MAMMOMAT Inspiration Biopsy Workbook

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More: Personalized More: More: Superior Clinical Performance More: Routine Expertise Confidence 2 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 _______________________________ 3 3 Table of Contents Learning Materials ................................................................... 5 Introduction............................................................................. 6 Agenda .................................................................................... 7 Topics..................................................................................... 7 Day One............................................................................... 7 Day Two............................................................................... 7 Day Three ............................................................................ 7 Day One: System Overview ................................................. 8-10 Objectives .............................................................................. 8 Switching On/Start-Up............................................................. 8 Attaching the Biopsy Unit ..................................................... 8 Needle Holders..................................................................... 9 Safety Switch ....................................................................... 9 Removing Biopsy Unit......................................................... 10 Day One: Key Hardware Features...................................... 11-21 Overview.............................................................................. 11 Biopsy Unit ........................................................................... 11 Compression Plates ............................................................... 12 Force Conversion Chart ......................................................... 13 Calibration....................................................................... 14-15 Daily Check...................................................................... 16-17 Weekly Phantom ................................................................... 18 ACR Requirements................................................................. 18 Radiologic Technologist ACR Quality Control Tests .................. 19 Biopsy Procedure .................................................................. 20 Needle Localization Procedure ............................................... 21 Day One: Exercises................................................................. 22 Day Two and Three: Review and Patient Studies .................... 23 Appendix A: How to Re-Reference .................................... 24-27 Notes ................................................................................ 28-29 Patient Transfer Examination Edit View Image Tools Scroll Options Help R.C.C. W 4096 C 2048 10985 Fletcher Examination R-CC Mae Scale 102% o.p. 1265 Open patient 4 LES Viewi Pro cedure: Learning Materials The following instructional materials are referenced throughout this training session: System Owner Manual Provides the necessary knowledge and expertise to accurately and safely operate the system. Training Workbook Supports the Systems Owner Manual through “big picture concepts,” examples, stories, interactive exercises, and references to on-line documentation. This book is yours to keep so you can write in the book. Step-by-Step These documents provide quick reference tips to aid customers in “just-in-time” learning opportunities. 5 Introduction The purpose of this training session Learning Objectives is to provide you with the skills and The learning objectives are: • knowledge to operate your system. Power up and activate the MAMMOMAT® Inspiration Biopsy Unit • Utilize key hardware features of the MAMMOMAT Inspiration Biopsy Unit • Identify and perform the required QC tests for the MAMMOMAT Inspiration Biopsy Unit • Perform a Biopsy Procedure • Perform a Needle Localization Procedure • Correctly power off the MAMMOMAT Inspiration Biopsy Unit 6 Agenda Agenda Topics Day One Day Two • Introduction of MAMMOMAT Inspiration • Review of MAMMOMAT Inspiration Biopsy Unit Biopsy Unit • Review of the AWS and Integrated Control Panel • Attaching the Biopsy Tower • Review of Required QC Tests • Explanation of the Three Needle Holders • and their Usage Perform Simulated Biopsy