angio smartbrush - brainlab user guides...smartbrush angio requires image series data containing...

SMARTBRUSHANGIOVersion 1.0

Software User GuideRevision 1.0Copyright 2014, Brainlab AG Germany. All rights reserved.

TABLE OF CONTENTSGENERAL INFORMATION ...................................................................................................5Contact Data and Legal Information ......................................................................................................5

Legal Information .........................................................................................................................................6

Symbols .......................................................................................................................................................7

Intended Use ...............................................................................................................................................8

Compatibility with Medical Devices .......................................................................................................9Non-Brainlab Software ...............................................................................................................................10

Training and Documentation .................................................................................................................11

USING SMARTBRUSH ANGIO ......................................................................................13Introduction ...............................................................................................................................................13

Opening Smartbrush Angio ...................................................................................................................14

Selecting Data...........................................................................................................................................15

Fusion.........................................................................................................................................................18

ROI (Region of Interest) ..........................................................................................................................22

Using Smartbrush Angio........................................................................................................................25

Closing Smartbrush Angio ....................................................................................................................31

INDEX ....................................................................................................................................................33

TABLE OF CONTENTS

Software User Guide Rev. 1.0 Smartbrush Angio Ver. 1.0 3

TABLE OF CONTENTS

4 Software User Guide Rev. 1.0 Smartbrush Angio Ver. 1.0

1 GENERAL INFORMATION1.1 Contact Data and Legal InformationContact Data

Support

If you cannot find information you need in this guide, or if you have questions or problems, contactBrainlab support:

Region Telephone and Fax Email

United States, Canada, Central andSouth America

Tel: (800) 597-5911Fax: (708) 409-1619 [email protected]

Brazil Tel: (0800) 892-1217

UK Tel: +44 1223 755 333

[email protected]

Spain Tel: +34 (900) 649 115

France and French-speaking regions Tel: +33 800 676 030

Africa, Asia, Australia, EuropeTel: +49 89 991568-44Fax: +49 89 991568-811

JapanTel: +81 3 3769 6900Fax: +81 3 3769 6901

Expected Service Life

Brainlab provides five years of service for software. During this period of time, software updatesas well as field support are offered.

Feedback

Despite careful review, this manual may contain errors.Please contact us at [email protected] if you have suggestions as to how we canimprove this manual.

Manufacturer

Brainlab AGKapellenstr. 1285622 FeldkirchenGermany

GENERAL INFORMATION


1.1.1 Legal Information

Copyright

This guide contains proprietary information protected by copyright. No part of this guide may bereproduced or translated without express written permission of Brainlab.

Non-Brainlab Trademarks

• Microsoft® and Windows® are registered trademarks of Microsoft Corporation in the UnitedStates and other countries.

Integrated 3rd-Party Software

This software is based in part on the work of the Independent JPEG Group.This software is based in part on iTextSharp by Bruno Lowagie and Paulo Soares.Smartbrush Angio is proprietary software. The Smartbrush Angio software is protected bycopyright. In addition to the Smartbrush Angio software, other software applications may also beinstalled on the Smartbrush Angio workstation that are licensed under the GNU General PublicLicense. The proprietary software and the free software are used in compliance with the "mereaggregation" clause defined by the GNU GPL. The full terms and conditions of the GNU GeneralPublic License can be found here:http://www.gnu.org/licenses/gpl-2.0.html

CE Label

• The CE label shows that the Brainlab product complies with the essential re-quirements of Medical Device Directive (MDD).

• According to MDD, Council Directive 93/42/EEC, Smartbrush Angio 1.0 is aClass IIb product.

NOTE: The validity of the CE label can only be confirmed for products manufactured by Brainlab.

Disposal Instructions

Only dispose of electrical and electronic equipment in accordance with statutory regu-lations. For information regarding the WEEE (Waste Electrical and Electronic Equip-ment) directive, visit:http://www.brainlab.com/weee

Sales in the US

US federal law restricts this device to sale by or on the order of a physician.

