Global Business Unit

Siemens AG
Medical Solutions
Angiography & Interventional X-ray Systems
Siemensstr. 1
DE-91301 Forchheim
Germany
Phone: +49 9191 18-0
www.siemens.com/healthcare

Global Siemens Headquarters Global Siemens Healthcare Headquarters Legal Manufacturer

Siemens AG Siemens AG Siemens AG
Artis Q/zeego/Q.zen/zeego.zen/zee
Wittelsbacherplatz 2 Healthcare Sector Wittelsbacherplatz 2
80333 Muenchen Henkestr.127 DE-80333 Muenchen
Germany 91052 Erlangen Germany Operator Manual
Germany
Phone: +49 9131 84-0
www.siemens.com/healthcare

www.siemens.com/healthcare
Artis Q/zeego/Q.zen/zeego.zen/zee
Operator Manual

Order No.: AXA4-100.620.15.01.02 | © 09.2012, Siemens AG

 Global Business Unit
Siemens AG
Medical Solutions
Angiography & Interventional X-ray Systems
Siemensstr. 1
DE-91301 Forchheim
Germany
Phone: +49 9191 18-0
www.siemens.com/healthcare

Global Siemens Headquarters Global Siemens Healthcare Headquarters Legal Manufacturer

Siemens AG Siemens AG Siemens AG
Artis Q/zeego/Q.zen/zeego.zen/zee
Wittelsbacherplatz 2 Healthcare Sector Wittelsbacherplatz 2
80333 Muenchen Henkestr.127 DE-80333 Muenchen
Germany 91052 Erlangen Germany Operator Manual
Germany
Phone: +49 9131 84-0
www.siemens.com/healthcare

www.siemens.com/healthcare
Artis Q/zeego/Q.zen/zeego.zen/zee
Operator Manual

Order No.: AXA4-100.620.15.01.02 | © 09.2012, Siemens AG

 Global Business Unit
Siemens AG
Medical Solutions
Angiography & Interventional X-ray Systems
Siemensstr. 1
DE-91301 Forchheim
Germany
Phone: +49 9191 18-0
www.siemens.com/healthcare

Global Siemens Headquarters Global Siemens Healthcare Headquarters Legal Manufacturer

Siemens AG Siemens AG Siemens AG
Artis Q/zeego/Q.zen/zeego.zen/zee
Wittelsbacherplatz 2 Healthcare Sector Wittelsbacherplatz 2
80333 Muenchen Henkestr.127 DE-80333 Muenchen
Germany 91052 Erlangen Germany Operator Manual
Germany
Phone: +49 9131 84-0
www.siemens.com/healthcare

www.siemens.com/healthcare
Artis Q/zeego/Q.zen/zeego.zen/zee
Operator Manual

Order No.: AXA4-100.620.15.01.02 | © 09.2012, Siemens AG

 Global Business Unit
Siemens AG
Medical Solutions
Angiography & Interventional X-ray Systems
Siemensstr. 1
DE-91301 Forchheim
Germany
Phone: +49 9191 18-0

Operator Manual
www.siemens.com/healthcare

Global Siemens Headquarters Global Siemens Healthcare Headquarters Legal Manufacturer

Siemens AG Siemens AG Siemens AG
Artis Q/zeego/Q.zen/zeego.zen/zee
Wittelsbacherplatz 2 Healthcare Sector Wittelsbacherplatz 2
80333 Muenchen Henkestr.127 DE-80333 Muenchen
Germany 91052 Erlangen Germany Operator Manual
Germany
Phone: +49 9131 84-0
www.siemens.com/healthcare

www.siemens.com/healthcare
Artis Q/zeego/Q.zen/

Order No.: AXA4-100.620.15.01.02 | © 09.2012, Siemens AG

Artis Q/zeego/Q.zen/zeego.zen/zee
Operator Manual

www.siemens.com/healthcare
 Legend  Prerequisites

 Instructions

 List items

 Cross reference

Caution/ Cause
Warning
Possible consequences
 Precautions or remedies

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 manual can cause serious injury to the patient, to the operator or to other per-
sons.

CE marking This product is provided with a CE marking in accordance with the regulations
stated in Appendix II of the Directive 93/42/EEC of June 14th, 1993 concerning
medical devices. In accordance with Appendix IX of the Directive 93/42/EEC, this
device is assigned to class II b.
The CE marking applies only to medical devices which have been put on the mar-
ket according to the above-mentioned EC Directive.
Unauthorized changes to this product invalidate this declaration.

Original language This Operator Manual was originally written in English.

Version This Operator Manual applies to system/software version VD10 and higher.

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 Table of Contents

Part: Safety 21
Chapter: User Information 21
Information about this Operator Manual 21
General information 21
Structure 23
Text layout 23
Highlighting of safety information 23
Illustrations 24
Value statements 24
Information about the software 25
Data protection 27
System date and time 27
Information about system handling 28
Visual contact to patient 28
Room lighting 28
Prerequisites for diagnosis and treatment planning 28
Pictograms and labels 29
Lasers 32
Monitors/LCDs 33
Large Display 34
Use of hardcopy cameras 34
Use of wireless footswitches 34
Use of video recorders 35
Cleaning and disinfection 37
Sterilization 40

Chapter: Safety Notes and Radiation Protection 41

Information about unit movements 41
Red emergency STOP buttons 41
Where are the emergency STOP buttons? 42
Emergency SHUTDOWN button (installed on-site) 44
Maximum patient weight 45
Damage to the tabletop 46
Warning signs 46
Danger zones / danger points ... 47
... on the Artis zeego stand 48
... on the floor stand (Artis floor/Artis biplane) 49
... on the top stand (Artis biplane) 50
... on the Artis ceiling stand/C-arm 51
... on the patient table 52
Rescuing the patient in an emergency 53

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Table of Contents

Radiation protection 61
Dose monitoring and reduction 61
Reducing radiation with CARE 63
Interventional application 67
Cardiopulmonary resuscitation (CPR) 68
Injection 69
Radiation protection (interventions) 69
AP safety for interventional examinations 70
Cleaning and disinfecting (interventions) 70
Additional devices 71

Chapter: Operating Safety and Safety Precautions 73

Laws and regulations 73
Protective measures 73
Protection against electric shock 73
Combination with other products/components 74
Fire protection 76
Installation, repair, or modifications 77
Maintenance 77
Product service life 78
Disposal 78
Dangerous components 79

Chapter: Security Package 81

Important notes 81

Part: System Overview 85

Application 85
System configurations 87

Chapter: Equipment in the Control Room 89

Imaging system overview 89
System console 89
Artis Cockpit 90
LCD monitors 91
Keyboard 92
Mouse 95
ON box with CD/DVD drives 96
On-site equipment 96
Intercom system 96

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 Table of Contents

Chapter: Equipment in the Examination Room 101

Acquisition system overview 101
Overview Artis zeego 101
The Artis zeego stand 102
Overview Artis floor 103
The floor stand (Artis floor and Artis biplane) 104
Overview Artis biplane 105
The top stand (Artis biplane) 106
Overview Artis ceiling 107
The Artis ceiling stand/C-arm 108
Patient table 109
Trolley for control modules 110

Chapter: Operating Elements and Displays 111

Control consoles 111
Emergency STOP button 112
Table control module - TCM 112
Stand/C-arm control module - SCM 114
C-arm control module for linear movements (Artis zeego) 117
Orientation key 117
Collimator control module (CCM) 118
Touchscreen control console 120
Laser positioner 122
Keys on the FD 123
Membrane keys for FD lift 123
Membrane keys for C-arm and FD movements 123
Handswitch 124
Footswitch 125
Standard or wireless footswitch 125
Footswitch control for table with lateral tilt 129
Display Ceiling Suspension (DCS) 130
Manual control for table with lateral tilt 134
Voice control units 134
Acoustic signals 136
“Plane ready for radiation” displays 137

Part: System Operation 139

Chapter: Switching On/Off 139
Switching on and starting 139

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Table of Contents

Switching on 139
Start-up 139
Logging in with active security 140
Switching on after a power failure or emergency SHUTDOWN 141
Tests and checks 141
Switching off 141
Shutdown (without active security) 142
Logoff/shutdown with active security 143
Disconnection from the on-site power supply 145
Switching off in an emergency 145

Chapter: Functional and Safety Check 147

General information 147
Performing checks 147
Daily checks 148
Monthly checks 151

Chapter: Unit Movements 155

Movement possibilities 155
Movements of the Artis zeego stand 155
Movements of the floor stand
(Artis floor and Artis biplane) 156
Movements of the top stand (Artis biplane) 157
Movements of the stand/C-arm (Artis ceiling) 158
Movements of the patient table 159
Basic positions of the units 160
General basic positions 160
Stopping in the basic positions 160
Overview of system positions 161
System positions of the Artis zeego stand 162
System positions of the floor stand
(Artis floor and Artis biplane) 166
Positions with the top stand (Artis biplane) 168
Initiating unit movements 169
Important information on unit movements 169
Collision protection 171
Stopping movements 175
Operating locations and priorities 176
Positioning the control consoles 177
Table movements 178
C-arm movements 183
Standmovements 186
FD lift / Setting the SID 188

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 Table of Contents

Rotating the FD / Setting portrait/landscape 189

Moving to system and programmed positions 190
Moving to system positions using shortcut keys
(direct positions I, II, III) 193
Automap 193
Storing programmed positions 194
Storing system positions with shortcut (direct positions I, II, III) 195
Deleting programmed positions 196
Manual stand movements 196
Movement to or from a position with rotated table 197
Positioning the monitors 199

Chapter: Image Format, Collimation and Filtration 201

Selecting the image format/zoom stage 201
Setting the collimators 202
Rectangular collimation 203
Filter diaphragms (wedge and finger filters) 204
Resetting the collimation completely 208
Collimation without radiation - CAREprofile 208
Grid 209
Grids for inserting at the FD 209

Chapter: Screen Layout and Configuration 211

Artis screens 211
Artis Cockpit screen layout 212
Large Display screen layout 215
Assist screen 216
Readings on the Assist screen 217
Patient coordinates 220
Selecting the screen layout of the Large Display 221
Selecting the image source for the additional color display 223
Operating the 4x4 Crossbar Videoswitch 223
Operating the 8x8 Crossbar Videoswitch 224
Operation via touchscreen control 225
Touchscreen control (TSC) 225
Selecting a task card 227
Selecting a different layout 227
Button types 228
Selecting the plane (Artis biplane) 228
Displaying tooltip help for buttons 228
Configuring the touchscreen layout 229
Mouse joystick functions 233
Display of the joystick function on the live screen 234

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Table of Contents

Sensis touchscreen operation 234

Chapter: Operation via Voice Control 239

Important information 239
Setup for operation 239
Operation via voice commands 240
Voice commands 242
Troubleshooting 245

Chapter: DVD Video Recording 247

Recording with DVO-1000MD 247
Important information 247
Control elements and displays 249
Setup 252
DVD recording 253
DVD playback 254

Part: Examination 255

Chapter: Preparations - Fluoroscopy - Acquisition 255
Registering a patient 255
Taking over patient data from the RIS 255
Registering an emergency patient 256
Registering the patient and starting examination 257
Registering a patient manually 258
Preregistering the patient 259
Searching for patient data 259
Searching in the HIS/RIS and registering 260
Taking over patient data from Sensis 262
Preparing the patient and equipment 262
Blocking radiation 262
Blocking unit movements 263
Transferring and positioning the patient 263
Attaching the ECG 264
Preparing for pressure measurement 265
Adjusting the units (stand and table) 265
Setting the isocenter 266
The Examination task card 268
Screen layout on the system console in the control room 268
Screen layout in the examination room 270

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Screen layout on the touchscreen in the examination room 270

Parameters for the examination 273
Patient data 273
Patient position 274
System position 277
Positioning the patient without radiation - CAREposition 279
Exam set, application profile and acquisition program 280
Fluoroscopy/roadmap program 289
Acquisition plane(s) 292
Image mirror/flip preselection 292
Monitoring status displays 294
Fluoroscopy/acquisition 298
Fluoroscopy 299
Storing a fluoroscopic scene 299
Storing images as Store Monitor 300
Using the dilatation timer 300
Resetting the fluoroscopy signal 301
Acquisition 301
Alternative acquisition 302

Chapter: Reference Images and Display Modes 305

Storing reference images 305
Reference image 305
2nd Reference image 306
CLEARstent reference image 307
XA reference image 309
Display modes for fluoroscopy/roadmap and acquisition 310
Selecting the display mode 311
Performing Overlay Reference 312

Chapter: Subtracted Fluoroscopy: Roadmap 315

Performing Roadmap 318
Normal Roadmap 318
Advanced Roadmap using a reference image 323
Replace mask during Roadmap 325
Anatomical background with Roadmap 325
Vessel/catheter contrast with Roadmap 326
Show Progress during Roadmap 327
Pixelshift during Roadmap 327
Roadmap with two system positions (single plane) 329
Roadmap with return to biplane system position
(Artis biplane) 330

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Table of Contents

Part: Image Postprocessing 333

The PostProc task card 333
On the monitor of the system console in the control room 333
On the touchscreen control in the examination room 335
Text information in images (full screen) 335
Text information in the scene/image directory 341
Starting postprocessing 341
Calling up the Patient Browser 342
Loading a scene/image 342
Searching for and importing data in the network 343
Changing patient data 344
Moving series/scenes/images accidentally acquired
under the wrong patient 348

Chapter: Managing and Viewing Scenes/Images 349

The scene directory of a patient 351
Representative 352
Limiting display to scenes/images/reference images 352
Scrolling through the directories 353
Selecting scenes/(reference) images 354
Scrolling through scenes/(reference) images 355
Scene overview 357
Controlling scene review (Loop) 358
Stopping the loop 358
Single step 359
Starting the loop 360
Acquisition mode and frame rate 360
Setting the review frame rate 361
Defining the default review mode 362
Loop through all scenes 364
Replacing the maximum fill image 364
Changing scene/image display 365
Image flip/mirror 366
Setting an electronic shutter 367
Inverting grayscale values 368
Magnifying the scene/image, zooming/panning 369
Panning without zoom 371
Using pointers 372
Switching image text on/off 373
Switching scene time display on/off 374
Switching ECG display on/off 374

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Chapter: Processing Scenes/Images 375

Defining window and filter values 376
Information about windowing 376
Setting window values manually 378
Assigning automatic window values 381
Edge enhancement filter 381
Adding text and graphics to images 383
General information about text and graphics 383
Annotating images 387
Drawing circles 391
Drawing lines or arrows 392
Drawing polygons 393

Chapter: DSA Postprocessing 395

Introduction 396
Setting a new mask 397
Default setting “Move Mask” or “Replace Mask” 398
Moving the mask 398
Replacing the mask 399
Switching over between subtracted and unsubtracted display 400
Anatomical background 401
Vessel/catheter contrast 402
Making the image and mask coincide exactly (Pixelshift) 403
Starting pixelshift 405
Automatic pixelshift 406
Further pixelshift corrections 406
Terminating pixelshift 407
Manual pixelshift 407
Flexible pixelshift 408
Undoing pixelshift 409
Generating the image with maximum contrast medium filling 409
Improving the noise suppression of a scene (averaging) 412

Chapter: Exam Protocol 415

Displaying the Exam Protocol 415
Calling up the Exam Protocol 415
Entries in the Exam Protocol 416
Entering comments 421
Printing the Exam Protocol 422
Closing the window 422

Chapter: Saving and documenting scenes/images 423

Automatic storage 423

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Table of Contents

Storing the current image (Store Monitor) 423

Documenting scenes/images 424
Filming/printing images 424
Archiving/sending/exporting patients/images 427
Sending an image to the CARTO system 433
Exporting scenes/images as video or bitmaps 433
Exporting scenes/images 434
Closing the patient 439
Configuring patient close 440
Procedure tracking with MPPS 441
Deleting patients/studies/series/scenes 442

Part: Advanced Examinations 447

Chapter: Cardiac Examinations 447
CLEARstent Dynamic acquisition 448
General information 448
CLEARstent Dynamic acquisition workflow 449
CLEARstent Live acquisition 450

Chapter: IVUSmap 453

IVUSmap examination workflow 454
Step 1: Start IVUSmap and acquire scene 455
Step 2: Mark the vessel segment of interest 457
Step 3: Pullback 459
Step 4: Review 461
IVUSmap review 461
The IVUSmap task card 462
IVUSmap in biplane configuration 463
IVUS ILD image segment 464
Replay 465
Scrolling 465
Bookmarks 467
Overlay Reference 468
Show/hide settings 469
Corrections 469
Correcting the centerline alignment 470
Correcting the pullback speed 471
Saving a corrected registration 471
Measurements 471

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 Table of Contents

Distance measurements 472

Area measurements 472
Drawing and measuring areas 473

Chapter: Rotational Angiography, 3D Acquisition 475

General information on rotational angiography 475
Acquisition programs for rotational angiography 479
General preparations 480
Preparing the examination 480
Preparing the patient 481
Preparing the stand and table 481
Setting the isocenter 481
Preparing the injection 482
DR-DYNAVISION 483
DR-DYNAVISION examination sequence 483
DR-DYNAVISION workflow 484
Preparing DR-DYNAVISION 485
DR-DYNAVISION test phase 486
DR-DYNAVISION fill phase 488
DYNAVISION 491
DYNAVISION examination sequence 491
DYNAVISION workflow 493
Preparing DYNAVISION 494
DYNAVISION test phase 495
DYNAVISION mask phase 497
DYNAVISION fill phase 498
3D 500
3D acquisition programs 506
3D DR examination sequence 508
3D DR workflow 508
3D DSA examination sequence 510
3D DSA workflow 511
DynaPBV Neuro examination sequence 513
DynaPBV Neuro workflow 514
3D CARD examination sequence 516
3D CARD workflow 517
3D DR - Large examination sequence (Artis zeego) 519
3D DR - Large workflow (Artis zeego) 520
syngo DynaCT 360 examination sequence (Artis zeego) 522
syngo DynaCT 360 workflow (Artis zeego) 522
3D eccentric rotation examination sequence (Artis zeego) 523
3D eccentric rotation workflow (Artis zeego) 523
Preparing 3D (all 3D examinations) 523

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Table of Contents

3D test phase 526

3D acquisition phases 527
Test of image quality for 3D 530

Chapter: Peripheral Angiography 533

General information on peripheral angiography 533
Acquisition programs for peripheral angiography 535
General preparations 536
Preparing the patient 536
Preparing the stand and table 537
Preparing the injection 538
Setting the start position 538
Setting the field of view 539
PERISTEPPING 539
PERISTEPPING examination sequence 540
PERISTEPPING workflow 542
Preparing PERISTEPPING 543
PERISTEPPING test phase 544
PERISTEPPING return phase 546
PERISTEPPING fill phase 547
PERIVISION 549
PERIVISION examination sequence 549
PERIVISION workflow 551
Preparing PERIVISION 551
PERIVISION test phase 553
PERIVISION mask phase 555
PERIVISION fill phase 556

Part: Exam Sets 559

Chapter: The Exam Set and Program Editor 559
Exam Sets 559
Managing and editing exam sets 560
Opening the Exam Set and Program Editor 560
Changing the password for the Exam Set Editor 562
Resetting the password for the Exam Set Editor 562
Viewing exam sets 563
Editing exam sets 564
Viewing and editing acquisition/fluoroscopy/roadmap programs 566
Organizing programs 568

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Storing and/or applying programs 571

Closing the Exam Set and Program Editor 572

Chapter: Parameters for Exam Sets 573

CLEAR image quality 573
Acquisition parameters 573
Exposure parameters for acquisition 574
Image parameters for acquisition 577
Frame rates and scene duration 579
Parameters for rotational angiography 582
Parameters for 3D 584
Parameters for peripheral angiography 586
Parameters for fluoroscopy/roadmap 587
Exposure parameters for fluoroscopy/roadmap 587
Image parameters for fluoroscopy/roadmap 587
Pulse rates 589
General parameters 590
K Factor and motion detector 590
Dynamic Density Optimization (DDO) 592

Part: Calibration and Measurements 593

Accessing calibration and measurements 595
Calibration 598
Calibration methods 598
Performing a calibration 600
Automatic isocenter calibration 600
Calibration using the table-object distance (TOD) 601
Manual distance calibration 604
Catheter calibration 607
Sphere calibration 610
Calibration with a calibration factor 613
Measurements 614
Preconditions 614
Drawing and measuring distances 615
Drawing and measuring angles 619

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Part: Quantification 621

Quantitative analysis methods 621
Important notes 621
The Quant task card 623
On the monitor of the system console in the control room 623
On the touchscreen control in the examination room 625
General postprocessing functions 625
Selecting patients and scenes/images 625
Defining window and filter values 626
Zooming/panning 626
Calibration and measurements 627
Undoing the last calibration step 628
Confirming calibration / calculating the average 628
Clearing the entire calibration 628
Recalling the last calibration 629
Common functions 629
Report 631
Configuration 633
Checking the installed options 633
Configuring the calibration 634
Closing configuration 635

Chapter: Quantitative Vascular Analysis (QCA/QVA, IZ3D) 637

Performing a vascular analysis 638
QCA/QVA workflow 638
IZ3D workflow 638
Selecting a scene/image 640
Scenes/images for IZ3D 641
Calibration 643
Selecting the analysis method 644
Vessel contour detection 646
Selecting the vessel segment 648
Correcting the contour 649
Manual restriction 650
Toggle ostial branch 650
3D vessel model in IZ3D 651
Creating a 3D vessel model 651
Common image point 654
Viewing the 3D vessel model 654
Stent planning in IZ3D 658
Displaying the quad view 664
Moving the C-arm according to the 3D vessel model 666

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Documentation of the 3D vessel model 667

Contour information 668
Entering analysis information 669
Selecting diagram display 670
Performing evaluations 674
Information about stenosis calculation 674
Automatically determined reference diameter 675
Modifying an analysis 676
Manually determined reference diameter 677
Manual subsegment 678
Local diameter 678
Recalling an analysis 679
Results (Report) 679
Preliminary results 679
Report 682
Results of the hemodynamic data 686
Configuring QCA/QVA/IZ3D 687

Chapter: Quantitative Ventricular Analysis (LVA) 691

Starting analysis 692
Selecting a scene 692
Selecting the analysis method 692
LVA workflow 694
Selecting images 696
Biplane LVA 697
Setting the frontal and lateral plane 700
Defining contours 701
Recalling an LVA analysis 707
Results (Report) 707
Regression formulae 709
Analysis parameters 710
Wall motion analysis 712
Configuring LVA 715

Part: Accessories and Auxiliary Devices

717
General information 717
Equipment with accessories 717
Handling accessory parts 717

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Table of Contents

Accessories for the patient table 717

Tabletops 717
Tabletop for headrest (Neuro) 719
Mattresses 720
Heated mattress 720
Accessory rails 721
Accessory rail extension 722
Cable holder 722
Cable clips 725
Connectors 726
Holder with rails 727
Head-end holder 728
Catheter tray, foot-end 729
Instrument tray 729
Infusion bottle holder 730
Anesthesia screen holder 730
Positioning aids 731
Head support with cushion set 731
Head holder 731
Handgrips with supports 732
Shoulder supports 733
Arm rest 734
Articulated arm support 735
Arm rest for vertebroplastic and kyphoplastic procedures 735
OR arm rest with holder 736
Arm holder 736
Set of body straps 737
Compression belt 738
Accessories for radiation shielding 740
Compensation filters 740
Lower body radiation protection 741
Upper body radiation protection 744
Protective shield for Large Display 746
Examination lamps 747
Injector 748
Sterile covers 749
Information about using sterile covers 750

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Part: Service Functions 753

Maintenance status 753
Local service 753
Logbook 754
Remote software update and virus protection 755
Virus pattern, hotfix, or software update available 756
Installing virus pattern file updates silently 757
Installing the hotfix or software update 758
Finishing the installation 758
Dealing with virus infections 759
Remote service 760
Providing images for Service 762
Remote assistance 762
Test images 765
Image quality of the camera 766
Providing images to the image evaluation program 767

Part: Troubleshooting 769

System messages 769
Error handling 770
Message lines 770
Messages, causes, measures 773
Messages for unit movements 774
No unit movement possible! 776
Stand battery charging (Artis zeego only) 777
No communication! 778
Restart necessary! 778
Shutdown necessary! 779
Buffer full! - Memory full! 779
Door open! 780
Footswitch/handswitch connection problem 781
Emergency operation 781
Power failure! 785
Test with emergency power supply 788
Restarting 789
Transfer problems 793
General problems - Troubleshooting ... 793

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Table of Contents

Part: Abbreviations/Glossary 807

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 Part: Safety
User Information

Information about this Operator Manual

General information
Scope of applicability This Operator Manual applies to the following Artis system variants:

System VC21 Upgrade VD10 VD10

FD 20x20 or as20 or zen30HDR
FD 30x40 as40HDR Abbreviation
Multi-axis system Artis zeego Artis zeego Artis zeego.zen Artis zeego
Floor-mounted system Artis zee floor Artis Q floor Artis Q.zen floor Artis floor
Biplane system Artis zee biplane Artis Q biplane Artis Q.zen biplane Artis biplane
Ceiling-mounted system Artis zee ceiling Artis Q ceiling Artis Q.zen ceiling Artis ceiling
Abbreviation for the above
system variants Artis zee/zeego Artis Q/zeego Artis Q.zen/zeego.zen Artis

For each system, various flat detectors are available. The following abbreviations
are used in this manual:

Flat detector Abbreviation

as20 (VD10) or FD 20x20 (VC21 Upgrade) FD 20x20
zen30HDR (VD10) FD 26x30
as40HDR (VD10) or FD 30x40 (VC21 Upgrade) FD 30x40

Options This Operator Manual describes all system features of all system variants.

Note The complete system is described with all options and components that have been
released. Possible options have not been specially marked.
Particular options or components may not be available for specific systems.

The quotation text of your order is the sole reference for the functional scope of
your system.
 If your system does not have a specific feature, please contact your local sales
representative.

Addenda  Please read the Addenda to the Operator Manual.

Installed system When reading this Operator Manual please remember that some system compo-
components nents described herein may not be installed in your system configuration.

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Safety

On the other hand, you will find further information in the operating manuals for
the components and options installed in your system, if they are not described in
the following chapters.

Updates/upgrades When software updates or system upgrades are installed on your system, a new
version of the Operator Manual may be delivered. Various components of your
system may not be available anymore, and therefore, the description of these
components will be missing in the new version of the Operator Manual.
 In order to hold the information about all the components of your system, al-
ways retain the old version of the Operator Manual.

Other products This Operator Manual takes reference to other Siemens products, e.g. the work-
station. The documentation of applications may use the terms LEONARDO,
X LEONARDO, syngo Workplace or syngo X Workplace.

Third-party Please take information about description, operation, construction and technical
components data of third-party components from the documents of the supplier.
Regarding potential hazards related to high-frequency surgical equipment, cardi-
ac defibrillators, and defibrillator-monitors please see instructions of the manufac-
turer.

syngo The Artis imaging system software uses the Siemens common medical software
syngo.
For more information, please refer to the syngo documentation.

System Owner Manual You have received a System Owner Manual folder with your system. There you
will find additional manuals and documents. Also you can file documents there.

Technical and special- Proper use of this product is only possible if operating personnel have the required
ist knowledge technical and specialist knowledge and are familiar with the Operator Manual.
This manual must be studied thoroughly before start-up.

Operation of the system by non-trained users

Caution Risk of incorrect diagnosis or treatment due to misinterpretation of image in-
formation.
 The Artis system must only be used by persons with the necessary specialist
knowledge, e.g., physicians, trained radiologists, or trained technologists, af-
ter an appropriate application training.

Safety  Please pay attention to the relevant safety information.

Statutory regulations If legally binding regulations govern the installation and/or operation of the sys-
tem, it is the responsibility of the installer and/or the operator to observe these
regulations.

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 User Information

Operating personnel must undergo training in the proper operational procedures.

This instruction must be repeated as required at appropriate intervals of time.
It is recommended that emergencies be simulated and appropriate measures be
practiced during this instruction.

Structure
Parts This Operator Manual comprises different part. The part title is stated in the first
header line.

Chapters Each part may contain one or more chapters. The chapter title is stated in the sec-
ond header line.

Page numbers The footer contains the page numbers and the total number of pages in the oper-
ator manual.

Text layout
A set of conventions has been observed in this Operator Manual that is intended
to help you perceive the importance of a piece of text at a glance.
The following conventions have been used:

Instructional text guides you in the proper use of your system.

 Text of this type is preceded by a diamond.

Item list  Text of this type is preceded by a square.

Explanatory text subdivides an instructional text or list text into further subitems.
– Text of this type is preceded by a dash.

Note A Note emphasizes important information without there being direct danger and
helps you to operate the system properly and to avoid errors.
A Note also provides additional useful explanations about a subject.

Highlighting of safety information

In this Operator Manual, safety information is indicated by two lines. We distin-
guish between possible hazards by the following safety levels and signal words:

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Safety

Caution/ Cause
Warning
Possible consequences
 Precautions or remedies

Warning is used to indicate the presence of a hazard which can cause severe
personal injury or death.
Caution is used to indicate the presence of a hazard which can cause less severe
personal injury or damage to the equipment.

Illustrations
All illustrations of equipment and of the program user interface shown in this Op-
erator Manual are examples only. The available functions depend on the type of
system, the installed options, and the current configuration.
Other differences in detail may occur in your system due to constant development
and improvement of the system.
Reproduction of images can cause loss of detail. Pictures in this Operator Manual
do not therefore provide any indication of image quality.

Names All names of patients shown in figures are purely fictional. Any similarities with ex-
isting persons are entirely coincidental.

Value statements
All technical data are typical values unless specific tolerances are stated.
Values shown in pictures of the software user interface have no clinical meaning.
 Only use predefined exam sets or exam sets provided by experienced applica-
tion specialists.

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 User Information

Information about the software

Language The user interface of the Artis imaging system can be configured in one of the fol-
lowing languages:
 German

 English

 French

 Spanish

 Japanese

Copyright The system and user software used in this product is protected by copyright.

DICOM conformity The imaging system software is conforming to the DICOM standard. A DICOM con-
formance statement is available from Siemens.

Software updates The Software Distribution configuration allows you to obtain information on cur-
rently installed software packages and available but not yet installed software
packages. The software can be installed in silent mode (in the background without
user interaction) or manually by the user.
 Select Options > Configuration from the main menu.
– The Configuration Panel is displayed.
 Double-click the Software Distribution icon.

 Check the installed software and change any necessary settings.

Software installation will disturb system functions.

Caution Interruption of patient treatment and loss of patient data.
 Do not start installation during patient treatment.

Installation of the update package failed.

Caution Failed software installation will result in an undefined system state.
 Do not use the system and call the UPTIME Service Center.

Third-party software Only software authorized by Siemens for use with this product may be used.

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Safety

Use of non-approved or manipulated software or hardware components

Caution Risk of malfunctions posing a hazard to patients and equipment
 Only use software or hardware components approved by Siemens.

 Repairs shall be performed only with our expressed written approval.

Impermissible or faulty manipulations from network

Caution Risk of delayed/no diagnosis possibly, suboptimal treatment or unnecessary
radiation exposure
 Make sure all necessary precautions with respect to the existing level of secu-
rity are considered when adding a functionality or altering the shipped config-
uration.

Virus scanner A virus scanner is part of the system software installed on your device and can be
activated by Siemens Service.
The required checking of virus patterns and scan software is performed by remote
updates during each start-up. It is automatically checked whether new data is
available. Virus patterns are updated automatically. If a new virus engine is avail-
able the Software Distribution dialog will appear.
Virus pattern, hotfix, or software update available 756
 We recommend installing every new scan software by clicking the Yes button.

New viruses will not be recognized

Caution System malfunction because of virus infection
 Confirm virus pattern file and scan engine updates at start-up time.

Screen saver If a screen saver has been enabled, it is automatically activated when there has
been no activity for a certain period. The screen saver will automatically disappear
when there is a mouse or keyboard action in the control room, or in case of radi-
ation release, stand or table movement, or actions on the table side control.

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 User Information

If security has been enabled, the screen saver has the same effect as Lock
Computer.

The screen saver locks the computer during a procedure

Caution Unwanted interruptions of treatment (until screen is unlocked)
 Do not change the time for the screen lock.

Regular restarts Make sure that the system is restarted at least once a week (Restart System or
shutdown and restart later).
During restart, a check is performed and system resources are optimized.
Virus patterns are updated.

Data protection
Personal data are subject to data protection.
 Please observe the relevant legal provisions.

System date and time

It is not possible to change the system time by more than 24 h. (Otherwise all li-
censes on the system would be irrevocably invalidated! A reinstallation would be-
come necessary.)
It is also not possible to switch on the automatic change to daylight saving time.

Changing the system time, e.g. setting DST

You may change the system time by less than 24 h, e.g. change to daylight saving
time.
 Select Options > Configuration from the main menu.
– The Configuration Panel is displayed.
 Double-click the Date and Time icon.
– The Date and Time Properties window is displayed.
 Change time to the correct time, e.g. by 1h for DST.

 Click OK.
– A warning message is displayed.

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Safety

 Click OK.
– If you changed the time for less than 24 h, the system time will be changed
accordingly.
– If you changed the time for 24 h or more, a message is displayed. The sys-
tem time will not be changed.

Information about system handling

Visual contact to patient

The operator of the X-ray system must ensure that there is visual and acoustic con-
tact with the patient, thus making it possible to remain informed about the condi-
tion of the patient at all times.

Room lighting
According to the standard DIN 68 68-571 the lighting in rooms in which diagnoses
are made on image display devices (monitors) must fulfill the following require-
ments:
 The lighting must be adjustable and glare-free.

 The setting of the illuminance must be reproducible, e.g. dimmer with scale.

 No mirroring or reflections of windows, lights, view boxes, etc. must occur in

the operating position of the monitors.

Prerequisites for diagnosis and treatment planning

The Artis imaging system software has been designed and tested for use in
diagnosis and treatment planning based on digital radiographic and angiographic
X-ray images and series. To ensure that the imaging system produces monitor im-
ages suitable for these purposes, the monitor must meet certain criteria for image
quality.

Checks Since image quality can deteriorate over time because of aging and normal wear
and tear of the monitor and other components, the image quality must be
checked at regular intervals (in Germany: once per month) after installation to en-
sure that the system is still suitable for use in diagnosis and treatment planning.

1 valid in Germany, international standard is in preparation

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 User Information

Note The operator must ensure that qualified personnel are chosen and that the criteria
for image quality described in the installation and maintenance instructions are
fulfilled.

Test images Test images for use in calibration of the monitor and/or to test the hardcopy cam-
era are stored in the system. Test images are only available in plane A.
You can restore the test images via Options > Load Test Image in the main menu.
After the test images are loaded they can be found on the Patient Browser in the
folder named "Service, Patient".
For more information, see Test images 765

Pictograms and labels

The following pictograms and labels may be present on and apply to your system.
For other labels, please refer to the System Owner Manual.

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Safety

Pictogram/label Short description

Class II equipment

Degree of protection type B 74

IPX4, IPX8 IP codes

Equipotentiality

Restricted duty cycle

AP equipment 70

Limited mechanical stability

Power ON for part of equipment 139

Power ON/OFF push button

Maximum patient weight 45

PD[ NJ

Maximum patient table load 45 (patient

load + accessory load - without CPR load)

CPR position 68

CPR position 68

Class 1 laser product (applies to the detector

positioning laser only)
Lasers 32

Non-ionizing electromagnetic radiation

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Pictogram/label Short description

Caution 46

Caution 46

Caution 46

Operation instructions 46

Consult the accompanying documents 46

Consult the accompanying documents 46

Accessory load 45

(Example)

Maximum accessory load 45

(Example)

Collision area 46

Collision area 46

Magnetic field 46

Emergency STOP 41

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Safety

Pictogram/label Short description

Footswitch 125

Patient salvage device 56

Patient salvage handheld 57

Lasers
Your system may have lasers installed.

Class 1 or Class 1M laser

HAZARD LEVEL 1M LASER RADIATION
DO NOT VIEW DIRECTLY WITH
NON-ATTENUATING OPTICAL INSTRUMENTS
Take care that neither you nor the patient nor other persons look directly into the
light beam for a lengthy time.
Avoid directing the beam to the eyes of a trauma or anesthesia patient.

Note Do not use optical lenses, mirrors and similar instruments if working with laser
light. The optical instruments within the laser beam may amplify the laser inten-
sity to dangerous values for eyes and skin.
Switch off the laser light when optical instruments are used.

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Laser positioner

Laser cross-line is not adjusted.

Caution Needle will be used at the wrong entry position.
 It is the responsibility of the operator to ensure that the laser crossline points
at the correct position.

Monitors/LCDs
Please observe the following information:
 The operating indicator must light up.

 Please keep the ventilation slots of the monitors unobstructed at all times.

 If the monitor shows no image, a blurred image, vertical lines or other unwant-
ed phenomena, please contact Siemens Service.
 If no input signal is applied (connected device is off), the monitor shows “No
Signal”.
 The surface of the display can be damaged by mechanical force.
Avoid applying any mechanical force to the surface of the display.

Note Monitors are suitable for medical on-line diagnosis only if special measures to as-
sure image quality are adopted (especially determining the brightness and con-
trast values).
 In case of doubt, film images on a hardcopy camera if you want to make a di-
agnosis.
Siemens undertakes no liability for diagnoses which are performed on non-Sie-
mens monitors or on monitors not calibrated by Siemens.

When displaying the image of connected devices / external video sources in the
Caution Artis monitors (e.g. Large Display or single monitors on the Artis DCS), the image
quality may be compromised.
The image quality of the external sources may not be adequate for clinical
purposes.
 It is the responsibility of the user and of the manufacturer of the connected
third party device to check and maintain that the image quality available at the
Artis monitors is adequate for clinical purposes.

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Safety

Large Display

Large Display unavailable due to malfunction or power supply cut-off (Artis sys-
Caution tem being restarted, shut down, or having power supply problems)
The image of external video sources/connected devices (ECG, ultrasound,
navigation, etc...) is not displayed, or not displayed properly potentially lead-
ing to an interruption of the examination or procedure.
 Consider therefore to provide emergency displays (backup monitors) for the
critical video signals, and the need to establish alternate procedures.

The display software is malfunctioning. The image freezes or gets dark.

Caution Interruption of the examination
 Finish the critical part of the intervention in BYPASS mode.

 When the clinical workflow allows, restart the system to restore full function-
ality.

Use of hardcopy cameras

Only hardcopy cameras approved by Siemens may be used. Approvals by Siemens
refer to DICOM image type XA. Siemens does not accept any liability for diagnoses
made on the basis of images from non-approved hardcopy cameras.

Use of wireless footswitches

Visual contact The wireless footswitch shall be operated in close vicinity to the patient table only
and with full visibility to the patient on the table.

X-ray release may be possible from remote locations

Caution Unnecessary dose
 Do not release X-ray mistakenly if not in viewing distance to the patient and
close to an emergency button.

Interference The wireless footswitch can interfere with life supporting devices.
The wireless footswitch must emit electromagnetic energy in order to perform its
intended function. Nearby electronic equipment may be affected.

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 User Information

Operation is subject to the following two conditions:

 This device may not cause interference.

 This device must accept any interference, including interference that may
cause undesired operation of the device.

Wireless footswitch too close to a life supporting device

Warning Interference with life supporting device and possible malfunctioning
 Make sure to keep a separation distance of larger than 7 cm between the wire-
less footswitch and the life supporting device.

The wireless footswitch may be interfered with by other equipment, including

Caution portable and mobile RF communication equipment, even if such equipment
meets the applicable emissions requirements.
Fluoroscopy or acquisition may sporadically be interrupted.
 The operator must assure that other wireless device in the 2,4-GHz ISM band
should not be operated in the vicinity of approx. 5 m around the Artis system.
 Please observe and verify normal operation of the wireless footswitch before
using it.

Batteries The batteries shall always be sufficiently charged.

Weak batteries of wireless footswitch

Caution Discontinuation of interventional treatment
 Make sure that the batteries are charged before starting an examination.

 In case of empty battery, use the provided power adapter to continue treat-
ment.

The batteries of the wireless footswitch must be exchanged once a year by autho-
rized and trained staff. Please call Siemens Service. Unauthorized exchange may
cause severe damage.
Changes or modifications not expressly approved by the party responsible for
compliance could void the user´s authority to operate the equipment.

Use of video recorders

A DVD video recorder per acquisition plane can be used for recording dynamic pro-
cesses such as fluoroscopy/Roadmap or acquisition series.

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Safety

The recorded video scenes can be used as a backup. They can be played back using
the same or another device.
Recording can be controlled automatically or manually.
Automatic recording must be programmed by Siemens Service:
 During all fluoroscopy procedures (normal fluoroscopy and ROADMAP)

 During CARD acquisition series

 During acquisition series (CARD, DA, DSA, PERIVISION, DYNAVISION)

All combinations of recording options are possible.

Connection The video recorder is properly connected at installation time. Do not disconnect or
change the connections.

Switching on/off The video recorder is switched on and off automatically with the system provided
the power switch of the video recorder is "ON".

Media type The media to be used depend on the installed recorder.

Note Only use media of highest quality.

Always use a new media for every new patient.

Compatibility The media can be played back with commercial video players on any television set
or on computer monitors. The image quality depends on the playback/display unit
used.

Original This operator manual describes only the functions required for Artis.
operator manual

Note The DVD video recorder is configured by Siemens Service according to your re-
quirements. Please do not change the settings of the recorder.

If necessary, additional information can be found in the original Operator Manual

of the manufacturer.

Recording Before start of recording check that a media with sufficient recording time is in-
serted.
To identify patients clearly it is advisable to use a separate media for each patient.
 Manual recording is started by pressing the Rec or Start button on the video
recorder.

Playback  Select the Replay button directly on the video recorder or on the remote con-
trol.
With the "FREEZE" function, still frame replay is optimized by full-screen display.

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 User Information

Cleaning and disinfection

Use of harsh cleaning agents, liquids or sprays.
Caution Risk of electrical hazard or damage to the system
 Use only substances for cleaning and disinfection, which are recommended.

 Do not let cleaning liquids seep into the openings of the system, e.g., air open-
ings, gaps between covers.
 Observe the following cleaning and disinfection instructions.

Note Sprays can penetrate the interior of equipment.

It can cause damage to electronic components and the formation of flammable
mixtures of air/solution vapor.

Cleaning and disinfecting

 Before cleaning the system, shut down the system properly.

Note Use gloves to avoid infection.

 Clean all contaminated parts and all parts which may or have come into contact
with the patient.
 Keep the ventilation slots of all components unobstructed.

Dust deposited on moving parts can impair unit movements.

 Regularly clean the dust off all rails and joints etc.

The adhesive capacity of the Velcro tapes will be reduced if contaminated.

 Remove any contamination using a plastic comb.

Instructions for all LC displays, Large Display, and for Artis Cockpit
 LC displays are very sensitive to mechanical damage.
– Avoid scratches, bumps, etc.
 LC displays are very sensitive to liquids.
Longer contact with the liquids can cause discoloration or can leave calcium
residue on the surface.
Droplets that run down between the panel and the frame can cause damage
or total failure of the panel!
 If possible, immediately clean any droplets of liquid.

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Safety

 If a cleaning agent is sprayed directly on the display surface, make sure that any
droplets that run down are wiped off with a microfiber cloth before they reach
the edge of the panel.
 If the front of the panel is soiled, clean it with a microfiber cloth and, if neces-
sary, with a glass cleaning agent. Clean housing parts with a cleaning agent for
plastics only.
 In the case of contaminated panel front clean with a microfiber cloth and if nec-
essary with a cleaning agent.
 Clean housing components only with the recommended agents.
If you are using agents not listed below, the panel surface will be irretrievably
damaged.

Active ingredient class Tested cleaning agents Additional examples

and disinfectants
Alcohol Ethyl alcohol 96% Hospiset cloth
Microcide liquid
Aldehyde Melsitt Aldasan 2000
Cidex Kohsolin
Gigasept FF
Chlorine derivates Terralin Quartamon Med
Disinfectants Taski DS5001
(Diverseylever Labs)
Morning Mist
Surfanios Fraicheur Citron
(Anios Labs)
Guanidine derivates Lysoformin
Quaternary compounds Incidur spray, full
strength
Commercially available Tempo Fairy Ultra, Palmolive
dishwashing liquid
Benzine Petroleum ether
Pyridine derivates Active Spray, full strength
Water Tap water
Distilled water

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Instructions for all other system parts

The following applies in general:
 Use a lukewarm detergent solution and a soft cloth to remove slight contami-
nation.
 Remove major contamination first with a cloth soaked in alcohol, then wipe off
with clear water.
 Remove blood spots best of all with cold water.

 Remove contrast medium spots best of all with warm water.

 After using disinfectants, always wipe off with clear water.

For some accessory parts special instructions for cleaning are given in the corre-
sponding chapters.

Note Some substances contained in disinfectants are known to be hazardous to health.

Their concentration in the air must not exceed the legally defined limit.
 Always follow the manufacturer's instructions when using the disinfectants.

The following active ingredient classes can be used:

Active ingredient class Cleaning agents and disinfectants

Aldehyde Incidin Perfekt
Alkylamine Lysoformin Plus
Chlorine derivates Clorina
Commercially available dishwashing Tempo, Fairy Ultra, Palmolive
liquid
Guanidine derivates Biguacid S
Organic acids Apesin SDR san
Quaternary compounds Oasis Pro
Peroxides Sanosil
Pyridine derivates Bacoban WB

The following products should not be used:

 All alcohol-based products

 All chlorine-releasing products

 Benzine / phenole-based products

 Products: Banicide Advanced, Wavicide, Terralin, Cidex OPA

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Safety

Note Always follow the safety data sheets of the manufacturer which provide detailed
information on the composition of the disinfectants.

Sterilization
 Please observe your hospital's regulations concerning sterilization.

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 Safety
Safety Notes and Radiation Protection

Information about unit movements

Because of the possible speed of movement of the stand and C-arm (of each
plane) and the tabletop, this system must be operated with particular care.
For reasons of safety the systems are equipped with collision sensors on the flat
detector, the primary collimator and the side of the C-arm of the floor stand facing
the floor.

Collision protection If one of the collision sensors is activated, further unit movements are blocked and
a message indicating that appears.

Dead man's grip All unit movements are controlled with a dead man's grip (DMG), that is, move-
ments are performed only while the operating element is being actuated. In the
event of danger, the movement can be stopped immediately by releasing the
dead man's grip.

Danger of crushing The patient and operating personnel must grip only the handles which are intend-
ed for the proper handling of the equipment or positioning of the patient. When
it is not possible, attention must be paid to possible risks of injury by crushing in
the vicinity of moving parts.
 Pay special attention to the risks of crushing fingers/hands between moving
parts and their guide openings.
 Before performing unit movements make certain that the patients do not grasp
the frame of the tabletop.

Abnormal movements If any part of the system moves although that movement was not released, for ex-
ample, if the display ceiling suspension moves downward by itself, there might be
a fault.
 Shut down your system and call Siemens Service.

UPS operation To prevent data/image loss, your system may have a UPS which shuts down the
imaging system in a controlled way in the event of a power failure.
Emergency operation 781

Red emergency STOP buttons

Triggering STOP 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 situation, 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.

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Safety

 Press one of the red emergency STOP buttons immediately.

STOP – All system drives are shut down and movements are stopped immediately.
Movement 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/expo-
sure release pedal again, even without canceling STOP.
– Injections1 are interrupted, but can be continued without canceling STOP.

Canceling STOP Only when the cause of the danger has been unequivocally identified and reme-
died, can the emergency STOP button be disengaged.
 To do so, pull the red emergency STOP button.

Note In the event of a system failure:

 Press the emergency STOP button and unlock it again.
– It will reinitialize the system.

Where are the emergency STOP buttons?

You will find emergency STOP buttons in the following locations:
STOP  on the front side of any table control module

STOP STOP
Control modules

1 if the injector is controlled by the system

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 Safety Notes and Radiation Protection

Artis zeego control modules

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

6723
 on the front side of the emergency STOP module of the OR patient table

Note Always position the control modules on the accessory rails in such a way that the
emergency STOP button remains accessible at all times!

Emergency STOP in the control room

 in the control room if an additional handswitch, footswitch, or remote control

is installed there.
– On the control table (Emergency STOP module)
– Or installed below the control table

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Safety

Emergency SHUTDOWN button (installed on-site)

Use this shutdown method only in an extreme emergency because it is an uncon-
trolled process!
Data could be lost, like unsaved images, exporting and filming jobs, etc. The tube
cooling system is also disconnected from the power supply, and the tube can over-
heat.
If a flat detector is used, it is also disconnected from the power supply. After the
power has been switched on again, an additional waiting time is required to en-
sure optimum image quality.

Shutdown using the emergency SHUTDOWN button

Caution Risk of data loss and/or
Damage to tube due to lack of cooling
 Operate the emergency SHUTDOWN button only in case of emergency or if the
system cannot be switched off by the End Session command.

Note An emergency power supply, if one is connected, will not be activated when
emergency SHUTDOWN is pressed.
It does not apply to the imaging system UPS, which will shut down only after a
configurable time. (The green LED indicator on the imaging system lights when
the UPS is still running.)

Switching off in an emergency in case of danger

Only exclusively, if there is danger for patients, operators, third parties or the unit:
 Press the on-site emergency SHUTDOWN button.
– The entire system is disconnected from the power supply.
This means that:
 all unit movements will be interrupted

 radiation will be turned off

 the current system program will be interrupted

 current operating sequences will be interrupted and cleared

 all current acquisition data will be cleared, unless they have been saved to non-
volatile memory

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 Safety Notes and Radiation Protection

Switching on again
Only if the cause of the danger has been unequivocally identified and remedied,
the emergency SHUTDOWN button can be released and the system operated
again.
 In all other cases, e.g. system malfunction, contact Siemens Customer Service
immediately.

Maximum patient weight

The permissible patient weight with which you can load your tabletop is stated on
the label on the tabletop and on the table column and in the technical data.
 The value on this label indicates the maximum patient load, without accessory
PD[ NJ load and without CPR load. 68
 The value on this label indicates patient load including accessory load but with-
out CPR load. 68
It is important that the load is distributed uniformly over the tabletop. Otherwise
there is a risk of material deformation and system malfunction. The patient weight
includes any parts permanently or loosely connected with the patient, such as
equipment, prostheses, implants, plaster casts.
Example of incorrect use with uneven weight distribution:
A patient with a maximum weight sitting at the end of a fully extended tabletop.

Patient is too heavy for the table

Warning Personal injury
 Do not position a patient with more weight than described in either label (label
on table column and label on tabletop) on the table.

Accessory load Additional loads may be attached to any accessory rail or to all accessory rails in
total. It includes all accessories, e.g. injector, radiation protection devices!
The weight of accessory parts is stated by labels.

The component, e.g. tabletop or accessory, must not be loaded with more than
weight indicated.

(examples)
In the interest of operating safety for the patient and unit, the permissible patient
weight and accessory weight must not be exceeded.

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Safety

Damage to the tabletop

A damaged tabletop is a potential hazard to the patient!
When the patient tabletop collides with an obstacle such as a bed or instrument
table, hairline cracks can result.
 Call Siemens Service and have the tabletop checked immediately if it is possible
that it might have been damaged (e.g. accidental collision with the patient
bed)!

Warning signs
Special danger points are marked on the unit with a warning sign:

Danger of crushing
This warning sign indicates possible danger of crushing for the patient and/or ex-
aminer.
Siemens angiography systems generally possess in their standard configuration a
safety system for preventing collisions (collision protection).

General danger However, under certain circumstances, additionally installed components, like
lead protective screens, lamps, auxiliary equipment etc. can cause collision with
the angiography system.
To protect these components and also to protect the patient, such components
are provided with a warning sign shown on the left.
We can provide you with these warning signs. Siemens Service will also attach
them to additionally installed components on request.

Observe the documents

These pictograms indicate that special instructions can be found in the accompa-
nying documents.
 Please read the Operator Manual.and other accompanying documents

Magnetic field The component, e.g. footswitch, must not be operated in areas where the mag-
netic field exceeds >0.5 mT, e.g., labeled area for MR systems, Artis-MR Miyabi and
Artis MN - Magnetic Navigation.

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 Safety Notes and Radiation Protection

Danger zones / danger points ...

The positions marked in the following illustrations indicate danger zones in which
patients or operating personnel could suffer injury by crushing or colliding:
 Due to the mobility of the stands, there is a danger of injury in certain areas
during unit movements.
 Make sure that there are neither persons or objects in the swivel or rotation
range of the stands or the lifting and rotation range of the patient table.
 Make sure that the knees of seated staff members are not located in an area
under a stand or the patient table.
 To avoid collisions, the display ceiling suspension, radiation protection devices
and other accessories should be outside the C-arm system.
Risk of injury by crushing or collision

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Safety

... on the Artis zeego stand

Danger points on the Artis zeego stand

Danger of crushing  At all joints during rotations and movements

The hand will be squeezed between “link arm” and “arm” of the muli-axis stand.
Caution Risk of injury of the hand
 Do not reach between “link arm” and “arm” during system movements.

 On the rails of the FD slide for FD lift

 Between the collimator and C-arm during collimator rotations1

Danger of collision  At the outer edges of the C-arm

1 only with angio collimator

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 Safety Notes and Radiation Protection

... on the floor stand (Artis floor/Artis biplane)

Danger points on the floor stand

Danger of crushing  At the pivot bearing of the C-arm during rotations

 At the friction bearing of the C-arm during orbital movements

 On the rails of the FD slide for FD lift

 Between the collimator and C-arm during collimator rotations1

Danger of collision  At the outer edges of the C-arm

1 only with angio collimator

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Safety

... on the top stand (Artis biplane)

Danger points on the top stand

Danger of crushing  At the pivot bearing of the C-arm during rotations

 At the friction bearing of the C-arm during orbital movements

 On the rails of the FD slide for FD lift

Danger of collision  At the outer edges of the C-arm

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 Safety Notes and Radiation Protection

... on the Artis ceiling stand/C-arm

Danger points on the top stand

Danger of crushing  At the pivot bearing of the C-arm during rotations

 At the friction bearing of the C-arm during orbital movements

 At the rails of the FD slide during upward movement of the FD

 Between the collimator and C-arm during collimator rotations1

Danger of collision  At the outer edges of the C-arm

1 only with angio collimator

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Safety

... on the patient table

Danger of crushing  Between the tabletop and the table frame

 Between the tabletop and the table column

 Between the handle and the frame

(if the handles are operated from both sides)

Danger of collision  On the outer edges of the table

 On the (sliding) accessory rails

Surgery table Trumpf Surgery Table TRUSystem 7.500 or Maquet Magnus table for Artis systems
Please refer to the manufacturer’s Operator Manual.

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 Safety Notes and Radiation Protection

Rescuing the patient in an emergency

E.g. in case of power failure, motorized system movements are not available.
However, you can move parts of the system manually.
 With a Artis zeego stand, it is possible to move the C-arm manually after the
brakes have been released.
 With a floor mounted stand, it is possible to move the stand manually in swivel
direction with reasonable force.
 With a second plane ceiling mounted stand, it is possible to move the stand
manually in longitudinal direction with reasonable force.
 With a ceiling mounted stand, it is only possible to remove the patient manu-
ally by turning the table or pulling the mattress.
 With a floor mounted table, it is possible to move the tabletop manually in lon-
gitudinal direction with reasonable force.

Note During the following steps make sure that the patient is not crushed!

Personnel  Use enough personnel for the rescue.

Accessories  Remove any accessories obstructing rescue.

C-arm You can move the C-arm of the floor stand and the C-arm of the top stand in a bi-
plane system manually.
 Pull/push vigorously to overcome the braking force.

Some axles cannot be moved while power is off.

Caution Risk that the patient cannot be removed from the patient table
To rescue or release the patient from the Artis system in case of a power failure:
 Rotate the patient table.

 Move the stand manually in swivel direction with reasonable force.

 Move the tabletop in longitudinal direction with reasonable force.

 Pull the mattress if the patient cannot be removed from the table by other
means.

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Safety

Power failure - The patient is squeezed between FD and patient table.

Caution Risk that the patient cannot be removed from the patient table
To rescue or release the patient from the Artis system in case of a power failure:
 Rotate the patient table.

 Move the floor stand manually in swivel direction with reasonable force.

 Move the second plane stand in longitudinal direction with reasonable force.

 Move the tabletop in longitudinal direction with reasonable force.

 Pull the mattress if the patient cannot be removed from the table by other
means.

Table tilt 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 horizontal position:
 Press both keys simultaneously and hold them pressed until the movement
stops automatically.
Or
 Press the Home key on the manual control and hold it pressed.
+20(

Table rotation 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 position.
 Rotate the patient table.

Tabletop If necessary, you can move the tabletop of patient tables with manual tabletop
movement manually in the longitudinal and transverse direction.
(It is not possible on patient tables with motor-assisted tabletop movement)
 Pull/push vigorously to overcome the braking force.

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 Safety Notes and Radiation Protection

Artis zeego Recovery procedure after power failure during interventions

Power failure - The patient is squeezed between FD and patient table.

Caution Risk that the patient cannot be removed from the patient table
To rescue or release the patient from the system, proceed as follows:
Table can be rotated:
 Rotate the patient table.

 Move the patient from the table to a bed or any other suitable device
or continue work with a mobile C-arm system.
Table cannot be rotated, e.g. prevented by C-arm position:
 Lift the mattress at the foot end to unfasten the hook and loop fastener or
Velcro fastener.
 Put some paper or cloth between tabletop and mattress so that the Velcro does
not fasten again.

Power failure - The patient is squeezed between FD and patient table.

Caution Risk that the patient cannot be removed from the patient table
 Release the brakes (C-arm and stand base) with the patient salvage switch.

 Move the C-arm out of the way and reactivate the brakes.

Stand battery empty

Caution Risk that the patient cannot be removed from the patient table and that in
case of a system shutdown, it will not come up anymore without service.
 Do not switch off the system while the message “Stand battery charging: DO
NOT POWER OFF” is displayed.
If for any reasons a power off is required in this state:
 Take care that the stand is in a position where the patient rescue is possible
without the need of any stand movement.

In case of power failure, all brakes of the Artis zeego stand joints are engaged.
There is an emergency power supply for release of the brakes. The release of the
brakes must be done manually.

Note The emergency power supply for release of the brakes (rescue kit) is an extension
to Artis zeego and must have been ordered and set up during installation.

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Safety

 Open the cover on the rear of the stand base.

1
2

 Open the flap.

– The stand leaves its normal operation mode. No more motorized move-
ments will be possible.

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 Safety Notes and Radiation Protection

(1) (2)

 Take out the handheld.

Note The handheld is not a sterile part. It must not be placed in the patient area.
Do not touch the handheld and the patient at the same time.

 Pull the button (1) on the handheld to release the brakes.

Now the C-arm and stand can be moved manually.

Note Only the brakes for stand swivel and C-arm rotation are released.
Movements of the other axis remain blocked.

Example

 Rotate the C-arm so that there is room to release the patient.

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Safety

 Swivel the stand to clear space.

Pull/push vigorously to overcome the weight of the C-arm.

Note Please note that the C-arm will sink down by its own weight when the brakes are
released. Do not forget to switch off again the brake release when you have fin-
ished.

 Press the button (2) on the handheld to fasten the brakes again.

Note Depending on the charging condition of the emergency power supply, the brakes
are released for about 5 minutes.

After a manual move of the C-arm/stand, the stand must be readjusted.

 Call Siemens Service.

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 Safety Notes and Radiation Protection

Artis ceiling Recovery procedure after power failure during interventions

Power failure - The patient is squeezed between FD and patient table.

Caution Risk that the patient cannot be removed from the patient table
To rescue or release the patient from the Artis ceiling system in case of a power
failure:
Table can be rotated:
 Rotate the patient table.

 Move the patient from the table to a bed or any other suitable device
or continue work with a mobile C-arm system.
Table cannot be rotated, e.g. prevented by C-arm position:
 Lift the mattress at the foot end to unfasten the hook and loop fastener or
Velcro fastener.
 Put some paper or cloth between tabletop and mattress so that the Velcro does
not fasten again.
 Unfasten safety straps, if applicable.

 Pull the mattress with the patient on it from the tabletop at head side end or
foot side end of the table - depending on room situation and accessibility.

During power failure, the ceiling stand cannot be moved

Caution The patient treatment cannot be continued during interventions
 Unlock the belt tensioner (clasp) of the ceiling rail and move the ceiling sus-
pended C-arm in head or feet direction.
 Continue the surgical procedure with a mobile X-Ray system.

In order to be able to quickly response and move the ceiling suspended C-arm
away from the patient an additional clasp at the ceiling suspension has been in-
stalled.

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Safety

(1) (2)

 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 completely release the belt.

Note Make sure that there is always a ladder available to reach the clasp.

(3)

 Once the belt has been released (3) the C-arm can be easily pushed away from
the patient towards the end of the table.
The patient is free for all necessary procedures.
After power recovery:
 Place the belt back in the ceiling rail and move the C-arm carefully back to the
previous 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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Immobilization

Patient table tilted

Warning Risk of patient sliding from the table
 Secure the patient sufficiently with shoulder supports, foot holder or body
straps before tilting the table.
The body straps and hand grips are not suitable for holding the patient when the
table is tilted.

 Loosen any fixtures.

Mattress In difficult cases, you may have to rescue the patient along with the mattress, e.g.
if the C-arm position does not allow another procedure.
 Lift the mattress at the foot end to unfasten the hook and loop fastener (or vel-
cro fastener).
 Put some paper or cloth between tabletop and mattress so that the velcro does
not fasten again.
 Unfasten safety straps (if applicable).

 Pull the mattress with the patient on it from the tabletop at head side end or
foot side end of the table (depending on room situation and accessibility).

Radiation protection
The Artis X-ray equipment with radiation protection complies with IEC 60601-1-3
and respectively IEC 60601-2-43.
Mode of operation: continuous

Dose monitoring and reduction

The CARE package 63 helps you reduce the radiation dose to the patient and
examiner considerably. Please observe the following:

Radiation protection  Release fluoroscopy for as short a time as possible, use the LIH function.
for the patient
 Use dose-saving fluoroscopy with CAREvision 63

 Collimate radiation-free in the LIH image; you can also set the filter diaphragms
in the LIH image without radiation: CAREprofile 63
 Position the patient radiation-free in the LIH image: CAREposition 64

 Pay attention to dose display: CAREwatch 64, CAREmonitor 65

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Safety

 If possible, ensure the best possible protection of the patient during fluorosco-
py and acquisitions in the vicinity of his or her reproductive organs (use gonad-
al apron, lead-lined rubber covers).
 Keep the radiation field as small as possible without reducing the active mea-
suring field.
 Remove all radiopaque parts from the fluoroscopic or radiographic field, if pos-
sible.
 Set the X-ray tube voltage as high as possible (not forgetting the image quality;
the optimum is 63 kV for iodine contrast).
 Set the X-ray tube to skin distance as large as is reasonable for each examina-
tion.

Radiation protection  If possible, release the acquisition series in the control room.
for the examiner
 The duration of your stay in the control area should be as short as possible.

 Wear protective clothing in the control area during examinations.

 Maintain the maximum possible distance from the source of radiation.

 Check your personal dose by wearing a radiation monitoring badge or a pen

dosimeter.
 If possible, use mechanical protective shields (protection for upper and lower
body). They contribute greatly to your personal radiation protection.

Switching off in an If a problem, e.g. a defect, occurs during the examination and radiation can no
emergency longer be interrupted by letting go of the radiation release button:
 Press the nearest emergency STOP button.
STOP Red emergency STOP buttons 41

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 Safety Notes and Radiation Protection

Reducing radiation with CARE

The CARE package (Combined Applications to Reduce Exposure) comprises fea-
tures for dose reduction. A complete set of CARE features can be found on your
system, consisting of:
 CAREmatic - Automatic exposure control 63

 CAREvision - Extended pulsed fluoroscopy 63

 CAREfilter - Automatic copper filter selection 63

 CAREprofile - Collimation without radiation 63

 CAREposition - Positioning without radiation 64

 CAREwatch - Display of Dose Area Product 64

 CAREmonitor - Display of skin entrance dose of the currently radiated patient

skin area 65
 CAREguard - Dose alert 67

 CAREreport - Detailed dose information for reports 67

CAREmatic The CAREmatic function provides fully automatic exposure control.

– During fluoroscopy, the water equivalent is determined for acquisition.
– kV, mA, pulse width and ADF filter are preset for acquisition.
– A phototimer is used during acquisition.

CAREvision Using CAREvision, you have at your disposal a selection of fluoroscopy modes
with different pulse rates that you can use to reduce the patient dose consider-
ably.

CAREfilter The CAREfilter function comprises various copper filters. They filter out the low
energy components of the X-ray spectrum that are not needed to create the im-
age.
This causes hardening of the beam, reducing not only the skin dose for the patient
but also the scattered radiation for the examiner.
Automatic dose rate control calculates the water equivalent of the patient from
the current kV/mA values and the pulse width. The additional copper filter is auto-
matically moved in or out of the beam path as a function of this value during ac-
quisition if the image quality becomes unacceptable because of a very high
patient density.
The CAREfilter function is automated and cannot be operated manually.

CAREprofile With the CAREprofile function, the positions of the multileaf collimator and the
filter diaphragms are displayed graphically in the last fluoroscopic or acquisition
image. You can change the collimation without additional radiation release.
Collimation without radiation - CAREprofile 208

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Safety

CAREposition The CAREposition function allows you to reposition the patient with the aid of the
last fluoroscopic image (LIH) without additional fluoroscopy.
Positioning the patient without radiation - CAREposition 279

CAREwatch With a dose measuring chamber, which is mandatory in some countries, the dose
area product and the skin entrance dose (reference air kerma) are shown on the
live screen in the examination room and on the console monitor in the control
room.

(1)
(2) (3)
(3) (4)
(4)
Dose indication in the control area in the Dose indication in the control area on the system
examination room (on every plane) console in the control room

(1) CAREmonitor radiation bar 65

(2) Fluoro timer 294
The elapsed fluoro time of uninterrupted fluoroscopy is recorded and dis-
played.
Overall radiation exposure:
 During fluoroscopy/acquisition: -  Without radiation:
(3) The current value of the reference air - The accumulated value of the
kerma rate in mGy/min (patient dose reference air kerma in mGy
rate)
(4) The accumulated value of the - The accumulated dose area product
reference air kerma in mGy (DAP) in µGy · m2

Note The dose measuring chamber must be calibrated at regular intervals. It is done un-
der the terms of a service contract. If you do not have a service contract, Siemens
Service or the manufacturer can calibrate the dose measuring chamber.

Note If the dose area product exceeds a certain limit value, radiation injury (initially red-
dening of skin) may occur on the patient.
This information allows the examiner to avoid radiation injury, e.g. by changing
the angulation.

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Reference point The reference dose and dose rate is calculated in relation to the patient entrance
for measurements reference point during fluoroscopy and acquisition.
The patient entrance reference point is defined at 15 cm in front of the isocenter.
 Artis floor/Artis biplane:
The reference point for measurements is equivalent to a distance of 60 cm
from the focal point of the X-ray tube.
 Artis ceiling/Artis zeego:
The reference point for measurements is equivalent to a distance of 63,5 cm
from the focal point of the X-ray tube.

FD

Isocenter

15 cm

x
60 cm

Schematic figure: The focus is marked with a red spot.

CAREmonitor The CAREmonitor function displays the accumulated skin entrance dose of the
currently radiated patient skin area. It gives a dedicated air kerma indication using
an internal model based on patient weight, patient height and irradiated skin
square.
CAREmonitor will only be possible if patient height and patient weight are en-
tered during patient registration.

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Safety

Please accept the following information for Caremonitor:

Patient height: XXX m or ft
Patient weight: YYY kg or lb
 Confirm the patient height and patient weight data or correct them.
Changing patient data 344
The system calculates a patient model using the patient height and patient
weight. For further calculations, the skin surface of the patient model is divided
into small squares. For every C-arm projection as well as table and collimation set-
ting, the applied skin entrance dose for every skin square in the radiation field will
be calculated.
The CAREmonitor bar shows the increasing radiation dose of the skin square in
the radiation field with the highest skin entrance dose during the whole examina-
tion.
The maximum value for the medically acceptable skin entrance dose in one skin
square is configurable according to your local requirements. The default value is
1 Gy.
When the maximum value is reached, the intensity of the bar changes and a ’>’
sign is added to the configured value, e.g. >2.0 Gy.
 In this case, if possible, change the C-arm angulation to avoid adverse skin ef-
fects.

Note The CAREmonitor radiation bar displays the maximum dose applied to a skin
square in the current radiation field.
If the angulation changes a bit only, a skin square close to the border of the pre-
ceding radiation field could still be in the new projection.
This skin square would assume the highest value of all skin squares in the new
field.
If the angulation changes a lot, the CAREmonitor radiation bar will go down to
zero when the new projection includes only skin squares without preceding skin
radiation of this examination.

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Misinterpretation of the CAREmonitor indicator

Caution More X-ray dose is applied than medically acceptable
 The user is responsible that the preset maximum dose is as low as reasonably
practicable.
The displayed skin entrance dose value is for guiding purposes only. It is based on
the entries of maximum reference air kerma and patient weight and height.
After every patient registration the accumulated value is set to zero. A repeated
examination of the same patient does not display the patient´s preceding dose
values.

CAREguard A dose alert is provided with three reference air kerma thresholds, which can be
set individually. When the value of the accumulated reference air kerma exceeds
the first, second, and third threshold, an acoustic signal will sound and a message
box will be displayed on the console monitor and on the touchscreen.
The threshold values can be configured by Siemens Service.

CAREreport Detailed dose information is given the Exam Protocol or the Exam Protocol SR,
e.g. for statistics.
Exam Protocol 415

Interventional application
Due to the complexity of the system, the loss of X-ray imaging or other system
Caution functions during an examination or procedure cannot be completely excluded.
Risk of failure during interventions
 Consider therefore the need to establish emergency procedures in such cases.

See also Rescuing the patient in an emergency 53

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Cardiopulmonary resuscitation (CPR)

Pressure compression / max. permissible patient weight

The Artis systems are designed for cardiopulmonary resuscitation (CPR = Cardio-
Pulmonary Resuscitation) with a pressure compression of up to 600 N (60 kg).
The maximum patient weight must not be exceeded.
Maximum patient weight 45
Make sure that there is enough free space for performing CPR.
 Remove any objects, such as chairs, from the examination area.

CPR label

Or

No Yes

This warning label indicates the position of the tabletop for cardiopulmonary re-
suscitation (CPR).

CPR position Artis floor/Artis biplane/Artis ceiling/Artis zeego

(Does not apply to Trumpf Surgery Table TRUSystem 7.500 or Maquet Magnus
table.)
To achieve the greatest possible table stability for a cardiac massage (CPR = car-
diopulmonary resuscitation), the table may not be tilted and the tabletop must be
moved so that it is directly above its supporting table column.
 Position the tabletop above the supporting table column.

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Note Only begin CPR when the tabletop is positioned over table column.

Injection
If an injector is connected to the system, injection will be automatic with some ex-
amination programs. However, the examiner can also inject manually.

Injector not connected (correctly) or not set to “armed” (especially with

Caution PERIVISION, DYNAVISION or 3D examinations)
Risk of X-ray radiation applied without diagnostic use
 Pay attention to the messages.

 Inject manually, if necessary.

 Before releasing acquisition with contrast medium, ensure that the injector is
“armed”.

Radiation protection (interventions)

Detailed information on radiation protection for patients and examiners you will
find in Radiation protection 61.

High skin doses The system is intended for procedures that, with proper use of the system, involve
high skin doses (deterministic effects), mainly due to the long examination times,
which presents a risk of radiation injury.

Accessories For instructions for use of radiation protection accessories see Accessories for ra-
diation shielding 740

Exam Sets The dose is determined in the exam sets (fluoro/roadmap and acquisition pro-
grams).

Note The available exam sets depend on the system type and the configuration.
The system comes preinstalled with a number of exam sets.
 For further information on the preinstalled examination sets ask your applica-
tions specialist.

The fluoroscopy/roadmap programs are always available in three versions, which

usually differ with regard to their dose.

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Safety

Example

(1)

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

(3)

Console, Examination task card Examination room, touchscreen control Exam Set and Programs Editor

(1) low
(2) normal
(3) high
 Select only suitable examination sets for the examination.

 If possible, select a dose-saving fluoro/acquisition program.

(Fluoro programs with a lower dose are further to the left).

Door contacts Recommended: In case of interventional applications, a current procedure should

neither be interruptible by door contacts nor by other measures.
Remedy: Install door contacts (or have them installed) in such a way that an inter-
ruption can be disabled.

Programs for Contact your Siemens service engineer in this regard.

interventions

AP safety for interventional examinations

The use in conjunction with flammable anesthetic gases is restricted to system
parts which are operating within the vicinity of the respiratory mask of the patient.
Follow the instructions for use of the Trumpf surgery table TruSystem 7500 or
Maquet Magnus table Operator Manual

Cleaning and disinfecting (interventions)

Prevention  Use sterile covers. 749

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 Safety Notes and Radiation Protection

System parts The following system parts can come into contact with body fluids, contrast me-
dium etc.:

System part Special cleaning measures

Patient table,  If necessary, remove the tabletop
tabletop
Control modules  To prevent system movements, press an emer-
gency STOP button.
Flat detector  Protect by sterile covers.
X-ray tube assembly with  Protect by sterile covers.
primary collimator
Scattered radiation pro-  Protect by sterile covers.
tection
Handswitch,  To prevent radiation release, activate
Footswitch Block Radiation in the Exam task card on the
touchscreen control. 262
Injector See the Injector Operator Manual
Integrated ultrasound See the Integrated Ultrasound Unit Operator
Manual

Cleaning Special cleaning instructions for the different surfaces can be found in Cleaning
and disinfection 37.

Additional devices
If an additional device is used in examinations, e.g. ECG unit:
 Before connecting the patient to an additional device, make an additional, con-
ductive connection between a point of the equipotential equalization, e.g. the
tabletop, and the device.

Note For approved injectors with the Siemens central connection cable, this additional
measure is not required for connection to the patient table. The central connec-
tion cable is already equipped with an additional conductor for the above purpose.

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Operating Safety and Safety Precautions

Laws and regulations

The statutory regulations and laws of the respective country must be followed.

Germany RöV (X-Ray Ordinance) - Legally required tests:

Before start-up
 Acceptance test

 Expert inspection

During operation according to the time intervals specified

 Constancy test

MPBetreibV (ordinance for system owners of medical equipment)

 Safety check for technical construction at least every 2 years

U.S.A. 21CFR
Caution: Federal law restricts this device to sale by or on the order of a physician.
This system is intended for use in radiographic examinations and under the guid-
ance of a trained health care professional.

Protective measures

Protection against electric shock

Power supply For all products that are operated within an X-ray system, the power supply must
be made through a conductor or other multipole circuit breaker installed on-site.
The room installation must comply with IEC 60364-7-710 or the corresponding
national regulations.

Injector connector When the injector is removed from the table, the adapter must also be removed
from the connector on the table for safety reasons.

Power outlet The country-specific multipurpose power outlet on the patient table is not
switched off and on with the system.
Only devices which accord to IEC 60 601-1 must be connected.
Do not connect a multiple portable socket outlet.
Do not connect life supporting devices to the power socket of the patient table.
The power socket does not have the necessary medical grade.

Covers If socket covers are damaged, they must be replaced.

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Safety

In the event of defects, for example, if a covering cap has broken off:
 Call Siemens Service.

Protection class Class I

The system belongs to protection class I with a type B applied part according to
IEC 60 601-1.

Applied part Type B: patient tabletop

Mode of operation Continuous

Protection against in- The protection against ingress of water is classified according to IEC 60529. The
gress of water number defines the protection against ingress of water with harmful effects.
 IPx4: Protected against splashing water
Control modules, patient table, handswitch
 IPx8: Protected against the effects of continuous immersion in water
Footswitches
 IPx0: Not protected
Rest of the system

Sterilization/ No sterilization
Disinfection

AP/APG 807

AP safety for interventional examinations 70

Equipotential Systems for which equipotential equalization is recommended must only be oper-
equalization ated in medical facilities where supplemental equipotential equalization has been
installed and tested according to the specifications in DIN 57107/VDE 0107/6.81
section 5 (Germany) or the relevant local and federal regulations.

Opening the units Only authorized service personnel are permitted to open the units.

Combination with other products/components

To ensure the necessary safety, only products/components expressly approved by
Siemens AG, Medical Solutions may be used in combination with the system.
To find out about the current state of the equipment and the combinations and
upgrades currently approved:
 Please contact your authorized local sales representative.

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 Operating Safety and Safety Precautions

Interfaces The use of ACCESSORY equipment not complying with the equivalent safety re-
quirements of this equipment may lead to a reduced level of safety of the resulting
system. Consideration relating to the choice shall include:
 Use of the accessory in the PATIENT VICINITY

 Evidence that the safety certification of the ACCESSORY has been performed in
accordance to the appropriate IEC 60601-1 and/or IEC 60601-1 series harmo-
nized national standard.
Everybody who connects additional equipment to the signal input part configures
a medical system, and is therefore responsible that the system complies with the
requirements of the valid version of the IEC 60601 standard series.
 If in doubt, consult the technical service department or your local representa-
tive.

Connection of third-party devices with Artis Cockpit and Large Display

To display images from third-party video sources, note the following require-
ments:
 The connection of third-party devices is only permissible if they meet the spec-
ifications of the Cockpit interface.
 The connection of the Cockpit interface to the Cockpit controller must be per-
formed by a Siemens service technician.
 The connection to the third-party device must always be performed by the
technician of the third-party company or by the responsible on-site hospital
technician.

 Siemens cannot assume any warranty for the connection of the third-party de-
vice with respect to the image quality and its suitability for diagnosis.
 It is recommended that the image quality tests prescribed by the third-party
manufacturer are performed again before use. These tests can ensure that the
required image quality is achieved.
 The system configurator is responsible for ensuring that the valid versions of
the relevant standards are met (e.g., EN/IEC 60601-1-1).

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Safety

If an external component is connected to the Cockpit system via a USB port - using
a separate keyboard as the operating unit - the following must be observed:
 The external component must support the use of a standard keyboard with
104 keys.
 If this requirement cannot be met, the third-party device can only be operated
directly via the keyboard supplied by the manufacturer of the device. A USB
connection between the Cockpit and the external component is then not per-
missible and operation using the Cockpit syngo keyboard is not possible.

Note Non-observance of these instructions may result in operating errors and loss of
data!

Fire protection
In the event of a fire shutdown the entire system immediately, that is, disconnect
the system from the main power supply.
 Press the emergency SHUTDOWN button or actuate the main or disconnecting
switch.
Emergency SHUTDOWN button (installed on-site) 44

Note Please note, that the imaging system UPS, will shut down only after a configurable
time. (The green LED indicator on the imaging system lights when the UPS is still
running.)

 Use a CO2 fire extinguisher.

Do not use water!

Fire inside or in the vicinity of the system

Caution Risk of injury of patient and personnel and damage to the property.
Risk of gas poisoning caused by burning plastics.
 Switch off the acquisition system in the event of fire.

 Make sure that you and the patient know where the escape routes are.

 Make sure that you know where the fire extinguishers are located and familiar-
ize yourself with the use of them.

 Contact Siemens Customer Service before performing any refurbishing work

and before starting the system up again.

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 Operating Safety and Safety Precautions

Installation, repair, or modifications

Modifications of or additions to the product must be made in accordance with the
legal regulations and generally accepted engineering standards.
Siemens cannot accept responsibility for the safety features and for the reliability
and performance of the equipment as the manufacturer, assembler, installer or
importer, if:
 installation, equipment expansions, readjustments, modifications or repairs
are not carried out by persons authorized by us to do so,
 components affecting safe operation of the product are not replaced by origi-
nal spare parts in the event of a malfunction,
 the electrical installation of the room does not meet the requirements of the
VDE regulation or the corresponding national regulations, or
 the product is not used in accordance with the Operator Manual.

Technical On request, we can provide you with technical documents for the product for a
documents charge.
It does not imply authorization to undertake repairs.

Note We recommend that you obtain a report indicating the nature and the extent of
the work performed from the persons carrying out such work. The report should
include all changes in rated parameters or operating ranges as well as the date,
the name of the company and a signature.

Note We accept no responsibility for repairs performed without our express written ap-
proval.

Maintenance
Legally required tests All legally required tests must be performed at the specified time intervals.
In Germany: constancy test, stipulated under §16 of the RöV

Regular maintenance To ensure the safety of the patient, operating personnel and others, tests must be
performed regularly to maintain the safety and proper functioning of the product.
The maintenance intervals are specified in the Maintenance Plan in the System
Owner Manual.
If more frequent inspections and/or maintenance are required by national regula-
tions, compliance with these regulations is essential.

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Safety

All parts of this system in which wear could lead to a hazard must be inspected by
trained technical personnel and replaced if necessary.
Maintenance work can be performed by Siemens Customer Service for a charge.

Service contract Regular inspections should be part of the annual maintenance performed by Sie-
mens Service under a service contract. We therefore recommend that you take out
a service contract.
It is also possible to take out a service contract based on system usage.
 Please contact your authorized local sales engineer in this matter.

Safety-related parts The safety-related parts subject to wear and the measures to be taken are listed in
subject to wear the Maintenance Plan in the System Owner Manual.

Tube assembly mainte- Maintenance of the tube assembly primarily involves cleaning the pump filter. The
nance two plastic cooling tubes up to 40 m in length and the connectors must be
checked for tightness and certain positions on moving parts for wear. Defective
parts must be replaced if necessary.
We also recommend that system operators check the water level of the cooling
circuit at least every three months.
 Open the filling gland of the cooling unit.

The water surface must be clearly visible above the cooling ribs.
 Replenish with water (drinking water quality) if cooling liquid is lacking.

Product service life

Our medical engineering products are designed for operation under average con-
ditions in accordance with the Operator Manual for a useful life of 10 (ten) years.
If the products are operated for longer than this time, additional checks and pos-
sibly repairs beyond the usual maintenance procedures may be necessary in order
to ensure the functional integrity and operating safety of these products. Please
talk to us about these measures early enough!

Disposal
There may be local regulations governing the disposal of your system.
The disposal of batteries shall be in compliance with local regulations.

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 Operating Safety and Safety Precautions

Improper disposal of hazardous waste material can cause damage to people and
Caution the environment.
Risk of injury and environmental damage
 The complete system or parts thereof shall be disposed of with care and in
compliance with industry standards, legally binding ordinances and other reg-
ulations valid at the location of disposal.

 To avoid environmental damage and/or personal injury, we recommend that

you contact Siemens Customer Service before removing the system from ser-
vice and disposing of it.

Dangerous components
Cooling fluid The cooling system contains the following cooling fluid: GLYCOSHELL

This substance is harmful if swallowed.

For more information, please refer to the original Safety Data Sheet included in
the System Owner Manual, part Technical Data.
 Please inform the service technician about it.

Fist aid measures Symptoms of poisoning may even occur after several hours. Medical observation
is necessary for at least 48 h after the accident.

After swallowing  Wash out mouth with water and obtain medical attention.

After eye contact  Rinse opened eye for several minutes under running water.
Then consult doctor.

After skin contact  Remove contaminated clothing and wash affected skin with soap and water.

After inhalation  Supply fresh air. Consult doctor in case of complaints.

Information for doctor The following symptoms may occur: Nausea

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 Safety
Security Package

The Health Insurance Portability and Accountability Act (HIPAA) comprises regula-
tions to secure the system, patient data and images from misuse by unauthorized
persons. The Security Package provides functions for securing the system.
When Security is activated, you can only perform the functions you are authorized
to do so.
For more information on the Security Package, please refer to the syngo docu-
mentation.

Important notes
Setting up security

There is no undo!
Caution After activating the security system, access is limited to only the defined us-
ers. Once the security system is activated, it is not possible to deactivate it (in-
stead, the system software would have to be reinstalled from scratch.
 Make sure that you have read and completed all preparatory steps.

 Back up your system before activating the security system.

Security and user management has to be set up on every system, except for satel-
lite consoles, which take the security settings from their main console.
Furthermore, if the computer is connected to a hospital network, all partner work-
stations have to be set up for security, otherwise a security gap will exist.
Because it is not possible to deny rights, the “Everyone“ group and role have but
the user shall not, we recommend taking special care when configuring the data
access permission and the functional privileges.

User accounts The user configuration depends on the security regulations of your hospital. For
questions about your rights, ask the system administrator.
If you are asked to work temporarily in another department, for example to take
over from a sick colleague, the administrator can temporarily assign you to this
group.

Log-on and off Do not misuse the emergency access account to log on to the system if you forget
your password!
Patient data acquired and processed during emergency access must be corrected
and rearranged later. As a consequence, the data will be assigned to the user who
carries out the alteration.

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Safety

Logging off or locking a workstation does not interrupt or abort running or queued
background jobs, such as filming images. Every background job is performed un-
der the identity of the user who initiated it.
Logging in with active security 140

Different user If the new user has the same (or sufficient) access rights, the current images are
not unloaded.
If the new user does not have the appropriate access rights, all patient data is un-
loaded and the currently active application function is terminated. Unsaved data
will be lost.
Using the Log In Different User function allows switching the user quickly.
Logoff/shutdown with active security 143

Data protection You can set data protections at patient or study level. Series and images inherit
protections from the patient or the study they belong to.

Service password Transfer the password as securely as possible to the service technician. Sending
passwords via unencrypted e-mail or mail is not secure!

Administration In any case, the security system should never be configured during an examina-
tion.
Always work in the syngo Security Configuration, never use the Microsoft Man-
agement Console (MMC) to create or to manage user accounts. syngo expands
the Windows-related security system by data security management and distin-
guishes between groups and roles.

The hospital’s security policy affects the behavior of the system in certain cases
Caution (e.g. password requirements, enabled empty passwords, or locking of an account
after a specific number of failed logins).
Risk that the system is not secure or cannot be used
 Establish a user model for your hospital and verify it before the security system
is activated.
 Establish a proper procedure for emergency access.

 If you enable an empty password for the emergency account, it is enabled for
all other users as well.
 Nevertheless, instruct the users to use appropriate passwords.

 Always back up your system before enabling the security system and before
any major changes.
 Inform all users about any changes and settings.

 The users should contact the administrator immediately in case of problems.

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 Security Package

User access may be prevented due to forgotten or unknown accounts or pass-

Caution words, or wrong setup (e.g. in case of an emergency).
Risk of an inaccessible system
 Do not forget to define a general user account for emergency access and assign
it to a group and a role both called EmergencyAccess.
 Regardless whether you specify a password for the emergency account or not,
users shall be prohibited from changing any passwords (especially for the
emergency account).
 The users shall contact the administrator immediately in case of problems.

We strongly recommend not to change passwords of any internal user accounts,

otherwise important system services may no longer work properly.
For reason of system integrity, it is not possible to delete internal users, DICOM
nodes, and special users.
Misuse of the emergency account defeats the security system!
Patient data acquired and processed during emergency access is logged in the au-
dit trail as belonging to the emergency account. As a result, the identity of the user
involved cannot subsequently be determined. The ownership of any data record-
ed this way must be altered and the data newly assigned. Ensure that all users
have been properly informed about the use of the emergency access account and
the use of the password. Misuse of the account is illegal!
User and group names have to be unique within the system. The name is case-sen-
sitive. Special characters such as " / \ [ ] : ; | = , + * ? < > are not
allowed.
Because you cannot rename groups or roles, you must instead delete them and
recreate them.
To reduce your configuration efforts, define permissions on group level and privi-
leges on role level whenever possible.
The different security levels applied to application functions and patient data in
the context of the clinical workflow are normally defined in the hospital’s security
policy.
Keep in mind that user rights are inherited. It is not possible to assign someone
function execution rights for a specific group.
For the emergency role and user, we strongly recommend not to grant any func-
tional privileges that allow deletion or export of patient data.
Please remember that the configuration of a user is also influenced by the config-
uration of the role a user is assigned.

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Safety

Audit trail The audit trail logs activities you perform on sensitive data in an audit trail. It also
includes your identity.
Except for emergency access, you are only allowed to work with a syngo worksta-
tion if you are logged in to your personal user account.
The system administrator will notify you about your user account and password.
Important! You carry the responsibility for all transactions that have been per-
formed under your user account.
In your own interest, lock the computer or log off when you have finished work or
when leaving the workstation unattended for a longer period!
Very detailed recording can slow down system performance.

The system blocks when the audit trail is filled (too many records, or too much
Caution drive space covered).
In this case, it is not possible to work with the system.
Emergency access is also not possible.
 To prevent system blockage, someone must archive the log files and remove
them from the audit trail on a regular basis.
 The SecuritySystem > BypassBlockedSystem and the AuditTrail > Archive
privileges are needed.

The system informs the users when the size of the audit trail exceeds the specified
warning levels. It issues low level and high-level warnings by displaying colored
icons in the status bar. Any user recognizing the warning should inform the sys-
tem administrator immediately for archiving the audit trail.
Inform the system users about what to do if audit trail archiving should be started.
If the current user does not have archiving rights, the End Session dialog box calls
the Log in different user function to switch to a user account with archiving
rights.
Archived log files obtain the status “archived“ and are marked with the archived
icons.
You carry the responsibility for maintaining the time server. Ensure that you set
the correct time, otherwise your service license may become outdated. It is be-
cause the license manager only accepts a jitter of 24 h. When the service license
becomes invalid, the system must be completely reinstalled.
If necessary, the secure data transfer function must be enabled on all syngo work-
stations with which you want to exchange data. Additionally, it is also possible to
communicate with “secured legacy systems“ (“Secured“ by means of restricted
physical access.)

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 Part: System Overview
Introduction

Application
Artis Q/zeego/Q.zen/zeego.zen is a fully digital angiography system equipped with
flat detector technology.

Applications Depending on the system configuration, an Artis Q/zeego/Q.zen/zeego.zen is suit-

able for innovative cardio-vascular examinations and interventions, universal an-
giography procedures and interventional procedures.

Intended use Artis is a family of dedicated angiography systems developed for single and bi-
plane diagnostic imaging and interventional procedures including, but not limited
to, pediatric and obese patients.
Procedures that can be performed with the Artis family include cardiac angiogra-
phy, neuro-angiography, general angiography, rotational angiography, multipur-
pose angiography and whole body radiographic/fluoroscopic procedures as well
as procedures next to the table for i.e. patient extremities.
Additional procedures that can be performed include angiography in the operat-
ing room, image guided surgery by X-ray, by image fusion, and by navigation sys-
tems. The examination table as an integrated part of the system can be used for
X-ray imaging, surgery and interventions.
Artis can also support the acquisition of position triggered imaging for spatial data
synthesis.

Known side effects For radiation emitting products, known side effects of X-ray applications are ery-
thema, cataracts, permanent epilation and delayed skin necrosis.
Radiation induced increased risk of cancer is the content of the physician’s medical
education. The necessity of an X-ray examination in relation to these risks must be
considered by the physician when prescribing such a type of examination.

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System Overview

Usability The Artis must only be used by persons with the necessary specialist knowledge
after training, e.g., physicians, radiologists, cardiologists and medical specialists.
 Patient population: newborn to geriatric.

 Operator profile: The usage of the system described in this Operator Manual re-
quires specific technical and medical knowledge and skills regarding, at a min-
imum, radiation protection, safety procedures and patient safety.
People using, moving, working with the system must have acquired such
knowledge and skills during their curriculum.
 Language understanding: Users must understand the language of the Opera-
tor Manual before touching the system.
 Equipment training: Application training is delivered with the equipment ac-
cording to the handover contract. It is mandatory to follow such application
training delivered by Siemens Representative before any use of the system.
The follow-up training, which is necessary due to change of personnel, is in the
responsibility of the operator of the system. Any additional training can be re-
quested from Siemens Medical Solutions.
 Operator Manual and precautions: Read and understand all the instructions in
the Operator Manual before attempting to use the system and request addi-
tional training from Siemens Medical Solutions if needed.
Keep the Operator Manual with the equipment at all times and periodically re-
view the procedures and safety precautions.
Failure to follow the operating instructions and safety precautions could
result in serious injury to the patient, others or yourself.
 Patient safety: Provide assistance for getting the patient on and off the table.
Be sure all patient health lines (IV, oxygen, etc.) are positioned so they will not
be caught when moving the equipment. Never leave the patient unattended
while in the system room.
An unattended patient could fall from the table, activate a motion control, or
encounter other problems which could be hazardous.
 Radiation safety: Always use proper technique factors for each procedure to
minimize x-ray exposure and to produce the best diagnostic results.

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 Introduction

 Establish emergency procedures: It is not always possible to determine when

some components, such as x-ray tubes, are nearing the end of their operating
lives. These components could stop operating during a patient examination.
Establish procedures for handling the patient in case of the loss of fluoro-
scopic imaging or other system functions during an examination.
 Indications for use: Artis is a family of dedicated angiography systems devel-
oped for single and biplane diagnostic imaging and interventional procedures
including, but not limited to, pediatric and obese patients.
Procedures that can be performed with the Artis product family include cardiac
angiography, neuro-angiography, general angiography, rotational angiogra-
phy, operating room angiography, multipurpose angiography and whole body
radiographic/fluoroscopic procedures.
Artis can also support the acquisition of position triggered imaging for spatial
data synthesis.

