Quickguide Q and Q.zen Ceiling

Artis Q/Q.zen ceiling

Quick Guide Volume 1

Software VD10 and higher

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Caution

21 CFR - Federal law restricts this device to sale by or on the order of a physician.

Usability

BEFORE USING THIS SYSTEM

This system should be used only by employees adequately trained in the use of this equipment.

Before using this system, the operator should be thoroughly acquainted with the instructions for use and safety recommendations provided in this manual.

Failure to follow the instructions for use and safety recommendations provided in this manu-al can cause serious injury to the patient, to the operator or to other persons.

Original language

This Quick Guide was originally written in English.

Version

This Quick Guide applies to system/software ver-sion VD10 and higher.

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Content Overview

System Overview (Exam Room).........8

System Operation ...........................16

Examination ...................................44

Postprocessing (Exam Room) ..........84

Quantification (Exam Room) .........102

IVUSmap.......................................130

Rotational Angiography, 3D ..........142

Peripheral Angiography.................166

Troubleshooting ...........................174

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Quick Guide LayoutThis Quick Guide contains pairs of opposite pag-es. As a rule, the right page shows the steps to be performed, the left page overviews, more de-tailed information, and figures.

Text layout

Prerequisites

Instructions

List items

Cross reference

Safety information:

Warnings are preceded by a warning triangle and a signal word. It is followed by a three-level indication of the hazardous situation and possi-ble evasive action.

NoteThese texts contain tips, more detailed informa-tion, and important notes.

Caution/WarningCause

Possible consequences

Precautions or remedies

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Table of Contents

System Overview (Exam Room).....................8Overview Artis ceiling ...........................................8

System Operation .......................................16Control consoles .................................................16Table movements ...............................................19C-arm movements ..............................................23Stand movements...............................................25Programmed movements....................................27Automap ............................................................31Image size and format ........................................33Collimation and filters.........................................39Touchscreen control (TSC) ..................................42

Examination ...............................................44Registering a patient ...........................................45Preparing the patient and equipment ..................49Setting the isocenter...........................................53Checking parameters ..........................................55Fluoroscopy........................................................63Acquisition .........................................................65Alternative acquisition ........................................67Roadmap ............................................................69CLEARstent .........................................................76Display mode......................................................79Dynamic scene replay .........................................81Scene directory...................................................83

Postprocessing (Exam Room) ......................84Windowing .........................................................85Zooming/panning ...............................................87Using the pointer ................................................87DSA postprocessing ............................................88Annotations........................................................97Calibration and distances ....................................99

Quantification (Exam Room) .....................102Calibration........................................................103Quantitative Vascular Analysis (QCA, QVA and IZ3D) ........................................107

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3D vessel model in IZ3D....................................111Left Ventricular Analysis (LVA)...........................121

IVUSmap...................................................130IVUSmap examination workflow .......................131Step 1: Start IVUSmap and acquire scene...........133Step 2: Mark the vessel segment of interest.......135Step 3: Pullback ................................................137Step 4: Review ..................................................141

Rotational Angiography, 3D ......................1423D ....................................................................1463D DR ...............................................................1483D DSA .............................................................150DynaPBV Neuro and DynaPBV Body ...................1543D CARD...........................................................158DR-DYNAVISION................................................162DYNAVISION .....................................................164

Peripheral Angiography.............................166PERISTEPPING ...................................................170PERIVISION .......................................................172

Troubleshooting .......................................174System messages..............................................174Emergency operation........................................176No unit movement possible! .............................178Buffer full! - Memory full! ..................................178Stopping movements........................................180Patient rescue...................................................182Restarting .........................................................186

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Introduction

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We welcome you as a user of an Artis Q/Q.zen ceiling acquisition system from Siemens.

This Quick Guide is designed to give you quick access to information on the basic operating steps and the most important functions of your system during routine examination work.

Content Overview

The following topics are covered by this Quick Guide:

Registering and positioning patients

Procedure for standard examinations

Image postprocessing and quantification in the exam room

Procedure for advanced examinations:- IVUSmap for coregistration of an angio-

graphic X-ray image and IVUS images- Rotational angiography: DR-DYNAVISION,

DYNAVISION and 3D- Peripheral angiography with step-by-step

movement: PERISTEPPING and PERIVISION

For switching on/off, postprocessing and evalu-ation in the control room, please refer to the Artis Volume 2 Quick Guide.

For review, postprocessing and diagnosis or treatment planning also refer to the syngo Workplace Quick Guides Vol.1 + Vol.2.

NoteThis Quick Guide is only valid in combination with the Instructions for Use and the safety information contained therein.

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System Overview (Exam Room)

Overview Artis ceiling

Example: Artis ceiling with 3 monitors

(1) Stand with C-arm, X-ray tube assembly and FD

(2) Patient table

(3) Display ceiling suspension system with LCD monitors or with Large Display

(4) Footswitch for releasing radiation (program-mable)

(5) Control consoles for controlling the stand, patient table and imaging system

(1)(2)

(3)

(4)

(5)

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The Artis ceiling stand/C-arm

An Artis ceiling system is equipped with a ceil-ing-mounted stand with a C-arm.

The stand (with C-arm) is mounted on rails and can be positioned longitudinally by motor drive. The C-arm can be swiveled about its longitudinal axis by motor drive. The stand swivel and projec-tion angles can be set isocentrically.

Angulation movements are performed either by moving the inner C-arm, the orbital lift carriage on the outer C-arm, or by combined move-ments.

The X-ray tube assembly with primary collimator and the flat detector (FD) are attached to the C-arm. The FD is mounted on a lifting device for a variable SID.

Example: Artis ceiling stand with FD 30x40

(1) Flat detector (FD)

(2) Membrane keys

(3) FD slide

(4) C-arm

(5) Telescopic C-arm slide

(6) X-ray tube assembly with primary collimator

(7) Ceiling rails

(1)

(2)

(3)

(5)

(6)

(4)

(7)

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Movements of the stand/C-arm

Example: Artis ceiling Card stand/C-arm

(1) Stand longitudinal movement (on ceiling rails)

(2) Stand swivel/rotation

(3) C-arm rotation (cran/caud angulations)

(4) C-arm orbital movement (RAO/LAO angula-tions)

(5) FD lift

All movements are motor-driven.

Stand positions

(2)

(3)

(5)

(1)

(4)

Head Side

Left Side

Right Side

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Patient table

The Artis patient table is equipped with a float-ing carbon-fiber tabletop with projecting and shadow-free sections optimized for tall patients.

The table height and tabletop longitudinal and transverse positions are continuously adjust-able. The patient table can also be rotated.

The table can be equipped with a motor-driven stepping mechanism for peripheral examination techniques. A tilting tabletop is also possible (transverse or transverse and longitudinally) with the OR version.

(1) Tabletop with mattress

(2) Slidable rails for control modules and other accessories

(3) Lever for releasing the table rotation lock

Tabletop versions

Surgery table

Trumpf surgery table TruSystem 7500: Please re-fer to the Operator Manual of the manufacturer.

(1)

(2)

(2)

(3)

(2)

Tabletop neuro Tabletop wide

Tabletop narrow Tabletop long

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Movements of the patient table

(1) Tabletop transverse movement (manual)

(2) Tabletop longitudinal movement (manual or servo-assisted)

(3) Table lift (motorized)

(4) Table tilt lateral (motorized)

(5) (Reverse) Trendelenburg table tilt (motor-ized)

(6) Table rotation (motorized or manual)

Changing the tabletop

To remove the tabletop, lift it at the head end and pull it off toward the front side.

To attach the tabletop, position it at an angle so that its end is anchored in the frame and both bolts lock into the holes of the holder.Then lower the tabletop and slide it to the end position.

(1)

(2)(3)

(4)

(5)

(6)

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Trolley for control modules

Trolley for other systems

(1) Rails for control modules and other accesso-ries

(2) Grip

(3) Cable holder

(4) Holder for handswitch

(5) Castors (without brakes)

(1)

(1)

(2) (3)

(5)

(4)

(5)

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Display Ceiling Suspension (DCS)

Depending on the application, your system can be equipped with a display ceiling suspension with up to 8 LCD monitors, or the Large Display.

Using the handle, the DCS can be moved rotated and adjusted in height.

Example of DCS 3

Example of DCS extended with 4 monitors

Example of DCS with Large Display and additional color display

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Screens

The current live image is shown on the Live screen. Besides the images, acquisition data is shown.

The Reference screen shows reference im-ages.

The Assist screen shows position data, sys-tem messages and menus for unit move-ments.

Other video sources may also be configured on and connected to a monitor or the Large Display.

Depending on configuration of the Large Dis-play, there is also a message bar, e.g. on top.

Large Display

The screen of the Large Display is divided into different areas.

The screen layout of the Large Display can be configured.

You can select the screen layout of the Large Display by pressing the icon on the touch-screen or by clicking the icon on the Exami-nation task card in the control room.

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System Operation

Control consoles

Example

Depending on the type and configuration, your system consists of one grouped or several indi-vidual control modules.

There are four basic types of control modules:

(1) Table (Table Control Module TCM)

(2) Stand/C-arm (Stand Control Module SCM)

(3) Collimation and filter (Collimator Control Module CCM)

(4) Imaging system (Touchscreen Control)

The control modules are equipped with a joy-stick and several keys.

Red emergency STOP buttons

You will find emergency STOP buttons in the fol-lowing locations:

on the front side of any table control module

on the front of any stand or C-arm control module

on the front side of the emergency STOP module of the OR patient table

in the control room if an additional hand-switch, footswitch, or remote control is in-stalled there.- On the control table (Emergency STOP

module)- Or installed below the control table

(1) (2)(3) (4)

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System Operation

Triggering STOP in case of an emergency

You can stop unit movements and radiation at any time, e.g. in the following cases:

If a malfunction of the system occurs.

If a unit movement causes an emergency sit-uation, danger to the patient, to operating personnel, or to the unit.

If unwanted radiation occurs, e.g. in case a radiation release pedal jams or it is blocked by a radiation protection lead rubber skirt.

Press one of the red emergency STOP buttons immediately.- All system drives are shut down and move-

ments are stopped immediately. Move-ment can only be resumed when STOP is canceled.

- Radiation is interrupted, fluoroscopy and acquisition are stopped. However, radiation can be released again if you press the fluoroscopy/exposure release pedal again, even without canceling STOP.

- Injections1 are interrupted, but can be con-tinued without canceling STOP.

Canceling STOP

Pull the red emergency STOP button.

1 if the injector is controlled by the system

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Table control module - TCM

With the table joystick/panning knob, you can adjust the tabletop position by pressing down the joystick and deflecting it to one side.

Depending on your patient table version, one of two versions will be integrated in the table:

Keys on the table control module

Perform table lift

Perform table tilt

Select lateral table tilt- LED lights while function active.

Unlock brakes for table rotation- LED lights while function active.

Set isocenterLED lights while function active.

Lock lateral tabletop movement- LED lights while function active.

Select orientationOrientation key 24

TCM-M/S: Knob with floating tabletop (with or without ser-vo assistance)

TCM-J: Joystick on additional control console

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System Operation

Table movements

Raising / lowering the table

Press the key for the required movement and keep it pressed until the required table height is reached.- The table height is changed immediately.

Stopping in the isocenter

Set the table height for the isocenter.

Press the Isocenter key.- The LED lights up.- The current table height is saved as isocen-

ter height.- The table stops every time this position is

reached.

No stop Press the Isocenter key again.

The ISO stop function is automatically deactivat-ed when a new patient is registered.

Moving the tabletop longitudinally only

Press the key for disabling lateral movement of the tabletop.- The LED lights up.- The tabletop can only be moved longitudi-

nally when the brakes are released.

To enable tabletop movement in any direction once again:

Press the key again.

NoteThe following also applies to the Trumpf surgery table TruSystem 7500.

For operating of the additional control module and additional movements, refer to the Opera-tor Manual of the manufacturer.

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The movement of the tabletop can be config-ured by Siemens service in two ways:

Continuous holdingThe brakes are released only if the panning knob is pressed:

Switchover functionThe brakes are released and applied again:

Press the panning knob once.

Position the floating tabletop.

Press the panning knob a second time.

Table with tilt

Longitudinal tilt (transverse axis)If a tilting patient table is installed, the table-top with the patient can be tilted by ±15° to the head-up position (reverse Trendelen-burg) or head-down position (Trendelen-burg).

Lateral tilt (longitudinal axis)If the table with lateral tilt is installed, the ta-bletop with the patient can be tilted sideways by another ± 15°.

Press this key to activate lateral tilt.- The LED lights up.

NoteThe Fluoro pedal of the footswitch can also be configured by Siemens Service to release the ta-bletop brakes (dual function).

NoteIf ISO tilting has been configured, the patient an-gle is maintained when the Isocenter key is ac-tivated.

Then, the patient table follows the C-arm angu-lation.

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System Operation

Moving the tabletop

Continuous holding has been configured

Press the panning knob down and hold it down.

Move the tabletop (floating movement).

Moving the tabletop (additional control con-sole)

The correct console orientation is set. 24

Press down the table joystick and deflect it sideways.- The tabletop follows the movement.

Tilting the tabletop

Press the key for the required movement and keep it pressed until the required table tilt is reached.- The table tilts in Trendelenburg or reverse

Trendelenburg direction.- The tabletop tilts sideways if lateral tilt is

activated.

Position the tabletop horizontally

Press both keys simultaneously and hold them pressed until the movement stops au-tomatically.- The tabletop is horizontal.

CautionPatient table tilted

Patient slips from the table to the ground.

Never leave a patient unattended on the ta-bletop.

Secure the patient sufficiently with the ac-cessories.

Always keep the mattress fixed on the table-top with the Velcro.

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Stand/C-arm control module - SCM

With the Stand/C-arm multifunction joystick the stand and C-arm positions can be adjusted by deflecting the joystick in the required direc-tion.

(View from the rear)

(1) Dead man's switch for releasing move-ments

(2) Buttons on each side with the same func-tion:switching over from C-arm angulation to stand longitudinal movement

(3) Rocker switch on the back: for lifting and lowering the FD (setting the SID)

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NoteThe movement direction depends on the con-sole orientation. 24.

The speed of the movements depends on how far you deflect the joystick: maximum speed with maximum tilt.

Combined C-arm movements are possible when the operating element is deflected diagonally, e.g. 45°.

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System Operation

C-arm movements

The correct console orientation is set. 24

C-arm rotation/orbital movement (cranial/caudal/LAO/RAO angulations)

Press the stand joystick down and deflect it in the required direction.- The C-arm performs the corresponding

angulation.

Overtable/undertable conversion

You can easily move the flat detector from its position above the patient table to a position un-der the patient table.

Move the stand longitudinally to a position outside the patient table.

Draw in the tabletop (footward), if necessary.

Rotate the C-arm about its transverse axis.

Take care to avoid possible collisions.

CautionContrast media or blood may seep into the sys-tem.

Risk of system malfunction and danger of in-fection

Use sterile covers.

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Keys on the stand/C-arm control module

Select programmed position- LED is lit while function active.

Select system position- LED is lit while function active.

Store position- LED is lit while function active.

Set zero stop- LED is lit while function active.

Select orientationOrientation key 24

Orientation key

The orientation key causes movements to be made in the same direction as the joystick of the respective control console is deflected.

You can change the orientation of the control console by pressing the key for more than 3 s. The illuminated LED indicates the active posi-tion.

Control console to the right of the tabletop(Default position)

Control console at the foot end of the table-top

Control console to the left of the tabletop

Control console at the head end of the table-top

If your system is equipped with a laser position-er, it can be switched on and off by pressing the orientation key for less than 3 s.

Select direct positions I, II, III- LED is lit while function active.

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System Operation

Stand movements

Positioning the C-arm longitudinally

Press one or both side buttons on the stand/C-arm joystick, press the joystick down, and deflect it to the left or right.

The C-arm moves to the left or right accordingly.

The movement stops automatically when the left or right end position is reached.

Stand swivel

The top stand can be swiveled about the patient table.

Swiveling the stand

Press one or both buttons on the side of the corresponding stand joystick, press down the joystick and deflect it backward or for-ward.- The stand swivels clockwise or counter-

clockwise.- The C-arm remains in the same position in

relation to the patient if the Isocenter key has been activated.

