SIEMENS Operating Instructions SIREMOBIL 4N-U/4H-U/4K-USIREMOBIL 4N-U/4H-U/4K-U Mobile X-Ray Image Intensifier Units Featuring Digital Technique for Fluoroscopy and Direct RadiographyImportant note Models, Application of the SIREMOBIL 4 Design of the SIREMOBIL 4 Components breakdown Operating controls and indicators Control panel ~Controis wutside the control pane! Sterile draping of the C-arm Transport position and transport Cable connection and startup Base movements Movements of the C-arm system Positioning the unit Fluoroscopy ~Fluorescopy with Automatic Dose Rate control ~ SIRETRON instant image = Image store Second monitor and image store = Fine grid for Nuoroseopy ‘Semi traneparrnt slot Diaphragm, = Tris deaphragm = Dual mode image intensifier = (iperating procedures Flucroscopy SIRETRON operation (instant image with SIRETRON | Radiography = Cassette are = Cassette holder = tris diaphragm in radiogcaphy = Radvography with autamatic exposure contial ~ Operating procedures Exposures with timer Exposures with the SIRETRON Accessories Gettering the image intensifier tube Cleaning and disinfecting Safety notes Protective measures Safety and operation! checks Technical description Additional copies af these operating instructions may be obtained hy quoting Print Na 37-023 201 02 04 02 a Page Pane wee 29 30 4 31 vu 4a 33 3 ay 38 26 37 a7 3a a9 43 44 a aT englischImportant note For correct use of this equipment, it is necessary for the operating personnel to be familiar with the ‘operating instructions These must be studied carefully before first use of the equipment, Special attention must be given to the "Safety notes” und "Protective measures” and “Operational and safety checks" sections Models The following SIREMUBIL 4 models are available SIREMOBIL 4N with VIDEOMED N television system (525 lines at 60 H2) SIREMOBIL 4t-U with high resolution VIDEUMED I television system (1023 lines at 60 112) SIREMOBIL 4K-U with VIDEOMED Kompakt TV system (525 lines at 60 Hz) SIREMORIL 4N-U and SIREMOBIL 4H-U contain the SIRETRON attachment (Inviant image technique and automatic exposure control) and a digital image memory Je in these operating instruclians apply for all versions. OBL AU refers to all models Unless otherwise noted, all statemetns m, Likewise, the abbreviated designation SIRE: Application of the SIREMOBIL 4U The SIREMOBIL 4U is a mobile X-ray isnage intensifier unit, intended primarily for appheatian in surgery, orthopedic medicine and traumatology The SIREMOBIL AU is intended for Nuoroseapy and radiography in all projections Thanks to the eusy directional movement of the unit and the great flexibility of the C arm, a wide range of applications is opened up to the SIREMOBIL AU,Design of the SIREMOBIL 4U The SIREMOBIL 4U can be moved in any direction on three wheels. Two of the wheels are steerable The SIREMOBIL 4U is locked by a foot operated lever. ‘The C-arm system with image intensifier and X-ray tubs assembly features a vertical travel of 470 mm and a horizontal travel tin the direction of the supporting arm) of 203 mm It can be swivelled through + 9° about the stand column in the borizontal plane. Rotation in the vertical plane about the horizontal supporting arm fungulativn) is possible through t 195°. ‘The orbital movement of the C-arm is 1159 (swivelling over from 909 horizon to + 250 vertical The control box of the SIREMOBIL 4 U contains among other things, the uutomatic dose cate contrat system (ADC), the television system, and the SIRETRON attachment for SIREMOBIL 4 U and SIRE MOBIL 4H1-U (equipment for insant electronic video and autamatic exposure ming) The unit is operated with sensor touch buttons on the control panel Important operating parameters sh\ mA, Muoroseopic and radiographic time) are displayed digitally The TY cart supports the monitar and the digital image memory ‘The OPTILUX X-ray image intensifier permits 17 em/10 em (74") dual mode for ohwet and deta! enlargement. ‘The multiformat cassette camera MULTISPOT K allows image documentation trim fiestrsesnyComponents breakdown 5 2 SIREMOBIL control box SIREPHOS X-ray tube assembly with spacer Control panel Vertical lift column of the C-arm system Horizontal support arm for the C-arm system Carm OPTILUX 17:10 em (7" x 4") image intensifier with TV camera TV monitor TY cartfor monitors, digital image store and multiformat cassette camera MULTISPOT kh.Operating controls and indicators Control panel “ @ SIREMOBIL ON.OFF (power switchs L. Selection of SIRETRON operation (electronic instant imaget twat SIREMONIL 4N U nod SIREMORIL ILC) The monitor displays a stored imaye [mark in the wae) This svateh may be used instead of the foatswiteb fic SIRETRON nperatiary 2, Selection of "pulsed Muoroscony” with SIREMOHIL AK -U (00 ms radiation - | second pause with image store MEMOSK OP! An image store ix required for this mode oCoperation ‘The monstor displays a stored image (mark on the image. This button cun alyo be used instead of the foot «wich for uperation with "pulsed fluoroscopy" 1, Density correction (screen compensation! by t J exposure points with the SIRETRON attachment tautonatie exposure timing only with SIREMOBIL 48 U and SIREMOBLL 411 U1 By pushing both parts of the ution. simultaneously, change ayer fram autamatic exposure Liming to timer mode takes place 2. Setting the exposure time for radiography with SREMOBIL 4K U, only manual adjustment is possibled ‘Operation is possible only if the exposure release switch 1s activated hy pulling out of the storage position13 ir 15 7 19 20 21 Selection of Muoroscopic operation Conventional Muoroscopy with automatic dose rate control (ADC). Fluoroscopy can be initiated with this button instead of the foot switch ~ 10 BB is proxeammed in as the preferred setting (button lightst, the selection need not he made after te unit has been turned on Preselection for manual recording (with digital image memory) Before starting radiation a definite picture can be recorded during Muorosenpy by ‘operating button (29) ~ Switchback to the normal mode, ie, recording the last Nuoroscopic image. takes place when the button ‘141 is actuated again Indication of the limit time during radiography (inoperative with SIRF MORI 4K-U ‘The button lamp flashes if the maximum possible exposure time (see technical description "Exposure time in radiography") would have to be exereded in an rx posure = The display is extinguished shen the button is depressed Brightness control + "Brighier"/ "Darker™ SIREMORIL AK. image intensifier wnput Image intensifier dual mode control ‘inoperative Selection of 17 em (7b and [0m 4" image diameter on th (The button Lamp lights up in the Hem 4") nage diametor moder Rotating the television picture for object orientation counterclockwise Fo WSbath buttons are activated simultaneously, rotation of tae