Operating locations An Artis is suitable for the following applications and operating locations:
 Fluoroscopy with radiography (acquisition) -
Operator close to the patient (application category A)
 Fluoroscopy with radiography (acquisition) -
Control of X-radiation during radiography from a protected area
(application category B)

System configurations
 Artis zeego: Systems with multi axis stand / one acquisition plane

 Artis floor: Systems with one floor stand / one acquisition plane

 Artis biplane: Systems with a floor stand and a top stand / two acquisition
planes (biplane)
 Artis ceiling: Systems with one top stand / one acquisition plane

The system can be equipped with different options supporting the different clini-
cal applications

Flat Detector (FD) Image acquisition is performed through a flat detector followed by digital image
processing and documentation.
 FD 20x20 with input field of approx. 20 cm x 20 cm (25 cm Ø)

 FD 26x30 with input field of approx. 26 cm x 28 cm (39 cm Ø)

 FD 30x40 with input field of approx. 30 cm x 38 cm (48 cm Ø)

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System Overview

Please note the following differences of systems equipped with flat detectors as
compared with a system equipped with image intensifiers:
 The irradiated acquisition/fluoroscopy field is square (FD 20x20) or rectangular
(FD 26x30, FD 30x40).
 The Assist screen shows the (approximate) diagonals of the corresponding
squares or rectangulars.
 We recommend performing fluoroscopy briefly before each acquisition series.
It is especially important for children and thin patients.

Imaging system The Artis imaging system is suitable for digital image acquisition and reporting
with the Artis radiographic systems.
It can be used both in single plane and in biplane systems.
The imaging system can be modularly equipped for different applications accord-
ing to its use.

Acquisition modes The following digital acquisition modes and associated postprocessing functions
are possible:
 Digital radiography (DR)

 Angiocardiography (CARD)

 Digital subtraction angiography (DSA)

Both acquisition series (scenes) and single images are possible.

Advanced acquisition Angiography with stepping (peripheral angiography):

modes
 PERISTEPPING

 PERIVISION

Rotational angiography:
 DR-DYNAVISION

 (DSA-)DYNAVISION

3D acquisition modes for 3D reconstruction on the syngo Workplace:

 3D DR

 3D DSA

 3D DR - Large Volume (Artis zeego only)

 3D CARD

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 System Overview
Equipment in the Control Room

Imaging system overview

The imaging system comprises the computer with electronics for image acquisi-
tion and image processing, input devices and monitors.

System console
The system console is used for patient administration, postprocessing and ar-
chiving. Using a footswitch or handswitch you can also release acquisitions here.
In addition, the system console is used to switch the system on and off.

(1)

(2) (3) (4)

Example: System console in the control room (with two monitors)

(1) Monitors (LCD)

(2) Keyboard
(3) Mouse
(4) On box

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System Overview

Artis Cockpit

The Artis Cockpit consolidates the system controls to one workplace in the control
room.
The Artis Cockpit displays and controls up to six systems such as Artis, syngo
Workplace or AXIOM Sensis with only one keyboard and one mouse on one med-
ical grade display.
The basic idea is to use only one keyboard and one mouse to control different
computers or applications.
Artis Cockpit screen layout 212

Note As a backup solution for the display of Artis Live a second workplace is available.

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 Equipment in the Control Room

LCD monitors

Operating elements The keys for setting the LCD monitor are located on the side or on the bottom of
the housing.
The necessary settings are made at installation. No operator actions are required
during operation.

Power on/off The unit has a power switch on the underside. You only need to operate this
switch if the LCD monitor is not switched via a system.

Operating indicator The unit has a green LED operating indicator on the right above the operating el-
ements (which are not operated).
Please observe Monitors/LCDs 33

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System Overview

Keyboard
The imaging system is equipped with a PC keyboard with a symbol keypad.

(1)

(2) (3) (4)

PC keyboard (different for different languages)

(1) Function keys

(2) Alphanumeric keys (vary for different languages)
(3) Cursor control keys
(4) Numeric/syngo keypad

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 Equipment in the Control Room

Keys on the symbol keypad

Key Function
Window center (WC) - (Num⇓)
(Brightness -)

Window center (WC) + (Num /)

(Brightness +)

Window Width (WW) - (Num *)

(Contrast -)

Window Width (WW) + (Num -)

(Contrast +)

Autowindowing (Num 9)

Scroll study back (Num 7)

Scroll study forward (Num 8)

Scroll series/scene back (Num 4)

Scroll series/scene forward (Num 5)

Scroll image back (Num 1)

Scroll image forward (Num 2)

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System Overview

Key Function
Mark image (Num 3)

Modify scene name (Num 6)

(in preparation)

Call up Patient Registration (Num 0)

Call up Patient Browser (Num ,)

Copy to Film Sheet (Num Enter)

Send To preferred network node (Num +)

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 Equipment in the Control Room

Mouse
A mouse with three buttons is connected to the computer.

Example

3 buttons You can start actions of the program with the mouse buttons:
 With the left button, for example, you can select objects, start applications and
execute commands.
 With the center button, you can change the window values of images.

 With the right button, you can open popup menus.

Click In this Operator Manual, various terms are used in connection with the mouse:
 Click: Move the mouse such that the mouse pointer on the screen points to the
object in question. Now press the mouse button1 and release it again.
 Double-click: Like clicking, except that you press the mouse button twice in
quick succession.
 Drag & drop: Like clicking, except that you keep the mouse button pressed
while moving the mouse.

1 Where “click” appears in the text, we always refer to the left mouse button
unless the right mouse button is mentioned explicitly.

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System Overview

ON box with CD/DVD drives

(3)

(1) (2) (4) (5)

Example

(1) Power-on pushbutton and indicator

(2) RESET button
RESET image evaluation system 792
(3) CD/DVD drive
(4) USB jacks (x2)
(5) Microphone and headphone jacks

On-site equipment
The following switches and keys are installed on site. Their location depends on
the circumstances and location of your system.
 Find out where these switches and buttons are located.

Disconnection from the The main switch disconnects the entire system from the power supply (power sup-
power supply ply interruption).

Emergency SHUT- With the emergency SHUTDOWN button, the system can be disconnected from
DOWN button the power supply in an emergency.
Emergency SHUTDOWN button (installed on-site) 44

Door contacts The doors to the examination room can be fitted with switching contacts which
prevent radiation from being released while a door is open.

Intercom system
The intercom system can be used for audio communication between patient and
operator when operating the Artis in the control room.

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 Equipment in the Control Room

Version 1

(1) Listening on/off with LED display (green)

(2) Music on/off with LED display (green)
(3) Speech on/off with LED display (green)
(4) Speaking volume (in the examination room)
(5) Listening volume (in the control room)
(6) Without function
(7) Without function
Volume of physiological trigger signals quiet/medium/loud
(8) Microphone
(9) Loudspeaker

Note If speech is switched on, listening is not possible and music is interrupted.

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System Overview

Version 2

Controls
 Intercom system ON/OFF
– LED on: Intercom system is activated.
– LED off: Intercom system is deactivated.
– LED flashing: Intercom system is in set-up mode.
 Speaker ON/OFF
– LED on: Speaker is ON.
– LED off: Speaker is OFF.
 Microphone ON/OFF
– LED on: Microphone is ON.
– LED off: Microphone is OFF.
 Audio IN ON/OFF
– LED on: Audio IN is ON.
– LED off: Audio IN is OFF.
 Increase volume
– LED brightens.
– LED flashing: Maximum volume
 Reduce volume
– LED darkens.
– LED flashing: Minimum volume

Note The volume can only be changed if the speaker, the microphone, or Audio IN is
activated.

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 Equipment in the Control Room

PTT mode The microphone is normally only active when the button is pushed and held.
You can enable or disable push-to-talk mode (PTT):
 Switch the intercom system off.

 Push and hold the button for approx. 5 s until the LED flashes.

Connections
 Connection for audio recorder on central unit

 Connection for audio player on microphone loudspeaker unit

 Connection for headset on microphone loudspeaker unit

Switchover from microphone loudspeaker unit to headset is performed by re-
moving and reinserting the headset microphone plug.
After switching on the intercom system, always the microphone loudspeaker
unit is activated, irrespective of whether the headset microphone is plugged in
or not.

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System Overview

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 System Overview
Equipment in the Examination Room

Acquisition system overview

Overview Artis zeego

(3)

(2)

(5)
(1)

(4)
Example of Artis zeego stand with FD 20x20 and Large Display

(1) Artis zeego stand with C-arm, X-ray tube assembly and FD
(2) Patient table
(3) Display ceiling suspension with LCD monitors or with Large Display
(4) Footswitch for releasing radiation
(5) Control console for controlling the stand, patient table and imaging system

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System Overview

The Artis zeego stand

Each Artis zeego system is equipped with a floor mounted multi-axis stand. It is
mounted on a swivel base. The stand can be moved into various positions relative
to the patient.
The X-ray tube assembly with primary collimator and the flat detector (FD) are at-
tached to the C-arm. The C-arm is divided in two parts. The part on which the FD
is mounted can be lifted for a variable SID.

(7)
(3) (1)
(8)
(2)
(4)

(9) (5)
(6)

Example of Artis zeego stand with FD 30x40

(1) Flat detector (FD)

(2) Membrane keys
(3) C-arm
(4) FD slide
(5) X-ray tube assembly with primary collimator
(6) Focus point (red)
(7) Stand arm
(8) Stand link arm
(9) Rotating column

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 Equipment in the Examination Room

Overview Artis floor

(3)

(2)

(1)
(5)

(4)

Example: Artis floor with 3 monitors

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

(2) Patient table
(3) Display ceiling suspension with LCD monitors or with Large Display
(4) Footswitch for releasing radiation
(5) Control console for controlling the stand, patient table and imaging system

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System Overview

The floor stand (Artis floor and Artis biplane)

Each Artis floor or Artis biplane system is equipped with a floor stand. It is mount-
ed on a swivel base. The stand can be moved between working and patient trans-
fer positions on the swivel base.
The stand can be moved into various positions relative to the patient. Oblique pro-
jections are possible by rotational and orbital movement (angulations) of the C-
arm.
The X-ray tube assembly with primary collimator and the flat detector (FD) are at-
tached to the C-arm. The FD is mounted on a lifting device for a variable SID.

(3)
(3)
(4)
(4) (2)
(2) (8)
(8)
(1)
(9)
(1)
(9)
(6)
(6)

(5) (5)
(10)
(7)
(7)
(10)

Floor stand with FD 20x20 (left) and FD 30x40 (right)

(1) Flat detector (FD)

(2) Membrane keys
(3) FD slide
(4) C-arm
(5) X-ray tube assembly with primary collimator
(6) Stand column
(7) Swivel base
(8) Unlocking button
(9) “Plane ready” display (green)
(10) Focus point (red)

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 Equipment in the Examination Room

Overview Artis biplane

(4)
(2)

(3)
(6)

(1)

(5)

Example: Artis biplane with Large Display

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

(2) Top stand with C-arm, X-ray tube assembly and FD
(3) Patient table
(4) Display ceiling suspension system with LCD monitors or with Large Display
(5) Footswitch for releasing radiation
(6) Control console for controlling the stand, patient table and imaging system

Note During installation, the floor stand may be marked by a blue label (plane A) and
the top stand by an orange label (plane B).

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System Overview

The top stand (Artis biplane)

In addition to the floor stand, Artis biplane systems are also equipped with a top
stand mounted on a ceiling rail (plane B).
The top stand has two working positions as well as one parking position at the
head end behind the floor stand. Oblique projections are possible by rotational
and orbital movement (angulations) of the C-arm.
The X-ray tube assembly with primary collimator and the flat detector (FD) are at-
tached to the C-arm. The FD is mounted on a lifting device for a variable SID.

(6)
(6)

(4)
(4)

(2)
(2)
(5)
(1)
(1) (7)
(5)
(7)
(3) (3)

Artis biplane Card top stand (left) and Artis biplane Angio top stand (right)

(1) Flat detector (FD)

(2) Membrane keys
(3) FD slide
(4) C-arm
(5) X-ray tube assembly with primary collimator
(6) Ceiling rails
(7) “Plane ready” display

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 Equipment in the Examination Room

Overview Artis ceiling

(3)

(2)
(1)

(5)

(4)

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

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System Overview

The Artis ceiling stand/C-arm

An Artis ceiling system is equipped with a ceiling-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 projection angles can be set isocentrically.
Angulation movements are performed either by moving the inner C-arm, the or-
bital lift carriage on the outer C-arm, or by combined movements.
The X-ray tube assembly with primary collimator and the flat detector (FD) are at-
tached to the C-arm. The FD is mounted on a lifting device for a variable SID.

(7) (7)

(3) (3)

(2) (2)
(4) (4)

(1) (1)

(5) (5)

(6)
(6)

Artis ceiling stand with FD 20x20 (left) and Artis ceiling stand with FD 30x40 (right)

(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

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 Equipment in the Examination Room

Patient table
Artis table Artis systems equipped with a floor-mounted patient table have a floating carbon-
fiber tabletop with projecting and shadow-free sections optimized for tall pa-
tients.
The table height and tabletop longitudinal and transverse positions are continu-
ously adjustable. The patient table can also be rotated.
The table can be equipped with a motor-driven stepping mechanism for peripher-
al examination techniques. A tilting tabletop is also possible (transverse or trans-
verse and longitudinally) with the OR version.

(1) (2)

(2)

(2)
(3)

(1) Tabletop with mattress

(2) Slidable rails for control modules and other accessories
(3) Lever for releasing the table rotation lock
Accessories for the patient table 717

Surgery table Trumpf Surgery Table TRUSystem 7.500 or Maquet Magnus table for Artis systems
Please refer to the manufacturer’s Operator Manual.

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System Overview

Trolley for control modules

(1) (4)

(1)

(2)
(3)

(5)
(5)
Trolley for other systems

(1) Rails for control modules and other accessories

(2) Grip
(3) Cable holder
(4) Holder for handswitch
(5) Castors (without brakes)

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 System Overview
Operating Elements and Displays

Control consoles
(2)
(1) (2)
(3)
(4)

Artis zeego control console (example)

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

Control console single plane (example)

(1) (2) (2)

(3) (4)

Control console biplane (example)

Depending on the type and configuration, your system consists of one grouped or
several individual 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 joystick and several keys.

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System Overview

Emergency STOP button

There is an emergency STOP button on the front side of every table or stand/C-arm
control module.

6723
Example

This button can be pressed to stop unit movements and radiation1 in an

emergency.
Red emergency STOP buttons 41

Table control module - TCM

Table control modules are marked by a patient table symbol.

Table joystick/panning knob

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

1 Radiation can be released again after a short interruption.

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 Operating Elements and Displays

Systems with floor- Depending on your patient table version, one of two versions will be integrated in
mounted patient table the table:

 TCM-M/S: Knob with floating tabletop

(with or without servo assistance)

 TCM-J: Joystick on additional control console

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System Overview

Table control module Joystick/panning knob Used with

TCM-M manual table without tilt
TCM-S servo-assisted table with tilt
TCM-J with joystick additional control console

Keys on the table control module

The following other movements can be controlled with the keys on the table con-
trol 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 isocenter
Isocenter key 220
 Lock lateral tabletop movement
– LED lights while function active.
 Select orientation
Orientation key 117

Stand/C-arm control module - SCM

Stand/C-arm control modules are marked with a C-arm symbol.

Stand/C-arm multifunction joystick

With the multifunction joystick the stand and C-arm positions can be adjusted by
deflecting the joystick in the required direction.
The movement direction depends on the console orientation.
Orientation key 117.

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 Operating Elements and Displays



   

!

(View from the rear)

(1) Dead man's switch for releasing movements

(2) Buttons on each side with the same function:
switching over from C-arm angulation to stand swivel (floor stand), stand lon-
gitudinal movement (top stand),
(3) Rocker switch on the back:
for lifting and lowering the FD (setting the SID)

Keys on the stand/C-arm control module

Stand/C-arm control module (single plane system)

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System Overview

Stand/C-arm control module for plane A Stand/C-arm control module for plane B
(biplane system)

 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 orientation
Orientation key 117
 Select direct positions I, II, III
– LED is lit while function active.
 Select biplane simultaneous angulation
– LED is lit while function active.

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 Operating Elements and Displays

C-arm control module for linear movements (Artis

zeego)
The C-arm control module for linear C-arm movements is marked with a C-arm
symbol with arrows.

 Joystick for horizontal movements

 Perform C-arm lift

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 position.
Assignment of the lit LEDs to the current position of the control console with re-
spect to the patient table:
 Control console to the right of the tabletop
(Default position for systems with floor-mounted patient table)
 Control console at the foot end of the tabletop

 Control console to the left of the tabletop

 Control console at the head end of the tabletop

Laser positioner If your system is equipped with a laser positioner 122, it can be switched on
and off by pressing the orientation key for less than 3 s.

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System Overview

Collimator control module (CCM)

(1) (1)
(2)

(2)

Card collimator control module (single plane) Angio collimator control module (single plane)

(1) (1)
(2)

(2)

Card collimator control module (biplane) Angio collimator control module (biplane)

Collimator versions
Depending on the system configuration and collimator version (Angio or Card col-
limator), the collimator control modules come in different versions.
Differences between Angio and Card collimator:

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 Operating Elements and Displays

Function Angio collimator Card collimator

Wedge filters two wedge filters one wedge filter
Finger filter one finger filter none
Additional keys not available

Joysticks  Lower joystick controls rectangular  Lower joystick controls rectangular

diaphragm diaphragm
 Left upper joystick controls left-  Upper joystick controls the wedge
hand wedge filter. filter.
 Right upper joystick controls right-
hand wedge filter.

Collimator and filter joysticks

The joysticks are used to set the primary collimator 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 selectively.

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System Overview

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 remove filter diaphragms

 Reset collimator leaves and filter diaphragms

 Switch over image input format/zoom stage

 Switch over wedge/finger filter1

 Collimator/FD rotation

 Select plane2

Touchscreen control console

Selected functions of the imaging system can be operated using the touchscreen
control console. It has a joystick which you can use like a mouse to move the cur-
sor over the screen(s).
Operation via touchscreen control 225

(1) (2)

(1) Touchscreen
(2) Mouse joystick
1
only with angio collimator
2 only with biplane systems

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 Operating Elements and Displays

Mouse joystick

The touchscreen control is equipped with a mouse joystick which has three buttons:

(1) Left mouse joystick button: Select button

(2) Middle mouse joystick button: Store Ref button
(3) Right mouse joystick button: Close button
The joystick can be deflected to the left/right/up/down and in any diagonal direc-
tion.
Different functions can be assigned to the buttons depending on the currently se-
lected function.
Mouse joystick functions 233

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System Overview

Laser positioner

(1) Lasers attached to the FD case

(2) Laser beams
(3) Center of FD
(4) Cross hair on patient skin
The laser positioner can be used, e.g. in syngo iGuide Needle Guidance.
Please refer to the iPilot/iGuide Operator Manual.
The laser positioner light can be switched on and off via the membrane key on the
FD 123 or with the orientation key 117.
The laser positioner light will switch off automatically after a configurable time
(30 s to 300 s, default: 180 s = 3 minutes).
Please observe Lasers 32

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 Operating Elements and Displays

Keys on the FD

Membrane keys for FD lift

FD 20x20 The flat detectors (FD) are equipped with membrane switch buttons for setting
the source-image distance (SID) from the focus of the X-ray source to the image
receptor plane of the FD.

Membrane keys for C-arm and FD movements

FD 26x30 and FD 30x40

Version 1

Version 2

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System Overview

 C-arm rotation (cran/caud angulations)

 C-arm orbital movement (RAO/LAO angulations)

 Longitudinal tabletop movement with stepping table

Longitudinal C-arm movement with Artis ceiling

-  Laser positioner light on/off

 FD rotation (setting portrait/landscape)

 FD lifting and lowering - setting the SID

Handswitch
The handswitch has two operating elements:

 Acquisition button
With the acquisition button, you can release acquisition series and single
acquisitions as preselected in the acquisition program.

 Multifunctional button
Depending on the acquisition program selected, the multifunctional but-
ton has different functions:
 In a program with manual variable frame rate, it is used to switch from
one phase to the next.
 In a PERIVISION or PERISTEPPING acquisition program, it is used to re-
lease stepping in a filling run.
 In a DR-DYNAVISION, DYNAVISION or 3D acquisition program, it is used
to start the next phase.

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 Operating Elements and Displays

Footswitch

Standard or wireless footswitch

There are two single plane versions with 4 pedal functions and a biplane version
with 8 pedal functions. The functions of the pedals can be configured by Siemens
Service to your preference.
Footswitch functions 126

(9) (9)

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

Single plane or biplane CARD cable footswitch and wireless footswitch

(9)
(9)
(8) (8)
(2) (2)
(7) (4) (7)
(4)
(1) (1)
(6)
(3) (6)
(3)

(5) (5)

Biplane Angio cable and wireless footswitch

Wireless footswitch The wireless footswitch has the same functions as the standard footswitch with-
out being connected by cable. The functions are activated via an RF transmitter.
In addition the footswitch can be configured for hands free movement with Voice
Control.
The immanent advantages are easier cleaning and no tripping over cables.
Please observe safety information Use of wireless footswitches 34 as well as
the Wireless Footswitch Addendum.

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System Overview

Note The wireless footswitch is active in a range of approximately 5 m (16 ft) around
the table/stand, where the receiver is mounted. If the footswitch is in a wider
range of the table, it may lose contact with the receiver and will then turn into an
inactive mode.

Footswitch functions
The footswitch pedals can be configured by Siemens Service. The standard assign-
ment of functions is as follows:

Symbol Default pedal Standard function

assignment
(1) Fluoroscopy generally

(1) Fluoroscopy in plane A

(3)* Fluoroscopy in plane B

(5)* Biplane fluoroscopy (plane A and plane B)

(2) Acquisition

*
Alternative acquisition*

(4)* Switch Roadmap on/off

* Reset Roadmap

(8)* Reset Roadmap mask in plane A

(6)* Reset Roadmap mask in plane B

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 Operating Elements and Displays

Symbol Default pedal Standard function

assignment
* Reset Roadmap mask in both planes (plane A and
plane B)

(4)* Tabletop brake

*
Auxiliary switch*, e.g. room light on/off

* Auxiliary switch 2*

- (9) Safety bracket

*
configurable by Siemens Service

Cable with plug

On newer systems, the footswitch cable is equipped with a plug.
This symbol marks the appropriate plug for the footswitch at the table column.

Signs and indicators on the wireless footswitch

The wireless footswitches are marked with a colored sign of different shape to
avoid a mix up for installations with more than one wireless footswitch.
The same marks are attached to the respective table and room during installation.

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System Overview

Status LEDs There are 3 LEDs showing the status of the footswitch.
 Activity LED
LED lights: Footswitch is on and is in active mode.
LED off: Footswitch is inactive.
– It is too far away from the table
– The Artis system is switched off
– The batteries are completely discharged
– The Footswitch is in “sleep mode”. Press a pedal swiftly to activate it again.
 Transmission LED lights: Any footswitch pedal is being pressed.

 Battery LED
– LED off: Battery is sufficiently charged, footswitch is not connected to the
power adapter.
– LED flashing yellow: Battery needs charging, remaining capacity is < 4 h.
– LED lights yellow: Footswitch is connected to the power adapter, batteries
are being charged.
– LED lights green: Footswitch connected to the power adapter, batteries are
fully charged.
 This symbol marks an RF transmitting component.

Power adapter for charging the wireless footswitch

Power adapter for charging the batteries of the wireless footswitch

Note It is recommended to connect the power adapter to the wireless footswitch every
day after deployment.

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 Operating Elements and Displays

Note If the wireless footswitch needs charging during a patient procedure, simply con-
nect the power adapter to it. The cable length of 7 m allows charging during the
procedure.

Note Never use another charging device than the power adapter delivered with the
wireless footswitch.
The usage of another charging device may cause severe damage to the wireless
footswitch or may result in hazards for the patients when the wireless footswitch
is recharged during operation.

Footswitch control for table with lateral tilt

(5)
(7)

(6)

(1)
(2)
(3)

(4)
(1) Tabletop movement footward / upward
(2) Tabletop movement headward / downward
(3) Table tilt lateral left / reverse Trendelenburg
(4) Table tilt lateral right / Trendelenburg
(5) Switchover tabletop longitudinal movement / table height
(6) Switchover table tilt lateral / Trendelenburg
(7) Display for active functions
– Display lit:
Tabletop longitudinal movement and table tilt are active
– Display not lit:
Table height and Trendelenburg table tilt are active

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System Overview

Display Ceiling Suspension (DCS)

Depending on the application, your system can be equipped with a display ceiling
suspension with up to 8 LCD monitors 91, or the Large Display 133.
Using the handle, the DCS can be moved rotated and adjusted in height.

DCS

Example of DCS 3

Keys on DCS Underneath the monitors, there is a handle for moving the display ceiling suspen-
sion. There you will find the following keys (also on the rear column).

(2) (1)

(2) (1)

(1) Key for longitudinal travel

– Key pressed: Longitudinal movement enabled - rotary movement disabled.
Positioning the DCS longitudinally 199
(2) Key for rotation
– Key pressed: Rotary movement enabled - longitudinal movement disabled.
Rotating the DCS 199

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 Operating Elements and Displays

DCS extended

Example of DCS extended with 4 monitors

Example of DCS extended with 8 monitors

DCS protected A variant of the DCS extended provides a protection frame around the monitors.

Indicator lights Two indicator lights are integrated on both sides of the DCS extendend and DCS
protected. The indicator lights inform you about the condition of the system:
 Off: The system is powered down or X-ray is not possible due to a defect.

 Green: The system is ON and ready for X-ray.

In Artis biplane, it applies to both planes except in BYPASS FLUORO mode or if
the top stand is in the parking position.
 Orange (or flashing, depending on configuration): X-ray is being released.

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System Overview

Keys on DCS extended/ Underneath the monitors, there is a handle for moving the display ceiling suspen-
DCS protected sion. There you will find the following keys (also on the rear column).

(1)
(2) (3)

(1)

(2) (3)

(1) Key for rotation axis 1 brakes

– Key pressed: Rotary movement 1 blocked - longitudinal movement and
rotary movement 2 possible
(2) Key for rotation axis 2 brakes
– Key pressed: Rotary movement 2 blocked - longitudinal movement and
rotary movement 1 possible
Rotating the DCS extended 200
(3) Key for longitudinal travel brakes
– Key pressed: Longitudinal movement blocked - rotary movements possible
Positioning the DCS extended longitudinally 199

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Large Display

Example of DCS with Large Display

Example of DCS with Large Display and additional color display

Large Display screen layout 215

Protective shield for Large Display 746

Monitors LCD monitors 91

Monitors/LCDs 33

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System Overview

Manual control for table with lateral tilt

You can adjust the height and tilt of the table and return the table to the zero po-
sition by manual control.
(1)
(1) Tabletop longitudinal movement

(2) (2) Table height

(3) Table tilt Trendelenburg
(3)
(4) Table tilt lateral
(4) (5) Without function

(5)
(6) Table tilt zero position
(7) LEDs for displaying the zero position
HOME HOME (6)

(7) Manual control also works during a power failure.

Voice control units

Headset The voice control consists of a headset with microphone and a transmitter.

(2)

(1)

(3)

Headset and Transmitter (ready to wear, open for switching on)

(1) On/off button

(2) On/battery indicator LED
(3) Battery pack

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 Operating Elements and Displays

The other components, i.e. receiver and PC, have been installed in the examina-
tion/control room and do not need to be operated.

Receiver

The receiver has been installed in the examination room. It has been set up by Sie-
mens Service and does not need any operation.
The display can change between red and green display. A green display shows
proper wireless connection to the transmitter. A red display shows that there is no
wireless connection to the transmitter.

Charging station

 Red LED: Loading

 Green LED: Transmitter is fully charged

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System Overview

Note The charging station must be connected to a power outlet, which is not turned off
by the system.
To charge the headset it needs to be snapped into the charging station.

Acoustic signals
With certain functions, a continuous or beeping sound indicates the operating
state of the system.

Events The following events are displayed:

For movements  If a C-arm is moved into a collision zone.

 If a collision sensor has responded (collision).

For acquisitions End of acquisition1

 If an acquisition was started by an operating element that was released too
early.
 After a successfully completed acquisition series.

 If an acquisition series was interrupted because of an error.

For fluoroscopy  Each time the set fluoroscopy time has elapsed.

 During high-contrast fluoroscopy

For radiation  If the tube load is too high or the temperature switch of the tube has respond-
ed.

Priorities If two events occur simultaneously, only the more important one of the acoustic
signals is output. Six different signals are used for this purpose:

Priority Event Signal

1 Collision (collision sensor) Strong beep
2 The set fluoroscopy time has elapsed Ringing signal
3 Tube load is too high or temperature Beep
switch has responded
4 During high-contrast fluoroscopy Bell
5 Movement within the collision zone Short beeps
6, 7 Rotating anode during fluoroscopy Tube sound

1 can be configured, depending on national regulations

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 Operating Elements and Displays

Priority Event Signal

8 One of the configured dose alert Beep
thresholds has been exceeded.
CAREguard 67
9 Stand and table have reached work- Snap
ing position with automatic drive
10 End of acquisition (configurable) Beep
11 Speech command recognized Short beep
12 Not used -

“Plane ready for radiation” displays

The stands of Artis floor and Artis biplane upgrade systems shipped before VD10
are equipped with “plane ready” display lamps. 104 106

Note In systems with GIGALIX X-ray tubes shipped with VD10 and higher, the “ready for
radiation” indication is integrated in the DCS. Indicator lights 131

The “plane ready” display lamp lights up (green), then the system is ready for ra-
diation.
Biplane system: The floor and top stands each have a “plane ready” display lamp.
If the display lamp lights up (green), then the relevant plane is ready for radiation.
If the display is not lit, fluoroscopy and acquisition are not possible.

Note The “plane ready” displays only indicate that the plane is ready. If radiation is still
not released, it may be because of an open door contact, etc.

Plane A The green display on the floor stand is normally always lit, even in BYPASS FLUO-
RO mode (radiation can be released).
Bypass fluoroscopy 782

Plane B The green display on the top stand (Artis biplane) is lit during normal operation. It
is not lit in the following cases (radiation cannot be released):
 If the top stand is in the parking position.

 In BYPASS FLUORO mode: In this case fluoroscopy is only possible in plane A.

Bypass fluoroscopy 782

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System Overview

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 Part: System Operation
Switching On/Off

The acquisition system and the imaging system are switched on and off together.

Switching on and starting

Switching on
 Make sure that the on-site main switch is switched on and the emergency
SHUTDOWN button is inactive.

 Press the power-on pushbutton on the system console for more than 0.5 s and
then release the button.

Start-up
The system performs a self-test and is started up.
See also Emergency operation 781

Bypass fluoroscopy or BYPASS FLUORO is displayed.

In an emergency, (continuous) fluoroscopy is possible at this stage (only in
plane A).
The task cards appear on the touchscreen in the examination room but cannot yet
be operated.

Backup mode or BYPASS FLUORO disappears and the buttons on the touchscreen
can be actuated.
A default patient is registered and a default exam set is available.
Fluoroscopy and acquisition (only in plane A) and review using the default patient
but without registration of new patients and without postprocessing are now pos-
sible in the examination room.
 In case of an emergency, you can start the examination.

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System Operation

Full operation The task cards appear on the monitor in the control room but cannot yet be oper-
ated.
The symbols on the monitor become selectable.
The ’broken link’ symbol disappears from the live screen (of plane A) in the exam-
ination room.
If fluoroscopy and/or acquisitions were performed in backup mode, images are
transferred from the buffer to the memory.
Processes that were not terminated when the system was last switched off
(e.g. sending images) are restarted.
All functions are now available.
 You can register patients, perform examinations, postprocess and document
images.

Logging in with active security

If the syngo security package has been licensed and activated, you must log in to
your system.
Please respect Security Package 81
The system allows access in a special mode without authentication control in or-
der to enable diagnosis in case of emergency. Therefore an ‘emergency’ user is im-
plemented in the user management. For this special user the option of no
password is possible. The default privileges and permissions of the emergency
user can be restricted.

Scene of a previous acquisition can only be recovered if a user with sufficient priv-
Caution ileges logs in to the system.
Delayed or no diagnosis possible. Unnecessary slight radiation exposure.
 In order to recover an acquisition scene on a system with security option after
interrupt by an abnormal restart/shutdown login as the same user which was
active when the scene was acquired.

In case of emergency login is not possible

Caution Risk that an emergency patient cannot be examined
 The configuration of the emergency user (e.g. with or without password, priv-
ileges and permissions, etc.) should be set up that the emergency login is easy
possible and all necessary tasks can be performed.
The setup is in the responsibility of the site administrator.

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 Switching On/Off

Note When the system has been started-up but no user is logged-in, the system is in
BYPASS FLUORO mode.

 Enter your user name and your password.

 Confirm by clicking Log In.

For more information on the Security Package, please refer to the syngo docu-
mentation.

Switching on after a power failure or emergency

SHUTDOWN
 Switch the system on again.

 Pay attention to error messages.

Note In the event of a power failure, the cooling system of the X-ray tube also fails.
 Pay attention to the thermal load on the X-ray tube after switching on the sys-
tem again.

Tests and checks

Before the examination, you as the user must check that all safety features are
functioning and that the system is ready for operation.
 Before each examination, check that all displays and signal lamps are function-
ing properly.
Functional and Safety Check 147

Switching off
Note Certain components (detector, detector cooling unit) remain on standby (i.e.
switched on) to keep the detector at operating temperature. It is important so that
you can work with the system immediately after restarting.

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System Operation

Switching off at the on-site room main switch or the emergency SHUTDOWN but-
Caution ton
Risk of data loss, data corruption or system damage
 Always shut down the system with Options > End Session from the main
menu.

Note In case of a hardware failure, e.g. error in shutdown circuit, you can use the on-
site emergency SHUTDOWN button.
Switching off in an emergency 145

Shutdown (without active security)

Terminating
 Terminate the current examination or postprocessing.

 Save changes if necessary.

 Select Options > End Session... from the main menu.

– The End Session dialog box is displayed.

Restarting
In certain cases, it is necessary to restart the system or the application only.
Restarting 789

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 Switching On/Off

Switching off
If you want to switch the system off completely, the imaging system must be shut
down.
 Click Shutdown System...
– Another dialog box appears.
 Click Yes.
– The application is terminated.
– The operating system of the computer is shut down.
– The system is switched off.

Logoff/shutdown with active security

If the syngo security package has been licensed and activated, you have various
possibilities to end your session and to shut down your system.
 Call up Options > End Session... in the main menu.
– The End Session dialog box is displayed.

Note During logoff, radiation is not possible for a short time.

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System Operation

Lock computer

 Click Lock Computer to restrict the access to your computer.

– The patient is closed.
– The screen saver appears.
– Radiation is blocked. The message “No Radiation; Unlock Screen” is shown.

Note After a configurable time of no input, fluoroscopy or acquisition, the screen saver
is automatically displayed.

Note When the system is locked, no fluoroscopy and no acquisition is possible. Unlock-
ing is only possible via entering the password or via a new login.

Logging off

 Click Log Off <user name>... to terminate the program.

– The system closes the patient saving any settings you have made.
– Radiation is blocked. The message “No Radiation; Please login” is shown.
– The screens are dark and the login dialog is displayed in the control room.
– After a configured time, the screen saver appears.

Note When no user is logged-in, the system is in BYPASS FLUORO mode.

Different user

 Click Log In Different User... to log in to the running system.

 Enter your user name and your password.

 Confirm by clicking Log In.

Note Dialog boxes and patient data may be hidden depending on your access rights.

For more information on the Security Package, please refer to the syngo docu-
mentation.

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 Switching On/Off

Shutting down
 Click Shutdown System... if you want to shut down the system to switch it off.
Switching off 143

Restarting
In certain cases, it is necessary to restart the system or the application only.
Restarting 789

Disconnection from the on-site power supply

In exceptional cases, you can disconnect from the on-site power supply.

Note Please note:

 Before disconnection, please wait for 20 minutes to allow the rotating anode
to cool down and stop (for MEGALIX Cat only).
In an emergency or in the case of a fault you can switch the system off earlier,
but only if you switch it on again immediately.
 If a flat detector is used, its temperature must be maintained at a constant lev-
el. If the power supply is disconnected, the system may take some time to
reach optimum image quality after switch-on.

 Switch off the system first.

Switching off 141

Note If necessary, the emergency power supply and the imaging system UPS or OR-UPS
must be switched off separately.

Switching off in an emergency

The emergency SHUTDOWN button in the room should only be used in extreme
emergencies, since it would also switch off the components (flat detector).
If the room shutdown button was operated for a longer period of time, it can take
up to 90 minutes for the system to be operational again (depending on ambient
temperatures in the examination room and equipment room).

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System Operation

Shutdown using the emergency SHUTDOWN button

Caution Risk of data loss and/or
Damage to tube due to lack of cooling
 Operate the emergency SHUTDOWN button only in case of emergency or if the
system cannot be switched off by the End Session command.

Note An emergency power supply, if one is connected, will not be activated when
emergency SHUTDOWN is pressed.
It does not apply to the imaging system UPS, which will shut down only after a
configurable time. (The green LED indicator on the imaging system lights when
the UPS is running.)

Emergency Only in the case of danger:

SHUTDOWN
 Press the on-site emergency SHUTDOWN button.
– The entire system is disconnected from the power supply.
Emergency SHUTDOWN button (installed on-site) 44

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 System Operation
Functional and Safety Check

General information
Tests and checks Before the examination, you as the user must make sure that all safety features
are functioning and that the system is ready for operation.
You must be familiar with the Operator Manual to be able to perform a safety
check.

Time You must work through the safety checks before positioning the patient.

Plane On biplane systems, the checks must be performed for each plane:
 If necessary, press the A/B key.
– The corresponding LED lights up.

Malfunctions In the event of malfunctions which impair safe operation:

 Shut down the system

 Notify Customer Service.

Performing checks
Before an examination  Ensure that:

 All required positioning aids (e.g. arm supports) are attached correctly,

 The tabletop of the patient table and the front of the flat detector are free from
contrast medium residue and dirt,
 All displays and signal lamps are functioning.

During an examination  Release unit movements only if it is ensured that

– they pose no danger to the patient or third parties
– any objects obstructing unit movements have been removed.
 If necessary, check patient immobilization and make sure that the patient is
gripping only the handles provided.
 Before releasing radiation ensure that the necessary radiation protection mea-
sures have been taken.
 Observe the kV and mAs values during fluoroscopy or acquisition.

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System Operation

Daily  Emergency STOP button

 System movements

 Collision sensors

 Radiation/radiation indicators

 Image orientation, image rotation, collimation

 FD input format/zoom factor

Daily checks 148

Weekly  Restart System or shutdown and restart

Restarting 789

Monthly  Dose rate control

 Brake test (Artis zeego)

Monthly checks 151

Annual  Maintenance
To ensure the safety and proper functioning of the system, maintenance must
be performed every 12 months. If you do not have a service contract, please
contact Siemens Customer Service.

Daily checks
Emergency STOP Check whether the emergency STOP buttons are functioning properly.
button

Emergency Stop button not functioning

Caution Stand stops too late in critical situation.
 For the locations of the emergency STOP buttons, refer to the picture Where
are the emergency STOP buttons? 42.

 Press the emergency STOP button:

STOP – Unit movements must no longer be possible.
– A message is displayed.
 Pull the emergency STOP button (control module).
– Unit movements are possible again.
– The message disappears.

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 Functional and Safety Check

Movements  Make sure that the following movements are possible:

 Stand/C-arm movements

 C-arm angulations

 FD lift (SID)

 Table lift

 Tabletop transverse and longitudinal movements

 Table rotation

 Table tilt

Collision sensors 174

 Collision sensor on the input of the flat detector

 Collision sensor on the primary collimator

 Collision sensor on the cover of the X-ray tube assembly

 Collision sensor on the two switching bars on both sides of the C-arm

 Collision sensor of the table detecting the lifting of the tabletop

 Artis zeego collision sensors

Undetected failure of the collision sensors.

Caution Risk of injury to patient or operator, or damage to unit parts as system stops
hm_um_DailyCheckOfCollisio too late following a collision.
nSensors
 Perform the check of the collision sensors according to the steps below.

 Check that the collision sensors are functioning. 174

 Release a unit movement, e.g. C-arm movement.

 During movement, press one of the collision sensors.

When a collision sensor has responded:

– Unit movements must be disabled.
– Messages must appear on the display.

Radiation protection  Check the radiation protection devices (upper and lower body protection,
devices aprons etc.) for damage.

Radiation, The radiation indicators must light up only if a button for fluoroscopy or acquisi-
radiation indicators tion is operated. An image must be visible on the screen

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System Operation

If any radiation indicator lights up although you have not pressed a button:
Caution Danger due to radiation
 Press the emergency STOP button.

 Notify Customer Service.

 Operate the fluoroscopy pedal on the footswitch.

– The radiation indicators must light up.

Note If present, perform these procedures for each plane!

Image orientation  Place a radiation-absorbing object on which left/right and top/bottom are clear-
ly visible in the beam path, e.g. lead letter.
 Operate the fluoroscopy pedal on the footswitch.
– The image displayed on the screen must match the orientation of the
object.

Note The image orientation depends on the patient position entered on the imaging
system.
The image is always displayed as if the patient (the object) were standing in front
of the viewer, facing the viewer.

Image orientation with collimator/camera rotation

 Check the image orientation as described above.

 Swivel the C-arm plane A into the Left Side position.

– The image display on the screen must retain the position as it was before
swiveling.

Collimation  Use the image from the previous test or create a new fluoroscopy image, if nec-
essary,
 Check the collimator setting. To do so, proceed as follows:

 Deflect the collimator joystick briefly.

– The graphic display of the collimator setting CAREprofile is shown.
 Change the collimation with the joystick.

 Create a new fluoroscopy image.

 Check the collimation:

– The radiation field must match the graphic display.

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 Functional and Safety Check

Note With the primary collimator, the electronic shutter is controlled automatically. The
shutter leaves at least one edge of the collimator leaves uncovered so that the po-
sition of the collimator leaves is visible.

Input format/ Depending on the flat detector installed, different input formats / zoom levels are
zoom factor available. The switch-over function between the formats/zoom levels must be
checked:
 Use the image from the previous test or create a new fluoroscopy image, if nec-
essary,
 Press the - or + key on the collimator control module.
– The zoom factor is reduced (= larger input field) or enlarged (= smaller input
field) by one step.

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

Options  Check that all components connected to the system are functioning properly.

For example:
 Video recorder: Record and play back short scenes

 CD/DVD drive: Access to inserted CD/DVD possible?

 Network: Access to other computers in the network possible?

Monthly checks

Note If present, perform these procedures for each plane!

Checking dose rate control

 Set the maximum SID.

 Set the maximum FD input field.

 Set the maximum collimator aperture.

 Select a fluoroscopy program.

 Remove all objects from the beam path.

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System Operation

 Activate fluoroscopy briefly.

 Check the kV display of the fluoroscopy data on the screen.

– The display must show approximately 50 kV.
 Place one lead apron (or 0.5 mm lead) in the beam path.

 Activate fluoroscopy briefly again.

 Check the kV display of the fluoroscopy data on the screen.

– The display must now show a value greater than 60 kV.

Checking automatic format collimation

 Set the maximum source-FD distance.

 Activate fluoroscopy briefly.

 Collimate to the visible radiation field:

– With maximum radiation field, the edges of the collimator are visible on the
screen.
 Perform fluoroscopy and reduce the source-FD distance:
– The set radiation field must be retained.
 Terminate fluoroscopy.

Checking the brakes (Artis zeego)

The system requests for a brake test regularly in a configurable time interval.

Note The the first time a user is demanded to perform the brake test is configurable (in
combination with next normal patient registration):
1 h to 648 h (27 days), default 600 h (25 days)
 Please ask Siemens Service for configuration.

With expiration of this time interval, another timer of 120 h (5 days) is started.

Inspection of the brake function

Warning A brake malfunction may lead to uncontrolled movements, thus injury to the
patient, to the clinical staff, or damage to property.
 Perform the brake test in a fixed time interval.
(The interval can be configurated.)

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 Functional and Safety Check

The brake test must be performed in the Parking position. The position assures,
that the patient or parts of the system cannot be harmed in case of a malfunction
of the brakes.

Brake test by user

Regularly perform the brake test.

Note If no brake test has been performed in the configured time interval, the message
“Stand test necessary within # days” will appear.
After this time has expired, the stand speed will be reduced. The message
“Reduced stand/table speed, Stand Test necessary” will appear.

 Select the Parking position.

 Press down the stand joystick and deflect it forward until the Parking position
has been reached.

– The system drives to the Parking position.

– The message “Stand Test: Activate stand movement # s” is displayed.
(# is a configurable time between 1 and 10 s)
 Press down the stand joystick and deflect it forward again.

– The brake test is started and the message “Stand Test: running” is dis-
played.
– The system performs the brake test for each axle (6 times).

Note Once the brake test has been started, you can interrupt the stand test at any time
by releasing the stand joystick.
The message “Stand Test: Will be aborted in # s” is displayed.
After expiration of the set time the brake test can be repeated.

 If the brake test is successful, the message “Stand Test: Successfully complet-
ed” is displayed.
Normal movements are possible again.
 If the brake test is not successful, the message “Automatic Stand Test failed,
SC” is displayed.
All movements of the Artis zeego stand are blocked. (Table movements are still
possible.)
 In this case, call Siemens Service.

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System Operation

Brake test by service

During regular checks, the brake test is performed by service.

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Unit Movements

Movement possibilities
This section provides a brief overview of general movement possibilities (degrees
of freedom) of the units.

Movements of the Artis zeego stand

(3)
(10)

(4)

(8)
(2)
(5) (6) (7)

(9)

(11)

(12)
(1)
Example: Artis zeego Angio floor stand

(1) Stand swivel (6) C-arm rotation

(2) Movement axis 1 (RAO/LAO angulations)

(3) Movement axis 2 (7) C-arm orbital movement

(cran/caud angulations)
(4) Movement axis 3
(8) FD rotation
(5) Movement axis 4
(9) C-arm lift
(10) FD lift
(11) Lateral movement
(12) Longitudinal movement

All movements are motor-driven.

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System Operation

Movements of the floor stand

(Artis floor and Artis biplane)

(4)

(5)

(6)
(3)

(1)
(2)
Example: Artis floor Angio floor stand

(1) Stand swivel

(2) Stand rotation
(3) C-arm rotation (RAO/LAO angulations)
(4) C-arm orbital movement (cran/caud angulations)
(5) FD lift
(6) FD rotation
All movements are motor-driven with the exception of stand rotation.

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Movements of the top stand (Artis biplane)

(3)

(1)
(2)
(4)

Example: Artis biplane Card top stand

(1) Stand longitudinal movement (on ceiling rails)

(2) C-arm rotation (cran/caud angulations)
(3) C-arm orbital movement (RAO/LAO angulations)
(4) FD lift
All movements are motor-driven.

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System Operation

Movements of the stand/C-arm (Artis ceiling)

(1)

(5) (4)
(3)

(2)

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 angulations)
(5) FD lift
All movements are motor-driven.

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Movements of the patient table

(1) (5)

(4)
(3)
(2)

(6)

(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 (motorized)
(6) Table rotation (motorized or manual)

Surgery table Trumpf Surgery Table TRUSystem 7.500 or Maquet Magnus table for Artis systems
Please refer to the manufacturer’s Operator Manual.

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System Operation

Basic positions of the units

General basic positions

C-arm A C-arm can be in the following basic positions:
 C-arm rotation 0°

 C-arm angulation 0°

Patient table The patient table can be in the following basic positions:
 Table tilt horizontal (0°)

 Table height isocenter

 Tabletop center position (Artis zeego only)

Isocenter The isocenter is the center of rotation, the fixed point of a C-arm. If an organ is in
this center of rotation, the image of the organ remains in the same place on the
screen during C-arm angulations.
Stop in the isocenter 178.

Stopping in the basic positions

By pressing a button, you can release stops for C-arm movements beyond a basic
position.
 Press the zero stop button.
– The LED lights up.
– Movements stop at the basic positions.
 If you now release the button and operate the operating element again, move-
ment is resumed.

No stop  Press the zero stop button again.

– The LED goes out.
– Movements are executed continuously beyond the basic positions.

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Overview of system positions

System/ Artis Artis Artis Artis

System Position floor biplane ceiling zeego
Patient Transfer* +† +† +† +†
Head Side + + + +‡
Biplane Head Side + - -
Left Side + + + +
Biplane Left Side - + - -
** **
Left Side, Table Rotated + + - -
Left Side, Table Rotated 15° - - - +†
Left Side, Table Rotated 30° - - - +†
Right Side - - + +
** **
Right Side, Table Rotated + + - -
Right Side, Table Rotated 15° - - - +†
Right Side, Table Rotated 30° - - - +†
Parking* - - - +
Automap + + + +
*
Radiation is blocked in this position.
†
Position can be configured by Service
‡
The table rotation angle can be configured by Service in the range ± 30° in steps of 5°, default 0°.
**
only with manual stand swivel

You can select System Positions with the key on the stand control module (SCM).
Moving to system and programmed positions 190

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System Operation

System positions of the Artis zeego stand

The Artis zeego stand can be in the following basic positions:

Example

 Patient Transfer, for patient transfer (configurable)

 Head Side, with left-side and right-side patient access

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 Left Side, with right-side patient access

 Right Side, with left-side patient access

Moving to system and programmed positions 190

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System Operation

 Left Side, Table Rotated 30°, table rotated, with right-side patient access

 Left Side, Table Rotated 15°, table rotated, with right-side patient access

Movement to or from a position with rotated table 197

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 Parking, parking position, also used for brakes test

 Automap, position at which a reference image has been acquired 193

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System Operation

System positions of the floor stand

(Artis floor and Artis biplane)

The floor stand of an Artis floor or Artis biplane system can be in the following ba-
sic positions:

 Transfer Headside, for patient transfer

 Head Side, with left-side and right-side patient access

 Left Side, with right-side patient access

Moving to system and programmed positions 190

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 Right Side, Table Rotated, with left-side patient access

 Left Side, Table Rotated "OR position", with right-side patient access
Movement to or from a position with rotated table 197

 Automap, position at which a reference image has been acquired 193

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System Operation

Positions with the top stand (Artis biplane)

The stands of an Artis biplane system can be in the following further basic posi-
tions:

 Biplane Head Side

 Biplane Left Side

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Initiating unit movements

Important information on unit movements

Movements are motor-driven, that is, when you operate an operating element,
e.g. stand joystick, the system performs a movement.
In an emergency, e.g. if there is a power failure, the units can also be moved man-
ually by applying sufficient force.
Rescuing the patient in an emergency 53

Note The patient table with lateral tilt can be returned to the original position in the
event of a power failure with the help of the integrated emergency power supply.
If there is a power failure, the emergency power supply is switched on after some
time.
Now you can execute table movements for about 5 minutes depending on the
battery charge and aging state.

Unit movements
Warning Risk of collision, risk of injury to patient or operator, risk of damage to unit
parts.
It is the responsibility of the operator to ensure that unit movements are released
only if it is certain that neither the operator, the patient, third parties nor other
pieces of equipment can be endangered by these movements.
 Always pay attention to possible collisions during unit movements.

 Make sure that nobody is standing inside the danger area.

 Remove any objects or accessories from collision area, e.g. injector or infusion
stand.
 Body penetrating objects introduced in the patient (e.g. catheter, biopsy/ky-
phoplasty needle) must not be actuated by system movements.

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System Operation

Movement of the patient on the tabletop

Warning Patient may slip from the table to the ground.
 Never leave a patient unattended on the tabletop.

 Use the provided accessories, e.g. immobilizing straps to secure the patient in
a stable position.
 Always keep the mattress fixed on the tabletop with the Velcro.

Body parts stretch over supporting devices.

Caution Physical injury of the patient due to collision or squeezing.
Body parts shall not stretch over supporting devices, for example, table or arm
holder to avoid collisions.
 Always keep the patient immobilized.

A patient examination is performed where the patient is not positioned on the pa-
Caution tient table. (Artis zeego)
Risk of personal damage. Treatment of the wrong side.
 Artis zeego must only be used for patient examinations with the patient posi-
tioned on the patient table.

Patient is not sufficiently secured.

Warning Patient falls from Surgery Table TruSystem 7500.
 Secure the patient sufficiently with shoulder supports, immobilization straps
and the foot bench before tilting or cradling the tabletop.
 Use an adequate number of immobilization straps for holding heavier patients
on the tabletop. The table below is valid for the straps from Siemens and the
vascular tabletop.
The universal tabletop shall be used with the safety belts from Trumpf.

Patient weight: Number of straps:

up to 90 kg min. 2
90 kg - 135 kg min. 3
135 kg - 180 kg min. 4

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Unintentional activation of system movements e.g. when leaning over the control
Warning modules to access the patient on the table.
Risk of collision, risk of injury to patient or operator, risk of damage to unit
parts.
 Before starting activities close to the control modules, always press the Block
Movement button on the TSC (Touch Screen Control) to prevent motorized
movements or temporarily remove the consoles.

Also observe the part Safety 21

Collision protection

Safety equipment
The systems are equipped with a number of safety mechanisms which help pre-
vent collisions during unit movements:
 Dead man's grip (DMG)
Movements take place only as long as the operating element is actuated.
 Collision computer 172
A computer constantly calculates all possible collisions between the stands/C-
arm(s) and the patient table.
 Speed reduction
The speed is automatically reduced for movements in the collision area or in
particular system positions and movement is stopped, if necessary.
 Collision sensors 174
In case of a collision, sensors, e.g. on the FD, automatically stop the move-
ment.
 Emergency STOP buttons
Movements are stopped immediately when an emergency STOP button is be-
ing pressed.
Red emergency STOP buttons 41
When movements are blocked, a message appears.

Note The safety equipment of the system does not release you as the user from your
obligation to pay attention to the patient and the system during unit movements!

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System Operation

Note If a C-arm is moved into the collision zone with the other C-arm (biplane) or with
the patient table, a warning sound (configurable) is emitted and the movement is
slowed down.
Please note that the movement is not stopped, i.e. collisions can occur!

Note In biplane systems, when one stand is moved, the other stand gets out of the way
(deviation movement) to avoid blocking the movement.

Collision computer
To keep the probability of a collision to a minimum, a collision computer continu-
ously monitors the positions of all integrated components of the system with re-
spect to one another and the room. The collision computer detects when defined
distances are violated. In such a case, it reduces the movement speed and triggers
an audible signal.

Monitored area The collision computer monitors the patient table, stands, floor, walls, and ceiling/
ceiling rails as well as a half cylinder shaped safety zone around the patient.

Example of a calculated collision area around the patient

Example for head holder collision zone (sphere)

Activation of the head holder collision zone 719

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Note Depending on the installed type of patient table and the configuration, the patient
table will be part of the collision monitoring or not.
In the latter case, the collision computer will not take account of the patient!

Extended monitoring It is possible to configure vertical cylinders and horizontal cylinders into the math-
area ematical model of the stand and table geometry.
Please note, that the following areas/components are not monitored by the colli-
sion computer:
 The actual area in which the patient is positioned, e.g. projecting extremities.

 Display ceiling suspension

 Trolley for control modules

 Corrugated hoses

 Movable accessory rails

 Attachments and accessories such as

– Arm rests, arm supports
– Radiation protection
– Examination lamp
 Mobile equipment such as
– Control consoles
– Footswitch
– Contrast medium injector
– IV bottle holder
– Instrument trays
– Pieces of furniture, e.g. chairs
 Parts of the system equipped with mechanical collision sensors such as
– Flat detector
– Primary collimator
– Outer edges of the C-arm

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System Operation

Collision sensors
The system is equipped with various collision sensors:
 Collision sensor on the input of the flat detector

 Collision sensor on the primary collimator

 Collision sensor on the cover of the X-ray tube assembly

 Collision sensor on the two switching bars on both sides of the C-arm

 Collision sensor of the table detecting the lifting of the tabletop

 Artis zeego collision sensors

Collision sensors on the flat detector, on the primary collimator, and on the X-ray tube assembly

Example of Artis zeego collision sensors

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Stopping movements
All 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 until stop,
6. an emergency STOP button is pressed.
See also Blocking unit movements 263

Note In certain situations, the speed of unit movements is reduced for safety reasons.
See also Safety equipment 171.

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 unintentionally:

 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 opposite direction by deflecting the op-
erating element in a different direction.

Case 3. If stopping at a basic position has been programmed:

 You can resume the movement by releasing the operating element and oper-
ating it again.

Resuming movement after collision (override)

Case 4. If a collision occurred and the collision sensor responded:
 You can initiate a movement by pressing buttons I and II simultaneously and
operating the operating element in a different direction.
– The message "Collision control deactivated" appears.

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System Operation

Safety override active

Caution Higher risk of collision
Risk of mechanical or personal damage
 Execute unit movements with great care when safety override is active.

 Deflect the operating element in one of the possible directions.

See also No unit movement possible! 776

Displays The possible directions are indicated on the Assist screen with + and -. Directions
which are not possible are marked with x.
See also Readings on the Assist screen 217

Case 5. If the movement has been slowed down by the collision computer, it can be re-
sumed until the unit stops.
In rare cases, e.g. when the patient table is tilted, it is not possible to resume the
movement:
 Proceed as described under Case 4..

Case 6. If an emergency STOP button has been operated:

 You can resume the movement by operating the operating element again after
you have rectified the cause and unlocked the emergency STOP button.
Red emergency STOP buttons 41

Operating locations and priorities

Artis systems can be equipped with more than one control console, e.g. for oper-
ation in the examination room at the patient table, on the trolley, or in the control
room.
There are also additional keys on the flat detector.

Priorities The following rules apply:

 System operator actions are structured in function groups, e.g.:
– Stand control module (SCM)
– Table control module (TCM)
– Collimator control module (CCM)
 Operation of an operating module in the examination room disables the func-
tion of the associated function group in the control room or at the trolley.
 There are two priorities for operating elements:
– higher priority: Control modules
– lower priority: Membrane keys on the flat detector.

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Examples:
– Operation of a membrane key on the flat detector can be interrupted by
operation at the stand control module.
– Operation at a table control module cannot be interrupted by operation at
the flat detector.

Positioning the control consoles

Control consoles can be hooked into the accessory rails of the patient table or into
the rails of the control console trolley.

Note Control consoles should always remain attached at the intended points when they
are operated.

Positioning a control console

 Remove the control console from the rail by pressing the handle underneath
the control console and lifting it tilted slightly backward.
 Hook it in again at the required position.

Setting the orientation

Note The "LAO/RAO" and "cranial/caudal" directions apply only if

 the control consoles are in the default position (on the right of the patient in
the default position Head First - Supine ) and
 the correct LED in the orientation key lights up.
Orientation key 117

 Check whether the orientation of the control console matches the current po-
sition.
If necessary, you can change the orientation of the control console (and therefore
the directions of movement)
 Press the orientation key (repeatedly if necessary) and hold it pressed for lon-
ger than 3 s.
Orientation key 117

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System Operation

Table movements

Note The lifting and tilting motors are specified for usage of max. 6 min/hour.

Note The following operating instructions for moving the patient table also apply to the
Trumpf surgery table TruSystem 7500 and the Maquet Magnus table.
For operating of the additional control module and additional movements please
refer to the manufacturer’s Operator Manual.

Raising / lowering the table

During lowering the table, an attached accessory like the lower body radiation
Caution protection device activates the footswitch.
Risk of unwanted radiation
 It is the responsibility of the operator to ensure that unit movements are re-
leased only if it is certain that no attached accessories collide with the foot
switch.

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

Stop in the isocenter

ISO stop You can program the table to stop automatically when the isocenter is reached.

Note In Artis zeego the Adjusting the working height (Artis zeego only) functionality is
configured by default.
Please ask Siemens Service if you want to have the ISO stop functionality instead.

 Set the table height for the isocenter.

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 Press the Isocenter key.

– The LED lights up.
– The current table height is saved as isocenter height.
– The table stops every time this position is reached.
– The displays of the table coordinates X-Position, Y-Position, and IO-Height
are set to zero and show the relative coordinates (relative to the patient
with reference to the patient position) as long as the LED is lit.

No stop  Press the Isocenter key again.

– The LED goes out.
– The table moves continuously through the isocenter.
– The displays of the table coordinates X-Position, Y-Position, and IO-Height
indicate absolute (table) coordinates again.
The ISO stop function is automatically deactivated when a new patient is regis-
tered.

Adjusting the working height (Artis zeego only)

You can keep the relative distance of C-arm and tabletop while adjusting the work-
ing height (configurable by service).
 Press the Isocenter key.
– The LED lights up.
 Adjust table height.
– The distance of the table to the collimator is kept at a constant value if table
height changes.

Moving the tabletop

The movement of the tabletop can be configured by Siemens service in two ways:

Switchover function The brakes are released and applied again:

 Press the panning knob once.
– The brakes are released.
– The tabletop can be moved freely.

 Position the floating tabletop.

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System Operation

 Press the panning knob a second time.

– The brakes are applied again.
– The tabletop is locked in position.

Continuous holding The brakes are released only if the panning knob is pressed:
 Press the panning knob down and hold it down.
– The brakes are released.
– The tabletop can be moved freely.
To apply the brakes:
 Release the panning knob.

Note Depending on the patient table version, the floating tabletop can either be moved
only manually or in a motor-assisted manner (servo).

Note The Fluoro pedal of the footswitch can also be configured by Siemens Service to
release the tabletop brakes (dual function).

Moving the tabletop (additional control console)

For a patient table with tilt, the control console can be installed separately from
the patient table, e.g. if mounted on the trolley for control modules. In that case,
"floating" operation of the tabletop is not possible. Instead, the tabletop is motor-
controlled by means of the table joystick:
 The correct console orientation is set. 177

 Press down the table joystick and deflect it sideways.

– The tabletop follows the movement.

Moving the tabletop longitudinally only

For some examinations, e.g. peripheral angiography, it is necessary to block trans-
verse table movement.
 Press the key for disabling lateral movement of the tabletop.
– The LED lights up.
– The tabletop can only be moved longitudinally when the brakes are
released.
To enable tabletop movement in any direction once again:

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 Press the key again.

– The LED goes out.
– The tabletop can be moved freely in the longitudinal and transverse direc-
tions.

Tilting the table

Longitudinal tilt (transverse axis)

If a tilting patient table is installed, the tabletop with the patient can be tilted by
±15° to the head-up position (reverse Trendelenburg) or head-down position
(Trendelenburg).

Note When the table is tilted to the Trendelenburg or reverse Trendelenburg position,
motorized movement of the tabletop in the longitudinal direction and "floating"
movement in the transverse direction are possible.

Lateral tilt (longitudinal axis)

If the table with lateral tilt is installed, the tabletop with the patient can be tilted
sideways by another ± 15°.

Note When the table is tilted laterally, the tabletop can only be moved in the longitudi-
nal direction.
 Check the tabletop position before tilting the table.

Activating lateral tilt

If you want to tilt the table laterally, you must activate this tilt type.
 Press the key for lateral tilt.
– The LED lights up.

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System Operation

Tilting the tabletop

Patient table tilted

Warning Patient slips from the table to the ground.
 Never leave a patient unattended on the tabletop.

 Secure the patient sufficiently with the accessories (e.g. body straps, shoulder
belts, Foot Boards) provided with the different table types, according to the ta-
ble-specific instructions and the exam type.
 Always keep the mattress fixed on the tabletop with the Velcro.

 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 automatically.
– The tabletop is horizontal.

Moving the table to the basic position

The basic position of the patient table is defined as:
 Tabletop horizontal
– Lateral tilt 0°
– Trendelenburg tilt 0°
 Tabletop in center position

 Table height is such that the patient is in the isocenter

 Press the Home key on the handheld remote control and keep it pressed.
+20( – The tabletop is tilted back into the horizontal position.
– The table height is adjusted to zero position (isocenter).

Note You can move the table to the basic position with the Home key even if there is a
power failure. (Emergency power supply)

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C-arm movements

Take care to avoid possible collisions.

Speed The speed of the movements depends on how far you deflect the joystick: maxi-
mum speed with maximum deflection.

Orientation The direction of the movement depends on the orientation of the control module.
Please take into account the orientation of the control module.
 The correct console orientation is set. 177

C-arm angulations
The C-arm is used to set the projection angle. Angulations are performed in the
cranial/caudal and LAO/RAO directions in relation to the patient.
Combined C-arm movements are possible when the operating element is deflect-
ed diagonally, e.g. 45°.

Note During angulations, organs which are located in the isocenter remain at the same
place on the screen.

Please note that the Artis zeego C-arm may not react immediately to your com-
mand. Please be patient and hold the joystick until the C-arm starts moving.

Artis floor/ C-arm rotation/orbital movement

Artis biplane/ (cranial/caudal/LAO/RAO angulations)
Artis ceiling/
Artis zeego
 Press the stand joystick (of the correct plane) down and deflect it in the re-
quired direction.
– The C-arm performs the corresponding angulation.

Or
 Press a membrane key on the flat detector.

– C-arm rotation (cran/caud angulations)

– C-arm orbital movement (RAO/LAO angulations)

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Table with tilt ISO tilting

If the patient table with motorized longitudinal table movement and reverse Tren-
delenburg / Trendelenburg table tilt is installed, Siemens Service can configure ISO
tilting.
In this case, the patient angle is maintained when the Isocenter key is activated,
that is, during angulation of the C-arm, the patient table performs the correspond-
ing compensating movement (table tilt, table height, and table longitudinal
movement) so that the organ under examination remains in the isocenter (posi-
tion and angulation).
 Press the Isocenter key on the table control module.
– The LED lights up.
See also Stop in the isocenter 178
 Press down the stand joystick and deflect it in the required direction.
– The patient table follows the angulation.

No ISO tilting
 Press the Isocenter key again.
– The LED goes out.

Note The ISO function is automatically deactivated on registration of a new patient.

Linear C-arm movements (Artis zeego)

The C-arm of the Artis zeego stand can be moved in all horizontal and vertical di-
rections.

Please note that the Artis zeego C-arm may not react immediately to your com-
mand. Please be patient and hold the joystick until the C-arm starts moving.

Moving the C-arm horizontally

 Press the C-arm joystick for linear movements down and deflect it sideways.
– The C-arm follows the movement.

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Moving the C-arm vertically

 Press the key for the required movement and keep it pressed until the required
C-arm height is reached.
– The C-arm height is changed immediately.

Simultaneous movements of both C-arms (Artis biplane)

In certain positions of the stands it is possible to angulate both C-arms simultane-
ously so that the relative position (angle) of the C-arms in relation to one another
does not change. (Only simultaneous LAO/RAO angulations are possible).

Take care to avoid possible collisions.

Simultaneous angulation
 Press one of the two keys on the side of the stand joystick (of plane B), press
down the joystick and deflect it in the required direction.
– Both C-arms move simultaneously.
Or

Switch over to simultaneous angulation

 Press the key for biplane simultaneous angulation.
– The LED lights up.
– A message appears.
 Press the stand joystick (of plane B) down and deflect it in the required direc-
tion.
– Both C-arms move simultaneously.

Single angulation
To cancel synchronous movement:
 Press the key once again.
– The LED goes out.
– The message disappears.

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System Operation

Overtable/undertable conversion

Contrast media or blood may seep into the system.

Caution Risk of system malfunction and danger of infection
 Use sterile covers.

Commercially available sterile and sterilizable covers can be used for the detector,
X-ray tube assembly with primary collimator and scattered radiation protection.
 In case the detector is operated underneath of the table pull the slipcover over
the detector.

Artis ceiling You can easily move the flat detector from its position above the patient table to
a position under the patient table.
 Move the stand longitudinally to a position outside the patient table.
Standlongitudinal movements (top stand) 186
 Move the tabletop away from the C-arm.
Moving the tabletop 179
 Rotate the C-arm about its transverse axis.
C-arm movements 183

Standmovements

Standlongitudinal movements (top stand)

The C-arm can be positioned in the patient longitudinal axis:
 Artis biplane top stand/C-arm

 Artis ceiling stand/C-arm

Speed The speed of the movements depends on how far you deflect the joystick: maxi-
mum speed with maximum deflection.

Positioning the C-arm longitudinally

Take care to avoid possible collisions.

 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.

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Or
 Press a membrane key on the flat detector.

– Longitudinal tabletop movement with stepping table

– Longitudinal C-arm movement with Artis ceiling

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

Stand swivel (floor stand or Artis ceiling top stand)

Floor stand The floor stand can be swiveled between specific positions, e.g. between Head
Side, Transfer Headside, and Left Side/Right Side.

Transfer Headside

Left Side

Head Side

Floor stand swivel positions

Top stand The Artis ceiling top stand can be swiveled about the patient table.

Left Side

Head Side

Right Side

Top stand swivel positions

Speed The speed of the movements depends on how far you deflect the joystick: maxi-
mum speed with maximum deflection.

Angulation Siemens Service can configure the stand swivel movement in such a way that the
angulation of the C-arm in relation to the patient is not changed, i.e. the C-arm ex-
ecutes a compensating movement when the stand is swiveled. The patient angle
remains constant.

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System Operation

Swiveling the stand

Take care to avoid possible collisions.

clockwise  Press one or both buttons on the side of the corresponding stand joystick,
press down the joystick and deflect it backward or forward.
– The stand swivels clockwise or counterclockwise.
counter-
– The C-arm remains in the same position in relation to the patient if the Iso-
clockwise center key has been activated.
– The stand automatically stops in the basic positions.

FD 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.

Take care to avoid possible collisions.

 Press the rocker switch on the back of the stand/C-arm joystick (of the correct
plane).
– Upper switch: increase SID
– Lower switch: decrease SID
Or

 Press a membrane key on the flat detector.

Note When the SID is changed, collimation is automatically readjusted.

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Rotating the FD / Setting portrait/landscape

Multispace The image rotation caused by swiveling of the Artis zeego stand, floor stand or
Artis ceiling stand is normally compensated automatically by collimator rotation.
The image on the screen is automatically aligned and always displayed as if the pa-
tient were standing in front of the examiner.

Manual override For objects lying obliquely with respect to the image, e.g. arms, the primary colli-
mator or the image can also be rotated manually. In this case, automatic collima-
tor rotation is switched off. This way, collimation can be performed parallel to the
object:

Portrait/landscape The 30x40 flat detector has a rectangular image format. The FD and also the col-
limator can be rotated by 90 degrees for best view of the region of interest.

Manual override: Rotating the image clockwise

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

Manual override: Rotating the image counterclockwise

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

Note If manual override is active, or if the FD has been rotated manually by 90°, then
the image is not rotated.
If manual override has been performed, a short press of one of the buttons will not
rotate the detector automatically into the portrait/landscape position. It will only
work if the FD was in portrait/landscape position before.

Changing from portrait to landscape or vice versa

 Press this key on the FD.

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

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System Operation

 Press one of these keys on the collimator control module shortly.

Note When the FD is rotated, collimation is automatically readjusted.

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

Switching back to automatic FD/collimator rotation

 Press both keys simultaneously.
– The FD, the collimators and the image return to the normal position.
– The corresponding LED goes out.
– The portrait/landscape rotation of FD 30x40 is also reset.

Moving to system and programmed positions

Targets First select the position type with the keys on the stand control module (SCM):
 System Positions: Some basic positions are saved as special system positions.
161
Please observe the information on Cardiopulmonary resuscitation (CPR) 68
 Programmed Positions: You can save a number of positions that you require
for examinations as programmed positions.

Note With system positions, the first position is always set as the default position.
You should use this position for cardio pulmonary resuscitation.

Note With programmed positions, the first program is preset via the first selection, the
second program is preset via the second selection, etc.
If system positions are arranged in the order in which they are needed during the
examination, they can be selected one after the other as required.

Note It can be configured by Service which motorized table movements are included in
programmed movements.

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Note Programmed positions are only valid if they were stored with the same tabletop.

Patient transfer
Warning The patient may fall to the ground.
 Move system into Patient Transfer position.

 Park the patient stretcher/bed right alongside the patient table without a gap.

 Lock the brakes of patient stretcher/bed.

 Always keep the mattress fixed on the tabletop with the Velcro.

 Press the Block Movement button on the TSC to prevent motorized move-
ments or temporarily remove the consoles.

Procedure Programmed stand, C-arm, and table movements are initiated as follows:
1. Select system or programmed position
2. Confirm target position
3. Move to target position

Selecting the target position

 Press the required key.
– The LED on the key lights up.
The System Positions menu appears on the Assist screen.
 Select the required target position by deflecting the stand/C-arm joystick (of
plane A) backward or forward repeatedly.

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

Moving to the target position

Take care to avoid possible collisions.

 Press the stand/C-arm joystick down and deflect it backward until the target
position has been reached.

Or, if hands free movement is configured:

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System Operation

 Press the configured hands free pedal on the footswitch.

– The system performs the required movements.
– When the target position is reached, the LED on the program key goes out.
– The system returns to its original state.

Notes on the sequence of movements

 The speed of the movements depends on how far you deflect the stand/C-arm
joystick: maximum speed with maximum deflection.
 Several necessary movements (stand, C-arm, table) are performed simultane-
ously if it is possible without any danger.
 If you release the stand/C-arm joystick or deflect it in a different direction, all
unit movements are stopped. The programmed movement is aborted.
 If a collision protection device (collision sensor) responds during unit move-
ments, all movements are stopped immediately and can be resumed only
when the cause has been remedied.
Information about the movement sequence is shown on the Assist screen / mes-
sage bar.
 Please pay attention to the information.

Stopping a programmed movement

You can stop a movement at any time by:
 Releasing the stand/C-arm joystick

 Pressing the program key.

– The LED on the program key goes out.
– The system returns to its original state.

Automatic cancellation
 If the stand/C-arm joystick is not operated within a certain time (configurable
by Siemens Service, default 30 s) after selecting the System Positions or Pro-
grammed Positions, the system automatically returns to its original state.
 If the movement is interrupted and the stand/C-arm joystick is no longer op-
erated within a certain time (configurable by Siemens Service, default 5 min),
the system will also return to the original state.
The LED on the program key goes out.

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Moving to system positions using shortcut keys

(direct positions I, II, III)
Movement to the three most frequently used system positions can be initiated
with the direct positions I, II, and III:

Take care to avoid possible collisions.

 Press the required position key.

– The LED on the program key lights up.
 Continue as described from Moving to the target position 191 onward.

Automap
The Automap feature allows you to restore the acquisition position of an existing
reference image or to display the reference image of the current system position.

Requirements 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.

Note Automap is not possible for images of other Siemens systems, other manufactur-
ers or other modalities such as CT/MR).
Automap is not possible when a reference image of plane B from a biplane system
is selected on a single plane system.

Note With biplane systems the Automap function restores the system positions of both
planes, regardless of the acquisition plane of the reference image.

Moving to the system position of the reference image

 Select the required reference image.
Managing and Viewing Scenes/Images 349.
 Press the System Positions key.
– The LED on the program key lights up.
– The corresponding menu appears on the Assist screen.

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System Operation

 Select the Automap position by deflecting the stand/C-arm joystick (of plane
A) backward or forward repeatedly.

 Confirm the position by pressing one or both buttons on the side of the stand/
C-arm joystick (of plane A).

 Continue as described from Moving to the target position 191 onward.

Displaying the reference image for the current 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 mes-
sage will appear.

Storing programmed positions

You can store any system positions. Then you can initiate programmed move-
ments to stored system positions.
Moving to system and programmed positions 190.

What is stored? All data important for imaging geometry are stored:
 Stand and C-arm position

 Table height and tilt (configurable by Siemens Service)

 SID, zoom stage, collimation and filter positions

See also Storing filter positions or deleting them 206

Storing a position
 Move the unit to the required position.

 Set the primary collimator and the filter diaphragms.

 Press the Store key.

– The LED on the key lights up.
The Programmed Positions menu appears on the Assist screen.
 Select the required memory position (number) by deflecting the stand/C-arm
joystick (of plane A) backward or forward repeatedly.

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Note Make sure to select the correct position. The select memory position will be over-
written.

 Press one or both buttons on the side of the stand/C-arm joystick (of plane A).

– The current system position is stored under the selected program number.
(The previous position is deleted.)
– The LED on the store key goes out.
– The system returns to its original state.

Note Programmed 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.

Canceling the process

 Press the store key, the System Positions key or the Programmed Positions
key.
– The LED on the store key goes out.
– The system returns to its original state.

Automatic cancellation
If the stand/C-arm joystick is not operated within 30 s after selecting the store
key, the system automatically returns to its original state.
– The LED on the store key goes out.

Storing system positions with shortcut (direct

positions I, II, III)
You can assign the three most frequently used system positions to the direct po-
sitions I, II, III:
 Move the unit to the required position.

 Press the store key.

– The LED on the key lights up.

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System Operation

 Press the required position key.

– The current system position is stored under the selected direct position
number. The previously stored position is deleted.
– The LED on the store key goes out.
– The system returns to its original state.

Deleting programmed positions

You can also delete the stored system positions.

Note Positions marked with a lock symbol can only be deleted by Siemens Service.

 Press the Programmed Positions key.

– The LED on the key lights up.
– The Programmed Positions menu appears on the Assist screen.
 Select the memory position (number) you want to delete by deflecting the
stand/C-arm joystick (of plane A) backward/forward repeatedly.

 Press the store key for longer than 2 s.

– The memory position is deleted.
– The LED on the store key goes out.

Manual stand movements

If a power failure occurs, the Artis floor and Artis biplane stands can be moved
manually by applying sufficient force.
 The Artis floor floor stand can be swiveled by pushing against the column.

 The Artis biplane top stand can be moved to the required position by pushing
the C-arm.

Note The Artis zeego stand cannot be moved manually in normal operation.
The Artis ceiling top stand cannot be moved manually in normal operation.
For manual movements in case of power failure, please refer to Rescuing the pa-
tient in an emergency 53

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(2)
(1)

(1)

Floor stand
 First unlock the floor stand by pressing the unlocking button (2).

Floor stand and top stand

 Hold the stand at the location marked (1) to move it manually.

Movement to or from a position with rotated table

To perform movements from one position to another, you may have to move the
stand and the patient table manually into another rotation position.
In case of Artis zeego, it applies especially when changing the system position
from Transfer Headside/Head Side/Left Side/Right Side to Left Side, Table Ro-
tated/Right Side, Table Rotated or vice versa.
System positions of the Artis zeego stand 162
In case of Artis floor and Artis biplane, it applies especially when changing the sys-
tem position from Transfer Headside/Head Side/Left Side to Right Side, Table
Rotated/Left Side, Table Rotated or vice versa .
System positions of the floor stand (Artis floor and Artis biplane) 166

Selecting the target position

 Select the required target position.
Selecting the target position 191.

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System Operation

Swiveling the floor stand manually

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

 Unlock the floor stand by pressing the unlocking button.

Manual stand movements 196
 Swivel the stand to the required position and move it back and forth slightly un-
til it engages.

Rotating the table manually

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

Electromechanical unlocking
 Press the table rotation key on the table control module.
– The LED on the key goes out
 Press the panning knob down and hold it down.
– The brakes for table rotation are released.
 Rotate the patient table.

 Release the table panning knob.

– The brakes for table rotation are locked.

Manual unlocking (e.g. when power failed)

Pulling both grips of the table rotation grips at the same time.
Caution Danger of crushing.
 Only ever pull one grip at a time.

 Pull out one of the two grips at the foot end of the patient table and hold it in
that position.

 Rotate the patient table.

 Release the grip.

 Rotate the patient table back and forth slightly until you hear it engage.

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Note While rotating the table back to the zero position, remember that collisions be-
tween the table and the unit can occur if, after rotating the table out of the zero
position, the tabletop was moved toward the head end or
the C-arm was moved toward the table.
No collision message is shown in these cases!

Positioning the monitors

Additional equipment/accessories are mounted on the display suspension or oth-

Caution er, ceiling-mounted support devices.
Ceiling-mounted support devices are pulled down by the additional weight.
 Do not place any additional load on the ceiling-mounted support devices.

Note Approach the end positions with reduced speed. Do not use the brakes for reduc-
ing the speed of the display ceiling suspension.
Always ensure that neither the patient nor you or others collide with equipment
(especially the monitors).

DCS Positioning the DCS longitudinally

 Press the key for longitudinal movement.
– Rotary movement is braked.
– Longitudinal movement is enabled.
 Grip the handle and push the monitors into the required position.

Rotating the DCS

 Press the key for rotary movement.
– Longitudinal movement is braked.
– Rotary movement is enabled.
 Grip the handle and rotate the monitors as required.

DCS extended Positioning the DCS extended longitudinally

 Press the two keys for rotary movement brakes.
+ – Rotary movement is braked.
– Longitudinal movement is enabled.
 Push the monitors into the required position.

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System Operation

Rotating the DCS extended

+ =

+ =

+ =

 Press the key for longitudinal movement brakes and one key for rotary move-
ment brakes.
– Longitudinal movement is braked.
– One rotary movement is enabled.
 Rotate the monitors as required.

Note Make sure to brake the movement of the display ceiling suspension at the required
target position.

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Image Format, Collimation and Filtration

Selecting the image format/zoom stage

Depending on the flat detector installed, the following image formats / zoom stag-
es are available:

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 2 16 cm 26 cm 32 cm
Zoom 3 10 cm 20 cm 22 cm
Zoom 4 - 16 cm 16 cm
Zoom 5 - 10 cm 11 cm

Check/select plane (Artis biplane only)

The last plane in which fluoroscopy was performed is automatically selected.
 If necessary, press the A/B key on the collimator control module.
– The LED of the selected plane lights up.

Setting the SID (source to image distance)

FD lift / Setting the SID 188

Setting portrait/landscape (on systems with FD30x40 only)

Rotating the FD / Setting portrait/landscape 189

Changing the zoom stage

Note If the zoom format is changed during fluoroscopy, then X-ray is always interrupted
for a short moment.
Reason: The collimator blades will be set to the new field of view and a possible
DIPP mode change has to be performed.

 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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System Operation

Collimation One of the following primary collimator responses to switching the zoom stage
can be configured by Siemens Service:
 The collimation size is retained.

 The collimation size is retained but the collimation is opened to the edge of the
image with Zoom -, if collimation is not performed manually (default).
 The collimator leaves are fully opened.

 Collimation with respect to the screen is retained.

An automatic control ensures that collimation remains constant if there are any
changes in the distance from the focus of the X-ray source to the image receptor
plane.

Measuring field If the input field was reduced and a measuring field was selected which would
(dominant) now be cut, it is automatically switched over (center measuring field).
It is not the case when the Intelligent Measuring Field is selected. In this case the
measuring field will not change.

Setting the collimators

Depending on the system configuration, your system can be equipped with differ-
ent primary collimators. Consequently the collimator control module comes in dif-
ferent versions.
Collimator versions 118

Note The behavior of the collimation when changing the zoom stage can be configured
in different manners.
Please ask Siemens Service.

Note When changing the SID (source to image distance) by raising/lowering the FD, the
collimation is automatically adjusted in order to keep the beam limited to the se-
lected field size.
If the C-arm is positioned in the range of ±15° LAO/RAO and ±15° CRAN/CAUD,
when changing the SOD (source to object distance) by raising/lowering the pa-
tient table, the collimation is automatically adjusted in order to keep the collimat-
ed field size in the object plane constant.

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 Image Format, Collimation and Filtration

Rectangular collimation
The collimator limits the radiation field to the region of interest (organ) or the
maximum input field corresponding to the zoom stage.

Speed The speed of the collimator leaves depends on how far you deflect the joystick:
maximum speed with maximum deflection.
The system controls the speed so that the speed on the screen does not depend
on the zoom stage selected.

Check/select plane (Artis biplane only)

The last plane in which fluoroscopy was performed is automatically selected.
 If necessary, press the A/B key on the collimator control module.
– The LED of the selected plane lights up.

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.

open vertically

horizontally horizontally
open close

close vertically

Note The directions refer to the display on the screen.

With CAREprofile, collimation is also possible without radiation on the LIH image.

Resetting the collimation

 Press the collimator joystick down.
– The collimator leaves are opened completely.

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System Operation

Filter diaphragms (wedge and finger filters)

To compensate for extreme contrast differences, you can use the semitransparent
filter diaphragms (wedge and finger filters). They can be positioned anywhere in
the image.
 Wedge filters
for example, for DSA or cardiological examinations
 Finger filter (finger-shaped graduated diaphragm filters)
for example, for DSA aortic arch or peripheral DSA of both legs

Speed The speed of the filter diaphragms depends on how far you deflect the joystick:
maximum speed with maximum deflection.
The system controls the speed so that the speed on the screen does not depend
on the zoom stage selected.

Note The movement of the diaphragms ends on the left or right side.
Rotational adjustment can be continued (even beyond 360°).

Check/select plane (Artis biplane only)

The last plane in which fluoroscopy was performed is automatically selected.
 If necessary, press the A/B key on the collimator control module.
– The LED of the selected plane lights up.

Selecting the filter type (with Angio collimator only)

Cardiac Systems equipped with a Card collimator have only one (single) wedge filter.
Therefore, this key is not available on the Card collimator control module.

Angio You can select between a pair of wedge filters and one finger filter.
 Press the wedge/finger filter key on the Angio collimator control module.
– The LED of the selected filter diaphragm type lights up.

Setting the wedge filters

Cardiac The wedge filter is set with the upper joystick on the Card collimator control mod-
ule.

Angio The wedge filters are set with the upper two joysticks on the Angio collimator con-
trol module.
 Check if the LED for the wedge filters lights up.

 If not, press the key.

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Note If no wedge filter has been set previously, it appears in the image center as soon
as the joystick is tapped briefly. Once the wedge filter has been set, it remains in
that position.
The directions refer to the movement on the screen.
With CAREprofile, setting is also possible in the LlH image without radiation.

 Deflect the required joystick in the required direction.

– The position of the wedge filters is shown in the live/LIH image.

Left filter* Right filter*

rotate clockwise rotate counterclockwise

move to the move to the left move to the

move to the left
right right

rotate counterclockwise rotate clockwise

*
with Angio collimator only

Note The left joystick controls the left filter, the right joystick controls the right filter.
For example, if you move the left filter over and slightly past the right one, then it
remains under the control of the left joystick as long as you keep moving it. How-
ever, if you release the joystick for more than 5 s, what was the left filter is now
the right filter and is controlled by the right joystick.

Resetting the wedge filter

 Press one of the two joysticks down.
– The wedge filter is moved out of the beam path.

Setting the finger filter

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

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Note The finger filter can be set with either of the two joysticks.
If no finger filter was set previously, it will move into the image parallel to the pa-
tient axis as soon as the joystick is tapped briefly. Any finger filter that has been
set will remain in that position.
The directions refer to the movement on the screen.
With CAREprofile, this setting is also possible in the LlH image without radiation.

 Check if the LED for the finger filter lights up.

 If not, press the key.

 Deflect one joystick in the required direction.

– The position of a finger filter is shown in the live/LIH image.

rotate clockwise rotate counterclockwise

move to the move to the left move to the

move to the left
right right

rotate counterclockwise rotate clockwise

Resetting the finger filter

 Press one of the two joysticks down.
– The finger filter is moved out of the beam path.

Storing filter positions or deleting them

When a CARD acquisition program is selected, the filter positions are also stored
when storing the positions of stand and table.
Storing programmed positions 194

Note The filter positions are stored only if a CARD acquisition program is selected.
The filter positions are restored automatically when a CARD acquisition program
is selected.

Storing the filter positions

 The active acquisition program is a CARD program.

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 Move the unit to the required position.

 Set the primary collimator and the filter diaphragms.

 Press the store key.

– The LED on the key lights up.
– The Programmed Positions menu appears on the Assist screen.
 Select the required memory position (number) by deflecting the stand/C-arm
joystick (of plane A) backward or forward repeatedly.

 Press one or both buttons on the side of the stand/C-arm joystick (of plane A).

See also Storing programmed positions 194

The filter positions are stored together with the positions of stand and table.
Whenever the projection is reached in a certain angle range, the system will re-
store the filter positions.

Deleting a single filter position

You can delete the position of a single filter from a programmed position.
 The stand and table are in the position which shall be changed.

 Press the store key.

– The LED on the key lights up.
 Press down the filter joystick and hold it pressed for more than 3 s.

The position of the single filter is deleted from the programmed position.

Deleting all filter positions

You can also delete the positions of both filters from a programmed position.
 The stand and table are in the position which shall be changed.

 Press the store key.

– The LED on the key lights up.
– The Programmed Positions menu appears on the Assist screen.
 Press this key and hold it pressed for more than 3 s.

The positions of both filters are deleted from the programmed position.

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Resetting the collimation completely

The entire collimation (collimator leaves, wedge and finger filters) can be reset,
i.e. moved out of the beam path in one step:
 Press this key.
– Collimator leaves and filter diaphragms are moved into their initial position
outside the image.

Collimation without radiation - CAREprofile

Whenever you move the collimator joysticks, the current positions of the collima-
tor leaves and filter diaphragms are displayed with lines in the image. It allows you
to change the collimation without performing fluoroscopy.

Note The display duration of the CAREprofile graphic can be configured by Siemens
Service.

Checking the collimator position

 Tap a collimator joystick briefly.
– The position of the collimator leaves and/or the filter diaphragms is dis-
played.

Example

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Grid
The flat detectors are equipped with scattered radiation grids. A grid reduces scat-
tered radiation and thus improves image quality. However, since a grid attenuates
primary radiation, it makes a higher dose necessary.

Adults The grid should be used for examining adults. If a grid is not used, the image qual-
ity will be impaired due to an increase in scattered radiation.

Infants The scattered radiation grid should be removed for pediatric applications. If the
grid is removed, the radiation exposure of the infant will be reduced. The impact
on image quality due to scattered radiation can be tolerated.

If the grid falls down or is not handled properly, it usually gets damaged.
Caution Risk of invisible damage and impaired image quality.
 Handle the grid with special care.

Grids for inserting at the FD

Example of FD 20x20 (FD 26x30/FD 30x40 is similar)

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Removing the grid

Note Make sure to catch the grid when the C-arm is angulated.

 Press the button at the front of the FD.

– The grid slides out of its holder.
 Pull the grid out to the rear.

 Place the grid in a safe place.

Inserting the grid

Note For biplane systems, the grids are labelled for plane A and B.
 Please check the label before inserting the grids.

 Insert the grid into the FD from the back.

 Pay attention to correct orientation.

– The arrows on the grid must point toward the detector and
– the label must point toward the patient.
 Pay attention to correct locking: Insert the grid till mechanical stop.
– The engagement must be clearly audible.

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Screen Layout and Configuration

Artis screens
Images and operating elements are displayed on screens. Depending on the Artis
system configuration, either one screen is displayed on one LCD each or various
screens are displayed on a large display.
Other devices, like syngo Workplace or AXIOM Sensis, or third-party devices may
also be integrated into the Artis screen configuration.
Different screen configurations are possible in the examination room and in the
control room.

Labels of the screens The LCDs or screens are labelled as follows:

Label Description
Artis Workplace System console/Live screen in the control room (single
plane systems only)
Artis Workplace A System console/Live screen in the control room
Artis Workplace B System console/Live screen in the control room
Artis Live Live screen in the examination room (single plane sys-
tems only)
Artis Live A Live screen of plane A in the examination room
Artis Live B Live screen of plane B in the examination room
Artis Assist Assistance screen (in case of a 2 or 3 screen configura-
tion)

Artis Assist A Assistance screen of plane A (in case of a 2 or 3 screen

per plane configuration)
Artis Assist B Assistance screen of plane B (in case of a 2 or 3 screen
per plane configuration)
Artis Reference Reference screen (in case of a 2 screen configuration)
Artis Reference A Reference screen of plane A (in case of a 2 screen per
plane configuration)
Artis Reference B Reference screen of plane B (in case of a 2 screen per
plane configuration)
syngo Workplace syngo Workplace screen
Sensis Live Sensis RTC screen
Sensis Dialog Sensis DMC screen
Sensis Sensis RTC screen (in case of 1 screen configuration)
Multi Modality Multi modality screen

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Artis Cockpit screen layout

Example of Artis, syngo Workplace and AXIOM Sensis

The Artis Cockpit may be installed in the control room. 90

Title bar
On the left side of the title bar of each window, the source of the window is
shown: Artis WP (workplace) A.
Additionally 1:1 is shown if the resolution of the image and the resolution of the
display match, which is each image pixel is displayed.

Screen layout The screen area can be arranged in 4 different layouts.

On the right side of the title bar of each window, the possible screen layouts are
shown. The current layout is inverted.
 Click the icon in any window to change the layout of the Artis Cockpit display.

Cursor The shape and color of the cursor indicates the state of control in the respective
window.
 The cursor is “active”. The buttons in the respective window can be activated
with a mouse click. The “active window” has a green frame.
 The cursor is in a “non-active window” in the title bar. The application cannot
be operated.

 The cursor is in a non-active window. The application cannot be operated.

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 Double-click in the window, which you want to activate.

– The cursor shape changes to “active”, the window gets a green frame and
the application can be operated.
 The cursor during drag and drop.

 Click and hold the mouse in a “non-active” window which you want to move.
– The cursor changes to drag and drop.
 Now you can drag the window to a different location on the display. Release
the mouse and both windows will have swapped.
 The cursor is in a window, which cannot be operated at all, for example AXIOM
Sensis Live.

Artis Cockpit 2 Artis Cockpit can be installed with two displays, two keyboards and two mouse de-
vices for two operators.
Each user can operate the applications on the respective display.
Nevertheless each application can be operated by one user only:
 A green frame shows an active application, which can be operated by the user.

 A red frame shows an application, which is just being operated by the other
user.
 Additionally the cursor changes to the symbol as shown on the left.

Symbol/Numeric During every change of an “active” window, a symbol keypad or numeric keypad
keypad is displayed in the right lower corner of the Artis Cockpit display area. It will disap-
pear after a short while unless you click the “staple” icon.
Depending on the “active” window being Artis, syngo Workplace, AXIOM Sensis,
or a third-party device, the keys of the keypad assume the respective functions dis-
played on the Artis Cockpit display area.

