Quickguide Q and Q.zen Ceiling

Artis Q/Q.
zen ceiling
Quick Guide Volume 1
Software VD10 and higher
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 persons.
Original language
Artis Q/Q.zen ceiling - Quick Guide
This Quick Guide was originally written in

English.
Version
This Quick Guide applies to system/software version VD10 and higher.
AXA4-100.622.24.02.02
Content Overview
System Overview (Exam Room).........8
System Operation ...........................16
Examination ...................................44
Postprocessing (Exam Room) ..........84
Quantification (Exam Room) .........102
IVUSmap.......................................130
Rotational Angiography, 3D ..........142
Troubleshooting ...........................174
AXA4-100.622.24.02.02
Peripheral Angiography.................166
Quick Guide Layout

This Quick Guide contains pairs of opposite pages. As a rule, the right page shows the steps to
be performed, the left page overviews, more detailed information, and figures.
Text layout
Prerequisites
Instructions
List items
Cross reference
Safety information:
Note
These texts contain tips, more detailed information, and important notes.
Warnings are preceded by a warning triangle

and a signal word. It is followed by a three-level
indication of the hazardous situation and possible evasive action.
Caution/Warning
Cause
Possible consequences
Precautions or remedies
AXA4-100.622.24.02.02
Table of Contents
System Overview (Exam Room) .....................8
Overview Artis ceiling ...........................................8
System Operation .......................................16

Control consoles .................................................16
Table movements ...............................................19
C-arm movements ..............................................23
Stand movements...............................................25
Programmed movements....................................27
Automap ............................................................31
Image size and format ........................................33
Collimation and filters.........................................39
Touchscreen control (TSC) ..................................42
Registering a patient ...........................................45

Preparing the patient and equipment ..................49
Setting the isocenter...........................................53
Checking parameters ..........................................55
Fluoroscopy ........................................................63
Acquisition .........................................................65
Alternative acquisition ........................................67
Roadmap ............................................................69
CLEARstent .........................................................76
Display mode......................................................79
Dynamic scene replay .........................................81
Scene directory ...................................................83
Postprocessing (Exam Room) ......................84

Windowing .........................................................85
Zooming/panning ...............................................87
Using the pointer ................................................87
DSA postprocessing ............................................88
Annotations........................................................97
Calibration and distances ....................................99
Quantification (Exam Room) .....................102

Calibration........................................................103
Quantitative Vascular Analysis
(QCA, QVA and IZ3D) ........................................107
AXA4-100.622.24.02.02
Examination ...............................................44
3D vessel model in IZ3D ....................................111

Left Ventricular Analysis (LVA)...........................121
IVUSmap...................................................130
IVUSmap examination workflow .......................131
Step 1: Start IVUSmap and acquire scene...........133
Step 2: Mark the vessel segment of interest.......135
Step 3: Pullback ................................................137
Step 4: Review ..................................................141
Rotational Angiography, 3D ......................142
3D ....................................................................146
3D DR ...............................................................148
3D DSA .............................................................150
DynaPBV Neuro and DynaPBV Body ...................154
3D CARD ...........................................................158
DR-DYNAVISION................................................162
DYNAVISION .....................................................164
Peripheral Angiography.............................166
PERISTEPPING ...................................................170
PERIVISION .......................................................172
Troubleshooting .......................................174
System messages..............................................174
Emergency operation........................................176
No unit movement possible! .............................178
Buffer full! - Memory full! ..................................178
Stopping movements........................................180
Patient rescue ...................................................182
Restarting .........................................................186
AXA4-100.622.24.02.02
Introduction
We welcome you as a user of an Artis Q/Q.zen
ceiling acquisition system from Siemens.
This Quick Guide is designed to give you quick
access to information on the basic operating
steps and the most important functions of your
system during routine examination work.
Note
This Quick Guide is only valid in combination
with the Instructions for Use and the safety
information contained therein.
Content Overview
The following topics are covered by this Quick
Guide:
Registering and positioning patients
Procedure for standard examinations
Image postprocessing and quantification in
Procedure for advanced examinations:
- IVUSmap for coregistration of an angiographic X-ray image and IVUS images

- Rotational angiography: DR-DYNAVISION,
DYNAVISION and 3D
- Peripheral angiography with step-by-step
movement: PERISTEPPING and PERIVISION
For switching on/off, postprocessing and evaluation in the control room, please refer to the
Artis Volume 2 Quick Guide.
For review, postprocessing and diagnosis or
treatment planning also refer to the syngo
Workplace Quick Guides Vol.1 + Vol.2.
AXA4-100.622.24.02.02
the exam room
System Overview (Exam 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
AXA4-100.622.24.02.02

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 orbital 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 attached to the Carm. The FD is mounted on a lifting device for a
variable SID.
(3)
(2)
(4)
(1)
(5)
(6)
Example: Artis ceiling stand with FD 30x40
(1) Flat detector (FD)

(2) Membrane keys
(3) FD slide
(4) C-arm
(5) Telescopic C-arm slide
(6) X-ray tube assembly with primary collimator
(7) Ceiling rails
AXA4-100.622.24.02.02
(7)
Movements of the stand/C-arm

(1)
(5)
(4)
(3)
(2)
Example: Artis ceiling Card stand/C-arm
(1) Stand longitudinal movement (on ceiling

rails)
(2) Stand swivel/rotation
10
(3) C-arm rotation (cran/caud angulations)

(4) C-arm orbital movement (RAO/LAO angulations)
(5) FD lift
All movements are motor-driven.
Stand positions
Left Side
Head Side
Right Side
AXA4-100.622.24.02.02

Patient table
The Artis patient table is equipped with a floating carbon-fiber tabletop with projecting and
shadow-free sections optimized for tall patients.
The table height and tabletop longitudinal and
transverse positions are continuously adjustable. The patient table can also be rotated.
The table can be equipped with a motor-driven
stepping mechanism for peripheral examination
techniques. A tilting tabletop is also possible
(transverse or transverse and longitudinally)
with the OR version.
(1)
(2)
(2)
(2)
(1) Tabletop with mattress

(2) Slidable rails for control modules and other
accessories
(3) Lever for releasing the table rotation lock
Tabletop versions
Tabletop neuro
Tabletop wide
Tabletop narrow
Tabletop long
Surgery table
Trumpf surgery table TruSystem 7500: Please refer to the Operator Manual of the manufacturer.
AXA4-100.622.24.02.02
(3)
11
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)
12
(6) Table rotation (motorized or manual)

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

To attach the tabletop, position it at an angle
so that its end is anchored in the frame and

both bolts lock into the holes of the holder.
Then lower the tabletop and slide it to the
end position.
AXA4-100.622.24.02.02

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
(4) Holder for handswitch
(5) Castors (without brakes)
AXA4-100.622.24.02.02
(3) Cable holder
13
Display Ceiling Suspension (DCS)

Depending on the application, your system can
be equipped with a display ceiling suspension
with up to 8 LCD monitors, or the Large Display.
Using the handle, the DCS can be moved rotated
and adjusted in height.
Example of DCS 3
14
Example of DCS extended with 4 monitors
Example of DCS with Large Display and additional color

display
AXA4-100.622.24.02.02

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

is shown.
The Reference screen shows reference im-
ages.
The Assist screen shows position data, sys-
tem messages and menus for unit movements.

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

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

Large Display
The screen layout of the Large Display can be

configured.
You can select the screen layout of the Large
Display by pressing the icon on the touchscreen or by clicking the icon on the Examination task card in the control room.
AXA4-100.622.24.02.02
The screen of the Large Display is divided into

different areas.
15
System Operation
Control consoles
(1)
(2)
(3)
(4)
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.
16
Red emergency STOP buttons

STOP
You will find emergency STOP buttons in the following locations:

on the front side of any table control module
on the front of any stand or C-arm control
module
on the front side of the emergency STOP
module of the OR patient table

in the control room if an additional hand-
switch, footswitch, or remote control is installed there.

- On the control table (Emergency STOP
module)
- Or installed below the control table
AXA4-100.622.24.02.02
System Operation
Triggering STOP in case of an emergency
You can stop unit movements and radiation at
any time, e.g. in the following cases:
If a malfunction of the system occurs.
If a unit movement causes an emergency sit-
uation, danger to the patient, to operating

personnel, or to the unit.
If unwanted radiation occurs, e.g. in case a
radiation release pedal jams or it is blocked

by a radiation protection lead rubber skirt.
Press one of the red emergency STOP buttons
immediately.
- All system drives are shut down and 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/exposure release
pedal again, even without canceling STOP.
- Injections1 are interrupted, but can be continued without canceling STOP.
Canceling STOP
Pull the red emergency STOP button.
if the injector is controlled by the system
AXA4-100.622.24.02.02
STOP
17
Table control module - TCM

With the table joystick/panning knob, you can
adjust the tabletop position by pressing down
the joystick and deflecting it to one side.
Depending on your patient table version, one of
two versions will be integrated in the table:
TCM-M/S: Knob with TCM-J: Joystick on
floating tabletop
(with or without servo assistance)
additional control
console
Keys on the table control module
Perform table lift
18
Perform table tilt

Select lateral table tilt
- LED lights while function active.

Unlock brakes for table rotation

Set isocenter
LED lights while function active.

Lock lateral tabletop movement

Select orientation
Orientation key 24
AXA4-100.622.24.02.02
System Operation
Table movements
Note
The following also applies to the Trumpf surgery
table TruSystem 7500.
For operating of the additional control module
and additional movements, refer to the Operator Manual of the manufacturer.
Raising / lowering the table
Press the key for the required movement and
keep it pressed until the required table height

is reached.
- The table height is changed immediately.
Stopping in the isocenter
Set the table height for the isocenter.
- The LED lights up.

- The current table height is saved as isocenter height.
- The table stops every time this position is
reached.
No stop Press the Isocenter key again.
The ISO stop function is automatically deactivated when a new patient is registered.
Moving the tabletop longitudinally only
Press the key for disabling lateral movement
of the tabletop.
- The tabletop can only be moved longitudinally when the brakes are released.
To enable tabletop movement in any direction
once again:
Press the key again.
AXA4-100.622.24.02.02
Press the Isocenter key.
19
The movement of the tabletop can be configured by Siemens service in two ways:
Continuous holding
The brakes are released only if the panning

knob is pressed:
Switchover function
The brakes are released and applied again:

Press the panning knob once.
Position the floating tabletop.
Press the panning knob a second time.
Note
The Fluoro pedal of the footswitch can also be
configured by Siemens Service to release the tabletop brakes (dual function).
Table with tilt
Longitudinal tilt (transverse axis)
20
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).
Lateral tilt (longitudinal axis)
If the table with lateral tilt is installed, the tabletop with the patient can be tilted sideways
by another 15.
Press this key to activate lateral tilt.
Note
If ISO tilting has been configured, the patient angle is maintained when the Isocenter key is activated.
Then, the patient table follows the C-arm angulation.
AXA4-100.622.24.02.02
System Operation
Moving the tabletop
Continuous holding has been configured
Press the panning knob down and hold it
down.
Move the tabletop (floating movement).
Moving the tabletop (additional control console)

The correct console orientation is set. 24
Press down the table joystick and deflect it
sideways.
- The tabletop follows the movement.
Tilting the tabletop
Caution
Patient table tilted
Patient slips from the table to the ground.
bletop.
Secure the patient sufficiently with the ac-
cessories.
Always keep the mattress fixed on the table-
top 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.
AXA4-100.622.24.02.02
Never leave a patient unattended on the ta-
21
Stand/C-arm control module - SCM

With the Stand/C-arm multifunction joystick
the stand and C-arm positions can be adjusted
by deflecting the joystick in the required direction.
(1) Dead man's switch for releasing movements

!
22
(View from
the rear)
(2) Buttons on each side with the same function:

switching over from C-arm angulation to
stand longitudinal movement
(3) Rocker switch on the back: for lifting and
lowering the FD (setting the SID)
Note
The movement direction depends on the console orientation. 24.
The speed of the movements depends on how
far you deflect the joystick: maximum speed
with maximum tilt.
Combined C-arm movements are possible when
the operating element is deflected diagonally,
e.g. 45.
AXA4-100.622.24.02.02
System Operation
C-arm movements
Take care to avoid possible collisions.
The correct console orientation is set. 24
C-arm rotation/orbital movement

(cranial/caudal/LAO/RAO angulations)
Press the stand joystick down and deflect it
in the required direction.

- The C-arm performs the corresponding
angulation.
Overtable/undertable conversion
Caution
Contrast media or blood may seep into the system.
Risk of system malfunction and danger of infection
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.

Draw in the tabletop (footward), if necessary.
Rotate the C-arm about its transverse axis.
AXA4-100.622.24.02.02
Use sterile covers.
23
Keys on the stand/C-arm control module

Select programmed position
- LED is lit while function active.

Select system position

Store position

Set zero stop

Select orientation
Orientation key 24
Select direct positions I, II, III
Orientation key
The orientation key causes movements to be

made in the same direction as the joystick of the
respective control console is deflected.
24
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.
Control console to the right of the tabletop
(Default position)
Control console at the foot end of the table-
top
Control console to the left of the tabletop
Control console at the head end of the table-
top
If your system is equipped with a laser positioner, it can be switched on and off by pressing the
orientation key for less than 3 s.
AXA4-100.622.24.02.02
System Operation
Stand movements
Positioning the C-arm longitudinally
Press one or both side buttons on the stand/
C-arm joystick, press the joystick down, and

deflect it to the left or right.
The C-arm moves to the left or right accordingly.
The movement stops automatically when the
left or right end position is reached.
Stand swivel
The top stand can be swiveled about the patient
table.
Left Side
Right Side
Swiveling the stand

clockwise
Press one or both buttons on the side of the
counterclockwise
corresponding stand joystick, press down

the joystick and deflect it backward or forward.
- The stand swivels clockwise or counterclockwise.
- The C-arm remains in the same position in
relation to the patient if the Isocenter key
has been activated.
- The stand automatically stops in the basic
positions.
AXA4-100.622.24.02.02
Head Side
25
System and programmed positions

System Positions
These are basic system positions.

