Artis with PURE Turnover Workbook

SIEMENS WIP 1mm LAOTRAO -83 DmaCT Nat Fill HU Smooth [InSpace Deutsches Herzzentrum Muenchen DmaCT Nat Fill HU Smooth [InSpace CRANICAUO 44 AXOOM-Artis Deutsches Herzzentrum Muenchen 2010-05-10 12:46:30 AXIOM-Artis 2010-05-1012:46:30 Artis zeego Artis zooga Prototype under clinical trial 256(256x1 95 113 b4 Prototype under clinical trial DH Herzzentrum Muenchen LACIRAD TES DynaCT Nat Fill HU Smooth [InSpace RANICAUD Deutsches Herzzentrum Muenchen 5-10 12:46:30 AXIOM-Artis 2010-05-10 12:46:30 AX SL 0.939198 P 0.939198 0.94 256x195 [13 bit] Contours on/off. STRG+V Prototype under clinical trial B 10 F 0 8 off-line request for C:\ENDOMAP\EXCHANGE suc www.usa.siemens.com/healthcare Artis with PURE Turnover Workbook Answers for life. Table of Contents Learning Materials . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Artis Calibration using the table-object distance (TOD). 39 . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Catheter calibration. . . . . . . . . . . . . . . . . . . . . . . 41 Learning Objectives . . . . . . . . . . . . . . . . . . . . . . . . 4 zeego Sphere calibration. 43 . . . . . . . . . . . . . . . . . . . . . . . Agenda. ........ 5 Calibration with a calibration factor. 45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Topics. 5 Distance Measurement. 45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Session One (4 hours) . . . . . . . . . . . . . . . . . . . . . . 5 Performing LVA. 47 . . . . . . . . . . . . . . . . . . . . . . . . . Session Two (4 hours) . . . . . . . . . . . . . . . . . . . . . . 5 O) Overview of Biplane LVA Workflow. 52 . . . . . . . . . . Session Three (2 hours). 5 Additional LVA information. 53 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Session Four (2 hours). . . . . . . . . . . . . . . . . . . . . . 5 Correction. 53 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annotating a contour. 54 . . . . . . . . . . . . . . . . . . . . Session One: System Overview. . . . . . . . . . . . . . 6 QCA/QVA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Objectives. 6 Contour Corrections. 60 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Switching on/start-up. 6 Special Examinations. . . . . . . . . . . . . . . . . . . . . . 62 . . . . . . . . . . . . . . . . . . . . . Key Hardware Features. 7 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 . . . . . . . . . . . . . . . . . . . . Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Dynavision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Exercise: Session One: . . . . . . . . . . . . . . . . . . . . . 11 DR DYNAVISION . . . . . . . . . . . . . . . . . . . . . . . . . . 64 DSA DYNAVISION. . . . . . . . . . . . . . . . . . . . . . . . . 65 Session Two: System Operation. 12 DSA DYNAVISION examination sequence. 66 . . . . . . . . . . . . . . . . . Objectives. 12 Peri Stepping. 74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Registering a patient . . . . . . . . . . . . . . . . . . . . . . 12 PERISTEPPING examination sequence. 74 . . . . . . . . Select an Examination Program. . . . . . . . . . . . . . 15 PeriStepping Workflow. 75 . . . . . . . . . . . . . . . . . . . Post Processing. 25 Perivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 . . . . . . . . . . . . . . . . . . . . . . . . . Filming Patient Images. 30 PERIVISION examination sequence. 76 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Archiving Patient Images to Network. 31 Fill phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 . . . . . . . . Archiving Patient Images to CD/DVD. 32 Perivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 . . . . . . . . . Exercise: Session Two: System Operation. . . . . . 33 Perivision Workflow. . . . . . . . . . . . . . . . . . . . . . . 77 Exercise: Session Three Quant and Special Session Three: Quantification and Special Examinations. 78 . . . . . . . . . . . . . . . . . . . . . . . . . . . Examinations. 34 . . . . . . . . . . . . . . . . . . . . . . . . . . Objectives. 34 Session Four . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Quantification and Special Examinations. 37 Objectives. 80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Performing a Calibration. 37 Abbreviations/Glossary. 81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Selecting a calibration method or recalibratin. 37 Contact Information Summary. 85 . . . . . . . . . . . . . . . Automatic isocenter calibration. . . . . . . . . . . . . . 38 2 Learning Materials The following instructional materials are referenced throughout this training session: System Owner Manual Provides the necessary knowledge and expertise to accurately and safely operate the system. Training Workbook Supports the System Owner Manual through “big picture concepts,” examples, stories, interactive exercises, and references to online documentation. This book is yours to keep so you can write in the book. Step-by-Step These documents provide quick reference tips to aid customers in “just-in-time” learning opportunities. 3 Introduction The purpose of this training Learning Objectives session is to provide you with the The learning objectives are: skills and knowledge to operate • Correctly perform startup and shutdown procedures. • the Artis with PURE system. Identify the key hardware features of the Artis with PURE system. • Describe the key features of the syngo® interface on the Control Panel. • Correctly perform a patient registration. • Utilize the examination task card to perform a patient procedure. • Identify key features of the Postprocessing task card to post process image data. • List the steps needed in order to archive patient data. • Follow the steps necessary to complete a patient procedure. 4 Agenda Agenda The training program occurs over a 3 or 4 day period, a total of 24 hours. Further details on location and specific times are included in your registration confirmation. Topics Session One (4 hours) Session Three (2 hours) System Overview Measuring • Operator’s Manuals and Quick Guides • Quantification (option) • Switching On/Startup • Postprocessing • System Overview, TCM, SCM, CCM, and TSC System Movements Special Examinations • • • Assist Monitor Perivision (option) • • Emergency Stop Buttons Dynavision (option) Session Two (4 hours) Session Four (2 hours) • Patient Workflow Review Checklists • Review Call to Uptime • Patient Registration • Review Education Website • Performing a Patient Study Exam Set Selection • Questions - Image Acquisition and Fluoro - Image Playback - Postprocessing - Image Archiving - Note: Patient imaging procedures may be performed after completion of Session 2. 5 Session One – System Overview Objectives Notes After this session, you will be able to: • Correctly perform startup and shutdown procedures. • Identify the key hardware features of the Artis with PURE system. • Identify the location of the emergency stop buttons and know how to use them. Switching On/Startup The Artis with PURE system is started from the switched off mode. The syngo Workplace is switched on and off by a separate switch. Starting the system from the off state. Press the main power button on the ACE box. ON box with CD/DVD drives (3) O O C For detailed startup instructions and a visual diagram of the system, please see: • Online User Manual located in the Help drop down of your system control panel 6 Session One – Key Hardware Features Overview Notes This section will discuss key hardware features of the system stand and control box. Emergency STOP Where are the emergency STOP buttons? You will find emergency STOP buttons in the following locations: • On the frontside of any table control module STOP STOP STOP Depressing the emergency STOP buttons: All system movements and X-ray radiation are stopped. Radiation can be released again if you press the fluoroscopy/exposure release pedal again, even without canceling STOP. Canceling STOP: Pull the red emergency STOP button. Table Side Controls (1) (2) (3) (4) -W Control console single plane (example) (1) Table (Table Control Module TCM) (2) Stand/C-arm (Stand Control Module SCM) (3) Collimation and filter (Collimator Control Module CCM) (4) Imaging system (Touchscreen Control) 7 Session One – Key Hardware Features (continued) Table Control Module (TCM) Notes Keys on the table control module The following other movements can be controlled with the keys on the table con- trol module: Perform table lift -¡- Perform table tilt Select lateral table tilt - I- - LED lights while function active. Unlock brakes for table rotation - LED lights while function active. Set isocenter Isocenter key #80 ock lateral tabletop movement LED lights while function active. Select orientation Orientation key -853 Stand Control Module (SCM) C-arm Control Joystick Programmed Positions System Positions Store Orientation button Zero stop Direct Positions I, II, III Collimator Control Module (CCM) Keys on the collimator control module With the keys on the collimator control module you can sell and filter functions and set the image input format: II- Open collimator leaves completely and remove filter di. Reset collimator leaves and filter diaphragms (2) N + Switch over image input format/zoom stage Switch over wedge/finger filter Collimator/FD rotation1 2 Select plane3 8 Session One – Key Hardware Features (continued) Table Side Control (TSC) Notes (1) (2) TTTTT (1) Touchscreen (2) Mouse joystick (1) (2) (3) Mouse joystick The touchscreen control is equipped with a mouse joystick, which has threee buttons: (1) Left mouse joystick button: Select button (2) Middle mouse joystick button: Store Ref button (3) Right mouse joystick button: Close button The joystick can be deflected to the left/right/up/down and in any diagonal direction. Different functions can be assigned to the buttons depending on the currently selected function. TSC Settings Exam Quant Physio 4D ? Exam Set A SM! Fluoro Prog. Acq. Prog REF : 15 p/s 3 f/s REF LAS RDMP ROMP B There are multiple task cards on the TSC. Different features are grouped by function. Press the tab of the task card you require on the touchscreen. The task card you have selected automatically moves to the foreground. 9 Session One – Key Hardware Features (continued) Flat Detector (FD) Notes Membrane keys for C-arm and FD movements • C-arm rotation (rran/caud angulations) • C-arm orbital movement (RAO/LAO angulations) • Longitudinal tabletop movement with stepping table. Longitudinal C-arm movement with Artis zee® multi-purpose/ Artis zee® ceiling • FD rotation (setting portrait/landscape) • FD lifting and lowering – setting the SID to Assist Monitor (1) A (1) Stand, C-arm and table position data 8 0 (2) Stand, table messages (3) System status messages (4) Menu area ( 4) 120 cm 42 cm 0 . 