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XtremeCT User Guide

1. scale_elsize IPSCOHS SISIZS noipseale elsiZe scale OW elsize noip SOT VAUS GO COL stetit ah Abadia ube aan inate A JOIN s DOUNGINGZADOXE CUT cesset een t a Pe RU DR RIEN RITUUM M on OG faced ID M OLS CTS OT canat clear offsel iiie REO RENS convert_to_type go S MSA ee ene nee a p vi from_aim_to_isq UCT_THREEDEE_BATCH Filenidlmie cce mc DI e be Shading SIZES Elevationm IoFetion st ss eoe ble a 105 oe EE 105 12 Etro IMeSSCICIOS 107 Appendix A Additional Information n r 110 8 mea pedit cea cr t RE eH c d 110 Elements of the Graphical User Interface 10 Window Dialog Box 10 Push Button 0 Toggle Button 10 Radio Button 10 Text Field 0 SGIOIIBQF tret 0 Option Menu 1
2. e qa 11 Neo ain 111 Input Change of the Header and Footer of the Print Out 111 Appendix B Files Used and Created by MiCroCT _ 112 Directory STtUCTUEte suerte oen te ee cago eh a e E 112 tein neto mend get cbe rit echa e rb e 112 MICROCT DATA SSSSSS85 MMMMMMMM 12 MICROCT DATA SCOUTS 13 MICROCT DATABASE 3 MICROCT MAIN 13 MICROCT RESULTS 13 MICROCT SCRATCH 3 MICROCTIIBS deinen dm dar E EO OE EU 13 MIGR GCTUIL a dots 113 MICROCT UTIL 13 MICROCT XDEFAULTS 3 Appendix C Logicals and Symbols e 114 Definition of Logicals and Symbols sss eene 114 ER 115 er EMI E 116 Appendix D 3D Batch Evaluation eere 117 XtremeCT Version 2 4 BatcbiProced ute set de Pee e ee ee E e b bina am cda rd 117 Checking Status and Progress of Batch Jobs sss eee eee 117 Appendix E Explanation of Structural Indices sss 118 III MIGTINO Gl tents 118 E 118 d pete ba deo di eet 118 Structure Model Nde te terret e
3. SCANN EVOIUGTION Determining the Reference Measurement RESOIUTION PHGANTONY g a ne eb eme d pe ra net ddl Schedule Mounting Scanning EVOIUGTION T Slice Sensitivity Profile Phantom 516 sate E Scanning EVOIUGTION i tetti o ec Low COnDTECISEPPCGIIEOFETE Schedule tr etre tt PO ERE DOES MOUPTING avai Es SC ONNAING tine EVGIUGTION 09 48 Starting the Evaluation Program sss OVOIVIOW 25 arte tubi a n e trt die are er D eee Standard Patient Evaluation Overview Selection of Patient and Measurement Selection of Non Archived Measurements Selection of Measurements already Archived Saved 52 Load Save Contours Print SQVEIMOAGESS x aere ETC HEN HERR BEEN ERES Header information sss LOOM tall cra DP RUE BrighitiYess SCollilig et Defining the ROI OF
4. 119 120 Contouring 2 0 eee eee eee eee eee eee eee 58 62 Controlfile 17 Creating a Volume 58 Cutplane p ooo 74 DatasecUrity eae eae 85 Database activating 97 query 3D values 105 106 query evaluation data 105 106 query measurement info 106 Deleting Objects 57 Density scaling 54 56 Device Information 87 DIAMETER 20 Directory Structure sees 112 Dismount See also Mount 88 Distance Measurement 67 Drawing 56 pho 56 Drawing Icons eese 56 69 DT Distance Transformation 90 119 E Ending Program eee 9 12 Enlarge 13 5 0 50 er aee 53 54 Error Messages 107 47 48 Starttig 2D 55 eve 62 Starting JD wu eds 65 Evaluation Methods 117 118 EXII Ripe 9 12 59 nip 124 Fixed Threshold serso as aS 93 amp E E E 103 Format 4 e eM 87 G Gauss Filter 5iiuhadnedasasosoasadu 93 Global Delete 4 oer eee er tulad 59 Global Scaling rne a aAA A NA h 59 1088 1 59 02
5. sss emn Pointer Ruler Profile Angle Tools 9 el RR NUT UU 70 Starting the 3D Display Program sse memes 70 General 3D SCenmne 71 Selecting the Sample and the Measurement sss eee 71 emi on 72 VISUALES CIS n 72 ODSETEK 72 73 OME Effects isse aet t area mi ver d peer age efe e pb re 73 CUIBIGNE EET 74 74 c E 74 Object PIODerlies aite et b bre n s er aea ba i sod 75 ColorMIIIgsss niei to HR p Ead 77 Printing Of SD SCSHESS irrito 78 Calculating Animated 3D Sequences sss eee eene 78 Presets dea else REDE eo TOR PERO TEMA deeds 79 10 Data MOIna lermefib nd coi Rd 81 OVENS miara a aio bo el Ra e E RR E RU o Starting Pr g Archiving Deleting Backup Data Selecting the Measurement Selecting the File Type sss Selecting the Destination Device Selecting the Copy Move Operation Starting the Move Copy Function seems BOGKUD Ha rre eo me rca e Operating System Backup Device Information sse lon c PEE MOUNT DISMMOUNT TE CK XtremeCT Version 2 4 11 DECterm
6. seeeseeeeeess 105 T l 88 Terminal Programs eee 89 Threshold adaptive 93 AER 93 117 118 TRI Triangulation Method 90 118 Turning On Equipment 1 U UCT LIST one 105 106 V VOL 56 124 Defining 64 Volume of Interest eee nen 56 W Window iR HERRERA SERES 110 X X Ray ahs lao Re AGACA SAA 1 Z ZOOM wesc 53
7. XtremeCT II Version 2 4 138 custom protocol center custom protocol off center patient protocol center patient protocol off center 0 6 w 0 5 0 4 0 3 0 2 0 1 0 T T 50 33 3 25 Resolution um Figure 116 Modulation Transfer Function MTF for all Combinations Stray Radiation Between measurements On the XtremeCT I the high voltage is continuously applied to the X ray tube and the emission of X rays is controlled with a shutter When the shutter is closed the emitted radiation does not exceed 0 25 uGy h at any accessible lo cation During measurements The stray radiation is measured in accordance to IEC 60601 2 44 in the hor izontal and the vertical planes which cross at the axis of rotation of the scan ner The dose is given in Air KERMA per mAs nGy mAs and in the ambient dose equivalent H 10 per measurement uSv For the stray radiation measurement a cylindrical PMMA phantom with a di ameter of 100 mm was used One standard measurement including patient positioning reference mea surements and the measurement itself takes about 15 minutes The weekly or monthly dose of the stray radiation can be calculated with the given data and the expected patient throughput Example Point D3 has 0 09 uSv measurement Assuming 5 measurements per hours Dose h 5 measurements h x 0 09 uSv measurement 0 45 uSv h XtremeCT II Version 2 4 139 XtremeCT II Vers
8. RR RARO RR ote tese mes 48 Overview Evaluation Program e Heer eee 49 Evaluation Selection of Patient and Measurement 52 Select Old Measurement oer YER Y ir Erir Ereti 52 GOBI areara r ete do HAAS ATA AP CAES 53 Print eode equae tegat Saadeh te gag qe dri open reda 54 Brightness Scaling cesedin ite tesa eee ERR MEHR ER RENI SERE EE IRAE EUR eR 55 Options Brightness Scaling 55 Drawing 1 E E N E E a Qu aa a R 56 THE Edit MENU tee Gee Gee Vee Ue Tee tee See ve tee TS 57 COMTOUTING Ao ducted Ah te 58 Contouring SUDWINdOW ice e ene eA bolita veg de nna ne veg n na Ha en nean 58 Color Coding in Image Selection Area E 60 Creating a VOL tete eee pre eee heen eet EE e 61 2D Eval ation ees reU E AD LA EAR EAT E IR ERR IRR 62 2D Histomorphomrnetty oiar toe ee px px ex ey una e 62 SAH VALU Ati Oni eU et NH eU NE IRI I Dra DA AE 64 3D Evaluation Subwindow eese ee eene 64 Modifying Scripts Basic Mode sees 66 Dist nce 3D er ep ertet reed eee ies eire nde 67 Distance Measurement ei AA Sen ed eate t Cea det sured 67 Print Images ta nese aa erc D eee o ke A ea edes 68 PrintImages Details 3 RA ELE RA LA REI REIR esis tetas 68 Pointer Ru
9. Se 8B X BEE wn UM UCT_ system dependent system dependent UM UCT EVALUATION V4 COM 500000000 500 MB DL3500_PS L3500 PS D TEK PS SCANCO DEF PRINTER UU UCT EVALUATION EN PS UU UCT HISTO 2D EN PS UU UCT RAY EN PS UU UCT SINGLE IMAGE EN PS UU UCT ONE IMAGE EN PS UU UCT FOUR IMAGES EN PS UU UCT SIXTEEN IMAGES EN PS UU UCT 3D LIST TXT UCT 3D SINGLE TXT UCTD UCT CONTROLFILES cust DAT UCTD UCT MEASUREMENTS cust DAT lt lt UCTD UCT EVALUATIONS cust DAT UCTD UCT SAMPLES cust DAT UCTD UCT SCANNER xxxx DAT UCTD UCT SLICENAME xxxx DAT UCTD UCT OPERATORS cust DAT UCTD UCT ZIP CODES cust DAT SYSSSCRATCH RESULTS TXT SYSSSCRATCH INFO TXT SYSSSCRATCH ARCHIVE COM 115 Type UU VU UU U las U H U U Symbols Symbol UCT UCT BACKUP UCT EVALUATION UCT LIST UCT MEASUREMENT UCT MOVIE UCT SAMPLE Ez UCT THREEDEE UCT THREEDEE BATCH UCT UTILITIES IPL SCANCO SUBMIT COMMAND SCANCO ANSI PRINT COMMAND SCANCO PS PRINT COMMAND WRITE INFO XtremeCT II Version 2 4 Meaning Foreign command for Main Program Foreign command for Backup Program Foreign command for 3D Evaluation Pro gram Foreign command for DB QueryProgram Foreign command for Meas
10. 8 x 23 x 30 cm 3 1 x 10 x 12 TFT Monitor 50 x 56 x 25 cm 24 20 x 22 x 37 24 Disk Tower optional 56x 30x 62 cm 22 x 12 x 25 Weights Weight kg Weight Ib XtremeCT IJ Scanner 605 kg 1334 Ib Workstation max 30 kg max 66 lb Tape Drive 5 kg 11 1b TFT Monitor 9 kg 20 Ib Disk Tower optional max 30 kg max 66 lb current devices at date of going to press January 2012 Workstation HP Integrity rx2800 i2 Tape Drive HP Ultrium 5 SAS TFT Monitor HP L2475w Disk Tower HP Storage Works MSA60 Power Consumption Heat Generation Gantry 400W Computer 1200W rx2800 i2 Monitor 40W Tape drive 40W Further options i e disk tower leads to additional power consumption To assure adequate circulation of air for cooling Caution make sure that the instrument is located at least 30 cm away from walls on each side of the equipment 133 Installation Personnel Qualification Installation of the equipment must be carried out only by SCANCO MEDICAL AG or specially authorized personnel Improper installation can lead to malfunction In Caution stallation instructions must be followed in detail Im proper installation will void any warranty claims XtremeCT II Version 2 4 134 Checklist for Site Planning XtremeCT II Version 2 4 Electrical Installation Emergency Stop if a cable length of 5 m is not
11. Fixed internal storage device of high capacity Here are stored all the pro grams all patient data all Scout Views and all images which have not been archived Cannot be exchanged by the user LUT Look Up Table Color scale normally adjusted to the gray tone scale Optical Disk Removable storage device with large capacity The images are archived on this device A separate optical disk is kept as a safety copy of the complete system see Backup ROI Region Of Interest Scanner Measuring unit in this case a tomograph Scout Scout View Overview image comparable to a radiograph Shutdown Program for ending the operating system Ensures that all data and programs in the computer can be read again without problem at the next operation VOl Volume Of Interest Zoom Magnify 124 Maintenance Plan Appendix Preventive Maintenance Maintenance Due to use of the equipment and environmental influence the equipment needs maintenance in regularly intervals By entering into a service agree ment with SCANCO MEDICAL AG you maintain the value and safety of your X ray equipment The user is responsible for the adherence of maintenance schedule Implication of Lack in Maintenance The lack of preventive maintenance may lead to reduced instrument perfor mance of your instrument or falsification of results Accomplishment of Maintenance Maintenance consists of tests which the user can per
12. XtremeCT II Version 2 4 Enter your name into the operator field See 15 and click with on the button with the evaluation graphs in the main program XtremeCT Operator scANcO Medical AG Edit SCANCO MEDICAL ales Figure 60 Start Evaluation With the evaluation program you can perform the following functions view slices XY XZ YZ view enlarge zoom document print convert EPS TIFF DICOM distance measurements measure angles display histograms view profiles linear attenuation coefficients along lines examine linear attenuation coefficient at cursor position define and analyze ROI Region Of Interest 2D ROI with different shapes rectangle ellipse contour analyze ROI attenuation coefficient determine area histomorphometric evaluation 2D amp 3D create data set for 3D Display Animation S3D Histo Evaluation 48 XtremeCT II Version 2 4 Evaluation Program V6 5 1 File Edit Zoom Tasks LUT Options Scripts 10 P1 X Y p Value i 0 P2 X Y p p 0 0 OV KY Vy YZ y XYZ V 3D y SCV 80 vi a WxH p Distance mm 0 0 0 Angle T 0 Figure 61 Overview Evaluation Program 7 Drawing Symbols Icon Box By clicking on these symbols the function which will be applied is selected These functions can only be used in the Main Window 4 See Defi
13. Input of Patient s Name or Number p 16 The input window shown in See Figure 62 Evaluation Se lection of Patient and Measurement on page 52 now appears again Click the XtremeCT II Version 2 4 Evaluation 52 patient the measurement as described above You will then be asked to put the corresponding tape with the archived images into the tape drive If you stored the data to tape you will first have Note to restore the data to the hard disk before you can re evaluate it Load Save Contours Contours that you have drawn for a measurement are saved as geometrical object GOBJ files Clicking on the menu FILE followed by LOAD GOB will open the window below Using the option add allows you to concatenate mul tiple GOBJ files Figure 64 Load GOBJ The menu save AS will allow you to give specific filenames e g C0040915 CORTEX GOBJ Print Save Images Clicking on the menu FILE followed by print opens three selectable options print MAIN WINDOW print overview WINDOW or print evaluation WIN DOW After selecting one of these options the Print Menu will appear For mat PostScript is used to print out paper sheets Format EPS or TIFF is used to get the image into a file When generating TIF files you can choose the di XtremeCT II Version 2 4 Evaluation 53 XtremeCT II Version 2 4 rectory e g Scratch Measurement Directory or a predefined directory for Ex port where to save your
14. Tasks Login Username You can use any valid account name typically MICROCT to perform the QC measurements Daily QC The quality control for density has to be performed once every day It has to be performed and checked before a patient is scanned Weekly QC The quality control for mechanical stability has to be performed once every week It has to be performed and checked before a patient is scanned Procedure Checklist Select QC1 or QC2 sample name e Select or QC2 controlfile Insert Phantom e Precalibrate e Perform scan Wait until all images reconstructed e Click EVALUATION 3D and START EVALUATION Compare results from printout Acceptance Limits QC1 limits Mean5 has to be within 8 mg HA ccm of reference value QC2 limits Rod volume x 2 of the reference value Reference value Each scanner must have its own reference values for QC1 and QC2 defined after installation Those reference values must be calculated as average value of repeated QC1 QC2 scans every day for 2 week after delivery or after an X ray tube detector change Cases when values are off limit It may happen that phantom results are off limits simply due to statistical phenomenon When you obtain off limit value repeat QC scans 2 5 times to check on the drift consistency If values remain off contact SCANCO Medical AG Plot the QC curves every month to catch slower drifts even before they would reach the 8 m
15. dress them to your SCANCO MEDICAL AG Any change on the configuration of the XtremeCT J System leads to loss of the CE conformity according the Medical Directive 93 42 EEC XtremeCT II Version 2 4 155 List of Figures Figure 1 Declaration of conformity me mense nennen Figure 2 Caution X Rays and Laser eese eee ee eme emen xviii Piere Ia Referte Users Guide esee HERE AER OR RT e RE ae xviii Figure TII 4 Caution X Rays AROR xviii Piggare M o Type Plate et eite et xix Figure 1 Turning On Equipment eisie erre rennen erepta eee nea era e ee aua ets 1 Figure 2 LO BIN BOX Ai ety En 2 Figure 3 Exiting Main Program XtremeCT II oo eee cece scence e em eme e eene 3 Figure 4 Exiting the Session eer eia nA RERENENE GENET EA e Le Ee Sende 3 Figure 5 Login Box for Shutdown A OA REREN 4 Figure 6 Control BOK rei aay cet oa et hes 6 Figure 7 Edit Operator Data eben ex repere eee ven Vee a nnn 7 Figure 8 Operator Registration Program esa 7 Figure 9 Find Operator zer ee enean ena eae ea ex erede e de edes 8 Higure 10 Select Operator eeepc tree tete tels Sie te des 8 Figure 11 Operator not Found ee enne ee er ee e enn 9 Figure 12 Exit Operat r Program eee e tee 9 Figure 13 Edit Patient Data erre e even e
16. DISK1 MICROCT MICROCT_SETUP COM Process Job DISK1 MICROCT MICROCT SETUP USER COM Process Job DISK0 MICROCT COMMON MICROCT SETUP COMMON COM Process Job XtremeCT II Version 2 4 114 Logicals Logical MICROCT SCSI LINE DISKO DISK1 DISK2 DKO MOO FDO TPO SYSSLOGIN SYSSSCRATCH UM SCM UU SCU UCTD SCD UCT SCANCO SCOUT DATA MEASUREMENT DATA CT HISTO RESULTS CT BATCH MEASUREMENT CT MEASUREMENT QUEUE CT RECONSTRUCTION ECONSTRUCTION QUEUE ECONSTRUCTION SCALING EAMHARD FACTOR R R CT RECONSTRUCTION FILE R B B EAMHARD POWER CT EVALUATION ui Len Als AG enun cedro pete in ed CT RAY VOLUMESIZ pi SCANCO_DEF_PRINTER SCANCO_BW_PRINTER SCANCO_COL_PRINT Di x SCANCO PS PRINTER UCT EVALUATION SH UCT HISTO 2D SHEET UCT RAY SHEET UCT SINGLE IMAGE SHEET UCT ONE IMAGE SHEET SHEET UCT SIXTEEN IMAGES SHEET UCT 3D LIST SHEET UCT 3D SINGLE SHEET UCT CONTROLFILES DATABASE DATABASE UCT EVALUATION DATABASE FOUR IMAGES UCT MEASUREMENT UCT SAMPLE DATABASE UCT SCANNER DATA UCT SLICE NAME FILE SCANCO PATIENT DATABASE SCANCO ZIP CODE DATABASE UCT DB RESULTS UCT DB INFO UCT BACKUP COMMANDFILE XtremeCT II Version 2 4 Meaning SCSI Controller SCSI Controller System Disk User Disk Data Disk Data Disk Magneto optical drive Floppy Drive Streamer Tap
17. Order of Precedence in most scripts if multiple objects are selected and their thresholds are overlapping object 1 wins then object 2 then object 3 then object 4 Starting Evaluation The green objects indicate the VOI which will be used for the 3D evaluation The VOI is further delimited by the white bounding box The volume inside of the white bounding box will be written to disk Everything outside the bound ing box will neither be evaluated nor be displayed in 3D If you have found your VOI click on START EVALUATION and the evaluation immediately starts as a batch process this means that you can now exit the program or launch a second evaluation The batch job will run in the back ground Type QUE in a terminal to see if it is still running The evaluation will only be performed inside of both a your objects contours green red Caution b the bounding box white The bounding box in its default size contains all your objects and thus does not further limit the ROI VOI Evaluation 65 XtremeCT II Version 2 4 Advanced Modifying Evaluation Scripts In the menu Scripts the available Evaluation Scripts can be modified main ly for ex vivo scans Do not change the script used for the standard patient analysis E Bone Trab Morphometry 3D Seg 3D Calc Print Sheet Pas i B Figure 78 Modifying Scripts Basic Mode Name of Script Enter a meaningful name for your Evaluation Script Help Text
18. diameters from 10 14 mm Internal Circuit Breaker 10A Characteristic D Optional on site installation Please contact Scanco Medical in advanced if needed EXTERNAL XRAY INDICATOR nee E INPUT of XtremeCTII Power for L L L external i N 3 a t Fi 4A SW SWDPST 100 240V N o po Sag at mie 20704 Neutrik cable plug POWERCON NAC3FCA Ui 097 Neutrik POWERCON NAC3MPA Cable to L iania Tue Xx M m external be i n A Indicator 1 3 t j F S To Om Z EXTERNAL XRAY INDICATOR POWER OUT PONER OUT OUTPUT of XtremeCTII Neutrik cabel plug POWERCON NACSFCB 2 098 Neutrik POWERCON Figure 112 Electrical installation Note the system will be delivered without the main supply cable the cable has to be provided by the electrician e g 3 x 1 5 mm flexible Computer The computer with its standard periphery will need five power outlets with protective earth connection 110 VAC or 230 VAC two for the workstation one for the monitor one for the tape drive one for the media converter Addi tional power outlets will be needed if e g a printer or a disk tower will be in stalled For some customized workstation setups instead the 110 VAC power outlets a 208 VAC or 230 VAC power outlet will be needed The required pow er cords for the computer will be supplied by SCAN
19. etc 9 amp cancel Figure 16 Select Patient XtremeCT II Version 2 4 Edit Patient Data 11 Click the desired name with 1 and confirm the entry by clicking Note Always use the same spelling because the pro gram is case sensitive The following window appears if your entry does not exist in the database WARNING Keyword not found CODE 26 FACILITY MEASUREMENT Figure 17 Keyword not Found The possibility now exists of changing or completing data Always use the same spelling Find Next By clicking the FIND NEXT button the next patient in alphabetical or numeri cal search order will appear depending on whether you entered the patients name or number while using FIND New If you click on the NEW button all fields become free to enable a new patient data to be entered Save Update If you click on the SAVE button labeled UPDATE in modifying mode all input data for this patient will be saved updated Exiting Patient Program Click on the FILE button followed by either QUIT or EXIT This will lead you back to the main menu Using EXIT any changes will be automatically saved whereas with QUIT you can return to the main menu without saving the edit ed data XtremeCT II Version 2 4 Edit Patient Data 12 XtremeCT II Version 2 4 Figure 18 Exiting Patient Program Edit Patient Data 6 Measurements Measurement Procedure For a single sca
20. laser beam This symbol defines equipment or operator relat ed information Disregarding these information may result in personal injury or may lead to dam age to equipment or loss of data This symbol defines information which requires elevated operator attention Safety Information xvii Labels Attached to the Equipment Labels on the Front of the Scanner Figure 2 Caution X Rays and Laser Figure 3 Refer to User s Guide Labels on the Back of the Scanner Figure 4 Caution X Rays XtremeCT II Version 2 4 Safety Information xviii SCANCO MEDICAL AG Modat XtremeCTII CH 8306 Bruettisellen Switzerland k www scanco ch SN 1 AXXXXXX Made in Switzerland ID 34xx Manufacturer SCANCO Medical AG Manufactured January 2014 Input max 480VA 100 240Vac 50 60Hz Fuse 10A oe Class Type IEC EN 60601 1 c US UL 60601 1 MEDICAL APPLIED ELECTROMAGNETIC RADIATION EQUIPMENT AS TO ELECTRICAL SHOCK FIRE AND MECHANICAL HAZARDS ONLY IN ACCORDANCE WITH ANSI AAMI 80801 1 2005 CAN CSA C22 2 No 60601 1 2008 0123 mum IEC 60601 1 3 IEC 60601 2 28 IEC 60601 2 44 E464784 Figure III 5 Type Plate Electromagnetic Compatibility EMC XtremeCT II Version 2 4 This equipment has been tested and found to comply with the EMC limits for the Medical Device Directive 93 42 EEC EN 55011 Class A and EN 60601 1 2 These limits are designed to provide reasonable prote
21. on one of the selec tion points using MB1 or you can resize it by clicking on one of the selection points using MB2 You can also define or adjust the position or dimension of the VOI by directly entering the coordinates sizes using the keyboard Segmentation For the standard patient analysis all the settings are fixed and cannot be changed by the user If the script is not locked the proposed segmentation values can be modified For ex vivo scans with ex vivo Evaluation Scripts Evaluation 64 XtremeCT II Version 2 4 choose SIGMA and SUPPORT of the Gauss filter and lower and upper THRESH OLD to binarize segment your image After clicking on Preview the Main Window shows the result of the segmenta tion and the Evaluation Window shows the histogram of the gray scales and the volume fraction of the segmented object s Toggling between preview and grayscale allows you to fine tune the segmentation parameters The histogram and the volume fractions that are shown in the Evaluation Window are computed Note on what is visible in the Main Window and inside of the contour if you zoom in on a region only the histogram of the zoomed region is shown If your chosen script can handle multiple objects click on the radio buttons numbered 1 to 4 Object 1 to Object 4 to change the settings for the different objects The unit selector to the right of the radio buttons allows you to spec ify in which units the threshold is given
22. DB UCT OPERATORS nnn DAT Operator DB UCT SAMPLES nnn DAT Sample DB UCT SCANNER xxxx DAT Scanner calibration UCT SLICENAME xxxx DAT Slicenumber UCT ZIP CODES nnn DAT Zip Codes operator where nnn is the name of the customer and xxxx is the scanner SN MICROCT MAIN contains all programs and command procedures needed for operating the system MICROCT RESULTS Contains the summary files of 2D Histomorphometric evaluations The file names are HISTO 2D xxx DAT where xxx is the measurement number MICROCT SCRATCH temporary files for evaluation and printing are stored to this directory Content can be deleted at any time MICROCT TIPS Sample documents describing OpenVMS tasks as well as actions to perform interactive segmentation etc MICROCT UIL User Interface Description Directory Files define the look of the programs If available subdirectories for different language variants The template files for printing PS also are located in this directory MICROCT UTIL This directory contains Utility Programs mainly used by Service Personnel MICROCT XDEFAULTS Directory containing settings for X Windows Environment XtremeCT II Version 2 4 113 Appendix Logicals and Symbols Definition of Logicals and Symbols The logicals and symbols used by MICROCT are defined in the following files SYSSSTARTUP SCANCO_SYLOGICALS COM Systemwide DISK1 MICROCT LOGIN COM Process Job
23. Figure 121 Rear of Equipment XtremeCT II Version 2 4 143 Indicators 1 Power On 2 X Ray Tube On 3 X Rays are Emitted Shutter Open 4 Laser Active 5 Progress Lights Error Lights when flashing XtremeCT II Version 2 4 Illuminated indicators indicating action in progress Figure 122 Indicators Figure 123 Indicators Safety Precautions General This pQCT instrument generates X rays The system was tested for radiation leakage at the factory and conforms with regulatory requirements under nor mal operating conditions It is dangerous for any person to operate this equipment without having appropriate training which have included instruc tion in the means for using X Ray radiation without hazard to patient user and surroundings The user must be aware of all regulations and requirements that may be ap plicable governing the installation and use of equipment producing ionizing radiation for medical purpose Do not operate your instrument if it is physically damaged The damage of the scanner housing may lead to uncontrolled emitted stray radiation In case of damage the system must be inspected by SCANCO MEDICAL AG or authorized personnel prior to using it again Do not remove any covers or panels giving access to live parts Any cover re quiring the use of a tool for its removal can be assumed to be in this category Safety circuits must neither be removed nor modified X rays may
24. IEC 6060 1 2 44 This medical device meets the provisions of the Medical Device Directive 93 42 EEC and the basic requirements according to Annex II 3 121 Any change on the configuration of the XtremeCT J System leads to loss of the CE conformity according Figure 110 CE Mark the Medical Device Directive 93 42 EEC CE Specs for the XtremeCT XtremeCT II Version 2 4 Field of view Max scan length Resolution 1096 MTF 140 mm 200 mm 5 patient protocol gt 8 5 Ip mm non patient protocol Reproducibility of density measurement Default voxel size Image matrix Stack height single rotation Detector size X ray tube Filter First half value layer Light field Light field position CTDI Effective dose Weight gantry Size gantry H x W x D lt 0 3 CV Phantom 61 um isotropic 2304 x 2304 for a default patient measurement max native image matrix 4608 x 4608 Voxel size 31 um up to 10 mm 4608 x 400 pixels 221 mm x 19 5 mm Nominal voltage 68 kVp DC 1 Nominal current 1 47 mA 1 Nominal power 0 1 kW Maximal voltage 70 kVp DC with up to 1 42 mA Maximal current 2 mA with up to 50 kVp Linearity of radiation output with mAs 1 Maximal power 0 1 kW Focal spot size 60 um EN12543 3 0 1 x 0 1 mm IEC60336 Target W Mode of operation Continuous operation Tube window 0 3 mm Beryllium Cooling closed loop water cooli
25. Sensitivity Profile There is only one beam collimation and in this beam collimation the geomet ric efficiency in z direction is 83 The geometric efficiency is dependent on XtremeCT II Version 2 4 137 the used pixel in detector height Below 323 used pixels the geometric effi ciency will drop of below 70 o o o geometric efficiency o o A o w 0 2 0 1 300 200 100 0 used pixels Figure 115 Geometric efficiency System Performance The system performance is measured for two protocols patient protocol highest resolution protocol with a homogeneous PMMA cylinder with a diam eter of 100 mm The two protocols are the patient protocol and a highest res olution protocol 1x1 binning 1500 projections per 180 600 ms integration time 4x data average The values are in milligram hydroxyapatite per cubic centimeter mg HA ccm This is the standard unit used in the XtremeCT II but it can also measure in Hounsfield units HU Patient Protocol Highest Resolution Protocol mean CT number 16 3 mg HA ccm 11 2 mg HA ccm Noise 141 5 mg HA ccm 42 1mg HA ccm Uniformity 0 0 4 mg HA ccm 5 5 mg HA ccm Uniformity 90 0 0 mg HA ccm 4 9 mg HA ccm Uniformity 180 0 6 mg HA ccm 4 7 mg HA ccm Uniformity 270 0 4 mg HA ccm 4 9 mg HA ccm MTF center 10 92 5 um 49 1 um MTF off center 10 112 6 um 64 6 um Tomographic Section 209 um 144 um Thickness
