Planmed Nuance Classic: User's Manual

Planmed Nuance Classic
™
EN
user's manual
20003127_6
Table of contents
1 INTRODUCTION ................................................................................................................. 1
1.1 Potential adverse events ............................................................................................................. 1
2 SYMBOLS .......................................................................................................................... 2
2.1 Notes, cautions, and warnings .................................................................................................... 2
3 WARNINGS AND PRECAUTIONS ....................................................................................... 3
4 CHECKLIST BEFORE OPERATION .................................................................................... 4
5 RELATED MANUALS .......................................................................................................... 4
6 NUANCE CLASSIC - MAIN PARTS ..................................................................................... 5
6.1 General view of the X-ray unit (standard configuration) .............................................................. 5
6.2 Compression paddles .................................................................................................................. 6
6.3 Buckys ......................................................................................................................................... 7
6.4 Multifunction magnification platform (for magnification views only) ............................................. 7
6.5 Chin guard ................................................................................................................................... 7
6.6 Film markers ................................................................................................................................ 8
6.7 Exposure button .......................................................................................................................... 8
6.8 CR interface adapter (optional) ................................................................................................... 8
6.9 Main control panel ....................................................................................................................... 9
6.10 X-ray unit controls ...................................................................................................................... 15
7 MAXVIEW BREAST POSITIONING SYSTEM (OPTIONAL) ................................................ 19
7.1 MaxView accessories ................................................................................................................ 19
7.2 MaxView sheet controls ............................................................................................................. 21
8 SWITCHING THE X-RAY UNIT ON .................................................................................... 22
9 PREPARING THE X-RAY UNIT ......................................................................................... 23
9.1 Attaching and removing the Bucky ............................................................................................ 23
9.2 Attaching and removing the compression paddle ...................................................................... 24
9.3 Paddle lock (optional) ................................................................................................................ 25
9.4 Attaching and removing the magnification platform
(for magnification views only, optional) ...................................................................................... 26
9.5 Loading the cassette ................................................................................................................. 26
9.6 Activating automatic paddle release & cassette ejection ........................................................... 27
9.7 Adjusting the film density ........................................................................................................... 27
9.8 Preparing the X-ray unit for MaxView Breast Positioning (optional) .......................................... 28
9.9 Ejecting the MaxView sheets (optional) ..................................................................................... 30
10 SETTING THE EXPOSURE VALUES AND SELECTING THE VIEW ................................... 31
10.1 Setting the exposure values ...................................................................................................... 31
10.2 Selecting the view ...................................................................................................................... 31
10.3 Normal view selection ................................................................................................................ 33
10.4 Three-second view selection ..................................................................................................... 33
10.5 Fine-tuning the viewing angle .................................................................................................... 34
10.6 Adjusting the X-ray unit height ................................................................................................... 34
10.7 Side Access Patient Positioning (optional) ................................................................................ 35
11 SCREENING MAMMOGRAPHY WITH NUANCE CLASSIC ................................................. 36
11.1 Breast positioning and compression with MaxView (optional) ................................................... 36
11.2 Breast positioning and compression without MaxView .............................................................. 38
11.3 Emergency compression release .............................................................................................. 39
11.4 Taking an exposure ................................................................................................................... 40
11.5 After the exposure ..................................................................................................................... 40
User’s manual Planmed Nuance Classic 1

Table of contents
12 DIAGNOSTIC MAMMOGRAPHY WITH NUANCE CLASSIC ............................................... 42

12.1 Magnification procedures (optional) ........................................................................................... 42
12.2 Biopsy procedures ..................................................................................................................... 44
13 FLEX AEC PRINCIPLES AND USER SETTINGS ............................................................... 46
13.1 Principles of the Flex AEC operation ......................................................................................... 46
13.2 Flex AEC user settings .............................................................................................................. 46
14 SPECIAL FUNCTIONS ...................................................................................................... 54
14.1 Automatic rhodium/molybdenum filter selection ........................................................................ 54
14.2 Setting the oblique view angle ................................................................................................... 55
14.3 Taking exposures manually ....................................................................................................... 55
14.4 Setting the time and date ........................................................................................................... 55
14.5 Setting the speed of the compression paddle movement .......................................................... 56
14.6 Setting the stop limit of the compression force .......................................................................... 57
14.7 Adjusting the volume of the exposure indicator signal ............................................................... 57
14.8 Enabling and disabling the Bucky grid movement ..................................................................... 57
14.9 mA limit (on/off) .......................................................................................................................... 58
15 TRANSPORTING NUANCE CLASSIC
(ONLY UNITS WITH A FREE STANDING BASE) ............................................................... 59
15.1 Preparing the X-ray unit for transportation ................................................................................. 59
15.2 Setting up the X-ray unit after transportation ............................................................................. 61
16 HELP MESSAGES ............................................................................................................ 62
17 ERRORS AND ERROR MESSAGES ................................................................................. 64
18 MAINTENANCE ................................................................................................................ 74
18.1 Daily check ................................................................................................................................ 74
18.2 Cleaning ..................................................................................................................................... 74
18.3 Servicing .................................................................................................................................... 75
18.4 MaxView maintenance ............................................................................................................... 75
19 DISPOSAL OF THE X-RAY UNIT ...................................................................................... 78
20 TECHNICAL SPECIFICATIONS ........................................................................................ 79
21 LIST OF ABBREVIATIONS ................................................................................................ 82
The manufacturer, assembler and importer are responsible for the safety, reliability and
performance of the unit only if:
- installation, calibration, modification and repairs are carried out by qualified author-
ised personnel
- electrical installations are carried out according to the appropriate requirements such
as IEC 60364
- equipment is used according to the operating instructions.
Planmeca pursues a policy of continual product development. Although every effort is

made to produce up-to-date product documentation this publication should not be re-
garded as an infallible guide to current specifications. We reserve the right to make
changes without prior notice.
COPYRIGHT PLANMED
Publication number 2003127 Revision 6
Released 10 July 2014
2 Planmed Nuance Classic User’s manual

