ImageFusion Module 321 User Guide

Image Fusion
3. 2. 1 ( I nt eleV iewer 4. 11. 1)

Us er G uide
COPYRIGHT can be communicated, processed, manipulated, enhanced, stored, and
© 2008-2015 Intelerad Medical Systems Incorporated. All Rights displayed within the system and/or across computer networks at
Reserved. distributed locations. Post-processing of the images can be performed
using Multi-Planar Reconstruction (MPR).
No portion of the contents of this publication may be reproduced or
transmitted in any form or by any means without the express written Lossy compressed mammographic images and digitized film screen
permission of Intelerad Medical Systems Incorporated. images must not be reviewed for primary image interpretations.
Mammographic images may only be interpreted using an FDA approved
Except as expressly provided otherwise in writing, the information monitor that offers at least 5 Mpixel resolution and meets other technical
provided in this document is provided AS IS, without any condition or specifications reviewed and accepted by FDA.
warranty, whether written, oral, express, implied, legal, or statutory. No
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applies to anything provided by Intelerad except as expressly provided in and technicians.
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is or will be accurate, error free or meets or will meet user requirements. physician.
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Apple Inc., registered in the United States and other countries. Title: Image Fusion User Guide
Software version: 3.2.1 (InteleViewer 4.11.1)
All other brand names, product names, or trademarks belong to their
respective holders. Date: March 11, 2015
Part number: IFEN321UG-O Issue 001
INDICATIONS FOR USE
IntelePACS is a device that receives digital images and data from various
sources (such as, CT scanners, MR scanners, ultrasound systems, R/F
units, computer and direct radiographic devices, secondary capture devices,
scanners, imaging gateways, or other imaging sources). Images and data
Table of Contents
I ma g e F u s io n 3 .2 .1 ( I n t e le Vie we r 4 .1 1 .1 ) Us e r Gu id e
Co p y r ig h t
Getting Started 5
About Image Fusion 6
Using the Documentation 6
System Requirements 8
Starting Image Fusion 9
Understanding the Interface 11
Comparing Studies 12
Linking Studies 15
Displaying the Control Panel 17
Displaying Annotations 18
Displaying or Selecting the Triangulation Crosshair 19
Opening Multiple Image Fusion Windows 20
Setting Preferences 21
About Setting Preferences 22
Setting the General Preferences 22
Adjusting the Opacity 23
Setting Opacity Preferences for Secondary Images 24
Adjusting the Window Level 25
Setting Window Level Presets 27
Working with Color Maps 28
Setting Color Map Preferences 32
Setting Colorbar Locking Preferences 33
Applying a Different Color Map 34
Setting Smart Fusion Preferences 34
Setting the Segmentation and SUV Thresholds 35
Setting Comparison Layout Preferences 36
Manipulating Viewports 38
Creating Custom Viewport Layouts 39
Selecting Viewports 40
Changing Viewport Layouts 41
Triangulating Viewports to a Specific Point 46
Rotating the MIP Viewport 47
Cine Playback in the MIP Viewport 49
Manipulating Images 50
About Manipulating Images 51
Changing Displayed Images 51
Changing the Image Layout 53
Orienting Images 54
Stacking Images 57
Measuring Lines, Areas, and Volumes 58
Tracking Volume and SUV Statistics 76
Registering Images 80
Peeking Inside Secondary Images 82
Capturing DICOM Images 83
Copying Images into Other Applications 84
Saving Images to PDF 85
Working with Presentation States 89
Keyboard and Mouse Shortcuts 90

List of Keyboard Shortcuts 91
List of Mouse Shortcuts 93
Index 94
4
2
Getting Started
Use Image Fusion to read fused data from standalone PET, SPECT, and CT
scanners and hybrid scanners.
In this Chapter:
About Image Fusion 6

Using the Documentation 6
System Requirements 8
Starting Image Fusion 9
Understanding the Interface 11
Comparing Studies 12
Linking Studies 15
Displaying the Control Panel 17
Displaying Annotations 18
Displaying or Selecting the Triangulation Crosshair 19
Opening Multiple Image Fusion Windows 20
About Image Fusion
About Image Fusion

Image Fusion is a clinical application integrated with InteleViewer that
provides access to the tools required for reviewing combined PET/CT images
and SPECT/CT images, also referred to as fused images. Use these tools to
review images from a CT or MR modality, referred to as primary images and
images from a PET or SPECT modality, referred to as secondary images. You
can also use these tools to fuse transverse images from standalone MR and
CT modalities with a PET/CT or SPECT/CT image to create a new fused
series.
Fused images allow you to view the anatomical information provided by the
CT images with the functional information provided by the PET or the
SPECT images to localize lesions accurately.
Image Fusion includes access to specific statistics such as maximum and

average Standard Uptake Values (SUV) and volume measurements, which are
used for the diagnosis, planning, and monitoring of treatments for cancer
patients.
You can view Multiplanar Reformatted (MPR) fusions and rotating Maximum
Intensity Projections (MIP) of the PET or SPECT image data. Use the MIP
view to triangulate the MPR fusions to a specific point of interest.
Additional key features of Image Fusion include:

l window leveling and color maps to isolate hot spots
l synchronizing actions
l saving images on the IntelePACS
l exporting images
l comparing current and prior studies
l measuring regions of interest and volumes of interest
l adjusting the percentage of anatomical image data displayed
l registering images
Using the Documentation

This guide contains detailed information about Image Fusion.
6
Getting Started 2
Viewing the Documentation

You can view this guide online and you can access this guide and more in
the Documentation Library of the Intelerad Education and Support Center:
http://support.intelerad.com
In addition to this user guide, two other documents are included with
InteleViewer:
l InteleViewer Quick Reference Card: Contains a reference to the
InteleViewer tools, icons, and keyboard shortcuts, as well as basic
information about starting and using the application.
l InteleViewer Release Notes: Contains information on new features for
each product release, as well as installation notes and troubleshooting
information.
The User Guide and the Quick Reference Card are provided as Adobe
Portable Document Format (PDF) files and require that you open them with
Adobe Reader, a free application for viewing and printing PDF files. If you
do not have Adobe Reader installed on your system, go to
http://www.adobe.com for more information.
To view the InteleViewer Image Fusion user guide:

From the Image Fusion application, choose Help | User Guide.
Obtaining Printed Documentation

Additional printed and bound copies of the InteleViewer Image Fusion User
Guide and other Intelerad product documentation can be obtained for a small
fee. For information, send email to:
documentation@intelerad.com
Notation Conventions
Several notation conventions are used throughout this guide. A list of these
notations and examples of their use is provided below.
Convention Example
Text that you type in a field, or on In the Date field, enter

a command line, are in Courier 2003/04/04.
font.
7
System Requirements
Convention Example
Keyboard commands are in SMALL Press CTRL+C to copy text.

CAPS AND BOLD.
New terminology or concepts are The process of automatically

italicized. distributing the images is referred to
as autorouting.
Menu choices are separated by Choose File | Exit to close the

vertical lines. application.
Comments and Questions

At Intelerad, we strive to create accurate and intuitive documentation that
provides you with effective product training and troubleshooting support. To
better help us develop documentation products that meet your needs, we
encourage you to send your comments and questions to:
documentation@intelerad.com
System Requirements
For workstations being used for diagnostic review, this section outlines the
recommended system requirements for using Image Fusion. For more
information on equivalent alternatives to these requirements, contact the
Intelerad Support Center.
l Dual Quad-Core Intel Xeon processor, E5-2609 2.4 GHz
l Microsoft Windows 7 Professional 64-bit version
l 8GB DDR3 RAM
l NVIDIAQuadro FX 600
l 146GB SAS hard disk for operating system and 300GB or 600GB SAS
hard disk for local image storage
l CD/DVD burner drive
Note: If you are using more than two monitors with Image Fusion,
Intelerad recommends having two identical video cards.
8
Getting Started 2
Starting Image Fusion

Start Image Fusion from the InteleViewer toolbar. To use Image Fusion,
InteleViewer must be connected to IntelePACS. You cannot access Image
Fusion if you open a study burned to a CD or DVD, open InteleViewer in
standalone mode, or run InteleViewer on a Mac. For more information on
InteleViewer, refer to the InteleViewer User Guide.
Image Fusion supports CT, PET and SPECT, and MR data, as well as the
fusion of CT with PET or SPECT data. It can handle a maximum of eight
datasets, four CT or MR and four PET or SPECT studies (two AC and two
NAC) at one time allowing you to compare PET/CT examinations at two
different time points.
There are certain conditions for fusing PET/CT, SPECT/CT, or MR datasets:

l At least one CT or MR dataset must be loaded in the viewports.
l The datasets must all have at least two images.
l The datasets must be loaded at the requested quality.
l The datasets must contain transverse images.
l The CT/PET or SPECT datasets must share a common frame of reference.
If the CT/PET or SPECT datasets being loaded do not share a common frame
of reference, a warning message appears when you start Image Fusion.
If there is more than one possible pair of compatible series loaded in the
viewports in InteleViewer, Image Fusion will automatically fuse the CT and
PET or SPECT series.
Note: Image Fusion does not fuse MR series with PET or SPECT series.
The MR series is launched alone. Image Fusion will fuse MR series with
PET or SPECT series if they were both acquired from the same scanner,
and share a common frame of reference. If the MR and PET or SPECT
series were not acquired from the same scanner, you can use the Fuse
Studies option in the Tools menu to fuse them into a new study. This
option is available only when there is a standalone modality and either
another standalone modality or hybrid modality loaded. Image Fusion
uses the current MR series and current PET or SPECT series for fusing.
To start Image Fusion:

1. Open one or more of the following combination of studies:
l CT
l PET
9
Starting Image Fusion
l SPECT
l CT and PET AC or NAC
l CT, PET AC, and PET NAC
l MR
l MR and CT/PET AC or NAC
l MR and CT/PET AC/PET NAC
l CT and SPECT AC or NAC
l CT, SPECT AC, and SPECT NAC
l MR and CT/SPECT AC or NAC
l MR and CT/SPECT AC/SPECT NAC
2. In InteleViewer, do one of the following:

l Choose a series layout where one CT series and one PET or SPECT
series are loaded in the viewports.
l Choose a series layout that contains multiple studies where each
study contains one CT or MR series and one or more PET or
SPECT series loaded in the viewports.
Image Fusion launches with all the CT-visible studies. It associates the
CT studies with the PET studies of the largest number of transverse
slices.
If the study includes a PET or SPECT AC and PET or SPECT NAC
series loaded in the viewports, Image Fusion launches them together.
3. Click the Image Fusion tool .

