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This next video. I'm going to show you how to use ombra

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to aviate coronary CT examinations. Ombra

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has the ability to do some

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reformatting, which we're going to talk about on the next

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video on how to read coronary CT.

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I'm going to demonstrate how you do that reformatting here on

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ombra for the subsequent cases. I'm going to be using my

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own packs workstation just to

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make it a little smoother.

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Let's start just with with how you approach this on ombra. So

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first by default, the tool that

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you need is actually not present on the

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Ombre toolbar. So you want to start by hitting settings.

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And then go into the toolbar on the left hand side. And

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then on the available tools on the left, you want

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to grab the one that says NPR so you have to scroll down to

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find it under Advanced visualization and you left

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click and drag into this middle column, which says toolbar and

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it doesn't really matter where you place it. Once you do that

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you hit save and then that puts the toolbar up on

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the top for you right here. Now, the

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one thing that's not ideal about that is that then it

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has to reload all the images again for this

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case.

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So we'll have to wait just a second as that happens. And what

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you want to do is grab the

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thin slice images and so you'll notice that we have a scout image

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here calcium score image.

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Just fit the images here. That's actually some thick slice

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images. And then this 300 image stack, which is the one that

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we want to use to look at the coronary CT.

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So I'm going to drag that over into the main window.

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And then you can see that I can scroll up and down and assess the

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coronaries on the axial images.

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I can certainly use the window level feature

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by clicking the level button up here.

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And then going back to scroll to make sure I get the level

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set correctly.

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The thing that becomes important though in coronary CT and

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we're going to see that as we go through some of these cases on the subsequent

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videos is that it is important to be able to make

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your own planes using the multiplayer reformat tool

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in order to get the best visualization of the coronary

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that you can so I'm gonna show you how to

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do that on hombre.

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So we start with the NPR tool

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up here.

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And then once you click it, you'll notice this pop-up that says

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sync window levels which you once selected and then

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allow rotations. You want to make sure you trigger that on.

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And then once that's on you'll notice there's a little gear here on the

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bottom left image.

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Which says resent your reset last rotation reset all

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rotations, so I'm going to put that to the side because we're going to use that.

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And then you'll see that we have.

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Different colors there's a purple line an orange

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line and a green line and they correspond to the different Windows here.

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You can see there's an axle which is the orange the purple

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is the sagittal and the bluish greenishes

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the coronal

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so if you scroll down if I wanted to make a plane to

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get

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Nice visualization on the right corner artery. What I

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can do is I can grab the crosshairs drag it

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over. So I'm moving my planes down here and then

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I can actually left click and drag and rotate the plane

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into the

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Navy Groove head. This is the way the standard way to get

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a nice look at the right corner artery.

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And then what I want to do is I want to go to the sagittal image scroll a

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little bit and then tilt my plane forward like

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that so that I'm lined up.

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With the top and the bottom of the right corner

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artery and then once you do all that, you can actually double click here

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and let me just adjust the window a little

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bit.

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and you get

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nice visualization of the right corner artery in

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the AV Groove. This is a nice way

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to look at the long axis of the corner arteries.

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It's really important to be able to manually evaluate

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the corner arteries using these data sets

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and mprs because the tools that we use

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the cprs that you're going to see me use a lot in this course,

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they don't always work 100% And

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that's because CPR success

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depends a lot on the quality of the study and you

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know, although the studies in this course are going to be all diagnostic quality.

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Sometimes you get some some studies which are more

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iffy and those cases then you're going to rely more heavily

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on manual and PRS. So it's good

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to practice them with ombre. Once you've done a couple reformats.

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Actually. There's one sort of

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kink in the system, which is that you have to in order to move the planes again.

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You have to reset the plane. So in order

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to do that, you hit this little gear

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And then you can hit reset all rotations.

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And then you can start over.

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So that's the the best way to manage this situation when you

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need to do some other reformats, you reset

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the planes and in general the concept for

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using the nprs is that if you want to

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evaluate the vessel and evaluate a stenosis you

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drop the crosshairs on this stenosis

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of Interest Let's Pretend There's a stenosis right here.

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In this case. I'm going to reset then you want to

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drag the plane so that one of your planes is

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aligned with the long axis of

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the vessel.

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You drag the other planes so that the other plane here is lined

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with up with a long axis of the vessel.

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And now you have three views you have two long axis views

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and a short axis View and this is honestly the best

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way to evaluate for stenosis and you can zoom in

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if you want.

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If you have scroll if you want on the

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short axis view, you can grab the plane and

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actually rotate it all the way around.

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And while you're doing that you can watch what happens

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to the vessel in the upper right hand corner.

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And find where you see this stenosis is best visualized

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and you can do the best assessment of stenosis severity and

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we're gonna get into this a lot more in subsequent cases,

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but I just want to show you this how to approach cases with

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the Ombre software and you'll have access

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to all the cases that we go through in the subsequent videos via ombre.

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So thanks a lot. That's helpful.