TV image goes hark to the start position ration’ clockwise rotanion Image reversal Vertical inversion The image is reversed Contrast control + Morecontrasy Less contrast [both buttons are actuated simultaneously, the contrast and the beaghiness return ta the standard levels Closing and opening the iris diaphragm Circular collimation of the field EL Closing’ JB opening In fluoroscopy, the radiation beam 1s limited to the image intensifier format I~ radiography, the 10” x 12” cassette format, when the exposure switch has been pulled Note: Settings under 10 ¢m/4" iris diameter will result in blooming of the fluoro image and increased density of radsography due to incomplete coverage of the automatic exposure control detector area Ifthe collimation set during Muoroscopy ‘even amaller than image intensifier format) is to be retained for direct radiography. push button BB (21) afer inserting the cassette, before the radiogrpahic switch is pulled Button J (21) lights up22 23 25 26 28 29 Closing and opening the slot diaphragm. Collimation of a narrow slit of the field with semi-transparent diaphragm OL Cosine’ JB Opening Open the slot duphragm completely for pulingraphy: Rotating the alot diaphragm Positioning the slot diaphragm @ Counterciockwise rotation’ J} Clockwise rotation Resetting the Nuoroscopic time Resetting the display of the elapsed fluoroscopye time (Display 33) to rere. Raising and towering the vertical columa Identical buttons on the right and the left of the contro! pane! Note: In the cate of unintentional movement of the stand column ‘eg if there we trouble control button in the opposite direciion (stand column stops) or auitch off the wnat with button (10) Shutting off the acoustic alarm ‘The warning signal sounds after a total fluoroscopic time of 4.57 5 selapsed. Setting the radiographic tube voltage (manual! (only ifthe exposure release switch is pulled out) "Automatic Stop" dose rate control ‘The momentarily set fuoroscopic parameters are retained Selective fluoroscopy recording ‘This function must be activated with button (14) “8.Digital displays 30 a1 32 au 35 a7 i) Oo Oo oO Bed Indication of readiness for operation Lights in green color approx 90 seconds (60 s with SIREMOBIL 4K- U) after switching on the unit (flashes as long as there is no readiness for operation, 1 extinguished in case of trouble) Radiation indicator Yellow display when radiation is on {fluoroscopy and radiography) Indication of excess temperature of the tube unit Flashes in red color if the temperature at the SIREPHOS is higher than 60% C Ifthis display flashes, fluoroscopy is switched off simultaneously by the fostew itch Emergency operation is still possible by operating the (button «135 Display of Nuoroscopic time Indication of the tntal flunrasenpre time nf 0 20 99-9 min All fuorosenpie time is totaled before resetting with the button QB ze Seren compensation tonly in the case of automatic exposure timing? Indication of the exposure enreretion points selected with the BEAR “Density correction” button (12) Radiographic exposure time Indication of the exposure time in seconds ipostindieator for expoaure time! Tube currentimAtindicator Depending on the selected mode of operation. Nuornaropy, SIRETROS i or radiograps, according to the kY value Tube voltage (k¥) indicator = In fuorosenpy, = in radiography with automatic expasire contral ta indicate the value provided hy the automatic system, = imradiography with manual setung to indicate the value set withthe QDR ot: button, = in ins:ant 1m) image Je operation to indicate the tube voltage of the preceding instant Radiographic limit-time indicator (also a button) (Only in conjunction with automatie exposure timing! = The lamp flashes if the maximum possible exposure time (see technical description. “Expoture time in radiography") would have to be exceeded By pushing the button, the flashing can he topped (For further details, see “limit indication button”, page)Controls outside the control pane! 38 Steering handle (For further detail, see the “Base Movements” section.: 30 ® Manual exposure release switch When pulled out, switchover from fivoroscopy to radiography is activated After withdrawing the exposure switch Adjustment of exposure time Adjustment of tube voltage (in Use absence of automatic exposure tm Releasing the exposure: ‘There is an acoustic signal for the durstion of the exposure (radiation) as long as the button is depressed 40 Getter switch (For further detail refer to the “Gettering the Image Intensifier tube” xeetion p ) ‘The getter switch can be set ON and OFF by comoving the plastic cover and gently dopressing the getter switch through the hole with a screwdriver “ Locking brake ‘The fuot-operated lever ia depressed to set oF to releose the brake (Do not pull the brake lever upward!) f 1 42 Fluoroscopy footswiteh i ‘The footswitch is operative only after the re quired function has been selected Selection, ® 13) fr Nuoroscopy CD for SIRETRON instant image of i “pulsed fluoroscopy” (in the case of SIREMOBIL 4K-U) 10+Connecting cables 43. 44 45 Connecting cable between the SIREMOBIL 4 U and the monitor earriage Power cable for the SIREMOBIL 4 U. Grounding cable for potential equalization (accessory) 7 Grounding cable according to DIN Standard 57 107/VDE Standard 0107 for rooms of Use Category 2& (for example major surgery, heart. catheterization) Clamp the grounding cable with the spring lock te the bolt on the base of the SIREMORIL UY Fasten the other end to a point of the potential equalization te g patient tabled On the monitor carringe Foot-operated slider out Lhe monitor carriage to afford hotter straight run during prolonged ‘travels ofthe monitor carriage Loven slider for transverse movement! MeSterile draping of the C-arm ‘The C-arm with the image intensifier and radiation source can be covered with a two-part sterilizable cloth drape. The drape is attached with sterilizable clamps. Pully draped C-arm Slip the drape over the image intensifier. Secure the image intensifier drape. Drape for the C-arm and the radiation source It is advisable to fold the drape in the manner illustrated befor draping the unit When unfolding the drape over the C-arm, be sure the outer surface, of the cover does not come into contact with the C-arm, eo sterility is not broken. teSlip the drape over the radiation source and cover the C-arm. Secure the drape near the radiation source with clamps. ~ FE Pass the C-arm drape over the image intensifier drape and secure with aclamp. Secure the drape below the radiation source.Transport position and transportt aod Transport position & Lower the vertical liN column! Move the longitudinal arm and the C-arm into the transport position illustrated on the left, and lock all movable parts with the ‘appropriate levers! (All levers must be seta