Syngo via workstation

Manufactured by Siemens

Sourced in Germany

The Syngo.via workstation is a medical imaging software platform developed by Siemens. It is designed to support healthcare professionals in the analysis and interpretation of medical images from various modalities, including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). The Syngo.via workstation provides tools and applications for image viewing, post-processing, and quantification to assist in clinical decision-making.

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36 protocols using syngo via workstation

Coronary Artery Calcium Scoring Protocol

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All images were read in consensus by a board-certified nuclear medicine physician and a board-certified cardiologist.
Calcium scoring was done, equally for the 80 and 120 kVp acquisitions using a dedicated semiautomatic software included in Syngo.Via workstations (Siemens Healthineers AG, Erlangen, Germany). In brief, all pixels with an attenuation equal or above the lowest threshold (i.e., ≥ 130 HU) having an area ≥ 1 mm² are automatically color-marked and then manually selected by creating a region of interest around all lesions found in a coronary artery. The software then calculates the CACS as previously reported,^{9 (link)} by multiplying the density score and the area of calcification.
Based on the CACS derived from both, the 80 and 120-kVp scans, each patient was allocated to the corresponding percentile group as reported in the literature^{9 (link)}: < 25%, 25% to 50%, 50% to 75%, 75% to 90%, > 90%.

Allio I.R., Caobelli F., Popescu C.E., Haaf P., Alberts I., Frey S.M, & Zellweger M.J. (2022). Low-dose coronary artery calcium scoring compared to the standard protocol. Journal of Nuclear Cardiology, 30(3), 1191-1198.

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PET/CT Imaging Protocol for Cervical Cancer

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Standard PET/CT scans (without iodine contrast) were acquired from the skull to pelvis according to a previously described protocol using 3D Gemini GXL Philips Medical Systems at 60 min (±10 min) after ¹⁸F-FDG injection (3 MBq/kg) and reconstructed using the line-of-response row-action maximum likelihood algorithm (three iterations and 33 subsets, voxel size: 4 × 4 × 4 mm³) [14 (link)]. The images were reviewed on Siemens Healthcare Syngo.via workstations. The volumes of interest (VOI) were carefully placed in the same anatomic site on all three PET scans for each patient; care was taken not to include bladder activity in the VOI. SUV_max, SUV_mean, MTV and TLG were calculated using a gradient-based method (PET Edge tool of MIM Encore software, version 6.9.3; MIM Software Inc., Cleveland, OH, USA) [14 (link),20 (link)]. Any focus of ¹⁸F-FDG uptake at the primary site higher than the surrounding background was considered abnormal and interpreted as positive. Tumor response was classified as follows: (1) complete response in patients with absence of abnormal ¹⁸F-FDG uptake at the site of the cervical tumor; (2) partial response in patients with residual abnormal ¹⁸F-FDG uptake at this site [14 (link)].

Pasciuto T., Moro F., Collarino A., Gambacorta M.A., Zannoni G.F., Oradei M., Ferrandina M.G., Gui B., Testa A.C, & Rufini V. (2023). The Role of Multimodal Imaging in Pathological Response Prediction of Locally Advanced Cervical Cancer Patients Treated by Chemoradiation Therapy Followed by Radical Surgery. Cancers, 15(12), 3071.

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Liver Volumetry Using Siemens and OsiriX

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All CT scans were analysed using the Syngo.via workstation (Siemens Healthineers GmbHs, Client 5.1; liver analysis programme). MRI liver volumetry assessment was performed using the OsiriX (DICOM Viewer Lite, v.12.5.3). Liver volumetry, using manual segmentation, was performed by a trained researcher and supervised by an experienced interventional radiologist. To train the researcher, twenty liver volumes and segmentations were performed together with the researcher and the interventional radiologist, before liver volumetry of the study population was performed.

Knapen R.R., Korenblik R., James S., Dams G., Olij B., de Boer S.W., van Dam R.M, & van der Leij C. (2023). The Effect of Microwave and Radiofrequency Ablation (MWA/RFA) on Liver Volume in Patients with Primary and Secondary Liver Tumours: A Retrospective Analysis. Cardiovascular and Interventional Radiology, 46(8), 991-999.

