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EN Solo CD-28483 18 09 2009 PDF
EN Solo CD-28483 18 09 2009 PDF
EN Solo CD-28483 18 09 2009 PDF
Operating Instructions
Ziehm Solo
P_28482_CD_28483 - EN-18/09/2009
Copyright Quality Standards
Copyright © 2009 Ziehm Imaging GmbH This document was produced in accordance with a certified QM
All rights reserved. system as per DIN EN ISO 13485. They conform to the require-
Transmission or reproduction of this document, exploitation and ments of Council Directive 93/42 EEC, Annex I, and other applica-
disclosure of its contents to third persons is not permitted without ble norms. The information provided in this document may be
express written consent of the manufacturer. Infringements shall updated at regular intervals. Subject to change without prior notice.
entitle to damage claims.
Manufactured by:
Registered Trademarks Ziehm Imaging GmbH
This document may contain the names of registered trademarks or Donaustr. 31
brands, the use of which by third persons for their purposes may 90451 Nuremberg (Germany)
infringe the rights of their respective owners. e-mail: info@ziehm-eu.com
http://www.ziehm.com
Rev. 09/2009
2 Ziehm Solo
P_28482_CD_28483 - EN-18/09/2009
With the Ziehm Solo, Ziehm Imaging GmbH provides an active medical device connected Preface
to the mains power supply. The above listed medical device is a non-contact device. It does
not require any contact with the patient to perform its intended use. It provides contactless
energy in the form of X-rays.
Ziehm Imaging GmbH authorizes only trained and skilled personnel to operate this medical
device. The system is intended for use by health care professionals such as physicians,
orthopedic surgeons, vascular surgeons, neurovascular surgeons, cardiologists, radiolo-
gists and technologists in hospitals, outpatient clinics and other clinical environments.
Ziehm Imaging GmbH anticipates the system will be used on a nearly daily basis. Ziehm
Imaging GmbH applications specialists and/or qualified site personnel provide on-site oper-
ator training in the proper use of the system.
The Ziehm Solo is a mobile C-arm. Using a non-invasive X-ray method during surgical inter- Intended use
vention, it provides image information and stores this temporarily.
The Ziehm Solo can be used for all medical indications where fluoroscopy is required.
The system is intended for use with human beings of any age. It is the physician's respon-
sibility to decide whether to use the system with infants, children and adipose patients. The
system can be used for the whole human body without restriction (e.g. organs, tissue,
bones, implants) depending on the medical indication. This device is not intended for use
in performing mammographic exposures.
The system provides contactless fluoroscopy and according to this does not have applied Normal use
parts.
The system may only be used in heights up to 6561.7 ft (2000 m) above sea level and must
be used within the limits defined by the technical specification. The use of the system is only
allowed in rooms used for medical purposes in accordance with EMC class A as well as
with protective earth conductor. The system may only be used in an environment with an
oxygen saturation of < 25%.
The system must be maintained at regular intervals in accordance with the maintenance
specification by qualified personnel that has been authorized by Ziehm Imaging GmbH and
it may be used only if it works properly as specified in the Operating Instructions.
The system may only be operated by personnel who has undergone radiological training. Operation
In the USA, Federal law restricts use of this device to trained personnel on the order of a Operation (USA)
physician.
Only authorized personnel are allowed to assemble and/or repair the medical equipment Authorized personnel
described in this document. Authorized personnel are persons who have attended an
appropriate training course provided by the manufacturer.
The exposure of humans to ionizing radiation must always be medically justified. Especially Contraindications to the
when used on pregnant women, adolescents, children, and pediatric patients, all proce- use of X-rays
dures using ionizing radiation should be used with caution or be avoided altogether. How-
ever, the final decision lies with the attending physician or attending surgeon.
The monitors are not suitable for diagnostic purposes.
The manufacturer accepts responsibility for the safety, reliability and performance of the Exclusion of liability
system only if
− any installation, modification or repair work is carried out exclusively by persons autho-
rized by the manufacturer;
− the electrical installation of the site where the system is operated complies with the
requirements of VDE 0107 or the corresponding national regulations of the country of
installation;
− only original spare parts or components that comply with Ziehm Imaging’s specifica-
tions are used;
− the system is used in accordance with the Operating Instructions.
The warranty becomes invalid in case that any repair, modification or installation work is
carried out by unauthorized personnel, or any seals on components are broken. No conse-
quential damages will be accepted either.
Ziehm Solo 3
P_28482_CD_28483 - EN-18/09/2009
The equipment conforms to Class IIb according to Council Directive 93/42/EEC.
This document has been written and reviewed originally in German and translated.
4 Ziehm Solo
P_28482_CD_28483 - EN-18/09/2009
Contents
Contents I
Ziehm Solo I
P_28482_CD_28483 - EN-18/09/2009
Contents
5 Controls 5-1
5.1 Control panel .................................................................................................... 5-1
5.1.1 Elements of the control panel............................................................ 5-1
5.1.2 Controls in the Fluoroscopy and Subtraction operating modes......... 5-2
5.2 Buttons and switches on the unit...................................................................... 5-12
5.3 Hand switch and foot switch ............................................................................. 5-13
II Ziehm Solo
P_28482_CD_28483 - EN-18/09/2009
Contents
14 Measurement 14-1
14.1 Measuring functions ......................................................................................... 14-1
14.2 Calibrating ........................................................................................................ 14-3
14.3 Measuring a length or distance ........................................................................ 14-5
14.4 3-point measurement........................................................................................ 14-8
14.5 4-point measurement........................................................................................ 14-11
14.6 4-point ratio measurement................................................................................ 14-15
IV Ziehm Solo
P_28482_CD_28483 - EN-18/09/2009
Contents
Appendix A A-1
A.1 Regular checks................................................................................................. A-1
A.1.1 Routine checks to be performed by the user .................................... A-1
A.1.2 Consistency test according to national regulations ........................... A-2
A.1.3 Checking the exposure rate control .................................................. A-2
A.1.4 Dose meter check ............................................................................. A-2
A.1.5 Checking the computed dose values ................................................ A-4
A.1.6 Checking the useful beam ................................................................ A-4
A.1.7 Gettering the image intensifier tube .................................................. A-5
A.2 Cleaning, disinfection, sterilization ................................................................... A-6
A.2.1 Cleaning ............................................................................................ A-6
A.2.2 Disinfection ....................................................................................... A-6
A.2.3 Sterilization ....................................................................................... A-7
Ziehm Solo V
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Contents
Appendix B B-1
B.1 Attaching sterile disposable covers to the C-arm ............................................. B-1
Index i
VI Ziehm Solo
P_28482_CD_28483 - EN-18/09/2009
1 General Information
For several system options, separate operating instructions may be Separate operating
available. They are supplied with the system, provided that the system instructions
configuration includes the respective option. You will find a corre-
sponding reference to those operating instructions in the relevant sec-
tions of this document.
The system does not produce any waste during operation. Environmental
compatibility
When the system has reached the end of its useful service life, the rel-
evant waste disposal regulations of the country of installation must be
observed.
Ziehm Imaging GmbH takes back your devices and undertakes to
dispose of them appropriately in accordance with national regulations. If
you want to return a device, please contact the Ziehm Imaging Service
department.
The useful service life defined for this medical device is seven years. For
this period Ziehm Imaging GmbH warrants that spare parts can be
supplied.
In this document, the following notations and formats are used to high-
light certain elements of the Solo Centercontrol panel or the documen-
tation itself:
DANGER
DANGER indicates a hazardous situation which, if not
avoided, will result in death or serious injury.
WARNING
WARNING indicates a hazardous situation which, if not
avoided, may result in death or serious injury.
CAUTION
CAUTION indicates a hazardous situation which, if not
avoided, may result in minor or moderate injury.
NOTICE
NOTICE indicates a property damage message.
NOTE
Notes are merely informative. Additional useful infor-
mation and hints are provided for the operator here.
Fig. 2-1 Ziehm Solo C-arm stand with monitor support arm
Fig. 2-2 Ziehm Solo C-arm stand with Ziehm Viewing Station
2.3 Features
Mobility With its compact design and combined steering & braking system, the
system offers unrestricted mobility at the operating table, even if space is
scarce.
The easy adjustability of the C-arm and the perfect counterbalancing of
the system make it possible to access even the most difficult positions.
Radiation dose The superior penetration capabilities of the digital high-frequency gen-
reduction erator enable a significant reduction in the patient skin dose.
Radiation-free collimation is provided by the system’s ‘Virtual Collimator’.
Image quality Flat-screen monitors guarantee flicker-free images. The advanced Full
Frame Technology, which uses non-interlacing throughout the entire
image processing chain, generates noise-free images without motion
artifacts, even if the subject has moved.
The optional DICOM 3.0 interface (Ziehm NetPort) enables integration Networkability
into any network supporting DICOM, e.g. PACS. Thanks to ‘Primary
Capture’ support, the original fluoroscopic images can be archived
without the changes which may have been applied to them later. The fol-
lowing DICOM classes are supported: Print, Storage (including multi-
frame capability), Storage Commitment, Media, Worklist, MPPS, Query/
Retrieve and Verification.
It is possible to connect and configure several DICOM servers for each
DICOM Class.
For more information on DICOM, please refer to our DICOM Con-
formance Statement included in the corresponding Service Manual.
2.4 Options
− Query/Retrieve Class
− Verification Class
− Ziehm DICOM Viewer
− Customer-specific foot switch assignment
− Wireless LAN
Horizontal carriage
Cassette holder
Handle
Steering &
braking lever
DVD writer Generator
Hand switch
Support for
foot switch
Interface panel
(→ Fig. 2-6)
Coupling cable
connection
Cable
guards
Lifting column
Swivel arm
EMERGENCY
STOP button
Video printer
Cable support
Hand switch
Power supply
connection
Equipotential
grounding
Circuit
breaker
Interface panel on
SERCAN con-
the C-arm stand
nection
DICOM connection
(RJ45)
VIDEO OUT 1
LM
or
USB port Split Screen
VIDEO OUT 1
VIDEO OUT 2
RM
VIDEO OUT
Connection for
external radiation
warning lamp
(optional)
Wireless LAN on If your system is equipped with Wireless LAN, a transceiver is integrated
the C-arm stand into the back of the C-arm stand. The other transceiver is supplied with
your accessories and must be connected to the hospital’s DICOM
network.
Live and reference On the system, the live screen function has been factory-assigned to the
screen left screen, and the reference screen function to the right screen.
During operation, the following images will be displayed on the screens:
− Live screen: Live images and saved images, both at full size
While the radiation warning lamp is illuminated, you always see a live
image.
When you terminate radiation, a composite image made up of 1 to 16
individual images (LIH – Last Image Hold) is displayed on the live
screen. The amount of images that are used for computing the LIH
depends on the LIH filter setting (→ Ch. 8.3.3, p. 8-8). The default
values are preset in the anatomical programs. You can modify these
settings using the LIH filter controls.
The kV and mA values that are displayed on the user interface are the
values set by the system upon termination of radiation emission. The
number that appears under LIH on the screen indicates how many
individual images have been used for computing the LIH (→ p. 15-2).
− Reference screen: Thumbnail mosaic, reference images at full size
NOTE
To avoid confusion, the neutral terms ‘live screen’ and
‘reference screen’ are used throughout this document,
regardless of your custom setting.
Changing the You can change the screen assignment in the Configuration operating
screen settings mode under Basic Settings (→ Ch. 18.3.2, p. 18-9).
You can also set the contrast and brightness of the flat-screen monitors
according to your preferences (→ Ch. 18.6, p. 18-22).
BNC sockets which are used for video connection (VIDEO OUT) are BNC socket
located on the C-arm stand.
The VIDEO OUT socket supplies a CCIR video signal of the live screen VIDEO OUT
image. The fluoroscopic image (live or stored) is available there for
further processing by a video cassette recorder, an external monitor, a
video printer, etc.
The VIDEO OUT 1 socket supplies a video signal of the left screen VIDEO OUT 1 LM
image. The fluoroscopic image (live or stored) is available there for
display on an external monitor.
The VIDEO OUT 2 RM socket supplies a video signal of the right screen VIDEO OUT 2 RM
image. The stored image is available there for display on an external
monitor.
NOTICE
Supplementary equipment used in combination with the
Ziehm Solo must comply with the safety requirements
according to IEC 60601-1 and/or IEC 60601-1-1 or furnish
proof of an equivalent degree of safety.
To ensure CE conformity, these components must have a
CE approval in accordance with Council Directive 93/42/
EEC. In addition, a declaration in compliance with Article
12 of the said directive must be provided.
For components without CE approval, a conformity
assessment procedure is obligatory.
If you combine the Ziehm Solo with equipment which
does not comply with these requirements, the safety of
the entire system is no longer given and the warranty will
become invalid.
Outside European territory follow the applicable national
regulations.
WARNING
You must be familiar with the contents of the present
Operating Instructions in order to be able to operate the
system as intended. Read and understand the present
Operating Instructions before operating the system.
It is important to observe all directions, safety instructions
and warnings!
The responsibility for any C-arm-assisted surgical inter-
vention lies with the physician in charge.
NOTICE
Supplementary equipment used in combination with the
Ziehm Solo must comply with the safety requirements
according to IEC 60601-1 and/or IEC 60601-1-1 or furnish
proof of an equivalent degree of safety.
To ensure CE conformity, these components must have a
CE approval in accordance with Council Directive 93/42/
EEC. In addition, a declaration in compliance with Article
12 of the said directive must be provided.
For components without CE approval, a conformity
assessment procedure is obligatory.
If you combine the Ziehm Solo with equipment which
does not comply with these requirements, the safety of
the entire system is no longer given and the warranty will
become invalid.
Please note that a combination with third-party devices
must be approved by Ziehm Imaging. A combination must
be possible in particular by the intended use of the two
devices.
The system may only be operated by personnel who has undergone Operation
radiological training.
The system may only be operated by properly trained personnel under Operation (USA)
the direction of a physician.
Assembly and Only authorized personnel are allowed to assemble the system and to
service provide technical service. The necessary qualifications can only be
obtained by attending a training course provided by the manufacturer.
CAUTION
Always observe the relevant regulations of the country of
installation for putting the system into service, training of
personnel and maintenance.
WARNING
Never use the system if you suspect any electrical or radi-
ation-generating components to be defective or if the
system exhibits unexpected malfunctions!
3.2 X-rays
General The system produces X-rays. If you do not observe the safety measures
and precautions required by your local radiation protection regulatory
body or other national radiation protection measures and precautions,
these X-rays can be hazardous both to operating staff and other persons
within the radiation zone of occupancy.
WARNING
The system is intended for procedures where the skin
dose may be so high that there is a risk of deterministic
effects, even if the system is used as intended.
WARNING
The system may only be operated by personnel who has
undergone radiological training.
WARNING (USA)
The system may only be operated by properly trained per-
sonnel under the direction of a physician.
WARNING
The relevant radiation protection regulations of the
country of installation must be observed.
WARNING
In order to avoid unintentional radiation, the foot switch
must be hung up on the foot switch support when the
system is switched on, but not in use.
Staff members who stay within the radiation controlled area must wear X- Protection of staff
ray protective clothing.
The radiation controlled area depends upon the size of the image inten-
sifier installed and has the following radius:
− 23 cm image intensifier: 4 m
To minimize the radiation burden of the patient, you must keep the Protection of the
source/skin distance as large as possible. The generator design guar- patient
antees a minimum source/skin distance of 20 cm (USA: 30 cm).
WARNING
Additional material located in the beam path (e.g. an oper-
ating table not suitable for X-raying) may result in a dose
increase when using a fluoroscopy mode with automatic
exposure rate control.
WARNING
When you initiate radiation and no live image is displayed
although all necessary settings have definitely been
made, please contact your after-sales service center!
All operating modes of the system have been considered in the EMC
tests. There are no exceptions to the rules.
Only conductors, connecting cables and accessories that are specified
by the manufacturer may be used.
WARNING
Using components other than those specified may result
in increased electromagnetic emissions or reduced elec-
tromagnetic immunity.
Heart and brain If you use the system in combination with other equipment for examina-
examinations tions of the heart or brain or the surrounding anatomical regions, equipo-
tential grounding is required for patient and operating staff safety (IEC
60601-1-1).
As an option, the system may be equipped with a laser positioning device Laser positioning
at the image receptor and/or generator. device
The laser positioning device uses diode laser modules which emit laser
radiation. Do not under any circumstances look directly at the laser
beam or any scattered laser radiation – either with the naked eye or with
optical instruments.
The laser positioning device is a Class 2M laser product according to IEC
60825-1. Make sure to comply with all operating safety precautions when
using the laser positioning device.
The maximum power output of continuous laser radiation, measured at
the laser beam apertures, is <1 mW. The wavelength of the emitted radi-
ation is 635 nm.
WARNING
Laser radiation – Do not stare into beam or view directly
with optical instruments (Laser Class 2M according to IEC
60825-1:2007).
Please observe the provisions of IEC 60825-1, Section 3,
“User’s Guide” for operation of the laser positioning
device.
Viewing the laser output with certain optical instruments
(e.g. eye loupes, magnifiers and microscopes) within a
distance of 100 mm may pose an eye hazard.
CAUTION (USA)
LASER RADIATION – DO NOT STARE INTO BEAM
CLASS II LASER PRODUCT (in accordance with FDA 21
CFR, Subchapter J, Section 1040.10-11)
Fig. 3-1 Laser beam apertures on the image intensifier (left) and on
the generator (right)
Generator housing
CAUTION
The generator housing can reach a temperature of 48°C.
Prolonged contact with the generator housing (longer
than 1 minute) may result in burns.
Make sure that the patient does not get in contact with the
generator housing.
WARNING
When working with any of the anti-freeze agents you must
wear protective gloves and safety goggles.
3.7 Printers
CAUTION
Risk of injury by cutting device!
You can hurt yourself touching the cutting device.
Do not touch the cutting device when adding or removing
paper.
Please refer to the Operating Instructions of the corre-
sponding printer.
NOTICE
When printing, tear off the printer paper on the Sony ®
UP-897.
Please refer to the Operating Instructions of the corre-
sponding printer.
NOTICE
Temperatures of 40°C or higher and relative air humidity
of 60% or higher may cause stains on the printer’s heat-
sensitive paper.
CAUTION
The system is a highly complex medical device that in
rare cases can fail like any other electrical device in spite
of comprehensive tests and maintenance.
This may cause obstructions to the operational pro-
cedure.
Please keep an emergency plan ready for this case.
CAUTION
Data transmission of the system can fail.
This may cause obstructions to the operational pro-
cedure.
Please keep an emergency plan ready for this case.
CAUTION
The system can fail due to mechanical defects.
This may cause obstructions to the operational pro-
cedure.
Please keep an emergency plan ready for this case.
3.9 Mechanics
CAUTION
Risk of stumbling due to improper cable laying.
This may cause obstructions to the operational pro-
cedure.
Avoid laying cables on walking areas from and to the
system. Avoid tension when laying the cables.
For safety reasons, you must return the system to its respective transport General
position before transporting it.
NOTICE
Do not move the system over floors with an inclination of
more than 10° from level during transport. This applies to
both the C-arm stand and the Viewing Station.
Exercise extreme caution when moving the system over
rough surfaces such as tile flooring, pavement, asphalt or
carpet. Take care that the cable guards do not drag and
the wheels do not catch or tilt causing damage to the
equipment.
To prepare the C-arm stand for a transport, do the following: How to proceed
• Wind the foot switch cable onto the foot switch support and hang up
the foot switch there.
• Put the swivel arm of the C-arm into an upright position and secure it
with the relevant brake (→ Fig. 4-2, p. 4-3 and → Fig. 4-5, p. 4-7).
• Swivel the horizontal carriage into a central position and secure it with
the relevant brake (→ Fig. 4-2, p. 4-3 and → Fig. 4-5, p. 4-7).
• Retract the horizontal carriage completely and secure it with the rel-
evant brake (→ Fig. 4-2, p. 4-3 and → Fig. 4-7, p. 4-9).
Plunger
block
Plunger
block
• Align the monitor head exactly in parallel with the monitor head
support arm.
• Lock the monitor head by pressing the plunger block until a black ring
is revealed. Keep swiveling the monitor head until it engages with an
audible click.
• Swivel the Solo Center support arm into a position of 90° to the hori-
zontal carriage.
• Lock the monitor head by pressing the plunger block until a black ring
is revealed. Keep swiveling the monitor head until it engages with an
audible click.
NOTICE
When swiveling the monitor head it may collide with the
C-arm.
This may damage the monitor head.
To avoid damages on the monitor head while swiveling,
you must put it into an upright position, so it does not
collide with the C-arm.
• Align the monitor head support arm exactly in parallel with the hori-
zontal carriage (→ Fig. 4-2, p. 4-3).
• Lock the monitor head support arm by pressing the plunger block until
a black ring is revealed. Keep swiveling the monitor head until it
engages with an audible click.
