Circle Cardiac MRI Tutorial

Transcript

• 00:04Welcome everyone, we're going to go
• 00:06over a circle tutorial here in order
• 00:09to open up the circle software,
• 00:11you would go to your desktop and you
• 00:13would find the icon. The CBI 42.
• 00:16Once it opens up to look like this
• 00:18an in order to find your patient,
• 00:21you would type in your name and we are
• 00:24putting in an anonymized study so that
• 00:26people can view this video far and wide.
• 00:29So in order to open up the study,
• 00:31you would come here and you
• 00:32would double click on the study.
• 00:37And it will open up this window
• 00:39here normally for importing the
• 00:41data you go to the patient data.
• 00:44You would include the height
• 00:46and also the weight and put that
• 00:48into your power scribe reporting.
• 00:51Then I come to the viewer and
• 00:53under the viewer you would drag
• 00:56in a couple views for the patient,
• 00:58including the short axis stack over here,
• 01:01and then draw.
• 01:03Pull in the four chamber view as well.
• 01:06This is the two Chamber view here.
• 01:10And the Ovilo TV was down here,
• 01:12so you drag all those in an you
• 01:15would come to either one of these
• 01:18icons here to play the Sini.
• 01:20This will give you a gestalt
• 01:22of wall motion abnormalities.
• 01:24You can also take a look at the valves,
• 01:27look at regurgitation and things like that.
• 01:31And then the next thing I like to do
• 01:34is to pull over the short axis stacks in a.
• 01:37This will give you a cut
• 01:40through the left ventricle.
• 01:42So coming over here an you
• 01:44would double click on it,
• 01:46but it will essentially stagger out
• 01:48all the sections across the LV short
• 01:51axis deck and this is a good view
• 01:53for you to evaluate for LV function.
• 01:56But most importantly for this
• 01:58view is to look for wall motion
• 02:00abnormalities so you would click that
• 02:03icon again to play the city images
• 02:06so you can see here at the base of
• 02:09the hard you can see the vertic bow.
• 02:12You can see the Atria,
• 02:14you can see the mitral valve here and then.
• 02:17Here is still the base of the heart.
• 02:19This is the LV.
• 02:20This is the RV,
• 02:22and so this is going from the top,
• 02:24the base coming down as we
• 02:26go through the images.
• 02:27So this is kind of mid model
• 02:29cardio here and then.
• 02:31This is the apex down here.
• 02:33The one other thing that you can
• 02:36do on the viewer is to assess your
• 02:40elvie left or your left atrial size.
• 02:43So you could come play here to
• 02:47find an systole where your left
• 02:50atrium is the largest.
• 02:52So just using your keystrokes,
• 02:54find where your left atrium is.
• 02:56Largest, you can use this tool up here.
• 02:59This blue lasso freehand tool.
• 03:02To trace your left atrium.
• 03:08You could also contour it if
• 03:10you don't like how it went.
• 03:15And then you can click on it so that
• 03:17it stays steady and then click on
• 03:19it again to trace the right atrium.
• 03:28So this will give you the left
• 03:31and the right atrial sizes,
• 03:33so we can see this patient Atria.
• 03:35The left is a little mildly
• 03:37enlarged at 25 centimeters squared,
• 03:39and the right atrium is also mildly
• 03:42enlarged at 20.7 centimeters squared,
• 03:44so that will give you the atrium.
• 03:46So for evaluation of the LV volume
• 03:49metrics as well as the LV function,
• 03:52and also RV function,
• 03:53you would go to the short 3D here
• 03:56and you would go over to the right.
• 03:59To pull the short axis stacks
• 04:01in a which is right here.
• 04:03So you'll drag it over
• 04:05over to this window here,
• 04:07and I'll also drag over one of the Sundays
• 04:10as well that we saw earlier in the viewer.
• 04:14And this is where you would define your LV.
• 04:19Space as well as apex,
• 04:20so it seems like it already
• 04:22has it defined there,
• 04:23but you would come up here you would.
• 04:26Put the base definition and then
• 04:28I'll drag down here to the apex.
• 04:30So it seems like already had that.
• 04:34In order to define the
• 04:36epyon endocardial borders,
• 04:37the easiest way now because
• 04:39it has a pretty good AI,
• 04:41is to come up to this icon here,
• 04:43and it will actually help you
• 04:45define end systole and diastole.
• 04:47It will trace the RV,
• 04:48or trace the Appian endocardial border.
• 04:50So that's what we're going to press here.
• 04:54It's gonna take a little bit of time and
• 04:56it's going to trace everything for you.
• 04:58Alright, so once it races everything,
• 05:00the numbers including the end,
• 05:02diastolic volume,
• 05:03and systolic volume stroke
• 05:05volume injection fraction,
• 05:06cardiac output,
• 05:07index mall cardio mass,
• 05:08and then the indices are going to
• 05:11show up at in this window here and
• 05:14the RV shows up at the bottom here.
• 05:17So going down into this viewer,
• 05:20what these circles and the axis mean?
• 05:22So if you go from top to bottom
• 05:25or along the Y axis,
• 05:27you start with the base of the.
• 05:32So as we come down and it goes all
• 05:34the way down to the apex so you can
• 05:37see that and then along the X axis you
• 05:40go between systole an end diastole.
• 05:43So this one is your end assally.
• 05:46Go get the ventricle get smaller.
• 05:48This is your end.
• 05:49Systole and the machine is picked out,
• 05:51where N Sicily is and it is also
• 05:54picked out where end diastole is.
• 05:56So in general these are about
• 05:59the right size slices for end
• 06:01systole and diastole and you want
• 06:03to check to make sure that it got
• 06:06the right slices and that it's not
• 06:08calling ventricle where there is no
• 06:11ventricle so the base is 10 tends
• 06:13to be the toughest slice to call.
• 06:16But sometimes you would use
• 06:17the stroke volume,
• 06:18match it up with your face contrast,
• 06:21which I will go over next.
• 06:23So just kind of look through your
• 06:26slices and make sure it matches up
• 06:29and that the contours are correct.
• 06:31The overall looks pretty good,
• 06:33so just going now over to the end
• 06:37diastole slices. So coming up.
• 06:39Actually looking here,
• 06:40so this is one example,
• 06:43so this marker here shows you
• 06:45that you're already kind of
• 06:47outside of the right ventricle,
• 06:49but it's calling this the right ventricle,
• 06:52so more or less you can.
• 06:56Delete that slice.
• 06:57If you indeed do not see
• 06:58right ventricle through there.
• 07:00So I'm going to actually go here.
• 07:03Right click and delete that
• 07:05right ventricle slice.
• 07:06I'm going to go up and see.
• 07:08Looks like there is some
• 07:11right ventricle there.
• 07:12This kind of going up.
• 07:14And making sure the tracings are
• 07:16OK and edit them as DB so you know,
• 07:19looking here,
• 07:20you can even kind of narrow the
• 07:22slice for the Epicardial border
• 07:24and you get smooth it out,
• 07:26so you would hold here and kind
• 07:28of just drag it to where you
• 07:30see the epicardial border is.
• 07:32So let's see if another slice we can
• 07:35do something similar so you would come here,
• 07:38drag it to highlight it so it turns green,
• 07:41the Epicardial border,
• 07:42and you would just shrink it like that,
• 07:44and you could smooth it
• 07:46out with this button here.
• 07:49Let me see if there's any other slice
• 07:51that needs a little bit of editing,
• 07:53so now we're getting very close
• 07:55to the base here at the junction
• 07:57of the ventricle and the atrium,
• 07:59let's see if there's anything else
• 08:01we need to edit for this slice.
• 08:04This one is calling this the arviso.
• 08:07Another thing to do is.
• 08:10Play it to see whether or not you
• 08:12actually see RV coming in there does
• 08:14look like it does come in there,
• 08:15so if you could keep keep that there,
• 08:18but you can see whether or not the.
• 08:20Stroke volume and also the.
• 08:23Yeah, it looks normal.
• 08:25If you visually think that it looks normal.
• 08:28Now I'm going to show you the flows so
• 08:31you would go over to the flow segment.
• 08:34Down here on the left and you
• 08:36would find your aortic and also
• 08:38your pulmonary flows.
• 08:40So this is the order flow so you pull
• 08:42it into the phase contrast window on
• 08:45the left here and you would circle
• 08:47your aorta and in order to circle
• 08:50the order you kind of find when the
• 08:53order is kind of circular by toggling on the.
• 08:56Key on the key with the arrows,
• 08:59the right arrow and then you
• 09:01would click this button up here,
• 09:03the first red one.
• 09:05And you would trace your aorta.
• 09:11Then you could always smooth it out.
• 09:14Contour an you would press this
• 09:16button up here to smooth that out.
• 09:19And then in order to take this
• 09:21forward across all phases,
• 09:22you would press this button next.
• 09:26And then it gives you the forward
• 09:28flow through the aorta and you
• 09:30would play it just to see that the
• 09:32tracing around the order is accurate.
• 09:34That is not picking up pulmonary
• 09:36artery or something like that.
• 09:37So it looks pretty good.
• 09:38And then after you get your aorta next,
• 09:41when you want to look at
• 09:43is the pulmonary flow.
• 09:45Owner flows down here.
• 09:48Alright, same thing so you.
• 09:51Advance so that you see kind
• 09:52of a circular pulmonary artery,
• 09:54which is right here and then you
• 09:56would select a different color
• 09:58to contour your pulmonary artery
• 10:00so it contour this here.
• 10:05And then forward it across all slices.
• 10:09By pressing this button here.
• 10:13Shrink that a little bit.
• 10:16Just gonna go through each licensee.
• 10:22If the contours of good and that
• 10:24is not picking up another vessel,
• 10:27so looks pretty good and.
• 10:30Overall there's about a 10CC difference.
• 10:34Between the. LV or the aortic
• 10:36flow and also the pulmonary flow.
• 10:40But you could adjust this.
• 10:42Normally this curve for your
• 10:43flow is automatically there,
• 10:45but if you don't see it,
• 10:47it means that it's essentially
• 10:49closed up and you would come to the
• 10:52left side and try to drag it over.
• 10:55That's essentially what happened
• 10:56for that and.
• 10:58Sometimes you could edit this
• 11:00flow like you can cut out some of
• 11:03this flow from the pulmonary side
• 11:05so that it can match up a little
• 11:08bit more with the systemic flow.
• 11:10Technically,
• 11:10if there is no shunt between the
• 11:13Atria or the ventricle or outside
• 11:15of the heart like the lungs or IVC,
• 11:17or somewhere the systemic flow volume
• 11:20which is seen here should match up
• 11:22with the pulmonary flow volume,
• 11:24which now is like the 78,
• 11:26so let me see if I can.
• 11:30Do that again. OK, there we go.
• 11:35Behavioral OK, so this is the systemic
• 11:39flow and this is the pulmonary flow.
• 11:43And this would be used for calculating
• 11:45assessing for any regurgitation.
• 11:47So you would compare what this volume is.
• 11:50So let's say for example
• 11:52like your systemic flow.
• 11:54With 72, you would go to your short 3D
• 11:57viewer again and look at your stroke volume,
• 12:00so they should match up pretty well,
• 12:03like if this were so 72.
• 12:05So there's like a 10CC difference.
• 12:08If that were real, that means this person
• 12:10is like mild mitral regurgitation.
• 12:13Because the stroke volume was 8283,
• 12:16but the aorta.
• 12:18Only saw 72, so there's a 10CC difference.
• 12:23OK, so once the circles are all traced
• 12:26and you have all your volume metric data,
• 12:30your volumes and your ejection fraction,
• 12:33you would go to your.
• 12:36Powerscribe, and that's where
• 12:38you're going to put all the data,
• 12:40so this is just an example of
• 12:43a template for an MRI stress,
• 12:45and this one allows you to put in,
• 12:48you know, the end diastolic volume.
• 12:50You would put the height and weight,
• 12:53and then your ejection fraction.
• 12:54Actually,
• 12:55I can show you the end diastolic
• 12:57diameter and end systolic diameter.
• 12:59So in order to do that,
• 13:01you would come down to about the mid
• 13:04ventricle. There an use this. Tool.
• 13:08Go across. Or and I actually saw that.
• 13:12Blink is 48.6 millimeters and two.
• 13:18Assess the.
• 13:20Thickness of the internal septum you
• 13:24would trace this portion portion here.
• 13:27Amanda trace the Inferolateral wall.
• 13:29It would be this portion here.
• 13:32So then it gives you thickness
• 13:34of anterior septum and the
• 13:36inferolateral or infralateral wall,
• 13:38and in order to get the end systolic.
• 13:44Diameter, you would trace it on the end.
• 13:47Systole phase here, so are the same.
• 13:51Slice as your diastole face,
• 13:52so this one is 35.
• 13:54So then, in your power scribe,
• 13:56you would be able to put in the end
• 13:59diastolic diameter and systolic diameter,
• 14:01and in the normal MRI they also ask for
• 14:03that Antero septal thickness as well as
• 14:06the inferolateral wall thickness as well.
• 14:08So you just input all the numbers for the LV.
• 14:12All the numbers for the RV put in your.
• 14:17Volumetrics and size for your left
• 14:19and right atrium, and then you.
• 14:21Of course, you would assess you
• 14:22know whether or not the there's any
• 14:25valvular issues through regurgitation,
• 14:26and then this would be a template
• 14:30dictation for that.
• 14:31Right, that's more or less set for today.
• 14:34Thank you everyone for your attention.