If you start Image Fusion before all the CT/PET or CT/SPECT or MR
images are streamed, a warning appears. If this occurs, click Cancel
Launch and start Image Fusion again.
If there is more than one possible pair of compatible series loaded in the
viewports in InteleViewer, Image Fusion automatically fuses the pair of
CT and PET or SPECT series.
The Rendering Fusion Views dialog appears indicating the progress of
the image fusion stage. The Image Fusion - 1 window opens. Each
compatible series pair appears in its own tab in the toolbar. The
following example shows four study tabs in chronological order of the
10
Getting Started 2
prior study from the most recent to oldest with respect to the current
study tab (shown with red text).
To exit Image Fusion:

Do one of the following:
l Choose File | Close.
l Click the “x” icon in the top right corner of the window.
The application closes. The size and position of the window is

remembered the next time you start Image Fusion.
Understanding the Interface

The main elements of the Image Fusion interface are the menu, toolbar,
control panel, and viewports. In the menu, you can choose among most of the
key functions, many of which are also accessible from the toolbar. Images and
related information appear in the viewports.
11
Comparing Studies
The Image Fusion window displays two types of viewports: a 2D Multiplanar

Reformat (MPR) fusion viewport and a 3D Maximum Intensity Projection
(MIP) viewport.
The MPR fusion viewports can display a single modality (CT, PET, SPECT)
or two modalities (PET/CT or SPECT/CT) in fused view.
The Maximum Intensity Projection (MIP) viewport provides a rotating 360°

3D MIP view of PET or SPECT volumes. By rotating the viewport, you can
get a general overview of the radiopharmaceutical within the body and draw
attention to possible areas of focal or abnormal activity to be closely
inspected on subsequent complete reviews of image data.
Comparing Studies
Image Fusion provides two comparison options for displaying prior studies
on the same monitor. You can use these comparison options to display a
PET/CT or SPECT/CT study with CT, PET, and MR fused images in different
orientations during an evaluation. Comparative evaluation is improved and
facilitated through automatic registration, linking, and the availability of
comparison options, which allow direct, side-by-side or top-down comparison
of pre and post studies or contrast and non-contrast images. You can further
enhance the viewing of multiple studies by linking them, at which point
navigation, window levelling, panning and zooming is synchronized on all
the studies.
Each prior study that is open has its own button in the toolbar. Image Fusion
maintains synchronization and registration between the current study and the
images of the prior studies that appear in the viewports after the studies have
been linked or synchronized.
There are two comparison options:
12
Getting Started 2
l Compare 2 - Use to compare the current study with the selected prior
study of the patient. You can choose to lay out the current study on the
top, bottom, left, or right of the monitor. By default, the current study
appears on the top and the prior study appears on the bottom.
Note: When you use the Compare 2 option, the viewport layout does not
include the sagittal view. In the Preferences dialog, you can change the
layout to display the sagittal view when comparing two studies.
l Compare All - Use to compare all studies in the same orientation as the
selected viewport in the currently-selected study, as indicated by a
yellow outline. The selected viewport for each study is displayed side-
by-side and in chronological order for comparison.
13
Comparing Studies
To apply the Compare 2 option:

1. Set your comparison layout preferences if you have not done so already.
See "Setting Comparison Layout Preferences" on page 36.
2. In the toolbar, click Compare 2.
The current study appears on the top and the most recent prior study
appears on the bottom.
Both studies retain synchronization and registration.
3. To replace the current study or most recent prior study, select the
viewport of the study that you want to replace, and then click the
button of the desired study.
4. To display only the currently-selected study, click the Single Study
button.
To apply the Compare All option:

1. Set your comparison layout preferences if you have not done so already.
See "Setting Comparison Layout Preferences" on page 36.
2. Select the viewport with the orientation that will be used to compare all
14
Getting Started 2
studies.
3. In the toolbar, click Compare All.
The selected viewports from each study are displayed side-by-side and
in chronological order.
4. To display only the currently-selected study, click the Compare All
button.
See Also
Linking Studies 15
Linking Studies
When you compare studies, Image Fusion performs a semi-automatic
registration by applying any previously-saved registrations. All the series in
the current study are automatically aligned spatially with all the series in the
prior studies. If you are not satisfied with the result of the semi-automatic
registration, you can manually adjust the series of one study so that it shows
the same anatomical or pathological structure of interest as the series of the
prior studies. Images will subsequently line up at the registration point, and
the crosshair locations between viewports of the same orientation will be the
same. Any image manipulations will be based on the registration point.
You can also perform an automatic alignment of images for comparison by

using the AutoFuse buttons. AutoAlign F performs a full automatic alignment
of images, including correction the offset along the patient's head to toe axis,
while AutoAlign L performs a local automatic alignment of images only,
excluding the head to toe offset correction. AutoAlign L is provided for those
cases where AutoAlign F cannot find the correct head to toe offset correction,
but an alignment in the other two dimensions can still be obtained
automatically.
15
Linking Studies
Once the studies have been aligned they are linked so that you can perform
image manipulations on the linked studies simultaneously. For example, you
can pan and zoom a specific region of interest on all related views of all
studies at the same time. The image manipulations you perform are then
applied to the images in the studies to the same degree based on the
alignment point. The image manipulations that you can perform on linked
studies are: zoom, pan, stack, triangulate, triangulate from MPR fusion or MIP
viewport, coronal/sagittal options in MIP, window level, and layout
selections.
To link studies:
1. Place the triangulation crosshairs at the same anatomical position in 3D
space in all the studies.
2. In the toolbar, click Synch.
The link position is saved, and the studies are synchronized.
3. Select one of the image manipulation tools that is available for linked
studies and then adjust the images as required.
When stacking through images, only the related images stack
simultaneously. Images that are not related do not stack.
4. To unlink the studies, click Unsynch/Resynch Last.
Image Fusion repositions the other studies to the same location as the
current study, using the original link position as the reference point.
16
Getting Started 2
Displaying the Control Panel

The main elements of the control panel are the layout selector, measurement
window, slice thickness and increment sliders, window level controls, and
opacity slider.
You can display or hide the control panel. If you are comparing studies, a
separate control panel appears in each study. In this case, you can display or
hide all the control panels at once.
To display the control panel:

1. From the menu, choose View | Control Panel (V).
2. To hide the control panel, choose View | Control Panel (V).
17
Displaying Annotations
Displaying Annotations
You can show or hide annotation information in the MPR fusion viewports.
The patient name, patient ID, and exam date are displayed in the top left
corner of the viewport. The slice number and total number of slices are
displayed in the bottom left corner of the viewport as you stack images.
For CT studies, the attenuation coefficient of different types of tissues is

measured and displayed in Hounsfield units (HU). For PET and SPECT
studies, pixel intensity values at the current triangulation crosshair location
appear. For PET images, the standard uptake value (SUV) appears as you
move through the images. For SPECT images, the event count at that point
appears labelled NM (Nuclear Medicine).
Note: For lossy DICOM JPEG images that include a compression ratio,
PET, SPECT and CT images are loaded at the maximum compression ratio.
In this case, the word “lossy” appears in red along with the compression
ratio in the annotation text, Lossy:P100, C50:1. If the lossy images do
not include a compression ratio, then “??:1” appears in the annotation
text, as in Lossy:P??, C??:1
18
Getting Started 2
To display annotations:
1. From the menu, choose View | Annotations (A).
2. To hide annotations, choose View | Annotations (A).
Displaying or Selecting the Triangulation Crosshair

You can show or hide the triangulation crosshair in viewports. You can also
select the triangulation crosshair to display in the viewports.
To display the triangulation crosshair:
1. From the toolbar, click .
2. To hide the triangulation crosshair, click .
To select the triangulation crosshair:

1. In the toolbar, click the Triangulation Crosshair menu.
2. Select the required triangulation crosshair.
19
Opening Multiple Image Fusion Windows
You can choose a default triangulation crosshair in the Preferences

dialog. See "Setting the General Preferences" on page 22.
Opening Multiple Image Fusion Windows

You can open several Image Fusion windows to work with studies of several
patients at the same time. Opening several Image Fusion windows is also
useful if you have more than four CT or MR and four PET or SPECT studies
to read. For example, if you have 8GB of RAM memory installed on your
computer, then you can open up to four Image Fusion windows each with
two CT or MR and PET or SPECT studies.
You can also open another Image Fusion window if you are interrupted while
reading a study, and need to open another patient’s study.
To open multiple Image Fusion windows:

1. In InteleViewer, open another PET/CT, SPECT/CT, or MR study. See
"Starting Image Fusion" on page 9.
The Image Fusion - 2 window appears.
2. Repeat step 1 for each new session that you require.
20
3
Setting Preferences
Set the Image Fusion preferences for viewing images.
In this Chapter:
About Setting Preferences 22

Adjusting the Opacity 23
Setting Opacity Preferences for Secondary Images 24
Adjusting the Window Level 25
Setting Window Level Presets 27
Working with Color Maps 28
Setting Color Map Preferences 32
Setting Colorbar Locking Preferences 33
Applying a Different Color Map 34
Setting Smart Fusion Preferences 34
Setting the Segmentation and SUV Thresholds 35
About Setting Preferences
About Setting Preferences

Set user preferences to customize the interface behavior, appearance, and
image layout.
Setting the General Preferences

You can set the general preferences for viewport display and behavior.
To set the general preferences:

1. Choose File | Preferences.
The Preferences dialog opens.
2. Click the General tab.
3. Do one of the following:
To: Then:
Move the triangulation Enable Update all Viewports when Moving

crosshair or stack Crosshair.
images in one viewport
and change the related
images simultaneously
in other viewports
Move the triangulation Disable Update all Viewports when

crosshair or stack Moving Crosshair.
images in one viewport
and change the related
images in other
viewports only after you
release the mouse
button
Hide the triangulation Enable Hide Crosshair on Image Export.

crosshair from DICOM
secondary capture
images
22
To: Then:
Include the Disable Hide Crosshair on Image Export.

triangulation crosshair
in DICOM secondary
capture images
Select the type of Choose a triangulation crosshair from the

triangulation crosshair available options.
to display in the
viewport
Adjust the size of the Choose an option from the ROI Text Font
measurement text (ROI, Size list. The minimum size is 8 pixels and
VOI, and linear the maximum size is 30 pixels. The default
measurements) size is 12 pixels.
displayed in the
viewports
Indicate where you Enter the path name in the PDF Export
want to save the PDF Directory text box. For more information on
saving images to PDF, see "Saving Images
to PDF" on page 85.
Indicate where you Enter the path name in the Statistics CSV
want to save the Export Directory text box.
Statistics CSV Export
file
4. Click OK.
The changes take effect when you restart Image Fusion. The new
measurement text font size is immediately applied and remembered the
next time you start Image Fusion.
Adjusting the Opacity

