Artis Pheno Turnover Workbook

SIEMENS Healthingers> ARTIS pheno ARTIS PARA www.usa.siemens.com/education Artis Pheno Turnover Workbook Answers for life. I. Contact Information Summary Welcome to Siemens Healthineers Clinical Education Offerings: Siemens Healthcare is dedicated to helping you Call 1-888-221-8010 (follow the prompts) • get the most out of your investment throughout Classroom Training the entire product life cycle and beyond. Our goal (Offerings, Registration & Scheduling) • is to enable you to take technology further, Educational Symposia • profitability higher, and patient care to the next On-site Training • level. Find the information, resources, and tools Printed Self-studies • you need to get the most out of your recent Virtual Education (Offerings & Registration) • investment and stay up-to-date. Visit Workshops & Fellowships www.usa.siemens.com/Welcome2Healthcare. Visit www.usa.siemens.com/education for more information regarding the current Clinical Training and Siemens Clinical Training and Continuing Continuing Education Education portfolio. Siemens Customer Care Center: Call 1-800-888-7436 Siemens Training Centers • Troubleshooting assistance Immediate assistance for software Siemens Clinical Education • applications and workflow issues Training Center – TDC2 • For Tech Support press option 2 / for 110 MacAlyson Court applications support, press option 3 Cary, NC 27511 • Press the * key or enter the last six digits of your Functional Location Number Functional Location Number ____________________ Serial Number ________________________________ IP Address System _____________________________ IP Address PACS _______________________________ 2 II. Contents I. Contact Information Summary .............................................................................................. 2 II. Contents ............................................................................................................................. 3 III. Course Agenda ................................................................................................................... 4 IV. Course Objectives ............................................................................................................... 6 1. Session One: System Overview............................................................................................. 7 1.1 Central power control (CPC) ......................................................................................... 7 1.2 Overview ARTIS pheno ................................................................................................. 9 1.3 Control consoles......................................................................................................... 10 1.4 Membrane keys on the FD .......................................................................................... 18 1.5 Large Screen Display ................................................................................................... 19 1.6 Safety ........................................................................................................................ 21 1.7 Session One – Exercises .............................................................................................. 24 2. Session Two: System Operation .......................................................................................... 25 2.1 Home screen in the control room ................................................................................ 25 2.2 Registering a Patient Using the Scheduler ................................................................... 26 2.3 Examination............................................................................................................... 28 2.4 Roadmap.................................................................................................................... 33 2.5 Image Postprocessing ................................................................................................. 39 2.6 Managing and viewing scenes/images ......................................................................... 40 2.7 Processing scenes/images ........................................................................................... 41 2.8 Text and graphics ....................................................................................................... 43 2.9 DSA postprocessing .................................................................................................... 44 2.10 Archiving/sending .................................................................................................... 45 2.11 Session Two Exercises ............................................................................................... 47 3. Session Three: Quantification and Special Examinations ...................................................... 48 3.1 Calilbration Methods................................................................................................... 49 3.2 Performing a Calibration ............................................................................................. 50 3.3 Quantification ............................................................................................................ 58 3.4 Special Examinations .................................................................................................. 68 3.5 Quantification and Special Examinations ..................................................................... 77 4. Session Four – Checklists ................................................................................................... 78 5. Abbreviations/Glossary....................................................................................................... 79 3 ARTIS pheno III. Course Agenda Session One: System Overview. Objectives Switching on/start-up Overview Session Two: System Operation Objectives Registering a patient Select an Examination Program Post Processing Filming Patient Images Archiving Patient Images to Network Archiving Patient Images to CD/DVD Exercise: Session Two: System Operation Session Three: Quantification and Special Examinations Objectives Quantification and Special Examinations Performing a Calibration Selecting a calibration method or re-calibration Automatic isocenter calibration Calibration using the table-object distance (TOD) Catheter calibration Sphere calibration Calibration with a calibration factor Distance Measurement Performing LVA Additional LVA information 4 Correction Annotating a contour QCA/QVA Contour Corrections Special Examinations Overview DR DSA DSA examination sequence Peri Stepping PERISTEPPING examination sequence Peri-Stepping Workflow Perivision PERIVISION examination sequence Fill phase Perivision Perivision Workflow Exercise: Session Three Quant and Special Examinations Session Four: Checklist Objective Abbreviations/Glossary 5 ARTIS pheno IV. Course Objectives Upon completion of this course, you will be able to: • Correctly perform startup and shutdown procedures. • Identify the key hardware features of the Artis pheno 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. 6 Turnover Workbook | Artis Pheno 1. Session One: System Overview Please refer to manual for complete system capability. Notes After this session, you will be able to: • Correctly perform startup and shutdown procedures. • Identify the location of the emergency stop buttons and know how to use them. • Identify the key hardware features of the Artis pheno system. 1.1 Central power control (CPC) (2), (3) (1) Power-on pushbutton and status LED (2) USB ports (3) Light band - Green: Ready for X-ray, Yellow: X-ray is active. (Active only with control consoles installed in control room) USB ports (1) (2) (3) ( 4) REC (1) (2) (3) (4) (1) USB port for memory stick (2) USB port for DVD drive (3) USB port for keyboard (4) USB port for mouse Shutting down 7 Turnover Workbook | Artis Pheno • The USB thumb drive for customer use is on the front of the CPC. Notes • It is not recommended that customers use any port on the back. Shutting Down End Session X Log Off ... Shutdown System. Restart System Restart Application Standby Cancel Help 1. Terminate the current examination or postprocessing. 2. On the Home screen, select Shut down > Shut down. or – – On an active task card, select Options > End Session from the main menu. The End Session dialog box is displayed. 8 Turnover Workbook | Artis Pheno Emergency STOP buttons Notes You will find emergency STOP buttons in the following locations STOP 1.2 Overview ARTIS pheno (3) (2) (1) (5) (4) (1) ARTIS pheno stand with C-arm, X-ray tube assembly and FD (2) Patient table (3) Display ceiling suspension with display (4) Footswitch for releasing radiation (5) Control console for controlling the stand, patient table and imaging system 9 Turnover Workbook | Artis Pheno 1.3 Control consoles Notes Control Console (1) (2) (3) (1) Table (Table Control Module TCM) (2) Stand/C-arm and imaging system (Pilot Control Module PCM) (3) Collimation and filter (Collimator Control Module CCM) TCM-S with panning knob for servo-assisted tabletop movement Image STOP 10 Turnover Workbook | Artis Pheno Keys on the table control module (TCM) Notes The following other functions can be controlled with the keys on the table control module: Key Function Press knob/joystick down (dead man's grip): Enable moving tabletop Lift table up Lower table down Block table movements .LED lights white while function is not active. .LED lights blue while function is active. .LED blinks blue when block all movements has been enabled on the Pilot control module. (The function must be disabled on the Pilot control module.) Unlock table rotation 33 .LED lights white while function is not active. . LED lights blue while function is active. Orientation of control module (Indication on top of the control module, key on the underside of the control module) The blue LED indicates the selected orientation. 11 Turnover Workbook | Artis Pheno Orientation key on the TCM Notes The orientation key causes movements to be made in the same direction as the joystick of the respective control console when deflected. • Control console to the right of the tabletop (default position) • Control console at the foot end of the tabletop • Control console to the left of the tabletop • Control console at the head end of the tabletop Pilot control module (PCM) With the Pilot control module, you perform stand/C-arm movements and operate the imaging system. (2) (1) (4) (3) 7 6) + (5) (1) Stand/C-arm joystick 1 (2) Stand/C-arm joystick 2 (3) Jog wheel (4) Touchscreen (5) Emergency STOP button (6) Keys on top and on the front of the control module 12 Turnover Workbook | Artis Pheno Stand/C-arm multifunction joysticks Notes (1) (5) (2) (4) (3) Deflections of the stand/C-arm joystick (1) Press joystick down (dead man’s grip) (2) Deflect joystick to the left (3) Deflect joystick towards you (4) Deflect joystick to the right (5) Deflect joystick away from you (2) (View from the back) (1) Dead man’s switch for releasing movements (2) Rocker switch on the back: for lifting and lowering the FD (setting the SID) Jog wheel The jog wheel is an input device which combines several functions: • It can be deflected like a joystick, e.g. for positioning the cursor on the screen. • It can be turned, e.g. for scrolling reference images. • It includes the OK button, e.g. for confirming an action. 