C.A.R.E. Reduce Radiation to the Patient Job Aid

Reduce X-ray dose Recommendations for your daily routine during interventions How to protect the patient 1. Select the adequate protocol 6. Remove grid and increase SID • Choose a proper organ program “Air Gap Technique“ Grid in • Replace acquisition by low dose Store for small children < 20 kg Grid out acquisition and/or fluoro as often Fluoro • Remove anti-scatter grid as possible (= additional absorber) Patient Patient • Use Fluoro Loop and/or Store Fluoro • Lift up receptor as a scatter reduction measure 2. Minimize footswitch-on time 7. Dose monitoring • The shorter the footswitch-on time, Acquisition Low-dose • CAREwatch: CAREguard the lower the air kerma acquisition Displays the dose values during the patient examination on the image Example: Half the time on the monitors in the examination room pedal results in less dose area as well as in the control room product for average patient size • CAREguard: Three dose threshold values (low, medium, and high) can be individually defined. If the accumulated patient entrance dose exceeds the threshold, an audible and visual signal is given 3. Use a low frame rate 8. Use CAREprofile CAREprofile • Using the last image hold (LIH) •T he lower the frame rate, the lower Patient dose as a reference, CAREprofile allows the air kerma 100% radiation-free collimation and Example: Half the frame rate results in 80% semitransparent filter position setting less dose area product CAREvision 60% to precisely target the region of interest • CAREvision enables individually 40% adjustable frame rates from 30 fps 20% down to 0.5 fps 30fps 15 10 7.5 4 3 2 1 0.5 4. Zoom out as much as practicable 9. Use CAREposition • Increasing the zoom factor increases • CAREposition provides radiation-free the skin dose area product but object positioning decreases skin dose (only for open Zoom level Input field • Graphic display of the outline of the FD 20 x 20 FD 30 x 40 collimation) (diagonal) (diagonal) subsequent image allows panning the • Effect on image quality: For large Nominal format/ 25 cm 48 cm table without fluoroscopic radiation patients at the dose rate limit, Zoom 0 exposure Zoom 1 20 cm 42 cm increasing the zoom factor increases Zoom 2 16 cm 32 cm image quality. For small patients, Zoom 3 10 cm 22 cm Zoom 4 – 16 cm decreasing the zoom factor increases CAREposition image quality Zoom 5 – 11 cm 5. Use shallow angles as much as possible • For every 3 cm patient thickness, entrance dose is doubled • Shallow angles reduce air kerma Constant patient exit dose Constant patient exit dose 20 cm water 23 cm water 26 cm water 20 cm at 0º 25.6 cm at 45º 28.5 cm at 55º 100% 200% 400% 360%/ 700%  100% Patient entrance dose Patient entrance dose A91GER-H-000018-C1-20-7600 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2018 Master Template: EFF Date 22 Aug 17 | HOOD/HILS HOOD05162002647849 Jobaid: Effective Date: 11/14/2018 | HOOD/HILS HOOD05162002969515Reduce X-ray dose Recommendations for your daily routine during interventions How to protect the patient 1. Select the adequate protocol 6. Remove grid and increase SID • Choose a proper organ program “Air Gap Technique“ Grid in • Replace acquisition by low dose Store for small children < 20 kg Grid out acquisition and/or fluoro as often Fluoro • Remove anti-scatter grid as possible (= additional absorber) Patient Patient • Use Fluoro Loop and/or Store Fluoro • Lift up receptor as a scatter reduction measure 2. Minimize footswitch-on time 7. Dose monitoring • The shorter the footswitch-on time, Acquisition Low-dose • CAREwatch: CAREguard the lower the air kerma acquisition Displays the dose values during the patient examination on the image Example: Half the time on the monitors in the examination room pedal results in less dose area as well as in the control room product for average patient size • CAREguard: Three dose threshold values (low, medium, and high) can be individually defined. If the accumulated patient entrance dose exceeds the threshold, an audible and visual signal is given 3. Use a low frame rate 8. Use CAREprofile CAREprofile • Using the last image hold (LIH) •T he lower the frame rate, the lower Patient dose as a reference, CAREprofile allows the air kerma 100% radiation-free collimation and Example: Half the frame rate results in 80% semitransparent filter position setting less dose area product CAREvision 60% to precisely target the region of interest • CAREvision enables individually 40% adjustable frame rates from 30 fps 20% down to 0.5 fps 30fps 15 10 7.5 4 3 