- The stand automatically stops in the basic positions.


Head Side

Left Side

Right Side

counter-clockwise

clockwise

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System and programmed positions

System Positions These are basic system positions.

Programmed Positions You can save a number of positions that you require for examinations.

Programmed stand, C-arm, and table move-ments are initiated as follows:

1. Select system or programmed position

2. Confirm target position

3. Move to target position

The speed of the movements depends on how far you deflect the stand/C-arm joy-stick: maximum speed with maximum de-flection.

If you release the stand/C-arm joystick or deflect it in a different direction, all unit movements are stopped.

If a collision protection device (collision sen-sor) responds during unit movements, all movements are stopped immediately.

Direct positions I, II, and IIIYou can also save three most fre-quently used positions that you re-quire for examinations.

NoteUse the Patient Transfer position for cardio pul-monary resuscitation (CPR).

NoteInformation about the movement sequence is shown on the Assist screen.

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System Operation

Programmed movementsSelecting the target position

Press the required position key.

The corresponding menu appears on the Assist screen.

Artis ceiling System Positions

Select the required target position by deflect-ing the stand/C-arm joystick backward or forward repeatedly.

Confirm the target position by pressing one (or both) side buttons.

Moving to the target position

Press the stand/C-arm joystick down and de-flect it to the backward until the target posi-tion has been reached.

Or, if hands free movement is configured:

Press the configured hands free pedal on the footswitch.


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What is stored?

All data important for imaging geometry are stored:

Stand and C-arm position

Table height and tilt (configurable by Sie-mens Service)

SID, zoom stage, collimation and filter posi-tions

NoteProgrammed positions can be protected against deletion or overwriting by Siemens Service.

Such positions are used for 3D examinations, for example.

They are marked by a lock symbol and cannot be overwritten.

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System Operation

Storing programmed positions

Move the unit to the required position.

Set the primary collimator and the filter dia-phragms.

Press the Store key.- The Programmed Positions menu appears

on the Assist screen.

(Schematic example without clinical meaning)

Select the required memory position (num-ber) by deflecting the stand/C-arm joystick backward or forward repeatedly.

Press one or both buttons on the side of the stand/C-arm joystick.

Storing system positions with shortcut (direct positions I, II, III)

Move the unit to the required position.

Press the store key.- The LED on the key lights up.

Press the required position key.

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The Automap feature allows you to restore the acquisition position of an existing reference im-age or to display the reference image of the cur-rent system position.

Automap is executed only if:

the reference image was acquired with the same or a similar acquisition system (the same Artis C-arm system and patient table)

the current patient position is identical with the stored patient position.

NoteAutomap is not possible for images of other Sie-mens systems, other manufacturers or other modalities such as CT/MR).

Automap is not possible when a reference im-age of plane B from a biplane system is selected on a single plane system.

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System Operation

Automap

Moving to the system position of the refer-ence image

Select the required reference image.

Press the System Positions key.- The LED on the program key lights up.- The corresponding menu appears on the

Assist screen.

Select the Automap position by deflecting the stand/C-arm joystick backward or for-ward repeatedly.

Confirm the position by pressing one or both buttons on the side of the stand/C-arm joy-stick.

Continue as described from Moving to the target position 27 onward.

Displaying the reference image for the cur-rent system position

Press this icon on the touchscreen.- The matching reference image is displayed.- If there is no reference image matching the

current system position, a message will appear.

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FD 20x20

Membrane keys for FD lift

FD 26x30 + FD 30x40

Membrane keys for C-arm and FD movements

Version 1

Version 2

C-arm rotation (cran/caud angula-tions)

C-arm orbital movement (RAO/LAO angulations)

Longitudinal C-arm movement

- Laser positioner light on/off

FD rotation (setting portrait/land-scape)

FD lifting and lowering - setting the SID

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System Operation

Image size and formatFD lift / Setting the SID

The image receptors are mounted on slides so that the distance from the X-ray source to the image receptor plane (SID) can be changed.

Press the rocker switch on the back of the stand/C-arm joystick.- Upper switch: increase SID- Lower switch: decrease SID

Or

Press the membrane key on the flat detector.


NoteWhen the SID is changed or the FD is rotated, collimation is automatically readjusted.

The image on the screen is changed accordingly so that the image always has the standard orien-tation regardless of the FD rotation.

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Collimator control module (CCM)

Card collimator control module Angio collimator control module

(1)

(2)

(1)

(2)

Card collimator Angio collimator

one wedge filter two wedge filters

no finger filter one finger filter

- Additional keys

Lower joystick controls rectangular diaphragm

Upper joystick controls the wedge filter.

Lower joystick controls rectangular diaphragm

Left upper joystick con-trols left-hand wedge fil-ter.

Right upper joystick con-trols right-hand wedge filter.

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System Operation

Keys on the collimator control module

With the keys on the collimator control module you can select different collimator and filter functions and set the image input format:

Open collimator leaves completely and re-move filter diaphragms

Reset collimator leaves and filter diaphragms

Switch over image input format/zoom stage

Switch over wedge/finger filter1

Collimator/FD rotation

1 with Angio collimator only

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Rotating the FD / Setting portrait/landscape

The 30x40 flat detector has an edgewise image format.

Multispace: The image rotation caused by swiveling of the stand is normally compen-sated automatically by collimator rotation.The image on the screen is automatically aligned and always displayed as if the patient were standing in front of the examiner.

The FD and also the collimator can be rotated by 90 degrees for best view of the region of interest.

Zoom stage Input field (diagonal)

FD 20x20 FD 26x30 FD 30x40

Nominal format / zoom 0

25 cm 39 cm 48 cm

Zoom 1 20 cm 32 cm 42 cm



Zoom 4 - 16 cm 16 cm

Zoom 5 - 10 cm 11 cm

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System Operation

Manual override: Rotating the image clock-wise

Press the top key and keep it pressed.- The upper LED lights up.- The image rotates clockwise.

Manual override: Rotating the image coun-terclockwise

Press the bottom key and keep it pressed.- The lower LED lights up.- The image rotates counterclockwise.

Changing from portrait to landscape or vice versa

Press this key on the FD.

Or (only if no manual image rotation is active):

Press one of these keys on the collimator con-trol module shortly.

Selecting the image format/zoom stage

Press the - or + key on the collimator control module.- The zoom stage is reduced (= larger input

field) or enlarged (= smaller input field) by one step.

- The size of the active input field is shown on the Assist screen.

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Collimator and filter joysticks

The joysticks are used to set the primary collima-tor and filters by deflecting them:

(1) the wedge and finger filters with the upper joysticks

(2) the rectangular diaphragm with the lower joystick

Pressing the joystick resets the settings selec-tively.

NoteThe behavior of the collimation when changing the zoom stage can be configured in different manners.

Please ask Siemens Service.

NoteThe speed of the collimator leaves depends on how far you deflect the joystick: maximum speed with maximum deflection.

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System Operation

Collimation and filters

Rectangular collimation

You can set the rectangular diaphragms with the lower joystick on the collimator control module:

Deflect the collimator joystick in the required direction.- The position of the collimator leaves is

shown in the live/LIH image.

Resetting the collimation

Press the collimator joystick down.- The collimator leaves are opened com-

pletely.

open horizontally close horizontally

open vertically

close vertically

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Filter diaphragms (wedge and finger filters)

To compensate for extreme contrast differenc-es, you can use the semitransparent filter dia-phragms (wedge and finger filters). The filters can be positioned anywhere in the image.

Wedge filters for example, for DSA or cardiological exami-nations

Finger filter (finger-shaped graduated dia-phragm filters) for example, for DSA aortic arch or peripheral DSA of both legs

Cardiac Systems equipped with a Card collimator have only one (single) wedge filter.

The wedge filter is set with the upper joystick on the Card collimator control module.

Angio The wedge filters are set with the upper two joy-sticks on the Angio collimator control module.

The finger filter is also set with the upper two joysticks on the Angio collimator control mod-ule.

The LED on the wedge/finger filter key on the Angio collimator control module indicates the selected filter diaphragm type.

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System Operation

Setting the wedge filters

The LED for the wedge filters is lit.1

Deflect the joystick in the required direction.- The position of the wedge filters is shown

in the live/LIH image.

Setting the finger filter1

The LED for the finger filter is lit.1

Deflect one joystick in the required direction.- The position of a finger filter is shown in

the live/LIH image.

Resetting the filters

Press one of the two joysticks down.- The filter diaphragms are moved out of the

beam path.

1 with Angio collimator only

Left or only joystick/filter Right joystick/filter

move to the left

move to the right

rotate counterclockwise

rotate clockwise

move to the left

move to the right


rotate clockwise

Left joystick Right joystick

move to the left

move to the right


rotate clockwise

move to the left

move to the right


rotate clockwise

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Touchscreen control (TSC)

(1) Touchscreen

(2) Mouse joystick

Mouse joystick

Input areas

(1) Left mouse joystick button: Select button

(2) Middle mouse joystick button: Store Reference button

(3) Right mouse joystick button: Close/Cancel button

(1) (2)

(1) (2) (3)

Example

In the stack of task cards, you will find buttons grouped by function.

Frequently required func-tions can be found out-side the card stack.

NoteYou can display a tool tip for every button by pressing the question mark button first.

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System Operation

Selecting a task card

Press the tab of the task card you require on the touchscreen.- The task card you have selected automati-

cally moves to the foreground.

Selecting a function

Press the button.

Configuring the touchscreen layout

You can configure the assortment of most of the buttons by using the TSC Configurator.

Select Options > Configuration in the main menu on the system console.

Double-click the TSC Configurator icon.

For easier operation, the possible joy-stick functions are displayed on the live screen in the examination room. If a joy-stick function is selected, it is indicated at the bottom of the control area.

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Examination

Default patient

An emergency patient is automatically regis-tered each time the system is restarted. It allows you to perform fluoroscopy and acquisition im-mediately after switching on the system as soon as the imaging system is ready.

An emergency patient is also registered each time a patient is closed.

NotePatient name, patient ID, date of birth and sex are used for unique identification of a patient in the databases and on archive media.

NoteIf you want to register the whole patient list of the day, you can preregister the patient.

Click Preregister after entering the patient data.- The patient is put in the Scheduler.

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Examination

Registering a patientTaking over patient data from the RIS

The Scheduler will automatically be updated with registration information at fixed intervals, as configured in your system.

Press the Patient Browser (Num .) key on the symbol keypad.- The Patient Browser window appears.

Double-click the Scheduler icon to update it and then open it.

Double-click the patient to be examined.- The Patient Registration window opens.

Add any required data.

Registering an emergency patient

Select Patient > Emergency... from the main menu or from the Patient Browser.- The Emergency Registration window is

displayed.

Enter the Date of Birth and the Sex of the pa-tient (if known) and select the Patient posi-tion1 from the list (data shown in boldface type are mandatory entries).

Registering a patient manually

Press the Patient Registration (Num 0) key on the symbol keypad.- The Patient Registration window opens.

Enter the data (data shown in boldface type are mandatory entries).

Select the required exam program from the Study list.

Select the Patient position from the list.1

1 Not required for cardiac examinations

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NoteWhen the system is in BYPASS FLUORO mode, or during radiation, the patient cannot be regis-tered for examination.

In this case, click Preregister.

CautionThe system assigns patient orientation labels to the images depending on patient position se-lected during patient registration.

Danger of treatment of the wrong side.

Do not acquire images with the patient posi-tioned different from the patient position se-lected during patient registration.

CautionData collision between Sensis and Artis.

Patient registration on the Artis causes incon-sistent patient data.

Register patient only by Sensis.

NoteIf you are using the Sensis Information System, you must select an examination type from the Study selection list.

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Examination

Registering the patient and starting examina-tion

Click Exam.- A dialog box is displayed in which you must

confirm the patient position.1

Click Confirm if the patient position is cor-rect.- The patient is registered.

The Examination task card is placed in the fore-ground and you can start the examination im-mediately.

Taking over patient data from Sensis

Select Patient > Register... in the main menu on Sensis.

Enter the data (data shown in boldface type are mandatory entries).

Select the examination type you are going to perform from the Study list.

Click Exam.- The patient is registered on Sensis and on

Artis.

1 Does not appear, if only the Cardiac application profile is configured. Also does not appear on Sensis.

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NoteDuring transfer and positioning of the patient, you can block motorized movements in order to prevent unintentional unit movements.

NoteIn some cases, for instance when the patient is repositioned or while cleaning, you can block ra-diation to prevent it from being released inad-vertently.

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Examination

Preparing the patient and equipmentPositioning the system for patient transfer

Press the System Positions key.- The LED on the key lights up.

The System Positions menu appears on the Assist screen.

Select the Patient Transfer position by de-flecting the stand/C-arm joystick backward or forward repeatedly.



Transferring and positioning the patient

Attach the accessories required for position-ing to the patient table and ensure that the accessories are attached securely.

If necessary, temporarily remove the control consoles from the repositioning area.

Transfer the patient using positioning aids.

Position the patient to feel comfortable.

Make sure that no parts of the body of the pa-tient, in particular, arms, legs, and hair, are protruding over the edge of the tabletop.

Remove any interfering metal parts and radi-opaque objects from the table.

If necessary, immobilize the patient using the appropriate accessories.

Attach and position the required radiation protection accessories.

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NoteDuring examinations, always make sure that there are no unwanted objects in the beam path.

NotePlease note that the collision computer does not take account of accessories.

NoteThe ECG cables could become tangled with or be broken by moving parts, e.g. the X-ray tube, dur-ing C-arm angulation.

Pay attention to the ECG cables during unit movements.

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Examination

Setting the examination position

Press the System Positions key.- The LED on the key lights up.

The System Positions menu appears on the Assist screen.

Select the required position by deflecting the stand/C-arm joystick backward or forward repeatedly.



Attaching the ECG

For ECG monitoring of the patient or ECG-gated fluoroscopy and acquisition:

Connect the ECG electrodes and cables in such a way that they do not appear in the beam path.

Check the connection of the gating signal from the ECG unit to the system if the ECG unit is not permanently installed.

Check the equipotential equalization.

Prepare for pressure measurement.1

Adjusting the units (stand and table)

Adjust table height and position the tabletop.Table movements 19

Position the stand and the C-arm as required.Stand movements 25C-arm movements 23

1 Only required for cardiac examinations

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Isocenter

To ensure that you do not have to readjust the table height during an examination with differ-ent angulations and to ensure optimum evalua-tion results, the organ of the patient, e.g. heart, or region of interest must be positioned in the isocenter of the C-arm.

(1) Focal spot of X-ray tube

(2) Isocenter

(3) Image receptor plane

(4) TOD (Table-Object Distance)

The Assist screen shows the distance between the tabletop (without mattress) and the object of interest in the isocenter.

In this way, you can position the patient without fluoroscopy.

NoteDepending on mattress thickness and patient thickness, isocentric movements are restricted.

(1)

(2)

(3)

(4)

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Examination

Setting the isocenterPositioning the patient approximately (with-out fluoroscopy)

Place the C-arm in frontal position, if it is not already positioned there.

Roughly center the organ in the beam path by adjusting the tabletop.

Estimate the distance of the organ to be ex-amined from the tabletop (T.O.D.).

Set the table height so that the required dis-tance is shown on the Assist screen.

Positioning an organ in the isocenter with flu-oroscopy

Place the C-arm in a.p. position.

Select the zoom stage:- Zoom 0 with FD 20x20- Zoom 1 with FD 30x40

Perform fluoroscopy in the a.p. position: for cardiac acquisition with deep patient inspira-tion.Press the FLUORO footswitch.

Position the tabletop so that the organ of in-terest is centered.

If necessary, activate the radiation field limi-tation and collimate the object.

Place the C-arm in lateral position.

Perform fluoroscopy briefly:Press the FLUORO footswitch.

Center the organ in the lateral beam path by raising or lowering the table.

Setting the isocenter

Press the Isocenter key.

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Patient position

Image mirror/flip preselection

You can flip next images to be acquired so that the catheter moves in the same direction in the image.

CautionThe system assigns patient orientation labels to the images depending on patient position se-lected during patient registration.

Danger of treatment of the wrong side.

Do not acquire images with the patient posi-tioned different from the patient position se-lected during patient registration.