120 cm (2) (3) Automatic run: Activate stand movement A:DOOR OPEN? XRAY disabled 0 em -29 cm Example of an Asset screen For more details and diagrams of the key hardware features, please see: • Online User Manual located in the Help drop down of your control room monitor 10 Session One – Exercises Notes Session One Complete the following exercises. Exercise 1: 1. Raise and lower table 2. Rotate the C-arm using the joystick 3. Move the system to each position in the System Directory 4. Store a position in the programmed directory 5. Store a position in the Direct Position I, II, or III 6. Rotate the tabletop 7. Change the zoom size (mag up or down) 8. Adjust the wedge filters 9. Adjust the collimator 10. Raise, lower and rotate the detector Exercise 2: 1. Rotate the c-arm to 30º RAO and 30º Cranial 2. Store the position in Direct Position I 3. Move the C-arm to 30º LAO and 15º Caudal 4. Store the position in Direct Position II 5. Move the C-arm to Direct Position I 6. Move the C-arm to 45º RAO and 0º AP 7. Store position in Programmed Position #1 11 Session Two – System Operation Objectives Notes After this session, you will be able to: • Correctly perform a patient registration • Properly select an examination program • Modify and override an acquisition program • Utilize the examination task card to perform a patient procedure • Perform Postprocessing on images • List the steps needed in order to archive patient data Registering a Patient Using Scheduler To register a patient from a worklist: 1. Open the patient Browser 2. Click on Scheduler 3. Click on View, Update Worklist (if worklist is not scheduled to update automatically) 4. Click on folder with patient’s name 5. Click on patient, Register 6. Verify patient information and insert initials in the operator box 7. Click on Exam To register a patient manually: 1. Press the patient Registration Key on the symbol keypad 2. Enter the data in the boldface type areas 3. Select the required exam program from the Study List 4. Select the patient position from the list 5. Click on Exam 12 Session Two – Registering a Patient Using Scheduler Registering a Patient Using Scheduler (continued) Notes Patient Registration X PROCEDURE PATIENT Last name Accession No First name Request ID Middle name Requested procdeure(s) Title Suffix Other Patient Name(s) Other Patient ID(s) Study Ethnic Group Study comment Military Rank Patient DD Head First - Supine Date of Birth Patient position Sex Male Female Other Age Years Institution name Height [nn'mm"] Weight [Ib] 1. Performing physician Address 2. Performing physician Additional Info 1. Operator NOTInITISNI 2. Operator Details HOSPITAL Refering physician Requesting physician Admitting diagnosis Ward Admission ID Preregister Exam Search Cancel Emergency Help 13 Session Two – Registering a Patient Using Scheduler Correct Patient Data Notes To correct patient or examination data: 1. Select the patient, study, series, or images in Patient Browser 2. Click Edit, Correct Click OK to save the new data I Correct Modifier's Name meduser Last name 30467 27-08:30 2- 05 Firstname FITer: D 06.07 27-08.50 36-DST37999 Refemno physicien Other Patientenamci:) Admission D Missyrank Accession No Date ofbrn Study D + Fande Notset Haight CARO SUO tal Benea date Number Comment OK Cancel Help For more details and actual steps on this topic, please see: • Online User Manual located in the Help drop down of your Acquisition Workstation (AWS) 14 Session Two – Select an Examination Program Select an Examination Program Notes from the Control Panel Acquisition Program can be selected from the Registration Page, Exam Set Editor in the Control Room, or from the Exam Task Card on the TSC. Select an Examination Program From the Control Panel and/or TSC Example Settings Exam Image Quant Physio 4D DSA Special DSA Special ( DSA 7.5 (7.5 f/s) E A+B 00:00:00 SM (1) FL - Angio 7.5 p/s DSA 7.5 [xDSA long(2 fs] [>DSA Venous (4 fs) FL Angio FL - Angio 7.5 p/s (1) FL - Angio (7.5 p/s) (2) FL ANIo (3) REF (2) FL Angio 7.5 p/$ 2 f's (2) FL Angio (10 p/s) FL + Angio 10 p/s (3) ¿ FL+ Angio (10 p/s) ms 1.0 Cumm 0.2 (3) FL+ Angio 10 p/s Console, Examination room, touchscreen control Exam Set & Examination task card Programs Editor (1) low (2) normal (3) high • Select only suitable examination sets for the examination Blocking Radiation In some cases, for instance when the patient is repositioned or while cleaning, you can block radiation to prevent it from being released inadvertently. Touchscreen Console • Press this icon. • Click this icon. Radiation will be blocked for the next radiation releases. Blocking Movements During transfer and positioning of the patient, you can block motorized movements in order to prevent unintentional unit movements. Touchscreen Console K 7 Ky • Press this icon. • Click this icon. Motorized movements will be blocked for the next movement releases. 15 Session Two – Select an Examination Program Notes Settings Exam mage ? DSA Special Pre SM FL Angio loft REFL 7.5 p/s Right ROMP midlle A V Click this icon. Series Description X Enter Series description or select from List. App'S Edit List. Close Select a series description text from the list. Console (only) Modifying the series description list Click Edit List ... Edit Series Description List X add Pre Post Left Right MoveUp MoveDown Delete Close & Apply Add text Enter a series description text and click Add. 16 Session Two – Select an Examination Program Changing Acquisition Programs Notes Settings Exam mage Quant Physio 4D ? DSA Special SM FL Angio DSA 7.5 2 f/s REF 7.5 p/S DSA long 2 f/s DSA Venous RDMP RDMP VFR man DR ACQ 2 f/s Acq. Prog. To select a different acquisition program: Changing Acquisition Framerate 3 f/s To Modify the acquisition framerate: 17 Session Two – Select an Examination Program Notes Performing a Classic Roadmap Settings Exam Image Quant 4D At TSC, Press this icon. yAnatom Previous Mask Show ºBackgr. Progress RDMP RM Neuro Reset Roadmap 15 p/s 7.5 f/s RDMP BSA RDMP Or At Console-Press one of these Icons. DSA Roadmap ? x Roadmap 5 G A A Close Help Close Help Single Plane Configuration Biplane Configuration Performing Roadmap phase 2 (contrast medium injection) • Keep the FLUORO pedal pressed • Now inject the contrast medium. In the fluoroscopy image, you can now see the vessels in subtracted – display as they are filled with contrast medium. • Release the FLUORO pedal when the area to be examined is sufficiently filled with contrast medium. The last image of the second phase is displayed inverted (contrast – medium white) and serves as the mask for subsequent fluoroscopic examinations. The opac indicator indicates that maximum opacification is effective. – • Keep the FLUORO pedal pressed 18 Session Two – Select an Examination Program • Now inject the contrast medium. Notes In the fluoroscopy image, you can now see the vessels in subtracted – display as they are filled with contrast medium. • Release the FLUORO pedal when the area to be examined is sufficiently filled with contrast medium. The last image of the second phase is displayed inverted (contrast – epac medium white) and serves as the mask for subsequent fluoroscopic examinations. The opac indicator indicates that maximum opacification is effective. – Performing Roadmap phase 3 (subtraction) Fluoroscopy can be interrupted as often as required. The system remains in phase 3 and displays additional subtracted images each time the fluoroscopy switch is pressed. • Press the fluoroscopy switch as often as required. You will see a fluoroscopy image from which the last filled image of – phase 2 is subtracted. After you have released the fluoroscopy switch, the last image is – retained and displayed (LIH or auto loop). Resetting Roadmap Performing Roadmap phase 3 (subtraction) If motion artifacts arise, roadmap can be reset (new mask): Footswitch • Actuate the Reset Roadmap pedal for less than 2 s. (If configured - example) Console • Click this icon. Touchscreen • Reset Roadmap Press the Reset Roadmap button. 19 Session Two – Select an Examination Program Biplane Configuration Notes Footswitch RDMP Reset A • Press the Reset A or Reset B pedal for less than 2 s. ROMP ONOFF ROMP Plane A or plane B will be reset. – Rusel B Or • Briefly press the RDMP ON/OFF pedal. –Plane A and plane B will be reset. Touchscreen • Press the required icon. TO Console • AB B Click the required icon Replace mask during roadmap • It is possible to replace the mask during review of a roadmap scene, but only if “Replace Mask” is set (not “Move mask”).Default setting “Move Mask” or “Replace Mask” • Replacing the mask is only possible during roadmap phase 1 and phase 2. Touchscreen & Console • Press the required icon. 20 Session Two – Select an Examination Program Additional Roadmap Features Notes Show Progress Show Progress during Roadmap During Roadmap phase 3, but not during X-ray, the current Roadmap mask can be replaced by the LIH. Performing Show Progress, e.g. during an Onyx injection, will improve the visualization of the progressive movement of the Onyx. Touchscreen _Show Progress • Press the Show Progress button. Console • Click this icon. G Vessel/ Catheter Contrast During Roadmap phase 3, but not during X-ray, the vessel/catheter contrast can be adjusted for Roadmap images. The initial values for Vessel Contrast and Catheter Contrast are defined in the Roadmap program. Note. Whenever a roadmap mask is restored with the previous mask function, vessel/ catheter contrast will be reset to the default values from the roadmap program Console •Acquisition > Set Vessel / Catheter Contrast is set in the main menu. Touchscreen Changing vessel/catheter contrast during roadmap phase 3 JE vc % Contrast • Press the VC Contrast button. • Deflect the mouse joystick. Up: more vessel contrast – Down: less vessel contrast – Left: more catheter contrast – Right: less catheter contrast – 21 Session Two – Select an Examination Program Additional Roadmap Features (continued) Notes console % • Click this icon Vessel / Catheter Contrast Vessel Contrast [%] 50 Catheter Contrast [%] GO Apply OK Cancel • Click an up/down arrow to adjust a value • Click Apply or OK Anatomical background with Roadmap During Roadmap phase 3, anatomical background can be added to the subtraction image. Anatomical background In the examination room, the anatomical background can be adjusted using the mouse joystick. Console •Acquisition > Set Anatomical Background is set in the main menu. Touchscreen Changing anatomical background during roadmap phase 3 1 % Anatom Backgr. • Press the Anatom. Backgr. Button. • Deflect the mouse joystick. Up: more anatomical background – Down: less anatomical background – Console • Click this icon. % Anatomical background 22 Session Two – Select an Examination Program Previous Roadmap Mask Notes Roadmap with two system positions (single plane) During roadmap, two roadmap mask images may be stored for two system positions, e.g. a LAO and a RAO C-arm position. You can move back and forth between these positions, performing roadmap at each position without the need of reacquiring a roadmap mask. It facilitates some of the benefits of a biplane system on a single plane system, especially on Artis zeego. • Select roadmap and perform a roadmap phase 1,2,3. • Move the C-arm and perform another roadmap phase 1,2,3. (If you reset roadmap, the system displays the following message: “Roadmap reset. A previous mask is available”.) • Press/click the Previous Mask icon in the Roadmap dialog. The following message appears in the examination room: Automatic run: Activate stand movement • Press the stand joystick down deflect the joystick and hold it in this A position until the previous roadmap position is reached. • Or press the hands free foot pedal. The C-arm moves back to the initial roadmap position. When the previous position is reached, the following message is displayed: “Roadmap Plane-A: Previous Mask is in use” Previous Roadmap Biplane Configuration • Roadmap with return to biplane system position (Artis zee biplane) • For biplane systems, the previous roadmap mask feature allows you to return to a single biplane system position, providing a little more flexibility to interruptions in the clinical workflow, e.g. if you want to perform fluoroscopy in another zoom stage or run a 3D acquisition. • The current roadmap mask image pair is the biplane roadmap mask image pair, system position, exam set, and organ program that have most recently been utilized for roadmap. • For biplane systems just one roadmap mask per plane is kept to be recalled by clicking the previous mask icon. Zooming/Panning during Roadmap It is possible to zoom and pan the Roadmap image during Roadmap x2 • subtraction phase. However, the native live image on the Assist screen will stay unzoomed. • Zoom will stay active even after Reset Roadmap. Zoom will be deactivated when a stand movement occurs or when deactivating Roadmap. Roadmap scenes will always be stored unzoomed. 