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syngo®.via1 is a multimodality reading solution built on a client-server platform. It offers a complete suite of molecular imaging applications for oncology, cardiology and neurology. It has been uniquely designed to provide a true hybrid reading experience. Advanced quantification tools enable reproducible results from virtually anywhere2 at anytime, including PACS. Its client-server architecture drives an integrated workflow from case preparation to reading to sharing, defining a new standard in image access.
 

 

syngo.via

syngo.via

syngo.via drives efficiency.

Access findings, anywhere.
Software helps to accelerate molecular imaging workflow and save valuable time.

syngo.via customer testimonial

Interview with Prof. Jerry Froelich, MD

syngo.PET Segmentation EQ-PET

Features & Benefits

syngo.via is intelligent.

 

Quantify the invisible.
The software1 delivers powerful quantitative reading functionality for oncology, cardiology and neurology cases.

 

syngo.via drives efficiency.


Access findings, virtually anywhere.2
Software helps to accelerate molecular imaging workflow and save valuable time.

syngo.via is flexible.

 

One platform for all modalities and needs.

You can customize layouts in line with your workflow.


syngo.via is intelligent.

Quantify the invisible.

The software delivers powerful quantitative reading functionality for oncology, cardiology and neurology cases and guides you through workflow.


syngo.via drives efficiency.

Access Prior Findings, Virtually Anywhere2

Operational Return on Innovation
 

  • syngo®.via1 offers up to 45% faster3 oncology reads compared to workstations. The RT export functionality now allows seamless collaboration with the oncology department.
  • syngo.via as a multimodality client-server solution orches­trates the imaging workflow, from acquisition to reading and sharing. Working off of a single database, cases are instantly available from virtually anywhere2, including PACS. Prior studies are automatically pre-fetched, results are available at the tumor board without extra preparation.
  • VA20 supports collaboration for radiation oncology. PET-based segmentations can be exported as DICOM RT Structures for use in RT planning. PET-based RT planning allows for innovative patient-friendly therapies by focusing dose on residual viable tumor and sparing other tissue.

 


Cases are automatically prepared by syngo.via and are accessible from the Quick Worklist. Simply selecting the patient launches the case-specific reading environment.
 

Increased reading efficiency with automated case preparation

To help keep up with productivity gains during acquisition, syngo.via automates many manual and routine steps in the reading workflow.

In oncology, hybrid exams are commonplace, which doubles the available diagnostic information. In addition, the studies are often whole-body exams, further increasing the volume. And many patients have a history of prior studies for comparison. syngo.via automates necessary preparation steps so your workflow starts where it should: with reading. When selecting a patient, the system can be configured so syngo.via:

  • has pre-fetched prior examinations.
  • fuses hybrid studies and registers them across up to 8 time points.
  • starts the appropriate reading environment: for example, the syngo.mCT Oncology Engine.
  • displays prior findings.


In cardiology, hybrid scanners are becoming more utilized by the acquisition of CT calcium score and CTA examinations in parallel with the PET or SPECT study. When selecting a patient, the system can be configured so syngo.via:

  • has pre-fetched prior examinations.
  • starts the appropriate reading environment: for example, the syngo.mCT Cardiology Pro Engine.
  • has already removed the rib cage, soft tissue and bloodpool.
  • has tracked and labeled the coronary arteries.
  • has performed a coronary lumen profile and plaque characterization.
  • has selected the appropriate normals database for perfusion analysis.


In neurology, PET brain imaging is becoming more utilized due to the aging population and development of new biomarkers. Depending on the type of procedure performed, the system can be configured so syngo.via:

  • starts the appropriate reading environment: for example, syngo®.PET Database Comparison
  • performs fusion to a CT and/or MR dataset
  • performs fusion to a normals database for visual analysis
  • performs registration to a reference brain template
  • provides predefined regions of interest for quantification


With all preparation work being performed by syngo.via, the case interpretation can begin immediately upon launching. syngo.via increases reading efficiency and helps reduce report turnaround time.


