Mindways Software, Inc.

3001 S Lamar Blvd, Suite 302

Austin TX 78704

Tel: 512.912.0871Toll Free: 877.MINDWAYS

Fax: 512.912.0872Email: support@qct.com

www.qct.com

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Images

Scan

ScanType

ScoutPlane

90

Thick(mm)

ImageInt'val Pitch

GantryTilt mA

HelicalFull

1.0 sec.3 3.0 1.0 S0.0 Large 120 100

1 Scout

StartLoc.

S250

EndLoc.

I75

1-28

No. ofImages

32

SFOV kV

120 100

DFOV(cm)

36

R/LCenter(mm)

0.0

A/PCenter(mm)

0.0

ReconType

Stand.

MatrixSize

512

Peris.

N

Recon

Examinations :

Exam | Name | Date | Description | Mod | Fmt | PPS | A |

945 | CARVER, DOROTHY | Jul 09 02 | Head | CT | DICO | - | N946 | BAKER, MARILYN | Jul 09 02 | L-Spine | CT | DICO | - | N947 | COHEN, HERMAN | Jul 09 02 | ABD/PELVIS | CT | DICO | - | Y948 | CHANG, GONG WU | Jul 09 02 | CHEST W/CON | CT | DICO | - | N949 | BLACK, COLLEEN | Jul 09 02 | HEAD | CT | DICO | - | N950 | SMITH, SUZANNE | Jul 09 02 | SINUSES | CT | DICO | - | Y951 | MARINEZ, HECTOR | Jul 09 02 | PELVIS | CT | DICO | - | Y952 | DOE, JANE | Jul 09 02 | BMD | CT | DICO | - | Y953 | SMITH, JANE | Jul 09 02 | BMD | CT | DICO | - | Y954 | VILAROSSA, MANUE | Jul 09 02 | HEAD | CT | DICO | - | Y955 | ALBERTSON, SAM | Jul 09 02 | HEAD | CT | DICO | - | Y556 | CARVER, DOROTHY | Jul 09 02 | BMD | CT | DICO | - | Y957 | CHOU, CHEN | Jul 09 02 | BIOPSY | CT | DICO | - | Y958 | MUNOZ, ANNA | Jul 09 02 | HEAD | CT | DICO | - | Y959 | LAI, KIT | Jul 09 02 | HEAD | CT | DICO | - | Y960 | PARK, YOUNG | Jul 09 02 | CHEST | CT | DICO | - | Y961 | MENDOZA, MIKE | Jul 09 02 | ABDOMEN | CT | DICO | - | Y

60 Examinations

Application Selection Remove Sort Network Archive PPS Queue

NetworkReceivePing DICOM hostSend examinationSend seriesSend imageSelected remote host : QCT

T0003 ©2005 Mindways Software, Inc.

Position phantom head end to correspond with patient

Phantom Setup Scanner Setup

Axial Scans Image Transfer

Patient Setup

Spine Scanning Overview3D QCT Bone Mineral Densitometry

• Obtain a lateral localizer from above the xyphoid to below L5/S1.

• Use a scan length of 30 cm or more. Using the iliac crest as the landmark, +250mm to -75mm will normally produce an adequate localizer.

• Select 1 to 3 vertebra between T11 and L4 for analysis. L1 and L2 are preferred.

• Set the starting and ending locations for the scan series to include the disc space above the first and below the last vertebra to be analyzed.

• Scan intervening vertebrae if vertebrae to be analyzed are not contiguous.

• If the patient has previously had a 3D spine BMD analysis, scan the same vertebrae as before.

• Use a stored scan protocol for consistency.

• Always use these or the closest available parameters.

• Always use the same table height, kVp and SFOV for all BMD patients.

• Exposure requirements vary due to patient size. Increase mAs for obese patients—2X to 3X increase may be necessary.

• Include as much of the following information as possible:

– Last name– First name– Date of birth– Gender– Medical record number

• Instruct the patient to breath normally during scanning.

• Remove all metal objects on the patient from the scan field.

• Sit the patient at the foot of the phantom.

• Place a bolus bag on the phantom.

• Carefully recline the patient onto the phantom without displacing the bolus bag.

• Top of phantom should be at the axilla.

• Legs flat, arms above scan area.

• Adjust the table height to the QCT height.

L2 Fracture

L1 Fracture Scan L2/L3

Multiple compression fractures, only L2 is uncompressed

Scan L2

Scan L1/L2/L3

• Send the QCT images to the QCT PC using your scanner’s image transfer function.

• Place the cutout pad and extenders on the CT table.

• Place phantom in the cutout pad. Orient the “head” end of the phantom to correspond with the patient.

Localizer Example

Localizer Examples with Spine Abnormalities

Axial Scan Example

Start localizer 5 cm above the xyphoid

End localizer beyond L5/S1

Patient and phantom should not be rotated

or miscentered

Phantom should be devoid of streaks or artifacts

Images must have sufficient exposure

Localizer

• Protocol Rules

■ Always use these or the closest available parameters.

