Vessel Analysis Guide

Application Training 5.
0
Image Manager- Function Panel
Vessel Analysis
Index
1 JiveX Information............................................................................................................ 3
1.1 General Information ................................................................................................. 3
1.2 System requirements ................................................................................................ 3
1.3 Software version CSI................................................................................................. 4
1.4 Requirements on image data .................................................................................... 4
1.5 License .................................................................................................................... 5
1.6 Interaction between Vessel Analysis-Panel and JiveX-Panel ....................................... 5
1.7 Terms and Abbreviations .......................................................................................... 7
2 Practical Application ..................................................................................................... 8
2.1 Overview ................................................................................................................. 8
2.2 Identify a vessel.......................................................................................................12
2.3 Adjust Vessel Centerline ..........................................................................................17
2.4 Vessel Analysis........................................................................................................18
2.4.1 General Functions ............................................................................................19
2.4.2 Adjust Contour .................................................................................................22
2.4.3 Aneurysm measurement ...................................................................................23
2.4.4 Stenosis measurement ......................................................................................26
2.4.5 Report..............................................................................................................28
JiveX 5.0 Application(Advanced) 08/2016 EN 2 FunctionPanel

Vessel Analysis
1 JiveX Information
1.1 General Information
In diagnostic radiology, the vessel analysis is very important for diagnosis. By MR-Angiography
(MR-A) and CT-Angiography (CT-A) sectional images (2D) of blood vessels can be acquired in a
very short time from head to toe. The challenge is to examine these blood vessels on possible
pathologies as quickly, reliably and efficiently as possible. In case of pathologies (aneurysm,
stenosis) these have to be measured and the result has to be presented with all necessary
information to the referring physician.
JiveX Vessel Analysis is a module which is available in the Diagnostic Advanced Client and in
the Demonstration Client. JiveX Vessel Analysis is a fully integrated third party vendor module
for detailed analysis, reporting and report documentation of blood vessels outside the heart. For
this, the external product ResMD with the clinical application Vessel Analysis of the company
Calgary Scientific (Canada) is integrated in the GUI of the RV Client.
The goal should be that the handling of the third party vendor module does not differ from the
use of the other functions of the RV Client.
1.2 System requirements
System requirements of the workstation are identical to the Diagnostic Advanced Client.
Server-sided the Vessel Analysis needs an additional vessel analysis server (see document
“Hardware specification Vessel Analysis Server”).

Vessel Analysis
1.3 Software version CSI
The released software of the OEM product supplied by Calgary Scientific carries the version
number 4.5.2 and the “build number” 38177.
Specific workstation graphic cards are needed (see servicemanual_vesselanalysis)
The “about“-dialog contains additional product information concerning the Calgary Scientific
Server (OEM).
1.4 Requirements on image data
In principle there are the same requirements for the image data as for the 3D VRT, MPR and
image registration.
Unlike the processing of image data in our implementations, the implementation of Calgary
Scientific requires completely equidistant spaces, i.e. the layer spacing may not vary. Our
programmed property „com.visustt.jiveX.viewer3d.maxSliceDeviation“ has no impact on the
behavior of the Calgary Server.
The image data of the Vessel Analysis must always have been first received by JiveX Server via
C-store. The Vessel Analysis with image data loaded from the local hard disc (via the file-open
dialog) is not possible.