13 Turnover Workbook | Artis Pheno Display of the jog wheel functions Notes For easier operation, the possible jog wheel functions are indicated in the Info area on the display in the examination room OK Image +/- Scene +/- Play ! Ref Image +/- Pause The possible directions for jog wheel deflections are indicated and the corresponding functions are displayed. Keys on the Pilot control module The following other functions can be controlled with the keys on the Pilot control module: 14 Turnover Workbook | Artis Pheno Key unction Key Function Synchronize C-arm movement with table movement Stand/C-arm functions: Press joystick down (dead man's grip): Block all stand/C-arm and table movements Angulate C-arm LED lights white while function is not active. LED lights blue while function is active. Swivel C-arm counter-clockwise General functions: Swivel C-arm clockwise Block radiation LED lights white while function is not active. Press joystick down (dead man's grip): LED lights blue while function is active. Move C-arm horizontally Orientation of control module Ct Lift C-arm up (Indication on top of the control module, key on the underside of the control module) Lower C-arm down The blue LED indicates the selected orientation. 7 Call-up help CA Drive to Home position Store Drive to CPR position = Open Onscreen menu Open layout selection Exit function OK button: Confirm action Imaging system functions: Open scene directory Open reference image directory Store reference Image • Notes 15 Turnover Workbook | Artis Pheno Touchscreen Notes Selected functions of the system can be operated using the touchscreen. It can be operated similarly to a mobile phone display. Artis Examination Display C-Arm Position Table Detector RDMP & Overlay Favorites Main menu of the touchscreen Touchscreen layout The touchscreen menu is arranged in the main menu and submenus. You can edit the submenus: • Rearrange the order of items in the submenus. • Define items to be displayed in the Favorites menu. 1. Open the submenu to edit. To start editing: 2. Perform a long touch on the touchscreen Editing Mode Patient Transfer If Left Side Right Side Head Side * Left, Table 15º Left, Table 30º Right, Table 15" 16 Turnover Workbook | Artis Pheno Notes To rearrange items: 3. Drag and drop the required item to the desired position. To add an item to the Favorites: 4. Touch the star next to the desired item. Favorites Head Side Height 15 cm To remove an item from the Favorites: 5. Touch the star next to the desired item * Collimator control module (CCM) (1) (2) Universal collimator control module (1) Filter joysticks - The upper joysticks control the wedge filter and the finger filters. (2) Collimator joystick - The lower joystick controls the rectangular diaphragm 17 Turnover Workbook | Artis Pheno Keys on the collimator control module Notes Key Function Toggle wedge filters/finger filter (only with Universal collimator) Press joystick down: Remove filter Press joystick down: Remove filter L - Press joystick down: Open collimator leaves completely and remove filter diaphragms Reset collimator leaves and filter diaphragms 1.4 Membrane keys on the FD -> C-arm rotation (cran/caud angulations) C-arm orbital movement (RAO/LAO angulations) Longitudinal tabletop movement with stepping table - Laser positioner light on/off # FD rotation (setting portrait/landscape) FD lifting and lowering - setting the SID 18 Turnover Workbook | Artis Pheno 1.5 Large Screen Display Notes Exam Room • The Large Display in the examination room shows all images as well as acquisition data, position data, system messages, and menus. • The screen is divided into different segments: • The Live segment shows the current live image or LIH (last image hold). • The Ref1/Ref2 segments show reference images. • The Application segment shows images of integrated applications. • The Info area shows acquisition parameters, basic position data, and display of the jog wheel functions. OK Image +/- Scene +/- Play ! Ref Image +/- Pause • Detailed information about stand and table position data is displayed after movements in a popup window. • There is a message bar, depending on configuration, e.g. on bottom of the display. • Other video sources, e.g. Sensis/ US, may also connect to the display and configured as segments. Control Room • You can select a display layout out of various configurable layouts. • Control room, Examination • Select this icon • Click the layout to use sur Giraplay Layoil Saletion Layout 01 Kely Layout 02 Layou os Layout 08 . Copy Layout 03 . Copy(3) Layout SH OK Apply Cancel 19 Turnover Workbook | Artis Pheno • Click Apply Notes • Configuring the screen layout of exam room display • You can customize the screen layout to your needs and to your examination practice. • Opening the Display Layout Configurator • On the system console in the control room: • Select Options > Configuration... in the main menu. • Double-click the Display Layout Configurator icon (3) (1) Layouts (2) (5) (4) 1) Menu bar (2) Layouts area (3) Layout build-up area (4) Segment Properties area (5) Source area 20 Turnover Workbook | Artis Pheno 1.6 Safety Notes Cardiopulmonary resuscitation (CPR) CPR label This warning label indicates the position of the tabletop for cardiopulmonary ressuscitation (CPR) Pressure compression / max. permissible patient weight The ARTIS systems are designed for cardiopulmonary resuscitation (CPR = Cardio- Pulmonary Resuscitation) with a pressure compression of up to 600 N (60 kg). The maximum patient weight must not be exceeded. 1. Make sure that there is enough free space for performing CPR. 2. Remove any objects, such as chairs, from the examination area. CPR position To achieve the greatest possible stability for a cardiac massage (CPR = cardiopulmonary resuscitation), the table may not be tilted and the tabletop must be moved so that it is directly above its supporting table column • Position the tabletop above the supporting table column. • Tilt the tabletop in horizontal position, if necessary. 21 Turnover Workbook | Artis Pheno Moving to CPR position Notes 1. Press the CPR key on the Pilot control module and keep it pressed until the movements stop. 2. Position the tabletop above the supporting table column. Fluoro Timer The elapsed fluoro time of uninterrupted fluoroscopy is recorded and indicated. Indication in the Info area in the examination room 0 00:00:09 Displays in the control area in the control room E A 00:00:02 The fluoro timer can be configured to the legal requirements: • CFR mode: 000.0 min [minutes, tenths of minutes] Legally required in the US Example: 005.1 min i.e. 5 minutes, 1 tenth minute It is possible to configure whether fluoroscopy should be blocked if the elapsed fluoroscopy time exceeds the preset value (service configurable range 1 ... 5 minutes). An audible signal will sound and a message box will appear. When a new patient is registered, the fluoroscopy time is automatically reset to zero. The elapsed fluoroscopy time of an examination is automatically recorded in the Exam Protocol as soon as the patient is completed. 22 Turnover Workbook | Artis Pheno Resetting the fluoroscopy signal Notes To continue working, when the fluoro timer has elapsed: Press the OK button on the jog wheel. or – – Examination room: touchscreen on the Pilot control module: Touch Reset Fluoro Timer. or – – Control room: Confirm with OK in the message box to continue working. The audible signal is switched off. The fluoroscopy time will start running again. If the preset value is exceeded again, the procedure will be repeated. Brake Test CA 1. Move to parking position by selecting “C-Arm Positions” / “System Positions”. The following message appears “Stand Test: Activate stand movement # s”. 2. Press the stand/C-arm joystick down and deflect it away from you. • The brake test is started and the message “Stand Test: running” is displayed. • The system performs the brake test for each axle (6 times). • If the brake test is successful, the message “Stand Test: Successfully completed” is displayed. Normal movements are possible again. • If the brake test is not successful, the message “No system movement: Stand test failed, SC” is displayed. All movements of the stand are blocked. (Table movements are still possible.) In this case, call Siemens Service. Resuming movement after collision (override) To override the collision control: 1. Press the”?” key on the PCM and deflect the corresponding joystick simultaneously to perform override The message “Collision control deactivated” appears. 2. Deflect the operating element in one of the possible directions. 23 Turnover Workbook | Artis Pheno Resetting the unit computer Notes ? + STOP 1. Simultaneously press the ? key and the emergency STOP button on the Pilot control module. The unit computer is restarted and should be ready for operation after a short time. 2. Do not forget to pull the emergency STOP button 1.7 Session One – Exercises Complete the following exercises. Exercise 1: Raise and lower table Rotate the C-arm using the joystick Move the system to each position in the System Directory Store a position in the programmed directory Store a position in the Direct Position I, II, or III Rotate the tabletop Change the zoom size (mag up or down) Adjust the wedge filters Adjust the collimator Raise, lower and rotate the detector Exercise 2: Rotate the C-arm to 30º RAO and 30º Cranial Store the position in Direct Position I Move the C-arm to 30º LAO and 15º Caudal Store the position in Direct Position II Move the C-arm to Direct Position I Move the C-arm to 45º RAO and 15º Caudal Store position in Programmed Position #1 24 Turnover Workbook | Artis Pheno 2. Session Two: System Operation Notes Please refer to manual for complete system capability. 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 2.1 Home screen in the control room After start-up of the system or after a configurable time when no action has been performed, the Home screen is displayed in the control room. SIEMENS » SABES PACS Home screen in the control room On the Home screen, you can start the following tasks: • Continue Exam Set: Continue the examination • Emergency Patient: Open the Emergency Registration and register an emergency patient • Register Patient: Open the Patient Registration and register a new patient • Schedule Patient: Open the Patient Browser Scheduler • Browse Data: Open the Patient Browser Local Database and load patient data • Import Data: Open the Patient Search and search for a patient in the net work • Search PACS: Open the Patient Search and search for a patient in the PACS Additionally, you can perform the following actions: • Settings: Open the Configuration Panel and change settings • Help: Browse the online help • Shut down: Log-off user, shutdown or restart the system 25 Turnover Workbook | Artis Pheno 2.2 Registering a Patient Using the Scheduler Notes 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 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 Patient Registration window Patient Registration PROCEDURE PATIENT Last name Accession No First name Request D Middle name Requested Tite Sutfix procecure(s) Other Patient Name(s) Other Patient [(s) Study Elmis Group Study comment Miltary Rank Pationt D Date of Birth Patient position Head First- Supine Sex OMale OFamale Other Age Istitution neme Haight [nn'm"] Weight [b] 1 Performing physician Address 2 Performing physician Ackitionsl Info 1 Cperator 2. Cperator Debelle HOSPITAL Retering physician Requesting physician Admitting deonceis Word Admission [ Search Emergency Help 26 Turnover Workbook | Artis Pheno 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 Note: the exam will need to be disabled from the “Protect mode” prior to editing Click OK to save the new data Correct Moditer's Name mecaser Firstnom Paturt D 06 07 27-09:58 26-DST37999 Mitde rose Oelce Pae orts nameis) Dat orbit 1/1/1900 Stady D · Ofer Fandle PRINT Seties descapeoi CARD SUO Walight Seres date 7/200008 Comming OK Cancel Heb 27 Turnover Workbook | Artis Pheno 2.3 Examination Notes (3) Hospital 1/1/1900 ISKO20 AXIOM-Artis = (4) Dr Testautomation STUDY 1 VE10A 180601 8/3/2016 HFS 1:08:08 PM IcomNN! 