AW StartMap 4.0

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GE Healthcare

AW - StarMap™ 4.0

Operator Manual

AW- StarMap™ 4.0

Operator Manual, English

5310243-300

Revision 2

© 2008 General Electric Company

All rights reserved.

Rendered PDF File Page 2 of 61 DOC0475625,



5310243-300 Rev. 2 (09/08) © 2008 General Electric Company. All rights reserved

Medical Device DirectiveThese products conform with the requirements of council directive 93/42/EEC concerning medical devices, whenthey bear the following CE Mark of Conformity:

European Representative:

GE Healthcare S.C.S

Quality Assurance Manager

283 rue de la Minière

78530 BUC France

Telephone: +33 1 30 70 40 40

This equipment generates, uses, and can radiate radio frequency energy. The equipment may cause radiofrequency interference with other medical and non-medical devices and radio communications. To providereasonable protection against such interference, the:

GE MR Systems

comply with emissions limits for (Group 2, Class A) Medical Devices as stated in EN 60601-1-2. However, there isno guarantee that interference will not occur in a particular installation.

If this equipment is found to cause interference (which may be determined by turning the equipment on and off),the user (or qualified service personnel) should attempt to correct the problem by one or more of the followingmeasures:

• reorient or relocate the affected devices;

• increase the separation between the equipment and the affected device;

• power the equipment from a source different from that of the affected device; and/or

• consult the point of purchase or service representative for further suggestions.

The manufacturer is not responsible for any interference caused by using interconnect cables that are not

recommended or by unauthorized changes or modifications to this equipment. Unauthorized changes ormodifications could void the user’s authority to operate the equipment.

Do not use devices that transmit RF Signals (cellular phones, transceivers, or radio controlled products) in thevicinity of this equipment as they may cause performance outside the published specifications. Keep the powerto these types of devices turned off when near this equipment.

The medical staff in charge of this equipment is required to instruct technicians, patients, and other people whomay be around this equipment to fully comply with the above requirement.




ii

5310243-300 Rev. 2 (09/08) © 2008 General Electric Company. All rights reserved.

Immunity/Emissions Exceptions: Note the exceptions from the EMC test results. Check with the business EMCengineer for this information.

In accordance with the international safety standard IEC 601-1, this system is a Class I device, acceptable forContinuous Operation, having ordinary protection against ingress of water with type B applied parts and is not foruse in the presence of flammable anesthetics.

CAUTION: This symbol indicates that the waste of electrical and electronic equipment must not bedisposed as unsorted municipal waste and must be collected separately. Contact anauthorized representative of the manufacturer for information concerning the

decommissioning of your equipment.




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5310243-300 Rev. 2 (09/08)© 2008 General Electric Company. All rights reserved.

Chapter 1: Safety Information

Introduction.................................................................................................................................. ......... 1-1Equipment Hazards.............................................................................................................. ..... 1-1Indications for Use ..................................................................................................................... 1-2Safety Notices .............................................................................................................................. 1-2

Chapter 2: Getting Started

Launching StarMap.............................................................................................................. .............. 2-1Quitting StarMap........................................................................................................................ ......... 2-2

Chapter 3: AW StarMap Windows

Introduction.................................................................................................................................. ......... 3-1Main Image Viewer ............................................................................................................................ 3-2

Procedure....................................................................................................................................... 3-4Quick Keys for Image Manipulation.............................................................................. 3-4

Image Viewer Menu Bar .................................................................................................................. 3-5

File Menu: New - Creating a Custom Series................................................................... 3-7Create a Custom Series Procedure ............................................................................... 3-7File Menu: Edit - Defining User Preferences ................................................................... 3-9

Report Layout Tab.............................................................................................................. ... 3-9Report Layout Procedure................................................................................................... 3-9Measurements Tab.............................................................................................................3-10Measurement Procedure .................................................................................................3-11Appearance Tab...................................................................................................................3-11Appearance Procedure.....................................................................................................3-12Users Tab.................................................................................................................................3-12Generating Users Procedure..........................................................................................3-13

Creating a New User.......................................................................................................3-13

Memory & Files Tab ............................................................................................................3-14Setting Memory and File Options Procedure..........................................................3-14

Report Window .................................................................................................................................. 3-15Report Window Icons..............................................................................................................3-16User Defined Parameters......................................................................................................3-17

Procedures..............................................................................................................................3-17Adding a customized parameter .............................................................................3-17Removing a customized parameter .......................................................................3-18Report Sign-off .................................................................................................................3-19Reviewing a Signed-off Report .................................................................................3-20

Browse Database Window...........................................................................................................3-21Browser Procedures................................................................................................................3-23

Viewing Exams in StarMap..............................................................................................3-23Exam in the AW database but not in StarMap database Viewer list. .... 3-23

Procedure for Removing Exams in the StarMap Database Viewer..............3-23

Chapter 4: StarMap Procedures

Description.................................................................................................................... ................. 4-1Considerations............................................................................................................................. 4-4

Procedures ............................................................................................................................................. 4-5

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5310243-300 Rev. 2 (09/08)© 2008 General Electric Company. All rights reserved.

Setting up Preferences ....................................................................................................... 4-5Define an ROI .................................................................................................................. ......... 4-6Select the Appropriate Series for Liver Analysis...................................................... 4-7Create a Myocardium Colormap.................................................................................... 4-8Create a Liver Colormap..................................................................................................... 4-9Analyze the T2* Curve.......................................................................................................4-10

Final Report.............................................................................................................................4-11

Chapter 5: Structured Reporting

Introduction.................................................................................................................................. ......... 5-1Description.................................................................................................................... ................. 5-1Notes tab ........................................................................................................................................ 5-2Macro Config window............................................................................................................ ... 5-3Considerations............................................................................................................................. 5-4

Chapter 6: Data Exporting and Archival

Introduction.................................................................................................................................. ......... 6-1

Description.................................................................................................................... ................. 6-1Exporting with Non-StarMap Data Procedure.............................................................. 6-3Exporting StarMap Data and Reader Procedure ........................................................ 6-4Archival Process .......................................................................................................................... 6-4

Procedure for PACS Archival & Viewing Feature for Cines and Report ........ 6-5Creating DICOM Cines ...................................................................................................... 6-5

Creating DICOM Reports..................................................................................................... 6-6


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Chapter 1

Safety Information

IntroductionPlease refer to the MR Safety Guide (direction number 2381696), which describes safety information you and the

physician must understand thoroughly before you begin to use the system. Note that you can find additionalsafety information throughout your Learning and Reference Guides and MR operator manual. If you needadditional training, seek assistance from qualified GE Healthcare personnel.

