syngo.via MR Oncology Job Aid edited

SIEMENS Healthineers syngo.via MR Oncology Template Effective Date: 10 Aug 2021| HILS 2223 Job Aid Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Table of Contents Overview 3 SIEMENS Healthineers Reading 4 MR Oncology LIVOI_ADC_WB MR Oncology Reading Findings 6 Einge Reading Viewing Track Findings 7 V Findings Trending 10 255 Oncology MR Oncology 1 11 148.3 ... 5/14/2011 MR Oncology 2 LZVOI_ADC_WB Segmentation L2 572.5 ... 1/16/2014 Mean= BC 1 37 Medan = 737 11 Left = 200 (SC 5%) Mitele = 7.1%: Richt = 1500 :233; Re Freq.cny (%) Histogram 13 OncoTrend 17 250 501 7:0 005 1250 1500 1750 2030 Tools 3298 2:00 Hice Hide Lines Graphics Time poi .. Threshold Segmentation Refine Histogram Statistics overlay @ Cuidance Edit Layout Snapshot Print Expuit mage 1:26 AM laaaa2508 There might be slight differences between software versions. 2 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Overview MR Oncology + MR Oncology Reading The MR Oncology workflow is used to read and evaluate oncological images of specific body regions and organs. The workflow offers dedicated layouts including Single Learn Click Segments OncoTrend layouts for whole-body cases, certain post-processing functions (e.g., histogram calculation), and the image alignment of several time points. SUV Parameters Reading OH With the MR Segmentation tool, you can easily segment lesions or small anatomical Viewing structures. The resulting segmentation objects can, e.g., be used for volumetric evaluation of the segmented lesions. mMR Reading is a feature within the MR Oncology workflow and is used to read MR, Findings Oncology PET MR MR, and MR-PET MR MR images. To compare images, you can also load PET Head MR Oncology 1 VVD L1 32.45 ... 4/27/2009 MR MR-CT images. MR Oncology 8 L7 3.58 cm 4/27/2009 L8 3.16 cm 9/9/2008 Findings and Reporting support RECIST classification (Response evaluation criteria in solid tumors) and enables documentation of the change of the lesion. + PDF MR Oncology requires additional licenses. 3 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Reading The preconfigured workflow has two steps, Reading and MR Oncology AFR Viewing. MR Oncology Reading In the layout gallery there are several layouts that can be used Learn Segments OncoTrend depending on the available images. SUV Parameters RHP Reading Volume 21.61 cm3 The workflow has some tools dedicated to Oncology reading. Viewing Min / Max: 87.00 /1715.00 Mean/SD: 1100.80 /294.03 Recist: 3.47 cm Some of them require an additional license*: • Track findings between current and prior 3.47 cm • Trending of the change of the finding Findings Oncology L1 AFL Head MR Oncology 1 Mean = 1100.80 Median = 1103 • MR Segmentation* Left = 630 (5.8%) Middle = 50.9% Right = 1172 (43.4%) L1 21.61 ... 4/27/2009 Abs. Frequency 800 • Histogram* 700 600 • Reading of PET MR MR MR images* 500 OncoTrend for Whole body b-value analyses* RAH 400 • Tools 300 L 200 Synch Align Full Text Hide Hide Lines Reset Graphics Timepoi ... 0 200 800 1000 1200 1600 1800 Edit Snapshot Print Export Undo Redo KU 400 600 1400 Layout Image Image Intensity 5:06 AM * MR OncoTrend, MR Segmentation, mMR PET MR MR reading requires an additional license. 4 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Reading Layouts The workflow can be configured with new steps and layouts Reading Series optimized to the customer scanning workflow i.e. MTDF145_Sari ER Add Study MR Whole Body or Series Name • (4/27/2009 5:51 PM MR PET MR MR workflow Head/Nec Thorax Abdomen/ Pelvis MR, Head_current • Liver 10 ... : HISTOGRAML1VOI 10 ... : Result series: MR Oncology ... 24 t1_se_sag In the layout gallery there are preconfigured layouts for 23 t1_mpr_thinMPR_cor_post .. Leg/Feet Multi Dynamics Dynamics Region 4D 23 t1_mpr_thinMPR_cor_post ... 