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System Operation

Symbol keypad for Artis or syngo Symbol keypad for AXIOM Sensis Standard numeric keypad, exam-
Workplace ple only

Keys on the symbol keypad 93

Fixing of keypad The symbol keypad or numeric keypad can be fixed so that it will be displayed per-
manently.
 Not fixed

 Fixed

 Click the staple icon to change the setting.

Third-party device For technical reasons the Artis Cockpit cannot display the functions of the special
keys of the third-party device keyboard. Therefore the special numeric keypad of
the Artis Cockpit resumes the standard numeric keypad functions of the third-par-
ty device when selected.
It is recommended to place the third-party keyboard side by side to the Artis Cock-
pit. Alternatively place a drawing of the functions of the numeric keypad of the
third-party device as a reference.

Note If you have activated the operation of the third-party device and you want to
switch back to any other application, you might have to press the Alt + Space
keys.

Please observe Connection of third-party devices with Artis Cockpit and Large Dis-
play 75

Saving a screen shot to USB memory

 Plug a USB memory stick into the USB jack.

 Wait a moment (until the LED on the drive stops blinking).

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 Select Transfer > Screenshot to USB from the main menu.

Large Display screen layout

If installed, the Large Display shows all images as well as acquisition data, position
data, system messages and menus for unit movements.
The screen of the Large Display is divided into different areas. The screen layout
of the Large Display can be configured. 221

Example of a single plane screen layout

Example of a biplane screen layout

Live screen The current live image is shown on the Live screen.
Besides the images, acquisition data is shown. 270 336

Assist screen The Large Display also contains the Assist screen which shows position data, sys-
tem messages and menus for unit movements.

Message bar Depending on configuration, there is also a message bar, e.g. on top of the Large
Display screen.

Other screen Other video sources may also be configured on and connected to the Large Dis-
play.

Note If an external video source is connected to the Large Display and assigned to a
screen area, the image quality may not be sufficient for diagnosis.
External video sources which have no Siemens image quality verification and no
Siemens release of the image quality with the actual Artis version must not be
used for diagnosis..

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System Operation

Note A screen saver protects the Large Display from burn-in effects.
The screen saver will be removed automatically as soon as an operation is invoked
from the table side controls.

Assist screen
(1)

(4)

(2)
(3)

Example of an Assist screen

(1) Stand, C-arm and table position data

(2) Stand/table messages
(3) System status messages
System Messages / Troubleshooting 769
(4) Menu area

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Readings on the Assist screen

Stand/C-arm position
 LAO/RAO angulation angle

 CRAN/CAUD angulation angle

Note The angle displays indicate the C-arm angulation (central beam angle) in relation
to the patient (patient angle), taking into account the patient position entered.
That is, if the position is changed, the displays also change.

 Angle of stand swivel about vertical axis

 Longitudinal stand/C-arm position

 Lateral stand/C-arm position

 C-arm position

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System Operation

Table position

 Angle of lateral table tilt

 Angle of the (reverse) Trendelenburg table tilt

 Angle of table rotation about vertical axis

 Longitudinal position of the tabletop

“0” is displayed if the tabletop is in the end position at the foot end.
 Transverse position of the tabletop
“0” is displayed if the center of the tabletop coincides with the beam center.
 Isocenter-tabletop distance

Note The data refers to the top edge of the tabletop.

The mattress must be taken into account additionally.

Note The data refer to the current patient position relative to the patient.
Patient coordinates 220

SID and input format

 SID: Source-image distance

 Zoom stage: diameter of the active input format

Values The following displays can be configured by Siemens Service:

No movement The currently set numeric values of the system position are displayed below the
symbols if necessary.

Movement If movement is in progress, only the values that are changing are displayed to fa-
cilitate operation.

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Collision If a collision has occurred, a “navigation aid” is displayed instead of the current val-
ue:
 A movement in the + direction will eliminate the collision.

 A movement in the - direction will eliminate the collision.

 An x indicates that movement is not possible.

Programmed positions If programmed positions are selected, additional symbols are displayed that sym-
bolize the stored positions.

Examples single plane (Artis floor):

 Left Side

 Left Side, Table Rotated

 Patient Transfer

 Head Side

 Right Side, Table Rotated

 Right Side

Examples biplane (Artis biplane):

 Floor stand Left Side

 Top stand in working position

 Floor stand Left Side, Table Rotated

 Top stand in working position

 Floor stand Right Side, Table Rotated

 Top stand in parking position

Examples Artis ceiling:

 Left Side

 Head Side

 Right Side

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System Operation

Protected positions Programmed positions can be protected against deletion or overwriting by

Siemens Service.
 Such positions are marked with a lock symbol.

Patient coordinates
The values shown on the Assist screen refer to the patient position currently en-
tered. A special coordinate system is used for it. The coordinate system starts on
the upper surface of the tabletop, that is, on the back of a supine patient, on the
abdomen of a prone patient.

z
Example of the patient-related coordinate system for the supine position

Lateral position Be careful if the patient is in the lateral position: Because the coordinate system is
attached to the patient, changing the table height changes the lateral value (y-ax-
is). Moving the tabletop in the transverse direction changes the dorsal value (z-ax-
is), the coordinates being in the center of the transverse direction.

Isocenter key With the Isocenter key, you can program the table to stop automatically when the
isocenter is reached.
The coordinates are also switched over:
 Selecting the Isocenter key (LED lights up): The coordinates x, y, z are set to
zero. Now relative coordinates are displayed.
 Deselecting the Isocenter key: The coordinates x, y, z are switched over to the
standard origins of the coordinate system.

Note Siemens Service can configure the Isocenter key to retain the isocenter during an-
gulations if the function is active.

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Standard origins The standard origins for a patient in the normal position (Head First - Supine) are
defined as follows:
 x: The tabletop is in its final longitudinal position at the foot end.

 y: The tabletop is in the central transverse position.

 z: The surface of the tabletop is in the isocenter.

Selecting the screen layout of the Large Display

The Large Display substitutes several single LCD monitors and allows adjusting the
screen area according to workflow needs. The screen area can be divided by con-
figuration into various sub-screens.
If your system is equipped with a Large Display you can select a display layout out
of various layouts configured at installation time.

Touchscreen  Settings task card

 Press this icon.

Example, depends on configuration

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

 Press the layout to use.

– The new layout is immediately applied to the Large Display.

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System Operation

 Close the window.

Console  Examination task card

 Click this icon.

Example, depends on configuration

 Click the layout to use.

 Click Apply.
– The new layout is immediately applied to the Large Display.

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Selecting the image source for the additional color

display
The additional color display can be used for displaying images from other equip-
ment such as
 syngo Workplace

 Patient monitoring

 Ultrasound

etc.

Touchscreen  Press the button for the active image source.

Example

 Press the button for the required image source.

– The image in the additional color display is switched over immediately.

Operating the 4x4 Crossbar Videoswitch

The 4x4 Crossbar Videoswitch provides access to up to 4 computers and displays
their video signals on up to 4 displays.

Selecting the video output

 Press the Output Select key.
– The green LED toggles from 1 up to 4.

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System Operation

 Choose the display, which is connected to the corresponding output.

Selecting the video input

 Press the Input Select key.
– The display above the green LED toggles from 1 up to 4 indicating the video
source connected.
 Choose the video source, which shall be displayed on the corresponding out-
put display.

Operating the 8x8 Crossbar Videoswitch

The Video Display Controller 8x8 provides access to up to 8 video signal sources
and displays the signals on up to 8 displays in freely selectable combinations.

During installation the OUTPUTS keys are connected to displays in the DCS, while
the INPUTS keys are connected to different dedicated image sources.
 Press an OUTPUTS key.
– The key lights up.
 Quickly press an INPUTS key.
– The relevant image source is connected to the chosen display.
 The above sequence can be freely repeated for each connected display and vid-
eo source.
 By pressing Pre 1 to Pre 4 for longer than 3 seconds, up to 4 combinations can
be programmed .

Note The Artis Live screen will always remain active and cannot be changed or discon-
nected.

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 Screen Layout and Configuration

 After switching on, the Pre 1 preset is the default combination.

 The keys can be freely marked during installation.

Troubleshooting
 There is an audible signal when a combination is not possible, i.e. an input or
output has not been installed.
 When the USB cable in the back of the box is unplugged, the Out 8 key is light-
ing up red.

Operation via touchscreen control

Selected functions of the imaging system can be operated with the mouse joystick
and touchscreen in the examination room.
Touchscreen control console 120

Touchscreen control (TSC)

Touchscreen The touchscreen control (TSC) has a touch-sensitive liquid-crystal display. It can
display graphics and texts like a conventional computer screen and at the same
time allow you to enter data by pressing the buttons on the touchscreen, a bit like
a membrane keyboard.

Note All touchscreen images shown are examples only. Your available functions de-
pend on the type of system and the system configuration.

Mouse joystick Basically the functions on the touchscreen control are performed in the same way
as with the mouse on the system console.
Mouse joystick 121

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System Operation

Input areas The input area of the touchscreen is divided into two parts:

 Frequently required functions can be found outside the card stack along the
left, right, and bottom sides, irrespective of the currently active task card.

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

Note You can configure the assortment of most of the buttons by using the TSC Con-
figurator. 229

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Task cards  On the Settings task card, you can select the touchscreen Layout and apply
further settings. 271
 On the Exam task card, you can set parameters which are important for the ex-
amination. 272
 On the Image task card, you can perform the licensed and configured image-
processing functions. 335
 On the Quant task card, you can start the licensed and configured quantitative
analysis functions. 625
 If Sensis is installed, the additional Physio task card will be available. 234
See the AXIOM Sensis Operator Manual
 If InSpace 3D, DynaCT, DynaCT Cardiac, DynaPBV Neuro, or/and DynaPBV
Body is installed, the additional InSpace task card will be available. 503
See the syngo InSpace 3D, DynaCT, ... Operator Manual

Selecting a task card

 To select a specific task card, press the tab of the task card you require on the
touchscreen.
– The task card you have selected automatically moves to the foreground.

Selecting a different layout

Touchscreen (only)  Settings task card

 Press this icon next to Layout.

 Select the required new layout.

– The touchscreen software restarts and loads the new layout.

Note Only the configured functions of the specific layout will be available.

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System Operation

Button types

Button Short description

Button, selectable

Button, selectable, a window or drop-down will open

Button, selected

Button, selected, a function is applied to mouse joystick

Selecting the plane (Artis biplane)

In biplane systems, some of the functions can be selected for either plane.

Blue button applies to plane A (floor stand)

Orange button applies to plane B (top stand)

To select the other plane:

 Press the A or B button on the right side of the task cards.

 Press the B or A.

Displaying tooltip help for buttons

If you want to know what an icon means:
 Press the question mark button.

 Then press the button you need help.

– A help text is displayed.

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 Screen Layout and Configuration

To disable tooltip help:

 Press the question mark button again.

Configuring the touchscreen layout

The TSC Configurator lets you configure the available functions on the touch-
screen control in the examination room.
You can customize the touchscreen to your needs and to your examination prac-
tice. You can position the available buttons on the task cards and outside the card
stack along the left, right, and bottom sides (fixed area).
You can create new layouts, save a layout, and upload it to the TSC. You can also
delete layouts which are no more needed.

System console Opening the TSC Configurator

 Select Options > Configuration in the main menu.

 Double-click the TSC Configurator icon.

– A window opens after startup of the TSC Configurator.

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System Operation

 Select the basic configuration to start with.

– Expert:

– Standard:

– Existing: Open a layout which has already been saved.

 Then click OK.

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 Screen Layout and Configuration

(1) (2)
(1) TSC layout area
(2) Button list tab cards

Functions

(1) Start a new layout

(2) Load an existing layout
(3) Save the layout
(4) Save the layout using a new name
(5) Undo last operation (up to 50 steps)
(6) Redo last undo operation
(7) Remove an item from the layout
(8) Group up to 6 buttons (lined up horizontally only)
(9) Ungroup grouped buttons
(10) Clear fixed area, i.e. remove all the buttons outside the card stack along the
left, right, and bottom sides
(11) Clear active task card area, i.e. remove all items from the tab card currently
positioned on top
(12) Call online help

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System Operation

The functions can also be found in the menu and in the popup menu (right mouse
button).

Adding items
 Select the item to add on the Function or Category tab card on the right-hand
side.
 Drag the item to the layout on the left-hand side.

 Drop the item to an empty stamp in the layout.

Moving items
 Drag and drop the item or button group from one position of a task card to an-
other position.
 Drag and drop a single button from a task card to the fixed area or vice versa.

 Drag a single button from a task card to the tab of another task card and then
drop it to the new position.

Saving a new layout

 Click this icon or select File > Save As from the menu.

 Enter a File Name.

– The TSC layout is saved in an XML file format. The .xml extension is added
automatically.
 Click OK.

Uploading a layout
 Save the layout if it has not been saved yet.

 Select File > Upload Layouts to TSC from the menu.

– The layout is transferred to the touchscreen in the examination room but
not selected as the “active” layout.

Note During upload, the touchscreen cannot be operated. The upload needs some
time!
 Make sure that there is no examination running when you start the upload.

To activate the new layout:

 Select the new layout on the touchscreen via Layout on the Settings task card.
Selecting a different layout 227

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 Screen Layout and Configuration

Mouse joystick functions

Basically the functions on the touchscreen control are performed in a similar way
as on the system console. The following operating elements have a corresponding
effect:

Function System console Touchscreen control

Operating elements Mouse Joystick
Control area on the screen Touchscreen
Buttons (icons) to be clicked Buttons (icons) to be pressed
Move pointer Move mouse left/right/up/down Deflect joystick left/right/up/down
Activate function / set se- Click with left mouse button. Press Select button = left mouse joy-
lection stick button.
Window images Press middle mouse button. First press Windowing icon and then
press left or middle mouse joystick but-
ton.
Store reference image - Press Store Ref button = middle mouse
(Click Store Reference icon.) joystick button (or press Store refer-
ence image icon).
Confirm changes Double-click with left mouse button. Press Close button = right mouse joy-
stick button.

The function of the mouse joystick buttons is different when the Mouse/Manipu-
late all objects function for syngo Workplace has been activated on the InSpace
task card of the touchscreen. In this case, the syngo Workplace mouse is con-
trolled remotely.

Function syngo Workplace console + Touchscreen control

Activate function / set se- Click with left mouse (joystick) button.
lection
Confirm changes Double-click with left mouse (joystick) button.
Window images Press middle mouse (joystick) button.
Call context menu Click right mouse (joystick) button.

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System Operation

Display of the joystick function on the live screen

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

(3)

(1)
(2)

(1) Joystick function without button pressed

(2) Joystick function with a button pressed
(3) Possible directions of joystick deflection
 A bright background indicates that the function is currently active.

 A dark background indicates that the function is not active.

Sensis touchscreen operation

In an integrated Artis/AXIOM Sensis environment, selected Sensis functions can
be executed from the examination room using the touchscreen component of the
Artis control console.

Physio task card The AXIOM Sensis buttons are available on the Physio task card of the touch-
screen control. The Physio task card presents a slightly different button selection
for the Electrophysiology and Hemodynamics application.

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 Screen Layout and Configuration

Physio task card (example)

Touchscreen Short description

Choose one of five predefined waveform views in the current setup to be dis-
played in the real-time waveform area.

Switch display on the dialog monitor of the remote monitors to display of real-
time signals (i.e. display of waveform card Real Time).

Switch display of the AXIOM Sensis examination room screen from real-time
monitor to dialog monitor display (and vice versa).

Create a snapshot recording (30 s).

Create a snapshot with focus on the 12 lead ECG.

 Hemodynamics application only

Display mean pressure curves for selectable pressure waveforms.

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System Operation

Touchscreen Short description

 Hemodynamics application only

Start a pressure calculation.

The pressure calculation results are presented in the Pressure Calculation Event
Properties dialog box on the dialog monitor.
Accept results.

Reject results

 Hemodynamics application only

Start a pullback procedure for gradient measurement across a valve.

Create a classified snapshot recording or set a pointer in an ongoing waveform

recording indicating a tachycardia, bradycardia, or general observation.

 Hemodynamics application only

Start/end a waveform recording.

Start/end a retro-recording.
Waveform recording already starts a few seconds (2 s to 30 s, configurable) be-
fore the button is pressed.
Start a non-invasive blood pressure measurement with a cuff.

Abort a non-invasive blood pressure measurement.

Mute the vital signs signal. (with Sensis VC10 or later)

Open Site or Label popup to label an ICEG or IBP waveform.

 When an IBP waveform is selected, this button will open the Site selection
popup.
 When an ICEG waveform is selected, this button will open the Label popup.

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Touchscreen Short description

Save the X-ray image currently displayed on the Artis Live screen (of the selected
plane) to the AXIOM Sensis database and make it available for Sensis study re-
ports.
Open More Waveform Options popup
Increase the sweep speed for the waveforms currently displayed on the screen.

Decrease the sweep speed for the waveforms currently displayed on the screen.

Displays the signal larger by decreasing the range of a pressure signal or increas-
ing the sensitivity of an ECG or ICEG signal.

Displays the signal smaller by increasing the range of a pressure signal or de-
creasing the sensitivity of an ECG or ICEG signal.

Note Scaling waveforms up or down from the touchscreen control is only possible if
only one waveform is selected, or only waveforms of the same type are selected.

Select the previous waveform above the current selection on the screen.

Select the next waveform below the current selection on the screen.

Hide the selected waveform.

Close popup

Display all waveforms of the current view again.

This button is only active if waveforms were previously hidden from this view.

Distribute ECG and ICEG waveforms evenly.

For more information, please refer to the AXIOM Sensis Operator Manual.

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 System Operation
Operation via Voice Control

Important information
Use The Voice Control facilitates the hands-free operation of major functions of your
Artis system. It operates independently of the corresponding manual operating el-
ements.

Radio transmitter too close to a life supporting device

Warning Interference with life supporting device
 Make sure to keep a separation distance of > 22 cm (8.7 inch) between the ra-
dio transmitter and a life supporting device for a frequency range of the radio
transmitter of 80MHz- 800MHz (in U.S.) and a separation distance of > 42 cm
(16.5 inch) for a frequency range of the radio transmitter of 800MHz-2.5GHz.
 In case of interference, turn the radio transmitter off or increase the distance
between the interfering devices.

Changes or modifications not expressly approved by the party responsible for

compliance could void the user´s authority to operate the equipment.
The Voice Control may be interfered with by other equipment, including portable
and mobile RF communication equipment, even if such equipment meets the ap-
plicable emissions requirements.
The Voice Control must emit electromagnetic energy in order to perform its in-
tended function. Nearby electronic equipment may be affected.
The Voice Control can be operated by either German or English language com-
mands only. The selection of the command language is done during the set-up
phase.
There is a default male voice profile and a default female voice profile for each
supported language.

Setup for operation

Switching on the transmitter
 Switch on the transmitter by pressing the “on/off” button inside the housing.

It is ready for use if the battery sign on the transmitter display shows fully charged
batteries.
If the battery sign shows discharged batteries, the batteries need to be recharged.

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System Operation

Switching off the transmitter

 Switch off the transmitter after usage by pressing the “on/off” button inside the
housing.

Note Always put the transmitter into the charging station after usage. It will switch off
the transmitter and ensure proper charging of the batteries.
Doing it will also prevent the transmitter from airing any conversation inadver-
tently to the outside world.

Set up of headset and transmitter

The headset needs to be connected to the transmitter and needs to be worn over
the mask. The microphone shall not touch the mask or skin.
 Put on the headset microphone so that the microphone has about 4 cm
(1.5 in.) distance to the corner of your mouth.

The transmitter needs to be worn over the lead apron for proper signal transmission.

Operation via voice commands

The voice commands menu is displayed either on the reference screen or on the
MMV monitor when the voice control application has been started by speaking
“Menu open” in the microphone.

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 Operation via Voice Control

On the left side of the menu the keywords are displayed (e.g. “Scene”, “Roadmap”)
which are combined with any of the words indicated to their right side. Thus all
the possible commands exist of two words, e.g. “Scene minus”, “Scene loop-on”,
“Roadmap on”.
Make sure that the transmitter is switched on. If a voice command is recognized,
it is highlighted on the commands menu and an acoustical feedback (configu-
rable) in form of a short sound is given.

Open voice commands menu

It is configurable on which screen the voice commands menu shall be displayed.
 Press Multimodality and then Other on the touchscreen control, if necessary.

 Speak "Menu open" in the microphone.

Remember this command, because it is not displayed.

Or
 Press this icon on the touchscreen.

Voice commands menu opens.

Adapting the voice profile

 Speak “Adaptation”.

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System Operation

You can choose if you want to:

 Adjust the microphone volume (Volume Adaptation)

 Speak for a few seconds until the display changes from “State of adaptation: In
progress” to “State of adaptation: Successful”.
 Train the system to your voice (Voice Adaptation)

 Teach the system how you pronounce specific commands (Command

Training)
 Follow the instructions displayed on the screen.

Closing the voice commands menu

 Speak "Menu close".

It is also done automatically after a configurable timeout if displayed on reference

screen.

Note The operating time of the transmitter is 6 - 10 h. After usage put it into the corre-
sponding charging station. It ensures continuous operability.
Never use another charging device or batteries than the ones delivered with the
Voice Control. Usage of another charging device may cause severe damage to the
Voice Control.

Voice commands
The following voice commands are available in English and German only:

Function Voice command Voice command

English German
General functions Open the voice commands menu Menu open Menü öffnen
Close the voice commands menu Menu close Menü schließen
Select plane Plane A Ebene A
Plane B Ebene B

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 Operation via Voice Control

Function Voice command Voice command

English German
Open profile dialog and Change the user profile Change Profile Profil ändern
select user profile
Select next higher profile Profile up Profil zurück
Select next lower profile Profile down Profil vor
Scroll one page up Page up Seite zurück
Scroll one page down Page down Seite vor
Select user profile Select profile Auswählen
Select a user profile by number Profile # Profil #
(# = 1 ... 20)
Open adaption dialogs Start adaptation (volume as well Adaptation Adaption
as voice adaptation and command
training)
Select volume adaption Volume Adaption Lautstärkeadaption
Select voice adaption Voice Adaption Sprachanpassung
Start command training Command Training Worttraining
Close adaption dialog Close Adaption Adaption beenden
Command training Choose words Train all Alle trainieren
Scroll one page up Page up Seite zurück
Scroll one page down Page down Seite vor
Scroll one line up Line up Zeile zurück
Scroll one line down Line down Zeile vor
Select command Select Auswählen
Start command training Start Training Training starten
Review functions Switch between acquired scenes Scene minus Szene minus
Scene plus Szene plus
Loop all scenes Scene loop-on Szenenloop ein
Stop (pause) the scene replay Scene stop Szene stop
Replay the scene Scene play Szene abspielen
Replay in slow speed Scene slow-motion Szene langsam
Single step through scenes Image minus Bild plus
Image plus Bild minus

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System Operation

Function Voice command Voice command

English German
Acquisition and postpro- Save Store Monitor image Store Image Bild speichern
cessing functions Save reference image Store Reference Referenz speichern
Store fluoro Store fluoro Fluoro speichern
Single reference image recall Reference minus Referenz minus
Reference plus Referenz plus
Zoom 2x and pan Zoom switch-on Zoom einschalten
Zoom switch-off Zoom ausschalten
Panning up Verschieben hoch
Panning down Verschieben runter
Panning left Verschieben links
Panning right Verschieben rechts
Zoom to acquisition size and pan Acquisition size on Aufnahmegröße ein
Acquisition size off Aufnahmegröße
aus
Panning up Verschieben hoch
Panning down Verschieben runter
Panning left Verschieben links
Panning right Verschieben rechts
Native/subtracted display DSA native DSA nativ
DSA sub DSA sub
Reset the fluoro timer Timer reset Timer zurücksetzen
Adjust the input format/zoom Magnify up Format plus
stage
Magnify down Format minus

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 Operation via Voice Control

Function Voice command Voice command

English German
Roadmap Roadmap on Roadmap einschal-
ten
Roadmap off Roadmap ausschal-
ten
Roadmap reset Roadmap zurück-
setzen
Roadmap A reset Roadmap A zurück-
setzen
Roadmap B reset Roadmap B zurück-
setzen
Programmed movement Open user positions list Position List open Position Liste öff-
functions nen
Close user positions list Position List close Position Liste schlie-
ßen
Select a user position 1 ... 50 Position one Position eins
... ...
Position fifty Position fünfzig
Cancel a user position selection Position cancel Position abbrechen
Select a direct position 1, 2, 3 Direct one Direkt eins
Direct two Direkt zwei
Direct three Direkt drei

Note After having selected a programmed position, you must operate the stand/c-arm
joystick or the footswitch pedal for handsfree movement.
Moving to the target position 191

Troubleshooting
 The microphone volume adjustment gives an error message that it could not
be successfully performed:
 Repeat the microphone volume adjustment.

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System Operation

 Check that the display on the receiver is highlighted green. If it is highlighted

in red, it does not have a connection to the transmitter. Bring the transmitter
closer to the receiver. The transmitter shall not be under the lead apron. Check
that the same frequency is displayed on the display of the receiver and of the
transmitter.
 Check that the headset microphone does not touch anything, e.g. skin or
tissue.
 Check the cable connection between headset and transmitter.

 Check if the transmitter and the receiver are switched on.

 Check the battery status of the transmitter. If battery sign shows empty batter-
ies, the transmitter needs recharging.
 The voice commands are not recognized properly:

 Perform a microphone volume adjustment.

 Perform the checks described in the previous bullet.

 The transmitter does not switch on when pressing the on/off button:

 The transmitter needs to be recharged. Put it in the loading station.

 Loading station does not recharge:

 Check power supply.

 Check if the transmitter has been put correctly into the loading station.

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 System Operation
DVD Video Recording

General See Use of video recorders 35

Recorder and media Depending on installation, one, or two in case of a biplane system, DVD recorders
may be installed to be used with the following media:
 DVO-1000MD
– DVD+RW: rewritable media

Recording with DVO-1000MD

Important information
The DVO-1000M records fluoroscopy/roadmap or acquisition scenes on a
DVD+RW in an MPEG-2 format.

DVD+RW Rewritable DVD+RW discs are used. A disc is automatically finalized and discs re-
corded with this unit can be played on other DVD+RW players.
The unit searches for the first blank space automatically and starts recording from
that point. Thus, it is not necessary to cue up and you can start recording right af-
ter you insert the disc.

Internal hard disk The DVO-1000MD is equipped with an internal HDD (Hard Disk Drive). Using the
HDD recording always starts immediately.
The DVO-1000MD first starts recording to its HDD while the inserted DVD is initial-
ized. Once the DVD is ready to record, the DVO-1000MD starts writing onto the
DVD using the data temporarily stored on the HDD. This mechanism, not available
on typical DVD recorders, makes it possible to start recording right after the DVD
disc is inserted, as well as when resuming the unit from “stop” mode.
In addition, the HDD can also be used for data recovery in the unlikely event that
a recording fails on the DVD disc. (Data recovery must be conducted by a Sony ser-
vice representative. For details, please contact your nearest Sony office.)

Recording modes The unit employs VBR (Variable Bit Rate) recording which varies the compressed
rate of MPEG2 dynamically according to the images recorded. High-quality record-
ing relative to recording time can be realized.
You can select picture quality from among three recording modes:
 HQ: about 60 minutes with CBR (Constant Bit Rate)

 SP: about 120 minutes with VBR (Variable Bit Rate)

 LP: about 180 minutes with VBR (Variable Bit Rate)

Recording indexes The unit allows you to record up to 49 titles on one disc.

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System Operation

The DVO-1000MD makes records as ‘titles’ - recording segments from when the
REC button is pressed until the STOP button is pressed.

Title 1 Title 2

Chapter 1 Chapter 2 Chapter 3

Index 1 Index 2

Within a title, you can set “indexes” to images of interest by pressing the PAUSE
button during recording - you can even set automatic index marking with a prede-
termined interval. A segment between two index points is handled as a “chapter”.
When playing back the disc, quick access to the top of a title or chapter is possible
with the press of a button. You can also quickly access a desired title or chapter
simply by selecting it from a list that is instantly displayed by pressing the LIST but-
ton.

Note If you load a disc which is full, a disc on which 49 titles have already been record-
ed, and so on, you cannot record any data. Be sure to check the disc before using
it.
When the remaining time of the disc becomes five minutes, the main display sec-
tion of the front panel display (TITLE/CHAP/time indicator) blinks.
Before performing an important recording, be sure to try to record whether the
unit records correctly.

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 DVD Video Recording

Control elements and displays

(1) (2) (3)

(4) (5) (6) (7) (8)

(1) POWER switch and standby indicator - not needed due to central operation via
Artis
(2) Disc tray - DVD is inserted here.
(3) OPEN/CLOSE button ( ) for the disc tray
(4) REMOTE 1 connector
Connect a SVRM-100A remote control unit (not supplied) to this connector for
remote control.
(5) REMOTE 2 connector
Connect a foot switch (not supplied) to this connector. You can control record-
ing and pausing using this foot switch.
(6) Front panel display
(7) Disc control section
(8) Menu/disc control section

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System Operation

Front panel display

(1)(2)(3) (4) (5) (6) (7) (8)

(9)
(1) Disc indicator
Lights when a DVD+RW disc which can be recorded and played back with this
unit is loaded in the tray.
(2) Recording mode indicator
(3) INPUT: input signal indicator
(4) Dolby indicator - not needed
(5) REPEAT indicator
Lights during repeat playback.
(6) TITLE indicator
Indicates the number of the title which is being recorded or played back.
(7) CHAP (chapter) indicator
Indicates the number of the chapter which is being recorded or played back.
(8) Time indicator
In normal operation, the elapsed time is displayed.
While recording, the elapsed time or the remaining time of the disc is displayed
according to the menu setting.
When the remaining time of the disc is selected, REMAIN is lit.
(9) Main display section

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 DVD Video Recording

Disc control section

(1) (2) (3) (4) (5) (6)

(1) STOP button ( )

This button is used to stop the recording and playback.
(2) PREV/UP button ( )
PREV: Used to jump to a chapter.
– When pressed once, moves to the start point of the chapter currently being
played back.
– When pressed twice, moves to the start point of the previous chapter.
– Pressing this button with the PLAY button held down allows you to view
fast reverse playback at a speed three times the speed of the normal play-
back.
UP: Used to go back to the previous page during title operation in the TITLE
LIST display.
(3) Playback button (PLAY )
(4) NEXT/DOWN button ( )
NEXT: Used to jump to a chapter.
– When pressed once, moves to the start point of the next chapter.
– Pressing this button with the PLAY button held down allows you to view fast
forward playback at a speed three times the speed of the normal playback.
DOWN: Used to go to the next page during title operation in the TITLE LIST dis-
play.
(5) PAUSE button ( )
(6) REC button ( )
When you press this button, this button lights and recording begins.

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System Operation

Menu/disc control section

(1) MENU button
(1) Used to enable the menu operation.
(2)
(3) Press this button to display the menu on the monitor screen and the front pan-
el display. Press it again to exit the menu display.
(2) LIST button
(4)
Press this button to display the TITLE LIST menu.
(3) SET button
Press this button to save new settings, such as selected menu items.
(4) Cursor buttons
– and buttons are also used to jump to the proper point during play-
back operations.
– button: When pressed once during playback, jumps to the start point of
the title currently being played back. When pressed twice, jumps to the start
point of the previous title. When pressed with the SET button during stop-
ping, jumps to the beginning of the first title in the disc.
– button: When pressed once during playback, jumps to the start point of
the next title. When pressed with the SET button during stopping, jumps to
the beginning of the last chapter in the disc.
– (FREEZE) button: When pressed the first time during playback, the picture
becomes a frame frozen picture. When pressed the second time, the frame
frozen picture is replaced with the frozen first field picture. When pressed
the third time, the first field frozen picture is replaced with the second field
frozen picture.
The FREEZE MODE of the SETUP MENU allows you to decide whether the
first frozen picture is a frame frozen or field frozen picture.

Setup
Setup is done during installation time. Do not change the settings.
You may check/change date/time and the recording mode.

Setting the date and time

 Press the MENU button.

 Select SETUP MENU > CLOCK SET.

 Enter the correct date and time.

– Use and buttons to select the digit to be set.
– Use and buttons to adjust the value for the selected digit.

 Press the SET button.

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 DVD Video Recording

Selecting the recording mode

 Press the MENU button.

 Select SETUP MENU > REC MODE.

 Select the desired recording mode. 247

 Press the SET button.

DVD recording
You can use the DVD+RW discs corresponding to quad speed.

Formatting An unused disc requires no formatting operation. The disc is automatically format-
ted when loaded into the unit.
When you use a disc formatted by a computer or recorded by using other DVD
equipment, format the disc using the FORMAT sub menu of DISC INFO.

Removing/inserting a DVD
 Open the disc tray by pressing the OPEN/CLOSE button ( ).
 If necessary, remove the DVD+RW

 Insert the DVD+RW into the disc tray.

 Close the disc tray by pressing the OPEN/CLOSE button ( ).

Recording scenes
Depending on configuration, recording is started and stopped automatically. Con-
figuration to record fluoro and/or acquisition scenes can be changed by Siemens
service.

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System Operation

DVD playback
Note If fluoroscopy or acquisition is initiated during DVD playback, the DVD recorder im-
mediately switches to recording mode!

Starting playback
 To start the playback, press the [PLAY] button.

Pause
 Playback can be paused at any time by pressing the [PAUSE] button.

 If you press this button again, playback will be continued.

Ending playback
 To end the playback, press the [STOP] button.

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 Part: Examination
Preparations - Fluoroscopy - Acquisition

Registering a patient
Before examining a patient, you have to register the patient and select an exami-
nation.

Note Archive/send/export all data via network or on CD-R/DVD before starting a new ex-
amination.
It is a preventive measure against loss of data in case of an error, e.g. failure of the
image storage disk.

Refer to Emergency operation 781

Default patient An emergency patient is automatically registered each time the system is restart-
ed. It allows you to perform fluoroscopy and acquisition immediately after switch-
ing on the system as soon as the imaging system is ready.
An emergency patient is also registered each time a patient is closed.
If an X-ray is not performed for this patient entry, the entry is deleted when the
system is started the next time.

Taking 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 icon for the scheduler to update it and then open it.

Or
 Select View > Update Worklist from the menu of the Patient Browser.
– All patients who are preregistered for examination on your system are listed
in the content area.
 Double-click the patient to be examined.
– The Patient Registration window opens.
 Add any required data.

 Select the Patient position from the list.1

 Registering the patient and starting examination 257

1 Not required for cardiac examinations

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Examination

Registering an emergency patient

 Select Patient > Emergency... from the main menu or from the Patient Brows-
er.
– The Emergency Registration window is displayed.

Or

 Press the Patient Registration (Num 0) key on the symbol keypad.

– The Patient Registration window opens. 258

 Click the Emergency button.

– The system automatically creates default entries for the mandatory fields.
– If necessary, you may be asked to enter some more data in the Missing
Information dialog box.
Or
 Enter the Date of Birth and the Sex of the patient (if known) and select the
Patient position1 from the list (data shown in boldface type are mandatory
entries).

1 Not required for cardiac examinations

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 Preparations - Fluoroscopy - Acquisition

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

For more information on Patient Registration, please refer to the syngo docu-
mentation.

Registering the patient and starting examination

Note When the system is in BYPASS FLUORO mode, or during radiation, the patient
cannot be registered for examination.
 In this case, click Preregister.

 Click Exam.
– A dialog box is displayed in which you must confirm the patient position.1

The system assigns patient orientation labels to the images depending on patient
Caution position selected during patient registration.
Danger of treatment of the wrong side.
 Do not acquire images with the patient positioned different from the patient
position selected during patient registration.

 Click Confirm if the patient position is correct.

– The patient is registered.
The Examination task card is placed in the foreground and you can start the ex-
amination immediately.

Note You can enter or change missing patient data at a later time.
Changing patient data 344

1 Does not appear, if only the Cardiac application profile is configured.

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Registering a patient manually

Note If you want to register a new patient, make sure that you have not selected a pa-
tient or study in the Patient Browser.

 Press the Patient Registration (Num 0) key on the symbol keypad.

Or
 Select Patient > Register... in the main menu.

Or
 Open the Patient Browser.

 Click this icon.

The Patient Registration window opens.

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Note Do not enter special characters, e.g., \:;#§.

Text entered may be wrong or missing.

 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

 Registering the patient and starting examination 257

Preregistering the patient

If 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.
All the input fields of the Patient Registration window are now empty again. You
can enter the data of the next patient.

Searching for patient data

You can search for patient data in the databases from the Patient Registration
window and then use the data for registration.
You can also use the Patient Browser to search for a patient in the Scheduler, in
the Local Database and in the archive. You can then transfer the data to the Pa-
tient Registration window.

 Open the Patient Registration window.

 Enter the known data in the fields Last name and Patient ID.

 Click Search.

Or
 Open the Patient Browser.

 Select Patient > Search from the menu of the Patient Browser.

Or
 Select a patient in the Patient Browser.

 Select Patient > Search Selected... from the menu of the Patient Browser.

1 Not required for cardiac examinations

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The Patient Search window opens.

 Enter search criteria. You may also use “wildcards”, e.g. * ?.

 Click Search.

 Select a patient from the search list and click OK.

– The data of the selected patient is transferred to the Patient Registration
window.
 Click Exam.

Searching in the HIS/RIS and registering

If you cannot find a particular patient in the databases although the patient name
has been entered in the HIS/RIS system, you can search through the entire HIS/RIS
system with a worklist query.
If configured, you can also use this method to access patient data intended for
other workstations and modalities.
 Select View > Patient based worklist query from the menu of the Patient
Browser.

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The Patient Worklist Query window opens.

 Enter search criteria. You may also use “wildcards”, e.g. * ?.

Note If you do not know the exact patient name, e.g. if you only know the last name,
enter the name with a wildcard *, e.g. Miller* instead of Miller. Otherwise the pa-
tient will not be found.

Note As empty fields are treated like "wildcards", you should complete at least one of
the fields so that the search result is better manageable.

Note You cannot use a patient ID which has been created automatically as a search
term.

 Click Get Worklist.

– The patient data found in the HIS/RIS system are listed in the window
Results of the Patient Based Worklist Query.
 Select a patient from the search list and click OK.
– The data of the selected patient is transferred to the Patient Registration
window.
 Click Exam.

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Taking over patient data from Sensis

Data collision between AXIOM Sensis and Artis.

Caution Patient registration on the Artis causes inconsistent patient data.
 Register patient only by 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.

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

 Click Exam.
– The patient is registered on AXIOM Sensis and on Artis.

Preparing the patient and equipment

Blocking radiation
In some cases, for instance when the patient is repositioned or while cleaning, you
can block radiation to prevent it from being released inadvertently.

Touchscreen
 Press this icon.

Console
 Click this icon.

Radiation will be blocked for the next radiation releases.

Note This function will not interrupt radiation!

To stop radiation, e.g. in case of a malfunction:
 Press one of the red emergency STOP buttons.
Red emergency STOP buttons 41

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Blocking unit movements

During transfer and positioning of the patient, you can block motorized move-
ments in order to prevent unintentional unit movements.

Touchscreen
 Press this icon.

Console
 Click this icon.

Motorized movements will be blocked for the next movement releases.

Note This function will not interrupt movements!

To stop motorized movements, e.g. in case of a malfunction:
 Press one of the red emergency STOP buttons.
Red emergency STOP buttons 41

Transferring and positioning the patient

Positioning accessories
 Attach the accessories required for secure positioning to the patient table.
Accessories and Auxiliary Devices 717.
 Ensure that the accessories are attached securely and function properly.

Note The patient table and patient positioning devices enable the patient to be posi-
tioned in such a way that impedes the development of pressure necrosis.
During long examinations, trained personnel have to minimize the risk of pressure
necrosis by active decubitus prophylaxis while the patient is in position.

 If necessary, temporarily remove the control consoles from the repositioning

area.

Note When transferring the patient, make sure that no unit movements are initiated in-
advertently.

 Move the units to a Transfer position.

Moving to system and programmed positions 190

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Patient transfer.
Warning The patient may fall to the ground.
 Move system into Transfer position.

 Park the patient stretcher/bed right along the patient table without a gap.

 Lock the brakes of patient stretcher/bed.

 Always keep the mattress fixed on the tabletop with the Velcro.

 Press the Block Movement button at the TSC to prevent motorized movements
or temporarily remove the consoles.

 Transfer the patient using positioning aids.

Comfortable positioning
 Position the patient to feel comfortable.

 Make sure that no parts of the patient's body, in particular, arms, legs, and hair,
are protruding over the edge of the tabletop.
 Ensure that the patient uses the grip locations provided where it is possible and
necessary.
 Remove any interfering metal parts and radio-opaque objects from the table.

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

Immobilization
 If necessary, immobilize the patient using the appropriate accessories.

Radiation protection
 Attach and position the required radiation protection accessories.
Accessories and Auxiliary Devices 717.

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.

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 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.

Note The ECG cables could become tangled with or be broken by moving parts, e.g. the
X-ray tube, during C-arm angulation.
 Pay attention to the ECG cables during unit movements.

Connection of a third party ECG device to Artis for QRS detection

Normally lead II is the best lead for making a QRS detection since it often has the
largest amplitude, but the QRS detector also works with other leads.
The applied ECG-lead signal shall be amplified by 1000 (default). A signal of 1 V to
the module corresponds to 1 mV of the original ECG-lead signal (signal range for
QRS detector: +/- 5 V). If other sampling frequencies (default 2000 Hz) or amplifi-
cation need to be used, the filters and detection levels in the QRS detector need
to be changed. The QRS detector outputs a digital signal when a QRS-complex in
the original ECG is detected.

Preparing for pressure measurement1

 Adjust the pressure elements to the atrial plane with the 3-way valve.

 Open the 3-way valve in front of the pressure element to measure the atmo-
spheric pressure (air).
 Perform zero pressure measurement compensation at the hemodynamic mea-
suring system.

Adjusting the units (stand and table)

 Move the patient table to the required working height.

 Position the tabletop.

 Position the stand and the C-arm as required.

Unit Movements 155

1 Only required for cardiac examinations

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Setting the isocenter

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

Note Depending on mattress thickness and patient thickness, isocentric movements are
restricted.

(3)

(2)

(4)

(1)

(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.

Positioning the patient approximately (without fluoroscopy)

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

 Roughly center the organ in the beam path.

 Estimate the distance of the organ to be examined from the tabletop (T.O.D.).

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 Set the table height so that the required distance is shown on the Assist screen.

Positioning an organ in the isocenter with fluoroscopy

 Place the C-arm in a.p. position.

 Select the zoom stage:

– Zoom 0 with FD 20x20
– Zoom 1 with FD 26x30
– Zoom 1 with FD 30x40
Perform fluoroscopy in the a.p. position:
 Press the FLUORO footswitch.

 Position the tabletop so that the organ of interest is centered.

 If necessary, activate the radiation field limitation 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.

Storing the isocenter height

Stop in the isocenter 178

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The Examination task card

With the Examination task card at the system console, as well as the Exam and
Settings task cards at the touchscreen control, you can view and edit the param-
eters for the examination.

Screen layout on the system console in the control

room

(1) (2)
(1) Image area
(2) Control area
Each screen in the control room is divided into image area and control area.
 The image, image text and graphics are shown in the image area.

 You can make settings and call functions in the control area.

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Note On a system with Japanese language configuration, the language bar keeps flick-
ering in the control room display if Examination task card is selected.
 Click the image area and the language bar will be hidden.

In case of a single plane system, the control area is located on the right-hand side.
In biplane systems, the positions of the control areas depends on configuration.

A B

Control Image area plane A Image area plane B Control

area area
plane A plane B

Example for biplane configuration

Calling up the Examination task card

 Click the tab of the Examination task card (of the required plane).

Or
 Press F5.
– The Examination task card is placed in the foreground.
– The current parameters are shown in the control area.

Using the other plane

You can set the parameters separately for each plane independently.
 Move the mouse pointer from one screen to the other.

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Screen layout in the examination room

Image area Control area

Each screen in the examination room is divided into image area and control area.
 The image, image text and graphics are shown in the image area.
Text information in images (full screen) 335
 Parameters are shown in the control area.
You can also select various postprocessing functions in the control area.

Screen layout on the touchscreen in the examination

room

Note The screen layout on the touchscreen in the examination room depends on the
system type and configuration.
Configuring the touchscreen layout 229

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Settings On the Settings task card, you can select the touchscreen Layout and apply fur-
ther settings.

Example (Expert layout)

Example (Standard layout)

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Examination You can set parameters which are important for the examination on the Exam
task card and also left and right as well as along the bottom outside the stack of
task cards.

Example (Expert layout)

Example (Standard layout)

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Parameters for the examination

Patient data
Once a patient has been registered, the data of this patient are displayed on the
screen:

Display in the examination room

 The active examination patient at the top left in the image area on the screen
in the control room and in the examination room (not until any image has been
acquired)

Display in the control room

 The active postprocessing patient on the top right in the control area on the
screen in the control room

Note The active examination patient and the active postprocessing patient can
be different!
 Click the Examination tab to see the patient registered for examination.

Checking/changing patient data

You can check the following patient data on the top left in the image area:
 Patient name

 Patient ID

 Date of birth

You will also find the name of the patient in the control area next to the folder
icon.

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Patient position

Note The patient position entered by you automatically results in correct orientation of
the display on the screen (horizontally and vertically), i.e., fluoroscopic images
and acquisitions are displayed as if the patient was standing in front of the viewer
and facing the viewer.

The system assigns patient orientation labels to the images depending on patient
Caution position selected during patient registration.
Danger of treatment of the wrong side.
 Do not acquire images with the patient positioned different from the patient
position selected during patient registration.

Misusing the patient position to flip an image

Caution Risk of misinterpretation and incorrect diagnosis
 Always enter the patient position correctly.

Note Siemens Service can configure whether the patient position will be entered in the
image data (DICOM Header) or not.
Contact Siemens Service if you want to have this configuration changed.

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The following patient positions are possible:

Patient position Abbreviation Display on the Abbreviation in

touchscreen image
Head First - Supine HFS HFS or H SP

Head First - Prone HFP HFP or H PR

Head First - Left Lateral HFLL HFDL or H LL

(Head First - Decubitus Left) (HFDL)

Head First - Right Lateral HFRL HFDR or H RL

(Head First - Decubitus Right) (HFDR)

Feet First - Supine FFS FFS or F SP

Feet First - Prone FFP FFP or F PR

Feet First - Left Lateral FFLL FFDL or F LL

(Feet First - Decubitus Left) (FFDL)

Feet First - Right Lateral FFRL FFDR or F RL

(Feet First - Decubitus Right) (FFDR)

Patient positions and abbreviations used for them

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Explanation:
 Head first: head at the head end of the table

 Feet first: feet at the head end of the table

Checking/changing the patient position

Touchscreen  Settings task card

 Select the required new patient position.

– The new patient position is registered and displayed.

Console You have already defined the patient position during patient registration.
Registering a patient 255
If you want to change the patient position, e.g. after repositioning the patient,
proceed as follows:

 Click the patient name on the top right-hand side with the right mouse button.

 Select the required new patient position in the pop-up menu.

– The new patient position is registered.

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System position
Assist screen The Assist screen shows the current data of the installed units (stand, C-arm, ta-
ble).
Readings on the Assist screen 217.

Calling up information on the system position

Console In the control room, you can call up the current positions (angulation data) of the
stands and the table position (table height, possibly tilt):

 Click with the right mouse button on the patient folder icon.

 Select Stand and Table.

– A window appears informing you about the current data.

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Example of unit data (depends on the system type)

(1) CRAN-CAUD / RAO-LAO

Angulation of the stand with reference to the patient
(2) SID (= Source Image Distance)
the distance between the X-ray source and the image receptor
(3) Tilt Angle
Angle of table tilt
(4) X-Position
Longitudinal position of the tabletop with reference to the patient
(5) Y-Position
Transverse position of the tabletop with reference to the patient
(6) IO-Height
Isocenter height

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Positioning the patient without radiation -

CAREposition
You can reposition the patient without radiation. If the patient table or the C-arm
is moved, the changed position is displayed graphically in the LIH.

   !

(1) Start the movement with CAREposition

(2) During the movement
(3) After the next fluoroscopy

Note In biplane systems, CAREposition can be used in both planes.

Note The state of CAREposition after system startup can be configured by Service.
(Default: enabled)

Performing CAREposition

Touchscreen (only)  Settings task card

 Press this icon.

If you move the patient table and/or the C-arm, it is displayed graphically in the
image.
 A rectangle shows the collimated area.

 The center point of the central beam is indicated by cross hairs.

 If the C-arm is angulated, the rectangle disappears, but the cross hair continues
to show the center point of the central beam.
 If the new acquisition position is outside the image, the direction is indicated
by an arrow.
The CAREposition diagram is removed when radiation is released.
It appears again if the patient table and/or C-arm are moved again.

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Exam set, application profile and acquisition program

Exam set Acquisition and fluoroscopy/roadmap programs are arranged in exam sets.
An exam set comprises:
 up to 16 acquisition programs
possibly 1 alternative acquisition program
 3 fluoroscopy programs
possibly 3 assigned roadmap programs

Note The pre-installed exam sets are recommendations. They can be modified.
Exam Sets 559

Application profile Depending on the system equipment and system configuration, you can choose
between different application profiles.
By selecting an application profile, specific exam sets become available:
 Cardiac
Programs for cardiological applications
 Neuro
Programs for neuroradiologic applications
 Universal
Programs for universal applications
 Multipurpose
Programs for multifunctional applications

Selecting the acquisition program/exam set

Touchscreen  Exam task card

 Press this icon next to the currently selected exam set.

– A selection of available exam sets and assigned acquisition programs
appears.

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Example

 Press the button of the required new exam set, if necessary.

 Press the button of the required new acquisition program.

– The new acquisition program is activated and the dialog is closed.
Or

 Press this button in order to display more exam sets.

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Example

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

 Press the button of the required new exam set.

– The new exam set is selected and the dialog is closed.
Or

 Press this button in order to display the assigned acquisition programs.

 Press the button of the required new acquisition program.

– The new acquisition program is activated and the dialog is closed.

Console  Examination task card

 Select the required exam set.

Or
 Click this icon.
– The Exam Set and Program Editor window appears.
 Select the required new Profile.

 Mark the required exam set in the tree view.

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 Click Activate Exam Set and Program.

For more information see Exam Sets 559.

Selecting/editing the series description

Note The series description must be set before acquisition.

To change it after acquisition, see Changing the name of a series 345

Touchscreen  Exam task card, Expert layout

 Press the drop-down button next to the currently selected series description.
– The available series description texts are displayed.

Example (Expert layout)

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

 Press the required series description text.

Console  Examination task card

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 Click this icon.

 Select a series description text from the list.

Console (only) Modifying the series description list

 Click Edit List...

Add text  Enter a series description text and click Add.

Note A series description text may have up to 24 characters.

However, if a series description text is longer than about 15 characters, depending
on the used characters, without blanks, series description texts may be displayed
truncated on the touchscreen.
If the text includes blanks, the text will be broken into the second line on the
touchscreen.
In any case, the series description texts will be added correctly and completely to
the scene.

Sequence  Select a series description text in the list and click Move Up or Move Down.

Delete text  Select a series description text in the list and click Delete.

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Save list  Click Close & Apply.

Changing the acquisition program in the current exam set

Touchscreen  Exam task card

 Press the drop-down button next to the acquisition program.

– The available acquisition programs of the exam set are displayed.

Example (Expert layout)

 Press the required acquisition program.

Console  Examination task card

 Select the required acquisition program.

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Checking the acquisition parameters

Console On the Examination task card in the control area below the exam set, you can
read and change the following information about the acquisition program.

Display Explanation
Display and selection of exam set.

Acquisition program

If the selected exam set offers an alternative acquisition program, an additional

icon is shown.
Alternative acquisition 302
Acquisition program

Tube voltage* for acquisition in kV

Tube current* for acquisition in mA

Measuring field (dominant)*

Pulse width* for acquisition in ms

Focus size* (micro/small/large)

Scene length or Dyna Time in seconds [s]

Copper filter for acquisition in mm

Frame rate in frames per second [f/s]

Angulation step [°/F], if a DR-DYNA/DYNA/3D/3D CARD acquisition program is

selected
* calculated from fluoroscopy or post-indication

Note Some acquisition parameters are calculated from fluoroscopy.

Therefore you must perform a short fluoroscopy before starting an acquisition.

Further parameters which are not displayed can be changed in the Exam Set and
Program Editor.
Viewing and editing acquisition/fluoroscopy/roadmap programs 566

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Changing the acquisition frame rate

Touchscreen  Exam task card

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

Example

 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.

Console  Examination task card

 Select the required frame rate from the f/s selection list.

Changing the scene length and/or measuring field

Depending on the organ to be examined, you must select one or more suitable
measuring fields so that the automatic exposure control can match the dose to the
organ of interest.

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Note Using an incorrect measuring field may result in poor image quality.
 Observe the image while switching over the measuring field.

Intelligent Measuring When Intelligent Measuring Field is selected, the best measuring field area ac-
Field cording to the position of the collimator and based on a histogram analysis is au-
tomatically set.
When using the Intelligent Measuring Field, changes of the irradiated region by
unit movements or patient movements will immediately be captured and result in
a dose adaptation.
The Intelligent Measuring Field is always on first position of the measuring field
list (square symbol).

Note With FD20x20, only the central measuring field and the Intelligent Measuring
Field are available.
With plane B, only the central measuring field and the Intelligent Measuring
Field are available. It is also valid for FD 30x40 in plane B.

Touchscreen  Exam task card

 Press this button.

Example

 Select the required new scene length and/or measuring fields.

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 Close the window.

Console  Examination task card

 Select the required new scene length from the Scene selection list.

 Select the required measuring field from the Measure Field selection list.

A measuring field graphic is displayed on the Live screens, but not with Intelli-
gent Measuring Field.

Fluoroscopy/roadmap program

Checking the fluoroscopy/roadmap parameters

Console (only) You can read or change the following data for the fluoroscopy program below the
data for the acquisition program:

Display Explanation
Elapsed fluoroscopy time (both planes in biplane systems)
Fluoro timer 294

Fluoroscopy program

Tube voltage* for fluoroscopy in kV

Tube current* for fluoroscopy in mA

Pulse width* for fluoroscopy in ms

Copper filter* for fluoroscopy in mm

Pulse rate in pulses per second [p/s]

*
Setting range defined in the fluoroscopy program, can only be changed by Siemens Service

Further parameters which are not displayed can be changed in the Exam Set and
Program Editor.
Viewing and editing acquisition/fluoroscopy/roadmap programs 566

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Changing the fluoroscopy/roadmap program

Touchscreen  Exam task card

 Press the drop-down button next to the fluoroscopy/roadmap program.

Example (Expert layout)

 Press the required fluoroscopy/roadmap program.

Console  Examination task card

 Select the required fluoroscopy/roadmap program.

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Changing the pulse rate

You can change the pulse rate before starting fluoroscopy/roadmap or even dur-
ing fluoroscopy, but not during roadmap.

Note If the system is in Overlay Ref mode and the pulse rate change results in a matrix
change, then the reference image is not overlaid and an error message is shown
“Overlay Ref not possible with current ref. image”.
 Stop fluoroscopy and start again.

Then Overlay Ref will be displayed correctly.

Touchscreen  Exam task card

 Press the pulse rate button to display all available pulse rates.

Example

 Press the required pulse rate.

Or (if configured)

 Press an arrow button next to the pulse rate to switch to the next higher or low-
er pulse rate.

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Console  Examination task card

 Select the required pulse rate in the p/s selection list.

Acquisition plane(s)1
In biplane systems, you can select one or both acquisition planes.
(In single plane systems the icons are not available.)

Selecting the other plane

Touchscreen  E.g. plane A is selected.

 Press the A button on the left side of the task cards.

 Press the B button to select this plane.

 Press the A button to deselect this plane.

Console  E.g. plane A is selected.

 Click the B icon to select this plane.

 Click the A icon to deselect this plane.

Selecting both planes

 Activate the second plane in addition to the first.

Image mirror/flip preselection

For example, if the patient is positioned prone during an intervention, you can flip
the image so that the catheter moves in the same direction in the image.
You can flip images of a scene horizontally and/or vertically.

Note The orientation labels are also flipped.

Flipping does not alter the orientation in the scene directory, that is, the image re-
mains as it was.

1 Artis biplane only

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Image flipped
Caution Confusion between up/down/left/right can cause incorrect diagnosis!
The examiner is responsible for using the functions and interpreting the images
correctly and the consequences resulting from it.
 Check patient position data in the current image to exclude any errors.

Note For biplane scenes, only one plane is flipped because, depending on the projec-
tion, flipping in one plane might not automatically correspond to flipping in the
other plane.
 Contact Siemens Service if you want images always to be displayed flipped.

Touchscreen (only)  Settings task card

 Press this button.

Possible image flipping functions (single plane)

Possible image flipping functions (biplane,

plane A = light blue, plane B = orange).

 Press the required image flipping buttons (up/down, left/right)

The next image acquired is flipped (top and bottom or left and right are swapped).

Note These selection fields are "preselection fields" and cause the next images to be ac-
quired to be displayed flipped.
If 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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Monitoring status displays

Radiation indication
If radiation is released during an examination, it is indicated by the radiation indi-
cators in the examination room and in the control area on the system console in
the control room.

Function passive active

Acquisition

Fluoroscopy

Fluoro timer
The elapsed fluoro time of uninterrupted fluoroscopy is recorded and indicated.

Indication in the control area in the examination room

Displays in the control area in the control room

The fluoro timer can be configured to the legal requirements:

 Euro mode: 00:00:00 [hours:minutes:seconds]
Legally required in the EU
Example: 00:05:20 i.e. 0 h, 5 minutes, 20 s
 CFR mode: 000.0 min [minutes.tenths of minutes]
Legally required in the US
Example: 005.1 min i.e. 5 minutes, 1 tenth minute
It is possible to configure whether fluoroscopy should be blocked if the elapsed
fluoroscopy time exceeds the preset value (service configurable range
1 ... 5 minutes). An audible signal will sound and a message box will appear.
Resetting the fluoroscopy signal 301

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Note For safety reasons, radiation will be blocked after 10 minutes of uninterrupted flu-
oroscopy.
In this case, you can continue with fluoroscopy by releasing the FLUORO pedal and
pressing it again.

When a new patient is registered, the fluoroscopy time is automatically reset to

zero.
The elapsed fluoroscopy time of an examination is automatically recorded in the
Exam Protocol as soon as the patient is completed.

High dose fluoroscopy or roadmap

Legal requirement for Switzerland and Australia only:

High dose fluoroscopy or roadmap is restricted to a maximum of 20 s, after which
a normal fluoroscopic mode shall be used.
After 20 s of high dose fluoroscopy or roadmap, the following message is dis-
played: "20 secs High Contrast Fluoro reached, select normal dose"
 Deselect the high dose fluoroscopy/roadmap program, if possible.

Note The high dose fluoroscopy/roadmap program will not be deselected automatically.

Legal requirement for Australia only:

When a high dose fluoroscopy or roadmap is selected and no fluoroscopy or road-
map is performed for 5 minutes, or the system is restarted, a normal fluoroscopic
mode shall be used.
After 5 minutes of inactiveness, the following message is displayed: "Attention,
High Contrast Fluoro is selected since 5 mins"
 Check the fluoroscopy/roadmap program to be used.

Note The high dose fluoroscopy/roadmap program will not be automatically deselected
after 5-min inactiveness during roadmap phase 3.

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Dose
Dose values are shown on the live screen in the examination room, on the Assist
screen in the examination room, and on the console monitor in the control room.
Dose monitoring and reduction 61
Reducing radiation with CARE 63,
CAREwatch 64, CAREmonitor 65, CAREguard 67

Note Pay attention to the dose display during the examination.

Make sure that the dose values remain within the usual range.

Messages
The imaging system keeps you continuously informed about the status of the sys-
tem.
 Please pay attention to the system messages.
Troubleshooting 769

Large Display System messages (imaging system) and messages about the units are displayed
on the Assist screen and/or in the message bar (2 lines of text). 216

Console monitor Messages are displayed on the task cards on the system console monitor:
Message lines 770
 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)

Message lines at the bottom of the control area

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Resources
The Examination task card on the monitor of the system console indicates the
available storage capacity in a pie chart as a percentage.

Displays at the bottom of the control area

 Pay attention to this indicator.

 Move the mouse cursor over the pie chart to display additional information.
Resource display 772
If the storage space available for scenes/images has run out, a message is dis-
played.
Buffer full! - Memory full! 779
 If you need more storage space, delete previously archived patients.
Deleting patients/studies/series/scenes 442

Note Please note that the resource display will never reach 100% because space is re-
served for storing one fluoro scene.

Thermal load
The thermal load of the X-ray tube is displayed in Heat Units on the live screen in
the examination room, on the Live screen in the examination room and on con-
sole monitor in the control room as percentage.
The heat unit display indicates the thermal condition of the anode.

Live screen

Indication in the control area in the examination room

Console monitor

Displays at the bottom of the control area

When the tube load becomes critical at approx. 75%1, an acoustic signal sounds
indicating overload and a message will be displayed.

1 The threshold at which the audible signal sounds depends on the X-ray tube and is configured by
Siemens Service.

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You can continue to perform fluoroscopy. However, we recommend selecting

pulsed fluoroscopy with a low pulse rate so that the anode cools down quicker.
Acquisition series are not blocked automatically. However, we recommend select-
ing an acquisition program with a low frame rate, if possible.

Note When the heat unit threshold value is exceeded, the overload computer of the
tube assembly is activated, because the tube is then being operated within the
range of increased wear.
Repeated exceeding of the Heat Unit threshold value can reduce the service life of
the tube.

Note Overload can cause permanent damage to the tube. It will void any warranty
claims.

Fluoroscopy/acquisition
If any radiation indicator lights up although you have not pressed a button:
Caution Danger due to radiation
 Press the emergency STOP button.

 Notify Customer Service.

If poor image quality results from the set parameters:

Caution Risk of poor image quality and unnecessary exposure to radiation
 Stop radiation immediately and check the parameters or call Service.

Malfunction in the detector cooling system and display of the message “No X-Ray
Caution available in ... min.”
Risk that the examination cannot be completed
When the countdown has elapsed, radiation will no more be possible.
 Complete the current examination within the remaining displayed time.

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Fluoroscopy
Single plane Using the FLUORO pedals
 Operate the FLUORO pedal of the footswitch.

Biplane With biplane systems, you can perform fluoroscopy in one plane or in both planes:

A+B
 Operate the correct FLUORO pedal of the footswitch.

A
B
– The radiation indicators lights up during radiation.
– Fluoroscopy images appear on the screen.
– In each case the last fluoroscopy image remains displayed on the screen
A+B
A after fluoroscopy is completed (LIH = Last Image Hold).
B

Subtracted Fluoroscopy: Roadmap 315

Reference Images and Display Modes 305

Storing a fluoroscopic scene

You can store the last fluoroscopy or roadmap scene.

Note Fluoroscopy or roadmap scenes with up to 1024 frames can be stored.

Touchscreen
 Press this icon.

Console
 Click this icon.

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Storing images as Store Monitor

You can store any image currently displayed, even during fluoroscopy, as a new
"acquisition" (Store Monitor).

Note A maximum of 512 Store Monitor images per study and plane can be stored.

Touchscreen
 Press this icon.

Console
 Click this icon.

The image is stored as "Store Monitor" on series or image level.

Using the dilatation timer

The system is equipped with an integrated timer for exact time measurements, i.e.
for dilatations. This timer appears as a digital time display.

Note The timer runs up to a maximum count of 59 minutes and 59 s.

Then it automatically stops and is reset to 00:00.

Touchscreen
 Press this icon.
– The timer is displayed on the live screen.1

Console
 Click this icon.

1 configurable

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Starting the timer

 Activate the timer icon.
– The timer starts.

Stopping the timer

 Activate the timer icon again.
– The timer stops.

Resetting the timer

 Activate the timer icon a third time.
– The timer is reset to 00:00 and restarts.

Resetting the fluoroscopy signal

If the message box appears or if you want to reset the signal before intervening,
for example:

Touchscreen  Exam task card

 Press this icon.

Or1
 Operate a FLUORO pedal on the footswitch.

– The audible signal is switched off.

– The fluoroscopy time will start running again.
If the preset value is exceeded again, the procedure will be repeated.

Console  Confirm with OK in the message box to continue working.

Acquisition

Using the handswitch

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

1 can be configured by Siemens Service

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Using the footswitch

 Press the acquisition pedal of the footswitch.

– The radiation indicators lights up briefly.

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

Alternative acquisition
In order to have a fast access to special acquisition program, an Alternative
Acquisition can be assigned to a footswitch pedal. That means it depends on the
footswitch configuration whether this function is available.
An alternative acquisition program can be used, for example, to provide a “low
dose acquisition program” instead of fluoroscopy at critical situations where the
fluoro dose is limited by the maximal skin dose.
The alternative acquisition program may be, e.g.:
 a low dose acquisition for CARD.
The dose shall be typically between fluoroscopy and normal acquisition,
e.g. 80 … 150 nGy
 a low dose DSA acquisition

 a single shot DR acquisition

 any acquisition program that is not a special mode, i.e. no 3D, DYNAVISION,
DR-DYNAVISION, PERISTEPPING, PERIVISION, DR Stepping

Configuration The alternative acquisition program is no option (no license key required).
The configuration to enable/disable the alternative acquisition is done by assign-
ing of one of the footswitch pedals to this function.
If configured, the alternative acquisitions programs (if there are any) will show up
in the exam sets.
In the Exam Set and Program Editor, the alternative acquisition program is locat-
ed between the up to 16 acquisition programs and the 3 fluoro programs. If any
acquisition program is visible there, then it is an alternative acquisition program
assigned to the footswitch pedal.

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Note If the alternative acquisition program is configured as a low dose acquisition for
CARD to be used in critical cases (to improve image quality) instead of fluoroscopy
where the dose per image is usually limited by the maximum skin dose prescrip-
tion, the dose will be higher than with fluoroscopy!
Therefore, the alternative acquisition program shall not be used in general as re-
placement for fluoroscopy, although the image quality is better.

Fluoro release foot pedal mixed up with the alternative acquisition release pedal.
Caution Increased irradiation by performing acquisition
 Be careful to use the correct foot pedal.

 Check the labels and the position of the foot pedals.

Restrictions with biplane footswitch configuration

Due to safety reasons, the alternative acquisition must be configured to one of the
upper footswitch pedals.
 On biplane CARD systems with a small footswitch, only the upper right pedal
A+B which is configured to biplane fluoroscopy by default, can be used for alterna-
tive acquisition. If this pedal is assigned to alternative acquisition then biplane
A
fluoroscopy will not be available anymore.
B

RDMP  On biplane NEURO systems, the default configuration of the upper pedals is ac-
Reset A
RDMP
ON/OFF cording to the figure. One of the functions, most likely RDMP ON/OFF, will not
RDMP
Reset B
be available from footswitch anymore if it is assigned to alternative acquisition.

No injector triggering with alternative acquisition

Injector triggering is only available from the normal acquisition footswitch pedal.
Injector triggering from the footswitch pedal assigned to an alternative program
is not possible.

Alternative acquisition pedal is used to start acquisition with automatic injection,

Caution although power injectors are triggered exclusively by pedal "2".
Exposure to radiation without clinical benefit
 If automatic injection is required, use the handswitch, or the “regular” acquisi-
tion pedal (pedal "2") on the footswich to release X-ray.

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Preparing alternative acquisition

 Alternative acquisition has been configured to a footswitch pedal.

 Create an exam set with an alternative acquisition program by copying either a

CARD, DR or DSA program down left besides the fluoro triplet.
 Edit the alternative acquisition program and, e.g., change the dose.

 Store the exam set.

Performing alternative acquisition

 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 Exam-
ination task card.
 Perform fluoroscopy.

Note For alternative acquisitions, always the measuring fields of the ‘regular’ acquisi-
tion program are used. The forecast parameters are displayed for the ‘regular’ ac-
quisition program and not for the alternative acquisition program.

 Start acquisition by means of the footswitch pedal assigned to alternative ac-

quisition.

Note Images acquired with an alternative acquisition program may not automatically
be transferred to the archive, e.g. if the alternative acquisition program is a low
dose CARD program, which will mainly be used instead of fluoroscopy in critical
situations.
It can be configured by service whether images acquired with an alternative ac-
quisition program shall automatically be archived or not.

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Reference Images and Display Modes

Reference image Either a fluoroscopy image (LIH) or an image from a digital acquisition scene (sub-
tracted or unsubtracted) can be stored as the reference image. 305

XA reference image Alternatively, an image from a different modality, e.g. CT, MR, can also be stored
as reference image. 309

2nd reference image If configured, two reference images can be stored and displayed on the respective
screens.

New reference image If a display mode with reference image is selected for fluoroscopy, the reference
image last stored will always be retrieved automatically. If you want to display a
different reference image which was stored previously, you must select it first.
Managing and Viewing Scenes/Images 349

Reference screens In systems with one or more reference image monitors, or with a Large Display,
the reference image is displayed on these screens.

Active reference If the system has been configured with two reference screens (per plane), a frame
screen with black and white lines indicates which reference screen is active.
The active reference screen can be selected. 306

Automap Using Automap you can restore the acquisition position of an existing reference
image or display the reference image of the current system position.
Automap 193

CLEARstent The CLEARstent imaging function allows you to create an enhanced reference im-
reference image age which provides a better view of fine structures, e.g. better visibility of inflated
stents for easier evaluation of stent deployment. 307

Overlay Reference You can superimpose the (inverted) reference image on the current fluoroscopic
image on the live screen (Overlay Reference). 310

Overlay 3D With iPilot Live, a 3D image is created on the syngo Workplace and is transferred
to the Artis. The 3D image is, like in Overlay Reference. superimposed to the cur-
rent fluoroscopic image on the live screen.

Storing reference images

Reference image
You can store any image which has been acquired on an Artis system and is being
currently displayed (acquisition or fluoroscopic image, even during fluoroscopy)
as a reference image.

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Note Up to 64 reference images (per plane) can be stored in each study folder.
It is not possible to store a Store Monitor image as reference image.

Storing an image as a reference image

Touchscreen  Stop the scene loop by briefly deflecting the mouse joystick to the side.

 Make sure, the required plane is selected.

 Press the middle button of the mouse joystick.

Or
 Press this icon.

Console  Stop the scene loop by clicking the image with the mouse.

 Click this icon (of the required plane).

The image is stored as the new reference image.

The newly created reference image is displayed on the active reference screen.

Note When initiated from touchscreen, only the image of the active plane is stored in
the corresponding plane.

2nd Reference image

If the system has been configured with two reference screens (per plane), you can
store an image as a reference image and display it on the Reference or Assist
screen.
 Press/click this icon to toggle the active screen (of the required plane).
– A black and white frame around the image area identifies the new active
reference screen.
To store a new reference image on the active reference screen:
 Press/click this icon (of the required plane).

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CLEARstent reference image

With the CLEARstent imaging functions, you can emphasize fine structures, e.g.
inflated stents. Composite images are created by averaging several frames of a
scene and considering the alignment of stent markers. If an ECG signal is available,
the heart phase will also be taken into account.
Using the CLEARstent function you can generate special reference images from
any scene or fluoroscopy scene acquired natively.
See also CLEARstent Dynamic acquisition 448
Example:

Original image CLEARstent image

Note CLEARstent is not possible for subtracted scenes displayed natively, rotational
scenes, Store Monitor images, Ready Processed images, reference images, or re-
port images.
CLEARstent is also not possible for images acquired using a large detector with
zoom format > 22 cm.
On a biplane system, the CLEARstent function is always performed in the active
plane only.

Generating and storing a CLEARstent image as a reference image

 The required scene or fluoroscopy scene is reviewed in full-screen mode.

 The stent/balloon marker should be clearly visible in the scene.

Touchscreen  Switch over the Image task card.

 Make sure, the required plane is selected.

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 Press this icon.

Console  Switch over to the PostProc task card and select the Image subtask card (of the
required plane).
 Click this icon.
Or
Select Image > CLEARstent in the main menu.
A preliminary result of the CLEARstent reference image is displayed on the active
reference screen.
The CLEARstent image is created and stored as the new reference image.
The newly created image is displayed on the Live screen and on the active refer-
ence screen.
The displayed image is panned and zoomed such that the stent/balloon markers
are visible (plus a configurable margin in horizontal and vertical direction). Please
note that the image is not cropped to this region of interest, i.e., you can still zoom
out and see the entire image.

Overlay Reference with a CLEARstent reference image

Automap is used to ensure that the current stand position corresponds to the po-
sition of the used reference image.

On a biplane system, the reference image from the master plane is used for Over-
lay Reference.
 A CLEARstent reference image is displayed on the active reference screen.

 To start overlay, press the Overlay Reference Image icon.

The following message appears on the Artis Assist screen / message bar: Auto-
matic 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 message appears on the Artis Assist
screen / message bar: Automatic run: Position reached
 Perform fluoroscopy.
– The rectangular CLEARstent image section is overlaid to the fluoroscopy
image.
– The image section outside the overlaid area is displayed as plain fluoros-
copy.

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No CLEARstent reference image

A CLEARstent reference image cannot be created in the following cases:
 The scene contains less than 25 frames.
The message “Too few frames acquired for CLEARstent processing” will be
displayed in this case.
 The stent/balloon markers cannot not be found in subsequent frames.

 Fill averaging could not be performed, e.g. when there are not enough frames
to average.
 Subsequent frames to be used for averaging are not available, e.g. when acqui-
sition ended too soon.
The message “Scene unsuitable for CLEARstent” will be displayed these cases.

XA reference image
You can also store an image of the same patient acquired in a different modality
(CT, MR) as XA reference image and display it on the reference screen for compar-
isons.
It can be done only if the CT/MR image of the patient is in the local database.
Images of other modalities, e.g. ultrasound, cannot be stored as reference images.

Note XA reference images are stored under the current acquisition patient, i.e. the pa-
tient data of the CT/MR examination, Patient Name, Patient ID, Date of Birth and
Sex must match the data of the current acquisition patient.
If they do not match, you must correct the data.

Storing a CT/MR image as an XA reference image

Console (only)  Have the image sent to you, or import it from the network or a data carrier, e.g.
CD-R.
 Select the required CT/MR image in the Patient Browser.

 Click this icon in the toolbar.

Or
 Select Patient > Save as XA Ref in the Patient Browser menu.
– The CT/MR image is stored as (XA) reference image and can be called up in
the scene directory of reference images.
– XA reference images are stored in a separate series.

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Note The Save as XA Ref function cannot be applied on an examination or series!

Display modes for fluoroscopy/roadmap

and acquisition
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 se-
lected.
The last fluoroscopic/roadmap image is displayed on the live screen after com-
pletion of fluoroscopy. Reference images are displayed on the reference
screen.
 Overlay Reference can be selected or deselected.
The (inverted) reference image is overlaid into the live/LIH fluoroscopic image.
Overlay Ref(erence) is an alternative to conventional roadmap with the ad-
vantage that motion artifacts do not interfere as much as for roadmap.
With Overlay Ref the reference image is always inverted (regardless of the set
acquisition mode, e.g. also with CO2).

Note Overlay Ref is only possible if the reference image was acquired with the same
modality (AX, no CT, MR), the same input format/zoom stage, the same patient
position, and the same portrait/landscape position with FD30x40.
Overlay Ref is automatically deactivated if you select Roadmap.
If a roadmap program is selected, Overlay Ref cannot be selected.
Due to technical reasons, it is not possible to store an Overlay Ref image.
If you do so, only the current fluoroscopy scene is stored.

Display modes subtracted

 Live Native Image
During roadmap or DSA, the unsubtracted live fluoroscopy image is displayed
on the reference screen.
 Reference Image
During roadmap or DSA, the selected reference image is displayed on the ref-
erence screen.
See also Defining the default review mode 362

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Note The availability of display modes depends on the screen configuration of your sys-
tem.

Note For biplane scenes, the display mode is always the same in both planes.

Selecting the display mode

Touchscreen  Settings task card
Expert layout or user-defined layout.

 Select the required display mode.

Console  Examination task card

 Click this icon.

 Select the required display mode.

 Click Close.

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Performing Overlay Reference

Starting Overlay Reference

 At least one reference image has been stored. 305

Touchscreen  Exam task card

 Press this icon.

Console  Examination task card

 Click this icon.

The display mode is changed to Overlay Reference, i.e. the overlay image is faded
in the image on the Live screen.

Selecting a reference image for use with Overlay Reference

You can use any “matching” Artis reference image for Overlay Ref to the fluoro-
scopic image / LIH which has been acquired in the same zoom stage and patient
position, as well the same portrait/landscape position with FD30x40.
You can also use other 3D and 2D images, also from other modalities, e.g. CT, MR,
which have been aligned on syngo Workplace and sent to Artis as AX reference im-
ages.

Note If a reference image has been acquired with a different zoom stage, patient posi-
tion, or portrait/landscape position with FD30x40, Overlay Ref will not be per-
formed. A plain fluoroscopic image will be displayed instead.

Storing reference images 305

Selecting the display mode 311
Reference images can be selected in the scene directory or via Ref - / Ref +.
The scene directory of a patient 351

Setting the degree of Overlay Reference/

Fading in or out the reference image
If Overlay Ref is active and a reference image has been stored, the reference im-
age (inverted display) is superimposed on the current fluoroscopy image.
You can set the reference image portion to a value between 0% and 80%.
The default setting for the reference image portion is 10%.

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Touchscreen (only) You can use the mouse joystick to change the degree of Overlay Ref in the refer-
ence image for the current and subsequent fluoroscopy runs.
 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.
The degree of Overlay Ref is shown in the lower right corner of the image,
e.g. Overlay: 10%

Stopping Overlay Reference

 Press the active Overlay Reference Image icon.

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Subtracted Fluoroscopy: Roadmap

Roadmap is a special operating mode in which fluoroscopy images are subtracted

from one another and displayed subtracted. During fluoroscopy, an image is in-
verted (mask) and superimposed over all subsequent fluoroscopy images.

Application Roadmap makes catheter and guide wire positioning easier by emphasizing the
vessels.
The Roadmap function allows you to view the region of interest with subtracted
fluoroscopy for dynamic navigation during procedures such as angioplasty, cath-
eterization, or plaque removal.

Note To avoid motion artifacts caused by changing the position between subtracted im-
ages, the patient should not move during roadmap nor should the patient table or
system be moved.

Roadmap phases Roadmap consists of three phases whereas phase 1 is split up in two sections,
phase 1a and 1b. Separate Roadmap parameters attitudes exist for every phase.
Phase 1 Phase 2 LIH 1 Phase 3 LIH 2
1a 1b
Display: native native subtracted subtracted subtracted
I (vessels blank) (vessels white) (vessels white) (vessels white)
Imax opac - M M - Imax opac I-M LIH - M

Images

Mask

Fluoro Regulation Start Fluoro Fluoro Fluoro Fluoro

ON stop phase 2 OFF ON OFF ON

Reset Roadmap Show Progress

Roadmap phases (I = live image, LIH = last image hold, M = mask image)

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Phase 1  After you have selected Roadmap and a Roadmap program, and pressed the
fluoro foot switch, Roadmap starts with phase 1a.
The fluoroscopy images are displayed natively.
– During phase 1a, dose control is active. The transition of phase 1a to
phase 1b is determined by the dose control stop event.
– During phase 1b, images are still displayed natively. The fluoro frames will
be averaged in order to get a mask frame with less noise.
The availability of a noise free fluoro frame triggers the transition of phase 1b
to phase 2. Switch-over to subtracted display will happen automatically.
With beginning of phase 2, an injection indicator is displayed. You are requested
to inject contrast medium.

Phase 2  The phase 2 serves to make a roadmap image of the contrast medium filled
vessels. Images are displayed subtracted.
After X-ray stop in this phase, the Live screen shows a LIH.
Maximum opacification is effective in this phase.
The opac indicator indicates it.

Phase 3  The phase 3 is started with renewed release of fluoroscopy.

Images are displayed subtracted.
The mask image is the maximum opacification image of the phase 2.
The phase 3 will be restarted with each new release of fluoroscopy.

Advanced Roadmap In Artis software VC20, an advanced Roadmap feature was introduced, which uses
DSA Ref a subtracted reference image, e.g. a DSA image, as the mask instead of the mask
created during normal Roadmap phase 2 with opacification.
The reference image, showing the vessel map, will be subtracted from subtracted
live fluoro images, showing the catheter/guidewire.
Besides the static reference image, the dynamic fluoro images are derived by sub-
traction from a mask, which is created during Roadmap phase 1 as before.
From phase 1 onward - without interrupting X-ray - the system directly proceeds
to phase 3 showing two superimposed subtracted images, vessel map and cathe-
ter/guidewire, over all subsequent fluoro images.
Advanced Roadmap DSA Ref requires no phase 2, because no contrast agent in-
jection is needed for creating a vessel map. It saves time and contrast agent. Using
a DSA image as the mask improves the Roadmap image quality.

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Advanced Roadmap Advanced Roadmap DSA Ref consists of two phases, whereas phase 1 is split up in
DSA Ref phases two sections, phase 1a and 1b. Separate Roadmap parameters attitudes exist for
every phase.
Phase 1 Phase 3 LIH 1 Phase 3 LIH 2
1a 1b
Display: native subtracted subtracted subtracted subtracted
I Fluoro - Ref Fluoro - Ref Fluoro - Ref Fluoro - Ref
(I - M) - R (LIH - M) - R (I - M) - R (LIH - M) - R

Images

Mask

Fluoro Regulation Start Fluoro Fluoro Fluoro Fluoro

ON stop phase 3 OFF ON OFF ON
Show Progress
Reset Roadmap

Roadmap phases (I = live image, LIH = last image hold, M = mask image, R = reference image)

Phase 1  After you have selected Roadmap and a Roadmap program, and pressed the
fluoro foot switch, Roadmap starts with phase 1a.
The fluoroscopy images are displayed natively.
– During phase 1a, dose control is active. The transition of phase 1a to
phase 1b is determined by the dose control stop event.
– During phase 1b, images are still displayed natively. The fluoro frames will
be averaged in order to get a mask frame with less noise.
The availability of a noise free fluoro frame triggers the transition of phase 1b
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 displayed subtracted.
The mask image is the reference image.
The phase 3 will be restarted with each new release of fluoroscopy.

K-Factor The k factor reduces image noise by weighted averaging.

K Factor and motion detector 590
 In Roadmap phase 1a, the K-Factor is set to 1 or Auto.

 In Roadmap phase 1b, the K-Factor configured in the Roadmap program is

used.
 In normal Roadmap phase 2 and phase 3, the K-Factor configured in the Road-
map program is also used.
 In Advanced Roadmap phase 3, the K-Factor Phase-3 configured in the Road-
map program is used.

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Roadmap with return It is possible to return to the same system position and configuration at which
to system position roadmap was last performed and reuse the roadmap mask image.
In this way, the amount of contrast agent that needs to be administered to the pa-
tient can be reduced, especially in pediatric cases or in patients who have a low
tolerance of contrast agents.
 Roadmap with two system positions (single plane) 329

 Roadmap with return to biplane system position (Artis biplane) 330

Performing Roadmap

Normal 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.

Single plane roadmap

Starting Roadmap phase 1 (native)

Touchscreen  Exam task card

 Press this icon.

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Console  Examination task card

 Click this icon.

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

– An injection indicator is displayed on the live screen.

– The message Injection is displayed.

Performing Roadmap phase 2 (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 contrast medium.
– The last image of the second phase is displayed inverted (contrast medium
white) and serves as the mask for subsequent fluoroscopic examinations.
– The opac indicator indicates that maximum opacification is effective.

Performing Roadmap phase 3 (subtraction)

Fluoroscopy can be interrupted as often as required. The system remains in
phase 3 and displays additional subtracted images each time the fluoroscopy
switch is pressed.

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 Press the fluoroscopy switch as often as required.

– You will see a fluoroscopy image from which the last filled image of phase 2
is subtracted.
– After you have released the fluoroscopy switch, the last image is retained
and displayed (LIH or auto loop).

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

Footswitch
 Actuate the Reset Roadmap pedal for less than 2 s.
(If configured - example)

Console
 Click this icon.

Touchscreen

 Press the Reset Roadmap button.

Biplane roadmap (Artis biplane)

The roadmap mask image is created either
 separately for each plane

 or simultaneously for both planes

During phase 3 fluoroscopy, can be performed in one plane or in both planes as

often as required.

Note You can perform either fluoroscopy or roadmap: It is not possible to perform sub-
tracted fluoroscopy in one plane and unsubtracted fluoroscopy in the other plane!

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Selecting/deselecting roadmap

Touchscreen  Exam task card

 Press this icon.

Console  Examination task card

 Click this icon.

Footswitch
RDMP  Press the RDMP ON/OFF pedal for longer than 2 s.
Reset A
RDMP
ON/OFF
RDMP
Reset B
– The reset possibilities are displayed.

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Performing roadmap

A+B
 Operate the corresponding FLUORO pedal.

 Perform roadmap as described under Single plane roadmap 318.

A
B

A+B
A
B

Resetting biplane roadmap

If motion artifacts arise, roadmap can be reset in each plane separately:
Roadmap can be reset separately for each plane:

Reset A  resets roadmap for plane A;

a new roadmap mask image must be created for plane A.

Reset B  resets roadmap for plane B;

a new roadmap mask image must be created for plane B.

Reset A + B  resets roadmap for both planes;

roadmap can be restarted.

Footswitch
RDMP  Press the Reset A or Reset B pedal for less than 2 s.
Reset A
RDMP
ON/OFF
– Plane A or plane B will be reset.
RDMP
Reset B
Or
 Briefly press the RDMP ON/OFF pedal.
– Plane A and plane B will be reset.

Touchscreen
 Press the required icon.

Console
 Click the required icon.

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Advanced Roadmap using a reference image

 A Roadmap program is selected which has set the Vessel Presentation DSA
parameter 589 (service parameter 567).
 A subtracted reference image, e.g. from a DSA scene, is shown on the active
reference screen.

Starting Roadmap phase 1 (native)

Touchscreen  Exam task card

 Press this icon.

Console  Examination task card

 Click this icon.

Moving to reference image position

If the C-arm angulation has been changed since acquisition of the reference im-
age, the following message appears on the Artis Assist screen / message bar: Au-
tomatic run: Activate stand movement

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Note In a biplane system, if there are reference images on each plane, e.g. from com-
pletely different projections, the reference image from the master plane has pri-
ority.

 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.

The C-arm moves to the angulation of the reference image.

When the position is reached the following message appears on the Artis Assist
screen / message bar: Automatic run: Position reached
Collimation and zoom stage are set corresponding to the parameters of the refer-
ence image.
Overlay Reference is activated.

Performing fluoroscopy
 The C-arm angulation is in position of the reference image.

 Actuate the FLUORO pedal and keep it pressed.

– After fluoroscopy has begun a normal fluoroscopy image is displayed.
Then, the display automatically switches to a subtracted image.

Performing Roadmap phase 3 (subtraction)

Fluoroscopy can be interrupted as often as required. The system remains in
phase 3 and displays additional subtracted images each time the fluoroscopy
switch is pressed.
 Press the fluoroscopy switch as often as required.
– You will see a fluoroscopy image from which the last filled image of phase 2
is subtracted.
– After you have released the fluoroscopy switch, the last image is retained
and displayed (LIH or auto loop).

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Resetting roadmap 320

Resetting biplane roadmap 322

Note When performing advanced roadmap on a biplane system, the following message
may be displayed:
“XRAY only enabled for plane x”
It occurs when performing roadmap on a single plane, e.g. plane A and then start-
ing biplane fluoroscopy. As both planes are not in the same roadmap phase, fluo-
roscopy will be released only on that plane which is not in phase 3, e.g. plane B.

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”).
Default setting “Move Mask” or “Replace Mask” 398
Replacing the mask 399
Replacing the mask is only possible during Roadmap phase 1 and phase 2.

Touchscreen & Console

 Press/click this icon.

Anatomical background with Roadmap

During Roadmap phase 3, anatomical background can be added to the subtraction
image.
Anatomical background 401
In the examination room, the anatomical background can be adjusted using the
mouse joystick.

Console  Acquisition > Set Anatomical Background is set in the main menu.

Touchscreen Changing anatomical background during roadmap phase 3

 Press the Anatom. Backgr. button.

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 Deflect the mouse joystick.

– Up: more anatomical background
– Down: less anatomical background

Console
 Click this icon.
Anatomical background 401

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 Catheter Contrast are defined in the
Roadmap program.

Note Whenever a roadmap mask is restored with the previous mask function, vessel/
catheter contrast will be reset to the default values from the roadmap program.

Console  Acquisition > Set Vessel / Catheter Contrast is set in the main menu.

Touchscreen Changing vessel/catheter contrast during roadmap phase 3

 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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Console
 Click this icon.

 Click an up/down arrow to adjust a value.

 Click Apply or OK.

Show Progress during Roadmap

During Roadmap phase 3, but not during X-ray, the current Roadmap mask can be
replaced by the LIH.
Performing Show Progress, e.g. during an Onyx injection, will improve the visu-
alization of the progressive movement of the Onyx.

Touchscreen

 Press the Show Progress button.

Console
 Click this icon.

Pixelshift during Roadmap

Between X-ray releases in Roadmap phase 3, it is possible to manually or automat-
ically perform pixelshift.
The pixelshift vectors resulting from this interaction remain the same for every
consecutive radiation release until the next Roadmap reset.
Making the image and mask coincide exactly (Pixelshift) 403

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Touchscreen
 DSA functions

 Press the Pixel Shift button.

Console
 Click this icon on the DSA subtask card.

 Automatic pixelshift 406

 Manual pixelshift 407

 Flexible pixelshift 408

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Roadmap with two system positions (single plane)

During roadmap, two roadmap mask images may be stored for two system posi-
tions, e.g. a LAO and a RAO C-arm position. You can move back and forth between
these positions, performing roadmap at each position without the need of reac-
quiring a roadmap mask. It facilitates some of the benefits of a biplane system on
a single plane system, especially on Artis zeego.
These two roadmap masks are referred to as the current roadmap mask and the
previous roadmap mask. The data, e.g., stand and table position, roadmap pro-
gram, zoom stage, associated with these masks are stored and persist whether
roadmap mode is enabled or disabled.
 The current roadmap mask holds the most recently utilized roadmap mask and
system position.
 The previous roadmap mask holds the second most recently utilized roadmap
mask and system position.
The present system position determines which of the roadmap masks will be re-
called when the Previous Mask icon is activated.
 The current roadmap mask is recalled when the system position is the same as
the current roadmap mask and the roadmap phase is set to phase 1.
 The previous roadmap mask is recalled for all other cases: when the system po-
sition is not the same as the current roadmap mask, or when the system posi-
tion is the same as the current roadmap mask and roadmap phase is set to
phase 3.
It is summarized in the following table:
System position Roadmap phase Mask recalled
Current position 1 Current Roadmap Mask
3 Previous Roadmap Mask
Any other position Any Previous Roadmap Mask

Performing Roadmap with two system positions (single plane)

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

 Move the C-arm and perform another roadmap phase 1,2,3.

(If you reset roadmap, the system displays the following message:
“Roadmap reset. A previous mask is available”.)
 Press/click the Previous Mask icon in the Roadmap dialog.

The following message appears in the examination room:

Automatic run: Activate stand movement

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Examination

 Press the stand joystick down, deflect the joystick and hold it in this position
until the previous roadmap position is reached.
 Or press the hands free foot pedal.

The C-arm moves back to the initial roadmap position.

When the previous position is reached, the following 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.

Note After the previous mask icon has been clicked, X-ray is blocked as long as the sys-
tem is moving to the previous roadmap position.
If the target position cannot be reached for any reason, the function is timed out
and the following message is displayed: “Automatic run: Cancelled”
This time-out takes 30 s. After that, X-ray is enabled again.
Clicking the previous mask button a second time - after it has been activated be-
fore - aborts the function. X-ray is possible thereafter.
After abort of previous mask function, it can be activated again. The roadmap
masks are furthermore available.

Note The latest roadmap masks are kept during the whole study and will be deleted
when a new patient is registered.

Roadmap with return to biplane system position

(Artis biplane)
For biplane systems, the previous roadmap mask feature allows you to return to a
single biplane system position, providing a little more flexibility to interruptions in
the clinical workflow, e.g. if you want to perform fluoroscopy in another zoom
stage or run a 3D acquisition.
The current roadmap mask image pair is the biplane roadmap mask image pair,
system position, exam set, and organ program that have most recently been uti-
lized for roadmap.
For biplane systems just one roadmap mask per plane is kept to be recalled by
clicking the previous mask icon.

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Performing roadmap with return to biplane system position

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

 Deselect roadmap.

 Now you can do something different, e.g. fluoroscopy at different zoom stage
or a 3D acquisition, for example.
 Select roadmap.

Depending on whether a current roadmap mask exists in one or both planes the
system displays one of the following messages:
 “Roadmap reset”

 “Plane A Roadmap reset. A previous mask is available”.

 “Plane B Roadmap reset. A previous mask is available”.

 “Roadmap reset. A previous mask is available”.

An according message is also displayed when you reset roadmap or when you
move a C-arm or change table height.
 Press/click the Previous Mask icon in the Roadmap dialog.

The following message appears in the examination room:

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.
 Or press the hands free foot pedal.

The C-arm moves back to the initial roadmap position.

When the previous position is reached, the following message is displayed:
“Roadmap Plane-A:Previous Mask is in use” or/and
“Roadmap Plane-B:Previous Mask is in use”

A+B
 Press the fluoroscopy switch.
– Roadmap continues with phase 3, using the previous masks.