3-1/5 0.00 560 -(5) Single CARE 1856 x 1858 EE 0% (6) kV 00 MA 172 D 5409 RAD 2 10 WW 2500 (7) (1) (2) (1) Image area (2) Control area (3) Patient information area (4) Task card stack (5) Display and setting of acquisition parameters (6) Quick access area (7) Status area with system messages and status icons Examination room, touchscreen on the Pilot control module: Touch Settings and select the required new patient position. Patient Position HF Supine HF Prone HF Lateral Right HF Lateral Left FF Supine FF Prone FF Lateral Right 28 Turnover Workbook | Artis Pheno Control room, Examination task card: Click the patient name on the top right-hand Notes side with the right mouse button. Select the required new patient position in the pop-up menu. The new patient position is registered. 01.05.21-11:37:51-DS. Head First - Supine Head First - Prone Head First - Left Lateral Head First - Right Lateral Feet First - Supine Feet First - Prone Feet First - Left Lateral Feet First - Right Lateral Stand and Table 2.3.1 Exam set and acquisition protocol Acquisition and fluoroscopy/roadmap protocols are arranged in exam sets. An exam set comprises: • A number of acquisition protocols possibly 1 alternative acquisition protocol • 3 fluoroscopy protocols possibly 3 assigned roadmap protocols Selecting the exam set Examination room, touchscreen on the Pilot control module: O Touch Examination Touch the active exam set and select the required new exam set. or – – Control room, Examination task card: Select the DSA Special required exam set. or – – Click this icon in order to select the exam set and the acquisition protocol in the Exam Set and X-Ray Protocol Editor. 29 Turnover Workbook | Artis Pheno Selecting the acquisition protocol Notes Examination room, touchscreen on the Pilot control module: Touch Examination > Protocol and select the required acquisition protocol. or – – Control room, Examination task card: Select the required acquisition protocol. DSA Fixed Overview 2.3.2 Changing fluoroscopy/roadmap and acquisition parameters Examination room, touchscreen on the Pilot control module: Touch Examination and select the required parameter. Examination Ò Fluoro LOW Pulse Rate 5,0 p/s Protocol Coro Frame Rate 60 f/s Series LCA Measure Field Scene Length or – – Control room, Examination task card: Select the required parameter from the selection lists. Further parameters which are not displayed can be changed in the Exam Set and X-Ray Protocol Editor. 30 Turnover Workbook | Artis Pheno 2.3.3 Acquisition parameters Notes On the Examination task card in the control area below the exam set, you can read and change the following information about the acquisition protocol. Display Explanation Display of grid status inserted/removed DSA Special v Display and selection of exam set. Acquisition protocol If the selected exam set offers an alternative acquisition protocol, an additional icon is shown. (+ Page 219 Alternative acquisition) Overview Acquisition protocol KV 81.6 Tube voltage* for acquisition in kV MA 638.3 Tube current* for acquisition in mA Measure Field@ Measuring field (dominant)* (> Page 208 Meas- uring field) ms 16.0 Pulse width* for acquisition in ms Focus Focus size* (micro/small/large) Time 20 5 Scene length or Dyna Time in seconds [s] Cu mm 0.0 Copper filter for acquisition in mm f/s 15 f/s v Frame rate in frames per second [fis] Angulation 7.5ª/F Angulation step [º/F], if a 3D acquisition protocol is selected 2.3.4 Fluoroscopy/roadmap parameters You can read or change the following data for the fluoroscopy protocol below the data for the acquisition protocol: Display Explanation Elapsed fluoroscopy time E A 00:00:02 (+ Page 215 Fluoro timer) Fluoro Angio v Fluoroscopy protocol kv 65.0 Tube voltage* for fluoroscopy in kV mA 129.1 Tube current* for fluoroscopy in mA ms 16.4 Pulse width* for fluoroscopy in ms Cu mm 0.0 Copper filter* for fluoroscopy in mm p's 7.5 p/s Pulse rate in pulses per second [p/s] 31 Turnover Workbook | Artis Pheno Changing the fluoroscopy/roadmap image quality Notes Examination room, Pilot control module: Press one of these buttons to select the fluoroscopy/roadmap protocol with the next lower/higher image quality (dose). or – – Examination room, touchscreen on the Pilot control module: Touch Examination > Fluoro and select the required fluoroscopy/roadmap protocol. Fluoro 16. fluoro low 15 p/s 17. fluoro normal 15 p/s 18. fluoro high 15 p/s Example or – – Control room, Examination task card: Select the required fluoroscopy/ roadmap protocol from the selection list. E A 00:00:00 FL Angio FL - Angio 7.5 p/s FL_Angio 7.5 p/s FL + Angio 10 p/s ms 1.0 Cu mm 0.2 32 Turnover Workbook | Artis Pheno 2.4 Roadmap Notes Performing Overlay Reference You can use any “matching” ARTIS reference image for Overlay Reference to the fluoroscopic image / LIH which has been acquired in the same zoom stage and patient position, as well the same portrait/landscape position of the FD. At least one reference image has been stored. 1. Examination room, onscreen menu: Select Overlay Ref or Overlay Ref 2 in the Roadmap & Overlay menu. or – – Examination room, touchscreen on the Pilot control module: Touch Roadmap > Overlay Ref > Overlay Ref 1 or Overlay Ref 2. or – – Control room, Examination task card: Click the required icon. The display mode is changed to Overlay Reference, i.e. the overlay image is faded in the image on the Live segment. When Overlay Reference is active and a reference image has been stored, the reference image (inverted display) is superimposed on the current fluoroscopy image. You can set the reference image portion to a value between 0% and 80%. The default setting for the reference image portion is 10%. You can use the jog wheel to change the degree of Overlay Reference in the reference image for the current and subsequent fluoroscopy runs. To fade in or out the reference image: 2. Deflect the jog wheel. • Away from you: The reference image will become clearer. • Towards you: The reference image will become less clear and the fluoroscopic image will become clearer. The degree of Overlay Reference is shown in the lower right corner of the image, e.g. Overlay: 10% 33 Turnover Workbook | Artis Pheno Features and differences between Roadmap variants: Notes Classic Roadmap: • The mask and vessel phases are triggered by the fluoroscopy pedal. • The vessel map is automatically generated. • The device phase is also triggered by the fluoroscopy pedal. • There is no possibility to manually select a bolus phase from a scene as a • vessel map Starting Classic Roadmap • Footswitch (if configured, example): Press the Reset Roadmap/RDMP ON/OFF pedal of the footswitch for more than a configurable time (default 2s) or – – • Examination room, touchscreen on the Pilot control module: Touch RDMP & Overlay > Roadmap > Roadmap or DSA RDMP Ref1 or DSA RDMP Ref2. or – – • Control room, Examination task card: Click the required icon. Performing Roadmap phase 1 (native fluoroscopy) Operate the correct FLUORO pedal of the footswitch and keep it pressed. After start of fluoroscopy, a few normal fluoroscopy images are displayed. Then, the display automatically switches to subtracted images. Performing Roadmap contrast injection 1. Keep the FLUORO pedal pressed. An injection indicator is displayed on the Live segment. The message Injection is displayed. 2. Now inject contrast. In the fluoroscopy image, you can now see the vessels in subtracted display as they are filled with contrast. H 3. Release the FLUORO pedal when the area to be examined is sufficiently filled with contrast. The last image of the second phase is displayed inverted (contrast white) and serves as the mask for subsequent fluoroscopic examinations. 34 Turnover Workbook | Artis Pheno Resetting Roadmap Notes When motion artifacts arise, Roadmap can be reset (new mask): Footswitch (if configured, example): Actuate the Reset Roadmap pedal of the footswitch for less than 2 s. or – – Examination room, touchscreen on the Pilot control module: Touch RDMP & Overlay > Roadmap > Reset Roadmap. or – – Control room, Roadmap dialog: Click this 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”). Replacing the mask is only possible during Roadmap phase 1 and phase 2. Show Progress during Roadmap During Roadmap subtraction phase, but not during X-ray, the current Roadmap mask can be replaced by the LIH. Show Progress is used to enter a new device phase with a new mask image but skip generating a new vessel map. It is useful to visualize an interventional progress, e.g. during coiling or gluing. Performing Show Progress, e.g. during an Onyx injection, will improve the visualization of the progressive movement of the Onyx. Progressive Show Progress is not set in the Roadmap protocol. Examination room, touchscreen on the Pilot control module: Touch RDMP & Overlay > Roadmap > Show Progress. or – – Control room, Roadmap dialog: Click this icon. GT Anatomical background during Roadmap During Roadmap subtraction phase, anatomical background can be added to the subtraction image. In the examination room, the anatomical background can be adjusted using the jog wheel. 35 Turnover Workbook | Artis Pheno Acquisition > Set Anatomical Background is set in the main menu of the Notes Examination task card on the console. 1. Examination room, touchscreen on the Pilot control module: Touch RDMP & Overlay > Roadmap > Anatomical Background. or – – Examination room, Onscreen menu (if configured): Select Anatomical Background in the DSA menu. or – – Control room, PostProc task card, DSA subtask card: Click this % icon. Anatomical Backgr ... ? X 100% 10 % 10% 0% Close Help To adjust the anatomical background: 2. Examination room, TSC: Deflect the jog wheel. • Away from you/towards you: Change anatomical background • Left/right: Scrolling or – – Control room, Anatomical Background dialog: Click and drag the slider. Vessel/catheter contrast during Roadmap During Roadmap subtraction phase, 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 protocol 36 Turnover Workbook | Artis Pheno Notes Acquisition > Set Vessel / Catheter Contrast is set in the main menu of the Examination task card on the console 1. Examination room, touchscreen on the Pilot control module: Touch RDMP & Overlay > Roadmap > VC/CC Contrast. or – – Control room, PostProc task card: Select Image > Change Vessel / Catheter Contrast in the main menu Vessel / Catheter Contrast Vessel Contrast [%] 50 Catheter Contrast [%] 50 Apply OK Cancel To change the vessel/catheter contrast: 2. Examination room, TSC: Deflect the jog wheel. • Away from you/towards you: Change vessel contrast • Left/right: Change catheter contrast or – – Control room, Vessel / Catheter Contrast dialog: Click an up/down arrow to adjust a value. Click Apply or OK. 2.4.1 DSA Roadmap (CLEARmap): DSA • The vessel phase is created by the DSA reference image (which is triggered by the acquisition pedal). • The device phase is triggered by the fluoroscopy pedal. • It is possible to manually select an image from a scene as a vessel map (via manual frame selection), e.g. to focus on a bolus phase like early arterial filling or late venous drainage. • When the DSA acquisition protocol is configured for maximum opacification,the reference image is generated automatically. • Phase 1 DSA Roadmap is performed with a subtracted reference image from a previously acquired DSA scene. It is also possible to use either a LIH or OPAC image from an entire DSA scene which was acquired before DSA Roadmap was activated. 