22 t1_mpr_ns_sag_p2_post reading of single time point or follow up. 21 t1_f12d_sag_post 20 t1_f12d_tra_post MRCP MR/PET MPR 3D 19 t1_fl2d_tra Details 18 t2_f12d_tra_hemo For optimization, please see the MR Workflow Configuration 17 ep2d_diff_3scan_trace_tra. 16 ep2d_diff_3scan_trace_tra_ Job Aid. 15 t2_tse_tra_p2 14 t2_tirm_dark-fluid_tra_p2 3 localizer Meancury Meancury PET Alignment e = 2x2 Meancury _91912008 11:01 AM MR, Head_prior 20 t1_se_sag 19 t1_se_cor_post 18 t1_mpr_sag_post Head/Nec Thorax Abdomen/ Pelvis 17 t1_se_tra_post k Follow- Follow-Up Liver Follow-Up 16 t2_f12d_tra_hemo Up Follow-Up 15 t1_se tra 14 ep2d_diff_3scan_trace_tr ... 13 ep2d_diff_3scan_trace_tra_ ... 12 t2_tse_tra Leg/Feet Multi Dynamics 11 t2_tirm_dark-fluid_tra_p2 Follow-Up Dynamics Region Follow-Up 4D Follow 1 localizer MR OncoTrend, MR Segmentation, mMR PET MR MR reading requires an additional license. 5 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Findings Findings Oncology Details Oncology Current 4/27/2009 Head MR Oncology 1 ) Attributes that are filled in automatically are indicated by . Check that the attributes are correct. L1 32.45 ... 4/27/2009 For all the findings, a detailed description of the findings MR Oncology 8 Summary L7 3.58 cm 4/27/2009 can be added in the Findings assistant Details view. Target Lesions 12 New Target Lesions !! 2 Volume Source E Approximated RECIST Tumor Burden 7.54 cm Target Tumors 0 cm5 Target Lymphnodes !! 0 cm3 Target Metastases !! 0 cm3 Volumetric Tumor Burden 56.52 cm3 The findings use RECIST 1.1. (in VB70) classification: Change Values (Inf ... In Body Region details, at the top level of all oncology PDF RECIST Burden Change Volume Burden Change • Volume Doubling Time Follow-Up Interval 230 days findings, you can edit general or regional details as a Tools L summary. Synch Align Full Text Hide Hide Lines Reset Graphics Timepoi. Previous Finding Next Finding • In Findings details, at the lower level of each finding, you can edit and specify the individual findings. Findings Oncology Details Head MR Oncology 1 Current 4/27/2009 Head MR Oncology 1 L1 32.45 ... 4/27/2009 Type MR Oncology MR Oncology 8 Attributes that are filled in automatically are Here you can also use the pictogram section to document L7 3.58 cm 4/27/2009 indicated by . Check that the attributes are correct. Region Unknown the finding position just by clicking on the pictogram. To Laterality unilateral Location report each oncology finding, you can select it from the Diagnosis Lesion finding list and assign the corresponding attributes. POS Severity unspecified Target Yes Acute NO Tools L Overall Rating Values Current Baseline Change Rate Current / Align Comment Baseline absolute (%) Synch Hide Hide Lines Reset Graphics Timepoi. Recist 3.96 cm n.a. n.a. Volume 32.45 cm2 n.a. n.a. KU ‹ Previous Finding Next Finding> MR OncoTrend, MR Segmentation, mMR PET MR MR reading requires an additional license. 6 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Track/Un-Track Findings Corresponding findings (e.g., findings that describe the same lesion) of prior and HA HAR current studies can be tracked. You can view the progress of up to eight time points. 36 cm The tracked findings are summarized as one finding in the Findings Assistant. In Findings details, the baseline values and changes of the findings are recorded. 1. Select a lesion measurement on the prior study/studies. Then select Findings the corresponding lesion measurement on the current study while Delete Measurement oncology Copy Measurement Head MR Oncology 1 VVD keeping the Ctrl key pressed. L1 32.45 ... 4/27/2009 MR Oncology 8 2. Right mouse click and select Track selected Onco Finding from the Un-Track selected Onco Finding L7 3.58 cm 4/27/2009 Delete Measurement L8 3.16 cm 9/9/2008 context menu. Copy Measurement Track selected Onco Finding The prior findings are removed from the Findings Assistant as it now refers to the current finding. The findings can be untracked again by selecting one or more tracked findings, right-clicking and selecting Un-Track selected Onco Finding from the context menu. MR OncoTrend, MR Segmentation, mMR PET MR MR reading requires an additional license. 