Programmed Positions
You can save a number of positions that you

require for examinations.
Direct positions I, II, and III
You can also save three most frequently used positions that you require for examinations.
Note
Use the Patient Transfer position for cardio pulmonary resuscitation (CPR).
Programmed stand, C-arm, and table movements are initiated as follows:
1. Select system or programmed position
2. Confirm target position
26
3. Move to target position
Note
Information about the movement sequence is
shown on the Assist screen.
The speed of the movements depends on
how far you deflect the stand/C-arm joystick: maximum speed with maximum deflection.
If you release the stand/C-arm joystick or
deflect it in a different direction, all unit

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

movements are stopped immediately.
AXA4-100.622.24.02.02
System Operation
Programmed movements
Selecting the target position
Press the required position key.
The corresponding menu appears on the Assist

screen.
Artis ceiling System Positions
Select the required target position by deflect-
ing the stand/C-arm joystick backward or

forward repeatedly.
Confirm the target position by pressing one
Moving to the target position

Press the stand/C-arm joystick down and de-
flect it to the backward until the target position has been reached.
Or, if hands free movement is configured:
Press the configured hands free pedal on the
footswitch.
AXA4-100.622.24.02.02
(or both) side buttons.
27
What is stored?
All data important for imaging geometry are
stored:
Stand and C-arm position
Table height and tilt (configurable by Sie-
mens Service)
SID, zoom stage, collimation and filter posi-
tions
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.
28
AXA4-100.622.24.02.02
System Operation
Storing programmed positions
Move the unit to the required position.
Set the primary collimator and the filter dia-
phragms.
Press the Store key.
- The Programmed Positions menu appears

on the Assist screen.
(Schematic example without clinical meaning)
ber) by deflecting the stand/C-arm joystick

backward or forward repeatedly.
Press one or both buttons on the side of the
stand/C-arm joystick.
Storing system positions with shortcut (direct
positions I, II, III)
Move the unit to the required position.
Press the store key.
- The LED on the key lights up.
Press the required position key.
AXA4-100.622.24.02.02
Select the required memory position (num-
29
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.
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 manufacturers 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.
30
AXA4-100.622.24.02.02
System Operation
Automap
Moving to the system position of the reference image
Select the required reference image.
Press the System Positions key.
- The LED on the program key lights up.

- The corresponding menu appears on the
Assist screen.
Select the Automap position by deflecting
the stand/C-arm joystick backward or forward repeatedly.

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

Continue as described from Moving to the
target position 27 onward.
Press this icon on the touchscreen.
- The matching reference image is displayed.

- If there is no reference image matching the
current system position, a message will
appear.
AXA4-100.622.24.02.02
Displaying the reference image for the current system position
31
FD
20x20
Membrane keys for FD lift
FD
Membrane keys for C-arm and FD movements
26x30 +
FD
30x40
Version 1
Version 2
C-arm rotation (cran/caud angula-
32
tions)
C-arm orbital movement (RAO/
LAO angulations)
Longitudinal C-arm movement
Laser positioner light on/off

FD rotation (setting portrait/land-
scape)
FD lifting and lowering - setting
the SID
AXA4-100.622.24.02.02
System Operation
Image size and format
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.
Press the rocker switch on the back of the
stand/C-arm joystick.
- Upper switch: increase SID
- Lower switch: decrease SID
Or
Press the membrane key on the flat detector.
When the SID is changed or the FD is rotated,

collimation is automatically readjusted.
The image on the screen is changed accordingly
so that the image always has the standard orientation regardless of the FD rotation.
AXA4-100.622.24.02.02
Note
33
Collimator control module (CCM)
(1)
(1)
(2)
(2)
34
Card collimator control module
Angio collimator control module
Card collimator
Angio collimator
one wedge filter
two wedge filters
no finger filter
one finger filter
Additional keys
Lower joystick controls
Lower joystick controls
rectangular diaphragm
rectangular diaphragm
Upper joystick controls
Left upper joystick con-
the wedge filter.
trols left-hand wedge filter.

Right upper joystick con-
trols right-hand wedge

filter.
AXA4-100.622.24.02.02
System Operation
Keys on the collimator control module
With the keys on the collimator control module
you can select different collimator and filter
functions and set the image input format:
Open collimator leaves completely and re-
move filter diaphragms

Reset collimator leaves and filter diaphragms
Switch over image input format/zoom stage
Switch over wedge/finger filter1
with Angio collimator only
AXA4-100.622.24.02.02
Collimator/FD rotation
35
Rotating the FD / Setting portrait/landscape

The 30x40 flat detector has an edgewise image
format.
Multispace: The image rotation caused by
swiveling of the stand is normally compensated automatically by collimator rotation.

The image on the screen is automatically
aligned and always displayed as if the patient
were standing in front of the examiner.
The FD and also the collimator can be rotated
by 90 degrees for best view of the region of

interest.
Zoom stage
36
Input field (diagonal)

FD 20x20 FD 26x30
Nominal format / 25 cm
39 cm
zoom 0
Zoom 1
20 cm
32 cm
Zoom 2
16 cm
26 cm
Zoom 3
10 cm
20 cm
Zoom 4
16 cm
Zoom 5
10 cm
AXA4-100.622.24.02.02
FD 30x40
48 cm
42 cm
32 cm
22 cm
16 cm
11 cm
System Operation
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.
Changing from portrait to landscape or vice
versa
Press this key on the FD.
Or (only if no manual image rotation is active):

Press one of these keys on the collimator con-
Selecting the image format/zoom stage

Press the - or + key on the collimator control
module.
- The zoom stage is reduced (= larger input
field) or enlarged (= smaller input field) by
one step.
- The size of the active input field is shown
on the Assist screen.
AXA4-100.622.24.02.02
trol module shortly.
37
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.
Note
The behavior of the collimation when changing
the zoom stage can be configured in different
manners.
Please ask Siemens Service.
Note
38
The speed of the collimator leaves depends on

how far you deflect the joystick: maximum
speed with maximum deflection.
AXA4-100.622.24.02.02
System Operation
Collimation and filters
Rectangular collimation
You can set the rectangular diaphragms with the
lower joystick on the collimator control module:
Deflect the collimator joystick in the required
direction.
- The position of the collimator leaves is
shown in the live/LIH image.
open vertically
open horizontally
close horizontally
close vertically
Resetting the collimation

Press the collimator joystick down.
- The collimator leaves are opened completely.
AXA4-100.622.24.02.02
39
Filter diaphragms (wedge and finger filters)

To compensate for extreme contrast differences, you can use the semitransparent filter diaphragms (wedge and finger filters). The filters
can be positioned anywhere in the image.
Wedge filters
for example, for DSA or cardiological examinations

Finger filter (finger-shaped graduated dia-
phragm filters)
for example, for DSA aortic arch or peripheral
DSA of both legs
Cardiac
Systems equipped with a Card collimator have

only one (single) wedge filter.
The wedge filter is set with the upper joystick on
the Card collimator control module.
Angio
40
The wedge filters are set with the upper two joysticks on the Angio collimator control module.
The finger filter is also set with the upper two
joysticks on the Angio collimator control module.
The LED on the wedge/finger filter key on the
Angio collimator control module indicates the
selected filter diaphragm type.
AXA4-100.622.24.02.02
System Operation
Setting the wedge filters
The LED for the wedge filters is lit.1
Deflect the joystick in the required direction.
- The position of the wedge filters is shown

in the live/LIH image.
Left or only joystick/filter
Right joystick/filter
rotate clockwise
move to the
right
move to the
left
rotate counterclockwise
move to the
left
move to the
right
rotate clockwise
Setting the finger filter1

The LED for the finger filter is lit.1
Deflect one joystick in the required direction.
Left joystick
Right joystick
rotate clockwise
move to the
right
move to the
left
move to the
left
move to the
right
rotate clockwise
Resetting the filters

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

beam path.
with Angio collimator only
AXA4-100.622.24.02.02
- The position of a finger filter is shown in

the live/LIH image.
41
Touchscreen control (TSC)

(1)
(2)
(1) Touchscreen
(2) Mouse joystick
Mouse joystick
(1) (2) (3)
(1) Left mouse joystick button:

Select button
(2) Middle mouse joystick button:

Store Reference button
42
(3) Right mouse joystick button:

Close/Cancel button
Input areas
Example
In the stack of task cards, Frequently required func-
you will find buttons

grouped by function.
tions can be found outside the card stack.
Note
You can display a tool tip for every button by
pressing the question mark button first.
AXA4-100.622.24.02.02
System Operation
Selecting a 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 function
Press the button.
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.
You can configure the assortment of most of the

buttons by using the TSC Configurator.
Select Options > Configuration in the main
menu on the system console.

Double-click the TSC Configurator icon.
AXA4-100.622.24.02.02
Configuring the touchscreen layout
43
Examination
Default patient
An emergency patient is automatically registered each time the system is restarted. It allows
you to perform fluoroscopy and acquisition immediately after switching on the system as soon
as the imaging system is ready.
An emergency patient is also registered each

time a patient is closed.
44
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.
Note
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.
AXA4-100.622.24.02.02
Examination
Registering a patient
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 Scheduler icon to update it
and then open it.

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

Add any required data.
Registering an emergency patient

Select Patient > Emergency... from the main
Enter the Date of Birth and the Sex of the pa-
tient (if known) and select the Patient position1 from the list (data shown in boldface
type are mandatory entries).
Registering a patient manually
Press the Patient Registration (Num 0) key
on the symbol keypad.

- The Patient Registration window opens.
Enter the data (data shown in boldface type
are mandatory entries).

Select the required exam program from the
Study list.
Select the Patient position from the list.1
Not required for cardiac examinations
AXA4-100.622.24.02.02
menu or from the Patient Browser.

- The Emergency Registration window is
displayed.
45
Note
When the system is in BYPASS FLUORO mode,
or during radiation, the patient cannot be registered for examination.
In this case, click Preregister.
Caution
The system assigns patient orientation labels to
the images depending on patient position selected during patient registration.
Danger of treatment of the wrong side.
Do not acquire images with the patient posi-
tioned different from the patient position selected during patient registration.
46
Caution
Data collision between Sensis and Artis.
Patient registration on the Artis causes inconsistent patient data.
Register patient only by Sensis.
Note
If you are using the Sensis Information System,
you must select an examination type from the
Study selection list.
AXA4-100.622.24.02.02
Examination
Registering the patient and starting examination
Click Exam.
- A dialog box is displayed in which you must

confirm the patient position.1
Click Confirm if the patient position is cor-
rect.
- The patient is registered.
Taking over patient data from Sensis

Select Patient > Register... in the main menu
on Sensis.
Enter the data (data shown in boldface type
are mandatory entries).

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

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

Artis.
Does not appear, if only the Cardiac application profile

is configured. Also does not appear on Sensis.
AXA4-100.622.24.02.02
The Examination task card is placed in the foreground and you can start the examination immediately.
47
Note
During transfer and positioning of the patient,
you can block motorized movements in order to
prevent unintentional unit movements.
Note
48
In some cases, for instance when the patient is

repositioned or while cleaning, you can block radiation to prevent it from being released inadvertently.
AXA4-100.622.24.02.02
Examination
Preparing the patient and
equipment
Positioning the system for patient transfer

The System Positions menu appears on the
Assist screen.
Select the Patient Transfer position by de-
flecting the stand/C-arm joystick backward

or forward repeatedly.
Transferring and positioning the patient

Attach the accessories required for position-
ing to the patient table and ensure that the

accessories are attached securely.
If necessary, temporarily remove the control
consoles from the repositioning area.

Transfer the patient using positioning aids.
Position the patient to feel comfortable.
Make sure that no parts of the body of the pa-
tient, in particular, arms, legs, and hair, are

protruding over the edge of the tabletop.
Remove any interfering metal parts and radi-
opaque objects from the table.

If necessary, immobilize the patient using the
appropriate accessories.
Attach and position the required radiation
protection accessories.
AXA4-100.622.24.02.02
49
Note
During examinations, always make sure that
there are no unwanted objects in the beam
path.
Note
Please note that the collision computer does not

take account of accessories.
50
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.
AXA4-100.622.24.02.02
Examination
Setting the examination position

The System Positions menu appears on the
Assist screen.
Select the required position by deflecting the
stand/C-arm joystick backward or forward

repeatedly.
Attaching the ECG
For ECG monitoring of the patient or ECG-gated
fluoroscopy and acquisition:
such a way that they do not appear in the
beam path.
Check the connection of the gating signal
from the ECG unit to the system if the ECG

unit is not permanently installed.
Check the equipotential equalization.
Prepare for pressure measurement.1
Adjusting the units (stand and table)

Adjust table height and position the tabletop.
Table movements 19
Position the stand and the C-arm as required.
Stand movements 25
C-arm movements 23
Only required for cardiac examinations
AXA4-100.622.24.02.02
Connect the ECG electrodes and cables in
51
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 of the patient, 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)
52
(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.
AXA4-100.622.24.02.02
Examination
Setting the isocenter
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
by adjusting the tabletop.

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

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

Positioning an organ in the isocenter with fluoroscopy
Place the C-arm in a.p. position.
Select the zoom stage:
- Zoom 0 with FD 20x20

- Zoom 1 with FD 30x40
cardiac acquisition with deep patient inspiration.
Press the FLUORO footswitch.
Position the tabletop so that the organ of in-
terest is centered.
If necessary, activate the radiation field limi-
tation and collimate the object.

Place the C-arm in lateral position.
Perform fluoroscopy briefly:
Press the FLUORO footswitch.

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

Press the Isocenter key.
AXA4-100.622.24.02.02
Perform fluoroscopy in the a.p. position: for
53
Patient position
Caution
The system assigns patient orientation labels to
the images depending on patient position selected during patient registration.
Danger of treatment of the wrong side.
Do not acquire images with the patient posi-
tioned different from the patient position selected during patient registration.
Caution
Misusing the patient position to flip an image
Risk of misinterpretation and incorrect diagnosis
Always enter the patient position correctly.
Image mirror/flip preselection
54
You can flip next images to be acquired so that

the catheter moves in the same direction in the
image.
Caution
Image flipped
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.
Restore the original image orientation at the
end of the examination.
Note
If you want to flip images that have already been
acquired, you can do that on the PostProc task
card in the control room.
AXA4-100.622.24.02.02
Examination
Checking parameters
Checking/changing the patient position
Settings task card
Select the required new patient position.
Flipping the next image/scene

Settings task card
Press this button.
Possible image flipping

functions
Press the required flipping buttons.
The next images to be acquired are flipped.
AXA4-100.622.24.02.02
- The new patient position is registered and

displayed.
55
Exam set and acquisition program

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
56
Note
Press the Acquisition Overrides button, to select a different scene length or measuring field.
AXA4-100.622.24.02.02
Examination
Selecting the acquisition program/exam set
Exam task card
Press this icon next to the currently selected
exam set.
- A selection of available exam sets and
assigned acquisition programs appears.
If necessary, scroll using the arrow up/down
buttons.
Press the button of the required new acquisi-
tion program.
- The new acquisition program is activated
and the dialog is closed.
Or
Press this button in order to display more
exam sets.
Press the button of the required new exam
set.
AXA4-100.622.24.02.02
Example
57
Example
58
Example
Example (Expert layout)
AXA4-100.622.24.02.02
Examination
Changing the acquisition program in the current exam set
Exam task card
Press the drop-down button next to the ac-
quisition program.
- The available acquisition programs of the
exam set are displayed.
Press the required acquisition program.
Changing the acquisition frame rate

Exam task card
Press the frame rate button to display all

Press the required frame rate.
Or (if configured)
Press an arrow button next to the frame rate
to switch to the next higher or lower frame

rate.
Selecting/editing the series description
Exam task card, Expert layout
Press the drop-down button next to the cur-
rently selected series description.