• Unlock the coupling cable connector on the C-arm stand and unplug
the connector.
• Release the parking brake by lifting the (green) steering & braking
lever (→ Fig. 4-2, p. 4-3).
C-arm + brake
(brake handle optionally blue)
Swivel brake
(brake handle optionally green)
Lifting column
Cable guards
Steering & braking The C-arm stand has a combined steering & braking lever. It is located
lever at the rear end of the C-arm stand (→ Fig. 2-4, p. 2-8).
• Lift the steering & braking lever and turn it until reaching the desired
position. The lever can be turned freely; however, detents are placed
at 90° increments. The rear wheels will always stay parallel to one
another aligned exactly in parallel with the steering & braking lever.
− To maneuver the C-arm stand freely, ensure that the steering &
braking lever has engaged in its central position, pointing directly
backward from the unit (→ Fig. 4-3, p. 4-5, left).
− To move the C-arm stand in an exactly-defined direction, rotate the
steering & braking lever until it points toward the desired direction
(→ Fig. 4-3, p. 4-5, right).
• Push the C-arm stand in the desired or predefined direction using the
lateral handles, or use the hand rail around the image intensifier to
pull the C-arm stand.
CAUTION
Release the parking brake only to move or position the C-
arm stand.
You can move the C-arm in virtually any plane. For each movement, a Mechanical brakes
separate brake is available, allowing you to secure the C-arm in any
position.
To release the corresponding brake, turn it counter-clockwise.
You can individually adjust the limit stop of the brake handles. To do so,
lift the spring-loaded brake handle, turn it until reaching the desired limit
stop position and release it to re-engage it at the new position.
CAUTION
Before moving the C-arm, make sure that there is nobody
within its range of movement.
WARNING
Release the mechanical brakes only for positioning.
Take care to always seize the C-arm at its handle during
any adjustment in order to prevent the C-arm from hitting
the respective limit stop at full speed!
Take care not to place your hand in the C-arm guide rails
when adjusting the C-arm.
Make sure that all mechanical brakes are locked when
transporting the C-arm stand!
CAUTION
Before rotating the C-arm, make sure that it does not
collide with any persons or objects.
You can rotate the C-arm by 135°: –90° from vertical to horizontal
position and +45° forward. A scale with 5° divisions on the outside of the
C-arm as well as a mechanical detent at the ‘zero’ position are provided
to facilitate precise positioning.
Angulation brake
(brake handle option-
ally red)
4.3.2 Angulation
You can rotate the C-arm by ± 225° in the vertical plane around the hor-
izontal axis (i.e., the horizontal carriage).
A scale with 10° divisions at the pivot joint of the horizontal carriage facil-
itates precise positioning.
You can swivel the C-arm 10° to the left or to the right around the vertical
axis of the lifting column.
Swivel brake
(brake handle optionally green)
CAUTION
Before moving the C-arm back and forth, make sure that
it does not collide with any persons or objects.
You can move the C-arm forward and backward by 22 cm in the hori-
zontal plane by means of the horizontal carriage. A scale with 1 cm divi-
sions facilitates precise positioning.
You can move the C-arm up and down by 41.5 cm. This movement is
motorized. A scale with 1 cm divisions on the lifting column facilitates
precise positioning.
The Move Up/Down arrow buttons are on the C-arm stand next to the
lateral handles. To move the C-arm up or down, you must press and hold
down the corresponding Move Up/Down arrow button.
CAUTION
Before moving the C-arm up or down, make sure that it
does not collide with any persons or objects.
When you move down the C-arm, the clearance between
the C-arm stand base and the horizontal carriage may get
so tight that there is a risk of bruising your hands and
fingers.
Move Up/
Down
buttons
Plunger block
Fig. 4-9 Monitor head support arm with two 18" flat-screens mon-
itors (left) and 24" flat-screens monitor (right)
You can swivel the support arm ± 90° to the left or to the right around its
vertical axis. The support arm can be locked in increments of 90°.
You can unlock the support arm by pressing the plunger block until a
black ring is revealed.
To lock the support arm, press the plunger block until a black ring is
revealed and swivel the support arm until it engages with an audible click.
You can swivel the Solo Center ± 135° to the left or to the right around its
vertical axis.
You can tilt the Solo Center appx. 0° - 20° around its horizontal axis.
You can swivel the monitor head support arm ± 90° to the left or to the
right around its vertical axis. The support arm can be locked in incre-
ments of 90°.
You can unlock the support arm by pressing the plunger block until a
black ring is revealed.
To lock the support arm, press the plunger block until a black ring is
revealed and swivel the support arm until it engages with an audible click.
You can swivel the monitor head ± 160° to the left or to the right around
its vertical axis. The monitor head can be locked in increments of 90°.
You can unlock the support arm by pressing the plunger block until a
black ring is revealed.
To lock the monitor head, press the plunger block until a black ring is
revealed and swivel the monitor head until it engages with an audible
click.
You can tilt the monitor head ± 10° around its horizontal axis.
Warning
symbols
Selected Title bar
operating
mode
Displays
Ziehm
SmartEye
Dynamic Buttons
control
area
Buttons
Tabs for
operating
mode
selection
− Buttons with a gray background and a green bar at the top: When
you press this button, you activate another mode.
Fluoroscopy oper- In the Fluoroscopy operating mode, you can make different settings for
ating mode fluoroscopies:
Fig. 5-2 Control panel in the Fluoroscopy operating mode with Air
Kerma display
Fig. 5-3 Control panel in the Fluoroscopy operating mode with Air
Kerma Rate display
Symbol(s) Meaning
Pulsed fluoroscopy
Activates the Pulsed Fluoroscopy mode and dis-
plays the pulse rate setting controls in the dynamic
control area.
Snapshot (digital radiography)
Activates the Snapshot mode.
Cine
Activates or deactivates the Cine Loop mode.
Image swapping
Swaps the images between the live and reference
screens.
Symbol(s) Meaning
Rotate Image CW
Rotates the image in clockwise direction.
Rotate Image to 0°
Resets the angle of rotation of the image in one
step to 0°.
Reverse Up/Down
Mirrors the image vertically around the horizontal
axis.
Reverse Left/Right
Mirrors the image horizontally around the vertical
axis.
Symbol(s) Meaning
Rotate Vertical Slot Collimator to 0°
Resets the vertical slot collimator in one step to 0°.
Bones
Activates the anatomical program for visualizing
any part of the skeleton.
Heart
Activates the anatomical program for visualizing
the heart and thorax region.
Abdomen
Activates the anatomical program for visualizing
the abdominal region.
Motion
Activates the Motion supplementary function.
Soft
Activates the anatomical program for visualizing
soft tissues.
Up Arrow
Displays the image with the next higher number in
the active patient folder at full size.
Down Arrow
Displays the image with the next lower number in
the active patient folder at full size.
Save
Saves the active image to the hard disk.
Laser
Activates or deactivates the laser positioning
device(s).
Filters
Shows or hides the controls for raw image pro-
cessing (recursive filter, edge filter, LIH filter) in the
dynamic control area.
Table 5-1 Controls in the Fluoro operating mode (cont.)
Symbol(s) Meaning
Magnify
Shows or hides the controls for setting the image
intensifier’s electronic magnification in the
dynamic control area. The buttons always show
the current image magnification level.
Zoom
Shows or hides the Zoom controls in the dynamic
control area.
Contrast/brightness
Shows or hides the screen setting and contrast
and brightness (windowing) controls in the
dynamic control area.
Printing the live screen image
Prints the image displayed on the live screen on
the video printer.
Text
Activates the Text mode.
Grayscale Inversion
Displays the active (positive) image with a neg-
ative grayscale or vice versa.
Fluoro
Activates the Fluoroscopy operating mode, which
is used for performing standard fluoroscopies.
Subtraction
Activates the Subtraction operating mode, which
is used for generating DSA images (for Germany -
SUB images).
Radiogr.
Activates the Radiography operating mode,
which is used for making direct radiographies.
Patient
Activates the Patient operating mode, which is
used for managing patient data.
Post Proc.
Activates the Post Processing operating mode,
which is used for post-processing saved images.
Measurement
Activates the Measurement operating mode,
which is used for measuring distances and angles
in saved images.
Table 5-1 Controls in the Fluoro operating mode (cont.)
Symbol(s) Meaning
Archive
Activates the Archive operating mode, which is
used for managing saved images.
Config
Activates the Configuration operating mode,
which is used for adjusting the operation settings
and the basic settings and for deleting data from
storage media.
Voltage display
Shows the automatically determined or manually
set tube voltage in kV.
After fluoroscopy, the last kV value remains
stored.
Current display
Shows the automatically determined or manually
set tube current in mA.
After fluoroscopy, the last mA value remains
stored.
Pulse width % display
Shows the current pulse width.
Pulses/s display
Shows the current pulse rate.
Symbol(s) Meaning
Temperature symbol
Shows the thermal conditions in the generator.
X-ray symbol
Lights up yellow during X-ray exposure (fluo-
roscopy and direct radiography).
Table 5-1 Controls in the Fluoro operating mode (cont.)
The Subtraction operating mode screen is to a large extent identical to Subtraction Oper-
the Fluoroscopy operating mode screen. Instead of the Soft and Metal ating Mode
buttons, it shows the DSA button (for Germany - SUB button):
Fig. 5-4 Control panel in the Subtraction operating mode with Air
Kerma display
Fig. 5-5 Control panel in the Subtraction operating mode with Air
Kerma display on (Germany only)
Fig. 5-6 Control panel in the Subtraction operating mode with Air
Kerma Rate display
Fig. 5-7 Control panel in the Subtraction operating mode with Air
Kerma Rate display (Germany only)
Symbol(s) Meaning
DSA
Displays the controls for the DSA mode settings of
the Subtraction operating mode in the dynamic
control area.
SUB (for Germany only)
Displays the controls for the SUB mode settings of
the Subtraction operating mode in the dynamic
control area.
Table 5-2 Additional controls in the Subtraction operating mode
Controls which are not required in a certain operating situation (e.g. Unavailable con-
playback of a saved cine loop) are automatically locked, i.e. they are not trols
available.
If you have selected Patient, Text, Archive Search, Archive Backup or Alphanumeric
Configuration, an alphanumeric keypad is displayed, allowing you to keypad
enter texts.
NOTE
It is not possible to press two keys on the keypad simulta-
neously. To combine a key with the Shift key, first press
and release the Shift key and then the desired key.
To generate uppercase letters and special characters, first press and Uppercase letters
release the Shift key and then the corresponding key. and special char-
acters
The Shift key acts on one subsequent letter or special character.
The C-arm stand is equipped with main switches for switching the entire
system on or off (→ Fig. 6-1, p. 6-3).The ON switches are green, while
the OFF switches are white.
Once you have switched off the unit, you cannot switch it back on until
after a delay of 5 s.
On the C-arm stand, there are two Move Up/Down arrow buttons, which
are used for lifting and lowering the C-arm on its mobile stand.
Fluoroscopy key
The system is equipped with a hand switch and a two-pedal foot switch. General
Hand switch
Two-pedal foot
.
switch
Radiation is initiated either with the hand switch or the fluoroscopy pedal
of the foot switch.
The default pedal assignment of the two-pedal foot switch is as follows:
− Left pedal: Fluoroscopy
− Right pedal: Save image (→ Ch. 7.9, p. 7-16)
NOTE
The foot switch pedals can be assigned with customer-
specific functions. If this is the case, the respective func-
tions are indicated on labels on the foot switch itself and
on the C-arm stand.
The following table lists the labels which may appear on the foot switch:
Symbol Meaning
Initiate Radiation
Initiates radiation.
Cine
Generates a cine loop.
Save
Saves the active image to the hard disk.
Table 5-3 Optional labels on the foot switch (→ Ch. A.4, p. A-19)
Before switching on the system, e.g. after a transport, you must connect General
the two system components to each other and also connect the entire
system to the power supply.
• Unwind the power cable from the cable support on the left side of the
C-arm stand.
• Make sure that a suitable supply voltage is available and that the
socket-outlet is properly grounded and fused.
• Check the power plug (→ Fig. 2-4, p. 2-8) and the socket-outlet for
compatibility.
• Make sure that the inclination of the system does not exceed 5° from
the level in operating position.
• Unwind the power cable from the cable support on the left side of the
C-arm stand.
• Make sure that a suitable supply voltage is available and that the
socket-outlet is properly grounded and fused.
• Check the power plug (→ Fig. 2-4, p. 2-8) and the socket-outlet for
compatibility.
CAUTION
Risk of injury by X-rays!
The radiation warning lamp must be clearly visible for all
persons in the room.
NOTE
The connection of a radiation warning lamp is mandatory
when you operate the Ziehm Solo only with external mon-
itors.
• Make sure that the inclination of the system does not exceed 5° from
the level in operating position.
The C-arm stand is equipped with main switches for switching the system
on or off (→ Fig. 6-1, p. 6-3). Each of the two power switches simulta-
neously switches on or off both system components.
NOTICE
Do not plug any USB stick into the USB port until the
system has fully completed its power-up sequence.
NOTE
Due to background radiation, the Air Kerma, Air Kerma
Rate or Dose Area Product display may indicate some
small value after power-up of the system.
The default settings after power-up vary from system to system, Customer-specific
according to the customer-specific setup. You may e.g. choose your pre- default settings
ferred start screen yourself (→ Ch. 18.2.5, p. 18-6).
Furthermore, you may choose to have a certain anatomical program and
various live image settings (→ Ch. 8, p. 8-1) preset as default after
power-up. You cannot make these presettings yourself.
• To unlock the EMERGENCY STOP button, press the red knob with a
slight twist in clockwise direction.
The unit remains switched off. You can switch the system back on
with the ON switch.
NOTE
If the system cannot be switched on, the EMERGENCY
STOP button may have been actuated inadvertently, e.g.
during a transport. Check whether the EMERGENCY
STOP button is locked and unlock it, if applicable.
The C-arm stand is equipped with one or two key switches. The X-Ray
key switch is optionally available on all systems. With this key switch you
can lock the radiation function of the system. If the unit is additionally
equipped with the Power on key switch, you can lock the complete unit.
CAUTION
Make sure to always use the key switch(es) in order to
prevent unauthorized persons from switching on the unit
and/or initiating radiation.
Fig. 6-2 Key switch for locking the entire system (left) or the radi-
ation function (right), Lock or Off position
Power on With the Power on key switch you can completely switch off the unit
(equivalent to OFF switch) and lock it. When you remove the key while it
is in the Lock position, the system can no longer be switched on with the
ON switch.
To be able to switch on and operate the system, you must first insert the
key and turn it to the Unlock position. While in the Unlock position, the
key cannot be removed.
X-Ray on/off With the X-Ray key switch, you can lock the radiation function of the unit.
When you remove the key while it is in the Off position, it is possible to
switch on the system and to use functions such as patient data man-
agement or image postprocessing. However, it is not possible to initiate
radiation with the hand or foot switch.
To be able to initiate radiation, you must first insert the key and turn it to
the On position. While in the On position, the key cannot be removed.
7.1 Overview
To perform a standard fluoroscopy, you must always make the following Steps and settings
steps and settings:
Anatomical pro- Both fluoroscopy modes work with automatic exposure rate control
grams (AERC), unless you explicitly activate the Manual Exposure Rate
Setting mode (→ Ch. 7.3, p. 7-8).
The tube voltage and the tube current are adjusted automatically, taking
into account the selected fluoroscopy program (→ Ch. 7.5, p. 7-11) as
well as the thickness and structure of the object.
Automatic exposure rate control (AERC) reduces the radiation burden of
both patient and operating staff to a minimum and prevents overex-
posure of the screened body region.
WARNING
Using the Manual Exposure Rate Setting mode influ-
ences the radiation quality, image quality, air kerma and
air kerma rate.
Automatic Dose The Bones and Abdomen anatomical programs include a motion
Reduction detection function, which automatically reduces the pulse rate when the
screened object does not move.
You may adjust the pulse rate. The lower the pulse rate setting, the lower Pulse rate
the radiation dose.
The pulse width is indicated in percent and cannot be modified. A pulse Pulse width
width of 100% corresponds to 40 ms (USA: 30 ms).
The pulse width and pulse rate for each anatomical program are preset Pulse settings for
in the Configuration operating mode under Service Settings. You anatomical pro-
cannot make these presettings yourself. grams
CAUTION
Risk of injury by X-rays!
Put on X-ray protective clothing, if you initiate radiation by
pressing the fluoroscopy key on the monitor support arm.
Acquiring images The Bones anatomical program (→ Ch. 7.5.1, p. 7-11) includes an
with Automatic Automatic Dose Reduction function. Depending on whether the
Dose Reduction screened object is moving or not, the pulse rate is constantly and auto-
matically readjusted. This means that you need not select a pulse rate
manually.
Fig. 7-2 Pulse rate setting with Automatic Dose Reduction (on
systems with 50 Hz)
• Initiate radiation.
CAUTION
Risk of injury by X-rays!
Put on X-ray protective clothing, if you initiate radiation by
pressing the fluoroscopy key on the monitor support arm.
Filter factors For each individual anatomical program, certain filter factors can be
preset for pulsed fluoroscopy mode. This is done in the Configuration
operating mode under Service Settings. You cannot make these preset-
tings yourself.
NOTE
This function has not been tested for interventional proce-
dures in accordance with IEC 60601-2-43.
In Snapshot mode, the radiation time does not depend on how long you
press the radiation switch. For each anatomical program, a specific
AERC characteristic is stored on the system for the digital radiography
mode. The fluoroscopy parameters are adjusted using the respective
AERC characteristic, and radiation is terminated automatically after-
wards.
The pulse rate controls appear in the dynamic control area. You cannot
make any further settings with these buttons, though.
Fields of appli- The snapshot mode is suitable for examinations involving no patient
cation movement. The aim of snapshot mode is to generate high-quality static
images, e.g. for printing / documentation purposes.
• Initiate radiation.
CAUTION
Risk of injury by X-rays!
Put on X-ray protective clothing, if you initiate radiation by
pressing the fluoroscopy key on the monitor support arm.
NOTE
When you activate the snapshot mode, the Cine button
disappears from the control panel.
For each individual anatomical program, certain filter factors can be Filter factors
preset for the snapshot mode. This is done in the Configuration oper-
ating mode under Service Settings. You cannot make these presettings
yourself.
Using the pulse rate setting function you can choose whether you want Manual dose
to work in standard control mode or low-level control mode. For standard reduction
control mode select 25 pulses/s or 30 pulses/s, for low-level control mode
≤ 8 pulses/s or ≤ 10 pulses/s.
If you select 8 pulses/s or less, you reduce the dose rate to a value <
0.012 mGy/min (this is equivalent to.< 0.2 μGy/s)
The Bones anatomical program (→ Ch. 7.5.1, p. 7-11) includes an Automatic dose
Automatic Dose Reduction function. Depending on whether the reduction
screened object is moving or not, the pulse rate is constantly and auto-
matically readjusted. When the object moves, the pulse rate is increased;
when the object is immobile, the pulse rate is decreased.
The tube voltage and the tube current are usually adjusted automatically
by the system’s automatic exposure rate control. You may, however, set
the exposure rate also manually, if necessary.
WARNING
To protect patients and staff against high radiation doses,
the Manual Exposure Rate Setting mode remains
blocked until you have initiated radiation in one of the flu-
oroscopy modes with automatic exposure rate control at
least once.
Only use the Manual Exposure Rate Setting mode in
exceptional circumstances. The automatic exposure rate
control provides optimum image quality while minimizing
the dose rate.
Using the Manual Exposure Rate Setting mode influ-
ences the radiation quality, image quality, air kerma and
air kerma rate.
or or
− Snapshot
(→ Ch. 7.2, p. 7-2).
CAUTION
Risk of injury by X-rays!
Put on X-ray protective clothing, if you initiate radiation by
pressing the fluoroscopy key on the monitor support arm.
• Select the desired kV and mA values using the Up Arrow and Down
Arrow buttons. Each time you press an arrow button, the value is
increased/decreased by 1 kV or 0.1 mA.
• Initiate radiation.
CAUTION
Risk of injury by X-rays!
Put on X-ray protective clothing, if you initiate radiation by
pressing the fluoroscopy key on the monitor support arm.
or or
• Press the Off button in the dynamic control area.
The Manual Exposure Rate Setting mode is deactivated.
Function The Bones anatomical program includes a grid control which automati-
cally detects objects in the entire field of view and accordingly sets
optimum exposure parameters for the ROI. This is achieved through a
grid of 256 measuring cells covering the entire field of view. This means
that even objects that are located off-center are optimally visualized.
Automatic Metal The Automatic Metal Artifact Correction function that is implemented
Artifact Correction in the Bones anatomical program corrects a possible flaring of the fluo-
roscopic image resulting from metal objects in the beam path and
increases contrast at tube voltages above 50 kV.