23 Session Two – Select an Examination Program DSA Roadmap - CLEARmap Notes A subtracted reference image, e.g. from a DSA scene, is shown on the active reference screen. DSA RDMP Settings Exam Image Quant 4D Settings Exam Image Quant 4D %Anatom. Previous Show Backgr Progress o/ Anatom. Backgr. Previous show Mask Mask Progress RM Neuro Reset Roadmap RM Neuro LO3 15 p/s 7.5 f/s 15 p/s 7.5 f/s RDMP ROMP x2 RDMI ROMP x2 B 1. Start DSA Roadmap. • If Overlay Reference was activated, it is deactivated 2. Select or change the Roadmap program. • If no reference image or DSA scene is present, the following message displayed: Roadmap: Please select a DSA Reference Image • If the system position of the reference image or DSA scene was different, the following message is displayed: Roadmap: System Movement after Ref Image, no overlay 3. Operate the correct FLUORO pedal of the footswitch and keep it pressed. • After start of fluoroscopy, normal fluoroscopy images are displayed. • When the mask is set, the display automatically switches to subtracted images (image - mask). 4. Release the FLUORO pedal. • The LIH or automatic fluoro loop is displayed on the Live screen as white vessels on a grey background ((image - mask) - reference image). 5. Change the vessel/catheter contrast, if necessary. • Fluoroscopy can be interrupted as often as required. The system remains in phase 3 and displays additional subtracted images each time the fluoroscopy switch is pressed. 6. Perform further fluoroscopy as needed. 7. Reset Roadmap, if necessary. 8. Perform Show Progress, if necessary. 9. Deselect Roadmap. 24 Session Two – Postprocessing Postprocessing from the Control Room Notes In order to post process the images, load the selected scene into the postprocessing task card. AX An Examination 125 - 1/1/1:00 MArt Ar Ando PC14A HIFS STUDY 11/8/200 10:08:32 /M 1002 - 0/03 STOP IM 4 PostProc: Quant T Filmning Renale 1240 E 10% MA 700 1000 0 421 RAO 71 WC 43 (1) (1) (2) (2) Full screen display on the PostProc task card (1) Image area (2) Control area Settings Exam mag Quant Physio 4D ? View x2 1:1 A Adjust n REF Applications DSA REF Tools AS Postprocessing can also be done at the TSC in the Image task card. 25 Session Two – Postprocessing (continued) The following functions are available in the Postprocessing task card in the control Notes room and in the Image task card on the TSC: The page numbers below refer to the location of further information in the Operator’s Manual Volume 2. Touchscreen Monitor screen Description Effects both Effects singh planes plane Loop All Scenes + 1371 + Image > Max. FIIl +1372 Pverride Shutter > #375 Invert Gray Scale + #376 Zoom 2x > 1377 x2 Zoom to Acquisition Size + 1377 1:1 Pan (Automatically activated with zoom.) Image mirror/flip preselection > #301 RIA R Flip Horizontally Image fllp/mirror + 1374 Fllp Vertically R 9 Image flip/mirror + 1374 CLEARstent > 1317 Opacification > #427 Pointer + #379 26 Session Two – Postprocessing (continued) Notes Touchscreen Monitor screen Description Effects both Effects singk planes pare Open the Image Player > #364 Scene Directory > #359 Reference Image Directory + 1359 Scena Content selection > #360 REF Ref. Image Store Monitor + Ref. Image + Store Monitor + Scene - / Scene + + 1362 - + Ref -/ Ref + > #362 Single step + 1367 ID DR 10 TJS Review controls >1366 Scene Overview > #365 Full-screen > #365 View > Review Mode +1370 Touchscreen Monitor screen Description Effects both Effects singh PETE Image display! Image processing Adjust subtask card Windowing: Adapt the digitally stored 2100 grayscale values to the visual aculty of the human eye. (Set"brightness" and 2250 'contrast") > #388 Auto Window > #391 Juto Window Home > #390 n 21 Edge Enhancement: Emphasize detalls + 1391 Edge Enhancement Home + 1392 Annotations and graphics: Tools subtask card EGEHE Annotation: Enter predefined or new text In the Image + #397 Circle >1401 Line >1402 Arrow > 1402 27 Session Two – Postprocessing (continued) Notes Touchscreen Monitor screen Description Effects both Effects singh planes Polygon > 1403 Pointer > #379 Hide annotations > #400 Del Delete annotations > #396 Callbration: Callbr. subtask card Distance calibration > #404 Auto ISO callbration > #612 Fruto Auto TOD callbration > #613 auto Manual callbration > #406 Measurements: Tools subtask card EGEH € Distance > 1408 Angle > #410 28 Session Two – Postprocessing (continued) The following functions are available in the DSA subtask card in the Postprocessing Notes task card: Touchscreen Monitor screen Description Effects both Effects single planes Move mask > #416 Adjustment Replace mask > #417 Native/Subtracted >#418 Anatomical Background > #419 On/Dt Adjustment Image > Change Vessel Vessel/Catheter Contrast > #420 Adjustment / Catheter Contrast Pixelshift > 1421 Opacification > #427 DE Averaging > #429 M MI '33 General functions: Invert Gray Scale + 1376 Zoom 2x + 1377 x2 Zoom to Acquisition Size > #377 1:1 Pan (Automatically activated with zoom.) 29 Session Two – Filming Patient Images Sending Images to Filming Notes To send images to the virtual film sheet in the Filming task card: 1. Select images in Patient Browser, or in Viewing 2. Click Patient, Copy to film sheet or utilize Copy to film sheet icon For more details and complete calibration procedures, please see: • Quality Control Manual 30 Session Two – Archiving Patient Images to Network To send patient data to network (PACS): Notes 1. Open Patient Browser 2. Click the study icon 3. All images and other data objects will be selected Or: Select scenes or store monitors from the directory in the Postprocessing tab 4. Select the icon to send 5. The Send to/Archive to Dialog box is displayed with a list of all available network addresses. Send To X Network Node Compression Quality Factor None ACOM: Lossless JPEG Send Cancel Help Cleaning For more details and complete cleaning and disinfection procedures, please see: • On-line User Manual located in the Help dropdown of your Acquisition Workstation (AWS). 31 Session Two – Archiving Patient Images to CD/DVD Overview Notes To archive patient data: 1. Open Patient Browser 2. Select Transfer, Eject from CD 3. Insert CD into tray and close 4. Select Study in Patient Browser 5. Select Transfer, Export to 6. Choose destination and click Export 7. Fill in Label and select Viewing tool if you want to see the images on a PC, OK 8. To see all pre-selected cases, Click Transfer, Local job status 9. Once the recording starts, in the bottom right-hand corner of the monitor, the recording icon will be displayed 10. Once the recording is complete, the icon will no longer be displayed 11. Once completed, Finalize Medium prior to ejecting is suggested. To verify study has been recorded on the CD: Click on CDRW in the browser and the patient’s name will display. 32 Session Two – Exercises Notes Session Two Complete the following exercises. Exercise 1: Hands-on Register a patient. Exercise 2: Hands-on Perform a mock patient study. 1. Position the C-arm 2. Select the acquisition program/example DSA 1F/s or Coro 15F/s 3. Fluoro 4. Modify fluoro selection 5. Fluoro 6. Acquire Exercise 3: Viewing and Postprocessing images Select the patient from the Patient Browser 1. Double click on the patient name to load. 2. Review the scene directory 3. Select a scene and double click to load 4. Modify the window values/EE 5. Select Home icon for window values/EE 6. Add annotation/text 7. Pixel Shift if DSA 8. Max Opac if DSA 9. Archive/export images (CD/DVD/Network/Film) 33 Session Three – Quantification and Special Examinations Objectives Notes After this session, you will be able to: • Perform LVA/QCA/QVA/Distance Measurement • IZ3D/QVA3D (Optional) • Complete Dynavision workflow (DR and DSA) • Complete Perivision workflow (Peristepping) Quantification and Special Examinations This day is reserved for patient procedures and hands-on training including: • Left Ventricle Analysis, 2D Coronary Analysis, 2D Vessel Analysis • Distance Measurement • 3D Coronary Analysis (Optional). • Console & TSC Measurement workflow • General Dynavision workflow • Perivision and Peristepping workflow Settings Exam Image Quant Physio 4D ? Calibration A SMI 2D Vessel Analysis REF 2D Coronary 3D Coronary Analysis Analysis REF Left Ventricle AS Analysis 34 Session Three – Calibration Methods Overview Notes Depending on the examination to be performed, you can use different calibration methods: Auto ISO Calibration Calibration is performed fully automatically for an organ positioned auto in the isocenter (= rotation center) on the basis of the known exposure geometry. Siemens Service performs an exact calibration for this exposure geometry during installation of the system. Advantage: You can work quickly. – Disadvantage: This calibration method should be used only if the – organ to be examined was in the isocenter during the acquisition. Otherwise there can be significant measuring uncertainties. TOD Calibration (table-object distance) The calibration is automatically computed based on the known auto exposure geometry. You only need to enter the TOD. Siemens Service performs a precise calibration when the system is installed. Advantages: The TOD is same in the supine position for most – patients. You can work quickly. Disadvantage: The error in the TOD value limits the measurement – accuracy. Distance Calibration Calibration is based on the known distance between two points of an object placed in the beam path. Advantage: The distance can be measured accurately. – Disadvantage: Measuring errors can occur due to geometrical – distortion -¡- Catheter Calibration Calibration is based on the known diameter of the catheter. Advantages: The catheter is, so to speak, “in situ”. There is only – slight uncertainty due to geometrical distortion. Another advantage is that you know the exact catheter diameter (usually in French units). Disadvantage: The diameter of the catheter is relatively small. – Therefore, the known diameter corresponds to relatively few pixels in the image. This places a limit on the measurement accuracy. 