Vessel Analysis
1.5 License
The Vessel Analysis-license of the CS fixes the number of the simultaneously available
(concurrent) Vessel Analysis-licenses. They will be automatically released after a defined period
of time without the JiveX Client must be stopped.
If no more free Vessel Analysis-licenses are available on the server, the notice “No free Vessel
Analysis-licenses available” is indicated and the initialization of the Vessel Analysis is stopped.
Terminating a Vessel Analysis Session in the Client, the Vessel Analysis License will be
released. A Session is considered to be finished, if a Viewer Bean “Reset” is performed. The
Demonstration Client behaves differently: The Viewer Bean “Reset” doesn’t release the license,
but “timeouts“ become effective.
If you don’t move the mouse nor use the keyboard in an active Vessel Analysis Session, the
“Idle-Timer“ starts, that monitors the period of inactivity. It is defined in the “globalValues.xml“
in seconds and runs 20 minutes (default value). A change to the function tab does not affect this
timer.
After these 20 minutes an additional 5 minutes timer notice appear, which counts down in
second steps. The note is that the session will be closed in five minutes because of inactivity.
This value is defined in the “globalValues.xml”.
1.6 Interaction between Vessel Analysis-Panel and JiveX-Panel
Once the Vessel Analysis is active, the activation of a function on all the other tabs of the
function panel or of a button in the toolbar, deactivates the active Vessel Analysis functions.
A Vessel Analysis session does not affect the functionality of the Captures. It can be created
neither Volatile Captures nor permanent Captures on the viewports of a Vessel Analysis-session.
The function buttons of the GUI creating Captures are disabled, if in the viewer a view is
shown, which is rendered by the Vessel Analysis server.
During a Vessel Analysis session the functions “Print“ and “Export“ are disabled. Only with
ending the Vessel Analysis session these functions can be used again.

Vessel Analysis
Simultaneously with the Vessel Analysis, only the following functions can be used:
VISUS “Reset“
Button and direct entry to change the series- and image matrix
MPR and VRT functions
Three buttons to adjust the standard views
Series generator on the MIP/MPR Tab
It is a button to reload a study. The Vessel Analysis Session is terminated without

prompting, the study will be reloaded.
Preliminary study dialog
Result/short note Editor
Study Manager / Images
Window levelling functions

Vessel Analysis
1.7 Terms and Abbreviations
Aneurysm Abnormal dilation of blood vessels. They are often lined

with thrombi, which can constrict the blood stream in spite
of a dilatation of the blood vessel.
CT-A Computed tomography of vessels with very high resolution

and layer thicknesses of 1-2 mm. It is always performed with
(CT- Angiography) contrast media.
Curved MPR MPR view along a defined anatomical structure.
(cMPR)
Gefäßbifurkation Vascular bifurcation
MR-A MR examination with the highest possible resolution of the

target organ. In the area of the neck and skull studies are
(MR- Angiography) often conducted as a TOF examination without contrast
media. For the other vessel sections normally contrast media
is used.
ROI Area which is marked by an arbitrary function (e.g. density

measurement, scalpel function).
Region of Interest
Vessel-Segmentation With the segmentation associated structures in a volume are

marked as a segment, e.g. in blood vessels the contrast-
(here used as a synonym for enhanced lumen along the vessel axis is detected as
vessel detection) belonging together. This results in necessary measurements
for the analysis such as diameter, length, angulation, which
can be used for further evaluation.
Stenosis Abnormal narrowing of blood vessels. The most common

cause is deposits on the inner vessel wall, which can be
calcified (hard plaque) or non-calcified (soft plaque).
Straightened MPR Projection of the cMPR as a projection on one plane. The

structure will be presented as a straight line.
(sMPR)
Thrombus Coagulated blood components
TOF This sort of sequence costs a lot of time and is not suitable
for organs which change their position during breathing.

Vessel Analysis
2 Practical Application
2.1 Overview
Please load a CT-study, which contains a series of images with a layer thickness less than 3mm.
Now you have to select the series that you want to use for Vessel Analysis. You can scroll to the
interesting part (pathology) of the dataset.
In the function panel select the tab “Vessel Analysis“ and start the function with the button
“Vessel Analysis”. Alternatively you can start the Vessel Analysis via the context menu (right
mouse click).
! Notice !
If all buttons remain inactive after loading the study, the chosen series can’t be reconstructed.
Please make sure that you have not selected a series with less than 10 images or a series with a
scout image. The layer spacing should also be equidistant!

Vessel Analysis
By initializing the Vessel Analysis the layout changes into a 2 x2 series matrix, and
automatically the different MPRs (transversal, coronal and sagittal) and a volume rendering are
created.
Once the reconstructions have been calculated, the various functions in the Vessel Analysis bar
are selectable.

Vessel Analysis
The Vessel Analysis tab is divided into three parts.
In the middle section, the following functions are represented via four tabs:
“vessel detection”, “correction of the center line”, “correction of the contour line
measurement reporting” and the “creation of the diagnostic finding”.

