FREQUENTLY ASKED QUESTIONS

4DM Integrated Application 4DM Personal Application Application Packages & License Types Options Essentials: SPECT + PET Advanced: SPECT + PET + Hybrid-CT Premium: SPECT + PET + Hybrid-CT + MFR 4DM Application Features: Floating license configurations Reconstruction add-on available for SPECT Packages Nuclear cardiac reporting engine - 4DM Reporting Multi-monitor displays 4DM is translated into over 20 languages Services On-site installation and training Workshops held at INVIA headquarters Web demonstrations of the 4DM application Assistance with report customization and site specific configurations (Product Features and Services may vary with Reseller)

Yes, you can try 4DM prior to purchasing it. You can request a free 60-day trial license, which allows you to install 4DM and import your patient imaging files into the application. Contact INVIA or visit the Reseller section of our website to find the best reseller partner who can provide you a free trial license: http://www.inviasolutions.com/resellers.

4DM contains three review screens for CT images: CT Viewer, Ca Scoring and Fusion. CT Viewer screen allows the user to review the CT in Transverse, Coronal and Sagittal viewports. Each viewport provides the user the ability to display MPR, MIP and Thin MIP displays, draw measurements with a ruler, draw regions of interest, and the ability to scroll through the slice display. Ca Scoring screen provides the ability to score individual vessels and valves for calcium, displays the number of lesions as well as the Agatston Score for diagnostic interpretation, and quantifies calcium percentile. The Fusion screen provides a way to review the co-registration of SPECT/PET Myocardial Perfusion Images with CTA, CaSc and Attenuation Correction maps (both mu Maps and CT maps) as well as MIP co-registration. If SPECT/CT is being performed for Attenuation Correction only, the Fusion page can be viewed without purchasing the CT option. Fusion includes a Nine Panel Layout, Contours, a Transparent Viewer Tool, an Orientation Toggle and the ability to display a 3D or Slice object while aligning CTA or Ca Scoring overlays. With v2013 and higher, 4DM also supports whole body PET studies. 4DM v2017 and higher includes a two study comparison layout. Review the co-registration utilized during image reconstruction of both Stress and Rest datasets at the same time.

It depends. If the camera vendor provides the necessary CTA vessel files in a supported file format, they will display as expected in the 4DM application. Contact INVIA for information on supported cameras.

No. You will be able to review the mis-registered display and manipulate the alignment to demonstrate proper alignment, but the changes needed to correct the mis-registration MUST be done on the vendor reconstruction workstation.

Yes. The 4DM MFR option is FDA-approved and validated. MFR is for use with Rubidium-82 and N-13 Ammonia PET perfusion imaging agents.

4DM uses these algorithms: Region of Interest (ROI) Compartment algorithm Region of Interest (FixedDV) algorithm developed out of Ottawa Heart to automatically calculate MFR

There are several advantages – FDA approved. All methods are automated. 4DM provides options for selecting the processing flow model. Choose from the Net Retention model, ROI Compartment model, or ROI (FixedDV) model to process the dynamic study. INVIA continuously researches and improves upon MFR quantification. With v2017 and higher, streamline the reviewing process with the new QA and Results Modes.

Yes. 4DM Integrated v2016 and higher provides the ability to quantify and review SPECT Myocardial Flow Reserve (MFR) datasets from certain camera systems. Currently, datasets must be acquired from the GE Discovery 530c – Alycone or Spectrum Dynamics DSPECT cameras.

Yes. With 4DM v2013 and higher, Motion Correction is part of the SPECT Reconstruction option. Technologists can perform all processing from within 4DM for SPECT datasets, eliminating the need for the technologist to switch programs, to help streamline the workflow.

You can correct for patient axial motion during acquisition, slight shifts between detectors, and cardiac creep.

4DM can reconstruct these type of SPECT patient datasets: 4DM reconstructs volumetric images from nuclear medicine tomographic and gated tomographic datasets.

Filtered Back Projection (FBP) Currently, 4DM only offers the Filtered Back Projection (FBP) method of reconstruction. Therefore, 4DM can only reconstruct non-Attenuation Corrected volumetric images.

The Reconstruction screen allows users to perform standard SPECT reconstruction processing for one-to-four datasets on a single screen and includes: Slice Selection: Slice plane indicators on the Tomo viewport determine which slices to include in the reconstructed volume. Reconstruction Filter Adjustments: Select Butterworth, Hanning, Hamming, Parzen, Shepp, or Gaussian as the filter; adjust cutoff and order (Butterworth only) settings. Reorientation Controls: Adjust reconstructed cardiac volumes along the long axis of the heart by clicking and dragging the circular control on the SA, HLA, and VLA slices. Multiple Image Displays: A Splash object displays for visualization of the reconstructed volume when one dataset is displayed on the Reconstruction screen.