35 Session Three – Calibration Methods Overview continued Notes Sphere Calibration Calibration is based on a sphere with known diameter. The sphere is placed in the beam path after the examination. The same distances must be observed as for the scene to be analyzed. Advantages: The diameter of the sphere can be determined – very accurately and does not depend on the beam direction (due to spherical shape). Disadvantages: A separate acquisition must be performed – with the sphere. If placed inaccurately, measurement uncertainties will occur depending on patient size. Calibration factor (Manual Calibration) Enter the calibration factor based on your experience with other calibration methods. Advantage: You can work quickly. – Disadvantage: If the measurement conditions are not absolutely – identical, significant measuring uncertainties can occur. Note For rotational scenes (DR-DYNAVISON, DYNAVISION or 3D), auto ISO and auto TOD calibrations are not possible. 36 Session Three – Performing a Calibration Overview Notes When you start measuring on a non-calibrated image, the system automatically suggests a calibration method depending on the image angle. Image Angle The image angle is the geometric sum of the image’s LAO/RAO angle and CRAN/ CAUD angle: Image angle = acos ( cos (LAO/RAO angle) * cos (CRAN/CAUD angle) ) Example: With RAO = 14° and CRAN = 10° the image angle is approximately 17°. For image angle 0° ... 15° or 165° ... 180°, the system suggests automatic TOD calibration. For image angle 15° ... 50° or 130° ... 165°, the system also suggests TOD calibration, but you must mark the point of interest in the image. If the object was at a defined distance from the tabletop, you can use TOD calibration. If that was not the case, we recommend to use manual calibration. For image angle 50° ... 130°, the system suggests automatic isocenter calibration. You should use this calibration method only if the object of interest was positioned in the isocenter. If that was not the case, we recommend to use manual calibration. Selecting a Calibration Method or Recalibrating Console • You will find the tools for calibrating the images on the Calibrate subtask card on the Quant task card and in the Options menu. • Activate the Quant task card, if necessary. Calibrate View • Click the Calibrate subtask card into the foreground auto auto -- -- Touchscreen auto Auto ISO Calibration Auto TOD auto Distance Catheter Note: Pay attention to the messages at the bottom of the image. They include notes for Sphere further operational steps. 37 Session Three – Performing a Calibration (continued) Automatic Isocenter Calibration Notes Console If the organ to be examined was in the isocenter during acquisition, you can use automatic calibration. auto • Click this icon. The system calculates the calibration factor on the basis of the image geometry. – The calculated calibration factor is displayed. – • Confirm by clicking on OK. Auto Isocenter Calibration Calibration Factor [mm/Pixel] 0.1084 Devietion of 1 cm in Isocenter will result in an error of approximately 1.5% OK Help Touchscreen • Press this icon. Calibration • Press this icon, if necessary. Auto ISO auto • Press this icon. OK Automatic calibration is performed immediately and displayed. 38 Session Three – Performing a Calibration (continued) Calibration Using the Notes Table-Object Distance (TOD) Console If the organ to be examined is at a defined distance from the tabletop, you can use TOD calibration. • Click this icon. auto The system calculates the calibration factor on the basis of the image geometry. – The calculated calibration factor is displayed. TOD calibration is automatically – preselected by the system for image angle 0° ... 50° or 130° ... 180°. For image angle 15° ... 50° or 130° ... 165°, you are prompted to mark the measurement point in the image. In that case, a message is displayed. – Click on the point in the image where you want to perform a measurement. – Auto Isocenter Calibration • Confirm by clicking on OK. Calibration Factor [mm/Pixel] 0:1084 Deviation Con non of 1 cm in Isocenter will result in an error of approximately 1.5% OK Help Touchscreen • Press this icon. Calibration XX • Press this icon, if necessary. Auto TOD auto • Auto TOD Calibration Enter the table-object distance using the ? numeric buttons. Adjust Table Object Distance with joystick • For angulations >15°, you are prompted r enter value. to mark the measurement point in the 1 2 3 16 cm im¬age. Only then you can adjust the TOD. 4 5 6 • Click the point in the image where you want to perform a measurement. 8 9 V OK O OK • Press this icon. Note: TOD calibration is not suitable for image angle 50°-130°! 39 Session Three – Performing a Calibration (continued) Distance Calibration Notes Console • Click this icon. • Click on the image to mark the starting point and drag the mouse along a line to the end point. • As soon as you move the mouse, a line is displayed. • Click the mouse button a second time to end the line. • The distance line is then drawn. • Use pre-defined values or enter the exact value in the field. • Then Press OK. Distance Calibration ? X Last Accepted Cal Facto [mm/Pixel] 0.2694 mm OK Cancel Help Touchscreen • Press this icon. Calibration XX • Press this icon, if necessary. Distance v • Click on the image to mark the starting point and drag the mouse along a line to the end point. • As soon as you move the mouse, a line is displayed. • Click the mouse button a second time to end the line. • The distance line is then drawn. Distance Calibration ? • Enter the correct value in the Draw calibration line with joystick and enter length numeric input field. 1 2 3 10.3 mm 4 5 6 7 8 9 0 VOK 40 Session Three – Performing a Calibration (continued) • Press this icon to accept. Notes V OK Note: The calibration object should be larger than the object to be measured. The calibration object must also be located in the same plane as the object to be measured! Note: When contrast between the calibrating object and the background is too low, the pixel size will be inaccurate. Check the image quality and make sure that contrast between the calibrating object and the background is good. Catheter Calibration Console • Click this icon. • Mark the starting position of the center line with a single click. • Now move the mouse pointer to the point where you want to end the centerline and mark this point with a mouse click. The contour detection algorithm automatically detects the edges of the catheter. – 5.00 5.0 F • Now enter the actual size of the catheter used for calibration (in French units). Or • Then click on the arrows to correct the value until you reach the exact value • Select the approximate French value by clicking on a button. Catheter Calibration 3 X Last Accepted Cal Factor • Press OK to accept. [mm/Pixel] 1.0000 5.5 F 6.OF 6.5F 7.5F 8.0 F 8.5F 9.0 F 9.5 F 10.0 F Cancel •Press this icon. V OK • Mark the starting position of the center line with a single click. • Now move the mouse pointer to the point where you want to end the centerline and mark this point with a mouse click. The contour detection algorithm automatically detects the edges of the catheter. 41 – Session Three – Performing a Calibration (continued) Catheter Calibration (continued) Notes Touchscreen Calibration • Press the appropriate button. Catheter Catheter Calibration ? Mark center line of catheter with joystick and select catheter size. 5.5 6.0 7.0 8.0 • Press this icon to accept. 8.5 9.0 F 9.5 10.0 F V OK 7.0 F OK 42 Session Three – Performing a Calibration (continued) Notes Sphere Calibration Console • Click this icon. • Click into the center of the sphere. The system attempts to determine the boundaries of the sphere. 50.0 • Select the approximate pre-defined diameter by clicking on a button. Or mm 50.000 • Click on the arrows to correct the value until you reach the exact value desired. Sphere Calibration ? x • Press OK to accept Sphere Calibration. Last Accepted Cal Factor [mm/Pixel] 1.0000 mm 50.0 55.0 mm nm 50 OK Help 43 Session Three – Performing a Calibration (continued) Sphere Calibration (continued) Notes Touchscreen Calibration • Press this icon. • Click into the center of the sphere. The system attempts to determine the boundaries of the sphere. Sphere Calibration ? Mark sphere with joystick and select sphere diameter • Press the appropriate button. size. 11- 45 mm 50 mm 55 mm V OK 50 mm OK • Press this icon to accept. 44 Session Three – Performing a Calibration (continued) Calibration with a Calibration Factor Notes Console (only) -¡- • Click this icon. The previous calibration factor—if there is one—is displayed. Manual Calibration ? X Last Accepted Cal Factor [mm/Pixel] 1.0000 Manual pixel size 1 mm/pixel OK Cancel Help • Enter the exact value in the field or use the arrows. Distance Measurement Console & Touchscreen Settings Exam Image Quant Physio 4D ? Calibration A SM 2D Vessel Analysis REF 2D Coronary 3D Coronary Analysis Analysis REF Left Ventricle AS Analysis • A suitable image is loaded and displayed in full screen. This can be a single plane image or one image of a biplane image pair. • The image has been calibrated. • Click this icon. 45 Session Three – Performing a Calibration (continued) Distance Measurement (continued) Notes Measurements ? X Select measurement type and draw with joystick. Measurement Distance A Angle • Click on the image to mark the first point and drag the mouse to the second point. As soon as you move the mouse, the length of the line drawn up to this point is displayed. • Release the mouse button to end the line. The distance line is drawn showing the number and the distance. Changing the Distance Line • Click on one of the two end points of the distance line, keep the mouse button pressed, and drag 2 Distance: 32.10 mm the line to enlarge or decrease it. The distance is updated as soon as you move the mouse pointer. 1 Distance: 50.20 mm 46 Session Three – Quantification Performing LVA Notes Console LVA • Load a suitable scene from the Patient Browser or Scene Directory onto the Quant task card by drag-and-drop or a double click. • Perform calibration. Calibrate View auto auto Note: In the case of a single plane scene, and for a -- full set of analysis results,the scene has been calibrated. In the case of a biplane scene, both planes must have -- been calibrated. • After you have calibrated the image, select the analysis method on the Analyze subtask card. Note: In the case of a biplane scene, both planes must have been calibrated. • Select a suitable ED frame. eft Ventricle Analysis ? x Analyze Info Corr ED ES ED ES auto X Cancel Help • Click this icon when you find a suitable ED frame. ED 47 Session Three – Quantification (continued) Performing LVA (continued) Notes • Perform contour detection in the ED image (define three points-Valve Plane and Apex) • Scroll to a suitable ES frame. • Click this icon when you find a suitable ED frame. ES • Perform contour detection in the ES image (define three points-Valve Plane and Apex). • Create and store the report. 