The opacity setting determines the blend value of the primary and secondary
images in an MPR fusion viewport as you move the cursor on an image. The
blend value is the combination of pixel information from both the primary
and secondary images. By setting the opacity, you determine the proportion
of primary versus secondary pixel information that appears in the image.
23
Setting Opacity Preferences for Secondary Images
A blend value equal to 0% means the fused image contains contribution from
only the secondary image. A blend value equal to 50% means the fused
image contains blended pixels with equal contributions from the primary
image and the secondary image. A blend value equal to 100% means the
fused image contains contribution from only the primary image.
Setting Opacity Preferences for Secondary Images

By default, the opacity for secondary images is 50%. You can however
change the opacity that Image Fusion applies to secondary images by setting
a new opacity value. Image Fusion applies your new opacity setting the next
time you open Image Fusion.
To set the opacity preferences for secondary images:

2. Click the Color Maps tab.
3. In Startup Secondary %, type the opacity percentage to apply by default
to secondary images.
4. Click OK.
The changes take effect when you restart Image Fusion.
24
Adjusting the Window Level

Use the window level to change the contrast and brightness of primary and
secondary images.
You can adjust the window level interactively for fused, primary, and
secondary images or choose predefined window level presets for primary and
secondary images. Window level presets allow you to apply predefined
settings to primary and secondary images in the selected series.
Note: If the window level defined in the DICOM header information for an
image is too small, the color bars on the window levels are small. The
image appears with few colors in the viewport. Additionally, if the window
level settings are placed in a position where there are no corresponding
image pixels, the image may appear washed out or dark. In both cases,
you need to open the window first and then adjust the window level
settings.
To adjust the window level of images interactively:

1. Apply a color map to primary or secondary images. See "Setting
Window Level Presets" on page 27.
l Choose Tools | Window Level (W ) or click the Window Level
tool . Click and drag in the viewport.

The mouse cursor changes to indicate you are adjusting the window
and level.
Drag: To:
Down Increase the brightness of primary images,

secondary images, or both.
Up Decrease the brightness of primary images,

Left Decrease the contrast of primary images,

Right Increase the contrast of primary images,

You can also click the middle mouse button and drag in the required
direction.
25
Adjusting the Window Level
Note: Dragging the mouse cursor in a viewport displaying secondary

images adjusts the window level setting of only the top position of
the window. Dragging the mouse cursor in a viewport displaying
both primary and secondary images adjusts the window level setting
of only the primary images. Furthermore, pressing and holding the
CTRL key while window leveling a fused imaged only affects the
PET/SPECT. Window leveling a fused image (without pressing the
CTRL key) affects the primary images only.
l In Control Panel, drag the color bars to adjust the window level.
3. For fine window level adjustments, right-click in the color bar and then
choose Scale, and then select Rescale.
This places the horizontal bars at the top and bottom of the color bar;
however, the maximum window level values correspond to where the
sliders were before you selected Rescale.
4. To reset the horizontal bar to the previous settings, right-click the
required color bar and then choose Scale, and then select Reset.
To adjust the window level by using presets:

1. Select the required series.
l Choose a setting from the Window Level menu .

l Press the key that corresponds to the window level preset that you
want to use. For example, press F5 to apply the lung window level
settings.
26
Choose: To:
DICOM Set the window level to correspond to the

DICOM data contained in the primary image.
Chest Apply chest window level settings (width=350,

level=40) to primary images.
Abd/Plv Apply abdominal/pelvis window level settings

(width=350, level=40) to primary images.
Lung Apply lung window level settings (width=1500,

level=-600) to primary images.
Brain Apply brain window level settings (width=60,

level=38) to primary images.
Bone Apply bone window level settings

Head/Neck Apply head/neck window level settings

SecPresets 1 - 6 Apply custom window level settings to

secondary images.
Setting Window Level Presets

Customize the window level settings for primary and secondary image
presets.
To customize the default window level presets for primary

images:
2. Click Primary WL.
3. Modify the window or level presets and then click OK.
The changes take effect the next time you restart Image Fusion.
To create custom window level presets for secondary images:

27
Working with Color Maps
2. Click Secondary WL.

3. Modify the name, window or level presets and then click OK.
The changes appear in the Window Level menu the next time you
restart Image Fusion.

By using the Color Map Editor, you can create your own color maps or edit
existing ones. Image Fusion provides eight predefined color maps.
The following table displays the predefined color maps and corresponding
color bar that you can apply to primary, secondary, and fused images. By
default, the Gray color map is used for all images.
Color map Color bar
Gray
Hot Iron
Hot Iron BK 1
Hot Iron BK 2
28
Color map Color bar
Inverse Gray
PETCT
Thermal
Thermal BK
Note: The color maps ares stored with a .map file extension in the
colormap folder. These files define the RGB color values of the color slots
that appear in the Color Map Editor. The default files are: gray.map, Hot
Iron.map, Hot Iron_BK1.map, Hot Iron_BK2.map, Inverse Gray.map,
petct.map, and thermal.map, thermal_BK.map.
Color maps include 256 levels of color (red, green and blue) and are used to
assign an arbitrary color to the pixel value in primary, secondary, and fused
images. The Color Map Editor allows you to enter a color for 17 color slots
(1st, 17th, 33rd, 49th…256th) in the 256 color slots which make up the color
map. Image Fusion performs linear interpolation to obtain all intermediate
values.
To create a color map:

1. Choose Tools | Edit Color Maps.
The Color Map Editor appears.
29
2. In the Name field, enter the name of the new color map.
The name you type appears in the list of color maps in the Color Map
menu when you right-click a window leveling control. This is also the
filename of the color map.
3. To use colors from an existing color map, click Get Color Map, select
the color map, and then click Open.
4. To set a new color, do one of the following:
l Click a color slot button, and use the Color dialog that appears.
l To specify the red, green, and blue value of the color, enter a value
from 0 to 255 in each of the RGB text boxes.
5. To set more new colors in the color map, repeat step five as many times
as necessary.
6. Click Update Colors to see the new colors.
7. To perform a RGB color interpolation between two colors, enter a value
from 1 to 17 in the First field and then the Second field, and click
Interpolate.
This action fills the specified range with an RGB interpolation between
the colors in the first color slot and the second color slot.
8. To specify the default color map for primary, secondary, and fused
images, do one of the following:
30
Activate: To:
Default Primary Specify the default color map for primary

images.
Default Secondary Specify the default color map for secondary

images.
Default Secondary Specify the default color map for secondary

Fusion fused images.
Image Fusion remembers the new default color map the next time you
start the application.
9. Click Save Color Map.
The color map is saved with a .map file extension in the colormap
folder.
10. Click Exit to close the Color Map Editor.
To edit a color map:

2. Click Get Color Map and select the color map that you want to edit.
3. Modify the color map, as required.
4. Click Save Color Map to save your changes.
To delete a color map:

2. Click Get Color Map and select the color map that you want to delete.
3. Click Delete Color Map.
4. Click Yes to confirm.
The color map is deleted from the colormap folder.
To invert an image color map:

1. In the Window Level area of the control panel, right-click the required
color bar and choose Inverse.
31
Setting Color Map Preferences
Depending on the color bar selected, all primary or secondary images

are inverted in the viewport.
2. To reset the image color map, click the required color bar again and
choose Inverse.
Setting Color Map Preferences

Choose the color maps that Image Fusionapplies automatically to primary,
secondary single and secondary fusion images when you open a new session.
You can choose from system color maps or custom color maps.
To set color map preferences for images:

2. Click Color Maps.
32
3. Select a color for primary, secondary single and fusion view images.
4. Click OK.
The changes take effect the next time you restart Image Fusion.
Setting Colorbar Locking Preferences

Use the Colorbar Lock to control primary and secondary window level
adjustments.
For example, by enabling the Primary colorbar, adjusting the window

levelling affects all primary images at the same time. By disabling the
Primary colorbar, you can adjust the window levelling of each primary image
separately.
You can set colorbar lock preferences; each time you open Image Fusion
these colorbar preferences apply. You can also set colorbar preferences for a
given session.
To set colorbar locking preferences:

2. Click Color Maps.
l Enable Lock Primary Colorbars or Lock Secondary Colorbars, or
both, to do simultaneous window leveling for primary or secondary
Images.
l Disable Lock Primary Colorbars or Lock Secondary Colorbars, or
both to do independent window leveling for primary and secondary
images.
4. Click OK.
The changes take effect the next time you open Image Fusion.
To change the colorbar locks interactively:

1. In the Window Level area of the control panel, enable Primary or
Secondary, or both.
2. Click and drag the fusion primary or single primary horizontal bars or
33
Applying a Different Color Map
fusion secondary or single secondary horizontal bars.
Applying a Different Color Map

You can apply another color map to primary, secondary, or fused images in
an MPR fusion viewport. You can also reverse the color map of primary,
secondary, and fused images to view it as white-on-black rather than black-
on-white.
To apply a different color map:

In the Window Level area of the control panel, right-click the required
color bar and choose Color Map, and then select a color map.
Setting Smart Fusion Preferences

Smart fusion enhances PET and SPECT images by fusing everything but the
“coldest” PET or SPECT colors in the selected color window, allowing the
CT part of the image to be displayed without obstruction or degradation. For
example, on a thermal color map, the coldest color is black. Depending on
the color bar settings, all black pixels in the PET or SPECT portion of the
fused image are not fused, regardless of their SUV or pixel value. If the
34
thermal map is inverted, the coldest color is then white. In that case, white
pixels are not fused.
Since the resulting image may not be what you expect, you can set a
preference value. You can set Smart Fusion preferences so that each time you
open Image Fusion the Smart Fusion preferences you set apply or you can
enable or disable Smart Fusion interactively as you go.
To set Smart Fusion preference:

2. Click the General tab.
3. Enable or disable Smart Fusion.
4. Click OK.
The changes take effect when you restart Image Fusion.
To enable or disable Smart Fusion interactively:

Choose View | Smart Fusion.
The feature is enabled or disabled for the current session only.
Setting the Segmentation and SUV Thresholds