The equipment is intended for use by qualified personnel only.

Federal Law restricts this device to sale, distribution and use by or on the order of a physician.

This device is limited by Federal Law to investigational use for indications not in the Indications Statement.

Make sure all of your Learning and Reference Guides and operator manuals are readily available at all times. Besure to review the procedures and safety precautions periodically.

Product identification labels (ratings) can be found on the tops and sides of the cabinets, the rear of monitors, andother exterior surfaces on the equipment. In the event you are unable to identify these labels, contact yourservice personnel.

Equipment Hazards

CAUTION: Using equipment that is damaged or has been compromised can put thepatient and/or you at risk of injury.

CAUTION: The MR system applications run on equipment that includes one or more harddisk drives, which may hold medical data related to patients. In some countries,such equipment may be subject to regulations concerning the processing of personal data and free circulation of such data. It is strongly recommendedthat access to patient files be protected from all persons not in medicalattendance.




Safety Information

Introduction

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Indications for Use

The GE StarMAP Software Option for AW is an analytical software tool that provides reproducible tools for thereview and reporting of medical images.

StarMAP can import medical images from a medical imaging device and display them in a viewing area on thecomputer screen. The viewing area allows access to multiple studies and series of multi-slice, multi-phaseimages. Multi-phase sequences of images can be displayed in cine mode to facilitate visualization.

A report input interface is also available. Measurement tools on the report interface make it possible to quicklyand reliably fill out a complete clinical report of an imaging exam. Available tools include: point, distance, area,and volume measurement tools such as ejection fraction, cardiac output, end-diastolic volume, end-systolicvolume, and volume flow measurements.

The results of the measurement tools are interpreted by the physician and can be communicated to referringphysicians.

When interpreted by a trained physician these tools may be useful in diagnosis.

NOTE: Only GE MR images are supported for analysis.

Safety Notices

The following safety notices are used to emphasize certain safety instructions. This guide uses the internationalsymbol along with danger, warning, or caution message.

DANGER: Danger is used to identify conditions or actions for which a specific hazard is known to exist whichwill cause severe personal injury, death, or substantial property damage if the instructions areignored.

WARNING: Warning is used to identify conditions or actions for which a specific hazard is known to exist whichmay cause severe personal injury, death, or substantial property damage if the instructions areignored.

CAUTION: Accurate placement of measurements is critical to the results.

CAUTION: Caution is used to identify conditions or actions for which a potential hazard isknown to exist that will or can cause minor personal injury or property damageif the instructions are ignored.




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Chapter 2

Getting Started

Launching StarMapStarMap can be launched by selecting the exam/exams to be analyzed in the AW browser, then clicking on

StarMap in the Application panel in the browser. Once StarMap is started, more exams can be added for analysisby choosing the Browse Database option in the File menu as described in “Browse Database Window” section inChapter 3.




Getting Started

Quitting StarMap

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To start the StarMap Tool on a Windows system, complete the following steps:

Quitting StarMapTo quit the StarMap Tool on any system, complete the following steps:

Table 2-1

Windows system Key

Select StarMap fromthe Applications list

Single left-click

Table 2-2

Step Window/ICON

1. Go to Main Menu Bar

2. Select FILE

3. Select Quit




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Chapter 3

AW StarMap Windows

IntroductionThe StarMap Application has two main windows, the Image Viewer and the Reporting Interface. The main menu

bar of the application is located in the Image Viewer. The Image Viewer is the only required window. It is possibleto hide the Report Interface window by selecting window under the main menu bar or by performing a Ctrl-R.

Figure 3-1 Image Viewer window with Image Viewer Interface to the right of the window. 1 = Main Image Viewer, 2 = Reporting Interface.

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Main Image Viewe

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Main Image ViewerThe Main Image Viewer provides quick access to patient exams for review and analysis.

Figure 3-2 Image Viewer.

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4

5 6 7 8 9 10 11 12 13 14 15




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Main Image Viewe

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Table 3-1 Image Viewer items.

No. Item Description/Procedure

1. Main Menu BarThe following items are on the Main Menu bar: File, Edit, Tools, View, Window,and Help. See “Image Viewer Menu bar” on page 3-5, for details.

2. Exam tab Click the Exam tab to view a listing of patient exams.

3. Series tabClick the Series tab to view a listing of each series under a patient exam. Eachseries can be quickly accessed by clicking on the desired series for viewing.

4. Main image viewer Allows for viewing of images of each series within the patient exam.

5. Number of columnsAllows for the user to select the number of columns in the image viewer. Thenumber of rows is then automatically set.

6.

Scope

This defines how changes to view settings in one sequence (series of imagesin one view port which can be played as a movie) are propagated to the otherimages in the view. The choices are:

• All: The setting changes made on the sequence are also propagated to allother sequences in the view.

• Current to End: The setting changes made on the sequence are alsopropagated to all sequences that follow in the view.

• Current only: The setting changes are not propagated to other sequences.

7. These icons rotate the image in 90 degree increments clockwise (right) orcounter clockwise (left).

8. These icons flip the image in the direction of the arrow: horizontal arrow flipsthe image to the left/right, and vertical arrow flips the image up/down.