7 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Track Findings When tracking findings, the trending graph and the Details MR Oncology 8 Current 4/27/2009 details to the findings are added in the lower part of the Type MR Oncology Trending Metric Volume finding's details. Attributes that are filled in automatically are O indicated by @. Check that the attributes are Change Rate (%) Volume cm3 Baseline correct. 45 23.99 Region Unknown 23 20.26 Volume - Displays the volume of the lesion. It can be Laterality unilateral 16.54 O Location -23 12.81 created by segmentation, approximation or estimation. Diagnosis Lesion finding -45 9.09 Severity unspecified -68 5.37 RECIST - Displays the RECIST (Response evaluation Target Yes -90 1.64 Acute No 09/09/2008 04/27/2009 criteria in solid tumors) of the lesion. Baseline - For follow-up studies. If the current finding is Overall Rating + Values Current Baseline Change Rate Current / Comment Baseline absolute (%) tracked against the corresponding prior finding(s), the Recist 3.58 cm 3.16 cm 0.42 (13.32%) volume and the RECIST of the baseline finding are Volume 24.06 cm2 16.54 cm3 7.53 (45.5%) Previous Finding Next Finding displayed. Change Rate - For follow-up studies. The volume and the RECIST change with respect to the baseline finding are displayed as a percentage. MR OncoTrend, MR Segmentation, mMR PET MR MR reading requires an additional license. 8 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Volume Findings Distance lines can be used for creating a volume estimation. HA HA 3.05 cm ................. L.2 .................. L2 3.51 3.51 AFL ALF AFL Press Shift while drawing the distance lines. The smaller one is used Details Head MR Oncology 2 HA HA Current 4/27/2009 Details Head MR Oncology 2 Current 4/27/2009 twice for the 3rd dimension. Type MR Oncology Type MR Oncology Attributes that are filled in automatically are Attributes that are filled in automatically are indicated by . Check that the attributes are O indicated by . Check that the attributes are correct. correct. Region Unknown Region Unknown Laterality unilateral Laterality unilateral Location Location Diagnosis Lesion finding Diagnosis Lesion finding Severity unspecified Severity unspecified Target Yes Target Yes Acute No Acute No Overall Rating Change Rate Current / Comment Values Current Baseline Overall Rating Baseline absolute (%) Comment Values Current Baseline Change Rate Current / Baseline absolute (%) Recist .51 cm n.a. n.a. Recist 3.51 cm n.a. n.a. Volume 22.73 cm3 n.a. n.a. Volume 17.08 cm3 n.a. n.a. Single distance line. Ellipsoid is calculated Several distance lines 9 Effective Date: 24 Feb 2023 | HOOD05162003335471 MR OncoTrend, MR Segmentation, mMR PET MR MR reading requires an additional license. Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Trending The Trending functionality helps to visualize quantitative changes, e.g., changes in Current 4/27/2009 the tumor diameter or volume over different imaging study time points. This helps Trending Metric Volume to predict therapy response. For examinations of several time points, you can Change Rate (%) Volume cm3 Baseline track the findings over the time points and create a trending plot of the ROIs or 45 23.99 23 20.26 VOIs in the finding details section. That displays the progress of the examination 0 16.54 -23 12.81 graphically. -45 9.09 -68 5.37 -90 1.64 09/09/2008 04/27/2009 You can collect up to eight findings and group them in a single finding. 