Scroll pos:
CPR - Straightened View
CPR straightened (static)

CPR - Straightened View

Distance: — / — mm | Delta: 0.0 mm
Thickness 3 mm

⏳ CPR straightened view not available.

Load study for interactive CPR, or generate server-side views.

Measurements

QC Status: --
Resolve critical QC issues in Report Validation.
Report measurements
Live workflow measurements
Editable AI areas
Manual MPR measurements

ROI / Area: click vertices, drag handles to adjust, double-click or click first point to close; ~¾ traced may auto-complete. Esc cancels in-progress ROI.

Centerline rescue
Click "Pick seed" then click the proximal aorta (annulus level) in the MPR.

Access Assessment

Measure minimum vessel diameters for transfemoral access.
Common Iliac: -- mm
External Iliac: -- mm
Common Femoral: -- mm
Common Iliac: -- mm
External Iliac: -- mm
Common Femoral: -- mm

C-Arm Planning

LAO / RAO
--
Cranial / Caudal
--
Alternative views
--

Aortic Root Levels

LVOT
funnel / trapezoid
-- mm
Avg Ø
Annulus
elliptical / oval
-- mm
-- mm²
SOV
Mercedes-Benz / cloverleaf
-- mm
Avg Ø
STJ
perfect circle
-- mm
Avg Ø
Asc. Aorta
uniform circle
-- mm
Max Ø
📋 Calcification Tagging Guide
1 Identify SOV by Mercedes-Benz shape and coronary origins (RCA/LCA).
2 Scroll superiorly until cross-section becomes perfect circle → that is the STJ (upper boundary).
3 Scroll inferiorly until the lumen narrows and LVOT structures appear → that is the annular base (lower boundary).
! Tag calcification only within SOV (annulus base → STJ). Exclude LVOT and ascending aorta.

Ostia Heights Helper

1. Annulus
2. RCA
3. LCA
Click in MPR at the level of the annulus plane.
RCA height
--
LCA height
--

Aortic Root Workflow

Workflow setup
Valve anatomy
Tricuspid workflow selected. Required hinge markers: 0/3 completed.
Primary markers
Supportive cusp markers
R
N
L
RCA
LCA
R-N
N-L
L-R
Active marker: R cusp nadir. Click in MPR to place it.
Workflow
0 / 7 completed
1. Prepare Orthogonal MPR
Open axial, sagittal and coronal MPR views and keep Lock 90 degrees enabled. This step is treated as complete when all three views are available and the orthogonal lock is on.
Current step: done
Step confirmations
Use this panel for the annular-plane workflow (MPR setup, phase, coronal & sagittal references, symmetry, plane checkboxes, then ROI on axial). Coronal click: LCC left / RCC right, lowest RCC, angulate through lower LCC. Sagittal click: NCC right / RCC left, lowest NCC, angulate through RCC. ROI / Area: drag vertices, ~¾ contour may auto-complete, Esc cancels in-progress ROI.
Measurements
Placed markers
R: --
N: --
L: --
RCA ostium: --
LCA ostium: --
Commissure R-N: --
Commissure N-L: --
Commissure L-R: --
Annulus metrics
Data source not available
Max Ø
--
Min Ø
--
Avg Ø
--
Area
--
Perimeter -- mm
Coronary heights
Data source not available
RCA
--
LCA
--
Inter-ostia dist --
Supportive anatomy
Cusp-to-cusp distances and commissures help orientation, but they do not replace root-plane measurements.
Hinge distances (R/N/L)
R – N-- mm
N – L-- mm
R – L-- mm
Workflow status
Validation thresholds
Plane controls
Rotation shortcuts (active viewport): Q/E roll, W/S pitch, A/D yaw. Mouse: drag reference line (no modifiers); Alt+drag pitch/yaw; Shift+Alt+drag roll.
Leaflet morphology review
Complete the cusp markers to generate MPR and rendering previews for the report.
Output

Offline cache

Valve Simulation

Advanced

Clinical Summary

QC & Measurements
--
Access Assessment
Right min: --
Left min: --
Feasibility: --
C-Arm Guidance
LAO/RAO: --
Cran/Caud: --
CPR
--
Series
--

Aortic Root Workflow - Clinical Quick Guide

Purpose

Standardize annulus sizing and coronary clearance assessment for TAVI planning with reproducible, auditable steps.