- The available series description texts are
displayed.
AXA4-100.622.24.02.02
available frame rates.
59
Note
The fluoroscopy/roadmap programs are always
available in three versions, which usually differ
with regard to their dose.
Example
60
Example
Note
The fluoroscopy programs automatically change
to Roadmap programs when Roadmap is selected.
AXA4-100.622.24.02.02
Examination
If necessary, scroll using the arrow up/down
buttons.
Press the required series description text.
Changing the fluoroscopy/roadmap program

Exam task card
Press the drop-down button next to the fluo-
roscopy/roadmap program.
Press the required fluoroscopy/roadmap pro-
gram.
Press the pulse rate button to display all avail-
able pulse rates.

Press the required pulse rate.
Or (if configured)
Press an arrow button next to the pulse rate
to switch to the next higher or lower pulse

rate.
AXA4-100.622.24.02.02
Changing the pulse rate
61
Note
You can store the last fluoroscopy (or roadmap)
as a scene.
Note
The system is equipped with an integrated timer

for exact time measurements, i.e. for dilatations.
62
Note
Press this icon, if the message box for the fluoroscopy signal appears, or if you want to reset
the signal before intervening, for example.
Caution
If any radiation indicator lights up although you
have not pressed a button:
Danger due to radiation
Press the emergency STOP button.
Notify Customer Service.
AXA4-100.622.24.02.02
Examination
Caution
If poor image quality results from the set parameters:
Risk of poor image quality and unnecessary
exposure to radiation
Stop radiation immediately and check the pa-
rameters or call Service.
Caution
Malfunction in the detector cooling system and
display of the message No X-Ray 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
Fluoroscopy
Press the FLUORO pedal of the footswitch.
The radiation indicators light up during radiation.

Fluoroscopy images appear on the screen.
In each case the last fluoroscopy image remains
displayed on the screen after fluoroscopy is
completed (LIH = Last Image Hold).
AXA4-100.622.24.02.02
remaining displayed time.
63
Note
You can store any image currently displayed,
even during fluoroscopy, as a new image (Store
Monitor), or as a reference image.
You can also press the middle button of the
mouse joystick to store a reference image.
Note
64
If the system has been configured with two reference screens, you can store an image as a reference image and display it on the Reference or
Assist screen.
Click the icon to toggle the active screen.
Note
Using the CLEARstent image function (Image
task card) you can generate special reference
images from any scene or fluoroscopy scene acquired natively.
The stent/balloon marker should be clearly visible in the scene.
If the stent/balloon marker is not visible in the
current image, CLEARstent will not be possible.
AXA4-100.622.24.02.02
Examination
Acquisition
Caution
Acquiring thin objects
Risk of unnecessary radiation exposure due
to incorrect dose
Always perform fluoroscopy before acquisi-
tion.
Using the handswitch
Press the acquisition button (two stage) of
the handswitch.
Using the footswitch
Press the acquisition pedal of the foot-
switch.
The acquisitions (scenes) are stored as set in the
acquisition program and appear on the screen.
AXA4-100.622.24.02.02
The radiation indicators light up briefly.
65
In order to have a fast access to special acquisition program, an Alternative Acquisition can
be assigned to a footswitch pedal.
An alternative acquisition program can be used,
for example, to provide a low dose acquisition
program instead of fluoroscopy at critical situations where the fluoro dose is limited by the
maximal skin dose.
The configuration to enable/disable the alternative acquisition is done by assigning of one of
the footswitch pedals to this function.
Example
66
In the Exam Set and Program Editor, the alternative acquisition program is located between
the 4 acquisition programs and the 3 fluoro programs. If any acquisition progam is visible there,
then it is an alternative acquisition program assigned to the footswitch pedal.
Caution
Fluoro release foot pedal mixed up with the alternative acquisition release pedal.
Increased irradiation by performing acquisition
Be careful to use the correct foot pedal.
Check the labels and the position of the foot
pedals.
AXA4-100.622.24.02.02
Examination
Alternative acquisition
Alternative acquisition has been configured
to a footswitch pedal.
Select an exam set containing an alternative
acquisition program.
If an alternative acquisition program is available,
an indicator will be present near the acquisition
symbol on the touchscreen, on the Live screen
and on the Examination task card.
Perform fluoroscopy.
Note
For alternative acquisitions, always the measuring fields of the regular acquisition program are
used. The forecast parameters are displayed for
the regular acquisition program and not for the
alternative acquisition program.
Alternative acquisition pedal is used to start acquisition with automatic injection, 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 acquisition pedal (pedal "2") on the footswich to release Xray.
Start acquisition by means of the footswitch
pedal assigned to alternative acquisition.
AXA4-100.622.24.02.02
Caution
67
Roadmap is a special operating mode in which

fluoroscopy images are subtracted from one another and displayed subtracted. During fluoroscopy, an image is inverted (mask) and
superimposed over all subsequent fluoroscopy
images.
Note
To avoid motion artifacts, the patient should neither move during roadmap nor should the patient table nor the system be moved.
Roadmap phases
Phase 1
After you have selected roadmap and
pressed the fluoro foot switch, the

mask for subsequent fluoroscopy is
created.
Phase 2
68
Switch-over to subtracted display hap-
pens automatically. Now you are requested to inject contrast medium to

display the vessels.
Phase 3
The vessel image is displayed subtract-
ed.
Indicators
Injection
An injection indicator is displayed when

you can start injecting during roadmap.
OPAC
An opac indicator is displayed when the

roadmap function is active and peak
opacification is enabled.
Review
A roadmap indicator is displayed when a

roadmap scene is reviewed in roadmap
mode.
AXA4-100.622.24.02.02
Examination
Roadmap
A Roadmap program is selected which has
not set the Vessel Presentation Phase 2 or

Vessel Presentation DSA check box.
Overlay Reference has not been activated.
First phase (native)

Exam task card
Press this icon.
Actuate the FLUORO pedal and keep it
Second phase (contrast medium injection)

Keep the FLUORO pedal pressed.
Now inject the contrast medium.
- In the fluoroscopy image, you can now see

the vessels in subtracted display as they are
filled with contrast medium.
Release the FLUORO pedal when the area to
be examined is sufficiently filled with contrast medium.

- The opac indicator indicates that maximum opacification is effective.
Third phase (subtraction)
Press the fluoroscopy switch as often as re-
quired.
AXA4-100.622.24.02.02
pressed.
- After fluoroscopy has begun a normal fluoroscopy image is displayed briefly, then the
display automatically switches to subtracted images.
- An injection indicator is displayed on the
live screen.
69
Replace mask during roadmap

It is possible to replace the mask during review
of a roadmap scene, but only if Replace Mask is
set (not Move mask).
Replacing the mask is only possible during roadmap phase 1 and phase 2.
Anatomical background with Roadmap
70
During Roadmap phase 3, anatomical background can be added to the subtraction image.
In the examination room, the anatomical background can be adjusted using the mouse joystick.
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.
AXA4-100.622.24.02.02
Examination
Resetting roadmap
If motion artifacts arise, roadmap can be reset
(new mask):
Actuate the Reset Roadmap pedal (if config-
ured - example).
Or
Press the Reset Roadmap button.
Replacing the mask

Replace Mask is set in the main menu on
the console.
Press this icon.
Changing anatomical background

Acquisition > Set Anatomical Background
Press the Anatom. Backgr. button.

Deflect the mouse joystick.
- Up: more anatomical background

- Down: less anatomical background
Changing vessel/catheter contrast
Acquisition > Set Vessel / Catheter Con-
trast is set in the main menu on the console.
Press the VC Contrast button.

Up: more vessel contrast

Down: less vessel contrast
Left: more catheter contrast
Right: less catheter contrast
AXA4-100.622.24.02.02
is set in the main menu on the console.
71
Advanced Roadmap DSA Ref phases

Advanced Roadmap DSA Ref consists of two
phases, whereas phase 1 is split up in two sections, phase 1a and 1b. Separate Roadmap parameters attitudes exist for every phase.
Phase 1
After you have selected Roadmap and
a Roadmap program, and pressed the

fluoro foot switch, Roadmap starts
with phase 1. The fluoroscopy images
are displayed natively.
The availability of a noise free fluoro
frame triggers the transition of
phase 1 to phase 3, while fluoro is still
ongoing. Switch-over to subtracted
display will happen automatically.
Phase 3
72
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.
AXA4-100.622.24.02.02
Examination
Advanced Roadmap using a DSA image
A Roadmap program is selected which has
set the Vessel Presentation DSA parameter.

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

screen.
Starting Roadmap phase 1 (native)
Exam task card
Press this icon.
Press this icon.
- Overlay Reference is activated.

Moving to reference image position
Message: Automatic run: Activate stand
movement
joystick and hold it in this position until the Carm position is reached.
Or press the hands free foot pedal.
When the position is reached the following message appears: Automatic run: Position reached
Collimation and zoom stage are set corresponding to the parameters of the reference image.
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.
Performing Roadmap phase 3 (subtraction)
Press the fluoroscopy switch as often as re-
quired.
You will see a fluoroscopy image from which
the last filled image of phase 2 is subtracted.
AXA4-100.622.24.02.02
Press the stand joystick down, deflect the
73
Roadmap with two system positions

During roadmap, two roadmap mask images
may be stored for two system positions, e.g. a
LAO and a RAO C-arm position. You can move
back and forth between these positions, performing roadmap at each position without the
need of reacquiring a roadmap mask.
These two roadmap masks are referred to as the
current roadmap mask and the previous roadmap mask. The data (e.g. stand and table position, roadmap program, 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 sec-
ond most recently utilized roadmap mask

and system position.
74
The present system position determines which

of the roadmap masks will be recalled when the
Previous Mask icon is activated.
System position Roadmap phase Mask recalled
Current position 1
Current Roadmap
Mask
3
Previous Roadmap
Mask
Any other posi- Any
Previous Roadmap
tion
Mask
Note
The latest roadmap masks are kept during the
whole study and will be deleted when a new patient is registered.
AXA4-100.622.24.02.02
Examination
Previous mask Roadmap
Select roadmap and perform a roadmap
phase 1,2,3.
Move the C-arm and perform another road-
map phase 1,2,3.

(If you reset roadmap, the system displays the
following message: Roadmap reset. A previous mask is available.)
Press the Previous Mask icon in the Road-
map dialog.
The following message appears:
Automatic run: Activate stand movement
joystick and hold it in this position until the

previous roadmap position is reached.
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.
AXA4-100.622.24.02.02
The C-arm moves back to the initial roadmap position.
75
CLEARstent
With the CLEARstent imaging functions, you
can emphasize fine structures, e.g. inflated
stents. There are the following possibilities for
CLEARstent:
Use the CLEARstent reference image func-
tion to generate a special reference image

from any scene or fluoroscopy scene acquired natively.
Example:
76
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 injecting contrast medium.
After end of acquisition, the algorithm to calculate the CLEARstent scene is automatically
started.
Acquire a CLEARstent Live scene, which pro-
vides a stabilized view of the stent.

Acquisition is performed simply using a
CLEARstent Live acquisition program.
AXA4-100.622.24.02.02
Examination
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.
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.
When processing of the CLEARstent Dynamic
image has concluded:
A CLEARstent reference image will be creat-
ed, stored, and displayed on the active reference screen.

If contrast medium is present in the images,
a CLEARstent Dynamic scene will be created, stored, and displayed on the live screen.
AXA4-100.622.24.02.02
5. Now inject the contrast medium manually.
77
Display modes native

Live FLUO/LIH (Live Fluoroscopy/Last Image
Hold)
This mode is the default display on the live
screen when no other mode is selected.
The last fluoroscopic/roadmap image is displayed on the live screen after completion of
fluoroscopy. Reference images are displayed
on the reference screen.
Overlay Ref(erence) can be selected or de-
selected.
The (inverted) reference image is overlaid
into the live/LIH fluoroscopic image.
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.
78
Display modes subtracted

Live Native Image
During roadmap or DSA, the unsubtracted

live fluoroscopy image is displayed on the
Assist screen.
Reference Image
During roadmap or DSA, the selected reference image is displayed on the Assist screen.
Note
The availability of display modes depends on the
screen configuration of your system.
AXA4-100.622.24.02.02
Examination
Display mode
Selecting the display mode
Settings task card
Expert layout or user-defined layout.
Select the required display mode.
To start overlay, press the Overlay Reference
Image icon.
- The display mode is changed to Overlay
Reference, i.e. the overlay image is faded
in the image on the Live screen.
Setting the degree of Overlay Reference/
Fading in or out the reference image
- Up: The reference image will become

clearer.
- Down: The reference image will become
less clear and the fluoroscopic image will
become clearer.
To stop overlay, press the active Overlay Ref-
erence Image icon.
AXA4-100.622.24.02.02
Performing Overlay Reference
79
Review modes
LIH (Last Image Hold): The last image of flou-
roscopic/roadmap scene is displayed.

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

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

from the beginning.
Toggle: The scene is played continuously
but, unlike Loop, the review direction is reversed after the last image (ping-pong effect).
Depending on scene type, different review
modes are available:
Available review
modes
80
LIH
Fluoro/Roadx
map scenes
DR/DSA/PERI
scenes
CARD scenes
Rotational
scenes
Report images
MFH
Loop
Toogle Single step

only
x
x
x
x
x
x
Note
You can change the Review Mode by selecting
View > Review Mode in the main menu in the
control room.
AXA4-100.622.24.02.02
Examination
Dynamic scene replay
Stopping the loop
Deflect the mouse joystick briefly.
Single step
- The loop stops.

- Left: one image backward

- Right: one image forward
Starting the loop
- Left: the scene runs backward

- Right: the scene runs forward
The review direction is indicated in the control

area of the live screen.
Setting the review rate
- The further left or right the joystick is

deflected, the faster the scene will be
played back.
Release the mouse joystick when the desired
review rate is reached.