1. Select the tracked finding from the finding list in the Findings Assistant to Values Current Baseline Change Rate Current / Baseline absolute (%) display the corresponding trending diagram in the details section. Recist 3.58 cm 3.16 cm 0.42 (13.32%) 2. From the Trending Metric list, choose the corresponding display type. Volume 24.06 cm2 16.54 cm3 7.53 (45.5%) 3. If required, adjust the baseline of the trending diagram to recalculate the values based on the new baseline. 4. To export a snapshot of the trending graph to the report, click the Snapshot icon. MR OncoTrend, MR Segmentation, mMR PET MR MR reading requires an additional license. 10 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Segmentation Tool With the MR Segmentation tool, you can segment lesions or AFR Distance Line ROI Circle small anatomical structures. The resulting segmentation objects Pixel Lens can be used e.g., for volumetric evaluation of the segmented Marker Arrow lesions. Before you can perform a segmentation, you must Angle RHP MR Segmentation specify the target area by drawing a freehand brush line, or by VOI Freehand VOI Sphere positioning a bounding box and a seed area. MR Segmentation The images need to be in MPR view. 3D Brush 3D Brush • Create Size Smoothness • The resulted segmentation can be used for creating a AFR histogram. 2 • MR Segmentation License is required for this functionality. L11 Volume 14.50 cm3 Min / Max: 22.00 /686.00 Mean/SD: Recist: 3. Delete Measurement RAP Copy Measurement Create Histogram 30 Brush Create 3D Brush 3D CU Size Based Smoothness MR OncoTrend, MR Segmentation, mMR PET MR MR reading requires an additional license. 11 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Segmentation Tool Options Select the MR Segmentation tool from the VOI selection list in the HA upper right corner. You can use: • Freehand brush • Left mouse brush the area, green color, to be segmented ALF • Right mouse brush the area, red color, where the segmentation should stop 30 3D Create Brush Based 3D Brush 3D Cut Size Smoothness • Bounding Box HA • Place the bounding box close to the edges • Place the seed area inside the tumor As a result, a segmentation and the volume of the lesion is calculated. ALF This segmentation can then be used for creating a histogram. C .. 3D Box Base Create 3D Brush 3D Cut Size Smoothness MR OncoTrend, MR Segmentation, mMR PET MR MR reading requires an additional license. 12 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 SIEMENS Healthineers MR - News & Improvements MR Oncology Histogram 13 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Histogram With the Histogram functionality, you can display each ROI, VOI, or segmentation AFR result graphically as a histogram. The histogram can be used to analyze an early response in lesions, e.g., with ADC images after a chemotherapy/TACE. • Images need to be in 2D or MPR mode. RHP • Draw a VOI or a ROI to define a region of interest. • Right-click the measurement and select Create Histogram, select the segment L1 MR_1 Volume 21.61 cm3 L1 MR_1 where the histogram should be displayed. Min / Max: 87.00 /1715.00 3.47 cm Mean/SD: 1100.80 /294.03 Recist: 3.47 cm • This can be done in the prior study to compare the histograms. L1 AFL Mean = 1100.80 Median = 1103 Left = 630 (5.8%) Middle = 50.9% Right = 1172 (43.4%) Abs. Frequency 800 700 The histogram is available as a result series in the Series Navigator and saved as 600 part of the current study when you save or complete the workflow. 500 RAH 400 300 An Onco Care license is required for this functionality. 200 100 0 200 400 600 800 1000 1200 1400 1 600 1800 Intensity MR OncoTrend, MR Segmentation, mMR PET MR MR reading requires an additional license. 