Procedure • Perform Simulated Needle Localization Procedure • Operation of Safety Switch • Question and Answer Period • Removing the Biopsy Unit • • Key Hardware Features Set Up for Biopsy Procedure • • Required QC Tests Perform Scheduled Biopsy Procedures • Biopsy Procedure Day Three • Perform Simulated Biopsy Procedure • Review of Required QC Tests • Perform Simulated Needle Localization Procedure • Question and Answer Period • Review ACR Requirements for Radiologists and • Set Up for Biopsy Procedure Technologists • Perform Scheduled Biopsy Procedures 7 Day One: System Overview The training program occurs over a three-day period; a total of 24 hours. Further details on location and specific times are included in your registration confirmation. Notes Objectives After this session, you will be able to: • Power up and activate the MAMMOMAT Inspiration Biopsy Unit. • Utilize key hardware features of the MAMMOMAT Inspiration Biopsy Unit. • Identify and perform the required QC tests for the MAMMOMAT Inspiration Biopsy Unit. Switching On/Start-Up The MAMMOMAT® Inspiration system is started from the switched off mode. Starting the system from the switched off mode. • Press the power ON button on the Control Panel. Once the HIPPA screen appears, click the OK button. Sign in with your User Name and Password. Please note, both are case sensitive. • This process takes approximatel 5-10 minutes to be completed. Wait until the RED X is gone in lower right corner between the pie and the computer. This means your system has completed start up Complete the 90 - 90 “Single Touch” activation. Notes: For detailed start-up instructions and a visual diagram of the system, please see: • Online User Manual located in the Help dropdown of your Acquisition Workstation (AWS) Biopsy Tower Attaching the Biopsy Unit • Slide biopsy unit over the detector until it engages (clicks) into position • Insert the biopsy unit plug into the port located below the detector until it locks in place Compression Paddle • Verify the hand box is plugged into the biopsy unit • Attach the biopsy compression paddle and face shield • Attach appropriate needle holder Carbon Fiber Cover (standard or vacuum assist) 8 Day One: System Overview (continued) Needle Holders Standard Vertical Horizontal Needle Holder Needle Holder Needle Holder Needle Loc Calibration Vacuum Thinly Daily Check Assisted Compressed Breasts Safety Switch Notes Safety Switch to Safety Switch to Side Front Position allows needle to be inserted and Allows for holder movement is disabled. movement 9 Day One: System Overview (continued) Removing Biopsy Unit Notes 1. Remove the needle. If necessary, move the swivel arm to the side using the single-touch button. 2. Remove biopsy compression paddle and biopsy face shield. 3. Bring tube head to zero using single-touch button. 4. Unplug biopsy unit cable from underneath detector. 5. Place hand box on biopsy unit. 6. Press and hold both “unlock” buttons located on the gray handrails of the biopsy unit. 7. Remove biopsy unit and store. Follow Shutdown Procedure for Inspiration Mammography Unit. Unlock Button Biopsy Cable - (1) Hand Box The hand box is used to control the needle positioning device. Movement in x direction Movement in y direction Movement in z direction 10 Day One: Key Hardware Features Overview Notes This section will discuss key hardware features of the Biopsy unit and the Hand Box. Biopsy Unit Needle Holder Single-Touch Button Compression Paddle (1) Biopsy Unit Unlock Button O Biopsy Cable O 11 Day One: Key Hardware Features (continued) Compression Plates Notes Fenestrated Fenestrated paddle (with the hole): Used for a vertical approach and needle localizations. Non-Fenestrated ............ Non-Fenestrated (without the hole): Used with the horizontal attachment. 12 Day One: Key Hardware Features (continued) Force Conversion Chart Notes Force in Kilograms (kg) Pounds (lbs.) Newtons (N) 1 2.2 9.81 2 4.4 19.61 3 6.6 29.42 4 8.8 39.23 5 11 49.03 6 13.2 58.84 7 15.4 68.65 8 17.6 78.45 9 19.8 88.26 10 22 98.07 11 24.2 107.87 12 26.4 117.68 13 28.6 127.49 14 30.8 137.29 15 33 147.1 16 35.2 156.91 17 37.4 166.71 18 39.6 176.52 19 41.8 186.33 20 44.1 193.13 For more details and diagrams of the key hardware features, please see the Online 13 User Manual located in the Help dropdown of your Acquisition Workstation (AWS). Day One: Key Hardware Features (continued) Calibration (Yearly or when Daily Check fails) Notes 1. Attach Biopsy Unit. 2. Click Patient>Biopsy Calibration. 