Using the pulse rate setting function you can choose whether you want
to work in standard control mode or low-level control mode. For standard
control mode select 25 pulses/s or 30 pulses/s, for low-level control mode
≤ 8 pulses/s or ≤ 10 pulses/s.
Fig. 7-5 Controls for selecting the number of pulses/s (on systems
with 50 Hz)
Soft
The Soft anatomical program is optimized for visualizing soft tissues. It
is used e.g. for foreign body localization and for visualization of syringe
needles and skin contours.
Filter factors For each of these anatomical programs, certain filter factors can be
preset. This is done in the Configuration operating mode under Service
Settings. You cannot make these presettings yourself.
The Motion function uses special filter settings to reduce motion blurring
in the fluoroscopic images.
The Motion function can be combined with any anatomical program.
When the Automatic Noise Filter Adjustment function is enabled in the
Bones anatomical program, the Motion function is not available.
To activate the Motion function, do the following:
When you terminate radiation (by releasing the hand or foot switch), the Last Image Hold
last fluoroscopic image is displayed on the live screen and as a thumbnail
(‘Ziehm SmartEye’) on the control panel (Last Image Hold).
This image remains displayed until it is replaced by a new fluoroscopic
image.
During the exposure, the tube voltage and the tube current are automat- Fluoroscopy
ically set by the system, and the values are shown on the Voltage (kV) parameters
and Current (mA) displays of the control panel.
During the exposure (fluoroscopy or direct radiography), the yellow radi- Visual alarms
ation warning lamp on the C-arm stand and the X-ray symbol on the
control panel are illuminated. (→ Ch. 5.1.1, p. 5-1).
The dose area product is saved for each patient folder and updated with
each new exposure. The total dose received by a patient so far is dis-
played on the live screen. This also includes the dose area product for
images which have not been saved.
Display on the When you activate a patient folder and switch to the Fluoroscopy or
control panel Subtraction operating mode, the total dose received by the patient so far
is shown in the Dose Area Product display on the control panel. If your
system is equipped with the air kerma and air kerma rate computation
option (→ Ch. 7.8, p. 7-16), the dose area product is only displayed on
the live screen, but not on the control panel.
Image information When you generate a new fluoroscopic image or open a saved image,
on the screen the accumulated dose area product for the active patient folder is dis-
played on the live screen (→ Ch. 15.2.4, p. 15-3).
Air kerma display The air kerma is saved for each patient folder and updated with each new
on the control panel exposure. The total dose in mGy received by a patient so far is shown on
the Air Kerma display on the control panel. This also includes the air
kerma for images which have not been saved.
Air kerma rate During the exposure, the Air Kerma Rate display showing the current air
display on the kerma rate in mGy/min appears on the control panel.
control panel
7.9 Save
NOTE
When the hard disk is full, the oldest patient folder is over-
written without warning.
Before saving an image, make sure that there is enough
free hard disk space, and regularly back up the patient
folders which are still needed to external storage media or
to the network.
Each saved image automatically receives an image number. These Image number
image numbers are assigned and incremented consecutively for each
separate patient folder.
Unsaved images (those without a number) will be replaced by a new flu-
oroscopic image during the next fluoroscopy.
On the two-pedal foot switch, the save image function is usually Default foot switch
assigned to the right pedal. Depending on the customer-specific config- assignment
uration, the foot switch pedals may be programmed with other functions
and are labeled accordingly in this case.
To save the last image displayed on the live screen to the active
patient folder, do the following:
• Press the Save button.
or or
• If the right foot switch pedal is programmed with the save image
function:
Press the right pedal of the two-pedal foot switch. 2
During the save operation, the save symbol is displayed on the live
screen.
When the save operation has been completed, the image number is dis-
played on the screen (→ Ch. 15.2.2, p. 15-1).
You can configure the system in such a way that during each fluoroscopy Autostore function
a new image will be saved automatically as soon as you terminate radi-
ation (Autostore function).
Auto-delete When you attempt to save an image and there is not enough hard disk
function (n/a for space left, the patient folders and/or images on the hard disk will be over-
USA) written automatically and without confirmation prompt in the following
order:
• First, the oldest patient folder is overwritten. If there is still not enough
disk space for the save operation, then the second oldest, third oldest,
etc., patient folder are deleted. However, the active patient folder is
never deleted.
• If it is not possible to free up enough space on the hard disk for the
save operation due to the large number of protected images, an
audible alarm sounds and the following alert message appears on the
control panel:
Out of memory. Image can not be stored!
The save operation is aborted.
Deleting images The Auto-delete function is not activated. If there is not enough disk
manually (USA) space for images, you must delete images manually to free up disk
space.
Cine loop When you attempt to generate a cine loop, the system will check whether
the remaining hard disk space is sufficient for the selected number of
images (→ Ch. 11.2, p. 11-1). If disk space is insufficient, the unpro-
tected patient folders and/or images are deleted in the above order. If this
does not free up sufficient disk space either, no cine loop is acquired.
The Print Live Screen Image function is available in the following oper-
ating modes: Fluoroscopy, Subtraction, Post Processing, Mea-
surement and Archive. This function is only enabled if the C-arm stand
is equipped with a video printer. The function always prints out the image
which is displayed at full size on the live screen.
The text information that is displayed on the screen together with the
image (name of the patient, angle of rotation of the image, etc.) will
appear as a text block on a gray background at the left margin of the
printout.
If you have performed measurements in an image and saved them sub-
sequently, the measured values are printed on a second page.
To print the live screen image on the video printer, do the following:
• Press the Print Live Screen Image button.
The image displayed on the live screen is printed.
CAUTION
Risk of injury by cutting device!
You can hurt yourself touching the cutting device.
Do not touch the cutting device when adding or removing
paper.
Please refer to the Operating Instructions of the corre-
sponding printer.
NOTICE
When printing, tear off the printer paper on the Sony ®
UP-897.
Please refer to the Operating Instructions of the corre-
sponding printer.
Warning function In order to prevent radiation from being accidentally generated over a
long time, the system has a warning function. After each 5 minutes of
elapsed total radiation time per patient, the system issues the following
interval warning:
− After 4 min 55 s, the following message appears on the control panel:
The radiation time is 5 minutes.Switch off alarm?
− 5 seconds later, an audible alarm sounds (if preset by your in-house
service engineer).
CAUTION
If you do not switch off the alarm after 30 s max., radiation
will be terminated automatically.
You can see the total radiation time for the active patient folder on the
Radiation Time display.
8.1 Overview
The system offers the following functions for adjusting the appearance of Individual
the live image to your individual needs: adjustment
• Contrast/Brightness:
To adjust contrast and brightness of individual images (windowing)
• Filter:
Recursive filter, LIH filter and edge filter
• Magnify:
Electronic image magnification
• Zoom:
To enlarge a selected image area
• Grayscale Inversion:
To display an image with negative grayscale
• Iris Collimator
• Image Swapping:
To move an image to the other screen
• Reverse Up/Down:
“Vertical image reversal
• Reverse Left/Right:
“Horizontal image reversal
• Image Rotation
• Text:
Text functions (→ Ch. 15, p. 15-1)
Any adjustments (except texts) that are applied to a live screen image
remain valid for all subsequent live images until you choose other set-
tings.When you save an image, it will be saved with all rotations,
reversals, filter settings, texts and markers, etc. All these modifications
(except texts) are visible when the image is displayed as a thumbnail in
the mosaic.
Function The windowing function allows you to adjust the contrast and brightness
of the image on the live screen. These settings affect any newly-acquired
live image which is displayed on the live screen and remain in force until
you make new windowing settings. When you save the live image, the
corresponding windowing values are saved together with the image.
After activating the Windowing function, you can select a number of gray
levels, which are then stretched over the entire range of 1024 gray levels
of the original image on the live screen. To achieve this effect, you set the
width and the level of the so-called contrast window.
The number of gray levels defines the width of the contrast window. The
width of the contrast window affects the image contrast. 1024 gray levels
correspond to the value W 100.
The position of the selected gray levels on the original image grayscale
(ranging from 0 to 1024 gray levels) defines the level of the contrast
window. The level of the contrast window affects the image brightness.
Example:
You select all gray levels between 325 and 875. These gray levels are
then mapped (stretched) to the range of 0 to 1024 gray levels in the pro-
cessed image. This enhances the contrast.
Gray levels 0 to 324 of the original image are displayed as black, and
gray levels 876 to 1024 of the original image are displayed as white. This
means that the processed image is darker than the original image.
NOTE
When you change the windowing values of a single cine
loop image, the change will apply to all images of the
respective cine loop.
• Under Width, set the number of gray levels using the arrow buttons.
The chosen width is indicated by the length of the blue bar in the
dynamic control area. The changes become immediately visible in the
live screen image.
• Under Level, set the brightness range using the arrow buttons.
The chosen level is indicated by the position of the slider in the
dynamic control area. The changes become immediately visible in the
live screen image.
• To restore the factory settings (level 50, width 100), press the Home
button.
• To restore the factory settings for step windowing, press the Home
button.
Step windowing is reset to step 0. Simultaneously, brightness and
contrast are reset to their default values.
• Press the Contrast/Brightness button.
The screen setting controls disappear from the dynamic control area.
8.3 Filters
You may apply different filters to the live image. The following filters are
available:
− Recursive filter
− Edge filter
− LIH filter
The recursive filter adds the specified number of images during fluo-
roscopy. Each newly-acquired image is superimposed by the result of the
previous addition with a certain weighting factor.
The higher the number of images you select, the greater the noise sup- Noise suppression
pression, but also the greater motion blurring.
There are three recursive filter levels, each corresponding to a preset
number of images between 1 and 16.
The Automatic Noise Filter Adjustment function in the Bones and Automatic Noise
Abdomen anatomical programs constantly and automatically readjusts Filter Adjustment
the recursive and LIH filter levels during fluoroscopy, depending on
whether the screened object is moving or not. When the object moves,
the filter levels are decreased; when the object is immobile, the filter
levels are increased. This means that you need not select a recursive
filter level manually.
The Automatic Noise Filter Adjustment function is enabled by default
in the Bones anatomical program.
To set the recursive filter for the live image, do the following:
• Press the Filter button.
The filter controls appear in the dynamic control area.
Fig. 8-4 Filter settings for recursive, edge and LIH filter
Configuration The individual presettings for the recursive filter levels are made in the
Configuration operating mode under Service Settings. You cannot
make these presettings yourself.
The edge filter allows you to select a greater or lesser degree of edge Edge enhancement
enhancement within the image. There are 4 levels available:
Level Meaning
Off No edge enhancement (original fluoroscopic image)
1 Slight edge enhancement
2 Medium edge enhancement
3 Strong edge enhancement
-1 Unsharp mask to reduce noise
Table 8-1 Edge filter levels
To set the edge filter for the live image, do the following:
• Press the Filter button.
The filter controls appear in the dynamic control area.
• Under Edge, select the desired edge filter level by pressing the corre-
sponding button.
The filter setting becomes immediately visible in the live screen
image. The chosen edge filter level is shown on the screen as RTE X.
• Press the Filter button.
The filter controls disappear from the dynamic control area.
The LIH filter generates and adds a specified number of images after
radiation has been terminated.
Noise suppression The higher the number of images you select, the greater the noise sup-
pression, but also the greater motion blurring if the patient moves during
image generation. You can choose between the following number of
images: 1 image (Off), 2, 4, 8, 16 images.
Automatic Noise The Automatic Noise Filter Adjustment function in the Bones ana-
Filter Adjustment tomical program constantly and automatically readjusts the recursive and
LIH filter levels during fluoroscopy, depending on whether the screened
object is moving or not. When the object moves, the filter levels are
decreased; when the object is immobile, the filter levels are increased.
This means that you need not select an LIH filter level manually.
The Automatic Noise Filter Adjustment function is enabled by default
in the Bones anatomical program.
To set the LIH filter for the live image, do the following:
• Press the Filter button.
The filter controls appear in the dynamic control area.
• Under LIH, select the desired LIH filter level by pressing the corre-
sponding button.
The filter setting becomes immediately visible in the live screen
image. The chosen LIH filter level is shown on the screen as LIH Z.
• Press the Filter button.
The filter controls disappear from the dynamic control area.
Fig. 8-7 Control panel with dynamic control area for image magnifi-
cation
Example:
• Select the desired image magnification level in the dynamic control
area.
The Magnify button on the right side of the control panel now displays
the selected image magnification level (e.g. 15).
Pre-magnification (PreMag)
The setting becomes immediately visible in the live screen image. The
fluoroscopic image last acquired is displayed in pre-magnification
view with the selected magnification level.
The PreMag image is displayed in the selected image magnification
level with no need to initiate radiation again. Using the image rotation
and image reversal functions you can modify the image as desired.
When you initiate radiation, the fluoroscopic image is displayed on the
screen as shown in the pre-magnification view.
The chosen image magnification level is shown on the screen as
MAG X, where X is a wildcard for numerical values from 0 to 2.
• Press the Magnify button on the right side of the control panel.
The magnification level controls disappear from the dynamic control
area.
The Zoom function allows you to enlarge a certain image area. There are Function
three zoom levels available. You can select the desired image area either
with the arrow buttons or with the integrated touchpad.
Touchpad
• Move the marking circle to the desired image area using the arrow
buttons.
The chosen image area is displayed on the reference screen with the
chosen zoom level.
• To move the marking circle back to the center of the live image, press
the Home button.
To enlarge an image area with the help of the touchpad, do the fol-
lowing:
• Press the Zoom button.
The active image also appears on the reference screen.
The zoom controls appear in the dynamic control area.
• Move the marking circle to the desired position by gliding your finger
slightly across the touchpad.
The chosen image area is displayed on the reference screen with the
chosen zoom level.
• To move the marking circle back to the center of the live image, press
the Home button.
The Grayscale Inversion function allows you to view the live image with Function
a negative grayscale.
8.7 Collimation
The system is equipped with an iris and a slot collimator. These colli- Function
mators allow you to limit the area of exposure of the patient just to the
region of interest.
This offers the following advantages:
− Reduction of the radiation burden
− Less chance of flaring
− Better detail rendition and higher contrast
The iris collimator can be adjusted steplessly. Normally, the iris collimator
is completely open, and only the Close Iris Collimator button is visible
on the control panel. As soon as you start closing the iris collimator, the
Open Iris Collimator button appears on the control panel.
• Press the Open Iris Collimator button until the collimator aperture on
the live screen is as desired.
In addition, you can fully open the iris collimator in one step:
• Press the Open Iris Collimator Fully button (in the upper button
row).
The slot collimator can be adjusted steplessly. Normally, the slot colli-
mator is completely open, and only the Close Vertical Slot Collimator
button is visible on the control panel. As soon as you start closing the slot
collimator, the Open Vertical Slot Collimator, Rotate Vertical Slot Col-
limator CW and Rotate Vertical Slot Collimator CCW buttons appear
on the control panel.
• Press the Rotate Vertical Slot Collimator CW button until the colli-
mator orientation on the live screen is as desired.
• Press the Rotate Vertical Slot Collimator CCW button until the col-
limator orientation on the live screen is as desired.
In addition, you can fully open the slot collimator or reset it to the 0°
position, each in one step:
• Press the Open Vertical Slot Collimator Fully button (in the middle
button row).
The slot collimator opens completely.
The system is equipped with a virtual collimator, allowing you to adjust Function
the collimators without radiation. Using this feature, you can significantly
reduce patient exposure.
• Press the Open Vertical Slot Collimator Fully button (in the middle
button row).
The vertical slot collimator opens completely.
CAUTION
Risk of injury by X-rays!
Put on X-ray protective clothing, if you initiate radiation by
pressing the fluoroscopy key on the monitor support arm.
• Adjust the iris and the slot collimator as desired without radiation.
The areas of the image that will not be visible later are shown beneath
a gray overlay. The collimator boundaries are represented by white
edges.
• Initiate radiation.
CAUTION
Risk of injury by X-rays!
Put on X-ray protective clothing, if you initiate radiation by
pressing the fluoroscopy key on the monitor support arm.
Function With the Image Swapping function, you can move an image from one
screen to the other. This allows you to generate two images and to
compare them directly to one another.
CAUTION
Risk of injury by X-rays!
Put on X-ray protective clothing, if you initiate radiation by
pressing the fluoroscopy key on the monitor support arm.
CAUTION
Risk of injury by X-rays!
Put on X-ray protective clothing, if you initiate radiation by
pressing the fluoroscopy key on the monitor support arm.
The image is displayed on the live screen. Now you can compare the
images on the two screens to one another.
Function The Image Reversal and Image Rotation functions are used for indi-
vidual adjustment of the image orientation on the live screen.
You can use these functions to align the image orientation with the
patient’s orientation. To make orientation easier for the operator, a label
is attached to both the image intensifier and the generator housing,
showing a patient in supine position. If the patient is positioned as illus-
trated by the label, then the image orientation on the live screen corre-
sponds to the patient’s orientation.
Both image reversal and image rotation are produced digitally and
without the need to initiate any further radiation.
• Press the Rotate Image CW button until the image orientation on the
live screen is as desired.
The image is rotated steplessly in clockwise direction.
• Press the Rotate Image CCW button until the image orientation on
the live screen is as desired.
The image is rotated steplessly in counter-clockwise direction.
The chosen angle of rotation is shown on the screen as R X.
Patient and image data is managed in the Patient (→ Ch. 9.2, p. 9-2)
and Archive (→ Ch. 9.3, p. 9-14) operating modes. All data of a patient
is stored in a patient folder on the hard disk. All image data is assigned
to the corresponding patient folder.
When you switch to the Fluoroscopy or Subtraction operating mode
and no patient folder is active, the system will automatically create a new
patient folder (→ Ch. 9.1.2, p. 9-2).
You can create as many patient folders as desired on the hard disk. In Storage capacity
each patient folder, you can store as many images as you wish. The total
number of images is limited only by the hard disk size (‘image memory’).
The size of the image memory depends on the chosen system configu-
ration.
When you save an image for which there would be no more space on the Auto-delete
hard disk otherwise, the oldest patient folder on the hard disk is automat- function (n/a for
ically overwritten (→ Ch. 7.9, p. 7-16). If the oldest patient folder contains USA)
one or more protected images (→ p. 9-30), only the unprotected images
are deleted, though. The folder itself as well as the protected images are
preserved.
The Auto-delete function is not activated. If there is not enough disk Deleting images
space for images, you must delete images manually to free up disk manually (USA)
space.
Generated data The patient name which is generated is composed of the time of day and
date, e.g. P_12_34_01_04_03 for a patient folder which was created on
April 1, 2003 at 12:34 o’clock. In addition, a patient ID called PAT xyz is
created. If you have predefined default data for the Hospital, Department
and Doctor input boxes, this data is also written to the generated patient
folder.
All new images and/or cine loops will be saved to the generated patient
folder until you activate another patient folder. You may edit or complete
all patient data later (→ Ch. 9.2.3, p. 9-12).
If the system has generated such a patient folder, but no images or cine
loops have been saved to it, the generated patient folder will be deleted
during the next power-up of the system.
Patient data is managed in the Patient operating mode. When you create
a new patient folder, you may retrieve the patient’s data from a DICOM
server under certain conditions (→ Ch. 10.2, p. 10-1).
Length of the The length of the patient ID is limited by the system to 64 digits.
patient ID
Display of the If the patient number cannot be displayed completely in the fluoroscopic
patient ID image, it is represented in the form 1234567....
In the read-only boxes in the Archive operating mode, only the first 18 or
24 digits of the patient ID are displayed. In the Patient ID input box in the
Patient operating mode, you can scroll through the whole patient ID
using the arrow keys of the keypad.
Subject You can enter a subject for each patient folder, which is saved together
with the patient data.
Editing data You can edit all data in an existing patient folder or add new data at any
time.
When you have created a new patient folder or activated an existing Importing images
patient folder, you can import one or more images or a series of images from a DICOM
from a DICOM server into this patient folder (→ Ch. 10.7, p. 10-21). server
NOTE
The date formats may vary, depending on the customer-
specific settings. In the present document, all date
formats appear in the format DD.MM.YYYY.
Buttons Input
for the boxes
input
boxes
Alphanu-
meric key-
pad
When you have activated a patient folder, the corresponding data is dis-
played in the input boxes. The title bar shows you – in addition to the
selected operating mode – the number of images that you can still save
to the hard disk.
In order to provide data security for patient data according to the „Health
Insurance Portability and Accountability Act“ (HIPAA), the system sup-
ports a password-protected user login (factory-set), if required.
Depending on the type of user login with the Login button you can get
full or restricted access to patient data in the Patient operating mode
(→ Table 9-1, p. 9-9).
NOTE
If you do not get access to certain patient data, you may
not be authorized due to the (user) group you are cur-
rently assigned to.
Refer to the following table (→ Table 9-1, p. 9-9) to check
out your access rights, and contact your system adminis-
trator, in case you request any changes.
Initial adminis- For patient data security reasons, you must immediately change your
trator login password after you have logged in as administrator for the first time.
NOTICE
You must now change your Password.