9. Cine or animation control buttons: Cine loops can be controlled with thefollowing buttons, from left to right:

• Skip to first phase.

• Skip to previous phase.

• Play/Pause. This button can also be toggled with the space bar.

• Skip to next phase.

• Skip to last phase.

10. Frame rate Changes frame rate of cine images. 20 FPS is the default.

11. Frame display rangeUse this field to type in the desired start frame and end frame for a cine

image.12. Image Tools from left to right:

• Hand Tool: This tool is used to drag and drop images when adding imagesto a report or creating a custom series.

• Line Tool: This tool is used to make distance measurements on an image.

• ROI tool: This tool is used to make area measurements on an image.

• Cross Hair tool: This tool is used to sample single pixels in an image.

• Label tool: This tool is used to insert label annotations on an image.




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Main Image Viewe

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Procedure

Quick Keys for Image Manipulation

Modifier Keys are keyboard short cuts that allow for quick access to image viewing functions. The Image Zoom orScale, Rotate, Flip, Pan, and Window/Level can be reset to the original display state by performing a right-clickdirectly on the Main Image Viewer and choosing Reset Display from the menu.

Table 3-2 Linux keyboard short cuts.

13.Click on this icon to review a cine as a flat panel display.

14. Refresh Click to update the Image Viewer with newly networked images.

15. Slider Bar Allows full viewing of Image Viewer by scrolling.

Function Action

Image Zoom Press Ctrl + left-click then drag.

Rotate image Press Ctrl + Shift + left-click then drag.

Image pan Press Shift + left-click then drag.

Window/Level Left-click then drag

Hide text and measurements Press Ctrl + T. Press Ctrl + T again to reset function.

Open Custom Series Editor Press Ctrl + N.

Open Database Browser Press Ctrl + O.

Start exporting function Press Ctrl + E.

Open/close Reporting interface Press Ctrl + R.

Print report Press Ctrl + P.

Reset DisplayRight click on the image in the Main Image Viewer, then chooseoption from menu.

Display Scan ParametersRight click on the image in the Main Image Viewer, then chooseoption from menu.

Quit StarMap Press Ctrl+Q.

No. Item Description/Procedure




AW StarMap Windows

Image Viewer Menu Ba

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Image Viewer Menu BarThe Image Viewer menu bar provides access to a number of functions.

Figure 3-3 Image Viewer menu bar.

Table 3-3 Image Viewer menu bar selections.

MainMenu

Sub Menu Description

File

New Click [New] to create a new custom series.

Browser DB

(database)

This menu displays the database browser.

ExportThe Export menu allows for exporting files related to the current exam tothe local database or optical media. This allows for distribution to referringphysicians.

Save Cine-DICOM

On selecting this option each phase of the series currently being viewedwill be saved as secondary capture images and will be saved as aseparate series called RC Cine series_description under thepatients series listing on the main AW browser. The original series namewill be appended to this new series.

Save Report-DICOM

Saves a copy of the report as a DICOM file under the patient series listing.

ExportPreferences

Selecting this option saves all user preferences and macros to CD.

ImportPreferences

Selecting this option allows for the restore of user preferences andmacros.

PreviewReport

Click [Preview Report] for a preview of the formatted report. Printing of the current exam can be performed by clicking [Print] from the Previewwindow.

Print Report The Print menu allows for printing the report of the current exam.

Save Analysis Selecting this option allows the user control of saving all analysis.

Quit Click [Quit] to exit the application.




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Edit

Undo Only implemented for window level, pan, zoom, fl ip vertical and horizontal.

Redo Only implemented for window level, pan, zoom, fl ip vertical and horizontal.

UnselectUnselects selected viewports in Main Viewer. Removes the red framearound the image.

Select AllSelects all viewports in Main Viewer indicated by a red frame around theimage.

Preferences Click [Preferences] to open the Preferences editor.

Tools

Window/Level Sets the Window/Level for the selected Viewports.

Pan Sets the pan offset (x,y) for the selected Viewports.

Zoom Sets the zoom or scale factor for the selected Viewports.

Flip Flips the image either horizontal or vertical for a selected image.

Rotation Rotates the images by typing in the number of degrees.

Database Click [Database] to open the Database interface.

ViewHide/Showannotations

Click [Hide/Show annotations] to toggle on and off the visibility of theimage annotations in the viewer. This applies to the entire application.

WindowHide/ShowReport

Click [Hide/Show Report] to toggle on and off the visibility of the reportinginterface.

Help

OperatorDocument

Allows access to the operator documentation.

AboutStarMap

Click [About StarMap] to display the software version.

Table 3-3 Image Viewer menu bar selections.

MainMenu

Sub Menu Description




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File Menu: New - Creating a Custom Series for Viewing Purposes

The custom series editor is used to create a new custom series that can contain images from other series withinthe same exam or from other exams for viewing purposes. A new custom series can be created in the currentexam by selecting File > New.

The images to include are chosen by dragging them from the image viewer into the Custom Series View EditorWindow. The editor also contains fields for labeling the new custom series and setting the number of columns.Including an image by dragging on it implies that all phases of that particular slice are included in the customseries. Hence the custom series can be played in cine mode.

WARNING: Creation of a new series should be for viewing purposes only. All analysis should be performed onthe original series within the exam for correct results.

Create a Custom Series Procedure

1. Select the application. From the Main Image Viewer menu bar select File > New. • The Custom Series Editor window appears in the bottom right-hand corner of the screen.

• The cursor changes to a hand icon.




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2. Select an image. Drag the desired image from the Main Viewer to the Custom Series Editor window.

• The drag mode is automatically selected when New is selected and the Custom Series Editor windowappears.

• Image(s) from a different series within the exam can also be placed into the Custom Series Editor window.

• Image(s) within a series from a different exam number can also be placed into the Custom Series EditorWindow.