3. Follow on-screen instructions (no paddle or paddle holder used position, insert the two bushings and Standard Needle Holder, flip safety switch to the front). Open patient Acquisition Calibration Please ensure that no paddle is mounted and the needle is removed from the needle holder, Afterwards press the Move to position button, Move to position Post processing Close patient 4. Click “Move to position” 5. Turn safety switch to the side and insert calibration needle. 6. Raise the bottom needle guide holder to the upmost position. This will allow you to see the tip of the needle on image. 7. Acquire Scan. (Do not lift off of exposure button/foot pedal until both images are acquired and the tube returns to the zero position). 8. Follow on-screen instructions. Open patient Acquisition Calibration ase adjust the reference mark with the Point button if needed, place the target to the peak of the calibration needle on the image and press Confirm. Ref. Point Confirm 9. Click “Ref. Point”. 10. Right click on the image and select zoom from point. Left click on the reference mark in the left image and then the same area on the right image to magnify the reference point. Click the ESC button on the keyboard to deactivate the zoom from point. For more detail and instructions on calibration and daily check, please refer to the 14 operator’s manual pages 15 and 16. Day One: Key Hardware Features (continued) Notes 11. Left click on the reference mark on the left image to adjust if needed. Adjust the mark on the right image as well and if needed. 12. Click “Confirm” 13. Right click on image “home zoom pan” 14. Right click on image “zoom from Point”. Left click on the tip of the needle in the left and right images to magnify. Click the ESC button on the keyboard to deactivate “zoom from point” 15. Place a target onto the needle tip in both images and hit confirm. 16. Click “Move to position”. 17. Remove needle. 18. Flip Safety Switch to front position or override by leaving the calibration needle in place and pushing the safety switch to the back. The holder will move to the next calibration position.. 19. Proceed in the same way for the second and third stereo pair as shown in the calibration window. The reference point won’t be checked again. WH AWS i Calibration has been successfuly ended. Please remove the needle from the needeholder if it is still inserted and after that press OK to close the calibration. OK 20. “Calibration Successfully Ended” box will appear. 21. Click “Ok.” 22. Remove needle. 23. Flip safety switch to the front. Holder will go to the “Home” position. 15 Day One: Key Hardware Features (continued) Daily Check Notes 1. Attach Biopsy Unit, Biopsy Paddle Holder, remove the Plastic Paddle, and attach the Standard Needle Holder and bushings. 2. Place pins into the Biopsy Phantom Pin Holder and tighten. 3. Attach the Biopsy Phantom by bringing the Paddle Holder down until phantom touches detector. 4. Register patient. 5. Choose “Daily Biopsy Check” located in the “Procedure” dropdown. 6. In the “Acquisition Tab” of the subtask cards, select “Daily Test Biopsy” from the IPPG drop down. In the Control Panel, from the drop down, change from OpDose to Manual, and very the technique displayed is 23kVp, 5 mAs and Mo/Mo. Please open and close the safety switch on the Biopsy Unit. Open patient Images Acquisition Hat Regina Acquisition mode: XP 002 Stereo Procedure:" Biopsie_RCC. IPPG: F1 Gent cc Daily.test. Biopsy F1 Gent -C F1 Imp ce F1 Mag Tomo proj Stereo OPDOSE .. 29 KV - MoiRh Post processing Close patient 50-59 mm 52 mm Advanced 7. Acquire “Scout” image. Select “Ok” to continue, or “New” to repeat the exposure. 8. Acquire the scan. Do not release the exposure button. The tube will acquire a -15 degree stereo image and then the tube will move to the +15 degree stereo for other exposure. Once the tube returns to the zero position, you can release the exposure button. 9. Check reference marks and “Confirm.” 10. Target the pin closest to the detector. If necessary, select “zoom from point”. Click “Confirm,” a dialog box should appear: “Target is out of Biopsy Range.” Click “Ok.” This verifies that the system is correctly calculating the safety distance. 11. Drag the cursor to the center target position. Click “Confirm.” 12. Highlight the target numbers (x, y, z in stereo tab in the subtask card) and click “transmit” Verify that the correct holder (standard) and needle (calibration) are selected. 