Elements Image Fusion PG

Purpose
This Training Guide is based on the Image Fusion software. It documents how Image Fusion may be
used in a clinical setting, but it is not meant as a replacement to the Image Fusion Software User Guide.
For questions regarding recommended use of Brainlab equipment and/or software, always refer to the
Software User Guide as your first level of product support.
The training provided to the customer is based on the product-specific training requirements. Users must
be trained and qualified to operate the Image Fusion. Contact Brainlab Customer Support if new users
require training.
Copyright
Copyright © 2017 Brainlab. All rights reserved.
Course Information
• Released: January, 2017
• TRM 21-88, Rev. 3
Brainlab Customer Support Information
Region Telephone and Fax Email
United States, Canada, Central
and South America
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Fax: (708) 409-1619
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us.support@brainlab.com
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France and French-speaking
regions
Africa, Asia, Australia, Europe
Japan
Tel: +33 800 676 030
Tel: +49 89 991568-44
Fax: +49 89 991568-811
Tel: +81 3 3769 6900
Fax: +81 3 3769 6901
support@brainlab.com
© 2017 Brainlab

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TABLE OF CONTENTS
BRAINLAB ELEMENTS IMAGE FUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Element Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Module 1: Image Fusion Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Module 2: Working with Fusion Pairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Module 3: Fusion Result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
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Overview
Image Fusion allows you to register image sets, with the same or different
modalities (CT, MR, PET, SPECT) with a minimum of two image sets. Once
two image sets are fused, they can be viewed synchronously. All planned
content (for example, objects, points and trajectories) defined in one image
set is visible in any other fused image set.
Modules
This element contains the following modules:
Module 1: Image Fusion Overview
Module 2: Working with Fusion Pairs
Module 3: Fusion Result
Element Outcomes:
Upon completion of this lesson, you will be able to:
• explain the key functions, features, and benefits of Image Fusion
• explain how Image Fusion is used in planning surgery and oncology
procedures
• describe rigid fusion for cranial and spine
• verify the fusion with the Spy Glass tool and the Blending tool
• perform cranial distortion correction
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Module 1: Image Fusion Overview
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Overview
This module provides an overview of the functionality of Image Fusion
including its features and benefits.
Module Outcome
Upon completion of this module, you will be able to:
• describe the features and benefits of Image Fusion and and how they are
used to manage images
What is Image Fusion?
Fusion is the process of merging different image sets with each other. The
fusion result is a link between several datasets generating a fusion chain.
Image Fusion merges image sets together. Images from the same or other
modalities (CT, MR, PET, SPECT) can be used, but a minimum of two images
are required. The software:
• proposes a fusion chain based on pre-defined pairing rules
• uses an algorithm to fuse the selected image sets
Image Fusion Features and Benefits
Image Fusion has many features and benefits including:
Table 1-1: Image Fusion Features and Benefits
Features
Benefits
Fusion pairs are automatically
pre-selected
Fusions are automatically
pre-calculated for all available
fusion pairs
Automatic streamlined workflow
Ease of use
Allows you to fuse image sets, with
the same or different modalities
Automated fusion calculation
NOTE
Selection is based on image modality, resolution, number of slices,
date and time, scan sequence, and image type.
NOTE
Screen navigation buttons are the same as what was covered in
previous topics.
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Module 2: Working with Fusion Pairs
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Overview
Image Fusion can be applied within different workflows. The application is
adapted for the clinical context (e.g., cranial or spine procedures) in which it
is intended to work.
Module Outcomes
Upon completion of this module, you will be able to:
• fuse image pairs for both spine and cranial images
• correct distortion in fused cranial images
• edit fusion pairs
Rigid Fusion
Inaccuracies in rigid fusion can be caused by distortion within one of the
image sets. When fusing cranial images, the fusion is automatic when the
application launches. When fusing spine images, the user must manually
initiate the fusion.
When images are fused:
• There is an automatic shift to the next unfused pair once the fusion is
accepted.
• All planned content (for example, objects, points and trajectories) defined
in one image set is visible in any other fused image set.
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Image Fusion for Cranial
Below is the workflow for Image Fusion for Cranial:
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Table 1-2: Cranial Image Fusion Workflow
Step
Action
1 Select Image Fusion.
2 Fusion calculation starts automatically when entering the
application.
3 Carefully verify the image fusion, especially in the region of interest
(ROI) in all three planes (axial, coronal, and sagittal).
4 Approve the fusion result by clicking on the check mark in the Do
you accept the result box.
