MammoTest Turnover Workbook

MammoTest® Workbook SIEMENS www.usa.siemens.com/healthcare MammoTest Workbook Power on Sequence 1. Turn on the generator – The tube one light will flash, when it stops flashing turn on the table. 2. Turn power on to the table (if not already on) –There is a rocker switch on the back of the table near the bottom. 3. Turn on computer by pushing the black button. Logging on and off the System Logging on User name: mammotest Password: siemens Logging off 1. Click Start at the bottom left of the screen. 2. Click shut down. 3. Click shut down system. Note: Weight limit of the table is 300 lbs. Calibration of the Camera — Daily The camera must be calibrated each morning prior to use. 1. Log in with user name and password. 2. Click Utilities. 3. Click Daily Calibrate – the screen will display the message Acquiring 0.1 Sec Dark Image. The screen will next display the message Acquiring 9.9 Sec Dark Image. The screen will next display the message Please Mount The Flat Field Phantom. Waiting For Flat Image #1. 4. Click on Exposure Control then Manual. (if your unit does not default to manual) 5. Set the manual technique at the generator – ___ kv ___ mas. This was established at install by the installer or physicist. 6. Mount the flat field phantom. 7. Position the X-ray tube to 0 degrees. 8. Make 8 exposures, rotating the phantom after every 2 exposures. 9. When all eight flat images have been acquired, a dialogue box pops up with min, max, average, and RMS factors. These values must be documented on the QC form. These numbers will be very useful for service if you notice a large variation day-to-day. a. Select OK to continue after recording the values. b. Remove the flat field phantom. c. Calibration is now complete and the program returns to the Logo Screen. Troubleshooting 1. If “out of range” is displayed on the monitor, it is greater than +/-15% of the baseline values. For ACR accreditation You must document average and RMS factors on your QC form. 2 MammoTest Workbook MammoTest Target Verification — Daily The AutoGuide polar coordinate system defines the target position in terms of horizontal and vertical degrees and depth in millimeters. These parameters are known as Target Values. The purpose of the Target Verification Procedure is to ensure the system is within + or – 1mm accuracy. Target verification must be done daily before patient procedures are performed. 1. Click Utilities. 2. Choose Target Verify. 3. Choose Phantom. 4. Select needle to verify default needle. 5. Mount target verification phantom. 6. Choose Exposure Control. 7. Choose Manual (22kv @20mas 100 ma). 8. Swing tube to the left and acquire +15 image. 9. Swing tube to the right and acquire -15 image. 10. Target the tip of the center pin on the left half of the monitor screen, then mark the same point on the right monitor. 11. The target values are now displayed on the bottom of the monitor. 12. To transfer the targets to the AutoGuide, you must press the target button twice to display the current target. Target 1 will be displayed. The “D” on the AutoGuide is the adjusted depth not the actual depth. Again press and hold the enable button and press the Go To button. The AutoGuide will now move into position and “AT 1” will appear on the screen. If using the Mammotome or SenoRX device, the device must be “cocked”. Set the depth stopper to the appropriate depth and tighten. 13. Move the biopsy device to the actual depth (not adjusted depth). The needle should just touch the tip of the pin. (You must check the horizontal, vertical, and depth for accurate positioning.) 14. You must be within 1 mm for the system to pass. 15. The lateral arm should also be checked for accuracy. 16. Attach the lateral arm to either side of the table. 17. Mount the AutoGuide to the lateral arm. 18. Acquire stereo pair. 19. Target only the pin closest to the biopsy device. 20. Move the lateral arm to the other side and repeat the same steps. Troubleshooting 1. Is the biopsy device cocked? 2. Have you chosen the correct needle? 3. Did you use actual depth instead of adjusted depth? 4. Lateral arm – change needle guide. 5. Lateral arm – did you select the correct slide? Phantom Image — Weekly (optional if not ACR accredited) 1. Log in with user name and password. 2. Choose MammoTest. 3. Type Phantom in patient name and fill in all necessary information. 4. If you are sending to PACS the accession number must be typed in next. 5. Choose Done. 6. Choose Exposure Control. 7. Choose Standard. 8. Mount stereo phantom. 9. Expose scout image (if not using a mini stereo phantom, you will have to acquire the images in quadrants. The phantom image will be too large.) 10. Score phantom. 11. Choose End Procedure. 3 MammoTest Workbook Recommendation and Guidelines for Phantom — Weekly To print phantom: 1. Choose Patient Database. 2. Choose Current Patient (if this was the last patient done) or choose list. 3. Choose Archive Images. 4. Highlight the image or images to be archived and choose Done. Or, choose Archive All to archive the entire case. 5. Choose destination. a. Archival disk is the CD b. Digital laser is the paper printer c. DICOM printer is the printer on site d. DICOM network is the PACS 6. If you choose DICOM print you must select the film size, number of rows and columns, and check annotations. Then check OK. 7. One CD will hold approx. 