■ Default mAs should be appropriate for normal patients.

Center at iliac crestArms above scan area

Phantom and bolus bag

Top of phantom at axilla

Do not scan a patient that…

• Has had intravenous contrast within the past 24 hours.

• Has high density barium contrast in the bowel.

• Is pregnant or may be pregnant.

• Has Harrington Rods or other metal in the spine.

Mindways Software, Inc.

3001 S Lamar Blvd, Suite 302

Austin TX 78704

Tel: 512.912.0871Toll Free: 877.MINDWAYS

Fax: 512.912.0872Email: support@qct.com

www.qct.com

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B DA C

A

B

A

B

A

B

ROI

Cortical bone

1 Rotate the sagittal image in the desired direction by clicking on it with the left mouse button and dragging clockwise or counterclockwise.

2 Center the sagittal crosshair in the vertebra.

3 Rotate the coronal image in the desired direction.

4 Center the coronal crosshair in the vertebra.

5 Rotate the axial image in the desired direction.

6 Center the axial crosshair in the vertebra.

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E

FThe exam must be saved before it can be printed

• Open the 3D Spine module and open the translated study.

Open

Results

Report

Patient Info Extraction

Rotation

• Use the rotation tools and steps to make each vertebral body resemble a “vertical box.”

• Repeat rotation steps 1–6, as needed, until a vertical box orientation has been achieved.

• Recenter the crosshair in the vertebra in either the sagittal or coronal view.

• Click on the “Save Rotation” button that matches the vertebra.

• Repeat for each vertebra.

Click on the “ROIs” tab to move to the next step.

Rotation StepsRotation Tools

Move crosshair to the center of the rotated vertebra

Press corresponding button after rotation is completed for all 3 views

Rotate by dragging with the left mouse button

Basivertebral plexus(exclude)

ROI should be in center of vertebra

• The results screen is a view-only screen.

Click on the “Report” tab to go to the last step.

A Extraction is automated. Inspect both the phantom box and the round target for appropriate placement.

If a position is unsatisfactory, adjust it. Extraction will occur again automatically.

To reposition Move the cursor inside the box or circle, depress the left mouse button and drag.

To resize the phantom box Move the cursor inside the box, press the right mouse button and drag.

• If the spine has too much curvature to stay within the visible region on the Extraction screen, turn off Auto Magnify here.

B Identify the vertebrae for analysis.

Click on the “Rotation” tab to go to the next step.

A Review, add, or modify the patient information as required.

• Last Name, First Name, Date of Birth, Sex and Patient ID are required. Other fields are optional.

B For new patients click on “Add New Record.”

• For returning patients click on “Confirm Match” if the displayed Patient Database Record is correct. Otherwise rescan or browse the database as necessary, click on “Update Record” if necessary, then click on “Confirm Match.”

Click on the “Extraction” tab to go to the next step.

If desired, information can be included in the report by typing information in the Interpretation field, selecting a pre-defined report from the Template list, or selecting a name from the Interpretation By list.

If desired, information can be included in the exam record by using the drop-down Condition and Therapy lists.

A Click on “Save Exam Record.”

B Click on “Print Report.”

A Osteophytes, low densitiesSize and shape the ROI to avoid areas in the vertebra affected by the pathology.

B OsteophyteSize and shape the ROI to avoid areas in the vertebra affected by the pathology.

C Bone island (focal high density region)Size and shape the ROI to exclude the focal high density.

D Diffuse density variationsUse a standard ROI including the region of variable densities.

F Pathologic vertebrae Exclude vertebrae containing metastatic lesions or Paget’s Disease involvement. In this example L1 and L3 contain pathology. Only L2 should be analyzed.

• ROIs are automatic. Inspect them to ensure they are appropriate. If they are not, adjust them manually.

Move the ROI ellipse by pressing the left mouse button within the ROI and dragging.

Resize the ROI by pressing the right mouse button within the ROI and dragging.

• Vertical ROI position can be adjusted by placing the cursor over the red line on the sagittal image and dragging with the left mouse button.

Click on the “Results” tab to go to the next step.

ROI Rules and Examples

• Place ROI in the anterior 1/3 to 3/4 of the vertebral body.

• Encompass a large area of exclusively trabecular bone.

• Exclude cortical bone.

• Exclude the basivertebral plexus.

• Exclude abnormalities.

ROI Examples in Abnormal Vertebrae

ROIs

Scroll buttons

Reference line

Intersection cursor

Rotation: Drag withleft mouse button

Spine Analysis Overview3D QCT Bone Mineral Densitometry

E Benign focal lesion within vertebral bodyMake the ROI slice thinner (using the menu at the bottom) and adjust its position to avoid the lesion.

T0004 ©2005 Mindways Software, Inc.