Vessel Analysis
In the upper part you can use general functions depending on the active tab during the
diagnosis and depending on the active viewport.
Upper button row:

Button “linear measure”, button “point measure” (Gray values), button “angle
measurement”, button “freehand annotation”
Lower button row:

Button “text annotation”, button “Image capture” “, button “DICOM Series generator”
(only for VRT)
In the section “Display” various “Default Color Presets”, the display of the “vessel tree”, the
“angiography view” and the “reset of the rotation of MPRs” can be activated.
The [B]-key on the keyboard for toggeling though the presets is active.
! IMPORTANT!
 The functions of the buttons in the upper row remain active until they are deactivated or
the [Esc]-key is used.
 Shortcuts as the [D]-key for distance measurement are not active in the Vessel Analysis.
 The handling click-drag-click is not active.
 Annotations can be selected by clicking on the line or using the handles at the end of
the lines. Generally a multi-selection is not possible. By clicking on an annotation or on
a measurement it will automatically change to the appropriate mode.
 All annotations show at the end of a line so-called “handles“ onto which the cursor
changes. By clicking and dragging, the length and angle of the annotation can be
changed. The label of the annotations can be similarly touched and moved. A
movement of the entire annotation/measurement at angle measurement and text
annotations is not possible.
 “Add image to the finding“ will be deactivated after a single use.
 [Ctrl]+[Z] resets all actions
 [Ctrl]+[Y] redo of the reseted actions

Vessel Analysis
2.2 Identify a vessel
To start a vessel detection, please select the button “Identify a vessel“ in the section “Finder”.
Now you are asked to set a start and an endpoint.
Advice:
 The start- and endpoints don’t have to be set in the same orientation (coronal, sagittal,
transversal, VR), different orientations can be chosen.
 Pressing the [Shift]-key while doing the second mouse click,a straight line is drawn
between both markers without vessel identification. In this way a vascular obliteration
can be skipped. This function can also be used in the vessel extension.

Vessel Analysis
The system detects the vessel and marks it in color.

Vessel Analysis
If needed, an additional vessel can be selected. After segmentation of a vessel, at once a new
vessel-entrance is provided in the list for selection. If you don’t want to select a new vessel, you
can skip the new vessel by using the [Esc]-key or deactivating the button.
All segmented vessels get a default name. Please select the previously segmented vessel and
rename it. When double clicking the name, you can type in the desired vessel name. Typing in,
e.g. the letter “a“, a popup menu is opened, where you can select the desired vessel name.

Vessel Analysis
In front of the vessel name, colored squares are shown. When clicking on it, a color palette
opens to change the color of the selected vessel, if wanted.
By using the cross behind the vessel name, you can activate or deactivate the display of the
vessels in the dataset. The asterisk behind the vessel name indicates that this vessel already has
been segmented.
Please now extend the segmented part of the vessel. For this, select the button “Extend a vessel“
and set an extension point into the vessel in a view of your choice. The centerline is updated in
all views.
To delete vessel segmentations completely, select the button “Remove the selected vessel from
the anatomical region“. The segmentation of the vessel and the entrance in the list are deleted.
The buttons “3D scalpel“ and “3D Clipping plane“ in the section “Tools” have the same
functionality as in the VRT in the Advanced Client. The shortcuts [S] and [C] on the keyboard
are active.

Vessel Analysis
! IMPORTANT!
 The grabbing dots of the clipping box are only displayed when the mouse cursor
touches the lines of the box.
To show only the vessel tree in the VRT orientation, select the button “Show the vessel tree“.
With the scrollbar you can fade in the surrounding tissue in the density you want.
Additionally, the “angiography view” can be activated.

Vessel Analysis
2.3 Adjust Vessel Centerline
Please click on the button “Step 2 of the vessel analysis“
In the second step you can correct the calculated center line of the selected vessel. For that the
blue bullets respectively the pink cross can be removed to the right position so that the system
recalculates the vessel. In the curved view (bottom right) additional blue bullets can be set for a
more distinct calculation. To replace the blue bullets or the crosses you only have to click with
the left mouse button on the desired place of the vessel. Only in the curved MPR you can
shorten the calculated vessel. For this purpose, one of the two outermost bullets is selected and
then positioned over the next bullet in the direction of the vessel center. The next stop needs to
be set beforehand; it defines up to which position the line should be shortened.