the < position) Note: When transporting the SIREMOBIL 4 U as weil as the manitor carriage i transport position, + 10% Shut off the SIREMOBIL 4 U (power awiteh:. Remove the power line plug from the power outlet. Always grasp the plug; never tug on the cord! Coil the power cable and the (uorascopy footswitch cable onto the holders provided for this purpose (right side of the SIREMOBILD. Unplug the connecting plug on the monitor carriage Coil up the connecting cable to the monitor rarringe and suspend into the pravided holder on the right side of the SIREMOBIL. Release the footbrake The steering handle and the handgrip for transport are on the control panel ‘When moving the unit, be sure thal the wheels do not collide with an obstacle (hazard of toppling!) teUnlock the wheels for transporting the monitor carriage. To ensure better straight run during prolonged travels, a slider (46) can be pushed over a wheel of the monitor carriage, For transverse movement of the monitor curriage, push back this slider. Cable connection and startup ‘Cable Connection 1. Connect SIREMOBIL 4 U with monitor earriage Insert plug of the connecting cable from the SIREMOBIL 4 U to the monitor carriage into the plug socket on the monitor carriage. Red mark of the plug over red mark of the plug socket! 1a, For examinations of the heart or the brain, connect an addi- tional grounding wire (43) for rooms of use group 2E according to DIN 87 107/VDE 0107 The cable can be clamprd to the Jeg of the SIREMONIL 4 U and a potential equalization point (for example the patient table) 2, Insert the power :'ug of the SIREMOBIL 4 U stand into the plug socket of the TV carriage Connect the TV carriage connection to the power supply Startup: Depress the button J cioy Unit moving into starting position: The green readiness indicator (304 lights up An average tube voltage (60 kV) establishos itself imA values are assigned to the tube voltages) ‘The monitor image rotates ino the zero position The button of the preferred operation programmed in §) or @ lights up. The SIREMOBIL 4 U is ready for operation in approximately 90 seconds (SIREMOBIL 4K-U 60 5) The green readiness indicator is illuminated. Note: Always observe the radiation protection notes (on p. 38) when operating the SIREMOBIL 4 U AS.Base movements The SIREMOBIL 4 U has three wheels of which two are steerable in any direction. ‘The SIREMOBIL 4 U is locked «ith a foot operaied brake, Note! The unit must not tilt more than t 5° from the horizontal when being inthe operating position. the foot locking brake. panel to move the SIREMOBIL 4 U. The handle strip is the narrow-side edge of the control pauel. The steering handle has three lock positions for straight forward and transverse travel to the right and tent (In the Fig : Steering handle in the straight forward direction.) To change the direction of movement: Raise the steering handle and turn it in the desired direction. The unit always moves parallel to th direction of the handle. “16.‘Steering handle in the click-stop position for transverse movement toward the right. (likewise, click-stop position to the left is possible) Lock the unit with the foot-operated brake. ateMovements of the C-arm system 40 Brake rel ed + movement is possible. +O Movement Is blocked. Disengage the appropriate lever to move the C-arm( “© and use the handgrip on the image intensifier Lock the lever: +O Handgrip (47) For manipulation of the C-arm, a handgrip can be attached to the image intensifier or to the SIREPHOS ‘The handgrip is sterilizable Insert the handgrip in the desired position into the clamping holder and lock in place by releasing the pin Por changing position or for pulling out the handgrip, depress the locking pin (48 The handle can be pushed from both sides of the image intensifier or tube unit, respectively, into the corresponding clamping type holder. ‘The handle for moving the C-arm can be fitted both to the image intensifier and to the tube unit, as required 18+Raising and lowering r — of the column stand with C-arm by means of switch (25) on the ' ! ‘control panel. (Vertical travel of the C-arm 470mm). Angulation of the C-arm Rotation in the vertical plane around the horizontal support arm. 195° + 1950, Scale on the support-arm joint VP ~~ 7 L1 Horizontal traved of the C-arm Horlzontal shifting of the support arm: max 203 mm | | Lo Swivel range of the C-arm a - , Jn the horizontal plane around the column stand £ 9 -20-Orbital movement of the C-arm: 115° 90° horizontal to vertical +250 overswing Marking scale on the outside of the C-arm “aPositioning the unit Among the multitude of possible positions, the above illustration is an example of positioning for examination of the neck of the femur The SIREMOBIL 4 U can be manoruvred between the lege (illustration) or to the side of the patient's chest Setting for the p.a. fuorosoepy projection Move the support arm for horizontal positioning ta the center position with the lever (51) Actuate the vertical lift column upward until tne C-arm can be conveniently positioned The image intensifier must be moved above the object. Lock the unit into position with the foothrake (41), Setting for the axial Nuoroscopy projection ‘Caution! Prevent colliaion with the patient or the table! Release the lever far orbital movement (53) and rotate the C-arm in the horizontal flueroscopy direction Lock the lever (53) Raise or lower the column stand under Nuorosopic control until the object appears in the center of the monitor. The positioning of the unit to the patient is now completed, and che C-arm ts centered in both planes Fluoroscopy in the p a, or axial direction can now be competed by rotating the U arm by 90° *22-The unit does not need to be moved for large-ares objects (approx. 10 x the image-intensifier input areal dust release levers 51 and 52, and move only the C-arm. In other cases, ¢ g in angiography of un extremity, the SIREMOBIL 4 U is positioned at right angles ta the object and the steering handle (38) rotated by 90°. The unit can then be moved parallel to the object Orientation of the image To obtain proper orientation of the image as if viewing radiograph...on a viewing box, it may be necessary wo rotate the image with the button QE JB_ (18) and/or operate the image reversal switch J 19). Simultaneous actuation of the two switches of the EEEB button causes rotation of the image to the starting position ‘The starting position OBIL 4 U utomatically assumed on initial startup of the SIRE. “2.Fluoroscopy Fluoroscopy Control (ADC) Preselection with the @@ bution: Auoroscopy footswitch or with the button ‘The ADC simultancously regulates the X-ray tube current and the high voltage, so that the maximum control range of the dose rate is achieved. Automatic adjustment of the dose rate to the thickness of the patient is