Aims Workflow of CTC Interpretation Supine-Prone Registration Quality Assurance: The Bottom Line Methods of Interpretation

Aims Workflow of CTC Interpretation Supine-Prone Registration Quality Assurance: The Bottom Line Methods of Interpretation www.phwiki.com

Aims Workflow of CTC Interpretation Supine-Prone Registration Quality Assurance: The Bottom Line Methods of Interpretation

Canedo, Mario, News Director has reference to this Academic Journal, PHwiki organized this Journal CTC Workflow: Reviewing & Reporting Exams Abraham H. Dachman The University of Chicago Aims Explain the workflow involved in interpreting in addition to reporting CTC Environment as long as Interpretation Quality assurance Common strategies of interpretation Generating a CTC report Mike Macari’s Office

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Workflow of CTC Interpretation Confirm segmentation in addition to map out colon 3D transparency view or coronals Quality assurance Distention, stool, fluid, tagging Search as long as polyps using both 3D in addition to 2D Characterize in addition to measure polyp c in addition to idates Secondary CAD-assisted evaluation Report (follow C-RADS guidelines) Search as long as extracolonic findings SUPINE PRONE Supine-Prone Registration

Q.A. CHECKLIST Location of segments tortuosity mobility when comparing supine to prone Identify ileocecal valve Quality of distention Q.A. CHECKLIST Retained stool size tagging Retained fluid quantity location tagging change supine – prone Artifacts (e.g., metal, breathing) QA by technologist includes review of axial images as long as distention Always Identify IC Valve Not always intuitive Identify by: Location Fat Shape Papillary (dome-shaped) Labial Mixed

Poor Preparation Excessive untagged feces Quality Assurance: The Bottom Line Are any segments suboptimal on both views Could a 10 mm polyp be obscured Methods of Interpretation 3D with 2D problem solving 2D with 3D problem solving Soft tissue windows as long as flat lesions Bone windows as long as dense oral contrast tagged fluid in addition to stool Virtual Pathology (open views) Computer-aided diagnosis (CAD)

Methods of Interpretation 3D with 2D problem solving 2D with 3D problem solving Soft tissue windows as long as flat lesions Bone windows as long as dense oral contrast tagged fluid in addition to stool Virtual Pathology (open views) Computer-aided diagnosis (CAD) 6 mm Polyp on a Fold Coated with tagging agent Basic Feature of Polyps prone supine

Non-tagged Stool Mobile, With Internal Gas PRONE SUPINE Well – Tagged Stool Lipoma on the ICV

Courtesy of J.L. Fidler, MD Dedicated Read as long as Flat Lesions Wide Soft Tissue Window in 2D Endoscopic view Polyps vs. Stool Solid, soft tissue Compare to muscle Use wide soft tissue window setting – interactively Does not move Compare supine to prone Decubs as needed Use many clues to confidently compare Nearby folds, tics Curvature of colon Lesion morphology, size Mottled pattern Use wide soft tissue window interactively Entire target is mottled Not a polyp covered by stool: no “footprint” along wall that is solid Moves To dependant surface Axial in addition to sagittal views best If solid; beware of colonic mobility Approach to Polyp C in addition to idate Analysis Polyp vs. fold > use > 3D or MPRs Polyp vs. stool > use > texture (W/L or color map) If solid Compare supine / prone as long as mobility If mobile, check as long as long stalk, colonic rotation / flip

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Primary 3D Read Strategies Forward in addition to backward Supine in addition to prone Special software features (e.g., color map as long as polyp characterization, show blind areas) Problem solve in 2D as needed as you read Bookmark & defer difficult problem solving (e.g., difficult supine/prone comparison) Primary 2D Read Learn to “Track the Colon” Highly magnified axial Go slowly ! Look at all surfaces Evaluate very short segments as you move along an imaginary centerline Use a lung window (1500/-600) setting or “colon” (2000/0) Non-magnified or magnified MPR Simultaneous or deferred endoluminal comparison 60° 90° 120° Antegrade 60° 90° 120° Retrograde

Polyp Transverse Colon Difficult 2D

C-RADS Classification C0 Inadequate study (can not evaluate 10 mm lesions) C1 Normal, routine follow up (Q 5 yrs CTC) C2 Indeterminate; 1-3 yr f/u Polyp 6-9 mm, < 3 in number Findings indeterminate; cannot exclude polyps 6 mm C3 10 mm or >3 6-9mm polyps Colonoscopy C4 Mass, likely malignant; surgical consult Zalis et al as long as the Working Group on VC. Radiology 2005;236:3-9. Summary Both 2D in addition to 3D skills are needed – use it in every case Use a systematic approach that involves QA of images, recognition of anatomic l in addition to marks in addition to supine-prone comparison Recognize pitfalls in addition to use CAD secondary read Report using C-RADS guidelines in addition to recommendations THANK YOU ! Acknowledgments Contributors to “The Atlas of Virtual Colonoscopy” Eds1 & 2 Mike Macari, Philippe Lefere.

Canedo, Mario News Director

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