Vessel Analysis
2.4 Vessel Analysis
In the “Step 3” you start the analysis.
In the first viewport a stretched MPR (sMPR) and in the second viewport a curved MPR (cMPR)
of the vessel is displayed. With the [cursor up]-key and [cursor down]-key of the keyboard the
views can be flipped in 90° steps. For analyzing the vessel, different tools are available.
In the left viewport the diameter of the selected vessel is visualized. For that on the left and
right sides of the vessel a curve is shown.
 In the left curve the minimum diameter of the vessel course (calculated in the cross
sections of the two dimensional measurement) is displayed.
 The right curve displays the vessel diameter in mm² in the course of the vessel axis.

Vessel Analysis
2.4.1 General Functions
In the section “General“ you will find the following tools:
Button “Add cross-section and marker”
After activating the function, select the desired part of the vessel. On the right side a new cross
section of the vessel is displayed, which shows the sectional plane orthogonal to the vessel
center line. The area is calculated from the coverage of the vessel contour.
Information in the displayed cross section:
 The corresponding diameter in mm² , suitable for the cutting plane
 Maximum expansion (DiameterMax1 x DiameterMax2) in mm

Vessel Analysis
Button “Add vessel length measurement”
The length measurement along the center line of the vessel is drawn by clicking and dragging
with the left mouse button. The amount is displayed in a text label in [mm].
The measurement mode is deactivated after each measurement automatically. The button keeps
active. But several measurements can be done successively. Therefore activate and deactivate
the button.
To delete a length measurement, go to a marker of the measurement until it is highlighted and

then press the [Del]-key on the keyboard. It is not possible to delete all measurements at once.

Vessel Analysis
Button “Add vessel angle measurement”
The angle measurement along the centerline of the vessel is done by clicking and dragging with
the left mouse button. The two legs of the angle and the value in [deg] of the measurement are
displayed.
Along the center line of the vessel three markers are displayed. The length of the legs (outer
marker) and the angular point (inner marker) can be moved with the left mouse button by
grabbing these markers. The measurement mode is deactivated after each measurement. The
button keeps active. However, several measurements can be generated sequentially. Therefore
activate and deactivate the button.

Vessel Analysis
2.4.2 Adjust Contour
In the section “Contour“, the following tools are available:
Button “Enable freehand contour editing”
In the display of the cross section the vessel contour can be circumscribed with a pressed left
mouse button to correct the automatically detected contour. The start and endpoint of the
freehand line have to cross each other. Then the manually correction will be adopted.
Button “Enable puck contour editing”
The puck minimizes or enlarges existing vessel contours. With a pressed left mouse button you
get a dot (puck). The size of this dot depends on the position of the first click. The more the first
click is set to the contour line, the smaller the dot will be. The more the first click is set into the
center of the detected vessel contour the bigger the dot will be. With a pressed left mouse
button you can move the dot (puck) and change the contour line.

Vessel Analysis
Button “Shows centerline”.
After clicking on the button the centerline of the vessel automatically is displayed.
2.4.3 Aneurysm measurement
The third part provides the automatic aneurysm measurement.
Button “Add vessel aneurysm measurement”.

Vessel Analysis
By activating this button an automatic measurement of aneurysms are made and displayed in
both viewports. In the cMPR view you automatically get the display of five cross sections at the
left side of the viewport.
The design and the display of the aneurysm measurement is divided into three parts:
 The proximal (upper) aneurysmal neck. It is displayed by the khaki-colored section.

This section is defined by the red line (=first relevant vessel junction above the
aneurysm) and the khaki line (= start of the vessel dilation).
 The section of the aneurysm, shown as a lilac line along the centerline of the vessel.
Proximal this section is defined by the khaki line and distal by the purple line,
which marks the passage to the normal diameter of the vessel in the distal part.
 The distal (lower) aneurysmal neck. This part is marked in blue and is proximal
defined by the purple line and distal by the blue line, which marks the first relevant
distal vascular bifurcation.

