BRAIN ANALYSIS PROGRAM RUNS WITH FOREGROUND LOADED. SELECT BRAIN STUDY AND AT COMMAND MR BRAIN TAKE POLAROID PHOTO OF REGIONS WHEN DISPLAYED. ROIS OK? IF YES, TYPE PA - RETURN ^X ^X THEN MR,10 (IF NO, TYPE MR,6 - MARK REGIONS MANUALLY AND TAKE FILM. THEN TYPE PA - RETURN ^X ^X AND AT COMMAND MR,10. TAKE FILM OF FINAL GRAPH AND COLLECT PRINT OUT. DUAL ISOTOPE ANALYSIS GALLIUM, TECHNETIUM LIVER SUBTRACT CALL UP 99MTC LIVER VIEW I.E. (IA-ISOTOPE A) IR OUTLINE SMALL NORMAL LIVER AREA AND NOTE AVERAGE CELLS EG 1200 ^X IB (ISOTOPE B) IT;S9 IR (NOTE AVERAGE CELLS IN B. EG 40) ^X CM (EG 40) IE. CONSTANT MULTIPLY BU;SM1 IA SM2;SA1-2 (IE GALLIUM - TECHNETIUM) BW;LD2 (IE LOAD DUAL ISOTOPE IN SA2) SW;W;BW - TAKE PHOTO. GASTRIC EMPTYING CALL UP STUDY, AT COMMAND IR AND OUTLINE STOMACH USING V PA - RETURN ^X ^X AT COMMAND MR CURVE (STORES CURVES IN SVAR01 + RUNS CURVE.SAV) RS1 DC1 MR EXFIT MOVE CURSOR TO LEFT AND MARK MOVE CURSOR TO RIGHT AND MARK TAKE FILM OF HALF EMPTYING TIME AT COMMAND DG (IE DISPLAY GAMMA) RI 1 (IE REGION OF INTERREST SECTION) RB CA (RETURNS TO BGAMMA). GATED HEART (SEE NEXT PAGE FOR GATED LIST) 1. CALL UP GRID AND AT COMMAND RI MARK POINTS 1 AND 2, THEN 2 AND 4 AND NOTE CELL COUNT IN RECORD BOOK EG X, 79 Y, 78 POINT 1 POINT 2 POINT 3 POINT 4 TO MOVE CROSS HAIR L,R ) J TO MOVE U,D ) 10 CELLS 2. CALL UP LAO AND AT COMMAND MR HRTANL WAIT FOR PLAYBACK AND MAKE MENTAL NOTE OF VALVE PLANE, SEPTUM AND ANEURYSM. ^X. 3. OPTION SELECT - SELECT 2 UNLESS RIGHT AND LEFT VENTRICULAR ANALYSIS IS REQUIRED. 4. ENTER X FACTOR ENTER Y FACTOR 5. OUTLINE LEFT VENTRICLE AND CONTINUE WITH SELF DOCUMENTING PROGRAM. NOTES: 1. BACKGROUND MUST NOT INCLUDE ANY HEART OR SEPTAL AREA. 2. IF APICAL POINT IS MOVED SHIFT CENSOR AND MARK USING INTERUPT BAR. 3. TAKE POLAROID FILMS OF GRAPHS AND COLLECT PRINT OUT. AFTER COMPLETING GATED ANALYSIS CONTINUE WITH PHASE STUDY. NB: EJECTION FRACTION = (END DIASTOLE-BACKGROUND)-(END SYSTOLE-BGD) --------------------------------- END DIASTOLIC COUNTS GATED LIST ANALYSIS CALL UP STUDY. FRAME STUDY 3 START TIME STOP TIME FRAME DURATION NO OF FRAMES 24 PRESET TRIGGER 64X64 IE NO 4 UNIT O SAVE FRAME DATA AS PATIENT STUDY Y TOLERANCE CHECK Y MOVE CURSOR 100 ECH SIDE OF HIGHEST 490 690 MARK 590 MARK HIGHEST REPEAT FOR OTHER LIST VIEWS. CONTINUE WITH ROUTINE HEART ANALYSIS. PHASE ANALYSIS SELECT LAO AND AT COMMAND MR FOUR TYPE PN - RETURN ^X ^X MARK LEFT VENTRICLE -PN - RETURN ^X ^X. MARK END DIASTOLE MARK END SYSTOLE MARK LAST EVEN NUMBERED FRAME NOTE: IF ODD FRAME MARKED THEN MOVE 1 CELL AND MARK AGAIN. NOW IN GAMMA TO ADJUST LOWER THRESHOLDS ONLY USING X OR W. THEN ^X. ERASE A.