26. VON y n leere etd eat le ree gt od Dreiwing Cons itinere ette eter rei e entis re e det DraWInG i iia ERE CO HER c GRE Ue ERIS ali Modifying Contours oo ccc Moving Scaling Objects Selecting ODISCIS ROW Deleting Graphical Objects Copy Cut Paste Replace Objects Creating a Volume of Interest sse Automatic Contouring xat eret PORA TORRE ES Iange Selection he et etes Breakpolint rerit tite ea ert micat ite XtremeCT Version 2 4 Global Scliol OW eade et INVER Morphing Color Coding in Image Selection Area Morphing Sequence Overview Evaluation 2D tee ROI Selection Segmentation Printing out of the 2D Histomorphometry Window seem 63 Starting EVOIUGHION vus reed 63 EV IUGTONSD 64 Selecting an Evaluation Task iii ii 64 Defining VOI 64 SCOMOENIGUOM 64 Staring Gas 65 Advanced Modifying Evaluation Scripts sss seen 66 Importing Evaluation SCNPIS tirer itte eei aec DISTANCE Print IMAGES teo o tale Pointer Ruler Profile Angle Tools
27. Ye Yea eR Y ea ERR 10 Figure 14 Patient Registration Program e eme memes esee eene 10 Figure 15 Find Patient oce edes e eta geret ure NT Ree oS 11 Hisure 16 Select Patient RE HG GER GRANI NEN Slee 11 Figure I7 Keyword not Found e ER eR eR e he e d de ae e e ele 12 Big re 16 Exiting Patient Program secr cepe pepe er a e cots 13 Figure 19 Start Measurement re teria deg eee T nen 15 Rigure 20 Main Program OCreen L o ee ee i eae RR RP ide RAE ORE RR RH EXE 16 Figure 21 Input of Patient s Name or Number eere 16 bigure 22 Confirmation esce rwr I I t MM 17 Figure 23 Selecting Controlfile e e ee e 17 Figure 24 Modifying a Controlle ied dH x ee 18 HBig ure25 SCOUt VIeW ict eee e ue ee cael nene qa aee Y e se apre er ree eee dade er gren 19 Figure 26 Evaluation Script Selection in eee hehe hene ene 19 Figure 27 Beam Hardening Script Selection esses eene 20 Figure 28 Modifying a Controlfile advanced mode eee 22 Figure 29 Scout View of a Radius me meme me me se se se seen 24 Figure 30 Scout View of a Radius with Notch position marked red cross 24 Figure 31 Scout View of a Radius with Reference Lines sese 24 Figure 32 Scout View of a Tibia with Notch position mark
28. accidentally entered as a patient or as a physician op erator must be a member of the staff No scout scans performed Number of slices is not allowed Not enough disk space left Hard disk is full First delete or archive other measurements Not enough space on disk Optical disk is full Use new optical disk Not more than 15 characters The label of a diskette or an optical disk may not be longer than 15 charac ters In addition no special characters or spaces may be used Opening database file General database error Opening filename General database error Opening scanner datafile Scanner calibration data cannot be opened Opening slicename file Slicename file cannot be opened Reading Slice Number General database error Reading filename General database error Reading indexed record An entry in the database is not found for example when looking for a sample or patient who has not been entered or has been spelt incorrectly UM FULL BACKUP COM General error by weekly backup Selected operator is not an operator You have attempted to enter an invalid person as the operator for example a patient or doctor If this is not the case check with the sample or patient re cording program whether the STAFF button is pressed Unable to translate logical General program error Unknown error Error for unknown reason Error Messages 108 Unlocking indexed record General database error Updating index
29. again Color lookup table Click with MB in this field to change the color lookup table for the display of the images By repeated mouse clicks with MBl you will return to the original black amp white display Pointer Histogram Profile Ruler Angle Tools and Tasks Click on a button for a tool and move the mouse pointer into the Main Window 4 Read the results in the Information Area 12 or in the Evaluation Information Win dow 13 See Pointer Ruler Profile Angle Tools on page 69 See Evalu Evaluation 49 ation 3D on page 64 for the button 10 Slice Selection Slider LOAD to preload all images for a fast access to those 11 Image Selection Area Moving the cursor in this field and clicking with MB causes the indicated image to be shown in field 4 You also can enter a slice number by using the keyboard or click on arrows to more troughs multiple slices one by one 12 Information Area Information window showing coordinates of cursor size of ROI and distance density and area calculations 13 Evaluation Information Window Printing 2D 3D histomorphometry 3D distance measurements The brightness scaling 7 does not affect any 1 Caution evaluation but only the display on the screen Standard Patient Evaluation Overview XtremeCT II Version 2 4 Start evaluation program Select patient and measurement Call up 3D evaluation window with clicking on the T and start the A
30. be present Failure to observe this WARNING warning may result in personal injury Risk of electrical shock Failure to observe this WARNING warning may result in personal injury death or equipment damage Radiation Protection Dosimeter Operating personnel working regularly with the instrument is strongly recom mended to wear radiation protection dosimeter which must be analyzed in a regular manner System Changes The user is not allowed to change any hardware configuration nor any pro tected software settings including process quotas for system parameters XtremeCT II Version 2 4 145 Accessories XtremeCT II Version 2 4 Safety Components OBS E 2 Gantry Stop 3 Avoid Exposure 1 Capture Key The scanner works only if the capture key is present and activated green lamp is lit Pushing the Gan try Stop button will immediately inter rupt the gantry movement and turn off the X Ray tube Laser radiation is emitted from this aperture Figure 124 Safety Components 4 Main switch Must be turned on before turning the capture key Figure 125 Safety Components Right arm cast Left arm cast Foot cast Quality control phantom KP70 Appendix SOPs SOP Quality Control daily and weekly XtremeCT II Version 2 4 Goal This documents lists and describes the necessary procedures for daily and weekly quality control Personnel XtremeCT II operators
31. diameter volume weighted mean Mean thickness and standard deviation are written to the database if activated The output object shows the spheres fitting inside the structure with the voxel values being their diam eter in voxel units Dt object param uses the contours of a GOBJ or AIM mask if it finds the GOBJ filename in the proceedings log Roi radius factor controls whether only a sphere is evaluated or the whole region default DT also works with GOBJ masked objects The epsilons are used for suppress ing artefacts due to rough surfaces You should usually not modify the de fault values For very coarse voxel sizes above 100 um assign epsilon 0 9 may be chosen Histogram or screen controls whether a histogram of the thickness distribution is written to a text file and or shown on the screen ipl dt obj DECterm Based Programs 97 XtremeCT II Version 2 4 input in output out gt gobj filename gobj from log peel iter 1 roi radius factor 10000 0 gt ridge epsilon 0 900000 assign epsilon 1 800000 histofile or screen none samp012 thickness tab dt background param Calculates the mean separation of the structure with the distance transfor mation DT method by filling largest spheres into the background of the ob ject and calculating their mean diameter volume weighted mean Mean separation and standard deviation are written to the database if activated The output object shows the s
32. done in up scaling It is suggested to use integrate true for gray scale images but integrate false for binary segmented images to preserve the binary status Otherwise a subsequent thresholding operation may be needed to ensure a binary image again Scale elsize automatically selects among the below described procedures ipscale elsize and noipscale elsize according to whether there are frac tional voxels who may then be interpolated gt ip For integer down scalings noipscale is chosen for non integer down scalings and any up scalings ipscale is chosen The exception is non averaging scaling of binary objects always with noipscale to maintain the binary status if the integrate flag is put on false If a GOBJ mask is used for the evaluation of an object the mask has to be transformed into an AIM mask with to aim and this AIM mask can then be scaled to the same voxel size as the original ob ject Use integrate false for the mask scaling to preserve the binary status of the mask alternatively after masking with integrate true perform a thresh old operation to produce a binary mask again ipl gt scale input in gt a sca gt x 2 000 2 000 2 000 gt 1 000 1 000 1 000 gt true output down scale up scale integrate ipscale elsize One constituent of scale elsize Ifthe new voxel grid is not a integer multiple of the original voxel grid then the new values lying between old voxels p
33. either tape or local disk If you use the tape drive you can add many backups to the same tape You should use a tape specially reserved for this purpose With tapes we recommend you to use two tapes alternating between them Use a new tape for this purpose Only tapes ini Note tialized with label BACKUP will be accepted Do not store your backup disks or tapes in the Caution same room as the equipment better still not in the same building Danger of fire water damage etc Before you start a backup procedure you should terminate all other pro grams or applications such as measurement program evaluation program etc Otherwise some files might be locked by those applications and there fore not be saved DataManagement 85 To start the backup operation insert the optical disk or the tape and click the DB BACKUP TO DISK DKO or DB BACKUP TO TAPE button e LN Figure 107 Backup Options Then confirm the following question whether you inserted the appropriate disk or tape A safety copy of all databases will then be made The procedure can be done in interactive or in batch mode Operating System Backup Every six month a pop up window occurs with a reminder to perform a back up of the operating system The backup should then be made as soon as pos sible In order to perform the backup make sure that no jobs are running or pend ing in the queue before starting and that all other users a
34. images belonging to a measurement have been deleted Freeing logical unit number General database error Getting Binary Time The time cannot be determined Getting current date time The time cannot be determined Getting free logical unit number General database error Getting number of free blocks Free space on a storage device cannot be determined Getting volume name The label of a storage device cannot be determined Keyword not found An entry in the database cannot be found for example when looking for a sample or patient who has nof yet been registered or whose name has been spelt incorrectly ErrorMessages 107 XtremeCT II Version 2 4 Name contains a wrong character Names of data media can only use the letters A Z or the numbers 0 9 but no spaces or special characters No Controlfile selected You have not yet selected a controlfile Measurement site and cast No Sample or Patientname You have not yet entered a sample s or patient s name No Sample Patientnumber You have not yet selected a sample or patient No images available The pictures for the measurements cannot be read Have you selected a valid measurement Have you possibly deleted its images No logical unit number free General database error No operator selected For measurement and evaluation the field OPERATOR must be filled in with a valid name Check in the sample or patient registration program whether the operator has been
35. in the image data After de selecting the Default Size you may select another voxel size of the reconstructed image which is achieved by an interpolation during the reconstruction It only makes sense to reduce the voxel size if binning equals 1 Figure Modifying a Controlfile Advanced Mode on page 22 16 Choose the number of slices wished On the right side an indicator shows the covered range in mm resulting from number of slices and current slice thickness Below the range in mm the number of stacks will be displayed together with the number of slices per stack The number of slices per XtremeCT I Version 2 4 Measurements 20 XtremeCT II Version 2 4 stack will vary depending on the number of total slices so that the slices are always equally distributed over the minimum number of stacks neces sary 17 Relative position to Scout View Reference Line or the absolute position O mm if Scout disabled 18 Integration Time For patient measurements the integration time is set to 43 ms and for the XtremeCT I compatible mode to 36 ms A longer integra tion time leads to a higher Signal to Noise ratio The reconstruction time is not affected by this value but the measurement time and radiation 19 Average Data multiply the integration time with the chosen factor The XtremeCT I is not designed to use the AVERAGE DATA OPTION 20 The total number of slices the resultant measurement time the time cur rent product and the CT
36. it appear smaller The PERSPECTIVE scaler lets you change the visual effect as if you moved to the object or further away The scale hereby is modified in a way that the size is not affected n MB2 for Scaling within Window Figure 91 Other Effects Alternatively you also can click with MB2 into the main window and as you move the cursor up and down you change the scaling XtremeCT II Version 2 4 3D Display 73 XtremeCT II Version 2 4 Cutplane To perform a virtual cut through the displayed object align the scaler be tween 100 and 100 96 is an exact cut through the middle of the object parallel to the monitor layer Figure 92 Cutplane Subdim Click on menu SUBDIM to open the following subwindow Changing the scal ers allows you to perform virtual cuts through the object along the principal axis of the image volume Figure 93 Subdimensioning Mode There are five different display modes available as are listed in the figure be low Figure 94 Display modes Object Values Click on menu OPTIONS followed by VALUES to open the following subwin dow You can change the brightness of the displayed image and the color lookup table You may want to enter Zero for Min for better contrast To fur ther increase brightness enter a lower Max value than proposed Click on the color bar to toggle between different colors Click on OK and click into the 3D Display 74 m
37. measurement can be per formed It is a requirement that this is performed before each patient scan and without the patient in the machine Casts The arm leg should be positioned inside the cast in a way that the patient feels comfortable Radius positioning Set the forearm in the cast and strap the Velcro Deflate the cushion with plastic beads using the provided air pump Tibia positioning Select the proper padding sizes for the foot and thigh sup port Chair Move the patient on the chair towards the system and adjust height and posi tion Make sure the patient feels comfortable and then lock the wheels 148 XtremeCT II Version 2 4 Scout View Reference Line Before starting the Scout View instruct the patient to stay still for the next 2 3 minutes not move any thing and to not talk If the patient moves between Scout View and Scan the reference line set during Scout View will be mean ingless Make sure the joint space is fully visible One can enlarge the scout view by adjusting the Start or End sliders position and redo the scout view Set refer ence line according to the following examples Here are some indications as to how position the reference line 1 The distal endplate of the Radius Tibia is the region where the reference line must be set Do not pay attention at the Ulna Fibula 2 Visualize the broad white line defining the endplate 3 Look for a notch on the endplate a Notch case Place the
38. metallic foil is includ ed This foil is inclined on purpose and serves to measure the scanning sen sitivity in the Z axis Figure 52 Slice Sensitivity Profile Phantom Schedule We recommend scanning the Slice Sensitivity Profile phantom once per year Mounting Pull the slider towards yourself and detach the cast holder from the slider fixed by 1 screw Replace it by the slice sensitivity phantom on the slider adapter and place it on the cast slider Scanning Measure the slice sensitivity phantom with a patient protocol or any other scanning control file you want to investigate XtremeCT II Version 2 4 Quality Control 43 The indicated angle is 6 The reconstructed images needs to be rotated by 6 clock wise this means the logical uct_recon struction_offset_angle needs to be set to 6 XtremeCT II Version 2 4 Proceed as usual precalibrate first then start a scout view The scanning re gion must include the two sides of the metallic foil Figure 53 Scout View of the Slice Sensitivity Profile Phantom Evaluation Start the evaluation program open your measurement and select the section al image you want to analyze If the image of the metal foil is not parallel to the y axis you have to determine the angle between the metal foil and the y axis To rotate the images you have to reconstruct the measurement with an offset angle Figure 54 Offset angle with regards to y axis def u
39. mm If the ScoutView setting OFFSET was selected in the Controlfile an addi tional row on the right hand side of the Scout View GUI Set here the given length of a reference object e g arm length or object length The relative off set in of this object is calculated automatically Start Scout View Click on the SCOUT VIEW button The scanner now starts acquiring the Scout View radiograph You can interrupt the Scout View at any position by clicking on the CANCEL button with MB Reference Line Click on the REFERENCE LINE button and then move the pointer to the current Scout View at the upper right The green reference line now follows the point Measurements 26 XtremeCT II Version 2 4 er As soon as MB is pressed the line is fixed You can correct the position ing of the line as often as you wish by again clicking on the REFERENCE LINE button As you move the reference line you also can adjust the number of slices by pressing and holding the SHIFT key Moving the pointer then adjusts the end of the scan scan length scan area By releasing the SHIFT key you can move the start line again Clicking with MB sets both start and end position If you have chosen a locked controlfile you will not be able to adjust the number of slices To center a certain number of slices move the reference line to the first land mark than press the ALT key and move the mouse pointer to the second landmark The reference line w
40. needs to be check visually If the contour matches the edge of the bone one can start the actual Evalua tion immediately If a correction has to be done on a range of slices 1 Determine the starting and ending slices numbers of that range 2 Correct the contour at the first slice of that range a Start the iteration process until the last slice of the range b Correct the last slice of that range then Morph in between 151 XtremeCT II Version 2 4 Figure 131 Example for matching of contours good on the left acceptable in the middle and not acceptable on the right Starting the Evaluation When you reached satisfaction with your contour one can start the actual Evaluation task Click the 3D Evaluation button T Check that Evaluation Script XtremeCT II Standard Patient Analysis 61um is selected then click Start Evaluation Check Result Sheet On the printout check the common region number It should be 709 If it is less or the parameters differ changes a few percent ensure the scan was performed on the same side L R and the patient ID was chosen right Load previous scan and compare the images visually If wrong side was measured patient has to be rescanned Procedure Checklist Select measurement e Check image quality Click 3D Evaluation e Start Contouring Task Open contouring window Check on the contours on all slices e Apply manual corrections Close contouring wi
41. of the measurement is limited to 30 The CTDI is linear to the mAs product If the measurement parameters are changed the new CTDI is automatically calculated with the formula vol mGy 0 064 Time current product expressed in mAs The CTDI will be displayed when the imaging parameters are changed and before a measurement is initiated Effective Dose The effective dose for one XtremeCT IJ standard measurement with 71 mAs is below 5 uSv For comparison the effective dose of a Dual X ray Absorptiome try DXA measurement is between 0 1 and 75 uSv Sources and effects of ionizing radiation 2000 Report to the General Assembly of the United Na tions Scientific Committee on the Effects of Atomic Radiation UNSCEAR an nex D Medical radiation exposures Dose and Sensitivity Profile With an X ray sensitive film the dose profile along the Z axis at the center of rotation has been measured The dose profile is independent of the selected parameters The sensitivity profile for the center of rotation has been mea sured for the patient protocol and for a highest resolution protocol 1x1 bin ning and 1500 projections per 180 Patient protocol 209 um Highest resolution protocol 144 um dose profile free air dose profile phantom sensitivity profile aquisition range 0 8 0 6 0 4 intensity a u 0 2 Jy 30 20 10 0 10 20 30 distance mm Figure 114 Dose
42. set a reference value one should average the Rod volumes values over 20 measurements ideally spread over 20 days If you have a deviation of more than 2 do not scan patients Contact SCAN CO MEDICAL AG XtremeCT II Version 2 4 Quality Control 39 XtremeCT II Version 2 4 1 Daily SCANCO MEDICAL Scanner ID 3407 Code Phantom S No 1 Filename C0000326 M No 302 Date 29 OCT 2014 08 28 EL E1 Imin Ctri File QC1 Daily Cylinder Densities mg HA ccm Alu Rod Volume mm 1 SD 5 1651 49 8383 Mean SD 100 1354 51 9715 Mean3 SD 202 7209 52 1654 Rod Volume Mean4 SD 404 9831 56 6256 Means SD 795 3510 66 3219 No of Measured Slices s4 Rod Threshold Mean Mean Value of Region in mg Hacc Rad Vel Veimme of Segmented Aluminium Rod sD Sm of Vates in Regien mg Bac Siege manage Piet 29 OCT 2014 08 38 3D Density and Geometry Phantom Evaluation SCANCO MEDICAL Figure 48 Example of a Printout Sheet for the Daily QC1 Measurement Quality Control 40 QC2 Weekly SCANCO MEDICAL Scanner ID 3406 Code Phantom S No 2 Filename 5 292 Date 20 OCT 2014 08 54 EL 1 Imin Ctii File QC2 Weekly Cylinder Densities mg H A ccm Alu Rod Volume mm 1 SD Mean2 SD Mean3 SD of Measured Slices 150 Rod Threshold 155 Mean Mean Value ef Regier it mg HACE Rec Vel Veimme af Sezmeared Alumi
43. sufficient please contact SCANCO Medical before shipping Connection to Power for Gantry permanent Check that sufficient and suitable electrical outlets for computer and periphery are available how many voltage power rating Fibre Optic Cable between Computer and Gantry if a cable length of 5 m is not sufficient please contact SCANCO Medical before shipping Computer Network One network port per standard workstation is required two are recommended Patch Cables RJ45 check that the right length is available External Indicator if necessary contact SCANCO Medical before shipping Telephone Electrician availability during installation power cable for the gantry must be provided by the electrician Room Layout Area to Handle the Patient Positioning of Operator radiation view to patient Positioning of Computer Workstation cable length power outlet Distances from Walls servicing air circulation Estimate whether the temperature of the room will remain within the desired range due to heating generated from the equipment Miscellaneous Table for Computer Workstation Chair for Operator Room Temperature with Dissipated Heat Surface of the Floor Load Capacity of the Floor Local Radiation Safety Regulations Transportation Check Tilt Watch and Shock Watch while Receiving Pallet Lifter Check Transportation Route from Loading Dock to the Room Special Transportation Gear if needed 135 Dose State
44. the AIM mask like to any other binary volume 1 gt gobj to aim gobj filename default file name gt U0001977 GOBJ out 0 gt output gt out peel iter cut2d shape ow Cut a two dimensional ellipse circle or rectangle extended along the z axis from an object and set all points lying outside to zero The size of the shape type of shape is adjusted to the biggest size lying within the x y plane if 1 is chosen for halfaxes x y otherwise to the given size may overlap the bound ary cutborder controls whether the border of the shape is set to zero true or not false The operation is overwriting i e the input object is altered 1 gt cut2d shape input output in gt type of gobj circle halfaxes x y gt midpos x y 1 1 gt cutborder false gt DECterm Based Programs 95 XtremeCT II Version 2 4 cl ow rank extract Component labeling CL of a segmented image Faces have to touch for voxels to be considered connected i e a voxel can have 6 connected neighbors Ex tracts the regions with the given rank in the size ordered table Overwrites the input Usually used with rank 1 to 1 to remove any small noisy speckles not connected to the main structure connect boundary controls whether the whole boundary of the box containing the object acts as a connector of sur face points input_output seg gt a first_rank 1 gt last_rank 1 gt connect_boundary f
45. the screen you can send it to a printer or save it as a EPS or TIFF file Choose the menu FILE and PRINT The following window appears AN AN C001234J_SEG Vv Pes Figure 98 Printing of 3D Scenes First choose the type of printout you want by clicking on one of the PRINT FORMAT options PostScript amp EPS or TIFF if available Then choose the printer attached and the corresponding button PRINTER FILE or BOTH If saving to TIFF you can choose the location directory now e g to Scratch or Export as defined in microct setup user com or to the measurement direc tory on the data disk The color of the output can be set to different values Choose COLOR or B W Then set the PRINT FILE to your wishes and click on OK Calculating Animated 3D Sequences XtremeCT II Version 2 4 Click on menu OPTIONS followed by ANIMATION The following window ap pears To save the image sequence the toggle button AUTO PRINT must be ac tivated previously in Figure 98 on page 78 To make an animation turn your 3D object into the initial position desired for the animation and click GET SETTINGS A Then adjust the settings of your object to its end position and click GET SETTINGS B When you move the object using the sliders Rotation Elevation Translation etc you need to push the button START to display the changes On the sliding bar below you can select the number of frames that you would like to create between the
46. then start scanning Evaluation For low contrast detectability the evaluation is qualitative and visual Signal to noise ratio SNR is especially critical at this low density range A scanning protocol can be adapted by augmenting the integration time for example to enhance the SNR The better SNR the better one can detect small structures with low contrast Quality Control 46 Low contrast phantom measured with a patient protocol The rows of the 8 mm 4mm and 2mm holes can be seen quite clear the row with the 1mm holes is difficult to recognize XtremeCT II Version 2 4 Figure 59 Low contrast phantom measured with a patient protocol Quality Control 47 8 Evaluation 2D and 3D histomorphometric evaluation can be performed on either a rect angular cubic volume or any irregular shaped ROI VOI Region Volume Of Interest The ROI VOI is defined by a set of Graphical Objects GOBJs which can be contours or geometric objects such as rectangles or ellipses The ROI VOI has to be drawn on a slice based method The 3D shape can be defined by either drawing objects on all consecutive slices or by creating a hull between any two slices interpolating the intermediate slices morph ing The defined ROI VOI is stored to disk and will be reloaded once the measure ment data is being reloaded Exactly the same VOI thus can be re evaluated at a later time Starting the Evaluation Program Overview
47. to con tain the turned image2 Subtraction of two binary images can be performed by a combination of set value of input2 to 127 and then concat it with in putl flag add true ipl gt concat inputl in gt input2 inl gt b output out gt c common region only true add not overlay true make edge false gt shift ofin2 000 gt turnangle 0 000000 turnpoint global 1 1 XtremeCT II Version 2 4 DECterm Based Programs 102 XtremeCT II Version 2 4 join uncompress This operation joins two segmented volumes directly while reading and un compressing from the disk thus only needs the memory of the output volume once It may be useful if concat does not work because of too small virtual memory The compressed files are read from disk and the uncompressing is done directly into the correct memory location in the output The volumes may be overlapping but then the respective part of file2 is overwritten in cluding zeros onto filel Join uncompress only works for compressed files Note on disk and only works for volumes with the same dimensions in x and y direction ipl join filel filel gt rat seg partl aim file2 file2 gt rat seg part2 aim output out shift ofin2 z 0 bounding box cut This operation determines the smallest box around the object of non zero voxels An additional boundary can be chosen with border z only controls if only the bounding box in z
