ARTIS zee and zeego AXA4 Operator Manual March 2012

Global Siemens Healthcare Headquarters Siemens AG Healthcare Sector Henkestr.127 91052 Erlangen Germany Phone: +49 9131 84-0 www.siemens.com/healthcare

Order No.: AXA4-100.620.12.03.02 | © 03.2012, Siemens AG

Global Siemens Headquarters Siemens AG Wittelsbacherplatz 2 80333 Muenchen Germany

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

Legal Manufacturer Siemens AG Wittelsbacherplatz 2 DE-80333 Muenchen Germany

Operator Manual

Artis zee/zeego

www.siemens.com/healthcare

Operator Manual

Artis zee/zeego

Global Siemens Healthcare Headquarters Siemens AG Healthcare Sector Henkestr.127 91052 Erlangen Germany Phone: +49 9131 84-0 www.siemens.com/healthcare

Order No.: AXA4-100.620.12.03.02 | © 03.2012, Siemens AG

Global Siemens Headquarters Siemens AG Wittelsbacherplatz 2 80333 Muenchen Germany

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

Legal Manufacturer Siemens AG Wittelsbacherplatz 2 DE-80333 Muenchen Germany

Operator Manual

Artis zee/zeego

www.siemens.com/healthcare

Operator Manual

Artis zee/zeego

Global Siemens Healthcare Headquarters Siemens AG Healthcare Sector Henkestr.127 91052 Erlangen Germany Phone: +49 9131 84-0 www.siemens.com/healthcare

Order No.: AXA4-100.620.12.03.02 | © 03.2012, Siemens AG

Global Siemens Headquarters Siemens AG Wittelsbacherplatz 2 80333 Muenchen Germany

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

Legal Manufacturer Siemens AG Wittelsbacherplatz 2 DE-80333 Muenchen Germany

Operator Manual

Artis zee/zeego

www.siemens.com/healthcare

Operator Manual

Artis zee/zeego

Legend

 Prerequisites  Instructions  List items  Cross reference

Caution/ Warning

Cause Possible consequences  Precautions or remedies

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 persons.

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 market according to the above-mentioned EC Directive. Unauthorized changes to this product invalidate this declaration.

Original language Version

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This Operator Manual was originally written in English. This Operator Manual applies to system/software version VC20 and higher.

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Table of Contents

Part: Safety

21

Chapter: User Information

21

Information about this Operator Manual General information Structure Text layout Highlighting of safety information Illustrations Value statements Information about the software Data protection System date and time Information about system handling Visual contact to patient Room lighting Prerequisites for diagnosis and treatment planning Pictograms and labels Lasers Monitors/LCDs Large Display Use of hardcopy cameras Use of wireless footswitches Use of video recorders Cleaning and disinfection Cleaning Disinfection Sterilization

21 21 23 23 23 24 24 24 26 26 27 27 27 28 28 31 32 32 33 33 34 35 35 38 39

Chapter: Safety Notes and Radiation Protection

41

Information about unit movements Red emergency STOP buttons Where are the emergency STOP buttons? Emergency SHUTDOWN button (installed on-site) Maximum patient weight Damage to the tabletop Warning signs Danger zones / danger points ... ... on the Artis zeego stand ... on the floor stand (Artis zee floor/Artis zee biplane) ... on the top stand (Artis zee biplane) ... on the Artis zee ceiling stand/C-arm

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... on the patient table ... on the Artis zee multi-purpose stand Rescuing the patient in an emergency Radiation protection Dose monitoring and reduction Reducing radiation with CARE Interventional application Cardiopulmonary resuscitation (CPR) Injection Radiation protection (interventions) AP safety for interventional examinations Cleaning and disinfecting (interventions) Additional devices

Chapter: Operating Safety and Safety Precautions

77

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

77 77 77 78 80 81 81 82 82 83

Chapter: Security Package Important notes

Part: System Overview Application System configurations

Chapter: Equipment in the Control Room Imaging system overview System console Artis zee cockpit LCD monitors Keyboard Mouse

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ON box with CD/DVD drives On-site equipment Intercom system

Chapter: Equipment in the Examination Room Acquisition system overview Overview Artis zeego The Artis zeego stand Overview Artis zee floor The floor stand (Artis zee floor and Artis zee biplane) Overview Artis zee biplane The top stand (Artis zee biplane) Overview Artis zee ceiling The Artis zee ceiling stand/C-arm Patient table Overview Artis zee multi-purpose The Artis zee multi-purpose stand/C-arm Trolley for control modules