Workflow checklist
  1. MPR setup: keep axial/coronal/sagittal visible and turn on orthogonal lock.
  2. Coronal reference: LCC on the left, RCC on the right — mark the lowest RCC point; angulate so the plane passes through the lower LCC. Click in the CORONAL viewport.
  3. Sagittal reference: NCC on the right, RCC on the left — mark the lowest NCC point; angulate through the RCC. Click in the SAGITTAL viewport.
  4. Cusp symmetry (tricuspid): counter-clockwise rotation without moving cranio-caudally until the second cusp insertion is transected; confirm the checkbox.
  5. Annulus plane: both basal insertions in the plane; in axial, the slice matching both side views is the annulus level for measurement.
  6. Long/short diameters: draw two annular diameters on the same annulus slice when required.
  7. Planimetry (ROI / Area): trace the annulus on the axial annulus slice; drag vertices to adjust; double-click or click the first point to close; ~¾ traced may auto-complete.
  8. RCA height: mark RCA ostium and confirm RCA lower border.
  9. LM height: mark LM ostium and confirm LM lower border.
Oblique controls
  • Keyboard: Q/E roll, W/S pitch, A/D yaw.
  • Mouse: drag reference line = pitch/yaw, Alt+drag pitch/yaw, Shift+Alt+drag roll.
  • Use Lock 90 degrees: ON to preserve orthogonal geometry and repeatability.
How to place each marker
  • Select a marker button in the right panel first, then click in MPR to place it.
  • Annulus Ref: click hinge-level valve center, not leaflet tips.
  • RCA Ostium / LM Ostium: click the lower border of the ostium used for clearance review.
  • R / N / L cusp markers: click the hinge nadirs on the same annulus level.
  • To correct a point, select the same marker again and click a new location.
  • Use mouse wheel to scroll slices before placing the point if needed.
Risk thresholds and output
  • Use Height warn and Distance warn as configurable warning thresholds.
  • Default warning thresholds: height 10 mm, geometric distance 8 mm.
  • Use Export Root JSON for Heart Team review/audit trail and Open Report PDF for summary output.
When workflow is complete
  • All 8 steps show done in progress panel.
  • Summary contains annulus metrics plus RCA/LM perpendicular and geometric distances, with warning flags.
  • Manual edits are logged for traceability.

Warning flags support decision-making and do not replace clinical judgement.

Pre-Report Review

Loading review state...

Annulus R / N / L and Valve Elements Guide

Purpose

This integrated workflow section enables measurement of the aortic annulus dimensions by marking three hinge points of the aortic valve leaflets: R (Right Coronary cusp), N (Non-Coronary cusp) and L (Left Coronary cusp). Optionally, coronary ostia (RCA, LCA) and valve commissures (R-N, N-L, L-R) can be marked for complete valve anatomy context. It works inside the same Aortic Root Workflow panel.