48. 00 gt roi radius factor 1 000000 t dir ortho no t dir ortho nr 8 gt t dir radius 2 gt fabric tensor yes histo Gives a histogram of an object With the default arguments same effect as examine in histo Optionally the histogram is shown from from_val to to val default from minimal value to maximal value found in input volume Optionally a tabulated version of the histogram is printed to a file given with fileout or screentab or the screen fileout or screentab screen in addi tion to the bar column representation with the number of bins given with nr bins in tab The number of bins in the bar column representation is not affected by nr bins in tab DECterm Based Programs XtremeCT II Version 2 4 ipl gt histo input in gt rat fileout or screentab none my histo tab from val 7 1 gt 1500 to val 1 3000 nr bins in tab 1 gt scale elsize Using this command you can change the voxel size of your object down scale enlarges the voxel size reduces the resolution up sca1e makes the voxel size finer Non integer scaling can either be given directly e g with down scale 1 5 or with a combination of down scale and up scale 2 The effect is exact ly the same the latter may just save you a division by hand The integrate flag controls whether averaging of voxels is done in down scaling and poten tial interpolation of partial voxels and whether interpolation is
49. 1 NEEE IEE NS SNN 124 gobh mMaASK ete iere ee te ees 94 Graphical User Interface 110 GUT bM EE 110 H Harddisk 5 uhahanedesasoseses 124 Header and Footer 111 Histograms eA AAT ee 100 Histomorphometry SDD 64 1 Initialize etre 87 Interactive Measurement 32 Interpolating ge te 59 90 L Load GOBJ sates te ARRA A ARAR 53 Logicals OpenVMS 114 Login BOX en e eanan 2 LUE nnna A 124 M ET MUN 53 MBI nee ete een ven ete dite tet 110 Measurement 13 14 Interactive Mode 32 Measurement time 21 MIL Mean Intercept Length 90 118 MIL Calculations 100 Modifying Objects 57 59 Mount See also Dismount 88 infor RENE 110 Moving Scaling eee 57 Object Properties 75 Object Val s i 74 Objects Deleting 57 Drawing 56 Modifying eee 57 Moving Scaling 57 Selecting 57 Operational conditions 121 sees teet 7
50. 1 or QC1 Daily Select the controlfile for the daily phantom measurement QC1 Daily Mea surement Perform the precalibration measurement PRECALIBRATE Start the measurement Evaluation Start the evaluation program and load the phantom measurement Check that all sections are available Then start the evaluation using the EVALUA TION 3D button and you will get a printout Compare the measurement for Mean5 with the reference measurement Determining the Reference Measurement To set a reference value one should average the Mean5 values over 20 mea surements ideally spread over 20 days If you have a deviation of more than 8 mgHA ccm on Mean5 it might be beneficial to perform some repeated QC scans to check if the off range value only due to statistical dispersion or if it is a confirmed drift out of range If the QC is out of range after 10 repeated QC do not scan patients Contact SCANCO MEDICAL AG Weekly Phantom Measurement referred to as QC2 Schedule The second section of the QC phantom needs to be scanned once a week Mounting See description Scanning See description but select the appropriate patient record Pat no 2 and controlfile QC2 Weekly Measurement controlfile Evaluation The reconstruction of the measurement is longer than that of the daily mea surement scan Start the evaluation the same way as for Determining the Reference Measurement To
51. 108 Device Information ce CA Rc e t e HR EINEN E VEN ER dn 87 Higure 109 Gaus p E E 93 ligure T0 vB RA RAI RA AR ASI AR RS 122 Figure lll Site Planning eere eR 129 Figure 112 Electrical installation esee e emen he hehehe 130 Figure 113 PMMA Phantom Top View eee heme heme se nennen 136 Figure lI4 Dose Sensitivity Profile eR ER ASA AIR 137 Figure 115 Geometric efficiency arinrin rnr r EA 138 Figure 116 Modulation Transfer Function MTF for all Combinations 139 Figure 117 Horizontal and Vertical Planes for Measurements 140 Figure 118 The Dose Distribution in the Horizontal Plane 141 Figure 119 The Dose Distribution in the Vertical Plane 142 Figure 120 Front of Equipment atesi arara eget dede uie e ud eee ea nan nus 143 Figure 121 Rear of Equipment tirir iiir 143 lisure 22 Indicators ure AA eee ee eee 144 Figure 123 Indicators esr eee te e ie eave eon ks 144 Figure 124 Safety Components he sense sense sense he nenne 146 Figure 125 Safety Components mense ensem sen sense hehehe 146 Figure 126 Scout View Reference Line ariere er eE E eee nemen 149 Figure 127 Example for Radius good example on th
52. 15 Optical DISK 124 P Password iaig eoe tete Ee te 2 POSITION 20 68 Printing 2D Histomorphometry 63 Printout 111 Program Overview 5 6 Q QUIE iokoan naian an n 9 12 R EN 59 Reconstruction 89 Reference Line 26 Region of Interest sees 56 Resolution ssepe aias 20 ROD aree a EIN ETE steed 56 124 E 62 S Safety Copy sese 85 trit RESPECT EESE 10 Scaling Voxelsize 101 Scan Ranger pes eret 26 Scout View esessesseseem seen eee 23 Segmentation 63 64 93 94 PA D 63 BD 64 modifying parameters 117 118 Segmentation Program 90 Selecting Objects 57 Shutdown 00 cece cee cee essere 4 Shutting Down eee 2 3 Slice Reconstruction 89 SMI Structure Model Index 90 118 Specifications 121 Starting MicroCT Programs 2 Startup 1 6 Subinde etc 74 Symbols OpenVMS 114 Symbols in IPL
53. 900 Projections 180 71 mAs The ambient dose equivalent in uSv measurement for the horizontal plane A 0 01 0 01 0 01 0 01 0 00 0 00 0 00 0 00 0 00 WO ANADUAWNEH B 0 02 0 02 0 02 0 01 0 00 0 00 0 00 0 00 0 00 C 0 03 0 04 0 05 0 04 0 02 0 00 0 00 0 00 0 00 D E F G H 0 02 0 01 0 02 0 03 0 02 0 04 0 01 0 04 0 04 0 02 0 09 0 02 0 09 0 05 0 02 0 19 0 06 0 19 0 04 0 01 0 15 0 28 0 15 0 02 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 I 0 01 0 01 0 01 0 01 0 00 0 00 0 00 0 00 0 00 The ambient dose equivalent in uSv measurement for the vertical plane b 0 01 0 01 0 01 0 01 0 01 0 00 0 00 0 00 0 00 0 03 0 03 0 02 0 01 0 01 0 00 0 00 0 00 0 00 f 0 03 0 01 0 01 0 06 0 01 0 03 0 11 0 02 0 05 0 12 0 06 0 12 0 06 0 28 0 06 0 00 0 00 0 00 0 00 0 00 0 00 Figure 118 The Dose Distribution in the Horizontal Plane 0 28 uSv measurement 70 mAs 0 05 uSv measurement 70 mAs 0 00 uSv measurement 70 mAs 141 8 b 7 6 5 d d 0 28 uSv measurement 70 mAs 3 2 r3 1 0 05 uSv measurement 70 mAs 0 00 uSv measurement 70 mAs Figure 119 The Dose Distribution in the Vertical Plane XtremeCT II Version 2 4 142 Appendix L Product Views Indicators and Accessories Views Front Figure 120 Front of Equipment Rear E
54. Based PIOQEIOES t atte dct deo big 89 General Guidelines REGONSTTUCTION catene tete e rn p a IPL Image Processing Language XtremeCT II Version 2 4 help aim read to aim T C EM delete EE dq threshold rr nad eden ee o a gauss seg and seg gauss cdeiptivesmbresholds4n nn ssn a Ne ML He MAR CR ttd Tit Teile ee DIOIEDEDUEIGI eee ges REDE ERIS TREE gobj maskaimpeel ow Conex MASKOM ree RR Or Ree eee ER EET c Re A PEG GOD remo np cut2d SHAPE OW nee entendi Peau ert e digas osuere wit anda tate QU AM GERE AS P Lu cI26 rank extract e LIUM EP E dscanceozactivale ccce eei tt tri e CREER dt object parat etes dt_background_param RNG emet en ea hee sed c ostia eren GCOMMANOG MD PER COMMU OS lp voxgobj_scanco_param VOX SCONCO DOIGMIMN sta crise x LUE E HARE AE CX E SA Tall MIV param fa t DE Ils TO a
55. CO MEDICAL AG Exten sion cords or power strips have to be supplied by the customer External Indicators If external indicators e g an illuminated sign X ray On are needed please contact SCANCO MEDICAL AG to discuss this option before the delivery of the 130 Transportation XtremeCT II Version 2 4 equipment because in some cases modifications of the equipment and addi tional electrical installations are needed Network Connections If data will be needed to be transferred to any other computer a computer network will be needed It is highly recommended to have the computer net work ready before the installation of the equipment One network port per workstation is required two are recommended One more network port is required if a printer is installed normally a printer is not supplied by SCANCO MEDICAL AG RJ45 cables have to be supplied by the customer Please have your following network information available during the installa tion of the equipment Two IP addresses for the computer workstation Hostname for the workstation Domain name of your network Gateway Router IP address e Subnet Mask Dynamic Name Server DNS IP address es e Printer IP address and name Telephone A phone near the workstation is recommended for communication with SCANCO MEDICAL AG in case of any support or any problems with the equip ment Miscellaneous A table for the computer workstation and a chai
56. D SESSION in the Session Manager Figure 4 Exiting the Session XtremeCT II Version 2 4 Shutting Down XtremeCTIl 3 Shutdown of Computer Enter sHUTDOWN as USERNAME and click on OK with mumoww se Figure 5 Login Box for Shutdown The computer closes all databases and programs so that you can use all the programs again without problems the next time Never switch the computer off without performing Note a correct SHUTDOWN Only in this way it can be guaranteed that all data can be read again with out problems XtremeCT II Version 2 4 Shutting Down XtremeCT II 4 Wait approximately one minute and then you can turn off the equipment as follows Turning Off Equipment 1 Monitor 2 Computer 3 Optical disk and or tape 4 Printer 5 Scanner XtremeCT II Version 2 4 Shutting Down XtremeCT XtremeCT II Version 2 4 3 Program Overview SCANCO MEDICAL Figure 6 Control Box With the program MicroCT the following can be done 1 Record or Change Operator Data Editing 2 Record or Change Patient Data Editing 3 Perform Measurements 4 Evaluate Measurements Slicewise Evaluation 2D Histomorphometry 3D Histomorphometry Image Documentation 3D Display and 3D Documentation an Data Management Archive Delete Measurement Data Weekly Database Backup 7 Exit XtremeCT II Main Program Program Overview 6 4 Edit Operator Data Start Progr
57. DIvol for the actual setting of the measurements parameters are indicated 21 After setting up your measurement protocol you have to test the consis tence of the protocol before you can use or save it by clicking on TEST If this is successful and your initial controlfile was not locked the buttons OK SAVE AS NEW and SAVE get sensitive and you now can use the modi fied protocol for the next measurement only by clicking on OK or save it first clicking on SAVE and the clicking on OK to return to the main screen If your initial controlfile was locked the SAVE button will not get sensitive SAVE AS NEW can be used to store a modified protocol under a different name and number Measurements 21 XtremeCT II Version 2 4 Modifying a Controlfile Advanced Mode Radius L Standard RE me Default Evaluation Change Figure 28 Modifying a Controlfile advanced mode Explanation 22 Number of Det lines for Scout View Defines how many lines on the detector shall be used during the Scout View Using all available lines pro vides faster Scout Views but some faint horizontal lines might be seen between the stacks Limit the number of lines to a small number to obtain Scout Views without these artifacts but the time of the Scout View will increase 23 Number of Det lines for CT scan Defines how many lines of the detector that should be used This number influences the number of slices within a stack Limit the number of d
58. ECterm Based Programs XtremeCT II Version 2 4 12 Error Messages The most common error messages caused by insufficient or incorrect infor mation for a measurement are self explaining Unforeseen system error messages are explained in the alphabetic list below All error messages must be acknowledged with MB If the error is only a WARNING you can continue working If the error is FATAL however the program will then be terminated as a continuation is impossible can also oc cur by ERROR Italic text shows what you can do yourself against the error If there is no italic text after the error message contact SCANCO MEDICAL AG Creating directory Write error on the hard disk Creating operator logical Operating personnel cannot be registered Try starting the program again Decoding Measurement Nr Measurement number invalid Decoding Sample or Patient Nr Sample or Patient number invalid Decoding Site Measurement site invalid Decoding Slice Number Image number invalid Deleting indexed Record An entry in the database cannot be deleted Disk must have a name Diskette was not initialized formatted Initialize the diskette Encoding Slice Number Image number invalid End of file No more records available There are no further entries to be read in the database as you have reached the end File Read Error A tomogram cannot be read Usually appears only when a measurement was interrupted or if the
59. Enter a short help text for the script Project Name Enter a short Project name less than 15 letters for your eval uation script This project name will also be used in the filename of the result txt file in disk1 microct results Eval IPL User Script Filenames Enter the names of the programs that you wish your evaluation script to call Changing them is recommended for ad vanced users only Object 1 to 4 Enter the default segmentation parameters if required by the script Gauss and Threshold for your current Project Those values will be used when you then start the script unless you override them manually by entering them through the GUI in Figure 77 3D Evaluation Subwindow on page 64 before starting the 3D evaluation At the end save or save as new or cancel your changes Importing Evaluation Scripts More Evaluation Scripts are available in the menu Scripts Import E g Con vert to Dicom and Convert to TIF scripts are available to be imported into your currently available Evaluation Scripts Evaluation 66 Distance 3D Click on menu TASKS followed by DISTANCE 3D Figure 79 Distance 3D The following window appears Figure 80 Distance Measurement Select the 1st slice you want to set a marker Then click on GET POINT A using 1 and move the cursor to the main window As you move the cursor the coordinates appear in the window at A If you have found your Position A cl
60. KET If a copy of the data already has been transferred to another device this can be seen within the parenthesis behind the name of the data DataManagement 84 d XtremeCT II Version 2 4 General Guidelines for daily operations Archiving use MOVE to Tape Restore use COPY to Hard Disk from Tape Starting the Move Copy Function Click on the START button to execute the desired function If your destina tion device is a tape you first have to mount the corresponding tape manual ly see Mount Dismount p 88 After your confirmation the images of the selected measurement will be cop ied moved to the destination device If you want to view these images later again in the evaluation program you will be asked to put in the appropriate tape If you archive or backup the images on tapes you first have to copy or move them back from tape to disk to be able to re evaluate them Under some circumstances it is possible that a hard disk can crash which makes it impossible to read sample data old measurement results or Scout Views again Such defects are extremely unlikely but are disastrous for fol low up studies as previous measurement results cannot be read any more You should therefore regularly make a copy of your databases data security preferably once a week A pop up window will open every time a weekly back up is needed Please do not ignore this warning You can backup your database to
61. Reconstruct a range from slice n to m so enter e g 5 19 Most programs operated in the terminal start counting the slices at O while the standard user Note programs start counting at slice 1 You might have to adjust for this difference of 1 DECterm Based Programs 89 IPL Image Processing Language re CES XtremeCT II Version 2 4 This program is used to execute the 3D segmentation and different morpho metric evaluations e g MIL Mean Intercept Length DT Distance Transfor mation TRI Triangulation SMI Structure Model Index etc The concept of this program is You work with multiple objects in memory One object is usually the input for a procedure whereas the result will be the next object You can delete objects internally in memory only You can also read and write objects from to disk Each object has to be given an internal name such as input output segmented or just a b c etc Once launched in interactive mode you can execute the commands below Each command takes a few arguments which usually have a default value By pressing the return key the value is entered If you have to enter values for all coordinates x y and z you can either give all three values separated by a space or just enter one value which is then applied to all coordinates If the order of the arguments is known by heart you can supply them in the correct order together with the command e g gauss in out and then pre
62. TA C0000372 AIM type aim uncompress true aim read Shortcut for reading an AIM from disk The file type has to be aim By read ing an object from disk you have to give it an internal name Same function as read but type and uncompress are assumed to be aim and true ipl gt aim name gt a filename default file name gt DISK3 DATA C0000372 AIM or on one line only ipl gt aim in DISK3 DATA C0000372 AIM isq to aim Reads an ISQ from disk and puts the requested volume of interest into mem ory as an aim object The volume of interest is given by pos upper left corner and dim dimension of aim object ipl gt isq aim name in gt a isq filename default file name DISK3 DATA C0000372 ISQ pos 0 0 0 150 240 0 dim 1 1 1 gt 210 210 210 write Writes an object to disk The file type should be aim You can compress seg mented files using run length or binary compression Default is binary but for gray scale images the compress type is always switched internally to none ipl gt write name default name a filename default file name DISK3 DATA XYZ AIM compress type bin gt r delete This command is used to delete an internal object i e to free memory ipl gt delete name gt a examine Use this command to examine different things of an object and show the re sults on the screen Possible values are geometry histogram statistics number log a
63. Version 2 4 Pointer Ruler Profile Angle Tools By clicking on the buttons shown alongside you can 1 2 Show Image Values at Cursor Position Show Histogram of image within the region of interest Show Profile along a user defined line The start and end point of the line can be moved using MB1 Determine Distances between two points in the image along a line The start and end point of the line can be moved using MB1 Determine Angles The angle between two edges of a triangle The vertices of the triangle can be moved using 1 Open 3D Evaluation window Figure 83 Pointer Ruler Profile Angle Tools Evaluation 69 9 3D Display Starting the 3D Display Program Enter your name into the operator field and click with MBl on the button with the 3D symbol in the main program SCANCO Medical AG ov Figure 84 Start 3D Display Figure 85 Main Program Screen XtremeCT II Version 2 4 3D Display 70 General 3D Scene The 3D Scene is as follows Light SS 3D Object Rotation Observer Figure 86 3D Scene There is an observer who moves around in the scene and looks at an object which is positioned at the origin The observer is at a specific elevation angle and looking either from above below or straight on the object He also moves around the object which is given by his rotation angle The light source is given relative to the observer So if the observer m
64. View Do not repeat scanning the exact same site more than 3 times Note re _ Starting the Measurement Program To start the measurement program you must first enter your name in the field OPERATOR Then on the main menu select the icon with the scanner symbol by clicking on it with MB XtremeCT Operator 5 Medical Edit SCANCO MEDICAL Has EXT Figure 19 Start Measurement XtremeCT II Version 2 4 Measurements 15 The main window of the measurement program will open Figure 20 Main Program Screen Selecting the Patient In the middle of your screen the following input window appears Figure 21 Input of Patient s Name or Number Click on the input field and fill it in accordingly Confirm your input by click ing the OK button Note The program is case sensitive XtremeCT II Version 2 4 Measurements 16 As in the patient registration program a list now appears of all patients who correspond to your entry Click on the patient that you require in the list and confirm with OK If the desired name cannot be found in the database the following question will appear ca o mm Figure 22 Confirmation You should now click on YES if you wish to enter the patient The input page of the patient registration program appears See Patient Registration Pro gram on page 10 Enter the corresponding data See Edit Patient Data on page 10 Afte
65. WARDS is usually performed For ex vivo scans morphing contours MORPH might be a good option Figure 71 Contouring Subwindow Automatic Contouring Once you have drawn an object its shape can be automatically adapted to the surface of the bone The object to start from hand drawn contour should approximately match the form of the bone To start the automatic contouring click on the button ITERATE FORWARDS OR ITERATE BACKWARDS The finding of the contour can be influenced by 1 Object to start from The closer the hand drawn object to the real contour the better the adaption 2 The value INNER VALUE should be set to the approximately value of bone see threshold setting in 2D 3D Evaluation 3 The value OUTER VALUE should be set to the approx value of soft tissue see threshold setting in 2D 3D Evaluation 4 Number of Iterations Usually the ITERATION 1X is sufficient If the shape of the bone changes very rapidly choose 2X or 8X If you select the FORWARDS OR BACKWARDS range the program automatical ly moves to the next slice after it has finished the contouring on the current slice Evaluation 58 Range Selection The following actions are performed on a RANGE You select the range by clicking on one of the options Current image in main window only e Range start and end of range are defined by BreakPoints BPs Reference slices green objects e Forwards range starts at current slice and extends fo
66. XtremeCtT User s Guide Revision 2 4 TD 326 Rev 2 4 Date of Release June 16 2015 all rights reserved SCANCO MEDICAL AG Fabrikweg 2 CH 8306 Bruettisellen Switzerland Content CONTACT INTOMMOTION susc qut NORD n E aU Db xi Manufacturer and Contact for Service or Support sse xi Europe Corporate Heaecddgucrter ss echoes e uto REG Ode xi USA arp ATeregs acne E PAR EOM rd xi II General Information tnnt xi P rpose of this Document ctos t o eo o AR tem aram o t i Typographic Conventions and Abbreviations Typographic CONVENTIONS itte ertet tr cree eerie riii eri i i eerte tet tubo de E e Ue lt i e HO p Xii User s Guide Upduates eren eiecit iter inen den xii Target Group and Users Qualification sss mes xii Intended Use Software Licence Agreement sss sss xiii EL DI MEUM iii Installation Reparation and Service Declaration ot Conformity store cie pee e ee e peret de citet did Iil Safety IMMAN N xvi USErS RESDONSIDINPY 4 5 tte dibs lead xvi FISTUSOO SS ascia dt mE RO DT nila xvi Description Of Warning Symbols xvi Labels Attached to the Equipment 2 Labels on the Front of the Scanner Labels on the Back of the Scanner oc
67. _scale 1 000 1 000 1 000 gt average true gt set_value With this command you can set the value of all non zero voxels of a segment ed object to a given value and all zero voxels to another Useful for inverting foreground background of the object and for producing a negative image value_object 127 ipl gt set_val input in gt value_object 127 gt value_background 0 gt concat Concatenates two objects Common region only if two objects with unequal di mensions or unequal positions are chosen this flag controls whether the re gion common to both objects is taken or whether the box region surrounding both objects is produced Add_not_overlay Controls whether voxel values of second object are added to the first object with overflow taken care of i e 60 90 127 50 127 for charimages or whether non zero values are laid over the first object useful for mapping the segmented image onto the original gray scale data Make edge controls whether edges are made of second object or first if second is gray scale and first is char The second object can be shifted with shift_ofin2 and turned in the x y plane with turnangle Turnpoint_global is tried to be set to the original rotation center of the scan ner i e for 512x512 images to 256 256 etc The turned image2 is mapped into the same box as image2 thus for larger angles the image may be cut at the boundary if there is not enough free space left around the object
68. a GOBJ filename If the GOBJ file is not found vox scanco param see below is applied Pee1 iter controls the num ber of 2D peel iterations for the mask By default pee1 iter is taken from the proceedings log ipl gt vox input seg gobj filename gobj from log peel iter i vox_scanco_param Evaluates a segmented image for the fraction of voxels set and writes result to the database if activated For gray scale original images mean attenuation coefficient is written to database If the proceedings log of the object contains a GOBJ mask operation the relative volume of the masked region is incorpo rated into the calculation ipl gt vox_scanco seg mil_param This command executes the MIL calculations Mean Intercept Length Parfitt You should usually not modify the default values If the database is activated the result of the calculations are written to the evaluation data base ipl gt mil_param input default name a 2 000000 gt 1 000000 ray plane scale roi radius factor t dir ortho no t dir ortho nr 8 gt t dir radius fabric_tensor yes gt milv1_param This command executes the MIL calculations in its first version different bor der handling You should usually not modify the default values If the data base is activated the result of the calculations are written to the evaluation database ipl gt milvl input default name a ray plane scale 2 0000
69. a Radius with Reference Lines Measurements 24 XtremeCT II Version 2 4 Figure 32 Scout View of a Tibia with Notch position marked red cross Figure 34 Scout View of a Tibia with Reference Lines Measurements 25 XtremeCT II Version 2 4 Select SCOUT VIEW with MB1 If the Scan Offset has been set in mm the fol lowing window will appear Figure 35 Scout View Start End Position For an example of how this window changes when a Scan Offset in 96 is se lected see Figure 37 on page 29 You can now Determine start and end position for the Scout View Set the angle of the Scout View Perform the Scout View Set the reference line OU Ge AND rs Save the Scout View this is done automatically for the first Scout View of each patient reference Scout View of reference measurement Start and End Position With the two scalers you can determine the extent of the Scout View The controlfile gives you default values which you can change for a specific pa tient The smaller the range the better you will see the details of the speci men Angle Using this scaler you can rotate the gantry to perform the Scout View from a different angle This allows better visualizing structures not visible from one angle but from another e g base plate of a joint 0 is a radiograph from the side 90 is a radiograph from the top Default Values Sets the scalers to their initial positions 100
70. ain image for a new image build up To change the color look up table click on the colorbar Datamin mas object mm w Figure 95 Object Values Object Properties Click on menu OPTIONS followed by OBJECT DISPLAY PROPERTIES to open the following subwindow This allows you to show or hide objects to change its colors etc Find a more detailed description on our Webpage FAQ Figure 96 Object Properties 1 The two sliders at the top selects different objects in the aim file if a seg mented file is opened there are only two objects where number is the background number 1 is the segmented object If the opened volume con tains pixels with different values they will be shown in bins 1 to about 255 With the sliders you can select e g 1 to 80 This then corresponds to XtremeCT II Version 2 4 3D Display 75 XtremeCT II Version 2 4 all the pixels with a relatively low gray scale value the numbers and the corresponding threshold numbers are displayed just below the sliders Once a range has been selected the display properties of those values can be altered see points below for options Display properties of object within the selected range Show Display objects in range as a solid object Transparent Join Joins all selected objects into one transparent object Transparent Separate Each object is displayed as separate objects but are transparent Transparency slider Regulates t
