Cios Select (with FD) VA20 Operating Modes Online Training

Welcome to the Cios Select Operating Modes Online Training module. This training module will introduce you to the operating modes and applications on the Cios Select system. In addition, you will learn about: Positioning the C-arm for surgery Pediatric examinations Setting parameters for thicker body regions   Congratulations. You have completed the Cios Select Operating Modes Online Training course. Listed below are the key points that have been presented. Take time to review the material before you proceed to the final quiz. Download and print a copy of the Course Review Operating modes: The mode of imaging depends on the selected operating mode As standard the operating modes Fluoroscopy and Single image are available. Fluoroscopy and Single image can be activated in Basic Mode and Advanced Mode If your system is licensed the operating modes Subtraction and Roadmap are available in Advanced Mode Fluoroscopy: Fluoroscopy uses pulsed X-ray to produce real time imaging of anatomy Fluoroscopy images are acquired in different pulse rates from 0.5 pulses per second up to 30 pulses per second, also known as continuous fluoroscopy The pulse rate is set automatically by the selected Application. The current pulse rate is displayed on the bottom of your control panel To change the pulse rate, press on the button, repeatedly if necessary Fluoroscopy is automatically selected after system start-up and with the start of each examination You can manually select Fluoroscopy in Basic Mode and in Advanced Mode in the bottom left corner of your touchscreen control panel To ensure adequate image quality, you should always perform fluoroscopy before acquiring images with another operating mode Fluoroscopy images are not automatically stored.  To store an image hand switch, press on the side button on the hand switch or press on the store button on the control panel Press the button for less than two seconds to store a single image, also known as a last image hold (LIH) Press the button for more than two seconds to store the fluoroscopy scene, also known as a last scene hold (LSH) The stored image or scene is displayed on the right monitor, unless the Hold Reference function is active   Single Image mode:  Single image mode provides an instant single image of the patient on the monitor In comparison with fluoroscopy the dose setting may be higher than a single fluoroscopy frame The image quality may be higher in Single image mode in comparison to fluoroscopy Single image mode is recommended for final images in an examination You activate Single image mode in Basic Mode and Advanced Mode. Press the button in the bottom left corner of the control panel When the foot pedal is connected, you use the left pedal on the footswitch to acquire images When you acquire an image, the image is automatically stored to the local database The image appears on the right monitor display unless the Hold Reference function is activated Subtraction: Subtraction is an optional operating mode used to demonstrate vessels In Subtraction mode, contrast medium is injected The pre-contrast images (the mask) are subtracted from the images with contrast medium (fill images) The result is a subtracted view, demonstrating only the contrast filled vessels You select Subtraction in Advanced Mode in the bottom left corner of your touchscreen control panel The images are automatically stored to the local database and can be displayed in subtracted or in non-subtracted (native) display  Roadmap: Roadmap is an optional operating mode to support guidewire and stent placement During Roadmap, contrast is injected and the fluoroscopy images are subtracted from one another to create a subtracted image of the contrast filled vessel (Phase A and Phase B) The subtracted image is then inverted and overlaid on the live fluoroscopy image You select Roadmap in Advanced Mode on the bottom left corner of your touchscreen control panel  Applications: The Application sets the acquisition and post processing parameters for the examination In Basic mode there are four default applications are available: Standard, Adipose, Extremity and Pediatrics In Advanced Mode there are more applications tailored to the specific body region and examination type Pediatric Examinations:  There are pediatric applications available in Basic Mode and Advanced Mode These default pediatric applications may be used for all pediatric patients up to 14 years of age For patients less than seven years of age, it is recommended to remove the scatter radiation grid It is recommended to use the scatter radiation grid for patients older than seven years of age When appropriate, additional dose saving measures should be considered, for example, reducing the fluoroscopy time and pulse rate and as much as possible Positioning the C-arm: Prior to positioning the C-arm for the examination, you should consider the following: The body region to be examined The type