Publications

5819086-1EN
Revision 1

User Guide

Part 1:
Overview of
Volume Viewer
Dynamic Shuttle

0459

© 2019 General Electric Company. All rights reserved.

1
Table of Contents
Regulatory Requirements ............................................................................................................................. 4
Legal Notices ...................................................................................................................................................... 4

Introduction ......................................................................................................................................................... 5
User Interface Note ..................................................................................................................................................................... 5

Product Description ......................................................................................................................................... 6

Safety...................................................................................................................................................................... 7
Intended Use / Indications for Use ....................................................................................................................................... 8
Cautions and Warnings ............................................................................................................................................................. 8
Software Safety-Related Messages ...................................................................................................................................15

Privacy and Security Information .......................................................................................................... 16

Getting Started: Simple Exam Review in 5 steps ........................................................................... 17

Volume Viewer Overview ........................................................................................................................... 23

Protocols Page Description....................................................................................................................................................23
Toolbar Description ...................................................................................................................................................................26
Floating & docked panels .......................................................................................................................................................39
On View Controls ........................................................................................................................................................................40
Contextual Menu ........................................................................................................................................................................43
Summary Table ...........................................................................................................................................................................46

Global Preferences ........................................................................................................................................ 52

Loading [CT only] ........................................................................................................................................................................52
Display .............................................................................................................................................................................................53
Viewports .......................................................................................................................................................................................54
Annotations...................................................................................................................................................................................56
Toolbar ............................................................................................................................................................................................57
Tools .................................................................................................................................................................................................59
Export ..............................................................................................................................................................................................60
General Review ...........................................................................................................................................................................62
Integrated Registration ...........................................................................................................................................................63

Compare and Correlate .............................................................................................................................. 64

Using VV General Review........................................................................................................................................................64
Using Dynamic Load .................................................................................................................................................................67

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MR in Volume Viewer ................................................................................................................................... 70
Standard MR Review Protocols ............................................................................................................................................70
Create a customized MR review protocol .......................................................................................................................73
MR AutoBind .................................................................................................................................................................................75

PET in Volume Viewer .................................................................................................................................. 79

Overview ........................................................................................................................................................................................79
Display and Controls .................................................................................................................................................................79
CT/PET Protocols.........................................................................................................................................................................79
Fused views ..................................................................................................................................................................................80
Other PET protocols...................................................................................................................................................................86

Dual energy CT................................................................................................................................................ 88

Keyboard Shortcuts and Tips................................................................................................................... 90

Measurement Accuracy ............................................................................................................................. 94

Revision History .............................................................................................................................................. 96

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Regulatory Requirements
This product complies with the regulatory requirements of the following:
• Council Directive 93/42/EEC concerning medical devices: the 0459 label affixed to the
product testifies compliance to the Directive. First CE marked in 2010 for Dynamic Shuttle.
First CE marked in 2012 for Volume Viewer.

• Medical Device Good Manufacturing Practice Manual issued by the FDA (Food and Drug
Administration, Health and Human Services, USA).

• International Electrotechnical Commission (IEC), international standards organization, when

applicable.

• USA/HHS
United States Federal law restricts this product to sale by or on the order
of a physician.

• GE Medical Systems SCS is ISO 9001 and ISO 13485 certified.

• The original document was written in English.

Manufacturer address:
GE Medical Systems SCS
283, rue de la Miniere
78530 Buc
FRANCE
Tel: +33 1 30 70 40 40

Legal Notices
GE and the GE Monogram are trademarks of General Electric Company.

Advantage Workstation, AutoBone, Innova, OncoQuant and VesselIQ are trademarks of General
Electric Company or one of its subsidiaries.

DICOM is the registered trademark of the National Electrical Manufacturers Association for its
standards publications relating to digital communications of medical information.

All other trademarks are the property of their respective owners.

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Introduction
This User Guide is a training material available on line on the workstation covering Volume Viewer
and Dynamic Shuttle. It can also be read from any PC using the Volume Viewer installation DVD.
Review operating procedures on a regular basis, paying special attention to the Safety and
Regulatory statements. Keep this User Guide available while using these products.

If you want to benefit from additional training, please contact your GE User Services representative
for assistance.

This User Guide is available in 3 parts.

You are now in Part 1: Overview which reviews the different functionalities of the software user
interface.

Additional information on these products is also available in:

- Part 2: Deep Dive in Volume Viewer which gives a detailed description of the main
functionalities.
- Part 3: Clinical Scenarios which is a step by step description of how to post process most
common clinical exams.

As with any medical imaging process, only qualified personnel should use this equipment.
You must be aware of the limitations of the basic imaging modality and of ensuing image
processing. This includes understanding the limitations of the initial series acquisition, image
processing technology used, and image display methods.

User Interface Note

Please note that the screen captures in this document are intended for demonstration purposes
only and may not always be fully identical to the actual user interface (e.g., in color scheme). Use
these screen captures as guides.

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Product Description
Volume Viewer is a post-processing application. Data acquired with CT, MR, PET, PET/CT, AdvantX
and InnovaTM 3D X-Ray systems can be processed using Volume Viewer. There are no limitations on
the patient population.

Dynamic Shuttle is a post-processing application intended to be used with CT GE Volume Shuttle

(Axial), Volume Helical Shuttle acquisitions and any axial dynamic CT acquisition. There are no
limitations on the patient population.

The above products run on different platforms. On the AW Server, there are no reporting features.
On the Seamless Integration, only one PACS viewport can display a 3D session.

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Safety
To assure an efficient and safe use of Volume Viewer / Dynamic Shuttle, it is essential to read this
chapter before attempting to use the packages.

The users of the Volume Viewer software application will be CT, MR, nuclear medicine, and radiology
technologists, radiologists, cardiologists, or physicians qualified with advanced applications training
for software competencies or other personnel that the owner feels is properly trained for this
software use (radiology assistants, physician assistants, etc.).

The users of Dynamic Shuttle software application will be CT Angiography radiology technologists,
radiologists, cardiologists, or physicians qualified with advanced applications training for software
competencies or other personnel that the owner feels is properly trained for this software use
(radiology assistants, physician assistants, etc.).

To avoid usability error, the user MUST have a good knowledge and understanding of both the
platform and its primary operating functions. This will be accomplished through applications
training and through the correct knowledge and application of User Guide content. Please contact
your GE representative to order and follow this mandatory training. The site determines a qualified
individual. The site is the owner of the program and can be located within a hospital, a clinic, or a
private office setting (fixed or mobile) or wherever this program is used.

Ensure that the correct versions of your User Guides are readily available at all times. Make a point
to review the procedures and safety precautions periodically. Additional safety concerns are
addressed in the AW VolumeShare/AW Server user documentation.

Safety notice legends:

THIS INDICATES A POTENTIALLY HAZARDOUS SITUATION, WHICH, IF NOT AVOIDED, COULD RESULT
IN DEATH OR SERIOUS INJURY.

This indicates a potentially hazardous situation, which, if not avoided, may result in minor or
moderate injury.

Notice
This indicates a non–hazardous situation, which, if not avoided, could result in equipment damage,
lost time, or reduced image quality.

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Intended Use / Indications for Use
Volume Viewer is a medical diagnosis software that allows the processing, review, analysis, and
communication of 3D reconstructed images and their relationship to originally acquired images
from CT, MR, X-Ray Angio, and PET scanning devices. The combination of acquired images,
reconstructed images, annotations, and measurements performed by clinicians are intended to
provide referring physicians with clinically relevant information for diagnosis, surgery, and
treatment planning.

Dynamic Shuttle Intended Use: Dynamic Shuttle is intended to facilitate segmentation of bony
structures from head and neck, body, and extremity data. When used with dynamic data, it
facilitates visualization of vessel features.

Cautions and Warnings

1. Image reliability
NON-GE IMAGES ACQUIRED CAN BE LOADED IN VOLUME VIEWER BUT GE DOES NOT
GUARANTEE THE QUALITY OR RELIABILITY OF ANY RECONSTRUCTION,
SEGMENTATION, OR MEASUREMENTS PERFORMED ON THESE IMAGES. NON-GE
IMAGES CAN EASILY BE IDENTIFIED BY THE CORRESPONDING IMAGE ANNOTATION.

FOLLOW THE DICOM ACQUISITION PARAMETER GUIDELINES LISTED IN EACH

APPLICATION USER GUIDE. CONSULT THE GE-PUBLISHED DICOM CONFORMANCE
STATEMENT OF VOLUME VIEWER WHICH IS AVAILABLE ON THE GE HEALTHCARE
WEBSITE AT
http://www.gehealthcare.com/usen/interoperability/dicom/products/workstation_dicom.html

ALWAYS CORRELATE ANY INFORMATION (CURSOR POSITION, IMAGE ORIENTATION,

MEASUREMENTS, IMAGE QUALITY, ETC.) IN ANY 3D RECONSTRUCTION (REFORMATTED
PLANE, OBLIQUE, MPVR, MIP, VOLUME RENDERING, NAVIGATOR ENDOLUMINAL
VIEWS, CURVED, SEGMENTATIONS, MEASUREMENTS, TRACKING, SAVED IMAGES, ETC.)
WITH THE ORIGINAL DATA (ACQUISITION OR BASELINE IMAGES).

CHECK THE RELIABILITY OF SAVED OBJECT ACCORDING TO ORIGINAL DATASETS

AFTER RELOADING AND POST PROCESSING (TRACKING, SEGMENTATION,
MEASUREMENTS, ...).

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 A 3D VIEW IS A TWO-DIMENSIONAL PROJECTION ON THE SCREEN OF THE 3D
VOLUME. THERE IS NO INDICATION ON A 3D VIEW OF THE DEPTH OF THE 3D CURSOR
INSIDE THE 3D VOLUME. ALWAYS CHECK THE ACCURACY AND CONSISTENCY OF 3D
COORDINATES BY CHECKING THE CURSOR POSITION ON ORIGINAL DATA
(ACQUISITION IMAGES).
ALWAYS USE ORIGINAL ACQUISITION IMAGES FOR DIAGNOSIS AND TAKE INTO
ACCOUNT GENERATED SECONDARY CAPTURES (SCPT) ONLY AS A SUPPLEMENTARY
TOOL.
JPEG IMAGES SHALL NOT BE USED FOR DIAGNOSIS.

1.1 Window Width and Level (W/L)

THE WINDOW WIDTH AND LEVEL (W/L) DETERMINE HOW CLEARLY PATHOLOGIES AND
OTHER ANATOMICAL STRUCTURES CAN BE DISCERNED. INCORRECT W/L SETTINGS
MAY RESULT IN PATHOLOGIES AND OTHER ESSENTIAL ANATOMICAL STRUCTURES
NOT BEING DISPLAYED CORRECTLY. AS A SINGLE W/L CANNOT DISPLAY ALL
FEATURES PRESENT IN AN EXAM, USE SEVERAL DIFFERENT SETTINGS, WHEN
NECESSARY, TO EXPLORE ALL EXAM DATA.

1.2 Volume Rendering

WHEN USING VOLUME RENDERING, INCORRECT SETTINGS OF OPACITY CURVES,
OPACITY THRESHOLDS, AND TRANSPARENCY SETTINGS WHEN MERGING VR OBJECTS
CAN RESULT IN PATHOLOGY OR ESSENTIAL ANATOMIES NOT BEING VISIBLE. ALWAYS
CORRELATE VOLUME RENDERING IMAGES WITH ORIGINAL IMAGES.

1.3 Navigator
WHEN USING NAVIGATOR IMAGES, AN INCORRECT THRESHOLD SETTING OR
INCORRECT THRESHOLD MODE CAN RESULT IN PATHOLOGIES OR OTHER ESSENTIAL
ANATOMY NOT BEING VISIBLE.
NAVIGATOR VIEWS USE CONICAL PROJECTIONS (PERSPECTIVES) THAT CAN
INTRODUCE DISTORTIONS, ESPECIALLY WITH FISH EYE VIEWS. FOR THIS REASON THE
ASSESSMENT OF DIMENSIONS AND DISTANCES TEND TO BE SUBJECTIVE.
NAVIGATOR VIEWS AND MEASUREMENTS SHOULD ALWAYS BE CORRELATED WITH
ORIGINAL AND REFORMATTED IMAGES.

1.4 Curved
CURVED REFORMATION CAN INTRODUCE DISTORTIONS IN THE SHAPE OF OBJECTS.
TO AVOID MISINTERPRETATION, USER SHOULD ALWAYS CORRELATE THE CURSOR
POSITION IN CURVED REFORMATION VIEWS WITH ACQUIRED IMAGES.

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1.5 Lumen
Lumen. This transformation results in geometrical distortion of the displayed
anatomical features because the successive intersections are not parallel. For this
reason the Lumen view should NOT be used for diagnostic purposes by itself, but
always in combination with other views.