71. all objects of one slice Deleting Graphical Objects You can delete a single object by clicking on Button 6 Strike over the object you want to have deleted by using 1 By clicking on Button 7 you delete all objects of the current active slice By clicking on Button 8 you can delete all graphical objects of all slices Copy Cut Paste Replace Objects To copy an object first select the object Selecting Objects p 57 then in the Edit menu click Copy or click CTRL C Same procedure is used for the Cut op tion Using Paste from the Edit menu pastes the object in a selected slice as an ad ditional object The Replace function replaces the existing object in the cur rent slice with the previously copied or cut object File Edit Zoom Tasks LUT Options Scripts Undo Cut Ctrl Z vz O i Remove _ Copy Ctrl C Paste Insert 4 Replace Ctrl Vv SelectChild Shift MB1 Select Parent Alt MB1 Tn Figure 69 The Edit menu XtremeCT II Version 2 4 Evaluation 57 Creating a Volume of Interest XtremeCT II Version 2 4 Drawing objects on all slices is very time consuming To create a volume you can get a quicker result by one of the following graphical methods Click on the C button or click on menu TASKS followed by CONTOURING for these tasks Figure 70 Contouring The following window appears For patient scans the automatic contouring with ITERATE FOR
72. alse gt value in range 127 rank extract Same as above but not overwriting the input Uses more memory ipl cl rank input seg output Lek gt first rank Ln last_rank 1 gt connect_boundary false gt value in range 127 cl26 rank extract Similar as above but also voxels only touching by an edge are considered connected ipl cl126 rank input seg gt output c1 gt first rank 1 last rank 1 connect boundary false value in range 127 cl extract Same as rank extract but extracting according to fractional volume of components Not available with connect boundary flag 1 gt cl extract input seg gt output cg lo vol fract in perc 1 gt up vol fract in perc 1 gt value in range PIZI gt cl_nr_extract Same as cl_rank extract but extracting according to number of voxels of components Not available with connect_boundary flag ipl gt cl_nr_extract input seg gt output c1 gt min number 10 max number 0 value in range 127 DECterm Based Programs 96 XtremeCT II Version 2 4 cl image Gives the component labeled image as output with value 127 for biggest con nected part 126 for second biggest etc ipl cl image seg fel gt input output db scanco activate Activates or deactivates the database for writing all subsequent evaluation results into it It sta
73. am JSCANCO Medical AG Mose Be Figure 7 Edit Operator Data In the main menu click on the framed button EDIT with 11 H A H g Figure 8 Operator Registration Program Enter the operator data Each field can be selected directly with MB1 using the RETURN key brings you to the next field The operator number is automatically allocated by the program and cannot be changed Upon finishing the data input the data can be saved by clicking the SAVE UP DATE button with MB XtremeCT II Version 2 4 Edit Operator Data 7 For a measurement the program requires at least a name The data can however be completed or Note changed at any time i e address change change of name because of marriage etc by using FIND changing the data and then finally using UPDATE Possibilities Find The following data window appears after clicking the FIND button Figure 9 Find Operator Click the data input field with MB and fill it in as required Confirm your in put by clicking the OK button Upon entry of a number or of the complete en try of the operator s name the data will appear in the fields If only the first few letters of a name are entered then a list showing all operators starting with these letters will appear Thus if J is entered the list will show all op erators whose name starts with J such as Joe Public John Doe etc Figure 10 Select Operator Clic
74. and Installation sss 129 SITesPIennib9 seo RO RR EORR eb ea 129 Positioning of the Equipment sss eee eem nnne 129 Electrical Astalan sso e te ener 130 Network COonnpecTiIOnmnsss ciii ea cec hv em P re i d a La v dg 131 Telephone oe ee ie eec e e CR ve iere MISCEIANGOUS nhe c e n e na RT TEUER MAMSHOMONOM t EE At the Loading Dock From the Loading Dock to the Final Room DIMBENSIONS GNG WEEIONIS cities cate vane wana are e adr ned deem dione DIMENSIONS er dander lege Power Consumption Heat Generation 133 lastele iaa eot e teta 134 Personnel 134 Checklist Tor site PIGNNING caeso teen en em d Re 135 Appendix K Radiation Safety 2 cette ton at n tonta nto tto meats 136 DOSS Statements Jr niae ees ae nc o PMMA Phantorri uentris Computed Tomography Dose Index CTDI Effective ee RS Dose and Sensitivity Profile sse System PetrfOrmiabiee s ret t Ee o i en tbe aa c ate Eod Stray Radiation arena e etes a tete Stray Radiation given in Air KERMA per Units Stray Radiation given in Ambient Dose Equivalent per Measurement 141 Appendix L Product Views Indicato
75. ber is the key to access all scan data and evaluation results concerning this patient Start Program Edit Patient data by selecting the framed button SCANCO Medical AG Figure 13 Edit Patient Data In the main menu click on the framed button with MB Figure 14 Patient Registration Program Enter the patient data Each field can be selected directly with MB1 using RETURN brings you to the next field The patient number is automatically allocated by the program and cannot be changed XtremeCT II Version 2 4 Edit Patient Data 10 Upon finishing the data input the data be saved by clicking the SAVE button with MB1 For a measurement the program requires at least Note a name The data can however be completed or changed at any time by using FIND changing the data and then finally using UPDATE Possibilities Find The following data window appears after clicking the FIND button Figure 15 Find Patient Click the data input field with MB and fill it in as required Confirm your in put by clicking the OK button Upon entry of a number or of the complete en try of the patient s name the data will appear in the fields If only the first few letters of a name are entered then a list showing all patients starting with these letters will appear Thus if J is entered the list will show all operators whose name starts with J such as Joe Public John Doe
76. by changing the value for TRANSLATION H and or vertically by changing the value for TRANSLATION V Figure 89 Observer Alternatively you also can click with MB into the main window and as you move the cursor up and down you change the ELEVATION if you move left or right you change the ROTATION If you release MB the calculation starts If you click with MB3 into the main window and as you move the cursor up and down you can change the TRANSLATION H and the TRANSLATION V If you click on 1 while iterating the views you interrupt and can then change the observer settings again by click and drag By holding down the SHIFT button the coordinates of the object where the mouse is pointing are displayed 3D Display 72 By holding down the CTRL button and then move the mouse the distance is measured between the initial position and new position on the object where the mouse is pointing Light Source By changing the ROTATION and ELEVATION of the light source you change the effect of shades on the object The values are relative to the observer position Figure 90 Light Source The scaler AMBIENT LIGHT affects the shading of the object where 0 means direct lighting only and 100 means ambient lighting only The values in be tween are a mixture of both light source types The scaler SHADOWS affects the translucency of the shadow Other Effects By changing the SCALE FACTOR you enlarge the object or make
77. c xviii Electromagnetic Compatibility EMC occas xix Active Implantable Devices and Body Worn Active Medical Devices Background loadicitiom t 1 Start up Procedure ll 1 ors dnte cotes 1 Turning On Equipment Starting Main Program XtremeCT ll 2 2 Shutting Down XTFEMECT ll 3 Exiting Main Program XtrerneG Tli susce cerei rer pr nr eee 3 Sh tdowrr ob Gormpilter c d Mc dede 4 Turning Off EQUIPMENT 5 XtremeCT Version 2 4 ii PHO SICA OW SS WW an haftet 6 Edit Operator 7 Start Program Possibilities Find Find Next ER Save UDpdgte soit a uomen Exiting Operator Program Edit Patent Data RN TT UM 10 Start Program Possibilities EE Find Next M M panaia Save Update Exiting Patient 12 RN a 14 Measurement Procedure sse eene 14 Starting the Measurement Program 15 Selecting the Patient sss esee 16 Controlfiles Measurement Protocol 7 arcte ei eee etis 17 Selecting a Controlfile sss esee 17 Creating a new Controlfile sss 18 Deleting a Controlfile neret mestre dre 18 Locking a Controlfile 18 Modifyi
78. cast with the two Velcro Figure 42 Leg Cast Figure 43 Hand Cast The measurement history is always displayed with date and measurement site Check the selected measurement site with the measurement history and check the selected measurement site matches with the foot or arm you have prepared for the measurement Ask about any possible fractures or implants in the measurement areas If a fracture or an implant is within the planned measurement area the contra lateral side should be measured Check that the patient is not wearing any high attenuating object such as a watch or jew elry within the measurement area XtremeCT II Version 2 4 Measurements 34 When the pre calibration measurement is finished you can open the bore cov er Please use the handle First fixate the cast in the front hitch Figure 44 Cast in the Cast Slider Then gently slide the foot or arm of the patient into the bore until you can snap in the cast at the gantry Check that the cast is positioned correctly and close the bore cover using the handle Figure 45 Cast tightly in place Then you can start a SCOUT VIEW and a SCAN XtremeCT II Version 2 4 Measurements 35 After the measure ment open the bore cover using the han dle Then you have to release the cast by raising the end of the cast which is pointing towards you a little bit and then pull gently the patient together with the cast out of the gantry Make
79. ct_reconstruction offset lt offset_angle gt 5 uct reconstruction file name rsq all batch 4 Reload your measurement in the evaluation program and check that the im age of the metal foil is now parallel to the y axis in the sectional image you plan to analyze Load all sectional images into the evaluation program and Quality Control 44 The indicated angle in the xz plane need to be measured to scale the element size of the slice sensitivity profile switch to the xz view Determine the angle of the image of the metal foil to the y axis in this view The angle should be in the range of 5 Figure 55 Offset angle in the xz plane Switch back to the xy view and select the evaluation script slice_sensitivity_ profile Place the VOI in the sectional image you selected to analyze The Z di mension of the VOI should be 1 and the y dimension should be about 20 and the metal foil should be placed in the center of the VOI Then start the evalu ation You will find in the directory of the measurement a text file which you can for example analyze in Excel The column mean is the slice sensitivity profile You have to scale the element size with the tangent of the angle you deter mined in the yz view to get the distance between two data points Slice Sensitivity Profile 1400 4 1200 4 1000 800 600 4 arbitrary Units 400 200 0 4 200 Figure 56 Slice sensitivity profile of a measurement with standard pati
80. ction against harmful interference in a typical medical installation The equipment gener ates uses and can radiate radio frequency energy and if not installed and used in accordance with these instructions may cause harmful interference to other devices in the vicinity However there is no guarantee that interfer ence will not occur in a particular installation If this equipment does cause harmful interference with other devices which can be determined by turning the equipment off and on the user is encouraged to try to correct the interfer ence by one or more of the following measures e Reorient or relocate the receiving device Increase the separation between the equipment Connect the equipment into an outlet on a circuit different from that to which the other device s is connected Consult the manufacturer Safety Information xix Active Implantable Devices and Body Worn Active Medical Devices Please be aware of the potential detrimental interaction of the X rays with ac tive implantable devices and body worn active medical devices If a patient is wearing an active implantable device or a body worn active medical device in the region of interest or close to it please check with the manufacturer of the device Background Radiation The detector of the XtremeCT II is sensitive to X rays and gamma rays There fore the equipment might be influenced by external X ray or gamma ray sources Please make sure that the backg
81. d radionuclides the activity of these radionuclides and its effect to the result should be evaluated Abuse The equipment is not intended and must not be used for whole body CT mea surements of infants The equipment is not designed for emergency situations nor for life support The equipment is not suitable for use in presence of a flammable anaesthetic mixture with air and oxygen or nitrous oxide Software Licence Agreement Transportation XtremeCT II Version 2 4 The software described in this document is a part of the XtremeCT may not be copied onto a computer other than that delivered with the equipment The operating system software OpenVMS DECwindows Motif is licensed for this computer only and may only be copied for safeguarding purposes Crate Your equipment was delivered in a specially designed crate This crate en sures that your equipment is protected against physical damages while transportation Please retain the material in case the equipment should be moved for any reason Please contact SCANCO MEDICAL AG for any relocation of the equipment Transportation Locks For avoiding damages due to rough handling while transportation special means must be taken Please refer to the separate shipping instructions pro vided by SCANCO MEDICAL AG Generallnformation xiii Installation Reparation and Service The system should only be installed and repaired by a trained and authorized person Only auth
82. d scale maximal normal Figure 66 Brightness Scaling You can achieve the same effect with the menu OPTIONS followed by Bright ness hace Figure 67 Options Brightness Scaling Evaluation 55 Defining the ROI or VOI XtremeCT II Version 2 4 Drawing Icons By clicking on the buttons shown alongside you can 1 10 Draw Contour Draw contours in the counter clockwise direction All contours are automatically closed A contour drawn clockwise excludes the region inside the contour Correct Contour The contour to be corrected must be crossed at two points The part lying in between these crossing points will be replaced by new contour segment counter clockwise drawing direction Correct with Straight Line The contour to be corrected must be crossed at two points The part lying in between these crossing points will be replaced by a new segment Draw Rectangle Square Contour By holding down the SHIFT button while drawing the contour remains square Draw Ellipse Circle Contour By holding down the SHIFT button while drawing the contour remains a circle Delete Contour Deletes one contour of the current image by crossing over it with the MB Delete All Contours Deletes all contours of the current image slice Delete Contours of All Images Deletes all contours of all images Move MB1 Scale MB2 contours Open Contouring Subwindow Also possible with double c
83. direction is determined and cut out with a given border ipl bounding box cut inputl in output out z only false border 00 0 flip aim Flips an object to a side i e x y and z direction are switched according to new xydir NB it is not necessarily a proper rotation of the object in 3D space The new x direction is the first letter given in new xydir the new y di rection is the second letter the new z direction is the remaining direction ipl gt flip aim input in gt a output out gt f new xydir yz xz offset add Changes the offset around the object The offset is the same for the beginning and the end for one direction voxels run from off x to dim xoff but may be different for the different directions x y and z The offset is then disregard ed in subsequent image processing or statistical examinations 1 gt offset add input in gt a add offset 0 0 0 gt 0 0 4 offset_set Changes the offset around the object independent of what it was before ipl gt offset_set input in gt b DECterm Based Programs 103 XtremeCT II Version 2 4 new offset 000 gt 221 Clear offset Sets all voxels in the optionally new offset to zero ipl gt offset set input in gt b new offset SELL 52 2 1 fill offset mirror Fills the offset of an object with the mirrored values just to the inside of the offset May be used after operations that steal f
84. e Login Directory Scratch Directory Directory for Programs Directory for Interface and Printing Directory for Database Files Measurement Main Directory Scout View Directory Directory for 2D Hist Results Batch Measurement Script Measurement Batch Queue Slice Reconstruction Image Reconstruction Batch Queue Reconstruction Command Proce Reconstruction scaling factor Beamhardening Correction Beamhardening Correction 3D Evaluation Batch Template Min Volume Size in MB for linear Default Printer Queue B W Printer Queue Color Printer Queue PostScript Printer Queue Template for 3D Histomorph Eval Template for 2D Histomorph Eval Template for Ray Tracing Template for Main Image Template for image printing 1 Template for image printing 4 Template for image printing 16 Template for Listing of 3D parame Template for Display of 3D param Controlfiles DB Measurement DB 3D Evaluation DB Samples DB Scanner Calibration Data Current Slice number OperatorDB Zip Codes DB operators Result File of DB 3D histo query Result File of DB Infor query Command Procedure for offline Default Value DKB100 MICROCT SCSI DKAO DKAO D D W D VAO MKC500 ROCT ROCT SCRATCH ROCT MAIN ROCT UIL ROCT DATABASE ROCT DATA CROCT DATA SCOUTS CROCT RESULTS BATCH MEASUREMENT COM SYSSBATCH UM FAN_RECONSTRUCTION EXE SYSSSLOW UM UCT_RECONSTRUCTION COM 4096 D D D
85. e file will neither be printed nor be deleted af terwards but is kept on the hard disk This option can be used to print it on a different printer later upat list accesses analyses and outputs evaluation data from XtremeCT IT scans Analysis involves optional matching of common slices between base line and follow up measurements and calculation of percentage variations of evaluation values over time series No data is saved in the evaluation data bases Three modes are supported by upat list to simplify automatic selection of de fault parameters You can delimit the range of your samples being listed by entering the mea surement number range upat list Program upat print list V1 9 Started 11 AUG 2010 11 12 13 14 Mode 1 list 2 print 3 show 1 choose 1 20r 3 First patient found 1 120 1 Last patient 4 found 1 120 120 Site RL RR R TL TR T CU is wildcard any site Start of measurement period 15 MAY 2009 End of measurement period 25 MAR 2010 Maximum of follow ups 0 19 19 DECterm Based Programs 105 UCT_LIST WRITE_INFO XtremeCT II Version 2 4 Template file UPAT LIST SHEET Output filename SYSSSCRATCH UPAT PAT 1 TO 120 ALL SITES TXT The resulting data is written to the file given in Output File The output file is written into SYS SCRATCH unless user specifies an alternative directory Use this program for ex vivo measurements only Once you have mea
86. e left bad on the right 149 Figure 129 Example for Image Quality good on the left acceptable in the middle and not acceptable on the right 150 Figure 128 Example for Tibia good example the left bad on the right 150 Figure 130 Example for Image Quality good on the left acceptable in the middle and not acceptable on the right 151 Figure 131 Example for matching of contours good on the left acceptable in the middle and not acceptable on the right 152 XtremeCT II Version 2 4 158 Numerics 2D Evaluation eredi 62 2D Reconstruction 89 3D Result Sheet TOPHNUNG 105 3D DISplay ere 69 3D Effects hightSource eet a 73 ODSELVED 72 PerspectiVe eos orn oE O RE 73 Scaling 73 3D Evaluation 64 116 117 118 3D Histomorphometry 90 A Adaptive Threshold 93 Adjusting Scan Range 27 Animation Sequence Calc lating 5d uere eee teer eem 78 B Backup eeaeee a 85 Brakepoints 59 C Ch cklists ecce une beue none 120 Color Mixing ee 76 Color Scale ede X e SEU ERU 124 Component Labeling 96 Concatenate AIMS 102 Connectivity eee 99 Connectivity Density
87. ect to need a longer cable for the second emergency stop please contact SCANCO MEDICAL AG before the installation The gantry is connected to the computer via a fibre optic link The provided fibre optic cable will be 5 m long If you need a longer cable please contact SCANCO MEDICAL AG before the installation 129 XtremeCT II Version 2 4 Electrical Installation The customer is responsible for the compliance of required electrical installa tions with local regulations Gantry The XtremeCT II will be permanently installed and a certified electrician is al lowed only to connect a system like this to the power line Therefore the cus tomer needs to make sure that an electrician is available during the instal lation to connect the system to the power line The XtremeCT II has at the back side a junction box with a PG16 cable gland The clamping range of the cable gland is 10 to 14 mm One end of the cable has to be connected by an electrician to the DIN rail terminal block which is located in the junction box of the system The other end has to be permanent ly connected to the power line Permanently connected means that a tool is needed to disconnect the system Mandatory on site installation MAINS JUNCTION BOX XtremeCTII Cable provided by your electrician 3x 1 5mm 2 recommended Permanent Installation 100 240V w 50 60 Hz 480 VA PE Cable Gland PG16 for cable s
88. ection 9 Scout View Scan offset Set the scan at an absolute position mm with an absolute offset relative to a landmark mm or relative to a landmark in of a given length i e arm or object length 9o The offset can be as e Distance mm or 96 from reference line to start of scan e Distance mm or 96 from reference line to center of scan Distance mm or from reference line to end of scan 10 Start Position of Scout View This value appears in the Scout View Dialog Box as the default value and can be altered for each measurement individ ually 11 End Position of Scout View This value appears in the Scout View Dialog Box as the default value and can be altered for each measurement individ ually 12 Angle under which the Scout View radiograph is taken O is a radio graph from the side 90 is a radiograph from the top 13 There are 5 modes of the resolution option Scan Mode Number of Projections 180 Image Matrix Standard 250 projections with 512 samples each 512 x 512 Medium 500 projections with 1024 samples each 1024 x 1024 High 750 projections with 1536 samples each 1536 x 1536 Native 3000 projections with 4608 samples 4608 x 4608 each Custom User defined up to 3000 180 up to 4608 x 4608 14 Diameter Field of View not changeable 15 Voxel size When Default Size is selected the voxel size is shown in the slider The chosen voxel size is the reconstructed pixel size
89. ed red cross 25 Figure 33 Scout View of a Tibia with Notch position marked red cross 25 Figure 34 Scout View of a Tibia with Reference Lines 25 Figure 35 Scout View Start End Position sese eee 26 Figure 36 Example relative offset mm from reference line to start of scan 28 Figure 37 Example relative offset 96 from reference line to start of scan 29 Figure 38 Example relative offset 9o from reference line to center of scan 30 Figure 39 Example relative offset 96 from reference line to end of scan 31 Rig re 40 Start Measurement siti d Aus dida dede dec e dade de A De rna eit 32 Figure 41 Chair Example Illustration 33 igure 42 LOS Cast avis ik ae etd eit etes ate Orie eatin a un wot SOG oou occae dor ea Cin 34 Figure 43 Hand oce uc ev ce ev Ge Gv ei ee A T AAA 34 Figure44 Castin the Cast Slider iis cove ene Ale ae RENE HERE ERR ER bea ase 35 Bigare45 Cast tightly in place sancera e HR exa a xx RERE ORRE 35 bigure4o Castelevated o roroa ER RAS ANAND ls tete en 36 Figure47 Image Phantom gt ee eee reete x e e se Rr RR Eee 38 Figure 48 Example of a Printout Sheet for the Daily QC1 Measurement 40 Figure 49 Example of a Result Sheet for the Weekly QC2 Mea
90. ed record General database error Error Messages 83 Writing Slice Number General database error Writing data General database error Writing filename General database error Writing indexed record General database error Wrong Volume label Wrong diskette or optical disk has been loaded copying files General database error deleting filename General database error dismounting device Error while dismounting a diskette or optical disk End the program and start again from new Possibly check with the archiving program whether the stor age device is still mounted Normally both optical disks and diskettes are dis mounted freeing context of libSfind file General database error get device information The specifications of a storage device could not be determined getting free luno General database error initializing device label Diskette or optical disk could not be initialized Check whether the Write Pro tect switch is correctly set Diskettes must be of the HIGH DENSITY HD format DD or ED diskettes are not allowed mounting device label Diskette or optical disk could not be mounted Check with the archiving pro gram see dismount PC formatted diskettes are not readable on your computer without format ting opening file General database error reading Scanner data General database error starting init command Initialization formatting error writing scanner da
91. ent number according to which toggle button is clicked Figure 103 Selecting Measurement Choose the corresponding measurement by clicking with 1 You can now either archive these measurements or delete them To select multiple data use CTRL and select the measurements with 1 To select several consecutive measurements use SHIFT and select the first and last sample with MB1 To get the data of archived measurements back to your local hard disk click on SELECT OLD MEASUREMENT and then you are prompted to enter the name or number of the sample you want Enter its name or number and all mea surements of that sample appear Select the desired measurement by clicking on it using After you have performed a copy move operation you can click on UPDATE LIST as this is not performed immediately because of performance reasons Selecting the File Type If you have selected the measurement you have to select the files you want to copy or move Click on the button RAW raw data RSQ or IMA Images ISQ GOBJs GOBJ and VOI AIM DCM TIF etc on the left For double security do not archive raw data and images on the same tape Depending on the destination device with IMA selected you also have to se lect images AIMs or everything except RAW which are handled separately for the following operation Figure 104 Selecting File Type XtremeCT II Version 2 4 DataManagement 83 XtremeCT II Ver
92. ent protocol The full with half maximum of the slice sensitivity profile which is also called the tomographic section thickness should be below 220 um for the standard patient protocols The tomographic section thickness gives you an indication of the system sensitivity along the z axis Low Contrast Phantom XtremeCT II Version 2 4 This phantom consists of a PEI rod with rows of 8 mm 4 mm 2 mm and 1 mm holes The PEI rod has to be placed in the provided container and then the container has to be filled with water and can then be placed in the hand cast The PEI has a linear attenuation coefficient close to water and depend ing on the imaging parameters holes of different sizes are detectable in the images Quality Control 45 XtremeCT II Version 2 4 Schedule Because the standard application of the XtremeCT II is related to bone mea surements where low contrast detectability is not a concern Scanco Medical has not a recommended measurement schedule for the low contrast phan tom Mounting The PEI rod has to be placed in the provided container and then the container has to be filled with water and can then be placed in the hand cast Figure 57 Mounting of the low contrast phantom Scanning Proceed as usual select the control file you need to check the low contrast for Precalibrate and start the scout view Figure 58 Scout View of the low contrast phantom Place the scanning region on the scout view