Contact Data and Legal Information


1.2 SymbolsSymbols Used in This Guide

Warnings

Warnings are indicated by triangular warning symbols. They contain safety-criticalinformation regarding possible injury, death or other serious consequences associatedwith equipment misuse.

Cautions

Cautions are indicated by circular caution symbols. They contain safety-critical informationregarding possible problems with the device. Such problems include device malfunctions,device failure, damage to device or damage to property.

Notes

NOTE: Notes are formatted in italic type and indicate additional useful hints.

GENERAL INFORMATION


1.3 Intended UseUsing the System

Intended Use

Smartbrush Angio is an application for the outlining of anatomical vascular structures andpathologies in medical images.

Intended User

This user guide is intended for healthcare professionals and/or their staff.

Plausibility Review

Before patient treatment, review the plausibility of all information input to and output fromthe system.

Responsibility

This application solely provides additional assistance to the surgeon or user and does notby any means substitute or replace the surgeon’s or user’s experience and/orresponsibility during its use.

Medical Electrical Systems

For information regarding the configuration of medical electrical systems, see the relevant SystemUser Guide and Technical User Guide.

Intended Use


1.4 Compatibility with Medical DevicesBrainlab Medical Software

Compatible Brainlab Medical Software

Smartbrush Angio 1.0 is compatible with:• Content Manager 2.0• DICOM Viewer 2.0• Patient Browser 4.0• DICOM Proxy 3.2

Other Brainlab Software

Other compatible Brainlab software may become available after the release of this user guide. Ifyou have questions regarding compatibility of the software contact Brainlab support.If you are currently running software versions other than those specified above, contact Brainlabsupport for clarification regarding compatibility.

GENERAL INFORMATION


1.4.1 Non-Brainlab Software

Compatible Non-Brainlab Software

Smartbrush Angio 1.0 is compatible with:• Microsoft Windows 7• Microsoft Windows 8

For information regarding compatible service packs, please contact Brainlab support.

Only critical Microsoft Windows operating system updates are allowed. It is notrecommended to download or install updates during patient treatment.

It is recommended to protect the system with a state-of-the-art antivirus software. Be awarethat this can negatively affect the system performance, e.g., real time scans (also known ason-access scanning, background guard, resident shield, auto-protect) can slowdownloading and saving patient data.

Compatibility with Medical Devices


1.5 Training and DocumentationOverview

Brainlab Training

To ensure safe and appropriate use, before using the system all users should participate in atraining program held by a Brainlab representative.

Documentation

This guide describes complex medical software that must be used with care.It is therefore important that all users of the system:• Read this guide carefully before handling the equipment• Have access to this guide at all times

GENERAL INFORMATION


Training and Documentation


2 USING SMARTBRUSHANGIO

2.1 IntroductionOverview

General Information

Smartbrush Angio is an application for outlining vascular structures and pathologies in medicalimages. It allows you to combine a 3D image series with an unlocalized 2D dynamic angiographyin order to simultaneously review the image information.Based on the imaging input, it is possible to outline vascular structures as 3D objects for furtherprocessing.

Smartbrush Angio Workflow

Workflow

1. Select an image series.

2. Create Fusion.

3. Highlight the region of interest in the image using ROI.

4. Verify and, if necessary, correct the 3D vascular object using Brush/Smartbrush Angio.

Workflow Indicator

There is a visual workflow indicator for Smartbrush Angio, which displays where you are in theworkflow.

Figure 1 Use the Back and Next buttons to navigate through the workflow.

USING SMARTBRUSH ANGIO


2.2 Opening Smartbrush Angio

How to Open the Angio Planning Workflow

Step

Select Angio Planning from the workflow options in Content Manager.

Opening Smartbrush Angio


2.3 Selecting DataSelecting Patients

How to Select a Patient

Steps

1. Choose a patient in Patient Browser.

2. Choose Select.

NOTE: For further information see the Patient Browser Software User Guide.