300 images. If using the Mini Stereo Accreditation Phantom you must see: 3 fibers, 3 speck groups, 2.5 masses If using the Mammography Accreditation Phantom you must see: 5 fibers, 4 speck groups, 3.5 masses Stereo Procedure 1. Log in with user name and password. 2. If your system is equipped with a Worklist, you can click > worklist > find then select the patient to be done > accept patient, and the system will fill in most of the data for you. If not then choose: a. Click MammoTest b. Enter patient information d. Click Done 3. Acquire digital scout. 4. Choose Save Scout. 5. Choose Exposure Control and set manual technique (if desired). 6. Move tube head to the left and acquire +15 image. 7. Move tube head to the right and acquire -15 image – Mark lesion will come up by default. Mark target on the image on the left and then on the right 8. Choose Select Needle and choose appropriate needle. 9. To determine if the cutter will be completely under the skin, take the thickness of the compressed breast minus the stroke margin. The difference is the distance the lesion is from the skin. 10. Choose Done and Save to save stereo pair with target. 11. Press target button on AutoGuide– Press and hold the black enable button and tap Go To button. AutoGuide will move to proper H and V positions and “AT 1” will be displayed. 12. Move depth stopper to proper depth and tighten. 13. Mount biopsy device. 14. After needle placement take pre-fire stereo pair. 15. Select Done. 16. After advancing device take post-fire stereo pair. 17. Select Done. 18. Take samples. 19. Place clip. 20. Remove biopsy device. 21. Select Done. 4 MammoTest Workbook Important Tips and Tricks for the Mammographer • Handle the AutoGuide by the hand grip or base — do not use the depth rail. • AutoGuide movement is not possible while MammoTest table movement is enabled. • Select Exposure Control to choose between manual and AEC mode. • Before you insert the needle verify the target parameters on the AutoGuide are identical to those on the monitor. • There is no stroke margin calculation for lateral arm. • You cannot delete a patient record from the patient data base until all images associated with that patient are deleted first. If the patient has been archived, the data base entry cannot be deleted. • If using a Mammotome or SenoRx device, you should ideally have 25-30 mm of compressed breast thickness in order for the entire cutting aperture to be under the skin. • Compressed breast thickness of less than 25 mm may require a lateral arm approach. • “Air Gap” technique, attaching a paddle to the imaging plate behind the breast, will help with a thinly compressed breast (useful for lateral arm approach). • Target lesions less than 5 mm in diameter just below the lesion so that the probe doesn’t obscure the lesion. • Target lesions larger than 5 mm in the center of the lesion. • Target on scout can be used for lesions not well seen on both stereo pairs but well seen on the scout. • If targeting in full resolution, do not use the mag glass. The mag glass may be used when targeting in the “squeeze” mode. Initializing the Diskette (CD) 1. At the MammoTest screen select: a. Utilities b. Setup c. Init Volume 2. The screen will display the following prompt – Please insert the archival disk into the archival disk drive. Volume number will be _____ . 3. Insert a blank disk. Click OK. Click format. This may take a few minutes. 4. Click Continue. 5. The next message will be: The archival disk has been correctly initialized for use. 6. Remove the disk and label with the appropriate volume. Deleting Images and/or Patients 1. Patient database > Find > List. 2. You must delete images first and then the database entry. 3. Click Patient (loads automatically). 4. Delete images – all or only images you don’t want to send to PACS or printer. 5. Now you can delete from the Patient Database – select Delete Entry. 6. If you have archived the patient, you cannot delete her entry name only her images. 5 MammoTest Workbook Lateral Arm Easy to attach, useful for thinly compressed breasts. 6 MammoTest Workbook Lateral arm To attach the lateral arm, hook the lateral arm onto the peg on the side of the table you have chosen to approach from. 1. Mount the AutoGuide and plug it in. 2. Bring AutoGuide to “Home” position. 3. Take scout image. 4. Take stereo pair. 30: 45 Lateral arm targeting In order to do a full clock rotation with a vacuum assisted device, your target must be 2cm from the breast support. Latarsi Apprauch fromas Pellant's Left Side Lateral Approach from Padent's Lafi Sida roast 7 MammoTest Workbook Arm through Technique Note: Useful for reaching axillary lesions. MammoTest Choose the cut out paddle for added comfort to the patient. Target on Scout If you have acquired a scout image and a stereo pair and the lesion is only clearly visible on one stereo image, you can replace the image that is poorly visualized with the scout image. After all three images have been acquired ,choose Target on Scout. A box will prompt you to replace either stereo one or two with the scout image. The images will be swapped and you can target as usual. It is important to review images before targeting. Continue the procedure as usual, although when taking images, you will need to take the zero degree image in place of the replaced stereo image. (One image at 0° and one at either + or - 15° depending on