48 Session Three – Quantification (continued) Touchscreen LVA Notes • Load a suitable scene into the Quant task card on the TSC. • Perform calibration. (In the case of a biplane scene, both planes must have been calibrated.) Settings Exam Image Quant Physio 4D ? Calibration A SM 2D Vessel Analysis -8 REF 2D Coronary 3D Coronary Analysis Analysis REF Left Ventricle AS Analysis Left Ventricle Analysis • After you have performed calibration, select the analysis method on the Quant task card. • LVA window appears for analysis. Left Ventricle Analysis ? × 1 ED 2 ES 3 Report Select ED image and mark aortic valve and apex. auto ! A x2 Mark as ED SM REF 49 Session Three – Quantification (continued) • Select a suitable ED frame. Notes • Click this icon when you find a suitable ED frame. Mark as ED • Perform contour detection in the ED image (define three points-Valve Plane and Apex) • Scroll to a suitable ES frame. • Click this icon when you find a suitable ES frame. Mark as ES 50 Session Three – Quantification (continued) Notes • Perform contour detection in the ED image (define three points-Valve Plane and Apex) • Create and store the report. Left Ventricle Analysis ? X 1 ED 2 ES 3 Report Select ED image and mark Bortic valve and apex. ID Mark as ED 51 Session Three – Quantification (continued) Overview of Biplane LVA Workflow Notes • Plane A is selected. A • Define the ED image pair. Mark as ED • Define the contour in plane A and correct the contour, if necessary. • Select plane B. B • Define the contour in plane B and correct the contour, if necessary. • Select plane A. A V • Define the ES image pair. Mark as ES • Define the contour in plane A and correct the contour, if necessary. • Select plane B. B • Define the contour in plane B and correct the contour, if necessary 52 Session Three – Quantification (continued) Additional LVA Information Notes Correction eft Ventricle Analysis ? X If the detected contour of the ventricle is not satisfactory, Analyze| Info Corr you can make manual corrections. 1. Move the mouse pointer close to the contour you want to modify. 2. Start the correction with a single click at the point from which you want to correct the existing contour. A line is drawn from this point. 3. Define the intermediate points along the required contour with a single click. 4. Define the end point with a double left click (mouse or mouse joystick) or right click (mouse joystick). In the control room, the Left Ventricle Analysis window switches to the Corr subtask card. Cancel Help Console In the control room, you can choose one of the following options: Smoothing 1. Soft: The corner points of the drawn curve are smoothed. 2. Hard: The drawn contour is unchanged. V The default correction method is applied automatically when marking a correction to a contour. At system startup the default correction method is set to Soft correction. • Click an icon to change the setting. Note: Touch screen In the exam room, the contour is automatically corrected with Soft. 53 Session Three – Quantification (continued) ED/ES Notes Console As an alternative you can also switch between ED and ES (provided an ED and an ES image have already been selected). Annotating a Contour Left Ventricle Analysis ? |x • On the Info subtask card, you can define the heart rate Analyze | Info Corr and comment on the analysis. You can: Study Name 1. Select or enter a research Study Name Unknown 2. Enter Free Text 3. Change the review heart rate. (Gives a cardiac output Heart Rate [bpm] with this added information) 1.0000 Free Text Cancel Help Checking the contour You can check whether you have selected the correct image more easily in the dynamic display, that is, if the heart is beating under the contour (provided a contour has already been drawn). Console • Click this icon. Touch screen • Press this icon 54 Session Three – Quantification (continued) QCA/QVA (continued Notes Both QCA (Quantitative Coronary Analysis) and QVA nalyze Adjust | Tools (Quantitative Vascular Analysis) allow physicians to determine various physiological properties of arteries, such as vessel diameter. The produced quantitative results can help determine the health of a patient’s vasculature. Using QCA/QVA the physician may also analyze a bifurcated vessel and rate it as ostial or non-ostial. QCA and QVA are in essence identical software packages, the only difference beingthe algorithms applied during the analysis. • Quantitative coronary analysis for measuring stenoses in coronary arteries (0.5 mm to 7 mm) • Quantitative vascular analysis for measuring stenoses in other arteries (0.5 mm to 50 mm) • Quantitative coronary analysis in three dimensions based on two 2-dimensional images. 55 Session Three – Quantification (continued) QCA/QVA Notes Console • After you have calibrated the image, select the analysis Analyze Adjust | Tools method on the Analyze subtask card. CC QCA QVA Coronary Analysis ? X Vascular Analysis Analyze Info Corr Analyze Info Corr auto auto + Cancel Help Cancel Help • Click on the appropriate icon (QCA/QVA) on the Analyze subtask card. The Coronary Analysis or Vascular Analysis window appears. • Define the proximal starting point in the center of the vessel with a single click. • Define any necessary intermediate points in the center of the vessel with single clicks. • Define the distal end point with a double left click (mouse or mouse joystick) or right click (mouse joystick). • As soon as you have defined the arterial segment you want to examine with a center line, the contour detection algorithm automatically detects the vascular margins. 56 Session Three – Quantification (continued) • As soon as you have defined the arterial segment you want to examine with a center Notes line, the contour detection algorithm automatically detects the vascular margins. • If the detected contour of the arterial segment is not satisfactory, you can make manual corrections. (see next section) • If satisfactory, create and store a report of the analysis results. Touchscreen After you have calibrated the image, select the analysis method on the Quant task card. Settings Exam Image Quant Physio 4D ? Calibration A SM 2D Vessel Analysis REF 2D Coronary 3D Coronary Analysis Analysis REF Left Ventricle AS Analysis • Press the appropriate icon. The QCA/QVA window appears. • Define the proximal starting point in the center of the vessel with a single click. • Define any necessary intermediate points in the center of the vessel with single clicks. • Define the distal end point with a double left click (mouse or mouse joystick) or right click (mouse joystick). • As soon as you have defined the arterial segment you want to examine with a center line, the contour detection algorithm automatically detects the vascular margins. 57 Session Three – Quantification (continued) Notes 2D Vessel Analysis ? X Mark Vessel 2 Report Select image and mark vessel centerline with joystick. A x2 SM • If the detected contour of the arterial segment is not satisfactory, you can make manual corrections. (see next section) • If satisfactory, create and store a report of the analysis results 2D Vessel Analysis ? Mark Vessel 2Report Select image and mark vessel centerline with joys 1- x2 ID 58 Session Three – Quantification (continued) Notes 59 Session Three – Quantification (continued) Contour Corrections Notes Console & Touchscreen • Start the correction with a single click at the point from which you want to correct the existing contour. • Define the intermediate points along the required contour with a single click. The line changes its direction each time. • Define the end point with a double left click (mouse or mouse joystick) or right click (mouse joystick). • In the control room, the Coronary Analysis or Vascular Analysis window switches to the Correction subtask card. Coronary Analysis ? X Vascular Analysis ? X Analyze | Info Corr Analyze | Info Corr Cancel Help Cancel Help • In the control room, if the currently marked contour does not include a bifurcation, you can choose one of the following options: Soft correction: The corner points of the drawn contour are slightly smoothed. - Hard correction: The corner points of the drawn contour remain unchanged. - • Click on the desired icon to change the setting. V 60 Session Three – Quantification (continued) Contour Corrections (continued) Notes Manual restriction If the defined contour is too large, you can trim the contour. • Start outside the contour with a single click. A line is drawn. • Define the intermediate points inside the vessel with a single click. The line changes its direction each time. • Define the end point outside the vessel with a double click. The restriction is applied to the contour. Console Toggle ostial branch In the case of a bifurcation, the system is able to determine whether a side branch is ostial or non-ostial. This determination is made by comparing the ratio between the branch’s diameter and the diameter of the main vessel segment with a configurable threshold. • Click on this icon to switch between non-ostial and ostial branch • Press this icon to switch between non-ostial and ostial branch 61 Session Three – Special Examinations Overview Notes Rotational angiography can be performed without or with digital image subtraction: DR-DYNAVISION • DR-DYNAVISION is the further development of classical rotational angiography in which an examination area is acquired from different directions in a single run. The acquisition can be carried out with or without contrast medium. The scenes are displayed native (unsubtracted). DYNAVISION (DSA) • DSA DYNAVISION is the angle-triggered acquisition technique with digital online subtraction. Mask and contrast images (mask and fill frames) are thus acquired in the same angle position of the C-arm. Since the mask and fill phases occur in the same direction, the images are acquired under the same conditions. The rotational range of the C-arm can be freely selected. 3D DYNAVISION • 3D Dynavision On Artis zee/zeego systems special 3D acquisition modes are available which enable the generation of image sets suitable for 3D reconstruction on the syngo Workplace. General information on rotational angiography Application • In rotational angiography, the vascular region of interest is acquired from several projection directions during an acquisition series by rotation of the C-arm. Rotational angiography is always used if superpositions have to be projected free, e.g. turning up bifurcations (carotid artery, iliac artery, renal artery) or projecting free the neck of an aneurysm. Advantages • With rotational angiography one obtains: 1. several projections of the vascular region with one injection 2. a spatial impression of the course of the vessels 3. the possibility for generating 3D images Isocenter • With rotational angiography, the volume to be imaged should always lie in the isocenter of the C-arm (i.e. center of rotation). Otherwise it may move out of the image area in some projections. This is essential for 3D examinations, where the region of interest must be positioned in the isocenter. The “isocenter assistant” helps you positioning the region of interest in the isocenter. Instructions • Instructions are given on the data display / Assist screen / message bar. Pay attention to the messages. Collisions • The effect of a collision depends on in which state of the rotational angiography examination the collision occurs: 1. If a collision occurs before the first run is started, the system returns to the test phase and does not deselect the acquisition. 