2 1 0.5 4. Zoom out as much as practicable 9. Use CAREposition • Increasing the zoom factor increases • CAREposition provides radiation-free the skin dose area product but object positioning decreases skin dose (only for open Zoom level Input field • Graphic display of the outline of the FD 20 x 20 FD 30 x 40 collimation) (diagonal) (diagonal) subsequent image allows panning the • Effect on image quality: For large Nominal format/ 25 cm 48 cm table without fluoroscopic radiation patients at the dose rate limit, Zoom 0 exposure Zoom 1 20 cm 42 cm increasing the zoom factor increases Zoom 2 16 cm 32 cm image quality. For small patients, Zoom 3 10 cm 22 cm Zoom 4 – 16 cm decreasing the zoom factor increases CAREposition image quality Zoom 5 – 11 cm 5. Use shallow angles as much as possible • For every 3 cm patient thickness, entrance dose is doubled • Shallow angles reduce air kerma Constant patient exit dose Constant patient exit dose 20 cm water 23 cm water 26 cm water 20 cm at 0º 25.6 cm at 45º 28.5 cm at 55º 100% 200% 400% 360%/ 700%  100% Patient entrance dose Patient entrance dose A91GER-H-000018-C1-20-7600 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2018 Master Template: EFF Date 22 Aug 17 | HOOD/HILS HOOD05162002647849 Jobaid: Effective Date: 11/14/2018 | HOOD/HILS HOOD05162002969515 Job Aid | Reduce X-ray dose Effective Date: 11/14/2018 | HOOD/HILS HOOD05162002969515 Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH 2018 ………………………………………………………… Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Telephone: +49 9131 84-0 siemens.com/healthineers Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2018 Page 2 of 2Reduce X-ray dose Recommendations for your daily routine during interventions How to protect the patient 1. Select the adequate protocol 6. Remove grid and increase SID • Choose a proper organ program “Air Gap Technique“ Grid in • Replace acquisition by low dose Store for small children < 20 kg Grid out acquisition and/or fluoro as often Fluoro • Remove anti-scatter grid as possible (= additional absorber) Patient Patient • Use Fluoro Loop and/or Store Fluoro • Lift up receptor as a scatter reduction measure 2. Minimize footswitch-on time 7. Dose monitoring • The shorter the footswitch-on time, Acquisition Low-dose • CAREwatch: CAREguard the lower the air kerma acquisition Displays the dose values during the patient examination on the image Example: Half the time on the monitors in the examination room pedal results in less dose area as well as in the control room product for average patient size • CAREguard: Three dose threshold values (low, medium, and high) can be individually defined. If the accumulated patient entrance dose exceeds the threshold, an audible and visual signal is given 3. Use a low frame rate 8. Use CAREprofile CAREprofile • Using the last image hold (LIH) •T he lower the frame rate, the lower Patient dose as a reference, CAREprofile allows the air kerma 100% radiation-free collimation and Example: Half the frame rate results in 80% semitransparent filter position setting less dose area product CAREvision 60% to precisely target the region of interest • CAREvision enables individually 40% adjustable frame rates from 30 fps 20% down to 0.5 fps 30fps 15 10 7.5 4 3 2 1 0.5 4. Zoom out as much as practicable 9. Use CAREposition • Increasing the zoom factor increases • CAREposition provides radiation-free the skin dose area product but object positioning decreases skin dose (only for open Zoom level Input field • Graphic display of the outline of the FD 20 x 20 FD 30 x 40 collimation) (diagonal) (diagonal) subsequent image allows panning the • Effect on image quality: For large Nominal format/ 25 cm 48 cm table without fluoroscopic radiation patients at the dose rate limit, Zoom 0 exposure Zoom 1 20 cm 42 cm increasing the zoom factor increases Zoom 2 16 cm 32 cm image quality. For small patients, Zoom 3 10 cm 22 cm Zoom 4 – 16 cm decreasing the zoom factor increases CAREposition image quality Zoom 5 – 11 cm 5. Use shallow angles as much as possible • For every 3 cm patient thickness, entrance dose is doubled • Shallow angles reduce air kerma Constant patient exit dose Constant patient exit dose 20 cm water 23 cm water 26 cm water 20 cm at 0º 25.6 cm at 45º 28.5 cm at 55º 100% 200% 400% 360%/ 700%  100% Patient entrance dose Patient entrance dose A91GER-H-000018-C1-20-7600 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2018 Master Template: EFF Date 22 Aug 17 | HOOD/HILS HOOD05162002647849 Jobaid: Effective Date: 11/14/2018 | HOOD/HILS HOOD05162002969515