1 INTRODUCTION
1 INTRODUCTION
This manual describes how to set up and use the
Planmed Nuance Classic mammography X-ray unit. This
X-ray unit must only be used for mammography.
NOTE
The use of Planmed Nuance Classic mammography X-ray
unit is allowed only under supervision of a health care
professional.
NOTE
For the optional MaxView Positioning System, refer to
section 7 “MAXVIEW BREAST POSITIONING SYSTEM
(OPTIONAL)” on page 19.
The Planmed Nuance Classic mammography X-ray unit

fulfills the requirements of Directive 93/42/EEC and
0598 complies to classification according to European Council
Directive 93/42/EEC: Class IIB.
NOTE
This manual is valid for the following Planmed Nuance
Classic software revisions:
- rear processor 1.0 or later
- tube head processor 1.0 or later
- shelf processor 1.0 or later
- AEC processor 1.0 or later.
All key illustrations indicate that the key should be

pressed, or where indicated, pressed and held down.
Pressing a key will switch a function on or off depending
on the original setting. When a function is on, or activated,
the key indicator light will either come on or start to flash.
The display values in this manual are only examples and
26 should not be interpreted as recommended values unless
otherwise stated.
NOTE
This manual includes also descriptions of optional items
that vary from market to market.
1.1 Potential adverse events

The potential adverse effects apply to mammography with
the Planmed Nuance Classic X-ray unit:
• Excessive breast compression
• Excessive X-ray exposure
• Electric shock
• Infection
• Skin irritation, abrasions, or puncture wounds

2 SYMBOLS
2 SYMBOLS
Type B equipment (Standard IEC 60601-1).
Alternating current (Standard IEC-60417).
Attention, consult accompanying documents (Standard

IEC 60601-1).
Electrostatic sensitive device (Standard IEC 60417).
Separate collection for electrical and electronic equipment

according to Directive 2002/96/EC (WEEE).
2.1 Notes, cautions, and warnings
NOTE
Note messages are used to indicate information which
may be helpful or of special interest to the reader.
CAUTION
Caution statements alert the user to the possibility of
a problem with the unit associated with its use or mis-
use. Such problems include unit malfunction, unit fail-
ure, damage to the unit or damage to other property.
WARNING
Warning statements alert the user to the possibility of
personal injury to the user or the patient, or other
serious damage associated with the use or misuse of
the unit.

3 WARNINGS AND PRECAUTIONS
3 WARNINGS AND PRECAUTIONS

CAUTION
This mammography X-ray unit may be dangerous to
both patient and operator unless correct operating
procedures are observed.
NOTE
Handle the Planmed Nuance Classic mammography X-
ray unit according to the instructions given in this manual.
NOTE
Portable and mobile RF communication equipment can
affect the Planmed Nuance mammography X-ray unit.
NOTE
The operator must protect himself against scattered
radiation. The minimum required protective shielding is 60
cm wide, minimum 185 high, and less than 15 cm above
the floor. The material used must have a minimum
attenuation equivalent of 0,08 mm of lead and it must
provide visibility to the patient and equipment. Note that
local regulations must be obeyed in case they differ from
the above.
NOTE
EMC requirements have to be considered and the
equipment must be installed and put into service according
to the specific EMC information provided in the
accompanying documents.
CAUTION
Planmed Nuance Classic mammography X-ray unit is
not suitable for use in the presence of a flammable
anaesthetic mixture with air or with oxygen or nitrous
oxide.

4 CHECKLIST BEFORE OPERATION
4 CHECKLIST BEFORE OPERATION
WARNING
It is very important that the place where the X-ray unit
is to be used and the position from which the user it
to operate the X-ray unit are correctly shielded. Since
radiation safety requirements vary from country to
country and state to state it is the responsibility of the
user to ensure that all local safety requirements are
met.
• Make sure that you are fully acquainted with the

appropriate radiation protection measures and these
operating instructions before using the X-ray unit.
• The X-ray unit is designed to operate using a line
voltage between 187 and 265 V~(50/60 Hz) and a
line current of 15 A. If the X-ray unit is being used in a
new location for the first time check that the power
supply you intend to use is suitable for the X-ray unit.
• Make sure that the exposure switch is installed
behind a radiation protection screen.
• Always use fresh film. Store and handle the film
according to the manufacturer’s instructions.
• Make sure that the film and screen are compatible.
• Make sure that the intensifying screen is clean and
free from dust. Clean the screen at the beginning of
each working session.
• Make sure that the film processor is correctly set up
for processing mammography films.
• Film viewing facilities should be available on site so
that the radiographs can be examined. Make sure
that the illumination level of the viewing equipment
being used meets the film manufacturer’s
recommendations.
5 RELATED MANUALS
• Planmed Nuance Classic DigiGuide User’s Manual
(optional)
• Planmed Nuance Classic Cytoguide User’s Manual
(optional)