Chapter: Operating Elements and Displays Control consoles Emergency STOP button Table control module - TCM Stand/C-arm control module - SCM C-arm control module for linear movements (Artis zeego) Orientation key Collimator control module (CCM) Touchscreen control console Laser positioner Keys on the FD Membrane keys for FD lift Membrane keys for C-arm and FD movements Handswitch Footswitch Standard or wireless footswitch Footswitch control for table with lateral tilt Display Ceiling Suspension (DCS) Data display Readings on the data display / Assist screen Manual control for table with lateral tilt Acoustic signals “Plane ready for radiation” displays

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Part: System Operation

155

Chapter: Switching On/Off

155

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

Chapter: Functional and Safety Check

163

General information Performing checks Daily checks Monthly checks

163 163 164 167

Chapter: Unit Movements

171

Movement possibilities Movements of the Artis zeego stand Movements of the floor stand  (Artis zee floor and Artis zee biplane) Movements of the top stand (Artis zee biplane) Movements of the stand/C-arm (Artis zee ceiling) Movements of the patient table Movements of the stand/C-arm/patient table  (Artis zee multi-purpose) Basic positions of the units General basic positions Stopping in the basic positions Overview of system positions System positions of the Artis zeego stand System positions of the floor stand  (Artis zee floor and Artis zee biplane) Positions with the top stand (Artis zee biplane) Initiating unit movements Important information on unit movements Collision protection Stopping movements

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Operating locations and priorities Connecting the control consoles (Artis zee multi-purpose only) Positioning the control consoles Table movements C-arm movements Stand/C-arm/system movements FD lift / Setting the SID Rotating the FD / Setting portrait/landscape Moving to system and programmed positions Moving to system positions using shortcut keys  (direct positions I, II, III) Automap Storing programmed positions Storing system positions with shortcut (direct positions I, II, III) Deleting programmed positions Manual stand movements Movement to or from a position with rotated table Swinglab operation Positioning the monitors

Chapter: Image Format, Collimation and Filtration

193 193 195 195 201 205 208 209 211 213 214 215 216 216 217 218 220 221

223

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

223 224 225 226 230 230 231 232

Chapter: Screen Layout and Configuration

235

Artis screens Artis zee cockpit screen layout Large Display screen layout Selecting the screen layout of the Large Display Selecting the image source for the additional color display Operating the 4x4 Crossbar Videoswitch Operation via touchscreen control Touchscreen control (TSC) Selecting a task card Selecting a different layout Button types Selecting the plane (Artis zee biplane)

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Displaying tooltip help for buttons Configuring the touchscreen layout Mouse joystick functions Display of the joystick function on the live screen Sensis touchscreen operation

246 247 251 252 252

Chapter: DVD Video Recording

257

Recording with DVO-1000MD Important information Control elements and displays Setup DVD recording DVD playback

257 257 259 262 263 264

Part: Examination

265

Chapter: Preparations - Fluoroscopy - Acquisition

265

Registering a patient Taking over patient data from the RIS Registering an emergency patient Registering the patient and starting examination Registering a patient manually Preregistering the patient Searching for patient data Searching in the HIS/RIS and registering Taking over patient data from Sensis Preparing the patient and equipment Blocking radiation Blocking unit movements Transferring and positioning the patient Attaching the ECG Preparing for pressure measurement Adjusting the units (stand and table) Setting the isocenter The Examination task card Screen layout on the system console in the control room Screen layout in the examination room Screen layout on the touchscreen in the examination room Parameters for the examination Patient data

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Patient position System position Positioning the patient without radiation - CAREposition Exam set, application profile and acquisition program Fluoroscopy/roadmap program Acquisition plane(s) Image mirror/flip preselection Monitoring status displays Fluoroscopy/acquisition Fluoroscopy Storing a fluoroscopic scene Storing images as Store Monitor Using the dilatation timer Stopping dose regulation Resetting the fluoroscopy signal Acquisition Alternative acquisition

Chapter: Reference Images and Display Modes Storing reference images Reference image 2nd Reference image CLEARstent reference image XA reference image Display modes for fluoroscopy/roadmap and acquisition Selecting the display mode Performing Overlay Reference