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Long-term Coronary Graft Patency Evaluation

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The first follow-up at a mean of 36 months was performed with conventional angiography in 99 patients (92%). The second and current follow-up was performed at 97 months using computed tomography (CT) angiography with a Somatom Flash dual-source CT scanner (Siemens, Erlangen, Germany). All subjects received 0.25 mg of nitroglycerin sublingually. Those with a heart rate >70 bpm and no contraindications were also given up to 10 mg of metoprolol intravenously before the examination. Contrast media (60-70 mL of Iomeron 400 mg/mL; Bracco, Milan, Italy) was administered with a pressure injector at a flow rate of 6 mL/s, followed by a 60-mL saline bolus. Scanning started at the left subclavian artery and ended at the base of the heart. The images were reviewed on a Siemens SyngoVia workstation. All images were independently reviewed by 2 thoracic radiologists who were blinded to group assignment. Disagreements were resolved by consensus. Where possible, the studies were compared with reports and images from previous coronary angiographies. A graft was judged as occluded when the graft was not opacified by contrast media. Graft stenosis was deemed significant when the narrowing of the lumen diameter was >50% relative to the adjacent parts of the vessel.

Dreifaldt M., Mannion J.D., Geijer H., Lidén M., Bodin L, & Souza D. (2021). The no-touch saphenous vein is an excellent alternative conduit to the radial artery 8 years after coronary artery bypass grafting: A randomized trial. The Journal of thoracic and cardiovascular surgery, 161(2).

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Cardiac Function Analysis via CT

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All datasets were transferred to an off-line syngo.via workstation for further analysis (Siemens Healthcare, Forchheim, Germany). The data were reconstructed by the Bv40 vascular algorithm for every 5% (0–95%) of the R-R interval and with a 1.5 mm slice width (with 1.0 mm increments). After reconstruction at the main station, these data were transferred to the workstation for cardiac function analysis by syngo.via software (Siemens Healthcare, Forchheim, Germany) to observe the end-systolic and end-diastolic image phases. By manual initialization, the mitral valve plane was edited, and the LV endocardial and epicardial contours were delineated. Finally, a quantitative index of global cardiac function and a bull’s-eye map with LV myocardial segmentation were obtained.

Li W., Lyu L., Yang W., Zhang R., Wang G., Fan D., Song W., Yin J., Yang J., Li W., Chen L, & Luo T. (2019). A Pilot Study of Third-Generation Dual-Source Computed Tomography for the Assessment of Global Dynamic Changes in Left Ventricular Structure and Function in a Porcine Model of Acute Myocardial Infarction. Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, 25, 7989-7997.

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Cardiac CT Angiography Protocol

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All CCTA evaluations were performed using a 2nd generation 2*128-slices dual source multi-detector CT (MDCT) scanner (Siemens Somatom Definition Flash; Siemens Healthineers, Erlangen, Germany). Optimal reconstructions at different percentage times of an R-R interval were performed (0.75 mm slice thickness) and submitted to the Syngo.via workstation (Siemens Healthineers) for image analysis (graft type and status, type of proximal and distal anastomosis, anastomosis angle).

Tinica G., Chistol R.O., Bulgaru Iliescu D, & Furnica C. (2018). Long-term graft patency after coronary artery bypass grafting: Effects of surgical technique. Experimental and Therapeutic Medicine, 17(1), 359-367.

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Quantifying Ventricular Blood Pool T1 and T2

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Right and left ventricular blood pool T1 and T2 values were respectively measured on the four-chamber slice of T1 map and T2 map with an Argus (SyngoVia workstation, Siemens Healthcare Sector, Forchheim, Germany). Region of interest (ROI) of the left and right ventricular blood pool were delineated along the endomyocardium on the four-chamber T1 Map and T2 Map (Fig. 1). To eliminate bias, right and left ventricular blood pool T1 and T2 values were analyzed independently by two observers who were blinded to other clinical information, and then one observer analyzed right and left ventricular blood pool T1 and T2 a second time after 4 weeks. The Right and left ventricular blood pool T1 ratio (RVT1/LVT1 ratio) and T2 ratio (RV/LV T2 ratio) were calculated from the mean value of three measurements.Fig. 1

Measurement of RV and LV blood pool T1 (a) and T2 (b) the 4-chamber cardiac view of T1 map and T2 map

Deng M., Liu A., Xu W., Yang H., Gao Q., Zhang L., Zhen Y., Liu X., Xie W, & Liu M. (2023). Right and left ventricular blood pool T2 ratio on cardiac magnetic resonance imaging correlates with hemodynamics in patients with pulmonary hypertension. Insights into Imaging, 14, 66.