of surgery The table type The range of C-arm movement required Possible obstructions to movement on the table and on the floor In general, the detector is positioned at the top of the C-arm. Some examinations require the detector to be positioned at the bottom Imaging thicker body regions: When imaging thicker body regions, if the correct parameters are not used, image un-sharpness could become an issue To ensure adequate image quality, always select the correct application for the body region, using the adipose application when applicable In many cases, it is beneficial to select the adipose application in Advanced Mode Prior to positioning the C-arm for the examination, you should consider the following: The body region to be examined The type of surgery The table type The range of C-arm movement required Possible obstructions to movement on the table and on the floor In general, the detector is positioned at the top of the C-arm. Some examinations require the detector to be positioned at the bottom.   Learn more about positioning the C-arm Learn more about positioning the C-arm Tab TitleTextPositioning the C-arm for examinations of the body For examinations of the body, the C-arm is generally positioned with the flat detector at the top. The C-arm approaches the table laterally. Before moving the C-arm towards the table, check that the horizontal axis is centrally positioned to allow for additional movements. Positioning the C-arm for examinations of the hand When imaging the distal upper extremities, in order to reduce image magnification the C-arm can be positioned with the flat detector at the bottom. To rotate the C-arm, release the brake lever on the top of the horizontal axis, marked with the yellow knob and rotate the C-arm. Lock the brake lever when the C-arm is in position. Fluoroscopy uses pulsed X-ray to result in real time imaging of the patient. In fluoroscopy, images are acquired in different pulse rates from 0.5 pulses per second up to 30 pulses per second (continuous fluoroscopy). Fluoroscopy is automatically selected after system start-up and with the start of each examination. You can manually select Fluoroscopy in Basic Mode and in Advanced Mode in the bottom left corner of your touchscreen control panel. Please note:  To ensure adequate image quality, you should always perform fluoroscopy before acquiring images with another operating mode.   Learn about Fluoroscopy pulse rates Learn about Fluoroscopy pulse rates Tab TitleTextWhy are there different Fluoroscopy pulse rates?   0.5   1 2 3 5 7.5 10 15 Continuous (30 p/s)   In fluoroscopy, images are created with pulsed X-ray with pulse rates ranging from 0.5 pulses per second (p/s) up to 30 p/s (continuous fluoroscopy).  Each X-ray pulse represents an image in the scene. Increasing the pulse rate, increases the number of images in the scene. In general, increasing the pulse rate also equates to an increase in imaging dose. In examinations involving dynamic anatomy or equipment, a higher pulse rate may be necessary to clearly visualize subtle changes. For static areas, a lower pulse rate may be sufficient.  The pulse rate is set in the Application with the pulse rate generally required for the examination type, this can be changed during the examination, based on the imaging needs.   Changing the pulse rate The pulse rate is set automatically by the selected Application. The current pulse rate is displayed on the bottom of your control panel. To change the pulse rate, press on the button, repeatedly if necessary. The button toggles through the available pulse rates. Learn how to store Fluoroscopy images Learn how to store Fluoroscopy images Tab TitleTextStore images using the hand switch In order to save space on the Hard drive (local database) Fluoroscopy images are not automatically stored. To store an image using the hand switch, press on the side button. Press the button for less than two seconds to store a single image, also known as a last image hold (LIH) Press the button for more than two seconds to store the fluoroscopy scene, also known as a last scene hold (LSH) The stored image or scene is displayed on the right monitor, unless the Hold Reference function is active. Store images using the control panel To store images using the control panel, press on the Store button on the bottom right corner of the control panel. Press the button for less than two seconds to store a single image known as a last image hold (LIH) Press the button for greater than two seconds to store the fluoroscopy scene, known as a last scene hold (LSH) The stored image or scene is displayed on the right monitor, unless the Hold Reference function is active. Single image mode provides an instant single image of the patient on the monitor. In comparison with fluoroscopy the dose setting may be higher than a single fluoroscopy frame and the image quality may be higher. Single image mode is recommended for final images. The image is automatically stored to the local database. The image appears on the right monitor display unless the Hold Reference function is activated.   