37 Turnover Workbook | Artis Pheno • After you have selected a Roadmap protocol, started DSA Roadmap, and Notes pressed the fluoroscopy pedal, Roadmap starts with phase 1a. The fluoroscopy images are displayed natively. • Phase 3 While you are still pressing the fluoroscopy pedal, the system goes directly from phase 1 to phase 3. Switch-over to subtracted display will happen automatically. Images are displayed subtracted. The mask image is the reference image. The phase 3 will be restarted with each new release of fluoroscopy. Additional Roadmap: • The mask and vessel map phases are initiated with the fluoroscopy pedal but use an acquisition protocol with acquisition dose. Therefore the scenes are stored with the study. • It is configured by the assignment of an alternative acquisition protocol. • It is more flexible in terms of dose increase in vessel phase but at the cost of additional time for a phase 3 when entering device phase for the first time. Phase 1 - After you have selected an Additional Roadmap protocol, and pressed the fluoro foot switch, Roadmap starts with phase 1a. Images are displayed natively. Switch-over to subtracted display will happen automatically. Phase 2 - The phase 2 serves to make a Roadmap image of the contrast filled vessels. Images are displayed subtracted. After X-ray stop in this phase, the Live segment shows a LIH. If maximum opacification is enabled within the Roadmap protocol, it is effective in this phase. Otherwise, the LIH is 2 displayed. Phase 3 - The phase 3 is started with renewed release of fluoroscopy. Images are displayed natively. Switch-over to subtracted display will happen automatically. 3 Phase 4 - While the fluoro foot switch is still being pressed, the phase 4 starts automatically. Images are displayed subtracted. The mask image is the vessel mask. The phase 4 will be restarted with each new release of fluoroscopy 38 Turnover Workbook | Artis Pheno 2.5 Image Postprocessing Notes The PostProc task card You can perform postprocessing at the system console in the control room. Selected functions for image viewing and processing are also available in the examination room. 13.10.21-12:49:33-DST AX R.D TC KO158 (3) 13.10 21-12:49 33-DST-81994 * 1/1/1900 ISKO24A AXIOM-Artis VA10A 131015 STUDY 1 HFS 10/21/2013 12:50:07 PM (4) 39/282 PrimiProc (5) FL(,) CTO 1560 x 1424 (6) cm 39 A KV 49 MA 14 D9 WC 2037 0 /0 WW 2700 (7) (1) (2) (1) Image area (2) Control area (3) Patient information area (4) Review controls (5) Subtask cards (6) Quick access area (7) Status area with system messages and status Active patients Examination Patient Review Patient • The patient control area shows two folder icons and patient names. The folder marked with the C-arm symbol indicates the current examination patient. • The second folder indicates the postprocessing patient who may differ from the examination patient. Image data of the postprocessing patient can be viewed and processed in the control room in parallel to a ongoing examination in the examination room. The opened folder icon indicates the patient, whose images are shown in the image area. If no patient is selected, the folder icon appears closed and the image area is dark. You can select the postprocessing patient by clicking a folder icon. 39 Turnover Workbook | Artis Pheno 2.6 Managing and viewing scenes/images Notes The following viewing functions can be used for optimized display of scenes: Function Description Scene Directory (> Page 262 The scene directory of a patient) Scene Content selection (> Page 260 Limiting display to Scene scenes/images/reference images) Ref. Image Store Monitor + Ref. Image + Store Monitor SM + Ref. Image 144 Scene - / Scene + (> Page 263 Selecting scenes/(ref- erence) images) 11 > ID ( Page 269 Single step) DR 10 [/S STOP Review controls (> Page 265 Controlling scene review (Loop)) Scene Overview (> Page 265 Scene overview) Function Description Full-screen (+ Page 265 Scene overview) View > Review Mode (- Page 267 Default review mode) Loop All Scenes (- Page 270 Loop through all Scenes) Image > Max. Fill (- Page 270 Replacing the maximum fill image) Override Shutter (+Page 273 Setting an electronic shutter) Invert Gray Scale (+ Page 274 Inverting grayscale values) Zoom 2x (+ Page 276 Zooming/panning) Zoom to Acquisition Size (- Page 276 Zooming/ panning) Pan (Automatically activated with zoom.) R Flip Horizontally (- Page 272 Image flip/mirror) Flip Vertically (+Page 272 Image flip/mirror) RA CLEARstent (-Page 223 CLEARstent reference image) Opacification (->Page 310 Generating the image with maximum contrast medium filling) iFlow (- Page 312 syngo iFlow) 40 Turnover Workbook | Artis Pheno Notes Function Description Pointer ( Page 277 Using pointers) Hide annotations (-> Page 297 Switching text/ graphics display off/on) View > Image Text ( Page 285 Switching image text on/off) View > Scene Timer ( Page 285 Switching scene time display on/off) View > ECG Display ( Page 285 Switching ECG display on/off) 2.7 Processing scenes/images Function Description Image display and image processing: Adjust subtask card 2100 Windowing: Adapt the digitally stored grayscale val- ues to the visual acuity of the human eye. (Set 2250 'brightness" and "contrast") (> Page 289 Setting window values) Auto Window (> Page 290 Assigning automatic window values) auto Window Home (+ Page 289 Setting window val- ues) 1 21 Edge Enhancement: Emphasize details (+ Page 291 Edge enhancement filter) Edge Enhancement Home (> Page 291 Edge enhancement filter) Annotations and graphics: Tools subtask card Annotation: Enter predefined or new text in the image (> Page 295 Annotating images with texts) Circle (+ Page 297 Drawing circles) Line (+ Page 298 Drawing lines or arrows) 41 Turnover Workbook | Artis Pheno Notes Function Description Arrow (=> Page 298 Drawing lines or arrows) 5 Polygon (> Page 298 Drawing polygons) Pointer (> Page 277 Using pointers) Measurements: Tools subtask card Distance (> Page 737 Drawing and measuring dis- tances) Polyline Curve/Curved Distance Measurement (+ Page 737 Drawing and measuring distances) Angle (+ Page 740 Drawing and measuring angles) Miscellaneous: Hide Annotations and Measurements (> Page 297 Switching text/graphics display off/on) Del key Delete Selected Annotation and Measurements (+ Page 292 Selecting and modifying graphical ele- ments) 42 Turnover Workbook | Artis Pheno 2.8 Text and graphics Notes The tools for annotating images with text and graphics can be found on the Tools subtask card. (2) Adjust Calibr. Tools View Image| DSA (1) (3) (10) (4) (6) ( 5) (9) (8) (7) (1) Annotations (2) Circles (3) Polygons (4) Lines (5) Arrows (6) Electronic shutter (7) Angles (8) Distances (9) A pointer is available for temporary marking of image details. (10) Hide/show text and graphics 43 Turnover Workbook | Artis Pheno 2.9 DSA postprocessing Notes DSA postprocessing functions can be used for optimized display of subtracted scenes. On the DSA and on the Image subtask cards, you will find the tools. View Image DSA View Image DSA R R M opac elopac .............. Function Description Move mask (- Page 302 Moving the mask) Replace mask (- Page 303 Replacing the mask) NativelSubtracted (+ Page 303 Switching over between subtracted and unsubtracted display) Anatomical Background (- Page 304 Anatomical background) Image > Change Ves- Vessel/Catheter Contrast (- Page 305 Vessel/cath- sel / Catheter Con- eter contrast) trast Pixelshift (- Page 306 Making the image and mask coincide exactly (Pixelshift)) Opacification (- Page 310 Generating the image with maximum contrast medium filling) iFlow (- Page 312 syngo iFlow) = Averaging (- Page 321 Improving the noise sup- pression of a scene (averaging)) MI General functions: Invert Gray Scale (- Page 274 Inverting grayscale volues) Zoom 2x (+ Page 276 Zooming/panning) Zoom to Acquisition Size (+ Page 276 Zooming) panning) 44 Turnover Workbook | Artis Pheno 2.10 Archiving/sending Notes Click this icon. or – – Click this icon in the Patient Browser. or – – Select Transfer > Send To... or Transfer > Archive To... in the main menu. A dialog box is displayed with the available target addresses in the network. 2.6.1 Exporting scenes/images as video or bitmaps If you want to use or process images in other applications, you can export them in a common format to a directory of the hard disk or on USB memory. The following image formats are supported: • AVI format (*.avi) Various video compression codecs are supported. • Windows Bitmap (*.bmp) • JPEG format (*.jpg) USB memory To export images/videos on your USB memory: 1. Plug a USB memory stick into the USB port. 2. Wait a moment (until the LED on the drive stops blinking). Exporting scenes/images üThe Local Job Status does not contain any jobs. üThe local media destination is configured by Service. üA media is inserted into the drive. 1. Display the scene to be exported as required (windowing....) in the PostProc task card. or – – Select a scene from the scene directory. or – – Select an image from the image directory. 2. Select Image > Export Image As... in the main menu of the PostProc task card. The Export Image As window appears. 45 Turnover Workbook | Artis Pheno System operations Notes Storing images as Store Monitor You can store any image currently displayed, even during fluoroscopy, as a new “acquisition” (Store Monitor). 1. Stop the scene loop by clicking the image with the mouse. 2. Examination room, Pilot control module: Press this key. or – – Examination room, Onscreen menu (if configured): Select Store Monitor in the General or Native/DSA menu. or – – SM Control room, Examination task card: Click this icon. The image is stored as “Store Monitor” on series or image level. Storing a fluoroscopic scene You can store the last fluoroscopy or roadmap scene. Examination room, Pilot control module (if configured): Press this key. or – – Examination room, Onscreen menu (if configured): Select Store Fluoro in the General or Native/DSA menu. or – – Control room, Examination task card: Click this icon. Reference image You can store any image which has been acquired on an ARTIS system and is being currently displayed (acquisition or fluoroscopic image, even during fluoroscopy) as a reference image. 46 Turnover Workbook | Artis Pheno Storing an image as a reference image Notes 1. Stop the scene loop. REF 2. Examination room, Pilot control module: Press this key. or – – 3. Examination room, Onscreen menu (if configured): Select Store as Reference... > Store Ref1 in the General or Native/DSA menu. or – – REF 4. Control room, Examination task card: Click this icon. The image is stored as the new reference image. The newly created reference image is displayed on the active reference segment. 2.11 Session Two Exercises Complete the following exercises. Exercise 1: Hands-on Register a patient. Exercise 2: Hands-on 1. Perform a mock patient study. 2. Position the C-arm 3. Select the acquisition program/example DSA 1F/s or Coro 15F/s 4. Fluoro 5. Modify fluoro selection 6. Acquisition 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 (USB) 47 Turnover Workbook | Artis Pheno 3. Session Three: Quantification and Special Examinations Notes Please refer to manual for complete system capability. Objectives After this session, you will be able to: • Perform LVA/QCA/QVA/Distance Measurement • QVA3D (Optional) • Complete workflow (DR and DSA) • Complete Perivision workflow (Peristepping) This day is reserved for patient procedures and hands-on training including: • Left Ventricle Analysis, 2D Coronary Analysis, 2D Vessel Analysis • Distance Measurement • Console & Touch2Move Measurement workflow • Perivision and Peristepping workflow The Quant task card in the control room 13.10.21-12:37:22-DST AX R-D TC KO15B Exameallin Pacen 3 13.10.21-12:37:22-DST-81994 · 1/1/1900 ISKO24A AXIOM-Artis O VA10A 131015 STUDY 1 HFS 12. 38.02 PM Icom///ll (4) 2 - 58/76 4.06 sec Jueno R (5) Coro CTO-SF 1560 x 1424 Auto Cal EE 16% 6) cm 39 DDO 50% A kV 51 mA 14 D 169 WC 1900 Select calibration or analysis method WW 2300 (7) (1) (2) 48 Turnover Workbook | Artis Pheno Notes 3.1 Calilbration Methods 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 the 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 -1- 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. 49 Turnover Workbook | Artis Pheno Sphere Calibration Notes 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-or 3D), auto ISO and auto TOD calibrations are not possible. 3.2 Performing a Calibration When you start measuring on a non-calibrated image, the system automatically suggests a calibration method depending on the image angle. 