CAUTION: User accepts responsibility for mixing series from different patient exams and should label thecustom series accordingly.

3. Enter data in Custom Series Editor window.

• Type a name in the label field. The new series label will appear with the letter C and a number. For example,C1 for the first custom series.

• Select a column value if you want to change the number of columns in the Editor.

Figure 3-4 1 = label field, 2 = column field.

4. Click [OK] to close the Editor and create a new series.

5. To delete an image from the custom series, click the image and press the Delete key. Deleting all of theimages from the custom series deletes the entire custom series from the series l isting.

Considerations

• The creation of a new series may be useful for comparing images from a current patient exam withimages from a prior exam for that same patient.

• The new series that is created is available for viewing only within the StarMap application within that examA new series can be saved as a DICOM file using File > Save Cine DICOM and exported using the Exportoptions.




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File Menu: Edit - Defining User Preferences

Selecting [Preferences] from the Edit menu on the Image Viewer menu bar displays a window with the followingtabs:

• Report Layout

• Measurements• Appearance

• Users

• Memory & Files

IMPORTANT!:It is advisable to set up user preferences prior to analyzing the first case to be reported. Changesmade to preferences do not take effect until a new exam is started.

Report Layout Tab

The Report Layout tab allows entering site information that will appear on the patient report. A site logo can beselected for the report by clicking on the Set button in the Report Layout tab and choosing a logo f ile from fileexplorer GUI in a compatible file format, i.e. jpeg, png, or gif.

Figure 3-5 Report Layout tab.

Report Layout Procedure

1. From the Main Image Viewer menu bar, click Edit > Preferences. Click [Report Layout] to display the tab.

2. Place the cursor in the desired field and enter information. The title, address, and logo will appear on thereport. To omit this information from the report deselect the “Use field values below in Report”. This will takeeffect for all patient reports that are printed.




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3. Click [Save] to store your entries and close Preferences. Note: some values are pre-filled.

• Click [Cancel] to exit the window without accepting any changes.

Measurements Tab

The Measurements tab allows you to set the range of normal values for cardiac analysis and customizeparameters to be printed on the report for all patient reports that are generated.

Figure 3-6 Measurements tab. 1 = template menu, 2 = template browser area.

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2




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Measurement Procedure

1. From the Main Image Viewer menu bar, click Edit > Preferences. Click [Measurements] to display the tab.

2. Select the desired Report Template from the pull-down menu (1). Currently, there is only 1 template available

3. Click the desired level from the template browser area (2).

4. Enter the appropriate values in the range fields.

5. All modified values can be reset to the original values by clicking on [Reset All to Default Values].

6. Click [Save] to store your entries and close Preferences.


NOTE: Changes do not take effect until a new exam is loaded.

Appearance Tab

The Appearance tab allows you to hide the patient name and ID from the report , set the default scope and look

and feel, and to set default measurement and date formats.Figure 3-7 Appearance tab. 1 = Anonymize feature, 2 = default for Scope for Main Image Viewer 3=formats for measurement and date.




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Appearance Procedure

1. From the Main Image Viewer menu bar, click Edit > Preferences. Click [Appearance] to display the tab.

2. Check the checkbox to set the Hide Patient Name and Patient ID property. The password to enter is StarMap(case sensitive). Click [OK] and then click on [Save]. All patient’s names will be displayed as “anonymous” andthe ID set to zeros [1]. This will take effect on the report and on the Main Viewer.

3. A default setting for Scope for the Main Image viewer can be selected by clicking on [View Change Scoping]under Viewer [2].

4. Select a measurement system and date format from the Localization pull-down menus[3].



Users Tab

The Users tab allows generation of the users that are allowed to sign the reports. Each user is assigned a login

name, a real name, and a password.Figure 3-8 Users tab.




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Generating Users Procedure

1. From the Main Image Viewer menu bar, click Edit > Preferences. Click [Users] to display the tab.

2. Click [New] to open the new user screen. Enter the user information and click [Save].



Creating a New User

1. From the Users tab, click [New].

2. Complete all entries on the New User window by typing a value in the fields.

• The default password for the Administrator account is operator. The Administrator account can bemodified but it cannot be deleted.

3. Click [Save] to accept your entries and exit the New User window.

• Click [Cancel] to exit the New User window without accepting the selections.

Figure 3-9 New User window.




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Memory & Files Tab

The Memory & Files tab allows you to change certain application options.

Figure 3-10 Memory and Files tab. 1= Image Cache, 2= DB Options, 3= Export Options.

Setting Memory and File Options Procedure

1. From the Main Image Viewer menu bar, click Edit > Preferences. Click [Memory & Files] to display the tab.

2. The Image Cache option [1] controls the image buffer size. Recommended setting is 256 MB for the StarMapapplication.

3. Database Options [2]: It is recommended to have the Auto-save turned on.

4. Export Options [3]: Select a default format from the available options.

5. Click [Save] to store your entries and close the application.


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3




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Report Window

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Report WindowThe Report window allows for navigational control throughout the reporting application.

Figure 3-11 Report window. 1 = Report icons, 2 = Measurements and results, 3 =Sign off and customize icons.

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Report Window

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Report Window Icons

Report TabIcon

Description

Stats tab: displays the following patient demographic information: study date, institution,referring physician, history, name, ID, age, sex, height, and weight.

Notes tab: The tab can perform the following functions:

• Is an automated feature that reports relevant clinical impressions.

• Allows the clinician to enter their own clinical impressions text into the report.

Image tab: This tab allows you to select specific images to be included in the report . Use thehand tool on the Main Image Viewer to drag and drop an image into the Image tab. A singledrag and drop is allowed. Reselect the hand tool to add additional images to the Image tab.

StarMap Analysis tab: allows for the evaluation of multi-echo fast gradient echo sequencesfor the heart and liver.