CautionMisusing the patient position to flip an image

Risk of misinterpretation and incorrect diag-nosis

Always enter the patient position correctly.

CautionImage flipped

Confusion between up/down/left/right can cause incorrect diagnosis!

The examiner is responsible for using the func-tions and interpreting the images correctly and the consequences resulting from it.

Restore the original image orientation at the end of the examination.

NoteIf you want to flip images that have already been acquired, you can do that on the PostProc task card in the control room.

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Examination

Checking parametersChecking/changing the patient position

Settings task card

Select the required new patient position.- The new patient position is registered and

displayed.

Flipping the next image/scene

Settings task card

Press this button.

Press the required flipping buttons.

The next images to be acquired are flipped.

Possible image flipping functions

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Exam set and acquisition program

Acquisition and fluoroscopy/roadmap programs are arranged in exam sets.

An exam set comprises:

up to 16 acquisition programspossibly 1 alternative acquisition program

3 fluoroscopy programspossibly 3 assigned roadmap programs

NotePress the Acquisition Overrides button, to se-lect a different scene length or measuring field.

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Examination

Selecting the acquisition program/exam set

Exam task card

Press this icon next to the currently selected exam set.- A selection of available exam sets and

assigned acquisition programs appears.

Example

If necessary, scroll using the arrow up/down buttons.

Press the button of the required new acquisi-tion program.- The new acquisition program is activated

and the dialog is closed.

Or

Press this button in order to display more exam sets.

Press the button of the required new exam set.

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Example

Example

Example (Expert layout)

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Examination

Changing the acquisition program in the cur-rent exam set

Exam task card

Press the drop-down button next to the ac-quisition program.- The available acquisition programs of the

exam set are displayed.

Press the required acquisition program.

Changing the acquisition frame rate

Exam task card

Press the frame rate button to display all available frame rates.

Press the required frame rate.

Or (if configured)

Press an arrow button next to the frame rate to switch to the next higher or lower frame rate.

Selecting/editing the series description

Exam task card, Expert layout

Press the drop-down button next to the cur-rently selected series description.- The available series description texts are

displayed.

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Example

Example

NoteThe fluoroscopy/roadmap programs are always available in three versions, which usually differ with regard to their dose.

NoteThe fluoroscopy programs automatically change to Roadmap programs when Roadmap is select-ed.

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Examination

If necessary, scroll using the arrow up/down buttons.

Press the required series description text.

Changing the fluoroscopy/roadmap program

Exam task card

Press the drop-down button next to the fluo-roscopy/roadmap program.

Press the required fluoroscopy/roadmap pro-gram.

Changing the pulse rate

Press the pulse rate button to display all avail-able pulse rates.

Press the required pulse rate.

Or (if configured)

Press an arrow button next to the pulse rate to switch to the next higher or lower pulse rate.

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NoteYou can store the last fluoroscopy (or roadmap) as a scene.

NoteThe system is equipped with an integrated timer for exact time measurements, i.e. for dilata-tions.

NotePress this icon, if the message box for the fluo-roscopy signal appears, or if you want to reset the signal before intervening, for example.

CautionIf any radiation indicator lights up although you have not pressed a button:

Danger due to radiation

Press the emergency STOP button.

Notify Customer Service.

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Examination

Fluoroscopy

Press the FLUORO pedal of the footswitch.

The radiation indicators light up during radia-tion.

Fluoroscopy images appear on the screen.

In each case the last fluoroscopy image remains displayed on the screen after fluoroscopy is completed (LIH = Last Image Hold).

CautionIf poor image quality results from the set param-eters:

Risk of poor image quality and unnecessary exposure to radiation

Stop radiation immediately and check the pa-rameters or call Service.

CautionMalfunction in the detector cooling system and display of the message “No X-Ray available in ... min.”

Risk that the examination cannot be complet-ed

When the countdown has elapsed, radiation will no more be possible.

Complete the current examination within the remaining displayed time.

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NoteYou can store any image currently displayed, even during fluoroscopy, as a new image (Store Monitor), or as a reference image.

You can also press the middle button of the mouse joystick to store a reference image.

NoteIf the system has been configured with two ref-erence screens, you can store an image as a ref-erence image and display it on the Reference or Assist screen.

Click the icon to toggle the active screen.

NoteUsing the CLEARstent image function (Image task card) you can generate special reference images from any scene or fluoroscopy scene ac-quired natively.

The stent/balloon marker should be clearly visi-ble in the scene.

If the stent/balloon marker is not visible in the current image, CLEARstent will not be possible.

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Examination

Acquisition

Using the handswitch

Press the acquisition button (two stage) of the handswitch.

Using the footswitch

Press the acquisition pedal of the foot-switch.

The radiation indicators light up briefly.

The acquisitions (scenes) are stored as set in the acquisition program and appear on the screen.

CautionAcquiring thin objects

Risk of unnecessary radiation exposure due to incorrect dose

Always perform fluoroscopy before acquisi-tion.

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In order to have a fast access to special acquisi-tion program, an Alternative Acquisition can be assigned to a footswitch pedal.

An alternative acquisition program can be used, for example, to provide a “low dose acquisition program” instead of fluoroscopy at critical situa-tions where the fluoro dose is limited by the maximal skin dose.

The configuration to enable/disable the alterna-tive acquisition is done by assigning of one of the footswitch pedals to this function.

Example

In the Exam Set and Program Editor, the alter-native acquisition program is located between the 4 acquisition programs and the 3 fluoro pro-grams. If any acquisition progam is visible there, then it is an alternative acquisition program as-signed to the footswitch pedal.

CautionFluoro release foot pedal mixed up with the al-ternative acquisition release pedal.

Increased irradiation by performing acquisi-tion

Be careful to use the correct foot pedal.

Check the labels and the position of the foot pedals.

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Examination

Alternative acquisition Alternative acquisition has been configured

to a footswitch pedal.

Select an exam set containing an alternative acquisition program.

If an alternative acquisition program is available, an indicator will be present near the acquisition symbol on the touchscreen, on the Live screen and on the Examination task card.

Perform fluoroscopy.

Start acquisition by means of the footswitch pedal assigned to alternative acquisition.

NoteFor alternative acquisitions, always the measur-ing fields of the ‘regular’ acquisition program are used. The forecast parameters are displayed for the ‘regular’ acquisition program and not for the alternative acquisition program.

CautionAlternative acquisition pedal is used to start ac-quisition with automatic injection, although power injectors are triggered exclusively by ped-al "2".

Exposure to radiation without clinical benefit

If automatic injection is required, use the handswitch, or the “regular” acquisition ped-al (pedal "2") on the footswich to release X-ray.

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Roadmap is a special operating mode in which fluoroscopy images are subtracted from one an-other and displayed subtracted. During fluoros-copy, an image is inverted (mask) and superimposed over all subsequent fluoroscopy images.

Roadmap phases

Indicators

NoteTo avoid motion artifacts, the patient should nei-ther move during roadmap nor should the pa-tient table nor the system be moved.

Phase 1 After you have selected roadmap and pressed the fluoro foot switch, the mask for subsequent fluoroscopy is created.

Phase 2 Switch-over to subtracted display hap-pens automatically. Now you are re-quested to inject contrast medium to display the vessels.

Phase 3 The vessel image is displayed subtract-ed.

Injection An injection indicator is displayed when you can start injecting during roadmap.

OPAC An opac indicator is displayed when the roadmap function is active and peak opacification is enabled.

Review A roadmap indicator is displayed when a roadmap scene is reviewed in roadmap mode.

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Examination

Roadmap A Roadmap program is selected which has

not set the Vessel Presentation Phase 2 or Vessel Presentation DSA check box.

Overlay Reference has not been activated.

First phase (native)

Exam task card

Press this icon.

Actuate the FLUORO pedal and keep it pressed.- After fluoroscopy has begun a normal fluo-

roscopy image is displayed briefly, then the display automatically switches to sub-tracted images.

- An injection indicator is displayed on the live screen.

Second phase (contrast medium injection)

Keep the FLUORO pedal pressed.

Now inject the contrast medium.- In the fluoroscopy image, you can now see

the vessels in subtracted display as they are filled with contrast medium.

Release the FLUORO pedal when the area to be examined is sufficiently filled with con-trast medium.- The opac indicator indicates that maxi-

mum opacification is effective.

Third phase (subtraction)

Press the fluoroscopy switch as often as re-quired.

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Replace mask during roadmap

It is possible to replace the mask during review of a roadmap scene, but only if “Replace Mask” is set (not “Move mask”).

Replacing the mask is only possible during road-map phase 1 and phase 2.

Anatomical background with Roadmap

During Roadmap phase 3, anatomical back-ground can be added to the subtraction image.

In the examination room, the anatomical back-ground can be adjusted using the mouse joy-stick.

Vessel/catheter contrast with Roadmap

During Roadmap phase 3, but not during X-ray, the vessel/catheter contrast can be adjusted for Roadmap images. The initial values for Vessel Contrast and Cath-eter Contrast are defined in the Roadmap pro-gram.

NoteWhenever a roadmap mask is restored with the previous mask function, vessel/catheter contrast will be reset to the default values from the road-map program.

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Examination

Resetting roadmap

If motion artifacts arise, roadmap can be reset (new mask):

Actuate the Reset Roadmap pedal (if config-ured - example).

Or

Press the Reset Roadmap button.

Replacing the mask

“Replace Mask” is set in the main menu on the console.

Press this icon.

Changing anatomical background

Acquisition > Set Anatomical Background is set in the main menu on the console.

Press the Anatom. Backgr. button.

Deflect the mouse joystick.- Up: more anatomical background- Down: less anatomical background

Changing vessel/catheter contrast

Acquisition > Set Vessel / Catheter Con-trast is set in the main menu on the console.

Press the VC Contrast button.

Deflect the mouse joystick.- Up: more vessel contrast- Down: less vessel contrast- Left: more catheter contrast- Right: less catheter contrast

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Advanced Roadmap DSA Ref phases

Advanced Roadmap DSA Ref consists of two phases, whereas phase 1 is split up in two sec-tions, phase 1a and 1b. Separate Roadmap pa-rameters attitudes exist for every phase.

Phase 1 After you have selected Roadmap and a Roadmap program, and pressed the fluoro foot switch, Roadmap starts with phase 1. The fluoroscopy images are displayed natively.The availability of a noise free fluoro frame triggers the transition of phase 1 to phase 3, while fluoro is still ongoing. Switch-over to subtracted display will happen automatically.

Phase 3 The phase 3 is started with renewed release of fluoroscopy. Images are dis-played subtracted. The mask image is the reference image.The phase 3 will be restarted with each new release of fluoroscopy.

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Examination

Advanced Roadmap using a DSA image

A Roadmap program is selected which has set the Vessel Presentation DSA parameter.

A subtracted reference image, e.g. from a DSA scene, is shown on the active reference screen.

Starting Roadmap phase 1 (native)

Exam task card

Press this icon.

Press this icon.- Overlay Reference is activated.

Moving to reference image position

Message: Automatic run: Activate stand movement

Press the stand joystick down, deflect the joystick and hold it in this position until the C-arm position is reached.

Or press the hands free foot pedal.

When the position is reached the following mes-sage appears: Automatic run: Position reached

Collimation and zoom stage are set correspond-ing to the parameters of the reference image.

Performing fluoroscopy

Actuate the FLUORO pedal and keep it pressed.After fluoroscopy has begun a normal fluo-roscopy image is displayed. Then, the display automatically switches to a subtracted image.

Performing Roadmap phase 3 (subtraction)

Press the fluoroscopy switch as often as re-quired.You will see a fluoroscopy image from which the last filled image of phase 2 is subtracted.

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Roadmap with two system positions

During roadmap, two roadmap mask images may be stored for two system positions, e.g. a LAO and a RAO C-arm position. You can move back and forth between these positions, per-forming roadmap at each position without the need of reacquiring a roadmap mask.

These two roadmap masks are referred to as the current roadmap mask and the previous road-map mask. The data (e.g. stand and table posi-tion, roadmap program, zoom stage, ...) associated with these masks are stored and per-sist whether roadmap mode is enabled or dis-abled.

The current roadmap mask holds the most recently utilized roadmap mask and system position.

The previous roadmap mask holds the sec-ond most recently utilized roadmap mask and system position.

The present system position determines which of the roadmap masks will be recalled when the Previous Mask icon is activated.

System position Roadmap phase Mask recalled

Current position 1 Current Roadmap Mask

3 Previous Roadmap Mask

Any other posi-tion

Any Previous Roadmap Mask

NoteThe latest roadmap masks are kept during the whole study and will be deleted when a new pa-tient is registered.

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Examination

Previous mask Roadmap

Select roadmap and perform a roadmap phase 1,2,3.

Move the C-arm and perform another road-map phase 1,2,3.

(If you reset roadmap, the system displays the following message: “Roadmap reset. A previ-ous mask is available”.)

Press the Previous Mask icon in the Road-map dialog.

The following message appears: Automatic run: Activate stand movement

Press the stand joystick down, deflect the joystick and hold it in this position until the previous roadmap position is reached.


The C-arm moves back to the initial roadmap po-sition.

When the previous position is reached, the fol-lowing message is displayed: “Roadmap Plane-A:Previous Mask is in use”

Press the fluoroscopy switch.- Roadmap continues with phase 3, using

the previous mask.

In a similar manner, you can perform roadmap again in the first C-arm position, and so on.

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CLEARstentWith the CLEARstent imaging functions, you can emphasize fine structures, e.g. inflated stents. There are the following possibilities for CLEARstent:

Use the CLEARstent reference image func-tion to generate a special reference image from any scene or fluoroscopy scene ac-quired natively.Example:

Acquire a CLEARstent Dynamic scene, which provides a sequence of images fading from inverted CLEARstent image to max fill image and back.This CLEARstent function requires a special workflow initiated by a special CARD pro-gram, where a couple of images are acquired natively before injecting contrast medium. After end of acquisition, the algorithm to cal-culate the CLEARstent scene is automatically started.

Acquire a CLEARstent Live scene, which pro-vides a stabilized view of the stent.Acquisition is performed simply using a CLEARstent Live acquisition program.

Original image CLEARstent image

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Examination

CLEARstent Dynamic acquisition workflow

A CLEARstent Dynamic acquisition is per-formed in the following sequence:

1. Prepare the patient, stand, C-arm and table.Check the injector.

2. Perform a brief fluoroscopy: Press fluoro ped-al of footswitch.Check/set SID, zoom stage, collimation, fil-ters and measuring fields.

3. Select a CLEARstent Dynamic acquisition program.

Ready for CLEARstent acquisition is displayed.

4. Start acquisition: Press the exposure release button or pedal and keep it pressed.- Acquisition phase 1 takes place.- At the beginning of phase 2, an injection

indicator is displayed on the Live screen.- The message “Injection” is displayed.

5. Now inject the contrast medium manually.

6. Stop acquisition when acquisition run is com-plete.

7. View the CLEARstent Dynamic scene.

A preliminary result of the CLEARstent Dynamic image is displayed on the active reference screen.

When processing of the CLEARstent Dynamic image has concluded:

A CLEARstent reference image will be creat-ed, stored, and displayed on the active refer-ence screen.

If contrast medium is present in the images, a CLEARstent Dynamic scene will be creat-ed, stored, and displayed on the live screen.

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Display modes native

Live FLUO/LIH (Live Fluoroscopy/Last Image Hold) This mode is the default display on the live screen when no other mode is selected.The last fluoroscopic/roadmap image is dis-played on the live screen after completion of fluoroscopy. Reference images are displayed on the reference screen.

Overlay Ref(erence) can be selected or de-selected. The (inverted) reference image is overlaid into the live/LIH fluoroscopic image.

Display modes subtracted

Live Native Image During roadmap or DSA, the unsubtracted live fluoroscopy image is displayed on the Assist screen.

Reference Image During roadmap or DSA, the selected refer-ence image is displayed on the Assist screen.

NoteOverlay Ref is only possible if the reference im-age was acquired with the same modality (AX, no CT, MR), the same input format/zoom stage, the same patient position, and the same por-trait/landscape position with FD30x40.

NoteThe availability of display modes depends on the screen configuration of your system.

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Display modeSelecting the display mode

Settings task cardExpert layout or user-defined layout.

