"user manual"
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1. Start Manuals VISOR2 NEURONAVIGATION QUICK START Setup Patient e Select existing patient or create new If using existing patient you may use existing MRI Otherwise Import and prepare patient MRI figure 2 Setup patient Select task Modify existing patient Test Create new patient Select MRI to associate with the patient Use existing MRI Standard MRI Import and prepare patient MRI Import new patient MRI data and run through the segmentation If MRI data is already present it will be moved to the patient s Archive folder together with already defined targets and previous session data Pressing Next will guide you through the necessary steps for data preparation G V062 51064 00005 MRO0176 DICOM z hama Figure 2 Setup patient e Select image path press refresh figure 3 select images and press OK When ready press next F m Open DICOM Images E No name 2 5 2004 SIEMENS MAGNETOM VISION Gi 180 images FMAIMP_LRAGE Echo Time 4 000 2 5 2004 3 43 21 PM DICOM Directory GVO L Cha amp l Include Subdirectories In Search Data Loaded From Disk Cache 0 Directories 0 Files Scanned 1 ltem Found Cancel Help Figure 3 Open MRI images 2 8 Aalto University School of Science A Aalto TMS Laboratory Quick Start Manuals VISOR2 NEURONAVIGATION QUICK START e Specify ficiduals from MRI images Recommended sites are left ear right ear and nasion Incre2. Neuronwegation omni SS D Tool Pen Neuro Navigation F Too Coit P Too Calit f Too Refe Your task a Stimulate Switch Coil Reproduce stimuli Validate Stimulate at Targets TMS intensity to use Stimulation intensity J 100 in rTMS filter Use rTMS filter Define new targets Add marker ia Save view for current task Finalize Figure 10 Neuronavigation Events list indicated e By clicking right mouse button in the navigation area you can select different layout or edit 3D Im age View Properties figure 11 To see E field mapping select layout Navigation with E field ro 3D Image View Properties a j General Management Scalp Brain TMS Coil Pen Target Helper EField Mapping 3D Marker Headshape points Position MRI Colors RGB Palette d ey opaque Transparency Standard Rainbow Palette Scaling Color Mapping C c interpolated Color Mapping C Discrete Color Mapping 0 00 0 00 Vim Vem fiz Threshold 90 se 35 Show iV Color Mapping O Contour lines M Values Wireframe Snap MRI Slices To Field Max Field Calculation Calculate For All Boundary Vertices Calculate Only For Vertices In Distance Distance 30 mm Cancel Help Figure 11 3D Image View Properties 7 8 Aalto University School of Science Aalto TMS Laboratory Quick Start Manuals VISOR2 NEURONAVIGATION QUICK START A e When you done with sti
3. School of Science Mikko Nyrhinen 15 10 2013 Quick Start Manuals VISOR2 NEURONAVIGATION QUICK Edited name date START to Universi A Aalto University Aalto TMS Laboratory Author date Ld VISOR 2 QUICK START Figure 1 Visor2 neuronavigation computer Polaris Vicra optical tracking system and power switch to the monitors Extension cord power switch computer power and optimal camera to reference tool distance illustrated Contents Starting Measurements cccccsccsseccseccsecescccseccseccsecesectaeetaeeteeseeeseesaeesaessesssessceusseusceseceusceeceseceseceseceseeeseetaees 1 SUN PU SU steers burn tienen toratederevanstasoens A T 2 TMS NEURO TIA VE ARON ie ceeetaae te ccreretsncranetsresecereneiconsnennsoveceatneutaeheneieieuiersneuntenie ania sues iesieren an eraenneovepenaawyenaaieyenas 5 OPENS PE oier E E S S 8 Alter Measurements gene rnn ee eee ee 8 Starting Measurements e Turn on the power from the extension cord and start the stimulation computer figure 1 e Turn on the monitors from the control switch on the wall figure 1 e Start the Visor 2 program 1 8 Aalto University Postal Address Street Address Contacts School of Science P O BOX 13000 Otakaari 5 358 0 50 4371613 Aalto TMS Laboratory 00076 AALTO Espoo aaltotms sci aalto fi amiserver project tms_internal TMS_Documents Official 2013 ENG AALTO_TMS_Visor2_Quick_Start Aalto University School of Science Aalto TMS Laboratory A Quick
4. ase lower scalp threshold until background artefacts noise etc are excluded from the mask figure 4 You can use the sliders to browse through slices aa H al 6 67 57 M B 0Ol Ej a amp Af 4 a RE Setup Patient TMS Neuronavigation Offline Review Tracking Settings Recording Settings a x Create Model Segmentation settings Lower scalp threshold 11 Brain segmentation Automatic Manual Lower brain threshold 21 Upper brain threshold i 255 Segment Head model settings a Number of Curvilinear Surfaces 40 Leave Workflow Done Figure 4 Adjusting lower scalp threshold Edit v e Adjust lower brain threshold so that the red mask covers the whole brain and the brain is not connected to scalp figure 5 Press segment NB The cursor must be located in the segmentation area red When using NifTl images adjust the lower brain threshold normally and after you find the correct threshold multiply it with 2 Notice that the preview is thus incorrect 3 8 Aalto University i School of Science Aalto TMS Laboratory Quick Start Manuals VISOR2 NEURONAVIGATION QUICK START A Figure 5 Adjusting lower brain threshold e View the segmentation and adjust parameters if needed You can use dilate erode to in crease decrease segmentation area e Select number of curvilinear surfaces and create head model Number of curvilinea