2. If a collision occurs while there is no rotational movement, e.g. acquisition in injection phase or X-ray delay from injector, the system displays a message and does not deselect the acquisition. 3. If a collision occurs during the movement (collision sensor), then the movement stops. The acquisition and the injection are stopped, the acquisition program is deselected by this, and the acquisition cannot be continued. 62 Session Three – Special Examinations (continued) Notes Patient movements • If the patient moves during a rotational angiography acquisition, there is a risk of collision and also the acquired scenes may not be suitable for the intended purpose. 1. Instruct the patient not to move, or immobilize the patient, if necessary. 2. Pay attention to patient movements during a rotational angiography acquisition and stop the acquisition/movement, if necessary. Exposure release • For exposure release, in principle the hand switch or foot switch can be used. However, to facilitate the examination sequence we recommend using the foot switch. Rotation • The start and the end position and the rotation range (angle) are determined before acquisition during the test phase. It is immaterial for performing rotational angiography whether the start position is in RAO or LAO or cranial or caudal respectively. System positions • Rotational angiographies can only be carried out in the following system positions: In Artis zeego, the C-arm can be the Head Side, Left Side, Right Side and Left Side, Table Rotated positions. Only one longitudinal position is supported. However, the following restrictions apply to Left Side, Table Rotated position:—Only the table rotation angles of 15° and 30° are supported.—No Eccentric Rotation is supported in this position.—No Large Volume is supported in this position. In systems with floor stand—Artis zee floor, the C-arm of the floor stand must be in the Head Side position. In biplane systems—Artis zee biplane, rotational angiographies can only be created single plane in plane A (floor stand) in the Head Side position. The top stand is not used and must be in the parking position. When a DR-DYNAVISION/DYNAVISION/3D program is selected, the system automatically switches over to single plane mode (plane A). In Artis zee ceiling, the C-arm can be in a selectable lateral position or in the Head Side, Left Side and Right Side positions. In Artis zee multi-purpose, the C-arm can be in a selectable Lateral position. Rotation angle and speed • The maximum rotation angle and the maximum rotation speed can be preselected in the acquisition program. They also depend on the position of the C-arm in relation to the rotation plane Frame rates • The frame rates are controlled by the acquisition program. Injection mode • The injection occurs just before start of fill run. Contrast medium can either be applied with the help of an automatic injector or manually. In general, injection with the injector produces better results as the flow of the contrast medium can be kept constant over the total duration of the injection. If the injector is set to “Armed” it will be triggered. It is recommended to set a delay time (X-ray delay) of 0.5 ... 1 seconds on the injector. With this an optimum contrast medium filling is achieved already with the first projection. The X-ray delay which is programmed at the injector is used to delay the begin of the injection phase. During this delay time there is no image acquisition. If the injector is not set to “Armed”, the system assumes that a manual injection is performed with no contrast medium applied and starts the injection phase immediately. For manual injection it is recommended to set a X-ray delay 0 seconds. 63 Session Three – Special Examinations Dynavision Notes DR Dynavision DR Dynavision Examination Sequence (2) (6) (4) (7) (5) (3) TO (1) Start position Optional: Brief fluoroscopy to check the examination region (2) Test run with rotating C-arm for ensuring that no collisions occur (3) Brief fluoroscopy for automatic setting of acquisition parameters (4) Injection if contrast medium is used (5) Start of acquisition (6) Fill run with rotating C-arm for image acquisition with or without contrast medium (7) End position Preparations • First of all you position the patient and unit and center the area to be examined in the isocenter. By selecting the acquisition program the examination sequence is started. Test phase • During the test phase, you determine rotational range (start and end positions as well as angle). You check the position of the examination region by briefly switching on fluoroscopy (mandatory at start and finish of the test phase). You also check object centering and collimation . Reversal point • You start the acquisition or it starts automatically according to programming at the reversal point Injection • The injector receives the start signal (if integrated) or you perform the injection manually, if required. Fill phase• In the fill phase, an image is acquired for every projection and displayed. 64 Session Three – Special Examinations (continued) DR Dynavision Workflow Notes A DR-DYNAVISION acquisition is performed in the following sequence: • Prepare the patient, stand, C-arm and table. Position the region of interest in the isocenter. Check the injector, if used. CO • Perform a brief fluoroscopy for automatic setting of acquisition parameters: Press fluoro pedal of footswitch. • Select a DR-DYNAVISION acquisition program. DR-DYNA ... • Perform the DR-DYNAVISION test run to make sure that no collision will occur. • Perform a brief fluoroscopy for automatic setting of acquisition parameters: Press fluoro pedal of footswitch. • Automatic or manual injection if contrast medium is used. • Start injector if manual injection is used. 65 Session Three – Special Examinations (continued) DR Dynavision Workflow (continued) Notes • Perform the DR-DYNAVISION acquisition run:—Start acquisition: Press the exposure release button or pedal and keep it pressed. Rotational run will start automatically, if Auto is programmed. Injection will also be performed automatically if the injector is set to “Armed”.—Start acquisition. Then start rotational run in time: Press the blue multifunctional button of the hand switch, if Manual is programmed • Stop acquisition when rotational run is complete. • View the rotational series. ... k-K-  DSA Dynavision DSA DYNAVISION Examination Sequence (2) (6)- 181 '(1) (5) (9) (3) (1) Start position Optional: Brief fluoroscopy to check the examination region (2) Test run with rotating C-arm for ensuring that no collisions occur (3) Brief fluoroscopy for automatic setting of acquisition parameters (4) Mask run with rotating C-arm for image acquisition without contrast medium (5) Reversal in the start position of the test run (6) Return run (7) Injection at reversal point (8) Fill run with rotating C-arm for image acquisition with contrast medium (9) Washout phase 66 Session Three – Special Examinations (continued) Preparations Notes • First of all you position the patient and unit and center the area to be examined in the isocenter. By selecting the acquisition program the examination sequence is started. Test phase • During the test phase, you determine rotational range (start and end positions as well as angle). You check the position of the examination region by briefly switching on fluoroscopy (mandatory at start and finish of the test phase). You also check object centering and collimation. Mask phase • In the mask phase, an image is acquired for every projection and displayed. After the fill phase, the mask images are subtracted from the fill images of the corresponding projection. Return phase • At the end of the mask phase the C-arm automatically returns to the start position of the test run (without radiation). Injection • The injector receives the start signal (if integrated) automatically or you perform the injection manually. Fill phase • You start the acquisition or it starts automatically (depending on the programming). The fill images are acquired angle-triggered to the mask frames and displayed (unsubtracted) after the injection. Washout phase • The C-arm stops in the end position of fill run. The acquisition runs on with the frame rate programmed for the washout phase until you let go of the exposure release button or pedal, or until the preset time for the washout phase has elapsed. The last image of the fill phase serves as the mask for the subtracted display of the washout images. Image viewing • After completion of the washout phase, the DYNAVISION scene is displayed subtracted 67 Session Three – Special Examinations (continued) Notes 68 Session Three – Special Examinations (continued) DSA Dynavision Workflow Notes A DYNAVISION acquisition is performed in the following sequence: • Prepare the patient, stand, C-arm and table. Position the region of interest in the isocenter. Check the injector, if used. 6. • Perform a brief fluoroscopy in the start position to check the examination region: Press fluoro pedal of footswitch. • Select a DYNAVISION acquisition program. DYNA • Perform the DYNAVISION test run to make sure that no collision will occur. (O • Perform a brief fluoroscopy for automatic setting of acquisition parameters: Press fluoro pedal of footswitch. • Perform the DYNAVISION mask run: Start acquisition: Press the exposure release button or pedal and keep it pressed. Movement is performed automatically. Mask images are acquired. • The return run takes place automatically 69 Session Three – Special Examinations (continued) Notes (O) • Automatic or manual injection. Start injector if manual injection is used. • Perform the DYNAVISION fill run:—Rotational run will start automatically, if Auto is programmed. Injection will also be performed automatically if the injector is set to “Armed”—Start rotational run in time: Press the blue multifunctional button of the hand switch, if Manual is programmed. Fill images are acquired. • Rotation stops automatically in the end point. The washout scene is being acquired. Do <-k-  • Stop acquisition when all rotational runs and the washout scene are complete. • View the rotational series. 70 Session Three – Special Examinations (continued) Peripheral Angiograph Notes Overview • Depending on the system equipment, there are different possibilities of producing a series of angiographic acquisitions from a larger linear examination region. A large-format image, for instance, can then be composed in the image processor Of the syngo® Workplace from such an acquisition series. PERISTEPPING • With a motor-driven stepping device, a linear examination region (e.g. legs, spine, intestine) can be acquired step by step (in native display) with PERISTEPPING (=DR Stepping). PERIVISION • PERIVISION is the stepping method introduced by Siemens with digital online subtraction. With an injection, an angiography is created in stepping technique in subtracted display. General information on peripheral angiography Application • A linear examination region (e.g. the legs or an arm) can be acquired step by step with PERISTEPPING or PERIVISION. PERIVISION can be used both for arterial and for venous vascular display. Acquisition series • In PERISTEPPING or PERIVISION, scenes (part series) are acquired at several examination positions and these are composed to form an overall series. The individual examination positions are moved to one after the other and scenes are acquired there. The maximum contrast image from every scene is determined. An acquisition series therefore consists of several scenes. Movement • A component is moved linearly according to the system type: 1. The C-arm in case of Artis zeego, Artis zee ceiling, Artis zee multi-purpose. 