Select the required display mode.

Performing Overlay Reference

To start overlay, press the Overlay Reference Image icon.- The display mode is changed to Overlay

Reference, i.e. the overlay image is faded in the image on the Live screen.

Setting the degree of Overlay Reference/ Fading in or out the reference image

Deflect the mouse joystick.- Up: The reference image will become

clearer.- Down: The reference image will become

less clear and the fluoroscopic image will become clearer.

To stop overlay, press the active Overlay Ref-erence Image icon.

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Review modes

LIH (Last Image Hold): The last image of flou-roscopic/roadmap scene is displayed.

MFH = Max. Fill Hold: The maximum fill im-age of an acquisition scene is displayed.

Loop: A scene is replayed continuously. After the last image, the same scene starts again from the beginning.

Toggle: The scene is played continuously but, unlike Loop, the review direction is re-versed after the last image (ping-pong ef-fect).

Depending on scene type, different review modes are available:

Available review modes

LIH MFH Loop Toogle Single step only

Fluoro/Road-map scenes

x x

DR/DSA/PERI scenes

x x

CARD scenes x

Rotational scenes

x x

Report images x

NoteYou can change the Review Mode by selecting View > Review Mode in the main menu in the control room.

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Examination

Dynamic scene replayStopping the loop

Deflect the mouse joystick briefly.

Single step

Deflect the mouse joystick briefly.- The loop stops.

Deflect the mouse joystick briefly.- Left: one image backward- Right: one image forward

Starting the loop

Deflect the mouse joystick.- Left: the scene runs backward- Right: the scene runs forward

The reviewing speed depends on how far you deflect the joystick.

The review direction is indicated in the control area of the live screen.

Setting the review rate

Deflect the mouse joystick.- The further left or right the joystick is

deflected, the faster the scene will be played back.

Release the mouse joystick when the desired review rate is reached.

Review with maximum speed

Deflect the mouse joystick to its maximum for more than 2 s.

To review with acquisition speed again:

Release the mouse joystick.

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Representative

A scene is represented by a specific image in the overview display.

Native: It is the center image for scenes ac-quired natively.

It is an image with maximum fill (Max Fill im-age) in DSA scenes.

NoteIf you want to use an image other than the auto-matically chosen image as scene representative, you can replace it.

A dotted frame is used to identify the input focus as navigational guidance.

A broken-line highlight frame is used to iden-tify an image representative of a scene or (reference) image as being selected.This scene/image is shown in the full-screen display when you switch back to it.

NoteThe scene overview shows single images (frames) of a scene.

To display the scene overview while the scene directory is open, press the right but-ton of the mouse joystick.

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Scene directoryScenes

Press this icon to open the Image Player.

Displaying the scene directory

Press this icon.Scenes (acquisitions and fluoroscopy) of the acquisition patient are displayed in 4 x 4.

Scrolling through scenes

Press Scene -/+.

Reference images

Press this icon to open the Image Player.

Press this icon.

Displaying the reference image directory

Press this icon.Reference images of the acquisition patient are displayed in 4 x 4.

Scrolling through reference images

Press Ref -/+.

Scrolling through the directories

Deflect the mouse joystick.

Selecting a scene/reference image

Switch back to full screen display.

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Postprocessing (Exam Room)

With windowing, you can adapt the image to display the gray scale region of interest with op-timal contrast conditions.

The window values are displayed at the bottom right in the image.

stored value range

screen value range

bright value

dark value

highest absorption

lowest absorption

WC: Window Center

WW

: Win

dow

Wid

th

max.

Principle of windowing (contrast agent/bones black)

Window center (native)

Brightness (subtracted)

WC

WB

Window width (native)

Contrast (subtracted)

WW

WC

NoteAfter acquisition, the image is displayed in ac-cordance with the window values defined in the exam set.

After loading again, the image is displayed using the window values stored with the image.

non-subtracted: subtracted:

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WindowingSetting window values manually

Click into the image with the middle mouse button and move the mouse with the button pressed.

The image is displayed immediately with the changed window values.

Or

Press this icon.


To reset window values:

Press the left button of the mouse joystick.

To close windowing:

Press the right button of the mouse joystick.

Assigning automatic window values

Press this icon.

Window values based on an algorithm defined in the corresponding exam set and the existing exposure conditions are used.

Window width/ Contrast +

Window width/ Contrast -

Window center/ Brightness +

Window center/ Brightness -

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Depending on image matrix and image type of the current scene/image, and the installed li-censes, different zoom functions are available:

Example for Acquisition Size:

Zoom by a factor of 2

Zoom to Acquisition Size (1:1 pixel display)

1024

1024

2480

1920 1024

1024

102410

24

2480

1920

FD Screen

FD Screen

Initial display after acquisition:

Display with Acquisition Size:

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Zooming/panning Image task card

Press the required icon.

Panning the image

Move the mouse pointer into the image.

Click and drag in the image area.

The image is moved simultaneously.

Using the pointerStart pointing

Press this icon.- The mouse pointer changes its shape and is

displayed on the screen in the control room.

Moving the pointer


Dropping a new pointer object

Or selecting a pointer object if mouse cursor is positioned over an existing pointer object.


Moving a selected pointer object

Press the left button of the mouse joystick and deflect it.

Exit pointing


Control room Examination room

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DSA postprocessing Press this icon.

During a DSA exposure, the mask (= image with-out contrast medium) is set automatically. It normally occurs after the second frame, but no later than after 2 s.

“Move Mask” or “Replace Mask” can be set in the main menu on the console.

DSA tools, Move Mask set DSA tools, Replace Mask set

NoteAll pixelshift values are reset when you set a new mask.

NoteIn the case of DYNAVISION or 3D scenes, only one mask image is usually available per acquisi-tion position (exception: washout scene).

The mask therefore cannot be redefined for DYNAVISION or 3D scenes.

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Setting a new mask DSA functions

Moving the mask

“Move Mask” is set.Scroll through the masks one by one

Press this icon.


When you reach the frame you want to select as the mask:


Replacing the mask

“Replace Mask” is set.Scroll through the scene image by image


When you reach the frame you want to be the new mask:

Press this icon.

Native display DSA functions

Native

Press this icon.

Subtracted

Press the icon again.

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Making the image and mask coincide exactly

Using Pixelshift, it is possible to adjust fill and mask images to coincide in subtracted DSA or Roadmap scenes.

Motion artifacts

As a result of patient or unit movement, the im-ages used for subtraction might not coincide completely. If it happens, the anatomical back-ground is not removed completely (motion arti-facts).

Pixelshift variants

NoteIn the case of DYNAVISION or 3D scenes, only one fill image and one mask image is usually available per acquisition position.

Pixelshift may need to be carried out individually for each acquisition position.

Use automatic pixelshift to shift a range of mask and fill frames.

Automatic pixelshift: You mark a region of interest (ROI). The com-puter automatically calculates the best result for this region.

Manual pixelshift You shift the mask manually to achieve the best subjective impression.

Flexible pixelshift: The image is divided into a “chessboard”. The computer independently calculates the best pixelshift value for each square.

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Pixelshift DSA functions

Starting pixelshift

Press this icon.

Automatic pixelshift

After selection of Pixelshift, automatic pixelshift is active by default.

- A square for the region of interest (ROI) is drawn in the middle of the image.


When the ROI is positioned correctly:

Press the left button of the mouse joystick.- The mask is shifted in such a way that sub-

traction is optimized for the marked region.

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Scope of action

Each pixelshift action (automatic or manual) al-ways applies to the current image and all images up to the end of the scene.

Movement Movement Movement

Pixelshift action Pixelshift

action Pixelshift action

Scene

NoteIf you scroll back and then perform pixelshift, the pixelshift values you set (further back in the scene) may be overwritten.

Therefore scroll forward only, if possible.

NoteDepending on the image content, the “Flex” im-age calculation may take a few seconds. It also applies to scrolling.

NoteAt the end of the scene, pixelshift is automatical-ly deselected.

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Manual pixelshift

Press this icon.

Click and drag in the image area.

Further pixelshift corrections

Page on in the scene.

If motion artifacts occur:

Perform pixelshift again.

Undoing pixelshift

Press this icon.

Terminating pixelshift


The pixelshift values are accepted.

Flexible pixelshift

Press this icon.

The mask is divided into squares like a chess-board. The optimum shift amount is determined and applied automatically to each square.

Saving the “Flex” image

Press the required icon.

A “Flex” image can be stored using the Store Monitor function.

You can also store the flexible pixelshifted im-age as a reference image.

You can also copy the flexible pixelshifted image to the filmsheet.

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The anatomical surroundings of the vessels of interest are normally not visible in a subtracted scene. The surrounding tissue can be empha-sized more or less by overlaying the native im-age.

The initial degree of anatomic background is de-fined in the exam set.

Using the Max Opac function (or Min Opac for CO2 DSA) the contrast-agent-filled pixels of dif-ferent images are merged to form a single im-age. The pixels filled with contrast medium from different images are combined into one image.

NoteThe opacity function cannot be applied to DY-NAVISION or 3D scenes.

NoteYou can also store the image with maximum contrast medium filling as a new image (Store Monitor), or copy it to the filmsheet.

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Anatomical background DSA functions

Changing the background

Press this icon.

Deflect the mouse joystick.- Up: more anatomical background- Down: less anatomical background

You can scroll though the scene during anatom-ical background:


To terminate the function:


Max/Min Opac. DSA functions

Scroll to the starting image.

Bolus start

At the image in which the contrast agent bolus is visible for the first time:

Press this icon.

Scrolling

The scene can be scrolled forward or up to one image backward.

Scroll the scene image by image:

Deflect the mouse joystick briefly.- With every step forward, a further image is

added to the Opac image.

Press the middle button of the mouse joy-stick.

The image with maximum contrast medium fill-ing is calculated, displayed and stored as a refer-ence image.

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Annotations Press this icon.

Placing predefined texts

Press the Text Annotation button.

Press this icon and select a text from the list.

Click the position in the image the text shall be placed.

Drawing lines or arrows

Press the Line or Arrow button.

Click the image to fix the starting point (= ar-row head), and drag a line to the end point with the mouse.

Release the mouse button to end the line.

Drawing polygons

Press the Polygon Line button.

Click in the image to set the starting point, hold down the left mouse button and draw a line to the first corner point with the mouse.

Draw the polygon point by point by clicking the mouse button once at each change of di-rection.

Double-click the last corner point.

Drawing circles

Press the Circle button.

Click the detail of interest in the image and drag the mouse pointer.- A circle appears around this point.

Click one of the four boxes on the circle bor-der, keep the mouse button pressed, and drag the circle to make it larger or smaller.

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Distance calibration

To perform a measurement, e.g. distance, the image must be calibrated.

When you start measuring on a non-calibrated image, the system automatically suggests a cal-ibration method depending on the image angle.

The image angle is the geometric sum of the im-age's LAO/RAO angle and CRAN/CAUD angle: Image angle = acos ( cos (LAO/RAO angle) * cos (CRAN/CAUD angle) ) Example: With RAO = 14° and CRAN = 10°, the image angle is approximately 17°.

For image angle 0° ... 15° or 165° ... 180°, the system suggests automatic TOD calibra-tion.

For image angle 15° ... 50° or 130° ... 165°, the system also suggests TOD calibration, but you must mark the point of interest in the im-age.If the object was at a defined distance from the tabletop, you can use TOD calibration. If that was not the case, we recommend using manual calibration.

For image angle 50° ... 130°, the system sug-gests automatic isocenter calibration.You should use this calibration method only if the object of interest was positioned in the isocenter. If that was not the case, we recom-mend using manual calibration.

NoteCalibrations performed in Quant are valid also for measurements done in PostProc and vice versa.

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Calibration and distancesStarting calibration

Press this icon.

Automatic calibration using the table-object distance (TOD)

Press the Auto TOD button, if necessary.

For angulations >15°, you are prompted to mark the measurement point in the image. Only then can you adjust the TOD.

In that case, click the point in the image where you want to perform a measurement.

Enter the table-object distance using the nu-meric buttons.

CautionIncorrect calibration

Inaccurate results possible

The examiner is responsible for applying the cor-rect calibration method.

Perform calibration carefully.

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NoteThe default TOD value is stated in the calibration dialog. It can be changed by Siemens Service.

NoteThe calibration object should be larger than the object to be measured.

The calibration object must also be located in the same plane as the object to be measured!

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Or

Deflect the mouse joystick.- Up: increase TOD- Down: reduce TOD


Automatic isocenter calibration

Press the Auto ISO button, if necessary.

Press the OK button.

Automatic calibration is performed immediately and displayed.

Manual distance calibration

Press the Distance Calibration button.

Click the starting point of the calibration line.

Click the end point of the calibration line.

Enter the length of the distance line (in mm).

Press the OK button to accept.

Drawing and measuring distances

Press the Distance button.

Click the image to mark the first point and drag the mouse to the second point.

Release the mouse button to end the line.- The distance line is drawn showing a num-

ber and the distance.

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Quantification (Exam Room)

NotePay attention to the messages at the bottom of the image.

They include notes for further operational steps.

NoteCatheter calibration is not recommended for LVA. For QVA, catheter calibration should be used with FD zoom stages only (not in full for-mat).

The catheter calibration software is validated for a catheter size of 7 French.

Using catheter calibration with catheter sizes of 5 French or smaller is not recommended be-cause accuracy could be reduced.

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Calibration Quant task card

Press the Calibration button.

Also see Calibration and distances 99

Automatic calibration using the table-object distance (TOD) 99

Automatic isocenter calibration 101

Manual distance calibration 101

Catheter calibration

Press the Catheter button.

Mark the approximate center line in the section of the catheter you want to use for calibration. This part of the catheter should be straight.

Mark the starting position with a single click.

Mark the end point with a mouse click.- The contour detection algorithm automati-

cally detects the edges of the catheter.

Now enter the actual size of the catheter used for calibration (in French units).

Press the appropriate button.

Press the right button of the mouse joystick.Or


E.g.

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NoteThe smaller the calibration object, the greater the calibration error.

Make sure that the image with the sphere was acquired under the same conditions (zoom stage, source-FD distance and object-FD dis-tance) like the image you want to analyze.

NoteYou can move the circle by dragging the circle center to the required position.

You can change the size of the circle by dragging the circle line larger or smaller.

Check, if center remains at the same posi-tion.

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Sphere calibration

Press the Sphere button.

For marking the sphere, you must draw a circle that corresponds to the projection of the sphere in the acquisition plane.

The circle can be marked in two ways:

Center, diameter Define the center of the sphere and deter-mine its diameter.

Click into the center of the sphere.- The system attempts to determine the

boundaries of the sphere.

3 points If the system was unable to automatically de-termine the sphere:

Click three points in succession on the line of circumference, with a single click at each point.

Finally, you enter the actual diameter of the sphere used for the calibration.


Press the right button of the mouse joystick.Or


E.g.

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Quantitative analysis methods for analyzing stenoses

With QCA (Quantitative Coronary Analysis), you can determine the dimensions of the cor-onary arteries.

With QVA (Quantitative Vascular Analysis), you can determine the dimensions of vessel sections.The difference between QVA and QCA is re-lated to the size of the vessels measured:- The QVA algorithm is validated for vessels

from 0.5 mm to 50 mm.- The QCA algorithm is validated for vessels

from 0.5 mm to 7 mm.

With IZ3D (QCA in 3D), you can determine the shape of the coronary arteries in three di-mensions based on two 2-dimensional imag-es.

You can display the results on the screen, film/print and send them to another network node.

NoteBefore you can perform a 2D quantitative vascu-lar analysis, you must calibrate the image. 99 103

NoteThe selected image plays an important role in ac-curate and reproducible contour detection.

We recommend selecting an image close to the diastolic phase of the cardiac cycle.

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Quantitative Vascular Analysis (QCA, QVA and IZ3D) Quant task card


QCA or QVA

Vessel contour detection

You must define the vascular segment you want to examine by drawing in an approximate center line. If the vessel is curved, a number of points (maximum 20) can be defined with a single click at the required positions.

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NoteThe center line must be marked in the direction of blood flow as it influences the calculation of the extent of stenosis.

NoteTo achieve reproducible analysis results, it is ad-visable to start and end the segment at a charac-teristic, conspicuous point. Side branches are suitable for this purpose.