Signature: This selection allows the reading physician to sign off on the report. No otheruser may change the report after this function is performed. Other reports can begenerated with a new user and signed off. The icon is located at the bottom of the Reportwindow.

Report template: This icon lists the templates available for reporting. Currently, there are 2templates available: GE cardiac and GE Pediatric. The icon is located at the bottom of theReport window.

Add Measurement: This selection allows for adding a user-defined parameter to any of the

tabs. The following can be added:• Additional comments

• An image

• A label

Trash Can: This selection allows for the removal of any customized measurement createdon any Tab.

Shutdown: This selection closes the application without saving any analysis. Use only if theapplication is not responding.




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Report Window

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User Defined Parameters

User inputs such as comments and additional images can be customized and added to the appropriate tab. Theseparameters have the same functionality as the parameters defined in the software. Any added customizedparameters can also be removed. Customized measurements are added per exam.

Procedures

Adding a customized parameter

Click on the desired tab on the Report Window, for example, click on the dims tab.

1. Click the Add Measure icon located in the lower right hand side of the Report Window.

2. This displays an Add selection window

Figure 3-12 Add Measure screen.

3. Click the tool you want to add.

4. Type a new label in the label text box.

5. Click [Add] to add the new measurement.




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Report Window

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Removing a customized parameter

1. Click the Trash Can icon in the lower right hand side of the Report Window.

2. This action displays a Remove selection window.

Figure 3-13 Remove selection window.

3. Click the check boxes in the Remove column for each of the parameters you want to remove and then click[Remove]. The parameters are removed from the list and tab.




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Report Window

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Report Sign-off

StarMap has a signature lock feature that locks the final report. The signed report can be viewed but it cannot bechanged or edited by another user.

NOTE: Prerequisites: 1) The user must be entered under the User tab under Preferences. 2) All tasks on each Reporttab are completed and ready for signature lock.

1. Click Signatures icon in the lower right hand side of the Report Window.

2. Select Sign to display the Signature Confirmation window.

Figure 3-14 Signature Confirmation window.

3. Select your user name from the Signing User pull-down menu (1).

4. Type in your password (2). This is mandatory.

5. Type in a signature description (3). This is optional.6. Click [OK] to confirm your sign-off and close the window. Click [Cancel] to exit the window without completing

the sign-off procedure.




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Report Window

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Reviewing a Signed-off Report

1. Click Signatures icon located in the lower right hand side of the Report Window.

2. This displays a sign selection window.

Figure 3-15 Signed report review window.

3. Select the line with the Backup date of the report. This opens a Confirm Signed Report Load.

4. Click [OK] to load the signed report . Any changes from the saved report overwrites the exam’s values on eachReport tab if different or changed by another user.




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Browse Database Window

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Browse Database WindowThe browse database window provides a view of the current contents of the local database. It features a view of exams in the database and controls which allow you to choose which exams to view.

Figure 3-16 Browse database window.




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Table 3-4 Browser selections.

No. Selection Description

1. SourceDatabase

Allows selection from the local AW database.

2. [Restore] Can restore any exported exams which are stored in the.dlt format.

3. Local AWdatabase listing

Displays the exams that are stored in the local AW database.

4. StarMapdatabase

ViewerThis window displays exams that are in the current StarMap database.

5. [Add to Viewer]Adds the selected exam in AW database (shown in the top portion of thewindow) to the StarMap database viewing area.

6. [Remove fromViewer]

Removes the exam from StarMap database viewing area.

7. [Update View]Click to close the Database Browser and bring exams in the viewable listingarea to the viewer after [Add to View] has been clicked.

8. [Cancel] Closes Browse database window with no changes to the Viewer content.

9. Database This field indicates available disk space on the Database/Images directories.




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Browser Procedures

Viewing Exams in StarMap

Exams can be viewed by selecting them from the AW database, adding them to the StarMap database Viewer list

and clicking “Update View.”Exam in the AW database but not in StarMap database Viewer list.

1. From the File Menu, click Browser DB or press Ctrl O to open the AW database viewer.

2. Locate the exam in the AW database viewer and click on the exam to highlight it.

3. Click [Add to Viewer].

4. Click [Update View].

5. The exam now appears in the StarMap database Viewer.

Removing Exams in the StarMap Database Viewer1. From the File Menu, click Browser DB or press Ctrl O to open the AW database viewer.

2. Locate the exam in the StarMap database Viewer list.

3. Highlight the Exam and then click [Remove from Viewer].

4. Click [Update Viewer].

• [Remove from Viewer] only removes the exam from the StarMap database Viewer; it does not delete theexam or the analysis from the AW database.

NOTE: Exams can be deleted from the AW database from the main AW patient list.




AW StarMap Windows


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4 - 1


Chapter 4

StarMap Procedures

Introduction

The StarMap analysis chapter reviews the process for analyzing a multi-echo fast gradient echo sequence(mfgre).

Description

The StarMap Analysis tool calculates the T2* values with an automatic background calculation and also displaysthe T2* curve. The parameter R2* (1/T2*) is displayed as a color overlay directly on the image. The color mappreference for T2* or R2* can be set under preferences. The StarMap Analysis tab displays the following results:

• T2 * value in msec

• T2* decay curve

• Hepatic Iron Concentration in milligrams/grams

• R2* value in Hz

• R2* Color Maps

The StarMap Analysis tab allows the following tasks:

• Generation of predefined ROIs for Myocardium, Liver and user defined.

• Editing of the ROIs.

• Reset of all ROIs and curves.

• User controlled color map overlays.

• Option of including curves, color maps and results on the final report.

• Preferences for type of results and ROI labeling can be user defined.




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4 - 2


Figure 4-1 T2* Analysis Tab. 1 = Advisory Panel, 2 = Gray scale option, 3 = Decay Curve, 4 = Cardiac number of ROI selector 5 = Calculationof Results, 6 = ROI Colormap Endocardium, 7 = ROI Colormap Epicardium, 8 = Hepatic ROI number selector, 9 = Calculation of results (ms),10 = Calculation of results (mg/g), 11 = Hepatic Colormap ROI, 12 = User ROI number selector, 13 = User ROI results, 14 = User definedColormap ROI.