1.6 Dynamic Shuttle

Calcifications may be removed along with bones when using the DSA bone
subtraction technique.
THE SHUTTLE REVIEW PROTOCOLS ARE DESIGNED ONLY FOR VISUALIZATION OF
VASCULAR KINETICS. THE PROCESSED IMAGES SHOULD NOT BE USED TO PERFORM
MEASUREMENTS OF ANY KIND. DUE TO RELATIVELY HIGH NOISE CONTENT, THESE
IMAGES SHOULD NOT BE USED FOR QUANTITATIVE VASCULAR ANALYSIS. MOREOVER,
BONE REMOVAL TECHNIQUES USED IN CONJUNCTION WITH THESE PROTOCOLS MAY
RESULT IN PARTIAL REMOVAL OF VESSELS.
THE BONE REMOVAL TECHNIQUES USED IN CONJUNCTION WITH SHUTTLE REVIEW
PROTOCOLS MAY RESULT IN PARTIAL REMOVAL OF VESSELS. THIS IS LIKELY TO
HAPPEN WHEN VESSELS ARE ALREADY OPACIFIED IN PHASE 1. IT IS ADVISED TO
ALWAYS CHECK THE RESULTS OF BONE SEGMENTATION.

1.7 Filter
STATISTICS PERFORMED ON FILTERED IMAGES WHICH ARE SAVED AND RELOADED IN
VOLUME VIEWER ARE NOT RELEVANT AND MUST NOT BE USED FOR DIAGNOSIS.

2. Image quality
AT ALL TIMES, IT REMAINS THE RESPONSIBILITY OF THE PHYSICIAN TO DETERMINE
WHETHER THE INTER-SLICE DISTANCE USED FOR A PARTICULAR EXAM IS
ACCEPTABLE.
LOADING NON-SQUARE PIXELS WILL RESULT IN BAD QUALITY IMAGES.

Notice
For a two monitor configuration, check the monitor calibration regularly to avoid a bad PET image
quality when displayed in inversed grey scale and to ensure images displayed as inverse grey are
identical on both monitors.

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3. Segmentation Tools
BEFORE USING ANY SEGMENTATION TOOL (THRESHOLD, SCALPEL, REMOVE & KEEP
OBJECT, AUTOSELECT, “FLOATER” FILTERS, ETC.) ALWAYS MAKE SURE THAT IT WILL
NOT REMOVE PATHOLOGIES OR OTHER ESSENTIAL ANATOMICAL STRUCTURES.
WHEN USING ANY SEGMENTATION TOOLS (AUTOSELECT, THRESHOLD, PAINT ON
SLICE, QUICK PAINT, ETC.), CHECK CONTOURS TO CHECK THE RELIABILITY OF THE
SEGMENTATION.
MAKE SURE THE CONTOURS MATCH THE CORRECT SEGMENTATION AND VOLUMES.
CHECK SEGMENTED VOLUMES MATCH CONTOURS.

CHECK THAT THE SEGMENTED VOLUME GENERATED FROM THE CONTOURS

MATCH THE DRAWN ONES.

4. Measurements
DO NOT USE 3D OR SLAB VIEWS ONLY TO PERFORM MEASUREMENTS (DISTANCE,
ANGLE, REGION OF INTEREST, REPORT CURSOR, AREA, VOLUME, ETC.). ALWAYS CHECK
THE POSITION OF MEASUREMENT POINTS AND REFER TO 2D BASELINE VIEWS
(ACQUISITION IMAGES OR REFORMATTED IMAGES OF MINIMAL THICKNESS) TO
CONFIRM MEASUREMENTS.
The software calculates and displays measurements with a resolution of one decimal
(such as 0.1 mm, 0.1 degree, etc.). You should be aware that the real measurement
accuracy is generally less for a number of different reasons (image resolution,
acquisition conditions, etc.).

Distance, angle, and area measurements are valid only if all trace segments are
longer than the inter-slice distance.
DEPENDING ON WW/WL SETTINGS, OBJECTS MAY DISPLAY DIFFERENTLY. CHECK
WL/WW BEFORE DEPOSITING MEASUREMENT POINTS.
IN CASE OF LOSSY COMPRESSION, THE MEASUREMENTS AND POINT DEPOSITION
MIGHT BE INACCURATE.

The software calculates and displays measurements with a resolution of

one decimal place (such as 0.1 mm, 0.1 degree, etc.).

You should be aware that the real measurement accuracy is generally

considerably less for a number of different reasons.

To assess the accuracy of the measurements performed with Volume

Viewer, you should be fully familiar with the section ”Measurement
Accuracy” in the chapter ”Measurements” of the Volume Viewer User
Guide.
11
 There is a difference between volume measurement in PET, volume
measurement in CT and volume measurement in MR.

WHILE ROI STATISTICS ARE CALCULATED ON DISPLAYED VOLUMES IN VOLUME

VIEWER (SEGMENTED OR NOT), THE SUMMARY TABLE ONLY DISPLAYS STATISTICS
CALCULATED FROM ORIGINAL VOLUMES (NON-SEGMENTED).

5. Measurements on centerline for Quick Vessel Trace

After Quick Vessel Trace vessel tracking, perform a visual check of the
segmented vessel. It is the user’s responsibility to verify the consistency of
results with the original acquisition images.

IN DIFFICULT SITUATIONS, SUCH AS A VESSEL WITH A COMPLEX

TRAJECTORY, OR VESSELS TOUCHING EACH OTHER IN THE IMAGES, THE
AUTOMATIC VESSEL TRACKING ALGORITHM MAY NOT ALWAYS FOLLOW THE
CORRECT TRAJECTORY. THE USER SHOULD ALWAYS EXAMINE THE
COMPUTED TRAJECTORY, AND IF NECESSARY CORRECT THE RESULT EITHER
BY MODIFYING THE CENTERLINE TRACE OR BY CORRECTING THE TRACKING
POINTS AND/OR ADDING INTERMEDIATE POINTS, THEN REPEATING THE
CENTERLINE DETECTION PROCESS.

The vessel centerline detection algorithm (vessel identification) relies on the

user correctly marking the start and end points of the vessel branches to
be tracked. It is the responsibility of the user to verify that all vessel
branches to be analyzed have been identified correctly by the software.
This verification is more reliable when done on a MIP view.

RELOADING A SAVED TRACKING RESULT SHALL RESTORE THE TRACKING

CENTERLINE IN A SIMILAR STATE AS WHEN IT WAS SAVED.

THE GEOMETRIC TRANSFORMATIONS NECESSARY TO “UNFOLD” THE VESSEL,

OR IN OTHER WORDS, TO TRANSFORM THE THREE DIMENSIONAL
CENTERLINE INTO A STRAIGHT LINE, RESULTS IN A DEGREE OF GEOMETRIC
DISTORTION OF THE ANATOMIC FEATURES DISPLAYED IN THIS VIEW, SO
THAT THE VIEW DOES NOT REPRESENT THE REAL ORIENTATION OR
TRAJECTORY OF THE VESSEL. FOR THESE REASONS, THE LUMEN VIEW
SHOULD BE USED FOR ORIENTATION PURPOSES ONLY, NOT FOR
DIAGNOSTIC PURPOSES. USE THE CORRELATED 2D VIEWS TO VERIFY
FINDINGS.

The software computes measurements, as follows:

MeasurementValue +/- XX mm (mm2, mm3…..). XX is the precision of the
measurement.
We are able to provide an optimal precision XX of the measurement value
(Value +/- XX mm) based on:
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 - Slice thickness: the smaller the slice thickness, the higher the precision.
- Image quality: the smaller the pixel size, the higher the precision.
- The tortuosity and the horizontal orientation of the vessel can have an
impact on the precision.

6. Filming and Saving Images

When filming or saving images for diagnostic purposes, always make sure
the patient name and geometry information is displayed on all views and
match the information on the reference views.
When exporting images using batch filming (Filmer, Printer, Screensave),
check the accuracy and consistency of geometry, FOV, RAS, localization
according to the prescribed parameters (geometry, FOV, RAS, localization).

7. 3D Export
The 3D Export tool is not intended for diagnosis. Do not use the 3D model
preview and exported 3D models for diagnosis, treatment planning or
patient assessment.
Accuracy of the dimensional measurements cannot be assured.

8. Patient confidentiality
Notice
The equipment on which the Volume Viewer application runs includes one or more hard disk drives
which may hold medical data related to patients. Such equipment may in some countries be
subject to regulations concerning the processing of personal data and the free circulation of such
data. It is strongly recommended that access to patient files be protected from all the persons not
in medical attendance.

9. Fused images
CHECK VISUALLY THAT FUSED IMAGES ARE CORRECTLY DISPLAYED FOR
BOTH REFORMATTED AND 3D VIEWS.

WHEN COMPARING PET–CT EXAMS, IT IS STRONGLY RECOMMENDED TO

LOAD BOTH NATIVE STUDIES IN THE DEDICATED PROTOCOL PET–CT
COMPARE.

13
 WHEN IMAGES BELONGING TO DIFFERENT PATIENTS ARE SELECTED AND
LOADED WITH VOLUME VIEWER AND VISUALIZED IN FUSED VIEWS, THE
PATIENT INFORMATION FOR BOTH PATIENTS IS DISPLAYED. THEREFORE, IT IS
THE USER’S RESPONSIBILITY TO CHECK AND VERIFY THAT ONLY IMAGES
THAT BELONG TO A PARTICULAR PATIENT ARE USED FOR MAKING
DIAGNOSIS AND DEFINING TREATMENT FOR THIS PATIENT.

10. AutoBind
STATISTICS PERFORMED ON RESIZED BOUND MR SERIES CREATED BY
AUTOBIND USING SERIES WITH DIFFERENT PIXEL SIZE AND RELOADED IN
VOLUME VIEWER ARE NOT RELEVANT AND MUST NOT BE USED FOR
DIAGNOSIS.

THE AUTOBIND PROTOCOL ALLOWS YOU TO LOAD SERIES SELECTED

INCORRECTLY (E.G. SERIES BELONGING THE SAME SCAN ARE SKIPPED IN
THE SELECTION OR SERIES NOT BELONGING TO THE SAME SCAN ARE
SELECTED AND LOADED), WHICH, IF LOADED AND SAVED WITH THE
APPLICATION, MAY LEAD TO MISDIAGNOSIS. THEREFORE MAKE SURE TO
VISUALLY CHECK AUTOMATICALLY BOUND SERIES BEFORE SAVING.

11. Q.Freeze 2 registration

THIS ALGORITHM USES DEFORMABLE REGISTRATION. IMAGE QUALITY IN
THE CREATED SERIES SHOULD BE CAREFULLY REVIEWED FOR VISUAL AND
QUANTITATIVE ARTIFACTS AND COMPARED TO THE ORIGINAL PET SERIES.

14
Software Safety-Related Messages
Messages giving information and warnings relating to the current system status are displayed on
the screens.

Some of these messages may be related to safety issues. For example, a message may warn that a
screen or printed image will be enlarged or reduced, and this must be taken into consideration
when making a diagnosis. It is important that users take note of and act on the information given in
these messages.

The table below shows safety–related messages which may be displayed. In manuals intended for
use in countries in which the on–screen language is different from the local language, the table
shows the displayed messages and gives a translation in the local language. In manuals intended
for use in countries in which the on–screen language is available in the local language, the table is
not present.

15
Privacy and Security Information
Volume Viewer Application does not encrypt data that are stored locally and externally.

16
Getting Started:
Simple Exam Review in 5 steps
Step 1: Launch the Exam in a 3D Protocol
N° Screen Capture Step Description
1
[AW]
[AW and AW Server]

Select a patient to Review and

Launch a protocol from the 3D
2 Protocols list (1) or from a 3D protocol
shortcut (2).

If needed, select desired series or

phases to be loaded, and press (OK)
1 to validate.

[AW Server]

2 1

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N° Screen Capture Step Description

[Seamless Integration] [Seamless Integration]

Click a patient to Review in order to

launch the corresponding hanging
protocol (1).
If no 3D viewport is displayed, select
the viewport containing the series to
be loaded in Volume Viewer and
select a 3D Protocol from the 3D
Applications list (2).

(e.g. Click on (Reformat))

1
If needed, select desired series to be
loaded, and press (OK) to validate.
2 Note: For more information about
customization of the PACS tools with
3D Applications and creation of
Hanging Protocols containing 3D
Viewport, refer to PACS User Guide.

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Step 2: Page through the images, adjust Window Width/Level, Rotate,
and Zoom
N° Screen Capture Step Description
2 In Volume Viewer:
To page through Axial, Sagittal or
Coronal images, select the
corresponding mouse mode in the
Mouse Modes tools (default mode).
Hold the left Mouse button and move
the mouse up & down.

To rotate oblique and 3D views,

select the corresponding mouse
mode (same as Page). Hold the left
mouse button while moving in the
direction to rotate.

