1 snapshot of each right and left carotids vessel probed/lesion tool

LARYNX

-Choose larynx/airway-3D-Cut from sagittal/axial-Spins only in VR and Semi Transparent Bone

06/20/2016

Left Atrium

Indication: For A-fib pre or post ablation.

Include left atrium body, appendage, and branching veins. Include main pulmonary branches, do not include too much of the peripheral vessels.

Show 3D image in both VR and MIP views.

Batch spin rotation from AP position at a step size of 12.

Batch flip rotation from a PA position that has been rotated upside down, then batch at step size of 12.

Send all 4 batches to PACS.

CHEST (Calcium Scoring)

- Load study in 2D VScore with Color

- Circle calcium in LM, LAD, CX, and RCA, if no calcium in the vessel then circle anywhere in the vessel to show a score of 0 in the report page.

- Send 1X1 axial batch showing what was circled if calcium was present, to PACS.

- Send report pages to PACS (Make sure you show a score for all four arteries or a score of 0 if no calcium).

06/20/2016

CTA Chest (Thoracic Aneurysm)

Include: Ascending aorta, Aortic arch, Descending Thoracic Aorta, Brachiocephalic trunk, Subclavian arteries, Right and Left Common Carotid, Start of vertebral arteries. Include mammary arteries for patients with Coarctation.

Make batch rotation (spins) in VR, MIP, and VR with Semi Transparent Bone. Step size 12.

Send all batch rotations to PACS.

06/20/2016

CardiacIndication: CAD, Anomalisis Coronary Artery, Abnormal Stress Test, etc.

Include: RCA, LAD, LCX. (If for indication of Anomalisis Artery, include any anomaly)

Vessel Probe the three main arteries listed above and use Lesion Tool (Single) to show Lumen, Wall, and Plaque. Click and drag the lesion tool down the vessel in the 2D image to demonstrate the colored measurements. Center to the vessel of interest and take snap shot. (Don’t send snapshots to PACS). Do this process to all three main arteries. (Snapshots will be used by the Radiologist when they log into Vitrea).

Then show Vessel folder only (Un-check the Heart and Base folder). Orient the vessel in the RAO CRA/LAD orientation and batch the image in step size of 12. Add the Heart folder back in and make another batch, Then make the heart Semi-Transparent and make third batch. Send all three batches to PACS.

CFALoad phases 0-90 in 10 phase increments into Cardiac: Functional CT, Pick LV Functional Analysis.

View Cardiac Analysis Graph to insure a smooth graph line (No spikes in graph), View the LV with tinted/MPR and LV Axis bar to insure that the entire LV is being included in LV Folder. Make adjustments to LV Axis bar as needed and click Compute if changes are made.

Type in the patient information (Height, Weight, and Ave HR during scan).

Take the Tint/MPR off and go to the batch tab to preform batches of all three 2D boxes ( LV View, 4 Chamber View and Short Axis View), Make sure to select the box that says “ Show all Phases”, Then make a Batch of each view with a step size of 8. Return to analysis tab to perform the final View ( Aortic Valve View) Maximize top left box and use the Oblique box( Bottom right of screen) to angle to the Aortic valve plane. Then Minimize the box and Maximize the Top Right Box and do the same. Use Oblique lines in both upper boxes to get the angle of the aortic valve into a direct axial view. The bottom right box should look like a direct axial view of the aortic Valve (Tricuspid or bicuspid). Maximize Aortic Valve view (bottom right box) and return to the Batch Tab. Make sure to select the box marked “ Show all Phases” and make batch through the Aortic Valve in step size of 8.

Send all 4 batches ( Views in motion through all phases) to PACS. In the Report tab, Transfer the CFA report to PACS and also transfer the larger image of the Color Wheels and the larger image of the Analysis Graph to PACS.