How to Select Images

③

①

②

Figure 2

Steps

1.

Select the image series you would like to use ①.The images appear under Selected Data ②.NOTE: If any required data type is missing, you are notified in the info area ③.

NOTE: Pre-existing Smartbrush Angio results can also be loaded.

2.Select OK.NOTE: You can only select OK when all required image series data is selected.

NOTE: For further information see the Software User Guide for Content Manager, PatientBrowser and DICOM Viewer.



Image Data Requirements

Smartbrush Angio requires image series data containing vascular details. Images such as CT orMRI are outlined automatically.Data selection only loads image series data which is relevant for the angio procedure and omitsall data that is not relevant.Suitable data is:• 2D image series: Frontal and lateral angiographic projections are required for the registration/

fusion with the 3D image series. The dynamic flow information is also used for visualization andcomparison with the anatomical data.

• 3D MRI or CT with contrast: Enhanced contrast is necessary in order to distinguish thevascular information.

• Vessel objects: Vessel objects are automatically outlined based on the selected 3D modalitieswith contrast.

NOTE: Contact Brainlab support for more scanning recommendations.

Vessel Segmentation

The selected and highlighted image series (marked by an orange border), triggers the priority forvessel segmentation.When different imaging modalities are selected, the highlighted image series is used first forvessel segmentation. The segmentation progress and image series is displayed in the info area.

How to Define Image Orientation

④

② ③①

For angio planning, a frontal and lateral images series is required. Usually the orientationinformation is shown in the DICOM header ①.If the scanner does not save the orientation, you can manually:

Steps

1. Select the pen icon ④.

2. Select the image orientation from the available options ③.

3. Select OK.

How to Remove Images

Step

Select the X ② to remove the image series from Selected Data.

Selecting Data


How to Finalize Data Selection

Step

After data selection, select Next.

Saving Changes

When navigating away from patient selection, you are prompted by the following dialog:

Figure 3

Options

Save Saves created content and returns you to patient selection.

Discard Deletes all created content and returns you to patient selection.



2.4 Fusion

Fusing Images

Figure 4 After selecting an image series, the software prompts you to fuse together (co-register) the imagedata.Selecting Fusion automatically fuses together the 2D and 3D image series. The images are fusedtogether based on anatomical structures common to both image series.

Review the fusion result before proceeding.

Fusion


Pre-Fusion Manual Alignment

②

④

⑤

⑦

③

⑥

①

Figure 5 Aligning the images manually aids the fusion algorithm and improves results.You can change the scale and rotate the 3D vessel layer about its axes, to better match theunderlying 2D image data.

No. Explanation

① Illustrates image and vessel orientation.

② Rotate the 3D vessel layer horizontally.

③ Rotate the 3D vessel layer on the X-Y axis.

④ Rotate the 3D vessel layer vertically.

⑤ Increase or decrease 3D image scale.

⑥ Play the angiogram.

⑦ Move slider to specific points within the angiogram.

How to Adjust the 3D Vessel Layer

Steps

1. Rotate or adjust the 3D vessel layer in relation to the underlying 2D image.

2. Once results are satisfactory, select Next to continue.



How to Create an Automatic Fusion

Steps

1. Select Fusion to start the fusion between the image series.

2. Verify fusion.

3. Select Next to continue.

Fusion Dialog

Figure 6 It is possible to skip the Fusion step without co-registering the image series data.It is recommended to select Yes and proceed with an automatic fusion upon viewing the abovedialog.

Fusion Functions

Function

Fusion: Optimizes the manually adjusted fusion between the image series.

Select Undo Fusion to undo the automatic image fusion.NOTE: During an automatic fusion, all other functions are disabled until the fu-sion is complete.