4DM Personal is stand-alone software that has the complete functionality of 4DM. Instead of requiring a fixed installation on your PACS, camera, or integrated workstation, 4DM Personal has the ability to install on any Windows laptop or workstation – creating a portable and convenient nuclear review and reporting environment, or supplementing your 4DM Integrated installation.

4DM Personal is ideal for a clinical environment with workstations from multiple manufacturers. With 4DM Personal’s built-in browser (DICOM file manager), you can store, import, receive, query/retrieve, and transfer DICOM image files across the local area network from a variety of sources. Once a file is ready for review, select the patient using the browser and launch 4DM.

No. 4DM Personal is compatible with desktop and laptop computers running a Windows operating system. In order to communicate with other site workstations, it needs to be installed on a computer within the same local area network (LAN). Additionally, it is not recommended for vendor acquisition, processing, or review workstations. Below is a list of recommended specifications. Operating Systems: Windows 10 (64 bit) and Windows 11 (64 bit) Windows Server 2016 through Windows Server 2022 Processor Speed: 2.0 GHz or greater Cores: 4 (minimum), 8 (recommended Memory: 8 GB (minimum), 16 GB or more (recommended Disk Space: 2 GB required for installation; 2-4 GB for image files Display: 24 bit color; 1280x1024 or higher recommended Video Card: 256 MB of on board Video Memory (minimum), 1 GB (recommended). 3D graphic card supporting OpenGL 3.0 (minimum) or greater (4.1 recommended) Monitor: 24-bit color; 1280 x 1024 recommended; 20-inch or greater; Maximum support - four HD (1920x1080) monitors

You can purchase 4DM Personal directly from INVIA or from some of our reseller partners. Contact an INVIA sales representative for more information or for a list of reseller partners offering 4DM Personal.

4DM Personal is cost-effective and flexible, it includes installation and training, as well as maintenance: Cost Effective: Software-Only version of 4DM Does not require you to purchase additional hardware Supplements 4DM integrated on your PACS, camera, or workstation Flexible: Flexible Workflow: Receive reconstructed data from multiple cameras or workstations Flexible Scheduling: Process and review patients studies at any time – day or night Flexible Licensing: Purchase licenses based on the number of simultaneous users anticipated Installation & Training: 8 hours of on-site installation and training included at no additional cost Personalized training designed for your staff International users receive installation and training remotely and scheduled at your convenience Maintenance Included: 1 year of support and upgrades included with each license at no additional cost INVIA automatically sends you the newest release of 4DM (targeted at one release per year) Email or phone INVIA for technical support during standard business hours

Within the 4DM Personal Patient Browser. 4DM Personal has a built-in browser that provides direct DICOM connectivity from the technologist processing workstation to the 4DM Personal PC. It also acts as the gateway to launching patients into the 4DM Personal software for quantification and interpretation. With 4DM v2017 and higher, view the status of the patients’ report before launching into 4DM.

Yes. Most facilities typically transfer the data (also called “pushing”) to the built-in browser. However, the browser also includes the capability to query/retrieve (also called “pulling”) as long as the processing workstation allows this.

Yes. Users can launch up to 250 patients into 4DM Personal by clicking the CTRL key as they select patients.

Yes. The built-in browser can be configured on each computer to pull patient studies from one centralized database. This saves substantial time when this workflow eliminates the need for duplicative data transfers from the technologist processing workstation.

All purchases of 4DM Personal include: Permanent license of the software (no annual licenses fees) The browser screen directly connects your PC to the vendor processing workstation so DICOM files can be transferred seamlessly The 4DM Reporting application for generation of reports The 4DM Administration application for customization of 4DM Additional purchases: One year of free maintenance and technical support One year of free upgrades (for all features purchased) Free 1-day on-site installation, configuration, and training by an INVIA specialist

Yes. INVIA encourages 4DM Personal customers to take advantage of our extended maintenance plans (one- and three-year options) that provide support and FREE upgrades (for all features purchased) for the length of the agreement.

No. 4DM Personal is a cost-effective, software-only solution that can be installed on your existing Windows desktop or laptop PCs. Be sure to check that your system meets the requirements specified above.