3.2.1 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. 50 Turnover Workbook | Artis Pheno Notes 3.2.2 Selecting a Calibration Method or Recalibrating Console Calibrato View • You will find the tools for calibrating the images on the Calibrate subtask card on the Quant task card and in auto aulo the Options menu. • Activate the Quant task card, if necessary. • Click the Calibrate subtask card into the foreground On-screen Menu Artis zee peripheral, MP relf.7.12 40759649 11/9/1938 4/4/2012 2:00:07 PM HES 6 - 14/29 Review M 6 6.72 sec Display Scene Native Store Ref2 . Store Monitor Store Fluoro Adjust Ref to C-Arm ... D' Auto Pixelshift Distance Measurement auto Anatomical Background Polyline Measurement ). Opacification Angle Measurement /\ Edge Enhancement Delete Graphics RIA Image Flip ... Hide Graphics Measurement ... Auto TOD Calibration auto DSA Var 2/1/0.5 EE 7% Auto Cal. TOD 15 C 8-3375 y 0.0/0.0 WB 3100 17.10.19-07:48:57-DST - Navigate DSA XCARE (2 Simple, (@ FL(-) Vase (4.0 pts) 9:19 AM 2 . 000.1 min Pediste manually disabled . Deselect Block Note: Pay attention to the messages at the bottom of the image. They include notes for further operational steps. 51 Turnover Workbook | Artis Pheno 3.2.3 Automatic Isocenter Calibration Notes Console If the organ to be examined was in the isocenter during acquisition, you can use automatic calibration. • Click this icon. The system calculates the calibration factor on – the basis of the image geometry. The calculated calibration factor is displayed. – auto • Confirm by clicking on OK. Auto Isocurdes Cal bration Calibreti on Factor immPool] 0 1084 OK Help On-Screen Menu 4073382 Peripheral, MP rell.7-12 9179/1998 8 9.4/29 HES Workhow Review 8.72 sec Display Scene Native Store Ref2 Store Monitor Store Fluoro Adjust Ref to C-Arm ... D Auto Pixelshift Distance Measurement auto Anatomical Background Polyline Measurement ). Opacification Angle Measurement /1 Edge Enhancement Delete Graphics RIA Image Flip ... Hide Graphics Measurement ... Auto TOD Calibration auto DSA Var 2/1/0.5 EE 7% Auto Cal. TOD 15 cm cm 48 A D 3275 y 0.0/0 6 0º /0º 17.10.19-07:48:57-DST (6) FL(G) Vase (4.0 pt5) 9:19 AM $ Navigate <3 000.1 min 00 130 cm E A XRAY manually disabled - Deselect Block Automatic calibration is performed immediately and displayed. 52 Turnover Workbook | Artis Pheno 3.2.4 Calibration Using the Table-Object Distance (TOD) Notes Console If the organ to be examined is at a defined distance from the tabletop, you can use TOD calibration. --- • Click this icon. The system calculates the calibration factor on the basis of the – auto 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. Confirm by clicking on OK. Enter Table Object Distance 2 Default TOD: 15 cm Change TOD: 15 cm Calibration Factor [mm/Pixel] 0.1223 Deviation of 1cm at 30 degrees will result in an error of approximately 1.7% OK Help On-Screen Menu Artis zee peripheral, MP relf.7.12 40759649 nikum Am Urban AXIS05085 Artis zee peripheral, MP relf.7.12 11/9/1938 Dr.Barakat 40759649 Vivantes Klinikum Am Urban * 11/9/1938 AXIS05085 4/4/2012 VC14H 100914 Dr. Barakat 2:00:07 PM HFS 4/4/2012 VC 14H 100914 6 - 14/29 R//////H 2:00:07 PM HFS M 6 6 - 14/29 R//////H 6.72 sec M 6 6.72 sec TOD Calibration Current TOD: 15 cm Default TOD: 15 cm DSA Var 2/1/0.5 EE 7% DSA Var 2/1/0.5 EE 7% Auto Cal. TOD 15 cm Auto Cal. TOD 15 cm cm 48 AB 0% cm 48 A A Wy 0.0/0.8 WB 3100 D 3275 x/y 0.0/0.0 D 3275 0º /0º WB 3100 WC 50 Select calibration or analysis method Artis zee peripheral MP relf.7.12 ( FL.(e) Vase (4.0 pts) 9:40 AM @ 000.1 min 8.08 130cm Radiador manually disabled - Deselect Block • Enter the table-object distance using the numeric buttons. Note: TOD calibration is not suitable for image angle 50°-130°! 53 Turnover Workbook | Artis Pheno 3.2.5 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 Last Accepted Cal Factor [mm/Pixel] 0.2694 15.0 35.0 50.0 mm mm mm 50 OK Cancel Help On-Screen Menu Can only change auto ISO and auto TOD from the On Screen Menu. 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. 54 Turnover Workbook | Artis Pheno 3.2.6 Catheter Calibration Notes 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). • Then click on the arrows to correct the value until you reach the exact value or - - • Select the approximate French value by clicking on a button. Catheter Calibration Last Accepted Cell Factor • Press OK to accept. [mm/Picci] 1.0000 5.5 F 5.0 F 6.5 F 7.0 F 7.5 F 8.0 F 4.5F 5.0 F 4.5 F 10.0 F DE Cancel Help 55 Turnover Workbook | Artis Pheno 3.2.6 Sphere Calibration Notes 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. mn or - - 50.000 • Click on the arrows to correct the value until you reach the exact value desired. Sphere Calibration • Press OK to accept Sphere Calibration. Last Accepled Cal Factor 45.0 SILU 55.0 OK Concel Help 3.2.7 Calibration with a Calibration Factor 56 Turnover Workbook | Artis Pheno Console (only) Notes • Click this icon. The previous calibration factor—if there is one—is displayed. Manual Calibration Last Araapiedi Call Faranr [mm/Pixel] 1.0100 Manual pixel size OK Cancell Help • Enter the exact value in the field or use the arrows. 3.2.8 Distance Measurement Console and On-Screen Menu 40759649 11/9/1938 Workflow 4/4/2012 General DSA 2:00:07 PM HES 6 - 14/29 Review R//////H M 6 6.72 sec LP Display Scene Native R_ Store Ref2 Store Monitor Store Fluoro Adjust Ref to C-Arm ... D Auto Pixelshift Distance Measurement auto Anatomical Background C Polyline Measurement ). Opacification Angle Measurement /1 Edge Enhancement Delete Graphics RIA Image Flip ... Hide Graphics Measurement ... Auto TOD Calibration DSA Var 2/1/0.5 EE 7% Auto Cal. TOD 15 cm cm 48 D 3275 0º / 0º 18 3100 17.10.19-07:48:57-DST single class (Single) <@ FL(-) Vase (4.0 pts) 9:19 AM @ 009,1 min Navigate 130 A XRAY manualy disabled - Deselect Block • A suitable image is loaded and displayed in full screen. • The image has been calibrated. ************* ********. • Click this icon 57 Turnover Workbook | Artis Pheno • Click on the image to mark the first point and drag the mouse to the second Notes 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 • 2 0 stance: 32.10 mm Click on one of the two end points of the distance line, keep the mouse button pressed, and drag the line to enlarge or decrease it. The distance is \1 Distance: 50:20 mm updated as soon as you move the mouse pointer Performing LVA 3.3 Quantification 3.3.1 Performing LVA 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. Calibrato View Note: In the case of a single plane scene, and for a full set of analysis results,the scene has been calibrated. I • After you have calibrated the image, select the analysis method on the Analyze subtask card. 58 Turnover Workbook | Artis Pheno • Select a suitable ED frame. Notes Left Ventricle An ... ?? Analyze Info Corr ED ES ED auto X OK Help • Click this icon when you find a suitable ED frame. • Perform contour detection in the ED image (define three points- ED 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). 59 Turnover Workbook | Artis Pheno • Create and store the report. Notes 3.3.3 ED/ES 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 Len Venancio Analysis 7| 3 On the Info subtask card, you can define the heart rate Com and comment on the analysis. You can: Sturdy Name 1. Select or enter a research Study Name 2. Enter Free Text Heart Rate [on] 3. Change the review heart rate. (Gives a cardiac output with this added information) Cincel 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). 60 Turnover Workbook | Artis Pheno Console Notes • Click this icon. Touch screen • Press this icon 3.3.4 QCA/QVA Analyze Adjust Tools Both QCA (Quantitative Coronary Analysis) and QVA (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 being the 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. 61 Turnover Workbook | Artis Pheno Notes Analyze Adjust| Tools • After you have calibrated the image, select the analysis method on the Analyze subtask card. QCA QVA Coronary Analysis ? X /ascular Analysis ? X Analyze Info Corr Analyze Info Corr auto auto X X 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). 62 Turnover Workbook | Artis Pheno Notes • 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. • 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. • 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. 63 Turnover Workbook | Artis Pheno On-screen Menu Notes Artis zee peripheral, MP relf.7.12 40759649 11/9/1938 im Am Urban AXIS05085 4/4/2012 Dr.Barakat 2:00:07 PM `14H 100914 6 - 13/29 QVA HFS M 6 R//////H 6.21 sec DSA Var 2/1/0.5 EE 7% DSA Var 2/1/0.5 EE 7% Auto Cal. TOD 15 Auto Cal. TOD 15 cm cm 48 AB 0% AB 0% A D 3275 x/y 0.0/0.0 x/y 0.0/0.0 WB 3100 WB 3100 0º /0º WC 50 Select calibration or analysis method WC 50 Artis zee peripheral MP relf.7.12 9:24 AM * Navigate A XRAY manually disabled - Deselect Block DE DSA XCARE (2.0 f/s) FL(-) Vasc (4.0 p/s) @ 000.0 min Single classic (Single) • 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 a single click. • Define the distal end point with a double left click (using the jogwheel) or right click. • 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. 64 Turnover Workbook | Artis Pheno Quant Notes Artis zee peripheral, MP relf.7.12 40759649 Am Urban AXIS05085 Artis zee peripheral, MP relf.7.12 Vivantes Klinikum Am Urban * 11/9/1938 Dr.Barakat 40759649 AXIS05085 4/4/2012 14H 100914 * 11/9/1938 Dr.Barakat 2:00:07 PM HFS VC14H 100914 R//////H 4/4/2012 2:00:07 PM HFS 8,12 sec 6 - 14/29 R//////H M 6 6.72 sec DSA Var 2/1/0.5 EE 7% DSA Var 2/1/0.5 EE 7% Auto Cal. TOD 15 cm Auto Cal. TOD 15 cm cm 48 AB 0% cm 48 x/y 0.0/0.0 A D 3275 0º / 0º WB 3100 WC 50 CF 0.2623 mm/pix Click along vessel. Double-click to calculate Aras Zee peripheral PSA XCARE (2.0 115) to FL(e) Vast (4.0 pt5) 9:41 AM @ 000.1 m CAUD Move Cursor end of Main Branch A XRAY manually disabled - Deselect Block Artis zee peripheral, MP relf.7.12 40759649 Vvantes Klinikum Am Urban * 11/9/1938 AXIS05085 Artis zee peripheral, MP relf.7.12 40759649 4/4/2012 VC14H 100914 * 11/9/1938 2:00:07 PM 4/4/2012 6 - 14/29 2:00:07 PM M6 6 - 14/29 M 6 6.72 sec DSA Var 2/1/0.5 EE 7% DSA Var 2/1/0.5 EE 7% Preliminary Results Auto Cal. TOD 15 cm MLD 2.97 mm 5 cm 48 AB 0% Ref D. 3.62 mm /y 0.0/0.0 % MLD % MLA 18 % 33 % D 3275 WB 3100 WB 3100 Length 4.64 mm 0º /0º CE 0.2623 mm/pix< Edit contour, select analysis, or create report Artis zee peripheral MP relf.7.12 @ FL(G) Vase (4.0 pt5) 9:42 AM 1 9 000.1 min More Cursor A XRAY manually disabled - Deselect "Block Radiation • If the detected contour of the arterial segment is not satisfactory, you can make manual corrections. (see next section) 65 Turnover Workbook | Artis Pheno • If satisfactory, create and store a report of the analysis results. Notes 3.3.5 Contour Corrections Console and On-screen Menu • 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 jogwheel). • • In the control room, the Coronary Analysis or Vascular Analysis window switches to the Correction subtask card. Coronary Analysis Vascular Analysis 7 X Analyze Into 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. 66 Turnover Workbook | Artis Pheno Notes V 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 67 Turnover Workbook | Artis Pheno 3.4 Special Examinations Notes Overview Rotational angiography can be performed without or with digital image subtraction: 3.4.1 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 / 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 is stopped, the acquisition program is deselected by this, and the acquisition cannot be continued. 