6 NUANCE CLASSIC - MAIN PARTS
6.1 General view of the X-ray unit (standard configuration)
MaxView Breast
Positioning Tube head assembly
System (optional)
C-arm controls
Electromechanical
compression control C-arm
Chin guard
Hand rail
Compression paddle
Bucky
CL_Nuance_main_lip.eps
C-arm controls
Main control panel
Telescopic column Column

Fixed column
On/Off switch
kg
Base display
cm
Base
Remote
control
cable
Pwr_swich.eps
Foot controls
CR
Inte
rfac
e Ada
pte
CR adapter.eps
r
Exp
Sw
itch
X-ra
yU
nit
CR interface adapter
(optional)

6.2 Compression paddles

The standard compression paddles are equipped with the
Flex AEC area markings. Optional compression paddles
include large area, magnification, spot and multihole and
rectangular biopsy paddles
3
2 3
1 2
1
Magnification
spot paddle 10 x 7 Compression paddle 24x30 cm
Compression paddle 18x24 cm
Magnification
spot paddle 10 x 10
Perforated biopsy paddle Perforated multi-hole

hole diameter 20 mm biopsy paddle 18x24 cm
hole diameter 8 mm
A
9
78
B
C
56
Rectangular biopsy paddle 18x24 cm
D
34
E
12
Spot paddle 10 x 7
A
B
biopsy opening 50x90 mm

C
D
E
for contact view
Spot paddle 10 x 10
for contact view

6.3 Buckys
There are two sizes of carbon fibre Buckys available.
Bucky_18x24.eps
Bucky 18x24 cm
Bucky_24x30.eps
Bucky 24x30 cm
6.4 Multifunction magnification platform (for magnification views only)

The magnification platform is attached onto the lower
18x24 cm multifunction shelf like the normal Bucky. It provides magnification
magnification platform factors 1.6, 1.8, and 2.0.
s
.ep
ble
-ta
ag
-m
film
2.0
1.8
1.6
6.5 Chin guard

The chin guard is attached to the C-arm as shown in the
figure.
Chin guard

6.6 Film markers

There are two sizes of film markers for the two Bucky
sizes, and several different versions for different market
areas.
6.7 Exposure button

There are two mutually exclusive types of exposure
buttons located behind the radiation protection screen.
The exposure buttons are shown in the figures.
Exposure button
OR
Exposure
button
6.8 CR interface adapter (optional)

The optional CR (Computed Radiography) interface
CR
Inte
rfac
adapter is used when mammography images are taken
eA
dap
ter
using CR plates instead of conventional film cassettes.
CR adapter.eps
Exp
Sw
itch
The exposure parameters used in the exposure are
X-ra
yU
nit
transferred to the CR console through the CR interface
adapter.
CR readers and CR consoles provided by Agfa, Fuji, and
Konica Minolta are supported. For instructions on using
the CR reader and CR console, see the documentation
provided by the manufacturer.

6.9 Main control panel

There are two control panels, one on each side of the X-ray unit. They are identical and either, or
both of them, can be used to operate the X-ray unit.
Angle display
Left cranio-caudal key Right cranio-caudal

key
Left oblique view key
Right oblique view
key
Left lateral key

Right lateral key
Stereotactic operation key
kV down key kV up key

and display and display
mAs down key mAs up

and display key and display
Density down Density up

key and display key and display
CTL key Compression
(secondary function) release key
MAG factor display
Reduce field/light key Expand field/light
key
Time/force display Breast thickness

display
Sensor indicator lights Automatic/manual

exposure indicator
lights
Sensor key Automatic/manual
exposure key
Focal spot selection
key (press and hold)
Exposure/ready indicator Focal spot indicator lights

lights Filtration/spot key and indicator
lights

6.9.1 Cranio-caudal (CC) key (left and right)

Press the left CC key to select the left cranio-caudal
viewing angle and the right CC key to select the right
viewing angle. The C-arm will rotate to this position if it is
not already there.
The posterior-anterior viewing angle can also be selected
using this key, see section 10.4 “Three-second view
selection” on page 33.
6.9.2 Oblique (OBL) key (left and right)

Press the left or right OBL key to select the oblique
viewing angle. The C-arm will rotate to the angle
previously used, either to the left or the right depending on
which key you pressed. The angle will appear on the
angle display.
If you wish to stop the C-arm moving before it reaches the
correct position press the key a second time. Press the
key a third time to start the C-arm moving in the same
direction again.
6.9.3 Lateral (LAT) key (left and right)

Press the left or right LAT key to select the lateral viewing
angle. The C-arm will rotate to the horizontal position,
either to the left or the right depending on key you
pressed.
If you wish to stop the C-arm moving before it reaches the
correct position press the key a second time. Press the
key a third time to start the C-arm moving in the same
direction again.
NOTE
In some countries X-ray units are set up so that the C-arm
will not automatically move to the selected view when one
of the view keys (CC, OBL, LAT) is pressed. To start and
stop the C-arm moving the foot control must be pressed.
See section 10.2 “Selecting the view” on page 31.
6.9.4 Angle display

The viewing angle in degrees and the breast selected are
shown on the angle display. After the exposure has been
taken, the amount of radiation emitted from the tube
during exposure will be shown on the angle display. The
value will remain on the display until a key is pressed.
If required, the X-ray unit can be set up so that the
radiation display is switched off. Contact your sales
representative.
NOTE
The X-ray unit has an additional angle display on the base.