1

2

3

4

5

6

7

8

9

10

11

12

1314




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Table 4-1 T2* Analysis Tab selections


1.Work flow instructions areprovided in the Advisory panel.

2.Applies a grayscale map to theimage.

3. Decay Curve Result display.

4.Selection of the number of Cardiac ROIs to be defined.

5. Cardiac T2*/R2* ROI 1 results.

6. Endocardium ROI for colormap.

7. Epicardium ROI for colormap.




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Considerations

• The StarMap Analysis tab supports the analysis of a multi-echo fast gradient echo sequence (MFGRE).

• Imaging specific anatomy of both the liver and heart is supported. To analyze the heart, acquire a shortaxis slice of the left ventricle midway between the base and apex. To analyze the liver, acquire a transverseslice across the liver 4 cm below the dome of the diaphragm.

• Based upon literature review, a two parameter fit for the T2* rate of decay yields the most accurateresults. To apply a two parameter T2* decay curve, on the Measurement tab of the Preferences window,select the option box for: [Set C=0 in the curve fit equation].

• The calculation for the T2* decay curve is the following formula: S = A*e (-TE/T2*) + C. The initial scalingfactor is 25 ms. References:

– D.J Pennell, et al. Eur Heart J 2001; 22: 2171-2179.

– Ghugre NR, et al. J Magn Reson Imaging 2006; 23: 9-16.

• The calculation for the hepatic iron concentration uses [Fe]R2* = 0.0254xR2* + 0.202. Reference:

– Wood JC, et al. Blood, 8/15/06;Vol 106:4, 1460-1465.

• It is recommended that you are qualified in performing cardiac analysis. If the analysis results in adiagnosis, the exam must be interpreted by a medical professional qualified to do so.

8.Selection of the number of Hepatic ROIs to be defined.

9. Hepatic T2*/R2* ROI 1.

10. Hepatic Iron ROI results in mg/g.

11. Hepatic Color Map 1.

12.Selection of the number of user

ROIs to be defined.

13. User defined T2*/R2* ROI results.

14. User defined ROI colormaps.





StarMap Procedures

Procedure

4 - 5


ProceduresThe procedures in this manual assume you have opened a StarMap compatible exam.

Step Selections

1.

Setting up Preferences

1. From the File menu, click Edit > Preferences > Measurement > T2* Analysis.

2. Select the type of parameter to be analyzed and displayed.

3. If desired, change the following parameters:• The intercept and slope parameters used to calculate iron concentration in l iver.

(Recommended values from the literature: m=0.0254, b=0.202.)

• Both the Cardiac T2* and Liver T2 * normal range from the default initial value which is 25msec.

• If [Set C = 0 in the curved fit equation] option box is selected, a two parameter f it is used. A twoparameter fit for the T2* decay curve is recommended.

4. Click the sub-heading of Iron Mapping to define ROI labels.

5. Set the parameters to be printed on the report.

6. Select Save to save the settings or Cancel to exit the window without changing the settings.

NOTE: When the measurement selection is set for either the T2* or R2* the image pixel values for T2*or R2* can be obtained when placing the crosshair cursor over an image with a color overlay.

2.

Select Images

1. Select the appropriate imaging series from the Main Viewer.

2. Select the Iron tab .




StarMap Procedures

Procedure

4 - 6


3.

Define an ROI

1. Under Cardiac ROI(s), click [Cardiac T2*/R2* ROI 1].

2. Click on image, a larger view of the image is displayed. Left click and hold to trace an ROI. -r.

3. Open the flat panel display to check the ROI position on all of the images.

• If the preferences were set to T2/T2* measurement display, the results will be displayed in msec.

• If the preferences were set to R2/R2* measurement display, the results will be displayed in Hz.The option to print the results can be made by clicking the printer icon.

• A reset can be performed on all measurements by clicking on the side arrow located to the rightof the measurements.

Step Selections




StarMap Procedures

Procedure

4 - 7


4.

Select the Appropriate Series for Liver Analysis

1. Under Hepatic ROI(s), click [Hepatic T2*/R2* ROI 1].

2. Click on image, a larger view of image is displayed, left click and hold to trace an ROI.

• For optimal results, the ROI should be positioned in an area where there is no increased signalintensities such as in the hepatic vessels. Place the ROI in an area where the signal ishomogenous.

• Open the flat panel display to check the positioning of the ROIs in all of the images.

• If the preferences were set to T2/T2* measurement display, the results will be displayed in msec.

• If the preferences were set to R2/R2* measurement display, the results will be displayed in Hz.The option to print the results can be made by clicking off the printer icon.

• A reset or a locate of the measurement can be performed by clicking on the side arrow to theright of the measurement.

Step Selections




StarMap Procedures

Procedure

4 - 8


5.

Create a Myocardium ColormapThe StarMap Analysis tab supports a colormap overlay of the myocardium and liver.

1. From the T2 Analysis tab, click [Endo Colormap] 1].

2. Click on image, a larger view of image is displayed, left click and hold to trace an endocardium ROIon an image.

3. From the T2 Analysis tab, click [Epi Colormap] 1].

4. Click on image, a larger view of image is displayed, left click and hold to trace an epicardium ROI onan image.

5. When both ROIs are drawn, the colormap is applied.

• Each pixel value can be determined by selecting the crosshair cursor and placing it over thecolormap overlay on the image.

• The dynamic color range (1) can be adjusted by clicking or dragging in the area of the colorbarrange numbers at the upper right hand and left hand corners of the image.

• A reset can be performed on the myocardium overlay by clicking on the side arrow located oneither the Epicardium or Endocardium selection.

Step Selections

1




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6.