Reset and Undo Fusion share the same location on the toolbar.When Undo Fusion is used after an automatic fusion, it returns the vessel to itsmanually adjusted pre-fusion state.Reset returns the vessel back to its initial position, prior to manual adjustment.NOTE: After Reset is used, the function is disabled until the vessel is reposi-tioned.

Fusion


Function

Figure 7 Vessel Visible: Turns the vessel overlay on or off, to aid manual fusion adjustment. The defaulttransparency of the vessel object is 50% so that the background image is also visible.Vessel Complexity: increases or decreases the level of vessel complexity shown on the imageoverlay.NOTE: Vessel Complexity is used to remove vessel segmentation artifacts and improve fusionresults. Only the visible vessel structures are considered for the automatic fusion.

General Functions

Function

Opens the main screen of Content Manager.

Opens data selection.

Confirms the results of your current step and advances to the next step.

Returns to previous step.The results are not automatically saved.

How to Finalize Fusion

Step

After fusion editing, select Next.



2.5 ROI (Region of Interest)

General Information

Use ROI to define regions of interest, e.g., a nidus on the angiogram.

How to Use ROI

①

②

③

Figure 8

Steps

1. Scroll through the images using the sliders ① (or mouse wheel) to find regions of interest.

2. Select ROI Brush.

3.

Highlight a region of interest in one view by drawing an outline ②.The area is marked in blue and creates a ray ③ in the other view.NOTE: If necessary, reduce the brush size to 50% by pressing the shift key (available onthe PC only) when drawing an outline.

4.Highlight the region of interest in the other view.NOTE: If the rays in both views fail to intersect, Next is disabled. Adjust the ROI Brushstroke.

5.

If needed, use ROI Erase to define the borders more accurately.NOTE: If a mouse is used, use the right mouse button to erase when ROIBrush is active.

Optionally, select Undo to undo previous brush/erase steps.

ROI (Region of Interest)


Steps

6. Verify the ROI Brush object.

7. Select Next.

View Options

Figure 9 Use the drop down menu to switch between DSA (grayscale) and CIP (color) views to helpidentify regions of interest more easily.



ROI Views

①

②

Figure 10

No. View Explanation

① CIP Color Intensity Projection: Dynamic angio flow with color-coded time informa-tion based on DSA images.

② DSA Digital Subtraction Angiography: Displays the angiography imaging in gray-scale.

How to Finalize ROI Editing

Step

After ROI editing, select Next.

ROI (Region of Interest)


2.6 Using Smartbrush Angio

General Information

After ROI definition, Smartbrush Angio automatically detects and builds a 3D nidus object basedon the selected anatomical image data. This object is displayed on each slice of your patientimage series.NOTE: If the nidus detection algorithm is unable to find useful data within your selected ROI, itcreates a default nidus with the same shape as the ROI you defined.

Main Screen Overview

Smartbrush Angio allows you to manually highlight and fine-tune regions of interest withinindividual slices.By default the 3x3 View displays an overview of the detected 3D nidus object as slices. Each sliceis available for editing. If you select a different view ②, the 3x3 View ④ updates accordingly.

②

⑤

⑦⑥

①

④③

Figure 11

No. Explanation

① Angiogram views, e.g., lateral left or frontal right and their respective controls for angio-gram playback.

②

View options:• Axial• Coronal• Sagittal• 3D

③ Orange border indicates the view in use in the main screen area

④ Image slices of the 3D nidus object

⑤ Toolbar

⑥ Drop down view selection menu

⑦ Adjustable slice thickness slider



Toolbar Functions

Button Function

Scroll: scroll through image slices by dragging the mouse pointer across thecurrent slice.

Zoom: zoom to the region of interest by dragging the mouse pointer across theslice.

Toggle between 3x3 View and Single View and display a drop-down menu ofavailable fused images.

Pan: pan to region of interest on the images.The position of the click/touch defines the view center.NOTE: In 3x3 View, when Pan is selected in one view, the other views updateaccordingly.

Retrace outlines of the 3D nidus object.

