MAMMOMAT Revelation TiCEM Examination Workflow Online Training

Welcome to the MAMMOMAT Revelation TiCEM Examination Workflow Online Training. This training will guide you through the steps of a contrast enhanced mammography examination. Please note: The information in this online training relates to software version VC10 or higher. Upon successful completion of this course, you will be able to: Load patient data from the scheduler Adjust the volume in the Contrast Condition dialog box Acquire low energy and high energy images Display TiCEM images Prepare the system for TiCEM acquisitions and change the default settings, if required Before you can start the TiCEM examination, you have to prepare the system for the procedure. To prepare the X-ray stand, please mount an appropriate compression plate and attach the standard faceshield. Overview of compression plates for TiCEM Overview of compression plates for TiCEM Compression plate Size SoftComp compression plate with high edge 12 cm x 24 cm 18 cm x 24 cm 20 cm x 26 cm Flexible compression plate with high edge 18 cm x 24 cm 24 cm x 30 cm Compression plate with low edge 18 cm x 24 cm 24 cm x 30 cm Compression plate with high edge 18 cm x 24 cm 24 cm x 30 cm Shifting paddle with high edge 18 cm x 24 cm Shifting paddle with low edge 18 cm x 24 cm Position the patient The TiCEM examination can be performed with the patient sitting or standing. Compressing the breast All preparations for the examination must have been made before the compression The breast must remain compressed until both exposures have been carried out 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.   Compress the breastHTML All preparations for the examination must be 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. To avoid misdiagnosis or unnecessary radiation or contrast agent dose due to repated image acquisition: Ensure the breast remains sufficiently compressed during the TiCEM procedure. Whenever possible, use the automatic OpComp function to ensure optimal compression.   Compression with OpComp®HTML When using OpComp® Precompress the breast to 20-40 N. It is recommended to carry out this precompression gradually by applying "pumping" technique on the foot switch, in order to maintain correct positioning of the breast and to avoid skin folds.   Perform compression by pressing and holding the foot switch until OpComp® interrupts the compression.   The force indicator on the stand display flashes when optimum compression is attained. We suggest to acquire the first projection view approximately 1.5 minutes to 2 minutes after the contrast media has been completely injected. Start patient positioning accordingly.     When you have finished all planned projection views, you can display the TiCEM images.   After the exposure, ensure that the breast is decompressed immediately, either automatically or manually. Position the patient for the next projection view immediately. To get the best possible image quality, it is mandatory that you acquire the next projection views as quickly as possible.   After you have prepared the X-ray stand, you need to load the patient data, perform contrast administration and check the default settings. The contrast agent is injected into the patient prior to the examination. You determine the period between injection of contrast agent and activation of the first exposure. We suggest that the first image is taken from 1,5 minutes to 2 minutes after the injection. Please note: Prior to the contrast media application, you can check the patient's creatinine value and you have to ask for the patient's weight to be able to determine the contrast media volume. Clarify beforehand who of your team is going to be responsible for the cannulation and for observing the patient and interaction in case of allergic reactions. Please note: The values displayed in the video are only examples and are not a recommendation.     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 Patient safety: The TiCEM option should not be used on patients with implants Inform the patient in detail about the single steps in the examination procedure. The patient needs to be prepared accordingly which will take time. Prior to the contrast media application, we suggest that you check the patient's creatinine value During the examination, one member of your team should observe and interact with the patient in case of an allergic reaction The physician is responsible for the selection of contrast agent, dose and the timing for intravenous application. Please follow appropriate medical guidelines and regard your specific country regulations As a prerequiste, you need to have the following accessories: Contrast media iodine Pre-heating cabinet to warm up the contrast media prior to the injection Power injector Needles for cannulation and all necessary accessories (for example gloves, desinfection, etc.) Saline Medicine in case of an allergic reaction (suggestion) TiCEM (Titanium Contrast Enhanced Mammography) involves the acquisition of two images using two different X-ray spectra, described as low energy (LE) and high energy (HE) acquisition, after the patient has