Steps
  1. Activate Aortic Root Workflow in the toolbar.
  2. In the same right panel, use the Annulus R/N/L and Valve Elements section and select the active marker button.
  3. Keep Axial/Coronal/Sagittal linked around one crosshair (multiplanar reformats). Use Oblique MPR if needed and keep Lock 90 degrees ON for orthogonal geometry.
  4. Click R, then click the right coronary cusp hinge nadir in MPR.
  5. Click N, then click the non-coronary cusp hinge nadir.
  6. Click L, then click the left coronary cusp hinge nadir.
  7. After marking R+N+L, annulus results are calculated automatically: Min Ø, Max Ø, Avg Ø, Area, Perimeter and hinge-point distances.
  8. Optional - click RCA ostium and mark the right coronary artery ostium, then LCA ostium for the left coronary artery. Coronary heights will be calculated (perpendicular distance from the basal plane).
  9. Optional - mark valve commissures: R-N, N-L, L-R. These points are stored for valve morphology review and audit traceability.
  10. Click Save to report to add the measurements to the study report.
Mouse and keyboard
  • Select the marker button first, then place it with left click in MPR.
  • Mouse wheel: scroll through slices.
  • Drag reference line: adjust plane orientation.
  • Alt + drag: pitch / yaw.
  • Shift + Alt + drag: roll.
  • Q / E: roll, W / S: pitch, A / D: yaw.
How are values calculated?
MetricMethod
Max ØLongest of the three hinge-point distances (R-N, N-L, R-L)
Min ØTriangle height to the longest side: 4 × S / dmax
Avg ØCircumscribed circle diameter on 3 points: 2R = (d1 x d2 x d3) / (2S)
AreaEllipse: π x a x b, where a = Max/2, b = Min/2
PerimeterRamanujan's approximation for an ellipse
RCA / LCA LPerpendicular distance from the ostium to the basal plane (R+N+L)
Clinical tips
  • Mark hinge points at the same level as the annulus plane, not at the leaflet tips.
  • Use the view with optimal symmetry of all three leaflets (cusp symmetry view).
  • Coronary height < 14 mm is flagged with a warning ⚠.
  • The 3-point measurement is an approximation; for full planimetry use the ROI tool on the same plane.
  • Click any button (R / N / L / RCA / LCA / commissures) again to correct a marked point.

Values are for guidance only and do not replace clinical assessment.

Pan

Click and drag to move the image within any viewport.

  • Left-click + drag to pan the view.
  • Works in all MPR viewports (axial, coronal, sagittal) and 3D.
  • Use mouse wheel to scroll through slices.

Zoom

Magnify or reduce the image in the active viewport.

  • Left-click + drag up/down to zoom in/out.
  • Mouse wheel can also be used for zoom when this tool is active.
  • Double-click to reset zoom to fit.

Window / Level

Adjust brightness (level) and contrast (window) of the CT image to optimize visualization of different tissues.

  • Left-click + drag horizontally to change window (contrast).
  • Left-click + drag vertically to change level (brightness).
  • Use presets (Cardiac, Abdomen, Lung, Bone) for common ranges.
  • Cardiac preset is recommended for TAVI planning.

Measure Distance

Measure point-to-point distance in any MPR viewport. Results appear in the Measurements panel on the right.

  • Click to place the first point, then click again for the second point.
  • Distance is displayed in millimeters based on DICOM pixel spacing.
  • Measurements are saved in the right panel under Manual MPR measurements.
  • Multiple measurements can coexist on the same viewport.

Measure Angle

Measure the angle between two lines in any MPR viewport.

  • Click 3 points to define two rays sharing a common vertex.
  • Angle is displayed in degrees.
  • Useful for assessing aortic angulation and implant trajectories.

Annotate

Add text annotations and markers to MPR viewports.

  • Click on the viewport to place an annotation marker.
  • Type a label for the annotation in the prompt.
  • Annotations are visible on screen and can be included in report exports.

ROI / Area

Draw a polygon on an MPR slice to measure enclosed area and perimeter (annulus planimetry, calcification ROIs, or any cross-section).

  • Click to place each vertex; double-click or click the first vertex (release without dragging) to close.
  • Drag a vertex (grab cursor) to reposition after placement, including on a saved ROI on the same slice.
  • After roughly three-quarters of the contour is traced, the tool may auto-complete the remaining arc.
  • Esc cancels vertex drag or clears an in-progress polygon.
  • Measured values: area (mm²), perimeter (mm); results sync to the list below and the report pipeline.

Ostia Marker

Place markers at the coronary artery ostia (RCA and LCA) for coronary clearance assessment.

  • Click in MPR at the lower border of each coronary ostium.
  • Markers are displayed in the 3D viewport and used for height calculations.
  • Pair with the Aortic Root Workflow for complete annulus-to-ostium distance.

Ostia Heights

3-step workflow to measure the perpendicular height from the annulus plane to each coronary ostium.

  1. Step 1 - Annulus: Click in MPR at the level of the annulus plane.
  2. Step 2 - RCA: Click at the lower border of the RCA ostium.
  3. Step 3 - LCA: Click at the lower border of the LCA ostium.
  • Heights < 10 mm trigger a warning (coronary obstruction risk).
  • Results are saved to the report and visible in Clinical Summary.