You can protect patient data from unauthorized access
only by assigning a custom password.
• Press the Retype Pass. button or the Retype Pass. input box.
(Retype Password).
• Enter the new password using the alphanumeric keypad.
NOTE
When creating the password consider the currently appli-
cable safety rules.
If you login as administrator, on the control panel, the list of users Initial adminis-
available in the system is displayed. Further all buttons and input boxes trator login
are displayed needed to setup User IDs or edit access data.
.
If you are logged in as administrator, you can create new User IDs. Creating a new
User ID
• Enter the password for the new User ID using the alphanumeric
keypad.
• Press the Retype Pass. button or the Retype Pass. input box.
(Retype Password).
• Enter the password for the new User ID using the alphanumeric
keypad.
NOTE
When creating the password consider the currently appli-
cable safety rules.
or or
• Press the Down Arrow button next to the Standard button.
All available (user) groups are displayed in the drop-down list box.
• Select the desired (user) group that you want to assign the user to by
pressing the respective item.
The (user) group determines the access rights to patient data and
user access data.
If you are logged in as administrator, you can change the (user) group Changing the (user)
assignment of an existing user. group assignment
of a user
• From the user list select a user by pressing the respective item.
The related access data is shown in the input boxes next to the user
list.
• Press the Down Arrow button.
All available (user) groups are displayed in the drop-down list box.
• Select the desired (user) group that you want to assign the user to by
pressing the respective item.
Changing the (user) If you are logged in as administrator, you can change the (user) group
group assignment assignment of existing patient data.
of patient data
Export log file If you are logged in as administrator, you can export a log file.
Delete log file If you are logged in as administrator, you can export a log file.
Delete input boxes If you are logged in as administrator, you can delete data in the input
boxes of the user administration.
• Select a user from the user list by pressing the respective item.
The related user data is shown in the input boxes.
• Press the New button.
All input boxes of the user administration are cleared.
When creating a new patient folder, you may choose between the fol-
lowing ways of entering the patient data:
− You enter the patient data manually using the alphanumeric keypad.
− You retrieve the patient data from the DICOM server (Query or
Worklist, → Ch. 10.2, p. 10-1).
NOTE
You may predefine default data for the Hospital,
Department and Doctor input boxes. The respective
data is entered in the Configuration operating mode
under Basic Settings.
NOTE
To type an uppercase letter, press and release the Shift
key before entering the respective letter. The Shift key
acts on one subsequent letter. To type several consec-
utive uppercase letters, press the Caps Lock key before
entering the letters.
• Enter the patient data using the alphanumeric keypad. To move to the
next input box, always press the Enter key.
You must fill in at least the Last Name input box. The length of the
patient ID must not exceed 64 digits. If you do not enter any patient
ID, the system automatically assigns a number (e.g. PAT123) in the
Patient ID box.
• Save the new patient folder and the data entered by pressing the
Save button.
The new patient folder is automatically activated. A blank fluoroscopy
mask with the newly-entered patient data appears on the live screen.
The display of the control panel automatically switches to the start
screen.
You may now proceed to generating fluoroscopic images (→ Ch. 7.1,
p. 7-1), which will be automatically assigned to the newly-created patient
folder.
• Switch to the Fluoroscopy or Subtraction operating mode and gen-
erate the desired fluoroscopic images.
or
You may edit the patient data in any existing patient folder at any time.
You can use the name of the patient, the patient ID or a subject to search
for the patient folder whose data you want to edit.
Effects Any patient data changes affect all existing and future images as well as
the active image.
NOTE
If you use the patient ID to search for a patient folder,
please verify the search result by checking the patient
name. It may happen occasionally that a patient ID is
assigned more than once on a DICOM network.
In the dynamic control area, the input boxes for searching as well as
an alphabetically sorted list of all patient folders are displayed.
Now you can browse through the patient folder mosaic with the help of
the arrow buttons or enter the desired search string:
• Press the button of the desired input box, e.g. the Last Name button.
The button is highlighted in yellow. The cursor jumps to the corre-
sponding input box.
NOTE
The search function is not case-sensitive.
With each letter you enter, the alphabetical hit list is more and more
confined to match the search string.
The All button appears, allowing you to redisplay the entire list.
• Select the desired item on the list using the arrow buttons and press
the OK button.
The data of the selected patient appears in the input boxes. You may
overwrite this data now.
• Press the button of the input box whose data you want to edit.
The button is highlighted in yellow. The cursor jumps to the corre-
sponding input box.
NOTE
You must log in using your user data to get access to
patient data of your (user) group and subordinate groups.
If you do not log in using your user data you only get
access to patient data of the (user) group Restricted.
Hard Disk
display
List
Read-only
boxes Arrow
buttons
Mosaic All patient folders on the hard disk are displayed as a thumbnail mosaic
(up to 16 images at a time) on the reference screen, each folder being
symbolized by its most recent image. In addition, the following infor-
mation appears for each patient folder of the mosaic: name of the patient
and number of images contained in the folder. You can browse through
the thumbnail mosaic using the arrow buttons.
The list shows the names of all patient folders in the order in which they List of patient
were created. The most recent folder appears at the bottom of the list, the folders
oldest one at the top.
The name of the folder which is marked by the cursor on the reference
screen is highlighted by a yellow bar in the list, and the related data is dis-
played in the read-only boxes. You cannot enter or edit any data in these
read-only boxes.
Using the arrow buttons you can move the cursor around the list and Arrow keys
simultaneously from one patient folder or image to another on the ref-
erence screen.
You can exit the active patient folder in the Archive operating mode and Cursor position
browse through another patient folder. If you exit the patient folder you
are currently browsing through, by pressing the Back button, the cursor
marker remains on this patient folder.
The display Hard Disk indicates the percentage of used hard disk space. Hard Disk display
The following functions for navigating and managing patient folders are
available in the Archive operating mode:
− Search:
To search for a patient folder (→ Ch. 9.3.2, p. 9-21)
− Pos 1:
To place the cursor on the first patient folder in the mosaic
− End:
To place the cursor on the last patient folder in the mosaic
− Mark:
To mark one or more patient folders
− Delete:
To delete patient folders
− DVD:
To write marked patient folders to DVD.
The title bar shows you – in addition to the selected operating mode
– the remaining storage capacity of the DVD to which you want to
write the marked patient folders.
− USB:
To save marked patient folders to a USB storage medium.
The title bar shows you – in addition to the selected operating mode
– the remaining storage capacity of the USB storage medium to which
you want to save the marked patient folders.
− DICOM Store:
To save marked patient folders to a DICOM server (→ Ch. 10.4,
p. 10-16)
− Backup:
To select patient folders and back them up to a USB stick or a DVD
(→ Ch. 9.3.7, p. 9-37)
• Select the desired patient folder in the thumbnail mosaic on the ref-
erence screen using the arrow buttons.
• Press the Mark button.
The patient folder is now marked and flagged with an M.
You can delete either all marked patient folders, or all unmarked patient
folders, or only the patient folder where the cursor is.
You can delete a patient folder only if it does not contain any protected
images (→ Ch. 9.3.5.3, p. 9-30). When you try to delete a folder which
contains protected images, the folder itself as well as the protected
images remain on the hard disk. Only the unprotected images are
deleted. To delete protected images, you must unprotect them first
(→ p. 9-31).
NOTE
Deleted patient folders are irretrievably lost.
Back up the patient folders you want to keep before
deleting them, or make sure that they are really no longer
needed.
• Mark the patient folders you want to delete and press the Delete
Marked Items button.
The following confirmation prompt is displayed:
or or
• Mark the patient folders you want to keep and press the Delete
Unmarked Items button.
The following confirmation prompt is displayed:
or or
• Use the arrow buttons to select an individual patient folder you want
to delete and press the Delete button.
The following confirmation prompt is displayed:
If you are used to viewing negative images (e.g. because you are a radi-
ologist), you can invert the grayscale of all images on the hard disk in one
step. Cine Loops and DSA Cine Loops (for Germany - SUB Cine Loops)
that have already been saved with a negative grayscale remain the way
they are.
• Terminate the Archive operating mode, or press the Invert All button
again.
The grayscale inversion of all images is undone.
Depending on your chosen system configuration, you can save images Storage formats
from one or more patient folders in various storage formats to different
storage media. Some formats with reduced resolution and color depth
are also available.
NOTE
Saving image data with a resolution of 512 × 512 pixels
may lead to information loss.
Whenever you save images in standard DICOM format or ‘reduced’ Ziehm DICOM
DICOM format (with a resolution of 512 × 512 pixels and 8 bit color depth) Viewer
to an external storage medium, the Ziehm DICOM Viewer program is
automatically saved to the storage medium as well. This program
enables you to view the DICOM images on any PC with Microsoft®
Windows® operating system (version Microsoft® Windows® 98 or
higher). When residing on a DVD, the Ziehm DICOM Viewer starts auto-
matically. When residing on a USB storage medium, the program must
be launched manually.
Saving to USB To save one or more patient folders to a USB storage medium, do
storage medium the following:
• Mark the desired patient folder(s).
• Plug the USB stick into the USB port on the monitor cart.
Writing to DVD With the DVD writer, data can be written to DVDs. The selected patient
folders are copied to a compilation file on the hard disk first. You can
decide whether you want to write the patient folders from the compilation
file to DVD immediately or later. This enables you to gather entire patient
folders and single images from different patient folders in the compilation
file and to write them to DVD later in one go.
If you switch off the system before having actually written the patient
folders and images from the compilation file to DVD, the system will pre-
serve the compilation file information.
A progress indicator informs you about the status of the write oper-
ation.
Once the write operation has been completed successfully, the fol-
lowing message is displayed:
Writing of DVD completed successfully
• Press the OK button.
The following criteria can be used to search for a patient folder: Search criteria
− Name of the patient (Last Name box)
− Patient number (Patient ID box)
− Keyword (Subject box)
You can combine these search criteria using an AND operation. Thus,
you could look e.g. for all patients called Miller with the subject Knee.
NOTE
If you use the patient ID to search for a patient folder,
please verify the search result by checking the patient
name. It may happen occasionally that a patient ID is
assigned more than once on a DICOM network.
NOTE
The search function is not case-sensitive.
With each letter you enter, the alphabetical hit list is more and more
confined to match the search string.
The All button appears, allowing you to redisplay the entire list.
• Press the Back button.
You are returned to the Archive screen. The data of all patients who
match the search string(s) is displayed in the list.
The All button appears, allowing you to redisplay the entire list.
• Select the desired patient folder using the arrow keys.
Thumbnail display The thumbnails in the mosaic reflect all the modifications applied to them
after fluoroscopy (e.g. contrast adjustment, rotation, zoom).
Image information The information pertaining to the image which is marked by the cursor on
the reference screen is displayed on the control panel:
Now you can browse through the patient folder mosaic with the help of
the arrow buttons or enter the desired search string:
• Press the button of the desired input box, e.g. the Last Name button.
The button is highlighted in yellow. The cursor jumps to the corre-
sponding input box.
NOTE
The search function is not case-sensitive.
With each letter you enter, the alphabetical hit list is more and more
confined to match the search string.
The All button appears, allowing you to redisplay the entire list.
• Select the desired item on the list using the arrow buttons.
NOTE
The search function is not case-sensitive.
With each letter you enter, the alphabetical hit list is more and more
confined to match the search string.
The All button appears, allowing you to redisplay the entire list.
• Press the Back button.
You are returned to the Archive screen. The data of all patients who
match the search string(s) is displayed in the list.
The All button appears, allowing you to redisplay the entire list.
• Select the desired patient folder using the arrow keys.
• Use the arrow buttons to browse through the active patient folder.
The Down Arrow button moves you to the image with the next lower
image number.
The Up Arrow button moves you to the image with the next higher
image number.
Read-only
boxes
Buttons for
marking Arrow but-
and delet- tons for
ing screen
navigation
Buttons
for printing
Buttons for
saving
The read-only boxes show patient data and image information. The Read-only boxes
Images (Total) box shows how many images or cine loops are stored in
the patient folder. If the cursor is on a cine loop within the patient folder,
the Images box shows the number of images that make up the cine loop.
If the cursor is on an individual image, the number 1 appears there.
In the following sections, we will describe how to process and output indi- Image processing
vidual images. For information on how to process and output cine loops and output
in a patient folder, please refer to → Ch. 11.5, p. 11-8.
The following functions are available in a displayed or active patient
folder for navigating within the folder and for displaying and processing
individual images:
− OK (with displayed patient folder only):
To display an image at full size on the live screen and to activate the
displayed patient folder
− Full-Screen Image:
To display an image at full size on the reference screen
Mosaic:
To restore the mosaic view on the live screen
The Mosaic button appears as soon as you have chosen the full-size
image view on the live screen.
− Pos 1:
To place the cursor on the first image of the patient folder
− End:
To place the cursor on the last image of the patient folder
− Mark:
To mark one or more images
− Protect:
To protect the image marked by the cursor against being deleted
− Delete:
To delete images
− DICOM Retrieve:
To import images from a DICOM server into the displayed or active
patient folder (→ Ch. 10.7, p. 10-21)
− Print:
To print marked images on the video printer
− DICOM Print:
To print marked images on a DICOM network printer (→ Ch. 9.3.5,
p. 9-27)
− DVD:
To write marked images to DVD
The title bar shows you – in addition to the selected operating mode
– the remaining storage capacity of the DVD to which you want to
write the marked patient folders.
− USB:
To save marked images to a USB storage medium
The title bar shows you – in addition to the selected operating mode
– the remaining storage capacity of the USB storage medium to which
you want to save the marked patient folders.
− DICOM Store:
To save marked images to a DICOM server (→ Ch. 9.3.5, p. 9-27)
You can protect images against being deleted. When you try to delete a
folder which contains protected images, the folder itself as well as the
protected images remain on the hard disk.
NOTE
Patient folders containing protected images cannot be
deleted automatically. If many folders on the hard disk
contain protected images, the Auto-Delete function will
not delete them, and you will be unable to save new
images.
To avoid this situation, regularly back up the patient
folders which are still needed to external storage media or
to a DICOM server. You can then manually delete those
patient folders or unprotect them and allow the Auto-
Delete function to free up space on your hard disk.
You can delete either all marked images, or all unmarked images, or only
the image where the cursor is.
NOTE
Deleted images are irretrievably lost.
Back up the images you want to keep before deleting
them, or make sure that they are really no longer needed.
• Mark the images you want to delete and press the Delete Marked
Items button.
The following confirmation prompt is displayed:
or or
• Mark the images you want to keep and press the Delete Unmarked
Items button.
The following confirmation prompt is displayed:
or or
• Use the arrow buttons to select an individual image you want to delete
and press the Delete button.
The following confirmation prompt is displayed:
You can mark one or more images in a patient folder and print them all in
one go. Besides, you can print the image displayed on the live screen.
CAUTION
Risk of injury by cutting device!
You can hurt yourself touching the cutting device.
Do not touch the cutting device when adding or removing
paper.
Please refer to the Operating Instructions of the corre-
sponding printer.
NOTICE
When printing, tear off the printer paper on the Sony ®
UP-897.
Please refer to the Operating Instructions of the corre-
sponding printer.
To print the live screen image on the video printer, do the following:
• Press the Print Live Screen Image button.
The image displayed on the live screen is printed.
The text information that is displayed on the live screen together with the
image (name of the patient, angle of rotation of the image, etc.) will
appear as a text block on a gray background at the left margin of the
printout.
If you have performed measurements in an image and saved them sub-
sequently, the measured values are printed on a second page.
NOTE
When you launch the print job directly from the video
printer, the resulting hard copy will be an exact repro-
duction of the live screen.
Further information For further information, please refer to the video printer’s separate oper-
ating instructions provided with this system.
Storage formats Depending on your chosen system configuration, you can save one or
more images in various storage formats to different storage media. Some
formats with reduced resolution and color depth are also available.
The desired storage format is defined in the Configuration operating
mode under Storage Media (→ Ch. 18.5, p. 18-16).
NOTE
Saving image data with a resolution of 512 × 512 pixels
may lead to information loss.
Ziehm DICOM Whenever you save images in standard DICOM format or ‘reduced’
Viewer DICOM format (with a resolution of 512 × 512 pixels and 8 bit color depth)
to an external storage medium, the Ziehm DICOM Viewer program is
automatically saved to the storage medium as well. This program
enables you to view the DICOM images on any PC with Microsoft®
Windows® operating system (version Microsoft® Windows® 98 or
higher). When residing on a DVD, the Ziehm DICOM Viewer starts auto-
matically. When residing on a USB storage medium, the program must
be launched manually.
• Plug the USB stick into the USB port on the monitor cart.
With the DVD writer, data can be written to DVDs. The selected images Writing to DVD
are copied to a compilation file on the hard disk first. You can decide
whether you want to write the images from the compilation file to DVD
immediately or later. This enables you to gather images from different
patient folders as well as entire patient folders in the compilation file and
to write them to DVD later in one go.
If you switch off the system before having actually written the images and
patient folders from the compilation file to DVD, the system will preserve
the compilation file information.
or or
To write the marked images to DVD right away, confirm by pressing
the Yes button. The write process is started, and the following
message appears:
Writing DVD. Estimated time x minutes.
A progress indicator informs you about the status of the write oper-
ation.
Once the write operation has been completed successfully, the fol-
lowing message is displayed:
Writing of DVD completed successfully
You may display saved images either from one patient folder or from
several different patient folders at full size on the live and reference
screen and compare them to each other.
To compare two images from the same patient folder, do the fol-
lowing:
• Activate the Archive operating mode.
• Using the arrow buttons, select the second desired image and press
the Full-Screen Image button.
The second image is displayed at full size on the reference screen.
The Mosaic button appears, enabling you to restore the mosaic view.
You may compare the two images now.
• Using the arrow buttons, select the second desired image and press
the Full-Screen Image button.
The second image is displayed at full size on the reference screen.
The Mosaic button appears, enabling you to restore the mosaic view.
You may compare the two images now.
You can back up the patient folders stored on the hard disk to a USB stick
or a DVD. To select the patient folders you want to back up, you can use
different search criteria (Last Name, Patient ID, Subject) and/or the
image creation date. You can combine all these search criteria and also
the image creation date (if desired) using an AND operation. Thus, you
could e.g. search for and back up all patients called Miller with the subject
Knee.
You can back up only entire patient folders with all images contained in Selecting patient
them. To determine which folders are to be backed up, you use the image folders
creation date and certain search criteria:
− Selection using the image creation date
When you enter e.g. a period between 01.01.YYYY and 31.01.YYYY,
all patient folders containing images that were created between
January 1, YYYY and January 31, YYYY will be backed up. These
folders are backed up in their entirety, including the images that were
not generated within the specified period of time.
Storage capacity To be able to back up images on a USB stick, the latter must be empty.
During backup, the system will check automatically whether the
remaining disk space is sufficient for the next folder to be backed up. If
the folder is too large to fit on the connected USB storage medium, you
will be prompted to plug another USB storage medium into the USB port.
Restoring backed- You can restore the data which has been backed up to a USB storage
up data medium to the system’s hard disk at any time (→ p. 9-41). If the backup
copy has been distributed to several USB storage media, you must plug
them in the same order as during the backup procedure for restoring the
data.
NOTE
The search function is not case-sensitive.
With each letter you enter, the alphabetical hit list is more and more
confined to match the search string.
The All button appears, allowing you to redisplay the entire list.
• If desired, press the Patient ID button and enter a patient number in
the related input box.
• If desired, press the Subject button and enter a search string in the
related input box.
• To confine the image creation period, press the Start Date button and
enter another date in the related input box.
• To further confine the image creation period, press the End Date
button and enter another date in the related input box.
Press the Show Selected button.
• Plug another USB storage medium into the USB port. Make sure to
label the USB storage media so that you can later identify the order in
which they were used.
• Plug another USB storage medium into the USB port. Make sure to
label the USB storage media so that you can later identify the order in
which they were used.
• Plug the USB storage medium that contains the first part of the
backup copy into the USB port.
• Press the Restore from USB Stick button.
All patient folders and images that have been backed up to the USB
storage medium before are restored and saved to the system’s hard
disk. All restored patient folders are recreated on the hard disk, in
addition to the already existing ones.
• Plug all further USB storage media used for the backup into the USB
port (if applicable). Make sure to keep to the same order as during the
backup procedure.
DVD writer With the DVD writer, data can be written to or retrieved from DVDs.
Storage capacity The contents of a patient folder cannot be distributed to several DVDs.
During backup, the system will check automatically whether the
remaining disk space is sufficient for the next folder to be backed up. If
the folder is too large to fit on the inserted DVD, you will be prompted by
a message to insert another DVD into the drive.
Restoring backed- You can restore the data which has been backed up to DVD to the
up data system’s hard disk at any time (→ p. 9-44). If the backup copy has been
distributed to several DVDs, you must insert the DVDs in the same order
as during the backup procedure for restoring the data.
NOTE
The search function is not case-sensitive.