68 Turnover Workbook | Artis Pheno Patient movements Notes 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) is determined before acquisition during the test phase. It is immaterial for performing rotational angiography whether the start position is in RAO or LAO. System positions for 3D acquisition 3D examinations can be performed only in the calibrated system positions. The C-arm can be the Head Side, Left Side, Right Side positions, and the Table Rotated positions. Predetermined longitudinal positions are supported. 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 of 0 seconds. 69 Turnover Workbook | Artis Pheno 3.4.2 Peripheral Angiography 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 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. System positions PERISTEPPING and PERIVISION can only be carried out in the following system positions: 1. In Artis Pheno, 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. Table tilt In most systems: The patient table must be in the horizontal position for peripheral examinations. 70 Turnover Workbook | Artis Pheno Running direction Notes 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: Feet - Head 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 / 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 / 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 possible. Storing and loading 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. 71 Turnover Workbook | Artis Pheno Documentation Notes The scenes can be documented in the following ways: • Each position individually after image reconstruction using the 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. 72 Turnover Workbook | Artis Pheno 3.4.3 Peri Stepping Notes Peri Stepping Examination Sequence (2) (2) (4) (3) (8) (6) 7 (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 Example for Peri Stepping examination sequence head to feet. 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. 73 Turnover Workbook | Artis Pheno 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. • 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. • 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 G 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 button of the hand switch briefly. (The return phase is radiation-free.) • Perform the PERISTEPPING acquisition 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 is complete. • View the PERISTEPPING series.  74 Turnover Workbook | Artis Pheno 3.4.4 Perivision Notes Perivision Examination Sequence do (2) 10) Da (7) (8) 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. 75 Turnover Workbook | Artis Pheno Perivision Workflow Notes A PERIVISION acquisition is performed in the following sequence: • • 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. • 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.s. • 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 is complete. - kok- • View the PERIvision series. 76 Turnover Workbook | Artis Pheno 3.5 Quantification and Special Examinations Notes 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 and QCA (if applicable) 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 (if applicable) 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 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 DCT Study 1. Position the C-arm 2. Position the patient 3. Set up the acquisition steps 4. Perform acquisition 77 Turnover Workbook | Artis Pheno 4. Session Four – Checklists Notes CleanGuide This CleanGuide is a non-binding recommendation developed by Siemens Healthineers on how to clean and disinfect ARTIS pheno®, Intermediate disinfection Preparation steps General Instructions · While cleaning and disinfecting, Drive ARTIS pheno® into wear gloves with chemical "cleaning position" resistance. Always work from top to bottom and from clean to dirty areas. Remove drapes from C-arm, patient table, and control modules After removing blood, discard the wet wipe or mop. Use a new one to continue cleaning. Start of disinfection . Use mops and wipes only as long C-arm: wipe from detector to tube as they leave a closed liquid film on the surface. Patient mattress: wipe from head-end to foot-end Dispose of used mops and wipes Control modules: according the instructions of your . Joysticks, buttons, surfaces facility. Give attention to the gaps between Upper- and lower-body radiation protection Positioning aids and any other accessories used Handles of the monitors Operating light: handles, illuminated area and outer surface up to the first angle Footswitch If necessary: bases of the patient table and trolley Terminal disinfection Continue disinfection Mattress: all sides k Monitor: all sides, remove any residues Patient table surface - I surfaces of the ARTIS pheno beyond the C-arm: wipe toward the base Use pre-soaked mops to disinfect the floor General Instructions The surfaces in the examination room must be completely dry End of disinfection before entering. Please refer to manual for complete system capability. This day is reserved for: • Review of Checklists • Review of Education Website - https://pep.siemens-info.com • Practice call to Siemens Customer Care Center 1-800-888-SIEM (7436). • Question and Answer 78 5. Abbreviations/Glossary 2D Two-dimensional, e.g. projection images 2D projection images 2-dimensional projection images created by a rotational acquisition, in particular by a 3D acquisition on an ARTIS system. 3D Three-dimensional, e.g. volume data 3D acquisition Rotational acquisition on an ARTIS system to create 2D projection images for 3D reconstruction which result in 3D volume data. 3D reconstruction Process for calculation of 3D volume data from 2D projection images. 3D Wizard For all parts of the body, the 3D Wizard provides a set of example images. When selected, the system loads the corresponding program and provides recommendations for injection parameters. 4D Four-dimensional, i.e. the three-dimensional information in space is shown as function of time, e.g. a three-dimensional cardiac volume is shown in 8 cardiac phases. µGy Microgray (1 µGy = 1/1,000,000 Gy), unit for measuring radiation dose Additional Roadmap Protocol The Additional Roadmap Protocol uses a special Roadmap technique with acquisition dose for improved image quality. The vessel mask with acquisition dose will be subtracted from subtracted live fluoro images, showing the catheter/guidewire. Angio Angiography, examinations of vessels ARTIS Product name of the angiography systems from Siemens ARTIS pheno Multi-axis angiography system Atrial, Atrium Anatomical: related to one of the two upper chambers of the heart (atria) Atrial fibrillation Cardiac arrhythmia related to the left atrium ATS Automatic Transfer Switch, device which switches power automatically to a generator or other standby power source after a power interruption. 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 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. 79 Bull's Eye View Viewing direction along the needle path during syngo Needle Guidance. 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) without LIH without the imaging system, is possible. It is not possible to release acquisitions. Card (Sub)task card. Elements of the syngo user interface are arranged in stacks of cards. CARD Cardiography, examinations of the heart CARE The CARE package (Combined Applications to Reduce Exposure) comprises features for dose reduction. A complete set of CARE features can be found on your system, consisting of: ◾ CAREmatic - Automatic exposure control ◾ CAREvision - Extended pulsed fluoroscopy ◾ CAREfilter - Automatic copper filter selection ◾ CAREprofile - Collimation without radiation ◾ CAREposition - Positioning without radiation ◾ CAREwatch - Display of Dose Area Product ◾ CAREmonitor - Display of skin entrance dose of the currently radiated patient skin area ◾ CAREguard - Dose alert ◾ CAREreport - Detailed dose information for reports ◾ Low-dose acquisition provides good image quality with a dose reduction in comparison to normal acquisition protocols. ◾ Low-dose fluoroscopy: The reduction “from Fluoro to Fluoro” results in a dose saving. ◾ Low-dose syngo DynaCT provides 3D acquisition during the treatment of very radiosensitive patients such as children. 3D imaging results can be achieved at only 0.3 mSv (neuro) based on Alderson phantom. CARTO system The CARTO system is an electro-anatomic mapping system that uses electromagnetic fields to locate the position and orientation of the tip of a suitably equipped mapping catheter. The CARTO system is used during electrophysiology procedures to diagnose, plan, and treat arrhythmias. CAUD Caudal direction of motion of the image receptor (footwards) CCM Collimator Control Module, console for setting the primary collimator Centerline Line, showing the approximate center of the vessel cross section. CF Calibration factor Classic Roadmap Classic Roadmap is performed in 3 phases. At the beginning of Roadmap, fluoroscopy is performed. An averaged fluoroscopy image is set as the mask (phase 1). 80 An injection is performed at the beginning of phase 2. In phase 3, the mask is subtraced from the fluoroscopy image with contrast medium. CLEARchoice Allows users to customize the image quality to their preferences. CLEARcontrol Histogram analysis provides a more homogeneous image impression by harmonizing over- and underexposed areas of the image. This is done fully automatically, thus eliminating any further manual user corrections through windowing. CLEARmap With CLEARmap (DSA Roadmap), either a reference image from a previous DSA scene or the automatically generated maximum opacification image of a DSA scene can be used as the mask. CLEARmap enables enhanced image quality for Roadmap, while saving dose and contrast. It allows zooming and panning during Roadmap and using pre- acquired DSA images for Roadmap. CLEARmatch Automatic pixel shift processing during Roadmap and DSA based on real time movement detection for most accurate subtracted image display. CLEARmotion Detection of fine structures, such as small vessels and guidewires, and suppresion of motion artifacts during fluoroscopy. Automatically detect fine structures and compensates for motion artifacts. CLEARpulse Optimize the X-ray pulse in two ways: ◾ The high pulse power allows for additional filtration to reduce radiation. ◾ Shorter pulse length allows to clearly visualize moving vessels and objects like coronary arteries. 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. CLEARstent Live Acquire a CLEARstent Live scene, which provides a stabilized view of the stent. Acquisition is performed simply using a CLEARstent Live acquisition protocol. Improves visibility of stents and balloons in real time, in relation to cardiac anatomy or previously deployed, for cardiac interventions. CLEARvessel Generate crisp visualization of the vessel edges without increasing noise. CLEARvessel enhances the contrast of the vessel to the surrounding tissue without increasing the noise as with normal edge enhancement. The result of the technology provides sharp vessel edges. CLEARview Dose-dependent filtering of the image data suppresses image noise, enabling clear, sharp images, even for low-dose acquisitions. Clip plane A clip plane is a 2D plane that cuts a 3D volume. The 3D volume on one side of the plane is not visible. A clip plane graphics can be used to change the position of the clip plane inside the 3D volume. CM Contrast medium 81 Commissure A site of union of corresponding parts, specifically, the sites of junction between adjacent cusps of the heart valves. Control scan A control scan can be performed during an interventional procedure in order to check the current position of the device and the patient, e.g. the needle during Needle Guidance. A control scan can be a Dyna3D or DynaCT acquisition. When a control scan is finished, a 3D/3D registration is automatically performed. When 3D/3D registration is confirmed, the planning volume and control scan volume are displayed merged. By this, it is possible to compare planning and the actual position. Each new control scan replaces the previous control scan. Coronary ostium Coronary ostium markers, i.e. the two openings in the aortic sinus that mark the origin of the left and right coronary arteries. COROwave Warped vessel view which shows all of the coronary arteries making up the segmented coronary tree. The centerlines are color-coded to indicate the amount of foreshortening. CPR Cardio-Pulmonary Resuscitation CRAN Cranial direction of motion of the image receptor (headwards) CT Computed Tomography: Technology that takes many X-ray images from different angles to produce computer-processed cross-sectional images (slices) of specific areas of a scanned object. CTA CT Angiography: Display of the vascular system using CT. CTO A chronic total occlusion (CTO) occurs when a coronary artery is completely blocked for 3 months or longer resulting in a significant decrease in blood flow. Cutting plane Plane perpendicular to the vessel centerline. 