Chapter: Subtracted Fluoroscopy: Roadmap Performing Roadmap Normal Roadmap Advanced Roadmap using a reference image Replace mask during roadmap Anatomical background with Roadmap Vessel/catheter contrast with Roadmap Show Progress during Roadmap Roadmap with two system positions (single plane) Roadmap with return to biplane system position  (Artis zee biplane)

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Part: Image Postprocessing

339

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

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339 339 341 341 347 347 348 348 349 350 354

Chapter: Managing and Viewing Scenes/Images

357

The scene directory of a patient Representative Limiting display to scenes/images/reference images Scrolling through the directories Selecting scenes/(reference) images Scrolling through scenes/(reference) images Scene overview Controlling scene review (Loop) Stopping the loop Single step Starting the loop Acquisition mode and frame rate Setting the review frame rate Defining the default review mode Loop through all scenes Replacing the maximum fill image Changing scene/image display Image flip/mirror Setting an electronic shutter Inverting grayscale values Magnifying the scene/image, zooming/panning Panning without zoom Using pointers Hiding patient information Switching image text on/off Switching scene time display on/off Switching ECG display on/off

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Chapter: Processing Scenes/Images Defining window and filter values Information about windowing Setting window values manually Assigning automatic window values Edge enhancement filter Adding text and graphics to images General information about text and graphics Annotating images Drawing circles Drawing lines or arrows Drawing polygons Distance calibration Drawing and measuring distances Drawing and measuring angles

Chapter: DSA Postprocessing Introduction Setting a new mask Default setting “Move Mask” or “Replace Mask” Moving the mask Replacing the mask Switching over between subtracted and unsubtracted display Anatomical background Vessel/catheter contrast Making the image and mask coincide exactly (Pixelshift) Starting pixelshift Automatic pixelshift Further pixelshift corrections Terminating pixelshift Manual pixelshift Flexible pixelshift Undoing pixelshift Generating the image with maximum contrast medium filling Improving the noise suppression of a scene (averaging)

Chapter: Exam Protocol Displaying the Exam Protocol Calling up the Exam Protocol Entries in the Exam Protocol Entering comments Printing the Exam Protocol Closing the window

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Chapter: Saving and documenting scenes/images

441

Automatic storage Storing the current image (Store Monitor) Documenting scenes/images Filming/printing images Archiving/sending/exporting patients/images Exporting scenes/images as video or bitmaps Exporting scenes/images Closing the patient Configuring patient close Procedure tracking with MPPS Deleting patients/studies/series/scenes

441 441 442 442 444 450 451 455 456 457 459

Part: Advanced Examinations Chapter: Cardiac Examinations CLEARstent acquisition General information CLEARstent acquisition workflow

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463 463 464 464 465

Chapter: Rotational Angiography, 3D Acquisition

467

General information on rotational angiography Acquisition programs for rotational angiography General preparations Preparing the examination Preparing the patient Preparing the stand and table Setting the isocenter Preparing the injection DR-DYNAVISION DR-DYNAVISION examination sequence DR-DYNAVISION workflow Preparing DR-DYNAVISION DR-DYNAVISION test phase DR-DYNAVISION fill phase DYNAVISION DYNAVISION examination sequence DYNAVISION workflow Preparing DYNAVISION DYNAVISION test phase

467 471 473 473 473 473 474 474 475 475 476 477 478 480 483 483 485 486 487

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DYNAVISION mask phase DYNAVISION fill phase 3D 3D acquisition programs 3D DR examination sequence 3D DR workflow 3D DSA examination sequence 3D DSA workflow Neuro-PBV IR examination sequence Neuro-PBV IR workflow 3D CARD examination sequence 3D CARD workflow 3D DR - Large examination sequence (Artis zeego) 3D DR - Large workflow (Artis zeego) 3D DR - Large Fast examination sequence (Artis zeego) 3D DR - Large Fast workflow (Artis zeego) 3D eccentric rotation examination sequence (Artis zeego) 3D eccentric rotation workflow (Artis zeego) Preparing 3D (all 3D examinations) 3D test phase 3D acquisition phases Test of image quality for 3D

