Understanding of 3D design presentations

Understanding of 3D

1. Understanding of 3D - Overseas Business Department

2. CONTENTS 1. What is CT? 2. 3D Basic Terminology 3. Necessity of 3D and its workflow

3. Gantry Table Generator Console Computer Table Gantry Generator CT Basic From the outside

4. CT Basic Tube Detector DAS* * Data Acquisition System From the inside Tube Detector DAS

5. Recon & postprocessing Data acquisition system (DAS) X-ray generation ( Kvp , mAs Volt) CT Basic Flow.. Tube Detector DAS: Transform signal into data

6. CT Basic X-rays pass through a collimator therefore only penetrating an axial layer of the object, called a " slice " Slice..

7. The numerical matrix is converted into a black and white image in a corresponding gray scale. 35 36 39 34 33 31 34 33 35 32 31 80 85 90 78 *Analog - Digital - Analog CT Basic ADA..

8. Water Mamma Air Bone Spleen Fat Pancreas Lung Kidneys Adrenal Gland Blood Heart Liver Intestine Tumor Bladder 3000 60 40 -100 -200 -900 -1000 This is the so-called CT number in Hounsfield unit ( HU ) Rule of thumb: The CT value of water is 0 and air -1000. The relative values of the other tissues are calculated relative to that of water CT Basic CT Number.. CT number - 1000 ~3071 air -1000, water – 0 , bone + 1000

9. width Level Range of pixel Air bone Window Width is the range of CT number values displayed within each level of the gray scale. Window Level is the value at the center of the gray scale. The contrast of an image can be controlled by manipulating these factors. CT Basic Window width & level..

10. Window width (W): the density range represented within the gray scale. Window center (C): the center of the density range. Hounsfield unit [phone] Window width W Window center C Gray scale display White Black CT Windowing CT Basic Image Display-windowing..

11. The range of CT density values is defined from -1000 to +3000, but the human eye can distinguish only 30 - 40 gray scales at best. So, the window settings must be in accordance with the structures to be visualized CT Basic Why..?

12. I.S.D* I.S.D I.S.D I.S.D I.S.D I.S.D * Inter Scan Delay Standard Scan: - Longer cycle time - but instant display Dynamic Scan: - Fast acquisition - but delayed display CT Basic

13. w/o I.S.D w/ I.S.D 2D Slice 3D Volume CT Basic

14. Scan a whole volume in one breath hold Reduce partial volume effects No gaps Overlapping images can be reconstructed without additional dose High quality data for 3D-rendering CT Basic advantages CT

15. Fast scanning of large anatomical volumes Gapless data acquisition during one breathhold Optimum utilization of contrast medium Retrospective reconstruction with arbitrary slice increments Why perform spiral CT? CT Basic

16. Use Spiral CT for contrast studies Use Spiral CT for all regions of the body Use it for pediatrics and trauma patients, who require quick scanning Use it for long anatomical ranges When to use spiral CT? CT Basic

17. CONTENTS 1. What is CT? 2. 3D Basic Terminology 3. Necessity of 3D and its workflow

18. Volume Rendering [ VR ] VR is a set of techniques used to display a 2D projection of a 3D discretely sampled data set. A typical 3D data set is a group of 2D slice images acquired by a CT, MRI or Micro CT scanner. To render a 2D projection of the 3D data set, one first needs to define a camera in space relative to the volume. Also, one needs to define the opcity and color of every voxel. 3D Basic Terminology– Volume Rendering 2D planar sliced images * OTF (Opacity Transparent Function) H/U -400 400 OTF Graph Opacity (O ) Transparency (T ) 3D Workstation Volume Rendering 3 차원 영상화의 기본개념 << Basic Concept of 3D volume Rendering >>

19. 3D Basic Terminology– MIP & MinIP Maximum/Min Intensity Projection [MIP/ MinIP ] MIP: used for the detection of Small Vessels, Calcification, Stent, etc. MinIP : Diagnosis of Bronchus and Liver Maximum Intensity Minimum Intensity Average Intensity Depth MIP Min IP

20. Cardiac MPR Multi Planar Reformation [MPR] Used to diagnose winding and bending structures like vessels on 3D image along with reconstructed MPR images on th e vessel direction - Reconstructed Sagittal , Coronal, Axial, Oblique plane - Curved Planar Reformation (CPR / 3D MPR) ex) Applied Clinical diagnosis : Abdomen Vessel, Cardiac Vessels, etc.. Cardiac Vessel CPR Abdomen Vessel CPR 3D Basic Terminology– INFINITT 3D MPR