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

To review with acquisition speed again:
Release the mouse joystick.
AXA4-100.622.24.02.02
The reviewing speed depends on how far you

deflect the joystick.
81
Representative
A scene is represented by a specific image in the
overview display.
Native: It is the center image for scenes ac-
quired natively.
It is an image with maximum fill (Max Fill im-
age) in DSA scenes.
Note
If you want to use an image other than the automatically chosen image as scene representative,
you can replace it.
A dotted frame is used to
82
identify the input focus as

navigational guidance.
A broken-line highlight frame is used to iden-
tify an image representative of a scene or

(reference) image as being selected.
This scene/image is shown in the full-screen
display when you switch back to it.
Note
The scene overview shows single images
(frames) of a scene.
To display the scene overview while the
scene directory is open, press the right button of the mouse joystick.
AXA4-100.622.24.02.02
Examination
Scene directory
Scenes
Press this icon to open the Image Player.
Displaying the scene directory

Press this icon.
Scenes (acquisitions and fluoroscopy) of the

acquisition patient are displayed in 4 x 4.
Scrolling through scenes
Press Scene -/+.
Reference images
Press this icon.
Displaying the reference image directory

Press this icon.
Reference images of the acquisition patient

are displayed in 4 x 4.
Scrolling through reference images
Press Ref -/+.
Scrolling through the directories

Selecting a scene/reference image

Switch back to full screen display.
AXA4-100.622.24.02.02
Press this icon to open the Image Player.
83
Postprocessing (Exam Room)

With windowing, you can adapt the image to
display the gray scale region of interest with optimal contrast conditions.
WW: Window Width
max.
bright value
highest absorption
WC: Window Center

screen value
range
stored value
range
lowest absorption
dark value
Principle of windowing (contrast agent/bones black)
The window values are displayed at the bottom

right in the image.
84
non-subtracted:
subtracted:
Window center (native)
WC
Brightness (subtracted)
Window width (native)
WB
WW
Contrast (subtracted)
WC
Note
After acquisition, the image is displayed in accordance with the window values defined in the
exam set.
After loading again, the image is displayed using
the window values stored with the image.
AXA4-100.622.24.02.02

Windowing
Setting window values manually
Click into the image with the middle mouse
button and move the mouse with the button

pressed.
Window center/
Brightness +
Window width/
Contrast -
Window width/
Contrast +
Window center/
Brightness -
The image is displayed immediately with the

changed window values.
Or
To reset window values:

Press the left button of the mouse joystick.
To close windowing:
Press the right button of the mouse joystick.
Assigning automatic window values

Press this icon.
Window values based on an algorithm defined

in the corresponding exam set and the existing
exposure conditions are used.
AXA4-100.622.24.02.02
Press this icon.
85
Depending on image matrix and image type of

the current scene/image, and the installed licenses, different zoom functions are available:
Zoom by a factor of 2
Zoom to Acquisition Size (1:1 pixel display)
Example for Acquisition Size:

Initial display after acquisition:
1920
2480
1024
1024
FD
Screen
Display with Acquisition Size:
86
1024
1024
1024
1024
1920
2480
FD
AXA4-100.622.24.02.02
Screen

Zooming/panning
Image task card
Press the required icon.
Panning the image

Move the mouse pointer into the image.
Click and drag in the image area.
The image is moved simultaneously.
Using the pointer

Start pointing
Press this icon.
Control room
Examination room
Moving the pointer

Dropping a new pointer object

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

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

Exit pointing
AXA4-100.622.24.02.02
- The mouse pointer changes its shape and is

displayed on the screen in the control
room.
87
DSA postprocessing
Press this icon.
DSA tools, Move Mask set
DSA tools, Replace Mask set
During a DSA exposure, the mask (= image without contrast medium) is set automatically. It
normally occurs after the second frame, but no
later than after 2 s.
88
Move Mask or Replace Mask can be set in the

main menu on the console.
Note
All pixelshift values are reset when you set a new
mask.
Note
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.
AXA4-100.622.24.02.02

Setting a new mask
DSA functions
Moving the mask

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

Press this icon.
When you reach the frame you want to select as

the mask:
Replacing the mask

Replace Mask is set.
When you reach the frame you want to be the

new mask:
Press this icon.
Native display
DSA functions
Native
Press this icon.
Subtracted
Press the icon again.
AXA4-100.622.24.02.02
Scroll through the scene image by image
89
Making the image and mask coincide exactly

Using Pixelshift, it is possible to adjust fill and
mask images to coincide in subtracted DSA or
Roadmap scenes.
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
As a result of patient or unit movement, the images used for subtraction might not coincide
completely. If it happens, the anatomical background is not removed completely (motion artifacts).
90
Pixelshift variants
Automatic pixelshift:
You mark a region of interest (ROI). The computer automatically calculates the best result
for this region.
Manual pixelshift
You shift the mask manually to achieve the

best subjective impression.
Flexible pixelshift:
The image is divided into a chessboard. The

computer independently calculates the best
pixelshift value for each square.
AXA4-100.622.24.02.02

Pixelshift
DSA functions
Starting pixelshift
Press this icon.
After selection of Pixelshift, automatic pixelshift

is active by default.
- A square for the region of interest (ROI) is
drawn in the middle of the image.
When the ROI is positioned correctly:

- The mask is shifted in such a way that subtraction is optimized for the marked
region.
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Automatic pixelshift
91
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
Pixelshift
action
Movement
Pixelshift
action
Movement
Scene
Pixelshift
action
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.
92
Note
Depending on the image content, the Flex image calculation may take a few seconds. It also
applies to scrolling.
Note
At the end of the scene, pixelshift is automatically deselected.
AXA4-100.622.24.02.02

Manual pixelshift
Press this icon.
Click and drag in the image area.
Further pixelshift corrections

Page on in the scene.
If motion artifacts occur:

Perform pixelshift again.
Undoing pixelshift
Press this icon.
Terminating pixelshift
Flexible pixelshift
Press this icon.
The mask is divided into squares like a chessboard. The optimum shift amount is determined
and applied automatically to each square.
Saving the Flex image
A Flex image can be stored using the Store
Monitor function.
You can also store the flexible pixelshifted image as a reference image.
You can also copy the flexible pixelshifted image
to the filmsheet.
Press the required icon.
AXA4-100.622.24.02.02
The pixelshift values are accepted.
93
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 initial degree of anatomic background is defined in the exam set.
94
Using the Max Opac function (or Min Opac for

CO2 DSA) the contrast-agent-filled pixels of different images are merged to form a single image. The pixels filled with contrast medium from
different images are combined into one image.
Note
The opacity function cannot be applied to DYNAVISION or 3D scenes.
Note
You can also store the image with maximum
contrast medium filling as a new image (Store
Monitor), or copy it to the filmsheet.
AXA4-100.622.24.02.02

Anatomical background
DSA functions
Changing the background

Press this icon.
- Up: more anatomical background

- Down: less anatomical background
You can scroll though the scene during anatomical background:
To terminate the function:

DSA functions
Scroll to the starting image.
Bolus start
At the image in which the contrast agent bolus
is visible for the first time:
Press this icon.
Scrolling
The scene can be scrolled forward or up to one
image backward.
Scroll the scene image by image:
- With every step forward, a further image is

added to the Opac image.
Press the middle button of the mouse joy-
stick.
The image with maximum contrast medium filling is calculated, displayed and stored as a reference image.
AXA4-100.622.24.02.02
Max/Min Opac.
95
96
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Annotations
Press this icon.
Placing predefined texts

Press the Text Annotation button.
Press this icon and select a text from the list.
Click the position in the image the text shall
be placed.
Drawing lines or arrows
Press the Line or Arrow button.
Click the image to fix the starting point (= ar-
row head), and drag a line to the end point

with the mouse.
Drawing polygons
Press the Polygon Line button.
Click in the image to set the starting point,
hold down the left mouse button and draw a

line to the first corner point with the mouse.
Draw the polygon point by point by clicking
the mouse button once at each change of direction.

Double-click the last corner point.
Drawing circles
Press the Circle button.
Click the detail of interest in the image and
drag the mouse pointer.

- A circle appears around this point.
Click one of the four boxes on the circle bor-
der, keep the mouse button pressed, and

drag the circle to make it larger or smaller.
AXA4-100.622.24.02.02
Release the mouse button to end the line.
97
Distance calibration
To perform a measurement, e.g. distance, the
image must be calibrated.
Note
Calibrations performed in Quant are valid also
for measurements done in PostProc and vice
versa.
When you start measuring on a non-calibrated
image, the system automatically suggests a calibration method depending on the image angle.
The image angle is the geometric sum of the image's LAO/RAO angle and CRAN/CAUD angle:
Image angle = acos ( cos (LAO/RAO angle) * cos
(CRAN/CAUD angle) )
Example: With RAO = 14 and CRAN = 10, the
image angle is approximately 17.
For image angle 0 ... 15 or 165 ... 180,
98
the system suggests automatic TOD calibration.

For image angle 15 ... 50 or 130 ... 165,
the system also suggests TOD calibration, 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 calibration. If
that was not the case, we recommend using
manual calibration.
For image angle 50 ... 130, the system sug-
gests automatic isocenter calibration.

You should use this calibration method only
if the object of interest was positioned in the
isocenter. If that was not the case, we recommend using manual calibration.
AXA4-100.622.24.02.02

Calibration and distances
Starting calibration
Caution
Incorrect calibration
Inaccurate results possible
The examiner is responsible for applying the correct calibration method.
Perform calibration carefully.
Automatic calibration using the table-object

distance (TOD)
Press the Auto TOD button, if necessary.
For angulations >15, you are prompted to mark

the measurement point in the image. Only then
can you adjust the TOD.
In that case, click the point in the image
where you want to perform a measurement.

Enter the table-object distance using the nu-
meric buttons.
AXA4-100.622.24.02.02
Press this icon.
99
Note
The default TOD value is stated in the calibration
dialog. It can be changed by Siemens Service.
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!
100
AXA4-100.622.24.02.02

Or
- Up: increase TOD

- Down: reduce TOD
Automatic isocenter calibration
Press the Auto ISO button, if necessary.
Press the OK button.
Automatic calibration is performed immediately

and displayed.
Press the Distance Calibration button.

Click the starting point of the calibration line.
Click the end point of the calibration line.
Enter the length of the distance line (in mm).
Press the OK button to accept.
Drawing and measuring distances
Press the Distance button.

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

Release the mouse button to end the line.
- The distance line is drawn showing a number and the distance.
AXA4-100.622.24.02.02
Manual distance calibration
101
Quantification (Exam Room)
Note
Pay attention to the messages at the bottom of
the image.
They include notes for further operational steps.
102
Note
Catheter calibration is not recommended for
LVA. For QVA, catheter calibration should be
used with FD zoom stages only (not in full format).
The catheter calibration software is validated for
a catheter size of 7 French.
Using catheter calibration with catheter sizes of
5 French or smaller is not recommended because accuracy could be reduced.
AXA4-100.622.24.02.02

Calibration
Quant task card
Press the Calibration button.
Also see Calibration and distances 99

Automatic calibration using the table-object
distance (TOD) 99
Automatic isocenter calibration 101
Manual distance calibration 101
Catheter calibration
Mark the approximate center line in the section

of the catheter you want to use for calibration.
This part of the catheter should be straight.
Mark the starting position with a single click.
Mark the end point with a mouse click.
- The contour detection algorithm automatically detects the edges of the catheter.
Now enter the actual size of the catheter used
for calibration (in French units).
E.g.
Press the appropriate button.

Or
AXA4-100.622.24.02.02
Press the Catheter button.
103
Note
The smaller the calibration object, the greater
the calibration error.
Make sure that the image with the sphere was

acquired under the same conditions (zoom
stage, source-FD distance and object-FD distance) like the image you want to analyze.
104
Note
You can move the circle by dragging the circle
center to the required position.
You can change the size of the circle by dragging
the circle line larger or smaller.
Check, if center remains at the same posi-
tion.
AXA4-100.622.24.02.02

Sphere calibration
Press the Sphere button.
The circle can be marked in two ways:

Center, diameter
Define the center of the sphere and determine its diameter.

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

boundaries of the sphere.
3 points
If the system was unable to automatically determine the sphere:

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

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

Or
AXA4-100.622.24.02.02
For marking the sphere, you must draw a circle

that corresponds to the projection of the sphere
in the acquisition plane.
105
Quantitative analysis methods for analyzing

stenoses
With QCA (Quantitative Coronary Analysis),
you can determine the dimensions of the coronary arteries.

With QVA (Quantitative Vascular Analysis),
you can determine the dimensions 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 arteries in three dimensions based on two 2-dimensional images.
Note
106
Before you can perform a 2D quantitative vascular analysis, you must calibrate the image. 99
103
Note
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 cycle.
You can display the results on the screen, film/
print and send them to another network node.
AXA4-100.622.24.02.02

(QCA, QVA and IZ3D)
Quant task card
Vessel contour detection

You must define the vascular segment you want
to examine by drawing in an approximate center
line. If the vessel is curved, a number of points
(maximum 20) can be defined with a single click
at the required positions.
AXA4-100.622.24.02.02
QCA or
QVA
107
Note
The center line must be marked in the direction
of blood flow as it influences the calculation of
the extent of stenosis.
Note
To achieve reproducible analysis results, it is advisable to start and end the segment at a characteristic, conspicuous point. Side branches are
suitable for this purpose.
108
Note
In the exam room, the contour is automatically
smoothed.
Note
You can film, print, or send a report in the same
way as normal images.
However, results of an analysis on the Quant
task card are only transferred to the film sheet if
the Report is stored.
AXA4-100.622.24.02.02

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

Define any necessary intermediate points
with single clicks.

Define the distal end point with a double left
click.
Marking a vessel segment with bifurcation
Define the proximal starting point of the
main branch with a single left click.

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

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

Mark the bifurcation point and the centerline
of the side branch off the main vessel with

single left clicks.
with a double left click.
Manual contour correction
Start the correction with a single click at the
point from which you want to correct the existing contour.

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

Define the end point with a double left click.
Generating and storing a report
Press the Report button.

Press this icon.
AXA4-100.622.24.02.02
Define the distal end point of the side branch
109
IZ3D
Scenes/images for IZ3D

Two projection images must be selected for
IZ3D or IZ3D - Large Vessel (=QVA 3D) in order
to obtain a 3D reconstruction.
Two projections are sufficient to create an accurate 3D reconstruction in the case that:
110
They are both orthogonal to the region of in-
terest.
There is at least a 30 difference between the
projections of the participating images.