With each letter you enter, the alphabetical hit list is more and more
confined to match the search string.
The All button appears, allowing you to redisplay the entire list.
• If desired, press the Patient ID button and enter a patient number in
the related input box.
• If desired, press the Subject button and enter a search string in the
related input box.
• To confine the image creation period, press the Start Date button and
enter another date in the related input box.
• To further confine the image creation period, press the End Date
button and enter another date in the related input box.
• Press the Show Selected button.
• Insert another DVD. Make sure to label the DVDs so that you can later
identify the order in which they were used.
Once the write operation has been completed successfully, the following
message is displayed:
Writing of DVD completed successfully
• Press the OK button.
• Insert another DVD. Make sure to label the DVDs so that you can later
identify the order in which they were used.
Once the write operation has been completed successfully, the following
message is displayed:
Writing of DVD completed successfully
• Press the OK button.
To restore backed-up data from a DVD to the hard disk, do the fol-
lowing:
• Press the Archive tab.
The Archive operating mode is activated.
• Insert the DVD that contains the first part of the backup copy into the
DVD drive.
• Press the Restore from DVD button.
All patient folders and images which have been backed up to the DVD
before are restored and saved to the system’s hard disk. All restored
patient folders are recreated on the hard disk, in addition to the
already existing ones.
• Insert all further DVDs used for the backup. Make sure to keep to the
same order as during the backup procedure.
10.1 Prerequisites
Depending on the system configuration, you can use the following Functions
DICOM functions:
− Downloading patient data from a DICOM server: Query
(→ Ch. 10.2.1, p. 10-1) or Worklist (→ Ch. 10.2.2, p. 10-3)
− Saving all images from one or several patient folders (→ Ch. 10.4,
p. 10-16)
− Saving and printing images and cine loops from a patient folder
(→ Ch. 10.5, p. 10-17)
− Saving or printing single cine loop images (→ Ch. 10.6, p. 10-19)
− Importing images and cine loops from a DICOM server (→ Ch. 10.7,
p. 10-21)
When creating a new patient folder (→ Ch. 9.2.2, p. 9-10), you can
download the patient data from the DICOM server (using Query or
Worklist).
10.2.1 Query
NOTE
If you use the patient ID to search for a patient folder,
please verify the search result by checking the patient
name. It may happen occasionally that a patient ID is
assigned more than once on a DICOM network.
NOTE
You may predefine default data for the Hospital,
Department and Doctor input boxes. The respective
data is entered in the Configuration operating mode
under Basic Settings.
You can download a specific Worklist from the DICOM server. The Contents of the
Worklist contains the patient data as well as the examinations which are Worklist
scheduled for the patient.
You can use a filter to determine the time span that is covered by the Time span of the
Worklist. The following filter criteria are available for that purpose: Worklist
− Default setting: Today (0:00 – 24:00 o’clock)
− Yesterday (0:00 – 24:00 o’clock)
− Yesterday and today (0:00 – 24:00 o’clock)
− Now +/– 8 hours
Besides you can limit the contents of the Worklist to be downloaded using Filters for Worklist
the following criteria: download
− Patient name (Last Name)
− Patient ID (Patient ID)
− Hospital-specific internal administrative number (Access. No)
− Specific procedure step (Req. Proc. ID)
Once you have downloaded a Worklist on a certain day, you can open it Opening the
as often as you like, even if the system is no longer connected to the Worklist offline
DICOM server. In this case, the word OFFLINE appears in the Worklist
on the screen.
When you try to open a Worklist in offline mode although no Worklist has
been downloaded on that day from the DICOM server yet, the message
No connection to server appears, and no Worklist is displayed.
To overwrite an active patient folder with data from a Worklist item, Overwrite function
do the following:
You can overwrite the data in an active patient folder with data from the
Worklist (e.g. in emergency cases, in order to correct or complete the
emergency patient’s data at a later moment).
CAUTION
When you overwrite a patient folder with the personal
data from the Worklist, the original personal data of the
patient folder is irretrievably lost and cannot be restored.
Only overwrite the personal data of the patient folder with
the personal data of the Worklist, if the patient folder con-
tains the images of the patient concerned!
• Use the arrow buttons to select the list item with which you want to
overwrite the active patient folder.
• Press the Overwrite button.
The active patient folder is updated.
NOTE
If you use the patient ID to search for a patient folder,
please verify the search result by checking the patient
name. It may happen occasionally that a patient ID is
assigned more than once on a DICOM network.
Overwrite function To overwrite an active patient folder with data from a Worklist item,
do the following:
You can overwrite the data in an active patient folder with data from the
Worklist (e.g. in emergency cases, in order to correct or complete the
emergency patient’s data at a later moment).
CAUTION
When you overwrite a patient folder with the personal
data from the Worklist, the original personal data of the
patient folder is irretrievably lost and cannot be restored.
Only overwrite the personal data of the patient folder with
the personal data of the Worklist, if the patient folder con-
tains the images of the patient concerned!
• Use the arrow buttons to select the list item with which you want to
overwrite the active patient folder.
• Press the Overwrite button.
The active patient folder is updated.
• Press the Req. Proc. ID button and enter the ID of the desired pro-
cedure step.
• If there is any data displayed in the Last Name, Patient ID and/or
Access. No boxes, press the Delete button.
The Last Name, Patient ID and/or Access. No boxes are cleared.
• Press the Worklist button.
The data of the specified procedure step is downloaded from the
DICOM server. The cursor is automatically positioned on the list item.
Overwrite function To overwrite an active patient folder with data from a Worklist item,
do the following:
You can overwrite the data in an active patient folder with data from the
Worklist (e.g. in emergency cases, in order to correct or complete the
emergency patient’s data at a later moment).
CAUTION
When you overwrite a patient folder with the personal
data from the Worklist, the original personal data of the
patient folder is irretrievably lost and cannot be restored.
Only overwrite the personal data of the patient folder with
the personal data of the Worklist, if the patient folder con-
tains the images of the patient concerned!
• Use the arrow buttons to select the list item with which you want to
overwrite the active patient folder.
• Press the Overwrite button.
The active patient folder is updated.
The DICOM function MPPS (Modality Performed Procedure Step) allows Function
you to open a procedure step (job) scheduled in a Worklist
(→ Ch. 10.2.2, p. 10-3), process it and then report it as being completed
to the MPPS server. The corresponding function must be enabled in the
DICOM settings for that purpose.
NOTE
You can use the MPPS function also when you create a
patient folder manually (→ Ch. 9.2.2, p. 9-10). In this
case, a procedure step is automatically generated and
started when you save the patient data, provided that the
MPPS function is enabled.
Overwrite function To overwrite an active patient folder with data from a Worklist item,
do the following:
You can overwrite the data in an active patient folder with data from the
Worklist (e.g. in emergency cases, in order to correct or complete the
emergency patient’s data at a later moment).
CAUTION
When you overwrite a patient folder with the personal
data from the Worklist, the original personal data of the
patient folder is irretrievably lost and cannot be restored.
Only overwrite the personal data of the patient folder with
the personal data of the Worklist, if the patient folder con-
tains the images of the patient concerned!
• Use the arrow buttons to select the list item with which you want to
overwrite the active patient folder.
• Press the Overwrite button.
The active patient folder is updated.
The MPPS server is notified that the selected procedure step has
been started. The message IN PROGRESS appears in the MPPS
box.
If an error message is displayed, please contact your in-house service
engineer.
NOTE
The message and the image list can be sent only once to
the MPPS server. Therefore make sure that you have
marked all relevant images.
A list of the images that have been transferred to the DICOM server
is sent to the MPPS server.
To cancel the procedure step, do the following:
• Press the Discontinue MPPS button.
The procedure step is canceled:
DICOM Store If the system is connected to a DICOM network, you can save images
from one or more patient folders to a DICOM server.
Saving options You can use the following options to save images to the DICOM server:
− Save images without text information and attributes (such as
rotation, reversal, etc.).
− Save images with their attributes.
− Save images with their text information and their attributes.
Resolution and You can save the images in the following formats:
color depth
Resolution Color depth
1024 × 1024 16/8 bit
512 × 512 8 Bit
Table 10-1 Image resolution and color depth
One of these formats is always preset as default. Please contact your in-
house service engineer if you need a different format.
Transferring If you send only images to the DICOM server which are not stored there
images already, all images are actually transferred and saved. Images that are
already stored on the DICOM server are not saved there again. Images
that have been downloaded from the DICOM server with the Retrieve
function will not be retransferred to the DICOM server.
You can edit the patient data of images (→ Ch. 9.2, p. 9-2) that have Editing patient data
already been stored on the DICOM server at any moment. Once you
have edited the patient data, the D flag is removed from the images. You
may retransfer them to the DICOM server with the new patient data after-
wards.
You can modify the attributes of images (→ Ch. 13, p. 13-1) that have Modifying archived
already been stored on the DICOM server at any moment. Once you images
have modified the attributes, the D flag is removed from the images. You
may retransfer them to the DICOM server with the new attributes after-
wards.
10.5 Saving and printing images and cine loops from a pa-
tient folder
Once you have displayed or activated a patient folder, you can save the
images and cine loops which are stored there to a connected DICOM
server and/or print them on a connected DICOM network printer.
or or
• Mark the images or cine loops you want to print.
Once they have been printed, the images or cine loops become
unmarked.
Transferring If you send only images to the DICOM server which are not stored there
images already, all images are actually transferred and saved. Images that are
already stored on the DICOM server are not saved there again. Images
that have been downloaded from the DICOM server with the Retrieve
function will not be retransferred to the DICOM server.
NOTE
Never modify any patient data in a patient folder after
having transferred images from this patient folder to the
DICOM server!
or or
• Mark the images or cine loops you want to save.
NOTE
If the cine loops to be transferred (in DICOM format)
exceed a file size of 2 GB, they are cut in size and trans-
ferred only up to this size.
A message window with a confirmation prompt is dis-
played, which allows you to accept this operation or
cancel saving.
or or
• Mark the images you want to print.
or or
• Mark the images you want to save.
To import one or more images from the DICOM server into a patient
folder, do the following:
• Press the Archive tab.
The Archive operating mode is activated.
or or
• Press the Patient tab.
The Patient operating mode is activated.
Fig. 10-12 Studies, Series and Images retrieval lists, with items on
the Studies list
• Select the desired study from the Studies list using the arrow buttons.
Fig. 10-13 Studies, Series and Images retrieval lists, with items on
the Studies and Series lists
• Using the arrow buttons, position the cursor on the desired series in
the Series list.
• Press the Refresh button next to the Series list.
All images of the selected series are displayed in the Images list.
Fig. 10-14 Studies, Series and Images retrieval lists, with items on all
lists
• Using the arrow buttons, position the cursor on the image of the
Images list you want to import.
or or
• Mark the images you want to import in the Images list.
NOTE
Do not switch off the system during image data transfer!
The transfer time depends on the network interface card
and the network load.
Fig. 10-16 Studies, Series and Images retrieval lists, with items on
the Studies list
• Select the desired study from the Studies list using the arrow buttons.
Fig. 10-17 Studies, Series and Images retrieval lists, with items on
the Studies and Series lists
• Using the arrow buttons, position the cursor in the Series list on the
series whose images you want to import.
• Press the Retrieve button.
All images of the series are downloaded from the DICOM server to the
patient folder. A progress indicator in a message window on the
control panel informs you about the status of the transfer operation.
Images that have been successfully downloaded are flagged with an
R.
NOTE
Do not switch off the system during image data transfer!
The transfer time depends on the network interface card
and the network load.
Storage Com- You can check whether the images that are flagged with a D
mitment function (→ Ch. 10.5, p. 10-17 or → Ch. 10.6, p. 10-19) have actually been
stored on the DICOM server, e.g. before you proceed to deleting them
from the hard disk of the system. The Storage Commitment function
must be enabled in the DICOM settings for that purpose.
All images which are present on the DICOM server are flagged with a
C in the thumbnail mosaic.
11.1 Overview
A cine loop consists of several fluoroscopic images that are acquired in General
sequence. It can be replayed like a movie later and also post-edited.
Cine loops are useful whenever dynamic movement needs to be visu- Applications
alized. Typical fields of application are:
− Orthopedics:
You can generate a cine loop for visualizing movements of the
skeletal system.
− Vascular surgery:
You can combine a cine loop with DSA (for Germany - SUB)
(→ Ch. 12.2, p. 12-2) to visualize a contrast medium flow.
You can define the frame rate (speed) and the number of frames (length) Settings
for each cine loop you acquire. With a maximum system configuration,
the following values are available:
− Frame rate:
1, 2, 4, 8 frames per second
(on systems with 50 Hz)
1, 2, 5, 10 frames per second
(on systems with 60 Hz)
− Length:
100, 200, 300, 400 images per cine loop
If you activate the Auto option, all images that are generated during
the time of exposure are automatically saved. With this option, you do
not need to set the recording length prior to fluoroscopy.
You can preset the frame rate (speed) and the number of frames (length)
of the cine loop in the Configuration operating mode under Operation
Settings (→ Ch. 18.4.1, p. 18-12). You can, however, modify these set-
tings during operation for each individual cine loop you acquire.
Saving a cine loop The cine loop images are automatically saved during radiation. The first
image of the cine loop is saved as the start image, the last one as the stop
image.
The number of images that are actually saved depends on the cine loop
length you have chosen:
− If you terminate radiation before reaching the selected cine loop
length, only the images generated during the time of exposure will be
saved.
− If radiation is continued beyond the selected cine loop length, only the
most recent images will be saved; the first images are lost.
− If you have activated the Auto option, all images that are generated
during the time of exposure are automatically saved.
Storage capacity Before you initiate fluoroscopy, the system checks automatically whether
there is enough hard disk space available for the preset cine loop. If,
despite the Auto-Delete function (→ p. 7-18), it is not possible to free up
enough disk space, an audible alarm sounds and the following alert
message appears on the control panel:
Out of memory. Image can not be stored!
NOTE
As long as the snapshot fluoroscopy mode is active, the
Cine button is hidden on the control panel.
• Select the desired cine loop length or the Auto function under
Length.
• Terminate radiation.
The new cine loop is now automatically replayed at the preset frame
rate in an endless loop on the live screen. You can control and edit
the cine loop (→ Ch. 11.4, p. 11-5).
You can reopen and replay a cine loop saved on the hard disk at any
time.
NOTE
The search function is not case-sensitive.
With each letter you enter, the alphabetical hit list is more and more
confined to match the search string.
The All button appears, allowing you to redisplay the entire list.
• Press the Back button.
You are returned to the Archive screen. The data of all patients who
match the search string(s) is displayed in the list.
The All button appears, allowing you to redisplay the entire list.
• Select the desired patient folder using the arrow keys.
The controls for playback and editing of the cine loop as well as those for
processing and outputting individual cine loop images appear on the
control panel:
Fig. 11-3 Archive operating mode during cine loop playback (on
systems with 60 fps)
Fig. 11-4 Cine loop (without DSA) (for Germany - without SUB)
playback and editing controls on systems with 50 Hz
(above) and 60 Hz (below)
All the settings that you make in the dynamic control area always affect
the cine loop which is marked by a white frame on the screen.
Changing the • To change the playback speed of the cine loop, choose another value
playback speed under Frms/s.
• To stop cine loop playback, press the Stop button.
The Play button appears.
Editing options The following options are available for editing a cine loop during
playback:
− Trimming the cine loop
− Cleaning up the cine loop
Trimming the cine You can trim the cine loop for playback, e.g. if the contrast medium has
loop been injected too late, thus making the first images of the cine loop
useless. This is done by defining a new start image and a new stop image
for cine loop playback.
• To replay the entire original cine loop, press the Complete button.
You can delete all images outside the trimmed cine loop, i.e. those before Cleaning up the
the start image and those after the stop image. cine loop
NOTE
Once you have cleaned up the cine loop, you can no
longer restore the original cine loop with the Complete
button.
Read-only
boxes
Buttons for
printing
Buttons for
saving
In the following sections, we will describe how to process and output cine
loops. For information on how to process and output individual images in
a patient folder, please refer to → Ch. 9.3.5, p. 9-27.
The following cine loop processing functions are available in a displayed
or active patient folder:
− Mark:
To mark one or more cine loops
− Protect:
To protect marked cine loops against being deleted
− Delete:
To delete cine loops
− DICOM Retrieve:
To import cine loops from a DICOM server (→ Ch. 10.7, p. 10-21)
− Print:
To print marked cine loops on the video printer
− DICOM Print:
To print marked cine loops on a DICOM network printer (→ Ch. 10.5,
p. 10-17)
− DVD:
To write marked cine loops to DVD
The title bar shows you – in addition to the selected operating mode
– the remaining storage capacity of the DVD to which you want to
write the marked patient folders.
− USB:
To save marked cine loops to a USB storage medium
The title bar shows you – in addition to the selected operating mode
– the remaining storage capacity of the USB storage medium to which
you want to save the marked patient folders.
− DICOM Store:
To save marked cine loops to a DICOM server (→ Ch. 10.5, p. 10-17)
You can protect cine loops against being deleted. When you try to delete
a folder which contains protected cine loops, the folder itself as well as
the protected cine loops remain on the hard disk.
• Select the desired cine loop on the reference screen using the arrow
buttons.
• Press the Protect button.
The cine loop is now protected and flagged with a P.
• Select the desired protected cine loop using the arrow buttons.
• Press the Protect button.
The cine loop becomes unprotected.
NOTE
Patient folders containing protected cine loops or images
cannot be deleted automatically. If many folders on the
hard disk contain protected cine loops or images, the
Auto-Delete function will not delete them, and you will be
unable to save new images.
To avoid this situation, regularly back up the patient
folders which are still needed to external storage media or
to a DICOM server. You can then manually delete those
patient folders or unprotect them and allow the Auto-
Delete function to free up space on your hard disk.
You can delete either all marked cine loops, or all unmarked cine loops,
or only the cine loop where the cursor is.
To delete one or more cine loops from a patient folder, do the fol-
lowing:
NOTE
Deleted cine loops are irretrievably lost.
Back up the cine loops you want to keep before deleting
them, or make sure that they are really no longer needed.
• Mark the cine loops you want to delete and press the Delete Marked
Items button.
The following confirmation prompt is displayed:
or or
• Mark the cine loops you want to keep and press the Delete
Unmarked Items button.
The following confirmation prompt is displayed:
or or
• Using the arrow buttons, position the cursor on the cine loop you want
to delete, and then press the Delete button.
The following confirmation prompt is displayed:
You can mark one or more cine loops and print all images contained in
them in one go.
CAUTION
Risk of injury by cutting device!
You can hurt yourself touching the cutting device.
Do not touch the cutting device when adding or removing
paper.
Please refer to the Operating Instructions of the corre-
sponding printer.
NOTICE
When printing, tear off the printer paper on the Sony ®
UP-897.
Please refer to the Operating Instructions of the corre-
sponding printer.
Depending on your chosen system configuration, you can save the Storage formats
images of one or more cine loops in various storage formats to different
storage media. Some formats with reduced resolution and color depth
are also available.
NOTE
Saving image data with a resolution of 512 × 512 pixels
may lead to information loss.
Ziehm DICOM Whenever you save images in standard DICOM format or ‘reduced’
Viewer DICOM format (with a resolution of 512 × 512 pixels and 8 bit color depth)
to an external storage medium, the Ziehm DICOM Viewer program is
automatically saved to the storage medium as well. This program
enables you to view the DICOM images on any PC with Microsoft®
Windows® operating system (version Microsoft® Windows® 98 or
higher). When residing on a DVD, the Ziehm DICOM Viewer starts auto-
matically. When residing on a USB storage medium, the program must
be launched manually.
• Plug the USB stick into the USB port on the monitor cart.
• Press the USB button.
The marked cine loops are saved to the USB storage medium. A
progress indicator in a message window on the control panel informs
you about the status of the save operation. The Cancel button
appears, enabling you to interrupt the save operation.
Once they have been saved, the cine loops become unmarked.
NOTE
If the cine loops to be transferred (in DICOM format)
exceed a file size of 2 GB, they are cut in size and trans-
ferred only up to this size.
A message window with a confirmation prompt is dis-
played, which allows you to accept this operation or
cancel saving.
With the DVD writer, data can be written to DVDs. The selected cine Writing to DVD
loops are copied to a compilation file on the hard disk first. You can
decide whether you want to write the cine loops from the compilation file
to DVD immediately or later. This enables you to gather entire cine loops
or patient folders as well as single images from different patient folders
and cine loops in the compilation file and to write them to DVD later in one
go.
If you switch off the system before having actually written the patient
folders and images from the compilation file to DVD, the system will pre-
serve the compilation file information.
NOTE
If the cine loops to be transferred (in DICOM format)
exceed a file size of 2 GB, they are cut in size and trans-
ferred only up to this size.
A message window with a confirmation prompt is dis-
played, which allows you to accept this operation or
cancel saving.
or or
To write the marked cine loops to DVD right away, confirm by pressing
the Yes button. The write process is started, and the following
message appears:
Writing DVD. Estimated time x minutes.