When you seta SUV window level threshold, only pixels with an SUV value
that is equal to or greater than the SUV threshold are displayed in the fusion
viewport.
When you set the segmentation threshold SUV, only pixels with an SUV
value that is equal to or greater than the segmentation threshold SUV are
used for lesion segmentation.
You can make both thresholds available as a preference that you can use
when necessary.
You can also change the displayed window level SUV threshold manually
by dragging the bottom of the secondary color bar in the control panel.
To set the SUV and segmentation thresholds:

2. Click the Color Maps tab.
35
Setting Comparison Layout Preferences
3. To set the SUV window level threshold, in Value, type the SUV limit.
This value appears as a preset in the Control Panel. Pressing the Preset
button causes the window level threshold to be applied.
4. To set the segmentation threshold, in Percentage of Max, type the

percentage of the maximum SUV value that is used as the lower
threshold for lesion segmentation.
The value appears in the Control Panel in the PET Segmentat. box.
See Also
Segmenting PET Volumes 66
Setting Comparison Layout Preferences

You can set the preferences for laying out the way the current study and prior
studies appear in the viewports for comparison.
Note: If the comparison option is already applied before you change the
comparison layout preferences, Image Fusion will not apply the changes
36
immediately. You need to first switch to the single study option, and then
click the Compare 2 or Compare All button.
To set comparison layout preferences:

2. Click the Comparison Options tab.
3. To specify the layout for comparing any two studies, in the Compare 2
section, choose one of the following options:
To: Choose:
Display the current study on the top Current on Top

and the prior study on the bottom of
the viewing area
Display the current study on the Current on Bottom

bottom and the prior study on the top
of the viewing area
Display the current study on the left Current on Left

and the prior study on the right of the
viewing area
Display the current study on the right Current on Right

and the prior study on the left of the
viewing area
4. To specify the layout for comparing all studies, in the Compare All
Orientation section, choose one of the following options:.
To: Choose:
Display the current study on the left and Current on Left

all prior studies side-by-side on the right
of the viewing area in chronological order
Display the current study on the right and Current on Right

all prior studies side-by-side on the left of
the viewing area in chronological order
5. Click OK.
The new comparison layout is immediately applied and remembered the
next time you start Image Fusion.
37
4
Manipulating
Viewports
Set the viewport layouts to view images based on your viewing preferences.
In this Chapter:
Creating Custom Viewport Layouts 39

Selecting Viewports 40
Changing Viewport Layouts 41
Triangulating Viewports to a Specific Point 46
Rotating the MIP Viewport 47
Cine Playback in the MIP Viewport 49
Creating Custom Viewport Layouts
Creating Custom Viewport Layouts

Use the Layout Editor to create custom viewport layouts and to modify the
comparison and user layouts. You can determine the type of viewports that
are displayed. Additionally, you can customize the size and sequence of the
viewports.
To create a custom viewport layout:

1. From the menu, click File and then Layout Editor.
The Layout Editor appears.
2. In the Select Layout to Modify menu, select a viewport layout to

customize from the three groups of default user layouts.
The selected viewport layout appears.
3. To change the position of viewports in the layout, click the caption
title and drag the viewport to a new location. Viewports cannot be
placed on top of each other. A warning appears if you try to save the
layout.
4. To adjust the width of a viewport, select the viewport and then set the
width fraction. The width as a percentage of the screen width appears in
Screen % field. Set the Multiplier value to increase the fraction width of
the viewport and then click Modify to change the viewport size.
5. To adjust the height of a viewport, select the viewport and then set the
height fraction. The height as a percentage of the screen height appears
in Screen % field. Set the Multiplier value to increase the fraction
height of the viewport and then click Modify to change the viewport
size.
6. To change the type of viewport, select a viewport and then select MIP
39
or MPR. You cannot create two MIP viewports, or two MPR viewports
of the same orientation and initial display in a layout. If that is the case,
the "Insert" button remains disabled. Either delete the existing viewport,
to create a new one, or select and modify it.
7. To set which type of viewport (primary, secondary or fusion) is
displayed first in the viewport and its orientation, select the initial
display and orientation. For example, change a Primary Transverse
viewport to Secondary Sagittal viewport.
8. To insert a viewport, click Insert. You can only insert a viewport type
that is not already there. There is a maximum of ten viewports: three
primary, three secondary, three fused, and one MIP.
9. To delete a viewport, select the viewport and then click Remove.
10. Click Modify after each modification to size, type, orientation or initial
display.
11. To override the default user layout settings with your own, click Save.
12. To create a new layout, click Create New and then provide a name for
your new viewport layout. This layout appears in two places: the
Layout Editor menu and in the Custom Layout menu.
13. Restart the application to see your new layout in the Custom Layout
menu.
Selecting Viewports
To perform certain functions, such as zooming images, you must first select
the required viewport. When you select a viewport, the outline of the
viewport is highlighted, indicating that it is the current viewport.
To select a viewport:
Click the required viewport.
The viewport is highlighted to indicate that it is selected.
40
Changing Viewport Layouts

Use viewport layouts to control the number and location of the viewports in
the Image Fusion window.
The Image Fusion application contains two types of layouts, user layouts and
standard layouts both of which are used for displaying single and fused
volumes in transverse, coronal, and sagittal views.
By default, Image Fusion includes three predefined user layouts. If required,

however, you can add an unlimited amount of customized user layouts to
meet your needs. To create new user layouts or modify existing ones, contact
your IntelePACS administrator.
41
User Layouts
User layout 1 displays a single study in three fused MPR viewports
(transverse, coronal, and sagittal view), a 3D MIP view of the PET AC
volume, three PET or SPECT MPR viewports (transverse, coronal, and sagittal
view), and one CT transverse MPR viewport.
User layout 1 appears by default when you start Image Fusion. Applying a
viewport layout modifies the view for your current window only. If you
restart the Image Fusion application, or open a different Image Fusion
application, User layout 1 is used.
User 2 layout displays a single study in three fused MPR viewports

(transverse, coronal, and sagittal view), three PET or SPECT MPR viewports
(transverse, coronal, and sagittal view), and three CT MPR viewports
(transverse, coronal, and sagittal view).
42
User 3 layout displays a single study in three fused MPR viewports

(transverse, coronal, and sagittal view) and a 3D MIP view of the PET or
SPECT volume.
43
To apply a user layout:

l In the Control Panel, click the required user layout button:1, 2, or
3. Only the first three layouts are available for selection from the
Control Panel. The subsequent layouts are available from the View
menu.
l Choose View | User Layouts and then select the required layout.
l On your keyboard, press the number that corresponds to the user

layout. For example, press number 4 to apply user layout 4.
To move between layouts:

1. Press the TAB key on your keyboard to move from one user layout to
the next.
44
2. Press the S PACEBAR to apply the layout.
To quickly set a 1-viewport layout:

1. Select the required MPR fusion viewport.
2. Right-click and select Toggle Full Zoom.
The image is displayed in a 1 x 1 layout. If your system is configured
with multiple monitors, the image expands to fill a single monitor.
3. To revert to the previous layout, right-click and select Toggle Full
Zoom again.
Standard Layouts
Image Fusion comes with 16 predefined layouts that display single or
multiple images based on the anatomical position (transverse, sagittal or
coronal) and type of image (primary, secondary or fused) you want to view.
To apply a standard layout:

l From the Control Panel, click one of the 16 layout buttons.
l From the menu, choose View | 1-Viewport Layouts. Select the

required layout.
l From the menu, choose View | N -Viewport Layouts. Select the
45
required layout.
To move between layouts:

1. Press the TAB key on your keyboard to move from one standard layout
to the next.
2. Press the S PACEBAR to apply the layout.
Triangulating Viewports to a Specific Point

Image Fusion provides triangulation between all primary, secondary, and
fused images in the same layout. Whether in the MPR fusion viewport or the
MIP viewport, clicking on a region automatically snaps all viewports to the
same location.
Triangulating viewports centers the crosshairs at the specified point in all the
viewports. If you select a measurement in the Measurements window, all the
viewports are triangulated to the position of the selected measurement.
To triangulate viewports to a specific point:

1. Select the required viewport.
2. To choose the triangulation crosshair that you want to use, select a type
from the Triangulation Crosshair menu.
The standard triangulation crosshair is used by default.
46
Rotating the MIP Viewport
Note: You can use a default triangulation crosshair in the

Preferences dialog. See "Setting the General Preferences" on page
22.
3. If you selected an MPR fusion viewport, do one of the following:
l Choose Tools | Triangulate.
l Click the Triangulate tool .

4. On the required image, click the left mouse button on the hot spot you
would like to triangulate.
The red triangulation crosshairs are centered at the specified point in all
the viewports.
Clicking a point in an MPR fusion viewport that is not the maximum

intensity point in the depth direction on the MIP viewport displays that
point with green crosshairs in the MIP viewport.
Clicking a point in the MIP viewport may not display the point as
expected in the MPR fusion viewports. Click another point in the MIP
viewport until the red crosshairs are centered to that point in the MPR
fusion viewports.
Rotating the MIP Viewport

You can manually rotate the MIP viewport.
47
To rotate the MIP viewport:

1. Select the orthogonal view that you want the volume to be rendered in.
To render the volume in: Click this button:
Sagittal view S
Coronal view C
Anterior view A
Left view L
Posterior view P
Right view R
2. At the bottom of the MIP viewport, click and drag the slider left or
right to rotate the viewport along the Z axis.
The icon in the bottom left corner of the viewport indicates the relative
position of the body: A (Anterior), P (Posterior), L (Left), and R (Right).
48
Cine Playback in the MIP Viewport
Cine Playback in the MIP Viewport

You can automatically rotate the MIP viewport to move any of the
orthogonal views through the PET or SPECT volume in a step-wise manner.
This enables you to see a series of parallel sections through the patient, as
intersected by the current orthogonal view.
To cine the MIP viewport:

1. Click the Start button at the bottom right of the viewport.
2. To stop cine in the viewport, click the Stop button.
49
5
Manipulating Images
Use a full range of image manipulation tools to facilitate image viewing.