16 Day One: Key Hardware Features (continued) 13. Click “Transmit,” click “Yes.” Arrows will appear in Notes the Acquisition tab while the holder is moving. Once the holder reaches the target a “Flag” is displayed next to the target on the AWS. 14. Insert Calibration Needle. 15. Touch the hand box to zero out. The tip of the needle should touch the tip of the pin targeted. If an adjustment is needed, push the safety switch to the back and adjust the needle by using the hand box. 16. Record the values displayed on the AWS and hand box in the appropriate place on the QC form. 17. Remove the needle and turn the safety switch to the front. The system will return to the home position when the study is closed. 17 Day One: Key Hardware Features (continued) Weekly Phantom Notes (optional if not ACR accredited) 1. Attach biopsy unit. 2. Register Patient. 3. In Procedure dropdown, choose “Biopsy Phantom”. 4. Verify Opdose is selected. 5. Compress stereo phantom. 6. Acquire scout image. (If not using the mini stereo phantom, you will have to acquire the image in quadrants.) 7. Score phantom. 8. End procedure and document on QC form. ACR Requirements Radiologists must be in compliance with ACR guidelines for interpreting mammography studies. Surgeons must review the mammography findings with an MQSA qualified Radiologist. Radiologist/Surgeon Initially, three hours of Category 1 CME didactic instruction in stereotactically guided biopsy. • Three supervised stereotactic procedures under qualified physician. • Completion of a residency or fellowship program that includes instruction in stereotactic breast needle procedures. • At least twelve stereotactic-guided biopsies per year are required by ACR for continued competency. • Three hours of Category 1 CME in stereotactically guided breast biopsy every three years is required by ACR. Technologist Initial three hours of Category A continuing education units in stereotactic-guided breast biopsy. • Documentation of five “hands on” procedures under the guidance of a qualified technologist or a manufacturer’s application specialist. • Participation in at least twelve stereotactic-guided breast biopsies per year. ACR Accreditation for stereotactic biopsy is voluntary at this time. Please contact the ACR for full details and any updates or changes. 18 Day One: Key Hardware Features (continued) Radiologic Technologist ACR Quality Control Tests Radiologic Technologist’s QC QC Text Description Frequency 1. Localization Accuracy Test Verifies system alignment and performance (procedure Daily before varies by manufacturer and system type) patient exams 2. Darkroom Cleanliness Minimizes artifacts on film images by maintaining the (NA if digital used) cleanest possible conditions in the darkroom Daily 3. Processor QC (NA if digital used) Ensures consistent performance of the film processor Daily 4. Phantom Images Ensures that film density, contrast, uniformity, and image quality of the X-ray imaging system are optimal Weekly 5. Screen Cleanliness Ensures that cassettes and screens are free of dust and (NA if digital used) dirt particles that may degrade image quality or mimic Weekly calcifications Viewboxes and 6. Viewing Conditions Ensures that the viewboxes and viewing conditions are (if film used) optimized and maintained at optimal levels Weekly Hard-Copy Output Quality Ensures that the quality of hard-copy output is 7. (if hard-copy produced from consistent over time and matches the gray scales Monthly digital data) presented on the CRT monitor Ensures that the mammography X-ray system and, if 8. Visual Checklist applicable, the digital imaging system are working properly and that the mechanical rigidity and stability of Monthly the system are optimal 9. Analysis of Fixer Retention in Film Determines the quantity of residual fixer (hypo) in (NA if digital used) processed film as an indicator of keeping quality Quarterly Ensures that the X-ray imaging system can provide 10. Compression adequate compression in the manual and automatic Semiannually powered mode Determines the number and causes of repeat patient 11. Repeat Analysis exposures and identifies ways to improve efficiency, Semiannually reduce patient breast dose, and cut costs 12. Screen-Film Contact Ensures that optimum contact is maintained between (NA if digital used) the screen and the film in each cassette Semiannually 13. Darkroom Fog Ensures that darkroom safelights and other light sources (NA if digital is used) inside and outside of the darkroom do not fog film Semiannually 14. Zero Alignment Test (If required by manufacturer) Verifies that zero coordinate is accurate Before each patient 15. Any additional tests required by As required by manufacturer manufacturer 19 Day One: Key Hardware Features (continued) Biopsy Procedure Notes 1. Attach Biopsy Unit, Paddle, Needle Holder, and Bushings if required. 