5 The application automatically jumps to next unfused fusion pair or
click Next Pair.
6 Repeat steps 3-4, if necessary.
7 Click Done to exit Image Fusion. The fusion result(s) is saved for
further processing.
Cranial Distortion Correction
Inaccuracies within fusion results can still exist after manual adjustment or
choosing ROI fusion. Such inaccuracies could be a result of distortion during
image acquisition.
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Follow the workflow below to complete a cranial distortion correction:
NOTES
Table 1-3: Cranial Distortion Correction Workflow
Step
Action
1 Adjust image sets, if necessary (rare for cranial cases).
2 Calculate the distortion correction.
3 Review and verify the distortion correction.
4 Toggle between the distortion correction and the original by
clicking on the Original button.
5 Approve the fusion result by clicking on the check mark in the Do
you accept the result box.
6 Automatic shift to next unfused fusion pair.
7 Repeat steps 4-5, if necessary.
8 Click Done to exit the cranial distortion correction. The cranial
distortion is saved.
Image Fusion for Spine
Image Fusion can be done within the spine workflow. Follow the workflow
below to perform Spine Image Fusion:
Table 1-4: Spine Image Fusion Workflow
Step
Action
1 Select Image Fusion for Spine.
2 Adjust the Region of Interest (ROI).
3 Align the image sets to roughly fit within the ROI.
4 Clicking on Fusion to start the image fusion calculation.
5 Carefully verify the image fusion, especially in the region of interest
(ROI) in all the planes (axial, coronal, and sagittal) using Spy Glass
and Blending functionality.
6 Approve the fusion result by clicking on the check mark in the Do
you accept the result box.
7 Repeat steps 3-6, if necessary.
8 Click Done to exit Image Fusion for Spine. The fusion result(s) is
saved for further processing.
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Editing Fusion Pairs
Preselected image pairs can also be edited by the user. Follow the steps in
the workflow below to edit the fusion pairs:
Table 1-5: Editing Fusion Pairs Workflow
Step
Action
1 Open the Fusions drop-down menu in the Data menu.
2 Review the fusion pairs.
3 Choose the datasets you want to fuse.
4 Click Use this Pair (Image Fusion automatically fuses the new
pair).
5 Return to the main screen to review the image fusion.
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Module 3: Fusion Result
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Overview
It is important to verify the image fusion. There are two ways to verify the
fusion: Spy Glass and Blending. This module explains the workflows
associated with both tools.
Module Outcome
Upon completion of this module, you will be able to:
• verify the accuracy of the fusion using the Spy Glass and Blending tools
Spy Glass
Spy Glass is used to visually verify the accuracy of the image fusion by
providing an overlay of a secondary image set that can be translated over the
primary image for review. You can view the shape, size, and position of an
anatomical structure or tumor in two image sets at the same time.
Follow the steps in the workflow below when using Spy Glass:
Table 1-6: Spy Glass Workflow
Step
Action
1 Click Spy Glass on the tool bar.
2 The Spy Glass superimposes the second image set over the first
image set. The window can be positioned anywhere over the
underlying image.
3 To resize, drag the corners of the windows to the desired area and
shape.
4 Scroll through the image slices using the arrows or the mouse
wheel.
5 Zoom in or out on the main view using the Zoom tool or by
pressing Ctrl and rotating the mouse wheel.
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Blending
Blending is used to distinguish between two fused image sets. The primary
image set is blue as indicated in the upper left hand corner. The secondary,
movable, image set is amber as indicated in the upper right hand corner.
Follow the steps in the workflow below when using Blending:
Table 1-7: Blending Workflow
Step
Action
1 Select Blending and modify the blended image, by by moving the
blending slider left or right in the main viewing area on the screen.
2 • Scroll through the image slices, using the arrow buttons.
NOTE: The mouse wheel can also be used to scroll.
• Zoom in or out on the main view using the Zoom tool or by
pressing Ctrl and rotating the mouse wheel.
3 Review the fusion and press Approve Fusion if the results are
satisfactory.
4 Press Done when finished.
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Element Review
This lesson provided an overview of the Image Fusion software application,
including a product overview, the basic functions, and key features and
benefits.
NOTES
CHECK POINT
Check Point is dedicated for a quick review of this section
• What image modalities are compatible with Image Fusion?
• What is the difference between using Image Fusion for spine and using
Image Fusion for cranial?
• How do you correct cranial distortion in Image Fusion?
• What tools are used in fusion verification? How is each tool used?
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