MAMMOMAT Revelation Stereotactic Biopsy Workflow Online Training

Welcome to the MAMMOMAT Revelation Stereotactic Biopsy Workflow Online Training. This training will guide you through the stereotactic biopsy workflow steps for a vertical approach at the MAMMOMAT Revelation. Please note: The information in this online training relates to the software version VC 10 or higher. Upon successful completion of this course, you will be able to: Prepare the system for a stereotactic biopsy procedure with a vertical approach Check the default settings and change the settings appropriate to the examination, if required Perform scout and stereo pair exposures Set biopsy targets Perform InSpect exposures Congratulations. You have completed the MAMMOMAT Revelation Stereotactic Biopsy Workflow Online Training. Listed below are the key points that have been presented. Take time to review the material before you proceed to the final quiz. In this online training, the stereotactic biopsy workflow with a vertical approach is presented. System preparation – Hardware Attach the biopsy unit and connect it to the system After a few seconds, the needle positioning device will check its zero position by moving to the left and to the middle again Please don't disturb the movement to avoid system errors Attach the compression plate Attach the handbox and connect it to the biopsy unit Attach the biopsy face shield Attach and remove the needle holder   System preparation – Software Load patient data from the scheduler Select an IPPG for implants, if required Click the checkbox for “Metal in Breast”, if applicable Check the settings in the Open Patient subtask, the Acquisition subtask card and the generator control field and adapt them, if necessary   Patient positioning Biopsy examinations are intended for the sitting patient, but are still possible with the patient lying down Necessary steps: Adjust the height of the swivel arm Adjust the angulation of the swivel arm Position the breast on the table so that the region of interest is in within the opening of the compression paddle (vertical approach) Compress the breast: Compression force of > 40 N is recommended Examination of breast with implants: Ask the patient about existing implants prior to the examination Provide information about the risks of providing false information: errors in treatment, risk of injury   Image acquisition: For a stereotactic biopsy workflow, the acquisition of a scout image and a stereo pair is mandatory. Depending on workflow needs and country regulations, the acquisition of further stereo pairs can be required, for example to check the correct positioning of the needle to check if all suspicious lesions have been removed   Scout exposure Acquire the scout image and check if the region of interest is within the possible biopsy volume If not, select New and repeat the scout exposure with different positioning and/or different settings If yes, select OK   Stereo exposure Acquire the first stereo pair The swivel arm automatically moves to -15° and +15°   Targeting Setting the reference point: Set the reference point directly over the reference cross in both images If necessary, you can enlarge the images Setting the target: Set the targets in both images with a left mouse click Use the scout image as a reference Select Confirm Select a needle from the pre-configured needle list Transmit the target   Performing the biopsy Inform the patient that the needle holder will move automatically to the target position Insert the needle guide and the biopsy needle For the installation of a taller needle, you can move the swivel arm to the side by pressing one of the overriding buttons and using the operation keys Ensure that the needle does not touch the swivel arm Press the single touch button to return to the 0° position At the end of the biopsy, remove the needle from the patient’s breast   Tissue sample examination Activate the InSpect exposure by double-clicking on the respective icon in the Images subtask card to examine the collected tissue with the biopsy unit and the breast compressed Attach the specimen cup to the correct side of the biopsy tower The system automatically decides on which side the specimen cup should be placed and will inform you via a system message Regard the “L”, the “R” and the circle inside the specimen cup   End the examination When all required tissue has been removed, decompress the breast If required, you can acquire subsequent stereo pairs before you decompress the breast, for example: To check if all required tissue has been removed To document the position of the clip in the biopsy area Click on the End examination button in the Close Patient subtask card to end the examination Please note: Once you have ended a biopsy examination, it cannot be re-entered. The stereo biopsy examination can be performed with the patient in sitting and lying position. For seated positioning: Use a suitable fixable chair with a rigid back rest to fix the posture of the patient in relation to the swivel arm. The breast should not be able to slip due to movement of the patient. For recumbent patient positioning: Ensure that the patient is positioned in a way that she will not be pinched or injured when the swivel arm moves. The projection angle displayed in the image text of the acquired images refers to sitting patients. Learn how to position the patient Learn how to position the patient. Checklist TitleChecklist TypeChecklist ContentAdjust the height of the swivel armHTML Use the operation keys or the foot switches to adjust the height of the swivel arm. Adjust the angulation of the swivel armHTML Press the buttons with the curved arrows to adjust the angulation. Please note: The single touch functionality for moving the swivel arm to the correct projection angle is not working for stereotactic procedures.   