93. entation The component labeling and extraction changes Note j the input volume ipl gt connectivity in out in conn nocl Calculates the connectivity density of a segmented object without prior com ponent labeling If the object consists of more than one unconnected part you would have to add the number of components minus one to the connec tivity and then calculate the connectivity density Likewise if the back ground is made up of more than one part you would have to add the number of background components minus one ipl conn nocl in out in conn bgcl Calculates the connectivity density of a segmented object with only compo nent labeling and extraction of the background If the object consists of more than one unconnected part you would have to add the number of compo nents minus one to the connectivity and then calculate the connectivity den sity The component labeling and extraction changes Note A the input volume 1 gt conn bgcl in out in XtremeCT II Version 2 4 DECterm Based Programs 99 XtremeCT II Version 2 4 voxgobj scanco param Evaluates a segmented image for the fraction of voxels set and writes result to the database if activated For gray scale original images mean attenuation coefficient is written to database The object is masked again with the given GOBJ or AIM mask By default the GOBJ filename is taken from the pro ceedings log last occurrence of
94. ents 28 Relative offset from reference line to start of scan The off set is set to 4 of 420 mm 16 8 mm XtremeCT II Version 2 4 Figure 37 Example relative offset from reference line to start of scan Measurements 29 Relative offset from reference line to center of scan The offset to the first slice is 2 of 420 mm e g 10 2 mm total scan length 2 3 3 mm XtremeCT II Version 2 4 Figure 38 Example relative offset from reference line to center of scan Measurements 30 Relative offset from reference line to center of scan The offset to the first slice is 2 of 420 mm 10 2 mm total scan length 2 18 6 mm XtremeCT II Version 2 4 Figure 39 Example relative offset 90 from reference line to end of scan Measurements 31 Measurement Click on the SCAN button The following window will appear 5 Pe Figure 40 Start Measurement Start Measurement Click on the START MEASUREMENT button with MB1 The computer system first allocates the disk space needed for the measurement and then starts the measurement The raw data sinogram of a measurement appear progres sively Cancel See cancel above of Scout View Patient Handling Do not put your hand or any object inside the bore unless attached to the cast slider i Caution If any objects gets squeezed inside the bore the gantry motor will be automatically stop
95. er Shutdown as Username press RETURN twice Wait approximately one minute Switch off equipment 120 Appendix G Specifications Operational Conditions Ambient conditions Temperature variations Relative air humidity Atmospheric pressure 10 C to 30 C 20 C to 25 C recommended room temperature maximum 3 C h 30 75 70 106 kPa Before starting the system it must have stayed within the above conditions for 2 hours Caution Dust smoke Vibrations Transport Conditions Classification Manufacturer Declaration of Conformity XtremeCT II Version 2 4 Ambient conditions Relative air humidity Atmospheric pressure IEC UL 60601 1 Measurements outside the temperature ranges can cause inaccuracies Operate the equipment in a clean environment Accumulations of dust or other particles can damage sensitive parts SCANCO MEDICAL AG recommends a smoking prohibition in the area of the scanner Vibrations can have negative influence on results Place the scanner on a flat and stable surface free from vibrations 40 C to 70 C water loop must be empty for temperatures below 0 In any case after a transport it must be checked that no air is in the water pump 10 100 non condensing 50 106 kPa Stationary equipment Class I with applied part type B Complies with ANSI AAMI ESB60601 1 2005 CAN CSA C22 2 No 60601 1 2008 60601 1 3 60601 2 28
96. eral The Scout View comparable with a conventional radiograph is used to deter mine the measurement area On the Scout View a reference line has to be set This reference line determines the position of the first middle last slice with a fixed offset from this line in mm or 96 depending on the controlfile settings This reference line also determines how follow up measurement have to be performed Therefore it must be positioned very carefully by using it an ana tomical landmark that can be used in the future to position the reference line at the same place Only this way changes in bone density and microarchitec ture can reliably be determined Here are some indications as to how position the reference line 1 The distal endplate of the Radius Tibia is the region where the reference line must be set Do not pay attention at the Ulna Fibula 2 Visualize the broad white line defining the endplate 3 Look for a notch on the endplate a Notch case Place the reference line at the tip of the notch on the upper side b No notch case Radius visualize the curve between the two tips of the joint place the line so that it crosses path with this curve at the middle height XtremeCT II Version 2 4 Measurements 23 XtremeCT II Version 2 4 Tibia the plateau is flat in most cases place the line along the pla teau Figure 30 Scout View of a Radius with Notch position marked red cross Figure 31 Scout View of
97. etection lines if the you see residual cone beam artifacts 24 FOV Scandiameter Chose the diameter of the field of view the number indicated is the size of the reconstructed area This action is cropping the area of the detector 25 Software binning factor of the pixels on the detector 26 Hardware binning factor 27 Samples number of possibly binned pixels on the detector that are used for each slice note this number is given for the whole FOV regardless of what is entered in 22 Proj 180 number of projections taken per 180 turn of the sample Before you now can perform either the SCOUT or SCAN procedure you have to PRECALIBRATE Measurements 22 Precalibration With the PRECALIBRATE button you start the automatic self calibration of the system If there is no valid calibration measurement you will not be able to start a SCOUT VIEW or a measurement A calibration measurement is valid for 15 minutes The patient has to be completely out of the gantry 1 Caution during the calibration measurement Positioning You can set the position of the measurement area with the help of the red line of light The laser line indicates the position of the first tomographic section or a fixed offset from this position depending on the control file setting Do not use the light field to set the position for a standard patient measurement because this method is not as accurate as the Scout View positioning mode Scout View Gen
98. f the ROI by directly entering the coordinates and dimensions using the keyboard Additionally you can select the number of slices which will be analyzed With the scaler SLICES you decide how many of them will be processed With the START Z and DIM Z you select the range of the evaluation 2D evaluation will start with slice START Z and continue to slice START Z DIM Z while processing SLICES in total equally distributed Evaluation 62 XtremeCT II Version 2 4 Note If you set SLICES to 1 only the first slice will be processed no matter how large your DIM Z is set Segmentation Using the scalers SIGMA SUPPORT and THRESHOLD you can change the seg mentation parameters Once you have found your optimal settings keep them constant for a series of evaluations Printing out of the 2D Histomorphometry Window The next selection affects printing Set the NUMBER OF COPIES to how many copies of each result sheet you would like to obtain The toggle buttons PRINT LIST and PRINT SHEET affect the result sheet output PRINT LIST will create a summary report for all processed slices including the mean values of all slices filename of summary report is HISTO 2D xxx DAT where xxx is the measure ment number The file is located in the directory with the logical name equiv alent UCT_HISTO RESULTS see Appendix PRINT SHEET creates an individual sheet for each slice showing the main image and the 2D histomorphometric values on it Keep in
99. files icon48985 Pas Figure 65 Print Menu Header information By clicking on Header Information the parameters used for the scan and that were given in the controlfile are displayed Zoom If you have to correct your contour you can display part of the screen en larged To do this click on the menu point ZOOM and choose the enlarge ment factor in the submenu ZOOM 2x to ZOOM 20x In the current image a green frame appears which shows the screen section which will be enlarged and which can be moved with the mouse Click with MB1 and the section dis played will be enlarged If you wish to have another section enlarged choose the menu point ZOOM once more and so on With ZOOM RESET you will return to the normal display It is also possible to zoom by click and drag with MB2 directly in the image Click and drag with MB3 to move the view within the window SHOW LEFT WINDOW and SHOW RIGHT WINDOW opens a window and shows the image from the main window or the overview window in 1024 x 1024 pixel resolution Click on CANCEL to close it Brightness Scaling Usually all slices are shown at the slice wise maximum brightness However this can lead to a difference in brightness between slices which prevents you from visually comparing the bone values to other bone measurements By Evaluation 54 XtremeCT II Version 2 4 clicking on the button above the color scale the images will be displayed in a unified norm fixe
100. find the most comfortable position a Move the chair slightly back and forth b Radius Rotate the chair to find the most comfortable angle for the shoulder opening c Tibia Align the chair facing the scanner d The backrest can move backwards if the patient likes to lay back e Have the head of the patient laid on the back rest A pillow may help here 9 Perform Scout View to set the reference line If necessary enlarge the Scout View range to display fully the joint where the reference line will be set 10 Scan 11 Wait for the scan preview to check on Motion Artifacts a If are Motion Artifacts propose the patient to repeat scanning Repeat 9 and 10 Scout View Scan XtremeCT II Version 2 4 Measurements 14 b If there are no Motion Artifacts take patient out of the scanner The Precalibration starts a 15 min timer It is NOT the maximum time you have to do your entire scan examination It is only the time within which we consider the applied correction to be valid The program will force you to Precalibrate again when time is out Note Check on the Precalibration timer before doing a Scout View If the timer is low less than 2 min utes for example Precalibrate again This is to avoid the Precalibration timeout happening be Note tween the Scout View and Scan action In this case you will be forced to take the patient out from the scanner precalibrate take the pa tient in again and redo the Scout
101. form and maintenance which is performed by SCANCO MEDICAL AG or by persons explicitly autho rized by SCANCO MEDICAL AG For continued reliable and safe operation of your equipment yearly mainte nance is strongly recommended Maintenance and repairs must be entered in Table 1 Interval Operation Daily Tests QC1 Before each use the user must be sure that the unit and its accessories are in good working order and the appropriate accessories are present Inspection by the user Defective indication lights damaged components labels and warning signs Inspection by the user e Irregularity of the display flickering breakdown Inspection by the user e System start up test with QC phantom daily QC See Quality Control on page 33 Incase of operational defects or other deviations from normal opera tional behavior occur switch off the equipment and inform the Service Organization Weekly Tests QC2 e test with QC phantom Geometry QC See Quality Control on page 33 Oncea week the system should be turned off so that the shutter fail save test will run during the next start up Monthly Performance XtremeCT II Version 2 4 fno scans were made over a longer period please perform a test with the QC phantom as described in weekly tests at least once a month to conserve the stability and the durability of the X ray tube Oncea month the main switch should be turned off so that
102. g HA ccm deviation 147 SOP Scanning XtremeCT II Version 2 4 Goal This documents lists and describes the necessary procedures for a patient scan Personnel XtremeCT II operators Time Frame This procedure should be performed at each patient scan Tasks Patient Instructions It is very important that the patient is instructed properly to ensure good im age quality Allow the patient to talk only before the real scan e g during position ing or scout view To stay still and quiet for the duration of the actual measurement 2 min To not move any part of the body during this time To not talk To watch the scan progress indicator only Login Username Use any valid username typically MICROCT and the corresponding pass word if you want to measure patients In case of another username account used you should notice as you won t find the patient IDs registered Ensure correct ID controlfile is selected Check the Patient ID and date of birth For the baseline scan make sure the correct side L R is chosen non domi nant wrist e g left for right handed patients and use same side for lower leg If there is a history of prior fracture at these sites scan the other limb For follow up scans Check ID and date of birth Check also in the measure ment history frame for past scans use the same controlfiles for follow up measurements Precalibration The XtremeCT requires a precalibration before a
103. g the term of the Limited Warranty covered by this warranty statement SCANCO MEDICAL AG will repair or re place the defective part s with new part s or at SCANCO MEDICAL AG s dis cretion a used part s that meets or exceeds the performance specifications for new parts In some cases SCANCO MEDICAL AG will ship a new user re placeable part s directly to you or at SCANCO MEDICAL AG s discretion a used part s that meets or exceeds the performance specification for new parts All exchanged parts and products replaced under this warranty will be come the property of SCANCO MEDICAL AG SCANCO MEDICAL AG is not responsible for any handling fees import duties or tariffs This Limited Warranty extends only to products initially purchased from SCANCO MEDICAL AG or from a SCANCO MEDICAL AG authorized re seller This Limited Warranty does not extend to any product that has been dam aged or rendered defective asaresult of accident misuse or abuse byoperation outside the usage parameters stated in the product s user documentation by the use of parts not manufactured or sold by SCANCO MEDICAL AG by modification of the product asa result of service by anyone other than SCANCO MEDICAL AG or a SCANCO MEDICAL AG authorized service provider SCANCO MEDICAL AG is not responsible for damage to or loss of any pro grams data or removable storage media SCANCO MEDICAL AG is not liable for any damages caused by the product or the fai
104. he measurement site in the body The batch job also creates a LOG file in the Scratch directory with that name Checking Status and Progress of Batch Jobs XtremeCT II Version 2 4 To check whether batch jobs are running enter one of the following com mands QUE or to see more details SHOW ENTRY SHOW ENTRY FULL SHOW SYSTEM BATCH To check the progress or status of a batch job you have to take a look at the batch log file in svs scRATCH Either double click on the log file in the Session Manager or use the following command TYPE PAGE SYSSSCRATCH UCT EVALUATION XXXX LOG with correct xxxx log filename You also can omit the PAGE qualifier and use Fl toggle for Hold Screen to check the file 117 MIL Method TRI Method Appendix E Explanation of Structural Indices for Ex Vivo Measurements With the original MIL method test lines are traced through the segmented volume and the intercepts are counted The test line length is then divided to give the mean intercept length The MIL method as implemented in the IPL module works only for a sphere within the volume of interest MIL is used to determine the surface to volume ratio BS BV and then assuming a plate model of bone trabecular number Tb N thickness Tb Th and separation Tb Sp can be derived The distribution of the MILs is taken to determine the principal directions of the MIL ellipsoid and the Degree of Anisotropy Further literature H J G Gu
105. he percentage of transparency Hide Hides all objects within the range Surface Object color Each object within the given range is displayed in the color given in the colorbar below By clicking on the colorbar the color mixing window see below opens and a different color can be selected Value color Each object is colored according to its value in the AIM file The color map can be changed using Object Value interface Figure 95 Object Values on page 75 Face Colors the artificial cutfaces at the boundary of the bounding box or along the defined cutplanes Like surface Uses the same surface color as for the rest of the object Object color Uses the same surface color as for the rest of the object Face color Uses a user defined color for the face This color can be changed by clicking on the colorbar that appears when you select this option Value color The face is colored according to the value of the object that is saved in the file The color lookup table can be changed using the Object Values interface Figure 95 Object Values on page 75 Change the color of the ambient and direct light using left and middle color button Change the color of th background by clicking on the right color button The slider is active for transparent objects where it regulates how many transitions between objects or object air that are displayed Printing options Clicked toggle buttons are information that will be pri
106. ick using 1 Proceed the same way for Point B You also can manually enter coordinates using the keyboard The distance from Point A to Point B is displayed in the window every time you click in the main window or enter coordinates using the keyboard Two green markers indicate the positions Use CANCEL to terminate 3D Distance measurements XtremeCT II Version 2 4 Evaluation 67 Print Images Click on menu TASKS followed by PRINT IMAGES a The following input window appears Figure 81 Print Images Figure 82 Print Images Details With the toggle buttons on the left side you can choose how many images per sheet you want to have printed The size of each printed image is dependent on this value Then select the requested images by clicking on the button with the corre sponding number using 1 Alternatively if you press the button 4 or 16 either 4 or 16 images are select ed equally distributed over the whole number of slices The button ALL selects all images while the button NONE clears all selec tions Confirm your selection with PRINT B W The images will appear after a few minutes If you have a color printer defined you may print on that specific printer by clicking on the PRINT COLOR button XtremeCT II Version 2 4 Evaluation 68 Note Do not switch off your computer SHUTDOWN be fore you have received all the prints Pointer Ruler Profile Angle Tools XtremeCT II
107. ill be centered in between Click with MB1 to fix this centered reference line Print Scout View Use this button to make a hardcopy of the image on the top right of your screen You can choose between PostScript sheet including patient name number etc or Encapsulated PostScript and TIFF format image data only file only Save Scout View The reference Scout View first measurement is automatically saved and is shown for every follow up measurement of the same patient The function SAVE therefore is only used if the reference Scout View for some reason can not be used OK When you have positioned the reference line as prescribed click on the OK button to start an interactive measurement This button also saves the Scout View to disk Cancel If you notice an error in your inputs for example wrong measurement proto col wrong patient etc or if the Scout View is unusable and you need to re position the patient you can use this function to return to the main window Correct the errors and start again with the Scout View Measurements 27 Relative offset mm from reference line to start of scan The absolute offset is set to 22 0 mm XtremeCT II Version 2 4 Examples of Scout View Modes In the examples below cases of Offset given in mm or from the reference line to the start center and end of the stack are shown Figure 36 Example relative offset mm from reference line to start of scan Measurem
108. initial and the end position 3D Display 78 XtremeCT II Version 2 4 Before you click START CALCULATION you need to set up the auto print mode To do so go to the Print menu and choose print to TIF and to File and enter the beginning of a file name e g DKO MICROCT DATA test The program will append _0000 TIF 0001 TIF etc afterwards Click on the AUTO PRINT box followed by OK Transfer those TIF files to your PC and combine the sequences in the pro gram that you are using to convert the TIF files to AVI or MOV files like Win dows Movie Maker 2 or Quick Time Pro or Adobe Premiere etc The order in the above list can also be reversed You can first set up the auto print and then go into the Animation menu choose start and end settings and hit START ANIMATION The positions A and B can be freely chosen e g with subdim you can first take everything A then slide it back to nothing B You can even slowly change the color of an object Or slowly hiding objects in the OBJECT PROPERTIES choose TRANSPARENT SEPARATE for object but change the Transparency from A to 1 0 B If you want to create a movie with different sections e g first rotate the object around then slowly make the object transparent then cut in Do this in mul tiple sections with the 3D program e g first create Auto Print files rota 0000 to rotation 0200 then transp 0000 to transp 0050 and then cut 0000 to cut 0100 Make
109. ion 2 4 Test setup Figure 117 Horizontal and Vertical Planes for Measurements Stray Radiation given in Air KERMA per Units The dose values in nGy mAs for the horizontal plane WO ANDUAWNEH A 0 096 0 096 0 096 0 096 0 000 0 000 0 000 0 000 0 000 B 0 192 0 192 0 192 0 096 0 000 0 000 0 000 0 000 0 000 C 0 287 0 383 0 479 0 383 0 192 0 000 0 000 0 000 0 000 The dose values in nGy mAs gt b 0 096 0 096 0 096 0 096 0 096 0 000 0 000 0 000 0 000 C 0 287 0 287 0 192 0 096 0 096 0 000 0 000 0 000 0 000 D 0 192 0 383 0 862 1 820 1 437 0 000 0 000 E 0 096 0 096 0 192 0 575 2 683 0 000 0 000 F 0 192 0 383 0 862 1 820 1 437 0 000 0 000 for the vertical plane d 0 287 0 575 1 054 1 150 0 575 0 000 0 000 0 096 0 096 0 192 0 575 2 683 0 000 0 000 f 0 096 0 287 0 479 1 150 0 575 0 000 0 000 G 0 287 0 383 0 479 0 383 0 192 0 000 0 000 0 000 0 000 0 192 0 192 0 192 0 096 0 000 0 000 0 000 0 000 0 000 1 0 096 0 096 0 096 0 096 0 000 0 000 0 000 0 000 0 000 XtremeCT II Version 2 4 Stray Radiation given in Ambient Dose Equivalent per Measurement The dose is measured with the following parameters Tube voltage Tube current Integration time Number of projections Time current product 68 kVp 1 47 mA 43 ms
110. isierte Normen wurden ber cksichtigt The following harmonized standards have been considered EN 60601 1 2006 Medical Electrical Equipment EN 60601 1 2 2007 Electromagnetic Compatibility EN 60601 1 3 2008 Radiation Protection in Diagnostic X ray Equipment EN 60601 2 28 2010 X ray Tube Assemblies for Medical Diagnosis EN 60601 2 44 2009 X ray Equipment for Computed Tomography In bereinstimmung mit der Richtlinie 93 42 EWG wird dem in Artikel 11 3 a und Anhang II Sektion 3 erw hnten Konformit tsverfahren Folge geleistet in Verbindung mit der unten benannten Stelle With regard to the Directive 93 42 EEC the conformity procedure referred to in Article 11 3 and Annex II section 3 has been followed in association with the notified body listed below T V S D Product Service GmbH M nchen Germany Das Produkt tr gt die CE Kennzeichnung The product bears the CE Mark 0123 Bevollm chtigter 8306 Br ttisellen 18 03 2014 Dr Stefan H mmerle Authorized representative Ort Datum Unterschrift City Date Signatui ET K Wi Lett f ff 3 f LEA AAN d vct Figure II 1 Declaration of conformity XtremeCT II Version 2 4 Generallnformation Il Safety Information THE FOLLOWING SAFETY INFORMATION APPEARS WITHIN THE USER S GUIDE READ THEM CAREFULLY BEFORE OPERATING THE UNIT AND FOLLOW THE INSTRUCTIONS User s Responsibility The user is obliged to read the following safety instructions before operati
111. ity 111 Directory Structure XtremeCT II Version 2 4 Appendix B Files Used and Created by MicroCT The directory structure is as follows MICROCT DATA 00000001 00000048 00000049 00000050 00000051 00000005 00000065 00000066 00000067 00000007 00000129 00000130 SCOUTS DATABASE MAIN RESULTS SCRATCH TIPS UIL UTIL XDEFAULTS The directories M1CROCT DATA reside on DISK2 all other directories lo cated on DISK1 MICROCT LOGIN COM User definitions MICROCTXXXX COM MicroCT definitions MICROCT DATABASE COM Database logicals MICROCT DATA SSSSSSSS MMMMMMMM Main measurement directory where 55555555 8 digits is the sample number and MMMMMMMM 8 digits is a consecutive measurement number unique for one database In these directories the following files can be found Cxxxxxxxx RSQ Raw Data Sinogram sequence Cxxxxxxxx ISQ Image Data Slice sequence Cxxxxxxxx AIM VOI of Image data Cxxxxxxxx SEG AIM Binarized VOI Cxxxxxxxx MSQ Animated 3D Sequence not always present where xxxxxxx is a consecutive 7 digit number unique number for scanner 112 MICROCT DATA SCOUTS ssssssssccc SCV compressed Scout Views where ssssssss is the 8 digit sample number and ccc is the 3 digit controlfile number MICROCT DATABASE UCT CONTROLFILES nnn DAT Controlfile DB UCT EVALUATIONS nnn DAT Evaluation DB UCT MEASUREMENTS nnn DAT Measurement
112. k on the desired name with MB and confirm the entry by clicking OK XtremeCT II Version 2 4 Edit Operator Data 8 The following window appears if your entry does not exist in the database e Operator name or number not found Create Figure 11 Operator not Found The possibility now exists of changing or completing data Always use the same spelling Find Next By clicking the FIND NEXT button the next operator in alphabetical or numer ical search order will appear depending on whether you entered the opera tors name or number while using FIND New If you click on the NEW button all fields become free to enable a new opera tor data to be entered Save Update If you click on the SAVE button labeled UPDATE in modifying mode all input data for this operator will be saved updated Exiting Operator Program XtremeCT II Version 2 4 Click on the FILE button followed by either QUIT or EXIT This will lead you back to the main menu Using EXIT any changes will be automatically saved whereas with QUIT you can return to the main menu without saving the edit ed data File Print Quit Exit Figure 12 Exit Operator Program Note Always use the same spelling because the pro gram is case sensitive Edit Operator Data 9 5 Edit Patient Data Before starting a scan a Patient number must be given to each Patient and a unique Patient number is assigned automatically This num
113. lename in the proceedings log Roi radius factor controls whether only a sphere is evaluated or the whole region default DT also works with GOBJ masked objects The epsilons are used for suppressing arte facts due to rough surfaces You should usually not modify the default val ues For very coarse voxel sizes above 100 um assign epsilon 0 9 may be chosen Histogram or screen controls whether a histogram of the thickness distribution is written to a text file and or shown on the screen ipl dt mat input in output out gt gobj filename gobj from log peel iter 1 roi radius factor 10000 0 gt ridge epsilon 0 900000 assign epsilon 1 800000 histofile or screen none DECterm Based Programs 98 dt_mat_output Performs the mid axis transformation of the structure and saves the mid axes in the output ipl gt dt_mat_output input in gt output out gt ridge epsilon 0 900000 gt connectivity Calculates the connectivity density of a segmented object according to Odgaard and Gundersen Bone 14 173182 1993 To insure that only one connected object and one connected background is evaluated a component labeling and extraction of the dominant component is performed for both the foreground and the background Use conn_nocl and conn if you wish no component labeling or only a background component labeling extraction e g if a component labeling is already incorporated into the segm
114. ler Profile Angle Tools eee ee 69 Start 3D Display i cese e AMA ee Ee em E 70 Maiti Program Screen ioter ea vo eee pere axe e UA ea ra ee 70 SD OCENE D nS 71 Selecting the Sample and the Measurement eee 71 Start Stop Calculation avatar ate nade ata S Sr 72 ODbS6rVer xe eee 72 Light SOUrce o TAUTA A A RENE Sa Cad Se bad Sms A RE ANTES 73 Other Effects s UE cen ee Peevey xn e eee ved verve ver ae e eee 73 Cutplanie iet eI IHRE A A ated 74 Subdirmensioning 5 2 SI Ue e e ene en 74 Display modes o Ned e Ie IRR IRR OI NEIN ate terete 74 Geyer C 75 Object Properties tbe toes bete diate tate deae o ee eau 75 Color Mixing for color model Picker eee 77 Printing of 3D Scenes Nee RARIUS A A E E RE REA EIN 78 Animation Settings 4 5 m abe heh eee tute eo ir te eg needed user deor 79 Preset menn ckone a ere ees eT Quo ote Quee ree rs conet 80 start Archiving Program even e dee 81 Archiving PrOgfam eet A e eee ees 82 Selecting Measurement rr ern eee er Nep eR a Sene i eae 83 Selecting File Type tt AER ASA O IA IDEs 83 Selecting destination device a eee ee RE eR 84 Selecting File Type for copying eene 84 Back p Options ee ee na ee eu 86 XtremeCT II Version 2 4 157 Pigre