A progress indicator informs you about the status of the write oper-
ation.
Once the write operation has been completed successfully, the fol-
lowing message is displayed:
Writing of DVD completed successfully
• Press the OK button.
As soon as you open a saved cine loop in the Archive operating mode
(→ Ch. 11.3, p. 11-3), the individual images of the cine loop are dis-
played as a thumbnail mosaic on the reference screen.
When you place the cursor on an individual image of the thumbnail
mosaic, this image is automatically displayed at full size on the live
screen.
The following functions are available for processing single cine loop
images:
− Mark:
To mark one or more images
− Protect:
To protect the image marked by the cursor against being deleted
− Delete:
To delete images
− Print:
To print marked images on the video printer
− DICOM Print:
To print marked images on a DICOM network printer (→ Ch. 10.6,
p. 10-19)
− DVD:
To write marked images to DVD
− USB:
To save marked images to a USB storage medium
− DICOM Store:
To save marked images to a DICOM server (→ Ch. 10.6, p. 10-19)
You can protect cine loop images against being deleted. When you try to
delete a folder which contains cine loops with protected images, the
folder itself as well as the respective cine loops remain on the hard disk.
NOTE
Patient folders containing protected images cannot be
deleted automatically. If many folders on the hard disk
contain protected images, the Auto-Delete function will
not delete them, and you will be unable to save new
images.
To avoid this situation, regularly back up the patient
folders which are still needed to external storage media or
to a DICOM server. You can then manually delete those
patient folders or unprotect them and allow the Auto-
Delete function to free up space on your hard disk.
You can delete either all marked images, or all unmarked images, or only
the image where the cursor is.
NOTE
Deleted images are irretrievably lost.
Back up the images you want to keep before deleting
them, or make sure that they are really no longer needed.
or or
• Mark the images you want keep.
or or
• Select the individual image you want to delete using the arrow
buttons.
You can mark one or more images of the cine loop and print them all in
one go. Besides, you can print the image displayed on the live screen.
CAUTION
Risk of injury by cutting device!
You can hurt yourself touching the cutting device.
Do not touch the cutting device when adding or removing
paper.
Please refer to the Operating Instructions of the corre-
sponding printer.
NOTICE
When printing, tear off the printer paper on the Sony ®
UP-897.
Please refer to the Operating Instructions of the corre-
sponding printer.
To print images from a cine loop on the video printer, do the fol-
lowing:
• Position the cursor on the desired image, or mark the images you
want to print.
To print the live screen image on the video printer, do the following:
• Press the Print Live Screen Image button.
The image displayed on the live screen is printed.
The text information that is displayed on the live screen together with the
image (name of the patient, angle of rotation of the image, etc.) will
appear as a text block on a gray background at the left margin of the
printout.
If you have performed measurements in an image and saved them sub-
sequently, the measured values are printed on a second page.
NOTE
When you launch the print job directly from the video
printer, the resulting hard copy will be an exact repro-
duction of the live screen.
For further information, please refer to the video printer’s separate oper- Further information
ating instructions provided with this system.
Depending on your chosen system configuration, you can save cine loop
images in various storage formats to different storage media. Some
formats with reduced resolution and color depth are also available.
NOTE
Saving image data with a resolution of 512 × 512 pixels
may lead to information loss.
Whenever you save images in standard DICOM format or ‘reduced’ Ziehm DICOM
DICOM format (with a resolution of 512 × 512 pixels and 8 bit color depth) Viewer
to an external storage medium, the Ziehm DICOM Viewer program is
automatically saved to the storage medium as well. This program
enables you to view the DICOM images on any PC with Microsoft®
Windows® operating system (version Microsoft® Windows® 98 or
higher). When residing on a DVD, the Ziehm DICOM Viewer starts auto-
matically. When residing on a USB storage medium, the program must
be launched manually.
Saving to USB To save cine loop images to a USB storage medium, do the fol-
storage medium lowing:
• Position the cursor on the desired image, or mark the images you
want to save.
• Plug the USB stick into the USB port on the monitor cart.
• Press the USB button.
The marked images are saved to the USB stick. A progress indicator
in a message window on the control panel informs you about the
status of the save operation. The Cancel button appears, enabling
you to interrupt the save operation.
Once they have been saved, the cine loop images become unmarked.
Writing to DVD With the DVD writer, data can be written to DVDs. The selected images
are copied to a compilation file on the hard disk first. You can decide
whether you want to write the images from the compilation file to DVD
immediately or later. This enables you to gather images from different
cine loops and patient folders as well as entire cine loops or patient
folders in the compilation file and to write them to DVD later in one go.
If you switch off the system before having actually written the images and
patient folders from the compilation file to DVD, the system will preserve
the compilation file information.
or or
To write the marked images to DVD right away, confirm by pressing
the Yes button. The write process is started, and the following
message appears:
Writing DVD. Estimated time x minutes.
A progress indicator informs you about the status of the write oper-
ation.
Once the write operation has been completed successfully, the fol-
lowing message is displayed:
Writing of DVD completed successfully
• Press the OK button.
12.1 Overview
The system provides the subtraction mode (DSA) (for Germany - SUB), Applications
which are used mainly in vascular surgery.
The SUB (Subtraction) mode generates a conventional subtracted SUB (for Germany
image. This means that one image is subtracted from the other, so that only)
only the differences between the images become visible.
SUB is always combined with a cine loop (→ Ch. 11, p. 11-1).
NOTE
In case the system is endangered by overheating the
pulse rate during fluoroscopy is automatically reduced to
avoid that the operation is aborted.
However, this safety measure may affect the image
quality.
The DSA cine loop (for Germany - SUB cine loop) is saved to the active Saving
patient folder and may be reopened or post-processed later.
− Subtracted image
A subtracted image is the result of the subtraction process: native
image minus mask image.
Showing or hiding You can preset whether you want the native image to appear on the ref-
the native image erence screen during the acquisition of a DSA cine loop (for Germany -
SUB cine loop). This is done in the Configuration operating mode under
Operation Settings (→ Ch. 18.4.2, p. 18-14). If you deactivate the
option DSA Native on (for Germany - SUB Native on), you may display
a reference image on the reference screen during the entire subtraction
procedure. If you activate the option DSA Native on (for Germany - SUB
Native on), any image which is displayed on the reference screen will
disappear as soon as you switch to the Subtraction operating mode.
Cine loop Each DSA (for Germany - SUB) is automatically combined with a cine
loop. The first image of the cine loop is saved as the mask image, and all
subsequent native images are subtracted from the mask image.
Scrolling You cannot scroll through the individual cine loops on the reference
screen.
Fig. 12-1 DSA cine loop settings (on systems with 50 Hz)
Fig. 12-2 SUB cine loop settings (on systems with 50 fps) (Germany
only)
To be able to acquire a DSA cine loop (for Germany - SUB cine loop), Prerequisite
you must first create a new patient folder (→ Ch. 9.2.2, p. 9-10) or
activate an existing patient folder (→ Ch. 9.3.3, p. 9-23).
With a DSA cine loop (for Germany - SUB cine loop), the system auto- Length of the DSA
matically saves all images that are generated during the time of cine loop (for
exposure. In the DSA cine loop settings (for Germany - SUB cine loop), Germany - SUB cine
the Auto option is preset under Length. You cannot select a defined loop)
length for a DSA cine loop (for Germany - SUB cine loop) (→ p. 11-2).
To acquire a DSA cine loop (for Germany - SUB cine loop), do the fol-
lowing:
• Press the Subtraction tab.
The Subtraction operating mode is activated.
• Press the DSA button (for Germany - SUB button ).
The cine loop setting controls appear in the dynamic control area. The
Auto option is preset under Length and cannot be changed. The
buttons for setting a specific cine length are unavailable for this
reason.
• Set the desired frame rate for the DSA cine loop (for Germany - SUB
cine loop) under Frms/s (→ Ch. 11.2, p. 11-1).
• Press the hand switch, the fluoroscopy pedal of the two-pedal foot
switch or the Fluoroscopy key on the monitor support arm.
CAUTION
Risk of injury by X-rays!
Put on X-ray protective clothing, if you initiate radiation by
pressing the fluoroscopy key on the monitor support arm.
NOTE
These alarms signal the start of the DSA (for Germany -
SUB) and the earliest possible moment you can inject the
contrast medium.
The final decision when to actually inject the contrast
medium lies with the attending physician or attending
surgeon.
• Terminate radiation.
The cine loop is automatically saved to the active patient folder. It is
replayed in an endless loop on the live screen.
The the cine loop playback (→ Ch. 11.4, p. 11-5) and editing controls
appear in the dynamic control area.
Fig. 12-3 DSA cine loop playback (for Germany - SUB cine loop) and
editing controls on systems with 50 Hz (left) and 60 Hz
(right)
The Subtraction operating mode remains active. When you initiate radi-
ation again, a new DSA cine loop (for Germany - SUB cine loop) is
acquired with the defined settings.
Various filter factors can be preset for the DSA mode (for Germany - SUB Filter factors
mode) in the Configuration operating mode under Service Settings.
You cannot make these presettings yourself.
The default windowing values (width and level of the contrast window) for Windowing values
the DSA mode (for Germany - SUB mode) can be preset in the Config-
uration operating mode under Service Settings. You cannot make
these presettings yourself.
Fig. 12-4 DSA cine loop playback (for Germany - SUB cine loop) and
editing controls on systems with 50 Hz (left) and 60 Hz
(right)
All the settings that you make in the dynamic control area always affect
the cine loop which is marked by a white frame on the screen.
• To change the playback speed of the cine loop, choose another value Changing the
under Frms/s. playback speed
• To stop cine loop playback, press the Stop button.
The Play button appears.
Editing options The following options are available for editing a cine loop during
playback:
− Trimming the cine loop
− Cleaning up the cine loop
− Defining another mask image
Trimming the cine You can trim the cine loop for playback, e.g. if the contrast medium has
loop been injected too late, thus making the first images of the cine loop
useless. This is done by defining a new start image and a new stop image
for cine loop playback.
• Select the desired start image with the arrow buttons and press the
Start Img button.
• Select the desired stop image with the arrow buttons and press the
Stop Img button.
The cine loop sequence is trimmed.
• To replay the entire original cine loop, press the Complete button.
Cleaning up the You can delete all images outside the trimmed cine loop, i.e. those before
cine loop the start image and those after the stop image.
NOTE
Once you have cleaned up the cine loop, you can no
longer restore the original cine loop with the Complete
button.
Defining a mask You can define a mask image other than the original one for a DSA cine
image loop (for Germany - SUB cine loop) (→ p. 12-1).
• Select the image you want to define as mask image with the arrow
buttons and press the Mask button.
13.1 Overview
Saved images can be post-processed at any time in the Post Pro- General
cessing operating mode. Any adjustments that you make in the Post
Processing operating mode affect only the selected image (exception:
screen settings).
− Filter:
Edge filter
− Zoom:
To enlarge a selected image area
− Grayscale Inversion:
To display an image with negative grayscale
− Reverse Up/Down:
Vertical image reversal
− Reverse Left/Right:
Horizontal image reversal
− Image Rotation
− Text:
Text functions (→ Ch. 15, p. 15-1)
Saving the changes Any modification becomes immediately visible in the live screen image.
When you save an image, any modifications are saved as well and will
be visible both when you reopen the image and in mosaic view. However,
you can post-process an image as often as desired, thus undoing any
changes you have made before.
Now you can post-process the selected image. You can browse through
the active patient folder on the live screen using the arrow buttons. In
addition, you can mark and delete individual images.
Function The windowing function allows you to adjust the contrast and brightness
of the image on the live screen. These settings affect only the selected
image. When you save an image, the modified windowing values are
saved as well, even if you have retrieved the image from the archive.
After activating the Windowing function, you can select a number of gray
levels, which are then stretched over the entire range of 1024 gray levels
of the original image on the live screen. To achieve this effect, you set the
width and the level of the so-called contrast window.
The number of gray levels defines the width of the contrast window. The
width of the contrast window affects the image contrast. 1024 gray levels
correspond to the value W 100.
The position of the selected gray levels on the original image grayscale
(ranging from 0 to 1024 gray levels) defines the level of the contrast
window. The level of the contrast window affects the image brightness.
Example:
You select all gray levels between 325 and 875. These gray levels are
then mapped (stretched) to the range of 0 to 1024 gray levels in the pro-
cessed image. This enhances the contrast.
Gray levels 0 to 324 of the original image are displayed as black, and
gray levels 876 to 1024 of the original image are displayed as white. This
means that the processed image is darker than the original image.
There are two different windowing modes available:
− Standard windowing:
The standard windowing mode allows you to freely choose the level
and width of the contrast window.
− Step windowing:
With step windowing, you choose between several predefined win-
dowing steps. These windowing steps are preset and cannot be mod-
ified.
The chosen windowing values are shown on the screen as W X and L Y.
• Under Width, set the number of gray levels using the arrow buttons.
The chosen width is indicated by the length of the blue bar in the
dynamic control area. The changes become immediately visible in the
live screen image.
• Under Level, set the brightness range using the arrow buttons.
The chosen level is indicated by the position of the slider in the
dynamic control area. The changes become immediately visible in the
live screen image.
• To restore the factory settings (level 50, width 100), press the Home
button.
• To restore the factory settings for step windowing, press the Home
button.
Step windowing is reset to step 0. Simultaneously, brightness and
contrast are reset to their default values.
• Press the Contrast/Brightness button.
The screen setting controls disappear from the dynamic control area.
The edge filter allows you to select a greater or lesser degree of edge
enhancement within the image. There are 4 levels available:
Level Meaning
Off No edge enhancement (original fluoroscopic image)
1 Slight edge enhancement
2 Medium edge enhancement
3 Strong edge enhancement
-1 Unsharp mask to reduce noise
Table 13-1 Edge filter levels
The Zoom function allows you to enlarge a certain image area. There are
three zoom levels available. You can select the desired image area either
with the arrow buttons or with the integrated touchpad.
Touchpad
• To move the marking circle back to the center of the live image, press
the Home button.
To enlarge an image area with the help of the touchpad, do the fol-
lowing:
• Press the Zoom button.
The active image also appears on the reference screen.
The zoom controls appear in the dynamic control area.
• To move the marking circle back to the center of the live image, press
the Home button.
Function The Grayscale Inversion function allows you to view the active image
with a negative grayscale.
• Press the Rotate Image CW button until the image orientation on the
live screen is as desired.
The image is rotated steplessly in clockwise direction.
• Press the Rotate Image CCW button until the image orientation on
the live screen is as desired.
The image is rotated steplessly in counter-clockwise direction.
• Press the Close Vertical Slot Collimator button until the collimator
aperture on the live screen is as desired.
The vertical slot collimator closes steplessly.
• Press the Open Vertical Slot Collimator button until the collimator
aperture on the live screen is as desired.
The vertical slot collimator opens steplessly.
• Press the Close Horizontal Slot Collimator button until the colli-
mator aperture on the live screen is as desired.
The horizontal slot collimator closes steplessly.
• Press the Open Horizontal Slot Collimator button until the colli-
mator aperture on the live screen is as desired.
The horizontal slot collimator opens steplessly.
Browsing through You can browse through an active patient folder in the Post Processing
the patient folder operating mode without having to switch to the Archive operating mode.
The live screen always shows the selected image at full size.
NOTE
Patient folders containing protected images cannot be
deleted automatically. If many folders on the hard disk
contain protected images, the Auto-Delete function will
not delete them, and you will be unable to save new
images.
To avoid this situation, regularly back up the patient
folders which are still needed to external storage media or
to a DICOM server. You can then manually delete those
patient folders or unprotect them and allow the Auto-
Delete function to free up space on your hard disk.
NOTE
Deleted images are irretrievably lost.
Back up the images you want to keep before deleting
them, or make sure that they are really no longer needed.
• Mark the images you want to delete and press the Delete Marked
Items button.
The following confirmation prompt is displayed:
or or
• Mark the images you want to keep and press the Delete Unmarked
Items button.
The following confirmation prompt is displayed:
or or
• Select the individual image you want to delete using the arrow
buttons.
You can save individual images to hard disk (→ Ch. 7.9, p. 7-16) or print Output options
them on the video printer in the Post Processing operating mode as
well. These actions are always applied to the selected image or to the
marked images.
When you save an image, all changes applied to it are saved as well and
will be visible the next time you open the image. However, you can post-
process an image as often as desired, thus undoing any changes you
have made before.
or or
• Mark the images you want to print.
The system lets you measure various distances and angles in a saved General
fluoroscopic image. You can use the same measuring method several
times in an image.
Measuring inac- The larger the distance between the object of measurement and the
curacy image intensifier, the more inaccurate the measurement will be.
Therefore position the object of measurement as closely as possible to
the image intensifier or use the electronic magnification function, espe-
cially if the object of measurement is very small.
The measuring resolution on the screen is 512 pixels. With a 23-cm i.i.,
this results in a pixel pitch of 230/512 = 0.45 mm in relation to the object
of measurement.
NOTE
To achieve a higher resolution, use smaller electronic
image formats.
Zoom function If you change the zoom factor (→ Ch. 13.5, p. 13-7) after making a mea-
surement, the measured values will no longer be correct. In this case, the
following message will be displayed on the control panel: Measurement
invalid due to zoom factor change.
Thumbnail mosaic The measurements that you have performed on an image are not visible
in the thumbnail mosaic view.
Cine loop When you perform a measurement on a cine loop image and save it, this
measurement is saved for the entire cine loop and will be visible in all cine
loop images.
14.2 Calibrating
Point A Point B
Measurements on a fluoroscopic image will only provide accurate results Validity of the cali-
if, during the acquisition of the relevant calibration image, the reference bration
object has been placed in exactly the same plane as the object to be
measured later.
If the position of the patient or the C-arm is changed after the calibration,
you must repeat the calibration before performing a new measurement.
The measuring points may have different designations, depending on the Designation of the
order in which the measurements are performed (→ p. 14-2). In the fol- measuring points
lowing procedure, the measuring points are designated as A and B by
way of example.
• Screen the reference object in the Fluoroscopy operating mode.
CAUTION
Risk of injury by X-rays!
Put on X-ray protective clothing, if you initiate radiation by
pressing the fluoroscopy key on the monitor support arm.
The reference object must be in the same plane as the object you
want to measure later.
The image is displayed on the live screen.
• Move the second marker square with the four arrow buttons to the
desired second measuring point on the reference object, e.g. the
second radiopaque marker on a balloon catheter.
• To edit the length you have entered, press the Delete button and
enter another value.
• Press the OK button.
The acquired and saved calibration value remains in force until you
switch off the system.
Point A Point B
The measuring points may have different designations, depending on the Designation of the
order in which the measurements are performed (→ p. 14-2). In the fol- measuring points
lowing procedure, the measuring points are designated as A and B by
way of example.
• Open the desired image in the Archive operating mode (→ Ch. 9.3,
p. 9-14).
• Press the Measure tab.
The Measurement operating mode is activated. The selected image
is displayed at full size on the live screen.
• Press the 2-Point button.
NOTE
If the 2-Point button is unavailable, you must perform a
calibration first.
• Move the second marker square to the final point of the desired length
or distance using the four arrow buttons.
The current length of the distance is shown in the Length 1 read-only
box on the control panel. The value is instantly readjusted as soon as
you change the position of any of the measuring points.
• To correct the position of a measuring point, press the Next Mea-
suring Point button until the corresponding marker square starts
flashing, and then move it to the desired new position.
The length of the modified distance is shown in the Length 1 read-
only box on the control panel.
• Press the OK button.
You can edit any distance or length measurement as long as the patient Editing a distance
folder containing the image with the respective measurement is active. or length mea-
surement
NOTE
You cannot edit any distance/length measurements in
images that have been retrieved from the archive. The
arrow buttons are unavailable. However, you can delete
any existing length or distance measurements and make
new ones.
• Press the Next Measuring Point button until the marker square is on
the measuring point whose position you want to change.
• Move the marker square to the desired new position using the arrow
buttons.
• Repeat these two steps until the marker square is on one of the mea-
suring points of the desired measurement.
360° - Angle
Point B
Angle
Point A Point C
Designation of the The measuring points may have different designations, depending on the
measuring points order in which the measurements are performed (→ p. 14-2). In the fol-
lowing procedure, the measuring points are designated as A, B and C by
way of example.
• Open the desired image in the Archive operating mode (→ Ch. 9.3,
p. 9-14).
• Press the Measure tab.
The Measurement operating mode is activated. The selected image
is displayed at full size on the live screen.
• Press the 3-Point button.
NOTE
If the 3-Point button is unavailable, you must perform a
calibration first.
• Move the third marker square to the desired point C using the four
arrow buttons.
3-point mea- You can edit any 3-point measurement as long as the patient folder con-
surement taining the image with the respective measurement is active.