Position the breastHTML Position the breast on the biopsy table so that the suspicious finding is located in the center of the compression plate opening. After acquiring the scout image, you have to check that the region of interest is in the possible biopsy volume. Compress the breastHTML All preparations for the examination must have been made before you can compress the patient´s breast. Use the foot switch or the compression control knobs to move the compression plate downwards to compress the breast. The breast must remain compressed until the conclusion of the examination.   A compression force of > 40 N is recommended, because compression can fall off during the compression phase. If the compression force changes by more than 15 N or drops below 15 N, you will receive a system message. You can decide to either continue or to interrupt the examination Warning: examination of breast with implants Warning: examination of breast with implants Ask the patient about existing implants prior to the examination. Provide information about the risks of providing false information, for example: Erros in treatment and incorrect settings during the examination Risk of injury during compression and biopsy examination! If the patient has breast implants, adjust the preparation and the examination of the patient accordingly (performing compression, examination settings). When you have accepted the scout exposure with OK, the first stereo pair is enabled and the detector parameters are loaded. Press the radiation release button on the control box until the complete stereo pair has been acquired. The swivel arm automatically moves to -15° for the first and to +15° for the second stereo exposure. After the stereo exposure is completed, the swivel arm returns to the start position. To start the biopsy workflow, please attach the biopsy unit at the stand by following the instructions in the video. After you have installed the biopsy unit, you need to load the patient data from the scheduler or register the patient manually. Check the examination settings and adapt them, if it is necessary for the planned procedure.   Learn how to perform a scout exposure.   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 After the stereo exposure has been completed, the images are shown in the image area. All tools, for example zooming and measuring, are deactivated after a stereo acquisition. You can start targeting immediately. Please note: No change of the compression force shall be done after setting the targets.     Before you can start the actual biopsy, please follow the steps below.  Inform the patient that the needle holder will automatically move to the target position.  Insert the needle guide and the biopsy needle with the selected sizes into the needle holder. To install a larger biopsy needle, move the swivel arm to the side. Learn how to move the swivel arm Learn how to move the swivel arm. The swivel arm can be moved to a specific side to install a larger biopsy needle.  Push one of the overriding buttons.  Press a button with the curved arrow from the operation keys to move the swivel arm.  Briefly press the single touch button to return to the 0° position.  Please note:  Ensure that swivel arm is in in the 0° positon again before acquiring the next image.  Ensure that the biopsy needle does not touch the swivel arm.  You can now perform the biopsy of the suspicious lesion. At the end of the biopsy, remove the needle from the patient's breast. After the biopsy, the tissue samples can be analyzed as part of the same examination: with the biopsy unit and the breast compressed with the biopsy unit without the biopsy unit In this video, you will learn how to examine the tissue samples with the biopsy unit and the breast compressed.     Learn how to attach the specimen cup Learn how to attach the specimen cup.     As a prerequisite for a biopsy workflow, the used needles must be configured prior to the examination. To guarantee precision of the biopsy examination, you have to perform a daily calibration check with the biopsy settings and the biopsy phantom.   General note: For a stereotactic biopsy workflow, the acquisition of a scout image and a stereo pair is mandatory. Depending on your workflow needs and specific country regulations, further images may be required. Therefore, you can acquire subsequent stereo pair images, for example: You can use a stereo pair to check the correct positioning of the needle. You can also use a stereo pair to check if all suspicious lesions have been removed during the biopsy. In this online training, you will learn about the standard biopsy workflow with the acquisition of a scout image and one stereo pair only. When all the required tissue has been removed, decompress the breast. Use the compression control knobs or the foot switches to move the compression plate upwards. Please note: If required, you can acquire a subsequent stereo pair before you decompress the breast to check if all required tissue has been removed to document the position of the clip in the biopsy area To end the examination, click the respective button in the Close Patient subtask card. Please note: Once you have ended a biopsy examination, it cannot be re-entered.