(I.E. EA) AND MARK RIGHT VENTRICLE AND LEFT VENTRICLE. ^X. IF THIS A RESTING STUDY Y DO YOU WANT PLAY BACK Y TAKE POLAROID FILM OF PHASE STATIC. AT COMMAND PB P1 VIEWS PHASE PLAY BACK. N.B. DELETE PHASE DP-SMH STUDY TO CREATE PLAYBACK (3 STUDIES + PHASE IN P1) 1. SELECT LAO AND AT COMMAND MR GSASM3 2. SELECT RAO AND AT COMMAND MR,5 3. SELECT L.LAT AND AT COMMAND MR,8 PLACKBACK IS AUTOMATICALLY CREATED AND JOINED. NOTE: IF ONLY LAO COLLECTED: SELECT LAO AND AT COMMAND MR GSASMH WHEN PLAYBACK CREATED IN P3 GET COMMAND AND MR JOIN,2 TO STORE PLAYBACK MR,9 OR MR RNMGPB AND MR JOIN,9 EXAMPLES SY0:P4=SY0:P1 (STORE P1 IN P4) *TTO420 (STORE GSACOM) OR R PIP *SY1:TS0001.GPB=SY1:GSACOM.GPB NOTE: -2 IENTER ERR (MEANS DISK IS FULL, I.E DELETE STUDIES OR GPB'S) TO CREATE EXERCISE PLAY BACK CHOOSE FIRST STUDY AND AT COMMAND MR GSASME OR MR GSASM4 3RD STUDY P1 P2 1ST STUDY 2ND STUDY P3 P4 N.B. DELETE TEMPORAL SM1 EXERCISE GATED HEART ANALYSIS 1. ACQUIRE GRID FACTORS AS FOR GATED REST STUDY. 2. CALL UP REST STUDY AND AT COMMAND MR HRTANE ANSWER NO TO AUTO ANALYSIS. 3. OPTION SELECT IS 6 IE EXERCISE. CONTINUE AS FOR GATED REST STUDY. 4. REPEAT ABOVE FOR ALL STRESS COLLECTIONS AND POST EXERCISE COLLECTION ANSWER YES TO AUTO ANALYSIS AND MODIFY REGIONS WHERE NECESSARY. 5. PHASE ANALYSIS FOR ALL COLLECTIONS. I-131 POST THERAPY CALL UP STUDY AND AT COMMAND RI MARK DIAGONAL CORNERS. N.B. AREA MUST BE LARGE ENOUGH FOR BOTH IMAGES. NOTE MAXIMUM COUNTS ^X SPACE FOR NEXT IMAGE. RI - MOVE CENSOR TO LOWER RT. HAND CORNER, MARK AND TYPE SA (I.E. SAME AREA) NOTE MAXIMUM COUNTS IN B. ^C R BASIC OPTIONAL FUNCTIONS(ALL, NONE OR INDIVIDUAL) READY PRINT COUNTS NECK X DOSE STANDARD = PATIENT DOSE ----------- COUNTS STANDARD E.G. PRINT 17962/4857*53 BYE OR AT COMMAND BA AND CONTINUE AS ABOVE KIDNEY ANALYSIS 1. SELECT STUDY AND AT COMMAND MR KIDNEY. A) TO MARK AORTA: SPACE RETURN UNTIL AORTA APPEARS AND AT COMMAND AD3;LT20;IT;S9;IR-MARK AORTA ^X B) TO MARK KIDNEYS AND BACKGROUND AT COMMAND. BE;SK30;AD10;LT20;S9;IR MARK RIGHT KIDNEY AND BACKGROUND THEN MARK LEFT KIDNEY AND BACKGROUND ^X C) TO MARK LEFT VENTRICLE AND BACKGROUND AT COMMAND BE;SK1;AD2;S9;LT70;IR ^X. FOLLOW COMMANDS AND TAKE PHOTO. NOTE: REGIONS ARE AUTOMATICALLY STORED IN SA7 CURVE IN SA8 AND MODIFIED KIDNEYS AND BACKGROUNDS IN SA6. GFR