optimized to achieve the minimum dose Dose-Rate Control "STOP" thutton a 28) Where the Automatic Dose-Rate Control is not required, a set k¥ can be locked with the{j"STOP™ button hh Automatic Dose-Rate the If metallic objects (such as bone pins! are introduced into the central beam or if objects with variable thickness are Muoroxeoped Mfor example when setting a fracture), it ix advisable to lock the value set at the beginning of a Muoroscopic examination with the "Dose-Rate Control STOP* button (28) Manual kV adjustment (27) is possible with dose rate con, trof "STOP" ea ‘On request, the acoustic Muoroscopic signal can he switched off by: the customer service Notes for the ADC ‘The dose rate is set al the factory to 1) 22 pRés (25 pR/s} measured at the input plane of the X rey image intensifier with an X ray tube voltage of 75 kY, with a 0 6 mim Cu auxiliary filter, without scattered radiation grid, and with fully open slat diaphragm If an adjustment to another does rate is desired, this must he regarded ax variable information according to the recording regulations: For further details as well ax particulars regarding deviation of the dose rate values from the setting data, xee page 48 "Technical -deeription® Measurement of the dove rate is based on ineasuced and stabilization of the video signal within the dominant This 8 in the image center and is circular, having a diameter of approxy mately half the image height In the case of VIDEOMED N and VIDEOMED H TV «ystems three different evaluations of the video aisinal ace possible 2 Black level evaluation The ven tre sal nat bilized inthe darkest parta othe picture by the ewntrn! es rod d tal Fecugmmaabitty cern am dark portions af # Mem faboct How. ver, direct radiation, foe pramipie im the region of ran adversely uffert picture quality in case of inadequate bilited within a dominant This ctremen of black and shite level waneSIRETRON instant image (With SIREMOIBL 4N-U and SIREMOBIL 411-U) The SIRETRON instant image technique yields an electronic instant image in the ms range, resulting in considerably reduced X ray exposure with good image quality (the stored image is practically free from quantum noise) Irrespective of the patient , the SIRETRON instant-image technique yields constant ity and is therefore especially recommended for obese SIRETRON operation releases a brief radiation pulse, of wich the duration and intensity ure controlled according to the thickness of the object. The radiation pulse expr ses the PASECON special TV pickup tube and is stored in the digite! image store Instant replay of the image is displayed as noise-free image on the monitor from the image atore until a new image is stored. ‘The dose per instant image set in the factory is 0.13 wGy (15 HR): measured in the input plane of the X-ray image intensifier at an X ray tube voltage of 75 kV, using an additional filter of 30 mm Cu, without scattered radiation grid and with the collimator futly opened SIRETRON operatio Preselection with button J any SIRETRON operation with footswitch or with button For each SIRETRON instant image, the footswitch or the button must be actuated again The SIRETRON instant image is identified by « mark to differentiate it from the live Muoroscopic image (squace, top left, on the monitor). Pulsed fluoroscopy (with SIREMOBIL 4K-U) In addition to conventional continuous fluoroscopy, the SIREMOBIL also allows a switch ww be made to “pulsed Muoros copy” Pulsed fluoroscopy achieves a considerable reduction in radiati a exposure compared with conventional fluoroscopy Applications for pulsed fluoroscopy include examinations either without or with only very small movements such as is the case in traumatology in the setting of fractures and in the localization of forcign bodies (Image repetition rate 1 pulse/s up to I pulse/3 s at the option of the user} ‘The pulsed fluoroscopy image can only be reproduced with an image store and this is indicated by a white mark superimposed in the image. -25- Marking - SIRETRON mode (stored image) Marking of stared image ISIREMOBIL 4K-U)Mark for stored image lection with the [9 (11) button; Nuoroscopy with the footswitch or with the (J) button Adjustment to a new patient transparency is done with continuous radi tor lights up ‘When fluoroscopy is switched off, the last television field is stored el fluoroscopy with dose rate control “STOP™ (button +28 depressed) ‘The patient transparency must be adjusted with the dose rate control. If the {MJ button is then depre readjustment of the transpareney can be made Image store (The digital image store MEMOSKOP U is supplied with separate operating instructions). The last image is recorded and displayea in Ruvroscopic operation with the image store when Muoroscopy is completed or inter rupted. This is called L.1.. mode of operation (Last Image Hold) The stored imnge is identified by « mark to distinguish it from real time Muoroscopic image (square, top lef on the monitor), {fa specific image from a Musrosenpie wene is to be selectively recorded, switchover to the E.R_mode of operation (Electrome Radiography) is made with the @J button (14) The button lights up. By actuating the button {§ (29), an image can be selectively recorded at any desired time. The playback follows fluoroscopy The stored image is preserved until button J (14) is released or a new image is stored Second monitor and image stcre One monitor serves as operating monitor (succession of fluores copy image and stored image) and the other one ax storage monitor (permanent display of a “filed” stored image) In the fuoroacopie pauses, monitor | ‘operating moniter”) shows ‘the last fluoroscopic image or a manually selected image Monitor 20"storage monitor® continuously displays a “filed” stored image ‘Via button QB (29), the tiuage 18 tracsferred in the fluoroscopic pauses from monitor 7 to monitor 2 and {-am moniter 2 to moni tor).Both monitor 1 and monitor 2 ean be the operating monitor. On the control pane! of the MEMOSKOP U the [ON] key is iluminated for the selected operating monitor (monitor 1 or monitor 2). ‘Change-over between operating monitor and storage monitor is effected by briefly the key (29). In doing s0, the key (13) must not be depressed. Spacer Caution! To assure compliance with 21 CFR 1020.32 (f) and consequent reduction. of skin dose the unit is provided with a spacer limiting the source to skin distance (SSD) to min, 310 mm (1' 13/64 ft) Whenever this SSD interferes with the use of the SIREMOBIL 4 U during @ special surgical procedure, the spacer may be removed by releasing the twa grip screws (54) The remaining cone spacer limits the SSD to min. 208 mm (8 vyed") Caution should be exercised in maximizing the SSD at all times The detachable spacer should therefore be replaced upon completion. of the special procedure Fine