It is essential that the selected frames are of the
same stage of the heart cycle. The optimal frame
is the one in which the heart vessels are at their
most still and enlarged stage (end diastolic
frame). This instance can be identified on the
ECG signal diagram as the portion between the
Q and the R waves.
If the selected scene was acquired with ECG data
and if Auto ED is configured by Service, the system detects and displays the least-motion frame
of the current scene in full-screen review.
For 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.
AXA4-100.622.24.02.02

3D vessel model in IZ3D
Creating a 3D vessel model
Mark a vessel in the first image.
Vessel contour detection 107
Next you load a second image.
rectory icon.
In the scene directory, scenes are marked for
IZ3D:
: already used
: already used and analyzed
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.
AXA4-100.622.24.02.02
Press the Scene - / Scene +, or the Scene Di-
111
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 uppermost and lowermost boundaries of the screen region within which the vessel should fall.
112
AXA4-100.622.24.02.02

Mark the same vessel segment in the second
image.
Vessel contour detection 107
Press the 3D Model button.
Displaying the quad view

The quad view displays the 2D image, the 3D
vessel model, diameter and area diagrams as
well as basic analysis results.
AXA4-100.622.24.02.02
Press this icon.
113
Note
You can rotate, pan and window the 3D vessel
model via pressing the left, right, or middle
mouse joystick button respectively, and deflecting the mouse joystick.
The Optimal Projection indicates a system position that meets the following requirements:
For 3D vessel models that do not include a bi-
furcation, the Optimal Projection is the projection that shows the least foreshortening
of the analyzed segment.
For 3D vessel models that include a bifurca-
tion, the Optimal Projection is the projection that displays the greatest angle between
the branches of the bifurcation.
114
The Optimal Projection is automatically displayed when the 3D vessel model has been created.
You can select one of the following items:
A: ... or A: ... B: ... : angulation of the single
plane image or the biplane image pair

0/0: LAO/RAO 0, CRAN/CAUD 0
If a 3D model has already been created:
Optimal Projection: angulation of the opti-
mal projection calculated by the system

Current 3D Position: current position of the
3D vessel model
AXA4-100.622.24.02.02

Rotating the 3D vessel model to the optimal
projection
Press the drop-down button in the 3D sub-
task card and select Optimal Projection.

Rotating the 3D vessel model corresponding
to the current C-arm position
Press this icon.
Moving the C-arm according to the 3D vessel

model
If the virtual C-arm indicates a physically possible position (by a blue color)1, the C-arm position can be adjusted according to the current 3D
vessel model display.
Press the drop-down button in the 3D Model
step and select the required projection.
The 3D vessel model is rotated to indicate the

new projection.
The following message appears in the examination room:
Automatic run: Activate stand movement
joystick and hold it in this position until the Carm position is reached.
The C-arm moves to the defined angulation.
with color display only
AXA4-100.622.24.02.02
Press the Adjust C-Arm button.
115
Stent planning in IZ3D

With Stent Planning, you can simulate the
placement of a stent within the vessel. You can
plan the placement of a stent by visualizing it in
the 2D image and the 3D vessel model.
The planned stent borders will also be shown in
2D live fluoroscopy and acquisition.
Stent placement
A stent with visible markers, either markers on
the balloon that delivers the stent or markers on
the stent itself, is inserted in the vessel with help
of a catheter. The insertion process is visualized
with live X-ray imaging. The stent is then placed
at the desired position in the vessel by visual selection of the desired position and visual estimation if this position is reached.
The stent graphics will show the desired position
of the stent and thus support positioning.
Note
116
For stent positioning, the acquisition geometry

must be identical for the live images and the
stent graphics image.
Stand and table must not be moved. Also, the
patient must not move during stent positioning.
AXA4-100.622.24.02.02

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

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

card) is shown.
- Stent borders are shown in red color in

every 2D image and in the 3D vessel model
to indicate the length and position of the
suggested stent aligning according to the
obstructed vessel segment.
- Stent borders are also shown in red color in
the Diameter and Area graphs according
to the obstructed vessel segment in order
to indicate the positions of the stent endpoints.
- The length and diameter of the stent are
suggested in the Preliminary Results window.
Adjusting stent length and diameter
Press the Length and Diameter button.

Up: Increase length

Down: Decrease length
Right: Increase diameter
Left: Decrease diameter
Adjusting stent position
Press the Position button.

- Up: Move stent distal

- Down: Move stent proximal
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Press the Stent Planning button.
117
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
118
Overlay in live image
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Fluoroscopy or acquisition during
stent planning
You can release fluoroscopy or acquisition at
any time during stent planning.

- Stent graphics are shown as lines in the live
fluoroscopy or acquisition image as long as
the geometry of stand and table is not
changed.
To disable overlay:
Press the Overlay on Live button.
Stopping stent planning
Press the OK button.
Resuming stent planning

Stent data and graphics are maintained as long
as the current analysis is running.
Press the Stent Planning button again.
AXA4-100.622.24.02.02
- Stent data and graphics are removed.
119
With LVA (Left Ventricle Analysis), you can determine the ejection fraction and the wall motion of the left cardiac ventricle.
The LVA software is designed for analyses of the
left ventricle of the heart in a 30 RAO projection.
Note
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.
Make sure that the calibration image and the
ventricle scene have the same geometric acquisition parameters.
Note
Deviation from the 30 RAO projection changes

the dimensions of the ventricle, which leads to
incorrect results.
120
If the deviation from the 30 RAO projection is

impermissibly large, it is not possible to select
LVA.
AXA4-100.622.24.02.02

Left Ventricular Analysis (LVA)
Press the Left Ventricle Analysis button.
As soon as you move the cursor inside the image, it changes shape to a pencil.
AXA4-100.622.24.02.02
- The LVA window appears.
121
LVA workflow
A suitable scene is loaded and displayed in
full-screen, not looping.

In case of a single plane scene, and for a full
set of analysis results, the scene has been calibrated.
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.
122
AXA4-100.622.24.02.02

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

1. Start LVA.
2. A suitable ED frame and a suitable ES frame
are automatically detected.
The ED frame is displayed.
Optionally you may single step through the
scene and select another ED frame.
3. Perform contour detection in the ED image
(define three points).
4. Press the ES button.
The ES frame is displayed.
Optionally you may single step through the
scene and select another ES frame.
5. Perform contour detection in the ES image
(define three points).
6. Create and store the report.
AXA4-100.622.24.02.02
123
An LVA analysis without Auto ED/ES detec-
tion is performed in the following sequence:

1. Start LVA.
2. Press the ES button.
3. Scroll to a suitable ES image and press the
Mark as ES button.
4. Press the ED button.
5. Scroll to a suitable ED image and press the
Mark as ED button.
6. Perform contour detection in the ED image:
Mark the valve points and the apex.
7. Toggle back to the ES image by pressing the
ES button.
8. Perform contour detection in the ES image:
Mark the valve points and the apex.
9. Create and store the report.
Note
124
There is a benefit for first marking the ES image

and the ED image and then continuing with automatic contour detection. Both the ED and ES
image information is taken into account for the
contour detection.
AXA4-100.622.24.02.02

Performing LVA
Press the ES button.
Scroll through the scene:

Or
Press the scroll back/forward button.
When a suitable ES frame is displayed:

Press the Mark as ES button.
Press the ED button.
Scroll through the scene:

Press the scroll back/forward button.
When a suitable ED frame is displayed:

Press the Mark as ED button.
Define the ED contour and correct it
if necessary.
- Automatic contour detection 127
- Defining a contour manually 129
Press the ES button.

Define the ES contour and correct it
if necessary.
- Automatic contour detection 127
- Defining a contour manually 129
AXA4-100.622.24.02.02
Or
125
Note
The ventricle contours serve as the basis for calculating the results of the analysis. There are
two ways to define the contours for the ED and
ES: either manually or by marking the valve
plane and the apex followed by automatic contour detection.
126
Note
In the exam room, the contour is automatically
smoothed with Soft.
AXA4-100.622.24.02.02

Automatic contour detection
As soon as you have selected an ED or ES image,
automatic contour detection is activated.
First define the position of the aortic valve with
a line:
The mouse pointer has shape of a square.
Click a point on the edge of (outside) the aor-
tic valve in a line with the valve plane.

Click a point on the opposite side of the aortic
valve.
- The points marking the valve plane are
indicated by squares.
Now define the position of the apex:
The mouse pointer has shape of a diamond.
Click the apex cordis.
- This point is indicated by a diamond.

- The contour is drawn.
Move the mouse pointer close to the contour
you want to modify.

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

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

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

Correcting the valve plane and/or apex
When you move the mouse pointer near the
points, the pointer turns into a square.

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

places it.
AXA4-100.622.24.02.02
Correcting the contour
127
Note
At the end of the manual contour definition, the
valve plane will be indicated with a line connecting the upper and lower point of the aortic valve.
These points are indicated as small squares.
Note
Pressing this icon you can hide or show analysis

graphics.
128
Note
Pressing this icon you can reject the current
analysis and delete analysis graphics.
Note
You can film, print, or send a report in the same
way as normal images.
However, results of an analysis on the Quant
task card are only transferred to the film sheet if
the Report is stored.
AXA4-100.622.24.02.02

Defining a contour manually
An image has been defined as ED or ES im-
age.
Press this icon.
Move the mouse pointer onto the upper
point of the aortic valve and perform a single

click.
Move the mouse pointer clockwise along the
edge of the ventricle, defining intermediate

points with a single click
- The line changes its direction each time.
Mark the lower edge of the aortic valve with
a double click.
The contour is drawn.
You can check whether you have selected the

correct image more easily in the dynamic display, that is, if the heart is beating under the
contour.
Press this icon.
Generating and storing a report
Press the Report button.

Press this icon.
AXA4-100.622.24.02.02
Checking the contour
129
IVUSmap
IVUS imaging
Intravascular Ultrasound (IVUS) is a catheterbased 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.
IVUSmap
For obtaining a coregistration of an angiographic X-ray image and IVUS images, the IVUSmap
feature is available. The IVUSmap workflow
consists of acquiring and selecting a dedicated
X-ray image to be used for coregistration, determining the vessel centerline, and performing of
the pullback.
Review
After pullback, the coregistrated images can be

reviewed and it is possible to perform measurements.
130
IVUS system
Currently, the Volcano s5i IVUS system is supported.
Catheter types
Currently, the following IVUS catheters are supported:
Volcano Eagle Eye Gold catheter
Volcano Eagle Eye Platinum catheter
IVUSmap exam set

An ECG gated exam set is configured and linked
to IVUSmap.
AXA4-100.622.24.02.02
IVUSmap
IVUSmap examination workflow
The IVUSmap feature can only be successfully
utilized when:
IVUSmap is properly licensed and config-
ured.
A supported IVUS system is powered on,
ready, and connected to the Artis system.

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

Artis system.
There is an ECG signal of good quality.
An IVUSmap examination is performed in the

following sequence:
Step 1 1. Register the patient on the Artis.
133 2. Position the IVUS catheter in the vessel of interest.
4. Acquire a scene with contrast medium in the
region of interest with ECG gating
Step 2 5. Mark the centerline points of the vessel seg135
ment of interest
Optionally correct the centerline
Step 3 6. Start the pullback, manually or using the pull137
back device
7. Record the pullback on the IVUS system
8. Start low dose acquisition or fluoroscopy on
Artis with ECG gating
When pullback is finished:
9. Stop acquisition and recording
10. Stop the pullback
Step 4 11. Review the pullback scene
141 12. Perform measurements
AXA4-100.622.24.02.02
3. Start IVUSmap
131
Note
132
To successfully coregister the IVUS images and

the angiographic x-ray images, the steps 1
through 3 should be done without closing the
IVUSmap dialog, and without taskcard switches
in the control room. Otherwise, the workflow
aborts and is restarted at step 1.
Note
The user interface of the IVUS system and the
Artis IVUSmap application are both displayed in
the exam room.
If a shared display is configured, it is automatically switched between both screens, otherwise
both screens are visible simultaneously.
AXA4-100.622.24.02.02
IVUSmap
Step 1: Start IVUSmap and
acquire scene
Position the IVUS catheter in the vessel of in-
terest.
Perform the Ring Down on the IVUS system.
Then advance the IVUS catheter beyond the
lesion.
Press this button on the touchscreen.
The Create Image workflow step is active.

The demographic data of the patient is transferred to the IVUS system.
Make sure, the same patient is registered on
the IVUS system.

The ECG gated acquisition program for IVUSmap is automatically selected.
The following message is displayed: Position IVUS catheter in vessel and acquire
angio scene
Inject the contrast medium.
After radiation release, the maximum fill

frame is identified by the system and displayed (MFH review mode).
The following message is displayed: Select
next work step or repeat acquisition
Check the angiographic scene via scrolling
frame by frame
- Left: one frame backward
- Right: one frame forward
Or
Press one of these icons.
AXA4-100.622.24.02.02
Press the exposure release button or pedal.
133
Caution
User inadvertently marks the wrong vessel during Angio/IVUS registration.
It may result in mis-registration of the IVUS
and Angio images.
The user is responsible for ensuring that the
134
correct vessel on Angio image is defined, i.e.

marked.
Note
In this step, make sure that you mark the two
points in the right sequence: first the marker at
the tip of the guiding catheter proximal vessel
location, then the distal vessel location.
Note
You may undo and repeat your marking.
AXA4-100.622.24.02.02
IVUSmap
Step 2: Mark the vessel
segment of interest
Press the Mark Vessel button.
- The following message is displayed:

Select distal marker of guiding catheter
Click in the image to mark the tip of the guid-
ing catheter.
- The indicated position is marked as the
guide catheter position.
- The following message is displayed:
Select distal vessel location
Click in the image to mark the distal part of
the vessel.
- The indicated position is marked as the distal vessel position.
The following message is displayed: Select
next work step or correct centerline
It is possible to place a maximum of 20 centerline correction points.
Press the Correct Centerline button.
- The following message is displayed: Set

centerline correction point
Move the cursor to a position in the image
and indicate this position as a centerline correction point by a mouse click.

- A new centerline point is set at the selected
location.
Repeat it until you are satisfied with the ves-
sel centerline.
Deselect the Correct Centerline function.
AXA4-100.622.24.02.02
Correcting the centerline
135
Caution
Movement of guiding catheter during transducer pullback.
It may result in mis-registration of the IVUS
and Angio images.
The user is responsible for ensuring the IVUS
and Angio images are properly registered.
136
Note
When selecting the Pullback workflow step and
the current stand position/table position differs
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 the stand joystick in any direction and
hold it deflected until movement stops.