Workflow integration from case preparation to results sharing
syngo.via is more than a diagnostic tool: it supports your workflow all the way to the tumor board presentation. From processing to diagnosis and sharing, syngo.via provides a single, common platform. Working on the same dataset preserves results and eliminates redundancies. First, the technologist can prepare the case. Next, the reading physician creates findings and documents the diagnosis. Finally, the case and its results can be elegantly presented in the tumor board meeting using the Findings Navigator.

RIS/PACS workplaces are often limited to 2D/3D image display and are not designed for hybrid reading or PET quantification. syngo.via overcomes these limitations through its advanced visualization and quantification functionality and can be fully integrated into the RIS/PACS workstation of all major vendors.
 

Reduced reading time
With a single database, your technologist can now prepare your cases before placing them in the reading worklist. Routine tasks will be completed, so more time is available for patient care and reading. All cases are available instantly, without sending studies across the network.


Advanced PET and CT reading on PACS

With syngo.via, you can freely navigate the entire dataset, use advanced PET and CT segmentation and quantification tools, and document your findings – right on the RIS/PACS reporting workplace. Cases can now be interpreted and reported with access to full clinical information, without depending on parallel ranges or switching between reporting and reading workplaces.


Live access anytime, virtually anywhere
2
On your PACS, at the tumor board meeting, in the OR, or even from home, live access to all cases and tools is just a login away on any PC.* Referring physicians can access WebReports to review findings and related images. This creates new possibilities, like easy second opinions and on-call scenarios, using the Findings Navigator to elegantly present cases, or using 3D visualization for surgery planning and patient communication. syngo.via frees medical images from the local workstation to bring the power of hybrid imaging to clinical routine.
*with a network connection and meeting minimum hardware requirements.


syngo.via is flexible.

One Platform for All Modalities and Needs

A department’s image management and reading solution is a key part of its infrastructure. As such, customers rely on uptime and state-of-the-art functionality to remain produc­tive and competitive. The syngo.via service offering helps customers keep up with innovations at a predictable cost.
The single-user syngo.via workstation, which does not require a server connection, runs all available syngo.via applications. Server clustering allows customers to go beyond five users, at a 60% discount.


Financial Return on Innovation

 
Whether it is the CT or MR portion of a hybrid examination or a standalone CT or MR study in a shared service model, collaboration between the molecular imaging and radiology departments is greatly simplified when the same tools are used. Even a common syngo.via server can be shared across departments and their users, effectively extending the financial benefits of a shared service model from the scanner to the reading solution.

The syngo.via client-server architecture is a modular platform that is fully customizable with a large selection of advanced applications to match specific modalities and case mix requirements.
 

Supported modalities include:
 

  • Positron Emission Tomography
  • Single Photon Emission Computed Tomography
  • General Nuclear Medicine
  • Computed Tomography
  • Magnetic Resonance
  • Angiography
  • Radiography and Fluoroscopy
  • Ultrasound

Image management and visualization solutions are part of the infrastructure of the department. Uptime and state-of-the-art functionality are required to remain productive and competitive. And, the infrastructure has to grow with future needs.
 

The number of syngo.via client licenses, applications and engines can be configured independently with regard to timing and quantity.4


Investment protection with cost-effective scalability and maintenance

The syngo.via service agreement keeps the system state-of-the-art with automatic remote updates. Uptime is improved with server-grade hardware that is remotely monitored and centrally managed. And with the flexible licensing model, additional user and application licenses can be configured as needed.


State-of-the-art applications

Remote updates become automatically available on the server and ready for installation by the local administrator. All users can immediately benefit from the continuous innovations.


Improved uptime

Server-grade hardware in a controlled server room can be centrally managed and remotely monitored. Siemens Remote Service monitors the server continuously for preventative maintenance to ensure system performance.


Cost-effective scalability

The flexible licensing model of concurrent users allows additional users and application licenses to be configured at any time.4 Existing computers can also be used as syngo.via clients, which can run on any standard PC meeting minimum requirements.

Clinical Use


syngo.via is intelligent.

Quantify the invisible.

The software1 guides you through the entire workflow - it automatically pre-processes images and delivers powerful quantitative reading functionality.


Due to its unique capability of imaging and quantifying biological processes, molecular imaging is the modality of choice for many complex clinical questions in the areas of oncology, cardiology and neurology.
To fully exploit the quantitative capabilities of recent scanner innovations, such as Biograph™ mCT, advanced applications are available from Siemens that can be configured on syngo.via.