A
B

A+B
A
B

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 Part: Image Postprocessing
Introduction

The system for angiographic examinations provides you with a series of postpro-
cessing functions for diagnosis and evaluation.

The PostProc task card

You can perform postprocessing at the system console in the control room. Cer-
tain functions can also be executed on the touchscreen control in the examination
room.

On the monitor of the system console in the control

room

(1) (2)
Full screen display on the PostProc task card

(1) Image area

(2) Control area

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Image Postprocessing

A B

Control Image area plane A Image area plane B Control

area area
plane A plane B

Example for biplane configuration

Processing the other plane

 Move the mouse pointer from one screen to the other.

 Click the image on the screen of the required plane.

Now you can select the icons of this plane.

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 Introduction

On the touchscreen control in the examination room

You can select several postprocessing functions on the Image task card and per-
form them with the mouse joystick.
Operation via touchscreen control 225

Example

Note The screen layout on the touchscreen in the examination room depends on the
system type and configuration.
Configuring the touchscreen layout 229

Text information in images (full screen)

In images various information is displayed as image text. This text information
identifies the patient and documents examination and image parameters.

Note Not all information is displayed in all images.

With the exception of the patient name and the patient ID number, you can
configure which texts are displayed.
 Call up the Configuration Panel via Options > Configuration and then
double-click Image Text Editor.

Image texts are grouped by content and displayed in the four corners and along
the bottom edges of each image.

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Image Postprocessing

Live screen

(6)
(1)

(5)

(2) (4)

(3)
Example

(1) Patient and examination data

(2) Exposure parameters
(3) Room for message line1 and ECG display2
(4) Image parameters
(5) Scale bar
(6) System-specific information

1
in control room only
2 with cardiac systems only

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 Introduction

Patient and examination data

Image text Abbrevia- Example

tion
Patient name - Peter Patient
Patient ID - 123
Date of birth - *06/01/62
Study ID - STUDY1
Acquisition date - 11.8.2003
Acquisition time - 10:08:32 AM
Scene and image number/ total num- - 1002 - 9/38
ber of images or number of frames
(center image)
Mask number - M4
Scene time - 4.00 s

Exposure parameters

Image text Abbrevia- Example

tion
Quality factor (only if the image is CQ CQ 40
compressed with loss)
Exam set - Renalis
Zoom - cm 20
Plane for images of biplane systems A
Plane A A
Plane B B
Tube voltage kV kV 82
Tube current mA mA 708
Dose (in nGy per image) D D 421
Angulation RAO-LAO / CRAN-CAUD - RAO 7° / 0°

Note If a question mark (?) appears instead of a value, no value is available for this
parameter.

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Image Postprocessing

System-specific information

Image text Abbrevia- Example

tion
Institution - Room 3
Manufacturer's model name - Artis
Program version - VB30B
Patient position HFS
Head first H
Feet first F
Left lateral L
Right lateral R
Supine position S
Prone position P
Work status of scene //////R

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 Introduction

Image parameters

Image text Abbrevia- Example

tion
Image matrix - 950 x 1240
Opacification OPAC OPAC
Edge enhancement filter EE EE 10%
Dynamic density optimization DDO DDO 10%
(harmonization)
Anatomical background (landmark) AB AB 0%
Vessel contrast VC VC 100%
Catheter contrast CC CC 100%
Overlay Ref Overlay Overlay 10%
Pixelshift (x,y) - x/y -2.4/-6.1
Window center (native) WC WC 123
Brightness (subtracted) WB WB 143
Window width (native) WW WW 2809
Contrast (subtracted) WC WC 43

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Image Postprocessing

Orientation and laterality labels

Example

(1) Orientation labels1

H = Head
F = Feet
R = Right
L = Left
A = Anterior2
P = Posterior2
(2) Laterality of the organ displayed in the image
R = Right
L = Left

Patient orientation Standard orientation labels (left center and top center in the image) are set auto-
matically when the patient position is entered.1

Laterality (right/left Laterality labels (R/L labels) are used to label paired organs, e.g. kidneys.
assignment) Entering/changing the laterality 347

Note Laterality (right/left assignment) applies to the image content (right/left organ)
and not to the right/left side of the patient.

1
The orientation labels can be permanently hidden by Siemens Service.
2 in the lateral position or angle >45° LAO/RAO

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Text information in the scene/image directory

In the overview mode (scene directory of a patient, image directory of a scene)
some selected text is displayed for each scene / each (reference) image.

Example

Image text Example

Image number 15
Angulation RAO:0 CRA:0
Acquisition mode DSA
Acquisition plane Plane A
Image type SCENE
Work status of scene /////R/

Starting postprocessing
Before you can start postprocessing, you select the patient using the Patient
Browser and load him into the PostProc task card.

Note If you want to postprocess images which are stored on an archive medium, you
must first copy the data to the Local Database.

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Active patient

The name of the active postprocessing patient is displayed at the top of the con-
trol area next to the folder icon.
If no patient is selected, the folder icon appears closed and the image area is dark.

Calling up the Patient Browser

 Press the patient browser key (Num .) on the symbol keypad.

Or:
 From the main menu, select Patient > Browser... .

Or:
 Click the folder icon with the right mouse button.

 Select Patient Browser from the popup menu.

The Patient Browser is displayed.

For more information on the Patient Browser, please refer to the syngo docu-
mentation.

Loading a scene/image
You can load and view any scenes/images which are stored in the local database
of your system and which are supported by syngo, e.g. have one of the following
formats:
 X-ray images (XA or XRF) up to 2048² with depth 8/10/12/14 bits

 CT images in 512² and 1024² with depth 8/10/12 bits

 MR images in 512² and 1024² with depth 8/10/12 bits

Note DICOM Waveform objects, e.g. Sensis Waveforms, can also be stored in the local
database but cannot be displayed.

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From the following systems:

 Artis

 syngo Workplace

 Other syngo® systems

 FLUOROSPOT Compact (Iconos ..., Luminos ...)

 HICOR T.O.P.

 POLYTRON T.O.P. (including PERIVISION and DYNAVISION scenes)

 DICOM-compliant images from systems of other vendors

 ACOM Report images

 Select the required patient, the required study/series/scene (images) in the

Patient Browser and load them by drag & drop or by double-clicking.
Or
 Navigate with the cursor keys on the keyboard.

 Press the Return or Enter key to load the selected object.

Depending on which data level was selected in the Patient Browser, the images
are displayed:
 Patient or study level: directory view

 Series or image level: full screen view

Scenes and single images are displayed on the live screen.

If a reference screen is configured, reference images are displayed on the active
reference screen.

Searching for and importing data in the network

Using the Patient Search, you can query and retrieve patient and examination
data from workstations and long-term archives that are working with other
DICOM program systems or older syngo program versions and are therefore not
displayed in the navigation area of the Patient Browser.
 Click this icon in the toolbar.

Or
 Select Patient > Search... from the menu of the Patient Browser.

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The Patient Search window is displayed.

 Enter your search criteria and click Search.

For more information on searching using the Patient Browser, please refer to the
syngo documentation.

Changing patient data

Note It is not possible to correct or rearrange patient data in the following cases:
 Specific data of special objects, e.g. patient position in the Exam Protocol SR

 Protected data

 Data of HIS/RIS patients

 Data of the current examination patient during radiation

 Data on external media

Note Corrections depend on the selected level in the Patient Browser: Patient - Study
- Series - Instance
Only those data can be modified which refer to the selected level. To modify the
name of the series (scene name), for example, the Series level must be selected.
Studies which include only one scene should be corrected on the Instance level.

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Open the Correct window

 Select Edit > Correct in the main menu of the PostProc task card.

Or
 Call up the Patient Browser.

 Select the patient entry, the study/series/scene.

 Select Edit > Correct in the menu of the Patient Browser.

– The Correct window is displayed.

Renaming/correcting an emergency patient

 Open the Correct window 345

 Click the Patient subtask card, if necessary.

 Enter the correct patient data.

 Change other data, if necessary.

 Enter the modifier’s name 347

Changing the name of a series

You can change an automatically assigned name of a series (scene name).

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Note When changing the name of a series, you should always change both Series
description and Protocol name.
It is, because different network software may use either the Series description or
the Protocol name from the DICOM header.

 Open the Correct window 345

 Click the Series subtask card, if necessary.

 Overwrite the text in the Series description input field as required.

 Mark the entered text.

 Press Ctrl + C on the keyboard (copy).

 Mark the old text in the Protocol name input field.

 Press Ctrl + V on the keyboard (paste).

 Enter the modifier’s name 347

Changing the registered patient position after acquisition

 Open the Correct window 345

 Click the Series subtask card, if necessary.

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 Select the correct position from Patient position selection list.

 Enter the modifier’s name 347

Entering/changing the laterality

Note When transferring scenes/images, make sure that the recipient system can display
the DICOM “Laterality” attribute.

Incorrect right/left labeling

Caution Risk of incorrect diagnosis, e.g. surgical intervention on the wrong side
The examiner is responsible for correct right/left labeling.
 Make sure that the R/L labels have been placed correctly.

 If necessary, use lead letters or similar devices during fluoroscopy/acquisition.

 Open the Correct window 345

 Click the Series subtask card, if necessary.

 Select the correct laterality from Laterality selection list.

 Enter the modifier’s name 347

Enter the modifier’s name

To close the Correct window, perform as follows:

 Enter your name under Modifier's name or select your name from the selec-
tion list.1
 Confirm by clicking OK.

For more information on Correcting and Rearranging, please refer to the syngo
documentation.

1 only necessary if security is not enabled

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Moving series/scenes/images accidentally acquired

under the wrong patient

Note Rearrange is not possible in the following cases:

 Rearrange to the wrong data level

 Rearrange scenes/images to a series acquired with another patient position

 When images were acquired on a different modality (e.g. CT)

 Call up the Patient Browser.

 Select the series/scenes (images).

Drag & Drop

 Drag the selected data to the target position and release the mouse button.

Cut & Paste

 Click this icon or call up Edit > Cut from the menu of the Patient Browser.

 Click the target position.

 Click this icon or call up Edit > Paste from the menu of the Patient Browser.
– The Rearrange dialog box will be displayed.

 Enter your name under Modifier's name or select your name from the selec-
tion list.
 Confirm by clicking OK.

For more information on Correcting and Rearranging, please refer to the syngo
documentation.

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Managing and Viewing Scenes/Images

Viewing functions The following viewing functions can be used for optimized display of scenes:

Touchscreen Monitor screen Description Effects both Effects single

planes plane

- Open the Image Player 356 +

Scene Directory 351 +

Reference Image Directory 351 +

Content selection 352 +

Scene - / Scene + 354 +

Ref - / Ref + 354 +

Single step 359 +

Review controls 358 +

Scene Overview 357 +

Full-screen 357 +

- View > Review Mode 362 +

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Touchscreen Monitor screen Description Effects both Effects single

planes plane

Loop All Scenes 364 +

Image > Max. Fill 364 +

Override

Shutter 367 +

Invert Gray Scale 368 +

Zoom 2x 369 +

Zoom to Acquisition Size 369 +

Pan (Automatically activated with zoom.) +

- Image mirror/flip preselection 292 +

- Flip Horizontally +
Image flip/mirror 366

- Flip Vertically +
Image flip/mirror 366

CLEARstent 307 +

Opacification 409 +

Pointer 372 +

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Touchscreen Monitor screen Description Effects both Effects single

planes plane

Hide annotations 390 +

- View > Image Text 373 +

- View > Scene Timer 374 +
View > ECG Display 374 +

The scene directory of a patient

Scene directory

Once you have selected a patient, you can call up an overview display of the stored
scenes/images/reference images.

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Displaying the scene directory

Console  PostProc or Quant task card

 Click this icon.

Touchscreen
 Press these icons.

The system switches to 4 x 4 display mode and displays the representative image
of each stored scene.

Representative
A scene is represented by a specific image in the overview display.
 Native: It is the center image for scenes acquired natively.

 Subtracted: It is an image with maximum fill (Max Fill image) in DSA scenes.

Replacing the maximum fill image 364

Limiting display to scenes/images/reference images

To make selecting a scene/image easier, you can apply a filter to the scene direc-
tory.

Console You have the following choice:

 Scene: only scenes (multiframes): acquisitions and fluoroscopy

 Ref. Image: only reference images1

 Store Monitor: only stored images

 + Ref. Image: scenes and reference images1

 + Store Monitor: scenes and stored images (no reference images)

 SM + Ref. Image: stored images and reference images

1 On systems with reference screens configured, reference images are displayed only on the active ref-
erence screen.

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 Pick the required display from the selection list.

– Only the selected types are displayed in the scene directory in an order that
flows left to right, top to bottom; in ascending order by series number and
then by image number.
– Types other than the selected ones are skipped when scrolling through the
full-screen display.

Touchscreen On the touchscreen control, you can switch between scenes and reference imag-
es.
 Press these icons.
– Only reference images are displayed.

Scrolling through the directories

 The scene directory is open. 357

If more than 16 scenes/images/reference images are stored in the study, you can
scroll through the overview display.

Console
 Use the scroll bar:

Or
 Press the Page Up or Page Down key on the keyboard.

Touchscreen
 Deflect the mouse joystick.

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Selecting scenes/(reference) images

 The scene directory is open. 357

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

guidance when performing multi-segment selection via the keyboard.
 A broken-line highlight frame is used to identify 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.

Changing the selection

Console  Click (with the left mouse button) on the required scene.
– The selected scene is displayed with a thick border.
Or
 Use the arrow keys on the keyboard.
Or
 Click the - or + button.

Touchscreen
 Deflect the mouse joystick.

Selecting more than one scene

Console (only) You can select more than one scene at a time, e.g. for filming/sending.

All scenes  Click the first scene, press the Shift key, scroll to the last scene, and click it.
Scrolling through the directories 353

A series of scenes  Click the first scene, press the Ctrl key, and click further scenes.

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The selected scenes are marked with a dashed border.

Selecting a scene/(reference) image

Console & Touchscreen  Double-click the required image.

– The scene / image is selected and displayed as full screen.
Or
 The required scene/image is marked with a border.

 Press the Return or Enter key on the keyboard.

Scrolling through scenes/(reference) images

 A scene or image is displayed in full screen or is selected in the scene directory.

Console
 Pick the required display from the selection list.

 Scene: Scenes and report images will be loaded in ascending order by series
number, when available, then by image number.
Ref. Image:
– If a reference screen is configured, reference images will be loaded in
ascending chronological order to the active reference screen.
– If no reference screen is available, reference images will be loaded in
ascending chronological order to the Live screen.
 Store Monitor: Store Monitor images will be loaded in ascending chronologi-
cal order.
 + Ref. Image: Scenes and reference images will be loaded in ascending chron-
ological order on the respective screen.
Every scene will be followed by any associated reports and reference images,
sorted by image number.
 + Store Monitor: Scenes and Store Monitor images will be loaded in ascend-
ing chronological order.
Every scene will be followed by any associated reports and Store Monitor im-
ages, sorted by image number.
 SM + Ref. Image: Store Monitor images and reference images will be loaded
in ascending order by series number.
 Click the - or + button.

Or

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Image Postprocessing

 Press the Scene - (Num 4) or Scene + (Num 5) keys.

Note When reviewing a biplane scene, i.e. plane A and plane B images, on a single plane
configuration, invoking Scene + and Scene - will not toggle between the plane A
and plane B images of the biplane scene. Instead Scene +/- will load the next/pre-
vious image or scene in the load order determined by the rules above.
When Scene + or Scene - loads a biplane scene on a single plane configuration,
the plane A image is displayed by default.

Touchscreen Scenes
 Press this icon to open the Image Player.

 Press Scene -/+.

Reference images
 Press these icons to open the Image Player for reference images.

 Press Ref -/+.

Note When you scroll using the Ref -/+ buttons the reference images are displayed in a
loop, i.e.:
 after the last reference image the first reference image is displayed,

 after the first reference image the last reference image is displayed.

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Scene overview

Scene overview

The scene overview displays single images (frames) of a scene.

Console Displaying the scene overview

 The scene is displayed in full screen or is selected in the scene directory.

 Click the 4 x 4 icon on the View subtask card.

The system switches to 4 x 4 display mode and shows the images of the scene
with reduced resolution.

Selecting an image and switching to full-screen display

 The required image is selected in the scene overview.

 Double-click the required image.

– The image is selected and displayed full screen.
Or
 Click the required image.

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 Click the icon for full-screen mode on the View subtask card.
– The system switches to full-screen display and displays the image which was
last selected in the scene.

Touchscreen Displaying the scene overview and selecting an image

 The scene directory is open. 357

 Deflect the mouse joystick to navigate within the scene overview.

 Press the left button of the mouse joystick.

– The image/scene is displayed in full screen.

Controlling scene review (Loop)

You can review scenes at the same frame rate as they were acquired or you can
slow down or speed up scene review depending on the acquisition frame rate and
system configuration.
After you have called up a scene, it is first displayed as preset: with the max fill im-
age or in a loop. 362
You can stop a scene at any time, scroll forward or backward by one image, or re-
sume reviewing.

Stopping the loop

Console
 Click the stop button.
– The scene is stopped at the last displayed image.
Or
 Click into the image area (with the left mouse button).

Touchscreen
 Deflect the mouse joystick briefly.

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Single step
Console
 Click a single step button.
– A running scene is stopped at the last frame displayed and switched back-
ward or forward by one frame.
– A stopped scene is switched forward or backward by one frame.
Or
 Click into the image area.
– If you click into the left half of the image, the scene is stopped. With the
next click, the previous frame is displayed.
– If you click into the right half of the image, the scene is stopped. With the
next click, the next frame is displayed.

backward forward
Or
 Rotate the wheel of the mouse.
– Each rest position one frame previous/next is displayed.
Or
 Press the Image - (Num 1) or Image + (Num 2) button.
– The previous/next frame is displayed.

Touchscreen
 Deflect the mouse joystick briefly.
– The loop stops.
 Deflect the mouse joystick briefly.
– Left: one image backward
– Right: one image forward
Or
 Press this icon to open the Image Player.

 Press one of these icons.

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Starting the loop

Console
 Click the review button.

Or
 Click into the image area and hold the mouse button pressed for a moment.
– The images are displayed in a loop (or in toggle display in the case of
DYNAVISION/3D).

Touchscreen
 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.
If the joystick is held in its final position for more than 2 s, scene review is speeded
up to its maximum speed.
If you release the joystick, the scene runs at acquisition speed again.
The review direction is indicated in the control area of the live screen.

Acquisition mode and frame rate

The acquisition mode and frame rate of the loaded scene are displayed on the top
left corner of the review controls.

Acquisition modes Depending on image type the following acquisition modes are displayed:

Image type Acquisition mode displayed

CARD (Cardangiography), CARD-DSA CARD
DSA (Digital Subtraction Angiography) DSA
DR (Digital Radiography) DR
PERIVISION PERI
PERISTEPPING DR STEP
(DSA-)DYNAVISION DYNA
DR-DYNAVISION DR DYNA
DR-Scanning DR SCAN

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Image type Acquisition mode displayed

3D CARD 3D CARD
3D DSA 3D DSA
3D DR 3D DR
3D Large Volume Large Vol.
DynaCT 360 Large Vol.
Reference image Ref Image
CLEARstent reference image Ref Image
CLEARstent Live scene Stent live
CLEARstent Dynamic scene STENT
Ready processed image Ready Proc.
Unstored fluoroscopy scene FLUORO
Stored fluoroscopy scene Store Fluoro
Unstored roadmap scene ROADMAP
Stored roadmap scene Store Roadmap
Exam protocol stored as XA image <blank>
ACOM report ACOM.Report
Quant reports <blank>

Setting the review frame rate

Console Acquisition frame rate
Depending on the acquisition mode, you can control the review frame rate with
the slider:
 Slider to the right: the scene is reviewed forward

 Slider in center position: the scene is stopped

 Slider to the left: the scene is reviewed backward

Changing the review frame rate

 Click and drag the slider to the required position.
– The scene is replayed immediately at the new frame rate, if possible.
– The current frame rate is displayed on the top right corner.

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Changing the review frame rate step by step

 Click the bar of the slider.
– Every time you click it, the frame rate is changed by one step.

Touchscreen Setting the review frame 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 frame 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.

Defining the default review mode

Console (only) When a scene is loaded again it is displayed as defined by the Default Review
Mode.

Review modes for  LIH (Last Image Hold)

fluoroscopy/roadmap The last fluoroscopic/roadmap image is displayed.
 Loop
A scene is replayed continuously. After the last image, the same scene starts
again from the beginning.

Review modes  MFH = Max. Fill Hold

for acquisitions After loading a scene its maximum fill image is immediately 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 effect).

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Depending on scene type, different review modes are available:

Available review LIH MFH Loop Toggle Single step

modes only
Fluoro/Roadmap x x
scenes
DR/DSA scenes x x
CARD and CLEARstent x
scenes
Rotational scenes x x
Report images x

Note CLEARstent scenes will be displayed in Toggle review mode when review mode
is set to Loop. It is an exception to the default review mode.

Defining the review mode

 In the main menu, select View > Review Mode.
– A dialog box appears with the available review modes.

 Select the required review mode for the available acquisition modes.

 Confirm your selection by clicking Close.

– Any current scene will immediately be reviewed with the mode selected for
the scene type.
– Any new scenes loaded for review are replayed with the modes you have
set.

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Loop through all scenes

You can set the review in such a way that the scenes in the current study are re-
played one after the other during full-screen display.

Console
 Click this icon.
Or
 Select View > Loop All Scenes from the main menu.

Touchscreen
 Press this icon.

– A loop indicator is displayed on the live screen in the examination room.

After the end of the first scene, the second scene is replayed, etc.

Replacing the maximum fill image

During acquisition, the acquisition system automatically selects the “maximum”
fill image (Max Fill) or “minimum” fill image in the case of CO2 DSA. This image is
used as scene representative, that is, it is displayed in the scene directory.
If you want to use an image other than the automatically chosen image as scene
representative, you can replace it as described below:

Console  Select Image > Max. Fill Override from the main menu.

Touchscreen
 Press this icon.

The currently displayed image is selected as the new scene representative.

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Changing scene/image display

Console On the View and Image subtask cards, in the View and Image menu, and in the
popup menu (right mouse button in the image), you will find the tools for chang-
ing the display of a scene/(reference) image.

Subtask card Main menu Popup menu

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Touchscreen Functions for image viewing and processing are located on the Image task card.

Example

Image flip/mirror
You can flip images of a scene horizontally and/or vertically.
 DR, DSA or CARD scenes are flipped accordingly.
All images of a scene are flipped.
 PERIVISION or PERISTEPPING scenes can be flipped about the vertical axis only.
All images of all steps are flipped.
Flipping around the horizontal axis is not possible.
 DYNAVISION, DSA-DYNAVISION, 3D or 3D CARD scenes can be flipped in both
axis.
All images of all phases are flipped (mask, injection, fill, washout).

Image flipped
Caution Confusion between up/down/left/right can cause incorrect diagnosis!
The examiner is responsible for using the functions and interpreting the images
correctly and the consequences resulting from it.
 Check patient position data in the current image to exclude any errors.

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Console Flipping an image

 Click the icon for the required function.
Or
 Select Image > Flip Horizontally / Flip Vertically from the main menu or Flip
Horizontally / Flip Vertically from the popup menu.
– The image is flipped (top and bottom or left and right are swapped round).

Note To achieve rotation through 180°, perform both functions one after the other.

Touchscreen Image mirror/flip preselection 292

Setting an electronic shutter

If you want to hide unimportant details outside the center of the image, you can
set an electronic shutter. It is done on an enlarged image in the same way as on
an unzoomed image.

Note Please observe, that some image review stations cannot correctly interpret the
electronic shutter.
 Open the electronic shutter completely before sending images.

Note If the shutter function is used with an image that was acquired with a polygonal
shutter, the polygonal shutter is removed and replaced with a rectangular shutter.
The polygonal shutter will no longer appear when the function is deselected.

Note The shutter position is stored with the scene for subsequent reviews.

Setting the shutter

Console  PostProc task card, View subtask card

 Click this icon.

Or
 Select View > Shutter from the main menu or Shutter from the popup menu.

You can now adjust the shutter.

 Move the mouse pointer to the horizontal or vertical shutter edge.
– The mouse pointer changes shape.
 Drag the shutter open or closed.
– The entire scene / the image is displayed symmetrically to the image center.

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Touchscreen  Image task card

 Press this icon.

You can now adjust the shutter.

 Deflect the mouse joystick.
– Left: the left and right shutters are opened symmetrically.
– Right: the left and right shutters are closed symmetrically.
– Up: the upper and lower shutters are opened symmetrically.
– Down: the upper and lower shutters are closed symmetrically.

Panning the image behind the shutter

Console
 Press and hold the Shift key.
6KLIW

 Click and drag the image behind the shutter.

Touchscreen
 Press the left button and deflect the mouse joystick.

Switching off the shutter

 Deactivate the function.

The shutter is no longer changeable.

Inverting grayscale values

You can invert the gray scale of an image / a scene, that is, bones black become
bones white and vice versa.

Note The electronic shutters will always be shown in black, regardless of inversion.

Console  PostProc task card, View subtask card

 Click this icon.

Or
 Select Image > Invert Gray Scale from the main menu or Invert Gray Scale
from the popup menu.

Touchscreen  Image task card

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 Press this icon.

The gray scale of the entire scene/image is inverted (black and white reversal).

Magnifying the scene/image, zooming/panning

If you want to see image details more clearly, you can magnify the scene/image
and then move the detail of interest to the image center.
Depending on image matrix and image type of the current scene/image, and the
installed licenses, different zoom functions are available:

Console Touch- Explanation

screen
Zoom by a factor of 2

Zoom to Acquisition Size (1:1 pixel display)

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Image Postprocessing

1920 2480 (1) (2)

1024

1024
(3)

2480 (1) (2)

1920

1024 1024

1024
1024

(4)

Example for Acquisition Size

(1) Image on the flat detector

(2) Display on the screen
(3) Initial display
(4) Zoomed to Acquisition Size

Note When zooming CLEARstent reference images or CLEARstent scenes from Artis
VC20 or higher, the CLEARstent ROI values saved with the image are used and the
image is positioned in the center of the viewing area. Unused borders will be dis-
played black.

Note Zoom and Pan are not available for downsized Store Monitor images after
archiving, for example to DVD.

Precondition Zoom to Acquisition Size is available only in the following cases:

 One side of the current image has more than 1024 pixels, if the 2K license is
configured.
 The current image is either a CLEARstent reference image or a CLEARstent
scene from Artis VC20 or higher, if the CLEARstent license is configured, but
not the 2K license.
Ready processed images cannot be zoomed to Acquisition Size.

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Note When a biplane scene is loaded and the precondition as specified above is satisfied
only for one plane, the zoom to Acquisition Size can be enabled in both planes,
but when selected, the function will apply only to the qualified plane.

Switching on zoom

Console  PostProc task card, View subtask card

 Click the required icon.

Or
 Select View > Zoom / View > Acquisition Size from the main menu or Zoom /
Acquisition Size from the popup menu.

Note If zoom is active, you cannot scroll through or stop the scene with a mouse click
in the image area.

Touchscreen  Image task card

 Press the required icon.

Console & Touchscreen Panning the image

 Move the mouse pointer into the image.

 Click and drag in the image area.

– The image is moved simultaneously.

Move image up

Move image to left Move image to right

Move image down

Panning without zoom

If only a part of the image is shown, you can pan the image without clicking any
icon.
 Press and hold the Shift key.
6KLIW
 Click and drag the image.

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Using pointers
When you are working at the console in the control/examination room, your
mouse pointer will normally not be displayed on the screen in the other room.
Using the pointer function you can point out certain image detail to someone else
on the screen in the other room.
The pointer function is especially useful during fluoroscopy, roadmap and overlay
reference, including iPilot reference images. The pointer function is also useful in
conjunction with magnetic navigation systems.

Independent pointers The system provides two independent pointers that can be activated at the same
time whereby one can be started from in the examination room and the other can
be started from in the control room.

Drop pointer objects When you wish to point out certain image detail in multiple locations at the same
time, e.g. on plane A and on plane B, you may “drop” pointer objects onto the im-
age while the pointer function is still active.
A maximum of five pointer objects can be placed in an image (both planes).

Console Start pointing

 Click this icon on the Tools subtask card.
– The mouse pointer changes its shape and is displayed on the screen in the
examination room.

Control room Examination room

Moving the pointer

 Move the mouse pointer within the image.
– The pointer on the Live screen in the examination room moves accordingly.

Dropping a new pointer object

 Perform a single mouse click.

Moving a selected pointer object

 Drag and drop the pointer object to the new position.

Deleting a selected pointer object

 Press the Del key on the keyboard.

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Exit pointing
 Click this icon.
Or
 Press the right mouse button.

Touchscreen Start pointing

 Press this icon.
– The mouse pointer changes its shape and is displayed on the screen in the
control room.

Control room Examination room

Moving the pointer

 Deflect the mouse joystick.

Dropping a new pointer object

Or selecting a pointer object if mouse cursor is positioned over an existing pointer
object.
 Press the left button of the mouse joystick.

Moving a selected pointer object

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

Exit pointing
 Press the right button of the mouse joystick.

Switching image text on/off

You can temporarily switch off the image text display and then switch it on again.

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Console (only)  Select or deselect View > Image Text from the main menu or Image Text from
the popup menu.
– The image text is shown/hidden (except for the patient´s name and ID).

Note If you do not want certain text to be displayed, you can configure every text entry
(with the exception of the patient name and patient ID) with the help of the Im-
age Text Editor in the Configuration Panel (Options > Configuration in the
main menu.

Switching scene time display on/off

The scene time is the current run time of the acquisition scene from the beginning
of the scene. You can switch this time display on or off.

Console (only)  Select or deselect View > Scene Timer from the main menu or Scene Timer
from the popup menu.
– The scene time is shown/hidden.

Switching ECG display on/off

For scenes acquired with an ECG, you can activate or deactivate the ECG display.

Console  Select or deselect View > ECG Display from the main menu or ECG Display
from the popup menu.

Touchscreen  Image task card

 Press this icon.

– The ECG is shown/hidden at the bottom of the image area.

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Processing Scenes/Images

Processing functions The following postprocessing functions can be used for optimized display and an-
notation of scenes:

Touchscreen Monitor screen Description Effects both Effects single

planes plane

Image display/ Image processing:

Adjust subtask card Windowing: Adapt the digitally stored +
grayscale values to the visual acuity of
the human eye. (Set “brightness” and
“contrast”) 378

Auto Window 381 +

- Window Home 380 +

Edge Enhancement: Emphasize +

details 381

- Edge Enhancement Home 382 +

Annotations and graphics:

Tools subtask card +
383

Annotation: Enter predefined or new +

text in the image 387

Circle 391 +

Line 392 +

Arrow 392 +

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Touchscreen Monitor screen Description Effects both Effects single

planes plane

Polygon 393 +

Pointer 372 +

Measurements:
Tools subtask card +
383

Distance 615 +

Polyline Curve/Curved Distance +

Measurement 615

Angle 619 +

Miscellaneous:
Hide Annotations and Measure- +
ments 390

Del key Delete Selected Annotation and +

Measurements 386

Defining window and filter values

Information about windowing

With contrast and brightness windowing, you can adapt the image to display the
gray scale region of interest with optimal contrast conditions.

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The individual pixels of an X-ray image are stored as integer values. These values
represent a range of image brightness divided into increments much finer than
the human eye can perceive. The screen can display a specific (smaller) range of
brightness values. The purpose of the windowing function is to define the range
to be displayed and the way it should be displayed.

DR images The displayed window area is defined by a pair of numbers.

The values used for non-subtracted images are the window center = WC and the
window width = WW.

DSA images DSA images displayed after subtraction (difference between fill and mask) can be
windowed in the same way as native images.
For subtracted images, the window brightness = WB and the window contrast =
WC are used.

max. highest absorption bright value

WW: Window Width WC: Window Center

screen value range

stored value range

lowest absorption dark value

Principle of windowing (display contrast agent/bones black)

Windowing You can enter these values directly or set them with the mouse.
Setting window values manually 378

Window center  The “image brightness” is altered by moving the window center.

Window width  The “image contrast” is altered with the window width.

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Value range
Window center (native) WC 0 to 4095 for 12-bit images
0 to 1023 for 10-bit images
Brightness (subtracted) WB
0 to 255 for 8-bit images
Window width (native) WW 1 to 4095 for 12-bit images
1 to 1023 for 10-bit images
Contrast (subtracted) WC
1 to 255 for 8-bit images

Display The window values are displayed at the bottom right in the image and on the
Adjust subtask card.

non-subtracted: subtracted:

Auto Windowing Using the Auto Windowing function, you can apply optimized window values
(window center and window width) to an image/scene.
Assigning automatic window values 381
Window values based on an algorithm defined in the corresponding exam set and
the existing exposure conditions are used.
 If auto windowing values are stored with the image/scene, these values will be
applied to the current image/scene.
 If no auto windowing values are stored with a scene, the auto window algo-
rithm calculates the optimal window width and center using the Best Image
Hold frame (or Max Fill frame) of the scene. The newly calculated window
width and center are then applied to all frames of the scene.

Setting window values manually

After acquisition, the image is displayed in accordance with the window values de-
fined in the exam set.

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

On the Adjust subtask card, you can set the window and edge enhancement filter
values.

Note Extreme window values can change image display in such a way that a diagnosis
is no longer possible.
 Check the image impression after windowing.

Note All changes are stored automatically with the scene / with the image.

Console Windowing with the mouse

 Click into the image with the middle mouse button and move the mouse with
the button pressed.
– The mouse pointer changes its shape (WL).

C+

W- W+

C-

 upward: to increase window center/brightness values.

 downward: to decrease window center/brightness values.
 to the right: to increase window width/contrast .
 to the left: to reduce window width/contrast .
The image is displayed immediately with the changed window values.

Windowing numerically
To use specific window values:

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Image Postprocessing

 Enter the values for window center/brightness

and window width/contrast .
Or
 Click an up/down arrow to adjust a value.
– Windowing is performed simultaneously.

Windowing with the keyboard

For fine adjustment of the window values, you can also use the keys on the symbol
keypad of the keyboard:
 Press these keys to increase or reduce the window width/contrast
step by step.

 Press these keys to increase/decrease the window center/brightness values

step by step.

Note You can also continuously adjust windowing via the keyboard by keeping the but-
ton pressed, i.e. auto-repeat is performed.

Resetting window values

 Click this icon.

Touchscreen Starting windowing

 Press this icon.

 Deflect the mouse joystick.

Resetting window values

 Press the left button of the mouse joystick.

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Closing windowing
 Press the right button of the mouse joystick.

Assigning automatic window values

Console
 Click this icon.

Or
 Press this key.

Touchscreen
 Press this icon.

Now the images will be displayed with optimized window values typical for the ex-
amination in question.

Edge enhancement filter

Depending on the examination (organ to be examined, dose, ...), it might be nec-
essary to improve the display of edges or to improve the noise suppression. It is
defined in the exam sets on the acquisition system but can be changed later.

Value range Edge enhancement EE: 0 to 100%

 Edge enhancement greater: sharper edges, more noise

 Edge enhancement less: softer edges, less noise

Note Extreme edge enhancement values can change image display in such a way that
a diagnosis is no longer possible. Artifacts may appear.
 Check the image impression after filtering.

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Console Setting edge enhancement

 Enter a percentage.

Or
 Click the arrows.
– The edge enhancement is performed simultaneously.

Resetting edge enhancement

 Click this icon.

Touchscreen Starting edge enhancement

 Press this icon.

 Deflect the mouse joystick.

– Up: more edge enhancement
– Down: less edge enhancement

Resetting edge enhancement values

 Press the left button of the mouse joystick.

Closing edge enhancement

 Press the right button of the mouse joystick.

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Adding text and graphics to images

Console

The tools for annotating images with text and graphics can be found on the Tools
subtask card.

Touchscreen
 Press this icon.

General information about text and graphics

According to the DICOM standard, a medical image consists of two “planes”:
 a pixel image (in which graphics may also be “burnt”)

 superimposed graphic elements (vector graphics)

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Graphic elements You can draw graphic elements into images. Graphic elements include:

(2)

(1) (3)

(10) (4) (6)

(5)

(9) (8) (7)

(1) Annotations
(2) Circles
(3) Polygons
(4) Lines
(5) Arrows
(6) Electronic shutter

Measurements Graphics are also added with measurements, e.g. with

(7) Angles
(8) Distances

Pointer (9) A pointer is available for temporary marking of image details. 372

Hide/show (10) Hide/show annotations 390

Selecting and manipulating graphic elements

Console Selecting and manipulating a single graphic element
You can select, move and modify existing graphic elements in the PostProc task
card at any time.
 Move the mouse pointer onto the graphic element.
– The mouse pointer changes shape.
 Drag and drop the graphic element using the left mouse button.

 Perform a double click when you want to finish an operation.

Console (only) Selecting several graphic elements

If several graphic elements are drawn in an image, you can select them simulta-
neously to - for instance - delete or move them at the same time. Proceed as fol-
lows:

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 Click the first graphic element.

 Press the Ctrl key and keep it pressed.

&WUO
 Click the other graphic elements one after the other.

Console (only) Selecting all graphic elements

You can also select all graphic elements on the image at once.
 Call Select All Annotations from the popup menu.

Touchscreen Selecting and manipulating a graphic element

 The Annotations functions have been selected.

 Position the mouse pointer on the graphic element to delete.

– The graphic element is selected.
 Position the mouse pointer on a graphic handle (square).

 Press the left button of the mouse joystick.

 Move the graphic handle to the required position.

 Press the left button of the mouse joystick. again.

Touchscreen Selecting and moving a graphic element

 The Annotations functions have been selected.

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 Position the mouse pointer on the graphic element to delete.

– The graphic element is selected.
 Position the mouse pointer anywhere on the graphic element but not on a
graphic handle (square).

 Press the left button of the mouse joystick.

 Move the graphic element to the required position.

 Press the left button of the mouse joystick. again.

Touchscreen Deselecting and storing

 Press the right button of the mouse joystick.

Deleting graphic elements

Console  Click the graphic element in question.

– It is marked with a border.
 Press the Del key on the keyboard.

Or
 Select Delete Selected Annotations from the popup menu.

Touchscreen
 The Annotations functions have been selected.

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 Position the mouse pointer on the graphic element to delete.

– The graphic element is selected.

 Press this icon.

Annotating images
Console With the Annotate function, you can use predefined texts or enter free texts.
 Click this icon.
– The Annotate dialog box is displayed.

 Laterality (right/left assignment) 387

 Placing predefined texts 389

 Entering free texts 390

Touchscreen You can place predefined texts in the image after selection of the Annotations
function.
 Placing predefined texts 389

Laterality (right/left assignment)

You can also use R or L to label paired organs, e.g. kidneys.

Note Laterality (right/left assignment) applies to the image content (right/left organ)
and not to the right/left side of the patient.

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Note When transferring scenes/images, make sure that the recipient system can display
the DICOM “Laterality” attribute.

Incorrect right/left labeling

Caution Risk of incorrect diagnosis, e.g. surgical intervention on the wrong side
The examiner is responsible for correct right/left labeling.
 Make sure that the R/L labels have been placed correctly.

 If necessary, use lead letters or similar devices during fluoroscopy/acquisition.

Changing the laterality

Console (only) See also Entering/changing the laterality 347

If an R/L label has been accidentally set incorrectly, you can change it or remove it.
 Move the mouse pointer onto the R or L label and press the right mouse button.

 Select Modify Laterality from the popup menu.

 Choose the correct laterality (R/L label) or None.

 Enter your name in the Modifier’s Name field.

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 Confirm with Save.

– The change is made immediately.

Placing predefined texts

Console Placing texts

 Select an entry from the list with a single click;

use the scroll bars to display further texts.
 Click the required position in the image.
– The text appears immediately.

Defining texts
Up to 20 predefined texts are possible. After installation, the predefined texts
have the default value “Default ... Str.##”. You can change the texts at any time.
 Double-click the required entry in the Annotate window.
– The Modify Annotation Text window appears.

 Overwrite the text as required.

 Click OK.

Touchscreen Placing texts

 The Annotations functions have been selected.

 Press the Text Annotation button.

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 Press this icon and select a text from the list.

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

Entering free texts

Console (only) Entering texts
 Click this icon.

 Click the required position in the image.

– A text field appears.
 Enter the text via the keyboard.

 Complete the entry with the Enter key.

Note To modify a text, delete it by pressing the Del key, and enter the text again.

Canceling the entry

 Press the Esc key on the keyboard.
– The previously entered text is deleted.

Switching text/graphics display off/on

If you want to view the image without texts and graphic elements, you can switch
the display on and off.

Console
 Click this icon.
– The icon state changes.
Or
 Select View > Annotation from the main menu or Annotation from the popup
menu.

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Touchscreen
 The Annotations functions have been selected.

 Press this icon.

The texts and graphics are hidden or shown in the image.

Drawing circles
If you want to emphasize image details, you can draw circles. You can also change
their size.

Console
 Click this icon.

Touchscreen
 The Annotations functions have been selected.

 Press the Circle button.

Console & Touchscreen  Move the mouse pointer into the image.
– The mouse pointer changes shape.
 Click the detail of interest in the image and drag the mouse pointer.
– A circle appears around this point.

Changing the size

 Click one of the four boxes on the circle border, keep the mouse button
pressed, and drag the circle to make it larger or smaller.
– The size of the circle changes, while the center remains fixed.

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 Release the mouse button.

Touchscreen Selecting and manipulating a graphic element 385

Selecting and moving a graphic element 385

Drawing lines or arrows

You can emphasize image details with lines or arrows:

Console
 Click the required icon.

Touchscreen
 The Annotations functions have been selected.

 Press the Line or Arrow button.

Console & Touchscreen  Move the mouse pointer into the image.
– The mouse pointer changes shape.
 Click the image to fix the starting point (= arrow head), and drag a line to the
end point with the mouse.
 Release the mouse button to end the line.
– The line or arrow is drawn.

Changing

 Click one of the two end points of the line/arrow, hold the mouse button
pressed, and change the line/arrow as required.
 Release the mouse button.

Touchscreen Selecting and manipulating a graphic element 385

Selecting and moving a graphic element 385

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Drawing polygons
You can draw open polygons.

Console
 Click this icon.

Touchscreen
 The Annotations functions have been selected.

 Press the Polygon Line button.

Console & Touchscreen  Move the mouse pointer into the image.
– The mouse pointer changes shape.
 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 clicking the mouse button once at each
change of direction.
 Double-click the last corner point.
– The polygon is drawn.

Changing

 Click the polygon line.

– The end points and corner points are marked.
 Click one of the end points or corner points, hold the mouse button pressed,
and change the polygon as required.
 Release the mouse button.

Touchscreen Selecting and manipulating a graphic element 385

Selecting and moving a graphic element 385

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DSA Postprocessing

DSA functions The following DSA postprocessing functions can be used for optimized display of
subtracted scenes:

Touchscreen Monitor screen Description Effects both Effects single

planes plane

Move mask 398 On/Off Adjustment

Replace mask 399 +

Native/Subtracted 400 +

Anatomical Background 401 On/Off Adjustment

Image > Change Vessel Vessel/Catheter Contrast 402 On/Off Adjustment

/ Catheter Contrast

Pixelshift 403 +

Opacification 409 +

Averaging 412 +

General functions:
Invert Gray Scale 368 +

Zoom 2x 369 +

Zoom to Acquisition Size 369 +

Pan (Automatically activated with zoom.) +

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Introduction
Unlike bones, vessels do not exhibit a greater absorption of X-rays than the sur-
rounding tissue. As a result, vessels are not particularly emphasized in X-ray imag-
es if you do not take further measures to ensure it.
In digital subtraction angiography (DSA), X-rays of the region to be examined are
taken:
 without contrast medium (CM): mask images

 with contrast medium (CM): fill images

Then a subtraction is performed between fill and mask images.

The regions with the same attenuation cancel one another out in the subtraction
image and the regions with (slightly) different attenuation, such as vessels con-
taining contrast medium when acquired, are clearly emphasized.

(1) Mask image (without CM)

(2) Fill image (with CM)
(3) Subtracted image

Console

On the DSA subtask card, you will find the tools with which you can optimally dis-
play a scene after subtraction.

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Touchscreen
 Press this icon.

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

Note The button type/size (with or without text) and position depends on touchscreen
configuration.

Setting a new mask

During a DSA exposure or roadmap, the mask (= image without contrast medium)
is set automatically. In DSA, it normally occurs after the second frame, but no later
than after 2 s. In roadmap, the mask is set at the end of phase 1.
You can change the automatically set mask image.

Note All pixelshift values are reset when you set a new mask.

Note Setting a new mask is possible for any subtracted scenes except for reference im-
ages, roadmap scenes, or subtracted rotational scenes, i.e. DYNAVISION or 3D
DSA.
In the case of DYNAVISION or 3D scenes, only one mask image is usually available
per acquisition position (exception: washout scene).
The mask therefore cannot be redefined for DYNAVISION or 3D scenes.

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Image Postprocessing

Default setting “Move Mask” or “Replace Mask”

Setting a new mask can be done via “Move Mask” or “Replace Mask”.

Console Setting “Move mask” (default)

 Select Options > Set Move Mask from the main menu.
– “Move Mask” is active.
– The next time you select the menu, the text of this item will be changed.

Setting “Replace Mask”

 Select Options > Set Replace Mask from the main menu.
– “Replace Mask” is active.
– The next time you select the menu, the text of this item will be changed.

Moving the mask

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

Console
 Click this icon.

 Click a single step button.

– The mask is scrolled forward or backward by one frame.
Or
 Click into the image area (with the left mouse button).
– If you click into the left part of the image, the mask is scrolled backward by
one frame (toward the beginning of the scene).
– If you click into the right part of the image, the mask is scrolled forward by
one frame (toward the end of the scene).

backward forward When you reach the frame you want to select as the mask:
 Click this icon.

The frame whose number is displayed on the left edge of the image area next to
M is set as the mask for the scene.

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Touchscreen
 DSA functions

 Press the Move Mask button.

 Deflect the mouse joystick briefly.

When you reach the frame you want to select as the mask:
 Press the right button of the mouse joystick.

Replacing the mask

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

Console
 Click a single step button.
– The scene is scrolled forward or backward by one image.

Or1
 Click into the image area (with the left mouse button).
– If you click into the left part of the image, the scene is scrolled backward by
one image.
– If you click into the right part of the image, the scene is scrolled forward by
one image.

backward forward When you reach the frame you want to be the new mask:
 Click this icon.
– The current image is set as the mask for this scene.

1 not for a zoomed image or after clicking a graphic object

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Image Postprocessing

Touchscreen
 Deflect the mouse joystick briefly.

When you reach the frame you want to be the new mask:
 DSA functions

 Press the Replace Mask button.

Switching over between subtracted and

unsubtracted display
A DSA scene is displayed subtracted. However, each subtracted scene can also be
displayed unsubtracted, that is native.

Console Native
 Click this icon.
– The scene is displayed native (unsubtracted).

Subtracted
 Click this icon again.
– The scene is displayed subtracted.

Touchscreen
 DSA functions

 Press the Display Scene Native button.

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Anatomical background
The anatomical surroundings of the vessels of interest are normally not visible in
a subtracted scene. The surrounding tissue can be emphasized more or less by
overlaying the native image.
The mask is overlaid to the subtracted image in order to show the surrounding tis-
sue in addition to the vessels, e.g. bones.
The initial degree of anatomic background is defined in the exam set.

Console Starting anatomical background

 Click this icon.

Switching on anatomical background

 Click this icon.
– The image is displayed with anatomical background.

Changing anatomical background

You can set the anatomical background between 0% and 100%.
 0% corresponds to subtracted display

 100% correspond to unsubtracted display (native)

 Click and drag the slider.

Or
 Enter a percentage in the input field and confirm with the Enter key.
– The scene is replayed with anatomical background.
(The degree of anatomic background is stored with the scene.)

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Image Postprocessing

Background off/on
 Click this icon.
– The image is displayed subtracted without anatomical background.
(You can no longer set the anatomical background.)
 Click this icon.
– The image is displayed with anatomical background again.

Undoing changes
 Click this icon.
– All changes since the last save operation are undone.

Touchscreen Changing the background

 DSA functions

 Press the Anatomical Background button.

 Deflect the mouse joystick.

– Up: more anatomical background
– Down: less anatomical background

You can scroll though the scene during anatomical background:

 Deflect the mouse joystick briefly.

To terminate the function:

 Press the right button of the mouse joystick.

Vessel/catheter contrast
As an alternative to anatomical background, the vessel/catheter contrast can be
adjusted for Roadmap images.

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Console (only) Changing vessel/catheter contrast

 Select Image > Change Vessel / Catheter Contrast in the main menu.

 Click an up/down arrow to adjust a value.

 Click Apply or OK.

Making the image and mask coincide ex-

actly (Pixelshift)
Using pixelshift, it is possible to adjust fill and mask images to coincide in subtract-
ed DSA or Roadmap scenes.

Note In 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.

Motion artifacts The patient or the system could have moved slightly between exposures with and
without contrast medium. As a result, the images used for subtraction might not
coincide completely. If it happens, the anatomical background is not removed
completely, especially in the region of image contrasts (motion artifacts).

Pixelshift You can make the image and mask match exactly by shifting the mask by a few
pixels or fractions of pixels.

ROI However, you may not be able to achieve good results for all regions of the image
as different pixelshift amounts may be necessary in different regions of the image
because of the image geometry and elasticity of the human body.

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Variants Pixelshift can be performed in the following ways:

 Automatic pixelshift: 406
Enter the region of interest (ROI) in an image or for a number of
images in a scene for which you want to optimize the pixel shift.
The computer automatically calculates the best result for this re-
gion.
 Manual pixelshift 407
You shift the mask manually to achieve the best subjective im-
pression.
 Flexible pixelshift: 408
The image is divided into a “chessboard”. The computer indepen-
dently calculates the best pixelshift value for each square. Pixel-
shift is adapted “flexibly” to the image.

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

Movement Movement Movement

Scene

Pixelshift
action Pixelshift
action Pixelshift
action

It is therefore advisable to start with pixelshift at the beginning of the scene. You
can then scroll through the scene to the end. Each time motion artifacts appear (if
the patient or unit has moved), you can make a further pixelshift correction.

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Starting pixelshift
Console
 Click this icon.

Note The pixelshift magnitudes in the horizontal (x) and vertical (y) direction are dis-
played in the Pixelshift window.

Touchscreen
 DSA functions

 Press the Pixel Shift button.

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Image Postprocessing

Note The pixelshift magnitudes in the horizontal (x) and vertical (y) direction are dis-
played on the screen.

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

Console
 Click this icon, if necessary.
– A square for the region of interest (ROI) is drawn in the middle of the image.

 Click and drag the square to the required position.

– The mask is shifted in such a way that subtraction is optimized for the
marked region.

Touchscreen
 Pixel Shift has been selected.

 Auto pixelshift is active.

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

 Deflect the mouse joystick.

When the ROI is positioned correctly:

 Press the left button of the mouse joystick.
– The mask is shifted in such a way that subtraction is optimized for the
marked region.

Further pixelshift corrections

 Page on in the scene.

If motion artifacts occur:

 Perform pixelshift again.

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Note If 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.

Terminating pixelshift
Console
 Click this icon again.
– The pixelshift values are accepted.

Touchscreen
 Press the right button of the mouse joystick.
– The pixelshift values are accepted.
– The function is deselected.

Note At the end of the scene, pixelshift is automatically deselected.

Manual pixelshift
Console
 Click this icon.

 Click and drag in the image area.

Or
 Press an arrow key.

The mask is shifted simultaneously (by small amounts).

Touchscreen
 Pixel Shift has been selected.

 Press the Manual pixelshift button.

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Image Postprocessing

 Click and drag in the image area.

 Further pixelshift corrections 406

 Terminating pixelshift 407

Flexible pixelshift

Note Depending on the image content, the calculation may take a few seconds. It also
applies to scrolling.
It is therefore recommended that you wait after each new image until the calcu-
lation is complete.

Console
 Click this icon.

Touchscreen
 Pixel Shift has been selected.

 Press the Flexible pixelshift button.

The mask is divided into squares like a chessboard. The optimum shift amount is
determined and applied automatically to each square.
“Flex” is shown in the image.

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Saving the “Flex” image

A “Flex” image can be stored using the Store Monitor func-

tion.

You can also store the flexible pixelshifted image as a ref-

erence image.

You can also copy the flexible pixelshifted image to the

filmsheet.

 Press/click the required icon.

Undoing pixelshift
Console (only) Reset
 Click this icon.

All pixelshift values from the image are reset to x=0, y=0.

Console Home
 Click this icon.

Touchscreen
 Press this icon.

All changes since the last save operation are undone.

Generating the image with maximum con-

trast medium filling
Usually the contrast medium does not fill the vessels uniformly after it is injected,
but the contrast medium bolus “travels” through the vessels.

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The opacity function (Max Opac or Min Opac in CO2 DSA) is used to integrate the
images of the fill phase (= phase in which contrast medium is in the vessels of in-
terest). The pixels filled with contrast medium from different images are com-
bined into one image. The entire path taken by the contrast
medium is displayed in one image.

Note The opacity function cannot be applied to DYNAVISION scenes or 3D scenes.

Starting
 Scroll to the starting image.

Console Bolus start

At the image in which the contrast agent bolus is visible for the first time:
 Click this icon.
– From now on, the image is composed of pixels from subsequent images.

Scrolling
The scene can be scrolled forward or up to one image backward.
Scroll the scene image by image:
 Click the single step button.

Or
 Click into the image area (with the left mouse button).
– With every step forward, a further image is added to the Opac image.
– The image with maximum contrast medium filling is calculated and dis-
played immediately.

Bolus end
backward forward When the optimum contrast medium filling is displayed, you can save the image.

As a reference image
 Click this icon.

As a Store Monitor image

 Click this icon.

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Copy to film sheet

 Click this icon.

Opac end
The function remains active as long you do not deselect it.
 Click the Opac icon again.

The scene is displayed normally again.

Touchscreen Bolus start

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

 Press the Opacification button.

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.
– The image with maximum contrast medium filling is calculated and dis-
played.
 Press the middle button of the mouse joystick.
– The image is selected as the end image.
– The image with maximum contrast medium filling is calculated, displayed
and stored as a reference image.

As a Store Monitor image

 Press this icon.

As a reference image
 Press this icon.

Copy to film sheet

 Press this icon.

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Image Postprocessing

Improving the noise suppression of a

scene (averaging)
Averaging can be used to reduce noise. It can be performed with mask images
and/or fill images. Averaging mask images is particularly useful if you want to re-
duce noise in DSA scenes. Fill images, however, should be averaged only if you
want to display non-pulsating vessels as otherwise vessel edges will be blurred.
Averaging cannot be applied to:
 Unstored fluoroscopy scenes

 Roadmap scenes

 CLEARstent scenes

 DYNAVISION or 3D scenes

Mask averaging is not possible for unsubtracted scenes.

Note The higher the number of images used for averaging, the better the noise sup-
pression. We recommend averaging both mask images and fill images for DSA
scenes.

Rules Averaging is performed according to the following rules:

 For mask images, addition is carried out in the “forward” direction, i.e. the se-
lected mask image and the subsequent mask images are added.
 For fill images, addition is carried out “in both directions”, i.e. the fill images be-
fore and after the selected fill image is/are added.
 In loop, the scene is limited to images for which addition can be carried out cor-
rectly. In other words, no image is used twice for the calculation.
 The summed mask image is subtracted from the summed fill image.

Example:
Mask Image

1 2 3 4 5 6 7 8 9 10 11

9-3
Addition:
4 mask images
4 fill images

Average (8,9,10,11) - Average (3,4,5,6)

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Averaging

Console
 Click this icon.

 Select the number of fill images to be used for averaging.

 Select the number of mask images to be used for averaging.

The calculation is carried out immediately and applied to the scene.

Touchscreen
 Press this icon.

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Image Postprocessing

 Select the new number of mask images and fill images to be averaged under
Mask and Image respectively.
The calculation is carried out immediately and applied to the scene.

Undoing averaging
 Select OFF.
– The scene is displayed with unaveraged mask again.

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Exam Protocol

Displaying the Exam Protocol

All parameters of an examination related to fluoroscopy and acquisition are re-
corded automatically in the Exam Protocol. You can also enter comments.
Depending on configuration, the Exam Protocol is stored as text, as an Exam Pro-
tocol XA image object, or as a Dose Structured Report object.

Note It can be configured by Siemens service whether the Exam Protocol will be includ-
ed in transfers or not. If it is excluded from transfer, a message will appear in the
status bar: “Non images have been skipped for transfer.”
It can also be configured whether the dose data is transferred as a Dose SR object,
as an Exam Protocol XA image object, as both or none.

Calling up the Exam Protocol

Console (only)  Select the required patient.

 Select Patient > Exam Protocol... from the main menu of the PostProc task
card.
Or

 Click the folder icon with the right mouse button and from the popup menu,
select Exam Protocol...
Or

 Double-click the Exam Protocol or the Exam Protocol SR icon in the Patient
Browser.
– The Exam Protocol dialog box opens.

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Entries in the Exam Protocol

Window contents Patient information is displayed in the upper part of the window.
"Events" are listed in the center part of the window. If there are more entries than
can be displayed in the window, you can use the scroll bar (on the right) to display
the required section of the examination data.
Below the event list, an input field for your comments is available.

Note Certain (automatically generated) entries in the Exam Protocol are displayed al-
ways in English, whatever language for the user interface is configured.

Note When merging two or more studies into a single study via the Rearrange function,
the text Exam Protocol of the most recent study will be kept, text Exam Protocols
of older studies will be lost.
 Save the exam protocols of the studies, e.g. on CD or printer, before merging.

Exam Protocol XA image objects are kept.

Dose SR objects will be merged.

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Patient position The Exam Protocol starts with the registration of the patient, i.e. the registration
or change of the patient position.
Example: Patient Position: HFS 16-Mar-07 15:53:44

Abbreviation Patient Position

(always in English) (English term)
HFS Head First - Supine
(Head First - Supine)
HFP Head First - Prone
(Head First - Prone)
HFDL Head First - Left Lateral
(Head First - Decubitus Left)
HFDR Head First - Right Lateral
(Head First - Decubitus Right)
FFS Feet First - Supine
(Feet First - Supine)
FFP Feet First - Prone
(Feet First - Prone)
FFDL Feet First - Left Lateral
(Feet First - Decubitus Left)
FFDR Feet First - Right Lateral
(Feet First - Decubitus Right)

Radiation events Every radiation event (fluoroscopy or acquisition) is recorded.

Note The values given in the examination protocol are nominal values i.e. the values are
not measured values but target values.
The real values may differ!

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Image Postprocessing

Each event entry consists of two lines. The following parameters are listed:

Entry Example Explanation

(from left to right) (always in English)
First line:
Number 1 Number of radiation events / scene number
Acquisition mode DR DR (Digital Radiography)
DSA DSA (Digital Subtraction Angiography)
CARD CARD (Cardangiography)
DR_DYNA DR-DYNAVISION
DYNA (DSA-)DYNAVISION
DR_STEP PERISTEPPING
PERI PERIVISION
DR_SCAN DR-Scanning
3D 3D acquisition
STENT CLEARstent scene
Acquisition position (1) Number of acquisition positions
(only with PERISTEPPING/PERIVISION)
Frame rate control FIXED Frame Rate Control: Fixed frame rate
VARIABLE Frame Rate Control: VFR Manual or VFR Time (vari-
able frame rate)
PERIAUT Stepping Mode: Auto
PERIMAN Stepping Mode: Manual
DYNAAUT DYNA Control: Auto Inj. (automatic injection)
DYNAMAN DYNA Control: Manual Inj. (manual injection)
Exam set <any> Name of exam set
Acquisition program <any> Name of acquisition program
Scene length 11s Length of scene
Frame rate 2F/s Frame rate of scene in frames per second (starting
frame rate)
Single Single image
Date and time 16-Mar-12 15:54:54 Date and time of radiation exposure (starting time of
radiation release)

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Entry Example Explanation

(from left to right) (always in English)
Second line:
Plane A Acquisition plane (on single plane systems: always A,
on biplane systems A or B)
kV 75kV Estimated tube voltage
mA 171mA Estimated tube current
ms 50.5ms Estimated pulse width
Control level 10.0CL Estimated Control Level: coarse indication to estimate
dose
Focus Estimated focus size of x-ray tube
micro Micro focus (only for 3-focus tubes)
small Small focus
large Large focus
Copper filter 0.1Cu Estimated copper filter
Zoom stage 10cm Input size
Dose area product (DAP) 30.1µGym² Dose area product in µGy ⋅ m2 of fluoroscopy/acquisi-
tion calculated from the output of dose measuring
device
Reference air kerma 1.1mGy Calculated reference air kerma with respect to refer-
ence conditions
LAO/RAO angulation 3LAO Lateral angulation angle (LAO/RAO)
cran/caud angulation 0CRA Cranial/caudal angulation angle
Number of frames 10F Total number of frames of the scene
Any ***** If a value could not be determined, it is replaced by as-
terisks.

Note Please note that for PERIVISION, DYNAVISION and 3D scenes both mask and fill run
are recorded in one entry each.

Accumulated data When the patient is being closed, i.e. another patient is registered, dose data is ac-
cumulated and added at the end of the examination protocol.
The following lines are added:

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Image Postprocessing

Entry Example Explanation

Heading ***Accumulated exposure data***
First line: (from left to right)
Date and time 16-Mar-12 16:06:05 Date and time of patient close
Second line: (from left to right)
Performing Physician: ... Name of performing physician
Number of acquisitions Exposures: 2 Total number of acquisition runs
(in both planes on biplane systems)
Fluoro time Total Fluoro: *** * Total fluoroscopy time
(in both planes on biplane systems)
Total: Accumulated values
Dose area product (DAP) 62.1µGym² Total dose area product in µGy ⋅ m2 of fluoroscopy/ac-
quisitions calculated from the output of dose measur-
ing device
Reference air kerma 5.6mGy Total calculated reference air kerma with respect to
reference conditions
Third line: (from left to right)
Plane A data A Fluoro: Acquisition plane A
Fluoroscopy Fluoro: *** * Total fluoroscopy time in this plane
Dose area product (DAP) 8.9µGym² Total dose area product in µGy ⋅ m2 of fluoroscopy in
this plane
Reference air kerma 0.3mGy Total calculated reference air kerma of fluoroscopy in
this plane
Total: Accumulated values
Dose area product (DAP) 52.7µGym² Total dose area product in µGy ⋅ m2 of acquisitions in
this plane
Reference air kerma 1.7mGy Total calculated reference air kerma of acquisitions in
this plane
Fourth line (only on biplane systems):
Plane B data B Fluoro: Acquisition plane B
...
* The fluoro time is displayed in the configured units: 00:00:00 [hours:minutes:seconds] or 000.0 min [minutes.tenths of minutes], see
Fluoro timer 294

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Note The dose values displayed in the Exam Protocol can be used to monitor the course
of the examination. However, they cannot be used to calculate the applied patient
dose!
The displayed dose area product (µGy ⋅ m2) has a tolerance of ±25% according to
DIN 6819. If a fault in a system component occurs during the examination, it can
result in incorrect entries in the Exam Protocol. In such a case, data could be incor-
rect or incomplete and should not be used for normal report generation. Siemens
accepts no warranty or liability for the loss of this information and data.
All liability for consequential damage is excluded!

Note On the Examination task cards for plane A and B, the accumulated fluoroscopic
time (hours : minutes : seconds) is displayed for both planes.
The Exam Protocol shows the values for both planes separately.

Note Depending on the problem, fluoroscopy times during BYPASS FLUORO might not
be recorded in the Exam Protocol.

Comments If any comments have been entered (see below), they are added as separate lines.

Note Due to compatibility reasons, it is not possible to have special characters in the ex-
amination protocol.
Some special characters, e.g., *, @ \, or the Euro sign , and all Japanese* charac-
ters are converted to question marks ?.
 Do not enter special or Japanese* characters in comments to Exam Protocol or
in names of acquisition programs.
* applies to the Japanese version only

Entering comments
Additional information, e.g., contrast medium, medication, can be entered in the
input field as follows:
 Enter the text.

 Click Append.
– The text is dealt with as an "event" and is appended to the end of the Exam
Protocol.

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Note It is not possible to enter comments while radiation is released.

Note The automatically registered entries and appended comments cannot be

changed.

Printing the Exam Protocol

If a printer is installed for your system, you can print the Exam Protocol:
 Click Print.
– The Exam Protocols of the selected patient are sent to the default printer.
Depending on the number of scenes, the printout might extend across several US
Letter (or DIN A4) pages. The page number and total number of pages are stated.
The patient identification is at the top of each page - the "header". It is followed by
the list of scenes, comments, and stopwatch events. The "events" are arranged
chronologically.

Closing the window

 Click this icon or on Close.

Note If you have not added your comments to the Exam Protocol with Append, they
will be deleted when you close the window.

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Saving and documenting scenes/images

Automatic storage
When you perform postprocessing functions, changes are always stored automat-
ically. At the next review of a scene/image, you will find it in the last working state.

Note Opacification and flexible pixelshift are not saved with a scene. The results of
these two postprocessing functions can only be stored as individual Store
Monitor images.

Storing the current image (Store Monitor)

You can store any image which is being currently displayed, including text and
graphic information, as a new image (Store Monitor image, i.e. secondary cap-
ture), for example, if this image contains precisely the information you require for
a diagnosis.
A Store Monitor image is created as a single frame derived image. This means
that the image is stored “as is” (WYSIWYG). All postprocessing except zoom/pan
and image text will be “burnt-in” to the pixel data.
Store Monitor images can be used, for example, to send subtracted images via
network, to view them on viewing stations.

Note A maximum of 512 Store Monitor images per study and plane can be stored.

Console
 Click this icon (of the required plane).

Touchscreen
 Make sure, the required plane is selected.

 Press this icon.

Note When indicated from touchscreen, only the image of the active plane is stored.

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Image Postprocessing

 If the current image is a grayscale angiographic image, it is stored as a Store

Monitor image on series/image level.
 If the current image is a color image, e.g. an IVUS image, or when exporting
an image to Sensis, the Save As window will appear.

 Select the save option and the name of the series.

– Save images in new series: Enter a new series description.
– Append images to series: Select a series from a list of existing series within
the study.
 Click OK.

Documenting scenes/images

Filming/printing images

Select images for filming/printing

You can select any displayed image for filming or printing on paper:
 images displayed in full-screen mode

 scene representatives, reference images, Store Monitor images in the scene

directory
 single images of a scene in the image directory (4 x 4)

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Selecting scenes from the scene directory

 Pick the required display from the selection list.
The scene directory of a patient 351

Selecting images from the image directory

 Click the 4 x 4 icon on the View subtask card.
Scene overview 357

Selecting all objects

 Select Image > Select All from the main menu.

Or
 Press Ctrl + A.

Or
 Click the first object.

 Press the Shift key.

 Scroll to the last object and click it.

Selecting a series of objects

 Click the first object.

 Press the Ctrl key and click additional objects.

Copying an image to film sheet

Note If a new patient is registered via Artis or AXIOM Sensis, no message will be dis-
played about images from the previous patient.
 Make sure that the virtual filmsheet has been emptied from the previous pa-
tient.

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Note When a filmjob is finished, the document is marked as filmed with a flag ‘P’ for
”regular” images. A multiframe image gets marked with ’p’ if at least one frame has
been printed. Therefore, it cannot be determined if a multi frame image has been
filmed completely or not.
 If the printouts are used for archiving purposes, always check for the complete-
ness of the printouts.

Note From the Patient Browser, you can only transfer individual images, i.e. Store
Monitor images, reference images or single frame images, to the virtual film
sheet.
From a task card, only the frame of a scene which is displayed on the screen is be-
ing transferred to the virtual film sheet.

Use of paper printouts for diagnosis

Caution Wrong diagnosis possible.
 Only use images on film for diagnostic purpose.

 You may use printouts for diagnostic purpose if the printer has specifically re-
ceived 510(k) clearance for this purpose.

By scaling down the image in scalable page mode the resulting image quality
Caution might no longer be sufficient.
Wrong diagnosis possible.
 Be aware of image quality reduction if scalable page mode is configured.

If you want to film the image being currently displayed:

Console
 Click this icon in the control area.

Note If you want to film an image from the Patient Browser, please click the icon in the
tool bar of the Patient Browser.

Touchscreen
 Make sure, the required plane is selected.

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 Press this icon.

The selected images are transferred to the virtual film sheet and displayed in the
preset film format there.

Note You cannot window DSA images on the Filming task card.
 Window the scenes first on the PostProc task card.

For more information on Filming and Printing, please refer to the syngo documen-
tation.

Archiving/sending/exporting patients/images

Safety notes
Statutory regulations There are statutory regulations governing the archiving period, data availability,
and data security, and recommendations concerning fire protection or water dam-
age for the archiving of image data.
The operator of the archive is responsible for observing these requirements.

Data migration Because of constantly advancing technical developments, it might not be possible
to implement storage and access for the required archiving period with a single
storage technology and type of medium. Migration of the data will therefore be
necessary to a greater or lesser degree under the responsibility of the operator of
the digital archive.

Automatic sending Via the Transfer Configuration in the Configuration Panel (Options > Configu-
ration in the main menu), you can configure destinations for sending and export-
ing and setting automatic sending/exporting.
Automatic sending should only be set for syngo products.

Always select "Don't care" in the second drop-down box, otherwise transfer rules
will not work!
An auto transfer rule consists of: "Don't care" + "Received" + "Series" or "Studies"
will not result in an auto transfer.
Set "Don't care" + "Received" + "Images" as an auto transfer rule.
Most cardiac networks and viewing stations only permit processing/viewing with
512²/8-bit image display!

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Compression settings  If you are sending / exporting to ACOM, set Lossless JPEG.

 For sending / exporting to syngo products, set Compression: None.

Compression method is set to irreversible compression (Lossy JPEG)

Caution The resulting images are no longer completely identical to the original imag-
es. Information of medical relevance may be lost.
 Do not use lossy compressed images for primary diagnosis, the image quality
may not be sufficient.

Transfer of images is set to downsize method via local service.

Caution Image information is reduced.
It is the responsibility of the user to decide whether the reduced image informa-
tion is sufficient for diagnostic purposes.
 Coordinate configuration of resize with Field Service Engineer

 Check the diagnostic basis for sending, exporting, and archiving images with
reduced image matrix and gray scale.

MagicView and It is not possible to send multiframe objects (DSA scenes) above a limit of about
multiframes 70 images in a 1024 x 1024 matrix or about 600 images in a 512 x 512 matrix to
workstations of the MagicView family.

Check transfers Always check that jobs are performed correctly. Check that jobs have reached their
recipient completely.
 Check the Export jobs by having a look at the series written onto the CD-R/DVD.

 Check the Send jobs by having a look at the series received.

In the event of an error, e.g. a network error or a faulty CD-R/DVD, it may result in
loss of data.

Reduced system performance due to overload of the network environment.

Caution Risk of unexpected system behavior
 Only use Artis Q/zeego/Q.zen/zeego.zen in a secure and load-adapted network.

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The flags A (Archived) and S (Sent) respectively only indicate the receipt of the im-
Caution ages. They do not indicate successful storage in the intended archive.
Risk that the data is lost if it is deleted by the sender e.g. by an auto delete
mechanism and if it cannot be stored by the receiver.
 Before deleting data from your local database ensure that this data is safely
stored in the intended archive. Always use ’storage commitment’ if supported
by sender and receiver of data.

Sending data with the attributes AC, SC via network indicates a safe data transfer
Caution but does not fulfill the regulatory requirements of long-term archiving. Objects
with the “committed” flag may be deleted by the user.
Risk that the data is lost within the required period for retention.
Misleading/misinterpretation of the flags AC/SC. Flags AC/SC depict receipt and
storage on hard disk on the receiver side which may be not sufficient to fulfill the
regulatory requirements of long-term archiving.
 Observe the regulatory requirements regarding the archiving procedure.

Resend after Please note that changes to images may not be accepted after resending to a
processing DICOM archive.
Reason: The archive detects the image as existing and refuses another transfer.

Exam protocol If patient or study transfer jobs were started from the Patient Browser, only one
job may display an error message. (That is the Exam Protocol that cannot be re-
ceived by non-syngo systems and by ACOM.net only as from Version VB11A.)
It can be configured by Siemens service whether the Exam Protocol will be ex-
cluded from transfer.

Transferred image format and annotations

Ready Processed It is possible to process the scenes/images to be transferred to the capabilities of
Images the target system. It means, that image format (e.g. downsizing), gray scale infor-
mation (LUT), DSA processing (e.g. pixelshift), edge enhancement, windowing,
zoom/pan and shutter can be adopted to the capabilities of each network node
and storage media separately.
It can also be configured whether DSA scenes shall be sent subtracted or not, and
whether annotations are maintained as an overlay or not, i.e. whether informa-
tion is burnt into the image or not.
 Please ask Siemens service for configuration.

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Note When transferring a subtracted rotational scene (DYNAVISION or 3D DSA) as ready

processed, only the ready processed composite mask and fill scene is sent, but not
the mask scene. If the scene viewed in native display, only the ready processed fill
scene is sent.

Note Do not use the "Ready Processing" function if you want to export a scene with an
ECG curve. The ECG curve will be lost during export.

Annotations and When images containing annotations (graphics, distance measurements, text) are
calibration sent, the data format of the annotation is changed such that subsequent modifi-
cation of this annotation, e.g. editing of text or moving graphics, may no longer
be possible.
However, you can certainly add further annotations to the images.
It occurs when images are sent to another workstation or an archive which is not
equipped with the syngo software or when the syngo version of the receiving sys-
tem is older than the one of the sending system.
Example: Sending an image from syngo Workplace to a MagicStore archive and
then reloading it into syngo Workplace.
Consequently, this means that:
 The annotation can no longer be changed, it can only be displayed or hidden
as a whole.
 If the image was calibrated at the time it was sent, other lengths, for example,
can be drawn with this calibration. If the image is recalibrated, only lengths
subsequently drawn refer to that recalibration. Existing lengths still refer to the
original calibration.
 Therefore, when evaluating length indications in such images, always establish
which calibration measurement these length indications relate to.

A previously calibrated image containing measurement values (e.g., distance

Caution measurements) is recalibrated and yet the existing measurement values are not
recalculated due to how they are stored (e.g., burned into image). However, new-
ly added measurements are based upon the new calibration factor.
All measurements previously drawn in remain referenced to the original
calibration.
 When evaluating the measurement values (e.g., distance measurements)
specified in such recalibrated images, be alert as to the nature of the measure-
ment values (i.e., if they were burned into pixel data) and whether they were
recalculated.

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Note Please note that any calibration factors will not be transferred for rotational scenes
(DR-DYNAVISION, DYNAVISION, 3D, 3D CARD).

Zoom and inversion Please note that the zoom and inversion settings are not included in the informa-
settings tion transferred.
If you want the image to be displayed the same way at the receiving end, it is ad-
visable to save it with Store Monitor and then transfer this image (as well).

Pixelshift and flipping Do not apply pixelshift along with image flip before exporting an image. When the
image is imported again, it may not appear as it was exported.

Selecting data and sending

Selecting data
 Display the image/scene in the PostProc task card.

Or
 Select the required scenes/images in the 4 x 4 view.
6KLIW &WUO
Or
 Select the data in the Patient Browser.

Archiving/sending
 Click this icon.

Or

 Click this icon in the Patient Browser.

Or
 Select Transfer > Send To... or Archive To... from the main menu.
– A dialog box is displayed with the available target addresses in the network.

Selecting a destination and archiving/sending

 Select one or more destinations and click Send/Archive.
– The image data will be sent to the selected addresses.

Inserting a CD-R/DVD

Media type To minimize the risk of loss of data, only use media approved by Siemens and clas-
sified as ‘medical’ for archiving purposes.
 Please ask your Siemens representative.

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Capacity It can appear that the capacity of a CD-R/DVD is not being used to the full because
of the administration information that also has to be stored.
It can occur especially when several patients with only a few images each are
stored on a single CD-R/DVD.

Open tray Do not open the CD/DVD tray manually to eject media.
 Use the Eject from ... command from the main menu instead.

Label The system can be configured by Siemens service whether a label shall be auto-
matically assigned to the media or not, and if enabled, whether a DICOM Viewer
shall also be added to the media.

 Insert an (empty) CD-R/DVD into the writer.

The first time you export data for a new media, the Enter Label dialog box is dis-
played.
 Enter a unique name for the media.

Exporting/archiving

 Click this icon in the Patient Browser.

Or
 Select Transfer > Export To... or Archive To... from the main menu.
– A dialog box with the available archiving destinations appears.

Note In case of an error, e.g. power loss, during multi session writing to CD-R/DVD, all
data previously stored on that media might get lost as well.
The software offers a service tool to restore the previous sessions.
Please ask Siemens service.

Switching to multi session mode may destroy data previously recorded on this me-
Caution dium.
Risk that previously stored data can no longer be read.
 Only delete the data that you have archived on a CD-R from the local database
after you have completed the session.

Selecting a destination and exporting/archiving

 Select one or more destinations and click Export/Archive.
– The image data will be archived at the selected addresses.

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Sending an image to the CARTO system

The currently displayed image can be transferred to the CARTO magnetic tracking
system. The CARTO system will use the data derived from the acquired 2D image,
i.e. from a DynaCT Cardiac acquisition, to compute the spatial transformation for
super-imposition of 3D images with 3D CARTO map.
 An image is loaded to full screen review and the reviewed image is not a report
image, e.g. Quant report or Exam Protocol.
 The CARTO DICOM network node is configured by Service for the CARTO desti-
nation.
The image transfer mode is set to Lossless JPEG.

Touchscreen  Exam or Image task card (not possible in Quant)

 Press this icon.

Console  Examination or PostProc task card (not possible in Quant)

 Select Transfer > Send to Carto from the main menu.

The currently displayed image is saved as a Store Monitor image and is trans-
ferred to the CARTO system.

Exporting scenes/images as video or bitmaps

If you want to use or process images in other applications, you can export them in
a common format to a directory of the hard disk or on USB memory.

Image formats The following formats are supported:

 AVI format (*.avi)
Various video compression codecs are supported.
 Windows Bitmap (*.bmp)

 JPEG format (*.jpg)

Note It is not possible to import images in this format.

Scenes/images exported as videos or bitmaps are not suitable for diagnostic pur-
Caution poses.
Image information is lost.
 Use only original scenes/images for diagnosis.

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The scenes/images are stored as individual files in a directory on your system hard
disk. Certain directories have been released (shared) for this purpose, e.g.
H:\CDR_OFFLINE.
Images can be recorded on media such as CD-R/DVD from there.

USB memory To export images/videos on your USB memory:

 Plug a USB memory stick into the USB jack.

 Wait a moment (until the LED on the drive stops blinking).

Exporting scenes/images
 The Local Job Status does not contain any jobs.

 The local media destination is configured by Service.

 A media is inserted into the drive.

 Display the scene to be exported as required (windowing....) in the PostProc

task card.
Or
 Select a scene from the scene directory.

Or
 Select an image from the image directory.

 Select Image > Export Image As... in the main menu of the PostProc task card.
– The Export Image As window appears.

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Selecting the format

 Select the desired format from the Type selection list.

Note The AVI format is only available in scenes with more than one image.

Selecting the range

 Enter the first (From) and the last image (To) to be exported or click the arrows.
– The corresponding image is displayed in the PostProc task card.

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Image Postprocessing

Or
 Click Select All to select all images of a scene.

Selecting planes
In the case of biplane scenes you can select whether only the images of one plane
(A or B) or the images of both planes (A and B) are to be exported.

 Select the desired plane from the Plane selection list.

Changing the settings

You can set the video format (video compression codec) for the AVI format.

 Click Change...
– The Video Compression window appears.

 Select the desired video compression codec from the Compressor selection
list.

Note The choices depend on the video compression codec that is installed.
 If you do not see the codec you need, please contact your system administra-
tor.

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Note The set video compression codec determines whether other systems can play the
video.
Recommended: Use the Microsoft MPEG-4 Video Codec V2. This codec offers a
good compromise between quality and compression. We do not recommend the
use of the Microsoft MPEG-4 Video Codec V1.
Older systems may experience hardware incompatibilities with the Microsoft
MPEG-4 Video Codec V2. In those cases, it is best to use the Microsoft Video 1
codec.

Note The number of frames per plane that will be converted to an AVI file is limited:
 511 frames - when converting to a 1024 x 1024 matrix size.

 1788 frames - when converting to a 512 x 512 matrix size.

 6767 frames - when converting to a 256 x 256 matrix size.

There is currently a technical limitation whereby the AVI file size cannot exceed
2 GB. It is independent of any compression.

Depending on the selected video compression codec, you can also choose addi-
tional settings:
 In the case of codecs with compression, you can set the compression quality
with the slider.
 Click Configure.
– A dialog window appears (depending on the selected codec).

Example

 Make the required settings here and confirm them with OK.

Setting the image matrix

 Select the desired video image matrix in the Output Size selection list.

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Image Postprocessing

Note Generally, the file resulting from doubling the image matrix will be four times larg-
er.

With our without text/graphics/ECG

 Click this box to determine whether the image text, the image graphics and, if
applicable, the ECG or pressure data are to be "burned" into the image and in-
cluded in the export.

Defining the file name and the export location

 Select the desired drive and directory.

 Enter the desired file name or keep the default name.

Note The default path can be configured by Siemens service.

If a USB memory has been plugged into a USB port before the dialog was opened,
you can select the corresponding path.

Note The default file names are made up as follows:

 For Bitmap and JPEG files:
<Patient name>_(S<Series #>_I<Image #>_
F<Frame #>_<Type>)P<Plane>.<Extension>
 For AVI files:
<Patient name>_(S<Series #>_I<Image #>_F<First frame #>-
<Last frame #>_<Type>)P<Plane>.<Extension>
S: Series
I: Image (scene)
F: Frame (image of a scene)
Type: SM (Store Monitor) or REF (Reference image)
Example: Patient Peter_(S2_I1_F5-35)PA.avi

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Starting the export

 Confirm by clicking OK.
– The selected images are saved with the selected settings.
– A text file with some data is saved at the same time.

Recording exported files to CD-R/DVD

 Insert an (empty) CD-R/DVD into the writer.

 Click Record Off-line Files.

Note The recording of offline data on CD-R/DVD is not shown in the Local Job Status
dialog.

Closing the patient

Note Always use the Close Patient function if an auto transfer rule is configured to send
the completed study to another node.
Otherwise, the exam protocol will not be transferred.

Note With activated Security Package, close the patient data before another user logs
in. Otherwise, users without the necessary rights will be able to view and change
data.

Console  PostProc task card

 Click this icon.

Or
 Select Patient > Close Patient from the main menu.

Touchscreen  Settings task card

 Press this icon.

– A confirmation dialog pops up.
 Press Yes, if you really want to close the patient.

All screens are cleared and a new emergency patient is registered.

Depending on configuration, the Patient Registration, Patient Browser or MPPS
window opens.

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Configuring patient close

You can configure which action shall be performed when a patient is closed:
 None

 Open Patient Registration window

 Open Patient Browser window displaying the Scheduler (worklist)

 Open Modality Performed Procedure Step window

 Set examination patient to “completed” and open Patient Browser window

displaying the Scheduler (worklist)

 Select Options > Configuration from the main menu.

– The Configuration Panel is displayed.
 Double-click the Close Patient icon.
– The Close Patient Assistant window appears.

 Click the required radio button.

 Confirm by clicking OK.

 Click Close to close the window.

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Procedure tracking with MPPS

After completion of an examination and all associated evaluations, you can docu-
ment the work you have done in a performance report. This report can then be
used, for example, for invoicing the costs.
For more information on MPPS, please refer to the syngo documentation.

Editing the performance documentation

 Call up the Patient Browser.

 Select the patient, the examination, or one of the associated series or images.

 Click this icon on the toolbar.

– The window Modality Performed Procedure Step is displayed.

As soon as you select a series the field Status indicates the MPPS status.

Checking data
 Check the entries for the patient and examination in the areas PATIENT,
STUDY, and MPPS.

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 Correct the data and enter a comment, if necessary.

Displaying Actions, Dose, Billing

 On the Actions card, a list of the examination steps performed (Exam Protocol)
is displayed.
 On the Dose card, a list of the data in connection with the radiation exposure
(e.g. applied dose) is displayed.
 On the Billing card, cost-related statement of the services rendered and the
materials consumed (film sheets) are displayed.
 Select data by clicking the corresponding tab.

Sending and concluding a report

 Click Save to save your changes to the report.

 Click Completed to conclude the report and the examination.

 Click Discontinued if you do not want to continue examination.

 Click Send to mark the report as "in progress" and pass it on the HIS/RIS system.

Deleting patients/studies/series/scenes
Note It is not possible to delete patient data in the following cases:
 Data is protected

 Data which is currently loaded in a task card

 Data has not the required work status

 Data which is temporally not available (because of an error)

Deletion confirmation deactivated

Caution Loss of data possible
 Do not deactivate deletion confirmation in the Configuration Panel.
The option Confirm Deletion on the General configuration should not be
switched off.
 Be careful when setting permissions to delete documents without check if flags
are not set.

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Deleting data manually

 Call up the Patient Browser.

 Select the objects to be deleted.

 Select Edit > Delete from the menu of the Patient Browser or open a popup
menu (right mouse button) and select Delete there.
Or
 Click this icon in the toolbar.

A dialog box appears in which you must confirm that you really want to delete the
data you have selected.
 Confirm the question with Yes to delete the selected patient and examination
data.

Configuring automatic deletion

 Select Options > Configuration from the main menu.
– The Configuration Panel is displayed.
 Double-click the Auto Delete icon.
– The Auto Delete Configuration window is displayed.

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Confirmation dialog for auto deletion is kept open for a long time on acquisition
Caution systems.
Loss of data if objects chosen for auto deletion are updated by acquisition
when the confirmation dialog is open.
 Do not keep the confirmation dialog open for a long time in parallel during a
patient examination and close it before a patient registration.

 Select whether Recycle Bin shall be used or not:

Click the Do not permanently delete data. Move data to recycle bin check
box to change the setting.
 Select the database (Local Database or Recycle Bin) for which automatic de-
letion shall be configured:
Click the Local or the Recycle Bin tab card.

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 Define the Timepoints for deletion.

Time points for deletion define when Auto Delete is started. It can be:
– when the local database has reached a certain fill state
– at a specific time on certain days during a week
– at a specific time on certain days within a month
 Select the options to be used.

In Auto Delete configuration, Sent flag is configured for rule Delete all Series
Caution with following flags.
In Auto-Transfer configuration, auto transfer is configured to start when Sent
flag is set.
Loss of data if both functionalities start in parallel
 Do not use auto transfer rule with Sent flag and auto deletion rule with Sent
flag in combination.
 Instead, use storage commitment whenever it is supported by the sending and
receiving systems.
 If this combination is not avoidable, always cross-check if the data chosen for
auto deletion is stored on the receiving system before confirming auto dele-
tion.

 Define the Data to be deleted.

– Series that contain certain flags (only for Local database)
– Data that is older than specified
 Select the rules to be used.

Deactivation of the confirmation dialog for Auto Delete

Caution Loss of data, delay of diagnosis or therapy
 The confirmation dialog for Auto Delete should always be switched on, espe-
cially on modalities. If the confirmation dialog for Auto Delete is switched off,
Auto Delete will start without user confirmation.

The rules will also used when users start Auto Delete manually.
 Define Ask confirmation before deletion.
If this option is selected, users are prompted when Auto Delete starts whether
data should be deleted.
 Click OK to make the settings take effect.

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 Part: Advanced Examinations
Cardiac Examinations

CLEARstent With the CLEARstent imaging functions, you can emphasize fine structures, e.g.
inflated stents. Composite images are created by averaging several frames of a
scene and by considering the alignment of stent markers. If an ECG signal is avail-
able, the heart phase will also be taken into account.
There are the following possibilities for CLEARstent:
 Use the CLEARstent reference image function to generate a special reference
image from any scene or fluoroscopy scene acquired natively.
CLEARstent reference image 307

Original image CLEARstent image

 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 program, where a couple of images are acquired natively before inject-
ing contrast medium. After end of acquisition, the algorithm to calculate the
CLEARstent scene is automatically started.
CLEARstent Dynamic acquisition 448
 Acquire a CLEARstent Live scene, which provides a stabilized view of the
stent.
Acquisition is performed simply using a CLEARstent Live acquisition program.
CLEARstent Live acquisition 450

3D cardiac Perform ECG gated 3D acquisitions

Please refer to Rotational Angiography, 3D Acquisition, 3D 500

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Advanced Examinations

CLEARstent Dynamic acquisition

General information
Acquisition program For CLEARstent Dynamic, a special cardiac acquisition program is available. This
acquisition program has variable frame rate with the following parameters:
 Number of phases: 2

 Phase 1: Phase time and frame rate are configured in such a way that a mini-
mum of 30 frames will be acquired.
 Phase 2: Phase time and frame rate can be defined by the user.

 Auto Processing is configured.

Note CLEARstent Dynamic is only possible for acquisition frame rates up to 15 f/s.

Biplane system On a biplane system, the CLEARstent function is always performed in the active
plane only.

CLEARstent scene The CLEARstent Dynamic scene is created such that the first frame shows 100%
stent detail and the last frame shows 0% stent detail, whereby the percentage of
stent detail gradually fades between the first and last frames.

CLEARstent scene, first frame CLEARstent scene, middle frame CLEARstent scene, last frame

CLEARstent scene  When Review Mode is set to Loop, CLEARstent scenes will be displayed in
replay Toggle review mode. It is an exception to the default review mode.
 When Review Mode is set to MFH (max fill hold), the CLEARstent scene will
be displayed with MFH.

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Zooming/panning CLEARstent Dynamic images can be zoomed and panned via zoom to Acquisi-
tion Size in postprocessing. When zooming, the CLEARstent ROI values saved with
the image are used and the image is positioned in the center of the viewing area.
Unused borders will be displayed black.

CLEARstent Dynamic acquisition workflow

A CLEARstent Dynamic acquisition is performed in the following sequence:
1. Prepare the patient, stand, C-arm and table.
Check the injector.

2. Perform a brief fluoroscopy: Press fluoro pedal of footswitch.

Check/set SID, zoom stage, collimation, filters 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 complete.

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

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When processing of the CLEARstent Dynamic image has concluded:

 A CLEARstent reference image will be created, stored, and displayed on the ac-
tive reference screen.
 If contrast medium is present in the images, a CLEARstent Dynamic scene will
be created, stored, and displayed on the live screen.
 If no contrast medium is detected in the image, the CLEARstent reference im-
age will also be displayed on the live screen.

Note If Store Reference is performed during a CLEARstent Dynamic acquisition:

 A preliminary result of the CLEARstent image will not be displayed on the ac-
tive reference screen. The last stored reference image will be displayed.
 The newly created CLEARstent reference image and, as applicable, the
CLEARstent Dynamic scene will be stored to the local database, but not dis-
played.

CLEARstent Live acquisition

Acquisition program For CLEARstent Live, a CARD program with variable frame rate and two phases
can be used. It is activated by the Auto Processing = CLEARstent Live acquisition
program parameter.
The first phase is defined with 1 s and 15 fps to get 15 images within a short time,
the second phase with a lower frame rate to move the catheter. The frame rate for
the second phase can be defined as required up to 15 fps.

Zoom stage CLEARstent Live is only possible for specified zoom stages. If a zoom stage other
than specified is set, the following message will be displayed: “CLEARstent Live
not allowed for xx cm zoom format”. Acquisition will be possible but no stabili-
zation will be performed.

Artis biplane For biplane acquisition, the algorithm is applied only to the master plane images.
The master plane displays CLEARStent Live images and second plane displays
normal acquisition images.

Review The stabilized scene will not be automatically loaded for review after X-ray stops,
because it is used to guide the placement of the stent.
For each CLEARstent Live acquisition, two scenes are stored: the live acquired
scenes and the stabilized scene. If stabilization fails, e.g. when the stent is moved
outside of the image, only one scene is saved.

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Performing a CLEARstent Live acquisition

 Selects a CLEARstent Live acquisition program.

 Start acquisition: Press the exposure release button or pedal and keep it
pressed.
– As long as the detection algorithm has not finished detection, the following
message is displayed: “CLEARstent Live in preparation”
– When the detection algorithm has finished detection, the following mes-
sage is displayed: “CLEARstent Live processing”.
Images processed by CLEARstent Live algorithm are displayed, providing a
stabilized view of the stent.

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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 vessel size, plaque area and volume,
and the location of key anatomical landmarks.
IVUS offers to measure the stage and severity of disease present in cardiac and pe-
ripheral vessels.
IVUS is also used in post-stent placement procedures to confirm expansion of the
stent and full apposition to the vessel wall.

IVUSmap For obtaining a coregistration of an angiographic X-ray image and IVUS images,
the IVUSmap feature is available. IVUSmap facilitates to acquire and select a ded-
icated X-ray image to be used for coregistration, determining the vessel center-
line, and performing of the pullback.

Review After pullback, the coregistrated images can be reviewed and it is possible to per-
form measurements.

IVUS system Currently, the Volcano s5i IVUS system is supported.

For operation of the IVUS system, see the Volcano IVUS operating manual.