NOTE
On X-ray units equipped with the MaxView Breast
Positioning System, the angle display also shows the
traction distance. Refer to section 7 “MAXVIEW BREAST
POSITIONING SYSTEM (OPTIONAL)” on page 19.
6.9.5 kV keys and display

The kV up and kV down keys allow you to select the kV
value. The kV value is adjustable from 20 to 35 kV in
steps of 1 kV.
6.9.6 mAs keys and display

The mAs values can only be selected when the X-ray unit
is used in the manual mode. Taking exposures in the
manual mode is described in section 14.3 “Taking
exposures manually” on page 55.
Select the mAs value with the mAs up and mAs down
keys. The mAs value is adjustable from 10 to 500 (in
some areas the maximum mAs value is 300 or 600) with
the large focus and 10 to 200 with the small focus,
depending on the kV value selected.
In the AEC (automatic exposure control) modes the mAs
value will appear on the display after the exposure has
been taken.
6.9.7 Density keys and display

The density keys allow you to select the film density, see
section 9.7 “Adjusting the film density” on page 27. The
keys function only when you are taking exposures in the
AEC modes.
Note that also the cassette, the screen, the film, the type
of the film processor, and the processing chemicals affect
the film density.
6.9.8 CTL (secondary function) key

Press the CTL key to activate the secondary function
mode. The indicator light will come on. The CTL key is
also used to clear error codes from the display.
6.9.9 Compression release key

Press the compression release key after taking an
exposure to release the compression paddle.
To minimize patient discomfort you can set the paddle to
automatically release immediately after an exposure has
been taken. The cassette will also be automatically
ejected. See section 9.6 “Activating automatic paddle
release & cassette ejection” on page 27. When the
indicator light is on the Automatic Paddle Release &
Cassette Ejection function is activated and when the light
is off the function is not activated.

NOTE
When performing biopsy the Automatic Paddle Release &
Cassette Ejection function MUST be switched OFF.
6.9.10 Field/light keys

Press either of the field/light keys to switch the field light
on. The light that appears on the Bucky corresponds to
the radiation field. The size of the light field, and therefore
the radiation field, can be adjusted with these keys. To
enlarge the field, press the key on the right side of the
control panel, and to reduce it press the key on the left
side.
The light will stay on for 25 seconds. If you need more
time press either of the keys again. The field light will
automatically come on when you start compression and
can be adjusted with field/light keys.
NOTE
The field size will return to its maximum after each
exposure.
NOTE
The field/light keys are also used as minus and plus keys
when changing parameter values.
6.9.11 Time/force display

In standby mode, the current time is displayed on the
time/force display. During compression the compression
09:00 force (in decanewtons) is shown on this display.
After taking an exposure a waiting time will appear on the
display. This indicates the delay before the next exposure
can be taken.
If the X-ray unit malfunctions or you make a mistake when
using the equipment an error message will appear on the
time/force display. See section 17 “ERRORS AND
ERROR MESSAGES” on page 64.
NOTE
The X-ray unit has an additional time/force display on the
base.
6.9.12 Breast thickness display

The distance between the compression paddles, i.e.
breast thickness, in centimeters is shown on the breast
thickness display. After the exposure the actual duration
of the exposure (in seconds) is shown on the display.
NOTE
The X-ray unit has an additional breast thickness display
on the base.

6.9.13 Sensor key and indicator lights

In the AEC modes you must select the position of the
radiation sensor according to the size of the patient’s
breast. Select the sensor you require by pressing the
sensor key. The indicator lights refer to the markings and
numbers on the compression paddles.
You can select all 48 sensors into use, or one out of the
three subgroups: 1, 2 or 3. Selection is done with the
sensor key that toggles 1-2-3-all-1 etc.
Even with a selected subgroup of detectors the ones
measuring a non-human tissue composition are
disregarded to avoid accidental image quality
deterioration. The best result in all imaging modes is
achieved by always selecting all the sensors into use and
letting the system to choose as many sensors as possible
to participate into the operation of the AEC. For more
information about the AEC modes, see section 13 “FLEX
AEC PRINCIPLES AND USER SETTINGS” on page 46.
NOTE
Subgroup 3 cannot be selected with the spot collimator.
Even when you have selected all the sensors, subgroup 3
is ignored.
NOTE
In the stereotactic mode, only subgroup 1 can be selected.
6.9.14 Automatic/manual exposure key and indicator lights

The automatic/manual exposure key is used to select
either the manual exposure mode or either of the AEC
(automatic exposure control) modes.
There are two AEC modes: the conventional AEC and the
advanced AEC (AAEC). The indicator light shows the
selected exposure mode.
For more information about the AEC modes and user
setting, see section 13 “FLEX AEC PRINCIPLES AND
USER SETTINGS” on page 46.
NOTE
The advanced AEC mode can not be used with the
aluminum filter.
The focal spot size is changed by pressing and holding

the automatic/manual exposure key for 4 seconds. The
focal spot indicator lights show the selected focal spot.
6.9.15 Focal spot indicator lights

When the lower focal spot indicator light is on it indicates
that the large focal spot has been selected.
When the upper focal spot indicator light is on it indicates
that the small focal spot has been selected.
The large focal spot is normally used for contact view
procedures, and the small focal spot for more detailed

diagnostic procedures. The focal spot size is changed

with the automatic/manual exposure key (see above).
NOTE
In magnification mode, the small focal spot is automatically
selected, and when you exit the magnification mode, the
large focal spot is selected.
6.9.16 Filtration/spot collimator key and indicator lights
Select the filter by pressing the filtration/spot key.