been given an intravenous injection of iodine contrast agent. Acquisition of the low and high energy images takes place within a limited time period within the same breast compression phase. The images are combined to produce an image in which the grayscale signal is in proportion to every point in the surface concentration of the contrast agent. The aim of this application is to identify and localize lesions. The procedure workflow is identical to a 2D mammogram. For further information about contrast enhanced mammography, please also regard the Whitepaper “Contrast-Enhanced Dual Energy Mammography – Opportunities and Challenges”. Image: Courtesy of Prof. Dr. Uhlenbrock, Dortmund, Germany To end the examination, click on the respective button in the Close patient subtask card. Congratulations. You have completed the MAMMOMAT Revelation TiCEM Examination 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. General hints Patient safety Don’t use the TiCEM option on patients with implants Inform the patient in detail about the single steps in the examination procedure. The patient needs to be prepared accordingly You can check the patient’s creatinine value prior to the contrast media application Name one person of your team who is responsible for observing the patient and for interaction during the examination in case of an allergic reaction The physician is responsible for the selection of contrast agent, doese and the timing for i. v. application. Please follow appropriate medical guidelines and regard your specific country regulations   Accessories needed for a TiCEM examination Contrast media iodine Pre-heating cabinet to warm up the contrast media prior to the injection Power injector Needles for cannulation and all necessary accessories Saline Medicine in case of an allergic reaction   System preparation – Hardware Mount an appropriate compression plate Attach the standard face shield   System preparation – Contrast Conditions and Examination Settings Load the patient data from the scheduler or register the patient manually Contrast agent administration Contrast media need to be preconfigured In the Contrast Conditions window, you can Select the used contrast agent from the list View the concentration value, the volume and the flow rate and adjust the values, if necessary Set the delay time, if necessary Please note: The time since injection cannot be edited The stop watch function is for indication only. Double check the timing of the contrast agent application by an additional clock Checking examination settings Check the settings in the Open patient subtask card (operator, selected procedure, PV sequence) and adjust them, if necessary PV sequence: Start the examination with the breast in which the suspicious area is located, for example with an MLO view Please acquire the images according to the defined clinical workflow in your facility Check the settings in the Acquisition subtask card (acquisition mode, Image Processing Parameter Group (IPPG), Dual Processing Parameter Group (DPPG) and adjust them, if necessary   Patient positioning TiCEM examinations can be performed with the patient sitting or standing All preparations for the examination must have been made before the compression The breast must remain compressed until both exposures have been carried out It is possible to use the OpComp® function for compression Start positioning early enough so that the first projection view can be acquired approximately 1.5 minutes to 2 minutes after the contrast media has been completely injected   Image acquisition We suggest to acquire the first projection view approximately 1.5 minutes to 2 minutes after the contrast media injection Activate the first projection view by double-clicking on the button in the Images subtask card The detector parameters are loaded Check the exposure parameters in the generator control field Click on the “L” button in the generator control field, to see the exposure parameters for the low energy exposure Click on the “H” button in the generator control field, to see the exposure parameters for the high energy exposure TiCEM images can be taken using the OpDose®, AEC or the manual exposure mode The used anode/filter combination is W/Rh for the low energy exposure and W/Ti for high energy Keep the exposure button on the control box pressed until both views (low and high energy) have been acquired See the status of the exposure by the icons with the sand glass in the TiCEM subtask card After the exposure, ensure that the breast is decompressed immediately For best possible TiCEM image quality, position the patient for the next projection view immediately   Display and process TiCEM images – TiCEM subtask card: TiCEM low button: Display 2D exposure with the settings of a regular mammogram Insight CEM button: Display combined image (low and high energy) TiCEM Twin View button: Display the low energy image on the left side and the combined Insight CEM image on the right side of the image area Recombine button: Opens Recombination of image dialog box Select a new IPPG   End the examination Click on the End examination button in the Close patient subtask card