Yes. 4DM Personal PET licenses are available with the CT option added as an adjunct. The CT option provides: Review of volumetric CT data (including CTAs and calcium scoring CTs) Fusion review screen Dedicated CT Viewer Calcium Scoring screen (quantifies Agatston calcium scores) Ability to overlay 2D/3D coronary trees and 4DM-quantified calcium deposits

Yes. The technologists can have their own fixed license, while the physicians can use a 1-seat floating license for 4DM Personal amongst them. 4DM Personal is a software only version of 4DM compatible with Windows PCs. Install 4DM Personal on an unlimited number of PCs, but only pay for the number of simultaneous users (seats) needed.

Yes. 4DM can support separate subnets through the use of manual definition of the network pathway. This configuration setting is implemented by INVIA during the onsite installation and configuration visit.

Yes, with variable licensing. Each 4DM License Manager can control multiple 4DM License Types, and each Type can contain varying number of seats. This enables End-users to purchase the optimal number of seats to most economically meet their needs. The License Manager checks out the License Type and number of seats used, notifying the next-user when all seats have been checked-out. License types include SPECT, PET, Hybrid-CT, MFR, and SPECT Reconstruction. Example: A site with three imaging systems (two SPECT and one PET-CT) could order multiple License Types with a varying numbers of seats (such as 2 SPECT Essentials and 1 PET with Hybrid-CT Advanced) and check-out the License Types on various workstations as needed.

Floating licenses, also known as concurrent licenses, allow a customer to install 4DM on a greater number of computers than the number of floating license seats purchased. The maximum number of individuals using 4DM simultaneously is limited to the number of seats purchased.

When an individual tries to launch 4DM from an available workstation, the application requests a seat via the license manager. If a seat is available, the application launches. When the application is closed, the seat becomes available to other 4DM workstations. Example: A site purchases 1 floating seat. The 4DM software is installed on 2 workstations. There is currently one user using 4DM. A 2nd user wants to launch 4DM but is unable to because there are no available seats.

Floating licenses are great for sites with: Multiple physicians reading studies at varying times Physicians who want greater flexibility when reading within the network Administrators looking to save money by streamlining software expenses or workflows An INVIA Product Specialist can help identify the optimal number of seats for your hospital or clinic.

4DM’s quantification values have been compared to competitive quantification values and show equivalence. For more information see 4DM validation papers posted at https://www.inviasolutions.com/clinicalrelevance

TID ratios are automatically calculated and displayed for ungated stress datasets when a rest dataset is also present.

No. 4DM provides a single user interface for review of SPECT, SPECT/CT, PET, PET/CT, SPECT/MFR, PET/MFR and MUGA studies within a single review session.

In most cases, no. If you purchase the same version of 4DM from multiple vendors, they will provide the same quantification values, supported datasets, screens, and preferences. Some features, like 4DM’s integrated reporting, may not be available with all of INVIA’s reseller partners.

Yes. 4DM results files are compatible across the different versions of 4DM.

Yes. 4DM Personal is compatible with all 4DM installations, including those integrated with one of our many reseller partners’ workstations and PACS systems.

Yes. Reporting is integrated into the 4DM Personal application and sometimes comes included with 4DM Integration installations. 4DM Reporting can be accessed from 4DM Personal’s Patient Browser or from within the 4DM application. Exporting reports is now easier than ever. Customization of report templates can be done by following steps in the Help Sheets provided on our website or by ordering template customization through INVIA (ask an INVIA specialist for prices).

Reports can be exported to XML, RTF, PDF, DICOM Encapsulated PDF, HL7 v2 Encapsulated PDF, HL7 v2 Referenced PDF, and HL7 v2 Encapsulated RTF.

Yes. 4DM report files from older versions of 4DM are compatible with the new reporting engine included in 4DM v2016 and newer. However, report files saved in the new reporting engine cannot be opened in the old reporting engine.

With v2013 and higher, it is automatic. 4DM automatically matches study protocol to the appropriate report template, so you don’t have to manually select your templates. If you want to select a different template, use the Template Selector tool in 4DM Reporting.

Yes. 4DM v2016 and higher includes the ability to use Dragon Nuance dictation software for speech-to-text input.

With 4DM v2016 and higher, 4DM Reporting was overhauled to provide more efficient reviewing. 4DM Reporting includes features such as automatic-sentence generation, real-time report preview and editing capability, and drop-downs and check-boxes to make reporting convenient and efficient.

Yes. With 4DM v2016 and higher, reports can be started or edited independently from 4DM, and prior to images being acquired. Fill-in patient information and EKG results in advance of imaging your patient.

With 4DM v2012 and higher, you can read a patient study across multiple monitors, displaying various 4DM screens on each monitor.