grid for fluoroscopy The fine grid should always be attached to the image-intensifier input. The reduction of scattered radiation achieved with the grid improves the contrast and thus permits the details to be obscrved. better Insert the fine grid in the two cutouts of the ring (legend outward) and secure in position by slight rotation in the clockwise direct.» (bayonet lock), The line (55) under the SIEMENS nameplate indicates the direction of the leaves. During radiography, the fine grid may remain on the image intensifier. However, the plates of the fluoroscopic grid should not be arranged in pavailel to those of the radiographic grid (sce also Note on position of cassettes”, page 33). “2+Fiuoroscopie image with vemi- trantparent shot diaphragm Fluoroscopie image with small ield collimation Semi-transparent slot diaphragm ‘The semi-transparent slot diaphragm is opened and closed with the EJB button (22) on the control panel. For example, if the extremities are examined, the collimated field can be orientated to the direction of the abject by rotating the slot diaphragm with the @f-JB button (23) The semi-transparent slot diaphragm is used primarily for the beam collimation for the examination of extremities The instruments can be made visible outside the object under Muoroscopic control with the aid of the semi-shadow of the low. absorption diapragm, and can be accurately guided to the object At the same time, picture contrast ix improved as a result of the collimation. The radiation passing through the soft tissues causes no overexposure. Iris diaphragm When a small field is collimated, not only better detail resolution but also a better contrast in the Muorosopic image is obtained ‘Concentric collimation of the iris diaphragm (bution RFR 20, will reduce the radiation dose to the doctor and patient in fluoroscopy of small, low-contrast objects. When collimating <10¢em (4°) this will continue being ensured by operating the ‘automatic stop button @ When the unit is initially turned on, the iris diaphragm automatically opens to the image intensifier format When the exposure release switch is pulled out, the iris diaphragm opens to the 10" x 12" cassette format If the collimation set during fluoroscopy (even smaller than image-intensifier format) is to be retained for direct radiography. Bush bution fer inserting the cassette, before the radio. graphic switch Is pulled. Button lights up. Note: Settings under 10cm (4°) iris diameter will result in blooming of the fluoro image and increased density in radiography due to incomplete coverage of the nuto~ntie expoture control detector area. Dual-mode iinage intensifier (not with SIREMOBIL 4K-U) OPTILUX image in“ensifier with dual mode ‘ormat 17.7 cm 17") standard »urvey to be changed over to 10m (4") for detail en.argement (e.g. visualization of joints) 28+Operating procedures “luoroscopy Positioning the unit to the patient Initial setup and starting of the wu Centering the object ler | Fluoroscopy | Match contrast GDB and brightness QB optimally | In the case SIREMOB. SIRETRON attachment): “Pulsed fluoroscopy” is possible 1 | Orientation of the image Image intensifier format | Iris diaphragm | Semi-transparent slot diaphragm. | Automatic kV hold Recording with i | Shutting off the acoustic alarm signal te | Resetting of fluoroscopic tive image store Shutting off the unit in the image field IL 4 k-U (without See transport, and movement ofthe C asia and bate Set p. 1S, Readinens for operation it indicated by the green light See euvements of the base, movement of th system and positioning Ove Footewitch with thermal shutdown tn ease of any poasible overlonding. Radiation ON indicator, bY ndication, Indications, Moorascopic ts Depreanng both pars ofthe GY burton a the same time cavern preprorremmed setting of brightness and contean, Stored image imari in the picture? eA — Soe page 25 an o-.- Change Uf necessary The button lights up «hen sa ‘dhe amall format ipat with SIREMOBIL, 4K U) Seep 28 ralar collimation for better devas! resolution, Particularly useful for Nunroseapy ofthe extremitieg The Muoroacopic parameters are feisined when witch inactivated Ser page 24 Sounds afer 4$ minut-sof total fluoroscopy time osarbles woop 16 When a ave procedure x started -29-SIRETRON operation (instant image with SIRETRON) (with SIREMOBIL 4N-U and SIRRMOBIL 4H-U) [eae] Positioning the unit to the patient. See teanaport, and movements ofthe C-acm tnd the [3 - Initial setup and starting of the unit 8 Seep. 15 Readiness fr operation Ia ndicated by the green light: Center the object in the image feld ie mevenents fhe base, earemant of thn Care | . trem and pattioning | Selecting SIRETRON instant image 8 Reloasing the SIRETRON instant \ image Anewimageappearsaftereach «| depression of the footswitch \2- | Changee “between SIRETRON 6 Possible st any time ducing radiation instan| ge and fluorcscopy —_ instant image t entified by a marke i Image positon, emi traneparent slot diaphragm: ‘Changing the operating conditions 36 NER position pa phrags under fluoroscopic control AS — rin diaphragm, image intensifier format, Bede 7 oo Shutting offthe acoustic alarm @ Sounds ater 8 minutes of total Nooroarepe te signal eB When a oew procedure «started Shutting off the unit 30+Radiography Cassette size Only 10 x 12" cassettes must be used Note: For operation with automatic exposure control (SIRETRON) a lead free cassette must be used. A radiography grid having the size of the cassette format can be inserted into the cassette holder simultaneously with the cassette. Cassette holder The cassette holder can be attached to the image intensifier in one position only, In this connection, the centering pins (56) must lock in place in the appropriate holes of the image intensifier housit ind the elever on the cassette holder 157) must be engaged with the switch on the image intensifier housing (58) Caution: Pay attention o the warning notes on the cassette holder! ‘Safety instructions for mounting the cassette holder above the patient. 