Chapter: Peripheral Angiography General information on peripheral angiography Acquisition programs for peripheral angiography General preparations Preparing the patient Preparing the stand and table Preparing the injection Setting the start position Setting the field of view PERISTEPPING PERISTEPPING examination sequence PERISTEPPING workflow Preparing PERISTEPPING PERISTEPPING test phase PERISTEPPING return phase PERISTEPPING fill phase PERIVISION PERIVISION examination sequence PERIVISION workflow Preparing PERIVISION

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PERIVISION test phase PERIVISION mask phase PERIVISION fill phase

548 550 551

Chapter: Scanning Examinations

555

General information on scanning examinations Acquisition programs for scanning examinations DR-Scanning - Artis zee multi-purpose only DR-Scanning examination sequence Preparing DR-Scanning DR-Scanning run

555 556 556 557 557 559

Part: Exam Sets

561

Chapter: The Exam Set and Program Editor

561

Exam Sets Managing and editing exam sets Opening the Exam Set and Program Editor Changing the password for the Exam Set Editor Resetting the password for the Exam Set Editor Viewing exam sets Editing exam sets Viewing and editing acquisition/fluoroscopy/roadmap programs Organizing programs Storing and/or applying programs Closing the Exam Set and Program Editor

Chapter: Parameters for Exam Sets

575

CLEAR image quality Acquisition parameters Exposure parameters for acquisition Image parameters for acquisition Frame rates and scene duration Parameters for rotational angiography Parameters for 3D Parameters for peripheral angiography Parameters for DR-Scanning (Artis zee multi-purpose only) Parameters for fluoroscopy/roadmap Exposure parameters for fluoroscopy/roadmap Image parameters for fluoroscopy/roadmap

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Pulse rates General parameters K Factor and motion detector Digital Density Optimization (DDO)

Part: Quantification Quantitative analysis methods Important notes The Quant task card On the monitor of the system console in the control room On the touchscreen control in the examination room General postprocessing functions Selecting patients and scenes/images Defining window and filter values Zooming/panning Measurements Common functions Report Configuration

Chapter: Calibration Calibration methods Performing a calibration Selecting a calibration method or recalibrating Automatic isocenter calibration Calibration using the table-object distance (TOD) Distance calibration Catheter calibration Sphere calibration Calibration with a calibration factor Undoing the last calibration step Confirming calibration / calculating the average Clearing the entire calibration Recalling the last calibration Configuring the calibration

Chapter: Quantitative Vascular Analysis (QCA/QVA, IZ3D) Performing a vascular analysis QCA/QVA workflow IZ3D workflow

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Selecting a scene/image Scenes/images for IZ3D Calibration Selecting the analysis method Vessel contour detection Selecting the vessel segment Correcting the contour Manual restriction Toggle ostial branch 3D vessel model in IZ3D Creating a 3D vessel model Common image point Viewing the 3D vessel model Stent planning in IZ3D Displaying the quad view Moving the C-arm according to the 3D vessel model Documentation of the 3D vessel model Contour information Entering analysis information Selecting diagram display Performing evaluations Information about stenosis calculation Automatically determined reference diameter Modifying an analysis Manually determined reference diameter Manual subsegment Local diameter Recalling an analysis Results (Report) Preliminary results Report Results of the hemodynamic data Configuring QCA/QVA/IZ3D

632 633 635 635 638 639 640 641 641 642 642 645 645 649 655 657 658 659 660 661 665 665 666 667 668 669 669 670 670 670 673 677 678

Chapter: Quantitative Ventricular Analysis (LVA)

681

Starting analysis Selecting a scene Selecting the analysis method LVA workflow Selecting images Biplane LVA Setting the frontal and lateral plane Defining contours

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Recalling an LVA analysis Results (Report) Regression formulae Analysis parameters Wall motion analysis Configuring LVA

Part: Accessories and  Auxiliary Devices General information Equipment with accessories Handling accessory parts Accessories for the patient table Tabletops Tabletop for headrest (Neuro) Connectors Accessory rails Accessory rail extension Mattresses Heated mattress Holder with rails Head-end holder Catheter tray, foot-end Instrument tray Infusion bottle holder Anesthesia screen holder Positioning aids Head support with cushion set Head holder Handgrips with supports Shoulder supports Arm rest Articulated arm support Arm rest for vertebroplastic and kyphoplastic procedures OR arm rest with holder Arm holder Cable holder Set of body straps Compression belt

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