0:00

We're going to do is then we're gonna move

0:02

to the last case for the week.

0:04

And that's, uh, case number five.

0:07

So again, this one,

0:09

it's gonna be a little bit different in how you load this.

0:12

Again, I would recommend we start with the, the phase

0:15

that you're going to need.

0:17

I would do 25 to 35, right?

0:21

And again, you know,

0:22

I didn't give you the full cardiac segments for this

0:24

because we, we didn't really need them.

0:28

But in this case, you know, for the, for the sake of time,

0:33

you know, we'll pull up just segment number 40,

0:36

which ended up being the, the, the one we use for that

0:41

for, for the largest diameter.

0:44

So you pull up your volume assessment,

0:46

and again, we're gonna go through the tower workflow.

0:49

You go here, you're gonna look at TAVR right

0:54

now, remember we tried before

0:55

to do the aortic route, et cetera.

0:57

You can still do that, but again,

0:59

it's not something you need.

1:00

I usually come to the oblique

1:02

and it'll, it'll try to kind of center you there.

1:05

It's not something that I myself like

1:07

to do with the machine.

1:08

I kind of myself like to do it manually.

1:11

But again, it's something that

1:12

to each other, to each their own comfort.

1:14

So if I don't find that that's, uh, where I need it to be,

1:18

then I just usually get it myself and, and line it up here.

1:23

So that's what we're going to do.

1:25

See, we got our planes in view.

1:28

We're gonna scroll right through the valve, right?

1:30

And then we're gonna start at the right coronary cusp.

1:34

Looking over here. So this is my right coronary cusp.

1:39

And you're gonna come right to the bottom of it.

1:42

See where I no longer see that, uh, calcium, right?

1:45

Because that's not part of the leaflet. Okay?

1:49

Then we're gonna rotate, kind of go to like,

1:54

you know, eight o'clock in the, in the clock position.

1:57

We're gonna rotate away from that, okay?

2:00

We're gonna scroll and check here.

2:03

We're in a good position in the plane here.

2:05

We're in a good position in the plane.

2:07

And remember we had already moved to the right,

2:09

but we wanna verify just to make sure

2:11

that we don't have anything to out

2:13

of the ordinary or abnormal.

2:15

So we just wanna make sure here, good here,

2:19

we're good and here we're good.

2:21

Okay? Once you find those measurements, then you go

2:25

to your landmarks.

2:26

So again, I encourage you to click left,

2:31

which click right, non coronary cusp, okay?

2:36

Then your landmarks are put into place.

2:39

So then what you're going to do is once you have these,

2:43

remember you're gonna mark where the esophagus this, so

2:48

esophagus this here, okay?

2:50

So now that you have the esophagus, you go

2:53

to your three Cus p, you go to this,

2:56

you can always change it to to half.

2:58

Okay? So if you feel that it's changed things

3:02

for you, don't worry.

3:03

You go to this and it'll bring you right back.

3:05

So, so don't feel that you've lost your measurements

3:08

'cause you didn't go interior view.

3:11

Click and click okay?

3:14

Now, if you're not sure if you lost it

3:17

or not, come back to your landmarks, you'll make this big

3:20

and go to annulus.

3:21

Click on this. Remember we're gonna hold shift.

3:25

Hold the button that looks good. Leave it there.

3:28

Obviously this area of, of calcium isn't right

3:32

where I want to include in here.

3:33

So I'm gonna correct for this a little bit.

3:36

So let me make sure, perfect. That's where it needs to be.

3:41

Again, you can move your arrows

3:43

and you'll give you the measurements.

3:44

27.2 by 22.3 with a mean diameter of 24.4,

3:49

an area of 4 69 with a perimeter of 78.

3:53

Once you've had those, you're going to simply remember, go

3:57

to the coronary cusp, uh, to the left

4:00

and right coronary artery origins.

4:03

So here we're gonna scroll right through and see the oste

4:08

or the origin of the left main.

4:10

See, we see it right there.

4:14

So what I'm gonna do,

4:16

and you can, don't forget, you can uh, zoom in, hold on.

4:21

Okay? So that's, if you do something like that,

4:24

just hit a rank and delete measurement.

4:27

That way you don't, you don't feel that you're,

4:30

you're stuck with a bad measurement.

4:31

So again, we begin here, here, here,

4:36

15 millimeters

4:38

and then right one is right here already.

4:41

So you go to the right coronary height, you go from the

4:46

bottom of that vessel to here.

4:49

Very good. This is maybe a little bit more generous than

4:52

what I want it to be, but right there, yes.