Vessel Analysis
Each section has a label which shows the length of the section with its name. Each horizontal
line has a corresponding cross-section that displays the vessel diameter as a 2D measurement
as well as the calculated area.
The section of the aneurysm has three additional horizontal markers (green), which display the
maximum diameter of the contrast enhanced lumen, the minimum diameter of the contrast
enhanced lumen and the entire diameter of the vessel. The maximum entire diameter has to be
marked in the middle cross-section as a 2D measurement. Then the aneurysm measurement
has finished and can be saved in a report. Per report only one aneurysm measurement is
possible.
The transversal views of the horizontal lines are displayed in cross-sections of the
corresponding color at the left side of the viewport. The middle cross-section does not
Button “Measure maximum aneurysm diameter”
Please select the button “Identification of the aneurysm diameter”. You can measure the
maximum diameter in the middle cross section in two dimensions. After the first measurement
you can automatically start with the second measurement. Changes are not possible. To make
changes, the whole measurement has to be repeated.
Once you have identified the maximum aneurysm diameter, the entire aneurysm measurement
is finished and can be stored in the report. Button “Save maximum aneurysm diameter to
report“

Vessel Analysis
The transfer of the aneurysm measurement to the report can be undone with the recycle bin
button, as long as the fourth tab has not been activated. Button “Remove maximum aneurysm
diameter measurement”
If an aneurysm measurement has to be removed, you draw the mouse over the middle part of
the horizontal marker, so that the line is highlighted. With the [Del]-key on the keyboard you
can now remove the measurement.
2.4.4 Stenosis measurement
In the fourth part the stenosis measurement is available.
Please activate the button “Add vessel stenosis measurement“. To start this tool you have to
make a left mouse click on a MPR view. The start point has to be set above a stenosis. Two
blue lines appear. The second line has to be placed underneath the stenosis. Automatically the
stenosis will be calculated.

Vessel Analysis
The blue colored normal diameter is labeled with the text „normal“. The red colored narrowed
diameter shows in the label the stenosis in percent (ratio of the area of the constricted lumen to
the area of the normal lumen * 100).
Additionally two cross-sections are displayed at the bottom left side of the viewport, which
display the normal and the constricted lumen. Above the upper cross-section the degree of the
stenosis is shown.
The measurement results are also displayed in the function panel. The measurement can be
changed at any time dragging the marker with the left mouse button to another position.
When saving the measurement the result is transferred to the report. Button “Save measured
stenosis to the result list“

Vessel Analysis
After selection of saved measurements, they can be removed from the result list. They are also
removed from the report. Button “Remove stenosis from result list“
2.4.5 Report
In the fourth part the report can be viewed, edited and saved.
To add a finding, select the button “Add diagnostic findings and assessments“. It opens a
dialog, where you can type in your finding. This finding is saved in the report.

Vessel Analysis
If you have used the button “Image capture“ during the session, these images will also
displayed in the report.

Vessel Analysis
Finally save your report via the button „Save report“ and go to the study manager. In the series
list an additional series is displayed with the report as a “DICOM Encapsulated PDF” object.
Most of the functions can be activated also via the context menu.

Vessel Analysis
Infos as of 2012/09/17:
 JiveX Server and Viewer Version obligatory 4.5.2 (Released approximately end of
september 2012)
 No customer logo in the report
 Changes of the report template only:
o Vessel Analysis
o Report
o Summary
o "...\Programme\csi-server\conf\clinicalapps\vesselanalysis.xml"
<?xml version="1.0"?>
<Configuration
xmlns:typeless="http://calgaryscientific.com/typeless/200
8">

<CrossSectionSize>70</CrossSectionSize>
<Report>
<Title>Gefäßanalyse</Title>
<DescriptionTitle>Befund</DescriptionTitle>
<NotesTitle>Zusammenfassende Beurteilung</NotesTitle>
</Report>
<Vessels>
<VesselList>
</VesselList>
</Vessels>
</Configuration>
 Curved MPR in the second step of the vessel analysis can not be saved in the report
 Fensterung im 2D Stapel aktualisiert die Werte im Hammer Tab der Funktionsleiste

nicht
 The definition files vesselnames.xml and vesselnames_de.xml have to be filed in the

server-directory
o %jcs_home%\resource_provider\vesselanalysis

Vessel Analysis

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Application Training 5.