Create a Liver Colormap

1. From the StarMap Analysis tab, click on [Hepatic Colormap 1].

2. Click on image, a larger view of image is displayed, left click and hold to trace an ROI. Once the ROI

is completed the colormap appears automatically.

• Each pixel value can be determined by selecting the crosshair cursor and placing it over thecolormap overlay on the image.

• The dynamic color range (1) can be adjusted by clicking or dragging in the area of the colorbarrange numbers at the upper right hand and left hand corners of the image.

• A reset can be performed on the Hepatic overlay by clicking on the side arrow located on theColormap selection.

Step Selections




StarMap Procedures

Procedure

4 - 10


7.

Analyze the T2* Curve

The T2* curve is a graph of the signal intensity versus echo time using an exponential decay curveformula. On occasion, it may be necessary to remove later echo points from the decay curve for abetter curve f it . This may occur in extreme cases of iron overload when the signal intensity can be very

low.

1. Click the desired echo point directly on the T2* curve. The image updates showing that echo withthe ROI.

2. Place the cursor on the image and right-click Delete Annotations > Current Image Only > DeleteCardiac T2*/R2* ROI. The T2* results update automatically.

Step Selections




StarMap Procedures

Procedure

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8.

Final Report

Images with colormap overlays, curves and selected numerical results can be included on the f inalreport.

Step Selections




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5 - 1


Chapter 5

Structured Reporting

IntroductionStructured Reporting reduces the time spent reporting an exam by using standard macro’s that reflect your

personal workflow.

Description

Structured Reporting allows you to complete the following tasks:

• Generate predefined clinical impressions that can be automatically inserted on the impression tab.

• Create and save macros from a streamlined user interface.

• Access macros from the Notes/Impression tab via buttons you label.

• Automatically insert quantitative results from the reporting tabs.





Introduction

5 - 2


Notes tab

Figure 5-1 1=Impression text box, 2=Example user def ine Macro, 3= Macro Editor button

1

2

3





Introduction

5 - 3


Macro Config window

From the Notes/Impression tab, click [Macro Config] to open the Macro Config window.

Figure 5-2 Macro Config window: 1 = Add macro button 2= Delete macro button, 3 = macro name field, 4 = macro text box, 5= parameterselection, 6= Save macro/ Exit window button, 7= Cancel button

Table 5-1 Macro Config window selections


1. Allows creation of a macro.

2. Allows deletion of the selected macro.

3.Allows editing the name of the currently selectedmacro button. My Macro is the name of the examplemacro button.

1 2

34

5

6 7





Introduction

5 - 4


Considerations

• Generation of predefined impressions should be performed by a trained clinician.

• An existing macro is saved when you click [Export Preferences] from the Main viewer and it can beimported when you click [Import Preferences] from the Main viewer. Exporting macros allows you toimport them if for some reason they were removed from your AW system. If you do not export the macrosin this scenario you would have to rebuild all of them.

• Numerical calculations can be part of the macros. All appropriate analysis needs to be performed beforethe results appear in the macro.

• You can change the analysis results after the selection of a macro, by manually updating the content inthe Impressions area of the Notes tab. These changes do not update automatically once a macro has beenused.

4. Text box space for entering macro text.

5.Each tab allows you to automatically insertquantitative results into the text.

6.Saves all created macros and exits the Macro Configwindow.

7.Closes the Macro Config window without saving anychanges.





6 - 1


Chapter 6

Data Exporting and Archival

IntroductionThe exporting feature allows you to create uncompressed AVI movies, compressed QuickTime movies, and JPEG,

TIFF, and PNG files of the image data. These files can be stored either on the hard drive or burned to a CDROM. Thecompleted study with all results including the final report can also be exported. Selecting the “include StarMapReader” will allow the inclusion of software for the viewing of the images on a PC. Data reported on theapplication tabs can be exported as an Excel spreadsheet. Textual information from the final report can beexported into a text file.

Description

The File > Export window is the window from which all selections are made when exporting images.




Data Exporting and Archiva

Introduction

6 - 2


Figure 6-1 File Export window 1 =Series list, 2= Export options, 3=Report format options, 4= Export/Cancel selections.

Table 6-1 File Export window selections;


1. Series selection

Once an exam has been selected and the Export

window is open, all the series related to the exam aredisplayed.

• The option “StarMap” checked means that theimages will be backed up in the StarMap applicationformat. Exam series can be individually selected forexporting.

• The option “Movies” checked means thatselected series will be exported as a movie file in theselected formats.

• The option “Images” checked means thatselected series will be exported in a JPEG, TIFF, orPNG format.

2.

[Export]

[Cancel]

Click [Export] to initiate the export process and toclose the window.

Click [Cancel] to close the window and not start anyof the export processes.

1

2

3

4





Introduction

6 - 3


3.

Check the box to define the end destination for the exported data:

• CDROM. (Recommended for backup of exam for future review on StarMap)

• The local hard drive.(Not recommended)

• Include the StarMap Reader if the exam is being sent to a referring physician.

• Include Report in PDF and/or HTML.

• Click Excel Report to export the analysis done in an Excel format.

• Click Text Report to export flow results as a text file.

4.Selecting Excel Report exports all analyzed dataincluding graph data and tables based on theStarMap reporting tabs. The Excel spreadsheetorganizes each tab as a separate worksheet.

5.Selecting Text Report exports all report data basedupon the PDF report. The data is a subset of whathas been selected for the report. The file opens upwith WordPad on a PC.






Introduction

6 - 4


Exporting with Non-StarMap Data Procedure

Step Selections

1.

Image Preparation

a) Select the series.

b) Prepare the series by adjusting the window level, zoom, rotate and pan settings.

c) All text and annotations can be removed by pressing Ctrl + T. Note: This is not a permanentremoval; pressing Ctrl + T again brings the text and annotations back.

2.Open the Export Window

From the Main Image Viewer menu bar, click [File] > [Export].