NOTE
You cannot edit any 3-point measurements in images that
have been retrieved from the archive. The arrow buttons
are unavailable. However, you can delete any existing 3-
point measurements and make new ones.
• Press the Next Measuring Point button until the marker square is on
the measuring point whose position you want to change.
• Move the marker square to the desired new position using the arrow
buttons.
• Repeat these two steps until the marker square is on one of the mea-
suring points of the desired measurement.
180° - Angle
Point B
Point C
Angle
Point A
Point D
The measuring points may have different designations, depending on the Designation of the
order in which the measurements are performed (→ p. 14-2). In the fol- measuring points
lowing procedure, the measuring points are designated as A, B,C and D
by way of example.
• Open the desired image in the Archive operating mode (→ Ch. 9.3,
p. 9-14).
NOTE
If the 4-Point button is unavailable, you must perform a
calibration first.
• Move the third marker square to the desired point C using the four
arrow buttons.
• Move the marker square to the desired point D using the four arrow
buttons.
You can edit any 4-point measurement as long as the patient folder con- 4-point mea-
taining the image with the respective measurement is active. surement
NOTE
You cannot edit any 4-point measurements in images that
have been retrieved from the archive. The arrow buttons
are unavailable. However, you can delete any existing 4-
point measurements and make new ones.
• Press the Next Measuring Point button until the marker square is on
the measuring point whose position you want to change.
• Move the marker square to the desired new position using the arrow
buttons.
• Repeat these two steps until the marker square is on one of the mea-
suring points of the desired measurement.
Point B
Point C
Point A
Point D
The measuring points may have different designations, depending on the Designation of the
order in which the measurements are performed (→ p. 14-2). In the fol- measuring points
lowing procedure, the measuring points are designated as A, B,C and D
by way of example.
• Open the desired image in the Archive operating mode (→ Ch. 9.3,
p. 9-14).
• Press the Measure tab.
The Measurement operating mode is activated. The selected image
is displayed at full size on the live screen.
• Press the 4-Point Ratio button.
NOTE
If the 4-Point Ratio button is unavailable, you must
perform a calibration first.
• Move the third marker square to the desired point C using the four
arrow buttons.
• Move the marker square to the desired point D using the four arrow
buttons.
You can edit any 4-point ratio measurement as long as the patient folder Editing a 4-point
containing the image with the respective measurement is active. ratio measurement
NOTE
You cannot edit any 4-point ratio measurements in
images that have been retrieved from the archive. The
arrow buttons are unavailable. However, you can delete
any existing 4-point ratio measurements and make new
ones.
• Press the Next Measuring Point button until the marker square is on
the measuring point whose position you want to change.
• Move the marker square to the desired new position using the arrow
buttons.
• Repeat these two steps until the marker square is on one of the mea-
suring points of the desired measurement.
15.1 Overview
Some image information is always displayed automatically as text on the Image information
screen. Detailed patient and image data can be found on the control
panel (→ Ch. 9.3, p. 9-14).
In addition, you may enter your own text or markers directly onto the flu-
oroscopic image in a text annotation area on the screen and save a
comment together with the image.
In this area, the last name, first name, patient ID and date of birth of the Patient data
patient are displayed. Patient data is entered or corrected in the Patient
operating mode (→ Ch. 9.2, p. 9-2).
In this area, the name of the hospital, attending physician and hospital Hospital data
department are displayed.
The default hospital data can be entered in the Configuration operating
mode under Basic Settings (→ Ch. 18.3.3, p. 18-10) and may be cor-
rected later in the Patient operating mode, if necessary (→ Ch. 9.2.2,
p. 9-10).
As soon as you have saved an image, its image number is displayed Image number and
(→ Ch. 7.9, p. 7-16). For marked or protected images, the flag M or P is flag
displayed directly behind the image number.
DICOM status If the image has already been transferred to a DICOM server
(→ Ch. 10.5, p. 10-17) or imported from a DICOM server into the system
(→ Ch. 10.7, p. 10-21), it is flagged with DICOM X:
− DICOM D: The image has been transferred successfully to the
DICOM server
− DICOM C: The image has been transferred successfully to the
DICOM server and stored safely (Storage Commitment)
− DICOM R: The image has been imported from the DICOM server into
the system
Image type If a cine loop or DSA image (for Germany - SUB image) is displayed, it is
flagged correspondingly (CINE, DSA).
Image reversal Image reversal is symbolized on the screen by an R which is either mir-
rored upside-down or left-right. This symbol appears in the following
cases:
− The live image is reversed (→ Ch. 8.9.1, p. 8-17).
− An image which has been saved with reversal is displayed
(→ Ch. 13.8, p. 13-9).
Recursive filter The chosen recursive filter level (→ Ch. 8.3.1, p. 8-5) is shown as NR X.
Edge filter The chosen edge filter level (→ Ch. 8.3.2, p. 8-7 or → Ch. 13.4, p. 13-6)
is shown as RTE X.
LIH filter The chosen LIH filter level (→ Ch. 8.3.3, p. 8-8) is shown as LIH X.
Angle of rotation The angle of rotation which has been chosen for the image (→ Ch. 8.9.2,
p. 8-18 or → Ch. 13.7, p. 13-9) is shown as R X.
Windowing values The chosen windowing values (→ Ch. 8.2, p. 8-2 or → Ch. 13.3, p. 13-4)
are shown as W X and L Y.
Time and date of The time and date of saving are automatically assigned by the system
saving and cannot be edited.
Furthermore, the image magnification level chosen for the image is Image magnifi-
shown as MAG X. cation level
Activating the You can activate the Text operating mode from any of the following oper-
mode ating modes:
− Fluoroscopy
− Subtraction
− Post-processing
− Measurement
• Press the Text button in the corresponding operating mode.
The Text mode is activated.
You may add the following elements to a fluoroscopic image on the live
screen:
− Any desired text
− An arrow in various sizes pointing to different directions
The texts, markers or arrows you have added to the image are not visible Thumbnail mosaic
in the thumbnail mosaic view.
In the Text mode, you may furthermore enter a note on the current Note
image. This note is displayed in the Archive operating mode together
with the image information (→ Fig. 9-8, p. 9-14).
• Enter the desired text using the alphanumeric keypad which is dis-
played on the control panel.
NOTE
To type an uppercase letter, press and release the Shift
key before entering the respective letter. The Shift key
acts on one subsequent letter. To type several consec-
utive uppercase letters, press the Caps Lock key before
entering the letters.
The text appears both in the input box on the control panel and in the
fluoroscopic image on the screen. The text in the fluoroscopic image
is surrounded by a marker frame.
• Move the text to the desired position using the arrow buttons.
• To undo your input, press the Cancel button.
The text and its position are deleted.
or or
• To confirm your input, press the OK button.
The marker frame disappears. The text input box on the control panel
is cleared.
• Select the arrow or the marking letter you want to insert by pressing
the corresponding button.
The arrow or the marking letter appear in the fluoroscopic image on
the screen.
• Move the arrow or marking letter to the desired position using the
arrow buttons.
• Press the Size button until the marker size is as desired.
The chosen size (large, medium, small) is indicated in the center of
the arrow block.
• To undo your input, press the Cancel button.
The arrow or marking letter and its position are deleted.
or or
• To confirm your input, press the OK button.
• Enter the desired note using the alphanumeric keypad which is dis-
played on the control panel.
NOTE
To type an uppercase letter, press and release the Shift
key before entering the respective letter. The Shift key
acts on one subsequent letter. To type several consec-
utive uppercase letters, press the Caps Lock key before
entering the letters.
The laser positioning device uses diode laser modules which emit laser Safety Instructions
radiation. Do not under any circumstances look directly at the laser
beam or any scattered laser radiation – either with the naked eye or with
optical instruments.
Make sure to comply with all operating safety precautions when using the
laser positioning device. The maximum power output of continuous laser
radiation, measured at the laser beam apertures, is <1 mW. The wave-
length of the emitted radiation is 635 nm.
The laser positioning device generates a laser-beam crosshair, the
central point of which marks the position of the central X-ray beam on the
patient.
For safety, the laser positioning device is switched off automatically after
1 minute.
WARNING
Laser radiation – Do not stare into beam or view directly
with optical instruments (Laser Class 2M according to IEC
60825-1:2007).
Please observe the provisions of IEC 60825-1, Section 3,
“User’s Guide” for operation of the laser positioning
device.
Viewing the laser output with certain optical instruments
(e.g. eye loupes, magnifiers and microscopes) within a
distance of 100 mm may pose an eye hazard.
CAUTION (USA)
LASER RADIATION – DO NOT STARE INTO BEAM
CLASS II LASER PRODUCT (in accordance with FDA 21
CFR, Subchapter J, Section 1040.10-11)
16.1 Applications
You can use the laser positioning device for the following tasks:
− As alignment aid for positioning the C-arm
− For foreign body localization
− As a navigational aid for nail fixations.
CAUTION
Use of controls or adjustments or performance of proce-
dures other than those specified herein may result in haz-
ardous radiation exposure.
Positioning aid The laser positioning device allows you to position the C-arm exactly
above the patient without having to initiate radiation:
• Press the Laser button.
A laser-beam crosshair is generated, the central point of which corre-
sponds to the position of the central X-ray beam.
• Position the C-arm in such a way above the patient that the central
point of the laser-beam crosshair is exactly in the center of the region
of interest.
• Initiate radiation.
CAUTION
Risk of injury by X-rays!
Put on X-ray protective clothing, if you initiate radiation by
pressing the fluoroscopy key on the monitor support arm.
Foreign body local- You can use the laser positioning device also for foreign body local-
ization ization: For that purpose, you must activate the on-screen crosshair first
(→ Ch. 18.2.4, p. 18-5).
CAUTION
Risk of injury by X-rays!
Put on X-ray protective clothing, if you initiate radiation by
pressing the fluoroscopy key on the monitor support arm.
The foreign body becomes visible in the image on the live screen.
• Position the C-arm in such a way above the patient that the center of
the crosshair on the screen lies exactly over the foreign body in the
fluoroscopic image.
• Press the Laser button.
The laser positioning device’s laser-beam crosshair now marks the
patient’s skin exactly above the point where the foreign body lies, thus
allowing a precise determination of the point of surgical incision.
17.1 Overview
The system can also be used for making direct radiographic film expo-
sures.
Direct radiographies are only possible if your system is equipped with a
film cassette holder (optional accessory).
• Pull the spring-loaded securing lever on the film cassette holder out-
wards.
• Slide the film cassette holder over the supporting ridge on the image
intensifier.
• Insert a loaded film cassette fully into the film cassette holder from the
side.
Image intensifier
Film cassette
Fig. 17-1 Fitting the film cassette holder and inserting the film cas-
sette
For direct radiography, you can set the following maximum collimator
apertures for the film or cassette size used:
23 cm image intensifier:
− 24 cm; the visible image has a diameter of 23 cm
WARNING
Make sure that the selected collimator aperture does not
exceed the cassette size used.
Manual settings For tube voltage, use the value that the system has automatically
selected during the previous fluoroscopy. You may correct this value
manually if necessary.
The mAs value (tube current in mA × time in s) is always set manually.
The tube current ranges from 15 mA to 20 mA. The system automatically
adjusts this value to reach the manually set value. The exposure time is
also computed automatically from the manually set value and appears
rounded to the first digit after the decimal point on the display.
WARNING
Make sure that the film cassette holder is properly
attached to the image intensifier, so that the cassette
cannot fall down onto the patient!
NOTE
Make sure that the source/skin distance is at least 45 cm.
• Set the desired tube voltage value using the arrow buttons.
• Set the desired tube current × time (mAs) value using the arrow
buttons.
• Initiate radiation using the hand switch or the Fluoroscopy key on the
monitor support arm. In the Radiography operating mode, you
cannot initiate radiation with the foot switch.
CAUTION
Risk of injury by X-rays!
Put on X-ray protective clothing, if you initiate radiation by
pressing the fluoroscopy key on the monitor support arm.
18.1 Overview
The control panel provides access to the Service Settings. This access Service settings
is password-protected. Consequently, the following settings and/or
actions can and must be made by trained service engineers only:
− Settings for anatomical programs
− DICOM settings
− Collimator adjustments
Function Under Operation Settings you define the settings which determine the
operational conditions during fluoroscopy.
• Press the Config tab.
The Configuration operating mode is activated. The Operation Set-
tings controls appear.
18.2.1 Autotransfer
Under Autotransfer you activate or deactivate the Autotransfer (auto- Moving the fluoro-
matic image swapping) function. scopic image
− Autotransfer activated:
When you initiate radiation, the fluoroscopic image on the live screen
is moved automatically to the reference screen.
− Autotransfer deactivated:
When you initiate radiation, the present fluoroscopic image on the live
screen is automatically deleted.
When you switch on the system, the Autotransfer function is deactivated
by default.
18.2.2 Autostore
− Autostore activated:
During each fluoroscopy, a new image will be saved automatically as
soon as you terminate radiation.
− Autostore deactivated:
The system does not save the images automatically. You must save
the desired fluoroscopic images manually (→ p. 7-16).
Under Image Swap with Save you activate and deactivate the Image
Swap with Save function.
The following table shows the crosshair setting options and their
meanings.
The crosshair is per- The crosshair is per- If you switch to the If you switch to the
manently hidden. manently shown. operating mode Fluo- operating mode Fluo-
roscopy or Sub- roscopy or Sub-
The Laser button (in The Laser button (in
traction, the laser traction, the laser
the operating modes the operating modes
positioning device is positioning device is
Fluoroscopy or Sub- Fluoroscopy or Sub-
hidden. shown.
traction) only traction) only
switches on the laser switches on the laser By pressing the Laser By pressing the Laser
positioning device. positioning device. button, the crosshair button, the crosshair
is shown and hidden. is shown and hidden.
Table 18-1 Correlation of crosshair and Laser button
To have the crosshair activated with the Laser button, do the fol-
lowing:
• Press the Config tab.
The Configuration operating mode is activated. The Operation Set-
tings controls appear.
• Press the Crosshair – with Laser on option.
The check box is checkmarked.
To discard the operation settings which have not been applied yet,
do the following:
• Press the Cancel button.
or
Under Basic Settings you make different settings which directly affect Function
the user interface, e.g. default data for the date or hospital department.
Usually, the basic settings are made by a service engineer when putting
the system into service. However, you can modify the basic settings if
you wish to.
• Press the Basic Settings button.
The Basic Settings controls are displayed in the dynamic control area.
The system date and the system time must be entered once in order to
enable the system to store and display the date and time of saving
together with the image data.
The displayed date format may vary depending on the customer-specific Date format
settings (order of day, month and year; dot or slash as date separator).
The set date format is also used for displaying patient data in the Patient
(→ Ch. 9.2, p. 9-2) and Archive (→ Ch. 9.3, p. 9-14) operating modes.
Throughout this document, the DD.MM.YYYY date format is used.
• If you want to change the date format, please contact your in-house
service engineer.
• Enter the system time in the Time input box using the format
hh:mm:ss.
• Press the Date button.
The button is highlighted in yellow, and the cursor jumps to the Date
input box.
Under Live Image you determine which screen will act as the live screen.
The live screen is the screen where the live fluoroscopic image is dis-
played. The other screen serves as reference screen, where the saved
fluoroscopic images from the image memory are opened and displayed.
In order to avoid having to type the same hospital data for each new
patient folder you create, you can preset default data for the Hospital,
Department and Doctor input boxes (→ Ch. 9.2.2, p. 9-10). This data
appears automatically in the Patient operating mode.
To define default data for the Hospital, Department and Doctor input
boxes, do the following:
• Press the Config tab.
The Configuration operating mode is activated.
• Press the Basic Settings button.
The Basic Settings controls are displayed in the dynamic control area.
• Press the Hospital button.
The button is highlighted in yellow, and the cursor jumps to the Hos-
pital input box.
After having defined or modified the basic settings, these settings must
be applied explicitly in order to become valid in the system. As long as
the settings or changes have not been applied yet, you can discard them,
so that the previous settings remain valid.
To discard the basic settings which have not been applied yet, do
the following:
• Press the Cancel button.
or
Under Cine you preset the frame rate (speed) and the number of frames
(length) that are used for generating cine loops. You can change these
preset values during operation for each cine loop you acquire.
• Select the desired frame rate (number of frames per second) under
Rate with the help of the arrow buttons.
• Press the Apply button.
When you acquire a cine loop, the selected value is preset under
Frames/s (→ p. 11-3).
Under Autoplay you activate or deactivate the Autoplay (automatic cine Autoplay function
loop playback) function.
− Autoplay activated:
After you have acquired a cine loop, it is replayed automatically.
− Autoplay deactivated:
You must start cine loop playback manually.
When you switch on the system, the Autoplay function is deactivated by
default. If you activate the Autoplay function during operation, it will be
deactivated automatically when you switch off the system.
Under DSA (for Germany - SUB) you determine whether the native
image is displayed on the reference screen during generation of a DSA
(→ Ch. 12.2, p. 12-2).
− Native on activated:
When you generate a DSA cine loop (for Germany - SUB cine loop),
the native image is displayed on the reference screen.
− Native on deactivated:
When you generate a DSA cine loop (for Germany - SUB cine loop),
the native image is displayed on the reference screen. Before
switching to the Subtraction operating mode, you may open a ref-
erence image on the reference screen, which remains displayed there
during the entire subtraction process.
• Press the SUB Native on check box under SUB (Germany only).
The check box is checkmarked.
• Press the Apply button.
When you generate a DSA cine loop (for Germany - SUB cine loop),
the native image is displayed on the reference screen.
After having defined or modified the settings on this tab, these settings
must be applied explicitly in order to become valid in the system. As long
as the settings or changes have not been applied yet, you can discard
them, so that the previous settings remain valid.
To discard the settings which have not been applied yet, do the fol-
lowing:
• Press the Cancel button.
or
Function Under Storage Media you can define the storage formats used for
saving images to different storage media. Furthermore, you can delete
data from different external storage media.
Depending on your chosen system configuration, you can save one or Storage formats
more images in various storage formats to different storage media. Some
formats with reduced resolution and color depth are also available.
NOTE
Saving image data with a resolution of 512 × 512 pixels
may lead to information loss.
For saving selected images to a USB storage medium (→ p. 9-34) in the Storage formats
Archive operating mode, the following storage formats are available:
− TIF with a color depth of 16 bit (for further use on a PC)
− JPEG with a resolution of 512 × 512 pixels and a color depth of 8
bit (for further use on a PC)
− DICOM (for further use on a DICOM network or viewing with a
DICOM viewer in 1024 × 1024 pixels/16 bit original format)
− DICOM with a resolution of 512 × 512 pixels and a color depth of
8 bit (for further use on a DICOM network or viewing with a DICOM
viewer)
Under USB Format you determine which of these storage formats is
used for saving images to a USB stick. There is no possibility to set the
desired storage format on the spot in the Archive operating mode when
saving images.
DVD writer With the DVD writer, data can be written to DVDs.
Storage formats For writing selected images to DVD in the Archive operating mode
(→ p. 9-35), the following storage formats are available:
− TIF with a color depth of 16 bit (for further use on a PC)
− JPEG with a resolution of 512 × 512 pixels and a color depth of 8
bit (for further use on a PC)
− DICOM (for further use on a DICOM network or viewing with a
DICOM viewer in 1024 × 1024 pixels/16 bit original format)
− DICOM with a resolution of 512 × 512 pixels and a color depth of
8 bit (for further use on a DICOM network or viewing with a DICOM
viewer)
− Multimedia (JPG and AVI files for viewing or replaying on the PC)
Under DVD Format you determine which of these storage formats is
used for writing the images to DVD. There is no possibility to set the
desired storage format on the spot in the Archive operating mode when
saving images.
You can select the desired DICOM storage server from the drop-down list
box below the storage formats (→ Fig. 18-21, p. 18-20). You can access
only the servers that have been enabled by your in-house service
engineer.
Under Quick Cine Export you can activate or deactivate the Quick Cine
Export function (export of a reduced number of images in order to save
them on a storage medium).
If you activate the Quick Cine Export function during operation, it will be
deactivated automatically when you switch off the system.
Screen settings You can change the following screen settings yourself:
− Brightness
− Contrast
− Backlight brightness
− Menu language for screen settings
In addition, you can restore the factory settings.
The factory-set menu language is English. Therefore, the English desig-
nations are used in this document.
If you want to change any of the following screen settings, please contact
your in-house service engineer:
− Video source (Inputs)
− Gamma
− Display settings (Picture), e.g. horizontal and vertical position,
sharpness, scaling
− Menu setup (Setup), e.g. menu lock (exception: language setting)
Safety measures
NOTICE
The system may only be set up and put into service by
service engineers who are authorized by the manufac-
turer.
If service is needed, the system may only be repaired by
authorized service engineers.
WARNING
When the system is opened, there is a risk of electric
shock. The system may only be opened by qualified
service personnel.
To prevent fire or electric shock, the system must not be
exposed to rain or moisture.