5. ls Use remote control to acquire ficiduals figure 7 Use the same locations as marked in setup patient Press Next when done a ci Figure 7 Reference tool pen tool and remote control 5 8 A Aalto University School of Science Aalto TMS Laboratory Quick Start Manuals VISOR2 NEURONAVIGATION QUICK START Create head shape points It is recommended to do the head shape points generation because it makes the co registration of navigation and MRI files more accurate Select points from all vari ous locations the scalp forehead cheeks and occiput Remember to pause the head point collec tion if you need to lift the pen from patients head You can reset the head points when collection is paused Selecting display results shows statistics of the co registration figure 8 It s recom mended to collect 100 200 points Press Proceed when done Head Shape Points Generation Please note In order to perform the head shape points fit you have to digitize at least 20 points Minimum distance between points 5 mm Points Generated 38 A sufficient number of head shape points has been acquired Proceed to perform the head shape points fit Figure 8 Head Shape Points Generation Validate coil optional Use pointer tool to point the center of X marked on the coil figure 9 Be sure that the camera can see both the coil and pointer tool If validation doesn
6. mulations press Finalize e Complete neuronavigation Validating the nasion is recommended to make sure the headband reference tool hasn t moved during the session e Proceed either with complete or proceed to review Offline review e By selecting Offline Review from the workflow menu you are able to review TMS sessions figure 12 ae 7 Be Te tr a fe al setup Patient TMs Neuronavigation Offline Rewiew Tracking Settings Recording settings Complete Neuronavigation Figure 12 Workflow menu After Measurements e Shut down Visor2 program and turn off computer e Cut the power off the extension cord figure 1 8 8
7. r surfaces indi cate how deep in the brain from the cortex surface you are able to navigate Every surface is a 2 mm slice so 10 surfaces gives you the ability to see as deep as 2 cm from the cortex surface You can browse through head surfaces with a slider figure 6 When ready press next 4 8 Aalto University School of Science Aalto TMS Laboratory Quick Start Manuals VISOR2 NEURONAVIGATION QUICK START 4 0 0 R S 0R Ger s h aa e ico uk ae oe a F Wee S irois Hla Setup Pebert TMS Neuronwegeton Oline Review Tracing Stings Fecordeng Seng Create Model Segmentation settings Lower scalp threshold 11 Brain segmentation Automatic Manual Lower brain threshold 21 Upper brain threshold 255 Segment Refine Brain Compartment Dilate Brain Erode Brain Head model settings Number of Curvilinear Surfaces 40 Create Head Model Ta Save Segmentation view Leave Workflow Figure 6 Create head model e Define stimulation targets or proceed to neuronavigation Use targets to preterminate stimulation area for example the motor cortex Place the mouse pointer to appropriate area and press Add marker TMS Neuronavigation e Select Coil and press Next The coil number is written on the coil cable e Specify head coordinate system Adjust the Polaris camera according to figure 1 Place refecence tool on subjects head and use pen tool to point ficidua
8. t succeed do the cal ibration Please refer to Visor2 User Manual or contact laboratory s laboratory engineer Validate the calibration of your TMS coil Please use the pointer tool to indicate the red control dot attached on the coil Your coil Identifier round Manufacturer MagVenture Model C 100 e Skip Validate Figure 9 Validating the coil Start the neuronavigated TMS session Select patient Select target file and previous session mark ers if required Proceed pressing Next Neuro navigation figure 10 The correctly view calculted values e g E field the TMS Intensity slider must be the same as in the Magstim system Selecting Use rTMS filter gives only one trigger mark per train Stimulate at targets gives the possibility to stimulate predefined targets look setup patient 6 8 Aalto University School of Science Aalto TMS Laboratory Quick Start Manuals VISOR2 NEURONAVIGATION QUICK START e Reproduce stimuli gives you possibility to stimulate previous stimulation site either from this ses sion or a previous one Select events events you want to see from the list figure 10 You can disa ble viewing or delete events from right mouse click menu FF Vico INavigated INE TA f fie Edit View Dusta Toob Help Se H g gt kij M R f ORBo A TLE aan 3 Recording Montas Automatic 1000ec gt mm 5 za Oe th Bem Oo m gr t TMS
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