115. lick on main window or via menu TASKS Figure 68 Drawing Icons Drawing Contours Choose the slice where you want to draw a contour by clicking on the appro priate field or by entering its number Then click on one of the drawing options CONTOUR CIRCLE ELLIPSE or SQUARE RECTANGLE Button Button 1 4 or 5 You can get circles squares by using SHIFT MB1 Note Without the SHIFT modifier you can also draw el lipses rectangles Drawing a contour has to be performed counter Note clockwise Evaluation 56 Modifying Contours You can modify contours by clicking on Button 2 or 3 Then draw over the contour you want to modify You have to keep the same drawing direction counter clockwise The original contour has to be crossed at least twice The part between the first and last crossings will be replaced by the new drawing Moving Scaling Objects By clicking on the Button 9 you select the Scale Move mode You can grab the objects by moving the pointer on one of the eight handles By clicking and holding 1 you can move the object around By clicking and holding MB2 you can scale the objects By using SHIFT MB2 the scaling will be constraint Note which means that the scale factor will be equal for both horizontal and vertical direction Selecting Objects Click on the MOVE SCALE BUTTON 9 Then use the repeated SHIFT MB1 to select the individual object you want to select By using ALT MB1 you select
116. luation program to draw contours using either the semi automatic snake algorithm See Automatic Contouring on page 58 or Morph features See Morphing on page 59 Evaluation 51 Selection of Patient and Measurement Selection of Non Archived Measurements After starting the evaluation program you will see the following input win dow Figure 62 Evaluation Selection of Patient and Measurement On the left hand side you see all the samples whose measurements have not yet been archived Click on the desired sample with MB and all the available measurements of this sample will appear on the right hand side After you have clicked on a measurement and confirmed with the OK button an over view of the images belonging to this measurement will be loaded and appear on the screen Per default only the original image file ISQ file for each mea surement is displayed By using the toggle buttons at the lower left side one can chose to display AIM files or Files If you later need to choose other measurements click on the FILE button fol lowed by SELECT MEASUREMENT Figure 62 on page 52 Selection of Measurements already Archived Saved If you want to select a measurement that has already been archived interrupt the above procedure using the button CANCEL and click on the FILE button followed by SELECT OLD MEASUREMENT Figure 63 Select Old Measurement Enter the name or number of the patient see
117. lure of the product to per form including any lost profits lost savings incidental damages or conse quential damages SCANCO MEDICAL AG is not liable for any claim made by a third party or made by you for a third party Limitations of Remedy EXCEPT AS EXPRESSLY SET FORTH IN THIS WARRANTY SCANCO MEDI CAL AG MAKES NO OTHER WARRANTIES EXPRESS OR IMPLIED INCLUD ING ANY IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE SCANCO MEDICAL AG EXPRESSLY DISCLAIMS ALL WARRANTIES NOT STATED IN THIS LIMITED WARRANTY ANY IM PLIED WARRANTIES THAT MAY BE IMPOSED BY LAW ARE LIMITED TO THE TERMS OF THIS EXPRESS LIMITED WARRANTY This limitation applies whether damages are sought a claim made under this warrant by or as a tort claim including negligence and strict product lia bility a contract claim or any other claim This limitation cannot be waived or amended by any person This limitation of liability will be effective even if SCANCO MEDICAL AG or an authorized representative of SCANCO MEDICAL AG has been advised by you of the possibility of any such damages This lim itation of liability however will not apply to claims for personal injury Manufacturer Declaration of Conformity This medical device meets the provisions of the Medical Directive 93 42 EEC and the basic requirements according to Annex II 3 If you have further ques tions regarding the applicable national or international standards please ad
118. ments XtremeCT II Version 2 4 Appendix K Radiation Safety PMMA Phantom A PMMA phantom corresponding to IEC 60601 2 44 but with a diameter of 100mm was used for the dose measurements The diameter of the phantom was changed because the field of view of the XtremeCT II is only 140 mm The phantom was positioned in that way that the center position is in the center of rotation and the deg position is in a vertical line above the center of rotation 0 deg center OQ 180 deg 270 deg C C 90 deg Figure 113 PMMA Phantom Top View Computed Tomography Dose Index CTDI The CTDI of the XtremeCT II was measured with the following imaging param eters Tube voltage 68 kVp Tube current 1 47 mA Integration time 43 ms Number of projections 900 Projections 180 Time current product 71 mAs These parameters are the values used in the standard predefined controlfiles for tibia and radius measurements The following values have been measured with a ionization camber CTDI 00 center 10 02 mGy CTDI oo deg 15 25 mGy CTDI 90 deg 10 70 mGy CTDI oo 180 deg 76 20 mGy CTD1 270 deg 11 09 mGy CTDlw 10 55 mGy CTDI ioo peripheral 10 81 mGy CTDIw 1 3 CTDIioo center 2 3 peripheral CTDI peripheral CTDI 95 CTDI 00 139 CTDI 2795 4 136 air 11 37 mGy Due to the very low dose rate the accuracy
119. mind that these sheets are very large in size and could fill your hard disk if you process all slices of your measurement 200 or more Starting Evaluation If you have checked all your settings click on START EVALUATION The evaluation will only be performed inside of both a your objects contours green red Caution b the bounding box white The bounding box in its default size contains all your objects and thus does not further limit the ROI VOI Evaluation 63 Evaluation 3D XtremeCT II Version 2 4 Click on the T button or click on menu TASKS followed by EVALUATION 3D Figure 76 3D Evaluation The following window appears at the lower right Figure 77 3D Evaluation Subwindow Selecting an Evaluation Task By clicking on SELECT an Evaluation Task can be chosen from the list of cur rently available scripts For the standard patient evaluation XtremeCT IT Standard Patient Analysis 61 um is preselected This task is usually prese lected for patient scans For ex vivo scans you may choose other Tasks See below for more info of about the Evaluation Scripts Defining VOI If you have drawn any graphical objects before a white bounding box around all your objects appears on the screen If you have not drawn any contours a default sized box appears in the middle of the image The bounding box de limits the valid area for the evaluation You can move the VOI around by clicking and dragging
120. n the general procedure to keep in mind is Precalibrate Position patient e Scout View e Scan Detailed Procedure The following detailed procedure addresses the case of a standard scan proto col at 61um for the distal radius and tibia In case of different protocol some adaption may be needed 1 Welcome the patient give him her initial information about the scanning operation a Explain the examination scan procedure and duration b Stress on the importance of stillness no talking during scan c Ask for dominant limb non dominant limb is usually scanned d Ask for fracture history if non dominant side had a fracture scan the opposite limb e Ask to remove watch or bracelet that may cover the wrist 2 Create or call the patient record in the Measurement Program 3 Prepare the patient for scan Have the patient sit in the chair and set the limb in cast a Radius positioning Move out the armrest if possible b Tibia positioning Lift the chair with the patient sitting on it 4 Select the appropriate control file Radius Tibia and Left Right Check for the slider position It must be completely out 6 Precalibrate the scanner This starts 15 min timer The patient should not be in front of the scanner at that time 7 Approach the chair in front of the scanner Attach the cast to the front hitch 8 Slide the patient chair inside the scanner Ask for his her comfort try a few different position to
121. n two reference slices The program interpolates the slices in between To create complex shapes repeat the morphing step for different ranges Hand drawn XtremeCT II Version 2 4 Evaluation 59 XtremeCT II Version 2 4 contours are automatically taken as BP s but you may use the SET BP CLEAR BP and RANGE functions for to alter the proposed ranges Morphing only occurs between matching number of objects If you have two objects in the first slice you also need 2 objects in the last slice of Note your range The first drawn object in the first slice is morphed to the first drawn object in the last slice The second drawn object to the second drawn object and so on Color Coding in Image Selection Area The color coding helps you in the process of morphing objects Breakpoints are marked green morphed slices are marked red If slices are marked yellow a re morphing is necessary because of the reference objects was modi fied Figure 72 Color Coding in Image Selection Area Sequence Overview Click on 1st slide which should be included in VOI Draw object hand drawn or geometric shape Click on last slice which should be included in VOI Draw new object in this slice Open the Contouring menu as shown above Click on RANGE selects your VOI inside of your selected slices Click on MORPH extends the shapes inside of your selected slices Click on CANCEL closes the Contouring dialog box S
122. nd z_mean_max mean and max values of each slice along z ax is ipl gt examine input default_name gt a item geometry gt dim 504 122 223 Uo OEE 000 pos 266 308 0 DECterm Based Programs 91 sup_divide This command is used to subdivide an object into smaller objects This is helpful in examining only a small part of the complete object or for segment ing the whole object using small subobjects to save memory You can either define the subvolume s by entering the number of subvolumes supdin in all directions or their size in pixels subdim suppos is the offset of the object in pixels in local coordinates If you leave the value at 1 the object s will be centered testoff is used for overlapping the small subobjects in case of a procedure such as a gauss filter If supdim numbers is not a divisor of the orig inal object s dimensions a few voxels may be discarded at most subdim number voxels per direction x y or z ipl gt sup divide input in gt a supdim numbers 1 1 1 4 testoff pixels 0 0 0 gt 2 suppos pixels local 1 1 1 gt subdim pixels 1 1 1 If you plan to subsequently use a gauss filter on Note the object testoff must be equal to the support in the gauss filter sub get Extracts a sub volume that has the position and size as entered by pos and dim The flag g1obal pos flag controls whether pos is the global position giv en by the original measurement or the local
123. ndersen T B Jensen R Osterby Distribution of membrane thick ness determined by lineal analysis J Microsc 1978 113 2743 TRI is used to triangulate the surface of the segmented object and calculate the volume of the enclosed tetrahedrons and the surface of the triangles It is more direct way to get to the surface to volume ratio BS BV than with the MIL method Still assuming a platemodel of bone Tb N Tb Th and Tb Sp can be calculated To calculate the principal directions of the MIL ellipsoid and the Degree of Anisotropy the area of the surface triangles are projected onto a directional surface distribution skalar product of areaweighted normal vector with the directions of the direction distribution which is the inverse of the directional MILs Artificial boundaries at the edge of cubic or conforming GOBJ produced vol umes of interest are not counted in the calculation i e boundary problems are taken care of Further literature T Hildebrand A Laib R M ller J Dequecker P R egsegger Direct 3 D morphometric analysis of human cancellous bone microstructural data from spine femur iliac crest and calcaneus J Bone Miner Res 1999 14 7 1167 74 Connectivity Density XtremeCT II Version 2 4 Connectivity density Conn D is calculated with the Conn Euler method of Odgaard et al Their boundary edge problem suppression is applied on the surfaces of cubic AIMs but not on the possibly artificial surface of con
124. ndow Click 3D Evaluation T Check volume of interest e Start 3D Evaluation Take result sheet and check common region 152 SOP Archiving Goal This documents lists and describes the necessary procedures for archiving data Personnel XtremeCT operators Time Frame This procedure must be performed at least weekly Tasks Initializing of Tapes Formatting Tapes have to be formatted using the following naming RAWxxx and IMAxxx where xxx indicate consecutive numbers starting 001 Archiving RAW Data All RAW data RSQ files have to be archived daily as soon as all images indi vidual sections have been checked Use the RAWxxx tapes for RAW data and archive them using the MOVE option in the backup archiving tool Archiving IMA Data All IMA data ISQ AIM GOBJ etc excl RSQ have to be archived when you run out of disk space or have finished the study Use the IMAxxx tapes for IMA data and archive them using the MOVE option in the backup archiving tool This will remove the data from the hard drive Image data will be accessi ble only if one does a COPY or MOVE from Tape to DISK afterwards Weekly Backup SCANCO MEDICAL AG recommends to perform a weekly data backup Under some circumstances it is possible that a hard disk can crash which makes it impossible to read patient data old measurement results or Scout Views again You should therefore regularly make a copy of your databases The weekly back
125. ng 0 2 mm Cu 1 mm Al Equivalent filtration 6 7 mm Al 68 kVp 4 5 mm AI 68 kVp Class 2M Laser P 1 mW CW lambda 635 nm according to reference line settings 1 mm 10 5 mGy for a default patient measurement 5 uSv for a default patient measurement 605kg 1 48mx 1 38mx 1 15 m 122 XtremeCT II Version 2 4 Beam geometry small angle cone beam Measurement time per stack 2 min for a default patient measurement Power input 100 240 VAC 50 60 Hz 10A Main Circuit Breaker 10 A characteristic D inductive load Computer Itanium Workstation with OpenVMS Note Specifications are subject to change without notice 123 XtremeCT II Version 2 4 Appendix H Glossary Archive Move measurement data from internal hard disk to tape or external hard disks It is recommended to do this regularly to prevent the disks from getting full Always archive the RSQ and ISQ on different tapes Artifact Error in the exposure caused by for example a sample holder being too large movement of the sample during the measurement malfunction of the equipment etc Visible in the form of lines light or dark areas or stripes in the image Backup Safety copy of the databases and programs from internal hard disk to tape or disk It is recommended that a backup is made once a week CT Abbreviation for Computed Tomography File Collection of related data in a computer for example letters a tomogram etc Harddisk
126. ng the equipment The safety of both patient and operator was a major consideration in the de sign and manufacturing of this equipment The equipment will function reli ably when operated maintained and repaired according to the instructions in this manual Misuse however could result in hazards to patient operator and or equip ment The unit should be carefully operated and the phantom measurement must be performed according the interval and procedure described in the chapter Preventive Maintenance Operating system parameters may only be changed by an authorized person First Usage Before the unit is first used the Manufacturer or their official agent shall have fully tested the unit in the position in which it is to be used have given full operational instructions for the unit to a responsible person Description of Warning Symbols XtremeCT II Version 2 4 Following warning symbols are used within this user s guide X Rays may be present Failure to observe this WARNING warning may result in personal injury Risk of electrical shock Failure to observe this WARNING warning may result in personal injury death or equipment damage To avoid the risk of electrical shock this equip WARNING _ ment must only be connected to a supply mains with protective earth Safety Information xvi XtremeCT II Version 2 4 WARNING Caution Note Laser light present Do not stare directly into the
127. ng a Controlfile Basic Mode sss nennen 18 Modifying a Controlfile Advanced Mode eee eene 22 Precalibrefior aereo a be n atre e 23 POSITIONING 23 SGOLITSVIOW 23 23 Start and ENG POSION s c tit mri om eere e a t e DAS 26 Angle Default Values TOO EE tact tht ener hdd nrc RO E Start SCOUt VIOW Jine deed iere de den cn e rea 26 Reference Lire saei eet dite dnd err and e ee Print Scout View SOVe SCOUF VIOW sisi dto na e ROM OE 27 Examples of Scout View sse 28 d a a B CO Start Measurement RR Chair XtremeCT Version 2 4 QUITS 38 cte cod tuto Daily Phantom Measurement referred to as QC1 scheclulg z5 ctae tono oe heri der taa MOUNTING m EE SCANNING eee a Evaluation Determining the Reference Measurement ssssssss esee eene Weekly Phantom Measurement referred to as QC2 39 Schedule uud tret oed e MOURINO
128. ning the ROI or VOI on page 56 Orthogonal View Selection Main Window Selection of orthogonal view in the Main Window Note as per default only 16 slices are loaded first the XZ and YZ views are interpolated It is recommended to use LOAD 10 in XY mode first to load all the slices first before switching to XZ or YZ For large data sets this can be a rather time consuming operation Image Information Controls Temporarily hide the contour the scale bar or the sample info for printing e g Main Window In this field the image being operated on current picture is shown As soon as the mouse pointerr moves in this field and MB1 is pressed and or is held down the drawing function selected in field 1 takes place Overview Window In this field a certain number of slices are displayed normally 16 Clicking with 1 on an image in this field it will become the current image and is displayed large in field 4 Orthogonal Selection Overview Window Selection of orthogonal views in 2D or 3D or Scout View Brightness Scaling Changing the brightness scaling causes all images to be reloaded While being reloaded all images are displayed at a fixed brightness scale so you can compare brightness values visually Clicking the arrow pointing up makes the images brighter whereas the arrow down makes the images darker To return to the original display all images at the most possible brightness click on the button
129. nium Red sD of Values ix Reziam mg HAC Slope 1584 035 Intercept 389 140 Pure 22 OCT 2014 12 319 3D Density and Geometry Phantom Evaluation MEDICAL Figure 49 Example of a Result Sheet for the Weekly QC2 Measurement All following task should be performed while logged as CALIBRATION user not the usual user account Note Those tasks are meant to be done during a main tenance service by a SCANCO engineer or during an audit check performed by a qualified local staff XtremeCT II Version 2 4 Quality Control 41 Resolution phantom The resolution phantom is an Aluminium cylinder which is machined with high precision on its ending tip It is this part that must be scanned to deter mine the MTF of a scanning protocol MTF is determined at the isocenter of the scanner therefore the cylinder must be placed at the center of the mounting plate as illustrated below Figure 50 Resolution Phantom Schedule We recommend measuring the resolution once per year Mounting Pull the slider towards yourself and detach the cast holder from the slider fixed by 1 screw Replace it with the Resolution phantom by inserting the 2 bottom pins into the slider Then screw the bolt on the left side to fix its position Scanning Use the control file defined for patient scanning for any one limb There is no need to repeat the scan for each of the 4 predefined patient protocols From a re
130. nted in the 3D window Options Print Name Print LUT Look up table Print Scale Print Company 3D Display 76 XtremeCT II Version 2 4 Color Mixing Clicking on a color bar in the object properties subwindow opens the color mixing subwindow which allows you to toggle between different colors Figure 97 Color Mixing for color model Picker 1 Color model Picker Use the interface as described in the points 2 4 HLS Adjust the sliders for Hue Lightness and Saturation to obtain the color of your choice RGB Adjust the sliders for Red Green and Blue to obtain the color of your choice Browser Browse through a list of colors to select a predefined color Grayscale Adjust the level of gray by using the slider 2 Select the color pallet Spectrum Pastels Vivids Earthtones 3 The color interpolator To mix two colors first select one color in the pallet above and click on the color bucket in the left corner then select another color in the pallet and click on the colorbucket in the right corner When you click Smear you will get a range of color tones interpolated between the two selected colors The range of interpolated colors can then be made lighter darker using the arrows on the left side or warmer cooler using the arrows on the right side 4 Scratch pad By clicking here you can saved the generated colors for later use 3D Display 77 Printing of 3D Scenes After you have a 3D Display on
131. of type float that has to be normed to short again with norm max Redim pow2 can be used to simultaneously interpolate the object to a new vox el size by fourier interpolation in powers of 2 redim pow2 2 gt 4 times inter polation Laplace epsilon controls the weight of the curvature image the higher the epsilon the more edge enhanced the image appears Lp cut off freqis the Hamming filter lowpass frequency in units half the Ny quist frequency 0 5 is a filter rolling off to just at the Nyquist boundary Hamming amp is the amplitude of the Hamming filter its default is best not var ied ipl fft laplace input in gt in output 1h out redim pow2 0 0 0 gt laplace_eps 0 900000 gt lp_cut_off freq 0 400000 gt hamming amp 1 000000 norm max Norm max has to be applied after ft laplace hamming to convert the float values to short again max in the input will be set to the maximal possible val ue of the chosen data output type type out 32767 for short as will all val ues above max The values from zero to max will be scaled to the data range available for the output data type With examine 1h histo the histogram of the ft laplace output be viewed and a suitable max can thus be chosen normally a value at the upper end of the main distribution The range of the fft laplace output can vary greatly for different types of objects since the curvature can be very different I
132. oints are interpolated gt ip and depending on the integrate flag also averaged over the voxel volume The center flag controls whether the center of the ob ject is still in the center of the scaled object or whether the upper left top cor ner is also the beginning of the scaled object center false The computation time and memory needed is larger than for noipscale elsize ipl gt ipscale elsize input in gt output sca gt b down scale 2 000 2 000 2 000 gt 1 up scale 1 000 1 000 1 000 gt 2 center false gt integrate true noipscale elsize Scales the objects without interpolating non integer voxel locations in the scaled object but takes nearest neighbor approach Computational faster and uses less memory but nearest neighbor choice may create less accurate scaling Does not account for fractional voxels for non integer scaling even if DECterm Based Programs 101 average flag is true e g for down_scale 2 6 and average true only 2 voxels are averaged per direction ipl gt noipscale input in gt a output sca x down_scale 2 000 2 000 2 000 gt up_ scale 1 000 1 000 1 000 gt average true gt scale_ow_elsize_noip Same as noipscale elsize but overwrites input Saves memory Does not work for increasing resolution since output memory would have to be bigger than input memory ipl gt noipscale input_output in gt a down_scale 2 000 2 000 2 000 gt up
133. olfile If you have created or modified a user defined controlfile you can lock it change its type to system defined and hereby prevent its further modifica tions or deletion Click on LOCK for this purpose and confirm your action Modifying a Controlfile Basic Mode SCANCO MEDICAL AG recommends to use the system defined controlfiles for patient and quality control measurements For other measurements you can alter its protocol before starting the measurements by clicking on MODIFY TC KU Figure 24 Modifying a Controlfile Measurements 18 Scanner Position mm without Scout View Start 190 mm 10 Scout Scan Extremity Figure 25 Scout View Explanation 1 Enter a meaningful name describing the measurement protocol Display mode Display mode of the controlfile basic or advanced Holder type No selectable option for this scanner type Scan mode No selectable option for this scanner type Ur gis wt Select the appropriate evaluation script by clicking on CHANGE Figure 26 Evaluation Script Selection 6 Energy and Current Settings not selectable 7 Filter not selectable XtremeCT II Version 2 4 Measurements 19 8 Select the appropriate calibration record by clicking on CHANGE 1 Default Calibration Generic BH correction units 17cmD 2 60 kVp 200 mg HA wedge 8192 scaling Selection Perm E Figure 27 Beam Hardening Script Sel
134. on fibre jacket equipped with a cushion made of neoprene chloroprene rubber and PUR Polyurethane For cleaning please keep in mind The method of disinfection used must comply with the legal regulations and guidelines regarding sanitation The material should be cleaned by wiping it with a moistened cloth You may disinfect the accessories by wiping only using use water based solutions e After cleaning and disinfecting the equipment let it dry for sufficient time in respect to the used agents If you use disinfectants which form explosive mix Caution tures of gases these must first have evaporated be fore you switch the X ray equipment on again XtremeCT II Version 2 4 127 Contact Information for Service and Maintenance XtremeCT II Version 2 4 SCANCO Medical AG Fabrikweg 2 CH 8306 Bruettisellen Switzerland Telephone 41 0 44 805 98 00 Telefax 41 0 44 805 98 01 URL www scanco ch e mail general info scanco ch e mail support support scanco ch e mail sales sales scanco ch 128 Site Planning XtremeCT II Version 2 4 Appendix J Site Planning and Installation A recommended room layout is shown in the figure below 100 to 230 VAC 50 60 Hz 110 208 or 230 VAC 50 60 Hz L N L2 PE L N L2 PE Main Circuit Breaker Common Electrical Outlet min 10 A Characteristic D inductive load to be placed close to or 0 3 m if a pallet mover is available Emergency Stop at least 1 m the opera
135. orized persons are allowed to service the system Disclaimer SCANCO MEDICAL AG will not accept any claims for compensation for any damages incurred in connection with this equipment and software SCANCO MEDICAL AG will not be liable for technical or editorial errors or omissions contained herein nor for incidental or consequential damages resulting from the furnishing or use of this material XtremeCT II Version 2 4 Generallnformation xiv Declaration of Conformity With the CE mark SCANCO MEDICAL AG confirms compliance with the Eu ropean directives stated below SCANCO MEDICAL EG Konformitatserklarung gem ss EG Richtlinie 93 42 EWG EC Declaration of Conformity according EC directive 93 42 EEC Wir we Name des Herstellers Manufacturer SCANCO Medical AG Anschrift Address Fabrikweg 2 CH 8306 Br ttisellen ZH erkl ren in alleiniger Verantwortung dass das Produkt declare under our sole responsibility that the product Ger teart Equipment Stationary X Ray System class IIb 10 For measuring the bone density and to quantify the three dimensional micro architecture of the bone at the human extremities Handelsmarke Brand Name 2 Scanco Medical Model XtremeCT Il SN 14030301 ID 3403 den grundlegenden Anforderungen der corresponds to the essential requirements of EG Richtlinie ber Medizinprodukte 93 42 EWG Anhang EC directive for medical products 93 42 EEC Annex 1 entspricht Folgende harmon
136. ot disposed correctly Please consider local regulation and contact SCANCO MEDICAL AG before disposal of equipment or X ray tube Equipment and Chair For outside cleaning use soft materials moistened with water only Equipment must be turned off before making any cleaning action Clean it by using cotton cloth and don t use abrasive detergent Do not use organic solvent or any kind of detergent containing any kind of organic solvent Do not utilize spray it can penetrate into the equipment and damage the electronics inside Ensure that no water or other liquids can enter the X ray equipment This precaution prevents electrical short circuits and corrosion forming on components 126 To disinfect the equipment we recommend using water based solutions connecting cables by wiping only We recommend to not utilizing aggres sive detergent based on Alcohol Ifyou perform room sanitation with an atomizer you must first switch off the X ray equipments capture key When the X ray equipment has cooled down cover it carefully with a plastic sheet When the mist of disinfectant has subsided you can remove the plastic sheets and disinfect the X ray equipment by wiping Shut down properly and turn off capture key before 1 Caution cleaning Never spill liquids on or in the equipment Caution Never use corrosive solvent or abrasive deter gents or polishes Patient support The patient support consists of carb