Catheter types Currently, the following IVUS catheters are supported:

 Volcano Eagle Eye Gold catheter

 Volcano Eagle Eye Platinum catheter

IVUSmap exam set A special exam set for IVUSmap is available which contains:
 For acquisition of a contrast enhanced angiographic image:
An ECG gated acquisition program with a Cardiac Phase Width of 0%
This acquisition program must be the default acquisition program, i.e. the first
acquisition program in the exam set.
A Cardiac Phase Width value of 0% indicates that only one X-ray image is ac-
quired per cardiac cycle.
 For acquisition in the pullback phase (either or both):
– An ECG gated alternative acquisition program with a Cardiac Phase Width
of 0%
– One fluoroscopy triplet with at least one ECG gated fluoroscopy program
with a Cardiac Phase Width of 0%

Input field/ IVUSmap is supported in the following zoom stages:

zoom stage
 FD 20x20: All zoom stages

 FD 26x30: Zoom 1 and up

 FD 30x40: Zoom 2 and up

Artis biplane It is only possible to perform the angio IVUS coregistration on plane A of a biplane
system.

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When attempting to acquire an X-ray image for coregistration on plane B only, the
following message is displayed: "Registration requires ECG-gated x-ray on
Plane A"
When acquiring a biplane image, the plane A image will be used for coregistra-
tion.

IVUSmap examination workflow

IVUSmap can be selected when:
 The imaging system is in normal viewing mode.

 IVUSmap is properly licensed.

 A supported IVUS system is powered on, ready, and connected to the Artis
system.
 Enough storage capacity for ultrasound images is available on the IVUS system.

An IVUSmap examination is performed in the following sequence:

Step 1 455 1. Register the patient on the Artis.

2. Select the IVUSmap exam set.
3. Start IVUSmap
4. Position the IVUS catheter in the vessel of interest.
5. Acquire a scene with contrast medium in the region of interest with ECG

Step 2 457 6. Mark the centerline of the vessel segment of interest

Optionally correct the centerline

Step 3 459 7. Start the pullback, manually or using the pullback device
8. Record the pullback on the IVUS system
9. Start low dose acquisition or fluoroscopy on Artis with ECG
When pullback is finished:
10. Stop acquisition and recording
11. Stop the pullback

Step 4 461 12. Review the pullback scene

13. Perform measurements

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Step 1: Start IVUSmap and acquire scene

Start IVUSmap

Touchscreen  Exam task card

 Select an IVUSmap exam set.

 Press this button.

The Create Image workflow step is active.

The demographic data of the patient is transferred to the IVUS system.

 Make sure, the same patient is registered on the IVUS system.

Note You can close the IVUSmap dialog at any time and reopen it returning to the latest
workflow step.

Acquire a contrast enhanced angiographic image to be used for

coregistration
The ECG gated acquisition program for IVUSmap is automatically selected.
The following message is displayed: “Position IVUS catheter in vessel and ac-
quire angio scene”
 Position the IVUS catheter in the vessel of interest.

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 Inject the contrast medium.

 Press the exposure release button or pedal.

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 frame

TSC
 Deflect the mouse joystick briefly.
– Left: one frame backward
– Right: one frame forward
Or

 Press one of these icons.

Console
 Click one of these icons.

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Step 2: Mark the vessel segment of interest

Touchscreen  Press the Mark Vessel button.

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

Marking the centerline

User inadvertently marks the wrong vessel during Angio/IVUS registration.

Caution 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.

TSC or console  Click in the image to mark the tip of the guiding catheter.
– The indicated position is marked as the proximal vessel position.
 You may undo and repeat your marking.

The following message is displayed: “Select distal vessel location”

TSC or console  Click in the image to mark the distal part of the vessel.
– The indicated position is marked as the distal vessel position.
 You may undo and repeat your marking.

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

centerline”

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Correcting the centerline

It is possible to place a maximum of 10 centerline correction points.

Touchscreen

 Press the Correct Centerline button.

Console
 Click this icon.

The following message is displayed: “Set centerline correction point”

TSC or console  Move the cursor to a position in the image and indicate this position as a cen-
terline correction point by a mouse click.
– A new centerline point is set at the selected location.
 Repeat it until you are satisfied with the vessel centerline.

 Deselect the Correct Centerline function.

 You may undo any correction.

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Step 3: Pullback
Touchscreen  Press the Pullback button.
Returning to acquisition position after stand movement 460

The following message is temporary displayed: “Creating registration image”

The created single-frame registration image with vessel centerline information is
loaded and displayed.
The following message is displayed: “Perform ECG-gated x-ray during pullback”
 If alternative acquisition is available, the ECG-gated alternative acquisition for
pullback is automatically selected.
 If a fluoroscopy program is identified for IVUS use in the IVUSmap exam set,
the fluoroscopy program is automatically selected.
 Check the pullback speed on the pullback device and on the IVUS system.

 Start the pullback, manually or on the pullback device.

 Start US acquisition on the IVUS system.

 Start X-ray acquisition: Press the footswitch pedal for

(alternative) acquisition or fluoroscopy.
The location of the IVUS catheter in each frame acquired is detected and stored
during pullback.

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Movement of guiding catheter during transducer pullback.

Caution 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.

Note If stand movement occurs during the pullback, coregistration cannot be per-
formed. The following message is displayed in this case: "Coregistration not pos-
sible - stand movement".

 Stop X-ray acquisition: Release the footswitch pedal.

The following message is displayed: “Waiting for the End of Pullback ...”
 Stop US acquisition on the IVUS system.

The following message is displayed: “IVUS images will be transferred. Please

wait.”
 Stop the pullback.

US images are transferred in the background from the IVUS system to the Artis.
The subset of US images is displayed which has already been transferred.
 Wait until all the US images have been transferred and are displayed.

When US images are displayed, you can already start placing bookmarks. 467

Returning to acquisition position after stand movement

When selecting the Pullback workflow step and the current stand position/table
position differs by more than 0.5°/1.0 mm from the stand and table position of the
ECG gated angio scene used for registration, the following message is displayed:
“Return system to registration position (deflect joystick)”
 Deflect a stand joystick or table joystick in any direction and hold it deflected
until movement stops.

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Step 4: Review
Touchscreen The Review workflow step is automatically selected.

In the last workflow step, you can review the coregistrated angiographic image
and the IVUS images.
If the registration between the X-ray angiographic image and the IVUS images
does not match exactly, you can correct it.
Corrections 469
You can also calibrate the angiographic image and perform measurements.
Measurements 471
When finished, or if you want to review later:
 Close the window.

IVUSmap review
You can review the coregistrated angiographic image and the IVUS images in
step 4 of an IVUSmap examination, or at any time, loading data of a former exam-
ination.

Console  The IVUSmap task card is on top.

 The coregistrated angiographic image and the IVUS images are still loaded.

Or

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 Open the Patient Browser.

 Select the required series and load it by drag & drop or by double-clicking.

The IVUSmap task card

(1) (2)
(1) Image area
– Top left: 2D angiographic image segment
– Bottom left: IVUS cross-section image segment
– Right: IVUS ILD image segment (ILD: inline digital display)
(2) Control area

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Markers in 2D angiograph- in IVUS ILD image segment

ic image segment
Active frame
(green)

Correction point
(blue)

Bookmark
(yellow)

IVUSmap in biplane configuration

The IVUSmap task card is only available for plane A.

A
B

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IVUS ILD image segment

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

(1) Bookmarks
(2) ILD image
(3) Ruler with markings in millimeters
(4) Measurement bookmarks

IVUS ILD frames Each ILD frame represents a single ECG gated IVUS frame and potentially several
ungated IVUS frames.
 When no ungated image is loaded, 5 rows of pixels in an IVUS ILD frame iden-
tify one gated IVUS image.
 When displaying ungated images, each row of pixels in an IVUS ILD frame iden-
tifies a different ungated IVUS ILD frame.

(3)

(1)
Time

(2)
Time

(1) Ungated frames

(2) ECG gated frames
(3) ILD slices

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Replay

Loop, single stepping

TSC  Review workflow step

 Press one of these icons.

Console  Review subtask card

 Click one of these icons.

Or
 Click anywhere in the cross-section image segment, except for on top of the
IVUS ILD orientation arrow.
– A single click in the left half of the image will initiate a single frame step in
the proximal direction.
– A single click in the right half of the image will initiate a single frame step in
the distal direction.
 Perform a long mouse click to start or stop the loop.

Scrolling

Navigating along the vessel/ILD image

TSC  Review workflow step

 Deflect the mouse joystick up/down.

– The cross-sectional images are scrolled accordingly.

Rotating the vessel view/ILD image

TSC  Review workflow step

 Deflect the mouse joystick left/right.

– The ILD view is indicated in the cross-sectional image.

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Selecting the active IVUS frame

Console  Perform a single click in the IVUS ILD image segment or in the 2D angiographic
image segment.
Or
 Click and drag in the IVUS ILD image segment or in the 2D angiographic image
segment.
– The loop is stopped, if the scene was looping.
– The frame closest to the current cursor position is set as the active frame.
– The active frame is shown in the IVUS cross-section image segment.

Setting the orientation of the ILD image segment

The orientation of the ILD image is indicated on the IVUS cross-section image as
an arrow. The arrow points to the portion of the IVUS cross-section image which
is drawn in the right half of the IVUS ILD image segment.

Console  Click and drag in the IVUS cross-section image segment.

– The loop is stopped, if the scene was looping.
– The IVUS ILD orientation indicator is moved to the calculated IVUS ILD orien-
tation closest to the position indicated by the cursor location in the IVUS
cross-section image segment.
– The selected IVUS ILD orientation image is displayed in the IVUS ILD image
segment.

Changing the direction of the IVUS ILD image

The ILD image can be flipped so that the distal to proximal frame ordering can be
displayed either bottom to top or top to bottom.

Console  Select Options > ILD: Distal End on Top.

Or
 Select Options > ILD: Proximal End on Top.

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Bookmarks

A bookmark is automatically created for each distance measurement in the IVUS

ILD image segment. Bookmarks can also be placed manually. Bookmarks are indi-
cated on the left of the ILD image segment. A maximum of 10 bookmarks can be
placed.
The distances between the bookmarks are indicated on the right of the IVUS ILD
image segment. To the right of the ruler, 5 columns for distance measurements
are shown:
 The two left-most columns indicate the distances between adjacent book-
marks.
 The third column indicates the total distance between the most proximal and
most distal bookmarks.
 The two right-most columns indicate user specified distance measurements
between any two selected bookmarks.

Adding a bookmark

Console  Review subtask card

 Right-click in the image and select Add Bookmark from the context menu.

TSC  Review workflow step

 Press the left button of the mouse joystick.

A new bookmark is added, distance measurements are updated.

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Deleting the last bookmark

TSC  Review workflow step

 Press the right button of the mouse joystick.

The bookmark is deleted, distance measurements are updated.

Selecting a bookmark

Console  Review subtask card

 Click the bookmark.

Note Bookmarks can only be selected if they are visible. Bookmarks may not be visible
in all the image segments. E.g.:
 The IVUS cross-section image segment only shows a bookmark indicator if the
displayed frame is bookmarked.
 The 2D angiographic image segment only shows the bookmarks that are locat-
ed on registered IVUS frames.
Only the IVUS ILD image segment shows all the bookmarks.

Entering a bookmark label

 Select the bookmark to label.

 Enter the label text on the keyboard.

Deleting a bookmark
 Select the bookmark to delete.

 Right-click in the image and select Delete Bookmark from the context menu.

Overlay Reference
 At least one reference image has been stored. 305

Touchscreen  Exam task card

 Press this icon.

Console  Review subtask card

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 Click this icon.

Performing Overlay Reference 312

Note When Overlay Reference is active, it will not be possible to perform measure-
ments with the mouse joystick.
 Deactivate Overlay Reference before starting a distance measurement or area
measurement.

Show/hide settings

Touchscreen Monitor screen Description

- View > Image Text 373
View > ECG Display 374

View > Annotation Hide Annotations and Measure-

ments

Corrections
If the registration between the X-ray angiographic image and the IVUS images
does not match exactly, you can correct it. Corrections are made by specifying cor-
rection points.
Each pair of correction points identify a centerline position in the X-ray angio-
graphic image and in an IVUS image that specify the same location in the vessel.
The correction points are used to identify landmarks in the vessel both in the 2D
angiographic image and the IVUS image.
Each centerline position identifies also a time stamp that it maps to. Similarly,
each frame in the IVUS scene also identifies a time stamp when the image was ac-
quired. The difference between these time stamps (time shift) represents the cor-
rection to be applied.
The registration will be updated to force the registration to agree with the user
specified correction points, and stretch/compress the registration linearly be-
tween the correction points.

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Starting correction

Console  Review subtask card

 Click this icon.

Correcting the centerline alignment

A maximum of 20 correction points can be placed.

Adding correction points

 Zoom/pan the 2D angiographic image, if necessary.

 Add a correction point by clicking in the 2D angiographic image and in the IVUS
ILD image at the required correction locations.
 Correct the position of a correction point by drag and drop, if necessary.

 Click this icon to accept the correction points.

 Add or correct further correction points accordingly.

Saving corrections
 Click this icon to accept your corrections.

Restoring the original registration calculated during pullback

 Click this icon to reject all your corrections.

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Correcting the pullback speed

If the pullback speed has not been set correctly during acquisition on the pullback
device and on the IVUS system, you can correct it.

 Select the correct Pullback Speed.

Select Manual if manual pullback has been performed.

Saving a corrected registration

 Click the Close button in the Corrections dialog.
– The Save Registration? dialog pops up.
 Click Yes.
– The current registration will be replaced by the corrected registration.

Measurements
Note When Overlay Reference is active, it will not be possible to perform measure-
ments with the mouse joystick.
 Deactivate Overlay Reference before starting a distance measurement or area
measurement.

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Distance measurements
Preconditions  Distance measurements are possible in all the image segments, i.e. in the 2D
X-ray image segment, the IVUS ILD image segment, and the IVUS cross section
image segment.
 For distance measurement in the 2D X-ray image segment:
– The single frame XA images must have square pixel spacing.
– A maximum of 15 measurements is possible.
 For distance measurement in the IVUS cross section image segment:
– Distance measurements are only possible in the IVUS cross section image
segment if the pixel spacing values for the IVUS image are specified and
non-zero. If the pixel spacing values are not correct, the following message
is displayed: "Measurement prohibited - invalid pixel spacing"
– A maximum of 15 measurements per frame is possible.
 For distance measurement in the IVUS ILD image segment:
– Distance measurements are only possible in the IVUS ILD image segment if
the IVUS pullback was performed using an automatic pullback device and
pullback rate was non-zero. If manual pullback was used, the following mes-
sage is displayed: "Measurement prohibited - manual pullback"
– Distance measurements in the IVUS ILD image segment cannot be moved or
modified directly.
– A maximum of 2 measurements is possible. When the maximum number of
measurements is reached, the oldest of the existing manual distance mea-
surement will automatically be removed and replaced by the new measure-
ment.
Bookmarks 467

Drawing and measuring distances 615

Calibration 598

Area measurements
Preconditions  Area measurements are only possible in the IVUS cross section image segment.

 Area measurements are only possible if the pixel spacing values for the IVUS
image are specified and non-zero.
 A maximum of 20 corner points can be defined for each area measurement to
define the shape of the area being measured. When the 20th control point is
added, the system will automatically complete the area measurement.
 Up to 3 area measurements are possible for each IVUS frame.

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The area measurements and ratios of areas are indicated in Results window.

Note The area values and ratios of area values are indicated in the order in which the
areas where drawn.

Drawing and measuring areas

You can measure areas in the IVUS cross-section image by drawing closed poly-
gons.

Drawing an area

Console  Review subtask card

 Click this icon.

Touchscreen  IVUSmap is active, Review workflow step

 Press the Area Measurement button.

Console & TSC  Move the mouse pointer into the image.
– The mouse pointer changes shape.
 Click in the image to set the starting point.

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 Draw the polygon point by point clicking the mouse button once at each
change of direction.
 Double-click the last corner point.
– The area is drawn.

Moving an area polygon

 Click and drag the polygon line to the required location.

Changing an area polygon

 Click the polygon line.
– The corner points are marked.
 Click one of the corner points, hold the mouse button pressed, and change the
polygon as required.
 Release the mouse button.

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Rotational Angiography, 3D Acquisition

Rotational angiography can be performed without or with digital image subtrac-

tion:

DR-DYNAVISION DR-DYNAVISION is the further development of classical rotational angiography in

which an examination area is acquired from different directions in a single run.
The acquisition can be carried out with or without contrast medium. The scenes
are displayed native (unsubtracted).
DR-DYNAVISION 483

DYNAVISION (DSA-)DYNAVISION is the angle-triggered acquisition 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. Since the mask and fill phases occur in the
same direction, the images are acquired under the same conditions. The rotation-
al range of the C-arm can be freely selected.
DYNAVISION 491

3D On Artis systems, special 3D acquisition modes are available which enable the
generation of image sets suitable for 3D reconstruction on the syngo Workplace.
3D 500

General information on rotational angiography

In rotational angiography, the vascular region of interest is acquired from several
projection directions during an acquisition series by rotation of the C-arm.

Application Rotational angiography is always used if superpositions have to be projected free,

e.g. turning up bifurcations (carotid artery, iliac artery, renal artery) or projecting
free the neck of an aneurysm.

Advantages With rotational angiography one obtains:

 several projections of the vascular region with one injection

 a spatial impression of the course of the vessels

 the possibility for generating 3D images

Isocenter With rotational angiography, the volume to be imaged should always lie in the iso-
center of the C-arm (i.e. center of rotation). Otherwise it may move out of the im-
age area in some projections.
It is essential for 3D examinations, where the region of interest must be positioned
in the isocenter. The “isocenter assistant” helps you positioning the region of in-
terest in the isocenter. 525

Instructions Instructions are given on the Assist screen / message bar.

 Pay attention to the messages.

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Collisions The effect of a collision depends on in which state of the rotational angiography
examination the collision occurs:
 If a collision occurs before the first run is started, the system returns to the test
phase and does not deselect the acquisition.
 If a collision occurs while there is no rotational movement, e.g. acquisition in
injection phase or X-ray delay from injector, the system displays a message and
does not deselect the acquisition.
 If a collision occurs during the movement (collision sensor), then the move-
ment stops.
The acquisition and the injection are stopped, the acquisition program is dese-
lected by it, and the acquisition cannot be continued.

Patient movements If the patient moves during a rotational angiography acquisition, there is a risk of
collision and also the acquired scenes may not be suitable for the intended pur-
pose.
 Instruct the patient not to move, or immobilize the patient, if necessary.

 Pay attention to patient movements during a rotational angiography acquisi-

tion and stop the acquisition/movement, if necessary.

Exposure release For exposure release, in principle the hand switch or foot switch can be used.
However, to facilitate the examination sequence we recommend using the foot
switch.

Rotation The start and the end position and the rotation range (angle) are determined be-
fore acquisition during the test phase.
It is immaterial for performing rotational angiography whether the start position
is in RAO or LAO or cranial or caudal respectively.

Patient moves hand or arm into the way of the moving C-arm.
Caution Patient injury
 It is the responsibility of the operator to ensure proper immobilization of the
patient.

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System positions Rotational angiographies can only be carried out in the following system posi-
tions:
 In Artis zeego, the C-arm can be the Head Side, Left Side, Right Side and Left
Side, Table Rotated positions.
Only one longitudinal position is supported.
However, the following restrictions apply to Left Side, Table Rotated
positions:
– Only the table rotation angles of 15° and 30° are supported.
– Eccentric Rotation is not supported in these positions.
– Large Volume is not supported in these positions.
 In systems with floor stand - Artis floor, the C-arm of the floor stand must be in
the Head Side position.
 In biplane systems - Artis biplane, rotational angiographies can only be created
single plane in plane A (floor stand) in the Head Side position.
The top stand is not used and must be in the parking position.
When a DR-DYNAVISION/DYNAVISION/3D program is selected, the system au-
tomatically switches over to single plane mode (plane A).
 In Artis ceiling, the C-arm can be in a selectable lateral position or in the Head
Side, Left Side and Right Side positions.
Perform 3D or DR-DYNAVISION/DYNAVISION preferably in the Left Side or
Right Side position for better matching accuracy.

Rotation angle and The maximum rotation angle and the maximum rotation speed can be preselected
speed in the acquisition program. They also depend on the position of the C-arm in rela-
tion to the rotation plane.

Frame rates The frame rates are controlled by the acquisition program.

Injection mode The injection occurs just before start of fill run.
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 triggered.
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 injection phase. During this delay time, there is no image acquisition.
 If the injector is not set to “Armed”, the system assumes that a manual injection
is performed 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.

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Injector not connected (correctly) or not set to “armed” (especially with

Caution PERIVISION, DYNAVISION or 3D examinations)
Risk of X-ray radiation applied without diagnostic use
 Pay attention to the messages on the Assist screen / message bar.

 Inject manually, if necessary.

Note The message “Injector disabled, manual injection.” indicates that the injector
has not been set to “Armed” and a manual injection must be performed.
For other injector-related problems, please refer to ... if there are problems with
the injector 804.

Washout phase The C-arm automatically comes to a halt after running through this region during
acquisition. Further acquisitions can be performed to observe the outflow (wash-
out) of the contrast medium. It is designated as the “washout phase”.

Acquisition scenes Several scenes are acquired in a rotational angiography acquisition.

 Injection phase (only with 3D)

 Mask phase (only with DYNAVISION or 3D DSA)

 Fill phase

 Washout phase (only with DYNAVISION)

Playback The acquisition series are played back directly after the acquisition according to
the settings in the acquisition program.
DR-DYNAVISION acquisition series are always played back in native display. Subse-
quent subtraction is not possible.

Note DR-DYNAVISION and DYNAVISION scenes are normally played back in the Toggle
display.
Alternatively MFH (= Max. Fill Hold) can be set.
Defining the default review mode 362

Storing The acquisitions are stored automatically in the local database.

Loading and playback You can load the series and scenes as usual from the Patient Browser to the
PostProc task card.

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Depending on where which scene is selected for playback, e.g. by double-clicking,

a native or subtracted DYNAVISION or 3D scene is played back:
 On selection of the series in the Patient Browser, the DYNAVISION scene is
played back subtracted.
 On selection of a mask, fill or washout scene in the Patient Browser the select-
ed scene is played back native.
 On selection of a mask or fill scene in the scene directory, the DYNAVISION
scene is played back (reviewed) subtracted in the PostProc task card.

Acquisition programs for rotational angiography

To set the parameters for acquisitions, use an existing acquisition program or copy
an existing program to produce a new one. The acquisition program used must
have the Mode DR Dyna or Dynavision. Only then is access to the special param-
eters possible.
Parameters for Exam Sets 573
Siemens provides a number of predefined exam sets that can be adapted individ-
ually.

Windowing The data for programming the window values depend very much on the concen-
tration and amount of the contrast medium used.
Therefore these values must frequently be adapted individually, also to the image
impression wanted by the examiner.
 DR-DYNAVISION is always performed unsubtracted. Therefore only the values
for native display can be set in this program.
 DYNAVISION is always performed subtracted. Therefore the values for both dis-
plays can be set in this program.

Auto windowing Instead of manual windowing, automatic windowing can also be selected in the
programming. Then the windowing is calculated automatically, related to the
maximum contrast image.
We recommend that manual windowing is programmed. Automatic windowing
functions well provided the image is not collimated and no direct radiation (e.g.
when imaging air) is present in the image.

Dose The dose should be set at 1.2 μGy per image.

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Automatic/manual The rotational examination sequence depends on the DYNA Control or 3D Con-
control trol setting in the acquisition program:
 If Auto is set in the acquisition program, then the movement of the C-arm
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 of the C-arm (and start of the acqui-
sition) manually with the multifunctional button (blue button on the hand
switch).
– The injection must also be carried out manually.

Note The DYNA Control or 3D Control setting in the acquisition program primarily re-
fers to the unit's sequence of movement, not to the injector setting.
You must operate and enable the injector independent of the unit!
Only if an injector is connected and enabled will it receive a start signal from the
system (depending on the setting in the acquisition program).

Dyna Time The Dyna Time is the time required to run through the set rotation angle.
The Dyna Time should be as short as possible (2 to 3 s), to guarantee optimum ro-
tational speed of the C-arm.

Angulation step The Angulation Step parameter determines the angulation step (in degrees per
image) of the C-arm between two acquisitions.
3°/Image for example means that the system starts an acquisition every 3°.

Note The messages, e.g. DYNA test phase: Auto, DYNA X s, Y °/F, show the Dyna Time
X in seconds (time required to run through the set rotation angle) and the angu-
lation step Y in degrees per image (resolution of the angulation).

General preparations

Preparing the examination

 Register the patient.

 Prepare the patient and units.

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 Check the exam set, change it if necessary.

 Check the frame rate and the dominant. Recommendation: middle dominant

Preparing the patient

 Position the patient.

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

 Check for correct entry of the patient position.

 Inform the patient about the coming examination procedure.

Preparing the stand and table

Move the C-arm of plane B into parking position (only biplane systems)
 Press the stand joystick of plane B down, press one of the two buttons on the
side and deflect the joystick to the side until the parking position has been
reached.

Position the C-arm (of plane A) in Head Side position

 Press the System positions key on the stand control module.

 Select the required system position.

 Press down the stand joystick and deflect it forward until the target position is
reached.
 Or press the hands free foot pedal.

Setting the isocenter

Positioning the region of interest in the isocenter ensures that this region does not
drift out of the displayed field of view.
See also Setting the isocenter 266

Position the patient in the frontal beam path

 Press the FLUORO pedal on the foot switch for approx. 2 s.
– An image appears on the screen (LIH).

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 Center the organ to be examined by moving the tabletop.

Position the organ in the lateral beam path

 Position the organ in the center of the image by lifting and lowering the patient
table.
 Check the exact height with fluoroscopy, if necessary.

Preparing the injection

 Puncture and insert the catheter.

 Connect the contrast medium injector and program it.

See the Injector Operator Manual
 Set the data so that the injection results in a good filling of the vessels during
the entire fill phase.
 Perform fluoroscopy and collimate.

 Position the catheter in the target area.

Automatic injection
 Set the X-ray delay on the injector.
See Injection mode 477
 Switch the injector to “Armed”.

Manual injection
 Deselect synchronization.

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DR-DYNAVISION

DR-DYNAVISION examination sequence

(2)

(6)

(4)
(7) (5)
(1) (3)

(1) Start position

Optional: Brief fluoroscopy to check the examination region
(2) Test run with rotating C-arm for ensuring that no collisions occur
(3) Brief fluoroscopy for automatic setting of acquisition parameters
(4) Injection if contrast medium is used
(5) Start of acquisition
(6) Fill run with rotating C-arm for image acquisition with or without contrast me-
dium
(7) End position

Preparations First of all you position the patient and unit and center the area to be examined in
the isocenter.
By selecting the acquisition program the examination sequence is started.

Test phase During the test phase, you determine rotational range (start and end positions as
well as angle). You check the position of the examination region by briefly switch-
ing on fluoroscopy (mandatory at start and finish of the test phase). You also
check object centering and collimation.

Reversal point You start the acquisition or it starts automatically according to programming at
the reversal point.

Injection The injector receives the start signal (if integrated) or you perform the injection
manually, if necessary.

Fill phase In the fill phase, an image is acquired for every projection and displayed.

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It is independent of whether contrast medium was applied or not.

DR-DYNAVISION workflow
A DR-DYNAVISION acquisition is performed in the following sequence:
1. Prepare the patient, stand, C-arm and table.
Position the region of interest in the isocenter.
Check the injector, if used.

2. Perform a brief fluoroscopy in the start position 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.

5. Perform a brief fluoroscopy for automatic setting of acquisition

parameters: Press fluoro pedal of footswitch.
6. Automatic or manual injection if contrast medium is used.
Start injector if manual injection is used.
7. Perform the DR-DYNAVISION acquisition run:
– Start acquisition: Press the exposure release button or pedal and keep it
pressed. Rotational run will start automatically, 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 multifunc-
... tional button of the handswitch, if Manual is programmed.

Automatic/manual control 480

8. Stop acquisition when rotational run is complete.
9. View the rotational series.

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Preparing DR-DYNAVISION
 General preparations 480

 In biplane systems, the top stand is in the parking position.

 The C-arm is in the required start position.

Select the acquisition program

Note DR-DYNAVISION is started by selecting the DR-DYNAVISION program.

It means you first position the patient or unit and then select the DR-DYNAVISION
program.

 Activate the required DR-DYNAVISION program on the touchscreen control.

– Stand/C-arm longitudinal movements, stand swiveling and possibly table tilt
are blocked.

Note The normal functions can be restored by selecting a non-DR-DYNAVISION program

or registering a new patient.
The end position is redetermined with the selection of another DR-DYNAVISION
program.

Check the parameters

 Check to make sure that the required rotational range (angle), the required an-
gulation step and the required frame rates are set.

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DR-DYNAVISION test phase

 The catheter is located in the target area.

 The injector or manual administration of contrast medium is prepared, if nec-

essary.

Perform fluoroscopy briefly

At the beginning of the test run the end position of the fill phase is determined by
the first fluoroscopy.
 Press the FLUORO pedal on the foot switch for approx. 2 s.
– An image appears on the screen (LIH).

Note Fluoroscopy is not absolutely necessary at the start of the test phase and in inter-
mediate positions, but recommended in order to be able to collimate well and
thus achieve optimum image quality.
Fluoroscopy must be performed at the end of the test phase to determine the start
position of the fill phase.

Collimate
 Tap the collimator joystick briefly, if necessary.
– The collimator leaves are displayed graphically in the LIH image.

Carry out the test phase

 Press the stand joystick down, deflect the joystick and hold it in this position.
(With respect to the set orientation of the control console.)

– The C-arm moves in the direction in which the stand joystick was deflected.

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Note The first deflection of the stand joystick determines the direction of rotation.
Combined C-arm movements (diagonal deflections) are not possible.

The following message is shown:

– DR-DYNA test phase: Auto, DYNA X s, Y °/F with automatic control
– DR-DYNA test phase: Manual, DYNA X s, Y °/F with manual control
Automatic/manual control 480
 Perform fluoroscopy, collimate and position filters as required.
– The exposure data are calculated and the generator is automatically preset
from fluoroscopy in an acquisition position. (The system takes account of
the patient transparency in this case.)

Note It is not necessary to perform fluoroscopy in every position, but it is advantageous.

If fluoroscopy was not performed in every position, then the exposure data of
each acquisition position are calculated back from the determined values.

Note The test run must be repeated if a movement other than C-arm rotation is trig-
gered during the test run.
If the stand joystick is deflected afterwards, the stand moves back to the position,
from where the test run must be repeated.

Determine the rotational range

The rotational range (angle) is limited by the following parameters:
 Parameters in the acquisition program: Dyna Time, resolution of the angula-
tion
 Maximum rotational speed

 Maximum frame rate

 Hold the stand joystick until the desired position has been reached or the
movement stops automatically.

Enlarge the rotational range

If the Dyna Time set in the acquisition program is exceeded, then the following
message is shown:
DR-DYNA test: More angul. increases DYNA time

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 If you want to increase the rotation angle, let go of the stand joystick and de-
flect it again.
– The DYNA time is adapted so that the maximum mechanical angle can be
reached.

Note The rotational range is reduced by deflecting the stand joystick in the opposite di-
rection. The movement stops when the end position of the test run is reached.

Perform fluoroscopy briefly

The start position of the fill run (= end position of the test run) is determined by
the final fluoroscopy.
 Press the FLUORO pedal on the foot switch for approx. 2 s.

Note Fluoroscopy must be performed in the start position of the fill run, otherwise ac-
quisition cannot be performed.

DR-DYNAVISION fill phase

 The C-arm is in the required start position of the fill run (= end of the test run).

 Instruct the patient: “Do not move”, breathing, etc.

Starting acquisition
 Press the exposure release button or pedal and keep it pressed until the end
of the DR-DYNAVISION acquisition, i.e. until the fill phase is automatically com-
pleted.

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Note If you let go of the exposure release button or pedal, the movement is ended im-
mediately, the acquisition series and the injection are stopped, DR-DYNAVISION is
thus deselected, the acquisition series cannot be continued.

Automatic injection and rotation

 DYNA Control: Auto is set in the acquisition program.
Automatic/manual control 480
The message DR-DYNA fill phase: Auto, DYNA X s, Y °/F is displayed.
 The injector is connected and switched to “Armed”.
Injection mode 477
 Keep the exposure release button or pedal pressed.
– The injection takes place automatically in the start position of the fill run.
– The start of the contrast exposures is controlled by the injector and begins
after expiry of the X-ray delay time.

Manual injection and rotation

Manual injection
 DYNA Control: Manual is set in the acquisition program.
Automatic/manual control 480
 Keep the exposure release button or pedal pressed.
– The message DR-DYNA injection phase: Manual is displayed.
 Actuate the release button of the injector.
– The contrast images are acquired in the start position of the fill run.
 Watch the vessels fill with contrast medium on the screen.

Trigger rotation manually

 The message DR-DYNA fill phase: Manual, DYNA X s, Y °/F is displayed.

 The optimum contrast medium filling is reached.

 Press the blue multifunctional button of the handswitch in good time.

Or
 Wait until the maximum Phase Time has expired.

 Keep the exposure release button or pedal pressed.

The C-arm performs the rotation.

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The fill frames are produced and displayed on the screen (not subtracted).

Terminate the acquisition series

A DR-DYNAVISION acquisition series is completed,
 if the maximum Phase Time of the Fill has expired

 if you let go of the exposure release button or pedal

 if an error occurs, e.g. a collision sensor responds

 You can now let go of the exposure release button or pedal.

– The message DR-DYNA: Completed or DR-DYNA: Aborted is displayed.
– DR-DYNAVISION is automatically deselected and the first acquisition pro-
gram in the current examination program is selected.
The DR-DYNAVISION scene is displayed on the screen (not subtracted).
Review (playback) is performed according to the current setting (Toggle or MFH).

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DYNAVISION

DYNAVISION examination sequence

(2)
(4)
(6)
(8)

(9)
(5) (7)
(1) (3)

(1) Start position

Optional: Brief fluoroscopy to check the examination region
(2) Test run with rotating C-arm for ensuring that no collisions occur
(3) Brief fluoroscopy for automatic setting of acquisition parameters
(4) Mask run with rotating C-arm for image acquisition 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 acquisition with contrast medium
(9) Washout phase

Preparations First of all you position the patient and unit and center the area to be examined in
the isocenter.
By selecting the acquisition program the examination sequence is started.

Test phase During the test phase, you determine rotational range (start and end positions as
well as angle). You check the position of the examination region by briefly switch-
ing on fluoroscopy (mandatory at start and finish of the test phase). You also
check object centering and collimation.

Mask phase In the mask phase, an image is acquired for every projection and displayed.
After the fill phase, the mask images are subtracted from the fill images of the cor-
responding projection.

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Return phase At the end of the mask phase, the C-arm automatically returns to the start position
of the test run (without radiation).

Injection The injector receives the start signal (if integrated) automatically or you perform
the injection manually.

Fill phase You start the acquisition or it starts automatically (depending on the program-
ming).
The fill images are acquired angle-triggered to the mask frames and displayed (un-
subtracted) after the injection.

Washout phase The C-arm stops in the end position of fill run. The acquisition runs on with the
frame rate programmed for the washout phase until you let go of the exposure re-
lease button or pedal, or until the preset time for the washout phase has elapsed.
The last image of the fill phase serves as the mask for the subtracted display of the
washout images.

Image viewing After completion of the washout phase, the DYNAVISION scene is displayed sub-
tracted.

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DYNAVISION workflow
A DYNAVISION acquisition is performed in the following sequence:
1. Prepare the patient, stand, C-arm and table.
Position the region of interest in the isocenter.
Check the injector, if used.

2. Perform a brief fluoroscopy in the start position 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.

5. Perform a brief fluoroscopy for automatic setting of acquisition

parameters: Press fluoro pedal of footswitch.
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
handswitch, if Manual is programmed.
Automatic/manual control 480
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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Preparing DYNAVISION
 General preparations 480

 In biplane systems, the top stand is in the parking position.

 The C-arm is in the required start position.

Select the acquisition program

Note DYNAVISION is started by selecting the DYNAVISION program.

First position the patient or unit and then select the DYNAVISION program.

 Activate the required DYNAVISION program on the touchscreen control.

– Stand/C-arm longitudinal movements, stand swiveling and possibly table tilt
are blocked.

Note The normal functions can be restored by selecting a non-DYNAVISION program or

registering a new patient.
The end position of the mask and fill run is redetermined with the selection of an-
other DYNAVISION program.

Check the parameters

 Check to make sure that the required rotational range (angle), the required an-
gulation step and the required frame rates are set.

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DYNAVISION test phase

 The catheter is located in the target area.

 The injector or manual administration of contrast medium is prepared.

Perform fluoroscopy briefly

At the beginning of the test run the end position of the mask and fill phase is de-
termined by the first fluoroscopy.
 Press the FLUORO pedal on the foot switch for approx. 2 s.
– An image appears on the screen (LIH).

Note Fluoroscopy is not absolutely necessary at the start of the test phase and in inter-
mediate positions, but recommended in order to be able to collimate well and
thus achieve optimum image quality.
Fluoroscopy must be performed at the end of the test phase to determine the start
position of the mask and fill phase.

Collimate
 Tap the collimator joystick briefly, if necessary.
– The collimator leaves are displayed graphically in the LIH image.

Carry out the test phase

 Press the stand joystick down, deflect the joystick and hold it in this position.
(With respect to the set orientation of the control console.)

– The C-arm moves in the direction in which the stand joystick was deflected.

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Advanced Examinations

Note The first deflection of the stand joystick determines the direction of rotation.
Combined C-arm movements (diagonal deflections) are not possible.

The following message is shown:

– DYNA test phase: Auto, DYNA X s, Y °/F with automatic control
– DYNA test phase: Manual, DYNA X s, Y °/F with manual control
Automatic/manual control 480
 Perform fluoroscopy, collimate and position filters as required.
– The exposure data are calculated and the generator is automatically preset
from fluoroscopy in an acquisition position. (The system takes account of
the patient transparency in this case.)

Note It is not necessary to perform fluoroscopy in every position, but it is advantageous.

If fluoroscopy was not performed in every position, then the exposure data of
each acquisition position are calculated back from the determined values.

Note The test run must be repeated if a movement other than C-arm rotation is trig-
gered during the test run.
If the stand joystick is deflected afterwards, the stand moves back to the position,
from where the test run must be repeated.

Determine the rotational range

The rotational range (angle) is limited by the following parameters:
 Parameters in the acquisition program: Dyna Time, resolution of the angula-
tion
 Maximum rotational speed

 Maximum frame rate

 Hold the stand joystick until the desired position has been reached or the
movement stops automatically.

Enlarge the rotational range

If the Dyna Time set in the acquisition program is exceeded, then the following
message is shown:
DYNA test phase: More angul. increases DYNA time

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 If you want to increase the rotation angle, let go of the stand joystick and de-
flect it again.
– The DYNA time is adapted so that the maximum mechanical angle can be
reached.

Note The rotational range is reduced by deflecting the stand joystick in the opposite di-
rection. (The movement stops when the end position is reached.)

Perform fluoroscopy briefly

The start position of the mask and fill phase is determined by a final fluoroscopy.
 Press the FLUORO pedal on the foot switch for approx. 2 s.

Note Fluoroscopy must be performed in the start position of the mask run, otherwise
acquisition cannot be started.

DYNAVISION mask phase

 The C-arm is in the required start position of the mask run (= end of the test
run).
 If possible, start the mask phase immediately to avoid unnecessary patient
movements.
 Instruct the patient: “Do not move”, breathing, etc.

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Starting acquisition
 Press the exposure release button or pedal and keep it pressed until the end
of the DYNAVISION acquisition, i.e. until the mask phase and fill phase are com-
pleted.

Note If you let go of the exposure release button or pedal, the movement is ended im-
mediately, the acquisition series and the injection are stopped, DYNAVISION is
thus deselected, the acquisition series cannot be continued.

The following message is shown:

– DYNA mask phase: Auto, DYNA X s, Y °/F with automatic control
– DYNA mask phase: Manual, DYNA X s, Y °/F with manual control
Automatic/manual control 480
At the end of the mask phase, the C-arm returns to the start position of the mask
run at maximum speed (without radiation).

DYNAVISION fill phase

 The C-arm is again in the start position of the mask run (= end of the test run).

Automatic injection and rotation

 DYNA Control: Auto is set in the acquisition program.
Automatic/manual control 480
The message DYNA fill phase: Auto, DYNA X s, Y °/F is displayed.
 The injector is connected and switched to “Armed”.
Injection mode 477

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 Keep the exposure release button or pedal pressed.

– The injection takes place automatically in the start position of the fill run.
– The start of the contrast exposures is controlled by the injector and begins
after expiry of the X-ray delay time.

Manual injection and rotation

Manual injection
 DYNA Control: Manual is set in the acquisition program.
Automatic/manual control 480
 Keep the exposure release button or pedal pressed.
– The message DYNA injection phase: Manual is displayed.
 Actuate the release button of the injector.
– The contrast images are acquired in the start position of the fill run.
– The image system automatically switches over to subtracted display.
 Watch the vessels fill with contrast medium on the screen.

Trigger rotation manually

 The message DYNA fill phase: Manual, DYNA X s, Y °/F is displayed.

 The optimum contrast medium filling is reached.

 Press the blue multifunctional button of the handswitch in good time.

Or
 Wait until the maximum Phase Time has expired.

 Keep the exposure release button or pedal pressed.

The C-arm performs the rotation.

The fill frames are produced and displayed on the screen (not subtracted).

Note The exposure control adapts the exposure of the images of the fill phase automat-
ically to the ones of the mask phase.
The last subtraction image (LIH) is displayed on the screen.

Washout phase
You can follow the “washout” of the contrast medium bolus.
 The message DYNA: Washout phase is displayed.

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Advanced Examinations

 Keep the exposure release button or pedal pressed.

– The C-arm remains at rest in the end position.
– The washout images are produced and displayed (subtracted).

Terminate the acquisition series

A DYNAVISION acquisition is ended,
 if the maximum Phase Time (Fill or Washout) has elapsed

 if you let go of the exposure release button or pedal

 if an error occurs, e.g. a collision sensor responds

 You can now let go of the exposure release button or pedal.

– The message DYNA: Completed or DYNA: Aborted is displayed.
– DYNAVISION is automatically deselected and the first acquisition program in
the current examination program is selected.
The DYNAVISION scene is displayed on the screen (not subtracted).
Review (playback) is performed according to the current setting (Toggle or MFH).

3D
There are special acquisition modes intended to create Angiographic Computed
Tomography (ACT) 3D images for various applications (vessels and bones).
The images will be acquired in equidistant angular spacing. Rotation is carried out
with predetermined (calibrated) rotational ranges.
Special 3D acquisition programs are used. 3D acquisition programs have pre-
defined start and end positions and have special parameter settings.

3D acquisition modes The following special acquisition modes suitable for 3D are available:
 3D DR: Like in DR-DYNAVISION, images are acquired in a single run and no sub-
traction is performed.
3D DR examination sequence 508
3D DR workflow 508
 3D DSA: Like in (DSA-)DYNAVISION, images are acquired in mask run and fill
run and subtraction is performed.
3D DSA examination sequence 510
3D DSA workflow 511
 3D CARD: Images are acquired in several acquisition runs, which can be ECG
gated, to reduce motion artifacts. No subtraction is performed.
3D CARD examination sequence 516
3D CARD workflow 517

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 3D DR - Large Volume (Artis zeego only):

These modes are intended for imaging of organs in the abdominal area.
– DR Large: Images are acquired in two off-center rotational runs which are
combined to one run.
3D DR - Large examination sequence (Artis zeego) 519
3D DR - Large workflow (Artis zeego) 520
– DR Large 360 (syngo DynaCT 360): Images are acquired in one 360
degrees off-center rotational run. In this way, two halves of the region of
interest are acquired in one rotational run.
syngo DynaCT 360 examination sequence (Artis zeego) 522
syngo DynaCT 360 workflow (Artis zeego) 522
The images of each projection will be automatically stitched together and used
as basis for 3D soft tissue reconstruction and presentation.
 3D - Eccentric Rotation (Artis zeego only): Like 3D DR, 3D DSA or 3D CARD but
images are acquired in an eccentric rotational run.
This mode intended for imaging of lateral organs that could not be reconstruct-
ed entirely in a non-eccentric 3D acquisition due to collision with table.
3D eccentric rotation examination sequence (Artis zeego) 523
3D eccentric rotation workflow (Artis zeego) 523

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3D reconstruction Using syngo InSpace 3D, DynaCT and DynaCT Cardiac the acquired data sets can
be reconstructed to 3D images on the syngo Workplace.
 syngo InSpace 3D is the basic technique to reconstruct a 3D data set of 2D slic-
es from projection images acquired in a DR-DYNAVISION or DYNAVISION rota-
tional angiography run.
This technique is intended for Angio/High Contrast applications for vessel and
bone imaging. Typical protocols acquire around 130 projections in medium or
full pixel resolution.
 syngo DynaCT enables selected systems of the Artis family to create images
that are CT-like images.
This technique is intended for tumor imaging and imaging of bleedings.
Typical protocols acquire around 400 projections in medium or low pixel reso-
lution.
 syngo DynaCT Micro is a dose saving alternative to syngo DynaCT.
DynaCT Micro is acquired in zoom stage 3, that means with a 22 cm diagonal
detector field. It is done with regarding collimation.
 syngo DynaCT Cardiac creates cross-sectional 3D images of the beating heart/
the left atrium. By using multiple, e.g. 2 - 4, C-arm runs with ECG gated acqui-
sition and 3D reconstruction taking account of the cardiac phases, the tempo-
ral resolution of the 3D volume is optimized. This results in high-resolution
visualization of moving cardiac structures.
 syngo DynaPBV Neuro and syngo DynaPBV Body visualize the volume of
blood actually that has accumulated in a considered tissue.
– A DynaPBV Neuro volume is reconstructed from data acquired in a 3D DSA
examination on the Artis following a special workflow.
DynaPBV Neuro examination sequence 513
DynaPBV Neuro workflow 514
– A DynaPBV Body volume is reconstructed from data acquired in a normal
3D DSA examination on the Artis using a special acquisition program.
3D DSA examination sequence 510
3D DSA workflow 511
After reconstruction on the syngo Workplace, the volume is automatically visu-
alized in the InSpace task card as colored MPR images, where the colors corre-
spond to contrast agent enrichments (ml/l) and thus the blood density.
You will find further information for reconstruction in the syngo InSpace 3D,
DynaCT, ... Operator Manual

3D visualization 3D images are reconstructed on the syngo Workplace using InSpace

Reconstruction and the InSpace task card. The 3D images can be processed and
visualized using a variety of functions and applications.
See the respective Operator Manuals

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Touchscreen If InSpace 3D, DynaCT, DynaCT Cardiac, or/and DynaPBV Neuro is installed, the
additional InSpace task card will be available.
See the syngo InSpace 3D, DynaCT, ... Operator Manual

Example

Supported systems  InSpace 3D is possible with all Artis systems.

 DynaCT is available for systems with FD 30x40 only.

 DynaCT Cardiac with or without ECG gating is available for all Artis systems.

System calibration Calibration of your system is part of the standard installation procedure by
Siemens. During calibration, the hardware and software components of your sys-
tem are tuned to produce the best image quality.

Note It is the responsibility of the operator to make sure that the system is recalibrated
after major collisions to avoid wrong measurements and wrong pixel size.

Quality measurements You should perform a quick test of the 3D imaging quality once a month. For this
quality check, use the special phantom included in the syngo InSpace 3D and
DynaCT package and one of the standard 3D programs on your acquisition sys-
tem.
Test of image quality for 3D 530

Note Call Siemens Customer Service if the imaging quality changes or whenever the
system configuration has been altered.

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Patient positions Patients can be positioned and registered in all patient positions.

Patient motion (e.g. breathing) and acquisition problems (e.g. aborted acquisi-
Caution tion, missing frames) occurring during 3D acquisitions degrade the image quality
of the reconstructed 3D volume, or even prevent clinically relevant reconstruction
Exposure to radiation and possibly contrast medium with limited, or no clini-
cal benefit
Acquisition modes combining multiple acquisitions (Large Volume, 3D, 3D DSA,
Cardiac 3D) are especially prone to such issues.
 Besides the clinical goal and patient characteristics, the possibility of such an
issue needs to be considered when deciding about the imaging technique.

System positions 3D examinations can be performed only in the calibrated system positions.

Note To ensure best image quality using an Artis floor/Artis biplane system. it is advan-
tageous to perform the following movements before examinations:
 Move the floor stand to the Left Side position, if necessary.

 Then, move the floor stand to the Head Side position without interrupting the
movement.

Input field/ 3D acquisitions must always be performed with one of the following input fields/
zoom stage zoom stages, otherwise 3D reconstruction will not be possible.
 FD 20x20: Nominal format/Zoom 0

 FD 26x30: Nominal format/Zoom 0 only

 FD 30x40: Nominal format/Zoom 0 to Zoom 3

Note To optimize the image contrast in the 3D volume, we recommend that you use the
larger input field formats in each case.

Collimation and Collimation from top and/or bottom may be applied (e.g. for dose saving) as long
filtration as the collimators do not approach the volume of interest too closely.

Measuring field For 3D acquisitions, always the center measuring field or the Intelligent Measur-
ing Field is used.

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In Artis zeego with Large Volume acquisitions, the center measuring field is also
programmed. During the two acquisition runs 1/2, the right/left measuring field is
automatically set.

FD orientation 3D acquisition programs are calibrated in a definite FD orientation (landscape or

portrait). The FD is rotated automatically to the correct position when the 3D ac-
quisition program is selected.

Note Do not change the FD orientation after selection of the 3D acquisition program!

In rare cases, FD rotation may be obstructed, e.g. by the tabletop, when selecting
the 3D acquisition program.
 In this case, deselect the 3D acquisition program, move the C-arm to a position
where the FD is not obstructed and reselect the 3D acquisition program.
 Or use the “isocenter assistant”. 525

Large Volume Large volume is available on Artis zeego only.

Note Note, that Large Volume DynaCT acquisitions are prone for breathing artifacts.
 Observe the patient's breathing during the acquisition and check the stitched
projection images in InSpace Reconstruction for breathing artifacts.
Reason: Large Volume DynaCT acquisitions are composed out of two eccentric ac-
quisition runs. If the breathing phase changes between the two runs, the pairs of
projection images that get stitched together to a big projection image do not fit
optimally anymore. It leads to artifacts in the reconstructed volume.
If this context is ignored it might happen that such artifacts are misinterpreted as
lesions.

FD orientation for In Artis zeego with Large Volume acquisitions, there are two acquisition pro-
Large Volume grams, one for landscape and one for portrait.
 The portrait mode can be helpful for examinations where the height of the vol-
ume can be important, e.g. spine examinations.
 The landscape mode can be helpful for examinations where the width of the
reconstructed volume is important, e.g. for abdominal examinations.

Note Do only perform Large Volume (syngo DynaCT) in landscape mode if the portrait
mode does not deliver full patient coverage.
Direct radiation may degrade image quality.

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3D acquisition programs
When the system is set up, acquisition programs (runs) are calibrated. No other 3D
acquisitions than the calibrated programs should be performed, because every
geometric position has to be calibrated.
In Artis ceiling, a 3D acquisition may be acquired at any longitudinal position.

Note The 3D acquisition programs have been calibrated and optimized for 3D postpro-
cessing. Due to the high acceleration forces and speed, minor shaking of the C-
arm might be observed. The shaking induces no adverse effects on the 3D post-
processing results of the acquired images.
For 2D evaluation, use a DYNAVISION exam set without 3D.

Program name The acquisition programs for 3D acquisitions are named as follows:
definition <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
DynaPBV Liver parenchymal blood volume
Large Volume * Large volume acquired in two off-cen-
ter rotational runs
Large Volume Large volume acquired in one 360 de-
360 * grees off-center rotational run
<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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Name component Description

FD position for large volume:
P* FD in portrait position
*
L FD in landscape position
Calibrated for system position: †
L15 * Left Side, Table Rotated 15°
L30 * Left Side, Table Rotated 30°
*
R15 Right Side, Table Rotated 15°
R30 * Right Side, Table Rotated 30°
* Artis zeego only
†
If not specified: Calibrated for Head Side, Left Side, or Right Side positions.

Note All acquisition programs are subject of change.

Please ask your Siemens application specialist for actual programs.

Which program for Criteria for the choice of an acquisition program are required flow and rotation
which application? time. Both depend on the volume of the contrast medium injection that is still ac-
ceptable.
As a rule, the contrast medium bolus must remain in the volume to be examined
during the entire fill run, so that all projections show the filled vascular volume
(VOI).
The injection time should be long enough for the vessels and the vascular disease,
e.g. aneurysms and AVMs, to be completely dyed with contrast media.

Parameter settings Acquisition parameters of 3D programs should not be changed.

If necessary, however, you can adjust the following settings:
 3D Control: Auto or Manual
Automatic/manual control 480
 Edge Enhancement and Window settings

Note Acquisition programs should be changed by experienced application specialists

only.

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3D DR examination sequence
(2)

(6)

(4)
(7) (5)
(1) (3)

(1) Start position

Optional: Brief fluoroscopy to check the examination region
(2) Test run with rotating C-arm for ensuring that no collisions occur
(3) Brief fluoroscopy for automatic setting of acquisition parameters
(4) Injection if contrast medium is used
(5) Start of acquisition
(6) Fill run with rotating C-arm for image acquisition with or without contrast me-
dium
(7) End position

3D DR workflow
A 3D DR acquisition is performed in the following sequence:
1. Prepare the patient, stand, C-arm and table.
Check the injector, if used.

2. Select a 3D DR acquisition program.

e.g.

3. Position the region of interest in the isocenter.

– 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.

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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 fluoro pedal of footswitch.
Ready for 3D: #s Acquisition Time 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 automatically, 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 multifunc-
... tional button of the handswitch, if Manual is programmed.
Automatic/manual control 480
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 acquisition
– Manually as long as data is available on the Artis
11. Slice reconstruction using InSpace Reconstruction on syngo Workplace.
12. Visualization using the InSpace task card on syngo Workplace.

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3D DSA examination sequence

(2)
(4)
(6)
(8)

(9)
(5) (7)
(1) (3)

(1) Start position

Optional: Brief fluoroscopy to check the examination region
(2) Test run with rotating C-arm for ensuring that no collisions occur
(3) Brief fluoroscopy for automatic setting of acquisition parameters
(4) Mask run with rotating C-arm for image acquisition 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 acquisition with contrast medium
(9) End of acquisition
The 3D DSA examination sequence is widely the same as in (DSA-)DYNAVISION.
491

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3D DSA workflow
A 3D DSA acquisition is performed in the following sequence:
1. Prepare the patient, stand, C-arm and table.
Check the injector, if used.

2. Select a 3D DSA acquisition program.

e.g.

3. Position the region of interest in the isocenter.

– 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 DSA test run to make sure that no collision will occur.

6. Perform a brief fluoroscopy for automatic setting of acquisition

parameters: Press fluoro pedal of footswitch.

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Ready for 3D: #s Acquisition Time is displayed.

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
handswitch, if Manual is programmed.
Automatic/manual control 480
Fill images are acquired.
11. Let go the exposure release when all rotational runs are complete.
(Acquisition is stopped automatically.)
12. Transfer of image data to the syngo Workplace:
– Automatically immediately after the acquisition
– Manually as long as data is available on the Artis
13. Slice reconstruction using InSpace Reconstruction on syngo Workplace.
14. Visualization using the InSpace task card on syngo Workplace.

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DynaPBV Neuro examination sequence

(2)

(6)

(7)
(9)

(10)
(8)
(5)
(3)
(1) (4)

(1) Start position

Optional: Brief fluoroscopy to check the examination region
(2) Test run with rotating C-arm for ensuring that no collisions occur
(3) Brief fluoroscopy for automatic setting of acquisition parameters
(4) Manual start of injection
(5) Start of acquisition
– Manual start of mask run
(6) Mask run with rotating C-arm for image acquisition without contrast medium
(7) Return run
(8) Bolus watching phase: Subtracted images are shown, on behalf of which the
start of the fill run can be decided.
– Manual start of fill run at reversal point
(9) Fill run with rotating C-arm for image acquisition with contrast medium
(10) End of acquisition

DynaPBV Neuro is performed in the same sequence as InSpace 3D or Cardiac 3D

using 3D DSA, but injection, mask run, and fill run must be started manually.

Note DynaPBV Neuro is only possible in Artis Q/zeego systems with FD 30x40.

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Mask run Return run Fill run

Bolus reaches sinus

native

sagittalis
5s Bolus watching 8s
8s
10-15 s, max. 30 s
Injection duration 24-30 s

Total procedure ~31 s

DynaPBV Neuro examination time scale

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 workflow

A DynaPBV Neuro acquisition is performed in the following sequence:
1. Prepare the patient, stand, C-arm and table.
Check the injector, if used.

2. Select a DynaPBV Neuro acquisition program.

e.g.

3. Position the region of interest in the isocenter.

– 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.

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

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

6. Perform a brief fluoroscopy for automatic setting of acquisition

parameters: Press fluoro pedal of footswitch.
Ready for 3D is displayed.
7. Manual injection: Start the injector in time.

8. Perform the 3D DSA mask run

Start acquisition: Press the exposure release button (or pedal) and keep it
pressed until the fill run (step 12.) is finished.
9. Shortly press the blue multifunctional button of the handswitch to start the
3D DSA mask run (does not need to be kept pressed).
Mask images are acquired.
10. The return run takes place automatically.
11. Bolus watching phase
DSA images are acquired (max. 30 s).
12. Perform the 3D DSA fill run:
Start rotational run when the contrast bolus reaches the sinus sagittalis:
Shortly press the blue multifunctional button of the handswitch to start the
3D DSA fill run (does not need to be kept pressed).
Fill images are acquired.
13. Release the exposure release button (or pedal) when all rotational runs are
complete.
(Acquisition is terminated automatically.)
14. Automatic transfer of image data to the syngo Workplace immediately after
the acquisition.
15. Slice reconstruction using InSpace Reconstruction on syngo Workplace.
16. Visualization using the InSpace task card on syngo Workplace.

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3D CARD examination sequence

(2)
(4)
(6)
(8)

(9)
(5) (7)
(1)
(3)

Example of a 3D CARD acquisition sequence with 3 runs

(1) Start position

Optional: Brief fluoroscopy to check the examination region
(2) Test run with rotating C-arm for ensuring that no collisions occur
(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
(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 To take advantage of the improved contrast resolution of 3D soft tissue, an ap-
proach for cardiac 3D imaging is available which is based on intravenous or arterial
contrast injection.
The method is an analogon to cardiac spiral CT Angiography. To reduce motion ar-
tifacts, a special acquisition and reconstruction method is used. The movement of
an object is excluded in the reconstruction process as much as possible.
Under the assumption of an almost periodic movement of the heart, only those
projection data are used for reconstruction which are acquired at a heart phase
where the heart is expected to be almost in rest.
Minimal movement occurs in the end diastolic phase. ECG gating is used to apply
the nominal dose in the diastolic heart phase. Data gaps are filled by a series of
temporarily complementary but spatially redundant scans.

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Intravenous contrast injection allows a longer acquisition time to perform the se-
ries of scans as well as simultaneous imaging of the heart chambers and also of
the cardiac vessels.

3D CARD workflow
A 3D CARD acquisition is performed in the following 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.

e.g.

3. Position the region of interest in the isocenter.

– 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 CARD test run to make sure that no collision will occur.

6. Perform a brief fluoroscopy for automatic setting of acquisition

parameters: Press fluoro pedal of footswitch.

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Ready for 3D: #s Acquisition Time is displayed.

7. Automatic or manual injection if contrast medium is used.
Start injector if manual injection is used.
8. Perform the 3D CARD acquisition runs:
– Start acquisition: Press the exposure release button or pedal and keep it
pressed. Rotational run will start automatically, 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 multifunc-
... tional button of the handswitch, if Manual is programmed.
Automatic/manual control 480
9. Let go the exposure release when all rotational runs are complete.
(Acquisition is stopped automatically.)
10. Transfer of image data to the syngo Workplace:
– Automatically immediately after the acquisition
– Manually as long as data is available on the Artis
11. Slice reconstruction using InSpace Reconstruction on syngo Workplace.
12. Visualization using the InSpace task card on syngo Workplace.

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3D DR - Large examination sequence (Artis zeego)

(2)
(3)
(6)
(8)

(9)
(5) (7)
(4)
(1)

(1) Start position

Optional: Brief fluoroscopy to check the examination region
(2) Test run 1 with rotating C-arm for ensuring that no collisions occur
(3) Test run 2 with rotating C-arm for ensuring that no collisions occur
(4) Brief fluoroscopy for automatic setting of acquisition parameters
(5) Injection if contrast medium is used and start of acquisition
(6) 3D acquisition run 1 with rotating C-arm for image acquisition with or without
contrast medium
(7) Start of 3D acquisition run 2
(8) 3D acquisition run 2
(9) End position

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3D DR - Large workflow (Artis zeego)

A 3D DR - Large Volume acquisition is performed in the following sequence:
1. Prepare the patient, stand, C-arm and table.
Check the injector, if used.

2. Select a 3D DR - Large Volume acquisition program.

e.g.

3. Position the region of interest in the isocenter.

Follow the “isocenter assistant”.

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

5. Perform the 3D DR - Large Volume test run 1 and 2 to make sure that no colli-
sion will occur.

6. Perform a brief fluoroscopy for automatic setting of acquisition

parameters: Press fluoro pedal of footswitch.

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Ready for 3D: #s Acquisition Time is displayed.

7. Automatic or manual injection if contrast medium is used.
Start injector if manual injection is used.
8. Perform the 3D DR - Large Volume acquisition runs 1 and 2:
– Start acquisition: Press the exposure release button or pedal and keep it
pressed. Rotational run will start automatically, 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 multifunc-
... tional button of the handswitch, if Manual is programmed.
Automatic/manual control 480
9. Let go the exposure release when all rotational runs are complete.
(Acquisition is stopped automatically.)
10. Transfer of image data to the syngo Workplace:
– Automatically immediately after the acquisition
– Manually as long as data is available on the Artis
11. Slice reconstruction using InSpace Reconstruction on syngo Workplace.
12. Visualization using the InSpace task card on syngo Workplace.

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syngo DynaCT 360 examination sequence (Artis zeego)

(2)

(6)

(5)

(1) (7)
(4)
(3)

(1) Start position = end position

Optional: Brief fluoroscopy to check the examination region
(2) Test run with rotating C-arm for ensuring that no collisions occur
(3) Brief fluoroscopy for automatic setting of acquisition parameters
(4) Injection if contrast medium is used
(5) Start of acquisition
(6) Fill run with rotating C-arm for image acquisition with or without contrast me-
dium
(7) End position

syngo DynaCT 360 workflow (Artis zeego)

The workflow of a 3D syngo DynaCT 360 rotation acquisition is the same as of a
normal 3D DR rotation acquisition.
3D DR workflow 508

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3D eccentric rotation examination sequence (Artis

zeego)

Normally, with extended tabletop transversal position no full rotation is possible

due to collisions with tabletop or patient.
With eccentric rotation, the rotation center is closer to the flat detector, i.e. the
source to isocenter distance is increased, the collimator does no more collide with
the tabletop or patient.
It allows 3D acquisitions of organs, e.g. liver, which are not centered in the table-
top, i.e. with extended tabletop transversal position.
The examination sequence of an eccentric rotation acquisition is the same as a
non-eccentric rotation acquisition:
3D DR examination sequence 508
3D DSA examination sequence 510
3D CARD examination sequence 516

3D eccentric rotation workflow (Artis zeego)

The workflow of an eccentric rotation acquisition is the same as of a non-eccentric
rotation acquisition:
3D DR workflow 508
3D DSA workflow 511
3D CARD workflow 517

Preparing 3D (all 3D examinations)

Artis  General preparations 480

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syngo Workplace  The syngo Workplace has been switched-on and a user has logged-in.

 The InSpace task card has been started and is placed in the foreground.

Checking the table position

 Move the patient table back and forth slightly to check that it is engaged.

 Check table tilt position and table rotation position.

Note It is possible to perform a 3D examination with a tabletop tilted laterally or longi-

tudinally, or/and in Artis zeego a rotated table. In this case the tabletop tilt and the
table rotation must not be changed during the 3D examination.
Tilting the tabletop is possible within a certain range in systems with Trumpf sur-
gery table TruSystem 7500.

Avoiding artifacts
Since all projections are included in the reconstruction of every slice, motion arti-
facts in individual images (from breathing or movements) will lead to artifacts in
all reconstructed slices.
 Use positioning aids and immobilization aids (e.g. Velcro tapes) to avoid pa-
tient movements.
 Instruct the patient to hold the breath during acquisition.
– If the examination takes place under the supervision of an anesthetist, res-
piration can be stopped during the rotation of the C-arm.

Selecting the exam set and the 3D acquisition program

 Select the required exam set on the touchscreen console.

 Select the required 3D acquisition program on the touchscreen console.

e.g.
– Stand swiveling are blocked.
– Zoom and image flip are also blocked.

Note The normal functions can be restored by selecting a non-3D program or register-
ing a new patient.

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Centering the target volume in the isocenter

When a 3D acquisition program was selected, there are two possibilities:
1. The isocenter has already been set before selection of the 3D acquisition pro-
gram. The region of interest is positioned in the isocenter.
– The LED on the Isocenter key is lit.
You can start immediately.
Getting ready for 3D test phase 526
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 iso-
center. 525

Isocenter assistant
 The LED on the Isocenter key is flashing.

Note If you have already isocentered your patient before the isocenter assistant is dis-
played, press the isocenter key in order to skip the isocenter assistant messages.

 The following message is shown:

3D ISO: Frontal, activate stand movement
 Press the stand joystick down, deflect the joystick and hold it in this position
until the C-arm is positioned in the frontal position.
 Or press the hands free foot pedal.

 Center the region of interest in the image under fluoro or by use of the CARE-
position function.
In Artis floor/Artis biplane/Artis ceiling/Artis zeego:
– Adjust tabletop longitudinally and transversally.

 The following message is shown:

3D ISO: Lateral, activate stand movement
 Press the stand joystick down, deflect the joystick and hold it in this position
until the C-arm is positioned in the lateral position.
 Or press the hands free foot pedal.

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 Center the region of interest in the image under fluoro or by use of the CARE-
position function.
– Adjust table height.

Getting ready for 3D test phase

 The following message is shown:
3D Start Position: activate stand movement
 Press the stand joystick down, deflect the joystick and hold it in this position
until the C-arm stops moving.
 Or press the hands free foot pedal.

3D test phase
 The patient is correctly positioned and registered.

 The region of interest is positioned isocentrically.

 The C-arm is in the required start position.

 The catheter is in the region to be examined.

 Depending on the type of injection, one of the following messages is shown:

– 3D test phase: Auto, activate stand movement with automatic control
– 3D test phase: Manual, activate stand movement with manual control
Automatic/manual control 480

Performing the test run

 Press the stand joystick down, deflect the joystick and hold it in this position
until the C-arm stops moving.
 Or press the hands free foot pedal.

The message Test Phase: Start Fluoro to complete Test Phase is displayed.
 Press the FLUORO pedal on the foot switch for approx. 2 s.
– The message Test Phase: Completed, stop Fluoro is displayed.
Ready for 3D: #s Acquisition Time is displayed.
The approximate duration in seconds of the 3D acquisition run is indicated.

Note If an X-ray delay is set on the injector, the system stops before the fill run and waits
for the time set to elapse before continuing with the fill run.
The usual method is “X-Ray Delay”.

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3D acquisition phases

Starting acquisition
 The C-arm is in the required start position of the 3D run.

 Instruct the patient: “Do not move”, breathing, etc.

 Press the exposure release button or pedal and keep it pressed until the end
of the 3D acquisition, i.e. until the mask phase and fill phase are completed.

Note If you let go of the exposure release button or pedal, the movement is ended im-
mediately, the acquisition series and the injection are stopped, 3D is thus deselect-
ed, the acquisition series cannot be continued.

Automatic injection and rotation

 3D Control: Auto is set in the acquisition program.
Automatic/manual control 480
 The injector is connected and switched to “Armed”.
Injection mode 477
 Keep the exposure release button or pedal pressed.
– The injection takes place automatically in the start position of the fill run.
– The start of the contrast exposures is controlled by the injector and begins
after expiry of the X-ray delay time.
The following message is shown:
– 3D Acquisition: # secs until completed in 3D DR
– 3D Acquisition m/n: # secs until completed in 3D DSA, 3D DR LV, or 3D
CARD

Manual injection and rotation

Manual injection
 3D Control: Manual is set in the acquisition program.
Automatic/manual control 480
 Keep the exposure release button or pedal pressed.

 Actuate the release button of the injector.

 Watch the vessels fill with contrast medium on the screen.

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Trigger rotation manually

 The message 3D injection phase: Press Multifunction Button is displayed.

 The optimum contrast medium filling is reached.

 Press the blue multifunctional button of the handswitch in good time.

Or
 Wait until the maximum Phase Time has expired.

 Keep the exposure release button or pedal pressed.

The C-arm performs the rotation.

The following message is shown:
– 3D Acquisition: # secs until completed in 3D DR
– 3D Acquisition m/n: # secs until completed in 3D DSA, 3D DR LV, or 3D
CARD

Return run (during 3D DSA only)

The C-arm automatically rotates back to start position.
 Keep the exposure release button or pedal pressed.
– The message 3D: Returning is displayed.

Terminate the acquisition series

A 3D acquisition is ended,
 if the required number of images have been acquired in the required number
of 3D runs
 if you let go of the exposure release button or pedal

 if an error occurs, e.g. a collision sensor responds

If configured, an audible feedback signals the end of acquisition.

 You can now let go of the exposure release button or pedal.
– The message 3D: Completed or 3D: Aborted is displayed.
– 3D is automatically deselected and the first acquisition program in the cur-
rent examination program is selected.

The 3D scene is displayed on the screen.

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The 3D series is automatically transferred to the syngo Workplace.

 If a 3D DSA series has been acquired in subtracted mode:
The mask and all fill images will be transferred.
 If a 3D DSA series has been acquired in native mode or if a 3D DR series is ac-
quired:
All fill images of the acquired scene will be transferred.
 If a 3D CARD series has been acquired:
The images of all acquisition runs will be transferred.
A progress bar indicating the running reconstruction is displayed on the screen of
the syngo Workplace.

Note 3D scenes are optimized for 3D reconstruction on the syngo Workplace.

For this reason, the scenes are less suitable for viewing on the Artis.

Transferring a 3D series manually

You can transfer a 3D series manually, e.g.:
 If there was a connection problem with syngo Workplace, e.g. the syngo
Workplace had been switched off.
 If syngo Workplace was busy with another reconstruction.

 If data have been deleted on syngo Workplace.

Console  PostProc task card

 Press the Patient Browser key (Num .) on the symbol keypad.

 Select the 3D series in the Patient Browser and load it by drag & drop or by
double-clicking.
 Select Image > Send to 3D in the main menu.

Touchscreen  InSpace task card

 Press these icons.

 If a 3D DSA scene is viewed in subtracted mode:

The mask and all fill images will be transferred.
 If a 3D DSA scene is viewed in native mode, or if a 3D DR scene is being re-
viewed:
All fill images of the acquired scene will be transferred.
 If a 3D CARD series is viewed:
The images of all acquisition runs will be transferred.

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A progress bar indicating the running reconstruction is displayed on the screen of

the syngo Workplace.

Test of image quality for 3D

This test should be performed once a month or whenever the image quality dete-
riorates or can be assumed to have deteriorated (e.g. after a violent collision of the
C-arm).

Note If the image quality in this test does not fulfill the criteria stated below in the Eval-
uation section, the system must be recalibrated by Siemens Customer Service.

Acquisition program The following acquisition program must be used for the image quality test: 5sDR

Input field Depending on the installed flat-panel detector, one of the following zoom stages
must be set.

Image receptor Zoom stage Input field

FD 20x20 Zoom 0 25 cm (diagonal)
FD 26x30 Zoom 0 39 cm (diagonal)
FD 30x40 Zoom 1 42 cm (diagonal)

Acquisition procedure
 Register a new patient on the Artis.

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 Place the resolution test pattern type 41 from the accessories kit horizontally
on the examination table (see figure).
 Adjust the table height and the table position so that the test pattern is in the
isocenter.
 Acquire a 3D series with the settings mentioned above.

 Wait until the 3D series is transferred to the syngo Workplace.

 In the syngo Workplace main menu, select Patient > InSpace Reconstruction.

 Set the position and size of the VOI so that the ROI of the phantom will be fully
reconstructed. The calculated voxel size should be approx. 0.1 mm.
 Set the following reconstruction parameters:
Start with preset DynaCT Body.
– Kernel Type for reconstruction: HU
– Slice Matrix: 512x512
– Image Characteristics: Sharp
– Reconstruction mode: Nat Fill
– Automatic Visualization: No

Note The calculated voxel size should be approx. 0.1 mm.

Adapt the VOI dimensions, if necessary.

 Start the reconstruction.

Evaluation
 Load the data set using the Patient Browser into an application that is able to
process MPR images, e.g. into the 3D or InSpace task card. (As an example, the
procedure is explained for 3D, the procedure in InSpace is similar.)
For more details and use of the InSpace task card,
please refer to the Quality Assurance manual.
 Readjust the position of the orthogonal planes.

 Select Thick MPR display for the coronal slice (top right image segment).

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1.2 LP/mm should be visible both in horizontal and in vertical direction. (LP = line pair)

 It may be necessary to slightly readjust the position of the orthogonal planes.

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Peripheral Angiography

Depending on the system equipment, there are different possibilities of producing

a series of angiographic acquisitions from a larger linear examination region.
A large-format image, for instance, can then be composed in the image processor
of the syngo Workplace from such an acquisition series.

DR, DSA standing se- For example, the pelvis-leg arteries can be acquired section by section as standing
ries series with the DR (Digital Radiography) or DSA (Digital Subtraction Angiography)
acquisition techniques.

PERISTEPPING With a motor-driven stepping device, a linear examination region (e.g. legs, spine,
intestine) can be acquired step by step (in native display) with PERISTEPPING (=
DR Stepping).
PERISTEPPING 539

PERIVISION PERIVISION is the stepping method introduced by Siemens with digital online sub-
traction. With an injection, an angiography is created in stepping technique in
subtracted display.
PERIVISION 549

General information on peripheral angiography

Application A linear examination region (e.g. the legs or an arm) can be acquired step by step
with PERISTEPPING or PERIVISION.
PERIVISION can be used both for arterial and for venous vascular display.

Acquisition series In PERISTEPPING or PERIVISION, scenes (part series) are acquired at several exam-
ination positions and they are composed to form an overall series.
The individual examination positions are moved to one after the other and scenes
are acquired there. The maximum contrast image from every scene is determined.
An acquisition series therefore consists of several scenes.

Movement A component is moved linearly according to the system type:

 The C-arm in case of Artis zeego, Artis ceiling.

 The tabletop (with the patient) in case of Artis floor, Artis biplane.

Note In case of the tabletop moves, PERISTEPPING and PERIVISION can be performed
only if a motor-driven stepping device is installed (patient table with stepping).

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System positions PERISTEPPING and PERIVISION can only be carried out in the following system po-
sitions:
 In Artis zeego, in principle every system position can be used, except Parking
and Transfer Headside position.
Clinically relevant are the Left Side and the Right Side positions.
 In systems with floor stand, Artis floor and Artis biplane, the C-arm of the floor
stand must be in a lateral position, i.e. Left Side or Right Side, Table Rotated,
or Left Side, Table Rotated.
 In biplane systems, peripheral examinations are possible only with the floor
stand (plane A).
The top stand is not used and must be in the parking position.
When a PERISTEPPING or PERIVISION program is selected, the system automat-
ically switches over to the single plane mode (plane A).
 In Artis ceiling, the C-arm of the ceiling stand must be in the Left Side or Right
Side position.

Table tilt  The patient table must be in the horizontal position for peripheral examina-
tions.

Running direction The running direction of PERISTEPPING or of a PERIVISION run can be selected ac-
cording to the blood flow direction.
The running direction determined in the acquisition program defines the direction
of the filling run:
 for examining the leg arteries: head to feet

 for examining the leg veins: feet to head

Note The running direction always refers to the patient position.

Number of positions The unit performs a maximum of 11 steps in PERISTEPPING or PERIVISION, i.e.
scenes can be acquired at up to 12 positions.
The step positions are numbered consecutively from 0 to 11. The step position
number is indicated in the message on the Assist screen / message bar.
Typically, 5 to 6 steps are required for PERISTEPPING or PERIVISION in the pelvis-
leg region.

Frame rates The frame rates are controlled by the acquisition program.

Instructions Instructions are given on the Assist screen / message bar.

 Pay attention to the messages.

Collisions If a collision occurs during the movement (collision sensor), then the movement
stops.

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The acquisition and the injection are stopped, the acquisition program is deselect-
ed , and the acquisition cannot be continued.

Playback The acquisition series are played back directly after the acquisition according to
the settings in the acquisition program.
PERISTEPPING acquisition series are always played back in native display. Subse-
quent subtraction is not possible.

Storing and loading The acquisition series are stored automatically in the local database.
You can load the series and scenes as usual from the Patient Browser to the
PostProc task card or via scene directory, if the patient is the current review pa-
tient.

Documentation The scenes can be documented in the following ways:

 Each position individually

 After image reconstruction using Composing on the syngo Workplace

Acquisition programs for peripheral angiography

To set the parameters for acquisitions, use an existing acquisition program or copy
an existing program to produce a new one. The acquisition program used must
have the DR Stepping or Perivision Mode. Only then is access to the special pa-
rameters possible.
Parameters for Exam Sets 573
Siemens provides a number of predefined exam sets that can be adapted individ-
ually.

Windowing The data for programming the window values depend very much on the concen-
tration and amount of the contrast medium used.
Therefore these values must frequently be adapted individually, also to the image
impression wanted by the examiner.
 PERISTEPPING is always performed unsubtracted. Therefore only the values for
native display can be set in this program.
 PERIVISION is always performed subtracted. Therefore the values for both dis-
plays can be set in this program.

Auto windowing Automatic windowing is not possible with PERIVISION but on with PERISTEPPING.
Instead of manual windowing, automatic windowing can also be selected in the
programming. Then the windowing is calculated automatically, related to the
maximum contrast image.

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We recommend that manual windowing is programmed. Automatic windowing

functions well provided the image is not collimated and no direct radiation (e.g.
when imaging air) is present in the image.

Measuring field The selection of an incorrect measuring field (dominant) can lead to faulty expo-
sures especially in peripheral examinations.
For exposures of both legs use the two outer dominants, for one leg the middle
dominant.

Scene time The scene time is adjustable for the time from activating the acquisition until end-
ing acquisition.
As in the case of variable frame rate, PERISTEPPING and PERIVISION programs are
also used to divide a scene into phases of different lengths.

General preparations

Preparing the patient

 Register the patient.

 Prepare the patient and units.

Positioning
Comfortable positioning of the patient is especially important for examinations of
the pelvis-leg arteries. Only in this way can the patient be expected not to move
during the acquisition series.

Note In Artis zeego - Artis floor - Artis biplane, the patient is normally positioned Feet
First at the head end of the patient table for peripheral examinations.
Very tall patients can also be positioned Head First towards the foot end of the
patient table.
 Please make sure that the patient position is entered correctly!

In order to make sure that the feet can be reached from each position, the long
tabletop can be used.

 Position the patient.

 Position the patient centrally and in a supine position on the tabletop.

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Immobilization
To avoid motion artifacts, the legs should be immobilized in peripheral examina-
tions.
 Immobilize the patient's knees: Either run the fastening belt around the table-
top or pull it through underneath the positioning 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.

 Turn the patient's feet inward and immobilize them with adhesive tape, if nec-
essary.
 Check for correct entry of the patient position.

 Inform the patient about the coming examination procedure.

Preparing the stand and table

Move the C-arm of plane B into parking position (only biplane systems)
 Press the stand joystick of plane B down, press one of the two buttons on the
side and deflect the joystick to the side until the parking position has been
reached.

Move C-arm (of plane A) into lateral position

 Press the System positions key on the stand control module.

 Select the required position.

 Press down the stand joystick and deflect it forward until the target position is
reached.
 Or press the hands free foot pedal.

Adjust the SID

 Press the rocker switches on the stand joystick to move the FD into the re-
quired position.

 Observe the reading on the Assist screen / message bar.

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Move the patient as close as possible to the image receptor

 Press the table lift key on the table control module.

Preparing the injection

 Puncture and insert the catheter.

 Connect the contrast medium injector and program it.

See the Injector Operator Manual
 Perform fluoroscopy and collimate.

Automatic injection
 Set the X-ray delay on the injector (recommendation: 0 s).

 Switch the injector to “Armed”.

Injector not connected (correctly) or not set to “armed” (especially with

Caution PERIVISION, DYNAVISION or 3D examinations)
Risk of X-ray radiation applied without diagnostic use
 Pay attention to the messages on the Assist screen / message bar.

 Inject manually, if necessary.

Manual injection
 Deselect synchronization.

Setting the start position

Position patient with tabletop

 Press down the table joystick/knob and deflect it to the side.

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Set the LAO/RAO angulation

 Press the stand joystick down, deflect the joystick and hold it until the target
position is reached.
(With respect to the set orientation of the control console.)

Note Peripheral examinations can also be performed with a RAO/LAO-angulated C-arm

(max. 30°).

Setting the field of view

In order to cover a patient area as large as possible, set an SID as large as possible:
 Press the rocker switch on the stand joystick to move the FD.

 Then reposition the patient via table lift.

PERISTEPPING
A linear examination region (e.g. the legs or an arm) can be acquired with a step
by step movement (unsubtracted) via PERISTEPPING.
The most common application is the contrast medium display of the pelvis-leg
vessels.

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PERISTEPPING examination sequence

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
(3) Brief fluoroscopy for automatic setting of acquisition parameters
(4) Injection if contrast medium is used
(5) Start of acquisition
(6) Fill run for image acquisition with or without contrast medium
(7) End position

Test phase In the first step you determine the start position, the acquisition positions and the
end position.
After positioning the patient and immobilizing the patient's legs, check during the
test phase with short fluoroscopies the position of both legs (of the region under
examination) as well as the collimation and the possibly necessary transparency
compensation for each examination position.
In this way, the number of acquisition positions is also determined.

Return phase Start the acquisition series at the reversal point.

The unit first moves back to the start position.

Injection In the start position, the injector receives the start signal (if integrated) or you per-
form the injection manually.

Fill phase The contrast images are then acquired and displayed.
You can now observe the contrast medium bolus on the screen.
You switch on to the next acquisition position manually with the hand switch.
During the series, the acquisition frame rate is automatically controlled as deter-
mined in the acquisition program.

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Note The acquisition positions normally overlap approx. 1/3 (adjustable by Service).
Therefore you switch to the next acquisition position when the contrast medium
bolus has flowed into the lower third of the image.

Examples Pelvis-leg arteries Leg-pelvis veins

Test phase The start position for displaying the ar- The start position for displaying the
teries is proximal, i.e. in the region of veins is distal, i.e. in the region of the
the pelvis. feet.
Return phase The acquisition series starts distally, in The acquisition series starts proximally,
the region of the feet. in the pelvis or abdomen, depending
on how far the contrast medium should
be traced in the veins.
Fill phase The contrast medium is injected in the The contrast medium is injected in the
area of the pelvis, the stepping direc- area of the feet, the stepping direction
tion is “footwards”, commencing at the is “headwards”, commencing at the
start position. start position.

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PERISTEPPING workflow
A PERISTEPPING acquisition is performed in the following sequence:
1. Prepare the patient, stand, C-arm and table.
Check the injector, if used.

2. Perform a brief fluoroscopy in the start position: Press fluoro pedal of foot-
switch.
Check/set SID, table height, collimation, filters and measuring fields.
3. Select a PERISTEPPING acquisition program.

4. Perform the PERISTEPPING test run to check the position of the examination re-
gion and to make sure that no collision will occur.
Trigger steps by deflecting the C-arm joystick in running direction and hold it
until the next position is reached.
Where required, perform fluoroscopy, collimate, position the finger filter and
change the measuring fields.
5. Program a delay at the injector and set the injector to “Armed”.
In case the injector is not armed it is assumed that a manual injection is per-
formed. “Injector 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 phase
Press 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.
9. Stop acquisition when acquisition run is complete.
10. View the PERISTEPPING series.

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Preparing PERISTEPPING
 General preparations

 In biplane systems, the top stand is in the parking position.

 The C-arm must be in a suitable position (lateral to the patient).

 Check the injector.

Select the acquisition program

Note PERISTEPPING is started by selecting the PERISTEPPING program.

It means that you first position the patient or unit and then select the PERISTEP-
PING program.

 Activate the required PERISTEPPING program on the touchscreen control.

– The start position is determined with the selection of a PERISTEPPING pro-
gram.
– The unit now moves step by step.
– Angulations, table lift, tabletop movements and possibly table tilt are
blocked.
– The FD can be moved only away from the patient.
– The image orientation, the zoom factor and the patient position are frozen
up to the end of the PERISTEPPING acquisition.

Note The normal functions can be restored by selecting a non-PERISTEPPING program

or registering a new patient.
The start position is redetermined with the selection of another PERISTEPPING pro-
gram.

Check the parameters

 Check that the required frame rates are set.
(The frame rate can be entered separately for each acquisition position.)
 Pay attention to the correct running direction for the leg arteries: footwards,
for the leg veins: headwards.
 Check that the middle dominant is selected for one leg (or arm) or the two out-
er dominants for both legs.

Note Selection of an incorrect dominant impairs image quality by faulty exposure.

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PERISTEPPING test phase

 The patient / the C-arm is located in the required start position.

 The injector or manual administration of contrast medium is prepared, if nec-

essary.

Perform fluoroscopy briefly

 Press the FLUORO pedal on the foot switch for approx. 2 s.
– An image appears on the screen (LIH).

Note Fluoroscopy must be performed in the first position. Otherwise there will be no
movement.
Fluoroscopy is not absolutely necessary in intermediate positions, but recom-
mended in order to be able to collimate well and thus achieve optimum image
quality.

Collimate
 Tap the collimator joystick briefly, if necessary.
– The collimator leaves are displayed graphically in the LIH image.

Select wedge or finger filter

 Press a filter key.

Set diaphragms and filter diaphragms

 Set the filter diaphragms with the upper joysticks.

 Set the diaphragms with the lower joystick.

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Trigger steps
 The orientation of the operating console is set correctly.

The catheter can be withdrawn during stepping of the tabletop or the C-arm.
Caution Risk that X-ray dose will be applied without diagnostic information
 Before starting an examination with stepping, check the position and length of
the catheter.
 Observe the catheter during the examination.

 Press the stand joystick down, deflect it in running direction and hold it.

– The movement is carried out step by step in running direction.

Note In the start position, movement is possible only in the direction defined in the
PERISTEPPING program.

The message DR-Stepping test phase: Manual, n(m) is displayed.

Note Manual means that you must actuate the steps with the multifunctional button
(blue button on the hand switch).
The two numbers in the message show the current step (n) and the maximum
number of steps (m).

 Hold the stand joystick until the movement stops automatically.

 Where required, perform fluoroscopy, collimate, position the finger filter and
change the dominant.
– The exposure data are calculated and the generator is automatically preset
from fluoroscopy in an acquisition position. (The system takes account of
the patient transparency in this case.)
– The last settings of the diaphragms and filters of each step position are
assigned and stored automatically.

Note It is not absolutely necessary to perform fluoroscopy in every position, but it is ad-
vantageous.
If fluoroscopy was not performed in every position, then the exposure data of
each acquisition position are calculated back from the determined values of the
start position.

Note The last step can be shortened, since the entire longitudinal movement is restrict-
ed to a maximum length.

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Note Corrections to the settings are possible by moving once again to the correspond-
ing position.

PERISTEPPING return phase

 The patient / the C-arm is located in the last start position required (end of test
phase).
 If possible, start the acquisition immediately to avoid unnecessary patient
movements.

Start the acquisition series

Note For exposure release, in principle the hand switch or foot switch can be used.
However, to facilitate the examination sequence we recommend using the foot
switch.

Note If you let go of the exposure release button or pedal, the movement is ended im-
mediately, the acquisition series are stopped, PERISTEPPING is thus deselected,
the acquisition series cannot be continued.

 Press the exposure release button or pedal and keep it pressed until the end
of the PERISTEPPING acquisition, i.e. until the fill phase is automatically com-
pleted.

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Trigger the return phase

 Press the blue multifunctional button of the handswitch briefly.
– The table/C-arm moves back to the start position.
– The message DR-Stepping return phase: ... n(m) is displayed.

Note The return phase is radiation-free.

PERISTEPPING fill phase

 The patient / the C-arm is again located in the start position.

Automatic injection
 The injector is switched to “Armed”. 538

 Keep the exposure release button or pedal pressed.

– The injection takes place automatically in the start position.
– The start of the contrast images depends on how the injector is pro-
grammed: X-ray delay or injection delay

Manual injection
 Keep the exposure release button or pedal pressed.

 Actuate the release button of the injector.

– The contrast images are acquired immediately in the start position.

Contrast images in the start position

 Keep the exposure release button or pedal pressed.
– The contrast images are acquired in the start position.

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 Watch the vessels fill with contrast medium on the screen.

Trigger step
 The optimum contrast medium filling (approx. 2/3 of the image field) has been
attained.
 Press the blue multifunctional button of the handswitch in good time.

 Keep the exposure release button or pedal pressed.

– Movement occurs to the next position.
– The images are acquired automatically in this position.
– The message DR-Stepping fill phase: ... , n(m) is displayed.

Note The two numbers in the message show the current step (n) and the maximum
number of steps (m).

Note No acquisitions are made during stepping.

The acquisition positions overlap approx. 1/3.
The exposure control adapts the exposure of the images of the fill phase automat-
ically to the ones of the mask phase.
The last image (LIH) is displayed on the screen.

Trigger further steps

 The optimum contrast medium filling has been reached again.

 Press the blue multifunctional button of the handswitch in good time.

 Keep the exposure release button or pedal pressed.

 Continue up to the last acquisition position required.

Terminate the acquisition series

A PERISTEPPING acquisition series is completed,
 if the maximum number of steps is reached

 if you let go of the exposure release button or pedal

 if an error occurs

 You can now let go of the exposure release button or pedal.

– The message DR-Stepping: Completed is displayed.
– PERISTEPPING is automatically deselected and the first acquisition program
in the current examination program is selected.

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Note A continuous movement, e.g. back to the start position, is possible only if the dis-
play DR-Stepping: Completed has gone out.

The PERISTEPPING series (“scene” of Max-Fill images) is displayed on the screen.

PERIVISION
A linear examination region (e.g. the legs or an arm) can be acquired with step-
by-step subtraction via PERIVISION.
The most common application is the contrast medium display of the pelvis-leg
vessels.
Not only the pelvis-leg arteries, but also the pelvis-leg veins can be examined.
Here it is important to preselect the correct examination direction in the acquisi-
tion program.

PERIVISION examination sequence

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
(3) Brief fluoroscopy for automatic setting of acquisition parameters
(4) Mask run for image acquisition without contrast medium
(5) Injection at reversal point
(6) Fill run for image acquisition with contrast medium
(7) End position

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Test phase In the first step you determine the start position, the acquisition positions and the
end position.
After positioning the patient and immobilizing the patient's legs, check during the
test phase with short fluoroscopies the position of both legs (of the region under
examination) as well as the collimation and the possibly necessary transparency
compensation for each examination position.
In this way, the number of acquisition positions is also determined.

Mask phase Start the acquisition series at the reversal point.

The mask images are acquired in every acquisition position.
After each acquisition, the stepping device automatically moves the patient/C-arm
to the next acquisition position.

Injection The injector receives the start signal (if integrated) or you perform the injection
manually.

Fill phase Finally the contrast images (fill frames) are acquired and immediately displayed
subtracted.
You can now monitor the contrast medium bolus in the subtracted image on the
screen.
You switch on to the next acquisition position manually with the hand switch.
During the series, the acquisition frame rate is automatically controlled as deter-
mined in the acquisition program.

Note The acquisition positions normally overlap approx. 1/3 (adjustable by Service).
Therefore you switch to the next acquisition position when the contrast medium
bolus has flowed into the lower third of the image.

Examples Pelvis-leg arteries Leg-pelvis veins

Test phase The start position for displaying the ar- The start position for displaying the
teries is proximal, i.e. in the region of veins is distal, i.e. in the region of the
the pelvis. feet.
Mask phase The acquisition series starts distally, in The acquisition series starts proximally,
the region of the feet. in the pelvis or abdomen, depending
on how far the contrast medium should
be traced in the veins.
Fill phase The contrast medium is injected in the The contrast medium is injected in the
area of the pelvis, the stepping direc- area of the feet, the stepping direction
tion is “footwards”, commencing at the is “headwards”, commencing at the
start position. start position.

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PERIVISION workflow
A PERIVISION acquisition is performed in the following sequence:
1. Prepare the patient, stand, C-arm and table.
Check the injector, if used.

2. Perform a brief fluoroscopy in the start position: Press fluoro pedal of foot-
switch.
Check/set SID, table height, collimation, filters and measuring fields.
3. Select a PERIVISION acquisition program.

4. Perform the PERIVISION test run to check the position of the examination re-
gion and to make sure that no collision will occur.
Trigger steps by deflecting the C-arm joystick in running direction and hold it
until the next position is reached.
Where required, perform fluoroscopy, collimate, position the finger filter and
change the measuring fields.
5. Program a delay at the injector and set the injector to “Armed”.
In case the injector is not armed it is assumed that a manual injection is per-
formed. “Injector 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.
8. Stop acquisition when acquisition run is complete.
9. View the PERIVISION series.

Preparing PERIVISION
 General preparations 536

 In biplane systems, the top stand is in the parking position.