21. 3D Basic Terminology– Endoscopy Features: (Comparison to Conventional Endoscopy) 1. Non-invasive 2. Larger diagnosable area because of wide FOV 3. Able to diagnose area, where conventional endoscopy cannot 4. Able to observe organ, vessel, gastrointestinal tract, bladder, etc . from any point and any angle 5. Applied Clinical Diagnosis: Tumor, Polyp, Stenosis on real-time Fly around Object Fly through * Fly-through technique * Fly-around technique

22. 2D Planar Image Endoscopy ? Volume Rendering - Gastroscopy ( Stomach) 3D Basic Terminology– INFINITT 3D Endoscopy

23. 3D Basic Terminology– Vessel Analysis Able to perform quantitative analysis on interested vessels automatically Able to measure Min/Max/Avg . Thickness, Area of interested vessel Able to diagnose degree of stenosis by comparing normal and abnormal vessels  Stenosis : 50% narrower than normal vessels around Applied Clinical Diagnosis - Valuation of Vessel condition - Planning for Surgery (Stent planning) - Compare Prior-Post Surgery (Follow up) Stenosis: An abnormal narrowing in a blood vessel or other tubular organ or structure ex) Cerebral Artery Stenosis or Carotid Artery Stenosis, etc.

24. Table of Analysis Result Vessel Analysis <Right Carotid Artery Stenosis > 3D Basic Terminology – INFINITT 3D VA

25. Cardiac Disease Dyspnea , Chest Pain Nausea Myocardial infarction Evacuating the patient within 30-60 mins Causes Adult Disease (Stress, Cigarette, Alcohol, Wrong eating habits) Cholesterol Arteriosclerosis

26. 3D Basic Terminology - CA Calcium Scoring [ CA ] Measuring quantity of calcium, which is the major cause of cardiac diseases 1. Scaling calcification in coronary arteries and alerts the degree of danger 2. Scaling calcification with in vessels only. Generally, it counts more than CT Number 130 Measuring area and volume of calcium for each 6 coronary arteries * Cardiac Vessels (Coronary artery) 1. R ight C oronary A rtery (RCA) – 1-1. Posterior Descending a.(PDA ) 2. L eft C oronary A rtery (LCA) – 2-1. Left Main Coronary a. (LM) 2-2. L eft A scending Descen . a.(LAD ) 2-3. L eft C ircumflex a. ( LCx ) 2-4. Obtuse Marginal a. (OM )

27. 3D Basic Terminology – CVA Purpose : to analyze major coronary arteries, which supplie s blood to the heart Check the degree of stenosis through quantitative analysis of RCA , LCA (LAD, LCX ) * Stenosis analysis: 50% or less inside diameter / 75% or less Area Without sculpting, it is able to remove rib cage and select path of vessels with one-click Advanced Cardiovascular angiography application as improvement of MDCT cf.) SDCT – Difficult to take heart images MDCT – 320 Channel CT (TOSHIBA ) / at least 64ch or more CT * SDCT – Single Detector CT MDCT – Multi Detector CT

28. Select Interested Vessel (LAD) One-click Cardiac Vessel Analysis [ CVA ] < Cardiac > LAD MPR Table of Analysis Result Auto-rib cage removal (1~2sec) 3D Basic Terminology – INFINITT 3D(G3) CVA

29. 3D Basic Terminology – CFA Cardiac Function Analysis [ CFA ] Calculating Ventricle Volume with End-systolic (ES ) and End-diastolic (ED) Systolic function – 3 parameters 1. Ejection fraction (EF) / (How much quantity of blood is squeezed out of heart per minute) 2. LV E nd S ystolic Volume (LV ESV ) 3. LV E nd D iastolic Volume (LV EDV ) Normal Condition : 55% of LV EF = 55 % or more, LVEDV = 160ml, LVESV = 60ml Ejection fraction = EDV-ESV/ EDV= SV/EDV*100% 55%(normal), 45%, 20~25% (mild), 20% or less (severe)