Retouch individual slices of the 3D nidus object.NOTE: Single View only.

Correct imperfections and define borders more accurately.

Select Undo to undo the last change made.

Adjust the brightness by dragging the mouse pointer across the current slice.

Rotate around the 3D object using Rotate.NOTE: Available in the 3D View only.

Using Smartbrush Angio


How to Use Smartbrush for Editing Nidus Objects

Steps

1. Select 3x3 View from View options.

2. Center and zoom to the region of interest using the Zoom, Scroll and Pan functions.

3. Select Smartbrush.

4. Drag Smartbrush over your highlighted area in a brush-like motion.

5.Smartbrush highlights all connected pixels.NOTE: Smartbrush highlights the area you marked and creates an object using 3D in-terpolation.

6. If any edges of the highlighted area are not correctly separated from thesurrounding area, use Erase to define these borders more accurately.

7. Use Scroll to proceed to the next slice.

8. Adjust Slice Thickness if necessary (see page 29 for more information).

9. Repeat steps 4-8 until you are satisfied with the results.

10. Verify the 3D nidus object.

11.Select Done to complete angio planning.Content Manager opens.

How to Use Brush for Editing Nidus Objects

Steps

1. Select Single View from View options.

2. Center and zoom to the region of interest using the Zoom, Scroll and Pan functions.

3. Select Brush.

4. Drag Brush over your highlighted area in a brush-like motion.

5.Brush highlights all connected pixels and creates an object without interpolation.NOTE: Brush highlights the area you marked and does not add or remove voxels auto-matically.



Steps

6. If any edges of the highlighted area are not correctly separated from thesurrounding area, use Erase to define these borders more accurately.

7. Use Scroll to proceed to the next slice.

8. Adjust Slice Thickness if necessary (see page 29 for more information).

9. Repeat steps 4-8 until you are satisfied with the results.

10. Verify the 3D nidus object.

11.Select Done.to complete angio planningContent Manager opens.

Saving the Nidus Object

The 3D nidus object is saved in the workflow upon selecting Done.The default naming convention for the 3D nidus object is:• Nidus (“3D image series name”)

How to View in 3D

①

③

②

Figure 12

Steps

1. Select 3D from the view options ①.The main screen displays the 3D view.

2. Center and zoom to the region of interest using the Zoom, Scroll and Pan functions ②.

3. To aid viewing, increase or decrease the Vessel Complexity using the slider ③.



Visualization Functions

①

Figure 13 You can view 2D angiography projections as videos to aid correct nidus detection.

Steps

1. Select either the frontal or left/right angiography projection from the left side of the screen.

2.Click the play/pause button ① to play the video in the main screen view.Alternatively, click the play button directly in the chosen project window.

Viewing Options

Options Explanation

DSA View Digital Subtraction Angiography: Displays the angiography imaging in gray-scale.

CIP View Color Intensity Projection: Dynamic angio flow with color-coded time informa-tion based on DSA images

Red-Blue View Red-blue represents the early-late contrast flow phase

Slice Thickness

①

To aid viewing, increase the Slice Thickness using the slider ① within 3x3 View and SingleView.The views update accordingly and display greater image depth, similar to maximum intensityprojection (MIP).

Data Modification

Any modification to the ROI, triggers the creation of a new nidus object.An existing 3D nidus object that is modified, is saved in a new plan with the same name.



Reviewing Results

To verify your results you must consider the following:• Review/compare with projective images• Review CIP and Red-Blue images• Slice thickness

Always review and verify the ROI contouring result before proceeding.

The vessel segmentation results should be reviewed and compared with the originalimages and 2D projections.

Angio Planning Output

When an angio plan is complete, the following output is saved as DICOM data after selectingDone:• 3D objects (nidus and vessel segmentation)• 2D CIP image series• Fusions (2D projections with the 3D MR or CT volumes)

Reloading Angio Planning Data

When angio planning is complete, reloading the treatment plan skips the Fusion and ROIcontouring steps. The existing result is displayed in the 3x3 View within Brush.The output can be used for further processing.