2. Register Patient. 3. Procedure may not automatically populate from RIS.If needed, manually select the procedure from the “Procedure” drop down. Choose correct procedure. If the site does not have a mapped Stereo procedure, manually select the procedure from the “Procedure” dropdown. Choose correct procedure.. 4. Double click “Scout” Icon. (May take a minute to activate.) 5. Position the Patient. 6. Use Opdose. The compression force must display at least 15 N on tube stand. We “recommend” compression of 40-50 N during a stereo procedure. 7. Acquire scout image. Click “Ok” if scout acceptable. Click “NEW” to repeat scout. 8. Acquire the scan. 9. Check reference marks and “Confirm.” 10. Place targets on area to be biopsied in stereo pair. Click “Confirm.” 11. Highlight the target to be transmitted” 12. Verify needle and needle holder to be used. Click “Transmit”. “Blue Arrows” will appear in the acquisition tab while the holder is moving. Once the holder reaches the target, a “Flag” is displayed next to the selected target on the AWS. 13. Zero out the hand box by pressing any button on the hand box. 14. To mount biopsy device, verify needle is in the “cocked” position and move tube head out of the way by pushing and holding the “Single Touch” button. As a precaution: Push the safety switch toward the back and raise the “Z” coordinate on the Hand Box to a safe position until the radiologist is ready to insert. 15. Lower biopsy needle close to the skin to indicate where to inject the Lidocaine. Bring “Z” and tube back to the zero position. 16. Acquire stereo images. 17. Perform biopsy and acquire specimen image. 18. Deploy the clip per vendor recommendations and acquire clip placement image. 19. Move tube head out of the way, remove biopsy device, and flip “Safety Switch” to the forward position. 20. Release compression, remove Patient. Close Patient at AWS. 20 Day One: Key Hardware Features (continued) Needle Localization Procedure Notes 1. Attach Biopsy Unit, Paddle, Standard Needle Holder, and Needle loc “specific” Bushings. 2. Register Patient. 3. Procedure may not automatically populate from RIS. To manually select the procedure, click on the “Procedure” dropdown, and choose the correct procedure. 4. Double click “Scout” Icon. (May take a minute to activate.) 5. Position the Patient. 6. Use Opdose. The compression force must display at least 30 N on tube stand. 7. Acquire scout image. Click “Ok” if scout acceptable. 8. Click “NEW” to repeat scout. 9. Acquire the scan. 10. Check reference marks and “Confirm.” 11. Place targets on area to biopsied in stereo pair. Click “Confirm.” 12. Highlight the target to be transmitted, click “Transmit.” 13. Verify needle and needle holder to be used. Acknowledge the pop up box by selecting Yes or No. 14. Inject Lidocaine if desired. 15. Insert Localization needle. 16. Acquire scan. 17. Adjust Z value if needed. 18. Deploy wire and remove needle. 19. Slip wire out of bushings. 20. Flip “Safety Switch” to the forward position. Manually raise the “Z”. 21. Release compression, remove Patient. 22. Close Patient at AWS. Needle holder will move to home position. 21 Day One: Exercises Notes Day One Complete the following exercises. Exercise 1: Set the system up to perform a biopsy utilizing the Vertical and Horizontal Needle holders. Exercise 2: Perform stereo in CC projection and change to LM projection mid exam. Exercise 3: Perform a vertical approach biopsy on a phantom. Knowledge Check How many pins are targeted during Daily Biopsy Check? How many pass? 22 Day Two and Three: Review and Patient Studies Notes Day Two: Review and Patient Studies Objectives After this session, you will be able to: 1. Perform QC Tests. 2. Perform/Simulate Biopsy Procedures. 3. Perform/Simulate Needle Localization Procedures. Day Three: Review and Patient Studies Objectives After this session, you will be able to: 1. Perform QC Tests. 2. Perform/Simulate Biopsy Procedures. 