CT Protocols: (Brain, ENT, Spine, Vascular) - Department of Radiology
CT Protocols: (Brain, ENT, Spine, Vascular) - Department of Radiology CT Protocols: (Brain, ENT, Spine, Vascular) - Department of Radiology
136 Revised 7/22/09 (Gentry/Ranallo) o. You must straighten the Axis line by grabbing the boxes at either end to split the brain into two equal hemispheres. p. After you have done this, hold the control key down and click on all ROI’s and the axis line. This will turn them all green. Go back to the symmetry button and there is a little black tab, open that and click on that button. This will place the ROI’s on the left side. Now you are ready to film. q. In the upper left port, right mouse click and save view. r. In the upper right port go outside yellow box and right mouse click and save view. After doing that there are some numbers in red at the top and bottom left of the grid. Grab the numbers at the top and middle mouse scroll to the left. This should move your 1 and 2 graph up and out of the yellow box and bring the ROI’s you just created up in view. If it doesn’t, you can also grab the numbers at the bottom and bring them up. Once they are in view right mouse click and click on multiple graphs. This will show them in a nice graph. s. Go out of the yellow box again and save view. t. Place your cursor in the lower right port and on your keyboard hit the key with the (?/). This will bring up all 4 views at once. Now you can film them in order without having to change each one. Film Mean Transit Time first, then Blood Flow, Blood Volume, and Permeability Surface. u. Go Back up to your upper left port and hold down the control key and click on your ROI’s to turn them green. Hit CTRL-C to copy. Go to the image location and right mouse click to go to the next level. This will take a minute to process. Once it is done, Hit CTRL-V to paste or you can also use the right click menu. v. Now all ROI’s will be in the same spot as before. You may need to move them just a hair if they get too close to bone or a big blood vessel but otherwise try to leave them in the same spot. w. Now repeat all filming. Upper left port first, upper right port next, Mean Transit Time, Blood Flow, Blood Volume, Permeability Surface. This time when you finish you just click on the next level. You don’t need to copy again because you have already done it once. If you move them a lot you will need to make them green again and recopy. When you get to the third level, CTRL-V or right click to paste your ROI’s, adjust them if necessary, then film. x. After you have done all four/eight levels, click on film/save. Choose Functional Data and hit save. This will bring up a graph to the right called functional data. Click next until the button goes gray, and go back to the film/save box and click save again. y. Now you can exit and go back to the patient list. Send to ALI-STORE. 1. CTRL-C copy 2. CTRL-V or right click menu to paste 3. CTRL-X cut 4. CTRL and click to make ROI’s green
137 Revised 7/22/09 (Gentry/Ranallo) Vitrea: CT Perfusion Post Processing Protocol a. Go to PACS and choose perfusion series. b. Right click 3D and choose “View selected series in Vitrea 3D”. This will launch Vitrea and may take a few minutes. c. When perfusion comes up, it will be auto-selecting your artery and vein. The amount of time it takes will show on the task bar at the bottom of the screen. You need to check the placement of both vessels. Before you do this check for rotational motion. If there is motion click on motion correction. This should help unless the patient picked up their head completely. If no motion proceed with checking artery and vein placement. If you are happy with the vessels selected, click compute. If not scroll to your alternate location and left click to draw oval over the new artery. Click artery button. Do the same for the vein. These do not have to be on the same slice. After you have manually selected vessels click compute. d. You will now have your 4 main images – grey scale, blood volume, blood flow and mean transit time. Scroll to first image and check axis line for centering. If it needs adjusting, do so. e. Click on ROI Templates, choose the one that has square ROI’s all around periphery and 2 oval ROI’s in the center. Tight fit which is the box directly below this, should be checked. There is no need to adjust ROI’s. If you want to make them bigger, you can change the thickness. Default thickness is 15 mm and default count of ROI’s is 12. f. You are done except for screen saving images. g. Click on the camera (snap) or hit S on the keyboard. This activates the camera. Hold down the control key and left click in the grey-scale port (upper left hand box). Do this for all levels. On the bottom left task bar click back to HRS. Export all. Helpful hints: a. Wheel-roll the wheel in the middle of the mouse to go up and down levels. b. Window/Level-Click on the window/level button in the upper left hand side of the machine and left click with your mouse to change w/l. you MUST change back to ellipse when done. c. To delete something click on it to make it purple and hit delete on the keyboard. d. To screen save images-click on camera (snap) or hit S on the keyboard, hold down ctrl and left-click. This will save all four images as long as you are in upper left hand port.
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137 Revised 7/22/09 (Gentry/Ranallo)<br />
Vitrea: <strong>CT</strong> Perfusion Post Processing Protocol<br />
a. Go to PACS and choose perfusion series.<br />
b. Right click 3D and choose “View selected series in Vitrea 3D”. This will launch Vitrea and<br />
may take a few minutes.<br />
c. When perfusion comes up, it will be auto-selecting your artery and vein. The amount <strong>of</strong><br />
time it takes will show on the task bar at the bottom <strong>of</strong> the screen. You need to check the<br />
placement <strong>of</strong> both vessels. Before you do this check for rotational motion. If there is<br />
motion click on motion correction. This should help unless the patient picked up their head<br />
completely. If no motion proceed with checking artery and vein placement. If you are<br />
happy with the vessels selected, click compute. If not scroll to your alternate location and<br />
left click to draw oval over the new artery. Click artery button. Do the same for the vein.<br />
These do not have to be on the same slice. After you have manually selected vessels click<br />
compute.<br />
d. You will now have your 4 main images – grey scale, blood volume, blood flow and mean<br />
transit time. Scroll to first image and check axis line for centering. If it needs adjusting, do<br />
so.<br />
e. Click on ROI Templates, choose the one that has square ROI’s all around periphery and 2<br />
oval ROI’s in the center. Tight fit which is the box directly below this, should be checked.<br />
There is no need to adjust ROI’s. If you want to make them bigger, you can change the<br />
thickness. Default thickness is 15 mm and default count <strong>of</strong> ROI’s is 12.<br />
f. You are done except for screen saving images.<br />
g. Click on the camera (snap) or hit S on the keyboard. This activates the camera. Hold down<br />
the control key and left click in the grey-scale port (upper left hand box). Do this for all<br />
levels. On the bottom left task bar click back to HRS. Export all.<br />
Helpful hints:<br />
a. Wheel-roll the wheel in the middle <strong>of</strong> the mouse to go up and down levels.<br />
b. Window/Level-Click on the window/level button in the upper left hand side <strong>of</strong> the machine<br />
and left click with your mouse to change w/l. you MUST change back to ellipse when<br />
done.<br />
c. To delete something click on it to make it purple and hit delete on the keyboard.<br />
d. To screen save images-click on camera (snap) or hit S on the keyboard, hold down ctrl<br />
and left-click. This will save all four images as long as you are in upper left hand port.
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