 The C-arm must be in a suitable position (lateral to the patient).

 Check the injector.

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Select the acquisition program

Note PERIVISION is started by selecting the PERIVISION program.

It means that you first position the patient or unit and then select the PERIVISION
program.

 Activate the required PERIVISION program on the touchscreen control.

– The start position is determined with the selection of a PERIVISION program.
– The unit now moves step by step.
– Angulations, stand swivel, table lift, tabletop movements and possibly table
tilt are blocked.
– The FD can be moved only away from the patient.
– The image orientation, the zoom factor and the patient position are frozen
up to the end of the PERIVISION acquisition.

Note The normal functions can be restored by selecting a non-PERIVISION program or

registering a new patient.
The start position is redetermined with the selection of another PERIVISION pro-
gram.

Check the parameters

 Check that the required frame rates are set.
(The frame rate can be entered separately for each acquisition position.)
 Pay attention to the correct running direction for the leg arteries: footwards,
for the leg veins: headwards.
 Check that the middle dominant is selected for one leg (or arm) or the two out-
er dominants for both legs.

Note Selection of an incorrect dominant impairs image quality by faulty exposure.

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PERIVISION test phase

 The patient / the C-arm is located in the required start position.

 The injector or manual administration of contrast medium is prepared.

Perform fluoroscopy briefly

 Press the FLUORO pedal on the foot switch for approx. 2 s.
– An image appears on the screen (LIH).

Note Fluoroscopy must be performed in the first position. Otherwise there will be no
movement.
Fluoroscopy is not absolutely necessary in intermediate positions, but recom-
mended in order to be able to collimate well and thus achieve optimum image
quality.

Collimate
 Tap the collimator joystick briefly.
– The collimator leaves are displayed graphically in the LIH image.

Select wedge or finger filter

 Press a filter key.

Set diaphragms and filter diaphragms

 Set the filter diaphragms with the upper joysticks.

 Set the diaphragms with the lower joystick.

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Trigger steps
 The orientation of the operating console is set correctly.

When stepping the tabletop or the C-arm the catheter can be displaced or with-
Caution drawn
Non image relevant dose
 Before starting an examination with stepping, check the position and length of
the catheter.
 Observe the catheter during the examination.

 Press the stand joystick down, deflect it in running direction and hold it.

– The movement is carried out step by step in running direction.

Note In the start position movement is possible only in the direction defined in the PERI-
VISION program.

The message PERI test phase: Manual, n(m) is displayed.

Note Manual means that you must actuate the steps with the multifunctional button
(blue button on the hand switch).
The two numbers in the message show the current step (n) and the maximum
number of steps (m).

 Hold the stand joystick until the movement stops automatically.

 Where required, perform fluoroscopy, collimate, position the finger filter and
change the dominant.
– The exposure data are calculated and the generator is automatically preset
from fluoroscopy in an acquisition position. (The system takes account of
the patient transparency in this case.)
– The last settings of the diaphragms and filters of each step position are
assigned and stored automatically.

Note It is not absolutely necessary to perform fluoroscopy in every position, but it is ad-
vantageous.
If fluoroscopy was not performed in every position, then the exposure data of
each acquisition position are calculated back from the determined values of the
start position.

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 Peripheral Angiography

Note The last step can be shortened, since the entire longitudinal movement is restrict-
ed to a maximum length.

Note Corrections to the settings are possible by moving once again to the correspond-
ing position.

PERIVISION mask phase

 The patient / the C-arm is located in the last required position (end of test
phase, start of mask phase).
 If possible, start the mask phase immediately to avoid unnecessary patient
movements.
 Instruct the patient: “Do not move”, legs, breathing, etc.

Start the acquisition series

Note For exposure release, in principle the hand switch or foot switch in the examina-
tion room or control room can be used.
However, to facilitate the examination sequence we recommend using the foot
switch.

Note If you let go of the exposure release button or pedal, the movement is ended im-
mediately, the acquisition series and the injection are stopped, PERIVISION is thus
deselected, the acquisition series cannot be continued.

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 Press the exposure release button or pedal and keep it pressed until the end
of the PERIVISION acquisition, i.e. until the mask phase and fill phase are com-
pleted.
– The mask phase starts.
– The message PERI mask phase: ... n(m) is displayed.

Note The two numbers in the message show the current step (n) and the maximum
number of steps (m).

Mask images are acquired and step movements performed alternately until the
start position is reached again.

PERIVISION fill phase

 The patient / the C-arm is again located in the start position.

Automatic injection
 The injector is switched to “Armed”. 538

 Keep the exposure release button or pedal pressed.

– The injection takes place automatically in the start position.
– The start of the contrast images depends on how the injector is pro-
grammed: X-ray delay or injection delay

Manual injection
 Keep the exposure release button or pedal pressed.

 Actuate the release button of the injector.

– The contrast images are acquired immediately in the start position.

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Contrast images in the start position

 Keep the exposure release button or pedal pressed.
– The contrast images are acquired in the start position.
– The image system automatically switches over to subtracted display.
 Watch the vessels fill with contrast medium on the screen.

Trigger step
 The optimum contrast medium filling (approx. 2/3 of the image field) has been
attained.
 Press the blue multifunctional button of the handswitch in good time.

 Keep the exposure release button or pedal pressed.

– Movement occurs to the next position.
– The images are acquired automatically in this position.
– The message PERI fill phase: ... , n(m) is displayed.

Note The two numbers in the message show the current step (n) and the maximum
number of steps (m).

Note No acquisitions are made during stepping.

The acquisition positions overlap approx. 1/3.
The exposure control adapts the exposure of the images of the fill phase automat-
ically to the ones of the mask phase.
The last subtraction image (LIH) is displayed on the screen.

Trigger further steps

 The optimum contrast medium filling has been reached again.

 Press the multifunctional button in good time.

 Keep the exposure release button or pedal pressed.

 Continue up to the last acquisition position required.

Terminate the acquisition series

A PERIVISION acquisition series is ended,
 if the maximum number of steps is reached

 if you let go of the exposure release button or pedal

 if an error occurs

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 You can now let go of the exposure release button or pedal.

– The message PERI: Completed is displayed.
– PERIVISION is automatically deselected and the first acquisition program in
the current examination program is selected.

Note A continuous movement, e.g. back to the start position, is possible only if the dis-
play PERI: Completed has gone out.

The first acquisition program in the current examination program is automatically

selected.
The PERIVISION series (“scene” of Max-Fill images) is displayed on the screen.

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 Part: Exam Sets
The Exam Set and Program Editor

Exam Sets
The Artis provides a number of acquisition, fluoroscopy and roadmap programs
for standard examinations.
The acquisition, fluoroscopy and roadmap programs are arranged in exam sets
and stored in a database. The fluoroscopy/acquisition parameters and dose are de-
termined in the exam sets.

(1)

(2)

(3)

(4)

(1)

(2)

(3)

(5)

Example of an exam set in the Exam Set and Program Editor

(1) Exam set

(2) up to 16 acquisition programs
(3) possibly 1 alternative acquisition program
(4) 3 fluoroscopy programs
(5) possibly 3 assigned roadmap programs
The fluoroscopy/roadmap programs are always available in three versions, which
usually differ with regard to their dose.
You can view and edit the acquisition/fluoroscopy/roadmap programs which are
stored in the database and arranged in exam sets.
Every acquisition, fluoroscopy, or roadmap program is stored once in the system
and can be used in one or more exam sets.

Note In an exam set, the second (middle) fluoroscopy program is always the normal flu-
oroscopy program.

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Exam Sets

Note The exam sets on your system depend on the type of system and the application
profile set.
A number of exam sets are preinstalled on the system when it is delivered.
The programs should only be changed by experienced users.
 For further information on the preinstalled exam sets ask your applications spe-
cialist.

Note The settings of the current programs do not have to be the same as the settings
of the programs stored in the database.
The values shown in the images are only explanatory. They have no clinical mean-
ing.

Storage Changes in exam sets are automatically saved but not applied to the current ex-
amination.

EPS exam set When the system is running on system EPS (Emergency Power Supply), a special
exam set, the EPS exam set (named UPS Exam Set) is automatically selected.
System emergency power supplies 786
During system EPS, only the EPS exam set with continuous fluoroscopy is avail-
able, acquisition and roadmap are disabled.
When normal power supply is recovered and the system is no longer running on
system EPS the normal exam sets will be available again.

IVUS exam set If the system is equipped with IVUSmap, a special exam set for IVUS is available.
The IVUS exam set is marked by a special icon.

Managing and editing exam sets

Opening the Exam Set and Program Editor

You can edit existing exam sets, create new exam sets, and delete exam sets that
are no longer used.
 Examination task card

 Click this icon.

Or

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 The Exam Set and Program Editor

 Select Acquisition > Exam Set Editor... in the main menu.

If the use of a password has been configured, the Exam Set Password dialog ap-
pears:
 Enter the correct password and click OK.

Example

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Exam Sets

Changing the password for the Exam Set Editor

If a password has been configured, you can change it.
 In the main menu select Acquisition > Change Password.
– The Exam Set Password dialog is displayed.

 Enter the correct old password into the first box.

 Enter the new password into the second box.

 Enter the new password again into the third box.

 Click OK.

Note Password is not case-sensitive, must not contain spaces, and can be 5 to 16 char-
acters long.
The default Exam Set Editor password at system installation is: artis

Resetting the password for the Exam Set Editor

The password can be reset in service mode only.
 Enter service mode via Options > Service > Local Service... from the main
menu.
 In the main menu select Acquisition > Reset Password.
– The password is reset to the default: artis

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 The Exam Set and Program Editor

Viewing exam sets

After you have called up the Exam Set and Program Editor, it will appear in the
tree view.

Active exam set The currently active exam set with the currently active acquisition and fluoroscopy
programs is marked bold letters.

(1) (1)
(2) (2)

(3)

View with fluoroscopy programs View with roadmap programs

(1) active exam set

(2) active acquisition program
(3) active fluoroscopy program

Viewing roadmap programs

 Click Display Roadmap.
– The roadmap programs are displayed instead of the fluoroscopy programs.

Displaying fluoroscopy programs again

 Click Display Fluoro.
– The fluoroscopy programs are displayed again.

Scrolling in the tree of exam sets

The exam sets are arranged in a tree view.
 Use the scroll bar.

 Click a + sign to open an exam set.

 Click this icon to open all the exam sets.

 Click this icon to close all the exam sets.

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Exam Sets

Displaying exam sets of an application profile

Depending on the system and system configuration, you can use different types
of exam sets:
 UNIVERSAL: for universal angiography

 NEURO: for neuroradiologic examinations

 CARD: for cardiography

 MULTIPURPOSE: for multipurpose use

 Select the type of examination next to Profile.

Only the installed profiles are displayed.

Displaying parameters
Viewing and editing acquisition/fluoroscopy/roadmap programs 566

Editing exam sets

Note It is not possible to modify, rename, save, or delete the EPS exam set.

Logging in for editing exam sets and programs

 Click Login.

 Enter the correct password (default: artis).

Marking an exam set

 Click the required field exam set in the tree view.
– The exam set is marked.

Creating a new exam set

To create a new exam set, always use an existing exam set which is as similar as
possible to the exam set to be created.

Note The following characters are not allowed in exam set names: \ *
A maximum of 50 exam sets can be stored.

 Mark the required exam set in the tree view.

 Click Save As New Exam Set.

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 The Exam Set and Program Editor

 Overwrite or change the existing name.

 Confirm with OK.

Assigning an exam sets to an application profile

 Mark the required exam set in the tree view.

 Select the type of examination next to Profile.

Rearranging exam sets

 Drag and drop the exam set to a new position.
– The exam sets are rearranged accordingly.

Renaming an exam set

 Mark the required exam set in the tree view.

 Overwrite or change the existing name.

 Confirm with Store Exam Set Properties.

– The name of the exam set will be changed.

Assigning acquisition/fluoroscopy/roadmap programs 570

Applying an exam set

 Mark the required exam set in the tree view.

 Click Activate Exam Set and Program.

– The exam set is applied to the current examination.

Removing an acquisition/fluoroscopy/roadmap program from an exam set

 Mark the required acquisition/fluoroscopy/roadmap program in the tree view.

 Click Remove from Exam Set.

Note An acquisition/fluoroscopy/roadmap program itself is not deleted.

Deleting an acquisition/fluoroscopy/roadmap program 570

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Exam Sets

Setting as IVUS exam set

 Mark the exam set in the tree view.

 Select Set as IVUS Exam Set in the context menu.

– The IVUS exam set is marked by a special icon.

Deleting an exam set

 Mark the required exam set in the tree view.

 Press the Del key.

– A dialog box appears.
 If you want to delete the exam set, confirm with Yes.
– The exam set will be irreversibly deleted.

Note It is not possible to delete the active exam set.

When you delete an exam set, the acquisition/fluoroscopy/roadmap programs
used in it are not deleted.

Viewing and editing acquisition/fluoroscopy/roadmap

programs
 Click Expert >>.

 Mark the required acquisition/fluoroscopy/roadmap program with a mouse

click in the tree view.
– The parameters of the acquisition/fluoroscopy/roadmap program are dis-
played.

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 The Exam Set and Program Editor

Example

Note Depending upon the type of program (DR, DSA, CARD; fluoroscopy, roadmap,
etc.), only the applicable parameters are available.

Displaying service parameters

Certain parameters are accessible only in Service mode.
 Click this icon to display hidden parameters (password required).

Changing the name of an acquisition/fluoroscopy/roadmap program

Note Please do not include laterality in acquisition program names. It can be confusing.

 You have logged-in for editing. 564

 Mark the acquisition/fluoroscopy/roadmap program.

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Exam Sets

 Right-click it and select Rename from the context menu.

– A dialog box appears.
 Overwrite or change the existing name.

 Confirm with OK.

– The name of the program will be changed in all the exam sets.

Changing parameters
Parameters for Exam Sets 573.

Storing and/or applying programs 571

Hiding parameters
 Click << Standard.

Organizing programs
 Expert >> mode

 You have logged-in for editing. 564

 Click the Organize tab.

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 The Exam Set and Program Editor

Example

Viewing program parameters

 Right-click a program on the Organize tab card and select Details from the
context menu.

Finding out in which exam sets a program is used

 Right-click a program on the Organize tab card and select Used in... from the
context menu.
– A dialog box appears listing the exam sets.
 Click OK to close.

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Exam Sets

Assigning acquisition/fluoroscopy/roadmap programs

You can assign arbitrary existing acquisition/fluoroscopy/roadmap programs to an
existing or newly created exam set. The following rules apply:
 The active exam set cannot be selected as the source or destination.

 An acquisition program can be set only at the location of an acquisition pro-

gram.
 The first acquisition program must always be a DR or DSA program when per-
forming a PERISTEPPING, PERIVISION, DR-DYNAVISION, DSA-DYNAVISION or 3D
acquisition.
 The alternative acquisition program can only be a non-stepping, non-rotational
acquisition program, i.e. no PERISTEPPING, PERIVISION, DR-DYNAVISION, DSA-
DYNAVISION or 3D acquisition program.
 The EPS exam set and the IVUS exam set cannot be modified.

 A fluoroscopy program can be set only at the location of a fluoroscopy program

(Display Fluoro is selected).
 A roadmap program can be set only at the location of a roadmap program
(Display Roadmap is selected).
 Fluoroscopy programs and roadmap programs can only be added or replaced
as triplets.
 Click the required acquisition/fluoroscopy/roadmap program on the Organize
tab card, keep the mouse button pressed, drag it to the required location in the
tree view, and release the mouse button.
Or
 Mark the target position in the exam set tree, mark the program to assign in the
Programs column, then click the arrow left icon.
To move programs:
 Mark the program in the exam set tree, then click the arrow up or arrow down
icon.

Deleting an acquisition/fluoroscopy/roadmap program

Note If an acquisition/fluoroscopy/roadmap program is not used in any examination

program, it is marked with a grayed-out square bullet.

 Mark the program to be deleted.

 Right-click the program on the Organize tab card and select Delete Program
from the context menu.

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Storing and/or applying programs

If you have changed an acquisition/fluoroscopy/roadmap program, you can store
changes in the database or apply the settings to the current examination or both.

Note In each acquisition mode (DR, DSA, DYNA, PERI, 3D), 128 acquisition programs
can be stored.
When this amount is reached and you want to create another one, you must de-
lete acquisition programs not required anymore.
Deleting an acquisition/fluoroscopy/roadmap program 570
21 triplets of fluoroscopy/roadmap programs can be stored (3 x 21 = 63 fluoro pro-
grams in total). One of the fluoro triplets is reserved for the EPS exam set and can
only be used there.

Saving changed program parameters

 Click Save Parameters.

Storing a program
 Click Save As New Program.

Or
 Right-click a program on the Organize tab card and select Save as New Pro-
gram from the context menu.

 If no program with the name of the new program exists, changes are stored in
the exam set database.
 If a program with the name of the new program exists, a dialog box appears.

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Exam Sets

Accepting the changes for all exam sets

 Click Replace All.
– The acquisition/fluoroscopy/roadmap program is transferred to the exam set
database with the new settings.

Creating a new program

 Enter a new name or overwrite the existing name.

 Click Create New.

– A new program is created and assigned to the exam set but not applied to
the current examination.

Applying a program
 Click Apply Parameters.
– Changes are applied to the current examination but not stored in the exam
set database.

Storing and applying a program

 Click Save & Apply.
– Your changes are stored in the exam set database and applied to the current
examination.
– The Exam Set and Program Editor is closed.

Closing the Exam Set and Program Editor

 Click Close.
– If you have made changes, a dialog box appears asking you if you want to
save them.
 Confirm as required.

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 Exam Sets
Parameters for Exam Sets

CLEAR image quality

The software employs a comprehensive range of CLEAR applications to enhance
image quality. The image quality settings are incorporated in the acquisition pa-
rameters. CLEAR consists of:
 CLEARcontrol achieves optimal brightness for the whole image.
It offers fully automated histogram analyses in a universal measurement field.
The results provide good visibility of structures even in areas with high-density
differences
 CLEARview provides highly effective noise reduction especially for low dose
imaging.
It applies a unique dose adaptive algorithm to reduce the noise which results
in clear images with less noise when using low dose protocols.
 CLEARvessel generates crisp visualization of the vessel edges without increas-
ing noise.
It enhances the contrast of the vessel to the surrounding tissue without in-
creasing the noise as with normal edge enhancement. The result of the tech-
nology provides sharp vessel edges.
 CLEARmotion automatically detects fine structures and compensates for mo-
tion artifacts.
It results in the visibility of fine structures in every heart beat.

Acquisition parameters
The parameters for the acquisition/fluoroscopy/roadmap programs are arranged
in groups in the Exam Set and Program Editor.

Note The available parameters depend on the system configuration and the program.
Certain parameters are accessible only in Service mode.

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Exam Sets

Exposure parameters for acquisition

Settings for radiation generation are in the Exposure area.

kV Tube voltage in kV (kV plateau)

for iodine contrast approximately 70 kV.
The set kV value is maintained automatically for as long as possible. For extremely
thin or small objects, the kV value is reduced. In case of lower transparency, the
kV value is increased. It ensures correct image brightness.
Depending on patient transparency, a copper filter is automatically placed in the
beam to reduce the patient dose. To maintain (the relative) contrast, the nominal
kV value is reduced in accordance with the filter thickness.

Example kV plateau set to 70 kV, kV filter set to 81 kV

With increasing patient thickness and/or density, the following values will be set:
60 kV / 0.9 mm Cu
63 kV / 0.6 mm Cu
65 kV / 0.3 mm Cu
66 kV / 0.2 mm Cu
68 - 81 kV / 0.1 mm Cu
>81 kV / 0 mm Cu

Pulsewidth Pulse width in ms

Maximum required pulse width in milliseconds, depending upon the patient trans-
parency which is determined during fluoroscopy.
This value will be adapted to the patient transparency to ensure correct image
brightness. For a configurable kV ms value, e.g. 102 kV ms, the ms value is in-
creased by up to 60% for the same kV rather than increasing the kV value.
The automatic increase in the ms value is 60%, but not more than the maximum
pulse width set in the acquisition program (which depends on the frame rate).

fixed 266 ms If you select this value, a pulse width of 266 ms will be maintained irrespective of
(not with CARD) the patient transparency.
It keeps the noise down during examinations with very low contrast and little pa-
tient movement, e.g. DSA for lower extremities, intravenous examinations, and
CO2 examinations, where a long exposure time helps to smear out CO2 gas bub-
bles in vessels.

kV ms kV value at which the pulse width is switched over.

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 Parameters for Exam Sets

Focus Focus size of the X-ray tube

 Micro focus (only for 3-focus tubes)

 Small focus

 Large focus

or automatic focus selection

The smaller the focal spot, the sharper the image. However, because of a small fo-
cal spot, the load capacity of the tube is reduced, which causes the kV to increase
with an increasing object thickness and/or density.
The automatic focus selection always sets the smallest possible focus. The system
switches over to the next larger focus only if the automatic exposure control re-
quires it, e.g. to keep the kV low.

kV-Focus kV value at which switching from a smaller to a larger focus occurs.

 kV-Focus micro-->small: kV value at which switching from a micro focus to a
small focus occurs (with a 3-focus tube only)
 kV-Focus small-->large: kV value at which switching from a small to a large fo-
cus occurs.
Only available if Focus auto is selected.
The smaller focus will be maintained until the configured kV level is reached. If the
patient transparency requires a higher kV, the focal spot will automatically switch
to the next highest focus to maintain the image contrast (kV). This results in a loss
of resolution.
If kV Focus is set to Off, only the selected focus is used.

MField Measuring fields (dominants) in which the applied dose is measured.

The MField indicates size and position of the measuring field used for automatic
dose control (ADC).
The measuring field or a combination of measuring fields must be selected de-
pending on the object to be examined. It should always be in line with the object
of interest.
The Intelligent Measuring Field is always on first position of the measuring field
list (square symbol).
When Intelligent Measuring Field is selected, the best measuring field area ac-
cording to the position of the collimator and based on a histogram analysis is au-
tomatically set.
For each frame a gray value analysis of the full frame is performed. Based on the
histogram the highest dark (collimator) and lightest (overexposure) values are ex-
cluded. From the remaining histogram, 20 percent on both sides are cut off. The
remaining gray values define the new dose value.

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Exam Sets

When using the Intelligent Measuring Field, changes of the irradiated region by
unit movements or patient movements will immediately be captured and result in
a dose adaption.

Note In CARD or DYNA/3D programs, the center measuring field is preset and cannot be
changed.

Dose Dose per image

The dose entered is a nominal value in µGy which applies to the measuring condi-
tions at 70 kV, 2.1 mm Cu prefiltering, 22 cm FD input field.
With a large FD input field, the dose is reduced automatically, and with a small in-
put field it is increased automatically.

kV Dose kV value at which the dose is switched over for dose reduction.
The kV value increases depending on patient thickness and/or density. For image
quality reasons, especially for examinations with iodine contrast and kV values of
96 kV to 102 kV, we recommend keeping the kV value constant and reducing the
dose instead (more noise). Increasing the kV value always results in loss of image
contrast.
If kV Dose is set to Off, no dose reduction at a certain kV will be performed.

Min. CU Filter The system automatically selects a filter between 0.1 and 0.9
Max. CU Filter
Cu filter control during acquisition is used to reduce the applied skin dose. For
thinner objects more Cu is used which causes less skin dose, but also less contrast.
To achieve the same image quality, a kV reduction is performed according to the
applied Cu. Although the kV are reduced, skin dose reduction is gained in total.
With increasing object thickness, less Cu is used. The system performs a stepwise
decrease of Cu and kV-reduction until the kV plateau or the minimum Cu filter is
reached.
During fluoroscopy/roadmap with very thick objects, the Cu filter will be increased
again to allow more dose, but observing the maximum reference air kerma.
The filtration in a given step is applied as long as object thickness allows it to re-
main on the kV plateau minus the "Cu filter assigned kV reduction".
Cu filter control will be performed until the kV plateau is reached.
For acquisition, X-ray will be delayed until the correct filter is set. The maximum
delay is about 1s, then the X-ray will be released.
Cu filter will be changed only in X-ray pauses.

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 Parameters for Exam Sets

Image parameters for acquisition

Settings for image processing and image display are in the Image area.

Processing Mode Exposure control and display mode for observation

 Automatic:
with exposure control (automatic adjustment to object transparency)
 Regulation Stop:
stops exposure regulation after a fixed time (e.g. for left ventricular cardiac ex-
aminations)
 DSA Nat:
non-subtracted display
 DSA Sub:
subtracted display

Auto Processing  CLEARstent Live: CLEARstent Live acquisition 450

CLEARstent Live is only possible with Processing Mode = Automatic or Reg-
ulation Stop.

Note Because a CLEARstent Live acquisition program is not indicated by a specific icon,
it is recommended to define an appropriate name for the program, e.g.
‘CLEARstent Live’.

Contrast Medium Contrast medium used (for DSA acquisition only)

 None

 CO2

 Iodine

 Barium

This setting influences the max/min OPAC function in postprocessing:

 For iodine, the darkest gray-scale values are used.

 For CO2, the brightest gray-scale values are used.

I-Noise Reduction Compensation for increased noise

If automatic decrease of edge enhancement is configured, the imaging system ap-
plies the newly calculated edge enhancement value to the next acquisition run.
If dose is reduced, the resulting additional noise may be perceived as poor image
quality. To compensate for the increased noise, the acquisition program can be
configured to decrease the edge enhancement value whenever dose is reduced.
I-Noise Reduction is not available for DR/DSA-DYNAVISION or 3D programs.

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I-Noise Reduction Compensation curve for increased noise

Details

Edge Enhancement Set edge enhancement for non-subtracted and subtracted (DSA) acquisition
NAT/SUB
Edge enhancement results in a clearer display of contrast differences (vessel edg-
es). However, it also causes more noise as image noise is also displayed more
clearly due to the edge enhancement.

EE-Kernel Kernel for edge enhancement algorithm

DDO Dynamic Density Optimization (DDO) 592

DDO-Kernel Kernel for DDO algorithm

Window Center Pre-setting for window center (non-subtracted)

Window Width Pre-setting for window width (non-subtracted)

Auto Window Manual or automatic windowing

Automatic windowing occurs on the basis of a histogram analysis. It allows con-
trast enhancement for images with more homogeneous content.
Auto Window is only possible for non-subtracted images.
The maximum contrast enhancement can be configured by Siemens Service.

Sigmoid Window Alternative non linear windowing according to DICOM part 3 sigmoid descriptor
Once the windowing method has been set in the acquisition program, the same
windowing method will be used in postprocessing too.

Window Brightness Pre-setting for brightness (subtracted)

Window Contrast Pre-setting for contrast (subtracted)

Gamma Correction Brightness curve correction for acquisition

Gain Correction Radiation correction in Siemens exposure points (EP)

Corrects the image signal amplitude. Values are +/- EP ; 0 means no correction.

Bones White If this parameter is activated, the image is always inverted (Bones White).
A non-inverted image shows the contrast medium dark against a bright back-
ground, whereas an inverted image shows the contrast medium bright against a
dark background.

K-Factor Image averaging over time

K Factor and motion detector 590

EVE Extended Vessel Enhancement

Algorithm which emphasizes vessel edges. It works on a static image after chang-
es of K Factor.

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 Parameters for Exam Sets

Carto Correction Only available if CARTO XP is enabled in the system configuration

Stripe compensation Only available if I-Noise Reduction is set to Off.

These parameters are used to reduce disturbing signal components in an image
caused by electromagnetic localization systems and by ablators. These disturbanc-
es only occur during EP (electrophysiological) interventions. The stripe reduction
is performed by filters especially designed for this purpose.

Pixel Resolution Selection of pixel resolution (matrix size) with FD 30x40 only:
 Full

 Medium

 Low

Except for DYNAVISION programs, this choice is only displayed if the 2K option is
configured.
Pixel Resolution is not available for CARD programs.

Frame rates and scene duration

Settings for the frame rates and the duration of individual scenes are in the Acq
Type area.

Frame Rate Control There are several possibilities for the frame rate control during a DR or DSA acqui-
sition procedure. The process depends on the Frame Rate Control setting in the
acquisition program:
 Fixed: A constant frame rate is selected for the entire duration of the scene.

 ECG Gated: A constant frame rate is selected with ECG gating.

 VFR Manual (variable frame rate, manual):

Different frame rates (and breaks) can be selected for several phases of a
scene. The scene is advanced manually using the mode-dependent function
key on the manual release switch.
 VFR Time (variable frame rate, time-controlled):
Different frame rates (and breaks) can be selected for several phases of a
scene. However, the scene is automatically advanced after the preset time in-
tervals elapse.
The display changes depending upon the setting selected.

Fixed frame rate

Frame Rate Control: Fixed
With this setting, the frame rate remains constant during the entire scene.

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Exam Sets

Scene Time Maximum duration of the scene in seconds

You can end (interrupt) the scene before this time has elapsed by releasing the ex-
posure release button.

Frame Rate Frame rate (frames per second)

Depending upon the settings selected, the system determines the optimum load
curve for the X-ray tube as well as the storage space required.
With PERISTEPPING or PERIVISION, the frame rate can be set separately for each
step.

Note A reduced frame rate helps reduce the radiation load on the patient and person-
nel!

ECG gated frame rate

If an ECG is connected to the system, scenes can be acquired ECG gated.

Frame Rate Control: ECG Gated

Scene Time Maximum duration of the scene in seconds

Frame Rate Frame rate (frames per second)

Cardiac Phase Center The Cardiac Phase Center (CPC) marks a delay time after the R-peak in percent-
age of the ECG cycle duration.

Cardiac Phase Width The Cardiac Phase Width (CPW) defines the time duration in percentage of the
ECG cycle duration - symmetrically to CPT - when images shall be created with the
configured frame rate.

time

cardiac cycle

Example of CPC and CPW in the cardiac cycle

The CPC and CPW parameters define in combination which part of an ECG phase
should be used to trigger images.
Example: with CPC 70% and CPW 30%, images will be acquired from 55% phase
time (CPC-CPW/2) to 85% phase time (CPC+CPW/2).
Within the CPW, images are acquired with the configured frame rate.

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 Parameters for Exam Sets

Variable frame rate

With a variable frame rate, a scene is subdivided into phases of different lengths.
Manual or time-controlled advancement is possible.

Frame Rate Control: VFR Manual/VFR Time

Scene Time Maximum duration of the scene in seconds (with VFR Manual only)

No. Phases Number of phases with variable frame rate

Phase # - Frame Rate Frame rate (frames per second) in Phase No. #

Phase # - Phase Time Duration of the Phase No. # in seconds (with VFR Time only)

Possible frame rates Depending on the highest selected frame rate, only certain image rates may be se-
lected.
They must be the highest selected frame rate divided by an integer.
Example:
7.5 / 4 / 2 / 1 / 0.5 f/s (displayed frame rates)
7.5/3.75/1.88/0.94/0.47 f/s (technical frame rates)
Only the following combinations are possible:

Combination 1 Combination 2 Combination 3

60* 60* 60*
30 30 30
15
Possible choices for frame rate [f/s]

10
7.5
6
4
3
2
1
0.5
Pause Pause Pause
*
60 f/s are only available with CARD pediatric option

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Exam Sets

Parameters for rotational angiography

Dyna Time Time in seconds required by the C-arm to drive the selected DYNAVISION angle of
rotation.

Angulation Step Rotational angulation step (°/F)

DYNA Control There are several possibilities for the control of a DR-DYNAVISION or DYNAVISION
acquisition procedure. The process depends on the DYNA Control setting in the
acquisition program:
 If Auto is set in the acquisition program, then the movement of the C-arm
starts automatically with the acquisition.
I.e. the acquisition is started by pressing an exposure release button or pedal
and the injection, mask and fill phase occur automatically.
– If an injector is connected to the system and set to “Armed”, injection is also
started automatically (possibly with delay, recommended variant).
– If no injector is connected to the system or if it is connected, but not set to
“Armed”, you must carry out injection manually.
The Auto mode produces three scenes: mask phase, fill phase, washout phase.
 If Manual is set, the movement of the C-arm (and start of the acquisition) must
be started manually with the multifunctional button (blue button on the hand
switch).
After setting the rotational range, the C-arm moves up to the reversal point and
stops there.
The acquisition is started by pressing an exposure release button or pedal and
the injection must be triggered manually. The bolus can be monitored during
the injection.
When sufficient contrast medium filling has been reached, the mask/fill phase
must be started by pressing the multifunctional button (blue button on the
hand switch).
If the fill phase is not triggered manually, it starts after 30 s.
The Manual mode produces four scenes: mask phase, injection phase, fill
phase and washout phase.

Calculation To perform a DYNAVISION run, the user must select the following parameters:
 Start and end position of the run defined during the Test Run (= angle of rota-
tion)
 Dyna Time

 Angulation Step [°/F]

The speed of rotation and the frame rate are calculated and set automatically on
the basis of these three selected parameters.

Example Angle between the start and end positions = 125°

Dyna Time = 4.5 s

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 Parameters for Exam Sets

Angulation Step = 4.5°/F

125˚
Speed of C-arm rotation = = 28˚/s
4.5 s
›V
Frame rate = IV
›I
Frame Rate The frame rates for the mask and the fill phase are automatically calculated using
the Dyna Time, the Angulation Step, and the start and end positions of the run
(angle of rotation).
The frame rate for injection is fixed at 2 f/s.

Note Pay attention to the following parameters:

 The maximum C-arm speed
– 40°/s in Artis floor, Artis biplane
– 60°/s in Artis ceiling
 The maximum frame rate

Washout Phase If you continue pressing the exposure release button after the C-arm has reached
the fill phase end position, the Washout Phase will start. In this phase, subtracted
images are displayed with the washout frame rate.

Phase Time [s] The phase times for mask and fill phases are automatically calculated using the
Dyna Time, the Angulation Step, and the start and end positions of the run (an-
gle of rotation).

Washout Max. scene time for the washout phase in seconds.

The scene is terminated either when the footswitch or handswitch is released or,
at the latest, when the phase time for the washout phase has elapsed.

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Parameters for 3D
3D Type This parameter determines the type of 3D acquisition:
 DR: Like in DR-DYNAVISION, images are acquired in a single run and no subtrac-
tion is performed.
 DSA: Like in (DSA-)DYNAVISION, images are acquired in mask run and fill run
and subtraction is performed.
 CARD: Images are acquired in several acquisition runs to reduce motion arti-
facts. No subtraction is performed.
 3D_DR-LARGE (Artis zeego only): Like DR, but images are acquired in two off-
center rotational runs are combined to one run.
 3D_DR-LARGE360 (syngo DynaCT 360, Artis zeego only): Like DR, but images
are acquired in one 360 degrees off-center rotational run.

3D Control There are several possibilities for the control of a 3D acquisition procedure. The
process depends on the 3D Control setting in the acquisition program and is sim-
ilar to the DYNA Control setting.
DYNA Control 582

Start Position Programmed position of the stand/c-arm, including zoom stage and collimator
setting, to be used for the 3D acquisition.

Angle Total rotational angle range

Angulation Step Rotational angulation step (°/f)

3D Recon Preset Reconstruction preset to be used in InSpace 3D / DynaCT / DynaCT Cardiac for
primary reconstruction.

Overlap In 3D_DR-LARGE, the images of each projection of two eccentric rotational runs
will be automatically stitched together. The Overlap parameter defines the over-
lap range of images of the two rotational runs.
The value depends on the width of the image i.e. on zoom stage and portrait/land-
scape FD rotation.
This parameter is only available with the Artis zeego stand.

Extended Frame Rate If set, the maximum acquisition frame rate is extended from 60 f/s to 70 f/s.

Eccentric 3D Enable eccentric 3D (Artis zeego only)

Start Position Eccentric Programmed position of the stand/c-arm, including zoom stage and collimator
setting, to be used for the eccentric 3D acquisition. (Artis zeego only)
This parameter is only visible if Eccentric 3D is enabled.

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 Parameters for Exam Sets

3D image parameters
Processing Mode Processing Mode 577

Extended Pixel Depth For DynaCT, an extended pixel depth of 14 bits is required.

Pixel Resolution Pixel Resolution 579

Gamma Correction Gamma Correction 578

Bones White Bones White 578

EE-Kernel EE-Kernel 578

Sigmoid Window Sigmoid Window 578

Additional 3D CARD parameters

time
[s]

Exemplary timeline of image acquisition

Example of a 3D CARD acquisition sequence with 3 runs (3D Control: Auto)

(1) Test run

(2) Injection phase with optional image acquisition
(3) 3D run 1: angle triggered image acquisition
(4) 3D run 2: ECG start delay, angle triggered image acquisition in predefined car-
diac phases (see below)
(5) 3D run 3: ECG start delay, angle triggered image acquisition in predefined car-
diac phases (see below)

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Exam Sets

In 3D run 1 of a CARD acquisition (3), X-ray is applied with full dose and images
are acquired in all angle positions. In further 3D runs, e.g. (4)-(5), full dose is only
applied during the heart phase where the heart is expected to be almost in rest.
This heart phase in the cardiac cycle can be determined by the Cardiac Phase
Center and the Cardiac Phase Width.
ECG gated frame rate 580

mAs Modulation This parameter will only be available if the cardiac phase width is less than 100%.
In case the cardiac phase is not in the specified interval, images are acquired with
reduced dose (reduced mAs, but the same voltage) which serve as backup in case
the patient has an unreliable ECG with severe extra systoles.
Example:
mAs Modulation is 25%. With the beginning of the second run, only one quarter
of the dose is used in case the cardiac phase is not in the specified interval.
Remark: The first run is always fully radiated.

Number of 3D runs In 3D CARD, motion artifacts are reduced by spatially redundant rotational runs.
The number of 3D runs is determined by this parameter.

Parameters for peripheral angiography

As in the case of variable frame rate, PERISTEPPING and PERIVISION programs are
also used to divide a scene into phases of different lengths. Manual or automatic
step advancement is possible.

Scene Time Maximum duration of the scene in seconds

With PERISTEPPING or PERIVISION, you can set the scene time for the entire proce-
dure.

Note The step length of the unit can be set by Siemens Service.

Direction In PERISTEPPING or PERIVISION, you can set the direction of the (mask and) fill
phase:
 Head to feet: arterial blood flow
– With PERISTEPPING the scene runs toward the feet.
– With PERIVISION the mask phase and the fill phase run toward the feet.
 Feet to head: venous blood flow
– With PERISTEPPING the scene runs toward the head.
– With PERIVISION the mask phase runs toward the feet, the fill phase toward
the head.

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 Parameters for Exam Sets

Note The running direction always refers to the patient position.

Position # - Frame Rate Frame rate (frames per second) in Phase No. #

Parameters for fluoroscopy/roadmap

Exposure parameters for fluoroscopy/roadmap

Settings for radiation generation are in the Exposure area.

kV Tube voltage in kV (kV plateau) 574

Pulsewidth Pulse width in ms 574

kV ms kV value at which the pulse width is switched over. 574

Focus Focus 575

Dose Fluoroscopy dose per pulse

This setting varies for the three fluoroscopy/roadmap programs: low, normal, and
high.

kV Dose kV value at which the dose is switched over for dose reduction. 576

EP Reduction If the kV reaches the kV Dose level, the dose is reduced.

The value is set in steps of Siemens exposure points (EP).

Dose increase phase 1 Factor for dose increase in high dose roadmap phase 1 and 2.
&2

Min. CU Filter These parameters control which copper filter range will be used.
Max. CU Filter

kV Warning Level Generate a warning when a specified kV value is reached.

High Contrast High contrast fluoroscopy

If this parameter is activated, the X-ray tube is driven with the maximum current
(mA) in order to generate high contrast images.

Image parameters for fluoroscopy/roadmap

Settings for image processing and image display are in the Image area.

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Exam Sets

Auto Pixel Shift During the third phase of roadmap, when live fluoro is subtracted from the previ-
ously created opac image, pixelshift is done cyclically based on a histogram anal-
ysis without any user interaction, to reduce the effects of patient motion.

I-Noise Reduction Filter parameter for intelligent noise reduction

I-Noise Reduction Compensation curve for increased noise

Details

I-Noise Reduction Compensation curve for increased noise in roadmap phase 3

Details Phase 3

Edge Enhancement Set edge enhancement

Edge enhancement results in a clearer display of contrast differences (vessel edg-
es). However, it also causes more noise as image noise is also displayed more
clearly due to the edge enhancement.
Therefore, the filter value depends on the k factor used, but also on the preferred
image impression of the examiner. As a rule, the higher the k factor, the higher
the filter value can be; the lower the k factor, the lower the filter value must be.

EE-Kernel Kernel for edge enhancement algorithm

DDO Dynamic Density Optimization (DDO) 592

DDO-Kernel Kernel for DDO algorithm

Auto Window Set automatic windowing

Automatic windowing occurs on the basis of a histogram analysis. It allows con-
trast enhancement for images with more homogeneous content.
Auto Window functions well as long as the image is not collimated and does not
have any extremely bright spots (air).
The maximum contrast enhancement can be configured by Siemens Service.
Auto Window is only possible for non-subtracted images.

Window Center Pre-setting for window center (non-subtracted)

Window Width Pre-setting for window width (non-subtracted)

Window Brightness Pre-setting for brightness (subtracted)

Window Contrast Pre-setting for contrast (subtracted)

Sigmoid Window Sigmoid Window 578

Gamma Correction Display of the brightness curve correction for fluoroscopy

Gain Correction Radiation correction in Siemens exposure points (EP)

Corrects the image signal amplitude. Values are +/- EP ; 0 means no correction.

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 Parameters for Exam Sets

Bones White Display bones white during roadmap.

K-Factor K Factor for Roadmap phase 1 and phase 2

K Factor and motion detector 590

K-Factor Phase-3 K Factor for Roadmap phase 3 317

Averaged Frames Averaging in Roadmap phase 1

Phase 1

EVE Extended Vessel Enhancement for Roadmap phase 1 and phase 2

Algorithm which emphasizes vessel edges. It works on a static image after chang-
es of K Factor.

EVE Phase 3 Extended Vessel Enhancement for Roadmap phase 3

Vessel Presentation Enable Roadmap with opacification phase 2 image

Phase 2

Vessel Presentation Enable Roadmap with DSA reference image

DSA

Catheter Contrast Initial catheter contrast for Roadmap phase 3

Vessel Contrast Initial vessel contrast for Roadmap phase 3

CartoCorrection Only available if CARTO XP is enabled in the system configuration 579

Stripe compensation Only available if I-Noise Reduction is set to Off. 579

Pulse rates
Settings for pulse rates for fluoroscopy/roadmap are in the Fluoro Type area.

Fluoro Type Selection of fluoroscopy type, e.g. Pulsed

ECG means that there is one fluoroscopy pulse per heartbeat, that is, fluoroscopy
is always released in the same phase. (The phase can be configured by Siemens
Service.) This permits dose reduction for lower pulse rates.

Pulse Rate Fluoroscopy pulses per second (frames per second)

Biplane Pulse Reduc- Activation of the reduced frame rate in one plane for dose reduction (Artis biplane
tion only)

Pulserate Secondary Reduced pulse rate in the second plane (frames per second)
Plane
If this parameter is activated in a biplane system, you can use a reduced frame rate
in one plane and the full frame rate in the second plane. You can set the reduced
frame rate separately.

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Exam Sets

Note The plane, primary or secondary, is selected using the footswitch fluoro pedal. The
plane that was used last is regarded as the primary plane with full frame rate.

A reduced pulse rate in the secondary plane provides biplane fluoro information
without doubling the dose on the patient and personnel.

Possible pulse rates Depending on the pulse rate selected in the primary plane, only certain pulse rates
may be selected in the secondary plane.
The following combinations are possible:

Primary plane [P/s] Secondary plane [P/s]

0.5 0.5
1 1 / 0.5
2 2 / 1 / 0.5
3 3
4 4 / 2 / 1 / 0.5
6* 6/3
7.5 7.5 / 4 / 2 / 1 / 0.5
10 10
15 15 / 7.5 / 4 / 2 / 1 / 0.5
30† 30† / 15 / 7.5 / 4 / 2 / 1 / 0.5
30† 30† / 6 / 3
30† 10
*
6 P/s is only be available in Artis biplane with FD 20x20 in both planes.
† 30 f/s is not possible with FD 30x40 in both planes

ECG Gated If an ECG is connected to the system, fluoroscopy can be performed ECG gated.
ECG gated frame rate 580

Stripe compensation Stripe compensation 579

Only available if I-Noise Reduction is set to Off.

General parameters

K Factor and motion detector

K Factor Averaging over time, or motion detector (Auto1 ... Auto4)

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 Parameters for Exam Sets

Reduction of image noise by weighted averaging by the factor 2k – 1 . However,

noise reduction may result in reduced contrast and "ghost images" of fast moving
objects.
The k factor influences the noise impression of the image. A high k factor means
less, and a low k factor more image noise. If high k factors are used, lag effects
appear in the image.
The k factors in an Artis system are working as follows:
 If there is a fixed k-factor larger than 1.6 and motion of the stand/table is de-
tected the k-factor goes back to 1.6
 The same with fixed less than 1.6: no change in k-factor

 If Auto... is set, the motion detector itself detects the motion and goes back to
the defined value. These defined values are configured in the system
by Siemens.

Motion detector If the motion detector (Auto1 ... Auto4) is used, averaging varies depending on
the areas where motion occurs.
The motion detector detects bolus or catheter motion.
 In image areas with no motion (no difference to the previous image), a higher
k factor is used per pixel.
 In image areas in which motion is detected (difference compared to the previ-
ous image), the k factor is automatically reduced.
It improves the image quality also for images with motion.
The following table shows which parameters are used by an Auto algorithm:

Setting k-min. k-max. Usage

Auto1 1.25 2.0 "Cardiac speed", less integration, more noise
but almost no lag.
Auto2 1.12 1.6 "Cardiac standard", good relationship between
noise and lag for cardiac examinations
Auto3 1.38 2.5 "Angio" standard.
Auto4 1.88 3.0 "Roadmap" setup, very high integration but
also high lag, almost no noise.

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Exam Sets

Dynamic Density Optimization (DDO)

DDO (harmonization) reduces the dynamic range of an image (bright areas will be
less bright, dark areas will be less dark). By reducing the dynamic range, it is pos-
sible to increase the contrast without clipping bright or dark areas. It allows you to
increase the contrast of details without saturation of the image in bright or dark
areas.

Note For quantification: If the vessels are wide, DDO can reduce the accuracy while de-
termining the density values, for example:
 5 mm vessel, 17 cm image format, 80% DDO result in a density value error of
-17%
 2 mm vessel, 17 cm image format, 80% DDO result in a density value error of
-3%
With more than 30% DDO, densitometric measurement is no more reliable.

Note Too much DDO/harmonization can change image display in such a way that a di-
agnosis is no longer possible.
 Check the image impression after using DDO/harmonization.

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 Part: Calibration and Measurements

Measurement The following calibration and measurement functions can be used for measuring
functions objects in the scenes/images:

Touchscreen Monitor screen Description Effects both Effects single

planes plane

Calibration 598 +
Calib. subtask card 595 (PostProc) +

Calibrate subtask card 595 (Quant) +

- 595 (IVUSmap) +

Auto ISO Calibration 600 +

(PostProc/Quant/IVUSmap)

Auto TOD Calibration 601 +

(PostProc/Quant/IVUSmap)

Manual Distance Calibration 604 +

(PostProc/Quant/IVUSmap)

Catheter Calibration 607 +

(Quant)

Sphere Calibration 610 +

(Quant)

- Calibration factor +
(Manual Calibration) 613
(Quant)

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Calibration and Measurements

Touchscreen Monitor screen Description Effects both Effects single

planes plane

Measurements 614
Tools subtask card 595 (PostProc/Quant) +

Review subtask card 595 (IVUSmap) +

Distance 615 +
(PostProc/Quant/IVUSmap)

Polyline Curve/Curved Distance +

Measurement 618
(PostProc/Quant/IVUSmap)
Angle 619 +
(PostProc/Quant)

Area Measurement 473 +

(IVUSmap)

Miscellaneous
Hide Annotations and Measure- +
ments (PostProc) 390

Hide Measurements +
(Quant/IVUSmap)

Del key Delete Selected Annotation and +

Measurements (PostProc) 386

Delete Selected Measurements +

or Del key (Quant/IVUSmap)

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 Accessing calibration and measurements

Note Pay attention to the messages at the bottom of the image.

They include notes for further operational steps.

Note When calibrating a biplane scene for Quant, ensure that both Quant task cards
are on top. If another task card is on top, it might hide calibration-related
messages.

Console (PostProc)  Calib. subtask card and Tools subtask card

Quant  Calibrate subtask card and Tools subtask card

IVUSmap  Review subtask card

 Click this icon.

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Calibration and Measurements

Touchscreen (Image)
 Press this icon.

Touchscreen (Quant)

 Press the Calibration button.

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  Press this icon.

Touchscreen (IVUSmap)  Review workflow step

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Calibration and Measurements

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

Note Calibrations performed in Quant are valid also for measurements done in Post-
Proc and vice versa.

Note For biplane analysis, you must perform calibration for each projection direction
(RAO and LAO).

Incorrect calibration
Caution Inaccurate results possible
The examiner is responsible for applying the correct calibration method.
 Perform calibration carefully.

Note A new calibration factor will not be applied to previously performed measure-
ments that have been created with a different calibration factor.

Calibration methods
Depending on the examination to be performed, you can use different calibration
methods:

automatic  Auto ISO Calibration 600

Calibration is performed fully automatically for an organ positioned in the iso-
center (= rotation center) on the basis of the known exposure geometry.
Siemens Service performs an exact calibration for this exposure geometry dur-
ing installation of the system.
– Advantage: You can work quickly.
– Disadvantage: This calibration method should be used only if the organ to
be examined was in the isocenter during the acquisition. Otherwise there
can be significant measuring uncertainties.

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semi-automatic  TOD Calibration (table-object distance) 601
The calibration is automatically computed based on the known exposure ge-
ometry. You only need to enter the TOD.
Siemens Service performs a precise calibration when the system is installed.
– Advantages: The TOD is same in the supine position for most patients. You
can work quickly.
– Disadvantage: The error in the TOD value limits the measurement accuracy.
manual  Distance Calibration 604
Calibration is based on the known distance between two points of an object
placed in the beam path.
– Advantage: The distance can be measured accurately.
– Disadvantage: Measuring errors can occur due to geometrical distortion.
 Catheter Calibration 607
Calibration is based on the known diameter of the catheter.
– Advantages: The catheter is, so to speak, “in situ”. There is only slight uncer-
tainty due to geometrical distortion. Another advantage is that you know
the exact catheter diameter (usually in French units).
– Disadvantage: The diameter of the catheter is relatively small. Therefore,
the known diameter corresponds to relatively few pixels in the image. The
measurement accuracy is limited.
 Sphere Calibration 610
Calibration is based on a sphere with known diameter. The sphere is placed in
the beam path after the examination. The same distances must be observed as
for the scene to be analyzed.
– Advantages: The diameter of the sphere can be determined very accurately
and does not depend on the beam direction (due to spherical shape).
– Disadvantages: A separate acquisition must be performed with the sphere.
If placed inaccurately, measurement uncertainties will occur depending on
patient size.
 Calibration factor (Manual Calibration) 613
Enter the calibration factor based on your experience with other calibration
methods.
– Advantage: You can work quickly.
– Disadvantage: If the measurement conditions are not absolutely identical,
significant measuring uncertainties can occur.

Note For rotational scenes (DR-DYNAVISON, DYNAVISION or 3D), auto ISO and auto
TOD calibration are not possible.

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Calibration and Measurements

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

Image angle The image angle is the geometric sum of the LAO/RAO angle and CRAN/CAUD an-
gle:
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
calibration.
 For image angle 15° ... 50° or 130° ... 165°, the system also suggests TOD cali-
bration, but you must mark the point of interest in the image.
If the object was at a defined distance from the tabletop, you can use TOD cal-
ibration. If that was not the case, we recommend using manual calibration.
 For image angle 50° ... 130°, the system suggests automatic isocenter calibra-
tion.
You should use this calibration method only if the object of interest was posi-
tioned in the isocenter. If that was not the case, we recommend using manual
calibration.

Automatic isocenter calibration

If the organ to be examined was in the isocenter during acquisition, you can use
automatic calibration.

Automatic start

Console & Touchscreen The system is ready for calibration as soon as you click into the image. A message
is displayed in the lower part of the image.
Isocenter calibration is automatically preselected by the system for image angle
50° ... 130°.

Starting manually
If a different calibration was performed, you can restore the automatic isocenter
calibration.

Console  PostProc task card, Calib. subtask card or

Quant task card, Calibrate subtask card or
IVUSmap task card, Calibration dialog

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  Click this icon.
– The system calculates the calibration factor on the basis of the image geom-
etry.
– The calculated calibration factor is displayed.

 Confirm by clicking OK.

Touchscreen  Image task card

 The Measurements functions have been selected.

 Quant task card

 Press the Calibration button.

 Press the Auto ISO button, if necessary.

 Press the OK button.

Automatic calibration is performed immediately and displayed.

Calibration using the table-object distance (TOD)

If the organ to be examined is at a defined distance from the tabletop, you can use
TOD calibration.

Note The default TOD value is stated in the calibration dialog.

The default TOD value can be changed by Siemens Service.

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Calibration and Measurements

Console & Touchscreen Automatic start

TOD calibration is automatically preselected by the system for image angle
0° ... 50° or 130° ... 180°.
For image angle 15° ... 50° or 130° ... 165°, you are prompted to mark the mea-
surement point in the image.
– In that case, a message is displayed.

Note TOD calibration is not suitable for image angle 50° ... 130°!

 Click the point in the image where you want to perform a measurement.

Note Be sure to mark the center of the ventricle if you use TOD calibration for an LVA.
Otherwise an incorrect calibration factor will be used, which will result in wrong
measurements.

Starting manually
You can also select TOD calibration manually.

Console  PostProc task card, Calib. subtask card or

Quant task card, Calibrate subtask card or
IVUSmap task card, Calibration dialog
 Click this icon.
– The system calculates the calibration factor on the basis of the image
geometry.
– The previous calibration factor - if there is one - is displayed.

 Enter the table-object distance in the field or click the arrows to change the val-
ue.
– The calibration factor and the error are shown in the box.

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  Confirm by clicking OK.

Touchscreen  Image task card

 The Measurements functions have been selected.

 Quant task card

 Press the Calibration button.

 Press the Auto TOD button, if necessary.

For angulations >15°, you are prompted to mark the measurement point in the im-
age. Only then you can adjust the TOD.
 Click the point in the image where you want to perform a measurement.

 Enter the table-object distance using the numeric buttons.

Or
 Deflect the mouse joystick.
– Up: increase TOD
– Down: reduce TOD

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Calibration and Measurements

 Press the left button of the mouse joystick.

Or

 Press the OK button.

Manual distance calibration

Note The 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!

Note When contrast between the calibrating object and the background is too low, the
pixel size will be inaccurate.
 Check the image quality and make sure that contrast between the calibrating
object and the background is good.

Starting a manual distance calibration

Console  PostProc task card, Calib. subtask card or

IVUSmap task card, Calibration dialog
 Click this icon.

Drawing the distance line

 Move the mouse pointer into the image.
– The mouse pointer changes shape.
 Click the image to mark the starting point and drag the mouse to the end point.
– As soon as you move the mouse, a line is displayed.
 Release the mouse button to end the line.
– The Manual Distance Calibration dialog box opens.

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 Entering a calibration distance
Finally, enter the actual length of the distance used for calibration:
 Enter the length of the distance line (in mm).

 Confirm by clicking OK or pressing the Enter key.

– The calibration is applied.

Console  Quant task card, Calibrate subtask card

 Click this icon.

Drawing the distance line

 Click the image to mark the starting point and drag the mouse along a line to
the end point.
– As soon as you move the mouse, a line is displayed.
 Click the mouse button a second time to end the line.
– The distance line is then drawn.

Changing the distance line

 Click one of the two end points of the distance line, drag the line larger or
smaller, and click the new end point.
– The distance line changes accordingly as soon as you move the mouse
pointer.
 Release the mouse button.

Entering a distance
Finally, enter the actual length of the distance used for calibration.

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Calibration and Measurements

 Select the approximate distance by clicking a button.

E.g.

 Then click the arrows to correct the value until you reach the exact value.

Or
 Enter the exact value in the field.

Note You can configure the distances which are displayed. 634

Touchscreen  Image task card

 The Measurements functions have been selected.

 Quant task card

 Press the Calibration button.

 Press the Distance button.

 Click the starting point of the calibration line.

 Click the end point of the calibration line.

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

 Press the right button of the mouse joystick.

Or

 Press the OK button.

Catheter calibration
In order to mark the known diameter, you must trace the outer contours of the
catheter.

Note Some catheter brands cannot be used for calibration as their outer dimensions are
not accurate enough.
Always calibrate on the filled catheter.
To improve the calibration accuracy, we recommend measuring the actual cathe-
ter thickness before calibrating.
The smaller the calibration object, the greater the calibration error.

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

Using catheter calibration with catheter size of 5 French or smaller is not recom-
mended because accuracy could be reduced.

Note You must also take a possible error into account due to the difference in the de-
gree of magnification of the catheter and the vessel to be analyzed, if the catheter
and the vessel are located at different tissue depths. That is, at different distances
from the flat detector. The error is estimated to be 1 to 1.5% for each cm of differ-
ence in depth.

Note Catheter calibration is not recommended for LVA because the calibration object is
much smaller than the measured object, and even slight deviations in calibration
can result in significant errors in volume calculation.
For QVA, catheter calibration should be used with FD zoom stages only (not in
overview format).

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Calibration and Measurements

Note When contrast between the calibrating object and the background is too low, the
pixel size will be inaccurate.
 Check the image quality and make sure that contrast between the calibrating
object and the background is good.

Starting catheter calibration

Note You can configure the catheter sizes which are displayed. 634

Console  Quant task card, Calibrate subtask card

 Click this icon.

Touchscreen  Quant task card

 Press the Calibration button.

 Press the Catheter button.

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 Drawing in the center line of the catheter
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.

Note You can configure whether only straight or also curved catheters are permitted.
634

Console & Touchscreen  Mark the starting position of the center line with a single click.

 Now move the mouse pointer to the point where you want to end the center
line and mark this point with a mouse click.
– The contour detection algorithm automatically detects the edges of the
catheter.
Now enter the actual size of the catheter used for calibration (in French units).

Console Entering the catheter size

 Select the approximate French value by clicking a button.
E.g.

 Then click the arrows to correct the value until you reach the exact value.

Or
 Enter the exact value in the field.

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Calibration and Measurements

Touchscreen Selecting the catheter size

 Press the appropriate button.
E.g.

 Press the right button of the mouse joystick.

Or

 Press the OK button.

Sphere calibration

Note The smaller the calibration object, the greater the calibration error.

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

Note When contrast between the calibrating object and the background is too low, the
pixel size will be inaccurate.
 Check the image quality and make sure that contrast between the calibrating
object and the background is good.

Note You can configure the sphere sizes which are displayed. 634

Starting sphere calibration

Console  Quant task card, Calibrate subtask card

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  Click this icon.
– The previous calibration factor - if there is one - is displayed.

Touchscreen  Quant task card

 Press the Calibration button.

 Press the Sphere button.

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Calibration and Measurements

Console & Touchscreen Drawing a circle

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 determine its diameter.
 3 points
Define the sphere by fixing three points along the line of circumference.

Center, 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 determine the sphere:

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

Moving the circle

 Move the mouse pointer onto the center of the circle.
– The mouse pointer changes shape.
 Click and drag the circle to the required position.

 Release the mouse button.

Changing the size

 Move the mouse pointer onto the circle line.
– The mouse pointer changes shape.
 Click and drag the circle out larger or smaller.
– The size of the circle changes, while the center remains fixed.
 Release the mouse button.

 Check, if center remains at the same position.

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

Console Entering the diameter

 Select the approximate diameter by clicking a button.
E.g.

 Then click the arrows to correct the value until you reach the exact value.

Or
 Enter the exact value in the field.

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 Touchscreen Selecting the sphere size
 Press the appropriate button.
E.g.

 Press the right button of the mouse joystick.

Or

 Press the OK button.

Copying sphere calibration to a second image

You can copy a sphere calibration just finished to one subsequent image of the
same patient and study as the first image.
 Sphere calibration of an image has been completed.

 Select a second image via scene directory or via Patient Browser.

– The calibration factor calculated for the first image is applied to the second
image.

Note A successful transfer of the calibration factor is confirmed by a message.

This message may not always be displayed.

Calibration with a calibration factor

Console (only)  Quant task card, Calibrate subtask card

 Click this icon.

– The previous calibration factor - if there is one - is displayed.

Note You can configure the value range for the calibration factor. 634

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Calibration and Measurements

Entering the calibration factor

 Enter the exact value in the field or use the arrows.

Measurements

Preconditions
In PostProc The measurement functions, i.e. adding distance measurements or angle mea-
surements, are available when:
 An image is loaded to full screen review.

 The scene is not looping.

The measurement functions are not available when reviewing the following im-
age types:
 CLEARstent scenes

 XA reference images converted from CT/MR images and images from these

 Quant Reports

 ACOM.Reports

 Images with non square pixels

In Quant The measurement functions, i.e. adding distance measurements or angle mea-
surements, are available when:
 An image is loaded to full screen review.

 The scene is not looping.

 No quantitative analysis or calibration is active.

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 The measurement functions are not available when reviewing the following im-
age types:
 CLEARstent scenes

 Reference images (including XA reference images converted from CT/MR

images)
 Stored fluoroscopy images

 Unstored fluoroscopy images

 Stored Roadmap images

 Unstored Roadmap images

 Exam Protocol stored as XA images

 Store Monitor images

 Quant Reports

 ACOM.Reports

 Ready processed images

 Images with non square pixels

Note Angle/distance measurements and annotations on Store Monitor images are not
supported by the Quant task card.
 Perform them on the PostProc task card.

In IVUSmap 471

Drawing and measuring distances

You can measure the distance between two points in an image with the help of a
straight distance line.
You can also measure a distance along a curve, e.g. a vessel, via curved polylines.

Calibrated images Distance measurements are only possible for calibrated images.
If an image has not been calibrated yet, the calibration dialog opens automatically
when selecting distance measurement. 598
If no calibration information is stored for an image with distance measurements,
two question marks ?? will be displayed instead of the distance value.

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Calibration and Measurements

Note To calibrate the image, use objects whose size matches that of the object to be
measured. For distance measurements, it is advisable to calibrate over a distance
of at least 3 cm.

Note Distance measurements on DYNAVISION, DR-DYNAVISION or 3D acquisition

scenes are temporary and will not be saved.
 If you want to save a distance image, make a Store Monitor image.

Note Due to the limited precision after downscaling of images, e.g. 2480 x 1920 to
512 x 512, measurement results on downscaled images may differ from results
on original images.

Setting straight or curved distance measurement

Console  PostProc task card, Tools subtask card or

Quant task card, Tools subtask card
 Right-click in the image and select Curved Distance Measurement.
– A check mark indicates that curved distance measurement is active.
– If no check mark is set, straight distance measurement is active.

Drawing straight distance lines

Console  PostProc task card, Tools subtask card or

Quant task card, Tools subtask card
IVUSmap task card, Review subtask card
 Curved Distance Measurement is not set. (default)

 Click this icon.

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 Touchscreen  Image or Quant task card

 The Measurements functions have been selected.

 Press the Distance button.

 IVUSmap is active, Review workflow step

 Press the Distance Measurement button.

Console & Touchscreen  Click the image to mark the first point and drag the mouse to the second point.
– As soon as you move the mouse, the length of the line drawn up to this
point is displayed.
 Release the mouse button to end the line.
– The distance line is drawn showing a number and the distance.

Note When a second distance is added, the distance annotation text will move to the
bottom center of the image. Subsequent distance annotation texts will be
stacked.
 You can position the distance annotation text stack anywhere on the image via
drag and drop.
When the image is zoomed, the image may need to be unzoomed to see the dis-
tance annotation texts.

Changing a straight distance line

 Click one of the two end points of the distance line, keep the mouse button
pressed, and drag the line to enlarge or decrease it.
– The distance is updated as soon as you move the mouse pointer.
 Release the mouse button.

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Calibration and Measurements

Drawing curved distance lines

Console  PostProc task card, Tools subtask card or

Quant task card, Tools subtask card
 Curved Distance Measurement is set.

 Click this icon.

Touchscreen
 The Measurements functions have been selected.

 Press the Polyline Curve button.

Console & TSC  Click the start point in the image.

– A line is drawn when dragging the cursor.
 Click further points.
– Vertex points are set, and subsequent lines are drawn when dragging the
cursor.
 Double-click the end point.
– As soon as the end point is set, a smooth polyline curve and the distance are
shown.

Selecting curved distance lines, e.g. for manipulation

 Click the curved line anywhere on or near the line, except on or near the end
points or vertex points of that line.

Moving curved distance lines

 Click the curved line anywhere on or near the line, except on or near the end
points or vertex points of that line.

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  Drag and drop the curved line.

Modifying curved distance lines

 Click or near the start point, the end point or any intermediate vertex point of
the curved distance line.
 Reposition the selected point by drag and drop.
– The curved distance line is updated continuously while repositioning the
point.

Drawing and measuring angles

You can define an angle by drawing two lines - the sides of the angle - in the im-
age. The system determines the angle between the two drawn lines clockwise. If
the angle is larger than 180°, the program subtracts 180° from the angle.

A
A

(1) (2) (3)

The arrow direction shows the direction in which you have drawn the sides of the angle.

(1) Both sides have been drawn in the direction of the point of intersection.
Angle A between the sides is displayed.
(2) Both sides have been drawn away from the point of intersection.
Angle A between the sides is displayed.
(3) Otherwise angle B (A - 180°) is displayed.

Note An angle can only be measured correctly if the angle plane is parallel to the acqui-
sition plane.

Note If the angle approximates to 90°, 180°, 270°, it is not clear whether the angle be-
tween the legs or the supplementary angle has been entered.
 Label the angle with an annotation when you display the supplementary
angle.

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Calibration and Measurements

Note If no calibration information is stored for an image with angle measurements,

which has not been acquired on a Siemens imaging system, two question marks
?? will be displayed instead of the angle value.

Drawing an angle
Tip: Draw the lines in the image from outside to inside.

Console  PostProc task card, Tools subtask card or

Quant task card, Tools subtask card
 Click this icon.

 Move the mouse pointer into the image.

 Click the starting point of the first line, keep the left mouse button pressed,
draw a line to the end point, and release the mouse button there.
 Draw the second line in the same way.
– The measured angle is displayed while you are drawing it.

Touchscreen  Image or Quant task card

 The Measurements functions have been selected.

 Press the Angle button.

 Click the starting point for the first line.

 Click the end point of the first line.

 Click the starting point for the second line.

 Click the end point of the second line.

Note The two sides of an angle are provided with the same number, so that you can
clearly distinguish between several angles.

Changing an angle
You can change the sides of an angle independently of one another.
 Move the mouse pointer into the image.
– The mouse pointer changes its shape at positions where you can change a
side of the angle.
 Move the entire line or drag an end point to a new position.
– The angle is continuously updated.

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 Part: Quantification
General

Quantitative analysis methods

The Quant task card offers the following analysis methods:

 Particularly for analyzing stenoses:

Quantitative Vascular Analysis (QCA/QVA, IZ3D) 637
 With QCA (Quantitative Coronary Analysis), you can determine the dimen-
sions of the coronary arteries.
 With QVA (Quantitative Vascular Analysis), you can determine the dimen-
sions of vessel sections.
The difference between QVA and QCA is related 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 arter-
ies in three dimensions based on two 2-dimensional images.

 For determining the volume of cardiac ventricles:

Quantitative Ventricular Analysis (LVA) 691
 With LVA (Left Ventricle Analysis), you can determine the ejection fraction
and the wall motion of the left cardiac ventricle.
You can display the results on the screen, film/print and send them to another net-
work node.

Important notes
Specialized knowledge The analysis software may only be used by specially trained staff. The analysis data
must be interpreted by a trained specialist if you want to use them for a diagnosis
or as a basis for deciding on a treatment strategy.

State of the art The clinical analysis software has been carefully tested before delivery. The soft-
ware has been developed according to mathematical models which are discussed
in specialist literature and used in medical research. Siemens accepts no responsi-
bility for any inaccuracies of whatever nature resulting from the use of this soft-
ware.
 Please read the relevant bibliographic information.

Rectangular pixels The algorithms have been adapted in order to process images with square pixels,
such as are found in Siemens images. If you use images, e.g. from CDs, with other
pixel shapes (e.g. rectangular), then the results might be unreliable.

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Quantification

Unfiltered images Use only unfiltered images to ensure that contour detection leads to accurate re-
sults.

Matrix size You can improve measurement accuracy by using a larger image matrix.

Not supported data Averaged images cannot be used for quantification.

Contour detection does not work if CO2 is used as contrast medium.

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 General

The Quant task card

On the monitor of the system console in the control

room

(1) (2)
Quant task card (example)

(1) Image area

(2) Control area

Calling up the Quant task card

 Click the tab of the Quant task card.
– The Quant task card is placed in the foreground.

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Quantification

Control Image area plane A Image area plane B Control

area area
plane A plane B

Quant task card biplane (example)

Activating a plane
In the case of scenes of biplane systems, quantification can be performed sepa-
rately in each plane.
 To do so, move the mouse pointer from one screen to the other.

 Click the image on the screen of the required plane.

Now you can select the icons of this plane.

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 General

On the touchscreen control in the examination room

You can select calibration and quantification functions on the Quant task card and
perform them with the mouse joystick.
Operation via touchscreen control 225

Example

Note Quantification should only be performed either from the examination room or
from the control room.
Do not change the place of operation during quantification!

General postprocessing functions

Selecting patients and scenes/images

As in the case of the PostProc task card, you will find the patient data as well as
the operating elements for selecting the scene and the images in the upper part
of the control area.
Managing and Viewing Scenes/Images 349
You can control scene review (loop) in the same manner as on the PostProc task
card 359. Please note that single stepping of a scene by clicking into the left/
right half of the image is not possible during an analysis.

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Quantification

Note A scene will always be loaded simultaneously, i.e.only once, in the PostProc task
card and in the Quant task card. You can therefore toggle between Quant and
PostProc and will always have the same scene!

Defining window and filter values

As in the case of the PostProc task card, you can set the window values and use
edge enhancement filters on the Adjust subtask card. 376

Note On the Quant task card, you cannot window using the middle mouse button or
using the keys on the symbol keypad of the keyboard.
 Use controls on the Adjust subtask card instead.

Zooming/panning

On the View subtask card or in the View menu, you can switch on zooming and
pan the image.

Console Switching on zoom

 Click the required icon.
Magnifying the scene/image, zooming/panning 369
Or

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 General

 Select View > Zoom or View > Acquisition Size from the main menu.

Note Zooming is not possible for plane B image of a biplane scene being reviewed on a
single plane system.

Panning
Panning is automatically activated if the image is zoomed.

 Move the mouse pointer into the image.

– The mouse pointer changes shape.
 Click and drag in the image area.

No more panning
If you want to switch off panning, e.g. for graphic processing, proceed as follows:
 Click this icon.

Or
 Deselect View > Pan from the main menu.

Note After deactivation of Zoom Pan, the system will take several seconds to be ready
again.

Touchscreen Magnifying the scene/image, zooming/panning 369

Calibration and measurements

If the guidelines for calibration are not followed, the results of absolute measure-
ments can be inaccurate or unreliable.

Note Calibration accuracy has a direct influence on the accuracy of the calculated values
such as vessel diameters or ejection fractions. Generally the reason for large devi-
ations from expected values is incorrect calibration.

Note Regular reference measurements are necessary to ensure calibration accuracy.

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Quantification

Incorrect calibration
Caution Inaccurate results possible
The examiner is responsible for accurate calibration.
 Carry out calibration with care.

Calibration and Measurements 593

Undoing the last calibration step

Console (only) If, for example, you have made an error during the last calibration but would still
like to save the previous values (average), you can undo the last step:
 Click this icon in the corresponding calibration window.
– The last calibration step is undone.

Confirming calibration / calculating the average

Console (only) To increase the accuracy of the measurement, you can perform several measure-
ments and calculate their average.
 Click this icon after each measurement in the corresponding calibration win-
dow.
– The measurement is recorded and a new average value is calculated with
the previous values.
– The new calibration is applied.
– The new value is displayed immediately.

Clearing the entire calibration

If you wish to clear the entire calibration since the last scene / image call-up or
since selecting calibration:

Console
 Click this icon in the corresponding calibration window.
– All changes since the last save operation are undone.

Touchscreen
 Press this button.

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 General

Recalling the last calibration

Console (only) You can call up the last processed calibration image as long as you do not restart
the system or application, close the patient, or load a different study.

Note You can only recall the last completed manual calibration.
Recalling the last calibration does not work with the automatic calibration meth-
ods Auto ISO or Auto TOD.
Once the calibration is cancelled, even the last accepted calibration will not be
available for recall.

You have performed a manual calibration in a frame of the scene, marked a con-
tour and clicked OK.
 Click this icon on the Calibrate subtask card.
– The last valid calibration (and if necessary the corresponding frame of the
scene) is recalled.

Common functions
Touch- Console Description Action
screen
General functions during analysis
Analysis graphics are shown.  Press/click to hide analysis graphics.

Analysis graphics are hidden.  Press/click to show analysis graphics.

Delete analysis graphics  Press/click the icon to reject the current

analysis.

- Delete last local diameter  Click the icon.

- Call-up the last measurement  Click the icon.

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Quantification

Touch- Console Description Action

screen
General functions
- Mouse joystick function is as-  Select/manipulate graphics.
signed to graphics manipulation.
 Press the icon to assign mouse joystick
Open the Image Player function to scrolling.
- Mouse joystick function is as-  Deflect the mouse joystick left/right.
signed to scrolling.
 Press the icon to assign mouse joystick
function to graphics manipulation.
Scroll to next frame of the scene  Press/click the icon.

Scroll to previous frame of the  Press/click the icon.

scene

Scroll to next scene  Press/click the icon.

Scroll to previous scene  Press/click the icon.

Open scene directory  Press/click the icon.

Store a reference image  Press/click the icon.

Store the current image (Store  Press/click the icon.

Monitor) including all graphics

Copy the current image to the vir-  Press/click the icon.

tual film sheet

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 General

Touch- Console Description Action

screen
Report functions
Generate a report of the current  Press/click the icon.
analysis

Scroll to next page of the report  Press/click the icon.

Scroll to previous page of the re-  Press/click the icon.

port

Store the report  Press/click the icon.

Copy the current report page to  Press/click the icon.

the virtual film sheet

Close analysis
Close the current analysis and  Click OK.
store it for recall.
= Or (same function)
679, 707
 Click the x icon top right.

Report
After completing a QCA/QVA/IZ3D or LVA analysis you can store a report and film,
print or send it with the images you analyzed.
 Via Quant > Configuration in the main menu you can configure for each anal-
ysis method the report to be a “normal” or a detailed report.

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Quantification

It can be configured by Siemens service in which format the report is stored, as XA

images, as DICOM Structured Report objects, or both.
 XA report images will be stored in a series under the same study as the images
used in the analysis. The series will be named with the type of report:
QCA REPORT, QVA REPORT, IZ3D REPORT, or LVA REPORT
 Structured Reports will be stored in a DICOM Structured Report object under
the same study as the images used in the analysis. The object will be named
with the type of report:
QCA STRUCTURED REPORT, QVA STRUCTURED REPORT, IZ3D STRUCTURED
REPORT, or LVA STRUCTURED REPORT
You can see the reports in the Patient Browser. You can load, scroll, film, print, or
send an XA report image in the same way as normal images.

Note Quant reports stored as DICOM Structured Reports will not be reviewable by Artis
systems or by the Angio/Quant application on a syngo Workplace. These reports
are primarily intended to be used by other reporting/analysis applications.

Note Results of an analysis on the Quant task card are only transferred to the film sheet
if the Report has been stored as XA images.

Note If an image with contours is recalculated to a smaller image matrix, the contour
may be lost. Consequently, an image that is sent/exported in 512² may not include
the contour.
 Images with contours should only be sent /exported in the original image ma-
trix.
 You can create a Store Monitor image for this purpose.

Note There may be a discrepancy between the number of graphs and the legend infor-
mation under the diagram in QCA or QVA reports.

Note If Ready Processing or resizing is applied to Quant data, the Structured Report
will not display the analyzed image.
 Send images for Quant reports without Ready Processing or resizing.

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 General

Configuration
Console (only) In Quant Configuration, you can check and configure measurement and output
features.
 Configuring the calibration 634

 Configuring QCA/QVA/IZ3D 687

 Configuring LVA 715

Checking the installed options

Depending on the options installed, certain analysis methods will be available or
not.
 Select Quant > Configuration from the menu.
– The Quant Configuration window is displayed.
 Click the ABOUT subtask card into the foreground.
– The installed modules are displayed.

Example

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Configuring the calibration

Console (only) You can make a few settings to adapt calibration to your normal practice.
 Select Quant > Configuration from the menu.
– The Quant Configuration window is displayed.

Catheter detection On the CAL subtask card, it is possible to configure catheter calibration for both
method straight catheters and curved catheters.
 Restrict to straight: A single segment line may be marked on the image (two
points - one start point, one end point).
 Allow curved: A multi-segment line may be marked by two or more points sig-
nifying subsegments with one start point, one end point, and zero to multiple
points.
 Click a radio button to change the setting.

On the UI subtask card, you can enter values used in your organization.
 Click the UI subtask card into the foreground.

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Sphere sizes  Enter the sphere sizes used in your practice.

Catheter sizes  Enter the catheter sizes used in your practice.

Distance ranges  Enter the distances that could be used.

Pixel sizes  Enter the relevant pixel sizes for manual calibration in your practice.

Heart rate range Configuring LVA 715

Closing configuration
 Click Default to reset all settings to the Siemens default values.

 Click OK to accept your changes and close the window.

 Click Cancel to close the window without changing the previous settings.

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Quantitative Vascular Analysis (QCA/QVA, IZ3D)

QCA/QVA Both QCA (Quantitative Coronary Analysis) and QVA (Quantitative Vascular Anal-
ysis) allow physicians to determine various physiological properties of arteries,
such as vessel diameter. The produced quantitative results can help determine the
health of the vasculature of a patient.
Using QCA the physician may also analyze a bifurcated vessel and rate it as ostial
or non-ostial.
QCA and QVA are in essence identical software packages, the only difference be-
ing the algorithms applied during the analysis.

IZ3D The goal of IZ3D (=QCA 3D) is to perform measurements on a 3-dimensional rep-
resentation of a vessel including any stenotic regions.
The system creates the 3D vessel representation by analyzing two 2-dimensional
x-ray images of the vessel.
It also possible to analyze a bifurcated vessel with IZ3D.
With IZ3D, the placement of a stent is possible by visualizing it in the 2D image
and the 3D vessel model.

Bifurcation The coronary vessel to be analyzed may include a bifurcation. By looking at the
concrete anatomy of the bifurcation, e.g. the angle between the distal main and
distal side branch, and the location of the stenosis, the physician may decide on
different techniques, stents, and stent locations.
The measurements performed can aid in determining the vascular health of the
patient. In the case of stenosis, it can aid in determining the size of a balloon or
stent to be placed in the vessel.

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Performing a vascular analysis

QCA/QVA workflow
A QCA or QVA analysis is performed in the following sequence:
 A suitable image is loaded and displayed in full-screen.
It can be a single plane image or one image of a biplane image pair.
Selecting a scene/image 640
 The image has been calibrated.
In the case of a biplane image only the image from the plane that is to be ana-
lyzed must be calibrated.
Calibration 643
1. Start QCA or QVA
Selecting the analysis method 644
2. Mark a vessel in the current image
Vessel contour detection 646
The system detects the vessel walls and prompts to correct the contour.
The system detects the minimum luminal diameter and performs an analysis
on the vessel.
 Optionally perform manual evaluations
Performing evaluations 674
 Optionally comment the analysis and select the diagram type/parameter dis-
play
Contour information 668
3. Create and store a report of the analysis results
Report 631
Results (Report) 679

IZ3D workflow
An IZ3D analysis is performed in the following sequence:

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Single plane images  A suitable single plane image is loaded and displayed in full-screen.
Scenes/images for IZ3D 641
1. Start IZ3D
Selecting the analysis method 644
2. Mark a vessel in the current single plane image
Vessel contour detection 646
The system detects the vessel walls and prompts to correct the contour or se-
lect another 2D image.
3. Load a second single plane 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, and prompts to mark the vessel.
4. Mark the same vessel segment in the second image
Vessel contour detection 646
The system detects the vessel walls and minimum luminal diameter, performs
an analysis on the vessel, and creates a 3D vessel model of the marked vessel.
 Optionally perform manual evaluations
Performing evaluations 674
 Optionally comment the analysis and select the diagram type/parameter dis-
play
Contour information 668
5. Create and store a report of the analysis results
Report 631
Results (Report) 679

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Biplane image pair  A suitable biplane image pair is loaded on a biplane system, or one image of a
biplane image pair is loaded on a single plane system.
Scenes/images for IZ3D 641
1. Start IZ3D
Selecting the analysis method 644
2. Mark a vessel in the image of the first plane
Vessel contour detection 646
The system detects the vessel walls, and prompts to correct the contour or
mark the vessel in the image of the other plane.
3. Load the image of the second plane into review
(if working on a single plane system)
The system displays two lines in the image of the other plane to indicate the
approximate position of the vessel that was detected in the first image.
4. Mark the same vessel segment in the image of the other plane
Vessel contour detection 646
The system detects the vessel walls and minimum luminal diameter, performs
an analysis on the vessel, and creates a 3D vessel model of the marked vessel.
 Optionally perform manual evaluations
Performing evaluations 674
 Optionally comment the analysis and select the diagram type/parameter dis-
play
Contour information 668
5. Create and store a report of the analysis results
Report 631
Results (Report) 679

Selecting a scene/image
 Load a suitable scene from the Patient Browser onto the Quant task card by
drag-and-drop or a double click.
The selected image plays an important role in accurate and reproducible contour
detection.
We recommend selecting an image close to the diastolic phase of the cardiac cy-
cle. The vessel moves only minimally in this cardiac phase, so that the changes of
the display size are negligible and reproducibility of the detected contour is guar-
anteed. Changes in contour due to the rotation of an asymmetrical vessel are also
insignificant in this phase. In addition, possible kinetic blurring because of the
length of the X-ray pulse is minimal in the diastolic phase. It ensures improved im-
age quality and, consequently, more accurate contour detection.

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Note Make sure that enough contrast media was used during acquisition of images to
be used for vascular analysis.

Note Only use good quality images. Noise, background structures and vessel artifacts
may lead to detection failures.

Note The accuracy of the densitometric area results is negatively influenced by image
processings such as DDO.
Images having a DDO value larger than 30% should not be used for QCA analyses.
The results of the QCA analysis may be distorted due to the inaccurate detection
of vessels and disturbances.

Note Densitometric results are less reliable when the vessel of interest runs perpendic-
ularly across a sudden significant change in background density, e.g. the lung
field.

Note Do not perform QCA, IZ3D, or QVA on inverted images.

When using inverted images, vessel contours will not be detected accurately and
measurements will be incorrect.

 Scroll through the scene to the required image.

General functions 630

Scenes/images for IZ3D

Two projections Two projection images must be selected for IZ3D in order to obtain a 3D recon-
struction.
All participating images should be well separated. Well-separated images are the
ones in which there is at least a 30° difference between the projections.
Two projections are sufficient to create an accurate 3D reconstruction in the case
that:
 They are both orthogonal to the region of interest.

 They are well-separated (as defined above).

End Diastolic frame It is essential that the selected frames are of the same stage of the heart cycle. The
(IZ3D) optimal frame is the one in which the heart vessels are at their most still and en-
larged stage (end diastolic frame). This instance can be identified on the ECG sig-

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Quantification

nal diagram as the portion between the Q and the R waves. Furthermore, within
the 4 to 6 s of a typical duration of a scene, there are several ED peaks that can be
identified.

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

Manual ED It is important to preserve a constant phase of the heart cycle for all scenes that
participate in creation of the 3D reconstruction. For this reason, if a manual over-
ride is performed for one scene, repeat this process, using the same distance (in
terms of number of frames) for other scenes as well.

Note A table movement between the acquisitions of the different projections will result
in a different position of the vessels in relation to the x-ray system, causing the re-
sults to be incorrect.
The table must not be moved between the acquisitions used for the reconstruc-
tion.

Note A patient movement between the acquisitions of the different projections will re-
sult in different positions of the vessels in relation to the x-ray system, causing the
results to be incorrect.
It is important that no movement of the patient occurred between the acquisitions
used for the reconstruction.

Note Breathing motion will result in a different position of the vessels in relation to the
x-ray system, causing the results to be incorrect.
Therefore, it is important to consider breathing motion.

Performing Auto ED after manual scrolling or

selecting the next end diastolic frame

Console
 Click this icon.

Touchscreen  3D Coronary Analysis has been started.

 Press the Auto ED Detection button.

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– If Auto ED has not been invoked in the current scene then the system
detects and displays the least-motion frame of the current scene in full-
screen review.
– If Auto ED has been invoked in the current scene then the next ED frame
forward is detected and displayed. After the last ED frame of the scene the
first ED frame is used.
The ED frame is displayed as a thumbnail in the 3D Coronary Analysis win-
dow.
 Click a thumbnail to select the scene and display its ED frame in full-screen.

Calibration
Before you can perform a 2D quantitative vascular analysis, you must calibrate the
image. 598
When using IZ3D, a calibration by the user is not necessary. In this case, the appli-
cation performs an automatic calibration.

Note Make sure that the calibration object and the vessel segment have the same geo-
metric acquisition parameters, that is,
 the same focus-to-object and object-to-FD distances

 the same FD size and zoom stage

 the same image matrix

Otherwise the absolute distances will be less reliable.

To calibrate the image, use an object with almost the same size as the object to be
measured, e.g. an (empty) catheter for a vessel segment.
For distance measurements, it is advisable to calibrate over a distance of at least
3 cm.

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Selecting the analysis method

You can select one of the following analysis methods for analyzing stenoses:

QCA 2-dimensional quantitative coronary analysis for measur-

ing stenoses in coronary arteries (0.5 mm to 7 mm)

QVA 2-dimensional quantitative vascular analysis for measuring

stenoses in other vessels (0.5 mm to 50 mm)

IZ3D 3-dimensional quantitative coronary vascular analysis for

measuring stenoses in coronary arteries in three dimen-
sions based on two 2-dimensional images

Note Depending on the installation, some analysis methods may not be available to
you.

Note All analysis data will be lost after power failure or software crash. In such cases, an
analysis must be restarted from the beginning.

Console
 Click the appropriate icon on the Analyze subtask card.
– The Coronary Analysis, or Vascular Analysis, or 3D Coronary Analysis
window appears.

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Touchscreen

 Press the appropriate button.

QCA or QVA

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IZ3D

Note Pay attention to the messages at the bottom of the image.

They include notes for further operational steps.

Vessel contour detection

You must define the vascular segment you want to examine by drawing in an ap-
proximate center line. For a curved vessel, a number of points can be marked by
single mouse clicks at the required positions. (For vessels without bifurcation, a
maximum of 20 points can be marked, including the start and end points. With bi-
furcation, 20 points for the main branch and 19 points for the side branch can be
marked.)
The line connecting these points must be within the vascular volume.
The center line must be marked in the direction of blood flow as it influences the
calculation of the extent of stenosis. (The proximal and distal limits of the ob-
structed segment are calculated differently.)
To achieve reproducible analysis results, it is advisable to start and end the seg-
ment at a characteristic, conspicuous point. Side branches are suitable for this pur-
pose.

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Note It is important to select the correct start and end point.

The path-line detector functions work best if these points are in a vessel center in
an artifact-free region of the image.
Analyzing vessels containing a catheter or guide wire should be prevented.

Note Pay attention to subtraction artifacts near to the vessel of interest. Do not analyze
such images.

Note The path-line algorithm has no idea of vessel importance and may find a route
through minor vessels.
Select start and end point which leave only the desired path as a possibility.

Note The path-line detector cannot find a route through a fully obstructed vessel.

Note If there are parallel vessels next to the analyzed vessel segment the path-line de-
tector may result in a shortcut.
Add intermediate points in such cases or correct the contour manually.

Note The path-line detector does not distinguish between vessel branches and crossing
vessels. Both cases will be regarded as branches.

Note Especially for analyzing bifurcations, the vessels should be clearly visible without
disturbing crossing structures.

Note The pixel size should be determined correctly.

Note For IZ3D, it is important to select correct images and the same vessel in all images.
If not the same vessel is selected for a 3D reconstruction, the reconstruction may
fail because there are none or few corresponding points.

Note If identified side branches from the 2D images do not belong to the same vessel,
the 3D reconstruction will be not possible or incorrect.
It is important to select the correct vessel(-branch).

Note Due to vessel overlapping in the used projections, the exact geometric dimensions
of the overlapping part within the 3D reconstruction is estimated. This part of the
3D reconstruction is less reliable.
The projections of the vessels of interest should be chosen in such a way that the
overlap is minimal.

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Note Occasionally, some vessels may not be properly detected in images with extreme-
ly small or extremely large vessels.
 Repeat the analysis in this case.

Note It can be helpful to enlarge the image region containing the vascular segment you
want to analyze. 626
The calibration performed previously on the unzoomed image remains valid.

Selecting the vessel segment

Console & Touchscreen Marking a vessel segment via double-click
 Perform a double-click into the vessel of interest.
– The software automatically detects the contours of a vessel segment proxi-
mal and distal to the clicked location.

Note In some vessels, the automatic labeling of proximal and distal direction might be
incorrect.
 Check the P and D labels

 If incorrect, discard the analysis and redo it marking two or more points.

Marking a vessel segment without bifurcation

 Define the proximal starting point in the center of the vessel with a single click.

 Optional: Define any necessary intermediate points in the center of the vessel
with single clicks.

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

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Marking a vessel segment with bifurcation

(QCA with bifurcation or IZ3D only)
 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 outside of the
main vessel with single left clicks.
 Define the distal end point of the side branch with a double left click.

Note When you have marked the maximum number of centerline points (20 per
branch), the end point will be defined automatically, i.e. without double-click.
For side branches, maximum number of points is 19 and the 20th point (fusion
point) is set automatically, between side branch and main branch.

Automatic contour As soon as you have defined the vessel segment you want to examine with a cen-
detection ter line, the contour detection algorithm automatically detects the vascular mar-
gins.

Manual contour If the detected contour of the vessel segment is not satisfactory, you can make
correction manual corrections.

Correcting the contour

Console & Touchscreen You can correct the contour at any time.
 Start the correction with a single click at the point from which you want to cor-
rect the existing contour.
– A line is drawn.
 Define the intermediate points along the required contour with a single click.
– The line changes its direction each time.
 Define the end point with a double left click (mouse or mouse joystick) or right
click (mouse joystick).
– In the control room, the Coronary Analysis, or Vascular Analysis, or 3D
Coronary Analysis window switches to the Corr subtask card.

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Quantification

Smoothing the contour

Console In the control room, if the currently marked contour does not include a bifurca-
tion, you can choose one of the following options:
 Soft Correction: The corner points of the drawn contour are slightly
smoothed.

 Hard Correction: The corner points of the drawn contour remain unchanged.

The selected correction method is applied automatically when marking a correc-

tion to a contour. At system startup, the default correction method is set to Soft
Correction.
 Click an icon to change the setting.

If the currently marked contour includes a bifurcation, Hard Correction is applied.

Touchscreen In the examination room, Soft Correction is automatically applied.

Manual restriction
Console If the defined contour is too large, you can trim the contour.
 Start outside the contour with a single click.
– A line is drawn.
 Define the intermediate points inside the vessel with a single click).
– The line changes its direction each time.
 Define the end point outside the vessel with a double click.
– The restriction is applied to the contour.

Toggle ostial branch

In case of a bifurcation, the system is able to determine whether a side branch is
ostial or non-ostial.
This determination is made by comparing the ratio between the diameter of the
branch and the diameter of the main vessel segment with a configurable thresh-
old. 689
To switch between non-ostial and ostial branch:

Console (only)
 Click this icon.

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3D vessel model in IZ3D

Creating a 3D vessel model

Console & Touchscreen  Mark a vessel in the first image.
Vessel contour detection 646

Next, you load a second image.

Console
 You can do it via Scene - / Scene +, or by displaying the Scene Directory or
opening the Patient Browser and selecting the image there.
or

Touchscreen

 Press the Scene - / Scene +, or the Scene Directory icon.

In the scene directory, scenes are marked for IZ3D:

: already used
: already used and analyzed

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 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.

 Epipolarity lines are used to indicate the approximate region of the display
where the vessel being analyzed within a 2D image. The lines indicate the up-
permost and lowermost boundaries of the screen region within which the ves-
sel should fall.
 Mark the same vessel segment in the second image.
Vessel contour detection 646

Console  Click the 3D subtask card in the 3D Coronary Analysis window to view the 3D
vessel model of the marked vessel.

Touchscreen

 Press the 3D Model button.

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Screen

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Common image point

In every 2D image, a red cross is displayed which indicates the common image
point used in a 3D analysis. It indicates the same position within the anatomy of
the patient in every 2D image.

For example, the common image point indicates a vessel bifurcation (IZ3D only)
that is visible in every 2D image. This point used when calculating the 3D vessel
model.

Note If the common image point is not the same anatomical location in relation to the
3D reconstruction, the results may be incorrect.
It is important that the common image point is placed correctly.

 You can drag and drop the common image point to a different position.