Simulate Valve

Run a virtual valve deployment simulation based on annulus measurements and selected prosthesis.

  • Select a valve model and size in the right panel.
  • Adjust depth and rotation sliders for optimal positioning.
  • Click Run Simulation to compute oversizing %, PVL risk, and contact metrics.
  • Advanced controls allow fine-tuning of offset and tilt in all axes.

Place Valve

Manually place a valve prosthesis mesh in the 3D viewport for visual assessment.

  • The valve is positioned at the annulus plane derived from the Aortic Root Workflow.
  • Drag in 3D to reposition; use sliders for fine adjustments.
  • Use Remove Valve to clear the placed model.

Measurements Panel

Central hub for all measurements in the DICOM viewer. Shows QC status, AI-derived report measurements, live workflow measurements, and manual MPR measurements.

  • QC Status - automated quality control checks (PASS/FAIL/WARNING).
  • Report measurements - AI-extracted values from the analysis pipeline.
  • Live workflow measurements - values from the active workflow (root, cusps).
  • Editable AI areas - click to override AI landmarks (annulus, ostia, SoV, STJ, LVOT, calcification ROIs).
  • Manual MPR measurements - distance/angle/ROI measurements placed by hand.
  • Use Edit report measurements to open the full measurement editor.

Access Assessment

Measure minimum vessel diameters for transfemoral access route evaluation (right and left sides).

  • Measure Common Iliac, External Iliac, and Common Femoral arteries.
  • Click Measure next to each vessel, then click in the MPR at the narrowest point.
  • Switch between RIGHT and LEFT tabs.
  • Check Access route not in scan if the scan does not cover the femoral vessels.
  • Minimum diameters are summarized in the Clinical Summary panel.

C-Arm Planning

Computed angiographic projection angles for optimal C-arm positioning during TAVI.

  • LAO/RAO and Cranial/Caudal angles derived from the annulus plane normal.
  • Alternative views are listed when available.
  • Enable Show beam plane in 3D to visualize the projection in the 3D viewport.
  • Angles are only available after annulus QC passes.

Aortic Root Levels

Anatomical level navigator for the aortic root. Click any level to navigate the MPR cursor to that position.

  • LVOT - Left Ventricular Outflow Tract (funnel/trapezoid shape).
  • Annulus - Aortic Valve Base (elliptical cross-section).
  • SOV - Sinuses of Valsalva (Mercedes-Benz / cloverleaf shape with coronary origins).
  • STJ - Sinotubular Junction (perfect circle; upper boundary for valve calcification).
  • Ascending Aorta - Tubular aorta above STJ (uniform circle).

The calcification tagging guide below shows how to identify boundaries for accurate calcium scoring.

Valve Simulation Panel

Configure and run virtual valve deployment. Results include oversizing, PVL risk, and contact assessment.

  • Valve Model - select prosthesis type from the catalog.
  • Size - pick from available sizes for the selected model.
  • Depth / Rotation - adjust implant depth and rotational orientation.
  • Advanced - fine-tune model axis, offset (X/Y/Z), and tilt (X/Y/Z).
  • Run Simulation computes oversizing %, paravalvular leak risk, and contact metrics.
  • Reset Position returns all sliders to defaults.

CPR - Straightened View

Curved Planar Reformation (CPR) shows the aorta straightened along its centerline for diameter and length assessment.

  • Lock to centerline - keeps the CPR slice synchronized with the MPR cursor position.
  • Thickness slider - adjust the CPR slab thickness (1-20 mm).
  • Edit offset - manually adjust the centerline path.
  • Save / Reset - persist or discard centerline edits.
  • If CPR is not available, click Generate CPR Views for server-side computation.

Clinical Summary

Single source of truth for all clinical data. Aggregates QC status, key measurements, access assessment, C-arm angles, and CPR information.

  • QC & Measurements - quality control status, confidence level, and key report measurements.
  • Access Assessment - minimum vessel diameters (right/left) and feasibility.
  • C-Arm Guidance - recommended projection angles.
  • CPR - centerline distance summary.
  • Series - loaded DICOM series information.

This panel is always visible regardless of the active tool. Use it as the primary reference during clinical review.