The comprehensive toolset includes contrast and window level presets, slice
selection, triangulation, pan, zoom, and stack.
In this Chapter:
About Manipulating Images 51

Changing Displayed Images 51
Changing the Image Layout 53
Orienting Images 54
Stacking Images 57
Measuring Lines, Areas, and Volumes 58
Tracking Volume and SUV Statistics 76
Registering Images 80
Peeking Inside Secondary Images 82
Copying Images into Other Applications 84
Saving Images to PDF 85
About Manipulating Images
About Manipulating Images

The Image Fusion application provides you with a comprehensive set of
image manipulation tools that include contrast and window level presets,
slice selection, triangulation, pan, zoom, and stack.
Changing Displayed Images

You can change the images displayed in MPR viewports to display primary,
secondary or fused images. For example, if you applied a layout that includes
viewports displaying only fused images and primary images but you want to
see secondary images instead, change the image type.
You can also toggle between AC and NAC images for PET or SPECT
studies. The blue highlight indicates the nominal view of that viewport. This
51
is useful if you change the nominal view and want to remember what it was
before you changed it.
To change the image display:

1. Select the required MPR viewport.
2. To select the image that you want to display in the viewport, click one
of the following buttons along the bottom right side of the viewport:
Click: To:
P Display primary images in the viewport.
S Display secondary images in the viewport.
F Display fused images in the viewport.
i Display primary images and a movable window

of secondary images to show a fused image in
the area covered by the window.
C Toggle between AC and NAC images for PET

and SPECT studies.
The viewport displays the selected image.
52
Changing the Image Layout
Changing the Image Layout

You can customize the layout of images in the viewports as you work. This
can be useful when interpolating between ROI measurements. Y
You can choose from several grid options to indicate the way in which
multiple images appear in the series viewport, organized in rows and
columns. For example, a 2 x 2 layout displays a total of four images in the
viewport, organized in two rows and two columns.
To change the image layout:

1. Select the required viewport.
2. Choose a grid option from the Image Layout menu in the toolbar.
53
The layout of rows and columns is set automatically to suit the aspect
ratio of the application window.
The images in the selected series are displayed according to the new
layout.
Triangulation to other viewports is based on the first frame.
See Also
Interpolating Between ROI Measurements 72
Orienting Images
You can zoom and pan primary, secondary, or fused images to reorient them
in the viewport. Images in viewports of the same orientation are panned,
zoomed, and reset together. In synchronization mode, resetting the pan and
zoom occurs in both windows simultaneously.
Zooming Images
In an MPR fusion viewport, you can zoom a specific area, or a selected part
of a primary, secondary, or fused image. In a MIP viewport, you can zoom a
specific area of a PET or SPECT volume to increase its magnification.
You can also do a partial zoom that occupies half of the screen. and displays
other viewports on the other half. This can be useful if, for example, you have
a large monitor. In this case, instead of displaying one image on the entire
screen, you can do a partial zoom to display the image on only half of the
screen. If the viewports are spanned across several monitors, then doing a
partial zoom will display the image on the entire screen.
To zoom an image in an MPR fusion viewport:

1. Select the required image in the MPR fusion viewport.
54
Orienting Images
l Choose Tools | Zoom (Z).
l Click the Zoom tool .

The mouse cursor changes to indicate you are zooming.
3. Position your mouse cursor over the area in the viewport you would
like to zoom, and then click and drag.
Drag: To:
Up Increase the magnification of the area (zoom in).
Down Decrease the magnification of the area (zoom

out).
Note: You can also right-click and hold your mouse and drag up (to
zoom in) or drag down (to zoom out).
When zooming fused images, the zoom settings are applied to both the
primary and secondary images. If the selected MPR fusion viewport is
displaying fused transverse images, releasing the left mouse button also
zooms fused sagittal and fused coronal images in the other MPR fusion
viewports.
4. To revert the image to its original position, right-click the image and
select Reset Pan/Zoom.
To do a partial zoom in an MPR fusion viewport:

1. Double-click the required image in the MPR fusion viewport.
For example, if you are using User Layout 1 to show eight viewports,
and you double-click the fused sagittal viewport, the layout is updated
to display only five viewports.
55
2. To revert to the previous viewport layout, double-click the image again.
To zoom an image volume in the MIP viewport:

1. Select the MIP viewport.
Click: To:
Zoom Increase the magnification of the image volume

(zoom in).
UnZ Decrease the magnification of the image volume

(zoom out).
Note: You can also right-click the image and drag up (to zoom in) or
drag down (to zoom out). If your system is equipped with a two-
button mouse with a scroll wheel, you can use the mouse wheel to
zoom in and zoom out.
To zoom in a selected area:

l Right-click and choose Mouse Mode, and then select Zoom
Selected.
l Click the Zoom Selected tool .
The mouse cursor indicates that the Zoom Selected tool is active .
56
Stacking Images
3. Click and drag an outline of the area you want to select.

4. To complete your selection, release the left mouse button.
Only the selected area is zoomed in the viewport.
Panning Images
When zooming a primary, secondary, or fused image, a region of interest may
move out of the MPR fusion viewport. You can pan images to position them
as required.
To pan an image in an MPR fusion viewport:

l Choose Tools | Pan (P).
l Click the Pan tool .

The mouse cursor changes to indicate that you are panning.
3. Click the image and drag in the required direction.
Note: You can also left-click and hold your mouse and drag in the
required direction.
4. To revert the image to its original position, right-click the image and
select Reset Pan/Zoom.
To pan an image volume in the MIP viewport:

1. Select the MIP viewport.
2. Click the middle mouse button and drag in the required direction.
Stacking Images
You can stack through a series that contains multiple primary, secondary, or
fused images, viewing each image in the sequence.
To stack images:
1. Select the required series in an MPR fusion viewport.
l Choose Tools | Stack (S ).
l Click the Stack tool in the toolbar, and then click and drag in
the required MPR fusion viewport.
57
The mouse cursor changes to indicate that you are stacking.
Drag: To:
Down View the images in sequential order.
Up View the images in reverse order.
3. Click and drag in the required viewport.

Note: If your mouse has a scroll wheel, you can stack by scrolling up
or down.
When the Update All Viewports When Moving Crosshair general
preference is enabled, you can stack images in an active MPR fusion
viewport without updating the other viewports at the same time. This
greatly improves image stacking performance in that viewport and is
especially useful on slower computers. See "Setting the General
Preferences" on page 22.
Measuring Lines, Areas, and Volumes

You can measure straight lines, regions of interest (ellipse, circle, freehand,
and piecewise), and volumes of interest. You can create multiple
measurements of the same type or different types on a selected image, up to a
maximum of three measurement results per image. Image Fusion can be
configured to allow you to create more than three measurement results per
image. For more information, contact your IntelePACS administrator.
Note: If a drawn region of interest (ROI) has too few screen pixel points,
it is automatically deleted. You need to try again.
You can adjust the size of the measurement text displayed in the MPR fusion
viewport.
The measurements taken depend on the type of images being displayed in the
MPR fusion viewport. For example, if the viewport is displaying both
primary and secondary images, the Image Fusion displays measurements for
both types of images.
You can save your measurements in Image Fusion as presentation states so

that the next time you open the study, Image Fusion applies the latest
presentation state so you can view the latest measurements.
You can also copy the image to the system clipboard and then paste it into
another application (such as an image editing application), or save the
58
captured image with the measurement annotations as a new DICOM

Secondary Capture series.
Note: It is recommended that you use a test phantom to verify that

Image Fusion is displaying accurate measurements.
To select a measurement tool:

Right-click the required MPR fusion viewport and select the required
tool.
This tool is active until you choose a different one.
See Also

Measuring Straight Lines

Use linear measurements to measure a straight line.
To measure a straight line:

2. Right-click and select Ruler.
The mouse cursor changes to indicate that the ruler tool is active.
3. On the required image, click where you want the line to start.
4. Click where you want the line to end.
A measurement appears along with text describing the length of the line
in millimeters.
59
5. Repeat steps 2 to 4 for each measurement you want to take.
To move or resize a linear measurement:

Do either of the following, as required:
l To adjust the line length, click and drag either the start or end
point.
l To move the line, click and drag the line connecting the end
points.
The line updates to reflect your changes.
Measuring Elliptical and Circular Areas

You can create an elliptical or circular measurement to define and measure a
region of interest on the image. For PET, the area, PET average and SUV
average of the ellipse or circle are measured in Bq/ml. For SPECT, the area
and average NM counts are measured.
Once you create the measurement, you can rotate, move, and resize it as
required.
To measure elliptical or circular areas:

2. Right-click and choose ROI, and then select Ellipse or Circle.
The mouse cursor indicates that the elliptical or circular measurement
tool is active.
3. On the required image, click at the starting point of your measurement

and drag to adjust the size and shape of the ellipse or circle. Release the
mouse button at the end of your measurement.
For SPECT images, the NM average appears on the image. The
maximum NM also appears in the Measurement window in the control
panel. For PET images, the area and SUV average appear on the image.
60
The maximum SUV appears in the Measurement window in the control

panel.
4. Repeat step 2 for each measurement you want to take.
Measuring Freehand Areas

Use the Freehand measurement tool to draw an outline around an area on an
image. This tool measures area in square millimeters for a calibrated image or
square pixels for an uncalibrated image.
To measure a freehand area:

2. Right-click and choose ROI, and then select Freehand.
The mouse cursor indicates that the freehand measurement tool is active.
3. Click and drag an outline of the area you want to select.