2. The tabletop (with the patient) in case of Artis zee floor, Artis zee biplane. System positions • PERISTEPPING and PERIVISION can only be carried out in the following system positions: 1. In Artis zeego, in principle every system position can be used, except Parking and Transfer Headside position. Clinically relevant are the Left Side and the Right Side positions. 2. In systems with floor stand, Artis zee floor and Artis zee biplane, the C-arm of the floor stand must be in a lateral position, i.e. Left Side or Right Side, Table Rotated, or Left Side, Table Rotated. 3. In biplane systems, peripheral examinations are possible only with the floor stand (plane A). The top stand is not used and must be in 71 Session Three – Special Examinations (continued) the parking position. When a PERISTEPPING or PERIVISION program is Notes selected, the system automatically switches over to the single plane mode (plane A). 4. In Artis zee ceiling, the C-arm of the ceiling stand must be in the Left Side or Right Side position. 5. In Artis zee multi-purpose, in principle, any system position can be used. Table tilt • In most systems: The patient table must be in the horizontal position for peripheral examinations. 1. In Artis zee multi-purpose the patient table can be tilted. During movement, the C-arm follows the tilt angle by keeping the source to object distance. Running direction • The running direction of PERISTEPPING or of a PERIVISION run can be selected according to the blood flow direction. The running direction determined in the acquisition program defines the direction of the filling run: 1. for examining the leg arteries: Head Feet 2. for examining the leg veins: Head Feet Number of positions • The unit performs a maximum of 11 steps in PERISTEPPING or PERIVISION, i.e. scenes can be acquired at up to 12 positions. The step positions are numbered consecutively from 0 to 11. The step position number is indicated in the message on the data display / Assist screen / message bar. Typically, 5 to 6 steps are required for PERISTEPPING or PERIVISION in the pelvis-leg region. Frame rates • The frame rates are controlled by the acquisition program. Instructions • Instructions are given on the data display / Assist screen / message bar. Pay attention to the messages. Collisions • If a collision occurs during the movement (collision sensor), then the movement stops. The acquisition and the injection are stopped, the acquisition program is deselected by this, and the acquisition cannot be continued. Playback • The acquisition series are played back directly after the acquisition according to the settings in the acquisition program. PERISTEPPING acquisition series are always played back in native display. Subsequent subtraction is not possiblet. 72 Session Three – Special Examinations (continued) Storing and loadinge Notes • The acquisition series are stored automatically in the local database. You can load the series and scenes as usual from the Patient Browser to the PostProc task card or via scene directory, if the patient is the current review patient. Documentation • The scenes can be documented in the following ways: Each position individually after image reconstruction using Composing on the syngo Workplace. (Optional software). • The data for programming the window values depend very much on the concentration and amount of the contrast medium used. Therefore these values must frequently be adapted individually, also to the image impression wanted by the examiner. 1. PERISTEPPING is always performed unsubtracted. Therefore only the values for native display can be set in this program. 2. PERIVISION is always performed subtracted. Therefore the values for both displays can be set in this program. Auto windowing • Automatic windowing is not possible with PERIVISION but only with PERISTEPPING. Instead of manual windowing, automatic windowing can also be selected in the programming. Then the windowing is calculated automatically, related to the maximum contrast image. We recommend that manual windowing is programmed. Automatic windowing functions well provided the image is not collimated and no direct radiation (e.g. when imaging air) is present in the image. Measuring field • The selection of an incorrect measuring field (dominant) can lead to faulty exposures especially in peripheral examinations. For exposures of both legs use the two outer dominants, for one leg the middle dominant. Scene time • The scene time is adjustable for the time from activating the acquisition until ending acquisition. As in the case of variable frame rate, PERISTEPPING and PERIVISION programs are also used to divide a scene into phases of different lengths.. 73 Session Three – Special Examinations (continued) Peri Stepping Notes Peri Stepping Examination Sequence (2) (2) (4) (0) (8) Example for Peri Stepping examination sequence head to feet. (1) Brief fluoroscopy in the start position to check the examination region (2) Test run for checking the positions (3) Brief fluoroscopy for automatic setting of acquisition parameters (4) Injection if contrast medium is used (5) Start of acquisition (6) Fill run for image acquisition with or without contrast medium (7) End position Test phase • In the first step you determine the start position, the acquisition positions and the end position. After positioning the patient and immobilizing the patient’s legs, check during the test phase with short fluoroscopies the position of both legs (of the region under examination) as well as the collimation and the possibly necessary transparency compensation for each examination position. In this way the number of acquisition positions is also determined. Return phase • Start the acquisition series at the reversal point. The unit first moves back to the start position. Injection • In the start position, the injector receives the start signal (if integrated) or you perform the injection manually. Fill phase • The contrast images are then acquired and displayed. You can now observe the contrast medium bolus on the screen. You switch on to the next acquisition position manually with the hand switch. During the series, the acquisition frame rate is automatically controlled as determined in the acquisition program. 74 Session Three – Special Examinations (continued) Peri Stepping Workflow Notes A PERISTEPPING acquisition is performed in the following sequence: • Prepare the patient, stand, C-arm and table. Check the injector, if used. CO • Perform a brief fluoroscopy in the start position: Press fluoro pedal of footswitch. Check/set SID, table height, collimation, filters and measuring fields. • Select a PERISTEPPING acquisition program. PERISTEP ... • Perform the PERISTEPPING test run to check the position of the examination region and to make sure that no collision will occur. Trigger steps by deflecting the C-arm joystick in running direction and hold it until the next position is reached. Where required, perform fluoroscopy, collimate, position the finger filter and change the measuring fields. • Program a delay at the injector and set the injector to “Armed”. If the injector is not armed, it is assumed that a manual injection is performed. “Injector disabled, manual injection.” is displayed in this case. • Perform the PERISTEPPING acquisition run: Start acquisition: Press the exposure release button or pedal and keep it pressed. • Trigger the return phase: Press the blue multifunctional <-k- button of the hand switch briefly. (The return phase is radiation-free.) • Perform the PERISTEPPING acquisition run: Fill images are <-k- acquired. Start movement in time for each step: Press the blue multifunctional button of the hand switch. • Stop acquisition when acquisition run is complete.  • View the PERISTEPPING series. 75 Session Three – Special Examinations (continued) Perivision Notes Perivision Examination Sequence (2) (2) (4) (3) (4) ( B ) UP (7) (6) Example for PERIVISION examination sequence Head Feet (1) Brief fluoroscopy in the start position to check the examination region (2) Test run for checking the positions (3) Brief fluoroscopy for automatic setting of acquisition parameters (4) Mask run for image acquisition without contrast medium (5) Injection at reversal point (6) Fill run for image acquisition with contrast medium (7) End position Test phase • In the first step you determine the start position, the acquisition positions and the end position. After positioning the patient and immobilizing the patient’s legs, check during the test phase with short fluoroscopies the position of both legs (of the region under examination) as well as the collimation and the possibly necessary transparency compensation for each examination position. In this way the number of acquisition positions is also determined. Mask phase • Start the acquisition series at the reversal point. The mask images are acquired in every acquisition position. After each acquisition, the stepping device automatically moves the patient/C-arm to the next acquisition position. Injection • The injector receives the start signal (if integrated) or you perform the injection manually. Fill phase • Finally the contrast images (fill frames) are acquired and immediately displayed subtracted. 76 Session Three – Special Examinations (continued) Perivision Notes Perivision Workflow A PERIVISION acquisition is performed in the following sequence:injector, if used. • Prepare the patient, stand, C-arm and table. Check the injector, if used. • Perform a brief fluoroscopy in the start position: Press fluoro pedal of footswitch. Check/set SID, table height, collimation, filters and measuring fields. • Select a PERIVISION acquisition program. PERI ... • Perform the PERIVISION test run to check the position of the examination region and to make sure that no collision will occur. Trigger steps by deflecting the C-arm joystick in running direction and hold it until the next position is reached. Where required, perform fluoroscopy, collimate, position the finger filter and change the measuring fields. • Program a delay at the injector and set the injector to “Armed”. If the injector is not armed it is assumed that a manual injection is performed. “Injector disabled, manual injection.” is displayed in this case. • Perform the PERIVISION fill run: Fill images are acquired. Start movement in time for each step: Press the blue multifunctional button of the hand switch. • Stop acquisition when acquisition run <-k- is complete. • View the PERIVISION series. Do  77 Session Three – Exercises Notes Session Three – Quantification and Special Examinations Complete the following exercises. Exercise 1: Hands-on Perform a Distance Measurement on a vessel. 