When this indicator light is on it indicates that the 30 µm
thick molybdenum (Mo) filter is selected. The Mo filter can
be used with any kV value.
When this indicator light is on it indicates that the 0.5 mm
thick aluminum (Al) filter is selected. The Al filter can be
used only with kV values of 30 and above.
Note that in normal mode you may have to reduce the
mAs value in order to use kV values of 30 and above.
NOTE
The advanced AEC mode can not be used with the
aluminum filter.
When this indicator light is on it indicates that the optional

25 µm thick rhodium (Rh) filter is selected. The Rh filter
can be used only with kV values of 27 and above. Note
that in normal mode you may have to reduce the mAs
value in order to use kV values of 27 and above.
NOTE
The X-ray unit is equipped with either the aluminum filter
or the rhodium filter.
The spot collimator with 30 µm thick molybdenum is

selected by pressing and holding the filtration/spot key for
2 seconds. The filtration/spot key indicator light comes on.
The spot paddle should be used with the spot collimator.
NOTE
The X-ray unit can be set up so that the small focal spot is
automatically selected when the spot collimator is
selected. Contact your sales representative.
6.9.17 READY indicator light

The READY indicator light will come on when the cassette
is correctly positioned, the breast and the viewing angle
have been selected, and the C-arm is in the correct
position. It indicates that the X-ray unit is ready to
compress the breast.
Note that the green indicator light on the exposure control
holder will also come on.

6.9.18 Exposure indicator light

The exposure indicator light will come on when you take
an exposure.
You will also hear two tones during the exposure period.
The first tone is the start up tone and the second, a higher
tone, is the exposure tone. When the exposure is
complete the tone will stop. Note that the yellow indicator
light on the exposure control holder will also come on.
6.9.19 Stereotactic operation (optional)

When the stereotactic guide unit is attached to the X-ray
unit, it can be driven to the stereotactic position.
1. Press the stereotactic operation (ST) toggle switch to
select the desired ST position (ST1 or ST2).
2. Press the middle switch on the foot control to drive
the C-arm to the desired stereotactic position.
NOTE
If you release the switch before the unit has reached the
ST position, the movement is stopped. You can continue
the movement by pressing the switch again.
6.10 X-ray unit controls

This section describes where the X-ray unit controls are
located and how they are used.
NOTE
The optional MaxView Breast Positioning System has
additional controls. Refer to section 7 “MAXVIEW
BREAST POSITIONING SYSTEM (OPTIONAL)” on page
19.
6.10.1 C-arm controls

C-arm up Tube head away The X-ray unit has four C-arm control panels, two on each
from the user side of the C-arm.
The switches towards the front of the tube head change
the angle of the C-arm. Pressing the upper switch will
30 rotate the tube head away from the user, and pressing the
lower switch will rotate the tube head towards the user.
The switches towards the rear of the tube head adjust the
height of the X-ray unit by moving the C-arm up or down.
The switch in the middle drives the tube head to the Side
Access position (optional). For more information, see
section 10.7 “Side Access Patient Positioning (optional)”
Tube head on page 35.
C-arm down Side Access 30°
towards the user
Side_ctrl_keyb_left.eps
NOTE
It is recommended to use the view selection keys and only
fine-tune the desired angle with these switches.

NOTE
will not move up or down when the patient’s breast is
compressed.
6.10.2 Cassette ejection

The cassette can be ejected using the cassette ejection
key on the side of the lower shelf. The cassette will be
ejected on the side where you press the switch.
The X-ray unit can be set up to automatically release the
compression and eject the cassette after the exposure,
see section 9.6 “Activating automatic paddle release &
cassette ejection” on page 27.
Cassette ejection key
6.10.3 Foot controls

The X-ray unit has two foot controls, one on each side of
the X-ray unit. The foot controls are identical (not mirror
images of each other) and both can be used to operate
the X-ray unit.
Looking at either foot control with the cable to the rear, the
functions are (from left to right):
• C-arm up
• C-arm down
MaxView • MaxView (optional) or ST drive (optional)
or ST drive
(optional) • compression paddle up
C-arm down Paddle up • compression paddle down.
C-arm up Paddle down The movement will stop when the switch is released.
Note that the compression paddle can be moved up at
any time (excluding the stereotactic view in which the foot
controls are used for controlling the tube head
movements), but it will only move down after the view has
been selected and the C-arm is in the required view
position.
The X-ray unit can be stopped while it is moving to the
view position by pressing either paddle movement switch.
NOTE
will not move up or down when the patient’s breast is
compressed.
The paddle movement switches can also be used to stop

the X-ray unit when it is moving to or from the
transportation position, see section 15 “TRANSPORTING
NUANCE CLASSIC (ONLY UNITS WITH A FREE
STANDING BASE)” on page 59.