The most recent innovations allow for confident and efficient quantitative assessment of:
 

  • blood flow in cardiology
  • therapy response in oncology
  • dementia in neurology
     

The complete overview of molecular imaging applications on syngo.via can be found under Technical Details.


With its unique capability to accurately detect metabolic changes before anatomical changes are visualized, PET/CT has become instrumental for early detection and staging, as well as therapy response assessment. Quantitative therapy response criteria are well established in CT with RECIST and WHO. In PET, current practice incorporates SUVmax as the major quantitative parameter. However, since SUVmax is essentially a single voxel volume of interest (VOI), it is subject to larger statistical variation compared to other SUV measurement criteria. SUVpeak offers a metric that is reproducible while also being robust to noise.

SUVmax is subject to significant statistical variation, where SUVpeak is the mean value of the voxels within a fixed sphere of one cubic cm volume, centered on the hottest area of the tumor. This makes it close to SUVmax in terms of its representation of the maximum tumor metabolism, yet it avoids the statistical fluctuations of SUVmax due to incorporation of a larger number of voxels within the hottest tumor area. SUVpeak is easy to obtain in routine clinical use; the SUVpeak alogorithm automatically identifies the hottest 1 cm3 sphere within a VOI, which ensures reproducibility.

The illustration shows individual voxel SUVs in a lung tumor before and after therapy. The pre-therapy and post-therapy SUVmax evaluation shows a 17.6% decrease in metabolic activity, which reflects inadequate tumor response. The SUVpeak quantification, based on the average of multiple voxels involving the region with highest uptake, shows a more pronounced tumor response with a 30.3% decrease in metabolic activity.

syngo.via provides a comprehensive reading environment for hybrid oncology follow-up. Up to 8 hybrid examinations can be visually compared and quantified at the same time. For increased productivity, a single-click hybrid quantification tool provides the user with both CT and PET metrics, including SUVpeak, SUVmax, SUVmean, RECIST 1.0 or 1.1, WHO and volume. The quantitative segmentations can easily be exported to be used in radiation therapy planning.

The sequential 18F-FDG PET study illustrates the variation between SUVmax and SUVpeak for evaluation of therapy response. Decline in SUVpeak is more pronounced compared to SUVmax.


Cardiology


Conventional:

  • Factors introducing inter- and intra- reader variability
  • Depending on at least one normal reference region
  • Similar impression for normal and abnormal balanced perfusion


Siemens:

  • Features enabling accuracy and reproducibility
  • Absolute quantification of myocardial blood flow
  • Quantitative values for normal and low levels

Neurology


Quantification of SUV ratio for Amyloid Plaque

Several studies have illustrated that in certain clinical cases, visual assessment alone may lead to inconclusive or false reports which can be a source of risk to practices and patients. In specific, borderline cases and those where the intensity of amyloid uptake is insufficient, it may become challenging to accurately interpret based on visual assessment alone.


Dr. Adam Fleisher and his fellow researchers developed what came to be known as the Fleisher Method which established criteria to determine amyloid burden. This reference model compared against autopsy identified six optimal zones to evaluate pathological levels of amyloid plaque burden. It also identified threshold between normal and abnormal uptake that were researched in diseased and healthy patients

Siemens application may improve reproducibility and calculations of SUVr compared with only visual read.5


Conventional:

  • Factors that may introduce inter- and intra- reader variability
  • Manual identification of brain regions
  • Manual measurement of SUV averages
  • Manual computation of uptake ratios

 

Siemens:

  • Features that may improve reproducibility
  • Automatic mapping of brain regions
  • Automatic calculation of regional SUV averages
  • Automatic computation of uptake ratios

Technical Details


syngo.via is intelligent.

Quantify the invisible.

The software1 delivers powerful quantitative reading functionality for oncology, cardiology and neurology cases and guides you through the workflow.


Clinical Return on Innovation
 

  • Oncology: Reproducible PERCIST metrics for confi­dent therapy response assessment, allowing for early therapy adjustment.
  • Neurology: Reproducible SUVratio and database comparison aids PET amyloid exams in providing appropriate diagnostic evaluations and therapy planning.
  • Cardiology: Reproducible blood flow in ml/min supports detection of triple vessel disease for possible intervention.