To page, zoom, or pan, select the

corresponding mouse mode in the
Mouse Modes tools. Operate holding
the left mouse button and moving the
mouse.

To use select mode (to isolate or

select viewports, fuse viewports), click
from the Mouse Modes tools.

To adjust the Window Width and

Level, select the corresponding
mouse mode [AW and AW Server
only], or right click the viewport and
select W/L mode.
“Window Width/Window Level”
mouse modes can also be used to
adjust Volume Rendering settings.

19
Step 3: Use MPR and 3D Reformations
N° Screen Capture Step Description
3 To thicken a view:
5
Select the view to thicken and adjust
the thickness slider (2) (see “On View
controls section below) or type a
desired value on the view (3).

Change the rendering mode selecting

from available modes (4).

To work in 3D, set the view type to 3D

(5).

Change the rendering mode by

selecting from available modes (6).

3 2
4

20
Step 4: Make Measurements, Annotate, and Save images
N° Screen Capture Step Description
4
Measure/Annotate
To Make a measurement, select the
appropriate tool:

[AW/AW Server] • Measure Distance

• Report cursor gives the voxel

value
[Seamless Integration]

• Measure ROI gives an average

voxel value inside a Region of
Interest

To Annotate an image, select the tool:

[Seamless Integration]
Select first the Measurements menu

or the Labels menu .

Export
To Save a Batch of images,
select the tool Batch Film

To Save an image,
select the tool .

21
Step 5: Segment Structures
N° Screen Capture Step Description
5 To Segment Structures, select the
AutoSelect tool from Segment Tools.

From the AutoSelect panel,

• Select the button corresponding
to the structure you want to
segment (1)
• Select (Add) or (Remove) (2)

1 If available, select (Auto-Remove

Bone) to remove bones from CTA
exams (from thorax to feet only). This
button is activated by the AutoBoneTM
2
Xpress license.

Click (Transparent Background)

to set the background to transparent
for an optimized review of the
displayed objects.

You can also use other segmentation

tools from the Segmentation tools:

• The Scalpel tool

• The one-click or two-click

vessel tracking tools

3
Click the (Exit) button when the
review is finished (3).

22
Volume Viewer Overview
Protocols Page Description
The Volume Viewer protocols page is displayed every time Volume Viewer [AW] or 3D Viewer [AW
Server and Seamless Integration] shortcut is launched.

2 3 1 8

4
5

6
7

23
N° Protocol Page Description
1 The Protocol title is displayed as well as a subtitle indicating the protocol category.

The Protocol description is displayed when the mouse is over the image.

To Launch a protocol
Single click on the image.

[AW and AW Server only]

To declare a protocol as a “My Protocol”
Click the star.
The protocol appears as a shortcut accessible directly from the Patient List (for AWS,
logout and login again).

Note: To deselect the “My Protocol” preference, click the star again to de-activate it.

[AW only]
To declare a protocol as “One Touch”
Click the hand.
The hand turns grey and the protocol appears as a shortcut directly accessible in the
Patient List each time the current exam selection matches (same modality and/or
acquisition protocol). It is indicated by an arrow in the Patient List.

One Touch Protocols are created to link a post processing protocol to a specific
acquisition protocol or modality. One Touch protocols will appear in the Applications List
of the Patient List each time an exam selection matches the same modality and/or
acquisition criteria as when declaration was done.

2 Anatomical Filter

Select one anatomy tab to access the most relevant protocols for this anatomical
region.

Select (All Anatomy) to display protocols of all anatomy.

3 Category Filter

Filters protocols by:

- Care area: Cardiac, Oncology, Orthopedics, and Vascular…
- Available Applications: Lung Analysis, Vessel Analysis…
- Type: Basic, Fast Reading, Filming

24
N° Protocol Page Description
4 [AW and AW Server only]
“My Protocols” Filter:

Click (Show My Protocols Only) to display protocols only defined as “My Protocols” by
the user.

Click (Show More protocols) to display all protocols.

Anatomy, category, and “My Protocols” filters can be combined to refine a search.

5 Quick Search by Keyword:

Displays protocols from all anatomy that contains keywords in their title, subtitle, or
description.

6 To configure the Protocol Page:

Use (Protocol page layout) to adjust number of protocols displayed by page to 9, 12 or

16.

The order of protocols can also be changed dragging and dropping protocols to the
desired position. Order of the protocols must then be saved using (Save Protocol Order).

7 To configure loading options:

The (Configuration) button is used to toggle on and off High-Resolution at loading.

When the High-Resolution option is selected, images are loaded in full resolution (default
setting) otherwise images are loading in 256X256 resolution.

8 Exits Volume Viewer.

25
Toolbar Description
The Volume Viewer toolbar is displayed every time a Volume Viewer protocol is launched:
1 2 3 9 10 11 12

4 5 6 7 8

N° Button VV Desktop Description

1 [AW only]
Top Level Navigation space.

Click to open the Patient List, which can be opened at the

same time as the Volume Viewer.
From the drop-down list, select (Viewer) to open the 2D Viewer,
which can be opened at the same time as the Volume Viewer,
or click [Filmer] to open the Filmer window.
2 Dynamic Load / mini-patient list [AW & AW Server] allows:
- Loading of additional series on the fly in Volume Viewer
viewport by drag and drop.
- Loading of additional SCPT series in 2D mini-Viewer [AW]
or in Volume Viewer viewport [AW Server]
- Loading of Save State series
For more information, refer to Dynamic Load in Compare &
Correlate section below.

3 The Review Steps window displays layouts and protocols.

Any of these layouts or protocols can then be launched by
clicking on them.
The default set of Protocols should provide single click access to
the most frequently needed processing tasks. For example,
REFORMAT protocol contains following steps:
• Click (Reformat) to see a display reconstruction in 3
orthogonal planes and in oblique thin slices
• Click (3D MIP) to display a 3D MIP reconstruction
• Click (Volume Rendering) to display a Volume Rendering
26
N° Button VV Desktop Description
• Click (Curved Reformat) to automatically open the Trace
panel that guides you through the creation of a curved
reformation and switches the upper left viewport to
Curved type
• Click (Multi Oblique) to move to an optimized layout for
oblique prescription. Adjust the axis to set oblique
planes.
• Click (MPVR 3 mm Average) to automatically switch all
views to slabs of 3mm. Slab thickness of all views can be
modified simultaneously by using the thickness slider
from the MPR/3D tool while the Apply to all option is
selected.
• Click (Segment Structures) to open the AutoSelect tool
and change the layout.
Re-ordering the review steps can be done via drag and drop.
Press to save the new steps order.

Additional Layouts and protocols are available when clicking on

the Protocol List button .

Configuration of the Review steps list is available in the Review

Manager section under Layout and Review options .

4 The Mouse Modes provide the ability to change the function of the Left Mouse Button to
perform basic image manipulation:

Image Controls can also be adjusted via right-click (see section “Contextual Menu” below).

Page through slices/Rotate Volume *

Zoom *

Select a Viewport

Deposit measurement (automatic when selecting a tool)

Adjust Window Width and Level *

27
N° Button VV Desktop Description
Adjust fusion % on fused viewports
Available only if layout contains a fused viewport
Pan/Roam *

Magnifying glass
* Seamless Integration: modes available from the PACS tools only. W/L is only accessible via
the right click menu.
5 The Visualization tools provide the ability to interact with the display of the images.

The Image Orientation buttons are used to change the planes of 3D or

Oblique reformatted images.
[L] = Left
[A] = Anterior
[I] = Inferior
[P] = Posterior
[S] = Superior
[R] = Right
Link / Unlink
When comparing several exams or series, volumes are automatically linked
by the cursor location and are synchronized (or registered) as you scroll
through the images.
The Link/Unlink tool is used to manually adjust this registration by unlinking
volumes at series* or exam* level, changing the cursor location, and re-
linking.

indicates that all volumes are “linked”

indicates that all volumes are NOT “linked”

This tool is activated only when multiple volumes are loaded.

* see Global Preferences section below to know more about unlinking at
series level or at exam level (default).

• The Simple Oblique Mode button displays a line cursor in Reformatted

views that is used to define a new plane. Set the function of one viewport
to Oblique. Make another viewport primary and then click on the Simple
Oblique Mode button. A solid yellow line appears which represents the
28
N° Button VV Desktop Description
plane of the Oblique reformat. This line can be tilted to display the desired
anatomy: place the cursor on the solid yellow line, hold on the left mouse
button and drag to tilt the yellow line to display the desired plane.
• The Multi Oblique Mode button displays three oblique planes defined by
three adjustable color axes (orange, green, blue). Adjust any axis to
update the two other oblique planes. De-activating the Multiple Oblique
mode (click again on the button) will keep the orientations defined in
oblique viewports.
Enlarge
Click to view an image full screen and then click again to restore the initial
display.
When mouse mode is set to Page/Rotate, Zoom or Pan, it is also possible to
double click on a view to enlarge it.

Trace
This tool offers a guide to create a Curved reformation, a Profile, or an X-
Section.
If no Curved, Profile or X-section viewport is available in the layout, select a
viewport and click (Apply) to change it.
Holding the <Shift> key, click to add points in order to create a trace along a
structure of interest.
You can move the trace and navigate in parallel curved views using the
arrow buttons.
Cine
Allows the user to automatically page through all the slices of a single phase
series or control a 4D Cine of multiphase series.
Rotate / Translate
To rotate and translate an image from a specific angle and set degrees of
rotation.
In the Rotate tab, click in the center of the sphere to switch to an Anterior
view.
Use the Tumble mode to oscillate around the displayed angle.
MPR/3D
Guides the user through the creation of MPR and 3D views.
Adjustment of slab thickness to all viewports simultaneously is possible from
this panel as well as a selection of rendering modes such as MIP, Average,
MinIP, and Volume Rendering.

The Integrated Registration button is activated by a license and provides

tools for registration of multiple modalities.
Refer to the Integrated Registration User Guide for more information.
29
N° Button VV Desktop Description
The VR Tools will appear in Visualization tools when using a VR protocol or if
a VR image is loaded to one of the viewports.
Autofit – To change the structures opacity to the opacity of the cursor value.
Simply place the cursor on the structure of interest and press (Autofit) or <A>
key to display it. Continue adjusting the opacity with middle mouse button.
VR Presets – Gives access to a database of preset Volume Rendering
protocols. Select an anatomical region and the protocols associated with
that anatomy will appear. Click the preset button to apply the preset to the
selected viewport.

Advanced VR Settings – Allows you to change a structure’s opacity based on

an interactive histogram.
To see through an object, click and drag the upper cursor (a) up/down.

− To decrease background noise, increase the value of the lower threshold

(b)
− To increase visualization of soft tissue structures, decrease the value of
the lower threshold (b)
CTA studies typically use the “ramp up” option. With this ramp, values
below the lower cursor value (b) are rendered translucent. Depending on
where they fall along the ramp, values will have a different degree of opacity.
Values at or above the higher cursor value (a) are rendered at the degree of
opacity set (100% in the example above).

See “Volume Viewer – part 2” for more details about advanced VR settings.
Multi Objects – When several VR objects are merged in a viewport (drag &
drop, “Bone Transparency” with AutoBone), use this tool to adjust the
transparency of each object.

30
N° Button VV Desktop Description

The Navigator Tools will appear when using a Navigator protocol or if a

Navigator image is loaded to one of the viewports.
Fly Through displays a panel to:
- Optimize display position
- Fly though structures
- Record a navigator cine movie

See “Volume Viewer – part 2” for more details about Navigator settings.

Use the Navg Settings tool to adjust the navigator rendering mode
(surface/VR, vessel/airways, etc.).

Set Color
Select a Color Map or a Custom Color to apply it to all non-VR viewports.
Maps such as Inverse Gray for inverting gray levels, RainbowFunc for MRI
ADC maps, and Hot Iron for PET images are available.

31
 6 The Measure/Annotate tools allow to perform measurements and annotate the images.

Distance Measurement

Straight Distance
Click on the image to deposit the first and last points or click to deposit the
first point and drag and drop the last point.
- When endpoints are deposited on the same plane on a 2D image or
on a 3D image, the distance measurement is set as (2D).
- When endpoints are deposited at different depths on a 2D image, the
distance measurement is set as (3D).
Curved Distance
Deposit multiple points on the image with left click and validate the curved
line with right click.
2D Regions Of Interest
2D ROI types are Elliptical, Free Hand and Rectangular.
Click to deposit 2D ROI with predefined values (see Global Preferences) or
drag and drop diameter, then adjust size by dragging ROI corner, using shift
key to force to circle or square (Ellipse and rectangle ROIs).