4:55

So now we have the left and right coronary height

4:58

and we begin with the sinus on the left side.

5:01

So again, left sinus, okay here, go do

5:06

right sinus and,

5:07

and the workflow should walk you right through it.

5:10

See that you don't need

5:12

to do the non coronary sinus is not something

5:14

that it's really relevant.

5:17

You could if you wanted to,

5:18

but I don't, I don't usually include that.

5:20

I usually give 'em the left and right sinuses.

5:23

Then you go to your mean diameter, right?

5:27

Remember you go sinus to commissure for these,

5:30

not unlike when we do with the other ones where it's sinus

5:33

to sinus, sinus to commissure here.

5:36

Last but not least, sinus to the commissure.

5:39

Okay, last

5:40

but not least, remember we go to the sin tubular junction.

5:45

So we go right up to it. See that right?

5:48

Same tubular junction

5:49

and you get your measurements one here

5:55

and two over here.

5:57

Same. So now we have our synott

5:59

tubular junction measurements.

6:01

Last but not least, we get to the ascending aorta. Okay?

6:06

And again, you can uh, zoom out to ensure

6:10

that you can see where you are.

6:12

Uh, if you feel that you need to break the plane to allow

6:16

for retention, do so that's perfectly okay.

6:20

And then you just do your ascending aorta measurements,

6:25

see one and two.

6:29

Okay? And now we have the sending aorta measurements.

6:32

And then last but not least, we're going to get to the um,

6:38

to the actual peripheral component.

6:40

Now here you can do this series individually.

6:44

You can simply go back to the patient list.

6:46

We gave you this segmentation, you can load it,

6:50

you can save your workflow.

6:51

And this is another way that you can do it.

6:53

In case you run two issues, you come back

6:56

to the tablet workflow, right?

6:59

You zoom in, okay?

7:05

And then depending on the quality of the image here

7:08

or units

7:11

or the contrast timing, you can determine,

7:13

I usually again go to curve NPRI zoom in.

7:20

Remember you're gonna go to auto

7:23

and on your short axis you're going to select

7:28

the theoral arteries.

7:30

You press shift, select

7:32

and it should take you all the way

7:34

to the aorta and it did that time.

7:36

And then last but not least, you come back up here

7:41

and then get you there and see you're here.

7:45

Now when you make your way up to the order

7:47

and see how the measurements are off, because it's center

7:50

or center, the line is not thresholding,

7:53

you can click on this dot icon

7:56

and you can center this line.

8:00

So we can track it better if you want. Gonna give you this.

8:05

And it's the reason why the algorithm is thrown off is the

8:08

contrast bolus timing, right?

8:10

Last but not least, you can always again go back

8:13

to the threshold thing, see how it worked.

8:14

Here, it's just a matter of, uh, finding the area

8:18

where you're gonna make your measurement.

8:20

So again, if this is not the area

8:22

where you're gonna make your measurement,

8:24

just mark off the dots.

8:26

Come down to say you wanted to measure here threshold.

8:31

See that? There you go.

8:34

And then it gave you that measurement.

8:36

Calm down to like be sending aorta and again, threshold.

8:42

See, make some measurements for you

8:45

and make your way to the abdominal aorta.

8:49

Minimum diameter, right?

8:52

Or you know, just write the numbers

8:54

Down. You don't

8:55

need to make

8:56

Them yourself Manually. You

8:57

could if you wanted to,

8:58

but it's not something that I would necessarily do.

9:01

You come down here into the external I

9:04

or the common iliac, you come to your external iliac.

9:08

And last but not least, you find your con for moral

9:11

and you make your measurements.

9:13

And then if you need to switch

9:15

Vessels, Just, you know, click on the one

9:17

that you had previously selected.

9:19

We finish off the external iliac

9:22

or the common iliac, the external iliac and f

9:29

Just, uh, you do it.

9:31

Any other questions, any other concerns about these

9:34

workflows with, with Tar Rico?

9:36

And I showed you two ways of doing it

9:37

where you can load both series

9:39

or one where you can do cardiac section first to go back

9:43

to the patient list and load up that information.

9:46

Just make sure that if you're going to save things,

9:49

you know, you can capture measurements.

9:51

See how it says capture, you can capture

9:53

and send it to the output or save it.

9:55

That way you have that. Another option,

9:57

if you're working on terra recon is click save scene.

10:00

So if you save the scene, it will essentially save all

10:03

of the measurements and areas that you've marked

10:05

and then lets you to repopulate that back.

10:07

So that's another more easy option to, to measure the things

10:11

that you, you measured yourself.