1, Check whether cassette holder is firmly secured two image intensifier ring Inserting the cussette Hold cassette at the center Do not exert pressure downwards Do not band against cassette. Attaching the cassette holder Spread the wire brackets slightly and lift the cassette holder ovr the front ring of the image intensifier The centering bolts (56) must lack in place The cassette holder cun be ultached even if the image intensifier has been draped. Removing: Grasp one of the two wire brackets, lift the cassette holder over the front ring downward with a slight pull and detach it “ueEven with the ca: possible without a tte holder attached, normal fluoroscopy is ssette being inserted By inserting a cassette, the enabling an exposure to be released from the evntrol pane! Inserting the cassette Always insert the cassetie until it joins with the back of the sete holder (60).Iris diaphragm in radiography ‘When the exposure release switch is pulled out, the iris diaphragm opens to the 10” x 12" cassette format. If the collimation set during Muorescopy (even smaller than image- intensifier format) is to be retained for direct radiography, push button J afer inserting the cassette, before the radiographic switch is pulled. Button JB lights up. wg under 10 cm (4" iris diameter will result in blooming of the fluoro image and increased density of radiography due to incomplete coverage of the automatic exposure control detector area. Radiography with automatic exposure control (with SIRETRON) For exposures with SIRETRON automatic exposure control, the kV value is established from the preceding Muoroscopy or SIRETRON instant image. In the factory, the basic setting of the automatic exposure contr ol is adjusted to the Siemens Titanium 2U intensifying sereen Screen compen: button Immediately afer the film exposure, the radiographic image can be viewed on the monitor This ensures immediate verification of the radiographic exposure before the film is processed jon by £ Jexposure points with Notes for positioning of grids: The plates of the fluoroscopic and radiographic grids should not be arranged in parallel to rach other iin both grids, the plate cirection ts marked witha line Its necessary that the two plate directions ave perpendicular to cach other Depending on the position of the radio- graphic grid in relation of the fluoroscopic grid, differences of up to 1 5 esposure points may be obtained Time-limit indicator button @ If it was necessary to exceed the maximum exposure time sce technical description, tuble "Exposure time in radiography” during aN exposure, the time limit indicator button flashes. In this case, the radiograph is usually underexposed Solution: 1 Look for any sources of errar (possible, button @ depressed) Turn of the J button by pushing it. 2. Repeat the exposure, wfter changing the radiographic values (eg a higher kilovoltage) With the reinase switch pulled out, either increase the kV value or change the screen compen- sation (The unit is blocked during the interval time + quired! -33- TigOperating sequences Exposures with timer ie Position the unit to the patient Initial setup and starting of the unit a ae Attach the cassette holder | ara a ‘Center the object in the Image field me Verify the position of the object Rou with fluoroscopy @ \aa- a Insert the cassette (if necessary with grid) a Pull out the manual exposure release switch Adjust the iris diaphragm. Release the exposure See transport, unit movements and movements of the C-arm system, See p15 Rendineas for operation is indicated by Une green ight, Seep. ai the let of the semitranaparent slot hengm in the longutadinal cassette direetion Collate tne object acesncy QED Switch over radiography See the exposure chart mA value permanently assigned in oach cane See note on p. 23 An acoustic signal sounds during the exposure time Note: New exponures not posible curing the passe Fexponure time in seconds corresponds to the subsequent pause time in minut») Ifthe exposure time is leas than 2 seconds, ¢ further ‘expoture canbe triggered immediately.Exposures with the SIRETRON (with SIREMOBIL 4N-U and SIREMOBIL 4H-U) Fe] Position the unit to the patient [=| Initial Setup and starting of the unit 2 Attach the cassette holder Al Center the object in the image field Verify the position of the object with Muoroscopy Insert the cassette (if necessary, with grid) Adjust the iris diaphragm | Pull out the manual exposure release switch PPP Density correction Release the exposure -35- 6 x. See transport, and movements of C-arm and base Seep.is Readiness for operttion uw indicated by the green light. Seep. 31 Rotate the slot of the semi oaparent thot Jem in the longitudinal cassette direction. Ext matethe shee sfreceeery ETD See pote on p33 Changeover toradiography ‘The indicated AY value are required for radio Adjust the screen companantion (+ 2 exposure punta) An acoustic signal sound during U pour ine If weeesnry to eteved he masimum expr time the ume: i ndeatar button the reiograph i wndevetpned Tue-himit indies: torboton esp 33" han exporures not posssble during the pause time Cexponure time in seconds rorverponds to the pause humetn minutes) Ifthe exposure time is lesa than 2 seconds, further axposure canbe triggered immediately.Accessories (optional items) MULTISPOT K for image documentation on 8” x 10" transparent film Grounding cable, § m (16 "5") Equipped with two quick attachment clips for potential equalization according to DIN Standard 57 107/VDE Standard 0107, for roums of Application Groupe 2E (cardiac catheter} Cassette holder 10" x 12” sterilizable Grid frame with integrated grid Cassette cover, 24 cm (9 7/16") Cloth drape for SIREMOBIL 4 U Two-part sterilizable, for X-ray generator, C-arm and image intensifier lamps for cloth dr: One set, comprising six pieces Second monitor for simultaneous display of a stored image beside the fluoroscopic image (hiplane disptay? MAQUET extension table “36+Gettering the image intensifier tube age! appears, the In the event that an objectionable bright spot (ion spot, usually in the center of the i image intensifier tube must be gettered. ‘The gettering may be switched on or off only outside explosion- hazard ares Turn on the unit(it must be ready for operation), the green lamp is lit. ‘The getter switch is accessible through a hole in the side cover of the SIREMOBIL base (40/page 10) Switch on the gettering with a screwdriver inserted through the hole by depressing the xettering switch The green lamp goes out. Shut off the gettering in the same way after approximately two hours. With Nuoroscopy ON, verify that ‘the spot has disappeared. ICit did not, repeat the gettering. Neither Nuoroscopy nor radiography is possible during the gettering process Cleaning and disinfecting The unit is easy to clean since it has smooth surfaces and recessec guides for the C arm The unit must be shut down and disconnected from the power supply before it is cleaned or disinfected Cleaning Wipe the unit with a wet cloth or cotton swab Far moistening, use water or a lukewarm, diluted aquenus solution ofa rinsing agent Do not use any abrasive detergents and (because of incompatibility of materials) organic slvents or cleaning agents containing solvents e g gasoline used for cleaning purposes, alcohol, stain remover’ Do not spray the unit! The cleaning Muid must not penetrate into the unit under any circumstances! Disinfecting For surface disinfection, we recommend the use of aqueous solutions af commercially available surface disinfectants on an aldehyde and/or amphotenside base (e.g. Tego 103, Korsolin) Disinfectants