Statistics are displayed for average, minimum and maximum voxel values,
Standard Deviation, relative Standard Deviation and Area (mm2) within the
ROI.
Right click the 2D ROI to select statistics to be displayed in the viewport from
the Statistics menu.
Note: Only 2D elliptical ROIs can be deposited on SCPT (statistics are not
available).
Arrow Tool – Click the Arrow Tool button to deposit an arrow on the screen.
Grab the end of the arrow to resize and rotate it. Grab anywhere on the
arrow to move it.
When depositing an arrow on a 3D viewport, the arrow will appear as well on
all the corresponding 2D viewports.

ANNOTATIONS

Select the Annotate button to deposit an annotation on a viewport.

Click (Preset Annotations) to deposit or create preset annotations (text

annotation or measurement with a predefined label).

Click (Linked Annotation) to deposit an annotation linked to a structure of

32
 interest.

Report Cursor
Click the Report Cursor button to deposit a point on the viewports to display
a RAS coordinate and the voxel value for the current cursor position.
3D Region Of Interest

3D ROI types are Auto-contour, Spherical and Parallelepiped.

Right click the 3D ROI and select statistics to be displayed in the viewport
from the Statistics menu.

Displays statistics for average, minimum and maximum voxel values,

Standard Deviation, relative Standard Deviation and Volume (mm3) within the
ROI.

3D ROIs have the ability to colorize voxels inside the ROI based on
ranges of voxel value. Right click the 3D ROI and select (Activate
color coded display) to activate this feature.
The ranges can be updated on the fly directly from the color range
on the viewport (right click) and can be saved as user presets.
Statistics from sub-volumes defined by color ranges can be
displayed as well in the Summary Table as additional statistics.
See “Volume Viewer – part 2” for more details about 3D Color ROIs.
Volume Measurement
After an object of interest has been segmented, the volume of this object can
be assessed by clicking the Volume Measurement tool and then by clicking
on the segmented object in the viewport.
Angle Measurement
Click on the image to deposit three points.
When depositing an angle on a 3D viewport, the end points will appear as
well on all the corresponding 2D viewports.

Note: Angle measurement can be deposited on SCPT.

33
 The Export tools allow to perform saving of outputs and work.

Batch Film
Creates Rotation, Loop or Oblique batch images based on user prescriptions.
Options: “Hide annotations on saved SCPT images”, “Do not flip oblique images
when exporting batch”, Force orientation to axial, coronal, sagittal or keep
automatic orientation.

Save State
Saves the current status of Volume Viewer (3D Model, displays, ROIs, etc.) as
an additional series of the exam.
[AW only] A One-Touch protocol entitled “Save State” will appear in the
Application field providing the ability to restore the Volume Viewer State.

Save Image
Select tool, then click the viewport to save the image.
The default save format is a Screen capture. Refer to Global Preference
section in order to adjust preferences for Save Image.

Quick Export
Exports in a single click a batch of rotations of a 3D view or a full batch of
contiguous 2D images at the displayed thickness.

Summary Table
Click to open the Summary Table and display collected measurement
performed during the review.
See Summary Table section below for more information.

QTVR [AW and AW Server only]

Saves multiple projections of a volume rendering as a QuickTimeTM movie in
the Filmer.
This QuickTimeTM movie can be exported to CD-Rom [AW only], a local web
server [AW only], an ftp server [AW only], or a USB key.
The movie can be loaded in any computer to be freely rotated and zoomed
(installation of QuickTimeTM player is necessary to view/manipulate
QuickTimeTM movies).

34
 Movie
Creates a comprehensive movie including different rotations, zoom, and pan
of the volume.

See “Volume Viewer – part 2” for more details about the Movie tool.
Save/Recall
Opens the clipboard where segmented objects were sent and stored
temporarily within a current Volume Viewer session via right click menu.

Note: To save volumes permanently use “Save State”.

3D Export
Note: The 3D Export tool is not intended for diagnosis.

Allows to export 3D models to an external file, that can be used for 3D Printing.

Click the viewport containing volume(s) to launch the 3D export preview.

Click on the drop-down to select the file format. Adjust each object’s
rendering.

35
8 Segmentation Tools

Auto Select
This is the most frequently used tool for CTA and MRA studies.
Select the appropriate tool for the region to segment.
Use the Small Vessels segmentation tool to segment vessels under
5mm.

Use the Any Structure segmentation tool to segment vessels above

5mm or other structures such as soft tissue.

Use the Bones segmentation tool to selectively segment Bones in a

CT dataset.

If available, use Auto-Remove Bones for a CTA dataset (requires AutoBone

license).
To segment vessels, you can single click the vessel of interest that will be
automatically grown. For more precise segmentation, press the left mouse
button until the section of interest of the vessel is filled.
For structures other than vessels, press the left mouse button until the pointed
structure is filled.
Use the Pick from VR segmentation tool to segment any visible and
isolated structure in a Volume rendering in a single click.

Scalpel
Draw a structure to cut holding the left mouse button, then select if you want
to cut inside or outside the contours.
It is also possible to Double click in the view to apply an inside cut. Depth of
the cut can be adjusted from the panel.
Quick Vessel Trace
Allow vessel tracking in one click and two clicks. Length measurement can be
performed on the lumen viewports.

If a VesselIQTM Xpress license is available (CT, MR, or XA), the Quick Vessel Trace
tool becomes quick AVA, allowing additional vessel measurements such as

36
 auto-diameter and stenosis.
Refer to the corresponding “Vessel IQ Xpress” user guide (CT, MR, or XA) for
more information.

Paint on slices
Draw contours of the structure of interest on different slices of same plane.
The volume to keep will be interpolated based of the defined contours.
Select (Apply) to apply segmentation on the current viewport or (Convert to
ROI) to create a 3D ROI and get statistics (max diameter, volume, average
value, etc.)
See “Volume Viewer – part 2” for more details about the Paint on Slices tool.
Quick Paint
Paint a structure of interest in all planes to segment with the adjustable brush
and press (Apply) to keep only the painted structure.

Remove Objects
Allows you to Remove or Keep isolated objects as well as display removed
structures.

Threshold
Threshold the image keeping only voxels within a specified value range.
- Set the range of voxels to keep, using manual adjustment or
predefined “Air” and “Bone” thresholds for CT
- Click on (Apply Threshold) to segment the volume
- Segmentation can be refined as follows:
o Select (Remove Object) and click the structure to remove. All
voxels connected to the selected structure will be removed.
o Select (Keep Object) and click on structure of interest in order to
keep it. All structures that are not connected will be removed.
Advanced Processing - Consolidates many processes: dilate, erode, filters,
subtraction methods, close gaps/open bridges, close holds, and extract
surface.
See “Volume Viewer – part 2” for more details about advanced processing.
9 Layout and Review options
- Save Layout: save layout or protocol in given anatomies
- Split layout: change screen split and customize screen display
- Review Manager: build review scenario and review steps list
See “Volume Viewer – part 2” for more details on layout creation.

37
10
Global Preferences provides a unique access point to customize the
preferences in Volume Viewer. Check Global Preferences section below for
more information about customization parameters.
- Loading (bind/split CT multiphase overlapped series)
- Display (define W/L presets linked to F keys in Volume Viewer)
- Viewports (cursor shape, paging mode, ruler style, etc.)
- Annotations (viewport annotations)
- Toolbar (toolbar customization, rick click tools access customization)
- Tools (ROI clone preference, ROI default size, tools behavior)
- Export (save options, output formats, default printer [AW and AW
Server only])
11 Click the question mark to see the version number and/or launch
documentation – Reference User Guides.

12 Exit – Click to Exit Volume Viewer. It is recommended to exit the application

each time a case is finished being reviewed. On Exit, users can launch End
Review [AW only] and Auto Save State actions.

38
Floating & docked panels
Many tools from the toolbar are opening panels where corresponding parameters can be set up on
the fly. These panels can be docked on left or right side, but also floating by drag and drop.

When floating, these panels can be minimized without being closed by clicking icon or by
pressing Space bar on the keyboard.

“Rotate/Translate”, “VR Basic settings” and “Multi-Objects” (VR) can be detached and remain opened
simultaneously with other tools by pressing icon.

Specific panels opened with applications protocols are called Wizard and can be only docked on left
or right side (only on left screen, in case of dual screen configuration [AW and AW Server]).

39
On View Controls
On View Controls appear when the mouse is over a viewport.

No Controls Description
1
Paging and thickening
a a = Click and drag either side buttons to change the
thickness of the MIP image.
b b = Click and drag the slider to page through the image
set. To page you can also press the <Ctrl> key while
a moving the mouse up and down without clicking any
mouse buttons.

Press the icon in order to scroll paging in all slices

(off by default).

2
Bookmark scrolling
Click to scroll to the next/previous measurement.
For more details about ROI and report cursor, see
“Volume Viewer Desktop” section above.

40
Active Annotations on the Image
Some specific annotations are adjustable in the viewport. Active Numerical values can be adjusted
with left/right click to decrease/increase value while other active annotations can be modified
selecting options from drop down lists.
5

1 8
2
3
4
2

5 5

7 5

N° Annotation Description
1
Plane or View type: Click and select from the drop-down menu to change
the plane or select a 3D model.

41
 2 Image Location: Press the middle mouse button and drag horizontally to scroll through the
2D images or left-click to increment and right-click to decrement one image at a time.

3 DFOV: Press the middle mouse button and drag horizontally to magnify the image in real-
time or left-click to increment and right-click to decrement the magnification factor. It is
possible also to type in the desired DFOV value while the mouse is over the DFOV active
annotation.

4 Image Filter [CT only]:

Smooth 1 to 3, Edge 1 to 3 and Lung filters are 2D display filters and are available only on
Axial, Sagittal, Coronal and Oblique viewports.
Smooth 3D Plus is a 3D anisotropic filter which smoothies the whole volume. It can be applied
on any 2D or 3D viewport.
Important: The filter effect is purely visual and any statistics performed on a filtered image
will be performed on original volumes (non-filtered).
Note: CT Filters can be applied on thick slabs only when rendering is set to “Average”.
Note: These CT display filters can be combined with Cardiac filters when in Cardiac
Applications.

5 Image Roam: Press the left mouse button and move the image within the viewport.

6 Slice Thickness: Middle-click and drag horizontally to change the slice thickness in real-time
or left click to increment and right-click to decrement the slice thickness (2D images) or type
in the desired thickness value while mouse cursor is over the Slice thickness active
annotation. Thickening a 2D viewport will create a 2D MPR viewport where rendering can be
set to average, MIP, Min IP or VR next to the slice thickness.

7 Window width and level: Press the middle mouse button and drag horizontally to change the
W/L in real-time or left click to increment and right-click to decrement the W/L or type in the
desired value when mouse cursor is over the W/L active annotation.
Left click to select a predefined WW/WL setting.

8 Patient name: Click and select from the menu to show or hide the patient name.

9 Acquisition parameters: modality parameters used for acquisition are displayed only once
per monitor on the viewport displaying the acquisition plane (see Global Preferences /
Annotations).

42
Contextual Menu
Right click on a view to display the contextual menu. The menu will differ according to the type of
viewport. Corresponding keyboard shortcuts, if applicable, are indicated (see Keyboard shortcuts
section below).

N° Category Tools
1
The top line of the Contextual Menu displays six favorite
tools. These tools are specific to the application launched
Configurable Viewport Toolbar (Volume Viewer, VesselIQ, …).

See Global Preferences section to configure this top line.

2 Save Save Image – Saves the image to local database

Save Image As – Saves the images to local database,

asking for a series name

Save All Images – Saves each viewport from the screen

to local database

Save Screen (SCPT) – Saves whole screen into 1 screen

capture to local database

3 Send To Report [AW only] Requires Reporting tool license

Send image to Report – send screen capture of the
current viewport to the reporting tab
Send screen to Report – send screen capture of the
entire screen (without the toolbar) to the reporting tab

4 Display Properties Hide 3D cursor - To remove the 3D cursor from the

screen. Toggles back with Show 3D cursor.

43
N° Category Tools
Show Cross-References – To display current plane on
other series viewports from same exam. Select (Show all
planes) or (Show only current plane).
Reference Image -To display a small reference image
showing the plane orientation and position of the current
image.
Center on Cursor - To center the image on the cursor.

Additional items on 3D and 2D magnified viewports

Lock Orientation - Locks image orientation (3D and 2D

oblique only). It is not possible to change the orientation
with the mouse in the locked view.

Center on FOV - To center the image on the FOV.

Center on Object - To center the image on an object

(very useful after segmentation).

5
Annotations No Annotation - To hide all annotations including the
right and left markers.

Partial Annotation - To hide or show part of the image

annotations (scan parameters).

Full Annotation – When full annotations are not shown,

then there will be an option to select full annotations in
order to show all annotations.

Custom Annotation - To show the annotations which

have been checked in the Annotation tab of the Display
options Panel.

User Graphics – To show only user graphics including

measurements and annotations.

6
Trace Clear Last point – deletes the last point deposited

Clear trace – deletes all points

Lock cursor to trace – use this option to lock the 3D

cursor on the trace. When using the <Shift> key to move
3D cursor, it will move along the trace on all views.