Position the tabletop manually, if necessary.
If stand movement occurs during the pullback,

coregistration cannot be performed. The following message is displayed in this case: "Coregistration not possible - stand movement".
AXA4-100.622.24.02.02
IVUSmap
Step 3: Pullback
Note
The pullback should be stopped before the IVUS
catheter is pulled into the guiding catheter.
Press the Pullback button.
- The following message is displayed: Perform ECG-gated x-ray during pullback

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

IVUS system.
Start the pullback, manually or on the pull-
back device.
Press the Record button on the IVUS system.
pedal for (alternative) acquisition or fluoroscopy and keep it pressed until the end of
the pullback.
Stop X-ray acquisition: Release the foot-
switch pedal.
- The following message is displayed: Waiting for the End of Pullback ...
Press the Stop button on the IVUS system.
- The following message is displayed: IVUS

images will be transferred. Please wait.
Stop the pullback.
Annotations will be displayed on the image with

green points indicating the path of the catheter
pullback and with yellow brackets indicating the
length of the detected pullback.
AXA4-100.622.24.02.02
Start X-ray acquisition: Press the footswitch
137
138
AXA4-100.622.24.02.02
IVUSmap
The following message is displayed: Check if
dots are within brackets for reliable result.
Then select Review.
If the green dots are within the brackets:
Press the Review button.
If the green dots are not within the brackets,
the images are not registered properly.

Press the Restart Pullback button on the TSC
to repeat the pullback, or press the Create

Image or Mark Vessel buttons to repeat the
respective steps.
After a successfull pullback, IVUS images are
transferred in the background from the IVUS system to the Artis.
The subset of IVUS images is displayed which
has already been transferred.
Wait until all the IVUS images have been
When IVUS images are displayed, you can already start placing bookmarks.
AXA4-100.622.24.02.02
transferred and are displayed.
139
Note
If the registration between the X-ray angiographic image and the IVUS images does not
match exactly, you can correct it in the control
room.
See IVUSmap corrections in the Artis Volume 2

Quick Guide
140
AXA4-100.622.24.02.02
IVUSmap
Step 4: Review
In the last workflow step, you can review the
coregistrated angiographic image and the IVUS
images.
The Review workflow step is automatically selected.
Loop, single stepping
Press one of these icons.
Navigating along the vessel/ILD image

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

accordingly.
Rotating the vessel view/ILD image
- The orientation of the ILD view changes as
indicated in the cross-sectional image.
Adding a bookmark
- A new bookmark is added, distance measurements are updated.

Deleting the last bookmark
- The bookmark is deleted, distance measurements are updated.

Bookmarks can be overlaid on live fluoro, using
the Overlay Reference function. They can be
added or deleted at any time.
You can also calibrate the angiographic image
and perform measurements.
Calibration and distances 99
When finished, or if you want to review later:
Close the window.
AXA4-100.622.24.02.02
Deflect the mouse joystick left/right.
141
Rotational Angiography, 3D
3D
Special 3D acquisition modes are available
which enable the generation of image sets suitable for 3D reconstruction on the syngo
Workplace. 146
Using syngo InSpace 3D, DynaCT and DynaCT
Cardiac the acquired data sets can be reconstructed to 3D images on the syngo Workplace.
You will find further information for reconstruction in the syngo Workplace Quick Guide
(Volume 2).
Note
3D examinations can be performed only in the
calibrated system positions.
DR-DYNAVISION
142
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).
162
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. The rotational range of the C-arm can
be freely selected. 164
AXA4-100.622.24.02.02
Preparations
Preparing the patient
Immobilize the patient as well as possible to
avoid motion artifacts.

Check for correct entry of the patient posi-
tion.
Inform the patient about the coming exami-
nation procedure.
Preparing the stand and table
Position the C-arm in Left Side or Right Side
position.

Positioning the region of interest in the isocenter ensures that this region does not drift out of
the displayed field of view.
Position the region of interest in the frontal
Position the region of interest in the lateral
beam path.
Preparing the injection
Puncture and insert the catheter.
Connect the contrast medium injector and
program it.
Perform fluoroscopy and collimate.
Position the catheter in the target area.
Automatic injection
Set the X-ray delay on the injector.
Switch the injector to Armed.
Manual injection
Deselect synchronization.
AXA4-100.622.24.02.02
beam path.
143
Injection mode
Contrast medium can either be applied with the
help of an automatic injector or manually.
In general, injection with the injector produces
better results as the flow of the contrast medium
can be kept constant over the total duration of
the injection.
If the injector is set to Armed it will be trig-
gered.
It is recommended to set a delay time (X-ray
delay) of 0.5 to 1 s on the injector. With it, an
optimum contrast medium filling is achieved
already with the first projection.
The X-ray delay which is programmed at the
injector is used to delay the begin of the injection phase. During this delay time, there is
no image acquisition.
If the injector is not set to Armed, the sys-
144
tem 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.
Caution
Injector not connected (correctly) or not set to
armed (especially with 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.
AXA4-100.622.24.02.02
Automatic/manual control
The rotational examination sequence depends
on the Dyna Control or 3D Control setting in
the acquisition program:
If Auto is set in the acquisition program, then
the movement of the C-arm starts 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
Caution
Patient moves hand or arm into the way of the
moving C-arm.
Patient injury
It is the responsibility of the operator to en-
sure proper immobilization of the patient.
AXA4-100.622.24.02.02
the C-arm (and start of the acquisition) manually with the multifunctional button (blue
button on the hand switch).
- The injection must also be carried out manually.
145
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.
3D DR: Like in DR-DYNAVISION, images are
acquired in a single run and no subtraction is

performed. 148
3D DSA: Like in (DSA-)DYNAVISION, images
are acquired in mask run and fill run and subtraction is performed. 150
3D CARD: Images are acquired in several ac-
quisition runs, to reduce motion artifacts. No

subtraction is performed. 158
146
AXA4-100.622.24.02.02
Centering the target volume in the isocenter
(3D)
When a 3D acquisition program was selected,
there are two possibilities:
1. The isocenter has already been set before selection of the 3D acquisition program. The region of interest is positioned in the isocenter.
- The LED on the Isocenter key is lit.
You can start immediately.
2. The isocenter has not been set. The region of
interest is not yet positioned in the isocenter.
- The LED on the Isocenter key is flashing.
The isocenter assistant helps you positioning
the region of interest in the isocenter.
The following message is shown:

3D ISO: Frontal, activate stand movement
Press down the stand joystick and deflect it.

Hold it in this position until the C-arm is positioned in the frontal position.
Position the region of interest in the frontal
beam path.
The following message is shown:
3D ISO: Lateral, activate stand movement

Hold it in this position until the C-arm is positioned in the lateral position.
Position the region of interest in the lateral
beam path.
AXA4-100.622.24.02.02
If the region of interest is positioned in the isocenter, press the isocenter key in order to skip
the isocenter assistant.
147
3D DR
3D DR examination sequence
Preparations
3D DR test phase
You check that the programmed rotational

range is free of obstacles and hazards.
Injection if contrast medium is used
3D DR fill phase
An image is acquired for every projection.

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

(2)
(6)
148
(4)
(7)
(5)
(3)
(1)
(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 medium
(7) End position
AXA4-100.622.24.02.02
3D DR workflow
Check the injector, if used.
2. Select a 3D DR acquisition program.
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:
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.
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 multifunctional
button of the handswitch, if Manual is
programmed. 145
AXA4-100.622.24.02.02
Ready for 3D is displayed.
149
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.
3D DSA
3D DSA examination sequence
Preparations
3D DSA test phase
150

3D DSA mask phase
A mask image is acquired for every projection.

Return phase
Injection
3D DSA fill phase
For every projection, a fill image is acquired

and the mask image is subtracted from it.
AXA4-100.622.24.02.02
(2)
(4)
(6)
(8)
(5)
(9)
(7)
(3)
(1)
(1) Start position

(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
AXA4-100.622.24.02.02
151
3D DSA workflow
A 3D DSA acquisition is performed in the following sequence:
2. Select a 3D DSA acquisition program.
5. Perform the 3D DSA test run to make sure

that no collision will occur.
152

AXA4-100.622.24.02.02
7. Perform the 3D DSA mask run:
Start acquisition: Press the exposure release
Movement is performed automatically. Mask
images are acquired.
8. The return run takes place automatically.
9. Automatic or manual injection.
11. Let go the exposure release when all rotational runs are complete.
Workplace:
Artis
syngo Workplace.
AXA4-100.622.24.02.02
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. 145
Fill images are acquired.
153
DynaPBV Neuro and DynaPBV

Body
A DynaPBV Neuro volume is reconstructed
from data acquired in a 3D DSA examination

on Artis following a special workflow.
A DynaPBV Body volume is reconstructed
from data acquired in a normal 3D DSA examination on Artis using a special acquisition
program.
3D DSA examination sequence 150
DynaPBV Neuro examination sequence
(2)
(6)
(7)
(9)
154
(11)
(8)
(1)
(5)
(3)
(4)
(1) Start position

(4) Manual start of injection
Manual start of injection can be varied, e.g.
injection can also be started during or after
acquisition of mask run.
AXA4-100.622.24.02.02
DynaPBV Neuro workflow
with manual injection (i.v. injection)
Preparations
Prepare the injector: Add the contrast and sa-
line required for the desired acquisition.

Select Neuro-PBV acquisition program on
the touchscreen.
If C-arm is not in AP position
System message: 3D ISO: Frontal, activate
stand movement
Deflect stand joystick until C-arm reaches AP
position.
Adjust table to position region of interest in
isocenter.
Deflect stand joystick until C-arm reaches lat-
eral position.
Adjust table height to position region of in-
terest in isocenter.
System message: 3D Start Position: Activate
stand movement
Deflect stand joystick until C-arm reaches
start position.
Test phase
System message: 3D Test Phase: Auto, activate stand movement
Deflect stand joystick until test run is fin-
ished.
System message: Test Phase: Start fluoro to
complete test phase
Briefly press fluoro pedal on footswitch.
AXA4-100.622.24.02.02
System message: 3D ISO: Lateral, activate

stand movement
155
Injection
We recommend injecting intravenously about
2 s before starting the mask run. Typically, the
following injection may be applied:
60 ml @ 4-5 ml/s and after that 60 ml @ 4-
5 ml/s NaCl
Or (without dual-head injector):
80 ml @ 4-5 ml/s without NaCl
DynaPBV Neuro examination sequence

(continued)
- Manual start of mask run
156
(8) Bolus watching phase: Subtracted images

are shown on the Artis Live screen. Based on
the image content, the start of the fill run can
be decided.
- Manual start of fill run at reversal point
(10) End of acquisition
DynaPBV Neuro examination time scale
Mask run
Return run
native
8s
5s
Bolus watching
10-15 s, max. 30 s
Injection duration 24-30 s

Total procedure ~31 s
AXA4-100.622.24.02.02
Bolus reaches
sinus sagittalis
(7) Return run
Fill run
8s
Acquisition
System message: Ready for 3D
Start the i.v. injection: Press the acquisition
button or pedal.
Keep the acquisition button or pedal pressed
until the end of the fill run.
Mask phase
Press the blue multifunctional button of the
handswitch once to start the mask run (first

run).
Mask images are acquired.
Bolus watching phase
Once C-arm is back at its starting position, a 2D
DSA acquisition will automatically be performed.
Observe the contrast media propagation.
As soon as contrast is visible in superior sagittal

sinus:
handswitch once to start the fill run (second

run).
As soon as the fill run is completed and a beep is
heard:
Release the acquisition button or pedal.
3D data is automatically sent to the syngo

Workplace, reconstructed, and displayed.
AXA4-100.622.24.02.02
Fill phase
157
3D CARD
3D CARD examination sequence
Preparations
3D CARD test phase

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

Image data is sent to the syngo Workplace.
The 3D image is reconstructed and displayed.
(2)
(4)
(6)
(8)
158
(5)
(9)
(1)
(7)
(3)
Example of a 3D CARD acquisition sequence with 3 runs
(1) Start position

(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
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(5) Start of acquisition 3D run 2
(6) 3D acquisition run 2
(7) Start of 3D acquisition run 3
(8) 3D acquisition run 3
(9) End position
3D CARD workflow
A 3D CARD acquisition is performed in the following sequence:
Check the ECG, if used.
5. Perform the 3D CARD test run to make sure
that no collision will occur.
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2. Select a 3D CARD acquisition program.
159

medium is used.
8. Perform the 3D CARD acquisition runs:
programmed. 145
9. Let go the exposure release when all rotational runs are complete.
160

Workplace:
Artis
syngo Workplace.
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3D acquisition programs
The acquisition programs for 3D acquisitions are
named as follows:
<acquisition time> <acquisition mode> (<body
part>) (<specification>)
<specification>
Care
AVG
Description
Bolus time in seconds
For native reconstructions
For subtracted reconstructions
DynaCT
Cardiac without ECG gating
Cardiac with ECG gating
Neuro parenchymal blood volume
Liver parenchymal blood volume
For examination of the head
For examination of other body
parts, e.g. abdomen
Low dose acquisition program
For Aortic ValveGuide
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Name component
<acquisition time>
e.g. 5 s
<acquisition mode>
DR
DSA
DCT
Card
Card ECG
Neuro-PBV
Liver-PBV
<body part>
Head
Body
161
DR-DYNAVISION
DR-DYNAVISION examination sequence
(2)
(6)
(4)
(7)
(5)
(3)
(1)
(1) Start position


162

(6) Fill run with rotating C-arm for image acquisition with or without contrast medium
(7) End position
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DR-DYNAVISION workflow
Position the region of interest in the isocenter.
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.
7. Perform the DR-DYNAVISION acquisition run:

programmed. 145
8. Stop acquisition when rotational run is complete.
9. View the rotational series.
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medium is used.
163
DYNAVISION
DYNAVISION examination sequence
(2)
(4)
(6)
(8)
(5)
(9)
(7)
(3)
(1)
(1) Start position


164

(5) Reversal in the start position of the test run
(6) Return run
(9) Washout phase
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DYNAVISION workflow
Position the region of interest in the isocenter.
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.
7. The return run takes place automatically.

8. Automatic or manual injection.
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. 145
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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6. Perform the DYNAVISION mask run:

165
Peripheral Angiography
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). 170
PERIVISION
PERIVISION is the stepping method introduced
by Siemens with digital online subtraction. With
an injection, an angiography is created in stepping technique in subtracted display. 172
Moved component
If a motorized stepping device is installed, peripheral angiography can be performed.
A component is moved linearly according to the
system type:
The C-arm in case of Artis ceiling, .
Running direction
166
The running direction determined in the acquisition program can be selected according to the
blood flow direction. It always refers to the registered patient position.
for examining the leg arteries: head to feet
for examining the leg veins: feet to head
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Preparations
Transparency compensation
Transparency compensation is available to avoid
direct radiation and to compensate for the transparency differences in the pelvis-leg region.
Place the transparency compensation on the
patient table before positioning the patient.