NOTE
In standard configuration, the switch in the middle has no
function. In X-ray units with the optional MaxView Breast
Positioning System, the middle switch is used to pull the
MaxView sheets (see section 7 “MAXVIEW BREAST
POSITIONING SYSTEM (OPTIONAL)” on page 19).
NOTE
In the stereotactic operation (optional), the middle switch
is used to drive the guide unit to the stereotactic position
(ST1 or ST2) (see section 6.9.19 “Stereotactic operation
(optional)” on page 15).
6.10.4 Exposure control

The exposure button and holder will be installed at a safe
Exposure distance from the X-ray unit. The distance will depend on
button
the local radiation safety regulations.
When you take an exposure you must hold the exposure
button down for the duration of the exposure. If the button
is released before the exposure is complete the error
OR code E r 0 0 will appear on the display. Refer to section 17
“ERRORS AND ERROR MESSAGES” on page 64 for
information on how to clear the error message.
Holder
There are two indicator lights on the exposure control
holder. The green (lower) one will come on when the X-
ray unit is ready to compress the breast, and the yellow
Er00 kg Exposure interrupted (upper) one will come on when you take an exposure.
6.10.5 Paddle safety release

In case of emergency, pull the handle towards the patient
(see figure). This will release the compression paddle if
the compression force has become too great.
30
To return the paddle to its normal position simply push the
paddle back again.
NOTE
In magnification view the handle is not available, see
section 12.1.1 “Emergency compression release in
magnification mode” on page 43.
Cl_Nuance_pad_safe_rel.eps
Safety release
30

6.10.6 Emergency stop button
Emergency stop button

The red emergency stop button is located on the hood.
Press the button to stop the X-ray unit operating in an
emergency. The message S t 0 P will appear on the
display.
St0P kg
Pull the emergency stop button up to start the X-ray unit
again.
THIS X-RA WA
AND OPE Y UNIT MAY RNING
RAT BE LBL-787000
AND OPE OR UNLESS DANGER 6B
RATING SAF OUS TO
INSTRUC E EXPOSU PATIENT
TIONS RE
ARE OBSFACTORS
ERVED

7 MAXVIEW BREAST POSITIONING SYSTEM (OPTIONAL)
7 MAXVIEW BREAST POSITIONING SYSTEM

(OPTIONAL)
The MaxView Breast Positioning System uses hygienic
radiolucent sheets which not only pull more breast tissue
into the imaging field but also help to flatten it out better.
The upper and lower sheet can be moved together or
separately for optimum breast positioning.
CL_Nuance_C arm.eps
7.1 MaxView accessories

The MaxView Breast Positioning System has two traction
modules (the upper and lower MaxView modules). The
Sheet control panels upper MaxView module is fitted with a guide plate. The
lower module is integrated to the X-ray unit.
The upper module has two sheet control panels.
The third sheet control panel is located under the lower

shelf (see section 7.2 “MaxView sheet controls” on page
21).
The cover of the MaxView modules can be opened for

cleaning purposes. Refer to section 18.4 “MaxView
maintenance” on page 75.
NC_MV_mod.eps

The MaxView Breast Positioning System has separate

MaxView Buckys in two sizes.
NOTE
The MaxView Buckys can also be used for conventional
Bucky_18x24.eps
breast compression procedure, i.e. without using the

radiolucent sheets.
18x24 cm MaxView Bucky

Bucky_24x30.eps
24x30 cm MaxView Bucky
There are separate radiolucent sheets for the upper and

lower MaxView modules, and there are two sizes of both
them to match the two different compression paddle and
Bucky sizes (18x24 cm and 24x30 cm).
Nuance_sheets.eps
NOTE
Use always new sheets for every patient. Only sheets
provided by Planmed may be used.
NOTE
MaxView sheets Use always sheets of the right size, i.e. small sheets for
(18x24 cm and 24x30 cm) small Buckys/paddles and large sheets for large Buckys/
paddles. Wrong-sized sheets can scratch the patient’s
skin.
NOTE
MaxView sheets MUST NOT be used when performing
biopsy.
CAUTION
The sheet edges can be sharp.

7.2 MaxView sheet controls
7.2.1 Foot control

Both MaxView sheets are pulled in by using the middle
switch on the foot control.
maxv_jalkaohjain_yla.eps
Sheets in
7.2.2 Module control panel

The upper MaxView traction module has two sheet control
panels (see the figure on the next page). The third control
panel is located under the lower shelf (see the figure
beside).
Control panel The sheet control panels are mirror images of each other.
under the The lower switches on each side control the lower sheet
lower shelf and the upper switches on each side control the upper
sheet.
To pull both MaxView sheets in:
CL_Nuance_ctl_panel.eps
Press the outer switches on both sides.
To push both MaxView sheets out:

Press the inner switches on both sides.
To move the sheets separately:

Press only one of the switches.
To eject both sheets:

Press the switch in the middle.
NOTE
If you try to pull the sheets in when the compression
paddle is up, the sheets will be automatically moved back
into the start-up position when you release the switch.
Lower the paddle first before you start pulling the sheets.
Upper sheet in Upper sheet out Upper sheet out Upper sheet in
UPPER
SHEET
Eject both
sheets
LOWER
SHEET
Lower sheet in Lower sheet out Lower sheet out Lower sheet in

8 SWITCHING THE X-RAY UNIT ON
8 SWITCHING THE X-RAY UNIT ON

NOTE
Make sure that the C-arm locking knob has been removed
from the base of the X-ray unit. If not, remove it by turning
it counter-clockwise
Press the On/Off switch, which is located on the base

behind the fixed column.
When the power is switched on, the X-ray unit will carry
On/Off switch out a self-test. The self-test lasts for about 10 seconds,
during which the X-ray unit automatically checks itself.
When the self-test is satisfactorily completed a message

tESt kg indicating this will appear briefly on the time/force display.
The current time will then appear on the time/force display