137. oves the light source also moves Standard values are 20 higher and 20 to the right from the observer position Selecting the Sample and the Measurement If you start the program the selection window appears automatically If you want to choose another sample after displaying the first one click on the menu FILE and then OPEN This following window appears Figure 87 Selecting the Sample and the Measurement First choose the type of data by clicking on either SEGMENTED ALL FILES or ANIMATION Then click on the sample you want to display If there is data of the corresponding type available it appears on the right side Click on the measurement you want to display The data is loaded after you confirmed your choice with OK To display the data click on the START button at the bottom left of the screen XtremeCT II Version 2 4 3D Display 71 Start Stop Visual Effects XtremeCT II Version 2 4 Start the calculation of the 3D Scene by clicking on the START button You can interrupt the calculations by clicking on the STOP button Figure 88 Start Stop Calculation Alternatively you also can click with MB into the main window to start stop the calculation and the display In ANIMATION mode they start stop the animation Observer By changing the ROTATION ELEVATION and ROLL of the observer you change the angle from which you look at the object You can also move the object horizontally
138. ped and an error will be indicated Chair The XtremeCT IJ equipment requires a chair for the patient The chair must be on wheels and be adjustable for the patient to sit in a comfortable position during the scan It should be adjustable in height while the patient is sitting in the chair have an adjustable backrest dispose a wheel brake have remov XtremeCT II Version 2 4 Measurements 32 XtremeCT II Version 2 4 able armrests and have the possibility of securing the patient on the chair It must also have enough load capacity to support the patient Figure 41 Chair Example Illustration The equipment must only be operated by trained personnel Care must be taken that the patient can not fall out of the chair especially during the measure ment Caution It must be ensured that there is always sufficient space between the user and the wall when moving risk of crushing The maximum load capacity of the chair must not be exceeded Cast The patient has to be instructed that he has to sit completely quiet during the measurement Any movement induce artifacts and may require a repeated scan The blue light at the front of the gantry indicates the progress of the measurement When the patient is seated the arm or leg has to be placed into the appropri ate cast Pads of different sizes can be used to fit the patient as good and as Measurements 33 comfortable as possible The patient must be fixed to the
139. pheres fitting inside the background with the voxel values being their diameter in voxel units background param uses the contours of a GOBJ or AIM mask if it finds the GOBJ filename in the pro ceedings log Roi radius factor controls whether only sphere is evaluated or the whole region default DT also works with GOBJ masked objects The ep silons are used for suppressing artefacts due to rough surfaces You should usually not modify the default values For very coarse voxel sizes above 100 um assign epsilon 0 9 may be chosen Histogram or screen controls whether a histogram of the thickness distribution is written to a text file and or shown on the screen ipl gt dt back input in output out gt gobj filename gobj from log peel iter 1 roi radius factor 10000 0 gt ridge epsilon 0 900000 assign epsilon 1 800000 histofile or screen none dt mat param Calculates the mean trabecular number of the structure with the distance transformation DT method by filling largest spheres into the background of the mid axis transformed object gt mat and calculating their mean diameter volume weighted mean Mean number and standard deviation are written to the database if activated The output object shows the spheres fitting in be tween the mid axis structure with the voxel values being their diameter in voxel units DE mat param uses the contours of a or AIM mask if it finds the GOBJ fi
140. position in the input object 1 gt sub get input in gt a output sub gt s pos 0 0 0 10 30 10 dim 0 0 0 gt 120 global pos flag false sub pick Is an older version of sub get that needs previous execution of sup divide to enter the positions and sizes in the grid subpos numbers is the 0 based posi tion in numbers in the suppos grid 1 gt sub pick input in gt a output sub gt s subpos numbers 00 0 XtremeCT II Version 2 4 DECterm Based Programs 92 XtremeCT II Version 2 4 gauss This is the command to gauss filter an object The shape of the filter can be given using sigma and support You have to give an internal name for the out put object 2 sigma 2 support 1 p Figure 109 Gauss 1 gt gauss input in gt a output gauss b sigma 1 000000 1 2 support 2 gt threshold Using this command you can binarize an object All voxels below lower in perm and above upper in perm will be set to value the rest the ob ject will be given a value of value in range usually 127 The values for the lower and upper threshold are given in 1 1000 covering the whole range of the data values 0 to 32767 for gray scale 128 to 127 for char AIMs ipl gt thresh input gauss gt b output th gt c lower in perm 300 220 upper in perm 1000 value in range 127 gt gauss_seg and seg_ga
141. r for the operator must be provided by the customer It is recommended that the surface of the floor is smooth and hard A carpet is not recommended because the handling and moving of the patient chair will get difficult The whole equipment depending on the computer and its peripheries will consume about 1200 W to 1700 W which will be dissipates as heat Ina small room this can increase the room temperature significantly if no coo ling or ventilation is provided It is recommended to run the equipment not above 25 C and it is mandatory to have a stable room temperature For the radiation safety the installation must follow national regulations Therefore the customer is responsible for proper room shielding or additional protection for the operator if this is a requirement of the national regulations As the stray radiation is very low outside of a3 m x 3 m area in front of the scanner in most countries no room shielding is required At the Loading Dock When receiving the equipment please check the tilt watch and the shock watch for red indicators or have the receiving group updated with this infor mation These watches are mounted on the wooden box in which the XtremeCT Il is shipped If one of those indicators is red Do not refuse shipment Make notation on delivery receipt before signing Inform SCANCO MEDICAL AG 131 XtremeCT II Version 2 4 During the installation the system will be checked carefully If
142. r tend par TR PUR d 119 Distance Transformation Methods sse emnes 119 Appendix SSIS ES sitios ad 120 Checklist for Measurements sss nnm 120 Checklist for EVGIUGTION ucc tae en c ree nt iet ne n pe a Rc 120 ChecklisrorSButelewWLE s stet te oe et ha et e tuse ctt beet 120 Appendix Specifications ecer 121 Operational Conditions zeros et tet aries b ERU REOR dike 121 GONGITIONS ir PR 121 GIGSSITICOTION see err E p EDD RHENUS ERE RR OPE E dE 121 Manufacturer Declaration of Conformity sse 121 Specs Tor The Xtreme Tr Ioas t eee ob ed 122 esr eei LUT Look Up Table See mI Du M Scout Scout VIS W asus Er E a FR EP ce tete a ne n deb vs Appendix I Preventive Maintenance rrr 125 125 EET 125 Accomplishment of Maintenance seen 125 Maintenance PION yi wis cicer een eec e Spare Parts Disposal CICOMIAG Equipment and Chair XtremeCT Version 2 4 viii PotierYEsilopOLb ca eite 127 Contact Information for Service and Maintenance eee 128 Appendix J Site Planning
143. r you have chosen or entered a patient the main measurement window appears If the patient is not being measured for the first time its earlier mea surements will be displayed with date and number of slices performed Controlfiles Measurement Protocol Controlfile Types There are two types of controlfiles e System Defined with fixed measurement protocols e User Defined types can be altered by user The system defined controlfiles for patient and quality control measure ments should be used for patient and quality control measurements Selecting a Controlfile Select the correct measurement protocol Controlfile by clicking on one item of the list using MB1 Modify Delete New Lock Figure 23 Selecting a Controlfile XtremeCT II Version 2 4 Measurements 17 XtremeCT II Version 2 4 After the controlfile is selected you can pre calibrate the system be clicking PRECALIBRATION Creating a new Controlfile If you want to define a new controlfile click on NEW and the controlfile defi nition box appears For details on how to create a controlfile see Modifying Controlfile Basic Mode p 18 Deleting a Controlfile If you have selected a user defined controlfile you can delete it by clicking on DELETE You have to confirm the deletion of a controlfile The controlfile is not actually deleted but marked as invalid and does no lon ger appear in the list of controlfiles Locking a Contr
144. re logged off Log in to the calibration account Type in the DECterm window set proc priv bypass r um uct b Push either the button OS BACKUP TO DISK DKO or mount the specific OS backup tape and push the OS BACKUP TO TAPE button Exit the Backup Program and log out of the calibration account After a successful OS backup the message above will not appear for the next six months XtremeCT II Version 2 4 DataManagement 86 Device Information Figure 108 Device Information Initialize All media data carriers must be initialized formatted before they can be used for the first time In doing this every tape will be given a label The same as above has to be performed for tapes as well but tapes are one sided media only and the label is limited to 6 letters When initializing all data which could already ion Caution be on the medium will be lost XtremeCT II Version 2 4 DataManagement 87 Mount Dismount XtremeCT II Version 2 4 Before tapes can be used they must first be mounted by the system made accessible to the user and after use they will be dismounted This has to be done manually for tapes because of performance reasons DataManagement 88 11 DECterm Based Programs General Guidelines To start one of the following programs you need access to a terminal session window either directly on the machine or via the network telnet rlogin set host etc You can start the programs by
145. reference line at the tip of the notch on the upper side b No notch case Radius visualize the curve between the two tips of the joint place the line so that it crosses path with this curve at the middle height Tibia the plateau is flat in most cases place the line along the pla teau Figure 126 Scout View Reference Line Examples Figure 127 Example for Radius good example on the left bad on the right 149 XtremeCT II Version 2 4 Figure 128 Example for Tibia good example on the left bad on the right It is important that for follow up scans the reference line is set the exact same way as on the reference measurement Do not try to match the mm scale but to achieve a visually similar result Scan Start the actual scan Image Quality Check After a patient scan check its quality visually on the small image on the top right Use the following examples to decide if a scan has to be repeated or not Figure 129 Example for Image Quality good on the left acceptable in the middle and not acceptable on the right In case of not acceptable quality rescan the patient Make sure before that the patient sits comfortably and tell her him to relax You are allowed to per form 3 attempts per visit 3 each for radius and tibia However try to get a good scan in the first attempt as it will get more and more difficult the longer the patient has to sit with the arm or leg inside the machine P
146. rmines the resolution along the Z axis of a scan protocol e low contrast phantom which may be used to determine the perfor mances of low contrast imaging Among them only the QC phantom must be scanned on a regular basis by the operator The resolution and the slice sensitivity profile phantom should be scanned at least once a year during maintenance service for example The QC Phantom is divided into two sections The first section referred as is optimized for testing the stability of the density measurement The second section referred as QC2 is used to check on the stability of architec tural measurements For each section a dedicated locked controlfile has been defined for scanning The evaluation of the QC Phantom is automated Figure 47 Image Phantom Daily Phantom Measurement referred to as QC1 XtremeCT II Version 2 4 Schedule It is very important to run the daily phantom measurement prior to the first measurement of a patient every day and to compare the results with the ref erence phantom measurement Mounting Push gently on the holder lever and insert the QC phantom from the top Then release the holder and slide the phantom in until the phantom pegs reach the dedicated location Quality Control 38 Scanning Turn on the system and start the measurement program You will have to wait for 30 minutes for the power up Select the patient record to scan the phantom in Usually Pat no
147. rocedure Checklist e Ensure QC scan was successful today Ensure you are logged in at the correct account typically MICROCT Select patient record check DB entry Patient ID and name Check handedness compare with scans of last visit e Select correct controlfile Radius Tibia L R Precalibrate e Select cast and position patient Inform patient that scan will start now and last for 3 minutes e Perform scout view e Set reference line e Start scan e Check image quality repeat if necessary max of 3 attempts Remove patient SOP Evaluation XtremeCT II Version 2 4 Goal This documents lists and describes the necessary procedures for a standard evaluation of a patient scan Personnel XtremeCT operators Time Frame This procedure should be performed after each patient visit Tasks Image Quality Check After loading the images check the image quality visually Not acceptable scans should not be analyzed Figure 130 Example for Image Quality good on the left acceptable in the middle and not acceptable on the right Contouring To determine the volume of interest click the 3D Evaluation button Select Evaluation Script Autocontour Largest Bone Radius or Tibia then start the task Alternatively one can use the tools built in the evaluation program to draw contours using either the semi automatic snake algorithm or Morph fea tures Whichever way you define your contour it
148. rom the image e g gauss fil ter Be aware that voxel information is just duplicated and that values calcu lated afterwards can be biased ipl fill offset mirror input in in convert to type This converts objects from one input type to another e g a char image to a short image The output type is given by out type ipl gt convert to type input in output out out type short xray Produces a virtual linear X ray image of the object along the z axis flip the object with flip aim first for other desired orientations The output is a char image The voxel values for every x and y are added along the z axis from startslice for number of slices and the sum is either normalized with the largest occurring voxelsum ixed norm char false or to a fixed norm for binary input volumes norm char true 1 gt xray input in output out startslice 0 number of slices 16 fixed norm char true msq from aim Write an object in memory to disk in the MSQ format e g to view it with the 3D Display program ipl gt msq aim_name out gt msq filename default file name gt from_aim_to_isq Write an object in memory to disk in the ISQ format e g to produce a GOBJ with the Evaluation program again The object will be at its original global position ipl from aim to isq aim name out isq filename default file name g
149. round radiation does not exceed 10 uSv h XtremeCT II Version 2 4 Safety Information 1 Start up Procedure XtremeCT Equipment 1 Scanner 2 Workstation computer monitor mouse and keyboard should be kept outside the patient environment and not be touched while touching the patient e Casts left arm cast right arm cast foot cast 4 Phantom KP70 Turning On Equipment 1 Turn the main switch back side and the turn the capture key front top The power on lamp lights up front top 2 Turn on peripheral devices such as optical disc drive tape and printers 3 Turn on computer and monitor Figure 1 Turning On Equipment It takes about 5 minutes before your computer is ready to start The scanner must be switched on for at least 30 Note minutes before starting a measurement warm up of X ray tube XtremeCT II Version 2 4 Start up Procedure XtremeCT II 1 Starting Main Program XtremeCT Enter microct as USERNAME and press the RETURN key Then enter the re quired password and press the RETURN key again or click on the OK button Figure 2 Login Box XtremeCT II Version 2 4 Start up Procedure XtremeCT II 2 Shutting Down XtremeCT Exiting Main Program XtremeCT To exit the control box click on the EXIT button with MB ISCANCO Medical Figure 3 Exiting Main Program XtremeCT To exit completely click on the SESSION menu and select EN
150. rs and Accessories 143 denied ite dh Front Rear Indicators Safety PrECGUTIONS f trea te d o Pl Ee atari 145 Radiation Protection Dosimeter sss nnne 145 SYSTEM CHANGES tert t REED 145 5 iii isu mb Rena e ea te S 146 SOP Scanning GOGO 1 XtremeCT Version 2 4 Goal Appendix WAIT pity aorta do uda datasets 154 Manufacturer Declaration of Conformity sss 155 XtremeCT Version 2 4 Contact Information Manufacturer and Contact for Service or Support XtremeCT II Version 2 4 Europe Corporate Headquarter SCANCO Medical AG Fabrikweg 2 CH 8306 Bruettisellen Switzerland Telephone Telefax URL e mail general e mail support e mail sales USA and Americas Scanco USA Inc 985 Old Eagle School Road Suite 511 Wayne PA 19087 U S A Telephone Telefax 41 0 44 805 98 00 41 0 44 805 98 01 www scanco ch info scanco ch support scanco ch sales scanco ch 1 610 688 14 40 1 610 688 49 76 ContactInformation xi General Information Purpose of this Document The purpose of these instructions is to inform the user about the technical functioning of the equipment for the intended purpose its safe operation ad j
151. rwards e Backwards range starts at current slice and extends backwards e All entire volume The slice numbers which will be affected are indicated below the range op tions e g 17 34 See Figure 71 Contouring Subwindow on page 58 Breakpoint BP If you choose RANGE in range selection the range is defined by breakpoints Any slice containing a hand drawn object becomes a reference slice or BP Slice 1 and the last slice of your volume are also considered as BPs You can have as many BPs as you like The whole volume is then divided into different ranges each extending from one BP to the next BP You choose the range by clicking at any slice in your range You can modify any slice to be a reference slice by clicking on the SET BP but ton you can remove a reference slice from the BP list by clicking on CLEAR BP and you can reset all BP by clicking on CLEAR ALL BP Note The range extends from the previous BP not in cluded in the range to the next BP included Global Scaling You can scale objects in the selected range by setting the range the X and Y Scale factor and then clicking on the APPLY button Delete You can delete objects in a range by setting the range and then clicking on the DELETE button Invert You can invert objects in a range by setting the range selecting an object and then clicking on the INVERT button Morphing To create a VOI you can morph or extrude the missing objects betwee
152. s Round spheres have an SMI of 4 Values below O can come from air bubbles within the bone F concave structure gives negative dBS dr Artificial boundaries at the edge of the volume of interest are not included in the calculation and thus suppressed Further literature T Hildebrand P R egsegger Quantification of bone microarchitecture with the structure model index Comp Meth Biomech Biomed Eng 1997 1 15 23 Distance Transformation Methods By distance transformation the calculation of the metric distance of every bone object voxel to the nearest bone air background surface is under stood These distances can be imagined as the radius of a sphere with centre in this voxel that fits inside the structure Then redundant spheres are re moved big sphere eats small encompassed spheres The result is the mid axes transformed structure with the centres of maximal spheres filling the structure completely To calculate Tb Th each voxel then gets the value of the radius of the maxi mal sphere it sits in and twice the mean value of all structure voxels then is the mean thickness To calculate Tb Sp the same procedure is performed for the background of the structure i e object bone and background air are switched To calculate Tb N the spacing of the mid axes is calculated as for Tb Sp Then the inverse of the mean spacing is Tb N Further literature T Hildebrand P R egsegger A new method for
153. s a GOBJ file and a volume that should represent the cortex input mask This input mask has to be produces with seg gauss beforehand e g with a high sigma 10 0 and support 6 and an appropriate threshold 150 or 300 cortex peel iter gives a minimal cortex thickness i e the minimal boundary of the outer contour that is excluded in the mask A component labeling is per formed for every slice for the cortex gt cl cortexin percent and then for the inner mask gt cl_inner in percent in the example below fro every slice only parts of the cortex that take up more than 50 are considered for the slice wise exclusion and then only parts making up more than 60 are taken for the mask ipl gt cortex_mask input_mask in gt gobj filename default file name u0001234 GOBJ output out cortex peel iter 5 cl cortex 10 000000 50 cl inner 10 000000 gt 60 gobj to aim Produces a solid filled volume from a GOBJ file i e the inside of the GOBJ mask This function is needed if the element size voxel size of the original volume or segmented volume has been changed with scale el size e g to make the voxels cubic Then the GOBJ produced on the original ISQ file does not match anymore but the AIM mask produced with gobj to aim can be scaled to the appropriate voxel size scale with integrate false written to disk and then used maskaimpeel ow Also any other IPL commands can be applied to
154. sion 2 4 Selecting the Destination Device Click on the DEVICE button and the list of all available devices appears Select the appropriate 1 Hard Disk CD R DVD R p Tape Streamer ul Waste Basket Figure 105 Selecting destination device Depending on where the source files reside you cannot choose all devices e g if the files are on the hard disk you cannot choose the hard disk as a destination device The list of devices depends on which devices are available on your system and can also include NFS FTP DK1 etc If you want to delete any measurements you choose the waste basket as the destination device If you want to archive or copy some files choose the tape device Selecting the Copy Move Operation If you choose the COPY function the files are copied to the destination de vice but will still be available at the original device When using the copy command for the image files it is possible to copy differ ent types of files separately By clicking on the SELECT toggle button the choice of ISQ AIM GOBJ DCM TIFF TXT COM and SCV files appear One or several of these file types can then be selected Figure 106 Selecting File Type for copying If you choose MOVE the original is deleted after successful copy operation and the database entry is updated with information about the new location If you want to delete any measurement data choose MOVE and WASTE BAS
155. solution and dose point of view they are identical It can be used also to check on the resolution of other scanning protocols that have different settings that may affect their resolution Proceed as usual precalibrate the scanner and adjust the scout view region to make sure the end of the phantom is in your scout view In the scout view select the end of the phantom where the diameter is thin ner Figure 51 Scout View of the Resolution Phantom Evaluation Check in the evaluation program for completeness of reconstruction Start the reconstruction manually by command line if needed Check for the cylin XtremeCT II Version 2 4 Quality Control 42 der shape and visibility Figure 51 on page 42 Run the evaluation using QUE QC3 AUTO COM FILE NAME ISQ gt All results are recapitulated in the JOB file which is generated in the measurement directory It can be opened with any text editor The result file may be transferred or printed for archiving or further analysis The program detects situations in which the scan quality or threshold values might be borderline or insufficient Take these warnings seriously and check the scan and the diameter estimates console output At the end of the process pull back the slider to you to remove the Resolution phantom from it Then re attach the Cast holder on it using the screw Slice Sensitivity Profile Phantom This phantom is built as a plastic case within which a
156. ss return to be asked the next arguments IPL commands may be abbreviated The procedure name list is searched against your input and IPL takes the first command that matches the abbre viation execute 1 to see the list and search order There is no ambigu ous command warning Note IPL only accepts lower case input In the standard evaluation Start Evaluation 3D IPL is operated in batch mode Then the two dots in the last IPL line of the batch com Note mand file are very important DO NOT DELETE OR FORGET THEM At the IPL start up in batch mode the whole string is read up to the two dots and then commands in the string are executed one by one On the other hand in interactive mode IPL executes the commands immedi ately To exit interactive IPL use quit help Gives the list of all available procedures or a short description of a procedure ifipl gt help xxxx is typed quit Quits the program ipl gt quit or q list Lists all objects currently in memory or lists all procedures optionally only items starting with beginning with ipl gt list objects true gt procedures false beginning with i 9 DECterm Based Programs 90 XtremeCT II Version 2 4 read Reads an object from disk The file type has to be aim By reading an object from disk you have to give it an internal name ipl gt read name in gt a filename default file name gt DISK3 DA
157. sure the pegs are entirely removed from the sockets before pulling the cast out XtremeCT II Version 2 4 Figure 46 Cast elevated If the cast slider is in the outer most position you can release the cast using the cast release handle then pull it out completely After each measurement the cast should be cleaned using commercially avail able ethanol based disinfectant Any high attenuating object such as a watch jew Note elry or implants within the volume to be scanned will affect the results and have to be removed It is not allowed to introduce a hand or foot of a Caution patient into the bore if it is not fixed into the cast During the whole scan procedure the patient 1 Caution must be under surveillance of the operator Measurements 36 Reset XtremeCT II Version 2 4 Images are only for visual control The numbers Caution on the result sheet not the images have to be in terpreted for a diagnosis Use this button to reset the gantry Measurements 37 Phantom 7 Quality Control Each system is delivered with its own set of phantoms which are used to check its performances and stability There are 4 phantoms in total The Quality Control phantom QC phantom which monitors for stability of density measurements and architectural parameters e The resolution phantom which serves to measure the MTF of a scan pro tocol The slice sensitivity profile phantom which dete
158. sure ALL the settings from the last view of the previous section match those of the first view of the next section so you get smooth transitions To save the settings A and B for the film to reuse on another sample click SAVE PRESETS FILE A dialog box will open where you can define folder and file name for the file The file should be saved in DAT format The AUTO PRINT box can also be used without the Animation Menu Activate it like above with sys scratch test only the beginning of filename Click OK Then whenever a 3D image is completely built up so when you are happy with a view and you do not interrupt the build up automatically a TIF file is generated numbered sequentially Get Settings Get Settings 200 No of frames Start Calculation OK Figure 99 Animation Settings Presets Under the PRESETS menu it is possible write the currently applied settings from the 3D window to a DAT file or to open a previously written file with pre sets By clicking on APPLY PRESET A and APPLY PRESET B only activated if two 3D Display 79 XtremeCT II Version 2 4 sets of presents are defined in the file the settings defined in the opened file are applied Figure 100 Preset menu 3D Display 80 10 Data Management Overview e Archive RAW data and image data to tape local disk remote server via NFS or FTP or USB drives formatted for VMS e Copy files to USB disk format