For SPECT images, the area and NM average appear on the image. For
PET images, the area, PET average and SUV average appear on the
image. The maximum SUV value appears in the Measurement window
in the control panel.
61
5. Repeat steps 3 to 4 for each freehand area you want to make.
Measuring Piecewise Areas

Use the Piecewise measurement tool to draw a closed polygon around an area
on an image that does not have a distinguishable edge. This tool measures
area in square millimeters for a calibrated image or square pixels for an
uncalibrated image.
To measure a piecewise area:

2. Right-click and choose ROI, and then select Piece.
The mouse cursor indicates that the piecewise measurement tool is
active.
3. Click and release the left mouse button to start the drawing.
4. Move the mouse cursor to the next point along the boundary.
5. Click the left mouse button again to confirm the point.
6. Repeat step 5 to draw more points along the boundary.
7. When you are close to the starting point, click the right mouse button
to close the boundary.
For PET images, the maximum SUV value appears in the Measurement
window in the control panel. For SPECT images, the maximum count
value in the 2D ROI appears.
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8. Repeat steps 3 to 7 for each piecewise area you want to measure.
Determining the Maximum SUV in a Cubical Volume

and Spherical Volume
Use the Volume of Interest (VOI) measurement tool to draw a region of
interest over a lesion or portion of tissue visually demonstrating the greatest
radiopharmaceutical activity on attenuation-corrected image data. This tool
measures the maximum SUV. For SPECT images, VOI measures the maximum
count value.
You can also triangulate all the viewports to the maximum SUV value of the
currently-selected volume area.
Note: Image Fusion supports body weight-based SUV calculations in

Bq/mL (Becquerel/milliliter) units. If the DICOM header does not specify
pixel units in Bq/mL for PET images, then the SUV is not calculated. The
pixel units are then unknown and labelled as “PET,” but usually related to
counts. Similarly, for SPECT images, if the DICOM units are not CNTS, the
units are labelled as “NM.”
To determine the maximum SUV in a cubicalor spherical

volume:
2. In the menu, click Create VOI or Create Sphere VOI.
The mouse cursor indicates that the VOI measurement tool is active.
3. Click and drag an outline of the area that you want to select in the
image.
For SPECT images, the maximum count value appears. For PET images,
the maximum SUV value appears. A numbered volume region
beginning with “VOI” and the volume measurement and maximum
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SUV (or max NM) also appear in the VOI Info tab of the Measurement
window in the control panel.
The other MPR fusion viewports are updated with the corresponding
profile of the volume area.
Note: You can sort the VOI measurements by name or by volume

by clicking either the Name column or one of the measurement
columns in the VOI info tab.
5. Stack to another image and repeat steps 3 to 4 for each volume you
want to measure.
You do not have to draw regions in consecutive images.
Note: When you select a volume measurement in the
Measurements window, the viewport triangulates to the position of
that VOI.
To triangulate all viewports to the maximum SUV value of the

current volume area:
Right-click the VOI and then select Go to Max.
The maximum pixel is highlighted gray on all the MPR fusion
viewports except the MIP viewport. This is useful when stacking
images.
All viewports are triangulated to the same position.
To display the maximum SUV value on a MIP image:

Select the MIP viewport, and then click VOIs.
The maximum SUV values of all volume areas drawn in the MPR
fusion viewports appear on the image in the MIP viewport. Image
Fusion uses the positions of the VOI measurement annotations on the
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coronal MPR viewports to place the annotations at the same positions

on the MIP image. You can click and drag to move the annotations
where you would like.This information can be particularly useful as a
quick summary of all the VOI measurements created on the patient.
When you exit Image Fusion, the VOI measurement annotations are
saved so that they are consistent when the study is reloaded.
To move annotations on a MIP image:

1. Place the cursor over the SUV value you want to move.
The cursor changes to indicate that you can move the SUV.
2. Left-click the cursor and then move the annotation to a new location.
Measuring Volume ROIs

You can use regions of interest created on several images in a contiguous set
of slices to measure the volume of an arbitrary area. You can add to a set of
ROI measurements for a given volume. When you create the ROI
measurement, the last-selected ROI measurement on a previous transverse
location is the one that is drawn on the current location.
65
To measure a volume ROI:

2. Draw the region of interest (ellipse, freehand, circle, or piecewise) that
you want in the first image.
3. Stack to another image and draw another region of interest.
The region of interest is drawn in the same color as the previously-
drawn region of interest. The application assumes that the drawn ROIs
at the two scroll positions correspond to the same physical structure and
calculates the volume between the ROIs as the average area of the ROIs
multiplied by the distance between them. The calculated volume is
displayed in the VOI Info tab of the Measurements window in the
control panel.
4. Continue drawing as many regions of interest as you want on different

images to improve the volume estimate.
Segmenting PET Volumes

Image Fusion provides two methods to draw ROIs on transverse PET image
slices. You can manually draw the ROIs, or automatically draw them by
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using the segmentation feature.
Typically a nuclear medicine physician estimates the volume of a tumor by

manually drawing ROIs in transverse PET images slice-by-slice. This method
is laborious and time-consuming.
When the physician uses the automatic method, Image Fusion segments PET
or SPECT lesions based on a user-defined threshold. This method provides a
faster and accurate estimation of lesion volumes in PET images than does
manual lesion segmentation. When you create a VOI measurement around the
lesion and instruct Image Fusion to proceed with the segmentation operation,
an estimated volume is automatically generated by summing the volume of
all the slices that were classified as part of the lesion. The total volume of the
area is measured in milliliters (mL), of the region.
To segment a PET volume:

1. Select the required PET MPR fusion viewport with a transverse
orientation.
2. Edit the Pet Segmentation value or use the value that was specified in
the preferences.
The threshold is represented as a percentage of the maximum SUV in
the VOI, or as the absolute SUV value. As you drag the horizontal bar
up or down, the values displayed in the Abs and %Max text boxes in
the Control Panel change with respect to the maximum SUV.
Depending on the currently-selected VOI, the value displayed in the
%Max text box is with respect to the maximum SUV displayed in the
viewport.
The absolute value of the threshold displayed in the Abs text box is in
SUV units. This value indicates the minimum SUV value being
displayed. As you drag the bottom horizontal bar up, Image Fusion
hides any pixels that have a value lower than absolute threshold value.
For example, if the absolute threshold value is 3.3, Image Fusion
displays only the pixels that have a value equal to or greater than 3.3.
The percentage maximum SUV value displayed in the %Max text box
is with respect to the currently selected maximum SUV. For example, if
the lower threshold value displayed in the Abs text box is 3.28, and the
maximum SUV value is 17.5, then the value displayed in the %Max
text box is 19% (100% x 3.28/17.5). This means that 19% of the
maximum SUV value is hidden and 82% of the maximum SUV is
displayed in the viewport.
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3. Click the VOI measurement tool in the toolbar.

The mouse cursor indicates that the VOI measurement tool is active.
4. Right-click an image to display a menu. You can draw a cube VOI or a

sphere VOI.
5. Click and drag an outline of the 3D volume that you want to select in
the image.
You need to adjust the area in the coronal, sagittal, and transverse
views to ensure that the bounding box covers the lesion in three
dimensions; otherwise, the segmentation is truncated at the bounding
box.
For PET images, the maximum SUV value appears. A numbered volume
region beginning with “VOI” and the volume measurement and
maximum SUV (or max NM) also appear in the VOI Info tab of the
Measurement window in the control panel.
The other MPR fusion viewports are updated with the corresponding
profile of the volume area.
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7. Right-click inside the volume area, and select Segment NM.

Image Fusion automatically calculates the lesion area and volume, and
creates the ROIs within the VOI based on the segmentation of the
images within the volume area.
The region of interests are drawn in the same color as the previously-
drawn region of interest. The application assumes that the drawn ROIs
correspond to the same physical structure and calculates the volume
between the ROIs as the average area of the ROIs multiplied by the
distance between them. Since the segmentation operation uses a binary
threshold, for best results, the area to be segmented must be clear of the
background area.
Note: The segmentation may result in contours that lie within the
visible lesion, depending on the segmentation threshold used. To
increase the segmented area, use a smaller segmentation
threshold, say 5%. To decrease the segmented area, use a higher
segmentation threshold. The calculated volume is displayed in the
VOI Info tab of the Measurements window in the control panel.
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Warning: After segmentation, you must review the drawn ROI

measurements. Click the plus sign (+) next to the volume of lesion
measurement to expand the list of ROIs. When you click an ROI in
the list, Image Fusion moves all the viewports to the center of the
selected ROI. Check that the segmentation results are sufficient,
and edit the ROIs, if necessary. Any ROIs that are separated by more
than 6mm on adjacent slices are marked with a "!!" in the list. You
must review and edit these ROIs. You can add to the ROIs by
manually drawing contours on adjacent slices. By default, Image
Fusion continues with the last-selected ROI. That is, if the last-
selected ROI was drawn in pink, then the new ROIs will also be
drawn in pink.
After segmentation, the VOI box is hidden. To display the bounding
box, in the control panel, right-click the VOI measurement, and select
Show All.
If you change the size of the VOI, you can resegment the images. When
prompted to delete the exiting ROI measurements, click Yes.
8. Place the triangulation crosshair within the VOI, and inspect the VOI
on the coronal and sagittal viewports to ensure that the VOI covers the
3D region.
9. To change the size of an ROI measurement, see "Moving and Resizing
ROI and VOI Measurements" on page 70.
10. To interpolate between ROI measurements, see "Interpolating Between
ROI Measurements" on page 72.
11. To grow all ROI measurements, see "Growing ROI Measurements" on
page 73.
Moving and Resizing ROI and VOI Measurements

You can move and resize ROI and VOI measurements on an image.
To move an ROI or VOI measurement:

1. Click a measurement to select it in the viewport.
2. Click the crosshairs and drag it anywhere in the viewport.
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The measurement updates to reflect your changes.

3. To move the measurement annotation, click the crosshairs and drag the
caption to the desired location.
To resize an ROI or VOI measurement:

1. To select the measurement, do one of the following:
l Click the number of the measurement in the VOI Info tab of the
Measurement window in the control panel.
l Click the measurement in the viewport.
2. To resize the measurement, click and drag any of the resize points at the
corners of the measurement.
3. To add or to subtract from your selection, position the hand cursor and
click where the segment is to begin.
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The hand cursor changes to a pen cursor.

4. Drag the pen cursor to where you want the segment to end.
5. Release the mouse button to close the area.
The measurement updates to reflect your changes. In addition, the

calculated volume is updated in the VOI Info tab of the Measurements
window in the control panel.
The drawn segment replaces the shortest contour between the start and
end points of the edited region.
Interpolating Between ROI Measurements

When using the automated segmentation method, Image Fusion creates ROIs
on a range of consecutive slices in the PET image. If during review of the
segmentation results, you find slices on which the segmentation was
suboptimal, you can either edit those ROIs manually, or delete them, and ask
Image Fusion to interpolate the unsatisfactory ROIs by using the adjacent
contours for interpolation.
To interpolate between ROI measurements:

Right-click an adjacent ROI, and then select Interpolate.
Image Fusion creates and displays the intermediate ROIs.
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Growing ROI Measurements

You can quickly adjust all of the ROIs associated with a VOI to grow or
shrink together uniformly from the center when stretched. For example, you
are viewing ROI measurements on the bladder in a CT viewport, and notice
that the measurements are too tight. You can use the Grow All mode to
adjust all the ROI measurements at once.
To grow ROI measurements:

1. Change to a multi-image layout. See "Changing the Image Layout" on
page 53.
2. Right-click the ROI and then select Grow All ROIs.
3. Click and drag any of the resize points at the corners of an ROI
measurement.
The ROI measurements associated with the VOI are updated to reflect
your changes.
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Showing and Hiding VOI Measurements

You can choose whether to show or hide a selected VOI measurement or all
VOI measurements, as needed.
To show and hide a VOI measurement:

1. To hide a VOI measurement, right-click the VOI measurement in the
MPR fusion viewport, and then select Hide.
2. To show the VOI measurement, right-click the VOI measurement in the
VOI Info tab of the Measurement window in the control panel, and then
select Hide.
To show and hide all VOI measurements:

1. To hide all VOI measurements, right-click any VOI measurement in the
select Hide All.
2. To show all VOI measurements, right-click any VOI measurement in the
select Show All.
Copying VOI Measurements

When you link studies, you can copy VOI measurements from the most-
recent prior study onto the current study without having to recreate the
measurements.
To copy VOI measurements:

1. Use a comparison option to compare the current study with the most-
recent prior study. See "Comparing Studies" on page 12.
2. Check that both studies have been linked. See "Linking Studies" on
page 15.
3. Select the current study.
4. In the toolbar, click Place VOIs.
The VOI measurements from the most-recent prior study are copied onto
the current study.
Deleting Measurements
You can delete a selected measurement on an image.
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To delete a selected measurement:

l Right-click the measurement that you want to delete and choose
Delete.
l Right-click the measurement that you want to delete and press
DELETE .
The measurement is deleted.
Recalculating SUV
If incorrect patient information such as the wrong patient weight or incorrect
dose concentration results in a faulty SUV, change the SUV calculation
values temporarily in order to recalculate the SUV.
Note: The changes you make to the SUV Calculator do not affect the
information contained in the DICOM header or the values calculated in
the viewports.
To adjust the SUV value:

1. Select a viewport.
2. Choose Tools | SUV Calculator.
The SUV Calculator appears with the DICOM values.
3. Modify the required patient information and then click Calculate SUV.
The SUV value for the selected viewport appears at the bottom of the
SUV Calculator.
Note: You can click the ROIs and VOIs in the ROI/VOI control panel
window. If the SUV calculator is present, the max dose
concentration within that ROI or VOI is shown in the SUV calculator,
and the SUV is recalculated.
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4. To return to the original values, click DICOM Values.
Tracking Volume and SUV Statistics

You can create several types of graphs providing statistical information on
the progression of a lesion or the efficiency of a treatment. For example, you
can track how the volume of a lesion has changed in the past six months.
You would typically create measurements when you complete a patient scan.
In this way, when you complete a new patient scan, the studies are registered,
and the measurements are repeated on the current scan by copying the
previous VOIs to the current study.
Note: Image Fusion saves only the measurements for the current study.
You can change the measurements on the prior studies, but you cannot
save them. To change measurements on prior studies, load the study as a
single study, or load the studies such that they are the current ones, and
then change them.
The types of graphs that you can create are:
Volume Graph—Calculates and tracks volumes over time per VOI.
Maximum SUV Graph—Calculates and tracks the maximum SUV over

time per VOI.
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Peak SUV Graph—Calculates and tracks the variation of the averaged

SUV in a 12.5 mm diameter about the maximum pixel over time, referred to
as PERCIST.
Lesion Diameter Graph—Calculates and tracks the absolute value of the

maximum lesion diameter over time, referred to as RECIST.
You can also export the statistical information in the graphs to a Comma
Separated Value (CSV) file.
To track the volume and SUV statistics:

1. In the toolbar, click Compare 2.
The current study appears on the top and the most recent prior study
appears on the bottom.
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2. In the current study, create a VOI, and segment it. See "Segmenting PET
Volumes" on page 66.
3. Draw a linear measurement on a transverse view, and then right-click
anywhere along the line, and select Use for RECIST.
This value is included in the graphs.
You can have several linear measurements within the VOI. However, if
you mark another linear measurement and select Use for RECIST, Image
Fusion deletes the RECIST value of the previous linear measurement
and instead uses the RECIST of the new linear measurement.
4. In the prior study, create a VOI in the same region as the current study,
and segment it.
Two volumes are created and named VOI_0.
l Draw a linear measurement, and then right-click anywhere along
the line, and select Use for RECIST.
l Draw a linear measurement in an existing VOI, and then select Use
for RECIST.
6. In the toolbar, click Generate Graph .

Three graphs are created, each displaying two points. For example, in
the first graph, you can see that the volume of the prior study was 65 ml
and the volume is 72 ml in the current study.
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To generate the graphs:
In the toolbar, click Generate Graph .
To export statistical information to a CSV file:

1. Set your Statistics CSV Export directory. See "Setting the General
Preferences" on page 22.
2. In the toolbar, click Export CSV .

The Save As dialog appears.
3. In the Save As dialog, enter the name of the CSV file, and then click
Save.
The CSV file appears in the location you designated in your
preferences.
4. Start a spreadsheet application and open the CSV file that was saved
locally.
See Also
Copying VOI Measurements 74
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Registering Images
When primary and secondary images are acquired on the same scanner, it is
assumed that the patient has remained in the same position throughout both
scans. The primary and secondary images are fused automatically based on
DICOM coordinates.
If the primary and secondary images are acquired on different scanners and
there are differences in spatial resolution between both scanners, then a
potential misregistration between the primary and secondary images can
occur. In this case, you can register the primary and secondary images
manually through visual inspection of secondary images superimposed on
primary images. You can define the orientation, rotation and translation of
the secondary images for registration.
If there are any ROI and VOI measurements on images when you try to
register them manually, a warning appears. You can save these images before
registering them manually.
You can also register images automatically by using the AutoFuse buttons.
Use the AutoFuse F button to perform a full registration registration, which
includes all rotations and translations including the translation in the patient
head to toe direction. Use the AutoFuse L button to perform local corrections
for rotations and the other translations but excluding the translation in the
patient head to toe direction.
When you exit Image Fusion, you can save the image registrations as a
presentation state to the IntelePACS. The next time you open the study,
Image Fusion applies the latest presentation state so that you can view the
latest image manipulations.
To register images manually:

2. In the control panel, click the Registration tab.
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Registering Images
3. Click the required viewer orientation button: Transverse, Sagittal, or

Coronal.
The outline of the affected viewports is highlighted in yellow.
l To rotate the images, click the required rotation button: CW
(clockwise) or CCW (counterclockwise). You can also enter the
rotation angle in the Angle field, using increments between 0° and
99°.
l To translate the images, click the required translation button: Up,
Down, Left, or Right. By default, the translation distance is a
40mm/10 increment. You can also enter the translation distance in
the Dist field, using increments between 0 and 999 mm/10.
Images in all affected viewports are also registered.

5. To reset images to their original registration, click Reset All.
81
To register images automatically:

2. In the control panel, lick the Registration tab.

l Click F to perform a full registration that includes rotation and
translations including translations in the patient head to toe
direction.
l Click L to perform local registration which includes rotations and
translations but does not include translations in the patient head to
toe direction. This option is provided in the case where manual
adjustment in the head to toe offset improves the automated
adjustment determined in the full registration, and only the other
rotation and translation parameters need to be adjusted
automatically.
4. Images in all affected viewports are registered.
Note: You must visually confirm registration and alignment that is
automatically performed. If the automatic registration fails, follow
the steps for manual registration.
See Also
Peeking Inside Secondary Images

In an MPR fusion viewport, you can display secondary images in a rectangle
on top of primary images to quickly view functional and anatomical
information together.
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Capturing DICOM Images
To peek inside secondary images:

2. Enable I.
A rectangle, referred to as the Peek window, appears in the viewport.
3. Click and drag the rectangle to the required area on the image to view
the secondary image.
Capturing DICOM Images

You can capture images in a single viewport, all visible viewports, or capture
an image of the entire screen. These images are saved as a DICOM secondary
capture series and sent to IntelePACS for permanent storage. Once sent to
IntelePACS, a DICOM secondary capture series is saved with the original
study.
In the InteleViewer Search tool, a modality of “OT” and the words “IMAGE
FUSION SECONDARY CAPTURE” in the Series Description indicate that
the series contains DICOM secondary capture images.
You can capture images from both synchronized windows. In your captured
images, images from instance 1 appear on the left while images from instance
2 appear on the right. If you are comparing a current study to a prior study,
Image Fusion saves the screen captures to the current study.
83
Note: To capture images, your user account must have the Send Data to
PACS privilege. For more information, contact your IntelePACS
administrator.
To capture an image:
2. Choose Tools | DICOM Capture, and then select the type of capture.
Select: Press: To:
Image S HIFT +I Capture the active viewport.
Viewing Area S HIFT +V Capture all visible viewports.
Screen S HIFT +S Capture the entire screen.
The image is captured as a 24-bit color image with no image

compression and is saved as a DICOM secondary capture series with the
original study on the IntelePACS system.
If you search for the original study in the InteleViewer Search tool, the
DICOM secondary capture series is indicated by a modality of “OT”
(for secondary capture).
It may take a few moments for the DICOM secondary capture series to
appear in the Search tool, depending on the number of images being
transferred.
To capture a series:
2. Choose Tools | Export DICOM Series (C).
The image is captured as a 24-bit color image with no image
compression and is saved as a DICOM secondary capture series with the
original study on the IntelePACS system. The DICOM secondary
capture series is indicated by a modality of “OT” (for secondary
capture).
Copying Images into Other Applications

You can copy an image to the system clipboard and then paste it into another
application, such as an image editing application.
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Saving Images to PDF
To copy an image:
2. Choose Tools | Copy to Clipboard, and select the copy option.
Select: Press: To:
Image CTRL+I Copy the active viewport.
Viewing Area CTRL+V Copy all visible viewports
Screen CTRL+S Copy the entire screen.
The image is copied to the Windows system clipboard as a 24-bit color

image with no image compression.
3. To paste the information, open the application into which you want to
copy the image and press CTRL+V.

You can create a scrapbook of images taken from studies belonging to a
patient. Using PDF Atlas, you save the images to an Adobe Portable
Document Format (PDF) file in a location designated in your preferences.
A PDF can contain images from multiple studies from the same patient, but
cannot include images from different patients.
PDF Atlas offers you flexibility and tailoring in terms of a multi-page grid
layout for images. You can drag images from the viewports and drop them
into a grid. For example, you can specify a two-column grid layout that
displays one image of a fusion viewport with a coronal orientation in the first
column, and the second image of a secondary viewport with a sagittal
orientation on the second column.
You can also click the SUV in the ROI/VOI Measurement window to
triangulate all viewports to the maximum point in a lesion. You can then
adjust the image (window/level, zoom, pan, and stack), and save the
configured set of viewports to a PDF file to create a set of images with
different views (transverse, coronal, and so on.) of the same lesion.
Note: SUV calculations are included in image captures.
To save images to PDF:

1. Specify the directory where Image Fusion stores PDF files. See "Setting
the General Preferences" on page 22.
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2. In the toolbar, click Generate PDF Atlas .