NoteIn the exam room, the contour is automatically smoothed.

NoteYou can film, print, or send a report in the same way as normal images.

However, results of an analysis on the Quant task card are only transferred to the film sheet if the Report is stored.

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Marking a vessel segment

Define the proximal starting point in the ves-sel with a single click.

Define any necessary intermediate points with single clicks.

Define the distal end point with a double left click.

Marking a vessel segment with bifurcation

Define the proximal starting point of the main branch with a single left click.

Define intermediate points of the main branch with single left clicks.

Define the distal end point of the main branch with a single right click.

Mark the bifurcation point and the centerline of the side branch off the main vessel with single left clicks.

Define the distal end point of the side branch with a double left click.

Manual contour correction

Start the correction with a single click at the point from which you want to correct the ex-isting contour.

Define the intermediate points along the re-quired contour with a single click.

Define the end point with a double left click.

Generating and storing a report

Press the Report button.

Press this icon.

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IZ3D

Scenes/images for IZ3D

Two projection images must be selected for IZ3D or IZ3D - Large Vessel (=QVA 3D) in order to obtain a 3D reconstruction.

Two projections are sufficient to create an accu-rate 3D reconstruction in the case that:

They are both orthogonal to the region of in-terest.

There is at least a 30° difference between the projections of the participating images.

It is essential that the selected frames are of the same stage of the heart cycle. The optimal frame is the one in which the heart vessels are at their most still and enlarged stage (end diastolic frame). This instance can be identified on the ECG signal diagram as the portion between the Q and the R waves.

If the selected scene was acquired with ECG data and if Auto ED is configured by Service, the sys-tem detects and displays the least-motion frame of the current scene in full-screen review.

For Manual ED, it is important to preserve a con-stant phase of the heart cycle for all scenes that participate in creation of the 3D reconstruction.

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3D vessel model in IZ3DCreating a 3D vessel model

Mark a vessel in the first image.Vessel contour detection 107

Next you load a second image.

Press the Scene - / Scene +, or the Scene Di-rectory icon.In the scene directory, scenes are marked for IZ3D:

Select the second image.- The system adds it to the current analysis,

displays two lines in the image to indicate the approximate position of the vessel that was detected in the first image.

: already used

: already used and analyzed

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Epipolarity lines are used to indicate the approx-imate region of the display where the vessel be-ing analyzed within a 2D image. The lines indicate the uppermost and lowermost bound-aries of the screen region within which the ves-sel should fall.

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Mark the same vessel segment in the second image.Vessel contour detection 107

Press the 3D Model button.

Displaying the quad view

Press this icon.

The quad view displays the 2D image, the 3D vessel model, diameter and area diagrams as well as basic analysis results.

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The Optimal Projection indicates a system posi-tion that meets the following requirements:

For 3D vessel models that do not include a bi-furcation, the Optimal Projection is the pro-jection that shows the least foreshortening of the analyzed segment.

For 3D vessel models that include a bifurca-tion, the Optimal Projection is the projec-tion that displays the greatest angle between the branches of the bifurcation.

The Optimal Projection is automatically dis-played when the 3D vessel model has been cre-ated.

You can select one of the following items:

A: ... or A: ... B: ... : angulation of the single plane image or the biplane image pair

0°/0°: LAO/RAO 0°, CRAN/CAUD 0°

If a 3D model has already been created:

Optimal Projection: angulation of the opti-mal projection calculated by the system

Current 3D Position: current position of the 3D vessel model

NoteYou can rotate, pan and window the 3D vessel model via pressing the left, right, or middle mouse joystick button respectively, and deflect-ing the mouse joystick.

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Rotating the 3D vessel model to the optimal projection

Press the drop-down button in the 3D sub-task card and select Optimal Projection.

Rotating the 3D vessel model corresponding to the current C-arm position

Press this icon.

Moving the C-arm according to the 3D vessel model

If the virtual C-arm indicates a physically possi-ble position (by a blue color)1, the C-arm posi-tion can be adjusted according to the current 3D vessel model display.

Press the drop-down button in the 3D Model step and select the required projection.

Press the Adjust C-Arm button.

The 3D vessel model is rotated to indicate the new projection.

The following message appears in the examina-tion room: Automatic run: Activate stand movement

Press the stand joystick down, deflect the joystick and hold it in this position until the C-arm position is reached.


The C-arm moves to the defined angulation.

1 with color display only

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Stent planning in IZ3D

With Stent Planning, you can simulate the placement of a stent within the vessel. You can plan the placement of a stent by visualizing it in the 2D image and the 3D vessel model.

The planned stent borders will also be shown in 2D live fluoroscopy and acquisition.

Stent placement

A stent with visible markers, either markers on the balloon that delivers the stent or markers on the stent itself, is inserted in the vessel with help of a catheter. The insertion process is visualized with live X-ray imaging. The stent is then placed at the desired position in the vessel by visual se-lection of the desired position and visual estima-tion if this position is reached.

The stent graphics will show the desired position of the stent and thus support positioning.

NoteFor stent positioning, the acquisition geometry must be identical for the live images and the stent graphics image.

Stand and table must not be moved. Also, the patient must not move during stent positioning.

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Starting stent planning

A 3D vessel model is been created.(Contours have been marked in two images.)

A 2D image with contours (QCA subtask card) or the 3D vessel model (3D subtask card) is shown.

Press the Stent Planning button.

- Stent borders are shown in red color in every 2D image and in the 3D vessel model to indicate the length and position of the suggested stent aligning according to the obstructed vessel segment.

- Stent borders are also shown in red color in the Diameter and Area graphs according to the obstructed vessel segment in order to indicate the positions of the stent end-points.

- The length and diameter of the stent are suggested in the Preliminary Results win-dow.

Adjusting stent length and diameter

Press the Length and Diameter button.

Deflect the mouse joystick.- Up: Increase length- Down: Decrease length- Right: Increase diameter- Left: Decrease diameter

Adjusting stent position

Press the Position button.

Deflect the mouse joystick.- Up: Move stent distal- Down: Move stent proximal

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Display of stent borders

The stent borders are displayed differently de-pending on whether the user has modified the stent dimensions:

Stent borders by the sys-tem

Stent borders by the user

Display in analyzed 2D image

Display in 3D model

Overlay in live image

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Fluoroscopy or acquisition during stent planning

You can release fluoroscopy or acquisition at any time during stent planning.- Stent graphics are shown as lines in the live

fluoroscopy or acquisition image as long as the geometry of stand and table is not changed.

To disable overlay:

Press the Overlay on Live button.

Stopping stent planning

Press the OK button.- Stent data and graphics are removed.

Resuming stent planning

Stent data and graphics are maintained as long as the current analysis is running.

Press the Stent Planning button again.

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With LVA (Left Ventricle Analysis), you can de-termine the ejection fraction and the wall mo-tion of the left cardiac ventricle.

The LVA software is designed for analyses of the left ventricle of the heart in a 30° RAO projec-tion.

NoteFor a single plane image, calibration is optional. If LVA analysis is performed on an uncalibrated image then the set of results will be limited.

Make sure that the calibration image and the ventricle scene have the same geometric acqui-sition parameters.

NoteDeviation from the 30° RAO projection changes the dimensions of the ventricle, which leads to incorrect results.

If the deviation from the 30° RAO projection is impermissibly large, it is not possible to select LVA.

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Left Ventricular Analysis (LVA)

Press the Left Ventricle Analysis button.- The LVA window appears.

As soon as you move the cursor inside the im-age, it changes shape to a pencil.

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LVA workflow

A suitable scene is loaded and displayed in full-screen, not looping.

In case of a single plane scene, and for a full set of analysis results, the scene has been cal-ibrated.

Depending on configuration (by Siemens Ser-vice), an LVA analysis is performed with or with-out automatic detection of the ED (end diastolic) frame and the ES (end systolic) frame. Auto ED/ES detection is only possible if the scene con-tains ECG data.

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An LVA analysis with Auto ED/ES detection is performed in the following sequence:

1. Start LVA.

2. A suitable ED frame and a suitable ES frame are automatically detected.The ED frame is displayed.Optionally you may single step through the scene and select another ED frame.

3. Perform contour detection in the ED image (define three points).

4. Press the ES button.The ES frame is displayed.Optionally you may single step through the scene and select another ES frame.

5. Perform contour detection in the ES image (define three points).

6. Create and store the report.

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An LVA analysis without Auto ED/ES detec-tion is performed in the following sequence:

1. Start LVA.

2. Press the ES button.

3. Scroll to a suitable ES image and press the Mark as ES button.

4. Press the ED button.

5. Scroll to a suitable ED image and press the Mark as ED button.

6. Perform contour detection in the ED image: Mark the valve points and the apex.

7. Toggle back to the ES image by pressing the ES button.

8. Perform contour detection in the ES image: Mark the valve points and the apex.

9. Create and store the report.

NoteThere is a benefit for first marking the ES image and the ED image and then continuing with au-tomatic contour detection. Both the ED and ES image information is taken into account for the contour detection.

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Performing LVA

Press the ES button.

Scroll through the scene:

Deflect the mouse joystick.Or

Press the scroll back/forward button.

When a suitable ES frame is displayed:

Press the Mark as ES button.

Press the ED button.

Scroll through the scene:

Deflect the mouse joystick.Or

Press the scroll back/forward button.

When a suitable ED frame is displayed:

Press the Mark as ED button.

Define the ED contour and correct it if necessary.- Automatic contour detection 127- Defining a contour manually 129

Press the ES button.

Define the ES contour and correct it if necessary.- Automatic contour detection 127- Defining a contour manually 129

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NoteThe ventricle contours serve as the basis for cal-culating the results of the analysis. There are two ways to define the contours for the ED and ES: either manually or by marking the valve plane and the apex followed by automatic con-tour detection.

NoteIn the exam room, the contour is automatically smoothed with Soft.

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Automatic contour detection

As soon as you have selected an ED or ES image, automatic contour detection is activated.

First define the position of the aortic valve with a line:

The mouse pointer has shape of a square.

Click a point on the edge of (outside) the aor-tic valve in a line with the valve plane.

Click a point on the opposite side of the aortic valve.- The points marking the valve plane are

indicated by squares.

Now define the position of the apex:

The mouse pointer has shape of a diamond.

Click the apex cordis.- This point is indicated by a diamond.- The contour is drawn.

Correcting the contour

Move the mouse pointer close to the contour you want to modify.

Start the correction with a single click at the point from which you want to correct the ex-isting contour.

Define the intermediate points along the re-quired contour with a single click.

Define the end point with a double left click or right click (mouse joystick).

Correcting the valve plane and/or apex

When you move the mouse pointer near the points, the pointer turns into a square.

A single click a point causes the point to start moving with the mouse cursor, a second click places it.

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NoteAt the end of the manual contour definition, the valve plane will be indicated with a line connect-ing the upper and lower point of the aortic valve. These points are indicated as small squares.

NotePressing this icon you can hide or show analysis graphics.

NotePressing this icon you can reject the current analysis and delete analysis graphics.

NoteYou can film, print, or send a report in the same way as normal images.

However, results of an analysis on the Quant task card are only transferred to the film sheet if the Report is stored.

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Defining a contour manually

An image has been defined as ED or ES im-age.

Press this icon.

Move the mouse pointer onto the upper point of the aortic valve and perform a single click.

Move the mouse pointer clockwise along the edge of the ventricle, defining intermediate points with a single click- The line changes its direction each time.

Mark the lower edge of the aortic valve with a double click.

The contour is drawn.

Checking the contour

You can check whether you have selected the correct image more easily in the dynamic dis-play, that is, if the heart is beating under the contour.

Press this icon.

Generating and storing a report

Press the Report button.

Press this icon.

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IVUSmap

IVUS imaging

Intravascular Ultrasound (IVUS) is a catheter-based system that allows physicians to acquire images of diseased vessels from inside the artery.

IVUS provides measurements of lumen and ves-sel size, plaque area and volume, and the loca-tion of key anatomical landmarks.

IVUSmap

For obtaining a coregistration of an angiograph-ic X-ray image and IVUS images, the IVUSmap feature is available. The IVUSmap workflow consists of acquiring and selecting a dedicated X-ray image to be used for coregistration, deter-mining the vessel centerline, and performing of the pullback.

Review

After pullback, the coregistrated images can be reviewed and it is possible to perform measure-ments.

IVUS system

Currently, the Volcano s5i IVUS system is sup-ported.

Catheter types

Currently, the following IVUS catheters are sup-ported:

Volcano Eagle Eye Gold catheter

Volcano Eagle Eye Platinum catheter

IVUSmap exam set

An ECG gated exam set is configured and linked to IVUSmap.

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IVUSmap

IVUSmap examination work-flowThe IVUSmap feature can only be successfully utilized when:

IVUSmap is properly licensed and config-ured.

A supported IVUS system is powered on, ready, and connected to the Artis system.

Enough storage capacity for ultrasound im-ages is available on both the IVUS and the Artis system.

There is an ECG signal of good quality.

An IVUSmap examination is performed in the following sequence:

Step 1 133

1. Register the patient on the Artis.

2. Position the IVUS catheter in the vessel of in-terest.

3. Start IVUSmap

4. Acquire a scene with contrast medium in the region of interest with ECG gating

Step 2 135

5. Mark the centerline points of the vessel seg-ment of interestOptionally correct the centerline

Step 3 137

6. Start the pullback, manually or using the pull-back device

7. Record the pullback on the IVUS system

8. Start low dose acquisition or fluoroscopy on Artis with ECG gating

When pullback is finished:

9. Stop acquisition and recording

10. Stop the pullback

Step 4 141

11. Review the pullback scene

12. Perform measurements

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NoteTo successfully coregister the IVUS images and the angiographic x-ray images, the steps 1 through 3 should be done without closing the IVUSmap dialog, and without taskcard switches in the control room. Otherwise, the workflow aborts and is restarted at step 1.

NoteThe user interface of the IVUS system and the Artis IVUSmap application are both displayed in the exam room.

If a shared display is configured, it is automati-cally switched between both screens, otherwise both screens are visible simultaneously.

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IVUSmap

Step 1: Start IVUSmap and acquire scene Position the IVUS catheter in the vessel of in-

terest.

Perform the Ring Down on the IVUS system.

Then advance the IVUS catheter beyond the lesion.

Press this button on the touchscreen.The Create Image workflow step is active.The demographic data of the patient is trans-ferred to the IVUS system.

Make sure, the same patient is registered on the IVUS system.The ECG gated acquisition program for IVUS-map is automatically selected.The following message is displayed: “Posi-tion IVUS catheter in vessel and acquire angio scene”

Press the exposure release button or pedal.

Inject the contrast medium.

After radiation release, the maximum fill frame is identified by the system and dis-played (MFH review mode).The following message is displayed: “Select next work step or repeat acquisition”

Check the angiographic scene via scrolling frame by frameDeflect the mouse joystick briefly.- Left: one frame backward- Right: one frame forward

Or

Press one of these icons.

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CautionUser inadvertently marks the wrong vessel dur-ing Angio/IVUS registration.

It may result in mis-registration of the IVUS and Angio images.

The user is responsible for ensuring that the correct vessel on Angio image is defined, i.e. marked.

NoteIn this step, make sure that you mark the two points in the right sequence: first the marker at the tip of the guiding catheter proximal vessel location, then the distal vessel location.

NoteYou may undo and repeat your marking.

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IVUSmap

Step 2: Mark the vessel segment of interest Press the Mark Vessel button.

- The following message is displayed: “Select distal marker of guiding catheter”

Click in the image to mark the tip of the guid-ing catheter.- The indicated position is marked as the

guide catheter position.- The following message is displayed:

“Select distal vessel location”

Click in the image to mark the distal part of the vessel.- The indicated position is marked as the dis-

tal vessel position.

The following message is displayed: “Select next work step or correct centerline”

Correcting the centerline

It is possible to place a maximum of 20 center-line correction points.

Press the Correct Centerline button.- The following message is displayed: “Set

centerline correction point”

Move the cursor to a position in the image and indicate this position as a centerline cor-rection point by a mouse click.- A new centerline point is set at the selected

location.

Repeat it until you are satisfied with the ves-sel centerline.

Deselect the Correct Centerline function.