44
N° Category Tools
7 Mouse Modes Left Mouse Button Modes – Sets the action of the left
mouse button. Active mode is highlighted.

8 Enlarge/Reset Size Enlarges the active viewport (same as Enlarge viewport

from Visualization tools) on full screen. Click again to
reset screen size.

9 Reset Pointer To send the 3D cursor back to the center of the volume.
Use this tool when you have blank viewports.

10 Restore Volume Displays the initial volume (before segmentation).

11 Convert to ROI Converts the segmented volume into a 3D ROI.
12 Viewports specific All viewports

Enlarge – Refer to item #8.

Reset Pointer – Refer to item #9.

Contextual menu in Navigator views

Light/contrast – Opens the Navigator settings panel (see

Part 2 – “Advanced VR Settings” for more information).
Turn around – makes a U-turn in the navigator view.
Look at – locks the navigator direction to always “look”
toward the 3D cursor.
Start Synchronized Navigations – displays real time
synchronization between the Navigator view and 2D
perpendicular oblique views (3 views will switch
automatically to Oblique when this mode is enabled).

Contextual menu in Lumen viewports

Clip to width – If a 3D viewport is defined, shows the 3D

voxels along the trace and within the width defined on
the lumen viewport.

Contextual menu in 3D and VR viewports

Save Volume - Saves segmented volume and stores it in

a temporary clipboard accessible via Save/Recall tool
from Export tools.

Contextual menu in Fused viewports

Blend Modes – set the fusion mode. See “Fusion modes”

section in “PET in Volume Viewer” below.

45
Summary Table
The summary table is a standard Volume Viewer feature which automatically captures
measurements as they are made during a VV session. The summary table is optimized in advanced
applications to provide a user friendly display of the statistics. Statistics can be compared over time
to a reference date, which can be easily modified and will display the percentage of change on
comparison measurements.
If OncoQuantTM license is available, the advanced parameters can be set in Morphological Criterion
mode which can be used with RECIST and WHO from any Volume Viewer standard protocol.

The summary table can be opened and “docked” or “expanded” as a floating panel.

General Description
Docked Summary Table
2

4 5

46
Item Description

EXPAND SUMMARY TABLE

1 Click this icon or drag and drop the title bar to expand the Summary Table in a floating
window and display more dates. In docked mode, only 1 date can be displayed at a time.

CHANGE DISPLAY MONITOR (2 screens only)

When a 2 screens configuration [AW and AW Server], the Summary Table can be displayed
2
either on the left or right screen.
Location is saved from one session to another.

DATES IN COLUMNS
Only 1 date can be displayed in docked mode. If measurements have been performed on
3 more than 1 date, click the left/right arrow to navigate forward or backward, or right click the
date to choose another one to display from drop-down list. If you need to display more than
1 date, switch to expanded mode.

FINDINGS IN ROWS
Every finding (lesion, abnormality…) can be measured with multiple tools (distance, ROI….)
4 Thus, every measurement made on the viewport is associated to a finding (automatically or
manually) and a single finding can have multiple measurements.
In docked mode, only the finding ID (automatically set) is displayed. Click the arrow on top of
ID column to list based on ascending or descending ID.

MEASUREMENTS (cell description)

For each compatible measurement performed on a viewport (arrow, report cursor, 2D ROI, 3D
ROI, distance, angle, AutoContour), the measurement cell displays:
• The volume on which it was performed (*)
• The measurement name/label
• The statistics computed on the measurement (selectable)
• Hyperlink: click in the cell to display the corresponding image in viewport. If the volume
5 on which measurement is not displayed in any viewport, an error message is displayed
in the status bar (see item 6).
Right click on the statistics area to:
• Select which statistics to display
• Delete current measurement
(*) volume number might be different when reloading Save Sate from one exam to the other
when new exams are present.

COMMENTS
6 User free comment can be entered and saved for each exam.
When reloading Save State series, free comment is restored but is not editable.

47
Item Description

STATUS BAR
If issues are raised when using the Summary Table, all messages to user are displayed in the
status bar, from simple warning to error message.
7 In docked mode, the entire message might be cut off. Hover the mouse over the status bar to
read the complete message.
Messages are displayed temporarily in Status Bar. To review history of major messages,
simply click on the arrow icon on the status bar in bottom left of Summary Table.

Expanded Summary Table

6 5 4 3 2 1

48
Item Description

MINIMIZE
1
Click to switch to docked mode.

EXPORT IMAGES
• Save images either locally as DICOM SCPT, or to the Filmer [AW and AW Server only]:
o Summary Table only: a simplified screen capture of the Summary Table
o Measures only: The flagged images only (click the icon to flag/unflag it)
o Summary Table and measures (requires OncoQuant license): a mini-report
containing the numeric values of the measurements and the associated image
(with the plane, FOV and W/L set during measurement deposition). For a better
readability, the number of dates is set to 4 dates in the mini-report when more
than 4 dates are displayed in the table. The 4 dates include at least Baseline,
Nadir, Prior and Current exams. This option is not available by default in standard
Volume Viewer protocols. Activate advanced mode from Options icon, then switch
back to simple mode.
Note: When reviewing screen shots of Summary Table, keep in mind that the volume number
might be different when reloading Save Sate from one exam to the other.

COPY TO CLIPBOARD [AW Server only]

Click to copy the displayed content of the Summary Table to the Windows clipboard. It
can then be pasted in any compatible software (such as Microsoft Office, OpenOffice, …).
2 Note: This feature might not be available in all advanced Volume Viewer applications.

EXPORT TO CSV (requires OncoQuant license)

Export all the measurements statistics as a CSV file on a USB key or on a local directory
[AW Server only]. CSV files can be imported in Excel or OpenOffice for advanced data
analysis.

EXPORT FOR REPORTING [Seamless Integration only] (requires OncoQuant license)

If a compatible RIS or another compatible reporting system is connected and configured:
Exports the measurements in a structured XML file to the PACS platform which will push
the data to the compatible RIS or reporting system. Once the export is done, the button
becomes inactive. If a significant change is performed (see OncoQuant User Guide -
“Important notes on Advanced Mode” section), the Export for Reporting button becomes
active again allowing you to send updated values to the compatible RIS or compatible
reporting system.

SAVE STATE
Opens the Save State panel to save the work of current review.
For specific oncology follow up workflow, refer to the OncoQuant User Guide.

49
Item Description

OPTIONS
• Switch between simple and advanced modes (requires the OncoQuant license)
In simple mode, any measurement can be deposited and compared over time. It is not
possible to compute sum of statistics, nor flagging lesions as target/non-target lesions.
To enable these functionalities, select (Show morphological tools). To disable these
functionalities, select (Hide Morphological tool).
• Sort Findings
Sort findings by ID, location, Target type (Advanced Mode only) or Anatomy (Advanced
Mode only). Sorting can be performed ascending or descending order.
• Display options
3
o Show/hide RAS coordinates and/or series number/slice location.
o Show/hide relative comparison (%) and/or absolute comparison (multiple dates
only)
o Dates: Show/hide specific dates when multiple dates are displayed in Summary
Table columns.
o Volumes: Show/hide specific modality when measurements have been
performed on multiple modalities (e.g. show only measurements performed on
MR series).
• Flag / Unflag measurement images
Set all measurements images as flagged or non-flagged (see item 3 above, “Export Images”, “Measures
Only”).

DATES & REFERENCE EXAM

Each date is displayed in a column.
One date can be set as a reference for comparison with other dates for all similar
measurements performed by having a flag icon displayed on top of this date.
4 To change the reference date, drag & drop the flag icon over the selected date or click the
arrow icon below the any date and select (Set as Reference).
Comparison of all statistics for linked measurements will be computed as percentage change
and/or as absolute change of the values to the reference date, but only for dates posterior to
this reference date.

50
Item Description

MEASUREMENTS
Measurements of the same kind can be linked over time in a single finding. In this case, they
will display the same statistics and will be aligned on the same row and highlighted.
When 2 similar measurements of a finding are performed on different dates within a sphere
of 10mm (based on their RAS coordinates), they will be automatically linked to the same
finding, and thus displayed on same line and highlighted.
If a measurement is not linked because of registration issue, simply drag and drop it over the
5 corresponding measurement line in the expanded Summary Table to link it and display
comparison statistics over time (absolute and/or relative).
Drag and drop allow you to:
• Link measurement to a similar measurement in another finding

• Unlink a linked measurement in a new finding

Compatible measurements and actions are highlighted during drag and drop action.

FINDING NAME
6 The finding name can be modified manually directly in the expanded Summary Table (press
(Enter) to validate modification).

51
Global Preferences
Global Preferences allows you to set preferences for Volume Viewer applications from a single
location. Click and select preferences category to be set.

Preference panel will be displayed at the corresponding preference category (Viewports,

Annotations, Toolbar, Tools, Export, Integrated Registration and other VV applications).

Loading [CT only]

When loading multiple CT series containing multiple acquisition volumes (multi-phase, multi-
acquisition sequences…), it is possible to bind several volumes based on the overlap. Check the box
and set up the maximum overlap allowed to automatically bind phases into a single volume at
loading.

Note: If there is a gap between 2 volumes, an interpolation will be performed when loading these
volumes.

52
Display

Set WW/WL presets linked to <F5> to <F10> keys in Volume Viewer.

Presets: select modality to display presets values (CT, MR, PET, NM, XACT).

Enter values or press to capture current W/L from selected viewport.

Click [Apply] to apply modification(s).

Click [Reset] to reset presets to factory values for selected modality.

Note: If a viewport containing one or more volumes is selected and the function keys <F5-F10> are
used, then the WW/WL will be adjusted in every viewport where the first volume is displayed,
including fused viewports.

Note: For PET presets, min and max will be applied with the current displayed SUV unit. To display
the min and max with another SUV unit, change the unit first (refer to the SUV section in the PET in
Volume Viewer chapter), then apply the min/max preset with <F5-F10> key.

53
Viewports

Cursor: set the cursor type used by default (Crosshair, arrow, dot, full cross, triangulation Cursor*).
* [Seamless integration]

Trace type: set the trace type used by default (Polygon, Smooth trace or free hand).

Paging mode: Page through all individual slices, whatever the slice thickness (Continuous), or page
through slabs (Contiguous, default mode).

FOV: Sets the “steps” when adjusting FOV with left/right mouse buttons. E.g. when setting 130mm,
an original DFOV of 37.5 cm will decrease will left click to 26 cm, then 13 cm, then 6.5 cm…

Default % Fusion: sets the default fusion % when creating fused views via drag and drop.

Reference image: display/hide a reference image in the viewports corner.

Link pan/zoom for like views: if activated, pan and zoom all the viewports with same plane
displayed (Axial, Coronal, Sagittal and Oblique views).

54
Do not flip images [Volume Viewer only]:
If checked (default mode), force oblique planes orientation to the closest standard point of view
(inferior, anterior or right) and can lead to automatic image flip.
If unchecked, oblique planes orientation are free and can lead to image rotation (always check
orientation annotations).

Link/Unlink: When multiple exams are loaded, unlink the views will apply to exams (i.e. series from
the same exam will remain linked) or to series (i.e. each series will be unlinked from other series).

Ruler Style: Display/hide a ruler for distance references on viewports.

Table Removal: If activated, automatically removes table from CT images on 3D VR and 3D MIP
viewports.

55
Annotations

Annotations: Customize the annotations level in the default viewports with None, Full, Partial, User
graphics (measurements and annotations only) or Custom.

Optimization of Acq Parameter: (only if “Full” or “Custom”, with Acq Parameters checked, are set). If
activated, displays the details of acquisition parameters only on 1 viewport per screen. If not
activated, details of acquisition parameters will be displayed on all viewports.

Font: Set the font size displayed on viewports globally (Global Annotation) or by type of annotations
(Custom). This preference is only for display in Volume Viewer. When sending images to the Filmer
via F1 or F2 [AW and AW Server] the font will not be the same in the Filmer.

56
Toolbar

57
Customize the right click menu:
6 tools can be accessed via the right click menu for each application (Volume Viewer, VesselIQ...).
Drag and drop the tools to be accessed from the right click menu.

Customize the main toolbar:

• Select the tools to be displayed for each category by checking them. Icon size in the toolbar can
be adjusted and description text of tools categories can be displayed or not.
OR
• Drag and drop the tools directly from the toolbar to remove them or insert them in the toolbar.

Display name category:

Displays/Hides the name of the toolbar category. By default, the toolbar category is displayed.