06/20/2016

CTA-CAPIndication: Aneurysm, Dissection, Trauma, Coarctation of aorta, aortic stenosis, etc…

Include: Break exam into segments (Chest, Abd/Pel)

Chest: Include Ascending aorta, Aortic arch, Descending Thoracic Aorta, Brachiocephalic trunk, Subclavian arteries, Right and Left Common Carotid, Start of vertebral arteries. Include mammary arteries for patients with Coarctation.

Abd/Pel: Include Abdominal Aorta, Celiac axis, Left Gastric Artery, Splenic Artery, Hepatic Artery, Epigastric Artery if seen, Right and left Renal Arteries, SMA, Inferior Mesenteric Artery origin, Bifurcation and iliac Vessels to femoral vessels.

For Chest segment, make batch rotation (spins) in VR, MIP, and VR with Semi Transparent Bone, Step size 12. Also make Sag/Coronal batches 10mm/2mm MIP.

For Abd/Pel segment, make batch rotations (spins) in VR, MIP and VR with Semi Transparent Bone, Step size 12. Also make Sag/Coronal batches in 10mm/2mm MIP.

Send all batch rotations and Sagittal/Coronal reformats to PACS.

06/20/2016

Liver VolumeIndication: Liver Mass, pre surgical.

Include: Liver segments requested by the Radiologist. (Requested segments and reference line will be saved by the radiologist under the presentation state of the study on PACS). Segment liver and label as requested.

Take snap shot of each segment showing the volume of each, and a Total liver Volume as well.

Make Axial batch to show how liver was segmented.

Send Snap Shots and Axial Batch of segments to PACS.

06/20/2016

Abdomen/Pelvis

Indication: Evaluate for AAA, Follow up Endograph repair, Renal artery stenosis, Mesenteric ischemia, etc.

Use stent protocol and be sure to include all of thrombus

Include: Abdominal aorta, all main arterial branches off the aorta through iliac arteries.

Make batch rotations (spins) in VR, MIP and VR with Semi Transparent Bone, (you may include the kidneys with the Semi Transparent Bone image). Step size 12.

Send all batch rotations to PACS.

06/20/2016

EVSP MeasurementsDo the same as you would for AAA then do these measurements:

1. Aorta-Neck Angle: Measure down from the orifice of the superior mesenteric artery to the orifice of the uppermost renal artery to the start of the aneurysm.

2. Neck-AAA Angle: Measure up from the end of the aneurysm to the start of the aneurysm to the orifice of the lowermost renal artery.

3. Aortic Neck Length: Defined as the distance from the orifice of the lowermost renal artery to the start of the aneurysm.

4. Diameter of Aorta above aneurysm, (aka: Start of aneurysm and should be the same point used in the measurements of both angles and the aortic neck length).

5. Max Aneurysm Diameter in 2 planes (Include all thrombosed portions of aneurysm

6. Right Common Iliac Max Diameter

7. Right Common Iliac Min Diameter

8. Right External Iliac Max Diameter

9. Right External Iliac Min Diameter

10. Left Common Iliac Max Diameter

11. Left Common Iliac Min Diameter

12. Left External Iliac Max Diameter

13. Left External Iliac Min Diameter

Please rename all measurements in Vitrea to match what is listed above.

Take snapshots of each measurement and send snapshots to PACS stacked all in the same group (13 snapshots total).

Send report page to PACS. Email the radiologist a copy of the report

Renal Recipient Images: Spins of each.

Renal Donar Images: Spin and flip of the 2 artery/kidney/vein images and spins of the 2 KUB images.

06/20/2016

RunoffIndication: Peripheral artery disease (PAD), non-healing wound or ulcer, trauma, etc..

Include: Break exam into segments : Abdomen/Pelvis, Thighs, Knees, Below knees to feet

Abdomen/pelvis: Abdominal aorta, all main arterial branches off the aorta through iliac arteries.

Thighs: Femoral arteries Knees: Popliteal artery to the Tibio peroneal trunk, peroneal artery, anterior

and posterior artery junction. Below knees to feet: Peroneal artery, anterior and posterior artery down to

the feet.

For Abd/Pel segment, make batch rotation (spins) in VR, MIP, and VR with Semi Transparent Bone, Step size 12. Also make Sag/Coronal batches in 3mm/3mm Average, and 10mm/2mm MIP.