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CautionMovement of guiding catheter during transduc-er pullback.

It may result in mis-registration of the IVUS and Angio images.

The user is responsible for ensuring the IVUS and Angio images are properly registered.

NoteWhen selecting the Pullback workflow step and the current stand position/table position differs from the stand and table position of the ECG gat-ed angio scene used for registration, the follow-ing message is displayed: “Return system to registration position (deflect joystick)”

Deflect the stand joystick in any direction and hold it deflected until movement stops.

Position the tabletop manually, if necessary.

If stand movement occurs during the pullback, coregistration cannot be performed. The follow-ing message is displayed in this case: "Coregis-tration not possible - stand movement".

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IVUSmap

Step 3: Pullback

Press the Pullback button.- The following message is displayed: “Per-

form ECG-gated x-ray during pullback”

If a pullback device is used, set the same pull-back speed on the pullback device and on the IVUS system.

Start the pullback, manually or on the pull-back device.

Press the Record button on the IVUS system.

Start X-ray acquisition: Press the footswitch pedal for (alternative) acquisition or fluo-roscopy and keep it pressed until the end of the pullback.

Stop X-ray acquisition: Release the foot-switch pedal.- The following message is displayed: “Wait-

ing for the End of Pullback ...”

Press the Stop button on the IVUS system.- The following message is displayed: “IVUS

images will be transferred. Please wait.”

Stop the pullback.

Annotations will be displayed on the image with green points indicating the path of the catheter pullback and with yellow brackets indicating the length of the detected pullback.

NoteThe pullback should be stopped before the IVUS catheter is pulled into the guiding catheter.

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IVUSmap

The following message is displayed: “Check if dots are within brackets for reliable result. Then select “Review.”

If the green dots are within the brackets:

Press the Review button.

If the green dots are not within the brackets, the images are not registered properly.

Press the Restart Pullback button on the TSC to repeat the pullback, or press the Create Image or Mark Vessel buttons to repeat the respective steps.

After a successfull pullback, IVUS images are transferred in the background from the IVUS sys-tem to the Artis.

The subset of IVUS images is displayed which has already been transferred.

Wait until all the IVUS images have been transferred and are displayed.

When IVUS images are displayed, you can al-ready start placing bookmarks.

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NoteIf the registration between the X-ray angio-graphic image and the IVUS images does not match exactly, you can correct it in the control room.

See IVUSmap corrections in the Artis Volume 2 Quick Guide

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IVUSmap

Step 4: ReviewIn the last workflow step, you can review the coregistrated angiographic image and the IVUS images.

The Review workflow step is automatically se-lected.

Loop, single stepping

Press one of these icons.

Navigating along the vessel/ILD image

Deflect the mouse joystick up/down.- The cross-sectional images are scrolled

accordingly.

Rotating the vessel view/ILD image

Deflect the mouse joystick left/right.- The orientation of the ILD view changes as

indicated in the cross-sectional image.

Adding a bookmark

Press the left button of the mouse joystick.- A new bookmark is added, distance mea-

surements are updated.

Deleting the last bookmark

Press the right button of the mouse joystick.- The bookmark is deleted, distance mea-

surements are updated.

Bookmarks can be overlaid on live fluoro, using the Overlay Reference function. They can be added or deleted at any time.

You can also calibrate the angiographic image and perform measurements. Calibration and distances 99

When finished, or if you want to review later:

Close the window.

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Rotational Angiography, 3D

3D

Special 3D acquisition modes are available which enable the generation of image sets suit-able for 3D reconstruction on the syngo Workplace. 146

Using syngo InSpace 3D, DynaCT and DynaCT Cardiac the acquired data sets can be recon-structed to 3D images on the syngo Workplace.

You will find further information for reconstruc-tion in the syngo Workplace Quick Guide (Volume 2).

DR-DYNAVISION

DR-DYNAVISION is the further development of classical rotational angiography in which an ex-amination area is acquired from different direc-tions in a single run. The acquisition can be carried out with or without contrast medium. The scenes are displayed native (unsubtracted). 162

DYNAVISION

(DSA-)DYNAVISION is the angle-triggered acqui-sition technique with digital online subtraction. Mask and contrast images (mask and fill frames) are thus acquired in the same angle position of the C-arm. The rotational range of the C-arm can be freely selected. 164

Note3D examinations can be performed only in the calibrated system positions.

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PreparationsPreparing the patient

Immobilize the patient as well as possible to avoid motion artifacts.

Check for correct entry of the patient posi-tion.

Inform the patient about the coming exami-nation procedure.

Preparing the stand and table

Position the C-arm in Left Side or Right Side position.

Setting the isocenter

Positioning the region of interest in the isocen-ter ensures that this region does not drift out of the displayed field of view.

Position the region of interest in the frontal beam path.

Position the region of interest in the lateral beam path.

Preparing the injection

Puncture and insert the catheter.

Connect the contrast medium injector and program it.

Perform fluoroscopy and collimate.

Position the catheter in the target area.

Automatic injection

Set the X-ray delay on the injector.

Switch the injector to “Armed”.

Manual injection

Deselect synchronization.

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Injection mode

Contrast medium can either be applied with the help of an automatic injector or manually.

In general, injection with the injector produces better results as the flow of the contrast medium can be kept constant over the total duration of the injection.

If the injector is set to “Armed” it will be trig-gered.It is recommended to set a delay time (X-ray delay) of 0.5 to 1 s on the injector. With it, an optimum contrast medium filling is achieved already with the first projection.The X-ray delay which is programmed at the injector is used to delay the begin of the in-jection phase. During this delay time, there is no image acquisition.

If the injector is not set to “Armed”, the sys-tem assumes that a manual injection is per-formed with no contrast medium applied and starts the injection phase immediately.For manual injection, it is recommended to set an X-ray delay of 0 s.

CautionInjector not connected (correctly) or not set to “armed” (especially with PERIVISION, DYNAVI-SION or 3D examinations)

Risk of X-ray radiation applied without diag-nostic use

Pay attention to the messages on the Assist screen / message bar.

Inject manually, if necessary.

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Automatic/manual control

The rotational examination sequence depends on the Dyna Control or 3D Control setting in the acquisition program:

If Auto is set in the acquisition program, then the movement of the C-arm starts automati-cally with the acquisition.- If an injector is connected to the system

and set to “Armed”, injection is also started automatically (possibly with delay).

- If no injector is connected to the system or if it is connected, but not set to “Armed”, you must carry out injection manually.

If Manual is set, you must start movement of the C-arm (and start of the acquisition) man-ually with the multifunctional button (blue button on the hand switch).- The injection must also be carried out man-

ually.

CautionPatient moves hand or arm into the way of the moving C-arm.

Patient injury

It is the responsibility of the operator to en-sure proper immobilization of the patient.

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3DThere are special acquisition modes intended to create Angiographic Computed Tomography (ACT) 3D images for various applications (ves-sels and bones).

The images will be acquired in equidistant angu-lar spacing. Rotation is carried out with predeter-mined (calibrated) rotational ranges.

3D DR: Like in DR-DYNAVISION, images are acquired in a single run and no subtraction is performed. 148

3D DSA: Like in (DSA-)DYNAVISION, images are acquired in mask run and fill run and sub-traction is performed. 150

3D CARD: Images are acquired in several ac-quisition runs, to reduce motion artifacts. No subtraction is performed. 158

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Centering the target volume in the isocenter (3D)

When a 3D acquisition program was selected, there are two possibilities:

1. The isocenter has already been set before se-lection of the 3D acquisition program. The re-gion of interest is positioned in the isocenter.- The LED on the Isocenter key is lit.You can start immediately.

2. The isocenter has not been set. The region of interest is not yet positioned in the isocenter.- The LED on the Isocenter key is flashing.

The “isocenter assistant” helps you positioning the region of interest in the isocenter.

The following message is shown: 3D ISO: Frontal, activate stand movement

Press down the stand joystick and deflect it.Or press the hands free foot pedal.Hold it in this position until the C-arm is posi-tioned in the frontal position.

Position the region of interest in the frontal beam path.

The following message is shown: 3D ISO: Lateral, activate stand movement

Press down the stand joystick and deflect it.Or press the hands free foot pedal.Hold it in this position until the C-arm is posi-tioned in the lateral position.

Position the region of interest in the lateral beam path.

If the region of interest is positioned in the iso-center, press the isocenter key in order to skip the isocenter assistant.

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3D DR3D DR examination sequence

Preparations

3D DR test phaseYou check that the programmed rotational range is free of obstacles and hazards.

Injection if contrast medium is used

3D DR fill phaseAn image is acquired for every projection.

Image data is sent to the syngo Workplace. The 3D image is reconstructed and displayed.

(1) Start positionOptional: Brief fluoroscopy to check the ex-amination region

(2) Test run with rotating C-arm for ensuring that no collisions occur

(3) Brief fluoroscopy for automatic setting of ac-quisition parameters

(4) Injection if contrast medium is used

(5) Start of acquisition

(6) Fill run with rotating C-arm for image acqui-sition with or without contrast medium

(7) End position

(1)

(2)

(3)

(6)

(5)(7)

(4)

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3D DR workflow

1. Prepare the patient, stand, C-arm and table.Check the injector, if used.

2. Select a 3D DR acquisition program.

3. Position the region of interest in the isocen-ter.- You can start immediately if the LED on the

Isocenter key is lit. - Follow the “isocenter assistant” if the LED

on the Isocenter key is flashing.

4. Move C-arm to start position:Press down the stand joystick and deflect it.

5. Perform the 3D DR test run to make sure that no collision will occur.

6. Perform a brief fluoroscopy for automatic setting of acquisition parameters: Press fluo-ro pedal of footswitch.

Ready for 3D is displayed.

7. Automatic or manual injection if contrast medium is used.Start injector if manual injection is used.

8. Perform the 3D DR acquisition run:- Start acquisition: Press the exposure

release button or pedal and keep it pressed. Rotational run will start automati-cally, if Auto is programmed. Injection will also be performed automatically if the injector is set to “Armed”.

- Start acquisition. Then start rotational run in time: Press the blue multifunctional button of the handswitch, if Manual is programmed. 145

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9. Let go the exposure release when rotational run is complete.(Acquisition is stopped automatically.)

10. Transfer of image data to the syngo Workplace:- Automatically immediately after the acqui-

sition- Manually as long as data is available on the

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11. Slice reconstruction using InSpace Recon-struction on syngo Workplace.

12. Visualization using the InSpace task card on syngo Workplace.

3D DSA3D DSA examination sequence

Preparations

3D DSA test phaseYou check that the programmed rotational range is free of obstacles and hazards.

3D DSA mask phaseA mask image is acquired for every projec-tion.

Return phase

Injection

3D DSA fill phaseFor every projection, a fill image is acquired and the mask image is subtracted from it.

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(4) Mask run with rotating C-arm for image ac-quisition without contrast medium

(5) Reversal in the start position of the test run

(6) Return run

(7) Injection at reversal point

(8) Fill run with rotating C-arm for image acqui-sition with contrast medium

(9) End of acquisition

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

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3D DSA workflow

A 3D DSA acquisition is performed in the follow-ing sequence:


2. Select a 3D DSA acquisition program.


Isocenter key is lit.- Follow the “isocenter assistant” if the LED



5. Perform the 3D DSA test run to make sure that no collision will occur.


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7. Perform the 3D DSA mask run:Start acquisition: Press the exposure release button or pedal and keep it pressed.Movement is performed automatically. Mask images are acquired.

8. The return run takes place automatically.

9. Automatic or manual injection.Start injector if manual injection is used.

10. Perform the 3D DSA fill run:- Rotational run will start automatically, if

Auto is programmed. Injection will also be performed automatically if the injector is set to “Armed”.

- Start rotational run in time: Press the blue multifunctional button of the hand-switch, if Manual is programmed. 145

Fill images are acquired.

11. Let go the exposure release when all rota-tional runs are complete.(Acquisition is stopped automatically.)



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DynaPBV Neuro and DynaPBV Body A DynaPBV Neuro volume is reconstructed

from data acquired in a 3D DSA examination on Artis following a special workflow.

A DynaPBV Body volume is reconstructed from data acquired in a normal 3D DSA ex-amination on Artis using a special acquisition program. 3D DSA examination sequence 150

DynaPBV Neuro examination sequence




(4) Manual start of injectionManual start of injection can be varied, e.g. injection can also be started during or after acquisition of mask run.

(1)

(2)

(3)

(6)

(7)

(8)

(9)

(11)

(4)(5)

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DynaPBV Neuro workflow

with manual injection (i.v. injection)

Preparations

Prepare the injector: Add the contrast and sa-line required for the desired acquisition.

Select Neuro-PBV acquisition program on the touchscreen.

If C-arm is not in AP position

System message: “3D ISO: Frontal, activate stand movement”

Deflect stand joystick until C-arm reaches AP position.

Adjust table to position region of interest in isocenter.

System message: “3D ISO: Lateral, activate stand movement”

Deflect stand joystick until C-arm reaches lat-eral position.

Adjust table height to position region of in-terest in isocenter.

System message: “3D Start Position: Activate stand movement”

Deflect stand joystick until C-arm reaches start position.

Test phase

System message: “3D Test Phase: Auto, acti-vate stand movement”

Deflect stand joystick until test run is fin-ished.

System message: “Test Phase: Start fluoro to complete test phase”

Briefly press fluoro pedal on footswitch.

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Injection

We recommend injecting intravenously about 2 s before starting the mask run. Typically, the following injection may be applied:

60 ml @ 4-5 ml/s and after that 60 ml @ 4-5 ml/s NaCl

Or (without dual-head injector):

80 ml @ 4-5 ml/s without NaCl

DynaPBV Neuro examination sequence (continued)

(5) Start of acquisition- Manual start of mask run


(7) Return run

(8) Bolus watching phase: Subtracted images are shown on the Artis Live screen. Based on the image content, the start of the fill run can be decided.- Manual start of fill run at reversal point


(10) End of acquisition

DynaPBV Neuro examination time scale

native

8 s 5 s 8 sBolus watching 10-15 s, max. 30 s

Injection duration 24-30 s

Mask run Return run Fill run

Total procedure ~31 s

Bolu

s re

ach

es

sin

us

sagi

ttal

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Acquisition

System message: “Ready for 3D“

Start the i.v. injection: Press the acquisition button or pedal.Keep the acquisition button or pedal pressed until the end of the fill run.

Mask phase

Press the blue multifunctional button of the handswitch once to start the mask run (first run).Mask images are acquired.

Bolus watching phase

Once C-arm is back at its starting position, a 2D DSA acquisition will automatically be per-formed.

Observe the contrast media propagation.

Fill phase

As soon as contrast is visible in superior sagittal sinus:

Press the blue multifunctional button of the handswitch once to start the fill run (second run).Fill images are acquired.

As soon as the fill run is completed and a beep is heard:

Release the acquisition button or pedal.

3D data is automatically sent to the syngo Workplace, reconstructed, and displayed.

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3D CARD3D CARD examination sequence

Preparations

3D CARD test phaseYou check that the programmed rotational range is free of obstacles and hazards.


3D CARD fill phases 1, 2, ...An image is acquired for every projection.

Image data is sent to the syngo Workplace. The 3D image is reconstructed and displayed.

Example of a 3D CARD acquisition sequence with 3 runs



(3) Injection if contrast medium is used and start of acquisition

(4) 3D acquisition run 1 with rotating C-arm for image acquisition with or without contrast medium

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

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(5) Start of acquisition 3D run 2

(6) 3D acquisition run 2

(7) Start of 3D acquisition run 3

(8) 3D acquisition run 3

(9) End position

3D CARD workflow

A 3D CARD acquisition is performed in the fol-lowing sequence:

1. Prepare the patient, stand, C-arm and table.Check the injector, if used.Check the ECG, if used.

2. Select a 3D CARD acquisition program.


Isocenter key is lit. - Follow the “isocenter assistant” if the LED



5. Perform the 3D CARD test run to make sure that no collision will occur.


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8. Perform the 3D CARD acquisition runs:- Start acquisition: Press the exposure



9. Let go the exposure release when all rota-tional runs are complete.(Acquisition is stopped automatically.)



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3D acquisition programs

The acquisition programs for 3D acquisitions are named as follows: <acquisition time> <acquisition mode> (<body part>) (<specification>)

Name component Description

<acquisition time>

e.g. 5 s Bolus time in seconds

<acquisition mode>

DR For native reconstructions

DSA For subtracted reconstructions

DCT DynaCT

Card Cardiac without ECG gating

Card ECG Cardiac with ECG gating

Neuro-PBV Neuro parenchymal blood volume

Liver-PBV Liver parenchymal blood volume

<body part>

Head For examination of the head

Body For examination of other body parts, e.g. abdomen

<specification>

Care Low dose acquisition program

AVG For Aortic ValveGuide

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DR-DYNAVISIONDR-DYNAVISION examination sequence






(6) Fill run with rotating C-arm for image acqui-sition with or without contrast medium

(7) End position

(1)

(2)

(3)

(6)

(5)(7)

(4)

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DR-DYNAVISION workflow

1. Prepare the patient, stand, C-arm and table.Position the region of interest in the isocen-ter.Check the injector, if used.