Display ON Display OFF

58
Tools

Region of Interest:
• Auto-clone level when depositing a ROI (current volume, all series of all exams, all
phases of current series of all series of current exams).
• Default ROI size when deposited in 1 click.
Shape of Measurement Report Cursor:
Set the measurement report cursor type used by default.
Float Stats attached to ROI:
• Checked: ROI statistics will be floating next to the measurement on the viewport.
• Unchecked: ROI statistics will be displayed in bottom right of the viewport. Number of
ROI statistics lines displayed can be adjusted (1 to 3).
Keep the tool active:
• Unchecked: tool is not active after deposition. To deposit again the same type of
measurement, user has to select again the tool.
• Checked: tool is still active after deposition (the mouse mode is still in deposition
mode) until user selects another tool or another mouse mode or close the tool.

59
Export

Ask for description: if checked, displays a popup message to ask for description for saved image
(i.e. “Save as…”). If unchecked, will use the default description set in Current Description.

Format:
• Color: saves non-VR images in Color SCPT. Due to DICOM format restrictions, Window Level
and Width of color SCPT images cannot be modified. It is then recommended to unselect this
option to be able to perform windowing adjustments when reading saved images in PACS or
other DICOM viewers.
• Color (VR images): saves VR images in Color SCPT.
• Hide Cursor on Copies: Saves images with cursor hidden.
• Key Image Note: when checked, all saved images are referenced into a single Key Image
series (DICOM standard) when exiting Volume Viewer. This Key Image series can be opened
in the Viewer or any compatible PACS or other workstation (all referenced images must be
pushed on a remote host).
• Save State: saves the current status of Volume Viewer (3D Model, displays, ROIs…) at the
same time as saving the image. This Saved State can be used later on to restore the Volume
Viewer State.
• Force Saving Square Images: When sending rectangular viewport, adjusts the image in a
square format (no resize but adding space around image). This option is mainly used for
PACS or other DICOM systems not supporting rectangle images.
• High Definition: Saves the image in high resolution.

60
Save as Reformatted or PJN: Images saved under these formats contain geometrical information
so that they can be reloaded in 3D software and freely windowed.

Check Save as Reformatted or PJN to save images in this format every time it is possible. Images
saved under these formats contain geometrical information so that they can be reloaded in 3D
software and freely windowed. Click the link [when possible] to display the list of image types that
can be saved as Reformatted and PJN according to DICOM requirements.

Uncheck the option Save as Reformatted or PJN to benefit from Color and Save State capabilities
every time you save an image.

Color and Save State options are not compatible with Reformatted DICOM format. These settings
cannot apply to images which were saved as Reformatted.

The following viewports will be automatically saved in color (i.e. no W/L possible) whatever the
export preferences:
- viewports with color map applied
- viewports with color ROI deposited
- viewports containing XA, NM, Fused or color SCPT images

61
General Review

This preference tab is available only from the protocol “VV General Review” (or “Oncology Review”
which requires the OncoQuant license).

Pairing series:
Pairing of the loaded series between exams which display on the viewports is done automatically
for the VV General Review protocol.
General pairing is based on series that have the same flags for contrast, image types and image
orientations.
Specific pairing rules options can be found for CT, MR and PET modalities.
Uncheck an option if you don’t want that criteria to be used for finding the matching pairs of series
from other exams.

Example: if you want to review (side by side) 3 CT series from different exams that match in slice
thickness, image orientation but maybe 1 of them does not have contrast, then uncheck contrast
option to make them all pair up for the review. Click Apply button to update the viewports display.

Display order:
Select from the drop down the date order for review of your current and prior studies in VV General
Review (from oldest to current or from current to oldest).

Refer to “Compare & Correlate” section below for more information about how to use “VV General
Review” protocol.

62
Integrated Registration

(requires the Integration Registration license)

Refer to Integrated Registration User Guide for more information on Integrated Registration
preference parameters.

63
Compare and Correlate
Using VV General Review
VV General Review is a standard protocol designed to create a simple PACS-like layout and with a
built in smart design finding “like” series between different exams to layout side by side for
comparison/correlation. This protocol is for use with all modalities.

what Description

The number of volumes

3 Volumes loaded will determine the
default layout.

If you load 3 volumes,

then the layout will
contain a total of 3
viewports.
Loading:
…4 volumes, 4 viewports,
…5 volumes, 5 viewports,
etc., up to 8 total
viewports on AW
workstation.

If more than 8 volumes

Drop-down are loaded, the additional
series list volumes are also loaded
and available to view
from the red drop down
menu on the viewports.

If multiphase data is
loaded, then an additional
drop down list will exist
for phase selection.

1-monitor configuration:
When screen size is
1280x1024 or less, the
max number of viewports
will be 4 but the same
general philosophy
applies.

64
 Intelligent Layout
a This protocol has a built-in
intelligence whereby it
searches volumes to be
loaded and tries to lay
them out on the viewports
according to “like” series.

Depending on the
modality, different rules
will apply:
For example:
(a) CT series in the same
acquisition plane,
reconstruction filter, slice
thickness, etc. will display
side by side on the views.
MR in the same
acquisition plane,
reconstruction filter, IV
contrast information, etc.
will display side by side on
the views.
All volumes will load in the
Axial plane for quick
review but all other 3D
MIP, VR, and multi-planar
reformats will always be
available from the red
annotations on the
viewports.

Pairing of the loaded

series is done
automatically for the VV
General Review protocol.
Adjust the Preferences to
customize your pairing
needs. General pairing is
based on series that have
the same flags for
contrast, image type, and
image orientation.
Specific paring rules can
be set for each modality.
Uncheck options in
General Review Paring

65
 Rules and modality
pairing rules if you do not
want to use the criteria.
Set the display order for
comparison exams in the
Display Order drop down
menu.

Cross Reference
Cross reference is
available to display the
location of the selected
primary view on other
viewports for correlation.
Right mouse click on a
primary view and Select
Show Cross-References. A
single cross reference line
will display on
corresponding views of
the same exam.

A single cross reference

line will display by default.
After displaying a single
line, the right mouse
menu will display Hide
Cross-References or Show
all planes.

After posting all planes,

the right mouse menu will
allow users to return to a
single plane (Show only
current plane) or Hide
Cross-Reference to turn
off all cross-reference
planes.

66
Using Dynamic Load
Dynamic Load is a feature allowing loading of extra series on-the-fly in Volume Viewer.

[AW and AW Server]

This feature is available in most Volume Viewer Review Protocols whereas advanced applications
such as VesselIQ, LungVCAR, ColonVCAR, will only benefit from the 2D mini viewer feature described
below.
Access to the panel is via the icon next to the Review Steps toolbar.

1
2
3

5
2

7 4

Item Description

1 Patient Name
Exam information: modality, exam date, exam description
2 All available exams on the local database from the currently loaded patient are
listed.
Drag & Drop any 3D series (Axial, Reformatted, etc.) from the MiniPatientList to a
desired viewport in order to display it.
3 [AW Server only]
Drag & Drop 2D series from the MiniPatientList to a desired viewport in order to
display it. Only screen captures generated by Volume Viewer and single image
series can be loaded in Volume Viewer.

67
 Item Description
Note: Automatic registration can be performed when loading new volumes on-
the-fly with the Integrated Registration option via Global Preferences. Refer to the
Integrated Registration User Guide for more information.
Note: Ensure that all images have been transferred on the local workstation prior
to loading them from mini-patient list. Only images stored on the workstation will
be loaded with drag and drop. If images are missing, please restart your Volume
Viewer session.
[AW only]
When some exams from the active patient are stored on the local workstation
but are not displayed in miniPatientList (misspelling, different patient ID, …):
4
• Click (Add Patient)
• Select desired exam from Patient List
• Click again on (Add Patient) to validate
[AW only]
2D series such as screen captures, DSA or single image series cannot be loaded
5 in Volume Viewer.
Click the (2D) button to load these series in the miniViewer which displays on top
of bottom left viewport.

Click the (Load) button next to the “Save State” series in the miniPatientList to
load it in a new Volume Viewer session (new tab on AW Server and right screen
on dual screen AW).
6 If the OncoQuant license is available, it is possible to load volumes referenced in
the Save State series with corresponding measurements in current Volume
Viewer session by using the (Merge) button. Refer to the OncoQuant User Guide
for more information about this feature.

If all exams are not yet transferred when launching Volume Viewer, click the
7 Refresh button to refresh the list of exams/series available on the local
workstation.

68
[Seamless Integration]

To load images on the fly, open the Series Navigator from the PACS then drag and drop the desired
series into the Volume Viewer viewport.
When dropping a Save State series, a popup asks whether the Save State series should be “Loaded”
(i.e. replacing all series in current Volume Viewer session) or “Merged” (i.e. import referenced series
and measurements from Save State in current Volume Viewer session).

69
MR in Volume Viewer
Volume Viewer MR is a Volume Viewer option which allows the recognition of MR image types
(acquisition sequence, weighting, etc.) acquired on GE HDxt MR and later systems.
This option includes:
– Access to standard MR Review Protocols for dedicated anatomies (Brain, Knee, Breast, Liver,
…)
– The possibility to customize MR Review Protocols (User Protocols)
– Fusion of MR sequences (as well as registration between MR sequences). Available from
Integrated Registration MR option

Standard MR Review Protocols

Anatomy MR Review Protocols
• MR Brain Review
o MR Brain Review
o MR 3D Reformat
o MR 3D MIP

• MR Brain Stroke
HEAD o MR Brain Stroke
o MR Brain FLAIR vs DIFFUSION
o MR Brain ADC vs MTT
o MR 3D Reformat
o MR 3D Multiple Oblique
o MR 3D MIP

• MR Breast Review
o MR Breast Review
o MR Breast Diffusion
CHEST
o MR Breast Dynamic
o Water/Fat/IP/OP

70
 Anatomy MR Review Protocols
• MR Cardiac AutoCine
o MR Cardiac AutoCine
o CARDIAC Time Course vs MDE
CARDIAC
o CARDIAC FIESTA vs MDE
o CARDIAC Time Course Stress-Rest

• MR Prostate Review
o MR Prostate Review
o MR Prostate Diffusion
o MR Prostate Contrast Uptake

• MRCP Review
o MRCP Review
o MR MRCP 3D
o MR MRCP MS-MA

• MR Hips Review
ABDOMEN o MR Hips Review
o MR Hips Coronal
o MR Hips Sagittal
o MR Hips Axial

• MR Liver Review
o MR Liver Review
o MR LAVA Dynamic
o MR LAVA Coronal
o MR LAVA 3D MIP
o Water/Fat/IP/OP

• MR Spine Review
o MR Spine Review
SPINE o MR Spine Multi-View
o MR 3D Multiple Oblique

71
 Anatomy MR Review Protocols
• MR Shoulders
o MR Shoulders
o MR Shoulders Coronal
UPPER LIMBS
o MR Shoulders Sagittal
o MR Shoulders Axial

• MR Knee Review
o MR Knee Review
o MR Knee Coronal
o MR Knee Sagittal
LOWER LIMBS
o MR Knee Axial
o MR 3D Reformat
o MR 3D Multiple-Oblique

• MR Review General
o MR Review General
o MR 3D Reformat
o MR 3D Multiple Oblique
GENERAL
o MR 3D MIP
o MR Functool Outputs
o Water/Fat/IP/OP

72
Create a customized MR review protocol
The save layout panel contains specific information for MR series (images acquired on GE HDxt MR
and later). The following MR information can be set when creating new layouts, from Advanced
Mode section in Save Layout panel:
• Sequence name: Pulse Sequence name of the acquired series.
• Options: acquisition options (EPI, Propeller, 3D, …). Displayed if applicable.
• Weighting: T1, T2, T2/T1, T2*
• Bvalue: b value for diffusion images. Appears when diffusion image is displayed.
• Flex: Water, Fat, In Phase, Out of Phase. Appears when Flex image is displayed.
• Contrast: Appears with “Yes” when contrast flag is set up on displayed series.
• Funct: functool type of image (ADC, MTT, etc.). Appears when a Functool image is displayed.
• Slice Type: if checked, forces the display of a series acquired in a specific plane (axial,
sagittal, coronal).
• Align to Plane: if checked, the displayed series will be aligned to the actual acquisition plane.
• Acquisition plane: (for 3D acquisitions only) if checked, will display the 3D acquisition
performed in a given plane.

In order to maximize number of series displayed in MR Review protocols, 4 checks are performed for
each viewport based on layout criterions:

Checking series with expected PSD + expected series found Series displayed in viewport
weight + plane + options No further check for this viewport

expected series not found

Checking other viewports, then expected series found Series displayed in viewport
checking series with expected weight + plane No further check for this viewport

expected series not found

Checking other viewports, then expected series found Series displayed in viewport
checking series with expected weight No further check for this viewport

expected series not found

Checking other viewports, then expected series found Series displayed in viewport
checking series with expected Plane No further check for this viewport

expected series not found

Displaying remaining unloaded series
OR
1st series in series list

73
Example: What will be displayed on top left viewport?

Scenario 1:
Volume Viewer will try to find a 3D
FSPGR sequence, with T1 weight
acquired in an Axial plane.
If not found, it tries to find any T1
sequence acquired in an Axial plane.
If not found, it tries to find any T1
sequence or/and series acquired in an
Axial plane.
The series found will be displayed in
the acquisition plane.