1. Select Auto Calibration Method 2. Select the Distance Measurement icon and measure the vessel. 3. Recalibrate using Manual Distance Calibration 4. Measure the vessel again. Exercise 2: Hands-on Perform QVA, QCA, and LVA. 1. Perform Auto Calibration 2. Select the QCA or QVA icon 3. Analyze the vessel 4. Correct the analysis 5. Create report 6. Store report Exercise 3: Hands-on Perform LVA. 1. Perform Auto Calibration 2. Select the LVA icon 3. Draw the contour for the ES and the ED images 4. Create Report 5. Store Report 78 Session Three – Exercises Notes Session Three – Quantification and Special Examinations Complete the following exercises. Exercise 4: Hands-on Perform a mock Perivision Study 1. Position the C-arm 2. Position the patient 3. Set up the acquisition steps 4. Perform acquisition Exercise 5: Hands-on Perform a mock Peristepping Study 1. Position the C-arm 2. Position the patient 3. Set up the acquisition steps 4. Perform acquisition Exercise 6: Hands-on Perform a mock Dynavision Study 1. Position the C-arm 2. Position the patient 3. Set up the acquisition steps 4. Perform acquisition 79 Session Four – Checklists Objectives Notes This day is reserved for: • Review of Checklists • Review of Education Website • Practice call to Uptime for Service/Applications support. • Question and Answer 80 Abbreviations/Glossary Artis Product name of the modular angiography system from Siemens Artis zee® floor (Angio/Card): System with floor-mounted stand/C-arm (angiographic or cardiac system) Artis zee® biplane (Angio/Card): Biplane system (angiographic or cardiac system) Artis zee® ceiling (Angio/Card): System with ceiling-mounted stand/C-arm (angiographic or cardiac system) Artis zee® multi-purpose (Angio): Multi-purpose system (angiographic system) Artis zeego® (Angio/Card): Multi-axis system (angiographic or cardiac system) Angio Angiography, examinations of vessels Angio collimator X-ray collimator mainly used in angiographic systems equipped with rectangular diaphragms and also with two wedge filters and one semitransparent finger filter. Assist screen Essential unit position and acquisition data as well as system messages and menus for unit movements are shown on the Assist screen. Backup mode Artis emergency operation mode, e.g., during switch-on or switch-off or if a technical fault occurs. Only fluoroscopy and acquisition (only in plane A) without patient registration and postprocessing are possible. Images are acquired into the buffer. Binning Merging of 2 neighboring pixels (horizontal and vertical) BSA Body Surface Area Buffer For safety reasons, images are always acquired into a buffer first and then transferred in the background to the memory on the imaging system. If images have been acquired in backup mode, e.g., immediately after power-on, they must be transferred from the buffer to the memory first. BYPASS, Bypass Fluoro Bypass fluoroscopy, Artis emergency operation mode, e.g., during switch-on or switch-off or if a technical fault occurs or when no user is logged in. Only continuous fluoroscopy (only in plane A) and LIH without the imaging system is possible. It is not possible to release acquisitions. CARD Cardiography, examinations of the heart Card collimator X-ray collimator mainly used in cardiographic systems equipped only with rectangular diaphragms and one semitransparent wedge filter. Card (Sub)task card. Elements of the syngo user interface are arranged in stacks of cards. CAUD Caudal direction of motion of the I.I./FD (footwards) CCM Collimator Control Module, console for setting the primary collimator CF Calibration factor CLEARstent Create an enhanced reference image and a scene which provide better view of fine structures, e.g. better visibility of inflated stents for easier evaluation of stent deployment. CM Contrast medium CPR Cardio-Pulmonary Resuscitation CRAN Cranial direction of motion of the I.I./FD (headwards) DAP Dose-Area Product, the radiation dose to air times the area of the X-ray field. The DAP is expressed in micro-Gray times square meters (μGy m2). Data display The data display is attached above the monitors (if installed). DCS Display Ceiling Suspension, support system for LCD monitors DMG Dead Man’s Grip: Unit movements are controlled by a dead man’s grip, that is, movements are performed only while the operating element is being actuated. DR Digital radiography, digital acquisition technique without subtraction 81 Abbreviations/Glossary ED End diastole, heart phase EDV End-diastolic volume, volume of the ventricle in the ED EF Ejection Fraction, measure of cardiac performance EPS System Emergency Power Supply provides interrupted supply for the generator, and uninterrupted supply for imaging system, stand and table. ES End systole, heart phase ESV End-systolic volume, volume of the ventricle in the ES f/s frames per second, frame rate during acquisition fps frames per second FD Flat detector FL Fluoroscopy Frame Single frame of a multiframe image (scene) (one image out of a series of images to form a movie-like sequence) Heat Unit Thermal load state of the tube assembly, stated as a percentage HIS Hospital Information System HU Houndsfield Units: X-ray attenuation (density) measurement unit used to describe voxel values in CT scanning. In a 12-bit CT image, the voxel values will range from -1024 to +3071 HU. For example, water is defined as 0 HU, air as -1024 HU, fat as -100 to -20 HU, soft tissue as +20 to +80 HU, and bone as > +500 HU. Artis zee®/zeego® (VC14B) AXA4-100.620.11.01.02 679 / 694 iFlow The Time Enhanced Opacification (TEO) function—referred to as iFlow—provides a single composite image that shows the history of the contrast medium movement through the vessels in time in a colored image. I.I. Image intensifier IS Imaging system IZ3D 3D Quantitative Coronary Analysis, QCA in 3D, three-dimensional representation of a coronary vessel including any stenotic regions. The system creates the 3D vessel representation by analyzing two 2-dimensional X-ray images of the vessel. kV Kilovolt (1 kV = 1,000 V), unit for measuring tube voltage LAO Left Anterior Oblique, angle of rotation of the image plane in degrees, to the left of the reference vertical LPO Left Posterior Oblique—not used in Artis zee®/zeego® LCD Liquid Crystal Display, monitor with flat screen LED Light-Emitting Diode, indicator lamp of a control element LIH Last Image Hold, display of the last fluoroscopic or acquisition image LVA Left Ventricle Analysis, calculation of the ejection fraction and wall motion of the left ventricle of the heart mA Milliampere (1 mA = 1/1,000 A), unit for measuring tube current mAs Milliampere seconds, unit for the product of tube current (mA) and time (s). Equivalent to the applied radiation dose 82 Abbreviations/Glossary μGy Microgray (1 μGy = 1/1,000,000 Gy), unit for measuring radiation dose MFH Max Fill Hold, review is stopped at the frame within a scene in which the contrast agent is maximally filled Mouse joystick Joystick on the touchscreen control, operating element that functions similar to a mouse, used for operating the imaging system Multiframe image A multiframe image is an image object (scene) whose pixel data consist of a sequence of single frames. OEM Original Equipment Manufacturer OM Operator Manual OR Operating Room OR-UPS UPS for imaging system, stand and table Ostium An ostium is a small opening or orifice, as in a body organ or vessel. Ostial/Non-ostial If a bifurcated vessel is obstructed on the bifurcation point, it is called ostial, else non-ostial. OT Overtable: I.I./FD is above the table P/s Pulses per second, frame rate for fluoroscopy QVA Quantitative Vascular Analysis, calculation for dimensions of vessel sections QCA Quantitative Coronary Analysis, calculation for dimensions of coronary arteries RAO Right Anterior Oblique, angle of rotation of the image plane in degrees, to the right of the reference vertical RPO Right Posterior Oblique—not used in Artis zee®/zeego® RESET Reset RIS Radiology Information System ROI Region of Interest, region under examination SC Service Center. This abbreviation in messages means “Call Service” SCM Stand Control Module, console for operating a stand/C-arm SD Standard deviation, a parameter in statistics SID Source-to-Image Distance, or distance between the source and the I.I./FD in cm SRS Siemens Remote Service syngo® syngo® is the standard medical software platform of Siemens. syngo® is a registered trademark of the Siemens AG. 83 Abbreviations/Glossary TCM Table Control Module, console for operation of the patient table TOD Table-to-Object Distance, distance between the tabletop and the center of the organ, used for calibration TSC Touch Screen Control, console with touchscreen near the patient table for controlling the imaging system in the examination room UI User Interface, all parts of the hardware and software that enable the system to operate UPS Uninterruptible Power Supply, battery-backed system that provides emergency power in the event of a main power supply failure. UT Undertable: I.I./FD is below the table VOI Volume of Interest, 3D region under examination VOI images 3D images stored for technical purpose in the local database WW Window Width (contrast) WC Window Center (brightness) 84 Contact Information Clinical Training and Continuing Education Customer Care Center Call 1-800-888-7436 • Troubleshooting assistance • Immediate assistance for software applications and workflow issues Please provide the Functional Location Number when calling for assistance. Clinical Education Offerings Call 1-888-221-8010 (follow the prompts) • Classroom Training (Offerings, Registration & Scheduling) • Educational Symposia • Onsite Training • Printed Self-Studies • Virtual Education (Offerings & Registration) • Workshops & Fellowships Visit www.siemenslearningcenter.com for more information regarding the current Siemens Clinical Training and Continuing Education portfolio. 85 On account of certain regional limitations of sales rights and service availability, we cannot guarantee that all products included in this brochure are available through the Siemens sales organization worldwide. Availability and packaging may vary by country and is subject to change without prior notice. Some/All of the features and products described herein may not be available in the United States. The information in this document contains general technical descriptions of specifications Local Contact Information and options as well as standard and optional Siemens Medical Solutions USA, Inc. features which do not always have to be 51 Valley Stream Parkway present in individual cases. Malvern, PA 19355-1406 Siemens reserves the right to modify the USA design, packaging, specifications and options Telephone: +1-888-826-9702 described herein without prior notice. Please www.usa.siemens.com/healthcare contact your local Siemens sales representative for the most current information. Global Business Unit Note: Any technical data contained in this Siemens AG document may vary within defined tolerances. Medical Solutions Original images always lose a certain amount Imaging & Therapy Systems of detail when reproduced. 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