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FDG PET/CT Quantitative Metrics for Liver Metastases

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MTV was obtained from all liver metastases by manually placing a volume of interest (VOI) over each metastasis using a Siemens SyngoVia workstation (version VB10A, Erlangen, Germany) and a fixed threshold of 40%. MTV was only registered if the uptake was higher than the mean liver background uptake × 1.5 + standard deviation of the liver background × 2 [17 (link)]. Patients without any metastases with uptake above this value were given an MTV value of zero. Liver background was measured by placing a VOI of 3 cm in the right liver lobe. Total MTV was calculated by adding the values from all metastases for each patient. Maximum standardized uptake value (SUV_max), SUV_mean, SUV_peak, tumor to background (T/B) ratio and total lesion glycolysis (TLG) were also registered. In patients with more than one liver metastasis the highest SUV was registered. SUV_peak was defined as the SUV_mean of the volume of 1 cm³ around the SUV_max. TLG was calculated by multiplying SUV_mean by MTV.

Grut H., Line P.D., Syversveen T, & Dueland S. (2022). Metabolic tumor volume predicts long-term survival after transplantation for unresectable colorectal liver metastases: 15 years of experience from the SECA study. Annals of Nuclear Medicine, 36(12), 1073-1081.

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Quantitative PET/CT Imaging Biomarkers in Colorectal Cancer

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The PET/CT images of the primary lesion of colorectal cancer were gauged by the Siemens syngo.via workstation (Knoxville, TN, USA). A volume of interest (VOI) at the primary tumor region was set to measure the maximum standardized uptake value (SUVmax). MTV and TLG were counted with 2.5 SUV as a threshold and 40% SUVmax as a threshold, respectively. In addition, we counted the coefficient of variation (CV) and heterogeneity index (HI) as heterogeneity parameters. CV is the ratio of the standard deviation of SUV to SUVmean, which reflects the variation degree of SUV (15 (link)). CV2.5 with 2.5 of SUV as the threshold and CV40% with 40% of the SUVmax as the threshold were measured. As the negative form of the linear regression slope of MTV was calculated according to different SUV thresholds, HI represents the MTV discrepancy under different SUV thresholds. Three fixed SUV values (2.5, 3.0, 3.5) were used to create the MTV-based HI-1 (Figure 1A) (16 (link)), and 30%–70% SUVmax thresholds were used to develop the MTV-based HI-2 (Figure 1B) (11 (link)). Two well-experienced nuclear medicine experts must be blinded to the patient’s information and separately review the images. In case of disagreement on the images, a high-level doctor would make the final decision.

Liu X., Zhang Y.F., Shi Q., Yang Y., Yao B.H., Wang S.C, & Geng G.Y. (2022). Prediction value of 18F-FDG PET/CT intratumor metabolic heterogeneity parameters for recurrence after radical surgery of stage II/III colorectal cancer. Frontiers in Oncology, 12, 945939.

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Tumor SUVmax Analysis in Nuclear Medicine

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Three nuclear medicine physicians in collaboration interpreted the images on the Siemens Syngo Via Workstation (S.L., M.C., and O.G.). For each study, a large region of interest (ROI) was drawn manually around the entire primary tumor, and maximum standardized uptake values (SUVmax) were obtained for further analyses.

Sánchez D., Romero L., López S., Campuzano M., Ortega R., Morales A., Guadarrama M., Cesarman-Maus G., García-Pérez O, & Lizano M. (2019). 18F-FDG—PET/CT in Canine Mammary Gland Tumors. Frontiers in Veterinary Science, 6, 280.

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