Scenario 2:
Volume Viewer will try to find any T1
series acquired in 3D mode, regardless
of the PSD and acquisition plane
(unchecked).
If not found, it selects the first
unloaded series.

74
MR AutoBind
MR AutoBind protocol (available from the anatomy General) is designed to merge any single-phase
MR axial series, Diffusion Weighted Images (DWI) or ADC maps. If multiple axial series were scanned
and a whole-body view is needed, AutoBind may be used.

1. Protocol launch:
a. [AW and AW Server*] Select the compatible MR series to be processed then select
MR AutoBind protocol from the General anatomy.
b. [Seamless Integration] Load MR exam in PACS viewer then select series viewports to
be bound (using <Ctrl> key) and launch “AutoBind” from Oncology sub-menu in 3D
Application menu.
c. [MR console and PET/MR console] Select the compatible MR series to be processed
then select AutoBind from Session Apps list.

2. After loading, the multiple selected series will be automatically bound in a single series and
the resulting volume is displayed in reformat layout (Coronal and Sagittal) for preview. The
AutoBind panel is displayed allowing you to:

– Recalculate the bind by applying

several quality improving
algorithms (uniformity correction,
registration and overlap blending)
which can be saved as
preferences for further sessions.
– Edit the series description.
– Save the volume set and exit.
– Exit the application without saving.

3. Repeat the operation for each MR sequence (ADC, DWI …).

*For AW Server in Full integration, load the MR exam in PACS and launch MR AutoBind protocol. The
series selection panel will be displayed to select which series should be used for binding.

75
Optional corrections
Description
Use Uniformity Correction algorithm to improve visualization of bound data to provide similar
window width and window length from head to feet.
Uniformity correction algorithm requires a minimum of 4 slices overlap between stations.

Use Registration algorithm to optimize continuity and alignment of anatomy from head to feet for
DWI acquisitions acquired with same pixel size.
Registration algorithm requires both:
- A minimum of 4 slices overlap between stations on DWI acquisitions
- Reference images for DWI stations coverage (WATER: LAVA Flex series for MR system and
WATER: MRAC series for PET/MR system). Reference images shall have same pixel size.
Reference images might be automatically loaded by the software, if not, user would have to
manually select corresponding reference images and DWI acquisitions at launch.

Use Overlap blending algorithm to get the images with improved intensity transitions at the overlap
region and hence across the whole body.
Overlap blending algorithm requires both:
- A minimum of 4 slices overlap between stations
- Perfect match between overlap slices will improve algorithm results

Corrections applicability
Uniformity correction and registration are available for axial DWI series only.
Uniformity correction and overlap blending are available by default for a limited set of PSDs
including FSE-XL, FSE-IR, FRFSE, PROPELLER, LAVA, LAVA Flex, MRAC, SSFSE, Fast SPGR,
efgre3d_aspir. Some PSDs will not propose those corrections by default and the user will have to
select the corrections manually to apply them.

In case no corrections can be applied, input axial images will be simply stacked.

76
Troubleshooting
Always check the resulting volumes on the reformat views before saving them because the
application does not limit you to series which share acquisition parameters or with the proper
inclusion criteria. For example, if you accidentally miss loading one station, the application will use
interpolation for that series that was not loaded (see image below).

77
Non-matching: If the patient moved during image acquisition, it may result in consecutive, non-
matching series, which, if merged with AutoBind looks like image below on the left.

Non-matching

If the loaded series have both =0 and >0 b-values, the application generates as many new series as
b values in the same exam from which the series were loaded. For 5 b-values, 5 bound series would
be created.
After saving the automatically bound volume(s), always double-check the accuracy of the resulting
series with the protocol you intended to use the bound images, and delete them if you find it
necessary. Delete all erroneously or unintentionally saved series from the repository, and make sure
that, if there were two series generated and saved, both of them are deleted.
For better identification, in the case of auto-bound series, the volumes are saved with the following
series description by default:
<AutoBind> <other parameters> <date, format: YYYY-MM-DD hh:mm:ss> <b-value (b=b-value)>
If the loaded series have the same b value, then the <b-value> part is omitted.
<Other parameters> may include the combination of the following parameters:
1. PSD name and weight (if PSD name is available);
2. weight and functional map name (when PSD name is not available)
Note that the “Apparent Diffusion Coefficient” string is replaced with “ADC”.

The default series description can be edited by modifying the series description in the AutoBind
interface.

When the input series have different resolutions, the saved series description will contain the text
“Resized”.

78
PET in Volume Viewer
Overview
PET protocols allow the review of PET/CT exams in Single and Compare modes with specific PET
features:
• Fused Views,
• SUV Quantification,
• Multi–Object Volume Rendering,
• Brain Study Reorientation,
• PET–MR Review.

Note: For PET datasets with matrix sizes over 256x256 some display performance issues may occur.

Display and Controls

Many of the basic viewing controls, such as those that you use to zoom in and out on the images, or
adjust window width and level (contrast and brightness), are available directly on the views.
In the main toolbar, a dedicated category is available to allow a quick access of PET tools.

In the right click menu, the user is also able to customize a quick access of up to 6 different tools.

CT/PET Protocols
A set of protocols is available for PET category:
• PET/CT Single Review
• PET/CT Follow up
• PET/CT QC Fused
Additional PET protocols are available in Volume viewer PET:
• Cardiac PET/CT QC
• PET 4D
• Reorient Guide

79
Fused views
The percentage of fusion is automatically displayed on the left-hand side of fused views (see Figure
below). Middle click and drag left/right the on–view annotation to adjust continuously the
percentage of PET information displayed (from 0 to 100%) in the fused view. Or, with the mouse over
the active annotation, type the new percentage of fusion desired.

Adjusting PET image % on fused views

The color ramp of the PET image is automatically displayed in all fused views.
Note: On Linked views, the color ramp is only displayed in the first image view.

To modify the Window Level of the PET part of the fused image, click and hold the middle mouse
button when over the max (resp. min) value active annotation above (resp. below) the color ramp
and drag the mouse left and right to modify the max (resp. min) value. Or, to modify the min or max
value, type in a new value with the mouse over the min or max value active annotation.
To modify the Window Level of the CT image, click and hold the middle mouse button anywhere
else on the view then drag the mouse. If a viewport contains the CT used in the fused viewport,
adjust the Window Level of the CT in this viewport (via the mouse or via keyboard shortcut) so it is
synchronized in the fused viewport.

Right click in the fused view and select fusion rendering from Blend Modes menu:

Fused Threshold Fused Inverse Fused

Tiled Windowed Swipe

80
Color map
To display/change a color map:
• Select the viewport(s) in which you would like to change the color map.
• Click directly on the color map (fused views) or click on the Set Color button available from the
Visualization tools . Select a predefined color map from the list.

A color ramp is displayed on the left side of the viewport. The min/max values are displayed next to
the color ramp. Once applied, a color map can be set as favorite for all fused views in the
predefined protocols.

Note: Color map only applies to PET or fused views.

Note: There is no way to create a user defined color map.
Note: This is not applicable with user layouts in which the colormap is saved.

ROI statistics on fused views

Fused viewports contain 2 volumes: 1 main volume and 1 secondary volume, both displayed on top
left of the viewport as “main volume <-> secondary volume”.
Main volume and secondary volumes can be swapped by clicking the <-> annotation.

When depositing a ROI on a fused view, the ROI will be attached to the main volume and the ROI will
be displayed in all viewports containing the main volume. Modality will be displayed next to the ROI
statistics in the fused viewport.

81
SUV
Workflow
Any ROI deposited on a PET view will provide statistics expressed in SUV values. Within a Volume
Viewer session, active annotations allow to change unit of SUV measurements, edit the SUV presets
and modify the patient information needed for SUV computing.

Note: In Compare mode, the values in the SUV panel correspond to the selected view. These values
are automatically updated when selecting another volume.

Information on unit of measure

Several SUV scales are available by right clicking the unit on–view annotation. The multiplicative
factors used for each scale are defined as follows (WT=weight, HT=height):
• bw (g/ml) = WT
• lbm (g/ml*) = 1.10 WT – 120x(WT/HT)2 for males (Legacy *)
• lbm (g/ml*) = 1.10 WT – 128x(WT/HT)2 for males (Consensus **)
• lbm (g/ml*) = 1.07 WT – 148x(WT/HT)2 for females
• bsa (cm²/ml) = WT0.425 x HT0.725 x0.007184

* Legacy: Based on reprint by Morgan et al. [1994] as 1.10 x WT – 120 x (WT/H)2, and consequently
adopted (legacy) by the PET community [Sugawara et al. 1999]. Earlier versions of VV use this formula
for Males. This is applied in the PET Preferences panel.
** Consensus: The original (consensus) formula for computing LBM for males was 1.10 x WT – 128 x
(WT/H)2 [James 1976]. Newer versions of VV support this calculation for males when the preference
is applied. This is applied in the PET Preferences panel.

Default SUV display settings:

• The initial factory default unit setting for PET W/L is kBq/ml.
• If not enough information to compute SUVbw, the default secondary preference is KBq/ml.
• Though no longer the default for unit selection, an option to maintain last selected units when
Volume Viewer PET is exited and reloaded is still available as a setting.
• Units are not saved in layouts.
• If SUV info is present but selected W/L units are kBq/ml, then m=0.0 M=(equivalent of 10.0 g/ml
in KBq/ml).

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SUV in comparison mode

SUV analysis is a frequently used tool to quantify and support a clinician’s interpretation of
variances in regional FDG uptake. They are relative (not absolute) values that aid in tumor
management when tracked serially, and as such must be calculated identically to be comparable.

In order to compare SUVs between successive exams, they must be calculated identically to be
accurately compared:
• Since the acquisition method (2D/3D) can influence the calculation of the SUVs, a message will
pop up when the acquisition method is different between two exams.
• Differences in uptake time (injection time – start of acquisition time) may be invisible sources of
errors for SUV calculation. A message will pop up when the differences between uptake times of
two exams are too large.

When comparing maximum SUVs of an object with its appearance on a prior exam, ensure that the
“hottest” pixel is actually being analyzed. It is important to ensure that it is contained within the VOI
by changing the size of the VOI in all three planes.

Note: The values displayed on the SUV panel correspond to the selected view. When changing the
selection, the values are automatically updated.

Volume Viewer supports both volumetric SUV analysis (3D) and 2D. In both 2D and 3D mode the
SUV statistics are computed from the original transaxial data regardless of the orientation of the
displayed image.

The following suggestions may help reduce discrepancies when reading follow up exams:
• If the prior exam has had SUV’s reported on another workstation then we suggest utilizing the
PET–CT compare mode layout for direct comparison between the current and prior exams.
• When comparing maximum SUVs of an object with its appearance on a prior exam, ensure that
the “hottest” voxel is actually being analyzed. While Volume Viewer’s 3D VOI performs this
search automatically, it’s important to ensure that it is contained within the VOI.

Note: It is important to note that Scanner calibration and other clinical factors also impact SUV
variability.

Note: When comparing PET–CT exams, it is strongly recommended to load both native studies in
the dedicated protocol PET–CT Compare.

Note: The position of the maximum pixel in the VOI can be in another slice that the one being
displayed. A small blue dot is displayed on the correct location.

Note: When hitting the <H> key, the VOI box is hidden and only the contours are displayed.

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Note: The contours are not displayed on slab thick views but only on views with the minimal slice
thickness.

Statistics
Right click on the bookmark → Statistics
List of available statistics for PET ROI (deposited via <Insert> key or via AutoContour tool): Volume,
Minimum, Maximum, Average, Standard Deviation, Relative Deviation, TLG (SUV only), Peak,
Threshold

Note: A maximum of three statistics can be selected and displayed.

Note: The units of display of the VOI will always match the WL units displayed in the lower left of the
viewport (VOI statistics in a fused viewport will be displayed in SUV, not HU).

Note: The TLG is the product between the volume of the tumor and its SUV average. TLG is only
available for VOIs that are automatically thresholded.

Note: The negative pixel values from PET images are not taken into account in the calculation of VOI
statistics.

Contextual options
Right clicking a ROI/VOI when it is active will enable you to:
o Show/Hide statistics in the ROI/VOI (will show/hide statistics for all ROI’s/VOI’s in all
viewports),
o Lock/Unlock ROI/VOI position, size and comments,
o Delete ROI/VOI,
o Clone ROI/VOI.
o Show/Hide max value in the VOI,
o Send cursor to max value.

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PET Preferences
All the preferences for PET features are available from the Global Preferences panel, tab PET.

Note: All preferences are automatically saved when closing this panel.