159. sured many biopsies you might want to have all your re sults in table form to include them into a spreadsheet program You can delimit the range of your samples being listed by entering the mea surement number range uct list Template File UCT 3D LIST SHEET SYS SCRATCH UCT_EVAL TXT 0 300 0 400 The resulting data is written to the file given in Output File The template file input field can be used for different types of report You can modify the files using a text editor If you start the program by entering a measurement num ber as parameter you will get the information of that specific measurement on the screen Output File From Meas 4 To Meas 4 uct list 43 Processing measurement 43 Measurement Nr 43 Measurement Date 15AUG1994 09 01 Filename C0000007 Sample Name Koller Bruno Sample Nr 1 Date of Birth 06 SEP 1994 MIL BV 5 0782 BS 35 4409 BV TV 0 3389 BS BV 20 5926 Tb Th 0 0971 Once you have measured many biopsies you might want to have all informa tion about filenames archiving data directories tape labels etc in table form You can delimit the range of your samples being listed by entering the sample numbers and or the sample names gt write info Sample Index from 0 13 Sample Index to 0 64 Sample Name from 186 Sample Name to ieee The logical UCT_DB_INFO usually points to the resultant text file which is usually in sys scratch D
160. surement 41 XtremeCT II Version 2 4 156 Figure 50 Figure 51 Figure 52 Figure 53 Figure 54 Figure 55 Figure 56 Figure 57 Figure 58 Figure 59 Figure 60 Figure 61 Figure 62 Figure 63 Figure 64 Figure 65 Figure 66 Figure 67 Figure 68 Figure 69 Figure 70 Figure 71 Figure 72 Figure 73 Figure 74 Figure 75 Figure 76 Figure 77 Figure 78 Figure 79 Figure 80 Figure 81 Figure 82 Figure 83 Figure 84 Figure 85 Figure 86 Figure 87 Figure 88 Figure 89 Figure 90 Figure 91 Figure 92 Figure 93 Figure 94 Figure 95 Figure 96 Figure 97 Figure 98 Figure 99 Figure 100 Figure 101 Figure 102 Figure 103 Figure 104 Figure 105 Figure 106 Figure 107 Resolution Phantom sayin dk CA eA Rice hes seus 42 Scout View of the Resolution Phantom eee 42 Slice Sensitivity Profile Phantom 2 0 0 0 nineta AEEA AAA 43 Scout View of the Slice Sensitivity Profile Phantom 44 Offset angle with regards to y axis emere 44 Offset angle in the xz plane eere n ien e eae e 45 Slice sensitivity profile of a measurement with standard patient protocol 45 Mounting of the low contrast phantom esee 46 Scout View of the low contrast phantom eee 46 Low contrast phantom measured with a patient protocol 4T otart EyaluatiOn c
161. t For an extensive discussion of the obtained structural indices see Appendix see Explanation of Structural Indices p 118 DECterm Based Programs 104 UCT_THREEDEE_BATCH UPAT_LIST XtremeCT II Version 2 4 Use this program to recreate a 3D result sheet including the 3D image and the histomorphometry values calculated by IPL Filename Enter the correct filename of the sample measurement you want It MUST have a filename of SEG AIM The file is usually located in the following di rectory DK0 MICROCT DATA ssssssss mmmmmmm where s is the 8 digit sample number and m is the 8 digit measurement number PrintFilename You can enter any valid filename for the intermediate storage of the resulting PostScript File We recommend a filename like Svs sCRATCH filename PS Ambient This value corresponds to the scaler of Ambient Light in the interactive 3D Display Program The value can be from to 100 here to be entered as a value between 0 0 and 1 0 Shading A value of 1 will lead to shadows a value of not Size This value determines the quality of the 3D image but also affects the calcu lation time Elevation Rotation These two numbers define the position of the observer relative to the object in degrees Copies Enter a value between and 9 and the corresponding number of copies will be printed At the end of printing the result file printfilename will be delet ed If you enter a value of th
162. t is advised however to use the same value for nax for one type of sample i e within one study population The value is not very crucial as long as it is above the respective value that is thresholded afterwards to produce a binary image ipl gt norm input 1h output norm max 50000 000000 type out short gobj maskaimpeel ow Performs a masking of an object with a GOBJ or a AIM mask needs more memory and time with AIM though Voxels outside the mask are set to Zero Peel iter gives the number of two dimensional peel iteration applied to the contours The operation is working directly on the object i e it is overwriting Zeros on it NB maskaimpeel ow may be repeatedly used the same object but using a smaller 1 iter number does not restore the region set to Zero anymore i e while trying out different peel iters go from small DECterm Based Programs 94 XtremeCT II Version 2 4 numbers upwards The relative volume of the mask is stored in the proceed ing log which may be shown with examine in log afterwards ipl gobj mask input output in gt in gobj filename default file name gt U0001977 GOBJ peel iter 0 cortex maskoff Expert function Combines a GOBJ contour e g the outer bone contour with a cortex seg mentation mask The resulting AIM mask is then the region inside the GOBJ but without the cortex i e only the trabecular region The input i
163. ta General database error XtremeCT II Version 2 4 ErrorMessages 109 Mouse Operation Appendix A Additional Information MB means left mouse button MB2 is the middle mouse button Usually all actions are performed using MB1 except for scaling a ROI or VOI in the eval uation program Elements of the Graphical User Interface On Off On Off Off Off XtremeCT II Version 2 4 Window Dialog Box windows have a frame The active window in which your switch com mands are carried out has a dark frame and the inactive windows have light frames You can move the windows around the screen by clicking on the top bar us ing MBl and dragging it to the desired position To iconize a window click on the small rectangle on the top right To restore the window from the icon double click on the icon using 1 All error messages must first be acknowledged with OK or CANCEL before you can make other entries This is also the case with most of the other input windows for example find ing a patient Scout View measurements etc Push Button Click with 1 on the button The function which describes the button will be carried out Toggle Button Selection The button can either be pressed or not with MB1 Radio Button Selection Only one button can be pressed with 1 Text Field Click on the field with MB1 and then enter the text Scroll Bar Click on the bar in
164. tart either 2D or 3D Evaluation as in previous versions Q9 00 DNLON UU d Tip Move forwards in your slices while you are morphing and the Range BP System automatically selects the correct range Following drawing is an example of how to create a complex 3D shape Evaluation 60 XtremeCT II Version 2 4 If you want to create the following VOI you have to define 3 reference slices Reference Slice BP Slice 12 Incorporated Slice Interpolated Slice Reference Slice BP Slice 33 Interpolated Slice Interpolated Slice Reference Slice BP Slice 55 Figure 73 Creating a VOI Evaluation 61 Evaluation 2D XtremeCT II Version 2 4 Note This function is not applicable for patient scans Only use for spec imen scans Click on menu TASKS and choose EVALUATION 2D Fle edit Zoom Tasks LUT Options Scrbts e Figure 74 2D Evaluation The following window appears at the lower right Figure 75 2D Histomorphometry ROI Selection If you have drawn any objects before a white bounding box appears around all your objects If you have not drawn any contours a default sized box ap pears in the middle of the image The bounding box delimits the valid area for the evaluation You can move the ROI around by clicking and dragging on one of the selec tion points using MB1 or you can resize it by clicking on one of the selection points using MB2 You can also set or adjust the position or size o
165. ted for Windows using FAT 32 Delete measurement data while keeping the sample information in data base Formatting initializing of VMS FAT32 Hard drives Determining capacity free blocks of the hard disk Backup of all databases and programs to optical disk or tape full backup Starting Program Click with on the diskette symbol semaine EDIT Operator SCANCO Medical AG Edit Figure 101 Start Archiving Program XtremeCT II Version 2 4 DataManagement 81 Archiving Deleting Backup Data Figure 102 Archiving Program Selecting the Measurement In the upper left hand side samples are listed depending on which toggle but ton has been selected CURRENT ON DISK Lists all samples that either have measurements that have not yet been archived or have not yet been deleted CURRENT WITH RAW shows a list all the above samples with the additional condition that the RAW datafile of the sample is still available on the disk ALL Lists all samples including archived samples Information about where the samples are stored which tape or which disk is then displayed next to the sample By entering the sample name part of the sample name or the sample number in the FILTER text box only sample containing the given text string will appear in the list XtremeCT II Version 2 4 DataManagement 82 The list of samples can then be ordered according to sample number sample name or measurem
166. the middle with MB1 Hold MBl pressed and move the mouse The field next to the scroll bar moves The length of the scroll bar corresponds to the whole field the length of the bar corresponds to the dis played area 110 Option p Menu Option 2 Option 1 Option Menu OPtion 2 Pulldawn Option 1 Option 2 0 _ _ Scaler Option Menu Selection Click on the menu with MB and all the possibilities then appear You can now make your choice with MB Pull edown Menu Selection Click on the menu with MB and all the possibilities appear You can now make your choice with MB Scaler Click on the scaler with MB1 Hold the key pressed and move the mouse The input values change If the scaler is surrounded by a rectangle click on it to make it active you also can use the LEFT and RIGHT ARROW keys to change the value By using CTRL ARROW you can change the values in larger steps Input Change of the Header and Footer of the Print Out XtremeCT II Version 2 4 On the result sheets the name of the physician or hospital appears at the top and bottom of the sheet You may have either the default output sheets or customized ones If you have the standard sheets you can change the header and footer Choose the operator registration program and find the number 1 At the top of the sheet appear the fields Name and Address 1 at the bottom of the sheet the fields Address 2 Zip Code and C
167. the model independent as sessment of thickness in threedimensional images J Microsc 1997 185 67 75 T Hildebrand A Laib M ller J Dequecker P R egsegger Direct 3 D morphometric analysis of human cancellous bone microstructural data from spine femur iliac crest and calcaneus J Bone Miner Res 1999 14 7 1167 74 XtremeCT II Version 2 4 119 Appendix F Checklists Checklist for Measurements Switch on Equipment 30 Minutes before first measurement Start main program Enter sample s data Start measurement program Insert sample sample holder Choose Define Modify measurement protocol controlfile Perform Scout View define Scout View region perform Scout View measurement if OK set reference line Perform Measurement batch or interactive mode Remove sample Checklist for Evaluation Switch on equipment printer optical disk and computer Start the main program Select evaluation program Select sample and measurement Click on EVALUATION Click on DEFINE VOI Draw volume of interest Position VOI using MB move or MB2 scale or enter values directly with keyboard Check Dimensions of VOI should be equal Rectangles indicate VOI for 3D Display Circles indicate VOI for 3D Histomorphometric Evaluation Click on START EVALUATION Exit program Checklist for Shutdown XtremeCT II Version 2 4 Exit from the main program click on EXIT button optional End Session using Session Manager Ent
168. the safety relay will be tested during the next start up 125 Table 1 Interval Operation Yearly Maintenance e Have the X ray unit serviced by SCANCO MEDICAL AG at least once a year Heavily used X ray equipment might need maintenance more fre quently All the necessary maintenance including the safety tests for the purpose of preventing hazards and the necessary settings for optimum image qual ity and minimum exposure to radiation is performed in order to meet reg ulatory requirements After Service and or Maintenance Visits Perform a daily and a weekly test with QC phantom see above Spare Parts Disposal Cleaning XtremeCT II Version 2 4 the medical device logbook including the following data Type and scope of work If necessary details of any change to settings or the working zone Data person performing the work signature The replacement of spare parts not supported by SCANCO MEDICAL AG or the replacement of spare parts by unauthorized people could negatively af fect the functionality of the XtremeCT II and Caution leads to the loss of the CE conformity according to the Medical Device Directive 93 42 EEC and may no longer be conform to relevant standards Replacement of computer should be made in agreement with SCANCO MEDICAL AG The equipment contains low quantities of several materials which may be hazardous to the envi Caution ronment if n
169. there is a de fect because of rough handling it will help determining the responsibilities From the Loading Dock to the Final Room The system will be delivered to the loading dock Generally the system will then stay there until a service engineer of SCANCO MEDICAL AG is on site and helps with the unpacking and the transportation of the equipment within the building A regular pallet lifter is needed to move it around Do not remove the XtremeCT II from the wooden carrier box yourself Note Do not remove any parts of the XtremeCT II your self The gantry cannot be disassembled although a few parts can be detached During transportation the size of the gantry can be as minimal as 148 cm high 132 cm wide and 90 cm deep Before delivery please ensure that all doors corners elevators etc along the transportation route are sufficiently large If there are steps doorsteps or stairs tools or auxiliary material and specialized movers have to be provided to move the gantry over these obsta cles The customer is responsible to ensure that the load capacity of the floor is sufficient to support the weight of this equipment Please keep the wooden carrier box as it may serve for future shipments 132 XtremeCT II Version 2 4 Dimensions and Weights Dimensions x W x D cm H x W x D in XtremeCT II Scanner 148x 138x 115 cm 59 x 55 x 46 Workstation 50x 30x 80 cm 20 x 12 x 32 Tape Drive
170. tor console Distance at least 148 cm x 138 cm x 115 cm H x W x D 2s i Distance at least 2 m Outside of this area red dotted line dose average lt 0 25 uGy h assuming less than 5 standard measurements 71 mAs per hour For detailed information see chapter Radiation Safety A Site Planning Stationary System permanently installed Scanner December 18 2013 Figure 111 Site Planning Positioning of the Equipment To handle the patient we recommend having a free area in front of the gantry of at least 2 m and 1 m at each side of the gantry area 2 m x 3 5 m The computer workstation and the chair of the operator should be placed outside of this area so the operator is not exposed to avoidable radiation for radia tion levels see Appendix K Radiation Safety To be able to service the equipment the gantry should be at least 1 m away from the wall at the back and on each side at least 0 5 m of clearance is needed If it is not possible to give this minimal clearance a pallet mover needs to be provided by the customer for each service Because of air circula tion a free space of at least 0 3 m is needed at the back There is an emergency stop on the front panel of the gantry A second emer gency stop provided with a 5 m long cable can be installed at a convenient place where it can be easily reached by the operator while he is sitting by the computer If you exp
171. toured GOBJ determined volumes Usually conforming volume of interests are much larger than cubic ones so the boundary problem has a much smaller effect For measurements of intact bones we propose to calculate the connec tivity of the complete bone incl cortex or to put an artificial cortex around the spongiosa again with the help of the GOBJ create mask aim from GOBJ with gobj to aim concat with segmented object with concat inputl seg input2 mask output shelled seg common true add true make edge true cl shelled seg then gobj maskaimpeel ow shelled seg again to calculate rel ative masked volume then calculate connectivity with conn_nocl shelled seg Further literature 118 A Odgaard H J G Gundersen Quantification of connectivity in cancellous bone with special emphasis on 3 D reconstruction Bone 1993 14 173 182 Structure Model Index With this index the structural appearance of trabecular bone is quantified The triangulated surface is dilated in normal direction by an infinitesimal amount and the new bone surface and volume is calculated By this the de rivative of the bone surface dBS dr can be determined The SMI is then dBS dr BS SMI 6 and relates the convexity of the structure to a model type Ideal flat plates have an SMI of no surface change with dilation of the plates whereas ideal cylindrical rods have an SMI of 3 linear increase in surface with dilation of rod
172. typing a shortcut or symbol The following ta ble summarizes the names functions and location of the programs Symbol Command Program Name Location Function UCT RECONSTRUCTION UM UCT RECONSTRUCTION EXE 2D Slice Reconstruction IPL UM IPL SCANCO M EXE 3D Segmentation 3D Evaluation UCT THREEDEE BATCH UM UCT RAY BATCH EXE Program to print 3D Result Sheet UCT LIST UM UCT LIST EXE DB Query 3D Histo UPAT LIST UM UPAT PRINT LIST EXE DB Query 3D Histo WRITE INFO UM UCT WRITE INFO EXE DB Query Sample Info Reconstruction XtremeCT II Version 2 4 If for any reason e g insufficient disk space the slice reconstruction is not finishing or you have destroyed the Slice data ISQ but still have the RAW data RSQ somewhere you can reconstruct the missing slices with this pro gram There is no shortcut for this program Start it using the following com mand RUN UCT RECONSTRUCTION Raw Data File DISK3 BRUNO DATA 00000033 00000680 C0000372 RSQ SliceSelection N 1 slice or N M from to or A all SliceNr 0 222 Neg to stop 17 34 You first have to give the input filename which is the RSQfile Then you de fine which or how many slices to reconstruct You can give the following val ues e AThis means reconstruct ALL slices NEnter one value then this slice will be reconstructed and you will be asked again To end the program enter a negative value N M
173. up has to be started manually as described in the manual Choose the function DB BACKUP TO TAPE within the backup program to per form a backup once per month and the function DB BACKUP TO DISK DKO to perform a backup the remaining weeks Important close all the scanner re lated programs before starting Procedure Checklist e Initialize Format tapes if needed MOVE RAW data daily MOVE IMA data as soon as images no longer needed e Perform Weekly Backup Weekly XtremeCT II Version 2 4 153 XtremeCT II Version 2 4 Appendix N Warranty Limited Warranty Statement This Limited Warranty defines the restrictions and warranty period that apply to the SCANCO MEDICAL AG products that you have purchased Contact SCANCO MEDICAL AG if you have questions about this Limited Warranty Terms of the Warranty SCANCO MEDICAL AG warrants that the product you have purchased from SCANCO MEDICAL AG or from a SCANCO MEDICAL AG authorized reseller is free from defects in materials or workmanship under normal use during the Warranty Period The warranty period commences on the date of installation and ends 12 month after the date of installation Your installation protocol showing the date of installation of the product is your proof of the date of in stallation This warranty is transferable to anyone who subsequently pur chases the product from you This Limited Warranty does not include expendable parts Should the product require service durin
174. urement Program Foreign command for AnimationProgram Foreign command for Sample Edit Program Foreign command for Interactive 3D Display Foreign command for Batch 3D Display Foreign command for Tools Program Foreign command for Segmentation Program How to submit batch jobs How to print text files How to print PostScript files Create Informational Report Default Value SUM UCT MAIN EXE UM UCT B EXE UM UCT K EXE SUM UCT LIST EXE QUM UCT MEASUREMENT COM SUM UCT MOVIE EXE SUM UCT_A EX SUM UCT RAY EXE SUM UCT RAY BATCH EXE UM UCT M EXE SUM IPL SCANCO M EXE INTER SUBMIT NOPRINT QUE SYSSFAST LOG SYSS SCRATCH PRINT QUE DL3500 DELETE PRINT QUE SCANCO PS PRINTER DELETE UM UCT WRITE INFO EXE 116 Batch Procedure Appendix D 3D Batch Evaluation As soon as you click START EVALUATION in the Evaluation Program the command procedure UCT_EVALUATION logical name see above for current file specification is submitted using the symbol SCANCO SUBMIT COMMAND After having selected an Evaluation Script a job with name EVAL PRO JECT SSSSSSSS MMMMMMMM is started where PROJECT is the project name as defined in the Evaluation Script e g KTEVAL The batch job also creates a LOG file in the Scratch directory with that name If the Evaluation is started without having selected any scripts a job with name UCT EVALUATION or UPAT EVALUATION XX is started where XX de pends on t
175. uss Use this command to do the gauss 1p and the threshold in one step This saves memory and reduces the computing time However you have no access to the intermediate object ipl gt gauss seg or seg input in gt a output seg gt b sigma 1 000000 1 2 support 2 lower in perm 300 220 upper in perm 1000 gt 1000 value in range 127 adaptive threshold Using this command you can find out which threshold leads to the best seg mentation of the bone The program examines the BV TV parameter at differ ent threshold values given by first threshold last threshold and nr steps It then tries to find the threshold with the least change which it DECterm Based Programs 93 XtremeCT II Version 2 4 considers to be the best choice At the end this value is applied to the input and written to the output object using the value in range as in threshold ipl gt adaptive thresh input gauss gt output th gt c first threshold 400 300 nr steps 30 50 value in range 127 fft laplace hamming Segmentation of an object based on zero crossing of second derivative The second derivative is calculated in the fourier domain by applying a w2 filter for noise smoothing a Hamming filter is simultaneously applied To ensure that regions with high attenuation are segmented as foreground the original image is added with variable weight 1 1aplace epsilon The result is an ob ject
176. ustment and user based maintenance All the equipment manufactured and supplied by SCANCO MEDICAL AG has been tested and examined to ensure as far as reasonably practicable that it is safe and without undue risk to the health when properly used The condition under which our equipment will operate safely and without un due risk to health are specified in this User s Manual and users should en sure that they fully understand the technical conditions regarding safe operating of the equipment and are conversant with and observe regulations and codes of practice which relate to X Ray equipment It is also the duty of the employer to ensure that this employees fully under stand the regulation and operating instructions Typographic Conventions and Abbreviations Typographic Conventions Within this manual special text formates will appear Below you find the for mate related meanings Action performed by the operator Text which is entered by keyboard SOFTWARE BUTTONS ON THE COMPUTER SCREEN Cross references Hyper links Abbreviations e MBI Mouse Button 1 i e left Mouse button e MB2 Mouse Button 2 i e middle Mouse button MB3 Mouse Button 3 i e right Mouse button User s Guide Updates The latest release of this document may be obtained contacting SCANCO MEDICAL AG See Manufacturer and Contact for Service or Sup port on page xi Target Group and Users Qualification These instructions are intended for users
177. utomatic contouring task To check the status of the contouring job which runs in batch mode in the background type QUE in a terminal Contouring tasks are tagged with AUTOR in the job name Load the contour to check it and correct if necessary Save modifications to the contour Check that all images of the measurement are available Check images for artifacts caused by the motion of the patient Call up 3D evaluation window with clicking on the T button and start the XtremeCT II Standard Analysis task To check the status of the 3D evaluation which runs in batch mode in the background type QUE in a terminal Evaluation tasks are tagged with UPAT_DT61 in the job name Take the result sheet from printer or check on the PDF files created in the measurement directory depending on the printing settings The user has to supervise the contouring and ifa single or more sections are missing do not start an evaluation Wait until all sections are recon structed Caution Evaluation 50 XtremeCT II Version 2 4 Caution Note Note Images are only for visual control The numbers on the result sheet not the images have to be in terpreted for a diagnosis While a contour evaluation task is being executed as a batch job one can submit other contouring tasks Those additional tasks will just go in the queue As alternative to the automatic contouring one can use the tools built in the eva
178. who have been instructed by SCANCO MEDICAL AG or their authorized representatives This equipment must be handled only by qualified people and in accordance with the operating instruction Only trained and qualified personnel should have access to the equipment XtremeCT II Version 2 4 Generallnformation Xii Intended Use Europe This computed tomography system is designed to measure the bone density and quantify the three dimensional micro architecture of the bone at the hu man extremities The equipment will be used in the diagnosis and treatment monitoring of osteoporosis Canada This computed tomography system is designed to measure the bone density and quantify the three dimensional micro architecture of the bone at the hu man extremities The equipment will be used as adjunct to conventional methods for the diagnosis of osteoporosis and as treatment monitoring of os teoporosis Contraindications Unborn children are particularly sensitive to X rays Even if the stray radia tion of the XtremeCT II is very low in general the measurement of pregnant women should be postponed The result of a measurement will be affected if a high attenuating object such as an implant watch or jewelry is within the measurement area If a fracture or an implant is in the planned measurement area the contra lateral side should be evaluated Radionuclides could influence the results Therefore before measuring a patient with incorporate
179. ys activated until scanco activate false is entered ipl gt db scanco activate write true tri da metric db This command triangulates a segmented object and calculates object volume and surface as well as the structure model index SMI Using the plate mod el trabecular number thickness and separation are derived Tri da metric db uses the contours of a GOBJ or AIM mask if it finds the GOBJ filename in the proceedings log Otherwise the whole box region is evaluated The results are written into the database gt db if the database was activated see db_scanco_activate You should usually not modify the default values of the arguments ip_sigma ip_support ip_threshold interpo late nrave iter t dir radius epsilon The output is an object with nr views different 3D views of the triangulated object This output may be written to disk with msq from aim and viewed with the 3D Display pro gram ipl gt tri input th gt seg output traps gobj filename gobj from log peel iter 1 ip sigma 2 000000 ip support 1 ip threshold 64 interpolate true gt nr ave iter 0 t dir radius 2 gt epsilon 1 200000 size image 512 512 scale image 0 700000 edges false nr views 0 dt object param Calculates the mean thickness of the structure with the distance transforma tion DT method by filling largest spheres into the object and calculating their mean

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