30. 3D Basic Terminology – CFA Cardiac Function Analysis [ CFA ] Normal Condition : Ejected quantity of blood is 55% of LV EF = 55 % or more, LVEDV = 160ml, LVESV = 60ml Ejection fraction = EDV-ESV/ EDV= SV/EDV*100% - 55%(Normal), - 45%, 20~25% (Mild), - 20% or less (severe) Healthy heart should eject minimum 50% of blood per pulse beat E.g ) Volume of LV : 100ml / Volume of ejected blood per pulse 50ml : EF 50% If EF is 50% or more, no treatment requrired If EF is less than 50%, it could mean not enough oxygen or not enough blood in coronary artery

31. 3D Basic Terminology – INFINITT 3D(G3) CFA Cardiac Vessel Analysis [ CFA ] ES ED Analysis Result

32. 3D Basic Terminology – VC & CTC Virtual Colonoscopy [ VC ] VC makes images like actual images from conventional colonoscopy and one is able to detect polyps throughout the colon. There is a high possibility to become a cancer from more than 6mm of polyp It is expected to reduce the death rate due to colon cancer Colorectal cancer is progressed from colon polyps (adenoma) in transformation of size and cellular atypism * Atypism : The condition of being uncharacteristic or lacking uniformity Normal Colon Membrane Colon Polyps 3-7 Yrs Colorectal Cancer

33. 3D Basic Terminology – Colonoscopy VR (Colon Path) Xelis -Colon Xelis -Colon

34. Brain Angio Subtraction BAS - Loading By Subtract function, one is able to acquire only vessel images by removing head bones with pre and post contrast Brain CT data Generate New series 3D Basic Terminology – BAS

35. Brain Angio Subtraction Non-enhanced / Pre Enhanced / Post 3D Basic Terminology – BAS

36. Volume Rendering [VR] vs. MIP Volume Rendering MIP[Max. Intensity Projection] 3D Basic Terminology – BAS

37. CT brain Pre Contrast (Pros) Well-known CT application Simple and short CT scan time Rapid and accurate diagnosis of stroke by cerebral hemorrhage Pre-contrast CT images give useful information on treatment Acute Stroke Pre-Contrast Brain Non-contrast LT intracerebral hemorrhage 3D Basic Terminology – brain perfusion

38. CT brain Pre Contrast (Cons) Cannot detect blocked vessels and their location Darker area means damaged lesion already Cannot estimate final size and area of lesion after certain period of time Cannot display Ischemic penumbra Acute Stroke Non-contrast LT intracerebral hemorrhage Brain CT Perfusion ! 3D Basic Terminology – brain perfusion

39. CTP Parameter 1. tMIP (time Maximum Intensity Projection); MIP for Time Axis 2. CBV (Cerebral Blood Volume ); (Based on theoretical calculation) 3. CBF (Cerebral Blood Flow ); (Based on theoretical calculation) 4. TTP (Time to Peak ); (Based on theoretical calculation) 5. MTT (Mean Transit Time ); Transit time of contrast (Based on theoretical calculation) 6. BAT (Bolus Arrival Time); Arrival time of contrast 7. MS (Maximum Slope); 8. PH (Peak Height); 3D Basic Terminology – brain perfusion

40. Brain CT Perfusion (CTP) Graph 3D Basic Terminology – brain perfusion

41. CTP Parameter CBF – Cerebral Blood Flow (Rainbow) CBV – Cerebral Blood Volume (Rainbow) TTP – Time to Peak (Reverse-rainbow) MTT – Mean Transit Time (Reverse-rainbow) Available Perfusion Images 3D Basic Terminology – brain perfusion

42. 3D Basic Terminology – brain perfusion Clinical Application

43. 3D Basic Terminology – brain perfusion

44. CONTENTS 1. What is CT? 2. 3D Basic Terminology 3. Necessity of 3D and its workflow

45. Why use to 3D? [ in Hospital ] [ to patient ] Increased diagnosis time due to rapid increase of 2D images from advanced MDCT -> Rapid and easy diagnosis by using 3D Image Various studies, which could not be done with 2D Images, are now possible -> ex. Vessel Analysis, Cardiac function, 4D… Better communication between clinicians and radiologits Better reputation on hospitals with 3D images due to advanced knowledge of patients Easier understanding of lesion by using 3D image of patient’s own organs

46. 3D Workflow -Ⅰ CT MRI Radiologist Clinician Better Anatomical Information (advanced visualization)  Efficient and Accurate Diagnosis Accurate operation planning prior to surgery  Quantitative Analysis Increased patients’ rate of agreement on therapy plan Saving time from diagnosis to surgery

47. CT Mini PACS 1mm recon Data 5mm recon Data Main PACS 3D Workflow - Ⅱ

48. Thank you!