Viewing the 3D vessel model

Virtual C-arm When you rotate the 3D vessel model, the virtual C-arm displayed in the top right
corner performs the rotation correspondingly. It moves to all positions, although
the C-arm may not be able to rotate to that position in reality.
The virtual C-arm indicates whether its current angulation is physically possible for
the C-arm by changing color.1

1 with color display only

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C-arm symbol Description

C-arm and table, both have blue color*:
– C-arm position is reachable.

C-arm has red color and table has blue color*:

– C-arm position is not reachable.

*
Currently the difference in color is not distinguished on b/w monitors as bright or dark. However this
is distinguishable on color monitors.

The virtual C-arm displays the position of the C-arm of the plane where the cur-
rently selected 2D image was acquired.
If a plane B image is being analyzed on a single plane Artis system or on a syngo
Workplace connected to a single plane Artis system then the plane A C-arm is dis-
played.
The virtual C-arm also takes account for current position of the table, detector and
tube.

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Rotating the 3D vessel model

Console & Touchscreen  Press and hold the left mouse button or mouse joystick button and drag the 3D
vessel model.

Depending on where the initial mouse click was performed the behavior is as fol-
lows:
 If the initial mouse click was outside the outer blue circle then the movement
of the reconstructed vessel is limited to rotating only around the center of the
image.
 If the initial mouse click was in between the outer and inner blue circle near
one of the radial lines, then the movement of the reconstructed vessel is lim-
ited to tilting around the corresponding perpendicular axis indicated in red
color.

 If the initial mouse click was inside the inner blue circle then the movement of
the reconstructed vessel is not limited in any way, and the reconstructed vessel
can be freely rotated and angulated.

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Panning and zooming the 3D vessel model

Console & Touchscreen  Press and hold the right mouse button or mouse joystick button and drag the
3D vessel model.

Console (only)  Rotate the mouse wheel to zoom the 3D vessel model.

Windowing the 3D vessel model

Console (only)  Click into the image with the middle mouse button and move the mouse with
the button pressed.
– up/down: increase/decrease brightness
– right/left: increase/decrease contrast

Auto-rotating the 3D vessel model

Console (only)
 Click this icon.

The 3D vessel model performs a pre-defined rotation.

 To stop rotation, click the icon again.

Rotating the 3D vessel model to the optimal projection

Optimal Projection The Optimal Projection indicates a system position that meets the following re-
quirements:
 For 3D vessel models that do not include a bifurcation, the Optimal Projection
is the projection that shows the least foreshortening of the analyzed segment.
 For 3D vessel models that include a bifurcation, the Optimal Projection is the
projection that displays the greatest angle between the branches of the bifur-
cation.
The Optimal Projection is automatically displayed when the 3D vessel model has
been created.

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Note The visualization of the 3D model viewed according to the calculated optimal pro-
jection angles does not take any detector rotation into account.
In this case, the visualized 3D model may be rotated compared to the real angio-
graphic projected image as obtained using the calculated optimal projection an-
gles.
In general, any detector rotation may provide a mismatch in rotation between the
visualized 3D model and the angiographic image in case the angiographic image
is acquired under the same projection angles as used during the 3D model visual-
ization.

Note For some analyses, the calculated angulation of the Optimal Projection corre-
sponds to an angulation that is not allowed by the system. The virtual C-arm is dis-
played in red color.

To display the Optimal Projection again:

Console  Select Quant > Optimal Projection for 3D in the main menu.

Touchscreen  Press the drop-down button in the 3D Model step and select Optimal
Projection.

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

Console
 Click this icon.

Touchscreen
 Press this icon.

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 acquisi-
tion.

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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 selection of the desired position and vi-
sual estimation if this position is reached.
The stent graphics will show the desired position of the stent and thus support po-
sitioning.

Note For stent positioning, the acquisition geometry must be identical for the live im-
ages and the stent graphics image.
Stand and table must not be moved. Also, the patient must not move during stent
positioning.

Bifurcation It is possible to position a stent in a bifurcated vessel. However, Stent Planning is

then limited to either the main branch or the side branch of the bifurcated vessel.
Stent Planning will be possible in the following situations:
 Obstruction is located in the proximal vessel, in the distal main vessel, or in the
distal side branch of a bifurcation (2 borders each).
 Obstruction is located in the bifurcation (3 borders).
In this case, Stent Planning will default to the main branch, and thus the main
branch borders. The segment border in the side branch will not be not consid-
ered.

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 sub-
task card) is shown.

Console
 Click this icon.

Touchscreen

 Press the Stent Planning button.

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Quantification

– 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 posi-
tions of the stent endpoints.

– The length and diameter of the stent are suggested in the Preliminary
Results window.

Note The suggested stent diameter is based on the maximum diameter between the
stent borders.

Note Tapering, overlap of vessels and bifurcations in the region of interest are not taken
into account.
 Select the stent based on the suggested stent dimensions.

Console Adjusting stent length, diameter, and position

 Click the Corr subtask card in the 3D Coronary Analysis window.

 Click this icon.

 Enter the stent length and the stent diameter in millimeters.

You may enter the physical dimensions of the stent to use in the format xx.yy ,
i.e. hundredths of millimeters are supported.

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 Click Apply to apply the stent dimensions.

Or/and
 Click OK to accept the stent dimensions.
– The entered stent length and diameter are indicated in the Preliminary
Results window.

– The entered stent parameters are applied symmetrically to the obstructed

vessel segment. The Diameter and Area graphs as well as the stent borders
in every 2D image are updated accordingly.
– The stent graphics are shown in the 3D vessel model.

 You may adjust the position one of the stent borders by dragging a stent end-
point in the Diameter or Area graph.
– Stent data and graphics are updated. Thus, the distance between the stent
borders is maintained.
 You may also enter a different stent length and/or diameter - see above.

Touchscreen Adjusting stent length and diameter

 Press the Length and Diameter button.

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Quantification

 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

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.

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To disable overlay:

 Press the Overlay on Live button.

Display of stent borders

The stent borders are displayed differently depending on whether the user has
modified the stent dimensions:

Stent borders by the system Stent borders by the user

Display in analyzed 2D
image

Display in 3D model

Overlay in live image

Stopping stent planning

Console
 Click this icon.

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Quantification

Touchscreen

 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.

Console
 Click the icon to show it again.

Touchscreen

 Press the Stent Planning button again.

Displaying the quad view

Console
 Click this icon.

Touchscreen
 Press this icon.

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 Quantitative Vascular Analysis (QCA/QVA, IZ3D)

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

Selecting the 2D image to display in the quad view

Console (only)
 Click the arrow button to the right of the 3D Coronary Analysis window.

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Quantification

 Click an image stamp.

– The selected 2D image is displayed in the quad view.
To remove an image from the analysis:
 Click this icon.

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

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

Console  Select Quant > Move C-Arm to > ... in the main menu.

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

 Press the Adjust C-Arm button.

1 with color display only

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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 optimal projection calculated by the

system 657
 Current 3D Position: current position of the 3D vessel model

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

The following message appears in the examination 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.
 Or press the hands free foot pedal.

The C-arm moves to the defined angulation.

Documentation of the 3D vessel model

In 3D view or in quad view, you can store the 3D vessel model, store it as a Store
Monitor image, store it as a reference image, or film it.
The 3D vessel model is also automatically documented via the report.
Due to technical reasons, the 2D image of the 3D vessel model is converted to gray
scale in these cases.

Console
 Click the required icon.

Touchscreen
 Press the required icon.

When performing Store Monitor:

– The 3D vessel model is stored using the current view.
– A Store Monitor image is also stored.

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Quantification

When the Store Monitor image is reloaded in Quant, the 3D vessel model will be
displayed again. In other applications, e.g. PostProc or Viewing, only the 2D
Store Monitor gray scale image will be displayed.

Store 3D Model
You can create a file in a configured path with stereo lithographic representation
of the list of facet data corresponding to the 3D model.
 Select Quant > Store 3D Model from the menu.

The created file is named as follows:

QCAN_<SOPInstanceUID>_<YYYYMMDDHHMMSS>.stl
– YYYYMMDDHHMMSS represents the year, month, date, hour, minutes and
seconds corresponding to the time, the file is created.
– SOPInstanceUID is a unique identifier of the image participating in the
analysis.

Contour information

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Console (only) On the Info subtask card, you can comment the analysis and select the diagram
type/parameter display. You can:
 Select or enter a Segment Name (QCA/IZ3D only)

 Select or enter a type of Intervention

 Select or enter a research Trial Name

 Select parameter/diagram type (Analysis Control)

 Enter Free Text

The analysis information entered on the Info subtask card will be cited in the
Report 631, 682.

Note In the Coronary Analysis, Vascular Analysis, and 3D Coronary Analysis win-
dow, the size of the Free Text field is limited. The maximum number of 64 char-
acters cannot be displayed at the same time.

Note Even though 64 text characters are supported for Free Text, the entered text may
be shown truncated in the quantification report.
 Insert line feeds in case of a more than 44 character long text is required.

Entering analysis information

Using texts
 Select a text from the Intervention or/and the Trial Name list.

Processing texts

 Select a text from the list.

Or
 Enter a new text.

 Select Add.
– The text is added to the list.
Or

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Quantification

 Select a text from the list.

 Change the text as required.

 Select Edit.
– The text is changed in the list.
Or
 Select a text from the list.

 Select Delete.
– The text is deleted from the list.

Entering a free text

 Enter the required text in the Free Text field.

Note Do not enter more than 40 characters.

Only up to 40 characters will be visible in the report. There will not be any indica-
tion that some text is missing.

Selecting diagram display

 Select the required diagram display from the Analysis Control selection list on
the Info subtask card.
 Diameter: The diameter curves are displayed.

 Main Side Diameter: The diameter curves of the main branch and of the side
branch are displayed (with bifurcation only).
 Diameter & Area: The diameter and area curves are displayed.

 Side Diameter: The diameter curve of the side branch is displayed (with bifur-
cation only).
 Side Diameter Area: The diameter and area curves of the side branch are dis-
played (with bifurcation only).
 Density Profile: The diameter and density curves are displayed.

 Background Analysis: The background densities are displayed.

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Diameter diagram
 The diameter curves are displayed.

Diameter curves The diameter graph includes two curves, which indicate the diameter of the de-
tected vessel and the diameter of the calculated “healthy vessel” reference.
The course of the vessel is drawn as a curve from left to right, corresponding to
proximal to distal. The position of the minimum lumen diameter (MLD) is dis-
played by a vertical line and specified as a value on the right in the Diameter dia-
gram. The maximum diameter value is shown above it.
In the Diameter diagram, you can modify certain parameters of an analysis.
676

Area diagram
 The diameter and area curves are displayed.

Area curve The Area diagram shows two curves: a light one indicating the area in mm² or
Units and a gray one showing the corresponding densitometric values.

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The course of the vessel is drawn as a curve from left to right, corresponding to
proximal to distal. The position of the minimum, densitometrically determined
cross-sectional area is indicated with a vertical line and shown on the right in the
Area diagram as a value. The value of the maximum area is shown above it.

Displaying a local density

 If you click the Area diagram, local density values are displayed above the area
curve.
– The position is shown as a dot in the vessel.

Density profile
 The diameter and density curves are displayed.

The grayscale value analysis of a vessel cross-section is also available.

The Profile diagram shows the density and brightness at the position of the vessel
corresponding to the position on the broken line in the image. The dashed lines in
the Profile diagram indicate the edges of the vessel.

Analyzing another position

 Move the dashed line in the Diameter diagram holding the left mouse button
down.
– The position is shown as a dot in the vessel.

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Background analysis
 The background densities are displayed.

Background curves The brightness of an image is influenced not only by the contrast medium in the
vessel, but also by the tissue (bone) overlapping the vessel. To correct this back-
ground influence, the background brightness is subtracted.
The continuous curve indicates the background brightness. The smoothed gray
curve takes into account the elimination of the effect of side branches. The latter
is used for background correction.
In the image, the left and right vessel edges (with respect to the direction of blood
flow) are marked with the letters L and R.

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Performing evaluations
Console (only) You can select various analysis methods depending on the detected vessel con-
tour.

Stenosis calculation based on automatically determined reference di-

ameter is the default analysis method. 675
Based on the diameter calculated at the MLD position, a reference di-
ameter for stenosis calculation is determined.
Using stenosis calculation based on manually determined reference
diameter, you can place reference lines at any position in the analyzed
segment. 677
With a manual subsegment, you can measure a specific part of the
vessel. 678

Using local diameters, you can determine several diameters on a

drawn contour, e.g. to measure aortic aneurysms. 678

In addition, you can modify certain parameters of an analysis. 676

Note All data of a stenosis calculation based on automatically determined reference di-
ameter are rejected if a stenosis calculation based on manually determined refer-
ence diameter is selected, and vice versa.
Only one method is valid. The reference information of the value used is also used
to calibrate the results of the density calculation.

Information about stenosis calculation

Lambert-Beer law The ratio between the contrast medium quantity at a defined point in the vessel
and the brightness in the clinical image is taken as the basis for a densitometric
calculation. This relationship is known as Lambert-Beer law.
The results of the densitometric calculation provide you with information about
possible vessel asymmetry.
The anatomical background changes, if a vessel is projected over bones, or it is
simulated, if a vessel is u-shaped. It moves toward the observer, it curves, and it
moves away from the observer. It can cause misinterpretation by the observer.
But a lower contrast medium density in a vessel can also be caused by a stenosis.
It is why the density is corrected for “normal changes” of the background.

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mm2 or units The density curve is initially only calculated in “units”. After a diameter calculation
(with an automatically or manually determined reference diameter), a conversion
factor (scaling factor) is calculated which states the relation between the density
in the vessel (brightness) and the area (mm²).
The brightness averaged over a cross-section of the vessel is therefore a measure
of the cross-sectional area. These values are stated in the area curve.
This calculation is automatically performed after a stenosis calculation with an au-
tomatically or manually determined reference diameter.
Until the brightness is calibrated to mm², the curve is stated in “units”.

Automatically determined reference diameter

Based on the diameter calculated at the MLD position, a reference diameter for
stenosis calculation is determined.
A second area curve is calculated and displayed based on the vessel diameter D as-
suming a circular form for .
Possible differences between the two area curves indicate asymmetry in the
plaque of the vessel or create the illusion of other phenomena that affect density.

Console
 Click this icon, if necessary.

Touchscreen Automatically determined reference diameter is the method when operating on

the touchscreen in the examination room.

The stenosis is calculated on the basis of the reference diameter defined by the
computer.
The results are displayed in the Diameter diagram.
The course of the vessel is drawn as a curve from left to right, corresponding to
proximal to distal. The position of the minimum lumen diameter (MLD) is dis-
played by a vertical line and specified as a value on the right in the diagram. The
maximum diameter value is shown above it.
The descending straight line represents the reconstruction line for the analyzed
vascular segment determined by the computer. Its gradient is calculated on the
basis of the diameters outside the stenosis region, so that 80% of all diameters are
underneath this line.

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Quantification

The point of intersection of the reconstruction line with the line which also indi-
cates the length of the MLD defines the length of the reference diameter.

Modifying an analysis

Note Each time you change the position of the MLD (minimum lumen diameter) or the
limits of the stenosis, parts of the analysis results are recalculated.
The position of the MLD also influences the position of the stenosis limits.

Moving the MLD line

If the MLD line does not appear in the expected position, e.g. in the case of a vessel
with more than one stenosis, you can shift it to the required position:
 Push the mouse pointer onto the MLD line in the Diameter diagram.
– It changes shape with an arrow.

Console  With the left mouse button pressed, you can move the line.

Touchscreen  Press the left button of the mouse joystick, release it, move the line and press
the left button again.

Changing the position of the limits

If necessary, you can change the position of the limits by moving the marking lines
in the diameter diagram:
 Move the mouse pointer onto the appropriate dashed line in the Diameter di-
agram.

Console  With the left mouse button pressed, you can move the line.

Touchscreen  Press the left button of the mouse joystick, release it, move the line and press
the left button again.
The new position of the limit is fixed when you release the button.

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The reconstruction line, parts of analysis results, and the plaque display are delet-
ed.

Note It is not possible to place the distal limit at a point on the left of the MLD or the
proximal limit at a point on the right of the MLD.

Displaying a local diameter

 The local diameter value is displayed above the diameter curve if you click the
Diameter diagram.
– The position is shown as a dot in the vessel.

Manually determined reference diameter

Manual reference is the method to place reference lines at any position in the an-
alyzed segment.
If the position of the reference diameter D is changed, the results will be recalcu-
lated. Assuming that the vessel is circular, the reference area for is calcu-
lated.
Because both the densitometric cross-sectional area and the area calculated with
the diameter are based on the assumption of a circular vessel, the reference diam-
eter value is used to calculate and display the density in mm².

Console (only)
 Click this icon.

Stenosis calculation, based on a defined reference diameter, is started.

The results are displayed in the Diameter diagram.
The diameter diagram shows dashed lines, 1 or 2 depending on configuration
688. They indicate the position of the reference diameters to be defined by
you.

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Quantification

If you reposition a line, the system corrects this position automatically to the local
minimum. That means: The reference diameter defined by you and the area are
calculated as the mean value of the selected diameter and all diameters in an area
comprising 10 pixels around the reference position defined by you.
The position of the MLD is indicated again with the continuous line. The value on
the right next to it indicates its length. The maximum diameter value appears
above.
While you move the reference diameter, the corresponding position in the image
is displayed as a white dot inside the vessel.

Manual subsegment
A manual subsegment can be used, e.g. if the marked segment shows several ste-
noses. The method allows you to analyze them individually and to calculate a
mean value. The method also provides a minimum diameter.
The subsegment is defined by a proximal and a distal limit.

Console (only)
 Click this icon.

 You can define the position of the subsegment by shifting the marks in the Di-
ameter diagram.
– As you shift the mark, the current position is displayed as a white dot in the
image.
– The results are displayed in the Diameter diagram.

Local diameter
You can define several diameters on a drawn contour, e.g. to measure aortic an-
eurysms.

Console (only)
 Click this icon.

 Double-click the position in the Diameter diagram at which you want to draw
a diameter.
If you find that the line drawn is not in the correct position, you can move it:
 With the left mouse button pressed, you can move the line.
– As you move the line, the diameter is displayed above the line and the cur-
rent position is indicated in the image as a white dot.
– The new position of the diameter line is fixed when you release the button.

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Deleting the last local diameter

 Click this icon.

Recalling an analysis
Console (only) You can call up the last processed analysis of the same type as long as you do not
restart the system or application, close the patient, or load a different study.
 Click this icon on the Analyze subtask card.

Note If a recalled IZ3D analysis contains only single plane images, this function is only
available if the displayed image is the first image participating in the analysis.

Results (Report)

Preliminary results
During analysis, results are displayed in the Preliminary Results window.

Examples

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Depending on analysis, the following parameters are displayed:

Analysis Parameter Description Unit

2D 3D

x x x x x x x - + Optimal Proj Optimal Projection 657 [°]

x x + + MLD Minimum lumen diameter of the ana- [mm]
lyzed segment
x x + + Ref D. Reference diameter of the analyzed [mm]
segment
x x + + % MLD Percentage of the diameter at the le- [%]
sion point versus the reference diame-
ter
x x + - DLesion (%D) Diameter at the lesion position (Per- [mm],
centage of the vessel diameter [%]
blocked at the lesion position)
x - + MLA Minimum lumen area of the analyzed [mm²]
segment
x - + Ref A. Reference area of the analyzed seg- [mm²]
ment
x x + + % MLA Percentage of the area at the lesion [%]
point versus the reference area
x x + + Length Length of the analyzed segment [mm]
x x - + Length(Main, Side) Length of the analyzed segment (main [mm],
branch and side branch) [mm]
x x + + Dprox (min, %) Minimum lumen diameter between [mm],
the proximal end of the segment and [%]
the point of bifurcation (POB). Percent
of blockage between the proximal end
of the segment and the POB.
x x + + Ddist (min, %) Minimum lumen diameter between [mm],
the POB and the distal end of the first [%]
branch of the segment. Percent of
blockage between the POB and the
distal end of the first branch.
x x + + Dside (min, %) Minimum lumen diameter between [mm],
the POB and the distal end of the sec- [%]
ond branch of the segment. Percent of
blockage between the POB and the
distal end of the second branch.

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Analysis Parameter Description Unit

2D 3D

x x + - 2D-Angle(Prox- 2D-angle between the proximal and [°]

Side) distal points of the branch
x x + - 2D-Angle(Dist-Side) 2D-angle between the distal points of [°]
the main vessel and the branch
x x - + Angle(Prox-Side) 3D-angle between the proximal and [°]
distal points of the branch
x x - + Angle(Dist-Side) 3D-angle between the distal points of [°]
the main vessel and the branch
x x - + LMain Length of the main branch [mm]
x x - + LSide Length of the side branch [mm]
x x + - Plaque(POC,Obstr) Blockage at the bifurcation's carina. [units,
Percent of blockage at the bifurca- %]
tion's carina.
x x + - Length(Main,Side) Length of the segment from the prox- [mm],
imal end of the segment to the distal [mm]
end of the first branch. Length of the
segment from the proximal end of the
segment to the distal end of the sec-
ond branch.
x + - Lsub Length of subsegment [mm]
x - + Dmain (min, max) Minimum and maximum diameter of [mm],
the main branch [mm]
x - + Dmain (mean) Mean diameter of the main branch [mm]
x - + Dside (min, max) Minimum and maximum diameter of [mm],
the side branch [mm]
x - + Dside (mean) Mean diameter of the side branch [mm]
x - + Length(main, side) Length of the main and side branches [mm],
[mm]
x + + Plaque (main, side) Percent of blockage in the branches [%],
[%]
x + - %DSub Percentage of segment diameter [%]
blocked
x + + %D (main, side) Percent of blockage in branches [%],
[%]

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Quantification

Analysis Parameter Description Unit

2D 3D

x + + Dmin Minimum diameter of the analyzed [mm]

segment
x + + Dmax Maximum diameter of the analyzed [mm]
segment
x + + Dmean Mean diameter of the analyzed seg- [mm]
ment
x - + Amin Minimum area of the analyzed seg- [mm²]
ment
x - + Amax Maximum area of the analyzed seg- [mm²]
ment
x + + Lsegment Length of the analyzed segment [mm]
x x x x x x x + - CF Calibration Factor (pixel size) [mm]/
pixel
x - + Max diameter Maximum diameter between stent [mm]
borders of the analyzed segment
x - + Stent length Selected stent length of the analyzed [mm]
segment
x - + Stent diameter Selected stent diameter of the ana- [mm]
lyzed segment

Report
Depending on configuration, the report consists of one or more pages.
Default report 688
Report functions 631
Report 631
The report consists of the image with drawn contours, curves and data fields.

Definitions The QCA/QVA/IZ3D output parameters are explained on the following pages.
The following conventions have been used:
 Analysis parameters are shown in boldface type.

 The associated units are shown in square brackets [ ].

 Sdev = standard deviation is the statistically determined variance around a

mean value.

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Patient, study, General information about the patient, the study and the analyzed scene/frame is
scene, ... shown on the left-hand side (of the first page) of the report.
Data entered on the Info subtask card are also shown here.

Calibration  Cal Object:

Diameter of the object used for calibration
Method used for calibration
 Cal Factor:
Pixel size determined by calibration

Area formula A vessel can have - compared with its anatomical background -
– a lower contrast density, for example, because of a stenosis,
– a higher contrast density, for example, because of superimposition of an
object such as a rib or a different vessel.
 Area Circ (circular) [mm²]
It is assumed that the vessel is circular at the reference point and therefore its
area is .
It is correct if there is no pathological change at that point. The density at this
point is considered to be the surface density. In other words: A vessel with di-
ameter x mm has a surface density of y. The diameter and density are correlat-
ed.

Note If the reference point is defined by the computer, it is assumed that everything
outside the stenosis is not pathological and therefore circular. Therefore, it is used
to place the curves in relation to one another.
If a different reference point is chosen, and it is a pathological or non-circular ves-
sel, the outcome will be untrue. The correlation between the two curves will be
incorrect.

 Area Dens (densitometric) [mm²] or units

The program takes account of the background with a densitometric analysis.
You can use this background information to interpret the results correctly.

Note The accuracy of the densitometric area results is negatively influenced by image
processings such as DDO.

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Stenosis  % MLD: [%]

Percentage of the minimum vessel diameter compared to the reference diam-
eter: stenosis diameter/reference diameter x 100%
 MLA circular (Minimum Lumen Area): [mm²]
Cross-sectional area at the location of the MLD calculated using the circle for-
mula assuming a round vessel cross-section
 % MLA circ: [%]
Stenosis value relative to the reference value calculated using the circle formu-
la
 MLA densitometric (Minimum Lumen Area): [mm²]
Densitometrically determined cross-sectional area at the location of the MLD
 % MLA dens: [%]
Densitometrically determined stenosis value relative to the reference value

Obstruction Segment  Lesion or MLD (Minimum Lumen Diameter) [mm]

The minimum vessel diameter at the position of the most severe stenosis.
 Ref or Reference: [mm]
Diameter of the vessel at the reference point
 Mean: [mm]
Mean diameter of the vessel at the reference point and at the lesion point

Analyzed segment  Min: Minimum diameter/area of the vessel segment

 Max: Maximum diameter/area of the vessel segment

 Mean: Mean diameter/area of the vessel segment

 Sdev: Standard deviation of the mean diameter/area in the vessel segment

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Polygon of Confluence The Polygon of Confluence (POC) is the central portion of a bifurcated vessel seg-
ment.

(1) Polygon Of Confluence (POC)

(2) Bifurcation point
 Prox-POC: Proximal obstruction boundary - Polygon of Confluence

 POC-Dist: Polygon of Confluence - distal obstruction boundary of main branch

 POC-Side: Polygon of Confluence - distal obstruction boundary of side branch

 Obstr Prox-POC: Obstruction boundary between proximal obstruction bound-

ary and start of the Polygon of Confluence

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Miscellaneous  Pos Prox: [mm]

Distance from the proximal segment to the proximal limit, calculated from the
initial marking; used for reproducibility.
 Position Ref D.: [mm]
Position of the reference point measured from the starting point of the seg-
ment
 Obstruction Length [mm]
Length of the obstructed vessel segment
 Obstruction Volume [mm³]
Volume of the analyzed vessel segment
 Plaque Area:
Plaque area of the lesion.
 Plaque Volume:
Plaque volume of the lesion.
 Plaque Symmetry:
Symmetry indicator for pathology; relation between plaque thickness and
maximum plaque thickness of the vessel.
A value of 1.0 means identical plaque thickness on both sides of the vessel
wall, a value of 0.0 means maximum asymmetrical distribution.
 Segment Length: [mm]
Length of the analyzed vessel segment
 Contour Corrected: [%]
Manual correction of the contour

Results of the hemodynamic data

The following data appear as the result of a hemodynamic analysis:

Influence of stenosis on distal blood flow

Not only the degree of stenosis but also its form and length effect the distal tissue.
A 20% stenosis with a “smooth” Gaussian curve form, for example, has less serious
consequences on distal blood saturation than a square form. This results from tur-
bulence in the blood before and after the stenosis.
With the Poisseuille algorithm it is possible to calculate the resistance of the blood
flow as “Rpois” on the basis of the form and length of the stenosis.
The turbulence resistance caused by the form of the stenosis is calculated as
“Rturb”.

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To simplify the calculations, some assumptions are made, for example, regarding
the viscosity of the blood.
 Flow: [ml/s]
Blood flow rate in the vessel
 R Poiseuille Rpois: [mmHg s/ml]
The Poisseuille resistance value based on the form and length of the stenosis,
calculated using the following formula:

C1 ⋅ (extent of the stenosis)

Rpois = (area of the stenosis)2

C1 = 8 x π x blood viscosity; a value of 0.03 g⋅ s/cm² is assumed for blood viscosity

 R Turbulent Rturb: [mmHg s/ml]
Turbulence resistance calculated with the following formula:

1 1
Rturb = C² x ( area of the stenosis
- )²
normal distal area

C2 = blood density / 0.266; a value of 1.0 g/cm³ is assumed for the blood density
 Pgrad: [mmHg s/ml]
Pressure difference before and after the stenosis
It is calculated with the following formula:
Pgrad = Q ⋅ Rpois + Q² ⋅ Rturb
Q = blood flow rate in ml/s

Configuring QCA/QVA/IZ3D
Console (only) You can define a few settings for vascular analysis:
 Select Quant > Configuration from the menu.
– The Quant Configuration window is displayed.
 Click the QCA, or QVA, or IZ3D subtask card into the foreground.

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Common section

Lesion Lesion Position at Local Select whether the MLD is to be calculated at a local
Minimum minimum.
Report Default report Select which report type shall be created by default.
Local Reference Reference method Select the reference method to use.
Local reference Select the required number of possible manual refer-
ence positions.
Average width Determine the average width for manual reference po-
sitions.

Single Vessel section

Default Curve Display Select whether only the diameter curve or the diameter curve and the area curve
should be displayed.
Manual maximum Determine a manual maximum vessel diameter for QVA (50 mm maximum).
diameter (QVA only)
It allows you to restrict contour detection to lower vessel diameters.

Note If the Manual maximum diameter is misadjusted to small values, vessel contours
of larger vessels may not be detected correctly.

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Bifurcated vessel section

(QCA/IZ3D only)

Ostium Ostial threshold ratio In case of a bifurcation, the system is able to determine
whether a side branch is ostial or non-ostial.
This determination is made by comparing the ratio be-
tween the diameter of the branch and the diameter of
the main vessel segment with a configurable threshold.
 If the ratio exceeds the threshold then the branch is
considered non-ostial.
 If the ratio does not exceed the threshold then the
branch is considered ostial.

Closing the window Closing configuration 635

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Quantitative Ventricular Analysis (LVA)

LVA The left ventricular analysis software (LVA) software is designed for analyses of
the left ventricle of the heart in a 30° RAO projection (in plane A), or for biplane
analyses, together with a 60° LAO projection in plane B.
The cardiac phases which are of most interest are the end diastole (= ED) and end
systole (= ES) phases. If you use these phases, you can calculate several values,
e.g. ejection fraction (EF).

Angulation All evaluation parameters depend on correct inputs. Changing the angulation
changes the dimensions of the ventricle, which leads to incorrect results. The
greater the deviation from 30° RAO or 60° LAO, the less reliable the results.

Note The formulas for volume correction (regression formulas) are based on the left
ventricle form in the 30° RAO projection (in plane A) or 60° LAO projection in
plane B
If the projection deviates from this projection, the results may be less reliable!
 Please ensure correct 30° RAO projection (in plane A) or 60° LAO projection in
plane B
The permitted deviation from this projection is configurable. 716

Calibration For a single plane image, calibration is optional. If LVA analysis is performed on an
uncalibrated image then the set of results will be limited.
For biplane images, calibration is mandatory for both planes. Neither single plane
nor biplane LVA are allowed unless both planes have been calibrated.
Calibration 598
We recommend performing analysis with sphere calibration. It provides the best
results.

Note Make sure that the calibration object and the ventricle have the same geometric
acquisition parameters, that is,
 the same focus-to-object and object-to-FD distances

 the same FD size and zoom stage

 the same stand positions

 the same image matrix

Otherwise the results will be less reliable.

For calibration, use an object with almost the same size as the object to be mea-
sured.

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Starting analysis

Selecting a scene
For LVA, single plane or biplane scenes of suitable projections can be used. LVA is
not possible with fluoro or roadmap scenes, not with rotational scenes (e.g. 3D,
DYNAVISION), not with reference images, not with ready-processed images, and
not with Store Monitor images.

Note A patient movement as well as breathing motion between the acquisitions of the
ED and ES images will result in different positions of the left ventricle in relation
to the x-ray system, causing the results to be incorrect.
The patient should not move or breath between the ED and ES phase.

Note LVA results are not accurate for scenes with frame rates below 12.5 f/s.

 Load a suitable scene from the Patient Browser onto the Quant task card by
drag-and-drop or a double click.

Selecting the analysis method

LVA Quantitative analysis for determining the wall motion of

the left cardiac ventricle

Note Depending on the installation, some analysis methods may not be available to
you.

Note If the deviation from the 30° RAO projection is impermissible large, it is not possi-
ble to select LVA. 716

Note Make sure that you have entered Height and Weight of the patient before you
start LVA. If not, the Index values will not be available.

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Console
 Click the LVA icon on the Analyze subtask card.
– The Left Ventricle Analysis window with the Analyze, Info and Corr sub-
task cards appears.

Touchscreen

 Press the Left Ventricle Analysis button.

– The LVA window appears.

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A message appears at the bottom of the image.

Note Pay attention to the messages at the bottom of the image.

They include notes for further operational steps.

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

LVA workflow
 A suitable scene is loaded and displayed in full-screen, not looping.
Selecting a scene 692
 In case of a single plane scene, and for a full set of analysis results, the scene
has been calibrated.
In the case of a biplane scene, both planes must have been calibrated.
Calibration 691
Depending on configuration (by Siemens Service), an LVA analysis is performed
with or without automatic detection of the ED (end diastolic) frame and the ES
(end systolic) frame. Auto ED/ES detection is only possible if the scene contains
ECG data.

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Auto ED/ES An LVA analysis with Auto ED/ES detection is performed in the following se-
quence:
1. Start LVA
Selecting the analysis method 692
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).
Defining contours 701
4. Click the Show ED/Show ES icon.
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).
Defining contours 701
6. Create and store the report.
Report 631

No Auto ED/ES An LVA analysis without Auto ED/ES detection is performed in the following se-
quence:
1. Start LVA.
Selecting the analysis method 692
2. Scroll to a suitable ES frame and define it as ES.
Defining the ES frame 696
3. Scroll to a suitable ED frame and define it as ED.
Defining the ED frame 696
4. Perform contour detection in the ED image: Mark the valve points and the
apex. Defining contours 701
5. Toggle back to the ES image. 706
6. Perform contour detection in the ES image: Mark the valve points and the apex.
Defining contours 701
7. Create and store the report.
Report 631

Note There is a benefit for first marking the ES image and the ED image and then con-
tinuing with automatic contour detection. Both the ED and ES image information
is taken into account for the contour detection.

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Selecting images
The images for defining the contours of the ventricle wall can be analyzed in any
order. However, we recommend starting by selecting the calibration image and
calibrating it, then selecting the ED (end diastolic) frame and ES (end systolic)
frame, then performing ES contour detection, and finally ED contour detection.

Note Selecting ED and ES frames from different heart cycles may result in wrong wall
motion and Ejection Fraction.
 Select ED frame and ES frame from the same heart cycle.

Defining the ED frame

Console Scrolling through the scene: General functions 630
 Click a single step button.

 Click this icon when you find a suitable ED frame.

Touchscreen Scrolling through the scene: General functions 630

 Deflect the mouse joystick.
Or

 Press the scroll back/forward button.

When a suitable ED frame is displayed:

 Press the Mark as ED button.

 Defining contours 701

Defining the ES frame

Console Scrolling through the scene: General functions 630
 Click a single step button.

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 Click this icon when you find a suitable ES frame.

Touchscreen Scrolling through the scene: General functions 630

 Deflect the mouse joystick.
Or

 Press the scroll back/forward button.

When a suitable ES frame is displayed:

 Press the Mark as ES button.

 Defining contours 701

Defining ED/ES frames automatically

Automatic detection of the ED frame and the ES frame is possible if the scene con-
tains ECG data.
It is only possible under the following conditions:
 The scene contains at least 50 frames.

 The scene contains at least four cardiac cycles.

 The scene contains a valid ECG curve with visible peaks stored in the images.

 Click this icon.

Biplane LVA
For images acquired in both planes on a biplane system, you can also perform bi-
plane analysis.

Note For biplane LVA, both planes must be calibrated first.

Biplane LVA must be evaluated on image pairs for ED and ES.

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Contour acquisition is then performed in both planes and the system takes ac-
count of both contours around the ventricular volume.

Biplane LVA workflow 1. Start LVA.

Selecting the analysis method 692
2. Scroll to a suitable ES image pair, check both projections and define them as
ES.
Defining the ES frame 696
3. Scroll to a suitable ED image pair, check both projections and define them as
ED.
Defining the ES frame 696
4. Perform contour detection in both ED images.
Defining contours 701
5. Toggle back to the ES image pair. 706
6. Perform contour detection in both ES images.
Defining contours 701
7. Create and store the report.
Report 631

Note If the deviation from the 30° RAO / 60° LAO projection is impermissible large, it is
not possible to select LVA. 716

Note The software does not distinguish which plane is the frontal plane and which the
lateral plane. LVA is possible in every configuration.
 In Artis biplane Card, the FD of the top stand is mounted to the left of the pa-
tient.
For this reason, plane A is used for the 30° RAO projection and plane B is used
for the 60° LAO projection for LVA acquisitions.
 In Artis biplane Angio, in which the FD of the top stand is mounted to the left
of the patient, plane A is used for the 30° RAO projection and plane B is used
for the 60° LAO projection for LVA acquisitions.
 In Artis biplane Angio, in which the FD of the top stand is mounted to the right
of the patient, LVA is possible by swapping the planes around: plane B is used
for 30° RAO projection and plane A for 60° LAO projection.
The system also takes account of flipping to compensate for head-feet image re-
versal.

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Performing biplane LVA

Console
 Click the icon on the Analysis subtask card to start the analysis.

 Scroll to a suitable ES image pair.

 Click this icon.

 Scroll to a suitable ED image pair.

 Click this icon.

 Click into the plane A image, if necessary.

 Define the ED contour in plane A and correct it if necessary.

– Automatic contour detection 702
– Defining a contour manually 703
 Click into the plane B image.

 Define the ED contour in plane B and correct it if necessary.

– Automatic contour detection 702
– Defining a contour manually 703
 Click this icon.

 Click into the plane B image, if necessary.

 Define the ES contour in plane B and correct it if necessary.

– Automatic contour detection 702
– Defining a contour manually 703
 Click into the plane A image.

 Define the ES contour in plane A and correct it if necessary.

– Automatic contour detection 702
– Defining a contour manually 703

Touchscreen

 Press the ES button.

 Define the ES image pair by pressing the Mark as ES button.

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 Press the ED button.

 Define the ED image pair by pressing the Mark as ED button.

e.g.
 Plane A is selected.

 Define the contour in plane A and correct the contour, if necessary.

 Select plane B.

 Define the contour in plane B and correct the contour, if necessary.

 Press the ES button.

 Select plane A.

 Define the contour in plane A and correct the contour, if necessary.

 Select plane B.

 Define the contour in plane B and correct the contour, if necessary.

Setting the frontal and lateral plane

In rare cases, the projection angles 30° RAO/60° LAO of the images may not be rec-
ognized correctly by the system, e.g. due to an exceptional patient position. In this
case, you can define the images as frontal and as lateral.
 Click the Corr subtask card.

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To mark the frontal plane:

 Click this icon.

To mark the lateral plane:

 Click this icon.

Note For a biplane image pair, Mark plane as Frontal and Mark plane as Lateral are
mutually exclusive, i.e. if one is selected, the other is de-selected and vice-versa.
If Mark plane as Frontal is selected in one plane then Mark plane as Lateral is
selected in the other plane and vice versa.

Defining contours
The ventricle contours serve as the basis for calculating the results of the analysis.
There are two ways of defining the contours for the end diastole and end systole:
either manually or by drawing in the valve plane and the apex followed by auto-
matic contour detection.
You can also draw the wall contour to determine the data of the ventricle wall.

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Automatic contour detection

Console & Touchscreen Starting

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

activated.

Aortic valve 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 aortic 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.

Apex 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.

Correction If the detected contour of the ventricle is not satisfactory, you can make manual
corrections.
 Move the mouse pointer close to the contour you want to modify.
– The mouse pointer has shape of a pencil.
 Start the correction with a single click at the point from which you want to cor-
rect the existing contour.
– A line is drawn from this point.
 Define the intermediate points along the required contour with a single click.

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 Define the end point with a double left click (mouse or mouse joystick) or right
click (mouse joystick).
– In the control room, the Left Ventricle Analysis window switches to the
Corr subtask card

Smoothing

Console In the control room, you can choose one of the following options:
 Soft Correction: The corner points of the drawn curve are smoothed.

 Hard Correction: The drawn contour is unchanged.

The default correction method is applied automatically when marking a correction

to a contour. At system startup, the default correction method is set to Soft Cor-
rection.
 Click an icon to change the setting.

Touchscreen In the examination room, Soft Correction is automatically applied.

Aortic valve and/or apex

You can change the positions of the aortic valve and the apex. It also changes the
contour you defined previously.

Console & Touchscreen  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.
– The contour detection is done automatically as soon as the point is placed.

Defining a contour manually

 An image has been defined as ED or ES image.

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Starting

Console
 Click this icon.

Touchscreen
 Press this icon.

Console & Touchscreen As soon as you move the mouse pointer into the image, it changes shape to a
square.
 Move the mouse pointer onto the upper point of the aortic valve and perform
a single click.
– A line is drawn.
 Move the mouse pointer clockwise along the edge of the ventricle, defining in-
termediate 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.
At the end of the manual contour definition, the valve plane will be indicated by
a line which connects the upper and lower points of the aortic valve. These points
are indicated as small squares.

Correction

Console & Touchscreen You can correct the contour which has been drawn.
 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 cor-
rect the existing contour.
– A line is drawn from this point.
 Define the intermediate points along the required contour with a single click.
– The line changes its direction each time.
 Define the end point with a double click (mouse) or right click (mouse joystick).
– The line is drawn.

Console (only) Smoothing

 Click once or several times on this icon.
– The edges are smoothed.

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Aortic valve

Console & Touchscreen The aortic valve position can also be changed. When the mouse pointer comes
near the valve points, the pointer changes shape to a square.
 When you move the mouse pointer near the points, the pointer turns into a
square.
 Single clicking a point causes the point to start moving with the mouse cursor,
a second click places it.
– The contour detection is done automatically as soon as the point is placed.
After you have changed the aortic valve position, the valve points are automati-
cally connected to the contour again by a line. This line connects the valve points
to the nearest point on the contour.

Drawing the wall contour

Epicardial wall In order to obtain results for wall thickness, wall volume, wall mass, and wall stress
the contour of the epicardial wall must be indicated in the RAO ED image.
You can indicate the epicardial wall either over a short segment or for the entire
ventricle wall.

Console & Touchscreen  You have marked the ventricle contour in the ED image in both projections, as
well as in the ES image in both projections.
 The 30 degrees RAO ED image is being displayed.

 Push the mouse pointer away from the RAO ED ventricle contour to the outer
ventricle wall.
– The mouse pointer changes shape.
 Start with a single click.

 Define the intermediate points along the required contour with a single click.

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

Checking the contour

Loop You can check whether you have selected the correct image more easily in the dy-
namic display, that is, if the heart is beating under the contour (provided a con-
tour has already been drawn).

Console
 Click this icon.

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Touchscreen
 Press this icon.

The scene is replayed dynamically under the contour.

ED/ES As an alternative you can also switch between ED and ES (provided an ED and an
ES image have already been selected).

Console (only)
 Click this icon once or several times.

The ED and the ES images are displayed alternately.

Annotating a contour

Console (only) On the Info subtask card, you can define the heart rate and comment the analysis.
You can:
 Select or enter a research Trial Name

 Enter Free Text

The analysis information entered on the Info subtask card will be cited in the
Report 631, 707.
Entering analysis information 669

Changing the review heart rate

Note In order to get a Cardiac Output, you must enter a Heart Rate.

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 Enter the required heart rate in the Heart Rate field.

See also Configuring LVA 715

Recalling an LVA analysis

Console (only) You can call up the last processed analysis of the same type as long as you do not
restart the system or application, close the patient, or load a different study.
Recall will be available when a previous LVA has been performed on any scene in
the current study.
 Click this icon on the Analyze subtask card.

Note If an image has been calibrated and LVA has been performed and a recalibration
is done, it is mandatory to perform LVA again instead of just using the "Recall”
function.
If ignored, the system will still use the previous calibration factor.

Results (Report)
Preliminary results During analysis, results are displayed in the Preliminary Results window.

Report Depending on configuration, the report consists of one or more pages.

Default report type 716
Report functions 631
Report 631
The report consists of the image with drawn contours, curves and data fields.

Definitions The LVA output parameters are explained on the following pages.

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The following conventions have been used:

 Analysis parameters are shown in boldface type.

 The associated units are shown in square brackets [ ].

Patient, study, General information about the patient, the study and the analyzed scene/frame is
scene, ... shown on the left-hand side (of the first page) of the report.

Calibration  Cal Object:

Diameter of the object used for calibration
Method used for calibration
 Cal Factor:
Pixel size determined by calibration

Index method BSA, BSA1.219 or Weight

The volume values are placed in relation to the body surface area (or the weight)
so that the LV analysis results can be compared with a normal function. To take
account of growth, the body surface area of children is raised to the power of
1.219.

Note You can select the index method with BSA, BSA^1.219, or Weight.
You can also define the Mass Regression formula to use.
Configuring LVA 715

Volume method Algorithm used for calculating the volume:

The method used for volume calculation and the regression constants used are
displayed for the ED and ES volume.
 Simpson (slice addition method)
A stack of thin slices models the ventricle. The volume is calculated for each
slice, using the thickness and diameter. The sum of all slices yields the ventricle
volume.
Volume = Σ π Di2 /4 hs cal3
Di = slice diameter
hs = slice height
cal = calibration factor
 Area length
The ventricle is assumed to be an ellipsoid.
Volume = 8/3 π A2 / L cal3
A = area of ventricle in pixels
L = length of the long semi-axis (in pixels)
cal = calibration factor

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 Quantitative Ventricular Analysis (LVA)

Note The volume method used for single plane operation can be changed.
In biplane operation, the area length method is always used.
Configuring LVA 715

Note If the calibration is not performed correctly, the error in the calculation is raised to
a power of three!
That means, by rule of thumb, that the resulting error is three times greater than
the original error. A calibration error of e.g. 5% results in an overall error of about
15% (since (1+Δx/x)3 ≈ 1 + 3Δx/x ).

The resulting volume must be corrected with the appropriate regression formulae
in order to calculate the ventricle volume.
 EDV regression: ⋅ X

 ESV regression: ⋅ Y

X and Y are the formulae used

Regression formulae
The volume calculated as an initial estimate must be corrected with a correction
formula to determine the correct left ventricle volume.
Various volume correction formulae can be found in specialist literature to correct
the end diastolic and end systolic volumes.

Predefined regression formulae

Various regression formulae are available for the area length method and the
Simpson method.
The regression formula to use can be set in configuration. 715

Note Changing the regression formula directly affects the results.

The results could then have less, or even no, clinical relevance.
 Pay attention to the regression formula.

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Quantification

User-defined regression formula

You can also use your own formula for volume correction:

User-defined formula (single plane and biplane)

EDVcor = a ⋅ EDVcalc + b a, b, c, d : defined constants
ESVcor = c ⋅ ESVcalc + d
Here you are free to define your own optimal formulae for correcting the EDV and
ESV. These factors may differ from the ones used in various volume calculation
methods.

Note When using regression factors other than the ones prescribed, the calculated LV
volume can be incorrect.
The physician is responsible to select the correct regression formula dependant
from the needs.
 Only use the prescribed regression factors, if possible, or select them carefully.

Note If only the EF percentage is required (no volumes etc.), calibration is not neces-
sary. The user-defined formula should be selected with a gradient of a=c=1 and an
offset of b=d=0, both for ED and ES.

Analysis parameters
A number of results are calculated on the basis of the contour data in the ED and
ES image field and the pixel size.
The scene and frame number of the image as well as the volume and the indexed
volume are shown directly above the image.
The ED and ES volumes are calculated with the formula of the selected volume
model on the basis of the contour and the calibration factor.
The volumes are corrected with the selected regression formula.

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 Quantitative Ventricular Analysis (LVA)

After the calibration factor has been calculated and the ED and ES images import-
ed into the report, all other parameters in the report are calculated by the system.
 EF (Ejection Fraction)
Ejection fraction = ratio of the difference between EDV and ESV and the EDV as
a percentage: 100% x (EDV-ESV) / EDV
 EDV [ml]
Volume of the ventricle in the ED phase
 ESV [ml]
Volume of the ventricle in the ES phase
 SV [ml]
Stroke volume of one heart beat, result of EDV-ESV
 EDVI
Ratio of the ED volume and index parameter
 ESVI
Ratio of the ES volume and index parameter
 SVI [ml/m² or ml/kg]
Ratio of the stroke volume and the selected index parameter; BSA, BSA1.219 or
weight
 Cardiac output [I/min]
Cardiac output per minute = stroke volume x heartbeats per minute
 Cardiac index [I/min / m²]
The cardiac output is always indexed with the body surface area (BSA).
= cardiac output/BSA
The index method cannot be changed for this parameter.

Wall parameters If the wall contour was drawn in addition to the ventricle contour 705, the fol-
lowing parameters will also appear:
 Wall thickness
Average thickness of the ventricle wall calculated from the ventricle contour
and the additionally drawn outer ventricle wall contour.
 Wall volume
Volume of the ventricle wall calculated by the ellipse method
 Wall mass
Wall mass calculated by the mass regression formula.
 Wall stress
Wall stress of the ventricle wall calculated by the ellipse method

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Quantification

Miscellaneous  Heart rate [beats per minute]

Heart rate of the patient
 BSA [m²]
The BSA (= Body Surface Area) is calculated from the height and Weight of the
patient (entered during Patient Registration).

Wall motion analysis

Depending on configuration, one or more pages will be added to the report.
Configuring LVA 715
The methods have been described in the specialist literature.

Centerline wall motion analysis

If configured, the Centerline Wall Motion analysis results are displayed on the
second page of the detailed report.
This method is used to describe the displacement of specific points on the left ven-
tricular wall between the end diastolic and end systolic phase. The calculations are
based on images in standard RAO 30 projection as used for EF calculation.
A centerline is defined between the ED and ES contours, and the length of 100
equidistant lines perpendicular to the centerline is calculated. 50 of these lines are
displayed. The software prevents the lines from intersecting each other.
Besides the image with the contours and lines, the Normalized Motion graph is
displayed based on the length of the lines. The length of the lines normalized to
the ED circumference is plotted as a curve against the cardiac wall position.
The vertical axis represents the length of the lines and the horizontal axis the lo-
cation of the measurement points.
The line indicates the average motion, the dot indicates the apex point.
The auxiliary line numbers are indicated on the horizontal axis.
Apart from the actual motion, there is a gray band which indicates the wall motion
parameters of the healthy population.
The Standard Deviation graph shows the deviation of the local wall motion pa-
rameters from the values for the healthy population. The gray band indicates the
average normal parameters ±2 standard deviations, thus expressing a probability
of 95%.

Regional wall motion analysis

The regional wall motion analysis results are presented on a further page of the
detailed report, if configured.

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 Quantitative Ventricular Analysis (LVA)

A graph with the ED and ES contours is displayed. It is divided into five segments,
with a line superimposed through the aortic valve center. This line intersects the
apical center in the mathematical center of gravity.
The points on the ventricular wall are assumed to move towards the central point
at 69% of the distance between the anterolateral edge of the aortic valve and the
apex point in the ED phase.
The regional wall motion analysis model describes the average shortening of the
five radial segments which contribute to the ejection fraction (EF). The sixth re-
gion is the mitral valve region which is not taken into account.
To determine the segments both in the ED and the ES contour, the lower mitral
valve point as well as the center of gravity are determined. The ED and ES left ven-
tricular wall between the anterior aortic point and the lower mitral valve point is
divided into five anatomical wall segments.
The radial lines separating the anterior segments are determined on the basis of
the angle between the anterior aortic valve point and the apex. The radial lines
separating the inferior segments are determined on the basis of the angle be-
tween the lower mitral valve point and the apex.
For the five segments of the left ventricle, the average shortening between ED and
ES is calculated and indicated as a percentage. The contribution of each segment
to the total shortening is displayed in the table.
 Antero-basal [%]

 Antero-lateral [%]

 Apical [%]

 Diaphragmatic [%]

 Postero-basal [%]

The calculations are considered valid for the same standard RAO 30 projection that
is used for the global ejection fraction calculation.

Radial wall motion analysis

The results of the radial wall motion analysis (according to Slager) are presented
on a further page of the detailed report, if configured.
On this report page, the ED and ES contours are plotted with the radial lines super-
imposed. The left ventricle is divided into 20 slices, each slice representing a vol-
ume. The contribution of each slice to the total EF is calculated.
The radial wall motion analysis model describes the displacement of the contour
points along the radial lines between the end diastolic and end systolic phases.
The motion center for the radial lines is the center of the long axis of the ES con-
tour.

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Quantification

Besides the graph with the contours and radial lines, the report contains a second
graph showing the length of the radial line section between the ED and ES con-
tours. The lengths of these sections describing the wall motion are normalized to
the length of the ED radius and plotted as a curve against their position along the
cardiac wall.
The vertical axis represents the normalized lengths and the horizontal axis the po-
sition of the measurement points.
The ES apex point is indicated by a diamond in the graph, and the radial line num-
bers are indicated on the horizontal axis.
Apart from the actual motion, there is a gray band which displays the wall motion
parameters of the healthy population. The gray band indicates the healthy aver-
age value ±2 standard deviations.
The third graph shows the magnitude of the local wall motion parameters com-
pared with the values for the healthy population. The gray band indicates the av-
erage normal parameters ±2 standard deviations, thus expressing a probability of
95%.

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 Quantitative Ventricular Analysis (LVA)

Configuring LVA
Console (only) You can and must define a few settings for ventricular analysis:
 Select Quant > Configuration from the menu.
– The Quant Configuration window is displayed.
 Click the LVA, LVA BIPLANE or UI card into the foreground.

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Quantification

Analysis method  Set the required Index method on the top of the LVA card and set which Wall
motion analyses you want to perform.

Single plane formula

 In the Monoplane area on the LVA card, set which method and which volume
formula you want to use for single plane LVA.

Biplane formula  In the Biplane area on the LVA BIPLANE card, set which volume formula you
want to use for biplane LVA.

Mass formula  In the Mass Regression area on the LVA card, set which mass formula you
want to use for LVA.

Permitted rotation  In the Rotation range area on the LVA card, set for which RAO/LAO range and
range CRAN/CAUD range no warning should be output.
When an LVA analysis is started on an image or image pair which is outside the
permitted range, LVA analysis will not be possible, and the following messages
will be displayed:
– Out of rotation range: RAO/LAO angle is out of range.
– Out of angulation range: CRAN/CAUD angle is out of range.

Default report type  Select which report type shall be created by default.

Threshold  Under Circumferential extent threshold on the LVA card, set which threshold
(standard deviations) should be used.

Heart rate  On the UI subtask card, enter the allowed Heart Rate Range (bpm) within
which the Heart Rate [bpm] on the Info subtask card shall be adjustable.

Further parameters on Configuring the calibration 634

the UI subtask card

Closing the window Closing configuration 635

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 Part: Accessories and Auxiliary Devices

General information

Equipment with accessories

Depending on the system type and configuration, the accessories described in the
following chapters either form part of the standard equipment supplied or can be
purchased optionally.
See current accessory catalog.

Other products/ For operation, technical description, models, and technical data, please see the
components documentation supplied by the manufacturer.

Handling accessory parts

Please handle accessory parts carefully. Prevent accessory parts from being dam-
aged. If a part has fallen down, then always check the part for damage.
Do not use a damaged part and have it replaced.
You should previously inspect in particular those accessory parts which you push
underneath the patient.

Cleaning Special cleaning instructions apply to some accessory parts.

You will find general information in Cleaning and disinfection 37.

Accessories for the patient table

Tabletops
Depending on the system type and configuration, the tabletop can be changed
without tools or cannot be changed.

Tabletop versions The following tabletop versions are available:

 Neuro tabletop

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Accessories and Auxiliary Devices

 Tabletop wide

 Tabletop narrow

 Tabletop long

Changing the tabletop

Removing the tabletop

 Lift the tabletop at the head end and pull it off toward the front side.

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 Mounting the tabletop
 Position the tabletop 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.

Activation of the head holder collision zone

In case tabletops both with and without a head clamp are used, it is possible to
activate/deactivate head holder-specific collision zone.

Console  Examination task card

 Select Acquisition > Head Holder Mounted from the main menu.
– The checkmark indicates the current setting.

Note For systems not using head holders at all, it is possible to permanently disable the
head holder-specific collision zone in service mode.

Tabletop for headrest (Neuro)

The Neuro tabletop is equipped with a dove tail interface for mounting a DORO®
Headrest System Radiolucent (pro med instruments, Freiburg, Germany) with an
appropriate dove tail adapter.
 Fix the head clamp with one arm only to the adapter. Do not use both arms and
avoid a V-shape to the head clamp to have enough space when rotating the C-
arm.
The head clamp is integrated in the collision model. That means there is an audible
noise when collimator or detector moves into the theoretical collision zone and
the speed of movement will be reduced. But the C-arm does not stop thus it may
come into contact with the clamp or the patient.

Note It is in the responsibility of the operator to exercise due care when moving the sys-
tem close to the head of the patient.

Weight of DORO® Headrest System: 3 kg

Maximum load which can be applied to the DORO® Headrest System: 12.5 kg

Note When the Neuro tabletop with DORO® Headrest System is used, deactivate motor-
ized table height movements in programmed positions.
If ignored, the table lift will not move with continuous speed but start and stop.

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Accessories and Auxiliary Devices

Mattresses

For every tabletop version, a thin and a thick mattress is available.

Use Mattresses are used for positioning the patient.

Note Although the mattress is water-proof, blood, or colored disinfectants may leave
stains that cannot be removed.

Note Make sure that the mattress is fixed with the velcro tape.

Covering the mattress

We recommend covering the mattress with a protective plastic sheet for hygiene
reasons.

Cleaning the mattress

 Clean with a weak soap solution and a soft brush.

 Rinse well and dry! Do not store when wet!

Heated mattress
Please refer to the operator manual of the heated mattress from Stihler, which has
been supplied together with the mattress.

In some examination types, the heated mattress may introduce significant, visible
Caution artifacts in the image.
The clinical value of the image is compromised, possibly resulting in misdiag-
nosis and/or image re-take, i.e. unnecessary exposure to dose.
 For exam types, where the image artifacts of the heated mattress may be dis-
turbing, use the non-heated mattress.

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 Accessory rails

Rails for control modules and other accessories are attached to the table.
The two lateral accessory rails can be moved headward or footward to facilitate
operation during head-end interventions or patient transfer.

An accessory rail can be moved by lifting the rail lever at the foot end.
 Headward movement through several latch positions is possible.

 Footward movement (patient repositioning) is not latched.

 On tilt tables, footward movement is limited to 200 mm for collision avoidance

reasons.

Attaching accessories

Accessories may be too heavy for the accessory rails and the table.
Caution Risk of personal injury by falling parts.
 Do not attach more than 40 kg to any accessory rail or to all accessory rails in
total. It includes all accessories, e.g. injector, radiation protection devices!

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Accessories and Auxiliary Devices

Accessory rail extension

The accessory rail extension holds the touchscreen control or other control con-
soles.
Load capacity: 6.2 kg
 Attach it to the accessory rail and fix it with the knobs.

Cable holder
Use The cable holder is intended to reduce the risk of damage for the patient/anesthe-
sia equipment by improving the management of ECG-cables, IV-lines and respira-
tion tubes.
The cable holder can be attached on the C-arm of the floor stand or on an acces-
sory rail of the patient table.

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 The cable holder base can be mounted on the C-arm of the floor stand by a local
technician.

The cable holder can also be attached on an accessory rail of the patient table.

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Accessories and Auxiliary Devices

Attaching the cable holder

 Attach the mounting base to the accessory rail.

 Pull the ring and insert the cable holder to the mounting base.

 Pull the knob on the left and open the flap.

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  Insert the cables and close the flap.

Cable clips

Cable clips

Cable clips for attaching to the tabletop

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Accessories and Auxiliary Devices

Cable clip for attaching to accessory rail

Use For fastening ECG cables.

Attaching cable clips

 Place the ECG cable in the clip and push the clip on the tabletop or the acces-
sory rail.
 Take care that the clips are guided in the groove on the underside of the table-
top.

Connectors
The following connectors may be provided at the foot end of the patient table:
 on the table column at the bottom left and/or right:
for compressed air and ultrasound
 on the top part of the table on the left and/or right:
for injector and ECG (The injector can also be connected to a wall-mounted in-
jector connection box.)
 Country-specific power outlet (see Planning Guide)
Power outlet 73

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 Holder with rails

Holder with rail for head-end of tabletop, wide 2 variants:

Holder with rail for tabletop, wide
Holder with rail for tabletop, narrow

Use You can push one or two holders onto the tabletop. They are provided with acces-
sory rails and can be moved.
Not for use with head-end lower body radiation shield.

Max. additional load 40 kg; reduced accordingly for a long lever

Do not exceed the total load of 40 kg! 721

Mounting the holders

 First push the holder without the head rail from the head end onto the table-
top.
 Then push the holder with the head rail from the head end fully onto the table-
top.

Note During unit movements with tilted table, collisions with the head rail of the holder
may occur.

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Accessories and Auxiliary Devices

Head-end holder

Use For attaching head and shoulder supports and anesthesia drapes to the narrow ta-
bletop
To attach standard rail-mounted Siemens accessories (anesthesia drapes, shoul-
der, head or arm supports), you can attach a holder with accessory rails on both
sides at the head end of the narrow patient table.

Note The head-end holder can only be attached to the narrow tabletop.

Max. load 20 kg

Attaching the head-end holder

 Attach the head-end holder to the head end of the tabletop.

 Turn the lever (on the underside of the holder) upward.

– The clamping mechanism is released.
 Slide the holder clamp rails over the tabletop.

 Turn the lever downward.

– The clamping mechanism locks.

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 Catheter tray, foot-end

The catheter tray can be attached to all Artis systems.

Load capacity: 5 kg
 Attach it to the accessory rail and fix it with the knobs.

Instrument tray

The instrument tray can be attached to both sides of the table of all Artis systems.
It can be turned and adjusted in height for your convenience.
Load capacity: 2 kg
 Attach it to the accessory rail and fix it with the knobs.

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Accessories and Auxiliary Devices

Infusion bottle holder

(2)

(1)

Use For suspending infusion bottles.

Attaching the infusion bottle holder

 Attach the infusion bottle holder to the table rail.

 Secure the infusion bottle holder with locking knob (1).

 Adjust the height of the infusion bottle holder with locking knob (2).

Anesthesia screen holder

Anesthesia screen holder, flexible

Use For attaching sterile cloths as an anesthesia screen between head and abdominal
area of the patient, depending on the tabletop used and the type of examination.
For attachment to an accessory rail of a Holder with rails 727.

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 Positioning aids

Head support with cushion set

Use The head support and the cushions are used to support the head during head ex-
aminations and to minimize motion artifacts.
 Slide it over the tabletop and fix it with two knobs.

 Place the cushions for comfort and reduced head motion.

Note The head support can be used with the narrow tabletop and the thin mattress on-
ly.

Head holder

Head holder for positioning the head of patients in prone position

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Accessories and Auxiliary Devices

Use During interventions requiring the patient to be positioned on the tabletop in

prone position, the head can be positioned on a head pad filled with soft gel ma-
terial.

Handgrips with supports

Use For cardiac exams, the arms are supported in a special position above the head to
permit the flat detector to move as close to the object as possible.
This positioning accessory allows the patient to hold on to the handgrips. The
arms rest comfortably on the supports.
The handgrips of stainless steel and the radiolucent supports are screwed to the
accessory rails of the head-end holder.

Note The handgrips can be attached only to narrow tabletops in combination with the
head-end holder.

Max. load 20 kg

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 Attaching the handgrips

 Slide the mounting block onto the rails.

 Secure with the locking knob.

Attaching the supports

 Insert the supports into the slots of the mounting blocks on the handgrips.

Shoulder supports

Use Shoulder supports are required during exercise ECGs or for patient Trendelenburg
positions of approx. 10° and above. They prevent the patient from sliding down or
off the patient table.
The padded shoulder supports are made from synthetic material that can be
wiped clean and are attached to steel brackets which attach to the head-end hold-
er.

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Accessories and Auxiliary Devices

Note The shoulder supports can be attached only to narrow tabletops in combination
with the head-end holder.

Attaching the shoulder supports

 The shoulder supports can be slid onto the rails of the head-end holder.

Arm rest

Use For metal-free positioning of the patient's arm for DSA of the arm and hand.
The unilateral arm rest has proven valuable for the Sones technique in cardiology
and for angiography of the arm.
It is made of shadow-free, radiolucent carbon-fiber material and is easy to clean.
The 1-m long arm rest is positioned under the mattress at shoulder level on the
right or left and held in place by the patient's weight.

Max. load max. 5 kg

Attaching the arm rest

The patient may be lifted to place/replace the arm rest.

Warning The patient may slip from the table to the ground.
Beware the following steps while positioning the arm rest:
 Secure patient in a stable position.

 We recommend using fastening belts.

 Lift patient only as much as necessary to place the arm rest.

 Use support by another person.

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  Insert the arm rest under the mattress at the level of the patient's shoulder.

Articulated arm support

Use For comfortable arm positioning. The arm can be adjusted in height and length.

Arm rest for vertebroplastic and kyphoplastic proce-

dures

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Accessories and Auxiliary Devices

OR arm rest with holder

Use Arm rest for use in the OR environment. Stable positioning of the arm on the arm
rest is ensured through height-adjustable supports.

Arm holder

Use For comfortable positioning of the arms alongside the patient's body.
Two arm holders allow the patient's arms to be comfortably positioned along the
patient's body, especially on narrow tables.
The arm holders are slipped under the patient's arms on both sides and held in
place by the patient's weight.
The patient's arms can be immobilized with commercially available straps.

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 Attaching the arm holders
 Insert the arm holders under the mattress at the patient's arm level from the
right-hand or left-hand side.

Set of body straps

2 1

3
4

Body strap (left), attaching the strap (right))

Use Two body straps with Velcro fasteners are available for immobilizing the patient.
You can attach them to the tabletop.

Attaching the body straps

 Pull the body strap through the holes in the tabletop.

 Pull the body strap through the loop at the end and fold it back, draw it tight if
necessary, and fasten it with the Velcro strap.
The body straps can also be attached in the way as illustrated below.

> 10 cm

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Accessories and Auxiliary Devices

Note The body straps must be overlapping with Velcro strap at least 10 cm in length for
safe fastening.

Two body straps should always be attached for immobilizing the patient. An addi-
tional arm rest can still be positioned if necessary.

Compression belt

Belt compression device with a radiolucent plastic belt.

Compression is achieved through an easy-to-clean, radiolucent plastic belt by
means of a tensioning device with locking.

Use The compression belt helps to secure patients quickly on the tabletop and also
serves to even out the thickness of body parts.
It is attached to the accessory rails on both sides of the patient tabletop.

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 Advantages of compression:
 Fast and reliable securing of the patient to the patient table.

 Reduction of patient thickness, i.e. improvement of image quality through re-

duction of scattered radiation.

Attaching the compression belt

 Attach the compression belt to the table rails.

3 B A

 Insert the tensioning part (A) of the compression belt into the tabletop.

 Secure the tensioning part with the hand screw (1).

 Release the belt lock by pulling the lever (2) toward you.
– You can now unroll the compression belt.
 Insert the guide part (B) into the opposite side of the tabletop and secure it
with the hand screw (3).

 Pump the lever (2) to tighten the compression belt.

 Pull the lever (2) toward you to release the compression belt.

Adjusting the tension

 Press the locking lever of the compression belt outwards several times.

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Accessories and Auxiliary Devices

Releasing the tension

 Press the locking lever of the compression belt inward.

Accessories for radiation shielding

Compensation filters
Blooming in the skull area is reduced in carotid artery angiography with a compen-
sating filter.
Two compensation filters in key-hole form are available:
 Compensating filter for the adult skull

 Compensating filter for the pediatric skull

Inserting the filter

 Open the tube cover by pressing the buttons on both sides.

 Turn the compensation filter into the correct working position (that is, into the
correct CRAN/CAUD position in relation to the patient).
 Insert the compensation filter into the lower rails of the primary collimator be-
tween the X-ray tube assembly and the dose measuring chamber.
 Push the compensation filter in until it snaps into place so that it is correctly
centered.

Note The compensation filter must be placed beneath the dose measuring chamber,
otherwise the measurement will be falsified.

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 CRAN CAUD

 Close the cover of the primary collimator until you hear it snap into place.

 Make sure that the cover is closed properly.

Note Perform unit movements only with the cover closed.

Removing the filter

 Do not forget to remove the compensation filter after the examination.

Lower body radiation protection

Use The lower body radiation protection is provided to reduce the scattered radiation
in the lower body of the examiner.

Note The swiveling part of the lower body radiation protection may only be pushed
onto the rail of the fixed part of the radiation protection attached to the table col-
umn.

Note The lower body radiation protection is not monitored by the collision computer.
 Avoid possible collisions while performing unit movements.

 You must swivel the radiation protection for the lower body away from the pa-
tient table in extreme LAO/cranial angulations to avoid collisions with the X-ray
tube.

Note If several systems are installed, it might be possible to confuse removable parts of
the lower body radiation protection.
 Use only those parts which belong to this system.

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Accessories and Auxiliary Devices

The heat resistance is approximately 80°C.

Cleaning and Slightly soiled lead leaves and metal parts can be cleaned with a soft cloth and
disinfection lukewarm water with a household detergent.
Heavy dirt and grime should be wiped off with a linen cloth moistened with alco-
hol and then rinsed with clear water.
Remove blood spots best of all with cold water.
Remove contrast medium spots best of all with warm water.
Use a disinfectant commercially available for medical use to disinfect the radiation
protection device.
Then wipe it off with clear water.

Head-end lower body X-ray protection

Use Lower body radiation protection for procedures, e.g., TIPSS, in which the examin-
er is at the patient‘s head.
Only for use with wide tabletop.

Attaching
 Slide the radiation protection over the wide tabletop as shown in the image.

 Adjust the sides to your needs.

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 Lower body radiation protection

(3)

(1)
(4) (2)

(5)

The fixed part of the lower body radiation protection with a rail is permanently in-
stalled by Siemens Service on the table column.

Note The lower body radiation protection is not suitable for supporting loads! It means,
it cannot bear additional weight of, for instance, lead-rubber aprons.
It could pull down the lower body radiation protection.
 Do not hang any objects on it.

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Accessories and Auxiliary Devices

Upper body radiation protection

Use The radiation protection window is used to reduce exposure of the examiner's up-
per body to scattered radiation. It is especially designed to decrease the exposure
of the examiner's eyes and thyroid to radiation.
The radiation protection window can be moved in any direction.

Cleaning and You can clean a slightly soiled lead glass pane with a lukewarm detergent solution
disinfection and a soft cloth.
Heavy dirt and grime should be wiped off with a linen cloth moistened with alco-
hol and then rinsed with clear water.
Remove blood spots best of all with cold water.
Remove contrast medium spots best of all with warm water.
Use a disinfectant commercially available for medical use to disinfect the radiation
protection device.
Then wipe it off with clear water.

Sterile cover Both window designs can be provided with sterile covers; contact your Siemens
sales representative.

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 Using the upper body radiation protection

Note The upper body radiation protection is not suitable for supporting loads! It means,
it is not suitable for carrying any additional weight.
It could pull down the upper body radiation protection.
 Do not hang any objects on it.

Note During unit movements, especially swiveling movements, there is a risk of colli-
sions and damage (could break off and fall down).
 Watch out for possible collisions while performing unit movements.

Positioning
The radiation protection device can be moved along the ceiling rail:
 Pull down and turn the brake handle.
– You can move the carriage freely in the ceiling rail.
 Move it to the required position.

 Release the brake handle.

 Position the radiation protection window so that it protects the examiner's eyes
and thyroid.

Note For patient positioning and when not in use, the upper body radiation protection
should be positioned outside the swivel range of the system.

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Accessories and Auxiliary Devices

Protective shield for Large Display

The protective shield protects the front side of the Large Display (LD) from me-
chanical forces. It is lightweight, made up of plexiglass and has an anti-glare
effect.
The protective shield can be easily attached or removed.
It hooks on the upper rim of the LD.
The bottom of the shield has a magnetic tape, which keeps the shield attached to
the LD.

Note Depending on the view angle toward the panel, there is image unsharpness as
well as reduction in contrast.
 We therefore recommend removing the shield when evaluating diagnostic
images.

 When not in use, remove it and store it in a safe place.

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 Examination lamps

(1)

(1)

(2)
(2)
Examination lamp 3-light OR lamp

(1) On/off switch

(2) Turn to adjust beam focus

Use An examination lamp is used to illuminate the puncture point. It is attached to the
carriage with a support arm, which can be moved freely in the ceiling rail.
An examination lamp may also be mounted on the adapter of the radiation pro-
tection for the upper body with a separate support arm.
The light can be dimmed, and the light beam can be focused.
Depending on the system configuration, the light is either turned off by "X-radia-
tion on" or it can be turned on or off using the footswitch.

Note During unit movements, especially swiveling movements, there is a risk of colli-
sions and damage.
 Watch out for possible collisions while performing unit movements.

Releasing the brakes / locking the brakes

Upper body radiation protection 744.

Positioning
 When the brakes are released, you can move the carriage freely along the ceil-
ing rail.

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Accessories and Auxiliary Devices

Switching on/off
The examination lamp is not automatically switched on when the system is
switched on. Generally the light is switched on/off directly at the lamp:
Depending on the configuration or installation, the light can be turned on or off
during the examination with the footswitch or by radiation on/off.
In a hospital installation, the examination lamp may be switched by the room light
contact.
 Press the on/off switch (1)

Dimming the examination lamp

 Turn the black knob (1).

Focusing the light beam

 Turn the handle (2).

Note The handle is also available in a sterilizable version.

Injector
Installation The injector is mounted in different ways depending on the system combination.
 Can be moved on floor stand, with connection at examination table

 On the wall with a special wall bracket

 Injector head ceiling-mounted and mobile on the rails of the radiation protec-
tion or permanently attached to a column on an articulated arm similar to the
radiation protection holder. The control console is installed in the control room
or the examination room.
 Injector head with holder on the accessory rails of the patient table

Note Although a system might offer several different possibilities for connecting injec-
tors, only one injector may be connected!
Only use injectors approved by Siemens.

See also the user manual for the contrast medium injector for details on installa-
tion and injector accessories.

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 Sterile covers
Disposable ready-sterile covers and protective hoods can be supplied to cover sys-
tem components.

Please note the expiration date on the package.

Disposable protective Suitable for:

hoods
 Radiation protection window with a round cut-out

Disposable covers Round shape, 50 cm diameter

size 1
Suitable for:
 System control consoles

Disposable covers Rectangular shape, 75 cm x 80 cm

size 2
Suitable for:
 System control consoles

 Imaging system control console

 Flat detector (CARD)

 Injector head

 Injector control console

 Upper body radiation protection

 Single plane footswitch

Disposable covers Rectangular shape, 90 cm x 90 cm

size 3
Suitable for:
 Flat detector (Angio)

 Examination lamp

Disposable covers Round shape, 115 cm diameter

size 4
Suitable for:
 all radiation protection shields without cut-out

 Megalix tube and collimator

 System control consoles

 Imaging system control console

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Accessories and Auxiliary Devices

Information about using sterile covers

Commercially available sterile and sterilizable covers can be used for the flat de-
tector, X-ray tube assembly with primary collimator and scattered radiation pro-
tection.

FD  Attach sterile cover to the FD.

correct incorrect

Example for fitting of the sterile cover

Note Please make sure that the sterile cover is only fitted directly around the FD
(see figure).
The cover must not be fitted around the slide of the collision protection of the FD
because it can cause system operating problems.

Collimator  Attach sterile cover to the x-ray tube assembly with primary collimator.

Note Please make sure on systems with FD 30x40, that the sterile cover is only fitted
directly around the collimator case (because of the collimator rotation).
The cover must not be fitted simultaneously around the collimator case and the x-
ray tube assembly case.

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 DCS  Attach sterile cover to the DCS handle.

Artis zeego  Attach sterile covers to the C-arm, to the FD, to the x-ray tube assembly with
primary collimator, and to the flexible hose.

Example

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Accessories and Auxiliary Devices

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 Part: Service Functions

Maintenance status
To ensure smooth operation, your system should be serviced at regular intervals.
The system provides a Ddialog box indicating when your system must be serviced
next.
 Select Options > Maintenance... from the main menu.
– The Maintenance Status dialog box appears.

The bar in the progress indicator shows the utilization of the system in %.
 At about 80%, you should call Service.

Note As an option, we offer a utilization-based service contract.

 Please contact your Service partner.

Local service
In addition to the user-specific configuration, there is a configuration level for au-
thorized users which is protected by a password.

Note Local service is only available to Siemens Customer Service or users who have ac-
quired a service license.

 Select Options > Service > Local Service... from the main menu.
– The Authentication dialog box appears.

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Service Functions

Depending on the configuration access rights in your system, several service levels
are available.

Note For further information, please contact Siemens Customer Service.

Logbook
Your system has a logbook that records all events which are relevant to the system
and application, e.g. error messages.
 Select Options > Service > Event Log... from the main menu.
– The Event Log dialog box appears.

Example

Note These messages are useful for service technicians.

For example, if you call a service technician about a problem, they might ask you
to call up this function.

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 Having messages displayed
You can select the type and period of the messages that you want to have dis-
played.
 Select, for example, "Severity" "All" (or "Warning") and "Facility" "Service" (= rel-
evant errors) and then click Go (bottom right).
– The relevant error messages are displayed.

Note The "Domain" "Application" contains the messages of all system applications, such
as the imaging system, touchscreen console, Assist screen, etc.
The "Domain" "Customer" contains remote service activities.
The data in "Domain" "Security" and "Domain" "System" are only important for Ser-
vice.

Remote software update and virus

protection
Note Virus protection is not released for all systems and is depending on installed SW
versions.

Updating your system with virus pattern, hotfixes, and software updates
In order to ensure fast provision of product enhancements and optimal protection
of your Siemens system against virus attacks, your system will receive software
updates and security-relevant hotfixes via Siemens Remote Service (SRS), if your
system is connected. Hotfixes are update packages of files meant to close a vul-
nerability in the operating system. Siemens assesses the security relevance of
each new hotfix released by the operating system manufacturer for each of our
systems. Siemens comprehensively tests and approves the hotfix before pushing
it via the SRS infrastructure onto your system. When the system gets started, it au-
tomatically checks whether a new software update or hotfix is pending for instal-
lation.

Using the virus scanner

Virus protection is not enabled on all systems. If you wish to enable Siemens Virus
Protection for your system, please contact your local Uptime Service Center or Sie-
mens sales representative.

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Service Functions

OfficeScan™ is configured to check your system for known viruses automatically ,

ensuring that the primary functions are prevented from being slowed down. As
long as the virus scanner does not detect a virus, the tool will run entirely in the
background, without disturbing your clinical work at any time.
If a virus is detected, you will receive a pop-up message with information on how
to proceed. See section "Dealing with virus infection" for more details.

Updating the virus scanner

In order to ensure optimal system protection, your virus scanner will continuously
receive automatic remote software updates with the latest Siemens validated vi-
rus pattern files. Siemens will transfer these updates onto your system via the Sie-
mens Remote Service infrastructure. During the next start of the system, it is
automatically checked if a new software package is available for installation.

Virus pattern, hotfix, or software update available

One of the below windows Software-Distribution or Software Distribution / In-
stallation will be displayed depending on the software version.
With server-based systems of the new generation, the IT Admin will be notified of
the remote software update by email.

Software installation window 1 (left) and window 2 (right)

It is recommended to install any remote software update immediately after start

of the system.
With newer software versions, an icon with a blinking exclamation mark is dis-
played in the status bar when a remote software update is available.
 Do not to click the icon during a patient study.

 By clicking it, the window software installation will open.

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 If it is called up with the icon later in the day, it is recommended to close all patient
studies before installing the remote software update.
In the event of a hotfix or software update installation, a reboot of your system
may be required to make the update effective. The dialog window indicates if a
reboot is necessary to complete the installation procedure.

Installing virus pattern file updates silently

(not available with all systems/software versions)

Since virus pattern file updates occur more or less daily and are installed within a
couple of seconds, you also have the possibility to define once that all future virus
pattern file updates are installed without specific notification and without asking
you to confirm the update each time.
On server-based systems, it will be done automatically.
 If you wish to accept the silent installation of virus pattern file updates, check
the window:

 Click the check box to confirm the installation of the pending update and the
silent installation of all future virus pattern updates.

HELP Provides a description of the fields.

Summary/Content A brief description of the package contents or special
information regarding the software package.
DESCRIPTION Provides detailed information about the remote soft-
ware update (optional, not supported by all software
versions)
Yes / Install Starts the software installation
Later / Defer / Defer All Defers the software installation until the next reboot
Estimated installation Time for the software installation; the time for the re-
time boot, if necessary is not included.

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Service Functions

Installing the hotfix or software update

Software installation will disturb system functions

Caution Interruption of patient treatment and loss of patient data
 Do not start installation during patient treatment

 Click the Install or Yes button to confirm the installation of the update. The in-
stallation will start immediately and its progress will be displayed in the lower
part of the dialog window.

Or
 Click the Defer, Defer All or LATER button if you do not wish to install the up-
date right now. The dialog box will close without installation.
As long as the update is not installed, the dialog window Software-Distribution
and the icon will be displayed after each system start, asking you to carry out the
installation.
Siemens advises you to carry out hotfix and software update installations imme-
diately. If you have to postpone an installation, make sure that you catch up on it
as soon as possible. Otherwise, your system is on a lower security level and more
vulnerable to outside attacks.

Finishing the installation

Successful installation Updates which do not require a reboot:
If the installation of the update has been completed successfully, you will receive
a corresponding message.
 Click OK to finish the installation procedure and close the dialog window.

Updates which require a reboot:

With some newer software versions, the system will automatically reboot after up-
date installation without display of a message; therefore no confirmation is nec-
essary anymore.
With some older software versions, the system will reboot once you have clicked
OK and will then be available for use.

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 Failed installation If the installation of the update has failed for any reason, you will be notified with
a corresponding message like following:

The installation of the hotfix failed. This failure has been reported automati-
cally to Siemens Uptime Services for resolution already. Please do not contin-
ue working on this system and call the Uptime Service Center for further
information and assistance.

Installation of the Update package failed

Caution Failed software installation will result in an undefined system state
 Do not use the system and call the Uptime Service Center

 Click OK to close the dialog window.

Dealing with virus infections

If the virus scanner has detected a virus on your Siemens system, the following
messages with similar text will be displayed.

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Service Functions

The information on the detected virus will be automatically reported via remote
to the Siemens Uptime Service Center for resolution action.
If the system is infected by a virus, proper function cannot be guaranteed. Any
procedures currently underway should be completed; afterwards the system
should not be used anymore. Please contact your Uptime Service Center to receive
all relevant information on how to proceed, before using your system again.

Remote service
Your system can also be serviced by Siemens Service via a modem. To permit that,
you must allow Siemens Service access to your system.
In the Service Remote Access window, you can assign access rights to Service to
enable them to perform maintenance.
 Select Options > Service > Remote Service... from the main menu.
– The Remote Service Access Control dialog box appears.

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 Defining the access rights
You can define the following types of access:
 Full Access
Service is given full access rights to your system.
 Limited Access Permanent
Service is given limited access,
that is, they can call up the error messages and reset passwords.
 Limited Access
Like Limited Access Permanent, but access is limited to a certain period.
 No Access
Service is not given access to your system.
 Click the option you require.

 Click OK.
– The settings are confirmed.

Note Remote service access is only possible from “trusted hosts” (systems with which
your syngo system has exchanged “proved certificates”).

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Service Functions

Note You cannot work with your system as long as you have assigned full access rights
(Full Access) to Siemens Service, i.e. as long as maintenance is in progress.
 Select Limited Access or No Access and then click OK if you want to continue
working with your system.

Terminating remote service without consultation with the service engineers.

Caution Terminating the remote service ends all service processes and may cause sys-
tem malfunctions.
 Always coordinate termination with the service engineer before terminating
remote service.

Note For further information, please contact Siemens Customer Service or your system
administrator.

Status display Icons appear on the status bar to indicate the status of remote service access:

 Remote service access is not enabled.

 Remote service access has been enabled.

 Remote service access has been enabled and is active,

that is, Siemens Service is accessing your system.

Providing images for Service

Sometimes Service will require an image to be able to diagnose problems. You can
save single images in a folder on your system hard disk for this purpose. Service
can then fetch them from there.
 Display the image you require in full-screen display mode.

 Select Options > Store Service Image from the main menu.
– The image is copied to the service folder.

Remote assistance
If you need help or support from a Siemens service technician, the technician can
access your system via the secure Siemens Remote Service (SRS) environment.

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 syngo Remote Assist allows Siemens customer service to access and to control
your Artis system from outside the network. The service technician has access
with a remote connection via Wide Area Network (WAN).

Note Do not perform a patient examination during remote assistance.

You can grant access to several service technicians at the same time.

Access modes You can grant access to your system either in View Only mode or in Full Access
mode:
 View Only mode (default): The remote user is not able to perform keyboard or
mouse actions. The remote user can only point to items on the screen with a
separate mouse cursor.
 Full Access mode: The whole screen is visible without restrictions. The service
technician can operate your system.

Establishing a connection
 Notify Siemens customer service that you need support.

If a remote connection via syngo Remote Assist is required, the service techni-
cian generates a single-session password - the session number.
 Select Options > Service > syngo Remote Assist... from the main menu.
– The syngo Remote Assist dialog box opens.
If there are sensitive data on your system, a corresponding message box is dis-
played - referring to privacy rules for these data.
 Enter the session number in the Session Number entry field.

 Click the Login button to activate the connection.

If remote assistance has been started successfully, the single connection tray icon
appears in the status bar. The service technician has access to your system in View
Only mode. The service technician can only point to items on the screen with a
separate mouse cursor.

Note You can click the tray icon at any time to get all information on the current con-
nection.

Activating a multi-user access

If another service technician wants to access your system, the single connection
tray icon in the status bar starts blinking.

 Click the single connection tray icon in the status bar.

– A corresponding request appears in the syngo Remote Assist dialog box.

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Service Functions

 Click the OK button if you agree to further access.

If remote assistance is started successfully, the multiple connections tray icon is

displayed in the status bar. Another service technician has access to your system
in View Only mode. The service technician can only point to items on the screen
with a separate mouse cursor.

Granting full access

If a technician wants full access to your system, the current remote assistance tray
icon in the status bar starts blinking.
 Click the tray icon in the status bar.
– A corresponding request appears in the syngo Remote Assist dialog box.
 Click the OK button if you agree to grant full access.

If transferring control access is started successfully, the remote user can operate
the system. Only one remote user can operate the system at the same time. If you
allow a remote user to operate the system, another remote user who is operating
the system will lose control automatically.

Restricting access to View Only mode

 Click the tray icon in the status bar.
– The syngo Remote Assist dialog box opens.
 Click the View Only button.

Or
 Press Ctrl + Alt + Backspace on your keyboard.

Disconnecting remote assistance

You can terminate the remote session at any time. If the connection is inactive for
a certain time, the connection is canceled automatically.

Note Terminating the remote service ends all service processes and may cause system
malfunctions. Therefore, always coordinate termination with the service engi-
neer.

 Click the remote assistance tray icon in the status bar to open the syngo Re-
mote Assist dialog box.
 Click the Disconnect button.

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 Test images
Test images for use in calibration of the monitor and/or to test the hardcopy cam-
era are stored in the system. Test images are only available in plane A.

Note You will find the test images under the patient "Service, Patient".

Note Please note that test images can be modified by users.

If test images are used for test of image quality, make sure that always the same
image-processing parameters (e.g. windowing) are used.
Only with the same image-processing parameters the results of quality tests can
be compared to each other.
We recommend restoring the original images (see below) before starting a quality
test.

Examples

Note Some test images are copyrighted by the AAPM and are subject to their rules and
regulations.
Citation for TG18 Report:
Samei E, Badano A, Chakraborty D, Compton K, Cornelius C, Corrigan K, Flynn MJ, Hemminger B, Han-
giandreou N, Johnson J, Moxley M, Pavlicek W, Roehrig H, Rutz L, Shepard J, Uzenoff R, Wang J, Willis
C. Assessment of Display Performance for Medical Imaging Systems, Report of the American Associa-
tion of Physicists in Medicine (AAPM) Task Group 18, Medical Physics Publishing, Madison, WI, AAPM
On-Line Report No. 03, April 2005.

Citation for TG18 Executive Summary:

Samei E, Badano A, Chakraborty D, Compton K, Cornelius C, Corrigan K, Flynn MJ, Hemminger B, Han-
giandreou N, Johnson J, Moxley-Stevens DM, Pavlicek W, Roehrig H,� Rutz L, Shepard J, Uzenoff RA,
Wang J, Willis CE. Assessment of display performance for medical imaging systems: Executive summa-
ry of AAPM TG18 report. Medical Physics 32(4):1205-1225, 2005.

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Service Functions

Restoring test images

If test images have been deleted by mistake, it is possible to restore them:
 Select Options > Load Test Image from the main menu.
– The test images are restored in the Patient Browser under the patient "Ser-
vice, Patient" and can be used again.

Image quality of the camera

With the camera test, you can check both the image quality and the settings of the
camera. You can also film test images of quality measurement and thus comply
with record retention regulations.
The optimum image quality of the camera was set during installation. Do not
change these settings.
 Please note the following points :

 Use the correct film type (emulsion number).

 Keep the developer bath at a constant temperature.

 Use the correct chemicals.

 Follow the development instructions supplied by the film manufacturer.

Test film After installation, a test film is recorded and evaluated. The results are summa-
rized in a table. These values are used as reference values for the daily quality
check of the camera.

Note If the equipment or the emulsion number of the film is changed, the camera must
be readjusted by a customer service technician who is authorized to do so. After
it, another camera test is required.

Starting the camera test

You can start the camera test in the PostProc task card, for example.
 Transfer the test images of the patient "Service, Patient" from the Patient
Browser to the PostProc task card.
 Film the test images of the service patient.

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 Providing images to the image evaluation
program
For service purposes, you can provide images to the program Win NIE = Windows
Numerical Image Evaluation in a folder on the system hard disk.
 Display the image you require in full-screen display mode.

 Select Options > Copy to WinNIE A/B from the main menu
(the last letter is the acquisition plane on biplane systems.).
– The image is copied to the WinNie folder.
– Any image already in the target folder is overwritten.

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Service Functions

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 Part: Troubleshooting
System Messages / Troubleshooting

System messages
Locations System messages are displayed:
 on the Assist screen / message bar (2 lines)
– Stand/table message line
– System status message line
See also Messages 296
 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)

Message lines 770

 Please pay attention to these messages.
See also Monitoring status displays 294

Types There 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

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Error handling
In case of a fault or during startup/shutdown, system status messages are dis-
played that indicate restrictions.
 The examination-specific messages indicate “rejection” if an operator attempts
an action that the system is currently unable to execute.
Example: “NO XRAY, please wait”
 The status messages indicate currently existing “operating restrictions” for as
long as the restriction exists.
They are used to show the status of system functionality and prevention of er-
rors, e.g defective hardware or network not available.
Example: “Buffer for < 4 Acq Runs”
 Operating restrictions that only the Service Center can remedy are marked with
“... SC ...“
Example: “NO XRAY: call SC”
... with fault messages marked “... SC” 794

Message lines
Line in lower part of im- This line consists of two lines occupying the same space:
age
 In the foreground: Examination-specific messages

 In the background: Messages for user guidance

Note The line with the user guidance messages is only visible if no message is being dis-
played in the line for examination-specific messages.

User guidance messages contain instructions from the Artis imaging system, e.g.
if you are working on the PostProc or Quant task cards. You can also release many
of these functions on the touchscreen control in the examination room. For that
reason, this line is also visible in the examination room.
The examination-specific messages provide comments about rejection or cancel-
lation of radiation or changes in examination programs or parameters, e.g. the se-
lection of PERI or DYNA.
Messages of this type are cleared again after a short time; any user guidance mes-
sages will then reappear.
Examination-specific messages are cleared as soon as an attempt is made to re-
lease radiation or change parameters/programs.

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Stand/table message The stand/table message line (= upper line on the Assist screen) also consists of
line two lines occupying the same space which display messages about the stand and
table:
 In the foreground, unit operations are rejected,
e.g. “Movement: End reached”, “Wrong direction”
 In the background, positive feedback messages/states are displayed, such as
“Position reached”, “Manual image rotation: active”, “DYNA: washout
phase”, ...
A rejection message is cleared when you release the incorrectly deflected joystick;
the message in the background reappears.

System status message The top line in the status area on the Live screen (= lower on the Assist screen) is
line the line for status messages.
Here, restrictions about the availability of system functions are displayed:
“Memory full”, “BYPASS FLUORO”, “Full access”, ...
This restriction is displayed for as long as it applies. If more than one restriction is
pending at one time, only the most important one is displayed.

Example 1 During bypass fluoroscopy it is irrelevant whether the memory is full or not.
Bypass fluoroscopy 782

Example 2 If the reason for the bypass fluoroscopy is the setting “full access”, it is displayed
so that the reason for bypass fluoroscopy can be seen.
Remote service 760
If two or more restrictions are of equal importance, they are displayed alternately.
When the Large Display is not connected to the Artis imaging system, e.g. during
start-up, asterisks “***” are displayed.

Line 2 in the The center line in the status area on the Live screen displays status messages of
status area the imaging system, e.g. messages about print or send jobs.

Note There is usually not enough space to display the whole message text.
 Move the mouse pointer onto the message line to have the text displayed in its
full length.

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Line 3 in the If functions are executed in the background, you will see the relevant application
status area as an icon in the third line.