2.7 Closing Smartbrush Angio

How to Close Smartbrush Angio

To leave your current session for any reason, proceed as follows:

Steps

1. Before closing, finalize your current task by selecting Done.

2.Select Home.The Content Manager main screen opens.

3. Select Exit on the Content Manager main screen.

Saving Data on Shutdown

Always finalize your current task before closing the software. Always close the softwarebefore shutting down the system. Data is not saved automatically if the system is shutdown without properly closing the software.



Closing Smartbrush Angio


INDEXNumerics

3Drotate...................................................................................... 26view........................................................................................ 29

AAngio Planning

output......................................................................................30workflow..................................................................................14

angiographyvisualization............................................................................ 29

BBrush.......................................................................................... 26

editing..................................................................................... 27toolbar functions..................................................................... 26using Brush.............................................................................27

Ddata modification

ROI data................................................................................. 30disposal instructions..................................................................... 6

EErase.....................................................................................26-28

FFunctions

fusion...................................................................................... 20Reset...................................................................................... 20Undo Fusion........................................................................... 20Vessel Complexity.................................................................. 21Vessel Visible......................................................................... 21

Fusionadjustment functions...............................................................19automatic fusion..................................................................... 20fusing images......................................................................... 18how to manually adjust........................................................... 20manual alignment................................................................... 19overview................................................................................. 18

Ggeneral functions

back........................................................................................ 21data.........................................................................................21home.......................................................................................21next.........................................................................................21

Hhow to

close Smartbrush Angio......................................................... 31open Smartbrush Angio..........................................................14remove images....................................................................... 16

save........................................................................................ 17use Brush............................................................................... 27use Smartbrush...................................................................... 27

Iimage

orientation...............................................................................16removal...................................................................................16

image data requirements............................................................16

Mmodifying data............................................................................ 30

Ooutput

saving treatment plans........................................................... 30

PPan............................................................................................. 26

RROI

CIP View.................................................................................24DSA View............................................................................... 24how to use ROI.......................................................................22view selection......................................................................... 24

ROI Brush...................................................................................22ROI Erase...................................................................................22ROI views................................................................................... 24Rotate.........................................................................................26

Ssave on shutdown...................................................................... 31saving

data on shutdown................................................................... 31discard.................................................................................... 17saving the nidus......................................................................28treatment plans.......................................................................30unsaved changes................................................................... 17

Scroll..................................................................................... 26-28select

images.................................................................................... 15patient.....................................................................................15

shutdownexit.......................................................................................... 31

Slice Thickness.......................................................................... 29Smartbrush.................................................................................26

editing.....................................................................................27using Smartbrush................................................................... 27

Smartbrush Angiogeneral information.................................................................13how to close............................................................................31how to open............................................................................14object creation workflow......................................................... 13overview................................................................................. 13

support......................................................................................... 5

INDEX


UUndo...........................................................................................26

Vvessel segmentation...................................................................16viewing options

3x3 View................................................................................. 27CIP view............................................................................ 29,30Red-Blue view................................................................... 29,30Single View.............................................................................27

views3D........................................................................................... 29

visualization functionsplay video............................................................................... 29

WWEEE...........................................................................................6Windowing..................................................................................26

ZZoom.......................................................................................... 26

INDEX


brainlab.com

Art-No. 60914-69EN

*60914-69EN*

TABLE OF CONTENTSGENERAL INFORMATIONContact Data and Legal InformationLegal Information

SymbolsIntended UseCompatibility with Medical DevicesNon-Brainlab Software

Training and Documentation

USING SMARTBRUSH ANGIOIntroductionOpening Smartbrush AngioSelecting DataFusionROI (Region of Interest)Using Smartbrush AngioClosing Smartbrush Angio

INDEX

angio smartbrush - brainlab user guides...smartbrush angio requires image series data containing...

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