Learn more about Single image mode Learn more about Single image mode Tab TitleTextControl panel You activate Single image mode in Basic Mode and in Advanced Mode. Press the button on the bottom left corner of the control panel. Footswitch When the footswitch is connected, you use the left pedal on the footswitch to acquire images in Single image mode. You can check the current allocation of the foot pedal functions in the control area on the left monitor display. Please note: You should always perform fluoroscopy prior to acquiring an image in Single image mode. Hand switch If preferred, you can release X-ray with the hand switch. After selection of Single image mode on the control panel, the top yellow button on the hand switch releases X-ray in Single image mode. If the footswitch is not connected, you can check the current allocation of the hand switch button in the control area on the left monitor display.  Please note: You should always perform fluoroscopy prior to acquiring an image in Single image mode. Subtraction is an optional operating mode used to demonstrate vessels. In Subtraction mode, contrast medium is injected. The pre-contrast images (the mask) are subtracted from the images with contrast medium (fill images). The result is a subtracted view, demonstrating only the contrast filled vessels. You select Subtraction in Advanced Mode in the bottom left corner of your touchscreen control panel. The images are automatically stored to the local database and can be displayed in subtracted or in non-subtracted (native) display.   Learn more about Subtraction mode Learn more about Subtraction mode Tab TitleTextControl panel If your system is licensed, you activate Subtraction mode in Advanced Mode. Press the button on the bottom left corner of the control panel. Footswitch When the footswitch is connected, you use the left pedal on the footswitch to acquire images in Subtraction mode. You can check the current allocation of the foot pedal functions in the control area on the left monitor display. Please note: You should always perform fluoroscopy prior to acquiring an image in Subtraction mode. Hand switch If preferred, you can release X-ray with the hand switch. After selection of Subtraction mode on the control panel, the top yellow button on the hand switch releases X-ray in Subtraction mode. If the footswitch is not connected, you can check the current allocation of the hand switch button in the control area on the left monitor display.  Please note: You should always perform fluoroscopy prior to acquiring an image in Subtraction mode. Phases in Subtraction Phases in Subtraction Tab TitleTextPhase A Phase A of Subtraction involves the creation of the mask image. The mask image is acquired in the area of interest before contrast medium is injected. Each subsequent image following Phase A has the mask image subtracted. To start Phase A, select Subtraction on the control panel. Start the acquisition by pressing the left pedal on the footswitch or the top button on the Hand switch. During generation of the mask image the native image (un-subtracted image) is displayed on both the left and right monitor displays. Keep the exposure button pressed. Phase B Phase B involves the injection of contrast medium. When the creation of the mask image is complete, the image is displayed subtracted and an injection symbol appears on the left monitor. Keep the exposure button pressed and inject the contrast medium as soon as the injection symbol appears on the monitor.  The subtraction image appears on the left monitor The native image appears on the right monitor Fill image When all of the vessels of interest have been filled with contrast, let go of the radiation release. The maximum fill image is calculated and displayed on the left monitor. The maximum fill image is a summation of the images in the fill phase, demonstrating the path taken by the contrast during injection. The right monitor displays the native image. Please note: The display of the images on the left and right monitor can be changed in Advanced Mode, in the Postprocessing menu, in the Sub Roadmap menu. Other options for display include displaying the native image on both monitor display or the subtracted image on both monitor displays. Post processing You can find Subtraction post processing options in the Acquisition menu, in the Sub Roadmap menu. Select Mask: Press the button to select a new mask image Landmark: Press the button to increase or decrease the amount of anatomical background. Pixel shift: Press the button if there is displacement of the mask image in relation to the fill image. Move the mask image with the arrows so that the images are aligned Roadmap is an optional operating mode to support guidewire and stent placement. During Roadmap, contrast is injected and the fluoroscopy images are subtracted from one another to create a subtracted image of the contrast filled vessel (Phase A and Phase B).  