14 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Histogram Color Mapping In the histogram segment, you can move the two sliders to divide the AFR histogram into three colored regions. The values of the slider positions are listed above the histogram. In the histogram segment, move the mouse over the lower area of the RHP segment to display the histogram mini toolbar. L1 MR_1 Volume 21.61 cm3 L1 MR_1 You can adjust the display of the histogram according to your Min / Max: 87.00 /1715.00 3.47 cm Mean/SD: 1100.80 /294.03 Recist: 3.47 cm requirements. The colors can be back mapped into the image to see the L1 AFL Mean = 1100.80 Median = 1103 Left = 630 (5.8%) Middle = 50.9% Right = 1172 (43.4%) clinical area of the representation. Abs. Frequency 800 700 600 You can copy the color mapping to another image: 500 RAH 400 In the image, select the color overlay and choose Copy Measurement from 300 the context menu. In the target segment, choose Paste Measurement to 200 100 insert the copy of the color overlay. 0 200 400 600 800 1000 1200 1400 1 600 1800 Intensity MR OncoTrend, MR Segmentation, mMR PET MR MR reading requires an additional license. 15 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Histogram Settings With the Histogram Settings dialog box, you can create your own Histogram Settings ? X histogram settings or adjust the existing settings and save them for further evaluations. Default OncoTrend Name of Setting Brain Brain The settings that you create in this dialog box are saved and applied to the 1 1 ntervals evaluation that is currently active. You can select the settings you created Number of bins 100 2 2 Scaling of Axis directly from the Histogram mini toolbar. X-axis min 3 max 519 Y-axis scaling Absolute O Relative Y-axis min O max 5 1. Value that defines the Number of Bins. 3 3 Region Coloring 2. Values to define the scaling range of the x- and y-axis (by setting the Left region Middle region minimum and maximum value), radio buttons allow you to select. Right region absolute (number of voxels) or relative (percentage of all voxels) scaling 4 4 Slider Positions Absolute Relative of the y-axis. Left slider 175 77.42 % + 5 5 Right slider 344 1.97 96 3. Lists to change the color settings for the colored regions. 4. Value to define the slider positions. OK Cancel 5. Icons to create, duplicate, or delete customized settings. A duplicated setting must be renamed before you can save it. MR OncoTrend, MR Segmentation, mMR PET MR MR reading requires an additional license. 16 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 syngo.via MR Oncology SIEMENS Healthineers Overlaid Histogram WholeBody_10000003 WholeBody_10000003 0000003 Avanto_fit 10000003 Avanto_fit MR E11 2019-05-21 | 2019-05-21 2019-05-21 HFS STUDY 2019-05-21 COMBO_adc Volume 1942.50 cm3 5900 COMBO latest Feature Min / Max: 0.00 /3646.00 atest 23 IMAn.a. FRM Mean/SD: 1006.83 /402.58 R R MIP FUSION 10cm AT MPR SL SPC D/R A TP H207 SP A31.0 × 50.00% MPR THICK : ... S/O( 120*132 120*132 Cor User can create histograms simultaneously for two timepoints 214 w 4096 A15/IR • 79 C 2048 BO2,3;SP5,6 2331 AC 1 ez_b50 900 / 90 C 1116 • Both curves are outlined with corresponding time point color WholeBody_1000000 WholeBody_10000003 10000003 Aera 10000003 Aera IR E11 • Results are automatically back mapped to source images 2019-01-032019 2019-01-039 HFS STUDY 2019-01-03 +LPH COMBO_adc 5900 COMBO latest Volume 2538.06 cm3 atest 31 IMA n.a. Min / Max: 0.00 /2944.00 R Mean/SD: 917.34 /313.00 MIP FUSION A 10cm MPR SL R A SPC TP H210 Restrictions SP A11.3 × 50.00% 120p*132 120*132 214 W 4096 A15/IR/PFP Cor VV 2395 AC 1 79 C 2048 BO3;SP5-7 2 050 900 / 90 1139 O Simulataneous Create Segmentation • None wholeBody_10000003 WholeBody_10000003 L1VOL_COMBO_L2VOL_COMBO Series Avanto fit 10000003 2019-05-21 | 2009-05-21 2019-05-21 Series Name Mean = 1071 06 Medan = 943 Left = 1200 (69 4%) Middle = 11% Right = 1500 (19 ... Current STUDY 2019-05-21 COMBO_atc Volume 1942 50 cm3 , Abs. Frequency Mean = 919.62 Median = 853 Left = 1200 (85.6%) Middle = 8% Right = 1500 (6 4%) Prior 01 Series Name 690D COMBO Latest Min/ Max:.0.00 /3646.00 2019-05-21 Ftest 23 MAna FRM Mean/SD: 1006.83 /402.58 MI, WhokBody 