 

Oncology Applications

The new syngo.via version VA20 adds features to oncology that complete the quantitative trending workflow: The SUVpeak metric is complemented with automatic detection of liver and blood pool background SUV, providing PET response criteria in solid tumors (PERCIST). Second, the new trending graph capability plots quantification metrics over time for quick visual therapy response assessment — a great addition to the display of up to eight time points and the quantification table. Together with the reproduc­ible quantification capabilities of Biograph mCT, follow-up studies can now be evaluated with confidence. Further, dynamic studies can be evaluated with time activity curves.

syngo.PET Dynamic Analysis

Graphs radiopharmaceutical uptake over time (time activity curve) via SUV-based quantification of volumetric regions of interest, using metrics such as SUVmax, SUVpeak and SUVmean.

syngo.PET Segmentation

Allows for SUV-based volumetric segmentation. Automatically provides volume, RECIST, SUVpeak, SUVmax and other metrics. Complete implementation of the PERCIST standardised response criteria for PET, incl. automatic placement of PERCIST reference regions.

syngo.SPECT Reading

Provides a comprehensive set of sophisticated layouts specifically designed for reading general nuclear medicine cases. The application automatically selects the most appropriate layout based upon the available data.

syngo.CT Segmentation

This application provides advanced features for faster, simpler oncological reading. It supports the automated segmentation and evaluation of lesions in the lungs, liver, lymph nodes and other organs – providing standardized quantification in RECIST (1.0 & 1.1), WHO and volume as well as Choi criteria and Advanced HU Statistics.

syngo.PET&CT Cross-Timepoint Evaluation

This application allows you to assess changes in tumor activity and size across four points in time, by comparing quantitative analysis of volume, RECIST, WHO, and minimum, average and maximum functional uptake.

syngo.PET&CT Onco Multi-Timepoint

Increases the number of time points that can be displayed at the same time in a single layout in fully synchronized view from four to eight.

syngo.PET&CT Therapy Interface

Publish Gross Tumor Volumes (GTV) contours as DICOM RT Structure Sets for use in radiation therapy planning. Convert diagnostic regions of interest such as PET iso-contours and PET and CT segmentatio ns into Gross Tumor Volumes (GTV) and visualize GTV contours over planning CT and other relevant volumes via fused segments.


Neurology Applications

Quantitative assessment of amyloid PET studies with SUVr are further enhanced in VA20 with a dedicated amyloid normals database. With a clear dedication to quantitative assessments, VA20 further offers the opportunity to create custom normal databases to match an institution’s patient population. Biograph mCT’s finest volumetric resolution6 of 87mm7, based on 400x400 matrix recon, and Neuro AC capabilities match the requirements for the quantitative assessment of amyloid scans.

syngo.MI Neuro Database Creation

Enables users to create and manage custom normal databases for any PET or SPECT neurology study to match site specific patient population and protocol needs. Patients can be easily added to custom databases during the normal workflow.

syngo.PET Amyloid Plaque7

Complements the qualitative visual interpretation of PET amyloid scans with quantitative information. It identifies six key brain regions with characteristic PET signal in diseased patients by registering to a template brain scan. SUV ratios are automatically computed for comparison against published thresholds. Also includes a PET amyloid normal database.

syngo.PET Neuro Database Comparison

Enables automated registration and fusion of PET studies with CT and MR. The application supports automated spatial normalization and 3D ROI placement, Voxel and 3D ROI-based quantification of neuroglucose metabolism (PET: FDG).

syngo.SPECT Neuro Database Comparison7

Provides physicians with information about the degree of deviation of a patient exam from the normal database, in standard deviations. Normal databases for SPECT are available for ECD and HMPAO.

syngo.SPECT Striatal Analysis

Enhances the syngo.via MI Neurology workflows by supporting comprehensive striatal evaluations for the assessment of movement disorders, especially Parkinson’s disease. It makes it possible to conduct symmetry evaluations and comparisons to a reference region based on DatScan studies.

syngo.CT Neuro DSA

(Digital Subtraction Angiography)
This dedicated post-processing application allows you to remove bone structures from CT Angiography (CTA) data sets in order to improve visualization of the cerebral vasculature. This enhances visualization of vascular structures in the area of the skull and helps to delineate aneurysms and other vascular diseases.

syngo.CT Neuro Perfusion

This application visualizes blood perfusion in the brain. In the case of ischemic stroke, it can help estimate the size of the core infarct and the extent of tissue at risk of infarction (penumbra) that could potentially be salvaged with further treatment.