which image was replaced). Prompts will always appear in the lower right corner of the screen. Cleaning and Disinfecting Refer to the MammoTest – Operators Manual Chapter 6.3 Cleaning and Disinfecting 8 MammoTest Workbook MammoTest Annotations 1. Patient Database 2. Find 3. List 4. Single click on desired patient 5. Click images to be annotated 6. Click Done 7. Click Annotate Images 8. Enter Text, Ovals, or other ROI tools where ever they are needed 9. Click Done 10. Click Get More Images 11. Click Archive Images 12. Select images a. If selecting single images, click Done b. If selecting multiple images, pick either Select Images to Archive or Archive All 13. Decide on method, PACS or Print a. If you want to send to PACS, click DICOM Network b. If you want to Print, i. Click DICOM Print ii. Check Print Annotations box iii. Click OK to print image with annotations Viewing Images from CD Archival Disk This process is utilizing AccuLite software to open Image files. AccuLite is loaded during formatting of your CD. 1. Initialize CD – see Initialization of CD Archiving Disk procedure. (Make sure you use long format initialization.) 2. Archive images. Here’s what you need to do to view the images from any computer. 1. Put the CD into a CD-ROM. 2. Close the CD-ROM. 3. Open Windows Explorer (double-click on My Computer desktop icon). 4. Double-click on Compact Disk (typically D:) to open (could say MammoVision). 5. Scroll till you see the AccuLite application. 6. Double-Click on the AccuLite application to open it. 7. Click Load button on the tool bar at top left of window. 8. Select Compact Disk (typically D:) as the source. Application will begin. Scanning and display all files on disk when done. 1. Doubleclick on an image to open. Remember: Once you select the image you want to view and open the file, the image will be inverted. You must: 1. Right click on the image (anywhere) and select Inverse from the drop down menu to display the image correctly. 9 MammoTest Workbook Archiving Patient Data 1. Choose Patient Database. 2. Choose Find > List. 3. Select the patient to be archived. 4. Select Archive Images. 5. Archive all or highlight images to be archived. 6. Select the destination: DICOM Network is PACS DICOM Print is the digital printer Digital Laser Printer is a paper printer Archival Disk is a CD 7. After archive is complete a dialogue box will be displayed asking if the images should be deleted. If you would like to delete the images, select Yes. Needle Localization Procedure Using MammoTest A needle localization done under stereotactic guidance is done almost the same way a stereo is. The only difference is that the depth will be set to 10mm beyond the lesion to ensure the wire is deep enough that the entire lesion will be removed. 1. Position patient. 2. Acquire scout image. 3. Acquire stereo pair. 4. Target lesion. 5. Select needle (common error). 6. Transfer coordinates. 7. On the depth stopper advance the depth 10mm beyond the value on the AutoGuide. 8. The minimum needle length is 10cm for a frontal approach and 14cm for lateral arm approach. 9. Make sure the box on top of the needle guide is pushed as far forward as possible or the depth will be off. (See image below.) 10. If the hub is not snug your depth could be off. 11. Once needle is in place do a stereo pair to confirm depth. 12. Advance wire. 13. Acquire stereo pair. 14. Remove needle. The universal holder can be mounted from the front or the back. TARGET HOHE 10 MammoTest Workbook Notes ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— ————————————————————————————————————————— 11 MammoTest Workbook On account of certain regional limitations of Local Contact Information sales rights and service availability, we cannot guarantee that all products included in this Siemens Medical Solutions USA, Inc. brochure are available through the Siemens 51 Valley Stream Parkway sales organization worldwide. Availability and Malvern, PA 19355-1406 packaging may vary by country and is subject USA to change without prior notice. Some/All of the Phone: +1-888-826-9702 features and products described herein may not www.usa.siemens.com/healthcare be available in the United States. The information in this document contains Global Business Unit general technical descriptions of specifications and options as well as standard and optional Siemens AG features which do not always have to be present Medical Solutions in individual cases. Special Systems Henkestr. 127 Siemens reserves the right to modify the design, DE-91052 Erlangen packaging, specifications and options described Germany herein without prior notice. Please contact your Phone: +49 9131 84-4746 local Siemens sales representative for the most www.siemens.com/healthcare current information. Note: Any technical data contained in this document may vary within defined tolerances. Original images always lose a certain amount of detail when reproduced. Global Siemens Headquarters Global Siemens Legal Manufacturer Healthcare Headquarters Siemens AG Siemens AG Wittelsbacherplatz 2 Siemens AG Wittelsbacherplatz 2 80333 Muenchen Healthcare Sector DE-80333 Muenchen Germany Henkestrasse 127 Germany 91052 Erlangen Germany Phone: +49 9131 84-0 www.siemens.com/healthcare www.siemens.com/healthcare 12 Order No. A9143-91959-C1-4A00 | Printed in USA 11-2009 | All rights reserved | © 2009 Siemens Medical Solutions USA, Inc.