3. Perform/Simulate Needle Localization Procedures. 4. Question and Answer Period. Cleaning All parts of the unit that come into contact with the Patient must be cleaned prior to examination. The plastic trays can be removed from the holder to simplify cleaning. Clean the dust from the ventilation slots on the detector on a regular basis. Caution: Using incorrect cleaning agents can accelerate the aging process of the plastics. Caution: Cleaning agents must not penetrate into the equipment. 23 Appendix A: How to Re-Reference 24 How to Re-Reference If the biopsy unit is mounted on the MAMMOMAT Inspiration, the needle holder automatically moves through the reference positions. The referencing movement of the needle holder must not be interrupted. 1. If a malfunction occurs during the referencing movement, the following window appears: WH AWS X The Biopsy Unit encountered a hardware problem during self test. Error. 7 A new Biopsy Unit referencing is required, Please remove needle and paddle and push OK to open the user interface for Biopsy Unit referencing. After successful referencing the system should be restarted. OK 2. Click on OK. The following window is displayed: Di Biopsy Referencing Tool - Microsoft Internet Explorer provided by Siemens Medical So 0 X Elle Edt Yiow Took balp Address a] CovwySul bloodarho To help protect your security, bemet Explorer has regaled ihrs he from showing arlive content hat could Appendix A: How to Re-Reference Information Ber Help 3. Open the popup menu (right mouse button) and select Allow Blocked Content. The following window is displayed: Security Warning A Allowing active content such as script and Activexx controls can be useful, but active content might also harm your computer. Are you sure you want to let this file run active content? 195 www.usa.siemens.com/healthcare SIEMENS Page 1 of 3 25 4. Click Yes. The following window is displayed: Zigma Service Modul - Microsoft Internet Explorer provided by Siemens AG Medical Solutions Zigma Webserver Bybin Version VCOOD BON+ E STATE FLOCKMOI `Bepsy Service Please check following - Biopsy # plugged System is in state where movements (compression unit, rotation. ... ) are possible - No paddle mounted - Ne obstacle on the biopsy table Start Hoferering 5. Click the Start Referecing icon Start Referecing 8. The referencing of the needle holder is started. The needle holder automatically moves through several positions. The needle holder should stop moving in the upper left-hand position. The following window is displayed: http #/zigmamu biopswaws_wait_referencing.him - Microsoft Internet Explorer provided by Siem ... -. 0 5 Zima Web server Page sent d 10:32 01 07 03 2009 Byuten Version 7000D Rt E STATE BLOCKED Back to Home Service Mode Ok confirm the Reference Position The needle guide should be in the top left inside position. Continue: Reference Postion is not ok Betry. Move to the reference position again OK Continue Retry www.usa.siemens.com/healthcare SIEMENS Page 2 of 3 26 7. Click Continue if the needle holder is not located in the upper left position Continue OR Click OK if the needle holder is located in the upper left position. OK The referencing of the needle holder was successful. The following window is displayed: Zigme Service Modul - Microsoft Internet Explorer provided by Siemens AG Medical Solutions Ziema Webserver Page cook d 10:47:33 07 08 2009 Byvion Version WOODD Std: E STATE BLOCKED Back to Home Referencing done! 8. Click the right button to close the window and the application. X The biopsy unit is ready for operation www.usa.siemens.com/healthcare SIEMENS Page 3 of 3 27 Notes 28 Notes 29 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 www.usa.siemens.com/healthcare for the most current information. Note: Any technical data contained in this Global Business Unit document may vary within defined tolerances. Siemens AG Original images always lose a certain amount Medical Solutions of detail when reproduced. X-ray Products Henkestr. 127 DE-91052 Erlangen Order No. A9113-11641-C1-4A00 Germany Printed in USA 04-2017 | All rights reserved Phone: +49 9131 84-4746 © 2017 Siemens Medical Solutions USA, Inc. www.siemens.com/healthcare Global Siemens Headquarters Global Siemens Healthcare Siemens AG Headquarters Wittelsbacherplatz 2 Siemens AG 80333 Muenchen Healthcare Sector Germany Henkestrasse 127 91052 Erlangen Germany Telephone: +49 9131 84-0 www.siemens.com/healthcare www.siemens.com/healthcare