ANALYSIS A) SELECT STANDARD AND AT COMMAND MR GFR,10 OUTLINE STANDARD AND BACKGROUND ^X. B) SELECT RENAL STUDY AND AT COMMAND MR,1 (I) DRAW ROI'S AS FOR KIDNEY ANALYSIS ABOVE, OR THEN PA - RETURN CTRL X TWICE (II) IF KIDNEY IS ALREADY ANALYSED MR,5-CURVES ARE ALREADY GENERATED, OR (III) IF GFR REQUIRES "MODIFIED" KIDNEYS - RR6 AND PA - RETURN. C) MR,4. COMMENTS CAN BE EDITED DURING GFR ANALYSIS OR PRIOR TO STARTING ANALYSIS . I NOTE : TO EDIT COMMENTS BEFORE ANALYSIS CALL UP STUDY AND AT COMMAND CO A ENTER COMMENTS LINE BY LINE ACCORDING TO RENAL RECORD SHEET. EG. 566072,308435 11,40 10,06 10,29 6.8,6.5 70,160 RENAL TRANSPLANT SELECT STUDY AND AT COMMAND MR KIDNEY. AT COMMAND, SPACE RETURN UNTIL FEMORAL ARTERY APPEARS. AT COMMAND AD3;IT;S9;LT30;UT75 THRESHOLDS WILL VARY FROM PATIENT TO PATIENT. AT COMMAND IR ALTER THRESHOLDS FURTHER USING Y TO DECREASE UT BY 5% STEPS OR W TO INCREASE LT BY 5% STEPS. OUTLINE FEMORAL ARTERY DISTAL TO KIDNEY TO TWO CELLS WIDE. ^X PREPARE TO OUTLINE KIDNEY AND BACKGROUND. AT COMMAND BE;SK30;AD10;S9;LT30. ADJUST THRESHOLDS FURTHER IF NECESSARY. AT COMMAND IR OUTLINE KIDNEY AVOIDING FEMORAL ARTERY OUTLINE BACKGROUND OVERLAPPING KIDNEY ^X KIDNEY - BACKGROUND. AT COMMAND ,4 ENTER DEAD TIME 10 ENTER KIDNEY (R,L,B=BOTH OR T) T PA - RETURN ^X^X SELECT PEAKS AND TAKE FILMSL. PANCREAS ANALYSIS CALL UP PANCREAS/LIVER DYNAMIC AND AT COMMAND BW;AD3;IT;SM4 (NOTE MAXIMUM COUNTS A ) AT COMMAND DX AND CALL UP LIVER FUNCTION STUDY. AT COMMAND BW;SK46;IT ( NOTE MAXIMUM COUNTS B) AT COMMAND CM 2.5 ( FACTOR = A/B TO NORMALISE COUNTS ) AT COMMAND SM3,SA4-3 - TAKE PHOTO 1. AT COMMAND LT20;BU - TAKE PHOTO 2. AT COMMAND IR SELECT 5 ROI'S AS FOLLOWS, TYPE M TO MARK REGIONS. A - HEAD OF PANCREAS B - BODY OF PANCREAS C - TAIL OF PANCREAS D - LIVER - MID PORTION E - BACKGROUND - TAKE PHOTO 3 OF REGIONS. TYPE ^X TO RETURN TO COMMAND. AT COMMAND SM5 AT COMMAND RS4;BU - TAKE FILM 4 AT COMMAND RS3;BU - TAKE FILM 5 AT COMMAND DX - CALL UP PANCREAS STUDY AT COMMAND AD3;BW;RR5 TAKE FILM 6 AT COMMAND PA ABC - RETURN - TAKE FILM 7 AT COMMAND PA ADE - RETURN - TAKE FILM 8. S.I. JOINTS CALL UP STUDY AND AT COMMAND RI - OUTLINE 4 AREAS A B C SI JOINTS USING SA I.E. SAME AREA. D FEMUR NOTE COUNTS IN EACH AREA R BASIC OPTIONAL FUNCTIONS (ALL, NONE OR INDIVIDUAL) READY PRINT AND CALCULATE A/D B/D A/C BYE OR AT COMMAND BA AND CONTINUE AS ABOVE THYROID ANALYSIS FOREGROUND MUST BE LOADED. CALL UP STANDARD AND AT COMMAND MR THY - THIS 1 LOADS STANDARD INTO SAVE AREA 2 2 LOADS STATIC INTO DUAL DISPLAY. 