Health Imaging & IT - October 2007 - (Page S1) When increasing or decreasing the size of logo, always scale proportionately. Smallest size should not fall below 1/2" (inch) to preserve quality and appearance. The CMYK logo treatment should be used in situations where 4 Color process is the chosen means for printing. Use best judgement to decide which logo (1 or 2) will suit the situation presented. TERARECON LOGO 1 USAGE GUIDELINES: This logo should be used in situations where the background color is NOT white (unless proper approval is given or specified). Best appearance will result when the logo is placed against dark color backgrounds and include, but are not limited to the blue and black color spectrums, as well as any dark colors that contain 50% and higher of one or more of the following: Magenta (M), Black (K) and Cyan (C). TERARECON LOGO 2 USAGE GUIDELINES: This logo should be used in situations where the background color is NOT within the same blue color spectrum as lthe logo gradient box and should NOT be placed against a black background (unless proper approval is given or specified). Best appearance will result when the logo is placed against a white or light color background and include, but are not limited to colors that are 50% or less in one or more of the followoing: Cyan (C), Magenta (M), Yellow (Y), and Black (K). LOGO COLOR SPECS a. Tri-Diamonds Fill: Left Diamond = C100% M75% Y0% K10% Middle Diamond = C90% M10% Y0% K0% Right Diamond = C0% M0% Y0% K0% Stroke: 2pt Black (K)15% b. Text Coronary CTA White Terarecon on top of 100% black Terarecon which serves as a drop shadow to it’s white colored counterpart. c. Gradient Box Blue C100% M75% Y0% K10% (Beginning on Left) Blue 100% M92.16% Y0% K60% (Ending on Right) 3D Interpretation in 5 Minutes or Less Perspectives from interviews with leading cardiac luminary physicians. Modern CT scanners are now capable of performing CT coronary arteriography (CTCA) using low intravenous contrast volumes with imaging completed in a less than 10 seconds. However, the issues of success are not so dependent on the actual image acquisition, but in the interpretation by the imaging specialist. A rapid method to navigate through the large “volumetric” CT dataset involves knowing how to best visualize the various epicardial segments and having a standardized method of review. Both John Rumberger, M.D. and Tony DeFrance, M.D., two cardiac experts who specialize in providing CTA certification training, agree that CTAs can be accurately read in a 5-15 minute time span. A normal study can be read and reported in 3-5 minutes; a study of a patient with a bypass condition and complicated anatomy can take up to 15 minutes. Dr. Rumberger is Director of Cardiac Imaging at the Princeton Longevity Center in Princeton, NJ. Dr. DeFrance is Program Training Director for the SCCT and Medical Director for CVCTA Education in San Francisco, CA. Both use a consistent cardiac protocol using “vessel navigation” to read CTAs. “The choice of a visualization workstation is one of the most important decisions to be made by physicians working with CTCA,” according to Dr. Rumberger. “The major concern is that the reading/interpretation platform must provide for rapid review of the huge 2-D and 3-D volume datasets and convenient structuring of the final report. The system must offer the ability to perform advanced image manipulation, and the potential to review dynamic imaging sequences for determining cardiac dimensions and volumes (such as with left ventricular size and global/regional function). Finally, the workstation should have a universal operating system so that further image processing (e.g. for formal presentations and research papers), image storage and communication (e.g. via a server or the PACS system), and report generation and distribution to referring physicians can be done easily and seamlessly. I use the TeraRecon Aquarius Workstation for these and other cardiac and noncardiac image processing purposes.” “The interpretation protocol should proceed along established guidelines for interpreting tomographic images and in a systematic fashion,” continued Dr. Rumberger. “My “work path” of how I approach CTCA of the native coronary arteries starts with the left main (LM) and then goes down the left anterior descending (LAD). Once I review the LAD, I return to the LM and proceed down the left circumflex (LCX) and its branches. Finally, I return to the right coronary artery (RCA) ostium, and proceed distally to the most inferior segments.” Dr. Rumberger’s protocol includes reviewing 6 different phases of the heart cycle, several end systolic views of 45-50%, and several around the 70% phase. “Even though I may not use all the phases, I need to quickly establish the best set of images to review. Dr. DeFrance reads in a similar and consistent fashion. After an initial evaluation of the 3D image looking for abnormalities, he opens a coronal MIP image to assess study quality and to identify artifacts. He next looks at non-coronary artery structures in a stepwise fashion. To evaluate coronary arteries, Dr. DeFrance uses centerline analysis, oblique rotation, and curved planar reformat techniques. “There is so much data in these studies that if you are not trained to read in a systematic and stepwise fashion, you can miss pathology and misdiagnose patients” said Dr. DeFrance. He believes that establishing your workflow 1 Coronary CTA w w w. t e r a re c o n . c o m http://www.terarecon.com http://www.terarecon.com
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