2019-05-21 10. A ISTOGRAMLTYON LIVO MR, WholeBody MP FUSION 10cm 10 .. & HISTOGRAMLTVOI LZVOI MPR 10 .. : Result series: MR. Oncology. A SPC DIR TP H207 14 ... Results MM Oncology Read. SP A31 8 a 50.00% MPR THICK: 120'139 CKS_t1_mprage sag_p2_isc 120132 1.W 4008 A154R Coo 104 BO2,3,SP5,6 W 2331 ACI IC 2099 ez 650 800/ 90 C 500 750 1000 1250 1500 1750 2000 2250 2500 12_tse_tra_02_512 104 _ca rip 103 104 _csa mpr + COM2 8900 COVOO 103 _mpr WholeBody_1000000 WholeBody_10000:03 103 _projection L. 10000:00 Agra 10000003 . COMP_6900 COMBO 41 12_haste_tra_p3_ct 2019-01-03 12098- 2019-01-03 + COMP_12_tse_dicon_cor_3. STUDY 2019-01-03 COMBO_arc + COMP t2 tse dieon cor 3. 600D COMBO Latest + CHIMP (2 be don cor Latest 31 MAna Volume 2538.06 cm3 Min / Max. 0.00/2944.00 + CTIME COMBO . COMP t2 tse_dicon_cor 3. R R Mean/SD. 817 84 /313.00 PAN DI MR.HISTOGRAMSEGMENT . COMP_12_tse_dicon_cor_3. MP FUSION tecm MPR TIWE . COMP COMEO SL 16 . COMP_COMED_adc A SPC 16 TP H218 SPA11 ? 101 TIN FO 0 50.00% 120g*132 120132 Cor 114 BRAIN_12_dirm_tra_dark-flu 214 | W 4095 AISIRPFP W 2395 11 250 500 750 1000 BO3,5P5-7 1250 1500 1750 2000 2250 2500 100 ADD 511 512 1 Overlaid Histogram & Backmapping Overlaid Histogram 17 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 SIEMENS Healthineers MR Oncology OncoTrend 18 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 OncoTrend SIEMENS Healthineers Overview and Background (1/3) • ADC-based whole-body tumor burden assessment and trending. • Efficient and reproducible workflow with quantitative results. • Intuitive back-mapping of active disease and responsive areas on the whole-body DWI images helps oncologists to understand the complex MR information. • This can help in standardization of whole-body MRI for High b-value treatment response and monitoring of bone disease in particular based on diffusion-weighted images. L1VOI ADC 50 900 WI COMBO Mean = 719.62 Median = 655 Left = 1055 (92.4%) Middle = 4.1% Right = 1400 (3.5%) Rel. Frequency (%) 10 00 7 4 ADC 250 500 750 1000 1250 1500 1750 2000 2250 2500 Intensity MR OncoTrend, MR Segmentation, PET MR reading requires an additional license. 19 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 OncoTrend SIEMENS Healthineers Overview and Background (2/3) With OncoTrend, you can analyze the trend of current and prior studies by applying segmentation to the whole-body diffusion data. For the OncoTrend evaluation, you need diffusion-weighted images (DWI) with ADC maps and b-value images for both the High b-value prior and current studies. L1VOI ADC_050 900 WI COMBO Mean = 719.62 Median = 655 The segmentation is performed on the b-value images and Left = 1055 (92.4%) Middle = 4.1% Right = 1400 (3.5%) Rel. Frequency (%) 10 projected onto the ADC maps used for the histogram calculation. ADC 250 500 750 1000 1250 1500 1750 2000 2250 2500 Intensity MR OncoTrend, MR Segmentation, PET MR reading requires an additional license. 20 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 OncoTrend SIEMENS Healthineers Overview and Background (3/3) Click the OncoTrend icon on the Case Navigator. The OncoTrend layout opens. The upper segments are used for the current study, the lower segments for the prior study. The toolbar below the image segments provides the controls used for the evaluation. The workflow of the evaluation is represented by the order of the controls. High b-value If necessary, load the images into the corresponding segments. Load the L1VOI ADC_050 900 WI COMBO Mean = 719.62 Median = 655 b-value images into the first (left) segment and the ADC images into the second Left = 1055 (92.4%) Middle = 4.1% Right = 1400 (3.5%) Rel. Frequency (%) 10 segment. If necessary, calculate the b-value or ADC images by using the Analysis Tools from the lower right corner menu. Select the b-value images of both time points in the left segments and click the ADC 250 500 750 1000 1250 1500 1750 2000 2250 2500 Intensity Create Segmentation icon. Segmentations are performed and shown as a color overlay in the corresponding b-value image (displayed in MIP mode). MR OncoTrend, MR Segmentation, PET MR reading requires an additional license. 