09:00 kg which indicates that the X-ray unit is ready for use.
Press and hold down the CC key (about four seconds)

until the C-arm starts to move.
The C-arm will rotate in a counterclockwise direction from
the transportation to the operating position. At the same
Paddle Paddle time the column will rise to a preset height, about three
up down quarters of the maximum height. When the C-arm
reaches to the correct position it will stop moving.
NOTE
You can stop the C-arm moving by pressing and holding
down the “paddle up” or “paddle down” switch on the foot
control.
NOTE
Er04 kg If the letters Er (error) and a number (error number) appear
on the display it means that there is something wrong with
the X-ray unit and it did not pass the self-test. Refer to
section 17 “ERRORS AND ERROR MESSAGES” on page
64.
NOTE
St0P kg If the word StOP appears on the display it indicates that
the emergency stop button on the hood has been pushed
down. Pull the button up to clear the display and allow the
X-ray unit to operate.

9 PREPARING THE X-RAY UNIT

This section explains how to prepare the X-ray unit for
your particular requirements. In normal circumstances it
only needs to be done if you are using the X-ray unit for
the first time, changing compression paddles or if you are
going to carry out some special procedures.
NOTE
For the optional MaxView Breast Positioning System, refer
to section 9.8 “Preparing the X-ray unit for MaxView Breast
Positioning (optional)” on page 28 for additional
preparation instructions.
9.1 Attaching and removing the Bucky
There are two sizes of Bucky, 18x24cm and 24x30 cm.

Select the correct Bucky size according to the cassette
you plan to use.
To attach the Bucky:
1. Slide the Bucky along the shelf surface as far as it
slides.
2. Turn the locking knobs backwards on both sides
simultaneously.
To remove the Bucky:

1. Turn the release knobs upwards on the sides of the
Bucky.
2. Slide the Bucky out.

9.2 Attaching and removing the compression paddle

There are two sizes of compression paddles, 18x24cm
and 24x30cm.
To attach the compression paddle:
1. Press the compression release key to move the
paddle holder up. This ensures that you will have
enough space between the paddle holder and Bucky
when attaching the compression paddle.
30
2. Place the compression paddle in the paddle holder in
a downwards tilted position.
3. Pull up the paddle to lock it into its position.
Pull up
30
To remove the compression paddle:

1. Press the compression release key to move the
paddle holder to the preset position.
2. If you are using the optional paddle lock, press the
green unlock button to release the paddle, see
section 9.3 “Paddle lock (optional)” on page 25.
3. Tilt the paddle down and lift it off.
30
30

9.3 Paddle lock (optional)

The paddle lock prevents any unintended release of the
compression paddle.
Press to lock
EAS
E To lock the compression paddle:
REL
ETY
1. Attach the paddle to the X-ray unit.
Paddle_lock1.eps SAF
CK
LO
UN
2. Press the red lock knob.

CK
LO
3
2
1
30
Cl_Nuance_pad_rel.eps
30
Press to unlock To unlock the compression paddle:

E
Press the green unlock knob.
EAS
REL
ETY
SAF
Paddle_lock2.eps
CK
LO
UN
CK
LO
3
2
1
30
Cl_Nuance_pad_rel.eps
30

9.4 Attaching and removing the magnification platform

(for magnification views only, optional)
Use the magnification platform with a cassette of the

same size (18x24 cm).
To attach the magnification platform:
1. Remove the Bucky.
2. Slide the magnification platform along the shelf
surface until it is in the bottom.
Cl_Nuance_mag.eps
simultaneously.
2.0
1.8
1.6
Locking knobs
To remove the magnification platform:
1. Turn the release knobs upwards on both sides
2. Slide the magnification platform out.
3. Attach the Bucky.
Cl_Nuance_mag_out.eps
2.0
1.8
1.6
Locking knobs
9.5 Loading the cassette

1. Switch the X-ray unit on.
2. Slide the cassette into the cassette opening until it is
pulled in by the loading mechanism. The cassette
can be inserted from either side of the X-ray unit.
Make sure that you insert the cassette the right way
round.
NOTE
CL_Nuance_Cass.eps
After loading the cassette, always check that the cassette

is in the middle of the Bucky (clearance on both sides
about 3 mm).

9.6 Activating automatic paddle release & cassette ejection

To minimize patient discomfort you can set up the X-ray
unit so that the compression paddle will automatically
open and the cassette will be automatically ejected
immediately after an exposure has been taken.
NOTE
This function MUST NOT be activated if a biopsy is to be
taken.
1. Press the CTL key to activate the secondary function

mode. The indicator light will come on.
2. Press the compression release key. The indicator
light will come on when the function is switched on.
To deactivate the function:
Repeat the above procedure. The indicator light will go
out.
NOTE
In CC projection, the cassette will be ejected on the right
side of the X-ray unit. In other projections, the cassette will
be ejected upwards.
NOTE
The X-ray unit can be set up so that the cassette will be
ejected on the left side of the X-ray unit in CC projections.
Contact your sales representative.
NOTE
When the paddle is up, the MaxView sheets will be
automatically moved into the start-up position.
9.7 Adjusting the film density

The density of the film can be adjusted if required. It can
only be adjusted in AEC and AAEC modes. Note that the
cassette, the screen, the film, the type of the film
processor, the processing chemicals and temperatures
used also affect the film density. For more information
about the AEC modes, see section 13 “FLEX AEC
PRINCIPLES AND USER SETTINGS” on page 46.
To adjust the film density select the density with the
density up and density down keys. The density level has
15 steps from -7 (light exposures) to +7 (dark exposures)
with each step representing a 13% change in density.