Cover the transparency compensation with a
hygienic, fluid repelling foil or cover.

Preparing the patient
To avoid motion artifacts, the legs should be immobilized in peripheral examinations.
Position the patient centrally and in a supine
position on the tabletop.

Immobilize the patient's knees:
Then push the foam parts on the side of the
patient's knees underneath the belt.

Make sure that the patient's legs lie close
against one another.

Place the long sack in the area between the
patient's legs, if necessary.

Turn the patient's feet inward and immobilize
them with adhesive tape, if necessary.

Place the foot cushion under the patient's
feet.
Inform the patient about the coming exami-
nation procedure.
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Either run the fastening belt around the tabletop or pull it through underneath the positioning mattress and fasten it.
167
Automatic/manual control
The examination sequence depends on the
Stepping Mode setting in the acquisition program:
If Auto is set in the acquisition program, then
the movement starts automatically with the

acquisition.
- If an injector is connected to the system
and set to Armed, injection is also started
automatically (possibly with delay).
- If no injector is connected to the system or
if it is connected, but not set to Armed,
you must carry out injection manually.
If Manual is set, you must start movement
(and start of the acquisition) manually with

the multifunctional button (blue button on
the hand switch).
- The injection must also be carried out manually.
Caution
168
Injector not connected (correctly) or not set to

armed (especially with 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.
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Preparing the stand and table
Position the C-arm in Left Side or Right Side
position.
Adjust the SID.
Move the patient as close as possible to the
image receptor.
Set the LAO/RAO angulation (max. 30).
Preparing the injection

Puncture and insert the catheter.
Connect the contrast medium injector and
program it.
Perform fluoroscopy and collimate.
Set the X-ray delay on the injector
(recommendation: 0 s).
Switch the injector to Armed.
Manual injection
Deselect synchronization.
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Automatic injection
169
PERISTEPPING
PERISTEPPING examination sequence
Preparations
Test phase
You determine the start position, all the acquisition positions and the end position.
You also check that the movement range is
free of obstacles and hazards.
Return phase
Fill phase
A scene is acquired for every position.

When the contrast medium bolus has filled
the image you switch on to the next acquisition position.
(2)
170
(1)
(2)
(4)
(6)
(6)
(3)
(5)
(7)
Example for PERISTEPPING examination sequence

Head
Feet
(1) Brief fluoroscopy in the start position to

check the examination region
(2) Test run for checking the positions
(6) Fill run for image acquisition with or without
contrast medium
(7) End position
AXA4-100.622.24.02.02
PERISTEPPING workflow
2. Perform a brief fluoroscopy in the start
position: Press fluoro pedal of footswitch.
Check/set SID, table height, collimation, filters and measuring fields.
3. Select a PERISTEPPING acquisition program.
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 performed. Injector disabled, manual injection. is displayed
in this case.
6. Perform the PERISTEPPING acquisition run:
7. Trigger the return phase
handswitch briefly.
(The return phase is radiation-free.)
8. Perform the PERISTEPPING acquisition run:
Start movement in time for each step: Press
the blue multifunctional button of the
handswitch.
10. View the PERISTEPPING series.
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4. Perform the PERISTEPPING test run to check

the position of the examination region and to
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.
171
PERIVISION
PERIVISION examination sequence
Preparations
Test phase
You determine the start position, all the acquisition positions and the end position.
You also check that the movement range is
free of obstacles and hazards.
Mask phase
A mask image is acquired for every position.

Injection
Fill phase
A fill scene is acquired for every position.

When the contrast medium bolus has filled
the image you switch on to the next acquisition position.
172
(2)
(1)
(2)
(4)
(3)
(6)
(7)
(4)
(5)
(6)
Example for PERIVISION examination sequence

Head
Feet
(1) Brief fluoroscopy in the start position to

check the examination region
(2) Test run for checking the positions
(4) Mask run for image acquisition without contrast medium
(6) Fill run for image acquisition with contrast
medium
(7) End position
AXA4-100.622.24.02.02
PERIVISION workflow
2. Perform a brief fluoroscopy in the start
position: Press fluoro pedal of footswitch.
Check/set SID, table height, collimation, filters and measuring fields.
3. Select a PERIVISION acquisition program.
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 performed. Injector disabled, manual injection. is displayed
in this case.
6. Perform the PERIVISION mask run:
7. Perform the PERIVISION fill run:
Start movement in time for each step: Press
the blue multifunctional button of the
handswitch.
9. View the PERIVISION series.
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4. Perform the PERIVISION test run to check the

position of the examination region and to
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.
173
Troubleshooting
System messages
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
Message lines
The line at the bottom of the images shows
exam-specific messages (instructions) in the

foreground and messages for user guidance
in the background.
Line 1 of the Assist screen / message bar
shows tips on system operation on the foreground and positive feedback/states in the
background.
Line 1 in the status area on the screen = line
174
2 on the Assist screen / message bar shows

state messages, e.g. "Memory full",
"BYPASS FLUORO"
Line 2 in the status area displays status mes-
sages of the image system, e.g. messages

about print or send jobs.
Line 3 in the status area shows icons of a
function active in the background.
Note
Operating restrictions that only the Service Center can remedy are marked with "... SC ...".
Example: "NO XRAY: call SC"
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Troubleshooting
System messages are displayed:
on the Assist screen / message bar (2 lines at
bottom)
- Stand/table messages
- System status messages
on the monitor of the system console
- line at bottom of image (1 line of text)

- status area in lower part of control area
(2 lines of text and 1 line of icons)
Please pay attention to these messages.
Displaying a message in full

mouse button).
- Clicking a text (lines 1 and 2) displays the
full message text.
- Clicking an icon (line 3) displays the associated status window.
Resource display
Your system also monitors the memory usage
and the storage capacity of the main database,
the scheduler database and the exchange board
(virtual memory).
Click the icon to display an overview of the
various resources.
AXA4-100.622.24.02.02
Click into the message line (with the left
175
Emergency operation
The Artis Q/Q.zen ceiling 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.
If one component fails, the other continue to
work.
Therefore, the system has several operation
states, so that a failure of one component does
affect the whole system as less as possible, e.g.:
1. If an image acquisition system fails, the 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
176
After switch-on, all components are poweredup. Some of them are faster, some are slower.
So various operation states pass:
Off -
Bypass
fluoroscopy No x-ray Continuous
fluoroscopy
only
Backup mode - Full operation

Fluoroscopy
All functions
and acquisition available
only
No patient registration or
postprocessing
Note
If images have been acquired in backup mode,
e.g. immediately after power-on, they must be
transferred from the buffer to the memory.
Then the following message is displayed:
Syncing database, ... scenes left
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Troubleshooting
Bypass fluoroscopy
In various system states, e.g. during switch-on
or switch-off or if a technical fault occurs or
when no user is logged-in, only bypass, that is,
continuous fluoroscopy without the imaging
system without LIH, is possible. It is not possible
to release acquisitions.
You can recognize it as follows:
The fluoroscopy image is only visible in the
examination room.
The last fluoroscopy image (LIH, Last Image
Hold) does not remain on the screen.
is displayed in the status area on

the Live screen:
Backup mode
During backup mode, it ist not possible to select

the exam set and acquisition program on the
system console, exam set and acquisition program must be selected on the touchscreen.
Images are acquired into the buffer.
You can recognize it as follows:
New fluoroscopy/acquisition images are only
visible on the Live screen.

On the Live screen, a broken link symbol is
displayed.
Review is possible in backup mode. Other scenes
can be loaded via Scene + / Scene - but only
CARD, DR and DSA scenes are loaded.
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In various system states, e.g. during switch-on

or switch-off or if a technical fault occurs, only
fluoroscopy and acquisition without patient registration and postprocessing are possible.
177
No unit movement possible!

Direction?
Pay attention to the direction in which you
have to deflect the operating element.

Message?
Pay attention to the information on the
Assist screen / message bar.

Emergency STOP?
Check the emergency STOP buttons.
Collision protection sensor?

Make sure that no collision protection sensor
has responded.
Movements blocked?
Check the Block Movement function.
Patient?
Do not forget to rescue the patient if it is not
178
possible to remedy the error.

Resetting the unit computer (SCU)
Simultaneously press the buttons I and II as
STOP
well as the emergency STOP button on the

stand/C-arm control module (SCM).
- The unit computer is restarted and should
be ready for operation after a short time.
Do not forget to pull the emergency STOP
button again .
Buffer full! - Memory full!

Depending on the configuration, the Artis 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.
AXA4-100.622.24.02.02
Troubleshooting
Message
Buffer for < 4 Acq Runs
No Buffer for the next Acq Run
No acq: No Buffer for the next Acq
Free space in the buffer is not sufficient (hard

disk is full).
In this case, normal fluoroscopy is still possible,
but acquisition (and Store Monitor/Store 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
Free space in the memory is not sufficient (hard
disk is full).
Acquisition is blocked, fluoroscopy is still possible.
Delete (archived!) patients (if possible, pa-
tients with many scenes).

If the message remains:
Contact Siemens Service.
AXA4-100.622.24.02.02
Memory full, delete patients
179
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.
Note
In certain situations, the speed of unit movements is reduced for safety reasons.
Resuming the movement
180
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 oppo-
site direction by deflecting the operating 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 operating it

again.
AXA4-100.622.24.02.02
Troubleshooting
Resuming movement after collision (override)
Case 4.
If a collision occurred and the collision sensor responded:

You can initiate a movement by pressing but-
tons I and II simultaneously and operating

the operating element in a different direction.
- The message "Collision control deactivated" appears.
Caution
Safety override active
Higher risk of collision
Risk of mechanical or personal damage
Execute unit movements with special care
when override is active.

Deflect the operating element in one of the
The possible directions are indicated on the
Assist screen with + and -.

Directions which are not possible are marked
with x.
Case 5.
If the movement has been slowed down by the

collision computer, it can be resumed until the
unit stops.
In rare cases, e.g. when the patient table is 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.
AXA4-100.622.24.02.02
possible directions.
181
Patient rescue
E.g. in case of power failure, motoric system
movements are not available. However, you can
move parts of the system manually.
It is only possible to remove the patient man-
ually by turning the table or pulling the mattress.

It is possible to move the tabletop manually
in longitudinal direction with reasonable

force.
During the following steps make sure that the
patient is not hurt!
Rescuing the patient in an emergency
Use enough personnel for the rescue.
Remove any accessories obstructing rescue.
On the OR table, motorized movement of the

patient table is still possible in a power failure.
182
If necessary, you can move the table in the horizontal position:

Press both keys simultaneously and hold
them pressed until the movement stops automatically.

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.
If necessary, you can move the tabletop of patient tables with manual tabletop movement
manually in the longitudinal and transverse direction.
(This is not possible on patient tables with motor-assisted tabletop movement)
Pull/push vigorously to overcome the braking
force.
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Troubleshooting
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 installed.
(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
(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.
AXA4-100.622.24.02.02
Make sure that there is always a ladder available

to reach the clasp.
183
Caution
Patient table tilted
Risk of patient sliding from the table
Secure the patient sufficiently with shoulder
supports, foot holder or body straps before

tilting the table.
Loosen any fixtures.
In difficult cases, you may have to rescue the patient along with the mattress.
Lift the mattress at the foot end to unfasten
the hook and loop fastener (or velcro fastener).

Put some paper or cloth between table top
and mattress so that the velcro does not fasten again.
Unfasten safety straps (if applicable).
184
Pull the mattress with the patient on it from
the table top at head side end or foot side

end of the table.
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Troubleshooting
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.
AXA4-100.622.24.02.02
185
Restarting
If a message ... Restart imaging system appears, you must terminate the imaging system
application and then restart it.
Restart needs some time.
There are three possibilities for restarting:
1. Restart Application 187
In this case, only the console in the control
room is restarted.
Acquisition and fluoroscopy are still possible.
Recommended if there is a problem in the
control room only.
2. Restart System 187

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).
186
3. RESET image evaluation system 189

In this case, the image evaluation system in
the control room is restarted by force.
Acquisition and fluoroscopy are still possible.
Only use it if Restart Application or Restart
System does not work.
4. Switch off the system manually and power
on again 189
In this case, the whole system is powereddown by force.
Only use it if the system does not react on inputs anymore and if the examination is finished or can be interrupted.
AXA4-100.622.24.02.02
Troubleshooting
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.
AXA4-100.622.24.02.02
187
Caution
Resetting the image evaluation system
Risk of data loss
Only ever press the RESET button when the image evaluation is not ready.
Do not press the RESET button during an ac-
quisition.
Wait until all drive activity has come to an end
(neither of the two LEDs is lit).
Note
There must be a pause of at least 30 s between

power-off and power-on again.
188
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 without any further action
when the 30 s have elapsed.
AXA4-100.622.24.02.02
Troubleshooting
RESET image evaluation system
Press the RESET button for longer than about
half a second.
- The image evaluation system (console in
the control room) is restarted and should
be ready again after a few minutes.
Switching off manually and power on again
Press the power-on pushbutton on the sys-
tem console for more than 4 s and then release the button.
Wait until everything is off.
Wait for about 30 s.
Press the power-on pushbutton on the sys-
tem console for more than 0.5 s and then release the button.
AXA4-100.622.24.02.02
Switch-off the system, only if the imaging system can no longer be terminated by software.
189
Index
-
1:1 pixel display 86