21 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 OncoTrend SIEMENS Healthineers Icon, Layout and In-Segment Controls OncoTrend icon - Navigates directly to the H MR Oncology Q+ CURRENT CURRENT OncoTrend layout. MR Oncology Reading 11/10/2016 11/10/2016 11:52:58 AM 11:52:58 AM 24 IMAna FRECp Colfer Layout loads high b-value and ADC series by CUIRE HRHISTOGRAMSEOKENT • 10cm default. Reading A Viewing SP P24.0 SP P24.0 TR 8580 0 TR $580.0 • The required b-value series could also be TE 59.0 FOV 605*848 TE 59.0 FOV 895-848 X KIP p2 DIFFA MIPR THICK 02 DIFFIADOR computed using the Calculated ADC & b- ‹ Findings Prior 01 Prior 01 value tool. 9/29/2016 9/29/2016 Oncology 09 2d_@ T_550 010 0:54:44 AM 0 54:44 AM 27 IMAna FRMIO R Prior 01.KR HISTOGRAMSEGMENT In-segment area 10cm A GP .AS D Tools TR 6720 0 TR L720.0 BL 1 7 TE 57.0 FOY 821 795 TE 57 0 FOV 821 195 The controls for the OncoTrend workflow are KIP: p2 DIFF NPR THICK : 02 DI-FADO • available in the in-segment area of the Threshold Segmentation Refinc Histogram Statistics Overlay Activate Windows @ Guidance Go to Settings to activate Windows. Saneshat Plint Export Undo OncoTrend Layout. MR OncoTrend, MR Segmentation, PET MR reading requires an additional license. 22 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 OncoTrend SIEMENS Healthineers Threshold-Based Segmentation Create Segmentation MR Oncology Q + test 10.11.2016 2 MR Oncology Reading 123 CURRENT CURRENT STUDY 11/10/2016 epo diff b50.300 tra COMP • Creates threshold-based segmentation in MPR or MIP Follow Up 11/10/2016 11.52:58 AM SPP24.0 1 BPP24.0 view. R Ore Trend • Per default, the segmentation mask is created on 10cm Reading A calculated b-value images. Viewing 9 50 00% MP FUSION TR 9580 0 4096 × TE 50.0 2048 Edit Threshold Prior 01 - Findings 9/29/2016 Oncology • The threshold can be changed using the twin slider. MR Oncology 3 0:54:44AM L3 471.4 ... Current • The mask gets updated automatically, based on the R changed value. • Default lower threshold value: 100. SP.A5.0 Tools TR 8720 0 TE 57.0 FoV 821-795 MIP : p2 DIFF All Custom Lunes Timepo Threshold Segmentation Refine Edit Lapost Storstat Print Boot Undo 558 2:48 PM MR OncoTrend, MR Segmentation, PET MR reading requires an additional license. 23 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 OncoTrend SIEMENS Healthineers Refine Segmentation (1/2) Areas with naturally high signal intensity that MR Oncology Q + are not metastasis, e.g., brain and kidneys, must MR Oncology Reading test_10.11.2016_2 123 be excluded from the calculation. CURRENT | CURRENT Follow Up STUDY 11/10/2016 ep2d_diff 650 800 tra COMP 11/10/2016 11.52.59 AM Onto Trend SP P240 | SPP24.0 The mask can be refined using the Punch tool: Reading Viewing X • The Punch tool can be applied in both MIP R and MPR view. Findings 10cm Oncology • In MIP view, the ROI is removed from the MR Oncology 3 L3 Current MR Oncology 4 whole volume. L4 1379.4 9/29/2016 A • In MPR view, the ROI is removed only from a 50:00% MP FUSION the visible slice. TR 8580 0 218 4096 TE 59.0 77 2048 Tools .Remove Insite Remove Outside Lines Timepo Threshold Segmentation Dafne Histogram Statistics Overlay GuidanceIV Go to Shopshat Print Indo KU 100 ¢ 573 % :07 PM MR OncoTrend, MR Segmentation, PET MR reading requires an additional license. 24 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 OncoTrend SIEMENS Healthineers Refine Segmentation (2/2) CO CO Remove Inside . Remove Inside . Remove Inside Remove Inside Refine Reset Refine Reset Remove Outside X Refina Reline Reset Remove Outside Segme Remove Outside Segme ... Segme Segme Reset Remove Outside Segme. Segme MR OncoTrend, MR Segmentation, PET MR reading requires an additional license. 