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 squaremeters (µGy m²). DCS Display Ceiling Suspension, support system for LCD monitors DDO Dynamic Density Optimization, also called harmonization. By reducing the dynamic range of an image, it is possible to increase the contrast without saturation of the image in bright or dark areas. 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 DSA Digital Subtraction Angiography, digital acquisition technique with subtraction DSA Roadmap (CLEARmap) In DSA Roadmap, either a reference image from a previous DSA scene or the automatically generated maximum opacification image of a DSA scene can be used as the mask. DSA Roadmap is performed in 2 phases. 82 The mask, showing the vessel map, will be subtracted from subtracted live fluoro images, showing the catheter/guidewire. ED End diastole, heart phase EDV End-diastolic volume, volume of the ventricle in the ED EF Ejection Fraction, measure of cardiac performance Embedded MPR With embedded MPR, the volume and one of the MPR views are displayed fused in the VRT image segment. EP Electrophysiology EP Lab Electrophysiological intervention suite EPS System Emergency Power Supply (EPS), provides interrupted supply for the generator, uninterrupted supply for imaging system and stand and table ES End systole, heart phase ESV End-systolic volume, volume of the ventricle in the ES Examination patient Patient which is registered for examination on the ARTIS. f/s frames per second, frame rate during acquisition FD Flat detector FL, Fluoro Fluoroscopy fps frames per second, frame rate during acquisition Frame Single frame of a multiframe image (scene); one image out of a series of images to form a movie-like sequence Heads-up Display ARTIS display which makes it possible to stay focused with context-sensitive Onscreen menu. Heat Unit Thermal load state of the tube assembly, stated as a percentage HIS Hospital Information System HU Hounsfield Units: X-ray attenuation (density) measurement unit used to describe voxel values in CT scanning. 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. iFlow The iFlow function provides a single composite image that shows the history of the contrast medium movement through the vessels in time in a colored image. IS Imaging system Isocenter The isocenter is the center of rotation, the fixed point in the projection image during a C-arm rotation or angulation. If an organ is in this center of rotation, the image of the organ remains in the same place on the screen during C-arm angulations. 83 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. JET Abbreviation for the Reconstruction Job List Editor A Reconstruction Job List consists of one or more Reconstruction Jobs, i.e. sets of 3D reconstruction parameters for 3D reconstruction of one or multiple 3D volumes. Jog wheel Input device which combines several functions: ◾ It can be deflected like a joystick, e.g. for positioning the cursor on the screen. ◾ It can be rotated, e.g. for scrolling within the scene. ◾ It can be pushed down, e.g. for confirming an action. 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 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 LPO Left Posterior Oblique - not used in ARTIS 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 Mesh Wireframe model describing the segmented object MFH Max Fill Hold, review is stopped at the frame within a scene, in which the contrast agent is maximally filled MIP, MinIP Maximum/Minimum Intensity Projection MIP is a rendering technique that projects the 3D volume onto a 2D image plane. During projection only the maximal grey value is applied to the resulting image (MaxIP or for short MIP). MinIP is the same technique using the minimum grey value. MIP Thin, MinIP Thin Maximum/Minimum Intensity Projection, Thin volume MIP/MinIP is a rendering technique that projects the 3D volume onto a 2D image plane. During projection only the maximal/minimal grey value is applied to the resulting image (MaxIP or for short MIP). For MIP or MinIP, the whole volume is used for projection. 84 For MIP Thin or MinIP Thin, only a partial volume (slice) is used for projection. MPR Multi-Planar Reformatting MPR is a rendering technique that projects the 3D volume onto a 2D image plane. During projection the averaged grey value is applied to the resulting image. MPR Thick Multi-Planar Reformatting, Thick slices Like MPR, MPR Thick is a rendering technique that projects the 3D volume onto a 2D image plane. The MPR slice thickness is one voxel. By MPR Thick, thicker slices are used. For calculation all the voxels within this slice contribute to the rendered image. If more than 1 voxel contributes, an average of the voxels along the planar slice's normal is calculated. MR Magnetic Resonance MR physics: Absorption or emission of electromagnetic energy by atomic nuclei in a static magnetic field, after excitation by electromagnetic RF radiation at resonant frequency. MR scanners use magnetic fields and radio waves to calculate cross-sectional images (slices) of specific areas of a scanned object. Multiframe image A multiframe image is an image object (scene) whose pixel data consist of a sequence of single frames. NavX The NavX system is an electro-anatomic mapping system that uses electric fields to locate the position and orientation of the tip of a suitably equipped mapping catheter. The NavX system is used during electrophysiology procedures to diagnose, plan, and treat arrhythmias. OEM Original Equipment Manufacturer OM Operator Manual OR Operating Room OR-UPS UPS for imaging system, stand and table Ostial / Non-ostial If a bifurcated vessel is obstructed on the bifurcation point, it is called ostial, else non-ostial. Ostium An ostium is a small opening or orifice, as in a body organ or vessel. Ostium plane Plane parallel to the ostium of a vessel. It can also be the ostium of an aneurysm. OT Overtable: The tube is above the tabletop. P/s Pulses per second, frame rate for fluoroscopy Parallel Patient Processing Share system capabilities between exam and control rooms to, for example, make procedure planning possible without interfering with an ongoing one. 85 PCM Pilot Control Module, console for performing stand/C-arm movements and operating the imaging system PERISTEPPING Peripheral digital angiography stepping of the stand with a single contrast- medium injection performed while observing the contrast medium bolus PERIVISION Peripheral digital angiography with stepping of the stand and online subtraction display in one examination procedure with a single contrast-medium injection while observing the contrast medium bolus PET Positron Emission Tomography (PET) is an imaging technology based on the detection of photon pairs produced by the annihilation of positrons and electrons. Planning volume Volume data of a recently acquired volume that is used for planning the current intervention or surgery. It can be an XA DynaCT/Dyna3D volume or a volume from another modality, like CT, MR, or other. Postprocessing patient Patient data which is is loaded for review and postprocessing in PostProc task card. Progression View 1/2 Views needed during syngo Needle Guidance which show the planned needle path in a defined C-arm angulation perpendicular to the needle. PTCA Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. Punching Punching is required in order to mask out disturbing regions of the volume, which otherwise would obstruct the visibility of interesting structures. In some cases, e.g. in aneurysm analysis, it is required to punch the volume of interest (VOI) from a volume. QCA Quantitative Coronary Analysis, calculation for dimensions of coronary arteries QCA 3D see IZ3D QuickZoom Focus and zoom with just one click – in the control room or at tableside. Click onto your region of interest, and QuickZoom centers and zooms automatically, and even provides high-resolution refinement of your 3D volume. QVA Quantitative Vascular Analysis, calculation for dimensions of vessel sections RAO Right Anterior Oblique, angle of rotation of the image plane in degrees, to the right of the reference vertical Reconstruction Job Set of 3D reconstruction parameters. Reconstruction Job List One or more Reconstruction Jobs, i.e. sets of 3D reconstruction parameters for 3D reconstruction of one or multiple 3D volumes. Reconstruction Job List ID This identifier is a number between 1 and 48. It is used as a reference for the ARTIS 3D Recon Preset acquisition parameter. Reference plane Plane perpendicular to the vessel centerline, assumed to be non-pathological in stenosis analysis. 86 Two reference planes are automatically placed at the beginning and the end of the analyzed vessel segment: ◾ The “proximal reference plane”: Closer to the heart, thicker vessel diameter ◾ The “distal reference plane”: Further from the heart, thinner vessel diameter It is also possible to place a further reference plane manually between the before described two reference planes. Registered volume 3D volume, for which a registration has been done to the position of the current examination patient on the ARTIS. Registration Registration is the process for aligning a 3D volume to another 3D volume or to 2D images. The 3D volume is adjusted by shifting and rotating it, so that the positions of the organs match to the positions in the other 3D volume or 2D images. The aligned 3D volume can then be used for comparison, guidance, and treatment. Registration result Result of performing a registration of a 3D volume, i.e. the alignment a 3D volume to another 3D volume or to 2D images. The aligned 3D volume can then be used for comparison, guidance, and treatment. Rendering mode Visualization technique for 3-dimensional image data, for example MPR, MIP, or VRT RESET Reset, restart Result segment The result segment displays the measurement results of an analysis. Review patient Patient data which is loaded for review in 4D task card. RIS Radiology Information System Roadmap Roadmap is a special operating mode in which fluoroscopy images are subtracted from one another and displayed subtracted. During fluoroscopy, an image is inverted (mask) and superimposed over all subsequent fluoroscopy images. ROI Region of Interest, region under examination RPO Right Posterior Oblique - not used in Artis SC Service Center. This abbreviation in messages means: "Call Service" SCM Stand Control Module, console for operating a Stand/C-arm SDev Standard deviation, a parameter in statistics Seed point Starting point for performing an automatic segmentation procedure Segment The screens of the Large Display in the examination room and the Artis Cockpit are divided into different segments which show different image types, e.g. live images or reference images, or different task cards. 