The Generate PDF Atlas dialog appears.
3. To change the page grid layout, select one of the following options:
Select: To:
1 x 1 Change the grid layout to display one image.
1 x 2 Change the grid layout to a two-column grid.
2t:1b Change the grid layout to a three-column

asymmetrical grid, two narrow columns on the top
and one wide column on the bottom.
2 x 2 Change the grid layout to display a 2 x 2 grid.
2 x 1 Change the grid layout to display a two-row grid.
1t:2b Change the grid layout to a three-column

asymmetrical grid, one wide column on the top
and two narrow columns on the bottom.
4. Select the image that you require.
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5. Manipulate the image as required. For example, pan and zoom the
image, adjust the window level, and apply measurement tools.
6. Place your cursor near one of the corners of the viewport.
The cursor changes to indicate you can drag the image.
7. Drag the image to the required location in the grid.
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8. To add other images, repeat steps 4 to 7 as required.

9. To replace an image, do one of the following:
l Drag a new image to the required location in the grid, and then
click Yes when Image Fusion prompts you to overwrite the current
image.
l Move the image between the gird elements themselves.
10. To add a new page, click Next.

The page number shown in the Page Count text box is increased by
one.
You can also change the grid layout of the page.
11. To insert a blank page in between your pages, click Insert.
12. To delete a page, click Delete.
The page number shown in the Page Count text box is decreased by
one.
13. Click Generate PDF.
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Working with Presentation States
The PDF file appears in the location you designated in your preferences
and is automatically opened in Adobe Reader if this application is
installed on your system.
See Also
Working with Presentation States

An Image Fusion presentation state is a set of image manipulations associated
with a CT, MR, PET, or SPECT study. If you manipulate an image by adding
ruler measurements, for example, and want to retain your measurements, you
can save your changes in Image Fusion as a presentation state. When you
close Image Fusion, a message appears indicating that the measurements have
been changed. If you save your image manipulations, Image Fusion saves
them to the IntelePACS as presentation states only if InteleViewer is running.
Warning: If you close InteleViewer and then close Image Fusion, all the
image manipulations are lost.
The next time you open this study, Image Fusion applies the latest
presentation state so you can view the latest image manipulations. If you
open this study in InteleViewer, any saved Image Fusion presentation states
are not applied to the images in the study.
The image manipulations you can save in presentation states are VOI, ROI,
ruler, maximum SUV measurements, and registrations.
Presentation states appear in the Series list of the Search tool window in
InteleViewer with a modality of PR and a series description of IMAGE
FUSION PRESENTATION followed by the first and last name of the user
who created the presentation state and the original description of the CT
series.
To save a presentation state:

1. Select the series and images to manipulate.
2. Create the measurements as required by using the measurement tools.
When you exit Image Fusion, a message appears asking you whether
you want to save or discard the measurements. Click Yes to save the
measurements to the IntelePACS.
89
6
Keyboard and Mouse
Shortcuts
Use keyboard and mouse shortcuts to quickly access the Image Fusion
application features.
In this Appendix:
List of Keyboard Shortcuts 91

List of Mouse Shortcuts 93
List of Keyboard Shortcuts
List of Keyboard Shortcuts

The Image Fusion application provides the following keyboard shortcuts:
User Layouts
To: Press:
Choose user layouts 1 through 8 1 through 8
Choose user layouts 9 or more 9 or more
Choose coronal layout - primary Shift+1
Choose coronal layout - secondary Shift+2
Choose coronal layout - fused Shift+3
Choose all - coronal layout Ctrl+4
Choose sagittal layout - primary Shift+4
Choose sagittal layout - secondary Shift+5
Choose sagittal layout - fused Shift+6
Choose sagittal layout - all Ctrl+5
Choose transverse layout - primary Shift+7
Choose transverse layout - secondary Shift+8
Choose transverse layout - fused Shift+9
Choose transverse layout - all Ctrl+6
Choose all primary layout Ctrl+1
Choose all secondary layout Ctrl+2
Choose all fused layout Ctrl+3
All Ctrl+7
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Keyboard and Mouse Shortcuts 6
Tools
To: Press:
Copy image to clipboard for image Ctrl+I
Copy image to clipboard for screen capture Ctrl+S
Copy image to clipboard for viewing area Ctrl+V
Export DICOM series C
Export secondary capture for image Shift+I
Export secondary capture for screen capture Shift+S
Export secondary capture for viewing area Shift+V
Hide/display annotations A
Hide/display the control panel V
Pan P
Stack S
Synchronize instances Y
Triangulate T
Window level W
Zoom Z
Window Level Presets

To: Press:
Choose window level presets - DICOM F2
Choose window level presets - Chest F3
Choose window level presets - ABD F4
Choose window level presets - Lung F5
Choose window level presets - Brain F6
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List of Mouse Shortcuts
To: Press:
Choose window level presets - Bone F7
Choose window level presets - Head/Neck F8
Choose secondary window level presets Shift F2-F8
List of Mouse Shortcuts
Button: Tool: Icon:
Left Triangulate (MIP viewport)
Zoom (MPR fusion viewport)
Middle Pan (MIP viewport)
Window level (MPR fusion viewport)
Right Zoom (MIP viewport)
Pan (MPR fusion viewport)
93
Index
A F
annotations, displaying and hiding 18 freehand measurements 61
full zoom 45
B
blend, adjusting 23 G
general preferences 22
C graphs, generating 79
cine, in MIP viewport 49
circular measurements 60 H
color map preferences, setting 32 help, viewing documentation 7
color maps
applying 34 I
Image Fusion
creating 29
exiting 11
deleting 31
opening multiple windows 20
editing 31
starting 9
colorbar locking preferences, setting 33
system requirements 8
Compare 2 option, applying 14
image layout, changing 53
Compare All option, applying 14
image volumes
comparison option preferences, setting 36
panning 57
comparison options 12
zooming 56
control panel, displaying and hiding 17
images
custom layouts 39
adjusting blend 23
D adjusting window and level 25
documentation, using 6 capturing 83
changing display 51
E color maps 34
elliptical measurements 60
panning 57
peeking inside secondary 82
registering 80 presets, using window level 26
saving to PDF 85
stacking 57 R
region of interest (ROI) measurements 58
zooming 54
ROI measurements
interface overview 11
growing 73
K interpolating 72
keyboard shortcuts 91 resizing 70
ruler measurements, creating 59
L
line measurements S
creating 59 secondary images, peeking inside 82
resizing 60 segmentation of PET volumes 67
selected area, zooming 56
M smart fusion
maximum SUV
setting preferences 35
determining in a cubical volume 63
using 34
displaying on MIP image 64
standard layout 45
triangulating all viewports to 64
statistical information, exporting to CSV file 79
measurements
straight line measurements
choosing tool 59
creating 59
circular area 60
resizing 60
deleting 74
studies
elliptical area 60
comparing 12
freehand area 61
linking 15
linear 59
SUV
moving 60
recalculating 75
moving ROI and VOI 70
SUV statistics, tracking 76
piecewise area 62
system requirements 8
resizing linear 60
resizing ROI and VOI 70 T
ruler 59 triangulation crosshairs 19
segmentation of PET volumes 67
volume ROIs 65 V
viewports
measurements text size preferences 23
changing layouts 41
MIP viewport 12
cine in MIP 49
cine in 49
MIP 12
rotating 48
MPR fusion 12
MPR fusion viewport 12
rotating MIP 48
O selecting 40
opacity preferences, setting 24 triangulating 46
opacity, adjusting 23 types of 12
VOI measurements
P copying 74
partial zoom 55
hiding 74
PDF Atlas 85
resizing 70
piecewise measurements 62
showing 74
presentation states 89
95
volume ROI measurements 65
volume statistics, tracking 76
W
window and level, adjusting 25
window level presets
setting 27
using 26
windows, opening multiple 20
96

ImageFusion Module 321 User Guide

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ImageFusion Module 321 User Guide

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Image Fusion

3. 2. 1 ( I nt eleV iewer 4. 11. 1)

Keyboard and Mouse Shortcuts 90

About Image Fusion 6

About Image Fusion

Image Fusion includes access to specific statistics such as maximum and

Additional key features of Image Fusion include:

l saving images on the IntelePACS

l comparing current and prior studies

l measuring regions of interest and volumes of interest

l adjusting the percentage of anatomical image data displayed

Using the Documentation

Viewing the Documentation

To view the InteleViewer Image Fusion user guide:

Obtaining Printed Documentation

Text that you type in a field, or on In the Date field, enter

Keyboard commands are in SMALL Press CTRL+C to copy text.

New terminology or concepts are The process of automatically

Menu choices are separated by Choose File | Exit to close the

Comments and Questions

l Microsoft Windows 7 Professional 64-bit version

l 8GB DDR3 RAM

Starting Image Fusion

There are certain conditions for fusing PET/CT, SPECT/CT, or MR datasets:

l The datasets must all have at least two images.

l The datasets must be loaded at the requested quality.

l The datasets must contain transverse images.

l The CT/PET or SPECT datasets must share a common frame of reference.

To start Image Fusion:

l CT, PET AC, and PET NAC

l MR and CT/PET AC or NAC

l MR and CT/PET AC/PET NAC

l CT and SPECT AC or NAC

l CT, SPECT AC, and SPECT NAC

l MR and CT/SPECT AC or NAC

l MR and CT/SPECT AC/SPECT NAC

2. In InteleViewer, do one of the following:

3. Click the Image Fusion tool .

To exit Image Fusion:

The application closes. The size and position of the window is

Understanding the Interface

The Image Fusion window displays two types of viewports: a 2D Multiplanar

The Maximum Intensity Projection (MIP) viewport provides a rotating 360°

There are two comparison options:

To apply the Compare 2 option:

To apply the Compare All option:

You can also perform an automatic alignment of images for comparison by

Displaying the Control Panel

To display the control panel:

For CT studies, the attenuation coefficient of different types of tissues is

Displaying or Selecting the Triangulation Crosshair

To display the triangulation crosshair:

1. From the toolbar, click .

2. To hide the triangulation crosshair, click .

To select the triangulation crosshair:

2. Select the required triangulation crosshair.

You can choose a default triangulation crosshair in the Preferences

Opening Multiple Image Fusion Windows

To open multiple Image Fusion windows:

Set the Image Fusion preferences for viewing images.

About Setting Preferences 22

About Setting Preferences

Setting the General Preferences

To set the general preferences: