GE Medical

Systems

AdvantageCTC Base/Plus/Pro

User Guide
2404557–100
Revision 2

Copyright
2004,
by GE Medical Systems
User Guide
 REGULATORY REQUIREMENTS
This product complies with the regulatory requirements of the following:

 Council Directive 93/42/EEC concerning medical devices: the label affixed to the product testifies
compliance to the Directive.
European registered place of business:
GE Medical Systems Europe
Quality Assurance Manager
BP 34
F 78533 BUC CEDEX France
Tel: +33 (0)1 30 70 40 40
 Medical Device Good Manufacturing Practice Manual issued by the FDA (Food and Drug Administration,
Department of Health, USA). AdvantageCTC approved by FDA under k number K041270.
 Underwriters’ Laboratories, Inc. (UL), an independent testing laboratory.
 Canadian Standards Association (CSA).
 International Electrotechnical Commission (IEC), international standards organization, when applicable.
 USA/HHS:
United States Federal law restricts this product to use by or on the order of a physician.
CAUTION

 General Electric Medical Systems is ISO 9001 and EN 46001 certified.

 The original document is written in English.

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AdvantageCTC 2404557–100 Rev. 2 2

 TABLE OF CONTENT
REGULATORY REQUIREMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
CHAPTER 1 – INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1 SOFTWARE OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2 ADVANTAGECTC OPTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
3 HARDWARE AND SOFTWARE REQUIREMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
4 IMAGE REQUIREMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
5 MANUAL OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
6 CONVENTIONS FOR THIS MANUAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
CHAPTER 2 – SAFETY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Review mode [Base, Plus, Pro] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Review mode [Plus, Pro] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Analysis mode [Base, Plus, Pro] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Analysis mode [Pro] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Closing the software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
CHAPTER 3 – STARTING THE ADVANTAGECTC PACKAGE . . . . . . . . . . . . . . . . . . . . . . . 23
1 OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

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2 IMAGE SERIES REQUIREMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3 IMAGE MEASUREMENT ACCURACY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
4 SERIES/IMAGE SELECTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
5 STARTING THE ADVANTAGECTC PACKAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
CHAPTER 4 – ON–VIEW OPERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
1 OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
2 MAIN CONTROL PANEL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3 THE REVIEW CONTROLLER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Reviewing the Slices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Managing Bookmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Shortcuts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
4 MAIN ON–VIEW MENU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
In Review Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
In Analysis Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
5 SCREENING PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
CHAPTER 5 – ADVANTAGECTC OPERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
1 OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
2 REVIEW MODE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

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 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Reviewing the Slices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Paging using On–view Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Navigation Using the Keyboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
3 COLONOGRAPHY PROTOCOL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Using the Adjustment Slider to align both series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
CHAPTER 6 – VIRTUAL DISSECTION PROTOCOL [PLUS, PRO] . . . . . . . . . . . . . . . . . . . 51
1 STARTING THE VIRTUAL DISSECTION OF THE COLON . . . . . . . . . . . . . . . . . . . . . . . . . . 52
2 DEFINING THE PATH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Manual points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Automatic points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
3 LAUNCHING THE CALCULATION OF THE PATH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
4 360 DISSECTION VIEW [PRO] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
5 SAVING AND RELOADING DATA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
6 EXPLORING THE COLON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Navigating along the centerline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Navigating against the wall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Stepping through the colon [Pro] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Rotating the navigator views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

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7 SYNCHRONIZING PRONE AND SUPINE SERIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
8 BUILDING A MOVIE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
CHAPTER 7 – AUTO DISSECTION PROTOCOL [PRO] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
1 LAUNCHING THE AUTOMATIC TRACKING OF THE COLON . . . . . . . . . . . . . . . . . . . . . . . 72
CHAPTER 8 – ANALYZING IMAGES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
1 BOOKMARKING A SUSPICIOUS LOCATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Creating bookmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Deleting bookmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
2 ANALYZING A SUSPICIOUS LOCATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Entering Analysis Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Using reformatted and Navigator views for closer study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Colorizing a polyp [Pro, VD & AD protocols only] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
3 QUITTING ANALYSIS MODE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
CHAPTER 9 – FILLING IN AND SAVING A REPORT [PLUS, PRO] . . . . . . . . . . . . . . . . . . . 85
1 FILLING IN A REPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Pre–Exam data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Exam Analysis data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

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 Post–Exam data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
2 RECORDING AND RETRIEVING THE REPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
CHAPTER 10 – QUITTING ADVANTAGECTC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
SERVICE OFFICES OF GE MEDICAL SYSTEMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
REVISION HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

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 CHAPTER 1 – INTRODUCTION
1

AdvantageCTC is an image analysis software package for Advantage Workstation (AW) systems. It is an
option of GE’s Volume Viewer Plus software and uses embedded Navigator and Volume Rendering.
AdvantageCTC allows the user to study the inside, wall and outside of the colon. It provides the user with the
possibility of concurrently viewing datasets from prone, supine and decubitus positions, in order to facilitate
the detection of colonic lesions. In comparison with classical colonoscopy, this tool has the advantage of
providing a non–invasive depth penetration of the colon, thanks to its 3D presentation capability.
Navigator provides endoluminal views of anatomical structures. It is meant to enhance and modify the current
image quality, the tools, the speed and the user interface for Navigator views, for an improved productivity.
Navigator is a visualization tool, which allows the user to investigate structures (such as polyps, tumors,
stones, calcification, etc.) within the anatomy, airways and organs. Its viewing capability of the inner and outer
surface of organs, as well as of their walls, provides additional information, coming in complement of
endoscopy/colonoscopy to support interpretation and treatment planning. Navigator is applicable to X–ray as
well as CT and MR. The Navigator User Manual is included within the Volume Viewer Plus User manual, GE
ref. 5110935–100.

Volume Rendering provides volume rendering views of anatomical structures. It is meant to enhance and
modify the current image quality, the tools, the speed and the user interface for Volume Rendering views, for
an improved productivity. Volume Rendering is applicable to X–ray as well as CT and MR. The Volume
Rendering User Manual is included within the Volume Viewer Plus User manual, GE ref. 5110935–100.
The resulting images can be recorded in the AW Browser as a new Save Screen series, for further study with
the different tools provided on the AW Workstation.

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1 SOFTWARE OVERVIEW 1
Colorectal cancer (CRC) is a very common cause of cancer death – ANY person can get it. The 5–year life
expectancy is rather low. It depends on the stage of the disease at operation. The prevalence of the disease
progressively increases throughout life after the age of 50. The cancer occurrence decreases or is eliminated after
polypectomy.
This is a key concept. It is believed that most cancers arise from pre–existing adenomatous polyps. Detection and
removal of these polyps can prevent the disease from occurring, and has been associated with a reduction in the
prevalence of colorectal cancer, and colorectal cancer mortality.
None of the currently available examinations are optimal in terms of performance, safety, cost or patient acceptance.
AdvantageCTC solves some of these problems. Patient acceptance of a faster more comfortable exam will be
important in improving compliance.
AdvantageCTC is an optional image analysis software package of GE’s Volume Viewer Plus software. It allows the
study of the inside, wall and outside of the colon. It is a tool designed to make the detection of colonic lesions, such
as polyps, easier.
The backbone of the sytem is a combination of traditional axial–paging functions, correlative multiplanar reformatted
views with 3D endoluminal correlation, and a 3D interactive exploration of the colon with dissection views of the
inner surface of the colon.
The images reviewed on GE’s Advantage Workstation allow the following functions to be efficiently performed:
 Softcopy review of entire series, with comparison of different anatomic orientation between acquisitions (supine
& prone)
 Identification of suspected lesions

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 Exploration of these ’lesions’ in 2D and 3D reformatted sections
 Display of perspective and isometric volume rendered views 1
 Recording of detected lesions
The study will be performed using helical CT –acquired images. Since the preparation of the patient is not always
perfect, some parts of the colon wall may not be seen in normal Supine views, as they may be covered by fluids or
other substances. It is therefore necessary to retrieve two sets of images, a Supine series and a Prone series.
Decubitus views may be necessary when areas of the colon are filled with fluid.
The study then occurs in two different steps, combining two different study modes:
 Review Mode: The user will start the study by reviewing the acquired images in order to locate any suspicious
region. Both series of image data are transferred to GE’s Advantage Workstation and loaded concurrently for
simultaneous viewing. Viewing both the Supine and Prone data sets on the same screen is one of the software’s
essential and unique feature. It can potentially help confirming the existence of a lesion, thus reducing the
number of false positive (or negative) examinations, for example due to retained stool. Once the user has
detected a potential lesion, a tool allows him to bookmark the concerned location.
 Analysis Mode: The software then toggles into Analysis mode, offering a combination of 2D reformatted views
with correlated 3D Navigator view, centered on the bookmarked location. This view will allow the user a closer
study of the suspicious region, so as to help him determine whether it really is a polyp or not. Images can then
be recorded for further study and printed within the AW Browser.

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2 ADVANTAGECTC OPTIONS 1
AdvantageCTC has three options: Base, Plus and Pro. Each option includes specific features as shown in the table
below. Always check this table to verify their applicability.
The intended use in Chapter 2 covers the whole range of clinical features available in AdvantageCTC Pro. Please
note that some of these features are not available in AdvantageCTC Base and AdvantageCTC Plus options.

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 AdvantageCTC features Base Plus Pro
SmartCursor    1
2D Analysis   
3D Analysis   
Multiple Series Load   
Prone/Supine/Decub Compare   
Save State Bookmarks   
Wall View   
Small Bowel Extraction  
Centerline Edit  
Semi Automatic Centerline  
Reporting  
120 Dissection  
Save State Centerline edits  
Movie Generator  
Centerline Navigation 
Color Centerline Tracking 
Polyp Color Display 
Whole Colon Movie 
Automatic Centerline 
Variable Speed Navigation 
360 Dissection 

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3 HARDWARE AND SOFTWARE REQUIREMENTS 1
The software package runs on a standard AW4.2P or later platform. The film output is done on the platform output
device. It accepts image data acquired through any AW compatible CT system. The Volume Viewer Plus software
package must be activated on the AW station.
The system requirements for the AW workstation are the same as those needed to install Volume Viewer Plus.

Note: The AdvantageCTC software being an option, you will need a key number to activate it.

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4 IMAGE REQUIREMENTS 1
It is recommended to reconstruct CT images with a 3mm interval and a slice thickness of 3mm or under. During a
single breath–hold, an approximately 40 cm thick section of the abdomen containing the entire colon is scanned.
Because of the difference in density between the insufflated colon lumen and the surrounding tissues, a dose as low
as 120 kV and 80 mA/s may be used.

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5 MANUAL OVERVIEW 1
The AdvantageCTC Package retains many of the original Volume Viewer Plus screens and features. This manual
provides a brief description of AdvantageCTC specific screens and features. Please refer to your AW Volume
Viewer Plus manuals, if available, for a description of the non AdvantageCTC specific screens and features.
 For a general overview of the features and functions of the AdvantageCTC software as well as basic
requirements concerning the software and the exams, read Chapter 1, ”Introduction”.
 To select an exam and start the AdvantageCTC Package from the AW Browser, refer to Chapter 3 “Starting the
AdvantageCTC Package”.
 To view and adjust the images displayed by AdvantageCTC , see Chapter 4 ”On–View Operation”.
 For a complete description on how to use the AdvantageCTC software including the Review Mode, the
Analysis Mode and the Colonography protocol, see Chapter 5 “AdvantageCTC Operation”.
 [Plus, Pro] To learn how to perform a virtual dissection of the colon with AdvantageCTC , refer to Chapter 6
“Virtual Dissection protocol”.
 [Pro] To learn how to perform an automatic dissection of the colon with AdvantageCTC , refer to Chapter 7
“Auto Dissection protocol”,
 To analyze images, refer to Chapter 8 “Analyzing images”,
 [Plus, Pro] To learn how to fill in and save a report, see Chapter 9 “Filling in and saving a report”.
 To quit AdvantageCTC , see Chapter 10 “Quitting AdvantageCTC”.

Note: This manual assumes the user understands AW Volume Viewer Plus software operation.

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Note: Graphic User Interface may change, depending of the screen configuration of your system. However, the
meaning of the buttons remains the same. You should only refer to the button’s name.
1

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6 CONVENTIONS FOR THIS MANUAL 1
Note: The text in this manual uses certain typing styles and symbols to differentiate between one tool or graphic
and another.
This manual uses the following conventions:
 Applicability appears in bold face italics, within brackets
(example: [Base, Plus, Pro])
 Menu titles appear in bold face
(example: Application Menu)
 Menu options appear in bold face, within brackets
(example: [exit])
 On-screen tools appear in bold face, within braces
(example: {Scroll Bar})
 Graphical buttons appear in bold face, within parentheses (example: (View))
 On-screen prompts and messages appear in italics
(example: Login:)
 User typed-in responses appear in bold face italics (example: root)
 Keyboard hardkeys and mouse buttons are underlined (example: Return or left)
 This manual calls the [Navg] or [Navg Smooth] view type, the “Navigator” view.
 This manual calls the graphic representation of the Navigator in each view type the “Navigator indicator.”

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 CHAPTER 2 – SAFETY

To assure an efficient and safe use of AdvantageCTC , it is essential to read this chapter before
attempting to use the package.
2
This chapter is extremely important. It contains safety information that you must thoroughly understand
before you begin to use the software.

AdvantageCTC is an application which runs in the Advantage Workstation environment. Therefore, the
user MUST have a good knowledge and understanding of both the Advantage Workstation and Basic
Display.

The software is intended for use by qualified and trained personnel only. If you need additional training, seek
assistance from your GE applications specialist by contacting the appropriate number near the end of the
manual.

Make certain that the correct version of your operator manuals are readily available at all times. Make a point
to review the procedures and safety precautions periodically.

Additional safety concerns are addressed in the Advantage Workstation Basic Display documentation and in
the Volume Viewer Plus User Guide, GE ref. 5110935–100.

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Intended Use

CAUTION
AdvantageCTC is a CT image analysis software package which allows the
visualization of 2D and 3D medical image data of the colon derived from DICOM 3.0 2
compliant CT scans for the purpose of screening of a colon to detect polyps,
masses, cancers, and other lesions. It provides functionality for 2D/3D rendering,
bookmarking of suspected lesions, synchronized viewing of the 2D, 3D and 360
dissection views, and an object oriented endoluminal display. In comparison to
Colonoscopy, this tool has an advantage of depth penetration due to its 3D
presentation capability. It is intended for use by Radiologists, Clinicians, and
referring Physicians to process, render, review, archive, print and distribute colon
image studies.

CAUTION
AdvantageCTC should not be used on its own for diagnosis or treatment. Diagnosis
and treatment are the responsability of the physician.

Review mode [Base, Plus, Pro]

CAUTION
Using both series (supine and prone) is important as the patient preparation is often
not perfect: some parts of the colon may only be visible for one patient orientation
and not for the other.

CAUTION
Always use different cross–reference views to check what is the local shape of the
colon wall.

AdvantageCTC 2404557–100 Rev. 2 20

CAUTION
Always check prone and supine series to make sure a suspected area is not induced
by retained stool.

Review mode [Plus, Pro]

2
CAUTION
Wrong colon tracking may lead to missing lesions. In case of wrong tracking, use
the semi–automatic tools to create the appropriate centerline.

CAUTION
In case of wrong tracking and of a complicated or twisted stretch, it is possible to:
– define intermediary points (to make calculating the path easier, and therefore
quicker, for the software),
– define bridges used to cross over an occlusion or to avoid a too tortuous part. To
cross over an occlusion, place a point on the axial view outside the lumen of the
colon and place all other tracking points on the 3D view. The protocol will
automatically define a bridge between an occlusion point and its immediate
neighbor,
– use the Automatic Points mode to detect occlusions and to automatically define
bridges.

CAUTION
Lumen views do not reflect the real shape of the colon. As polyps may be hidden in
the folds of the colon wall, check these folds using different cross–reference views.

CAUTION
Checking prone and supine series are synchronized in lumen views is essential to
check a suspected area.

AdvantageCTC 2404557–100 Rev. 2 21

Analysis mode [Base, Plus, Pro]

CAUTION
The different views and tools provided by the software enable to cross check the
location of a bookmark.
2
CAUTION
The different views and tools provided by the software around the designed
bookmark enable you to cross check the real shape of the focused object. Be careful
to use all those tools to avoid producing false positive results.

Analysis mode [Pro]

CAUTION
Check visually the proper colors of a bookmark.

Closing the software

CAUTION
After archiving the images and before leaving the application, always preview the
series for each polyp that was archived, with the help of the Viewer, to check that the
archived images are the ones you wanted, providing the best views of the suspected
lesion.

AdvantageCTC 2404557–100 Rev. 2 22

 CHAPTER 3 – STARTING THE ADVANTAGECTC PACKAGE

The CT image sets have to meet certain basic requirements to be processed with the AdvantageCTC
software package.

This chapter describes the image requirements and startup procedure.

AdvantageCTC 2404557–100 Rev. 2 23

1 OVERVIEW
This chapter explains how to access the AdvantageCTC Package from the AW platform.
Use the AdvantageCTC Package to:
 Review the helical CT acquired images of the colon.
 Analyze and record suspected lesions.
The installation procedure of the AdvantageCTC software package includes the necessary protocol required to start
3
the study.

AdvantageCTC 2404557–100 Rev. 2 24

2 IMAGE SERIES REQUIREMENTS
The following 3D image requirements also apply to the CT image set:
 Inter-slice distance  3 mm
 Slice thickness  3 mm
 Acquisition, if possible during a single breath–hold, of an approximately 40 cm. thick section of the abdomen
containing the entire colon 3
 Same Field of View, matrix size and display center
 Usually, two patient anatomic orientations, Prone and Supine
 Necessary dose of 120 kV and between 80 to 100 mA/s
 AdvantageCTC automatically selects the required image series (Prone, Supine and Decubitus), by browsing
through all the existing series for the selected exam.

The physician is responsible for determining if a maximum inter-slice distance of 3 mm is

CAUTION
acceptable for the exam.

Details are always larger than the inter–slice distance.

AdvantageCTC 2404557–100 Rev. 2 25

3 IMAGE MEASUREMENT ACCURACY
You may use the Volume Viewer Plus distance and angle measurement options on the CT image, with the same
measurement accuracy as the Volume Viewer Plus Package:
 Distance measurements are accurate to within  the inter–slice distance.
 Angles measured between segments at least five times larger than the inter–slice distance are accurate to  ten
degrees. Accuracy improves with the length of the segment. 3

AdvantageCTC 2404557–100 Rev. 2 26

4 SERIES/IMAGE SELECTION
Select the patient and the exam number on the AW Browser and start the Volume Viewer Plus software.
If only one series is selected within the Browser, AdvantageCTC looks within all the existing series for Prone, Supine
and Decubitus series (the software discards any Screen Save or Scout images found for the selected exam). A
panel is displayed allowing you to select the series you want to load.
If more than one series is selected within the Browser, AdvantageCTC automatically loads all selected series within 3
the exam.

CAUTION
Using both series (supine and prone) is important as the patient preparation is often
not perfect: some parts of the colon may only be visible for one patient orientation
and not for the other.

AdvantageCTC 2404557–100 Rev. 2 27

5 STARTING THE ADVANTAGECTC PACKAGE
Start the AdvantageCTC software applying the following procedure:
 Start the Volume Viewer Plus software, either with the button located on the Control Panel, or by clicking on the
More Software button of the Applications Menu. A submenu appears. Click then on the Volume Viewer Plus
button.
 Select the “Abdomen” anatomical category
3
 Select a protocol (Auto Dissection, Virtual Dissection or Colonography).

Note: The list of available protocols depends on your installed package. See the applicability table
located in Chapter 1.
To simplify the procedure, you can create a customized button on the Control Panel by dragging the software name
from the Software Manager. This button will allow a one–click start into the software.

Note: You can directly launch an AdvantageCTC protocol by double–clicking the series in the patient
list once you have built a One Touch Protocol (see Volume Viewer Plus User Guide, GE ref.
5110935–100).

AdvantageCTC 2404557–100 Rev. 2 28

 CHAPTER 4 – ON–VIEW OPERATION

The AdvantageCTC software package offers a specific Review Controller, which gives the user a quick
access to the different functions he needs for a thorough and accurate examination of the studied data set.

This chapter describes the Review Controller and the various controls that it provides.

It also describes the AdvantageCTC Main Control Panel and Main On–view Menus, as well as the parameters
to be found in the Screening Preferences panel.

All the other functions accessible from the AdvantageCTC screen are standard controls common to all
Volume Viewer Plus applications and are described in the corresponding User Guide.
4

AdvantageCTC 2404557–100 Rev. 2 29

1 OVERVIEW
This chapter describes the different functions that can be accessed directly from the AdvantageCTC software
screen and are specific to the AdvantageCTC software. All the other functions that are accessible from the
AdvantageCTC screen and are standard on–view controls common to all Volume Viewer Plus applications will not
be detailed here. They comprise:
 Active annotations
 Smoothing mode
 Threshold
 Aperture
4
 Patient Name
 Measuring functions
 Smart Cursor
 Lock mode
 Cut Mode
For a full description of these functions, refer to Volume Viewer Plus User Guide (GE document ref. 5110935–100)
Chapter 5 “Building the 3D Model”, Chapter 6 “Display and Controls” and Chapter 10 “Navigator”.

AdvantageCTC 2404557–100 Rev. 2 30

2 MAIN CONTROL PANEL
Note: The controls and corresponding functions are described either where relevant in the
different chapters of this user guide, or in the Volume Viewer Plus User Guide, GE ref.
5110935–100.
On the main Control Panel, you will find:

 Protocol buttons,
 Layout Presets panel ,
 Review Mode/Analysis Mode toggle, 4
 Rotation and translation controls,
 Tool menu buttons,
 Save/Recall button,
 Hide Panels button.

AdvantageCTC 2404557–100 Rev. 2 31

3 THE REVIEW CONTROLLER
One of the specificities of the AdvantageCTC software is the existence of a Review Controller, which allows the user
an on–view operation of the main controls provided for the software. This section describes the functions of each of
these controls (shown on Illustration 1 hereunder). They are ordered according to their use.

AdvantageCTC 2404557–100 Rev. 2 32

Illustration 1 – THE REVIEW CONTROLLER

Location Slider Enlarge/Split views

Slice Thickness Scalpel

Report Cursor
Annotation Tool

Create Bookmark
Distance Tool

Scroll to Start/Stop
next bookmark back/forth Cine mode ROI
4
Delete Bookmark menu Send Image
to Report
Start/Stop [Plus, Pro]
Scroll to Loop Cine mode
previous
bookmark Link/Unlink
Set paging Prone/Supine
direction speed

Hide Review
Controller

AdvantageCTC 2404557–100 Rev. 2 33

Reviewing the Slices
Different controls located on the Review Controller allow you to page through the different slices, in order to locate a
suspicious spot:
 {Image location slider}: Click on the vertical slider to move within the different slices. Clicking once will
activate the vertical slider. Another click then deactivates it. Holding the left mouse button down or using the
Left and Right Arrows will also produce similar results.
 {Slice Thickness}: Click and drag the outer bars to modify the Slice Thickness of the dataset within the active
viewport.
 {Set paging direction speed}: Click on the horizontal Jog Shuttle to start paging at selected speed in the
selected direction. Clicking once will activate the horizontal Jog Shuttle. Another click then deactivates it.
Holding the left mouse button down will also produce similar results. 4
 {Start/Stop Loop Cine mode}: allows you to have the views appear in a continuous forward mode, in a loop
movement : when the system reaches the last view, it starts up again with the first one.
 {Start/Stop back/forth Cine mode}: allows you to have the views appear in a continuous forward to backward
movement: when the system reaches the last view in a forward movement, it starts up again backwards and
vice versa.
 {Link/Unlink Prone/Supine series}: If activated (dark grey), the 3D cursor is linked on all prone and supine
views (i.e. it moves simultaneously on all the views).

If not activated (light grey), the 3D cursor is linked on either the Prone views or on the Supine views, depending
on where the mouse cursor is positionned.

AdvantageCTC 2404557–100 Rev. 2 34

Managing Bookmarks
A bookmark is created when a potential lesion has been located. For more information on the use of Bookmarks,
refer to Chapter 8 – Analyzing images, Section 1 – Bookmarking a suspicious location.
 {Create Bookmark}: Creates a new Bookmark. Once you have clicked on the button, bring the cursor on the
view. It takes the shape of a pencil with which you point on the interesting spot, before clicking with the left
mouse button. In Immediate Mode, creating a bookmark transfers you in Analysis Mode.
 {Scroll to Previous Bookmark}: Click on this button to automatically move to the previous bookmark.
 {Scroll to next Bookmark}: Click on this button to automatically move to the next bookmark.
 {Delete Bookmark Menu}: The small black arrow at the bottom of the Create Bookmark button allows to open,
on the side, the Delete Bookmark Menu.
 {Delete Current Bookmark}: Deletes current bookmark. This function only works when in Review Mode. This 4
button is located on the Delete bookmark Menu.
 {Delete all Bookmarks}: Deletes all bookmarks. This function only works when in Review mode. This button is
located on the Delete bookmark Menu.

AdvantageCTC 2404557–100 Rev. 2 35

Shortcuts
On the slider, a certain number of shortcuts to standard image management tools are provided to allow the user an
easier access to them:
 {Distance Tool}: Opens up a panel which allows you to execute distance measures, for straight or curved
lines. Refer to Volume Viewer Plus User Guide, GE doc. ref. 5110935–100 .

Measurements are more reliable when done on 2D views; we recommend you to at least
CAUTION
always check on the 2D reformatted views where exactly the points have been deposited.
 {Annotation Tool}: Opens up a panel which allows you to create predefined annotations on the views. Refer
to Volume Viewer Plus User Guide.
 {Scalpel}: Opens up a panel which allows you to define any kind of cut of the view you may need. Refer to
4
Volume Viewer Plus User Guide.
 {Enlarge/Split views}: enlarges the current view so that it takes up the entire viewing area. The icon then
becomes for returning the view to its normal size.
 {Report Cursor}: allows you to deposit a report cursor.
 {ROI}: allows you to deposit a 2D or 3D Region Of Interest.
 [Plus, Pro] {Send Image to Report}: allows you to send current viewport to the report.

AdvantageCTC 2404557–100 Rev. 2 36

4 MAIN ON–VIEW MENU
The Main On–View Menu is displayed when you press and hold the right mouse button anywhere on the view,
except on any of the red annotations or on the 3D cursor.

The content of the menus depends on the type of view. Most functions on these menus are
NOTICE common to all Volume Viewer Plus applications. This section will only describe the
functions specific to the AdvantageCTC software.

In Review Mode
On Axial Views 4
Save Image
[Show Less Annotations] hides part of the annotations to allow a clearer view of the
Send Image to Report slices.
[Hide Annotations] completely hides all annotations to allow a full clear view of the
Show Less Annotations slices.
Hide Annotations
[Reference Image] allows to hide the Reference Image or the selected view, in case
Reference Image they prevent a good view of the slice.
    For a description of the other functions of this menu, refer to Volume Viewer Plus User
Guide (GE doc. ref. 5110935–100).



 

AdvantageCTC 2404557–100 Rev. 2 37

On Coronal Views

Save Image
For a description of the other functions of this menu, see hereabove or in the Volume
Send Image to Report Viewer Plus User Guide.

Show Less Annotations

Hide Annotations
Reference Images

Center on FOV
Center on Object
Center on Cursor 4
   




 

AdvantageCTC 2404557–100 Rev. 2 38

In Analysis Mode

On the 2D views

Save Image
[Wall view] allows you to view a 30.0 mm volume rendered image of the wall of the
Send Image to Report colon. Color represents the lining of the wall of the colon.
Show Less Annotations For a description of the other functions of this menu, see hereabove or in the Volume
Hide Annotations Viewer Plus User Guide.
Reference Images

Wall View
4
Create Trace



Enlarge
 


  

   

   
    

 

AdvantageCTC 2404557–100 Rev. 2 39

On the Navigator view

  
For a description of the different functions of this menu, refer to Section 3–1 here above
Send Image to Report and to Volume Viewer Plus User Guide.

#$    

Hide Annotations

Reference Images

#  
4
   !

"  

  & #  ' 

Overlay Grid

Create Trace




    

 

AdvantageCTC 2404557–100 Rev. 2 40

5 SCREENING PREFERENCES
Some of the AdvantageCTC software parameters can be positionned on a panel called up by activating the
(Display Tools) > [Preferences] > (Screening Prefs) function.
These parameters are:
 (Analysis Mode) > (Immediate ) or (Deferred) :

In Immediate Mode, the software automatically toggles into Analysis Mode each time a bookmark is created by
the user on a view in Review Mode.

In Deferred mode, you have to toggle manually from Review Mode to Analysis Mode, by clicking on the Review 4
mode/Analysis mode toggle button of the Control Panel or by activating a predefined Analysis Mode Layout
Preset. Which means you can wait to have placed all the bookmarks you need before going in Analysis Mode to
study them. When entering the Analysis Mode, the Navigator pointer is focused on the last created bookmark.
 (Analysis Protocol) > (Name of an existing Preset):

This feature allows you to select one of the Layout Preset they created with the Preset Manager (refer to
Volume Viewer Plus User Manual) and make it the default analysis layout. When the user enters Into Analysis
mode, either Immediate or Deferred, this is the layout which will be applied.
 (Save 3D Localizer) :

Allows you to create and save a VR view of the colon among the views stored through the (Save) function (refer
to Chapter 9 “Filling in and saving a report”).

AdvantageCTC 2404557–100 Rev. 2 41

Blank page.

AdvantageCTC 2404557–100 Rev. 2 42

 CHAPTER 5 – ADVANTAGECTC OPERATION

Once the user has selected and loaded the exam he wants to study, he will have different ways of locating
and identifying the potential colonographical lesions.

The study will in fact occur in two main steps:

The first one, The Review Mode, allows the user to rapidly locate and register any suspicious location.

The second step, The Analysis Mode, allows the user, thanks to reformatted and navigator views, to more
closely study these locations in order to determine the cause of the detected defect and reduce the risk of
false positive examinations.

This chapter describes, in chronological order, all the operations needed to perform a thorough
colonographical study.

Eventually, this chapter describes the simple review mode provided by the Colonography protocol.
5

AdvantageCTC 2404557–100 Rev. 2 43

1 OVERVIEW
An AdvantageCTC study is separated into two different steps representing two different and complementary
working modes. When working on a case, you will regularly toggle from one to the other. This is a specific and very
important feature of the AdvantageCTC software. The two modes are :
 Review mode, for paging through the different slices in order to locate any potential lesion (such as polyps).
 Analysis mode, allowing to more thoroughly focus on a specific location that has been identified and
bookmarked, as well as to record any significant images, along with comments.
You will have three different ways of toggling between those two modes:
 using the toggle button of the Control Panel,
 using the keyboard,
 using one of the defined AdvantageCTC Layout Presets.

Note: In the AdvantageCTC software, the working mode (Review or Analysis) is memorized within the created
5
Layout Presets and is restored each time a Preset is activated.
This chapter will only give you a quick reminder of the different on–view buttons you may use to properly perform
this exam. For a more detailed description of each individual button or function, refer back to Chapter 4.

AdvantageCTC 2404557–100 Rev. 2 44

2 REVIEW MODE

Introduction
This mode allows you to page through the selected sets of images. At this level, all the Volume Viewer Plus image
control functions are available. In this mode, the Prone and Supine sets can be studied independently or linked
through a pointer.
Once you have located a potential lesion, you bookmark it using the appropriate button on the Review Controller or
the Insert key. Bookmarking a specific location on a view will allow you to study it more closely by transferring into
the Analysis mode. A parameter on the Preference menu allows you to choose whether switching to the Analysis
mode in an Immediate or a Deferred way. If you are in Immediate mode, the simple fact of creating a bookmark will
automatically transfer you into Analysis mode. If you are in Deferred mode, you will need to click on the Analysis
button of the Control Panel to execute this transfer.
You may place as many bookmarks as needed. It will allow you to study each suspicious location as often as 5
needed.

AdvantageCTC 2404557–100 Rev. 2 45

Reviewing the Slices
Once you have aligned both series, you can explore the anatomical structure. To do this, you need to page through
the slices, using the following methods:

Paging using On–view Controls

 Review Controller (Refer to Chapter 4, Section 3, Illustration 1): The Review Controller comprises a vertical
cursor and an horizontal cursor which provide the following controls:
– Vertical cursor
* Paging through slices
Click on the vertical cursor to move within the different slices. Clicking once will activate the cursor. Another
click then deactivates it. Holding the left mouse button down or clicking on the Control key will also produce
similar results.
* Navigating along the centerline (navg and lumen views only)
Click and drag the vertical cursor to navigate along the centerline. 5
– Horizontal cursor (Paging Speed)
Click on the horizontal cursor to start paging at selected speed in the selected direction. Clicking once will
activate the cursor. Another click then deactivates it. Holding the left mouse button down will also produce
similar results.
Note: When disengaged, the speed cursor returns to its central position (no motion).
 Active annotations:
You may use the image index annotations to page through the stack of slices. Use left or right mouse button to
increment or decrement and the middle mouse button for continuous adjustment. You can also type a value for
these annotations directly on the keyboard.

AdvantageCTC 2404557–100 Rev. 2 46

Navigation Using the Keyboard
 Arrow keys
You may use the left/right arrow keys to move to prior/next slices. If these keys are depressed for more than 1/3
sec, continuous paging starts, first slowly then at full speed.
 Shift key
Position the arrow pointer at the location where you want to place the 3D pointer. Depressing the Shift key will
move the 3D pointer to the current arrow pointer location. If you keep holding it down, the 3D pointer will follow
the mouse.
 Pressing the Shift key on a reformatted view with the cursor on a polyp will activate the lock to target mode on
the navigator view (i.e. the navigator view points at the polyp).
 H key
Allows to hide/show the bookmarks.

AdvantageCTC 2404557–100 Rev. 2 47

 3 COLONOGRAPHY PROTOCOL
Upon entering the Colonography protocol, the screen presents the following layout in Review mode, allowing
correlated reading of Prone and Supine series:

Axial Supine Axial Prone

Coronal Supine Coronal Prone

CAUTION
Using both series (supine and prone) is important as the patient preparation is often
not perfect: some parts of the colon may only be visible for one patient orientation
and not for the other.

AdvantageCTC 2404557–100 Rev. 2 48

Note: If your workstation is linked to two videos, a full–screen axial view will be displayed on the right–hand
video.
In most cases, the anatomical reference used for scan prescription are slightly different and the patient orientation
may induce changes in the shape of the colon. The two sets might therefore not be directly aligned and the same
anatomical feature might be translated between studies. To provide simultaneous reading, you need to set the
relative shift between the two series.
You may adjust this shift by identifying the same anatomical feature on both series:
 Deactivate the {Link/Unlink Prone/Supine series} button by clicking on it
 Position the slice to display a selected anatomical feature using the Paging Controls of the Review Controller
 Position the other slice to display the same feature in the other series using the Paging Controls of the Review
Controller
 Activate the {Link/Unlink Prone/Supine series} button by clicking on it.

Using the Adjustment Slider to align both series 5

Use the on–screen menu (right mouse button) to select the Prone/Supine Shift function. This will display a slider
that lets you adjust this shift. Taking as a reference the Axial Supine view, the slider allows you to page within the
Axial Prone view until you have reached the corresponding view in the new series. The slider then indicates the
relative shift between the two series, expressed as a number of images (–1,–5, +1 +20).

AdvantageCTC 2404557–100 Rev. 2 49

Blank page.

AdvantageCTC 2404557–100 Rev. 2 50

 CHAPTER 6 – VIRTUAL DISSECTION PROTOCOL [PLUS, PRO]

This function is a modified AVA protocol which allows manual tracking of the colon, provides a 120 display of
the colon and handles multiple supine, prone and decubitus series. It comprises a Lumen view (which is an
unfolded view of a predefined part of the colon) accompanied by a Volume Rendering view of the whole colon,
on which the user will define the part of the colon he wants to study and a Navigator view providing him with a
3D endoluminal view of the inside or wall of the colon.

Lumen views are not intended for diagnosis purposes, due to possible
CAUTION
significant image distorsions.

AdvantageCTC 2404557–100 Rev. 2 51

1 STARTING THE VIRTUAL DISSECTION OF THE COLON
In the Browser, select CT images of the colon. Start the Volume Viewer Plus software. Select the Abdomen
anatomical category, then click Virtual Dissection.
The following layout is displayed on the viewport:

Volume Rendered View Axial View

Sagittal View Coronal View

Note: If your workstation is linked to two videos, a full–screen axial view will be displayed on the right–hand
video.

AdvantageCTC 2404557–100 Rev. 2 52

2 DEFINING THE PATH

Manual points
When placed on any of the 3 views, the mouse cursor takes the shape of a pencil allowing to designate:
 the start point of the stretch to study (1st defined point)
 the end point of the stretch to study (last defined point)

Note: If it is a complicated or twisted stretch, it is possible to:

– define intermediary points (to make calculating the path easier, and therefore quicker, for the
software)
– define bridges used to cross over an occlusion or to avoid a too tortuous part. To cross over
an occlusion, place a point on the axial view outside the lumen of the colon and place all other
tracking points on the 3D view. The protocol will automatically define a bridge between an
occlusion point and its immediate neighbours.
The points may be defined on any of the views, depending on where its position can best be seen, as the mouse
cursor always remains linked on the three views. It is possible to move from one point to another between Start 6
point and End point using the left and right arrows at the top of the panels.

AdvantageCTC 2404557–100 Rev. 2 53

To define the path:
1. On the 3D supine series, click to select a point at the start of the colon.
2. Click to select optional points: these points will facilitate the calculation of the path.
3. Click to select a point at the end of the colon.
4. Launch the calculation of the path (see Section 3) for the supine series.
5. Once the tracking is done, repeat step 1 to step 4 on the 3D prone series.

Note: To remove a point, click the corresponding box in the protocol panel.

Note: To remove all points, click (Clear All Points).

AdvantageCTC 2404557–100 Rev. 2 54

Automatic points

Note: The Automatic Points mode is set by default. For a complicated or twisted stretch, the Automatic Points
mode will detect occlusions and will automatically define bridges. You can also place all points manually by
clicking (Manual Points) or use both manual and automatic techniques of point positionning by switching
from one mode to the other.
6
Note: Clicking (Clear All Points) will remove all points placed manually or calculated and will activate the
Automatic Points mode.

AdvantageCTC 2404557–100 Rev. 2 55

To define tracking points with the Automatic Points mode activated, proceed as follows and refer to the workflow
block diagrams below:
1. On the 3D supine series, click to select a point at the start of the colon. The software calculates and dispays the
start point and the closest point to the first occlusion (resp. Start Of Section and Optional Point 1).
2. Click to select a point after the first occlusion. The software calculates and displays the next two points:
 Optional Point 2 (the closest point to the first occlusion),
 Optional Point 3 (the closest point to the second occlusion).
3. If necessary, repeat step 2 until you reach the end of the colon.
4. Click the 3D supine view annotation and select 3D prone to display the 3D prone series.
5. Repeat step 1 to step 3 on the 3D prone series to define all tracking points for the prone series.

AdvantageCTC 2404557–100 Rev. 2 56

 Automatic Points workflow

AdvantageCTC 2404557–100 Rev. 2 57

3 LAUNCHING THE CALCULATION OF THE PATH
Once you have defined all the points you need, click (Next).
The software calculates the path between Start point and End point, located on the center of the colon. The Volume
Rendering view (top left view) is zoomed on the defined path represented by a green line.

Volume rendered view Axial View

Sagittal view Coronal View

AdvantageCTC 2404557–100 Rev. 2 58

Once the calculation is completed, a pop–up message prompts you to accept or reject the tracking result. Rejecting
the tracking result will activate the Manual Points mode allowing you to redefine tracking points and restart
calculation of the path. Accepting the tracking result will allow you to modify the centerline via (Edit) button if
necessary, and to save the centerline via (Save State) button.

Note: If the path calculated by the software is not correct, you can modify it using:
– the (Edit) button to modify the centerline,
– The (Back) button to redefine tracking points.
Click on the corresponding button then place the mouse cursor on the trace and drag it.

Note: Tracking is performed for each series.

Once all trackings are done/accepted, views are updated (see configuration layouts below) allowing you to study the
part of the colon you defined.

AdvantageCTC 2404557–100 Rev. 2 59

1–screen configuration layout

3D / Navg Supine Lumen Supine

3D / Navg Prone Lumen Prone

Axial Supine Axial Prone

AdvantageCTC 2404557–100 Rev. 2 60

2–screen configuration layout

Axial Supine view Navigator Supine view

Axial Prone view Navigator Prone view

Screen 1 layout

3D Supine view
Lumen Supine view
Oblique Supine view

3D Prone view
Lumen Prone view
Oblique Prone view
6
Screen 2 layout

 Two lumen views representing the stretch of the colon flattened on 120 and showing the centerline are
displayed: one for each series. For more than two series, only the lumen views of the two first series will be
displayed.

AdvantageCTC 2404557–100 Rev. 2 61

Note: If the path you defined is an overall vertical one, the Lumen view will be displayed vertically. If the path you
defined is an overall horizontal one, the Lumen view will be displayed horizontally.

Note: The Virtual Dissection view only represents 120.0 of the total 360 surface of the colon. You have the
possibility of orientating the view by a 45 step using the [Angle] active annotation (click with the left or
the right mouse button to increase or decrease the angle). The green angle on the VR view at the level of
the mouse cursor is the visual representation of the angle you requested.
 The Navigator views provide you with an endoluminal view of the inside or the wall of the part of the colon
pointed by the mouse cursor.

Note: The wet rendering mode is displayed by default on navigator and lumen views. Right–click the on–view
annotation to switch from wet rendering mode to classical mode.

Note: The part of the colon displayed in the lumen view can be identified in the 3D view thanks to its red
centerline.
Position the cursor on the colon on the Lumen view and watch the result on the Navigator view. On the Volume
Rendering view the mouse cursor follows the movements on and around the path.

AdvantageCTC 2404557–100 Rev. 2 62

4 360 DISSECTION VIEW [PRO]
The 360 Dissection view available through the right click menu on the VR 120 annotation displays an unfolded 360
view of the colon (see Figure below).

AdvantageCTC 2404557–100 Rev. 2 63

5 SAVING AND RELOADING DATA
Clicking (Save State) in the protocol panel will save the volume of the primary view as a secondary capture and will
allow you to reload it for later review. The secondary capture includes:
 current layout,
 segmentation of the colon,
 tracking points,
 centerline,
 bookmarks.

Note: (Save State) is only available in Review Mode. It is NOT available in Analysis mode.
Reloading a secondary capture will display the tracked air structure in 3D views. You can display the initial
segmetation of the colon to redefine tracking points.

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6 EXPLORING THE COLON

Navigating along the centerline

 Click and drag the slider of a dissection view to fly through the tracked air structure or use the key shortcuts:
 press and hold <F> to move forward,
 press and hold <B> to move backward.
All views (navigator, lumen, 3D) are updated in real time.

Note: [Pro] Click and drag the slider of a navigator view to fly through the tracked air structure.

Note: [Pro] Click and drag the slider in the protocol panel to adjust the fly through speed.

 Place the mouse cursor on the black strip below the lumen view and hit the <Shift> key. On this view the cursor
is represented by a yellow line. It is located in the middle of the colon. The movements of the Navigator follow
the movements of the cursor on the Lumen view. The Navigator looks along the colon axis.

You can navigate within the colon using the left (forward) or right (backward) mouse buttons on the [LP] active 6
annotation of the Lumen view (or the left or right arrows of the keyboard).

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Navigating against the wall
 Place the mouse cursor on the wall of the colon on the lumen view and hit the <Shift> key. The cursor is located
at the center of the colon and the Navigator looks at the selected spot of the wall.

You can navigate using the left (forward) or right (backward) mouse buttons on the [LP] active annotation of
the Lumen view (or the left or right arrows of the keyboard), but the Navigator still looks at the spot of the wall,
which means that the view turns around the selected spot or object.

Stepping through the colon [Pro]

Click the left and right arrows displayed on the lumen view or click <Page Up>/<Page Down> to step through the
colon. The section displayed on the lumen view appears in red on the 3D view.

Rotating the navigator views

Using the rotation handles displayed in navigator views when flying through the structure will automatically unlock
the X–Section mode and allow you to rotate navigator views and change orientation.

Note: Changing the orientation of the navigator view of one series will not change the orientation of the navigator
6
view of the other series.

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7 SYNCHRONIZING PRONE AND SUPINE SERIES

Note: Series are synchronized by default.

 Click the (Link/Unlink) button of the review controller to unlink the two series,
6
 Click a lumen stripe (or a navigator view) and fly through the volume to determine a noticeable area,
 Click the other lumen stripe (or the other navigator view) and fly through the volume to identify the same
noticeable area,
 Press and hold <SHIFT> while dragging the mouse to position the cursor line on the noticeable area,
 Position the cursor line of the other series on the noticeable area,

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 Use cross reference views to ensure synchronization on the same noticeable area is correct,
 Once both stripes are synchronized on the same noticeable area, click the (Link/Unlink) button of the review
controller to link the prone & supine series.

Note: Clicking again the (Link/Unlink) button will unlink the two series.

Note: The procedure remains the same for prone / supine / decubitus series.

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8 BUILDING A MOVIE
[Base, Plus, Pro] In Analysis Mode, AdvantageCTC enables you to build a movie of a Navigator view rotating
around a bookmark.
[Plus, Pro] In Review mode, AdvantageCTC enables you to build a movie of a Navigator view between two points
of the centerline.
[Plus, Pro] AdvantageCTC enables you to build a movie of a Lumen view between two points of the centerline.
[Pro] AdvantageCTC Pro includes an automatic whole–colon movie export feature. The VD and AD protocols
provide a dedicated button to launch the build and export of the movie.

Note: Refer to Volume Viewer Plus User Guide, GE ref. 5110935–100 for movie feature description.

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 CHAPTER 7 – AUTO DISSECTION PROTOCOL [PRO]

This function is a modified AVA protocol which provides automatic tracking of the colon, manual centerline
edition and a 360 display of the colon with overlapping areas. It comprises Lumen views (i.e. 360 unfolded
views of the colon), a Volume Rendering view of the whole colon and a Navigator view providing a 3D
endoluminal view of the inside or wall of the colon.

Lumen views are not intended for diagnosis purposes, due to possible
CAUTION
significant image distorsions.

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1 LAUNCHING THE AUTOMATIC TRACKING OF THE COLON
In the Browser, select CT image series to analyze. Start the Volume Viewer Plus software. Select the Abdomen
anatomical category, then click Auto Dissection. The Auto Dissection protocol automatically tracks the colon without
user interaction:
 tracking points are placed in the colon,
 centerline is calculated and displayed.

Once the tracking is completed, only the tracked air structure is displayed (see Figure below). A pop–up message
prompts you to accept or reject the tracking result.

Colon before tracking Tracked air structure

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Clicking (Reject) will allow you to perform the tracking manually (see Chapter 6 – Virtual Dissection protocol,
Section 2 – Defining the path).
Clicking (Accept) will display the following layouts:

1–screen configuration layout

3D / Navg Supine Dissection Supine

3D / Navg Prone Dissection Prone

Axial Supine Axial Prone

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2–screen configuration layout

Axial Supine view Navigator Supine view

Axial Prone view Navigator Prone view

Screen 1 layout

3D Supine view
Dissection Supine view
Oblique Supine view

3D Prone view
Dissection Prone view
Oblique Prone view

Screen 2 layout
7

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The protocol panel enables you to:
 save state (including centerline and bookmarks),
 edit the centerline,
 close the protocol.

Note: You cannot modify the calculated tracking points at this step. If you want to redefine tracking points, click
(Back) in the protocol panel and follow the panel instructions exactly like the Virtual Dissection protocol
(see Chapter 6 – Virtual Dissection protocol, Section 2 – Defining the path).

To save and reload data, see Chapter 6 – Virtual Dissection protocol, Section 5 – Saving and reloading data.
To explore the colon, see Chapter 6 – Virtual Dissection protocol, Section 6 – Exploring the colon.
To synchronize prone and supine series, see Chapter 6 – Virtual Dissection protocol, Section 7 – Synchronizing
prone and supine series.

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 CHAPTER 8 – ANALYZING IMAGES
8
Once the user has located a potential colonographical lesion, he will be able to bookmark and analyze it.

This chapter describes, in chronological order, all the operations needed to perform a thorough
colonographical study and store the results.

The first step consists in bookmarking suspected locations.

The second step, The Analysis Mode, allows the user, thanks to reformatted and navigator views, to more
closely study these locations in order to determine the cause of the detected defect and reduce the risk of
false positive examinations.

Finally, the user will be able to save the results of the study in the AW Browser, before quitting the software.

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1 BOOKMARKING A SUSPICIOUS LOCATION 8

Creating bookmarks
Once you have located a suspicious region, you will want to bookmark it to allow a more thorough analysis of the
suspect area. There are two possible ways of doing this:
 Click on the {Create Bookmark} button located on the Review Controller. Then, when you bring the mouse
cursor on the relevant view, it takes the shape of a pencil, which you can move on the suspicious location. You
then click with the mouse left button to deposit the bookmark.
 Use the Insert key of the keyboard. In this case, carefully check you have the cursor over the area of interest to
be bookmarked before selecting the key. Otherwise you might be bookmarking a non relevant location.
A green marker appears on the views at the bookmarked location, as well as a red mark on the Review Controller,
located at the level of the Location Slider at the time of the bookmarking.
When you create a bookmark, a numbered label (#1, #2...) appears on the top left side of each view. If you want to
give a name to the bookmark, click on the number. This will open a panel on the bottom left viewport of the viewing
area, in which you will have the possibility of entering the name of the bookmark. This name appears each time you
point on the bookmark, and disappears when you delete the bookmark.
Clicking on the Previous bookmark or Next bookmark buttons of the Review Controller will allow you to toggle
from one bookmark to the other.
If you have chosen to work in Immediate mode, bookmarking a location (either with the Bookmark button or with the
Insert key) will automatically transfer you into Analysis mode. If you have chosen to work in Deferred mode, you will
need to click on the Analysis button of the Control Panel to transfer to Analysis mode or to activate one of the
predefined Layout Presets.

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Deleting bookmarks 8
If you need it, you have the possibility of deleting either the current bookmark, which is the one on which the vertical
slider is now pointing, or all the created bookmarks.
 Click on the small arrow located on the Review Controller at the bottom of the Bookmark button.
 This will open a small menu on the side. The left button is for the Current Bookmark. The right button is for All
Bookmarks.

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2 ANALYZING A SUSPICIOUS LOCATION 8

Introduction
This mode allows you to obtain reformated and Navigator views of the potential lesions which you have located and
bookmarked.
Once you have located a potential lesion in Review Mode, you bookmark it and you are then transferred, either
Immediately or upon request, in a Navigator view of the region of interest. This view will allow you to more closely
study the suspicious location and determine whether it is in fact a lesion, simply retained stool, or even mere
haustral folds.

Entering Analysis Mode

To enter Analysis mode:
 If you are in Immediate mode, creating a new bookmark will automatically transfer you into Analysis mode,
 If you are in Deferred mode, you will need to click on the Analysis mode toggle of the Control Panel or to
activate one of the Analysis Mode predefined Layout Presets. When entering the Analysis Mode, the Navigator
pointer is focused on the last created bookmark.

Note: In this mode, all the On–view controls and all the features linked to Volume Viewer Plus and Navigator are
available on the different views. For a full description of all these functions, refer to Volume Viewer Plus
User Guide, GE ref. 5110935–100.

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Using reformatted and Navigator views for closer study
Upon entering Analysis mode, the screen presents the following layout, allowing a more thorough study of the 8
bookmarked suspicious location:
Screen 1 Layout

Oblique Oblique
View View

Axial Navigator
View View

Note: These screen layout and display characteristics are the default ones. However, you can choose to modify
them either individually, or by applying a previously stored Layout Preset.
The two displayed oblique views represent two planes intersecting at a 90 degree angle. They are both centered
around the axis formed by the vector from Navigator to bookmark. If you move the 3D pointer in the first view, the
second one will move concurrently, so as to remain perpendicular to the first one.

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When you enter Analysis mode, the Navigator view is centered on the bookmark. If you move it using the on–view
cube, the view will rotate around the bookmark. 8
Note: A position which will bring the Navigator within solid tissues will not be allowed.

CAUTION
The different views and tools provided by the software around the designed
bookmark enables you to cross–check the real shape of the focused object. Be
careful to use all those tools to avoid producing false positive results.
On the views, a green circle marks the region of interest. The two oblique views and the axial view are reference
views that can be adjusted using the navigator indicator by clicking and dragging around the navigator bar. You can
also adjust the Navigator view with the help of the three dimentional cube (For more information on how to handle
the navigator bar or the three dimentional cube, refer to Volume Viewer Plus User Guide – GE document ref.
5110935–100, Chapter 10 – Navigator).

Screen 2 Layout

Sagittal view Coronal view

Axial view 3D view centered on the bookmark

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Colorizing a polyp [Pro, VD & AD protocols only] 8
Once you have bookmarked a polyp:
 click (Color A Region) in the protocol panel: the Polyp Color Display panel is displayed,
 click the polyp on a reformatted view,
 click (Apply) in the Polyp Color Display panel: the polyp is colored in green on reformatted and navigator views.

Note: You can adjust the transparency of the colorization using the % color transparency annotation on view.

The Polyp Color Display panel buttons also allows you to:
 undo last paint,
 clear all paint,
 clear bookmark color,
 close panel.

Note: Deleting a bookmark will automatically remove its associated colorization.

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3 QUITTING ANALYSIS MODE 8
Once you are temporarily or finally finished with studying a bookmark in Analysis mode, you can go back to Review
mode by clicking on the Review mode toggle button of the Control Panel, or on one of the Review mode predefined
Layout Presets, or by hitting the Enter key.
This will display the following menu:

which offers four different possibilities:

 Archiving current images and going on with the analysis,
 Deleting bookmark and returning to review mode,
 Returning to review mode without archiving the selected images,
 Going on with the analysis without archiving current images.
Note: Clicking (Archive current images) will save current displayed viewports as screensaves in a new series.
Note: The images that will be archived will be taken within the series (Supine or Prone) on which the Bookmark
has initially been placed.

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 CHAPTER 9 – FILLING IN AND SAVING A REPORT [PLUS, PRO]

When the user has spotted on the exam a defect he estimates as being a polyp, he may record it on the
Browser, so as to be able to later report it for study or training purpose.

This chapter describes how to fill in, record and retrieve a report.
9

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1 FILLING IN A REPORT
Every protocol of AdvantageCTC package includes a reporting feature. The report is made of three types of data:
 Pre–Exam data that are automatically included in the report or entered by the user before the exam, 9
 Exam Analysis data entered by the user,
 Post–Exam data entered by the user.

To display the report panel, you can whether:

 click (Report) in the main panel and select Data Input or
 click a bookmark annotation.

Pre–Exam data
Click the Pre–Exam tab in the Report panel and fill in the following fields:
 Family and Patient history,
 Exam procedure,
 Patient follow up.

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Exam Analysis data
Place a bookmark on a polyp and set the type to Polyp using the on–view annotation. Click the bookmark annotation
and select Send to Report. Each bookmark placed in the colon is identified by a bookmark ID and its distance from
the rectum. For each of these bookmarks, you can add: 9
 Localization (Rectum/Sigmoid/Descending/Transverse/Ascending/Cecum/Other),
 Shape of lesion (Sessile/Pedonculated/Flat/Other),
 Size of lesion,
 Measurements associated to the bookmark,
 Comments,
 Images.

For a generic finding placed outside the colon:

 Click the Findings tab in the Report panel,
 Click (Create Finding) and select Finding,
You can then name your finding, add comments in the Finding Information sheet and send images in the Finding
Captures sheet associated to this finding.

To add an image in the Report, click the required view and click the Send Image To Report button of the Review
Controller: a thumbnail for this image appears in the Manual Images area of the Finding Captures sheet. Clicking the
thumbnail displays the Image Input panel allowing you to:

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 Enter image title,
 Enter a comment,
 Preview the image in the mini–viewer,
 Delete the image.
9
The Automatic Images area includes by default for each bookmark the six following images:
 Lumen image centered on bookmark with visual indication of bookmark,
 Axial image at bookmark location with visual indication of bookmark,
 3D endoluminal view looking at the bookmark,
 3D ectoluminal view.

To deposit a ROI, use the ROI button on the review controller. To place a Measurement, use the Measurement Tool
button on the review controller. Refer to Volume Viewer Plus User Guide for detailed explanations.

Post–Exam data
Click the Conclusion tab in the Report panel to display Post–Exam data. The General Images area includes by
default for each series a 3D view of the colon with all deposited bookmarks.
Fill in at your convenience Report Conclusion areas.

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2 RECORDING AND RETRIEVING THE REPORT
It is recommended to preview the report prior to save it:
 click the Conclusion tab in the Report panel,
 click (Preview Report) to launch the Reporting Tool in pre–visualization mode,
9
 verify images and data are relevant.
Note: For information about the Reporting Tool, refer to the Reporting Tool User Guide, GE ref. 5112594–100.

Clicking (Save Report in AW) will save the report in the browser as a SR object and launch the Reporting Tool in
full mode. You will then be able to read the report via the Reporting Tool and to retrieve all the images saved in the
report.
In the Browser, the recorded images are saved under the name “Screen save” and have a type described as
“SCPT” (i.e. Screen Capture). They appear as follows:

CAUTION
Before recording the chosen images, always check that the patient name does
appear on the different views.

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CAUTION
The images to be archived are taken within the series (Supine or Prone) on which
the Bookmark has initially been placed.

The Report contains by default four images per bookmark and one 3D image of the colon per series.
To view images sent by default and images sent manually to the Report, you can whether use the viewer or the 9
Reporting Tool.

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 CHAPTER 10 – QUITTING ADVANTAGECTC
At any moment during the study you can quit the software by clicking on the (Close) button located on the Volume
Viewer Plus Control Panel. This will put an end to the study and bring you back to the AW Browser, deleting any
currently defined but yet unsaved steps.
If you try quitting the software by clicking on the (Close) button without having first hit the (Enter) key, you will get a
message, asking you to confirm that you do not want to save the current images.

10

– If you click on (No), the message is closed and you can go on working with the images.
– If you click on (Yes), the second message is displayed asking you whether you want to archive the
images before leaving the software.

CAUTION
After archiving the images and before leaving the application, always preview the
archived images, using the Viewer, to check that they are the ones you wanted,
providing the best views of the suspected lesion.

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The following modes/parameters are stored as a user preference and memorized from one session to another:
 Wet or classical rendering mode for navigator views,
 Grey level (BW) or color rendering (color) for navigator views,
 [Plus, Pro] Wet or classical rendering mode for lumen views,
 [Plus, Pro] Grey level (BW) or color rendering (color) for lumen views,
 [Pro] Fly through speed.
10

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 SERVICE OFFICES OF GE MEDICAL SYSTEMS

For service issues, contact the On–Line Center (OLC) for your region.

GEMS – Americas GEMS – Europe GEMS – Asia

On–Line Center O.L.C.–E O.L.C.–A
Phone: 1–800–321–7937 (33)1–3920–0007 81–426–48–2940

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 REVISION HISTORY

REV DATE REASON FOR CHANGE PAGES

1 August 2004 First release 92

2 November 2004 Document updated with Base/Plus/Pro tiering 96

NUMBER SIZE REVISION

2404557–100TPH A5 2

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