based on, substituted phenols and compounds splitting off chlorine are partly aggressive and therefore, cannot be reommended generally The same limitations apply also to agents having a high aleohol content, which are to be applied undiluted (e.g. for disinfecting the hands) As a general principle, no disinfectant sprays must be used, since the wet fogs may penetrate inside the unit and the safety of the unit is no longer guaranteed (damage to electronic companents, formation of igni /solvent fume mixtures) Note: As you know, some components of disinfectants are detrimental to health Their concentration in breathable air must not excerd a legally determined limit We recommend you to observe the corresponding application rules issued by the manufocturers for these agents Sterilizing The removable handles for movement of the C-arm, the cassette holder and the cloth covering can be sterilizable +17.Safety notes Ii statutory regulations govern the installation and/or operation of the above equipment, it is the responsibility of the installer or the operator to observe same. According to the provisions of the regulations governing "Electrical Systems in Explosion-Hazard Areas” (Elex V), the equipment must be checked for safety-related performance in regular intervals and in no ease less frequently than every three years. To ensure the safety of the patient, the operators, and third parties, we recommend that the equipment be checked every 6 months to maintain its reliability and serviceability. More frequent checks are needed if ‘the quipment is operated under unusual conditions. Please contact our service engineering department to perform the required checks. Before using the equipment for examination, the user must ascertain that all safety-related devices funetion properly and that the unit is ready for operation. Special attention must be given to the displays and pilot lights (visual check) ‘The radiation-indication lamp may light during operation only as long ax the radiography or fluoroscopy switch is operated. In the event that this lamp lights while neither of these switches is ‘operated, the X-ray system must be shut off at once and service engineering must be notified. Modifications of or additions to the produet must be made in accordance with the applicable regulations and generally accepted rules of engineering Only the manufacturer or agencies expressly authorized by the manufacturer may modify or repair this equipment. If the work is performed by an authorized agency, a certificate describing the nature and extent of the work performed, as well as any changes in rates or working ranges must be issued by the same. The certificate must also show the data on which the work was performed, the name of the firm. cand « signature, Changes in the standard duta as well as records of repairs covered by the X-ray regulations are marked by the manufacturer on the service slip. = 38+Protective measures Emergency shutdown switch/power connection Uan emergency shutoff switch is installed in the bulding, the following must be noted The switch must be depressed at once if there is a hazard of the patient, the operators, or the equipment Operation of the switch immediately disconnects the power #-.d terminates all movements of the unit The emergency shutoff switch may be turned back on and the unit started up a only after the hazard was clearly recognized ard eliminated. In all other cases (e.g. malfunction of the unit), Siemens service engineering must be notified Ifno emergency shutoff switch is installed in the building, the power plug must be readily accessible to permit the unit to be dixconnected from the power supply at once in case of an emergency Accidental mations of the stand column Lhe case of unintention al movement of the stand column te x due to malfunctian), control button for “raising and lowering the stand column” in the opposite direction (stand column stops) or turn off the unit immediately by operating button ® Explosion protection This product is not designed for use in areas where there is an explosion hasard Radiation protection 1 Remote transmission of the X ray image enables the ubject ta be demonstrated by the surgran to a relatively large group of observes during surges y Observers outside the operating room (for example in an auditorium) may wiew the X ray image on the television monitor Because of this convenience, there may be a temptation to keep the X ray on for longer than absolutely necessary for the examination (this aves not apply to SIRETRON operation). Thus, utilize radiation only as long as absolutely necessary 2. The reproductive organs of the patient must be covered with gonad protectors whenesrr raduttion 1s switched on for examunations in the area of these organs 3 Do not reach into the unattenuated useful beam when repositioning the patient 4 Keepas far away as possible from the abject while radiation 1s on During radiography, make sure that there is no one in the film plane direct 6. Wear protective clothing 7. In image-intensitier fluoroscopy radiation protection 1s significantly affected by the procedures employed by the examiner {is strongly recommended that the exposure of the examiner be monitored by film badges or pen dosimeters +39.Notes on the regulations governing the dose rate According to DIN Standard 6811, January 1972 issue, Section 3.3.1.2, current limitation is mandatory when operating with automatic dose-rate control. In some special cases it is necessary for medical reasons to carry out fluoroscopy under higher current evels than usual (for example, when the femur of obese patients must be pinned) For this reasons, the automatic system of the SIREMOBIL 4 U isdesigned in such a manner that the X ray tube voltage can be raised toa maximum of 106 kV and the X-ray tube current to a maximum of 6 5 mA. In those cases where thigh voltage and current is needed for thick objects, the radiation ON time should be kept as brief as. ‘possible to minimize the exposure of the patient, Heartand brain examinations If the unit is used alone or in conjunetion with other equipment for heart (or brain) examination, it may ‘be connected to the patient only after an additional electrical conductor has been installed between the unit and a potential-equalization point such as the patient lable. An optional grounding cable (Part No. 21 71 767 E 2018) is available for t potential equalization according to DIN Standard 57 107/VDE Standard 010 Application Group 2E (cardiac catheter) purpose i provides rooms designated as 40+Overload protection Continuous radiation over a prolonged period is inadmissible in fluoroscopy at maximum output. As regards the upper limit value (106 kV/6.5 mA), the radiationvinterval ratio of 2 should not be exceeded, ie. a pause of 10 minutes, at least, must