87 Segmentation Image-processing algorithm for extraction of anatomical structures. Segmentation result Result of applying a segmentation algorithm to a volume, i.e. the anatomical structures of interest. SID Source-to-Image Distance, or distance between the source and the FD in cm SIS Sensis Information System: Information system for cath lab systems including inventory management and reporting. Slab mode In slab mode, two planes parallel to each other are provided. Only the volume between the two planes is visible. SPECT Single Photon Emission Computed Tomography (SPECT) is an imaging technology that detects single photons (energy emitted by the radioactive substance located within the body), by rotating detectors around the body and recording events at each detector location. SRS Siemens Remote Service Stenosis plane Vessel cross section being analyzed, by default the minimum cross section. STL format Stereolithography language: Description of a surface with triangles Many other names are also used for the STL format, for example, “standard triangle language” and “surface tesselation language”. The STL format is a standard format for describing 3D objects as a collection of polygonal shapes that define the surface or surfaces of an object. The STL format was originally used by stereo lithography (STL) equipment, and has been adopted as a basic format for the definition and interchange of 3D objects. Stroke The term stroke is used to identify a collection of image positions that are being marked in the same way that a paint brush stroke marks a canvas. Strokes are used for segmentation. syngo syngo is the standard medical software platform of Siemens. syngo is a registered trademark of the Siemens Healthcare. syngo 2D/3D Fusion With syngo 2D/3D Fusion, only two fluoro projections are required to easily fuse 3D volumes from other imaging modalities for live image guidance. syngo 3D/3D Fusion Using syngo 3D/3D Fusion, you can align two 3D volumes to each other. A volume just acquired on the ARTIS, for example, can be aligned to a volume from a former examination and overlaid to it. It can be an XA DynaCT/Dyna3D/... volume or a volume from another modality, like CT, MR, or other. syngo 3D Registration Registration of an existing volume to the examination patient. It can be: ◾ A 3D/3D registration: Align an existing 3D volume to a 3D volume of the examination patient on the ARTIS. ◾ A 2D2D/3D registration: Align a 3D volume with two 2D images of different projections. 88 syngo 3D Roadmap syngo 3D Roadmap is an overlay technique that combines 2D image information, e.g. fluoroscopic images, with 3D volume information. The overlay image is displayed on the 4D task card. syngo 3D Segmentation Segmentation is an image-processing algorithm for extraction of anatomical structures. syngo 3D Segmentation creates a graphical overlay that represents an anatomy of interest, e.g. soft tissue lesion, fibroid, or tumor, to overlay with live X-ray or for computational analysis, e.g., volume measurement. syngo 3D Stenosis Measurement syngo 3D Stenosis Measurement allows to analyze a vessel segment using 3D views, e.g. MPR, VRT. syngo 3D VRT Volume rendering of three-dimensional images like CT, MR, syngo Dyna3D, syngo DynaCT, syngo DynaPBV, PET datasets. syngo 4D Viewer With the 4D Viewer application, you can reconstruct, load, and view 3D volumes, and rotate them freely. You can use different rendering techniques like VRT (volume rendering technique), MPR (multi-planar reformatting), MIP (maximum intensity projection), or MinIP (minimum intensity projection). Colored VRT display helps you to distinguish between tissue types. syngo Adjust 3D Roadmap syngo Adjust 3D Roadmap can be used if the current patient position of a 2D image slightly differs from the registered position of the 3D volume. An alignment of a 3D volume to a 2D image is necessary if a patient movement took place. syngo Aneurysm Guidance Neuro syngo Aneurysm Guidance Neuro provides visualization and measurement tools to analyze the morphology of aneurysms. A virtual stent overlay is available for use in stent planning or flow diverter deployment as well as for embolization guiding. syngo Aortic Valve Guidance syngo Aortic Valve Guidance (AVG) provides automatic segmentation of the aortic root for visualization to support aortic valve implantation procedures. syngo Congenital Heart Disease syngo Congenital Heart Disease Guidance provides planning on pre-operative or Guidance acquired 3D volume depicting the endocardial heart surface and visualize the planning information in conjunction with live X-ray imaging to guide treatment. syngo CTO Guidance syngo CTO Guidance (chronic total occlusion guidance) provides the ability to safely plan and perform a PTCA procedure under fluoroscopic or angiographic image guidance. syngo DualVolume Simultaneous visualization of dual-volume imaging, e.g. stent and contrast- enhanced vessels. The syngo Application Software provides a special reconstruction algorithm that takes the mask image as well as the substracted image into account and displays both 3D images simultaneously. In this DualVolume mode, bones, solid materials (e.g. aneurysm clips, coils, stimulation electrodes, or hooks) and vessels can be visualized in one 3D rendering at the same time. syngo Dyna3D syngo Dyna3D is the basic technique from Siemens to reconstruct a 3D data set of cross-sectional images from 2D projection images acquired in a 3D acquisition run on an ARTIS system. 89 syngo Dyna3D HighSpeed Combined with ARTIS pheno, syngo Dyna3D HighSpeed provides a fast 3D high contrast acquisition protocol. It permits a short acquisition time of less than 3 s, thus, moving organs like the lungs can be represented with minimal motion artifacts and less contrast media. syngo Dyna4D With syngo Dyna4D, a series of subtracted volumes can be shown in a time sequence. syngo DynaCT syngo DynaCT enables selected systems of the ARTIS family to create CT-like images. syngo DynaCT 360 syngo DynaCT 360 provides a fast large-volume acquisition protocol in only six seconds. Instead of rotating twice around the patient, like syngo DynaCT Large Volume, this acquisition protocol rotates the C-arm by 360 degrees once along an elliptical path. syngo DynaCT Cardiac syngoDynaCT Cardiac is the same technique as syngoDyna3D used for cardiac applications. syngo DynaCT Clear syngo DynaCT Clear is an improved reconstruction method for optimized image quality of neurological acquisitions. syngo DynaCT Clear produces enhanced 3D image quality, especially in non- isocentric slices. syngo DynaCT Large Volume By rotating twice around the patient with a small shift of the C-arm, ARTIS pheno is able to cover a larger field of view than a standard syngo DynaCT acquisition protocol. syngo DynaCT Micro syngo DynaCT Micro provides high spatial resolution 3D imaging. The 50 % higher resolution compared to a standard syngo DynaCT enhances the visualization of smallest structures like flow diverters or stapes prostheses in order to check correct placement and proper function. Moreover, syngo DynaCT Micro enables the visualization of the inner structures of bones to detect e.g. fractures. It is particularly beneficial for temporal bone imaging. syngo DynaCT SMART Important diagnostic information can be obscured by metal artifacts. Reduce these artifacts with syngo DynaCT SMART (Streak Metal Artifacts Reduction Technology). This helps to increase diagnostic confidence and increases the chance for visualizing complications such as bleedings close to metallic objects. syngo Electrophysiology Guidance syngo Electrophysiology Guidance provides lesion planning on a segmented heart surface and visualization of the planning information in conjunction with live X-ray imaging to guide treatment, e.g. ablation. syngo Embolization Guidance syngo Embolization Guidance provides the ability to add colored vessel overlay graphics to user-defined vessel segments as centerlines, outlines, or surface. In addition, a segmentation can be performed in order to measure and visualize anatomic structures like tumors, lesions, or fibroids. syngo EVAR Guidance syngo EVAR Guidance (endovascular repair guidance) provides the ability to safely plan and perform endovascular procedures under fluoroscopic or angiographic image guidance. syngo Fly Through Provides virtual endoluminal views of hollow structures. syngo Fusion Package The syngo Fusion Package includes: syngo Toolbox, syngo 3D/3D Fusion. and syngo 2D/3D Fusion 90 syngo LA Segmentation The syngo LA Segmentation is an algorithm designed to segment the left atrium (LA) of the heart. Based on a pre-operative CT, MR, or an intraoperative syngo DynaCT Cardiac volume, the application software calculates the segmentation automatically. The segmentation can also be performed manuallywith just one click inside the left atrium. syngo Needle Guidance syngo Needle Guidance makes it possible to plan the insertion direction of a needle in the 3D volume and display the needle path on the ARTIS Live image. syngo Neuro Virtual Stent syngo Neuro Virtual Stent is a planning tool that provides a 3D virtual intracranial stent, which can be sized to a vessel during pre-stent deployment and can provide a 3D overlay onto a live X-ray or 2D roadmap image. The live 3D overlay of the stent can also be used post-stent deployment to provide guidance during coiling of intracranial aneurysms. syngo Neuro Virtual Stent is part of the syngo Aneurysm Guidance Neuro workflow. syngo Toolbox Collection of tools for creation, manipulation, and display of graphic elements on 3D volumes. syngo TrueFusion With syngo TrueFusion, you can utilize ultrasound 3D/4D TEE (transesophageal echocardiography) with fluoroscopy image information in cardiac procedures. 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 Table-Side Control, operation near the patient table for controlling the system in the examination room. UI User Interface, all parts of the hardware and software which enable to operate the system Universal collimator X-ray collimator mainly used in angiographic systems equipped with rectangular diaphragms and also with two wedge filters and one semitransparent finger filter. UPS Uninterruptible Power Supply, battery-backed system which provides emergency power in the event of a mains power supply failure. UT Undertable: The tube is below the tabletop. Vessel skeleton Lines walking along the middle of the vessel tree, in the direction of the vessel. VOI Volume of Interest, 3D region under examination Volume A stack of 2-dimensional images which is arranged to 3-dimensional data. A volume can be rotated and displayed from different directions by various visualization techniques, like for example VRT, MPR, MIP. VRT Volume Rendering Technique The VRT algorithm calculates a parallel projection of the volume. Every voxel along a projection line is categorized by its pixel value (HU value) whether it belongs to a certain tissue class. By that, every voxel receives a color and an opacity value. An accumulation of the classified voxel values along the projection line is then displayed. 91 WB Window Brightness in subtracted images WC Window Center, brightness in native images WC Window Contrast in subtracted images WW Window Width, contrast in native images XA X-ray Angio modality, angiographic X-ray images acquired on ARTIS systems. 92 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 and options as well as standard and optional Local Contact Information features which do not always have to be Siemens Medical Solutions USA, Inc. present in individual cases. 40 Liberty Blvd. Siemens reserves the right to modify the Malvern, PA 19355-9998 design, packaging, specifications and options USA described herein without prior notice. Please Telephone: +1-888-826-9702 contact your local Siemens sales representative siemens.com/healthcare for the most current information. Note: Any technical data contained in this document may vary within defined tolerances. Legal Manufacturer Original images always lose a certain amount Imaging & Therapy Systems of detail when reproduced. 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