4DM supports up to four displays.

There are many benefits to using multiple monitors: Multi-monitor review can improve your organization’s workflow, from processing to reporting Compare images, quantifications, and reports side-by-side for thorough study interpretation Increase efficiency in reading studies by viewing any combination of 4DM screens at one time Input report information while reviewing study result screens for improved report generation

If you purchased an integrated version of 4DM (one that is installed on the manufacturer’s workstation), 4DM upgrades are managed by that manufacturer. Most often, the details can be found within your service maintenance agreement. Speak to your sales representative for more information.

All customers who have a maintenance agreement direct from INVIA automatically receive the latest version of 4DM Personal with its annual release.

4DM Personal upgrades are available for purchase. Contact an INVIA Product Specialist for pricing.

4DM provides this information on our Polar Maps screen, which can easily be added to your list of active screens. Also, a custom screen can be built for the customer including this information.

Yes. TID ratios are automatically calculated and displayed for ungated stress datasets when a rest dataset is also present.

Yes. 4DM includes a MUGA processing screen, at no additional charge, which will process both RV and LV EF’s. It also includes automatic and manual methods. With v2017 and higher, MUGA screen includes regional EF and the ability to interpolate the ROI’s during editing mode.

Yes. 4DM has defined dataset types ending in -P to support the prone image layouts.

4DM has a similar tool called Constraints. This allows the algorithm contours to be set manually. Yes, you will still see the extra-cardiac activity; however constraints will not truncate the heart.

Yes. With 4DM PET licenses, 4DM provides an Inflammatory screen, which displays regional and global results to identify normal, infarct, and mixed tissue versus inflamed tissue.

The 4DM application provides a streamlined workflow for reconstruction, quality assurance, and review. INVIA provides training, collateral, and user preferences to help users conduct the necessary steps to provide reproducible results.

Yes. Extensive validation testing is performed with every release. Validation papers are posted on the INVIA website: http://www.inviasolutions.com/technical-presentations.

Yes, with 4DM v2013 and higher. FDG PET Standard Uptake Value (SUV) calculation displays as a 2D/3D Polar Map distribution of the LV on any quantification screen and is also included in the information for any manually defined ROI of the body on the Fusion screen.

Yes. The current 4DM user Interface is translated into 20 languages: Chinese, Czech, Danish, Finnish, French, German, Hungarian, Indonesian, Italian, Japanese, Korean, Norwegian, Polsih, Portuguese, Romanian, Russian, Spanish, Swedish, and Turkish.

Yes. For our international customers who purchase 4DM Personal, an INVIA Product Specialist will install 4DM Personal using remote access software and provide web-based training scheduled at your convenience. To ease the transition to 4DM, your INVIA Product Specialist can also set 4DM to display in your native language.

Yes. INVIA can come directly to your site and provide site-specific, version-specific training, in a format that best fits your patient scheduling to avoid costly downtime. Order additional training by a 4DM Product Specialist directly from INVIA, or through your camera or PACS vendor.

INVIA can provide a classroom-style training session, rotating groups through to leverage our time at your site. If you want to avoid any patient scheduling downtime, and prefer a one-on-one approach, we can accomodate you. An INVIA Product Specialist can assist you in determining how many days you need, based on the type of training requested, the total number of attendees and the number of locations.

There are several ways to obtain help with the 4DM application. Users Guide: Available by clicking Help within 4DM or online in User Center Website: Available online in User Center are step-by-step help sheets and other support material Vendor Support Desk: If you purchased 4DM from one of our many reseller partners, you should contact their support specialists OR if you have an active Maintenance Agreement with INVIA, contact us directly via e-mail (support@inviasolutions.com)

To gain access to the User Center go to www.inviasolutions.com/acquireloginaccess. You must be a current 4DM user to gain access to the User Center. If you are not currently using 4DM and would like to know about the software request access to the Prospect Center, www.inviasolutions.com/prospectcenterrequest.

When contacting either vendor or INVIA support personnel, it is important that you have the following information on hand: Software Version Camera and Workstation Manufacturer(s) Version of any manufacturer’s or third-party software (e.g., Microsoft) Your Maintenance Agreement Number

INVIA’s support staff are all experienced Nuclear Medicine Technologists who understand your environment and have become experts in most facets of 4DM.

Yes. INVIA is located in the East Standard Time zone in Ann Arbor, Michigan. Business hours are 8:30 a.m. to 5 p.m. EST. Support voicemail and email are available 24 hours a day, 7 days a week. Leave a detailed message, including the information provided above, your call will be returned as soon as possible.