be made after § minutes of continuous radiation. No interval time is required for fluoroscopic values below 80 kV. ‘The SIREPHOS has a thermal monitoring. If the temperature exceeds 60°, the red indicator (32) light» up. At the same time, the foot switch is switched off for fluoroscopy. From 70°, change-over to reduced output takes place. ‘Continued emergency operation for a brief period is then possible via the manual fuoroseopy switch The tube assembly warms up after a long period of fluoroscopic operation Direct contact with the patient's skin must then be avoided. The safety regulations specify that a pause of 8.5 minutes be obse:veu after an uninterrupted ON duration (raising or lowering the column stand) of 1.5 minutes. The provision is unlikely to be relevant in normal operation Note! After completion of each fluoroscopic 2 radiographic procedure r ake sure that the radiation-on indicator signaling high-voltage ON (31) has gone out Inthe event that th at lamp continues to light, shut off the ‘power ewitch at once! Checking the Automatic Dose-Rate Control and th utomatic exposure control system Note: Protective clothing must be worn, adequate distance must be kept, and if nrcestary a pen dosimeter must be worn for monitoring personal exposure in all operating checks where radiation must he turned on 1. Cover the radiation exit (for example with a lead-rubber apron folded several times) Switch on fluorseopy The kV meter must move to maximum value (approx. 106 kV) 2. Remote the cover and any diaphragms from the beam path. Switeh on fluoroscopy. The kV meter must move to minimum value (approx 40 kV) 3. Cover the image-intensifier input with a 0 25 mm or 0.35 mm thick lead eubber apron folded ance (0.5 mm or 0.70 mm Ph) The followings kV values estublish themsleves G5KV £ 1OKV witha 0.5 mm lead caver 72kV t LOKY witha 0.7 mm lead cover Automatic exposure control: (with SIREMOBIL 4N U and SIREMOBIL 411 Cy The following timesestablish themselves (with the release switch pulled out) Approx. 0.6 see with 05 mm tead cover tat 70 kV) Approx, 1.3 sec with 0.7 mm leud cover (at 80 kV) ate¥ Locations for operator hazards $ Locations for patient hazards Mechanical safety Because of the wide maneuverability of the C arm, the patient or the table could collide with the image intensifier and the tube- housing assembly ifthe SIREMOBIL, 4 U is improperly operated When the equipment is operated properly. only the handgrips provided for this purpose may be utilized Wherever this is not possible, caution must be exercised, particularly where there are moving parts or -openings for them. See the hazard locations indicated in the drawings above Note on stability ‘The unit must not be allowed to tilt more than + 5» from the horizontal when in the operation position or more than + 10° from the horizontal when in the transport position There is a hazard of toppling in extreme settings ~ for example when the C-arm is swiveled around the column stand more than 9° and the C-arm is swiveled to ensure that the front wheel is not biocked by an obstacle (for example by a cable or the operating table) 425Safety and operational checks The following checks must be performed daily: Before examination. = Check the footbrake and steering for proper operation. = Cheek the vertical movement of the column stand § buttonsh: = Movements of the C-arm must be released when the lever is set to 40 , and must be locked when the lever is set to “©. = Visual checking of all control displays: Readiness-of-operation indicator (green) lights up approximately 90 seconds (6 s with SIREMOBIL 4K-U) after the unit has been turned on When the heart or the brain is examined = Additional conductor between the unit and a potential equalization point such as \he patient table During examination = Check the patient restraints on the table, ~ When moving the unit, exercise care that the wheels do not run into an obstacle !toppling hazard’) = The radiation indicator lamp should light only if the fluoroscopy of radiography switch is operated Checks to be performed in monthly intervals = Check the automatic dose rate control system for proper operation (see p 411 Semiannual maintenance Required maintenance must be performed by authorited personal at 6 month intervalls to ensure that the ‘equipment operates safety and dependably Af the equipment malfunctions, shut it down and notify service, immediately. +43Technical description Power supply ‘The equipment may be used in rooms intended for medical purposes only if the installation complies with the provisions of VDE 0107.*) Potential equalization For heart (ot brain) examinations, this equipment may only be used in rooms intended for medical purposes if they have additional potential equalization as specified in DiN $7 107/VDE 0107/6.81 section 5 which has been checked for unrestricted effectiveness, SIREMOBIL 4N-U/4H-U/4K-U Model G5203 with single tank X-ray generator Sirephos, Model X 1007 STATEMENTS In accordance with Federal Radiation Performance Standards 1 CFR Subchapter J Paragraph 1020.30 (h) X-RAY CONTROLS AND GENERATORS: Nominal Rated line Line-voltage- Maximum line line voltage voltage regulation current 120V Nov. 1208 5% 36A + 10% 208 197 V... 219 5% BSAt 10% uoV RBV... 252V 5% HAE O% Technique factors for maximum line current: 4D kVp tube voltage 30 mA Lube current at 120 Vii 60 mA tube current at 208/240 Vi oltage voltage Generator ratings: Fluoroscopy: 106 kVp maximum voltage 6.5mA maximum current Duty cycle: 1 2 at 650 W continuous load I Republic of Germany, abserve Use applicable loral rer *) In all other countries than the Fed recommend compliance with the standards described herein provided they do not conteaduct whe 9 the aafety of te operators, pationta, and third partiesRadiography: Maximum deviated allowances Radiography ‘Tube voltage: Tube current: Exposure time: Fluoroscopy ‘Tube voltage Tube current: Fluoroscopic timer Basic measurements used Exposure time: Peak tube potential: Tube current: TUBE HOUSING ASSEMBLIES Maximum rated peak tube potential: Leakage technique factors Minimum filtration permanently in the useful beam: obtained at: Cooling curves: Anode cooling curve Tube housing cooling curve. Tube rating charts: The supplied tube rating chart is val SIREPIIOS, Type No. X 1077 Duty cycle: 1.60 120 VAC. 40kV30 mA 90kV/20 mA 208240 VAC 40 KV/E0mA 106 kV/30 mA t8e +8% 0.01 05.0sec Accuracy see curve on p 50 £a% 40 to 61 kV mA value ¢ 0,1 mA 62 to 106 KV mA value + 8% 01 t060min Accuracy see curve on p 50 buzzer sounding after 4 § min by xing an oscilloscope (storage type Filter method by unit a DC mil mperemeter, accuracy 15% 106 kVp 106 kVp22mA 3mm Al equivalent BOK ‘See instructions SR 90/1030 See Sirephos housing X 1007, p 49 only for the single phase full wave rectified high voltage generator 45+