Cardiology Applications

For cardiology, VA20 introduces the hybrid coronary view. A correlative view of stenotic areas on the CTA together with any hemodynamic impact based on PET results can be displayed. Myocardial surface projections can be selected from quantitative parameters including perfusion, blood flow, flow reserve, wall thickening and wall motion. Combined with the SMART Cardiac registration and single injection blood flow capabilities of Biograph mCT, a comprehensive solution for routine quantitative cardiac assessment is now available.

syngo.CT Extension Corridor4DM

An extension available for syngo.PET Corridor4DM and syngo.SPECT Corridor4DM. It enables volumetric registration of hybrid or stand-alone CT to PET and SPECT.

syngo.MI Hybrid Coronary View

Enables interactive fused VRT display of PET or SPECT quantification results with CT coronary angiography. PET or SPECT quantification results can be selected as stress or rest perfusion, reversibility, stress or rest blood flow and coronary flow reserve.

syngo.PET Corridor4DM

Offers full access to the Invia Corridor 4DM PET suite for assessment of PET perfusion scans.

syngo.PET Extension Corridor4DM CFR

Optional extension to syngo.PET Corridor4DM. Adds Coronary Flow Reserve (CFR) using the GFADS algorithm.

syngo.PET Myocardial Blood Flow

Enables physicians to review relative perfusion results together with myocardial blood flow in ml/min and flow reserve in a single application, and supports both rubidium and ammonia tracers.

syngo.SPECT Corridor4DM

State-of-the-art software for the quantification, review, and reporting of cardiac perfusion, function and anatomy. It includes transient ischemic dilation (TID), myocardial function incl. LV volumes and EF, regional wall thickening, motion, and time to peak contractility. It provides databases for assessment of FDG distribution and viability.

syngo.CT Cardiac Function

This application allows you to read and diagnose CT images of the heart in order to evaluate left ventricular function. As a result, it is now possible to complete a full cardiac assessment in less than four minutes.

syngo.CT CAScoring

This workflow step quantifies coronary calcifications (mass, volume, Agatston score) and calculates the patient's coronary age. During the evaluation, the patient's score is compared to the scores of a healthy reference group, e.g. the MESA study.

syngo.CT Coronary Analysis

This function provides a cardiac-specific set of automatic pre-processing steps and display functions, in order to rapidly and reliably evaluate and quantify angiography images of the coronary arteries - making it possible to rule out coronary artery disease in less than a minute.

Related Products, Services & Resources

1syngo.via can be used as a standalone device or together with a variety of syngo.via-based software options, which are medical devices in their own right. syngo.via is and the syngo.via based software options are not yet commercially available in all countries. Due to regulatory reasons, its future availability cannot be guaranteed.  Please contact your local Siemens organization for further information.

2Prerequisites include: Internet connection to clinical network, DICOM compliance, meeting of minimum hardware requirements and adherence to local data security regulations.

3The outcomes achieved by the Siemens customers described herein were achieved in the customer's unique setting. Since there is no "typical" hospital and many variables exist (e.g. hospital size, case mix,level of IT adoption) please be aware that there can we cannot guarantee, warrant or represent that others will actually achieve the same results. Data on file.

4Number of users/licenses is dependent on the available server hardware.

5510(k) pending.

6Based on competitive literature available at time of publication. Data on file.

7It is intended for use only with approved amyloid radiopharmaceuticals in the country of use. Users should review the drug labeling for approved uses.

syngo.via supports interpretation and evaluation of examinations within healthcare institutions, for example in radiology, nuclear medicine and cardiology environment.

Any PC with network connection and meeting minimum hardware requirements can be used as a client.