2. Perform a brief fluoroscopy in the start posi-tion to check the examination region: Press fluoro pedal of footswitch.

3. Select a DR-DYNAVISION acquisition program.

4. Perform the DR-DYNAVISION test run to make sure that no collision will occur.



7. Perform the DR-DYNAVISION acquisition run:- Start acquisition: Press the exposure



8. Stop acquisition when rotational run is com-plete.

9. View the rotational series.

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DYNAVISIONDYNAVISION examination sequence





(5) Reversal in the start position of the test run

(6) Return run



(9) Washout phase

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

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DYNAVISION workflow

1. Prepare the patient, stand, C-arm and table.Position the region of interest in the isocen-ter.Check the injector, if used.

2. Perform a brief fluoroscopy in the start posi-tion to check the examination region: Press fluoro pedal of footswitch.

3. Select a DYNAVISION acquisition program.

4. Perform the DYNAVISION test run to make sure that no collision will occur.


6. Perform the DYNAVISION mask run:Start acquisition: Press the exposure release button or pedal and keep it pressed.Movement is performed automatically. Mask images are acquired.

7. The return run takes place automatically.

8. Automatic or manual injection.Start injector if manual injection is used.

9. Perform the DYNAVISION fill run:- Rotational run will start automatically, if

Auto is programmed. Injection will also be performed automatically if the injector is set to “Armed”.

- Start rotational run in time: Press the blue multifunctional button of the hand-switch, if Manual is programmed. 145

Fill images are acquired.

10. Rotation stops automatically in the end point.The washout scene is being acquired.

11. Stop acquisition when all rotational runs and the washout scene are complete.

12. View the rotational series.

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Peripheral Angiography

PERISTEPPING

With a motor-driven stepping device, a linear ex-amination region (e.g. legs, spine, intestine) can be acquired step by step (in native display) with PERISTEPPING (= DR Stepping). 170

PERIVISION

PERIVISION is the stepping method introduced by Siemens with digital online subtraction. With an injection, an angiography is created in step-ping technique in subtracted display. 172

Moved component

If a motorized stepping device is installed, pe-ripheral angiography can be performed.

A component is moved linearly according to the system type:

The C-arm in case of Artis ceiling, .

Running direction

The running direction determined in the acquisi-tion program can be selected according to the blood flow direction. It always refers to the reg-istered patient position.

for examining the leg arteries: head to feet

for examining the leg veins: feet to head

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PreparationsTransparency compensation

Transparency compensation is available to avoid direct radiation and to compensate for the trans-parency differences in the pelvis-leg region.

Place the transparency compensation on the patient table before positioning the patient.

Cover the transparency compensation with a hygienic, fluid repelling foil or cover.

Preparing the patient

To avoid motion artifacts, the legs should be im-mobilized in peripheral examinations.

Position the patient centrally and in a supine position on the tabletop.

Immobilize the patient's knees: Either run the fastening belt around the ta-bletop or pull it through underneath the po-sitioning mattress and fasten it.

Then push the foam parts on the side of the patient's knees underneath the belt.

Make sure that the patient's legs lie close against one another.

Place the long sack in the area between the patient's legs, if necessary.

Turn the patient's feet inward and immobilize them with adhesive tape, if necessary.

Place the foot cushion under the patient's feet.

Inform the patient about the coming exami-nation procedure.

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Automatic/manual control

The examination sequence depends on the Stepping Mode setting in the acquisition pro-gram:

If Auto is set in the acquisition program, then the movement starts automatically with the acquisition.- If an injector is connected to the system

and set to “Armed”, injection is also started automatically (possibly with delay).

- If no injector is connected to the system or if it is connected, but not set to “Armed”, you must carry out injection manually.

If Manual is set, you must start movement (and start of the acquisition) manually with the multifunctional button (blue button on the hand switch).- The injection must also be carried out man-

ually.

CautionInjector not connected (correctly) or not set to “armed” (especially with PERIVISION, DYNAVI-SION or 3D examinations)

Risk of X-ray radiation applied without diag-nostic use

Pay attention to the messages on the Assist screen / message bar.

Inject manually, if necessary.

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Preparing the stand and table

Position the C-arm in Left Side or Right Side position.

Adjust the SID.

Move the patient as close as possible to the image receptor.

Set the LAO/RAO angulation (max. 30°).

Preparing the injection

Puncture and insert the catheter.

Connect the contrast medium injector and program it.

Perform fluoroscopy and collimate.

Automatic injection

Set the X-ray delay on the injector (recommendation: 0 s).

Switch the injector to “Armed”.

Manual injection

Deselect synchronization.

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PERISTEPPINGPERISTEPPING examination sequence

Preparations

Test phaseYou determine the start position, all the ac-quisition positions and the end position.You also check that the movement range is free of obstacles and hazards.

Return phase


Fill phaseA scene is acquired for every position.When the contrast medium bolus has filled the image you switch on to the next acquisi-tion position.

Example for PERISTEPPING examination sequence Head Feet

(1) Brief fluoroscopy in the start position to check the examination region

(2) Test run for checking the positions




(6) Fill run for image acquisition with or without contrast medium

(7) End position

(2)

(6)

(1)(2)

(3)(4)

(5)(6)

(7)

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PERISTEPPING workflow


2. Perform a brief fluoroscopy in the start position: Press fluoro pedal of footswitch.Check/set SID, table height, collimation, fil-ters and measuring fields.

3. Select a PERISTEPPING acquisition program.

4. Perform the PERISTEPPING test run to check the position of the examination region and to make sure that no collision will occur.Trigger steps by deflecting the C-arm joy-stick in running direction and hold it until the next position is reached.Where required, perform fluoroscopy, colli-mate, position the finger filter and change the measuring fields.

5. Program a delay at the injector and set the in-jector to “Armed”.In case the injector is not armed it is assumed that a manual injection is performed. “Injec-tor disabled, manual injection.” is displayed in this case.

6. Perform the PERISTEPPING acquisition run:Start acquisition: Press the exposure release button or pedal and keep it pressed.

7. Trigger the return phasePress the blue multifunctional button of the handswitch briefly.(The return phase is radiation-free.)

8. Perform the PERISTEPPING acquisition run:Fill images are acquired.Start movement in time for each step: Press the blue multifunctional button of the handswitch.


10. View the PERISTEPPING series.

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PERIVISIONPERIVISION examination sequence

Preparations

Test phaseYou determine the start position, all the ac-quisition positions and the end position.You also check that the movement range is free of obstacles and hazards.

Mask phaseA mask image is acquired for every position.

Injection

Fill phaseA fill scene is acquired for every position.When the contrast medium bolus has filled the image you switch on to the next acquisi-tion position.

Example for PERIVISION examination sequence Head Feet

(1) Brief fluoroscopy in the start position to check the examination region

(2) Test run for checking the positions


(4) Mask run for image acquisition without con-trast medium


(6) Fill run for image acquisition with contrast medium

(7) End position

(2)

(4)

(6)

(1)(2)

(3)(4)

(5)(6) (7)

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PERIVISION workflow


2. Perform a brief fluoroscopy in the start position: Press fluoro pedal of footswitch.Check/set SID, table height, collimation, fil-ters and measuring fields.

3. Select a PERIVISION acquisition program.

4. Perform the PERIVISION test run to check the position of the examination region and to make sure that no collision will occur.Trigger steps by deflecting the C-arm joy-stick in running direction and hold it until the next position is reached.Where required, perform fluoroscopy, colli-mate, position the finger filter and change the measuring fields.

5. Program a delay at the injector and set the in-jector to “Armed”.In case the injector is not armed it is assumed that a manual injection is performed. “Injec-tor disabled, manual injection.” is displayed in this case.

6. Perform the PERIVISION mask run:Start acquisition: Press the exposure release button or pedal and keep it pressed.Movement is performed automatically. Mask images are acquired.

7. Perform the PERIVISION fill run:Fill images are acquired.Start movement in time for each step: Press the blue multifunctional button of the handswitch.


9. View the PERIVISION series.

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Troubleshooting

System messagesThere are various types of system messages:

Feedback, e.g. “DYNA test phase, manual”

Instructions, e.g. “Automatic run: Move the table lift up”

Error messages

Message lines

The line at the bottom of the images shows exam-specific messages (instructions) in the foreground and messages for user guidance in the background.

Line 1 of the Assist screen / message bar shows tips on system operation on the fore-ground and positive feedback/states in the background.

Line 1 in the status area on the screen = line 2 on the Assist screen / message bar shows state messages, e.g. "Memory full", "BYPASS FLUORO"

Line 2 in the status area displays status mes-sages of the image system, e.g. messages about print or send jobs.

Line 3 in the status area shows icons of a function active in the background.

NoteOperating restrictions that only the Service Cen-ter can remedy are marked with "... SC ...". Example: "NO XRAY: call SC"

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System messages are displayed:

on the Assist screen / message bar (2 lines at bottom)- Stand/table messages- System status messages

on the monitor of the system console- line at bottom of image (1 line of text)- status area in lower part of control area

(2 lines of text and 1 line of icons)

Please pay attention to these messages.

Displaying a message in full

Click into the message line (with the left mouse button).- Clicking a text (lines 1 and 2) displays the

full message text.- Clicking an icon (line 3) displays the associ-

ated status window.

Resource display

Your system also monitors the memory usage and the storage capacity of the main database, the scheduler database and the exchange board (virtual memory).

Click the icon to display an overview of the various resources.

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Emergency operationThe Artis Q/Q.zen ceiling systems have been de-veloped in such a way that the highest possible system availability is guaranteed. In other words, the examination is obstructed as little as possible if, for instance, an error occurs due to a fault.

If one component fails, the other continue to work.

Therefore, the system has several operation states, so that a failure of one component does affect the whole system as less as possible, e.g.:

1. If an image acquisition system fails, the sys-tem goes into Bypass fluoroscopy

2. If the image evaluation system fails (console in the control room), the system goes into Backup mode

Operation modes during start-up

After switch-on, all components are powered-up. Some of them are faster, some are slower. So various operation states pass:

Off - Bypass fluoroscopy -

Backup mode - Full operation

No x-ray Continuous fluoroscopy only

Fluoroscopy and acquisition only

No patient reg-istration or postprocessing

All functions available

NoteIf images have been acquired in backup mode, e.g. immediately after power-on, they must be transferred from the buffer to the memory.

Then the following message is displayed: “Syncing database, ... scenes left”

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Bypass fluoroscopy

In various system states, e.g. during switch-on or switch-off or if a technical fault occurs or when no user is logged-in, only “bypass”, that is, continuous fluoroscopy without the imaging system without LIH, is possible. It is not possible to release acquisitions.

You can recognize it as follows:

The fluoroscopy image is only visible in the examination room.

The last fluoroscopy image (LIH, Last Image Hold) does not remain on the screen.

is displayed in the status area on the Live screen:

Backup mode

In various system states, e.g. during switch-on or switch-off or if a technical fault occurs, only fluoroscopy and acquisition without patient reg-istration and postprocessing are possible.

During backup mode, it ist not possible to select the exam set and acquisition program on the system console, exam set and acquisition pro-gram must be selected on the touchscreen.

Images are acquired into the buffer.

You can recognize it as follows:

New fluoroscopy/acquisition images are only visible on the Live screen.

On the Live screen, a ’broken link’ symbol is displayed.

Review is possible in backup mode. Other scenes can be loaded via Scene + / Scene - but only CARD, DR and DSA scenes are loaded.

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No unit movement possible!Direction?

Pay attention to the direction in which you have to deflect the operating element.

Message?

Pay attention to the information on the Assist screen / message bar.

Emergency STOP?

Check the emergency STOP buttons.

Collision protection sensor?

Make sure that no collision protection sensor has responded.

Movements blocked?

Check the Block Movement function.

Patient?

Do not forget to rescue the patient if it is not possible to remedy the error.

Resetting the unit computer (SCU)

Simultaneously press the buttons I and II as well as the emergency STOP button on the stand/C-arm control module (SCM).- The unit computer is restarted and should

be ready for operation after a short time.

Do not forget to pull the emergency STOP button again .

Buffer full! - Memory full!Depending on the configuration, the Artis imag-ing system can save a specific number of scenes/images in total and per patient.

If patients are not deleted regularly, it could re-sult in shortage of storage capacity, and the Artis imaging system will display a message indicat-ing this state.

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Message

“Buffer for < 4 Acq Runs”

“No Buffer for the next Acq Run”

“No acq: No Buffer for the next Acq”

Free space in the buffer is not sufficient (hard disk is full).

In this case, normal fluoroscopy is still possible, but acquisition (and Store Monitor/Store refer-ence image) are rejected after the second mes-sage is displayed.

Wait until the scenes have been transferred from the buffer to the memory.

If the message remains:

Contact Siemens Service.

Message

“Memory full, delete patients”

Free space in the memory is not sufficient (hard disk is full).

Acquisition is blocked, fluoroscopy is still possi-ble.

Delete (archived!) patients (if possible, pa-tients with many scenes).

If the message remains:

Contact Siemens Service.

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Stopping movementsAll motorized movements stop when:

1. the operating element is released,

2. an end position is reached,

3. a basic position is reached (can be configured by Siemens Service),

4. a collision sensor responds,

5. the collision computer reduces the speed un-til stop,

6. an emergency STOP button is pressed.

Resuming the movement

Depending on why the movement was stopped, different measures can be taken to resume the movement:

Case 1. If you have released the operating element unin-tentionally:

You can resume the movement at any time by operating the operating element again.

Case 2. If an end position has been reached:

You can only initiate movement in the oppo-site direction by deflecting the operating ele-ment in a different direction.

Case 3. If stopping at a basic position has been pro-grammed:

You can resume the movement by releasing the operating element and operating it again.

NoteIn certain situations, the speed of unit move-ments is reduced for safety reasons.

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Resuming movement after collision (over-ride)

Case 4. If a collision occurred and the collision sensor re-sponded:

You can initiate a movement by pressing but-tons I and II simultaneously and operating the operating element in a different direc-tion.- The message "Collision control deacti-

vated" appears.

Deflect the operating element in one of the possible directions.

The possible directions are indicated on the Assist screen with + and -.

Directions which are not possible are marked with x.

Case 5. If the movement has been slowed down by the collision computer, it can be resumed until the unit stops.

In rare cases, e.g. when the patient table is tilt-ed, it is not possible to resume the movement:

Proceed as described under Case 4..

Case 6. If an emergency STOP button has been operat-ed:

You can resume the movement by operating the operating element again after you have rectified the cause and unlocked the emer-gency STOP button.

CautionSafety override active

Higher risk of collision Risk of mechanical or personal damage

Execute unit movements with special care when override is active.

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Patient rescueE.g. in case of power failure, motoric system movements are not available. However, you can move parts of the system manually.

It is only possible to remove the patient man-ually by turning the table or pulling the mat-tress.

It is possible to move the tabletop manually in longitudinal direction with reasonable force.

Rescuing the patient in an emergency

Use enough personnel for the rescue.

Remove any accessories obstructing rescue.

On the “OR table”, motorized movement of the patient table is still possible in a power failure.

If necessary, you can move the table in the hori-zontal position:

Press both keys simultaneously and hold them pressed until the movement stops au-tomatically.

You can also rotate the patient table during power failure.

Pull out one of the two handles at the foot end of the patient table and hold it in that po-sition.