25 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 OncoTrend SIEMENS Healthineers Display Histogram MR Oncology L3VOI ep2d_diff b50 800 tra_ADC_COMP bost_10.11.2010 2 Mean = 1274:24 Madian = 1070 123 Let = 1210 (62.1%) Middle = 16.5% Right = 1500 (21 4%) MR Oncology Reading CURRENT CURRENT |CURRENT 11/10 0016 el. Frequency (% 10 STUDY 11/10/2016 HOME • Select the Histogram icon and the ep20_diff b50800 tra COMP 11:5258AM 11/10/2016 24 Mana FRAna Vilomme Follow Up 11:52:50AM Colles Fagmen segment where the histogram should SP P79 3 1 5P @79.3 R be displayed. Onco Trond The mask is copied to the ADC image Reading OB Viewing 0 50.00% SPP79.1 Mario UIP FUSION TR 85800 and the corresponding VOI histogram is TR 8580 0 4096 TE 590 FO/426'559 0 250 509 750 1010 1259 1500 1750 2008 2290 2500 X TE 59.0 2048 MER THICK D. GIFRAADC Ertensty computed. test 29.09.2016 1 123 Prior 01 09 Findings Prior 01 | Prior 01 9/29/20 16 Oncology STUDY 9/29/2016 ep2d_dm 650 800 Select OK. The histogram is created and MR Oncology 3 ep2e din b50.000 tra comp 85 • L3 267.9 . Current 9/29/2016 27 MMAna FREDe 8:54:14 AM MR Oncology 4 SP A5 0 1 SPA5 0 the backmapping is applied LA 1379.9/29/2016 R R Prior 01.KR HISTOGRAMSEGMENT automatically to the high b-value image. 0 50.00% SP A5.0 Tools MIP FUSION TR 67200 9L 1.7 TR 6720 0 4096 TE 57-D TE 57.0 2048 MIPR THICK: 02 Allen Text Crashes Uines mepo Threshold Segmentation Refine Histogram Statistics Overlay Guidancetiv A Go to Snapshot Print Boot Image Ungo n' come 100 % 573 :10 PM MR OncoTrend, MR Segmentation, PET MR reading requires an additional license. 26 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 OncoTrend SIEMENS Healthineers Backmapping Projection Modes Focus visualization to regions of response vs. regions of active disease. High Value Low Value The backmapping display in the b-value images can High be toggled between High Value and Low Value. Value High Value: MIP – Regions of therapy response (higher ADC) are visualized with higher priority. Threshold Segmentation Refine Display Histogram Statistics III Low Value: MinIP – Regions of remaining tumor Create Punch Histogram Show High Value Segmenta .. 30 165 Statistics T burden (lower ADC) are visualized with higher priority. MR OncoTrend, MR Segmentation, PET MR reading requires an additional license. 27 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 OncoTrend SIEMENS Healthineers Histogram Statistics Quantification of the histogram Histogram Statistics ? X • Compare up to three histograms using the Description Histogram L2 VOI Histogram L1 VOI Difference Show Statistics icon. Volume 146.54 1057.48 910.94 Mean 1250.8 719.62 -531.18 If only two histograms are selected, the StdDev 445.71 • 260.68 -185.03 Median 1292 655 637 difference in the values is computed 5% 567 469 -98 95% 710 and displayed. 1937 1227 Skewness 0.01 2.57 2.56 E. Kurtosis -0.96 9.9 10.86 %Left 35.9 92.4 56.5 %Middle • Snapshot of the Histogram Statistics table 22 4.1 17.9 %Right 42.1 3.5 -38.6 can be saved for PACS. Export Snapshot • CSV export of the table is supported. Close Threshold Segmentation Refine Display Histogram Statistics n Create Punch High Histogram Show Value Segmenta 30 146 _ Statistics MR OncoTrend, MR Segmentation, PET MR reading requires an additional license. 28 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023 SIEMENS Healthineers Please note this learning material is for training purposes only. For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Please note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. © Siemens Healthcare GmbH 2023 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Telephone: +49 9131 84-0 siemens-healthineers.com 29 Effective Date: 24 Feb 2023 | HOOD05162003335471 Unrestricted © Siemens Healthineers, 2023