JiveX 5.0 Application(Advanced) 08/2016 EN 2 FunctionPanel

1.1 General Information

1.2 System requirements

JiveX 5.0 Application(Advanced) 08/2016 EN 3 FunctionPanel

Specific workstation graphic cards are needed (see servicemanual_vesselanalysis)

1.4 Requirements on image data

JiveX 5.0 Application(Advanced) 08/2016 EN 4 FunctionPanel

1.6 Interaction between Vessel Analysis-Panel and JiveX-Panel

JiveX 5.0 Application(Advanced) 08/2016 EN 5 FunctionPanel

MPR and VRT functions

Three buttons to adjust the standard views

Series generator on the MIP/MPR Tab

It is a button to reload a study. The Vessel Analysis Session is terminated without

Preliminary study dialog

Result/short note Editor

Study Manager / Images

Window levelling functions

JiveX 5.0 Application(Advanced) 08/2016 EN 6 FunctionPanel

Aneurysm Abnormal dilation of blood vessels. They are often lined

CT-A Computed tomography of vessels with very high resolution

Curved MPR MPR view along a defined anatomical structure.

Gefäßbifurkation Vascular bifurcation

MR-A MR examination with the highest possible resolution of the

ROI Area which is marked by an arbitrary function (e.g. density

Vessel-Segmentation With the segmentation associated structures in a volume are

Stenosis Abnormal narrowing of blood vessels. The most common

Straightened MPR Projection of the cMPR as a projection on one plane. The

Thrombus Coagulated blood components

JiveX 5.0 Application(Advanced) 08/2016 EN 7 FunctionPanel

JiveX 5.0 Application(Advanced) 08/2016 EN 8 FunctionPanel

JiveX 5.0 Application(Advanced) 08/2016 EN 9 FunctionPanel

JiveX 5.0 Application(Advanced) 08/2016 EN 10 FunctionPanel

Upper button row:

Lower button row:

 The handling click-drag-click is not active.

 “Add image to the finding“ will be deactivated after a single use.

 [Ctrl]+[Z] resets all actions

 [Ctrl]+[Y] redo of the reseted actions

JiveX 5.0 Application(Advanced) 08/2016 EN 11 FunctionPanel

Now you are asked to set a start and an endpoint.

JiveX 5.0 Application(Advanced) 08/2016 EN 12 FunctionPanel

JiveX 5.0 Application(Advanced) 08/2016 EN 13 FunctionPanel

JiveX 5.0 Application(Advanced) 08/2016 EN 14 FunctionPanel

JiveX 5.0 Application(Advanced) 08/2016 EN 15 FunctionPanel

Additionally, the “angiography view” can be activated.

JiveX 5.0 Application(Advanced) 08/2016 EN 16 FunctionPanel

Please click on the button “Step 2 of the vessel analysis“

JiveX 5.0 Application(Advanced) 08/2016 EN 17 FunctionPanel

In the “Step 3” you start the analysis.

JiveX 5.0 Application(Advanced) 08/2016 EN 18 FunctionPanel

In the section “General“ you will find the following tools:

Button “Add cross-section and marker”

Information in the displayed cross section:

 The corresponding diameter in mm² , suitable for the cutting plane

 Maximum expansion (DiameterMax1 x DiameterMax2) in mm

JiveX 5.0 Application(Advanced) 08/2016 EN 19 FunctionPanel

To delete a length measurement, go to a marker of the measurement until it is highlighted and

JiveX 5.0 Application(Advanced) 08/2016 EN 20 FunctionPanel

JiveX 5.0 Application(Advanced) 08/2016 EN 21 FunctionPanel

In the section “Contour“, the following tools are available:

Button “Enable freehand contour editing”