Rotate the patient table.

If necessary, you can move the tabletop of pa-tient tables with manual tabletop movement manually in the longitudinal and transverse di-rection.

(This is not possible on patient tables with mo-tor-assisted tabletop movement)

Pull/push vigorously to overcome the braking force.

During the following steps make sure that the patient is not hurt!

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In order to be able to quickly response and move the ceiling suspended C-arm away from the pa-tient an additional clasp at the ceiling suspen-sion has been installed.

In case of a power failure open the clasp (1) at the ceiling suspension holding the belt and take the hook (2) out of the clasp and com-pletely release the belt.

Once the belt has been released (3) the C-arm can be easily pushed away from the pa-tient towards the end of the table.

NoteMake sure that there is always a ladder available to reach the clasp.

(1) (2)

(3)

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Loosen any fixtures.

In difficult cases, you may have to rescue the pa-tient along with the mattress.

Lift the mattress at the foot end to unfasten the hook and loop fastener (or velcro fasten-er).

Put some paper or cloth between table top and mattress so that the velcro does not fas-ten again.

Unfasten safety straps (if applicable).

Pull the mattress with the patient on it from the table top at head side end or foot side end of the table.

CautionPatient table tilted

Risk of patient sliding from the table

Secure the patient sufficiently with shoulder supports, foot holder or body straps before tilting the table.

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After power recovery:

Place the belt back in the ceiling rail and move the C-arm carefully back to the previ-ous position until the belt is tightened again.

Close the hook again (1) and switch on the system.

Please call the Siemens Service to ensure proper positioning of the C-arm.

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RestartingIf a message “... Restart imaging system” ap-pears, you must terminate the imaging system application and then restart it.

There are three possibilities for restarting:

1. Restart Application 187In this case, only the console in the control room is restarted.Acquisition and fluoroscopy are still possi-ble.Recommended if there is a problem in the control room only.

2. Restart System 187In this case, the imaging system in the con-trol room and in the examination is restarted.Only use it if there is a problem in the exam-ination room (too).

3. RESET image evaluation system 189In this case, the image evaluation system in the control room is restarted by force.Acquisition and fluoroscopy are still possi-ble.Only use it if Restart Application or Restart System does not work.

4. Switch off the system manually and power on again 189In this case, the whole system is powered-down by force.Only use it if the system does not react on in-puts anymore and if the examination is fin-ished or can be interrupted.

Restart needs some time.

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Restart application or restart system

Select Options > End Session... from the main menu.- The End Session dialog box is displayed.

Click Restart Application...- Another dialog box appears.

Click Yes.- The application in the control room is ter-

minated and restarted.

Or

Click Restart System...- Another dialog box appears.

Click Yes.- The whole system is shut down and

restarted.

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CautionResetting the image evaluation system

Risk of data loss

Only ever press the RESET button when the im-age evaluation is not ready.

Do not press the RESET button during an ac-quisition.

Wait until all drive activity has come to an end (neither of the two LEDs is lit).

NoteThere must be a pause of at least 30 s between power-off and power-on again.

A press of the power switch during the 30 s causes the LED next to the power-on pushbut-ton to blink which indicates that. Power-on will occur automatically without any further action when the 30 s have elapsed.

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RESET image evaluation system

Press the RESET button for longer than about half a second.- The image evaluation system (console in

the control room) is restarted and should be ready again after a few minutes.

Switching off manually and power on again

Switch-off the system, only if the imaging sys-tem can no longer be terminated by software.

Press the power-on pushbutton on the sys-tem console for more than 4 s and then re-lease the button.

Wait until everything is off.

Wait for about 30 s.

Press the power-on pushbutton on the sys-tem console for more than 0.5 s and then re-lease the button.

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-1:1 pixel display 863D 142, 146

acquisition programs 1613D CARD

acquisition mode 146examination sequence 158workflow 159

3D Control 1453D DR

acquisition mode 146examination sequence 148workflow 149

3D DSAacquisition mode 146examination sequence 150workflow 152

3D vessel modelcreating 111in IZ3D 111moving C-arm 115to C-arm position 115to optimal projection 115

AAcquisition 65Acquisition frame rate

changing 59Acquisition program

changing 57, 59Acquisition programs

3D 161Advanced Roadmap

performing 73phases 72

Alternative acquisition 67Alternative Acquisition Program 66Anatomical background 95

with Roadmap 70Angio collimator

control module 34Angiographic Computed Tomography (ACT) 146Angulations 23Annotations 97Aortic valve

in LVA 127Apex

in LVA 127

AXA4-100.6

Applicationrestart 187

Arrowsdrawing 97

Artis zee ceilingoverview 8

Assist screen 15Automap 31Automatic contour detection

in LVA 127Automatic control

in DYNA, 3D 145in PERI 168

Automatic isocenter calibration 101

BBackup mode

emergency operation 177Bifurcation

in QCA/QVA/IZ3D 109Blocking radiation 48Blocking unit movements 48Brakes

releasing brakes for table 20Brightness 84Buffer 177

full! 178Button

emergency STOP 16Bypass fluoroscopy

display 177emergency operation 177

CCalibration

exam room 103using the table-object distance 99

Card collimatorcontrol module 34

Cardio Pulmonary Resuscitation (CPR) 26C-arm

joystick 22movements 10moving 23positioning longitudinally 25

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C-arm control module 22keys 24

C-arm rotations 23Catheter

for IVUSmap 130Catheter calibration 103Changing

the tabletop 12Circles

drawing 97CLEARstent 76CLEARstent Dynamic 76CLEARstent Dynamic acquisition

workflow 77CLEARstent image 76CLEARstent Live 76CLEARstent reference image 76Collimation

resetting 39setting 39

Collimatorjoystick 38

Collimator control module 34keys 35

Collimator homekey 35

Collimator rotationkey 35

Collisionoverride 181

Combined C-arm movements 22Configuring

touchscreen layout 43Contour

checking in LVA 129correcting in LVA 127defining manually in LVA 129detection in LVA 127manual in QCA/QVA 109

Contrast 84Control console 16Control module

C-arm 22collimator 34imaging system 42patient table 18stand 22

Control modulestrolley 13

CPR position 26

AXA4-100.6

Creating3D vessel model 111

Current roadmap mask 74

DDCS 14DCS extended 14Default patient 44Degree

of Overlay Ref 79Dilatation timer 62Direct position

keys 24storing 29

Direct positions 26Disk

full 179Display

BYPASS FLUORO 177of stent borders 118

Display Ceiling Suspension (DCS) 14Display modes

native 78subtracted 78

Distancesdrawing and measuring 101

DR-DYNAVISION 142, 162examination sequence 162workflow 163

DSAnative display 89postprocessing in exam room 88

DSA-DYNAVISION 142, 164Dyna Control 145DynaPBV Body 154DynaPBV Neuro 154

examination sequence 154injection 156workflow 155

DYNAVISION 142, 164examination sequence 164workflow 165

EECG

attaching 51

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Emergency operation 176backup mode 177bypass fluoroscopy 177

Emergency patientregistering 45

Emergency STOP button 16locations 16

Epipolarity lines 112Exam set 56

for IVUSmap 130selecting 57

Examination sequence3D CARD 1583D DR 1483D DSA 150DR-DYNAVISION 162DynaPBV Neuro 154DYNAVISION 164PERISTEPPING 170PERIVISION 172

Examination-specific messages 174

FFD

rotation 36FD lift 33

membrane keys 32Fill phase

3D CARD 1583D DR 1483D DSA 150PERISTEPPING 170PERIVISION 172

Filterjoysticks 38

Filter diaphragms 40Finger filter 40

key 35setting 41

Flippreselection 54

Fluoroscopy 63changing the program 61storing a scene 62

Fluoroscopy signalresetting 62

Footswitch pedalalternative acquisition 66

Frame ratechanging 59

AXA4-100.6

HHelp

on touchscreen 42

IICStent reference image 64Image

making it coincide with mask 90mirror/flip preselection 54scrolling 83

Image angle 98Image directory

of a scene 82Image format

selecting 37Image texts

predefined 97Injection

3D CARD 1583D DR 1483D DSA 150DynaPBV Neuro 156PERISTEPPING 170PERIVISION 172preparing 143

Injection moderotational angiography 144

Input field 36Input format

key 35Intravascular Ultrasound (IVUS) 130ISO tilting 20Isocenter

in rotational angiography 143key 18setting 52, 53stopping 19

IVUS imaging 130IVUSmap 130

catheters 130exam set 130examination workflow 131pullback 137step 1 133step 2 135step 3 137step 4 141

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IZ3D 1063D vessel model 111exam room 107quad view 113Stent planning 116

JJoystick

C-arm 22collimator, filter 38patient table 18stand 22

KKey

orientation 24Keys

on the C-arm control module 24on the collimator control module 35on the stand control module 24on the table control module 18

LLarge Display 15

screen layout 15Large display 14Left Ventricle Analysis 120Left Ventricular Analysis (LVA)

exam room 121LIH 80Lines

drawing 97Live FLUO/LIH 78Live screen 15Lock tabletop movement

key 18Loop

display mode 80in LVA 129

Low dose acquisition 66LVA 120

exam room 121workflow 122

AXA4-100.6

MManual contour correction

in QCA/QVA 109Manual control

in DYNA, 3D 145in PERI 168

Maskmaking it coincide with image 90new 89

Mask phase3D DSA 150PERIVISION 172

Membrane keysfor C-arm and FD movements 32for FD lift 32

Memoryfull! 178

Message baron Large Display 15

Message lines 174MFH = Max. Fill Hold 80Mirror

preselection 54Mouse

joystick 42Mouse joystick 42Movement

after collision 181resuming 180stopped 180

Movementsblocking 48C-arm 23not possible 178patient table 12stand 25stand, C-arm 10

MovingC-arm to 3D vessel model 115

Moving the mask 89

NNative 89

display modes 78Native display

in DSA 89

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New masksetting 89

No unit movement possible! 178

OOptimal Projection

for IZ3D 114OR table 11Orbital movements 23Orientation

key 18, 24Orientation key 24OT/UT

conversion 23Overlay Ref 78, 79Overlay Reference

performing 79setting the degree 79

Override 181Overtable/undertable conversion 23Overview

Artis zee ceiling 8patient table 11

PPanning

exam room 87with zoom 87

Panning knobpatient table 18

Patientaccepting data from the RIS 45accepting from Sensis 47registering 45registering in an emergency 45registering manually 45rescuing in an emergency 182scene directory 83

Patient position 54checking/changing 55

Patient rescue 182

AXA4-100.6

Patient tablejoystick 18movements 12moving 19overview 11panning knob 18raising / lowering 19

PerformingAdvanced Roadmap 73Overlay Reference 79

PERIrunning direction 166

Peripheral angiography 166PERISTEPPING 166, 170

examination sequence 170workflow 171

PERIVISION 166, 172examination sequence 172workflow 173

PhasesAdvanced Roadmap 72roadmap 68

Pixelshift 90, 91automatic 91flexible 93manual 93starting 91

Pointerusing 87

Polygonsdrawing 97

Positionmoving to a reference image position 31

PostprocessingDSA in exam room 88

Preparations3D CARD 1583D DR 1483D DSA 150peripheral angiography 167PERISTEPPING 170PERIVISION 172rotational angiography 143

Pressure measurement 51Previous roadmap mask 74Programmed positions 26

key 24moving to 27storing 29

Pullbackfor IVUSmap 137

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Pulse ratechanging 61

QQCA 106

exam room 107QCA 3D 106

3D vessel model 111Quad view

in IZ3D 113Quantitative Coronary Analysis 106Quantitative Vascular Analysis 106Quantitative Vascular Analysis (QCA, QVA, IZ3D)

exam room 107QVA 106

exam room 107

RRadiation

blocking 48Rectangular collimation 39Reference image

displaying for system position 31fading in or out 79moving to a position 31scrolling 83

Reference screen 15Registration

default patient 44Replace mask

during roadmap 70Replacing the mask 89Report

generating and storing 109, 129

Representative 82Rescue 182RESET 189Resource display 175Restart

application or system 187Restarting 186Return phase

3D DSA 150PERISTEPPING 170

AXA4-100.6

ReviewIVUSmap 141

Review modes 80Review rate

setting 81RIS

accepting patient data 45Roadmap 68

anatomical background 70changing the program 61performing 69replace mask 70vessel/catheter contrast 70with two system positions 74

Roadmap phases 68Roadmapping technique 68Rotating

3D vessel model to C-arm position 115

Rotating the FD 36Rotational angiography 142Running direction

in peripheral angiography 166

SScene

image directory 82scrolling 83single step 81

Scene directory 83scrolling 83

Scene overview 82Screen layout

of the Large Display 15Screens 15Scrolling

in the directories 83SCU reset 178Sensis

accepting patient data 47Servo assistance

patient table 18Shortcut

storing a position 29SID

setting 33Single step 81Skin dose

alternative acquisition 66

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Sphere calibration 105Stand

joystick 22movements 10

Stand control modulekeys 24

Stand control modules 22Stand movements 25Stand swivel 25Stent borders

display 118Stent placement 116Stent planning 116Stepping Mode 168STOP button 16Stopping

in the isocenter 19of movements 180

Store Monitor 64Store Reference 64Storing

key for position 24Subtracted 89

display modes 78Surgery table 11Switching off

manually 189System

restart 187System messages 174System position

key 24storing with shortcut 29

System positions 26moving to 27

TTable

movements 19raising / lowering 19tilting 20

Table control module 18keys 18

Table liftkey 18

Table swivelkey 18

Table tiltkey 18

AXA4-100.6

Tabletopchanging 12moving longitudinally only 19moving with joystick 21moving with panning knob 20versions 11

Task cardson the touchscreen 42

Test phase3D CARD 1583D DR 1483D DSA 150PERISTEPPING 170, 172

Textspredefined 97

TODperforming a calibration 99

Toggledisplay mode 80

Tooltip helpon touchscreen 42

Touchscreen 42tooltip help 42

Touchscreen control 42Touchscreen layout

configuration 43Transparency compensation 167Trendelenburg

tilting the tabletop 20Trolley

for control modules 13Trumpf Surgery Table 11, 19TSC 42

UUnit computer

resetting 178Unit movements

blocking 48not possible 178

User guidance 174

VVessel contour detection

in QCA/QVA 107

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Vessel/catheter contrastwith Roadmap 70

WWedge filter 40

key 35setting 41

Window center 84Window values

automatic assignment 85manual setting 85

Window width 84Windowing

exam room 85Workflow

3D CARD 1593D DR 1493D DSA 152CLEARstent Dynamic 77DR-DYNAVISION 163DynaPBV Neuro 155DYNAVISION 165IVUSmap 131PERISTEPPING 171PERIVISION 173

ZZero stop

key 24Zoom

by a factor of 2 86to acquisition size 86

Zoom formatkey 35

Zoom stage 36selecting 37

Zoomingexam room 87

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Notes

DisclaimerAll the pictures of devices and the program user interface shown in this Quick Guide are only examples. The available functions depend on the type of system, the installed options, and the current configuration.Options have not been marked specially. The options will only be available if the corresponding licenses have been purchased and installed. The quotation text of your order is the sole ref-erence for the functional scope of your system.Other differences in detail may occur in your system due to constant development and improvement.Reproduction of images can cause loss of detail.All names shown in figures are purely fictional. Similarities to existing people are entirely coincidental.

Siemens reserves the right to change the implementation and specifications of this document without prior notice. For up-to-date information, please contact your local Siemens representative.

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Order No.: AXA4-100.622.24.02.02 | © 06.2013, Siemens AG

Global Business UnitSiemens AGMedical SolutionsAngiography & Interventional X-ray SystemsSiemensstr. 1DE-91301 ForchheimGermanyPhone: +49 9191 18-0www.siemens.com/healthcare

Legal ManufacturerSiemens AGWittelsbacherplatz 2DE-80333 MuenchenGermany

Global Siemens HeadquartersSiemens AGWittelsbacherplatz 280333 MuenchenGermany

Global Siemens Healthcare HeadquartersSiemens AGHealthcare SectorHenkestrasse 12791052 ErlangenGermanyPhone: +49 9131 84-0www.siemens.com/healthcare

Documents

Quickguide Q and Q.zen Ceiling