3 LOADS STATIC AND ROI'S IN SAVE AREA 1 4 CALLS MR THYDYN. CONTINUE WITH SELF DOCUMENTING PROGRAM. OUTLINE THYROID ACCURATELY - IF THRESHOLD O.K. CAN OUTLINE BY V (THIS AUTOMATICALLY LOADS TO SA1.) ^X MR,10 AND AT COMMAND CHOOSE THYROID DYNAMIC AT COMMAND MR,3 ADJUST THRESHOLDS IF NECESSARY AT COMMAND MR,6 OUTLINE THYROID AND BACKGROUND PA - RETURN ^X ^X ENTER INFORMATION FROM RECORD SHEET AND TAKE FILMS AS BELOW NOTE: CAMERA DEAD TIME AND CELLS/CM2 ARE: MOBILE 10,74 PHO V 10,36 VENTILATION LUNG ANALYSISL CALL UP EQUILIBRIUM STUDY AND AT COMMAND MR LUNG (ADJUST THRESHOLD USING X AND Y) V TO OUTLINE ^X SELECT WASH-OUT AND AT COMMAND ,6 NOW IN IR TO ALTER THRESHOLDS IF NECESSARY (DO NOT MARK REGIONS AGAIN) ^X SELECT PERFUSION AND AT COMMAND ,9 NOW IN IR ADJUST THRESHOLDS IF NECESSARY AND V TO OUTLINE CURVE ^X DO YOU WANT TO CHECK FOR EMBOLISM Y OR N TO RERUN TYPE MR SELF DOCUMENTING FROM HERE TAKE FILMS AS BELOW OESOPHAGEAL TRANSIT SELECT STUDY AND AT COMMAND MR OESTRN IF CINE PLAYBACK ALREADY MADE BY AUTOANALYSIS - THEN MR OESTRN,5 THIS CREATES A CINE PLAYBACK TEMPORARILY STORED AS GSACOM.GPB (IF REVERSE CHANGE WITH JOYSTICK) TO CONTINUE CTRL X RENAME PLAYBACK FOR STORAGE (SAME AS FOR HEARTS) MARK OESOPHAGUS EXCL STOMACH REGION MARK SCRATCH (ANY REGION) PA - RETURN CTRL X, CTRL X .COMMAND (VT100) MR OESTRN CHOOSE PEAK (R OR L) M CHOOSE BOLUS PEAK - TAKE FILM 2 BEFORE MARKING CHOOSE POINT 10 SEC AFTER BOLUS ENTRY E.G. X=5 THEN MOVE MARKER UNTIL X=15 M CHOOSE POINT 15 SEC AFTER BOLUS ENTRY M RESULTS DISPLAYED TAKE FILM RB CA - TO RETURN TO BGAMMA THALLIUM ANALYSIS STUDY IS COLLECTED IN 128X128 BYTE STUDY MUST BE CONVERTED TO 64X64 WORD 1. CALL UP GRID RI MARK X AXIS AND NOTE X FACTOR (AS FOR GATED HEART) 2. CALL UP EXERCISE STUDY AND AT COMMAND MR CONVRT (B) CALL UP DELAY AND AT COMMAND ,2 3.CALL CONVERTED EXERCISE AND AT COMMAND MR THAL (A) OUTLINE MYOCARDIUM OUTLINE CHAMBER MARK CENTROID WITH ONE CELL MARK APEX WITH ONE CELL - CTRL X (B) E (I.E. ERASE REGIONS) AND MARK REGIONS AGAIN FOR ANTERIOR - CTRL X (C) E (I.E. ERASE REGIONS) AND MARK REGIONS AGAIN FOR 70 LAO - CTRL X 4. (A) SELECT DELAY AND AT COMMAND ,7 N.B. DO NOT TYPE S X TO EXIT MOVE IMAGE UP (I.E U) OR DOWN (I.E. D) TO FIT REGIONS X TO EXIT (B) REPEAT ABOVE FOR ANTERIOR (C) REPEAT ABOVE FOR 70 LAO DO YOU WISH TO ADD RESULTS N ENTER X CELLS FROM GRID E.G. 70 TAKE FILMS AS BELOW N.B. DELETE HEART - 64