3D 142, 146
acquisition programs 161
3D CARD
acquisition mode 146
examination sequence 158
workflow 159
3D Control 145
3D DR
workflow 149
3D DSA
workflow 152
3D vessel model
creating 111
in IZ3D 111
moving C-arm 115
to C-arm position 115
to optimal projection 115
190
A
Acquisition 65
Acquisition frame rate
changing 59
Acquisition program
changing 57, 59
Acquisition programs
3D 161
Advanced Roadmap
performing 73
phases 72
Alternative acquisition 67
Alternative Acquisition
Program 66
Anatomical background 95
with Roadmap 70
Angio collimator
control module 34
Angiographic Computed
Tomography (ACT) 146
Angulations 23
Annotations 97
Aortic valve
in LVA 127
Apex
in LVA 127
Application
restart 187
Arrows
drawing 97
Artis zee ceiling
overview 8
Assist screen 15
Automap 31
Automatic contour detection
in LVA 127
Automatic control
in DYNA, 3D 145
in PERI 168
Automatic isocenter
calibration 101
B
Backup mode
emergency operation 177
Bifurcation
in QCA/QVA/IZ3D 109
Blocking radiation 48
Blocking unit movements 48
Brakes
releasing brakes for table 20
Brightness 84
Buffer 177
full! 178
Button
emergency STOP 16
Bypass fluoroscopy
display 177
emergency operation 177
C
Calibration
exam room 103
using the table-object
distance 99
Card collimator
control module 34
Cardio Pulmonary Resuscitation
(CPR) 26
C-arm
joystick 22
movements 10
moving 23
positioning
longitudinally 25
AXA4-100.622.24.02.02
Index
Creating
3D vessel model 111
Current roadmap mask 74
D
DCS 14
DCS extended 14
Default patient 44
Degree
of Overlay Ref 79
Dilatation timer 62
Direct position
keys 24
storing 29
Direct positions 26
Disk
full 179
Display
BYPASS FLUORO 177
of stent borders 118
Display Ceiling Suspension
(DCS) 14
Display modes
native 78
subtracted 78
Distances
drawing and measuring 101
DR-DYNAVISION 142, 162
workflow 163
DSA
native display 89
postprocessing in exam
room 88
DSA-DYNAVISION 142, 164
Dyna Control 145
DynaPBV Body 154
DynaPBV Neuro 154
injection 156
workflow 155
DYNAVISION 142, 164
workflow 165
E
ECG
attaching 51
AXA4-100.622.24.02.02
C-arm control module 22

keys 24
C-arm rotations 23
Catheter
for IVUSmap 130
Catheter calibration 103
Changing
the tabletop 12
Circles
drawing 97
CLEARstent 76
CLEARstent Dynamic 76
CLEARstent Dynamic acquisition
workflow 77
CLEARstent image 76
CLEARstent Live 76
CLEARstent reference image 76
Collimation
resetting 39
setting 39
Collimator
joystick 38
Collimator control module 34
keys 35
Collimator home
key 35
Collimator rotation
key 35
Collision
override 181
Combined C-arm movements 22
Configuring
touchscreen layout 43
Contour
checking in LVA 129
correcting in LVA 127
defining manually in
LVA 129
detection in LVA 127
manual in QCA/QVA 109
Contrast 84
Control console 16
Control module
C-arm 22
collimator 34
imaging system 42
patient table 18
stand 22
Control modules
trolley 13
CPR position 26
191
Index
Emergency operation 176
backup mode 177
bypass fluoroscopy 177
Emergency patient
registering 45
Emergency STOP button 16
locations 16
Epipolarity lines 112
Exam set 56
for IVUSmap 130
selecting 57
Examination sequence
3D CARD 158
3D DR 148
3D DSA 150
DR-DYNAVISION 162
DynaPBV Neuro 154
DYNAVISION 164
PERISTEPPING 170
PERIVISION 172
Examination-specific
messages 174
192
FD
rotation 36
FD lift 33
membrane keys 32
Fill phase
3D CARD 158
3D DR 148
3D DSA 150
PERISTEPPING 170
PERIVISION 172
Filter
joysticks 38
Filter diaphragms 40
Finger filter 40
key 35
setting 41
Flip
preselection 54
Fluoroscopy 63
changing the program 61
storing a scene 62
Fluoroscopy signal
resetting 62
Footswitch pedal
alternative acquisition 66
Frame rate
changing 59
H
Help
on touchscreen 42
I
ICStent reference image 64
Image
making it coincide with
mask 90
mirror/flip preselection 54
scrolling 83
Image angle 98
Image directory
of a scene 82
Image format
selecting 37
Image texts
predefined 97
Injection
3D CARD 158
3D DR 148
3D DSA 150
DynaPBV Neuro 156
PERISTEPPING 170
PERIVISION 172
preparing 143
Injection mode
rotational angiography 144
Input field 36
Input format
key 35
Intravascular Ultrasound
(IVUS) 130
ISO tilting 20
Isocenter
in rotational
angiography 143
key 18
setting 52, 53
stopping 19
IVUS imaging 130
IVUSmap 130
catheters 130
exam set 130
examination workflow 131
pullback 137
step 1 133
step 2 135
step 3 137
step 4 141
AXA4-100.622.24.02.02
Index
J
Joystick
C-arm 22
collimator, filter 38
patient table 18
stand 22
K
Key
orientation 24
Keys
on the C-arm control
module 24
on the collimator control
module 35
on the stand control
module 24
on the table control
module 18
L
Large Display 15
screen layout 15
Large display 14
Left Ventricle Analysis 120
Left Ventricular Analysis (LVA)
exam room 121
LIH 80
Lines
drawing 97
Live FLUO/LIH 78
Live screen 15
Lock tabletop movement
key 18
Loop
display mode 80
in LVA 129
Low dose acquisition 66
LVA 120
exam room 121
workflow 122
M
Manual contour correction
in QCA/QVA 109
Manual control
in DYNA, 3D 145
in PERI 168
Mask
making it coincide with
image 90
new 89
Mask phase
3D DSA 150
PERIVISION 172
Membrane keys
for C-arm and FD
movements 32
for FD lift 32
Memory
full! 178
Message bar
on Large Display 15
Message lines 174
MFH = Max. Fill Hold 80
Mirror
preselection 54
Mouse
joystick 42
Mouse joystick 42
Movement
after collision 181
resuming 180
stopped 180
Movements
blocking 48
C-arm 23
not possible 178
patient table 12
stand 25
stand, C-arm 10
Moving
C-arm to 3D vessel
model 115
Moving the mask 89
N
Native 89
display modes 78
Native display
in DSA 89
AXA4-100.622.24.02.02
IZ3D 106
3D vessel model 111
exam room 107
quad view 113
Stent planning 116
193
Index
New mask
setting 89
No unit movement possible! 178
Optimal Projection
for IZ3D 114
OR table 11
Orbital movements 23
Orientation
key 18, 24
Orientation key 24
OT/UT
conversion 23
Overlay Ref 78, 79
Overlay Reference
performing 79
setting the degree 79
Override 181
Overtable/undertable
conversion 23
Overview
Artis zee ceiling 8
patient table 11
194
P
Panning
exam room 87
with zoom 87
Panning knob
patient table 18
Patient
accepting data from the
RIS 45
accepting from Sensis 47
registering 45
registering in an
emergency 45
registering manually 45
rescuing in an
emergency 182
scene directory 83
Patient position 54
checking/changing 55
Patient rescue 182
Patient table
joystick 18
movements 12
moving 19
overview 11
panning knob 18
raising / lowering 19
Performing
Advanced Roadmap 73
Overlay Reference 79
PERI
running direction 166
Peripheral angiography 166
PERISTEPPING 166, 170
workflow 171
PERIVISION 166, 172
workflow 173
Phases
Advanced Roadmap 72
roadmap 68
Pixelshift 90, 91
automatic 91
flexible 93
manual 93
starting 91
Pointer
using 87
Polygons
drawing 97
Position
moving to a reference image
position 31
Postprocessing
DSA in exam room 88
Preparations
3D CARD 158
3D DR 148
3D DSA 150
peripheral angiography 167
PERISTEPPING 170
PERIVISION 172
rotational angiography 143
Pressure measurement 51
Previous roadmap mask 74
Programmed positions 26
key 24
moving to 27
storing 29
Pullback
for IVUSmap 137
AXA4-100.622.24.02.02
Index
Q
QCA 106
exam room 107
QCA 3D 106
3D vessel model 111
Quad view
in IZ3D 113
Quantitative Coronary
Analysis 106
Quantitative Vascular
Analysis 106
(QCA, QVA, IZ3D)
exam room 107
QVA 106
exam room 107
R
Radiation
blocking 48
Rectangular collimation 39
Reference image
displaying for system
position 31
fading in or out 79
moving to a position 31
scrolling 83
Reference screen 15
Registration
default patient 44
Replace mask
during roadmap 70
Replacing the mask 89
Report
generating and storing 109,
129
Representative 82
Rescue 182
RESET 189
Resource display 175
Restart
application or system 187
Restarting 186
Return phase
3D DSA 150
PERISTEPPING 170
Review
IVUSmap 141
Review modes 80
Review rate
setting 81
RIS
accepting patient data 45
Roadmap 68
anatomical background 70
changing the program 61
performing 69
replace mask 70
vessel/catheter contrast 70
with two system
positions 74
Roadmap phases 68
Roadmapping technique 68
Rotating
3D vessel model to C-arm
position 115
Rotating the FD 36
Rotational angiography 142
Running direction
in peripheral
angiography 166
S
Scene
image directory 82
scrolling 83
single step 81
Scene directory 83
scrolling 83
Scene overview 82
Screen layout
of the Large Display 15
Screens 15
Scrolling
in the directories 83
SCU reset 178
Sensis
accepting patient data 47
Servo assistance
patient table 18
Shortcut
storing a position 29
SID
setting 33
Single step 81
Skin dose
alternative acquisition 66
AXA4-100.622.24.02.02
Pulse rate
changing 61
195
Index
196
Sphere calibration 105

Stand
joystick 22
movements 10
Stand control module
keys 24
Stand control modules 22
Stand movements 25
Stand swivel 25
Stent borders
display 118
Stent placement 116
Stent planning 116
Stepping Mode 168
STOP button 16
Stopping
in the isocenter 19
of movements 180
Store Monitor 64
Store Reference 64
Storing
key for position 24
Subtracted 89
display modes 78
Surgery table 11
Switching off
manually 189
System
restart 187
System messages 174
System position
key 24
storing with shortcut 29
System positions 26
moving to 27
T
Table
movements 19
raising / lowering 19
tilting 20
Table control module 18
keys 18
Table lift
key 18
Table swivel
key 18
Table tilt
key 18
Tabletop
changing 12
moving longitudinally
only 19
moving with joystick 21
moving with panning
knob 20
versions 11
Task cards
on the touchscreen 42
Test phase
3D CARD 158
3D DR 148
3D DSA 150
PERISTEPPING 170, 172
Texts
predefined 97
TOD
performing a calibration 99
Toggle
display mode 80
Tooltip help
on touchscreen 42
Touchscreen 42
tooltip help 42
Touchscreen control 42
Touchscreen layout
configuration 43
Transparency
compensation 167
Trendelenburg
tilting the tabletop 20
Trolley
for control modules 13
Trumpf Surgery Table 11, 19
TSC 42
U
Unit computer
resetting 178
Unit movements
blocking 48
not possible 178
User guidance 174
V
Vessel contour detection
in QCA/QVA 107
AXA4-100.622.24.02.02
Index
Vessel/catheter contrast
with Roadmap 70
Wedge filter 40
key 35
setting 41
Window center 84
Window values
automatic assignment 85
manual setting 85
Window width 84
Windowing
exam room 85
Workflow
3D CARD 159
3D DR 149
3D DSA 152
CLEARstent Dynamic 77
DR-DYNAVISION 163
DynaPBV Neuro 155
DYNAVISION 165
IVUSmap 131
PERISTEPPING 171
PERIVISION 173
Z
Zero stop
key 24
Zoom
by a factor of 2 86
to acquisition size 86
Zoom format
key 35
Zoom stage 36
selecting 37
Zooming
exam room 87
AXA4-100.622.24.02.02
197
198
AXA4-100.622.24.02.02
Disclaimer
All the pictures of devices and the program user interface
shown in this Quick Guide are only examples. The available
functions depend on the type of system, the installed options,
and the current configuration.
Options have not been marked specially. The options will only
be available if the corresponding licenses have been purchased
and installed. The quotation text of your order is the sole reference for the functional scope of your system.
Other differences in detail may occur in your system due to
constant development and improvement.
Reproduction of images can cause loss of detail.
All names shown in figures are purely fictional. Similarities to
existing people are entirely coincidental.
Siemens reserves the right to change the implementation and
specifications of this document without prior notice.
For up-to-date information, please contact your local Siemens
representative.
AXA4-100.622.24.02.02
Notes
199
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
Global Siemens
Headquarters
Siemens AG
Wittelsbacherplatz 2
80333 Muenchen
Germany
Global Siemens
Healthcare Headquarters
Siemens AG
Healthcare Sector
Henkestrasse 127
91052 Erlangen
Germany
Phone: +49 9131 84-0
www.siemens.com/healthcare
Order No.: AXA4-100.622.24.02.02 | 06.2013, Siemens AG

Quickguide Q and Q.zen Ceiling

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Artis Q/Q.

Artis Q/Q.zen ceiling - Quick Guide

This Quick Guide was originally written in

Artis Q/Q.zen ceiling - Quick Guide

Quick Guide Layout

Artis Q/Q.zen ceiling - Quick Guide

Warnings are preceded by a warning triangle

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

Registering a patient ...........................................45

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

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

Artis Q/Q.zen ceiling - Quick Guide

3D vessel model in IZ3D ....................................111

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

Artis Q/Q.zen ceiling - Quick Guide

- IVUSmap for coregistration of an angiographic X-ray image and IVUS images

Artis Q/Q.zen ceiling - Quick Guide

the exam room

System Overview (Exam Room)

Example: Artis ceiling with 3 monitors

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

Artis Q/Q.zen ceiling - Quick Guide

(2) Patient table

(3) Display ceiling suspension system with LCD

System Overview (Exam Room)

Example: Artis ceiling stand with FD 30x40

(1) Flat detector (FD)

Artis Q/Q.zen ceiling - Quick Guide

Movements of the stand/C-arm

Example: Artis ceiling Card stand/C-arm

(1) Stand longitudinal movement (on ceiling

Artis Q/Q.zen ceiling - Quick Guide

(2) Stand swivel/rotation

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

System Overview (Exam Room)

(1) Tabletop with mattress

Artis Q/Q.zen ceiling - Quick Guide

Movements of the patient table

(1) Tabletop transverse movement (manual)

Artis Q/Q.zen ceiling - Quick Guide

(5) (Reverse) Trendelenburg table tilt (motorized)

(6) Table rotation (motorized or manual)

To remove the tabletop, lift it at the head end

and pull it off toward the front side.

so that its end is anchored in the frame and

System Overview (Exam Room)

Trolley for other systems

(1) Rails for control modules and other accessories

Artis Q/Q.zen ceiling - Quick Guide

(3) Cable holder

Display Ceiling Suspension (DCS)

Artis Q/Q.zen ceiling - Quick Guide

Example of DCS extended with 4 monitors

Example of DCS with Large Display and additional color

System Overview (Exam Room)

screen. Besides the images, acquisition data

tem messages and menus for unit movements.

on and connected to a monitor or the Large

play, there is also a message bar, e.g. on top.

The screen layout of the Large Display can be

You can select the screen layout of the Large

Artis Q/Q.zen ceiling - Quick Guide

The screen of the Large Display is divided into

Depending on the type and configuration, your