Function Active function Faulty function

Remote service

Remote service is enabled Remote service is deactivated

Remote service is active

Sending

Data is being sent It is not possible to send data

Import

Data is being imported It is not possible to import data

Export

Data is being exported It is not possible to export data

Film/Print

Images are being filmed/printed It is not possible to film/print images

Status line in windows Messages and information are also displayed in the bottom line of some windows,
e.g. the Patient Browser.

Resource display
Your system monitors the memory usage and the storage capacity of the main da-
tabase, the scheduler database and the exchange board (virtual memory).
By the storage capacity icon you can see how much space has already been taken
up in the local database. If the filled capacity rises above a configurable limit (de-
fault 95%), the icon changes color from green to red.
If you move the mouse pointer to this icon, the percentage of storage capacity al-
ready taken up is displayed.
 Click the icon to display an overview of the various resources.

Virtual memory By the blinking storage capacity icon in the status bar you can see that the virtual
memory is filled.
– The Resource Monitor dialog box is displayed.

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Insufficient system resources may lead to an instable or blocked system.

Caution Risk that the system is not available in emergency cases.
 Do not ignore the resource warning icon.

 Follow the instructions. Restart the system, if necessary.

 If the error remains, call Siemens Service.

Note Make sure that the system is restarted at least once a week (Restart System or
shutdown and restart later).
Restarting 789
During restart, a check is performed and system resources are optimized.
If it is ignored, system resources will decrease and limit the overall performance.

Action history
Actions executed by the program are logged together with information about
whether the individual steps were completed successfully or whether an error oc-
curred. You can query a list of the last entries in the history at any time.

Displaying messages
 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 associated status window.

Defining the number of messages

 Right-click on the second line of the status area.
– The History dialog box opens.
 Set the number of messages and confirm with OK.

Messages, causes, measures

This section lists and explains some typical types of messages.

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Messages for unit movements

Message  “... Activate stand movement“
A movement to a programmed position or a procedure must be performed.
 Activate the required operating element, i.e. C-arm joystick or footswitch pedal
for handsfree movement.

Message  “... completed”

 “Position reached”
A movement to a programmed position or a procedure has been completed.
 Continue with the next step (of the examination).

Message  “Automatic run: Move ...“

During movement to a programmed position, a manual movement is required
to continue the examination.
 Perform the necessary manual steps.

Message  “... GUARD ACTIVE”

A collision protection sensor has responded due to contact with an object or
person.
 Remove the obstacle or execute a movement away from the obstacle.

Message  “Collision with ...“

The collision computer has noticed an object approaching the monitored area.
 Remove the obstacle or execute a movement away from the obstacle.

If you continue to operate the respective operating element, the unit automatical-
ly moves in the opposite direction until the collision is averted.
 Release the operating element briefly.
– After that, you can continue to work normally.

Message  “Movement: End reached”

The unit has reached the limit beyond which it can no longer continue the
movement.
 Execute a movement in the opposite direction, if necessary.

Message  “Automatic run: Position reached”

An automatic run has been finished, e.g. to a system position, or during 3D or
DYNAVISION.
 Continue your examination.

Message  “Automatic run: Position not reached”

An automatic run has been interrupted by releasing the operating element.
 Actuate the operating element again.

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Message  “Automatic run: Position cannot be reached”

The movement cannot be continued, e.g. due to a possible collision on direct
path.
 Release the operating element and actuate it again.

If message occurs again:

 Deselect automatic run, if necessary.

 Drive the units manually to the desired target position.

Message  “Wrong direction”

 “... wrong direction”

The unit has reached the limit beyond which it can no longer continue the
movement, or another direction is required for the examination.
 Deflect the operating element in the opposite direction.

Message  “... release ...“

A movement or radiation release is no longer required.
 Release the operating element.

Message  “Stand/table error, use emerg. stop to reset”

The unit was informed that a movement has been made without pressing a
dead man's grip (DMG) and therefore automatically released an emergency
STOP because of the danger of collision.
Safety equipment 171
 Press an emergency STOP button and disengage it again.
Red emergency STOP buttons 41
Once the unit movements are functioning normally again and the message has
disappeared, you can continue to work.
If the message comes up frequently:
 Contact Siemens Service.

Message  “Reduced stand/table speed, SC”

The system has detected a misalignment of C-arm or patient table. All unit
movements are performed with reduced speed.
If the message comes up frequently:
 Contact Siemens Service.

Message  “Deactivate DMG or call SC”

A dead man's grip (DMG) was active during start-up, accidentally or due a de-
fective contact, and therefore automatically released an emergency STOP be-
cause of the danger of collision.
Safety equipment 171

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 Check if any joystick, a membrane key or the hands free pedal is pressed.

 Press an emergency STOP button and disengage it again.

Red emergency STOP buttons 41
Once the unit movements are functioning normally again and the message has
disappeared, you can continue to work.
If the message does not disappear:
 Contact Siemens Service.

Message  “TOO MUCH POWER CONSUMPTION”

The temperature of the transformer is too high, e.g. due to excessive stand and
table movements.
 Stop or reduce system movements, if any.

If the message remains:

 Check the ambient conditions.

 Allow the system to cool down.

If message occurs again without any identifiable reason:

 Contact Siemens Service.

Message (Artis zeego)  “Limited stand/table movement, wait”

Communication with the stand has not yet been established.
This message is normal during start-up.
 Wait until the message disappears.

If the message does not disappear:

 Contact Siemens Service.

Message (Artis zeego)  “Stand test necessary within # days”

 “Reduced stand/table speed, Stand Test necessary”

The system requests for a brake test regularly in a configurable time interval.
 Perform brake test.
Checking the brakes (Artis zeego) 152

No unit movement possible!

Note Pay attention to the direction in which you have to deflect the operating element.

Message?  Please pay attention to the information on the Assist screen / message bar.
Messages for unit movements 774

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Emergency STOP?  Check the emergency STOP buttons.

Red emergency STOP buttons 41

Collision protection  Make sure that no collision protection sensor has responded.
sensor? Daily checks 148

Movements blocked? When unit movements have been blocked manually, the following message is dis-
played:
“Movement manually disabled: 'Block Movement' active!”
 Check the Block Movement function.
Blocking unit movements 263

Patient?  Do not forget to rescue the patient if it is not possible to remedy the error.
Rescuing the patient in an emergency 53

Resetting the unit computer

If all these measures do not help, then there could be an error in the unit computer
(SCU). In order to restore a defined status, you can reset the computer:
 Simultaneously press the buttons I and II as well as the emergency STOP but-
STOP ton 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 .

Stand battery charging (Artis zeego only)

Message  “Stand battery charging: DO NOT POWER OFF”

The system has been switched off for a longer time. The backup battery of the
Artis zeego stand needs to be charged.
 Do not power off, if possible.

Stand battery empty

Caution Risk that the patient cannot be removed from the patient table and that in
case of a system shutdown, it will not come up anymore without service.
 Do not switch off the system while the message “Stand battery charging: DO
NOT POWER OFF” is displayed.
If for any reasons a power off is required in this state:
 Take care that the stand is in a position where the patient rescue is possible
without the need of any stand movement.

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Note You may power off for a short time and then power on again. But if you power off
for several days or longer, the backup battery might be discharged completely.
Then, stand movements will be blocked!
 In this case, contact Siemens Service.

No communication!
Message  “NO COMMUNICATION”

 “No communication with ...”

 “High Speed Link Problem, SC”

The “NO COMMUNICATION” message is normal during start-up.

If this type of message appears during normal operation, it is possible that a com-
ponent has failed, is powered down or a network connection is faulty.
 Check the relevant component.

If it is not successful:
 Shutdown and restart the relevant component or/and the system.

If the message reappears:

 Contact Siemens Service.

Restart necessary!
Some faults make it necessary to restart the imaging system or the entire system.
For most faults, it is enough to restart only the imaging system.

Message  “No Acq: Restart imaging system”

 “No Fluoro: Restart imaging system”

The system is in a state that makes a restart necessary.

 Close the imaging system application and restart.
Restarting 789

Note Pay attention to Emergency operation 781

 Register the patient again.

 Continue with the examination.

Message  “No Transfer: Restart the imaging system”

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An error occurred during database access.

 Restart the imaging system application (Restart Application).
Restarting 789
 Load the patient/scene again.

 Send the 3D scene again to syngo Workplace.

Shutdown necessary!
If it was not possible to restart, e.g. if there are faults in system communication,
you must restart the entire system.

Message  “... Please Power OFF”

Communication between the imaging system and the other units is faulty. The en-
tire system must be restarted.
Effect: Now only postprocessing is possible. Normal fluoroscopy, acquisitions, and
patient registration are not possible.
 Shut down off the system.
Switching off 141
 If it is not successful, you can power off manually.
Switching off manually and power on again 792
 If it is not successful either and there is a danger, the emergency SHUTDOWN
button is the last resort.
Emergency SHUTDOWN button (installed on-site) 44

Switching on again  Switch the system on again, if necessary.

Switching on and starting 139

Note Pay attention to Emergency operation 781

 Register the patient again.

 Continue with the examination.

Buffer full! - Memory full!

Depending on the configuration, the Artis imaging system can save a specific
number of scenes/images in total and per patient.
If patients are not deleted regularly, it could result in shortage of storage capacity,
and the Artis imaging system will display a message indicating 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 Moni-
tor/Store reference image) are rejected after the second message 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 possible.
 Delete (archived!) patients (if possible, patients with many scenes).
Deleting patients/studies/series/scenes 442
If the message remains:
 Contact Siemens Service.

Door open!
Due to legal requirements, x-ray must be disabled if a door of the examination
room (control area) is open.

Message  “DOOR OPEN?”

 “DOOR OPEN? XRAY disabled”

 “NO XRAY: close door”

 “XRAY aborted: close door”

A door contact installed on-site has been activated - door open?

 Close the door.

If the message is displayed again:

 Check door contacts.

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Footswitch/handswitch connection problem

Message  “Footswitch on table out of order, SC”

 “Footsw. in exam. room out of order, SC”

 “Footsw. in cntrl. room out of order, SC”

 “Footswitch(es) out of order”

 “Handswitch not connected?”

A footswitch or handswitch has failed.

 Check the footswitches/handswitch cables/connection.

If the message remains:

 Shutdown (switch off) and restart the system.
Switching off 141
Switching on and starting 139
If the message reappears:
 Contact Siemens Service.

Emergency operation
The Artis systems have been developed 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.

Biplane system only:

X-ray A X-ray B

Screens A Screens B

Assist screen Acquisition A Acquisition B

(Buffer A) (Buffer B)
1. 1.

Console
Touch- Console Other components
monitors
screen (Memory)
2.

Schematic representation of Artis components

If one component fails, the other continue to work.

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Therefore, the system has several operation states, so that a failure of one com-
ponent does affect the whole system as less as possible, e.g.:
1. If an image acquisition system fails, the system 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 Fluoroscopy and All functions available
in plane A only acquisition in plane A
only
No patient registration or
postprocessing

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 (only in plane A on Artis biplane), is pos-
sible. 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:
Only the nominal zoom format (zoom 0) is available during bypass fluoroscopy.

Note Depending on the problem, fluoroscopy times during BYPASS FLUORO might not
be recorded in the Exam Protocol.

Bypass fluoroscopy during start-up

The or BYPASS FLUORO message is normal during start-up.
After the imaging system is ready again, plane A is automatically active as the ac-
quisition plane (on Artis biplane).

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Note Please note that the monitors are not ready for operation immediately after
switch-on.

Bypass fluoroscopy during an examination

If the or BYPASS FLUORO display appears during a normal work se-
quence, please do not ignore this message!
 You might have to reset the imaging system with a restart.
Restart necessary! 778 and Shutdown necessary! 779

Note Please note on FD systems with detector rotation:

In bypass fluoroscopy mode each component is set to default regarding image ori-
entation. It may happen that the image is rotated in case of the detector position
is not landscape.
This can be corrected by manual detector rotation override.

Zoom stage and collimation during bypass fluoroscopy

During bypass fluoroscopy, zoom stage and collimation are fixed:
 Systems or planes with FD 30x40: Zoom stage 1 is used

 Other systems: Zoom stage 0 is used (full size, overview)

The collimator positions during bypass fluoroscopy are subject of configuration.

After recover from bypass fluoroscopy, the zoom stage and collimation are set,
that were active during last normal operation.

Backup mode
In various system states, e.g. during switch-on or switch-off or if a technical fault
occurs, only fluoroscopy and acquisition (only in plane A on Artis biplane) without
patient registration and postprocessing are possible.
During backup mode, it ist not possible to select the exam set and acquisition pro-
gram on the system console, exam set and acquisition program must be selected
on the touchscreen.
Images are acquired into the buffer.

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You can recognize it as follows:

 New fluoroscopy/acquisition images are only visible on the Live screen.

 On the Live screen of plane A, a ’broken link’ symbol is displayed.

 The Live screen of plane B in the examination room is dark.

Review is possible in backup mode. Other scenes1 can be loaded via Scene + /
Scene - but only CARD, DR and DSA scenes are loaded in plane A.

Backup mode during start-up

The ’broken link’ symbol display is normal during start-up.

Backup mode during an examination

If the ’broken link’ symbol appears during a normal work sequence, you can con-
tinue your examination.
 But you might have to restart the imaging system later.
Restarting 789

Artis biplane During backup mode, acquisition is only possible in plane A. If the system was in
biplane mode before entering the backup mode:
 Select acquisition plane A on the touchscreen.

Synchronization after backup mode

If images have been acquired in backup mode, e.g. immediately after power-on,
they must be transferred from the buffer to the memory.

Message  “Syncing database, ... scenes left”

Scenes are being transferred.

 If you are working with different scenes: none required

 If you want to work with the same scenes:

 Wait until transfer is finished.

Message  “Database not in sync, ... scenes left”

1 It is only possible to view scenes which have not been transferred from the buffer to the memory yet.

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Scenes shall be transferred but the image evaluation system is not ready (console
in the control room) or another operation, e.g. new fluoroscopy/acquisition,
caused the transfer to pause.
 If you are working with different scenes: none required

 If you want to work with the same scenes:

 Stop fluoroscopy/acquisition and wait until transfer is finished.

 If the problem persists:

 Shut down the system and start again. Check for remaining scenes/images un-
der the patient name emergency patient and register them under the correct
patient name.

Power failure!

Due to low line voltage the loss of radiological imaging or other system functions
Caution during an examination cannot be excluded.
Risk of failure during interventions
 Please consider the need to establish emergency procedures.

Hospital emergency power supply

A hospital emergency power supply cuts in if the mains power supply fails. How-
ever, it usually occurs with interruption and can take some time.
If no OR-UPS is installed the system must be switched on again.
 Switch on the room on/off switch after the generator has been started.

 Switch on the Artis system.

If line voltage comes back without power interrupt the system will switch back to
normal mode automatically after the hospital emergency power generator has
been switched off and line voltage is supplied.
If it happens during X-ray the switching will be delayed until X-ray is inactive.

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System emergency power supplies

The system can have one of three types of emergency power supplies:
 Imaging system UPS
Uninterrupted supply for the imaging system only
 OR-UPS
Uninterrupted supply for system control including imaging system, stand and
table
 System Emergency Power Supply (EPS)
Interrupted supply for the generator, uninterrupted supply for system control
including imaging system, stand and table

UPS UPS = Uninterruptible Power Supply

A UPS is a battery-backed system which provides emergency power in the event
of a mains power supply failure.

UPS for the imaging system

To prevent data/image loss, your system may have a UPS which shuts down the
imaging system in a controlled way in the event of a power failure.

UPS operation
In the event of power failure, all indicators and displays are dark. X-ray is no more
possible. Only the imaging system as well as the monitors in the control room are
still being powered by the UPS.
 Do not press any keys.

After 90 s, the imaging system will shut down to prevent the backup battery to be
exhausted.
 If battery capacity of the UPS is more than 67%, the following message will be
displayed: “Imaging System on battery.”
 If battery capacity of the UPS is less than 67%, the following message will be
displayed: “Imaging System on battery, shutdown in x s.”

Power recovers during this time

 Power on the system using the on-site room ON button, if necessary.1

The system will be switched on again by the (still running) imaging system and it
will be operable again after a short time.

1 mandatory in Germany

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Power does not recover

The imaging system will shut down when the recovery time has been elapsed. The
shutdown needs a few minutes.
 Let the imaging system shutdown.

After recovery of the power supply

 Power on the system using the on-site room ON (or emergency SHUTDOWN)
button, if necessary.
 Switch the system on.
Switching on and starting 139
 Pay attention to any error messages.

 Check if all data/images are present.

OR-UPS
The OR-UPS supplies the patient table, stands and the imaging system during pow-
er failure. Its main use is for systems in the OR (operating room).
All control modules remain functional during power failure.
Radiation is interrupted during power failure and will be possible again, when
mains power returns.

Emergency power supply (EPS)

If an emergency power supply is installed on your system for the unit and gener-
ator, it automatically switches to emergency operation if the mains power supply
fails or if it drops too low.
During emergency power operation, you can only perform unit movements and
continuous fluoroscopy (only in plane A for Artis biplane) without LIH. It is not pos-
sible to release acquisitions.

Continuous fluoroscopy during emergency power supply operation

If your system is equipped with an EPS, the system except the generator is still
powered but after switchover from mains to EPS operation.
The message “System on Power Backup” is displayed.
After the EPS has switched power to the generator, the generator restarts:
 After 10 s bypass fluoroscopy is possible.

 After 20 s continuous fluoro in EPS mode is possible.

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The message “No XRAY, please wait” is displayed.

The power that the emergency power supply can provide is limited. However,
pulsed radiation requires a high power. For that reason, acquisitions cannot be re-
leased during emergency power operation. As an exception, fluoroscopy is only
performed with continuous radiation.
As soon as radiation is possible, the message “Fluoro only, on Power Backup” is
displayed.
A waiting time is also necessary for restarting the generator when the switch-over
from emergency power to mains operation occurs.

Switching back to mains voltage

After recovery of the mains voltage, the message “AC power restored, press EPS
switch” is displayed.
 Then you must switch on the system manually on the ATS control panel.
Please refer to the operating instructions of the EPS.
After the switch has been pressed, power to the generator is shortly interrupted.
The generator is restarted and the systems returns to normal operation.
During restart, no X-ray is possible:
 After latest 10 s bypass fluoroscopy is possible.

 After latest 20 s normal mode is reached.

The message “Fluoro only, on Power Backup” disappears.

 Press any of the emergency STOP buttons, e.g. on the control modules, and
pull it again.
– The system communication is initialized.
1
 Register the patient.
2  Continue with the examination.

Test with emergency power supply

When performing a test, the different emergency power supplies must be taken
into account. In every case, a data loss free test is only guaranteed with the fol-
lowing procedure:

Before the test

 Complete any examination/postprocessing.

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Testing the EPS

 Simulate a power failure by switching off the system on the on-site power dis-
tribution panel.

Testing the imaging system UPS

 Switch the system off using the room off.

 Check if imaging system stays on and starts the automatic shutdown after 90 s.

 After shutdown switch room and system on again.

Testing the hospital emergency power supply

If a test of the hospital emergency power generator is requested:
 Check if the system detects the situation and displays a message “Fluoro only,
on Power Backup” (up to VC13 hardware) or “Problem with Power Backup in-
terface detected, SC” (as of VC14 hardware).
If the latter message appears in normal operation while no test of the hospital
emergency power generator is performed:
 Call Siemens Service.

After the test

Do not forget to switch the system on again.
Otherwise the flat detectors may not have the correct temperature when the next
examination starts.
 Switch on the room switch.

 Switch the system on.

Restarting

Automatic restart on errors

If a fatal software error occurs, the Artis imaging system has to be restarted. The
following window appears on the monitor of plane A in the control room:

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Troubleshooting

After a certain time (configurable by Siemens Service), the Artis imaging system is
restarted.

Restart immediately

As long as this window is shown on the monitor in the control room, it is possible
Caution to continue with fluoroscopy or an acquisition series in the exam room!
After the configured time has elapsed or after you have clicked Restart, the
imaging system is restarted; fluoroscopy and acquisition are then interrupt-
ed! Restarting takes some time.
 It may be necessary to wait during fluoroscopy/acquisition before clicking
Restart.

If no fluoroscopy or acquisitions are being performed in the examination room,

you can speed up restarting.
 Click Restart.
– The Artis imaging system is restarted.
– Bypass fluoroscopy is still possible.
Bypass fluoroscopy 782

Manual restart
If a message “... Restart imaging system” appears, you must terminate the imag-
ing system application and then restart it.

Note Restart needs some time.

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There are three possibilities for restarting:

1. Restart Application 791
In this case, only the console in the control room is restarted.
Acquisition and fluoroscopy are still possible (in plane A).
Recommended if there is a problem in the control room only.
2. Restart System 791
In this case, the imaging system in the control room and in the examination is
restarted.
Only use it if there is a problem in the examination room (too).
3. RESET image evaluation system 792
In this case, the image evaluation system in the control room is restarted by
force.
Acquisition and fluoroscopy are still possible (in plane A).
Only use it if Restart Application or Restart System does not work.
4. Switch off the system manually and power on again 792
In this case, the whole system is powered-down by force.
Only use it if the system does not react on inputs anymore and if the examina-
tion is finished or can be interrupted.

Note Images acquired during Restart Application or RESET are stored by the image ac-
quisition system (examination room) and transferred to the image evaluation sys-
tem (control room) after it is ready again.
Emergency operation 781

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 terminated and restarted.
Or
 Click Restart System...
– Another dialog box appears.
 Click Yes.
– The whole system is shut down and restarted.

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Troubleshooting

RESET image evaluation system

If it is unsuccessful:
Only if the image evaluation system (console in the control room) does not re-
spond to input even after some time, or if, for example, the screen is blue and only
shows “cryptic” characters, may you restart the imaging system with the RESET
button.
ON box with CD/DVD drives 96
In that case:

 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.

Use a pointed object to press the RESET button, e.g. a ballpoint pen.

Switching off manually and power on again

Switch off the system only if the imaging system can no longer be terminated by
software.

 Press the power-on pushbutton on the system console for more than 4 s and
then release the button.
 Wait until everything is off.

 Wait for about 30 s.

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 Press the power-on pushbutton on the system console for more than 0.5 s and
then release the button.

Note There 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
pushbutton to blink which indicates that. Power-on will occur automatically with-
out any further action when the 30 s have elapsed.

Transfer problems
Message “No Transfer: ...”
An image transfer to syngo Workplace was iniciated, e.g. for 3D. The transfer
failed.
 Read the message and fix the problem , then retransfer.
Transferring a 3D series manually 529

General problems - Troubleshooting ...

... if the monitors are dark but the units are still powered on
It may happen that the imaging system (image evaluation system and/or image
acquisition system) is shut down, i.e. the monitors are dark, but the units in the
examination room are still powered on.
 Power-off the system manually.
Switching off manually and power on again 792

... if the system does not shut down

If the system gets stuck during the automatic shutdown procedure:
 Confirm any error messages.

 Then restart the system by double-clicking the Start AXIOM icon and carry out
the shutdown procedure again.
Reason: Preventive measure against loss of data.
Consequence if it is ignored:
 Risk of data loss

 If the imaging system is operated by a UPS, the battery of the UPS will be com-
pletely discharged. It is possible that the system cannot be started again.

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 In the latter case, contact Siemens Service.

... with fault messages marked “... SC”

Message  “... SC”
A serious fault has occurred.
 Note down
– the text of the message
– the time of the fault (date/time)
– the function that was executed when the fault occurred
This information is useful for our service personnel.
 If necessary, perform a restart.
Restarting 789
If the message is displayed again:
 Contact Siemens Service.

... if there is a problem with the FD cooling system

When the FD cooling system has failed, the flat detector can operate for a definite
time until the detector gets too hot.
In this case, the message “No XRAY available in ... min.” is shown and a count-
down runs.
 Check the FD cooling system.

Malfunction in the detector cooling system and display of the message “No X-Ray
Caution available in ... min.”
Risk that the examination cannot be completed
When the countdown has elapsed, radiation will no more be possible.
 Complete the current examination within the remaining displayed time.

Message  “Cooling problem, FD may turn off soon”

There is no communication with the FD cooling unit.
The FD is functional. Radiation is not blocked.
 “No XRAY, Cooling Unit?”

 “NO XRAY, Cooling Unit, SC”

The temperature of the flat detector is too high.
 Contact Siemens Service.

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... if there is another problem with the FD

Message  “A: FD calibration needed, SC”

 “B: FD calibration needed, SC”

The FD of plane A/B must be calibrated. Image quality may be reduced.
 Contact Siemens Service.

Message  “FD sense adjustment needed, SC”

The FD or the X-ray tube has been replaced in the system. FD sense adjustment
should be performed to avoid bad image quality.
 Contact Siemens Service.

... in the event of overtemperature

Message  “Imaging System temperature high”
The temperature in the imaging system container is too high.
 “OVER TEMPERATURE, call SC”
The temperature in a component of the system is too high.
 Check whether the overtemperature has been caused, e.g. by impermissible
covering (drapes). Are the ventilation slots unobstructed?
 Check the ambient conditions.

If you cannot rectify the cause immediately:

 Shut down the system as quickly as possible (not for the X-ray tube assembly).

 Allow the system to cool down.

 Switch the system on again after it has cooled down.

If overtemperature occurs again without any identifiable reason:

 Contact Siemens Service.

Message  “Trafo temperature high: Reduce system movements, SC”

The temperature of the main transformer is too high, e.g. due to excessive
stand and table movements.
 Stop or reduce system movements, if any.

If the message remains:

 Check the ambient conditions.

 Allow the system to cool down.

If message occurs again without any identifiable reason:

 Contact Siemens Service.

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Message  “Trafo temperature too high: Shut down in ... minutes, SC”
The temperature of the main transformer is too high.
 Shut down the system as quickly as possible.
After the indicated time, the system will shut down automatically.
 Allow the system to cool down.

 Switch the system on again after it has cooled down.

If overtemperature occurs again without any identifiable reason:

 Contact Siemens Service.

... if the tube is too hot

See also ... if the X-ray tube assembly emits an audible signal 797

Message  “TUBE HOT, have a break”

The X-ray tube has run hot by excessive fluoroscopy/acquisitions.
 Have a break, if possible.

 You can continue fluoroscopy but use a dose saving fluoro mode, if possible.

Message  “NO XRAY: TUBE TOO HOT”

The X-ray tube has run too hot by excessive fluoroscopy/acquisitions or by a de-
fect in the cooling system.
See also ... if the pressure switch in the tube assembly responds 798
 Check the cooling system.

If you cannot rectify the fault immediately:

 Terminate the current examination and contact Siemens Service.

Message  “Tube hot or switch defect: Restrict radiation to a minimum”

The X-ray tube has run too hot by excessive fluoroscopy/acquisitions or by a de-
fect in the cooling system.
 Have a break, if possible.

 You can continue your current examination restricting X-ray release.

If the message persists:

 Contact Siemens Service.

Message  “Tube temperature out of range, SC”

The temperature of the X-ray tube has run out of the allowed range.
 Contact Siemens Service.

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Message  “Fluoro only: Tube too hot or switch defect, SC”

The X-ray tube has run too hot by excessive fluoroscopy/acquisitions or by a de-
fect in the cooling system.
Acquisition is blocked.
 Have a break, if possible.

 You can continue your current examination using fluoroscopy only.

If the message persists:

 Contact Siemens Service.

Message  “Bypass fluoro: Tube cooling unit defect, SC”

The X-ray tube has run too hot by a defect in the cooling system.
The system will run in BYPASS FLUORO mode. 782
 You can continue your current examination using continuous fluoroscopy only.

 Contact Siemens Service.

... if the X-ray tube assembly emits an audible signal

The permissible range of the cooling temperature can be exceeded if the load for
the tube assembly is excessively high or the cooling circuit is defective.
If it happens, an audible signal is emitted by the tube in addition to the Heat Unit
display.
See also ... at tube overload (MEGALIX) 798

High load If the warning was not caused by a defect in the cooling system but by a continu-
ous high tube load, you can continue fluoroscopy; use a dose saving fluoro mode,
if possible.
 In this case do not switch off the system since it would switch the cooling sys-
tem off at the same time.
 However, you should not release another acquisition scene before the oil-water
circuit has cooled down, i.e. the continuous audible signal is off and the Heat
Unit display shows < 60%.

Cooling circuit If the cooling circuit is defective, the tube assembly can emit the audible signal
even if the Heat Unit display shows a low value.
 If this audible signal is emitted, you should place the catheter in a position from
which it can later be withdrawn without fluoroscopy, if necessary.
 Check the cooling system.

If you cannot rectify the fault immediately:

 Terminate the current examination and contact Siemens Service.

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... at tube overload (MEGALIX)

MEGALIX X-ray tubes with closed circuit cooling feature protection from thermal
overload by warning and safety circuits.
 On tube overtemperature: Intermittent sound at tube

 On cooling unit fault: Continuous sound at tube

Preliminary warning This cooling unit fault is a fault in the outer cooling water circuit.
level
 In that case, terminate the examination as quickly as possible.

Otherwise the safety circuit of the generator will automatically block high voltage.
 Contact Siemens Service.

Tube overtemperature is caused by excessive operating power. You can finish off
any acquisition or fluoroscopy series in progress because the water cooling in the
cooling unit is working.
After a load break of about 5 minutes or if operation is resumed with reduced pow-
er, the unit will return to normal temperatures. The audible signal then stops.
 Ascertain which fault is the cause (cooling unit fault or excessive operating
power) and proceed as described above.

Shutdown level On persistent thermal overload of the tube, a safety circuit switches off the high
voltage at the generator. Switching on again is possible only after a cooling pause
of approximately 15 minutes.

... if the pressure switch in the tube assembly responds

If the oil temperature in the cooling circuit of the tube assembly continues to in-
crease after passing the threshold, generation of radiation is disabled for safety
reasons when it approaches approximately 78°C.
A continuous howling signal sounds.
 The message “NO XRAY: TUBE TOO HOT” is displayed.
... if the tube is too hot 796

Note Do not switch off the system since it would also switch off the cooling system.

 As soon as the radiation blockage is removed, that is, the message disappears,
you can continue fluoroscopy. If possible, use a dose saving pulsed fluoroscopy
mode with a low pulse frequency.
 Acquisition scenes should be released only after the oil-water circuit has cooled
down, that is, the continuous audible sound has stopped.
 Please inform Siemens Service.

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... in case of a focus defect

Message  “Micro focus defect, SC”

 “Small focus defect, SC”

 “Large focus defect, SC”

A focus of the x-ray tube has become defective.
 In case of a defective micro or small focus, you can use the next larger focus
and continue working with this focus.
 Contact Siemens Service.

... in case of a tube grid defect (GIGALIX)

Message  “Grid defect. Dose possibly increased, SC”
The tube grid of the x-ray tube has become defective. It results in a reduced
switching capability of the x-ray tube.
 You can continue working but dose may be increased.

 Contact Siemens Service.

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... if wrong dose is applied

Messages  "Possibly wrong dose, Cu Prefilter, SC"
During radiation, if either the wrong Cu prefilter is active or the active Cu pre-
filter is not known.
 "Reference air kerma possibly increased, SC"
The calculated mAs value is too small.
The applied dose may be exceeded with pulsed fluoroscopy.
 "Air kerma adjustment needed, SC"
Dose adjustment is required.
State after software installation.
 "Residual mAs adjustm. needed, SC"
Residual mAs adjustment is required.
State after software installation.
 "Air kerma adj. pulsed FL needed, SC"
Dose adjustment for pulsed fluoroscopy is required.
State after software installation.
 "Air kerma adj. cont. FL needed, SC"
Dose adjustment for continuous fluoroscopy is required.
State after software installation.
 "Tube adjustment needed, SC"
Tube adjustment is required.
State after software installation.
 Contact Siemens Service.

... if no radiation is released

Radiation indicator lights up

The radiation indicator lights up but no image is generated.
 Pay attention to the messages on the Assist screen / message bar.

 Restart the system.

Restarting 789
If a fluoroscopy image is still not displayed:
 Switch off the system and contact Siemens Service.

Note It is normal for the radiation indicator to light up briefly while the system is start-
ing up.

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Radiation indicator is not lit

Message? If a message “No XRAY ...” is displayed, radiation is blocked.

 Read the message and perform correspondingly.

If the message “XRAY manually disabled” is displayed, radiation is blocked man-

ually. 262
 Press this icon.

Door contact? Depending on your installation, it might be necessary for the doors of the exami-
nation room to be closed.
 Check the radiation disable switches, e.g. door contacts, if there are any.

Plane ready? Are the green “plane ready” displays on the stands lit?
“Plane ready for radiation” displays 137
 Restart the system.
Restarting 789

Other reason? In rare cases, radiation may not be released due to a system communication prob-
lem. In this situation, the system seems to be ready.

In rare cases, radiation may not be released due to a system communication prob-
Caution lem. In this situation, the system seems to be ready.
Risk that the examination cannot be completed
 Press any of the emergency STOP buttons, e.g. on the control modules, and pull
it again. The system communication is initialized. Now radiation should be pos-
sible again, at least in BYPASS FLUORO mode.

 The system message line 769 does not show any restriction.

But
 No footswitch pedal or handswitch action releases radiation.

 Press the emergency STOP button on the stand/C-arm control module (SCM)
and pull it again.
– The system communication is initialized.
1
Now radiation should be possible again, at least in BYPASS FLUORO mode.
2  Press a radiation release pedal/button again.

If still no radiation is released and no image is displayed:

 Switch off the system and contact Siemens Service.

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... if the radiation is aborted

Message On the screen at the bottom of the image, the following message is displayed:
“XRAY aborted: Dose less than 5%”
If during acquisition (or fluoroscopy) the dose falls below 5% of the nominal value,
e.g. because of a thick object, radiation is blocked due to radiation protection rea-
sons. In this case, the images would not have anymore diagnostic value.
If radiation is aborted during acquisition (or fluoroscopy) perform as follows:
 Check the kV display.

If 125 kV is indicated on the kV display, the dose is probably no more sufficient to

produce a usable diagnostic image.
To continue working, the radiation must be increased.
You can achieve it by the following measures, for example:
 Change the projection (angulation).

And/or
 Move the FD closer to the patient.

And/or
 Decrease the FD zoom factor.

If the radiation is aborted again (even with a thinner object), it is possible that
there is a technical defect.
 Pay attention to further messages.

If there is a technical defect:

 Contact Siemens Service.

... if the image quality changes

If you notice any changes in the image quality (fluoroscopy/acquisition) which
cannot be explained by special examination conditions, e.g., weight of the pa-
tient, patient to FD distance too large, extreme angulations, use of extreme en-
largement or acquisition programs, then proceed as follows:
 Perform a consistency test (as stipulated by national regulations).

 Ask Siemens Service to perform a quality assurance test.

Note Image quality control (IQAP, Image Quality Assurance Program) is part of a service
contract.

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 If necessary, provide images for remote service.

Providing images for Service 762

... if the live image is not collimated correctly

On a correctly collimated image a slightly blurred edge of the universal collimator
leaf must be visible within the edges of the electronic shutter.
If not, the system is not adjusted properly and there is a risk of parts being exposed
to radiation although they are not displayed in the image.
 Contact Siemens Service.

... if the format collimation is incorrect

The automatic format collimation (collimation to the input format) is normally set
so that you can see at least one of the collimator leaves in the fluoroscopy image
during bypass fluoroscopy (national regulations).

Note Enlarged collimation can cause increased scattered radiation.

If you notice a fault during collimation to the selected format when viewing the
screen or because of an error message on the display, proceed as follows:
 Press the red emergency STOP button and release it after 5 s

Or
 Restart the system.
Restarting 789
If there is still no collimation to the selected input format:
 Contact Siemens Service.

... if there is a fault in the primary collimator

Message  “Problem with Collimator”

 “Problem with Collimator/Dsa”

A fault has occurred in the primary collimator or the collimator is not ready for
operation.
Not normally necessary; faults in the primary collimator are usually cleared up au-
tomatically.
 If the collimator fault is not cleared up automatically, proceed as follows:

 Press the red emergency STOP button.

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Troubleshooting

 After about 5 s release the emergency STOP button again.

– This results in a unit reset.
 If the primary collimator is still not ready for operation:

 Contact Siemens Service.

... if the collimator rotation is not correct

 Press this key on the collimator control module.
– Collimator leaves and filter diaphragms are moved into their initial position
outside the image.

... if there are problems with the ECG

 Check correct placement of the electrodes with sufficient contact gel.

 Lay cables of the patient leads directly next to each other and parallel to the pa-
tient's body.
 Check the connection of all plug-in connections and ground conductors.

Message  “No ECG trigger, check cables”

A fluoroscopy or acquisition program requires ECG, but an ECG test signal is not
available.
 Check the ECG cables.

... if there are problems with the injector

Message  “Attention: Xray without contrast media”
X-ray has been released, but no injection was done, although injector was set
“Armed”. The injector “Run” signal was not active during x-ray release
 Check the injector.

 Repeat the operation, if necessary.

Message  “No Xray: Injector, no Injection”

No x-ray was released because the injector was not active.
No injection was started.
 Check the injector.

 Repeat the operation.

Message  “INJECTOR PROBLEM: try disable, enable”

A connection problem with the injector occurred.
Contrast medium injection shall not be started during the current acquisition
but with the next acquisition.

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 Disconnect injector, reconnect it and check if error persists.

 If no:

 Check the injector.

 If yes:

 Contact Siemens Service.

Message  “No automatic injection possible, SC”

A communication problem with the injector occurred.
 Contact Siemens Service.

Message  “Injector problem: No ACQ and no injection, SC”

The injector it is set to “armed” but cannot be triggered because of a hardware
error. Acquisition is blocked, because injection would not take place. Fluoros-
copy is still possible.
 Contact Siemens Service.

... if there is a problem with the Large Display

Message  “Layout ... does not contain ...”
There is a configuration error in the layout of the Large Display.
 Select a different layout. 221

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 Part: Abbreviations/Glossary

Artis Product name of the modular angiography system from Siemens

 Artis floor i.e. Artis zee floor, Artis Q floor, and Artis Q.zen floor:
System with floor-mounted stand/C-arm (angiographic or cardiac system)
 Artis biplane i.e. Artis zee biplane, Artis Q biplane, and Artis Q.zen biplane:
Biplane system (angiographic or cardiac system)
 Artis ceiling i.e. Artis zee ceiling, Artis Q ceiling, and Artis Q.zen ceiling:
System with ceiling-mounted stand/C-arm (angiographic or cardiac system)
 Artis zee multi-purpose: Multi-purpose system (angiographic system)

 Artis zeego i.e. Artis zeego and Artis zeego.zen:

Multi-axis system (angiographic or cardiac system)
Angio Angiography, examinations of vessels
Angio collimator X-ray collimator mainly used in angiographic systems equipped with rectangular
diaphragms and also with two wedge filters and one semitransparent finger filter.
AP/APG Class AP or APG anesthetic test (German: Anästhesiemittelprüfung)
Class AP equipment can be used within 5 to 25 cm range of flammable gas escap-
ing from a breathing system. Its temperature should not exceed 200°C.
Class APG equipment can be used within 5 cm range of flammable gas escaping
from a breathing system. Its temperature should not exceed 90°C.
Assist screen Essential unit position and acquisition data as well as system messages and menus
for unit movements are shown on the Assist screen.
Backup mode Backup mode, Artis emergency operation mode, e.g. during switch-on or switch-
off or if a technical fault occurs.
Only fluoroscopy and acquisition (only in plane A) without patient registration
and postprocessing are possible.
Images are acquired into the Buffer.
Binning Merging of 2 neighboring pixels (horizontal and vertical)
BSA Body Surface Area
Buffer For safety reasons, images are always acquired into a buffer first and then trans-
ferred in the background to the memory on the imaging system.
If images have been acquired in Backup mode, e.g. immediately after power-on,
they must be transferred from the buffer to the memory first.
, Bypass Fluoro Bypass fluoroscopy, Artis emergency operation mode, e.g. during switch-on or
switch-off or if a technical fault occurs or when no user is logged-in.
Only continuous fluoroscopy (only in plane A) without LIH without the imaging
system, is possible. It is not possible to release acquisitions.
CARD Cardiography, examinations of the heart

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Abbreviations/Glossary

Card collimator X-ray collimator mainly used in cardiographic systems equipped only with rectan-
gular diaphragms and one semitransparent wedge filter
Card (Sub)task card. Elements of the syngo user interface are arranged in stacks of
cards.
CAUD Caudal direction of motion of the I.I./FD (footwards)
CCM Collimator Control Module, console for setting the primary collimator
CF Calibration factor
CLEARstent Create an enhanced reference image and a scene which provide better view of
fine structures, e.g. better visibility of inflated stents for easier evaluation of stent
deployment.
CM Contrast medium
CPR Cardio-Pulmonary Resuscitation
CRAN Cranial direction of motion of the I.I./FD (headwards)
DAP Dose-Area Product, the radiation dose to air, times the area of the x-ray field. The
DAP is expressed in micro-Gray times squaremeters (µGy m2).
DCS Display Ceiling Suspension, support system for LCD monitors
DDO Dynamic Density Optimization, also called harmonization
By reducing the dynamic range of an image, it is possible to increase the contrast
without saturation of the image in bright or dark areas.
DMG Dead Man's Grip: Unit movements are controlled by a dead man's grip, that is,
movements are performed only while the operating element is being actuated.
DR Digital radiography, digital acquisition technique without subtraction
DSA Digital Subtraction Angiography, digital acquisition technique with subtraction
ED End diastole, heart phase
EDV End-diastolic volume, volume of the ventricle in the ED
EF Ejection Fraction, measure of cardiac performance
EPS System Emergency Power Supply (EPS), provides interrupted supply for the gen-
erator, uninterrupted supply for imaging system and stand and table
ES End systole, heart phase
ESV End-systolic volume, volume of the ventricle in the ES
f/s frames per second, frame rate during acquisition
fps frames per second
FD Flat detector
FL Fluoroscopy

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Frame Single frame of a multiframe image (scene)
(one image out of a series of images to form a movie-like sequence)
Heat Unit Thermal load state of the tube assembly, stated as a percentage
HIS Hospital Information System
HU Houndsfield Units: X-ray attenuation (density) measurement unit used to describe
voxel values in CT scanning. In a 12 bit CT image, the voxel values will range from
-1024 to +3071 HU. For example, water is defined as 0 HU, air as -1024 HU, fat as
-100 to -20 HU, soft tissue as +20 to +80 HU, and bone as > +500 HU.
iFlow The Time Enhanced Opacification (TEO) function - referred to as iFlow - provides
a single composite image that shows the history of the contrast medium move-
ment through the vessels in time in a colored image.
I.I. Image intensifier
ILD Inline digital display IVUS ILD image
IS Imaging system
IVUS Intravascular Ultrasound is a catheter-based system that allows physicians to ac-
quire images of diseased vessels from inside the artery.
IVUSmap For obtaining a coregistration of an angiographic X-ray image and IVUS images,
the IVUSmap feature is available. IVUSmap facilitates to acquire and select a ded-
icated X-ray image to be used for coregistration, determining the vessel center-
line, and performing of the pullback.
IVUS cross-section image Intravascular ultrasound cross-section view of the vessel
IVUS ILD image Constructed intravascular ultrasound lateral view of the vessel (ILD: inline digital
display)
IZ3D 3D Quantitative Coronary Analysis, QCA in 3D, three-dimensional representation
of a coronary vessel including any stenotic regions
The system creates the 3D vessel representation by analyzing two 2-dimensional
x-ray images of the vessel.
kV Kilovolt (1 kV = 1,000 V), unit for measuring tube voltage
LAO Left Anterior Oblique, angle of rotation of the image plane in degrees, to the left
of the reference vertical
LPO Left Posterior Oblique - not used in Artis
LCD Liquid Crystal Display, monitor with flat screen
LED Light-Emitting Diode, indicator lamp of a control element
LIH Last Image Hold, display of the last fluoroscopic or acquisition image
LVA Left Ventricle Analysis, calculation of the ejection fraction and wall motion of the
left ventricle of the heart

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Abbreviations/Glossary

mA Milliampere (1 mA = 1/1,000 A), unit for measuring tube current

mAs Milliampere seconds, unit for the product of tube current (mA) and time (s).
Equivalent to the applied radiation dose
µGy Microgray (1 µGy = 1/1,000,000 Gy), unit for measuring radiation dose
MFH Max Fill Hold, review is stopped at the frame within a scene, in which the contrast
agent is maximally filled
Mouse joystick Joystick on the touchscreen control, operating element which functions similar to
a mouse, used for operating the imaging system
Multiframe image A multiframe image is an image object (scene) whose pixel data consist of a se-
quence of single frames.
OEM Original Equipment Manufacturer
OM Operator Manual
OR Operating Room
OR-UPS UPS for imaging system, stand and table
Ostium An ostium is a small opening or orifice, as in a body organ or vessel.
Ostial / Non-ostial If a bifurcated vessel is obstructed on the bifurcation point, it is called ostial, else
non-ostial.
OT Overtable: I.I./FD is above the table
P/s Pulses per second, frame rate for fluoroscopy
QCA Quantitative Coronary Analysis, calculation for dimensions of coronary arteries
QCA 3D IZ3D 809
QVA Quantitative Vascular Analysis, calculation for dimensions of vessel sections
RAO Right Anterior Oblique, angle of rotation of the image plane in degrees, to the
right of the reference vertical
RPO Right Posterior Oblique - not used in Artis
RESET Reset
RIS Radiology Information System
ROI Region of Interest, region under examination
SC Service Center. This abbreviation in messages means: "Call Service"
SCM Stand Control Module, console for operating a Stand/C-arm
SD Standard deviation, a parameter in statistics
SID Source-to-Image Distance, or distance between the source and the I.I./FD in cm
SRS Siemens Remote Service

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syngo syngo is the standard medical software platform of Siemens.
syngo is a registered trademark of the Siemens AG.
TCM Table Control Module, console for operation of the patient table
TOD Table-to-Object Distance, distance between the tabletop and the center of the or-
gan, used for calibration
TSC Touch Screen Control, console with touchscreen near the patient table for control-
ling the imaging system in the examination room
UI User Interface, all parts of the hardware and software which enable to operate the
system
UPS Uninterruptible Power Supply, battery-backed system which provides emergency
power in the event of a mains power supply failure.
UT Undertable: I.I./FD is below the table
VOI Volume of Interest, 3D region under examination
VOI images 3D images stored for technical purpose in the local database
WW Window Width (contrast)
WC Window Center (brightness)

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Abbreviations/Glossary

812 / 830 AXA4-100.620.15.01.02 Operator Manual

 Index

- 3D vessel model
auto-rotating 657
Acquisition program 559
changing 285
1:1 pixel display 369 creating 651 changing the name 567
2D angiographic image documentation 667 for CLEARstent 448
in IVUSmap 462 in IZ3D 651 for CLEARstent Live 450
2nd Reference image 306 moving C-arm 666 organizing 568
3D 475, 500 panning and zooming 657 selecting 280
acquisition modes 500 rotating 656 service parameters 567
acquisition parameters 584 to C-arm position 658 storing and/or applying 571
acquisition phases 527 to optimal projection 657 viewing 566
acquisition programs 506 viewing 654 Acquisition programs
collimation and filtration 504 windowing 657 3D 506
FD orientation 505 3D visualization 502 for peripheral angiography 535
image quality test 530 4x4 Crossbar Videoswitch 223 for rotational angiography 479
injector problem 804 8x8 Crossbar Videoswitch 224 Acquisition scenes
input field 504 rotational angiography 478
patient positions 504 Action history 773
preparing 523 A Active exam set 563
reconstruction 502
Accessories Active patient 342
test phase 526
equipment 717 Active reference screen 305
zoom stage 504
for radiation shielding 740 Addenda
3D - Eccentric Rotation
for the patient table 717 to the Operator Manual 21
acquisition mode 501
handling 717 Additional color display
3D CARD
mattresses 720 selecting the image source 223
acquisition mode 500
tabletop 717 Additional devices 71
examination sequence 516
Accessory load Adults
workflow 517
label 31 grid 209
3D Control 480
Accessory rail extension 722 Advanced acquisition modes 88
3D parameter 584
Accessory rails 721 Advanced examinations 475
3D coronary analysis 637
3D DR Acoustic signals 136 Advanced Roadmap
acquisition mode 500 Acquisition 301 performing 323
examination sequence 508 acoustic signals 136 phases 317
workflow 508 display 294 Advanced Roadmap DSA Ref 316
dose 64 Alternative acquisition 302
3D DR - Large
examination sequence 519 exposure parameters 574 Alternative Acquisition Program 302
parameters 573
workflow 520 Alternative acquisition program 559
review modes 362
3D DR - Large Volume Analysis
storing as reference image 305
acquisition mode 501 centerline wall motion 712
Acquisition button 124
3D DSA radial wall motion 713
Acquisition frame rate 361 regional wall motion 712
acquisition mode 500
changing 287 results of LVA 710
examination sequence 510
workflow 511 Acquisition mode starting LVA 692
display 360 Analysis method
3D eccentric rotation
examination sequence 523 Acquisition modes 88, 360 for LVA 692
workflow 523 3D 500 in LVA 716
3D Recon Preset Acquisition parameters QCA, QVA, IZ3D 644
3D parameter 584 checking 286 Analyzed segment 684
3D series Acquisition phases Anatomical background 401
transferring manually 529 3D 527 with Roadmap 325
3D Type Acquisition plane Anesthesia screen holder 730
3D parameter 584 selecting 292 Anesthetic test 807
Aneurysms 678
Angio collimator
control module 118
Angiographic Computed Tomography
(ACT) 500

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Index

Angiographic image Arm rest 734, 735, 736 Automatic control

in IVUSmap 462 Arm support 735 in DYNA, 3D 480
Angle Arrows Automatic format collimation
3D parameter 584 drawing 392 safety check 152
changing 620 Articulated arm support 735 Automatic injection and rotation
display 218 Artis 807 3D 527
drawing 620 Artis Assist 211 DR-DYNAVISION 489
Angle of stand swivel DYNAVISION 498
Artis Cockpit
display 217 Automatic isocenter calibration 600
connection with third-party
Angles devices 75 Automatic restart 789
drawing and measuring 619 screen layout 212 Auto-rotating
Angulation Artis Cockpit 2 213 3D vessel model 657
for LVA 691 Available storage capacity
Artis Live 211
Angulation Step monitoring 297
Artis Reference 211
3D parameter 584 Average
Artis Workplace 211
Dyna parameter 582 in calibration 628
Artis zee biplane
Angulation step Averaged Frames Phase 1
overview 105
rotational angiography 480 roadmap parameter 589
Artis zee ceiling
Angulations 183 Averaging 412, 590
overview 107
Annotation 387 AVI
Artis zee floor
Annotations overview 103 format 433
via touchscreen 383 AXIOM Sensis
Artis zeego
Annual overview 101 touchscreen operation 234
safety checks 148
Artis zeego stand
Aortic aneurysms 678 battery charging 777
Aortic valve danger zones/points 48 B
in LVA 702, 705 movements 155 Background analysis
AP 807 overview 102 in QCA/QVA 673
safety 70 system positions 162 Background curves
AP equipment Assist screen 211, 216, 807 in QCA/QVA 673
pictogram 30 on the Large Display 215 Backup mode
Apex readings 217 during start-up 139
in LVA 702 Audible signal emergency operation 783
APG 807 from the X-ray tube 797 synchronization 784
Application 85 Auto Basic positions
interventional 67 Dyna parameter 582 of the units 160
peripheral angiography 533 Auto delete 443 stopping 160
restart 791 Auto ED/ES 695, 697 Battery
Roadmap 315 Auto ISO calibration 598 charging 777
rotational angiography 475 Bifurcation
Auto Pixel Shift
Application profile fluoroscopy parameter 588 in QCA/QVA/IZ3D 649
in exam sets 564 in vascular analysis 637
Auto Processing
Applications 85 acquisition parameter 577 with stent 659
Area Auto Window Biplane
changing 474 acquisition parameter 578 roadmap 320
drawing 473 fluoroscopy parameter 588 Biplane Head Side
moving 474 system position 168
Auto Windowing 378
Area curve Biplane Left Side
Auto windowing
in QCA/QVA 671 system position 168
peripheral angiography 535
Area formula rotational angiography 479 Biplane LVA 697
results in QCA/QVA 683 Biplane Pulse Reduction
Automap 193
Area length method 709 system position 165, 167 fluoroscopy parameter 589
Area measurements Automatic contour detection Biplane simultaneous angulation
in IVUSmap 472 in LVA 702 key 116
Areas in QCA/QVA 649 Blocking radiation 262
drawing and measuring 473 Blocking unit movements 263
Arm holder 736

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 Index

BMP CAREguard 67 CLEARmotion 573

format 433 CAREmatic 63 CLEARstent 307, 447
Bones White CAREmonitor 65 acquisition program 448
acquisition parameter 578 CAREposition 64, 279 reference image 305
fluoroscopy parameter 589 CAREprofile 63 scene 448
Bookmarks scene replay 448
CAREreport 67
in IVUSmap 467 zooming/panning 449
CAREvision 63
Booting 139 CLEARstent Dynamic 447
CAREwatch 64
Brakes acquisition 448
C-arm
overcoming 196 CLEARstent Dynamic acquisition
angulations 183
releasing brakes for table 179 workflow 449
basic positions 160
safety check 152 CLEARstent image 307
joystick 114
BSA 708 linear movements 184 CLEARstent Live 447
Buffer 781, 783 movements 158 acquisition 450
full! 779 moving 183 zoom stage 450
Button positioning longitudinally 186 CLEARstent Live acquisition
emergency SHUTDOWN 44 virtual 654 program 450
emergency STOP 41 C-arm control module 114 CLEARstent reference image 307, 447
Button types for linear C-arm movements 117 Overlay Reference 308
on touchscreen 228 keys 115 CLEARvessel 573
Bypass fluoroscopy C-arm lift CLEARview 573
display 782 key 117 Click 95
during start-up 139 C-arm position Closing the patient 439
emergency operation 782 display 217 CM 396
zoom stage and collimation 783 C-arm rotations 183 Collimation 201, 202, 203
CARTO during bypass fluoroscopy 783
sending an image 433 for 3D 504
C Carto Correction resetting 203, 208
Cable clips 725 acquisition parameter 579 safety check 150
Cable holder 722 fluoroscopy parameter 589 without radiation 208
Calibration 593, 598 Catheter Collimator
configuring 634 for IVUSmap 453 joystick 119
for 3D 503 Catheter calibration 593, 599, 607 resetting 208
for LVA 691 Catheter Contrast setting without radiation 208
for QCA/QVA, IZ3D 643 roadmap parameter 589 Collimator control module 118
performing 600 Catheter detection method 634 keys 120
Quantification 627 Catheter sizes Collimator home
using the table-object distance 601 configuration 635 key 120
with a calibration factor 613 Collimator rotation
Catheter tray 729
Calibration factor 593, 599 Causes key 120
Calibration methods 598 not correct 804
of errors messages 773
Camera Caution Collimators
image quality 766 setting 202
highlighting 24
Card collimator pictogram 31 Collision
control module 118 override 175
CD drive 96
Cardiac Centerline wall motion Collision area
profile 280 label 31
in LVA 712
Cardiac examinations 447 Collision computer 171, 172
Chapter 23
Cardiac Phase Center Collision protection 41, 171
Checks 147
acquisition parameter 580 Collision sensors 171, 174
Circles
Cardiac Phase Width safety check 149
drawing 391
acquisition parameter 580 Collision zone
Class II equipment
Cardiopulmonary resuscitation (CPR) 68 head holder 719
pictogram 30
CARE (Combined Applications to Reduce Combination
Cleaning 37
Exposure) 63 with other products/components 74
CLEAR image quality 573
CAREfilter 63 Combined C-arm movements 183
CLEARcontrol 573

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Index

Comfortable positioning Covers 73 DDO-Kernel

patient 264 notes 750 fluoroscopy parameter 578, 588
Common image point 654 sterile 749 Dead man's grip (DMG) 41, 171
Compensation filters 740 CPR label 68 Default curve display
Components CPR position 68 in QCA/QVA 688
dangerous 79 label 30 Default patient 255
Compression belt 738 CRAN/CAUD Default report type
Configuration display 217 in QCA/QVA 688, 716
screens 211 Creating Default setting
Configuring 3D vessel model 651 for dynamic image display 362
calibration 634 Cross hair 122 Definitions
LVA 715 Cross-section image in LVA 707
QCA/QVA/IZ3D 687 in IVUSmap 462 in QCA/QVA 682
touchscreen layout 229 CT image Degree
Connectors storing as reference image 309 of Overlay Ref 312
patient table 726 Current roadmap mask 329 Degree of protection
Contour biplane 330 pictogram 30
annotating in LVA 706 Curved distance line Degrees of freedom 155
automatic in QCA/QVA 649 drawing 618 Deleting data
checking in LVA 705 automatically 443
defining in LVA 701 manually 443
defining manually in LVA 703 D Density profile
manual in QCA/QVA 649 in QCA/QVA 672
Daily
Contour correction Deviation movement 172
safety checks 148
for LVA manual 704
Danger of collision Diamentor 64
in LVA 702
Artis zeego stand 48 Diameter
in QCA/QVA 649
floor stand 49 local 678
Contrast Medium
patient table 52 Diameter curve
acquisition parameter 577
stand 51 in QCA/QVA 671
Contrast medium 396, 577
top stand 50 DICOM
maximum filling 409
Danger of crushing 41 conformity 25
Control console 111
Artis zeego stand 48 Different user 144
positioning 177 floor stand 49 Digital subtraction angiography 396
Control module patient table 52 Dilatation timer
C-arm 114 stand 51
C-arm linear 117 using 300
top stand 50
collimator 118 Direct position
warning sign 46
imaging system 120 keys 116
Danger points 47 moving to 193
patient table 112
Danger zones 47 storing 195
stand 114
Dangerous components 79 Direction
Control modules
DAP Peri parameter 586
trolley 110
in exam protocol 419 Disconnection from the power supply
Control room
Data protection 27 disconnecting on-site 145
equipment 89
Cooling unit fault 798 Date Disk
setting 27 full 780
Copyright 25
Daylight saving time 27 Display
Correct
DCS 130 acquisition program 286
modifier 347
window 345 indicator lights 131 BYPASS FLUORO 782
positioning 199 ECG on/off 374
Correcting
DCS extended 131 Fluoroscopy/Roadmap 289
centerline alignment in
positioning 199 image text on/off 373
IVUSmap 470
DCS protected 131 joystick on the live screen 234
pullback speed in IVUSmap 471
DDO (Dynamic Density limiting 352
Corrections of stent borders 663
in IVUSmap 469 Optimization) 592, 808
acquisition parameter 578 scene time on/off 374
fluoroscopy parameter 588 Display Ceiling Suspension (DCS) 130

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 Index

Display modes DR-DYNAVISION 475, 483 ED

native 310 acquisition parameters 582 switching over 706
subtracted 310 examination sequence 483 ED (end diastole) 691
Displays fill phase 488 ED frame
plane ready for radiation 137 injector problem 804 autom. for LVA 697
programmed positions 219 preparing 485 defining for LVA 696
values 218 test phase 486 Edge Enhancement
Disposal 78 workflow 484 acquisition parameter 578
Distance calibration 598, 599 DSA fluoroscopy parameter 588
Distance line acquisition parameters 579 Edge enhancement 381, 578, 588
changing 617 postprocessing 395 value range 381
moving 617 via touchscreen 397
EE-Kernel
Distance measurements DSA images fluoroscopy parameter 578, 588
in IVUSmap 472 windowing 377
Electromagnetic radiation
Distance ranges DSA-DYNAVISION 475, 491 pictogram 30
configuration 635 DST 27 Electronic shutter
Distances Dust deposits 37 setting 367
drawing and measuring 615 DVD 35 Electrophysiology
Documentation DVD drive 96 Physio task card 234
3D vessel model 667 DVD video recorder 35 Emergency
Documents DVD+RW 247 switching off 145
technical 77 DYNA Control Emergency operation 781
Dominant Dyna parameter 582 backup mode 783
changing 287 Dyna Control 480 bypass fluoroscopy 782
with zoom 202 Dyna Time 480 Emergency patient
Door contact 96, 801 Dyna parameter 582 registering 256
Door contacts 70, 780 DynaCT 502 renaming 345
Door open! 780 DynaCT Cardiac 502 Emergency power operation
Dose DynaCT Micro 502 continuous fluoroscopy 787
acquisition parameter 576 DynaPBV Body 502 Emergency power supplies 786
fluoroscopy parameter 587 DynaPBV Neuro 502 Emergency power supply 787
monitoring 296 examination sequence 513 test 788
reference point 65 workflow 514 Emergency SHUTDOWN 44
rotational angiography 479 DYNAVISION 475, 491 switching on again 141
too low 802 Emergency STOP button 41
acquisition parameters 582
wrong dose applied 800 locations 42
examination sequence 491
Dose area product (DAP) 64 fill phase 498 on control modules 112
in exam protocol 419 injector problem 804 safety check 148
Dose increase phase 1 & 2 mask phase 497 Entries
roadmap parameter 587 preparing 494 in the Exam Protocol 416
Dose indication 296 test phase 495 EP Reduction
Dose measuring chamber 64 workflow 493 fluoroscopy parameter 587
Dose rate control Epicardial wall 705
safety check 151 Epipolarity lines 652
Dose reduction 61, 63 E EPS 786
Double-click 95 Eccentric 3D EPS exam set 560
DR 3D parameter 584 Equipment
acquisition parameters 579 ECG in the control room 89
DR images attaching 264 in the examination room 101
windowing 377 problems 804 Equipment training 86
Drawing switch display on/off 374 Equipotential equilization 74
angle 620 ECG Gated Equipotentiality
area 473 acquisition parameter 579, 580 pictogram 30
curved distance lines 618 fluoroscopy parameter 590 Error handling 770
straight distance lines 616 ECG gated frame rate ES
acquisition parameter 580 switching over 706

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Index

ES (end systole) 691 Examination sequence Filtering 201

ES frame 3D CARD 516 in Quant 626
autom. for LVA 697 3D DR 508 Filtration
defining for LVA 696 3D DR - Large 519 for 3D 504
Establish emergency procedures 87 3D DSA 510 Finger filter 204
Evaluations 3D eccentric rotation 523 key 120
in QCA, QVA, IZ3D 674 DR-DYNAVISION 483 setting 205
DynaPBV Neuro 513 Fire
EVE
acquisition parameter 578 DYNAVISION 491 how to respond 76
PERISTEPPING 540
fluoroscopy parameter 589 Fixed
PERIVISION 549
EVE Phase 3 acquisition parameter 579
syngo DynaCT 360 522
roadmap parameter 589 Fixed frame rate
Examination-specific messages 770
Exam acquisition parameter 579
Examiner
task card on touchscreen 227, 272 Flat detector
radiation protection 62
Exam Protocol 415 cover 750
Export
entries 416 Flat Detector (FD) 87
image formats 433
Exam set 280, 559 Flip
on USB memory 434
applying 565 preselection 292
Exposure parameters
assigning to profile 565 Flipping
creating 564 for acquisition 574
image 367
for fluoroscopy/roadmap 587
deleting 566 Floor stand
editing 564 Extended Frame Rate
danger zones/points 49
EPS 560 3D parameter 584
movements 156
for IVUSmap 453 Extended Pixel Depth overview 104
IVUS 560, 566 3D parameter 585
swivel 187
password 561 system positions 166
rearranging 565 Fluoro timer 294
removing programs 565 F Fluoro Type
renaming 565 Fault fluoroscopy parameter 589
selecting 280 in the primary collimator 803 Fluoroscopy 299
viewing 563 FD 87 acoustic signals 136
Exam Set and Program Editor 559 cover 750 changing the program 290
opening 560 keys 123 display 294
Exam Set Editor problems 795 dose 64
default password 562 rotation 189 exposure parameters 587
Exam sets FD cooling system parameters 587
parameters 573 problem 794 review modes 362
Examination 255 FD lift 188 storing a scene 299
advanced 475 membrane keys 123 Fluoroscopy parameters
parameters 273 FD orientation checking 289
peripheral angiography 533 during 3D 505 Fluoroscopy program 289, 559
rotational angiography 475 for Large Volume 505 Fluoroscopy signal
safety checks 147 Feet first 276 resetting 301
task card 268
Fill image 396 Focus
Examination lamps 747
Fill phase acquisition parameter 575
Examination room DR-DYNAVISION 483, 488 defective 799
equipment 101 DYNAVISION 492, 498 fluoroscopy parameter 587
screen layout 270 PERISTEPPING 540, 547 Footswitch 125
PERIVISION 550, 556 connection problem 781
Filling label 32
maximum 409 wireless 125
Filming images 424 Footswitch control
Filter for table with lateral tilt 129
joysticks 119 Footswitch pedal
storing positions 206 alternative acquisition 302
Filter diaphragms 204 Format collimation
incorrect 803

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 Index

Formats Head-end holder 728 Image angle 600

for export 433 Head-end lower body X-ray Image brightness 377
Frame Rate protection 742 Image contrast 377
acquisition parameter 580 Headphone jack 96 Image directory
Dyna parameter 583 Heart rate of a scene 357
Frame rate in LVA 716 Image display
changing 287 Heart rate range dynamic 362
display 360 configuration 635 postprocessing 375
Frame Rate Control Heat Unit 297 selecting 311
acquisition parameter 579 Heated mattress 720 Image format 201
Fixed 579 selecting 201
Help
Frame rates in the case of an error 769 Image formats
acquisition parameter 579 on touchscreen 228 for export 433
Framee Rate Control Hemodynamic data 686 Image orientation 340
ECG Gated 580 changing 367
Hemodynamics
Framerate Ctrl. Physio task card 234 safety check 150
VFR Manual 581 Image parameters
High Contrast
VFR Time 581 fluoroscopy parameter 587 for acquisition 577
Frontal plane High dose fluoroscopy 295 for fluoroscopy 587
marking in LVA 700 Image postprocessing 375
High dose roadmap 295
Full-screen display 357 DSA 395
High-contrast fluoroscopy
Function check 147 acoustic signals 136 Image processing 333
HIS/RIS postprocessing 375
searching 260 Image quality
G Holder camera 766
Gain Correction changes 802
head-end 728
acquisition parameter 578 CLEAR 573
Holder with rails 727
fluoroscopy parameter 588 test for 3D 530
Hospital emergency power supply 785
Gamma Correction Image text
test 789
acquisition parameter 578 switch display on/off 373
Hotfixes 755
fluoroscopy parameter 588 switching off/on 390
Germany Image texts
free texts 390
regulations 73 I predefined 389
Graphics
general 383 Icons Image viewing 333
in the status line 772 Images
postprocessing 375
switching off/on 390 ILD image adding text and graphics 383
in IVUSmap 462 annotating 387
Gray scale
inverting 368 Illustrations 24 incorrect collimation 803
Image providing for Service 762
Grid 209
archiving/sending/exporting 427 providing to WinNIE 767
inserting (FD) 210
removing (FD) 210 changing display 365 Imaging system 88
exporting as bitmap 433 operating in the examination
filming 424 room 225
H flipping 367
for LVA 696
Imaging system UPS 786
Immobilization
Handgrips for QCA/QVA, IZ3D 640 patient 264
with supports 732 full screen 357 Index method 708
Handswitch 124 loading 342
Indications for use 87
connection problem 781 magnifying by two 369
Indicator lights
Harmonization 592, 808 making it coincide with mask 403
on DCS 131
Head first 276 mirror/flip preselection 292
Infants
Head holder 731 moving 348
scrolling 355 grid 209
activation of collision zone 719
selecting 354 Infusion bottle holder 730
Head Side
system position 162, 166 sending to CARTO 433
storing 423
Head support 731
task card on touchscreen 227

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Index

Injection
DR-DYNAVISION 483
Item list
text layout 23
K
DYNAVISION 492 IVUS cross-section image 462 K Factor 590
Neuro-PBV 514 IVUS Exam Set 570 acquisition parameter 578
note 69 Roadmap 317
IVUS exam set 560
PERISTEPPING 540 setting 566 Key
PERIVISION 550 orientation 117
IVUS ILD image 462
preparing 482 Keyboard 89, 92
IVUS ILD image segment 464
Injection mode cleaning 39
IVUS imaging 453
rotational angiography 477 Keys
IVUSmap 453
Injector 748 on the C-arm control module 115
angiographic image 462 on the collimator control
alternative acquisition 303
bookmarks 467
connector 73 module 120
catheters 453
problems 804 on the FD 123
centerline alignment 470 on the stand control module 115
Inline digital display (ILD) 462 correcting the pullback speed 471
I-Noise Reduction on the symbol keypad 93
corrections 469
acquisition parameter 577 on the table control module 114
exam set 453
roadmap parameter 588 K-Factor
examination workflow 454
I-Noise Reduction Details fluoroscopy/roadmap
input field 453
acquisition parameter 578 parameter 589
measurements 471
fluoroscopy parameter 588 Overlay Reference 468 K-Factor Phase-3
Input field 201 roadmap parameter 589
pullback 459
for 3D 504 replay 465 Known side effects 85
for IVUSmap 453 review 461 kV
Input format scrolling 465 acquisition parameter 574
display 218 starting 455 fluoroscopy parameter 587
key 120 step 1 455 kV Dose
safety check 151 step 2 457 acquisition parameter 576
InSpace step 3 459 fluoroscopy parameter 587
task card on touchscreen 227, 503 step 4 461 kV ms
InSpace 3D 502 task card 462 acquisition parameter 574
InSpace Reconstruction 502 zoom stage 453 fluoroscopy parameter 587
Installation 77 IZ3D 621, 637 kV Warning Level
Instructional text 3D vessel model 651 fluoroscopy parameter 587
configuring 687 kV-Focus
text layout 23
quad view 664 acquisition parameter 575
Instrument tray 729
recalling analysis 679
Intelligent Measuring Field 288 Report 682
Intended use 85
Intercom system 96
results 679 L
Stent planning 658
Interventional application 67 workflow 638 Labels 29
of the screens 211
Intravascular Ultrasound (IVUS) 453 IZ3D - Large Vessel 637
Lambert-Beer
Invert 368
law 674
IP codes
pictogram 30 J Landscape
during 3D 505
iPilot Live 305 Joystick Language
ISO stop 178 C-arm 114 user interface 25
ISO tilting 184 collimator, filter 119
Language understanding 86
reverse Trendelenburg / display on the live screen 234
LAO/RAO
Trendelenburg 184 patient table 113
display 217
Isocenter 65, 160 stand 114
coordinates 220 JPEG
display 218 format 433
in rotational angiography 481
key 114
rotational angiography 475
setting 266
stop 178

820 / 830 AXA4-100.620.15.01.02 Operator Manual

 Index

Large Display 133 Local service 753 Mask

configuration error 805 Lock computer 144 making it coincide with image 403
connection with third-party Lock tabletop movement new 397
devices 75 key 114 Mask averaging 412
malfunction 34 Logbook 754 Mask image 396
protective shield 746 Mask phase
Logging in 140
screen layout 215 DYNAVISION 491, 497
Logging off 144
selecting the screen layout 221 PERIVISION 550, 555
Logoff 143
Large Volume Mattress 720
Longitudinal position
FD orientation 505 heated 720
display 218
Laser Max Opac. 409
Longitudinal stand position
label 30
display 217 Max. CU Filter
Laser positioner 122 acquisition parameter 576
Loop 362
on/off 117 fluoroscopy parameter 587
all scenes 364
Lasers Maximum fill image
controlling 358
safety notes 32 replacing 364
in LVA 705
Lateral plane Maximum patient table load
Low dose acquisition 302
marking in LVA 700 label 30
Lower body radiation protection 741
Lateral position 275, 417 Maximum patient weight
LVA 621, 691
patient coordinates 220 label 30
configuring 715
Lateral stand position Measurements 593, 614
marking frontal/lateral 700
display 217 in IVUSmap 471
preliminary results 707
Laterality 340, 387 recalling analysis 707 in postprocessing 376
changing 347, 388 Report 707 Measures
entering 347 results 707 in case of error messages 773
Laws 73 workflow 694 Measuring field 575
LC displays changing 287
cleaning 37 peripheral angiography 536
LCD M with zoom 202
notes 33 MEGALIX
Magnetic field
LCD monitor 91 overload 798
label 31
Left Side Membrane keys
Maintenance 77, 148
system position 163, 166, 167 for C-arm and FD movements 123
Maintenance status 753
Left Side, Table Rotated 15° for FD lift 123
Manual
system position 164 Memory 781
Dyna parameter 582
Left Side, Table Rotated 30° full! 779
Manual calibration 593, 599
system position 164 Message
Manual contour correction
Left Ventricle Analysis 621 overtemperature 795
in QCA/QVA 649
Left/right assignment 340, 387 Message bar
Manual control
LIH 362 on the Large Display 215
for table with lateral tilt 134
storing as reference image 305 Message lines 770
in DYNA, 3D 480
Limited mechanical stability Messages
Manual injection and rotation
label 30 examination-specific 770
3D 527
Linear movements for unit movements 774
DR-DYNAVISION 489
of the C-arm 184 system status 770
DYNAVISION 499
Lines MFH = Max. Fill Hold 362
Manual reference positions
drawing 392 MField
in QCA/QVA 688
Live FLUO/LIH 310 acquisition parameter 575
Manual restart 790
Live image Microphone jack 96
Manual restriction
incorrect collimation 803 Min Opac. 409
in QCA/QVA 650
Live screen 211 Manual stand movements 196 Min. CU Filter
on the Large Display 215 acquisition parameter 576
Manual subsegment
Local density fluoroscopy parameter 587
in QCA/QVA 678
displaying 672 Mirror
Maquet Magnus table 52, 109, 159
Local diameter preselection 292
mAs Modulation
analysis in QCA/QVA 678 MLD
3D CARD parameter 586
displaying 677 at local minimum 688

Artis Q/zeego/Q.zen/zeego.zen (VD10) AXA4-100.620.15.01.02 821 / 830

Index

MLD line Neuro-PBV Overlap

moving 676 injection 514 3D parameter 584
Modifier’s name 347 New mask Overlay 3D 305
Monitor 89 setting 397 Overlay Ref 308, 310, 312, 468
LCD 91 No communication! 778 Overlay Reference
notes 33 No unit movement possible! 776 in IVUSmap 468
Monitors No. Phases performing 312
dark 793 acquisition parameter 581 select reference image 312
positioning 199 Note setting the degree 312
Monthly text layout 23 with a CLEARstent reference
safety checks 148 Number of 3D runs image 308
Motion detector 590, 591 3D CARD parameter 586 Overload
Mouse 89, 95 Numeric keypad 92 of the tube 798
joystick 121 on the Artis Cockpit 213 Override 175
Mouse joystick 121, 225 Overtable/undertable conversion 186
functions 233 Overtemperature
Movement O message 795
after collision 175 tube 796
Obstruction Segment 684
resuming 175 Overview
Off
stopped 175 acquisition system 101
switching off 141
to position with rotated table 197 Artis zee biplane 105
On
Movement possibilities 155 Artis zee ceiling 107
switching on 139 Artis zee floor 103
Movements
ON box 96 Artis zeego 101
abnormal 41
On box 89 Artis zeego stand 102
acoustic signals 136
Artis zeego stand 155 On-site equipment 96 floor stand 104
blocking 263 On-site power supply imaging system 89
C-arm 183 disconnecting 145 patient table 109
C-arms simultaneously 185 Operating locations 87 system positions 161
floor stand 156 priorities 176 top stand 106
manual 196 Operating restrictions 770
not possible 776 Operation
notes 169 via voice control 239 P
patient table 159 Operation instructions Page numbers 23
safety check 149 label 31 Panning 369
stand 186 Operator Manual 3D vessel model 657
stand, C-arm 158 scope of applicability 21 CLEARstent 449
top stand 157 Operator profile 86 in Quant 626
Moving Optimal Projection with shutter 368
C-arm to 3D vessel model 666 for IZ3D 657 with zoom 371
Moving the mask 398 Options without zoom 371
MPPS 441 safety check 151 Panning knob
MR image OR arm rest 736 patient table 113
storing as reference image 309 OR position 167 Parameters
Multi modality screen 211 OR table 109 for the examination 273
Multifunctional button 124 in exam sets 573
Orbital movements 183
Multimodality Parking
Orientation
image source 223 system position 165
key 114, 116
Multipurpose setting 177 Parts 23
profile 280 Parts subject to wear
Orientation key 117
safety-related 78
Orientation labels 340
OR-UPS 786, 787 Password
N Ostial branch 650
changing 562
Native 400 default password 562
OT/UT
display modes 310 for exam set 561
conversion 186 resetting 562
Neuro Other products/components 74
profile 280

822 / 830 AXA4-100.620.15.01.02 Operator Manual

 Index

Patient Pediatry POC (Polygon of Confluence) 685

accepting data from the RIS 255 grid 209 Pointer 372
accepting from Sensis 262 Performing Polygons
active 342 Advanced Roadmap 323 drawing 393
changing data 344 Overlay Reference 312 Portrait
checking/changing data 273 Roadmap 318 during 3D 505
closing 439 Peripheral angiography 533 Position
moving images 348 acquisition programs 535 moving to a reference image
positioning without radiation 279 general information 533 position 193
radiation protection 61 PERISTEPPING 533, 539 Position # - Frame Rate
registering 255 acquisition parameter 586 Peri parameter 587
registering in an emergency 256 examination sequence 540 Positioning
registering manually 258 fill phase 547 DCS 199
renaming/correcting 345 preparing 543
rescuing in an emergency 53 Positioning accessories
return phase 546 using 263
scene directory 351 test phase 544
searching 259 Positioning aids 731
workflow 542
visual contact 28 Positions
PERIVISION 533, 549
Patient Browser Artis zeego stand 162
acquisition parameter 586
calling 342 floor stand 166
examination sequence 549
Patient coordinates 220 stand, C-arm, patient table 160
fill phase 556
with top stand 168
Patient data 273 mask phase 555
PostProc
Patient dose 64 preparing 551
task card 333
Patient entrance dose 64 test phase 553
workflow 551 Postprocessing 375
Patient orientation 340
DSA 395
Patient population 86 Permitted rotation range
in the control room 333
Patient position 274 in LVA 716
in the examination room 335
changing after acquisition 346 Phase # - Frame Rate
Power failure 785
checking/changing 276 acquisition parameter 581
switching on again 141
in the Exam Protocol 417 Phase # - Phase Time
Power off 141
Patient positions 275 acquisition parameter 581
Power ON
in 3D 504 Phase Time
pictogram 30
Patient safety 86 Dyna parameter 583
Power on 139
Patient salvage device Phases
Advanced Roadmap 317 Power ON/OFF
label 32
Roadmap 315 pictogram 30
Patient salvage handheld
Physio Power outlet 73, 726
labels 32
task card 234 Power supply 73
Patient table
accessories 717 task card on touchscreen 227 Power-on pushbutton 96
basic positions 160 Pictograms 29 Precautions 86
connectors 726 Pixel Resolution Predefined regression formulae 709
danger zones/points 52 acquisition parameter 579 Preliminary results
displays 218 Pixel sizes in LVA 707
footswitch control 129 configuration 635 in QCA/QVA/IZ3D 679
joystick 112 Pixelshift 403 Preparations
manual control 134 automatic 406 DR-DYNAVISION 483
movements 159 during Roadmap 327 DYNAVISION 491
moving 178 flexible 408 examination 255
moving to the basic position 182 manual 407 peripheral angiography 536
overview 109 starting 405 rotational angiography 480
panning knob 112 Plane Pressure measurement
raising / lowering 178 key 120 preparing 265
rotated 167 selecting on the touchscreen 228 Pressure switch
rotating 198 Plane ready responds 798
Patient Transfer display 137 Previous roadmap mask 329
system position 162 Playback Primary collimator
Patient weight peripheral angiography 535 fault 803
maximum 45 rotational angiography 478

Artis Q/zeego/Q.zen/zeego.zen (VD10) AXA4-100.620.15.01.02 823 / 830

Index

Printing images 424 QCA/QVA Rectangular pixels

Priorities configuring 687 Quantification 621
of operating elements 176 preliminary results 679 Reference diameter
Problems recalling analysis 679 automatic 675
with the ECG 804 Report 682 manual 677
with the FD cooling system 794 results 679 Reference image 305
with the injector 804 workflow 638 displaying for system position 194
Procedure tracking Quad view fading in or out 312
with MPPS 441 in IZ3D 664 for use with Overlay Ref 312
Processing Mode Quality measurements moving to a position 193
acquisition parameter 577 for 3D 503 scrolling 355
Programmed positions Quant second 306
deleting 196 task card 621, 623 selecting 354
displays 219 task card on touchscreen 227 storing 306
key 116 Quantification 621 Reference point
moving to 190 in the control room 623 dose 65
storing 194 in the examination room 625 Reference screen 211
Prone position 275, 417 notes 621 Regional wall motion
patient coordinates 220 Quantitative Coronary Analysis 621 in LVA 712
Proper use 22 Quantitative Vascular Analysis 621 Registration
Protection class 74 Quantitative Ventricular Analysis 691 default patient 255
Protective shield QVA 621, 637 Regression formulae 709
for Large Display 746 Regulations 73
Pullback Remote assistance 762
for IVUSmap 459 R Remote service 760
Pullback speed Radial wall motion Remote software update 755
correcting in IVUSmap 471 in LVA 713 Repair 77
Pulse Rate Radiation Replace mask
fluoroscopy parameter 589 acoustic signals 136 during roadmap 325
Pulse rate blocking 262 Replacing the mask 399
changing 291 is aborted 802 Replay
Pulse rates not possible 800 CLEARstent scene 448
fluoroscopy parameter 589 Radiation disable switch 801 IVUSmap 465
Pulserate Secondary Plane Radiation indication 294 Report 631
fluoroscopy parameter 589 Radiation indicators funtions 631
Pulsewidth safety check 149 in LVA 707
acquisition parameter 574 Radiation protection in QCA/QVA/IZ3D 682
fluoroscopy parameter 587 attaching 264 Representative 352
Push-to-talk mode (PTT) 99 general 61 Requirements
lower body 741 for diagnosis 28
upper body 744 RESET 792
Q Radiation protection devices button 96
QCA 621, 637 safety check 149 Resource display 772
QCA 3D 621, 637 Radiation protection window 744 Response
3D vessel model 651 Radiation safety 86 in case of fire 76
configuring 687 Radiation shielding 740 Restart
preliminary results 679 Readings application or system 791
Report 682 on the Assist screen 217 manual 790
results 679 Ready Processed Images 429 necessary! 778
workflow 638 Recalling Restarting 789
QCA 3D/QVA 3D LVA analysis 707 Restricted duty cycle
recalling analysis 679 QCA/QVA/IZ3D/QVA 3D analysis 679 label 30
Reconstruction Restriction
3D 502 manual in QCA/QVA 650
Rectangular collimation 203

824 / 830 AXA4-100.620.15.01.02 Operator Manual

 Index

Results
in LVA 707
S Searching
in the HIS/RIS 260
in QCA/QVA/IZ3D 679 Safety patient data 259
of the hemodynamic data 686 AP 70 Sending
Return phase Safety checks 147 to CARTO 433
DYNAVISION 492 daily 148 Sensis
PERISTEPPING 540, 546 monthly 151 accepting patient data 262
Return run Safety equipment touchscreen operation 234
during 3D DSA 528 for unit movements 171 Sensis Dialog 211
Review Safety information Sensis Live 211
IVUSmap 461 highlighting 23 Sensis screen 211
Review frame rate Saving
Series
setting 361 a screen shot to USB 214 moving 348
Review modes Scene
Series name
for acquisitions 362 changing display 365 changing 345
for fluoroscopy/roadmap 362 CLEARstent 448
Service
Right Side exporting as video or bitmaps 433
local 753
system position 163, 167 for QCA/QVA, IZ3D 640
maintenance 753
image directory 357
RIS Service contract 78
improving noise suppression 412
accepting patient data 255 utilization-based 753
loading 342
Roadmap 315 Service functions 753
magnifying by two 369
anatomical background 325 Service life
moving 348
application 315 of products 78
reviewing 358
biplane 320 Servo assistance
scrolling 355
changing the program 290 patient table 113
selecting 354
exposure parameters 587
sending/exporting 427 Set of body straps 737
K Factor 317
single step 359 Settings
parameters 587
Scene directory 351 task card on touchscreen 227, 271
performing 318
scrolling 353 Shortcut
phases 315
Pixelshift 327 Scene duration 579 moving to a position 193
replace mask 325 acquisition parameter 579 storing a position 195
review modes 362 Scene length Shoulder supports 733
Show Progress 327 changing 287 Show Progress
single plane 318 Scene name during Roadmap 327
vessel/catheter contrast 326 changing 345 Shutdown 142
with return to biplane system Scene overview 357 necessary! 779
position 330 Scene Time with active security 143
with two system positions (single acquisition parameter 580, 581 Shutter
plane) 329 Peri parameter 586 electronic 367
Roadmap parameters Scene time electronic shutter 367
checking 289 switch display on/off 374 SID
Roadmap program 289, 559 Scope of applicability 21 display 218
Roadmapping technique 315 Screen configuration 211 setting 188
Room lighting 28 Screen layout 211 Sigmoid Window
Rotating Artis Cockpit 212 acquisition parameter 578
3D vessel model 656 in the examination room 270 fluoroscopy parameter 588
3D vessel model to C-arm Large Display 215 Signals
position 658 on the system console 268 acoustic 136
Rotating the FD 189 on the touchscreen 270 Simpson method 709
Rotational angiography 475 selecting for Large Display 221 Simultaneous movements
acquisition programs 479 Screen saver 26 of both C-arms 185
general information 475 Screen shot Single plane
saving to USB 214 roadmap 318
Scrolling Single shot
in the directories 353 alternative acquisition 302
IVUSmap 465 Single step 359
SCU reset 777

Artis Q/zeego/Q.zen/zeego.zen (VD10) AXA4-100.620.15.01.02 825 / 830

Index

Skin dose 63, 64, 65 Stopping System console 89

alternative acquisition 302 in the basic positions 160 screen layout 268
Smoothing the contour of movements 175 System date and time 27
for LVA manual 704 Store Monitor 423 System Emergency Power Supply
in LVA 703 Storing (EPS) 786
in QCA/QVA 650 a CLEARstent reference image 307 System messages
Software a reference image 306 locations 769
language 25 an XA reference image 309 types 769
Software updates 25, 755 key for position 116 System Owner Manual 22
Specialist knowledge 22 Straight distance line System position 277
Specialized knowledge drawing 616 calling up information 277
Quantification 621 Stripe compensation key 116
Speed reduction 171 acquisition parameter 579 moving to 190
Sphere calibration 593, 599, 610 fluoroscopy parameter 589, 590 moving to, using shortcut keys 193
Sphere sizes Study storing with shortcut 195
configuration 635 moving 348 System positions
Stand 101 Study Report 415 Artis zeego stand 162
joystick 114 Subtracted 400 floor stand 166
movements 158 display modes 310 overview 161
Subtracted fluoroscopy peripheral angiography 534
Stand control module
keys 115 Roadmap 315 rotational angiography 477
Subtracted image 396 System status messages 770
Stand control modules 114
Stand movements 186 Supine position 275, 417
manual 196 patient coordinates 220
Stand position Surgery table 52, 109, 159 T
display 217 Switching off 141 Table
Stand swivel 187 in an emergency 44, 145 movements 178
Start Position manually 792 moving to the basic position 182
3D parameter 584 Switching on 139 raising / lowering 178
Start Position Eccentric after emergency SHUTDOWN 45 rotated 167
bypass fluoroscopy 782 rotating 198
3D parameter 584
Symbol keypad tilting 181
Start-up 139
keys 93 Table control module 112
State of the art
on the Artis zee cockpit 213 keys 114
Quantification 621
Symbols Table lift
Status displays
on the footswitch 126 key 114
monitoring 294
Synchronization Table position
Status line
after backup mode 784 displays 218
icons 772
syngo DynaCT 502 Table swivel
in windows 772
syngo DynaCT 360 501, 584 display 218
Statutory regulations 22
examination sequence 522 key 114
Stenosis
workflow 522 Table tilt
results in QCA/QVA 684
syngo DynaCT Cardiac 502 display 218
Stenosis calculation key 114
auto reference 675 syngo DynaCT Micro 502
syngo DynaPBV Body 502 Table-object distance 599
manual reference 677
syngo DynaPBV Neuro 502 Tabletop 717
notes 674
syngo InSpace 3D 502 damage 46
Stent borders
moving longitudinally only 180
display 663 syngo keypad 92
moving with joystick 180
Stent placement 659 syngo Remote Assist 763
moving with panning knob 179
Stent planning 658 syngo Workplace screen 211 versions 717
with bifurcation 659 System Task card
Sterile covers 749 restart 791 Examination 268
Sterilization 40 System components IVUSmap 462
Stop installed 21 Physio 234
in the isocenter 178 System configurations 87 PostProc 333
STOP button 41 Quant 621, 623

826 / 830 AXA4-100.620.15.01.02 Operator Manual

 Index

Task cards
on the touchscreen 226, 227
Transfer Headside
system position 166
V
Technical documents 77 Transfer problems 793 Value statements 24
Technical knowledge 22 Transferring Values
a 3D series 529 displays 218
Test
of hospital emergency power Transverse position Variable frame rate 579
supply 789 display 218 acquisition parameter 581
Test film 766 Trendelenburg Ventilation slots 37
Test images 29, 765 display 218 Vessel contour detection
restoring 766 tilting the tabletop 181 in QCA/QVA 646
Test phase Trolley Vessel Contrast
3D 526 for control modules 110 roadmap parameter 589
DR-DYNAVISION 483, 486 Trumpf Surgery Table 52, 109, 159, 178 Vessel Presentation DSA
DYNAVISION 491, 495 TSC roadmap parameter 589
PERISTEPPING 540, 544 configuration 229 Vessel Presentation Phase 2
PERIVISION 550, 553 Tube roadmap parameter 589
Tests 147 too hot 796 Vessel segment
Text Tube grid selecting in QCA/QVA 648
general 383 defective 799 Vessel/catheter contrast 402
in images (directories) 341 Tube load 297 with Roadmap 326
in images (full screen) 335 acoustic signals 136 VFR Manual
switching off/on 390 Tube overtemperature 798 acquisition parameter 579
Text layout 23 VFR Time
Texts acquisition parameter 579
free texts 390 U Video recorder 35
predefined 389 Videoswitch 223, 224
U.S.A.
Thermal load 297 Viewing
regulations 73
Third party components 22 3D vessel model 654
Unit computer
Third-party software 25 resetting 777 Virtual C-arm 654
Time Virtual memory 772
Unit movements 155
setting 27 blocking 263 Virus infections 759
TOD not possible 776 Virus pattern 755
calibration 599 notes 41 Virus protection 755
performing a calibration 601 Virus scanner 755
Units
Toggle 362 basic positions 160 Visual contact 28
Toggle ostial branch 650 conversion in QCA/QVA 675 Voice commands 242
Tooltip help opening 74 Voice control 239
on touchscreen 228 Universal Volume correction formulae 709
Top stand profile 280
danger zones/points 50, 51 Updates 22
movements 157
overview 106
Upgrades 22 W
Upper body radiation protection 744
swivel 187 Wall contour
UPS 786 drawing in LVA 705
system positions 168
test 788 parameter 711
Touchscreen 120, 225
UPS Exam Set 560, 570 Wall motion analysis
annotations 383
Usability 86 in LVA 712
button types 228
DSA 397 USB Warning
screen layout 270 saving a screen shot 214 highlighting 24
task cards 227 USB jacks 96 Warning signs 46
tooltip help 228 USB memory Washout
Touchscreen control 120 exporting to 434 Dyna parameter 583
Touchscreen control (TSC) 225 User guidance 770 Washout phase 478, 499
Touchscreen control console 120 User interface DYNAVISION 492
Touchscreen layout languages 25 Wedge filter 204
configuration 229 User-defined regression formula 710 key 120
Using pointers 372 setting 204

Artis Q/zeego/Q.zen/zeego.zen (VD10) AXA4-100.620.15.01.02 827 / 830

Index

Weekly Zoom
safety checks 148 by a factor of 2 369
Window Brightness to acquisition size 369
acquisition parameter 578, 588 Zoom factor
Window Center safety check 151
acquisition parameter 578, 588 Zoom format
Window center 377 key 120
Window Contrast Zoom stage 201
acquisition parameter 578, 588 display 218
Window values during bypass fluoroscopy 783
automatic assignment 381 for 3D 504
manual setting 378 for CLEARstent Live 450
Window Width for IVUSmap 453
acquisition parameter 578, 588 selecting 201
Window width 377 Zooming 369
3D vessel model 657
Windowing
3D vessel model 657 CLEARstent 449
in Quant 626
automatic 378
in Quant 626
notes 376
peripheral angiography 535
rotational angiography 479
value range 378
Windows Bitmap 433
WinNIE 767
Wireless footswitch 125
Workflow
3D CARD 517
3D DR 508
3D DR - Large 520
3D DSA 511
3D eccentric rotation 523
CLEARstent Dynamic 449
DR-DYNAVISION 484
DynaPBV Neuro 514
DYNAVISION 493
IVUSmap 454
IZ3D 638
LVA 694
PERISTEPPING 542
PERIVISION 551
QCA, QVA 638
syngo DynaCT 360 522

X
XA reference image 309
X-ray tube assembly
audible signal 797
maintenance 78
overload 798
pressure switch responds 798

Z
Zero stop 160
key 116

828 / 830 AXA4-100.620.15.01.02 Operator Manual

 Notes

Artis Q/zeego/Q.zen/zeego.zen (VD10) AXA4-100.620.15.01.02 829 / 830

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Order No.: AXA4-100.620.15.01.02 | © 09.2012, Siemens AG