3.

Movie Image Selection

a) From the Export window, click [Non-StarMap Data Only] check box.

b) Click the box next to the desired image format and choose [Movies], [Images], or both.

NOTE: The StarMap selection column can be changed. This creates a .dlt file on the media whichallows for the exam to be restored on StarMap for review.

4.

Select Export Destination

a) Click one of the two selections:

• Click the [Export to Optical Media] check box to burn images/movies to CD-ROM.(Recommended)

• Click the [Export to Local File System] check box to write images/movies to the hard driveof the workstation.

5.

Initiate the Export Process

Click [Export] to start the exporting process and close the window.Click [Cancel] to close the window without accepting any selections.





Introduction

6 - 5


Exporting StarMap Data and Reader Procedure

Archival Process

StarMap uses the AW database to load, store and retrieve images. For instructions on loading or networkingimages to and from AW workstations, refer to the AW operator manual.

StarMap stores the analysis data for each exam as a secondary-capture DICOM image in a separate series called“StarMap Data” within the relevant exam. It also creates a separate series for each signed exam, which appearsas “StarMap Data Signed” in the AW browser. To archive an exam together with its analysis, network the entireexam along with its StarMap data series to PACs and restore them back to the AW when you wish to review themagain in StarMap.

StarMap has the ability to archive StarMap generated reports and Cine images as a DICOM format in the StarMapso that they can be viewed on any colored DICOM secondary image capture viewer outside of the StarMapapplication.

Step Selections

1. From the Main Image Viewer menu bar, click [File] > [Export].

2. From the [Export] window, click [StarMap Reader] check box.

3.

Click the [StarMap] check box for desired series.

Figure 6-2 Data Export error window.

When exporting StarMap data, if a series is selected that has associated regions of interest and/oruser annotation, a dialog box appears (Fig. 15-2) notifying you that the series must be included forexporting.

4. Click [Export] to start the exporting process and close the window.





Introduction

6 - 6


Procedure for PACS Archival & Viewing Feature for Cines and Report

Creating DICOM Cines

1. Select the series in the StarMap viewer to be exported. This series needs to be the currently selected in theviewer.

2. Perform all necessary image manipulations.

3. From the Main Image Viewer menu bar, click [File] > [Save Cine DICOM].

• On selecting this option each phase of the series currently being viewed willbe saved as secondary capture images and will be saved as a separate seriescalled StarMap Cine-<series_description> under the patientsseries listing on the main AW browser. The original series name will beappended to this new series.

• This new series will be created while the status bar is showing.

4. Close out of StarMap when exporting is finished.

5. Verify that the correct images and phases have been exported.

6. Network this series to a selected outside DICOM viewer.





Introduction

6 - 7


Creating DICOM Reports

1. The report to be exported should be a completed signed report.

2. From the Main Image Viewer menu bar, click [File] > [Save Report DICOM].

• On selecting this option each page of the report gets saved as a secondary capture image and all images

associated with the report are stored in a separate series called “StarMap RC Report” under the patient’sseries listing on the AW browser.

• This new series will be created while the status bar is showing.

3. Close out of StarMap when the exporting is finished.

4. Verify that the correct report has been exported.

5. Network this series to a selected outside DICOM viewer.





Section name or

Page numberWhat Changed

Page 4-3 Changed table 4-1 header from StarMap Analysis

Tab to T2* Analysis Tab

Page 4-3 Replaced screen capture in Table 1 - #1. Old screen

capture read: Iron Analysis. New screen capturereads: T2* Analysis.

Page 4-1 Fifth bullet under Description: removed "T2* or"

and "(Default color map is R2*)"

Page 5-4 Row #6- under Description removed "to the StarMap

database"

Page 6-1 Second from last line in Intro paragraph: replaced

"remote workstation" with "PC." Replaced last

sentence in Intro paragraph with "Textual

information from the final report can be exported

into a text file."

Page 6-1 Under Description: added " >" between the words

File and Export.

Page 6-2 In Table 6-1, row #1 in Description column: first

bullet, replaced "StarMap Check" with The option

"StarMap" checked. Second bullet replaced "Movies

check" with The option "Movies" checked. Third

bullet replaced "Images check" with The option

"Images" checked.

Page 6-3 Row #3 in table: replaced screen capture. Added two

bullets to list: 1- Click Excel Report to export the

analysis done in an Excel format. 2-Click Text

Report to export flow results as a text file.

Page 6-4 Row #3 in Note: added space between "a" and ".dlt"

Page 6-5 Under Archival Process, second paragraph, second

line "StarMap data" capitalized the "d" in data.

Page 6-6 Under #3, inserted -< > around the words

"series_description"

Page 3-6 In table 3-3, under Edit: removed "window/level"

from sub menus for Undo and Redo. Replaced

Description for Undo with" Only implemented for

window level, pan, zoom, flip vertical and

horizontal. Replaced Description for Redo with

"Only implemented for window level, pan, zoom,

flip vertical and horizontal."

page 3-7 Paragraph #1, last sentence: changed "The" to "A",

changed "is" to "can be" inserted "current" between

"the" and "exam" deleted "that was selected while

clicking" replaced it with "by selecting."

page 4-2 Replaced screen capture.

Document name, Number and Revision

AW StarMap -- 5310243-300 Rev 2







Author Name/Date

Cindy Comeau 10/8/08

Reason

Tab on screen capture for this function reads T2*

Analysis. No such tab as StarMap Analysis.

Name of tab changed from Iron Analysis to T2* analysis.

More accurate description of program function



Make line conform with conventions for representing

links in the rest of the manualMake descriptions clearer.

To better represent and explain program function and

options.

Provide greater clarity.

Accurately represent what user sees on screen.

Accurately represent what user sees on screen.

More accurately describe program function.

Indicate that a custom series can be created in the current

view.

To conform with program visual.




Documents

AW StartMap 4.0