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Other PET protocols
Cardiac PET/CT QC
The Cardiac PET/CT QC protocol allows the review of alignment for cardiac PET/CT studies, by fusing
PET images with the CT images that were used for attenuation correction in the PET reconstruction.

The fusion is composed of a CT series and a PET series.

• Need PET images and corresponding CT image series which was used for CTAC
• For each PET slice loaded its corresponding CT slice that was used for Attenuation Correction
will be loaded and displayed fused to that PET slice

After images are loaded, the internal Cardiac registration can be analyzed in the axial, coronal, and
sagittal views. The PET and CT images will remain linked as you scroll through all slices in all
directions.

Note: Desired Alignment Correction measurements can be taken using the standard measurement
tools but these values will not be transferred back to the PET system for reconstruction.

PET/MR Fused
The PET/MR Fused protocol allows the display and fusion of pre–registered PET & MR datasets. CT
and MR series can be aligned by using the Fusion package.
After registration, you may want to reorient the dataset using Reorient Guides (see next section) to
correctly align the 3D volumes for optimal review. This protocol may be used with PET and MR data,
as well as PET–CT data.

Reorient Guide
Reorient Guide is a protocol used for re–orienting and saving a registered series (i.e. PET–MR, PET–
CT). This is particularly useful in correcting for differences in the scan orientation and what is desired
for review.

When the protocol is launched, follow the protocol panel instructions to re–orient CT series. Once
the orientation is defined in CT series, it will be applied in PET series. You can then save both series
with the same spacing and thickness as PET and these may be reviewed in the standard Volume
Viewer layouts.

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Objectives:
• used to correct for differences in the scan orientation against the desired review orientation
• used to create oblique reformats:
o neuro cases (to align the head to standard review planes)
o melanoma cases
Limitations:
• steps MUST be performed sequentially—work only in the currently active view

Reoriented CT series will save as:

• type: Reformat
• description: Average
Reoriented PET series will save as:
• type: Static Image
• description: Reformatted
New series can be loaded into Volume Viewer as if they were the original axial series.
Note: Weighted MIP image quality may be slightly degraded using reformatted series. If this occurs,
change the view type to HD MIP.
Note: When a dataset is reoriented, the Standard Uptake Values (SUV) measurements may change
as data are interpolated. Thus, the Max SUV may change, especially when the Max value is isolated.

PET 4D
PET 4D is a specialized protocol providing the ability to review a gated or dynamic (4D) PET exam.
Objectives:
• Accurately localize active tumor
• Exclude non–active tissue
• Accurately quantify tumor volume in each of the respiratory phases
• See and quantify the tumor movement over time (4D)

For more information about the PET 4D tools available in this protocol, refer to the “PET/CT Tools”
section in the “Volume Viewer – part 2: Deep Dive” User Guide.

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Dual energy CT
Material characterization can be performed based on dual energy acquisition. Indeed, HU values
depend on the energy used during acquisition, closely linked to the voltage used. Below is the
example of the HU values for calcium.

Considering that an acquisition made with 80 kVp corresponds roughly to 56 keV and an acquisition
made with 140 kVp corresponds roughly to 84 keV, it is easy to imagine that materials can be
characterized based on the HU ratio values between high kVp and low kVp.

HU (80kVp) HU (56keV )

HU(140kVp) HU (84keV )

Volume Viewer proposes 3 dual energy protocols based on similar workflow:

1. Check registration between low kVp and high kVp series which must have same slice
thickness, same slice spacing, same reconstruction FOV and same reconstruction algorithm.
2. For Calcium and Uric Acid protocols, a material map is generated based on the values from
literature*.
3. For Custom protocol, a map can be created adjusting the threshold on native image and the
threshold based on ratio value.

Refer to “Volume Viewer – part 3: Clinical scenarios” for more information about how to use these
protocols.

* Refer to the literature for more information about the values used for Calcium and Uric Acid (“Dual-
Energy CT as a Potential New Diagnostic Tool in the Management of Gout in the Acute Setting” -
Savvakis Nicolaou, Charlotte Jane Yong-Hing, Sandro Galea-Soler, Daniel J. Hou, Luck Louis and Peter
Munk – American Journal of Roentgenology, 2010; 194:1072-1078.)

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Once the 2 series, high kVp and low kVp are loaded and registered, 2 types of thresholds are applied
automatically to generate the material map:
- Lower threshold and upper threshold, to specify the range of voxels to take into account for
the material map creation (soft tissues, …). Default values for Dual Energy protocols are 150
and 500.
- Ratio threshold, lower OR upper:
o For uric acid, upper threshold is set to 1.25 and cannot be modified
o For calcium, lower threshold is set to 1.25 and cannot be modified
o In custom protocol, upper threshold is set to 1.25 and can be modified (values +
upper/lower).

Example: Uric acid map with upper threshold 1.25 for HU in range [150-500]

Refer to “Volume Viewer – Part 3: Clinical scenarios” for more information on how to use the Volume
Viewer Dual Energy protocols.

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Keyboard Shortcuts and Tips
Export shortcuts
Send the image behind the mouse cursor to the Filmer [AW and AW
Server only].
Send the screen behind the cursor to the Filmer [AW and AW Server
only].
Send the screen behind the cursor to the Filmer as a unique page [AW
and AW Server only].
Perform a quick Export of the active viewport.

<S>: Save image (with default series description).

<Alt>+<S>: Save image as.
+
Display shortcuts
Preset W/L 1:
• CT: Abdomen [WL 40 WW 400]
• XA: Abdomen [WL 40 WW 400]
• MR: Preset1 [WL 20 WW 40]
• PET/NM: Predef1 [min 0 Max 1024]

Note: Use <F6> on GE CT, MR & PET scanners.

Note: Values can be customized from 2D Viewer [AW and AW Server]
Note: PET presets can be also customized in Volume Viewer, by clicking the
SUV unit in bottom left of the PET viewport and selecting “Edit Preferences”.

Preset W/L 2:
• CT: Head [WL 35 WW 100]
• XA: Head [WL 35 WW 150]
• MR: Preset2 [WL 50 WW 100]
• PET/NM: Predef2 [min 0 Max 1000]

Note: Use <F7> on GE CT, MR & PET scanners.

Note: Values can be customized from 2D Viewer [AW and AW Server].
Note: PET presets can be also customized in Volume Viewer, by clicking the
SUV unit in bottom left of the PET viewport and selecting “Edit Preferences”.

Preset W/L 3:
• CT: Lung [WL -600 WW 1500]
• XA: Lung [WL -600 WW 1500]
• MR: Preset3 [WL 100 WW 200]
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 • PET/NM: Predef3 [min 0 Max 2000]

Note: Use <F8> on GE CT, MR & PET scanners.

Note: Values can be customized from 2D Viewer [AW and AW Server].
Note: PET presets can be also customized in Volume Viewer, by clicking the
SUV unit in bottom left of the PET viewport and selecting “Edit Preferences”.

Preset W/L 4:
• CT: Mediastin [WL 40 WW 350]
• XA: Tissues 1 [WL 50 WW 600]
• MR: Preset4 [WL 500 WW 1000]
• PET/NM: Predef4 [min 0 Max 4000]

Note: Use <F9> on GE CT, MR & PET scanners.

Note: Values can be customized from 2D Viewer [AW and AW Server].
Note: PET presets can be also customized in Volume Viewer, by clicking the
SUV unit in bottom left of the PET viewport and selecting “Edit Preferences”.

Preset W/L 5:
• CT: Spine [WL 35 WW 300]
• XA: Spine [WL 35 WW 300]
• MR: Preset5 [WL 1000 WW 2000]
• PET/NM: Predef5 [min 500 Max 4500]

Note: Use <F10> on GE CT, MR & PET scanners.

Note: Values can be customized from 2D Viewer [AW and AW Server].
Note: PET presets can be also customized in Volume Viewer, by clicking the
SUV unit in bottom left of the PET viewport and selecting “Edit Preferences”.

Preset W/L 6:
• CT: Vertebrae [WL 350 WW 2000]
• XA: Tissues 2 [WL 350 WW 2000]
• MR: Preset6 [WL 2000 WW 4000]
• PET/NM: Predef6 [min 1000 Max 5000]

Note: Use <F11> on GE CT, MR & PET scanners.

Note: Values can be customized from 2D Viewer [AW and AW Server].
Note: PET presets can be also customized in Volume Viewer, by clicking the
SUV unit in bottom left of the PET viewport and selecting “Edit Preferences”.

Apply automatic windowing based on the pixel density of the image

displayed on the viewport.

Optimize VR settings based on voxel value of 3D cursor.

91
 Show/hide measurement and trace (vessels or manual).

Show/hide the 3D cursor on the viewports.

+ Switch between the loaded volumes (next, previous) in current viewport.

+
Image Interaction shortcuts
Scroll up & down in slices or rotate 3D models.

Paging through slices.

Targeting.

Hold down the <F> key to move forward in a navigator viewport. Use <B>
key to navigate backward.
In navigator viewport, automatically aligns the orientation of the
navigator view to the main axis of the lumen (when a trace is defined).
In navigator viewport, displays the navigator view in opposite direction
(“Turn around”).
Tools shortcuts
Swap between mouse modes.

Delete last point defined on trace.

Insert a bookmark.

(Requires the Integrated Registration license)

Activate regional registration based on 3D cursor location and using
parameters set in Global Preferences.
(Requires the Integrated Registration license)
Activate manual registration mode (opens the Integrated Registration
panel if not opened).
Edit trace.

Draw Trace.

Activate 2D measurement tool.

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 Focus on <P>rior or <N>ext measurement.

Delete active measurement (<Delete> on QWERTY keyboard, <Suppr> on

other type of keyboards).
This can be done also using the <Backspace> key.
Delete the current Trace.
+
In fused viewports, switches the master volume with the overlay volume.
+
In fused viewports, set the fusion factor to:
- 50% when current fusion factor is between 0% and 50%
+ - 100% when current fusion factor is more or equal to 50%
- 0% when current fusion factor is 100%
When a tool panel is opened, press space bar to minimize the panel,
without closing it.

• Hover the cursor over a button and a tool tip appears describing the button function.
• Watch the progress bar at the bottom of the desktop. It shows the task progress when loading
data or processing images.
• Double click on the viewport to enlarge it and display it as full screen. Double Click again to
come back to the original display. This will not apply when in Select mouse mode.
• Typically click (Next) and (Back) to navigate through the wizard panels.

93
Measurement Accuracy
Voxel Dimensions
The image set resolution, i.e., the dimensions of the voxels (volume elements) that constitute the
image set, is determined by the size of the field-of-view, the matrix size, and the inter-slice distance.

Ideally, voxels should be isotropic (with the same dimensions along all three axes), i.e., the inter-slice
distance should be the same as the voxel dimension in the acquisition plane. In practice, however,
considerations such as patient irradiation dose levels will usually lead to the choice of a larger inter-
slice distance.

You should be aware that details with dimensions in the order of or less than the inter-slice distance
cannot be identified or measured with any degree of reliability.

Geometrical accuracy
For CT image sets, the largest dimension of a voxel (normally the inter-slice distance) determines
the geometrical accuracy:
o For a distance measurement, the geometrical accuracy of the displayed length is equal to
+/– largest voxel dimension,
o For an angle measurement, the geometrical accuracy depends on the length of the
segments, and improves as the length of the segments increases. As an example, for an
angle measured between segments, which are five times larger than the largest voxel
dimension, the geometrical accuracy of the displayed angle value is equal to +/– 10 degrees.
o For an area measurement, the geometrical accuracy of the displayed area value is equal to
+/– the circumference of the region of interest multiplied by (largest voxel dimension)2 / 2.

The geometrical accuracy defines a lower bound on the overall accuracy that can be obtained.
Further limiting factors are the vessel analysis quantification algorithm, acquisition accuracy, partial
volume effects, display settings and display resolution.

Acquisition Accuracy
Any errors resulting from the acquisition process that are present in the original image set
(calibration and slice interpolation errors, motion artifacts) will be added to the same extent to the
measurement error.

Partial Volume Effects

In X–ray exams (CT and 3DXR), the value of a voxel is the weighted average for all materials in the
voxel. Because of the high attenuation coefficient of calcium, even a small amount of calcium in a
voxel will weigh its value towards that of calcifications or bone, so that the entire voxel appears to
be calcifications or bone.

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Display Settings and Display Resolution
Since anatomical features are rarely of a uniform density, the apparent dimension of an anatomical
feature can change when you change the display settings (window width and level).

However, when you place the measurement points yourself, (e.g., for an additional diameter
measurement), the apparent diameter can differ by one or more voxels depending on the W/L
settings, thereby adding another factor of uncertainty.

The display resolution of each view depends on the screen split and the screen resolution, and you
obviously cannot place a manual measurement point with a precision better than a single pixel.

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 Revision History
Revision Date Reason for change Pages
1 2019-05 Initial release based on 5802665 rev1 96

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