The subtracted image is then inverted and overlaid on the live fluoroscopy image. You select Roadmap in Advanced Mode on the bottom left corner of your touchscreen control panel.   Learn more about Roadmap Learn more about Roadmap Tab TitleTextControl panel If your system is licensed, you activate Roadmap mode in Advanced Mode. Press the button on the bottom left corner on the control panel. Footswitch When the footswitch is connected, you use the left pedal on the footswitch to acquire images in Roadmap mode. You can check the current allocation of the foot pedal functions in the control area on the left monitor display. Please note: You should always perform fluoroscopy prior to acquiring an image in Roadmap mode. Hand switch If preferred, you can release X-ray with the hand switch. After selection of Roadmap mode on the control panel, the top yellow button on the hand switch releases X-ray in Roadmap mode. When the footswitch is not connected, you can check the current allocation of the hand switch button in the control area on the left monitor display.  Please note: You should always perform fluoroscopy prior to acquiring an image in Roadmap mode. The Phases of Roadmap The Phases of Roadmap Tab TitleTextPhase A Phase A of Roadmap involves the creation of the mask image. The mask image is acquired in the area of interest before contrast medium is injected. Each subsequent image following Phase A has the mask image subtracted out. To start Phase A, select Roadmap on the control panel. Start the acquisition by pressing the left pedal on the footswitch or the top button on the hand switch. During generation of the mask image the native (un-subtracted) image is displayed on both the left and right monitor displays. Keep the exposure button pressed. Phase B Phase B involves the injection of contrast medium. When the creation of the mask image is complete, the image is displayed subtracted and an injection symbol appears on the left monitor. Keep the exposure button pressed and inject the contrast medium as soon as the injection symbol appears on the monitor.  The subtraction image appears on the left monitor The native image appears on the right monitor Phase C   After radiation is released, the maximum fill image is displayed. With the next release of fluoroscopy  the fill image is inverted and overlaid on the live fluoroscopy image. The right monitor displays the native image The left monitor displays the subtracted Roadmap image Position the catheter or guidewire under fluoroscopy. You can repeat fluoroscopy as often as required, Roadmap will remain active until deactivated on the control panel. To deactivate Roadmap, press the button on the bottom left corner of the control panel again. There are pediatric applications available in Basic Mode and Advanced Mode. These default pediatric applications may be used for all pediatric patients up to 14 years of age. For patients less than seven years of age, it is recommended to remove the scatter radiation grid. It is recommended to use the scatter radiation grid for patients older than seven years of age. When appropriate, additional dose saving measures should be considered, for example, reducing the fluoroscopy time and frame rate as much as possible.   Pediatric Applications Pediatric Applications Tab TitleTextBasic Mode In Basic Mode the Pediatric Application is available. As default, the applications in Basic Mode are set for Orthopedic examinations. It is possible however, for the application to be configured by Siemens Healthineers Service to another setting, for example, Vascular. Please note: If the Application setting is changed, the icons on the control panel do not change. In this case, the icons on the control panel may not represent the setting behind the icon. For example, if the settings are changed to vascular, the pediatric icon will no longer contain pediatric settings, rather the new vascular settings. Advanced Mode In Advanced Mode, pediatric applications are available for each application group. Additionally, there is an application group, Pediatrics. These default pediatric applications may be used as the basis for examinations for all pediatric patients up to 14 years of age   Please note: Depending on the patient stature, in some cases, the kV may increase above 100 kV. In such cases it is suggested to switch to the corresponding adult program to ensure that the image quality is not compromised. Adjust parameters When appropriate, you can adjust the parameters in pediatric examinations to reduce the dose. For example, you can reduce pulse rate. To reduce the pulse rate, press on the Pulse rate button repeatedly to toggle through the available pulse rates. Dose comparison Fluoroscopy Subtraction   Application Group Standard Dose rate (mGy/min) Pediatric Dose rate (mGy/min) Standard Dose rate (mGy/min) Pediatric Dose rate (mGy/min) Card. 1.4 0.2 1.6 0.4 Gastro 1.4 0.2 1.5 0.2 General