The system must not be operated next to flammable
anesthetic gas mixtures of air, oxygen and nitrogen
oxides.
• Select the Setup tab with the help of the + or – arrow keys.
• Press the SCROLL key until the Menu Lock item is highlighted.
Each flat-screen monitor has a built-in keypad with six keys, which are Built-in keypad
used for accessing the screen setting menus.
NOTE
Lowering the backlight level will increase the backlight
lifetime.
Setting the menu The factory-set menu language is English. You can choose one of the fol-
language lowing languages as menu language:
− German
− French
− Italian
− Swedish
− Spanish
− Dutch
• Select the Setup tab with the help of the + or – arrow keys.
• Move to the Language item with the help of the SCROLL key.
After having changed the screen settings, you may restore the factory- Restoring the fac-
set values at any time. tory settings
• Select the Defaults tab with the help of the + or – arrow keys.
Safety measures
NOTICE
The system may only be set up and put into service by
service engineers who are authorized by the manufac-
turer.
If service is needed, the system may only be repaired by
authorized service engineers.
WARNING
When the system is opened, there is a risk of electric
shock. The system may only be opened by qualified
service personnel.
To prevent fire or electric shock, the system must not be
exposed to rain or moisture.
The system must not be operated next to flammable
anesthetic gas mixtures of air, oxygen and nitrogen
oxides.
Menu display
NOTE
The menu display for setting the brightness and contrast
is not locked. Do not change the values in order to ensure
optimum display settings.
Built-in keypad Each flat-screen monitor has a built-in keypad with four keys, which are
used for accessing the screen setting menus.
NOTE
Lowering the backlight level will increase the backlight
lifetime.
Setting the menu The factory-set menu language is English. Alternatively, you can choose
language German as the menu language:
Restoring the fac- After having changed the screen settings, you may restore the factory-
tory settings set values at any time.
18.7.1 Overview
Safety measures
NOTICE
The system may only be set up and put into service by
service engineers who are authorized by the manufac-
turer.
If service is needed, the system may only be repaired by
authorized service engineers.
WARNING
When the system is opened, there is a risk of electric
shock. The system may only be opened by qualified
service personnel.
To prevent fire or electric shock, the system must not be
exposed to rain or moisture.
The system must not be operated next to flammable
anesthetic gas mixtures of air, oxygen and nitrogen
oxides.
Built-in keypad The flat-screen monitor has a built-in keypad (→ Fig. 18-28) with six
keys, which are used for accessing the screen setting menus.
Screen settings On systems with flat-screen monitors, the screen settings are made
directly on the monitors using a built-in keypad.
You can change the following screen settings yourself:
− Brightness
− Contrast
− Backlight
− Menu language for screen settings
In addition, you can restore the factory settings.
NOTE
Lowering the backlight level will increase the backlight
lifetime.
The factory-set menu language is English. You can choose one of the fol-
lowing languages as menu language:
− German
− French
− Italian
− Swedish
− Spanish
− Dutch
• Select the Setup tab with the help of the + or – arrow keys.
• Move to the Language item with the help of the SCROLL key.
After having changed the screen settings, you may restore the factory-
set values at any time.
To restore the factory settings, do the following:
• Press the MENU key.
The on-screen menu appears.
• Select the Defaults tab with the help of the + or – arrow keys.
NOTE
For a detailed maintenance schedule, please refer to the
corresponding Technical Manual. Technical information
necessary to repair or upgrade the system will be made
available by Ziehm Imaging to authorized and qualified
personnel upon request.
At regular intervals, at least once a month, you must check whether the
system shows any deviations from the reference values by performing a
consistency test.
NOTE
The relevant radiation protection regulations of the
country of installation must be observed.
Check the displayed dose values during the regular consistency test by
comparing them to the values of a reference measurement.
Quantitative method:
The system is in its initial state after switching it on.
The following value must be achieved:
70±3 kV
Measured with a 25 mm Al + 1.5 mm Cu patient equivalent filter inserted
in the X-ray beam.
Test interval You should check the dose meter each time you switch on the system.
You must perform and document a dose meter check once a month when
you perform the consistency test.
If the measured values are beyond the tolerance limits, the following
message appears:
DAP fault; nominal value: x, actual value: y
• Confirm by pressing the Yes button.
• If the values are beyond the tolerance limits, repeat the dose meter
check.
• If the values measured are still beyond the tolerance limits, please
contact your in-house service engineer.
Check the displayed dose values during the regular consistency test by
comparing them to the values of a reference measurement.
Inspection interval Together with the consistency test, it is necessary to check the size and
centering of the useful X-ray beam.
Centering To determine the correct alignment of the X-ray beam to the center of the
image intensifier and any possible deviation, do the following:
• Angulate the C-arm by 180°, so that the X-ray generator is above and
the image intensifier or digital flat-panel detector is below.
Collimator diameter The size of the collimator diameter in the image plane must not differ from
accuracy the nominal image diameter by more than 2% of the source/image
receptor distance (SID). The SID and the nominal image diameter
depend on the image intensifier or flat-panel detector size.
Maximum radiation When the iris collimator is completely open, the edges of the collimator
field size must be just visible on the screen.
To increase the useful life of the image intensifier, we recommend get- Increasing the
tering the image intensifier tube after a period of 6 months of continuous useful life
non-use or storage.
We recommend keeping an operator’s log, where all operating times, Operator’s log
gettering times and maintenance events are recorded.
Preparation Always switch off the system and disconnect it from the power supply
before cleaning or disinfecting it.
A.2.1 Cleaning
Recommended For cleaning the system, use only water with mild detergents applied with
detergents a slightly damp cloth. Never use abrasive cleansing agents, organic sol-
vents or detergents which contain solvents (e.g. alcohol, petroleum
ether, liquid stain remover).
NOTE
If the unit presents dirt stains that cannot be removed with
the method described above, please contact your in-
house service engineer.
WARNING
Take care that no liquids penetrate into the unit through
sockets, plugs, ventilation holes or gaps (integrated
external devices!).
Never apply spray cleaners directly onto the unit!
Cleaning the For cleaning the display screens, use only pure alcohol or a mixture con-
monitor screens sisting of 1/3 alcohol and 2/3 distilled water. Wipe the screens and sur-
rounding painted surfaces dry with a soft cotton cloth immediately after
cleaning.
A.2.2 Disinfection
You must use one disinfectant that is suitable for disinfecting the system
(for details refer to the operating instructions of the disinfectant provided
by its manufacturer):
• Dampen a cloth with the solution and thoroughly wipe the entire
outside of the unit with this cloth.
NOTE
We recommend users in Canada to use the following dis-
infectant:
− Optim 33 TB (Canadian Drug Identification Number
(DIN) 02282488)
WARNING
Never use pure alcohol or Sagrotan for disinfection, as
these substances may corrode the surfaces.
Never use disinfecting sprays, since the liquid droplets
may penetrate inside the unit, endangering safe system
operation. Electronic components may be damaged, and
explosive air/solvent vapor mixtures may develop.
A.2.3 Sterilization
CAUTION
The disposable covers are not resterilizable.
Be sure to discard the disposable covers properly after
use!
For attaching the sterile disposable covers to the C-arm → Appendix B.1,
p. B-1.
A.3 Malfunctions
WARNING
If an error message is displayed, the system is not ready
for operation!
The error must be corrected by your after-sales service
center!
Please communicate the error code number (E...) and the
serial number of the system to your after-sales service
center.
WARNING
If an error message is displayed, the system is not ready
for operation!
The error must be corrected by your after-sales service
center!
Please communicate the error code number (E...) and the
serial number of the system to your after-sales service
center.
WARNING
Please contact your after-sales service center also if a
certain error occurs frequently!
ON-OFF-circuit If the mains fuse on the C-arm stand (→ Fig. A-3) has triggered (rocker
breaker with rocker switch in OFF position, circuit breaker is not illuminated), you can switch
switch it on again.
Circuit breaker
A.4 Labels
3#
1#a
3( 1(
2(b
H
1!
1)
G
1#b
4!b-4@b
1!
1)
B 1&b
Foot switch labels (41b-42b)
→ Ch. A.6, p. A-35 5%
2@ 2#
Fig. A-5 Labels on C-arm stand, side view (left) and view from
above (right)
I
1$ 1%
1$
1%
SERCAN con-
nection
DICOM connection
(RJ45)
VIDEO OUT 1
USB port LM
VIDEO OUT 2
RM
VIDEO OUT
Connection for
external radiation
warning lamp 2%a/b
The labels shown in the following table are merely reproductions. Their
sizes and colors may differ from reality and serve illustrative purposes
only.
German-speaking countries 1
ZIN Art. No.: 58390
2@ Equipotential grounding 1
ZIR Art. No.: 10-2964
ZIN Art. No.: 58331
Table A-4 Labels (n/a for USA) (cont.)
5% EU countries only 1
ZIN Art. No.: 58408
1#a
3(
2(b 1(
3&+3*
3%+3^
2)/2! G
1#b
4!b-4@b
1!
1@
J
C D
E F 1)
B
Foot switch labels (41b-42b)
→ Ch. A.6, p. A-35
4)
2@ 2#
Fig. A-9 Labels on C-arm stand, side view (left) and view from
above (right)
3^ 1& a i
3% 1$
3! b 1%
(23 cm image
intensifier)
1*a
3)
front
1^
Fig. A-10 Labels on the generator (USA)
1# a
3@
1%
1^
1* b
1&b 1$
front rear
The labels shown in the following table are merely reproductions. Their
sizes and colors may differ from reality and serve illustrative purposes
only.
D Canada only 1
ZIR Art. No.: 10-2937
ZIN Art. No.: 58451
2! Canada only 1
ZIR Art. No.: 10-2963
ZIN Art. No.: 58455
2@ Equipotential grounding 1
ZIR Art. No.: 10-2964
ZIN Art. No.: 58331
2# Spare GND connection 1
ZIR Art. No.: 10-2965
ZIN Art. No.: 58338
Table A-5 Labels (USA) (cont.)
3^ Canada only 1
ZIR Art. No.: 10-2978
ZIN Art. No.: 58461
Canada only
ZIR Art. No.: 10-2982
ZIN Art. No.: 58463
3( ZIR Art. No.: 10-2983 1
ZIN Art. No.: 58407
4!a-4@a
Reference axis
8°
Focal spot Anode
(red dot) angle
80
75
70
65
60
Temp. (°C)
55
50
45
40
35
30
25
20
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36
Time (min.)
70
65
60
55
Temp. (°C)
50
45
40
35
30
0 15 30 45 60 75 90 105 120 135 150 165 180 195 210 225 240 255 270 285 300 315 330 345 360 375
Time (min.)
Copper
Water
phantom
Patient
positioning Significant zone of
occupancy
80 × 60 × 200 cm
A.10 Dimensions
C-arm stand
Tube
Image intensifier
During storage/transport
Environmental
C-arm
Source/image receptor distance
970 mm
Vertical free space (generator/i.i.)
Dimensions
760 mm
C-arm depth 680 mm
Orbital rotation 23 cm i.i.: 135° (+45° – -90°)
Angulation ±225°
Swiveling (panning) ±10°
Horizontal movement 220 mm
Vertical movement 420 mm
C-arm stand
Weight
Systems with a voltage / 100 VAC ± 10%, 120 VAC ± 10%, 200 VAC ± 10%,
frequency rating of: 50/60 Hz 50/60 Hz 50/60 Hz
Power supply fuse C 20 A or C 32 A C 20 A C 20 A or C 32 A
rating
(tripping characteristic C acc. to VDE 0641, Part 11; DIN EN
60898 + IEC 898)
Required residual IN ≥ 20 A, IN ≥ 20 A, IN ≥ 16 A,
current circuit
breaker (RCD) IAN = 30 mA IAN = 30 mA IAN = 30 mA
Systems with a voltage / 100 VAC ± 10%, 120 VAC ± 10%, 200 VAC ± 10%,
frequency rating of: 50/60 Hz 50/60 Hz 50/60 Hz
Power
Direct radiography
40–110 kV 40–110 kV 40–110 kV
12 mA min./ 15 mA min./ 15 mA min./
20 mA max., 20 mA max., 20 mA max.,
1.5 mAs min./ 1.5 mAs min./ 1.5 mAs min./
100 mAs max. 100 mAs max. 100 mAs max.
Fluoroscopy
40–110 kV 40–110 kV 40–110 kV
1.5–10 mA 1.5–10 mA 1.5–10 mA
1.5–20 mA (USA) 1.5–20 mA (USA) 1.5–20 mA (USA)
Pulsed fluoroscopy
Pulse width 10-30 ms
1, 2, 4, 8, 12.5, 25 pulses/s (on systems with 50 Hz)
1, 2, 5, 10, 15, 30 pulses/s (on systems with 60 Hz)
Generator
Systems with a voltage / 100 VAC ± 10%, 120 VAC ± 10%, 200 VAC ± 10%,
frequency rating of: 50/60 Hz 50/60 Hz 50/60 Hz
Digital radiography
110 kV / 12 mA 110 kV / 15 mA 110 kV / 18 mA
65 kV / 20 mA 80 kV / 20 mA 80 kV / 20 mA
Max. power output
Fluoroscopy
1100 W 1100 W 1100 W
(110 kV / 10 mA) (110 kV / 10 mA) (110 kV / 10 mA)
Direct radiography
1320 W 1650 W 1650 W
(110 kV / 12 mA) (110 kV / 15 mA) (110 kV / 15 mA)
Digital radiography
1320 W 1650 W 1980 W
(110 kV / 12 mA) (110 kV / 15 mA) (110 kV / 18 mA)
Nominal electric power
1000 W at 100 kV / 1000 W at 100 kV / 1000 W at 100 kV /
Generator
Systems with a voltage / 220 VAC ± 10%, 230 VAC ± 10%, 240 VAC ± 10%,
frequency rating of: 50/60 Hz 50/60 Hz 50/60 Hz
Power supply fuse C 16 A (tripping characteristic C acc. to VDE 0641, Part 11; DIN
rating EN 60898 + IEC 898)
Required residual IN ≥ 16 A, IAN = 30 mA
current circuit
breaker (RCD)
Typical current 12 A continuous,
consumption 16 A momentary
Power supply in standby mode
approx. 370 VA (approx. 1.6 A)
System
Fluoroscopy
40–110 kV
1.5–10 mA
1.5–20 mA (USA)
Pulsed fluoroscopy
Pulse width 10-30 ms
1, 2, 4, 8, 12.5, 25 pulses/s (on systems with 50 Hz)
1, 2, 5, 10, 15, 30 pulses/s (on systems with 60 Hz)
Table A-9 Systems with a voltage rating of 220 V, 230 V, 240 V
Systems with a voltage / 220 VAC ± 10%, 230 VAC ± 10%, 240 VAC ± 10%,
frequency rating of: 50/60 Hz 50/60 Hz 50/60 Hz
Digital radiography (snapshot)
40-110 kV
0.1 mA min./
20 mA max.
Operating fre- 20 kHz
quency
DC-HV ripple 40 kHz
Max. operating data
Fluoroscopy
110 kV / 10 mA
110 kV / 18 mA (USA)
80 kV / 10 mA
Direct radiography
110 kV / 15 mA
110 kV / 18 mA (USA)
80 kV / 20 mA
Digital radiography
Generator
110 kV / 18 mA
80 kV / 20 mA
Max. power output
Fluoroscopy
1100 W (110 kV / 10 mA)
Direct radiography
1650 W (110 kV / 15 mA)
Digital radiography
1980 W (110 kV / 18 mA)
Nominal electric power
1000 W at 100 kV / 10 mA / 0.1 s
X-ray tube
Single-focus stationary-anode tube
Focal spot nominal size, in relation to reference axis
0.6 acc. to IEC 336
Focal spot horizontal tolerance, in relation to reference axis
± 0.5 mm (controlled)
Table A-9 Systems with a voltage rating of 220 V, 230 V, 240 V (cont.)
Systems with a voltage / 220 VAC ± 10%, 230 VAC ± 10%, 240 VAC ± 10%,
frequency rating of: 50/60 Hz 50/60 Hz 50/60 Hz
Anode angle, in relation to reference axis
8°
Anode material
Generator
Tungsten
Total filtration
≥ 3.9 mm Al, including Cu ≥ 0.1 mm
Maximum X-ray tube loading factors for
1h; 3 mA at 110 kV 10800 mAs/h
Table A-9 Systems with a voltage rating of 220 V, 230 V, 240 V (cont.)
NOTICE
Temperatures above 40°C and relative air humidity above
60% may cause stains on the printer’s heat-sensitive
paper.
Additional absorption 3 mm Al
Voltage correction
Additional absorption: 3 mm Al filtration
Correction factor
B Collapsible-folded hose
facilitates placement over the
spring clasp.
UNIVERSAL
Ziehm C-SET Hose cover B for image intensifier: R for X-ray tube assembly:
REF: 341 B/R # 34100 3 # 30077 2 # 30054
7 # 30094
0 without – please order
separately
Rev.: 11-09-2005 / P0142-01
STERINORM UNIVERSAL Ziehm C-Arm Set Rev03.doc
Ziehm Solo i
P_28482_CD_28483 - EN-18/09/2009
Index
ii Ziehm Solo
P_28482_CD_28483 - EN-18/09/2009
Index
iv Ziehm Solo
P_28482_CD_28483 - EN-18/09/2009
Index
Ziehm Solo v
P_28482_CD_28483 - EN-18/09/2009
Index
vi Ziehm Solo
P_28482_CD_28483 - EN-18/09/2009
Index
Ziehm Solo ix
P_28482_CD_28483 - EN-18/09/2009
Index
x Ziehm Solo
P_28482_CD_28483 - EN-18/09/2009
Index
Start screen
Defining 18-6 T
Steering
C-arm stand 4-4 Tab ‘Archive’ 5-7, 9-14, 9-21, 9-24, 9-39,
Steering & braking lever 9-40, 9-41, 9-42, 9-43, 9-44, 10-16,
on the C-arm stand 2-8 10-17, 10-18, 10-19, 10-21, 10-24,
Step windowing 8-3 11-4
Step windowing (post-processing) 13-4 Tab ‘Config’ 5-7, 18-2, 18-3, 18-4, 18-5, 18-6,
Sterilization A-7 18-7, 18-9, 18-10, 18-13, 18-14, 18-18,
Stop (button) 11-6, 11-7, 12-5, 12-6, 12-7 18-19, 18-21, A-2
Stop image of a cine loop 11-6, 12-6 Tab ‘Fluoro’ 5-6
Stop Img (button) 11-7, 12-6 Tab ‘Measure’ 5-6, 14-4, 14-5, 14-12
Storage Commitment 10-26 Tab ‘Patient’ 5-6, 9-3, 9-11, 9-12, 9-23, 10-2,
Automatic 10-27 10-3, 10-6, 10-8, 10-11
Storage format Tab ‘Post Proc.’ 5-6, 13-3
DVD 18-18 Tab ‘Radiogr.’ 5-6, 17-2
USB 18-17 Tab ‘Radiography’ 5-6, 17-2
Storage media 18-16 Tab ‘Subtraction’ 5-6, 12-3
Storage Media (button) 18-18, 18-19, 18-21 Technical Data A-40
Studies (DICOM list) 10-21 Temperature in the generator 7-21
SUB 12-1 Temperature monitoring 7-21
SUB (button) 5-11, 12-3 Temperature symbol 5-8, 7-21
SUB cine loop 12-1 Text
Subject 9-2 Adding to an image 15-5
Subtracted image 12-2 Deleting 15-6
Subtraction (operating mode) 5-9, 7-1 Editing 15-6
Defining as start screen 18-6 Processing 15-4
Subtraction (tab) 5-6, 12-3 Text (button) 5-6, 15-4, 15-5
Subtraction Modes Text (mode) 15-4
Acquiring a DSA cine loop 12-2 Three-point (button) 14-8
DSA 12-1 Time (button) 18-9
Mask image 12-1 Time (input box) 18-9
Native image 12-1 Time of saving
SUB 12-1 Information on the screen 15-2
Subtracted image 12-2 Touchpad (digital zoom) 8-12
Switches Transport position
Hand switch 5-13 System 4-1
Two-pedal foot switch 5-13 Two-pedal foot switch 5-13
Switching off in emergency situations 6-4 Assignment 5-13
Swiveling (panning) Two-Point (button) 14-5
C-arm 4-8 Typographical conventions 1-2
System
ON/OFF switches 6-3
Preparing 6-1
Switching on 6-3
Transport position 4-1
U
System date 18-9 Up Arrow (button) 5-5
System time 18-9 Uro (button) 5-5
USA
Labels on the C-arm stand A-26
Labels on the generator A-27
Labels on the image intensifier A-27
Labels on the two-pedal foot switch A-35
Ziehm Solo xi
P_28482_CD_28483 - EN-18/09/2009
Index
W
Warning function (radiation time) 7-20
Warning symbols
Temperature 5-8, 7-21
X-rays 5-8, 7-15, 7-20