For all other segments, make batch rotations (spins) in MIP and VR with Semi Transparent Bone, Step size 12. Also make Sag/Coronal batches in 10mm/2mm MIP

Send all batch rotations and Sagittal/Coronal reformats to PACS.

06/20/2016ORTHOPAEDIC

- Hipo Spin and Flip of hip.o Disarticulate Femur and Acetabulum

- Do Spin and Flip of Femur- Do Spin and Flip of Acetabulum (in lateral position to better visualize acetabulum)-Change transparency between 8-15 to best show fracture or fragments of bone and make same batch rotations of each segment.

- Kneeo Spin and Flip of knee (window/level so that you include tendons on

one spin view)- Do Spin and Flip of Femur- Do Spin and Flip of Tib/Fib-Change transparency between 8-15 to best show fracture or fragments of bone and make same batch rotations of each segment.

- Ankleo Spin and Flip of ankle (window/level so that you include tendons)

- Do Spin and Flip of Tib/Fib (depending on where fracture is)- Foot

o Spin and Flip of foot (window/level so that you include tendons)

06/20/2016

Shoulder

Indication: CAM Lesion, Fracture, Pre surgical, etc.

Include: Shoulder girdle in its entirety. Then disarticulate the humerus and spin and flip each bone in VR and then Semi Transparency (12-15 Transparency for most studies). Spin and flip according to what will demonstrate the anatomy or fracture better.

Send all batches to PACS.

Summary:

Spin and Flip of shoulder including clavicle, scapula and humerus.- Do Spin and Flip of Humerus- Do Spin and Flip of Shoulder girdle

06/20/2016

WristIndication: Fracture, Pre or Post Surgical, etc.

Include: Entire wrist in VR, Semi Transparent (15-20 Transparency in most studies), Tendon View (Window and level to show the tendons).

Segment: Disarticulate the fractured bone or separate the Radius and Ulna from the Metacarpals. Make batches in Spin and Flip rotations of VR and Semi Transparent Views. Spin and Flip images to show the fracture or pathology best.

Tip: Use bone ghosting if the bone of interested is not easily identified without the adjacent bones. Have bone of interest in VR and adjacent bones with high Transparency (Ghosting).

Summary:Spin and Flip of wrist (window/level so that you include tendons)- Do Spin and Flip of Radius/Ulna (depending on where fracture is)- Do Spin and Flip of Carpal bones (depending on where fracture is)

3D HEAD (TRAUMA)

- Spin and Flip in AP view- Flip in LATERAL view- Highlight patient on vitrea worklist- Click on series tab and load the soft tissue volume in advanced

viewer. Select musculoskeletal CT and pick 3D analysis.- Use your trim and or sculpting tools to remove the head holder.- Take a snap shot- Orientate the skull into an AP view. Select batch tab, under 3D

rotation select full 360 rotation, select the right arrow→, it should default to a step size of 12.9. Hit batch.

- Select the up arrow ↑ and batch again. - Orientate the skull into a lateral view. Select batch tab, under 3D

rotation select full 360 rotation, Select the up arrow ↑ and batch again.

- Click on the report tab and send batch images to stentor.- Be sure to bill using the “adds charges” 3D modifier.

3D RIBS (TRAUMA)

- Highlight patient on vitrea worklist- Click on series tab and load the soft tissue volume in advanced

viewer. Select musculoskeletal CT and pick 3D analysis.- Window and level to remove organs and vessels out so you just see

bone. - Use the sculpting tool to remove the arms and scapulas. You can

rotate the image to get the scapulas out of the way. - Take a snap shot.- Orientate your image in an AP view.- Click on the batch tab, under 3D rotation select Full 360 rotation,

select the right arrow →. It should default to a step size of 12.9. Hit batch.

- Select the up arrow ↑ and batch again.- Click on the report tab and send batch images to stentor.- Be sure to bill using the “adds charges” 3D modifier.