information 0.8 0.2 1.1 0.2 Ortho 0.8 0.2 1.1 0.2 Uro 0.8 0.2 1.1 0.2 Vascular 0.8 0.2 1.0 0.2 For orientation of the dose savings please see the table above which compares the dose with pediatic and standard protocols. Object: 10 cm PMMA directly located on the FD cover (without anti-scatter radiation grid for pediatric programs) Settings guide     < 2 years  2-6 years 7-14years >14 years Application Pediatric Pediatric Pediatric Pediatric/Adult Grid No No Yes Yes Learn how to remove and insert the grid Learn how to remove and insert the grid   When imaging thicker body regions, if the correct parameters are not used, image un-sharpness could become an issue. To ensure adequate image quality, always select the correct application for the body region, using the adipose application when applicable. In many cases, it is beneficial to select the adipose application in Advanced Mode.   Tips for imaging thicker body regions Tips for imaging thicker body regions Checklist TitleChecklist TypeChecklist ContentSelect the correct ApplicationHTML To ensure adequate image quality confirm that you have the correct application selected for the body region and patient stature. For thicker body regions, select the Adipose application in Basic Mode. In Advanced mode, select the correct application group and application. Use the scatter radiation gridHTML The scatter radiation grid filters scatter radiation from the image, resulting in a sharper image appearance. In thicker body regions there is more scatter radiation. The image quality will be compromised if the scatter radiation grid is not used. Use Single image modeHTML Single image mode can provide a higher quality image than fluoroscopy. You can select this mode for critical and final images. Please note: You should always perform fluoroscopy prior to acquiring an image in Single image mode. Collimate the imageHTML Collimation reduces the scatter radiation to the detector. To improve image quality and reduce radiation dose, you should collimate to the region of interest as much as possible. Position the detector close to the patientHTML Decrease the object to detector distance to help reduce image un-sharpness. When possible, position the detector close to the anatomy of interest. Use Tech lockHTML In some cases, Tech lock can be used to stabilize the imaging parameters. Particularly when moving the C-arm in and out of position. 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 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. The information in this material contains general technical descriptions of specifications and options as well as standard and optional features that do not always have to be present in individual cases. Certain products, product related claims or functionalities described in the material (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 The mode of imaging depends on the selected operating mode. As standard the operating modes Fluoroscopy and Single image are available. Fluoroscopy and Single image can be activated in Basic Mode and Advanced Mode. If your system is licensed the operating modes Subtraction and Roadmap are available in Advanced Mode.   The application sets the acquisition and post processing parameters for the examination. In Basic mode there are four default applications available: Standard, Adipose, Extremity and Pediatrics. In Advanced Mode there are more applications tailored to the specific body region and examination type.   Learn more about applications Learn more about applications Tab TitleTextApplications in Basic Mode There are four default applications in Basic Mode: Standard Adipose Extremity Pediatrics As default, the applications in Basic Mode are set for Orthopedic examinations. It is possible however, for the application to be configured by Siemens Healthineers Service to another setting, for example, Vascular. Please note: If the application setting is changed, the icons on the control panel do not change. In this case, the icons on the control panel may not represent the setting behind the icon. For example, if the settings are changed to vascular, the pediatric icon will no longer contain pediatric settings, rather the new vascular settings. Applications in Advanced Mode In Advanced Mode, more applications are available tailored to the specific body region and examination type. The applications are organized into Groups. To select an application: Select the group from the Application Group Select the application from: Select Application   Patient positioned lateral on the table Patient positioned lateral on the table   Upon successful completion of this course, you will be able to: Operate the system in the operating modes; Fluoroscopy, Single image, Subtraction and Roadmap Select the Application in Basic Mode and Advanced Mode Position the C-arm for common surgical procedures Understand the workflow for pediatric examinations Recognize settings to improve image quality when imaging thicker body regions