9.8 Preparing the X-ray unit for MaxView Breast Positioning (optional)
9.8.1 Attaching the upper MaxView module

1. Move the C-arm to the vertical position by pressing
the CC key, if it is not already in that position.
2. SWITCH OFF THE POWER. The X-ray unit’s On/Off
switch is located on the base behind the fixed
column.
3. To place the upper MaxView module (with a guide
plate) in position, hold it under the paddle holder and
slide it upwards so that the MaxView module pins go
into the corresponding holes in the paddle holder.
4. Secure it by turning the two finger screws on the
upper side of the paddle holder clockwise.
5.
6. Switch the power back on.
7.
8. Wait until the X-ray unit has completed its self-test
(lasts approx. 10 seconds) and until the MaxView
traction modules have been calibrated (lasts approx.
2-3 seconds).
Guide plate When the X-ray unit is ready for use the time will appear
Upper MaxView module 09:00 on the time/force display.
NOTE
The MaxView traction module(s) will be calibrated each
time the X-ray unit power is switched on.
To remove the upper MaxView module:

1. Move the C-arm to the vertical position by pressing
the CC key, if it is not already in that position.
2. SWITCH OFF THE POWER. The X-ray unit’s On/Off
switch is located on the base behind the fixed
column.
3. Turn the finger screws counterclockwise.
9.8.2 Attaching the MaxView sheets

There are two forms of radiolucent sheets (upper and
lower sheets), and two sizes of both of them to match the
different Bucky sizes.
NOTE
Use always new sheets for every patient. Only sheets
provided by Planmed may be used.
NOTE
MaxView sheets MUST NOT be used when performing
biopsy.
CAUTION
Sheet edges can be sharp.

9.8.3 Attaching the lower sheet

1. Place a radiolucent sheet on the MaxView Bucky with
the cut-out corners towards the X-ray unit.
2. Using both hands, slide the sheet along the Bucky
surface so that it goes into the slot in the lower
MaxView module. Keep sliding the sheet until it is
locked into position, that is, when about 5 mm of the
sheet has been pushed in.
NOTE
Make sure that the sheet is positioned straight when you
slide it in. Use the edges of the Bucky as a guideline.
NOTE
If needed, you can eject the sheet by pressing the center
switch on one of the sheet control panels. Pull the sheet
out and wait for 5 seconds to allow the MaxView module to
return to the start-up position. You can then slide the sheet
in again.
3. Check that the sheet is properly locked in position by

gently tugging it towards you. The sheet must stay
firmly in place when you try to pull it. Otherwise you
have to slide the sheet in again.
4. Fold the free end of the sheet to the underside of

Bucky. Press down the handle and put the sheet
between Bucky and handle.
5. Lift the handle up. You may tighten the sheet by

spinning the wheel.

9.8.4 Attaching the upper sheet

1. Place a radiolucent sheet on the underside of the
compression paddle with the cut-out corners towards
the X-ray unit.
2. Using both hands, slide the sheet along the guide
plate so that it goes into the slot in the upper
MaxView module. Keep sliding the sheet until it is
locked into position, that is, when approx. 5mm of the
sheet has been pushed in.
NOTE
Make sure that the sheet is positioned straight when you
Guide plate slide it in. Use the edges of the compression paddle as a
guideline.
NOTE
If needed, you can eject the sheet by pressing the center
switch on one of the sheet control panels. Pull the sheet
out and wait for 5 seconds to allow the MaxView module to
return to the start-up position. You can then slide the sheet
in again.
3. Check that the sheet is properly locked in position by

gently tugging it towards you. The sheet must stay
firmly in place when you try to pull it. Otherwise you
have to slide it in again.
4. Press the free end of the sheet onto the suction cups
on the compression paddle lip.
9.9 Ejecting the MaxView sheets (optional)

After the exposure, eject the MaxView sheets as follows:
1. Press the center switch on one of the sheet control
panels.
2. Pull the sheets out and wait for 5 seconds to allow the
Eject MaxView modules to return to the start-up position.
sheets 3. You can then slide new sheets into the modules for
the next patient (refer to section 9.8.2 “Attaching the
MaxView sheets” on page 28).
NOTE
If the sheets are not intact when you pull them out you will
have to open the MaxView modules and remove any sheet
fragments before you can use the system again. Refer to
section 18.4.1 “Removing sheet fragments from the
MaxView modules” on page 75.

10 SETTING THE EXPOSURE VALUES AND SELECTING THE VIEW
10 SETTING THE EXPOSURE VALUES AND

SELECTING THE VIEW
This section describes how to select the desired exposure
parameters and viewing angle, and how to prepare the X-
ray unit for patient positioning and exposure.
10.1 Setting the exposure values

1. Press the automatic/manual exposure key to select
the desired automatic exposure control (AEC) mode
if it is not already selected.
With conventional AEC the correct kV must be selected
before exposure, and with the AAEC mode the kV value
will be automatically selected before, and adjusted during,
the exposure.
When the AEC mode has been selected the correct mAs
value will appear on the mAs-display after the exposure.
For more information about the AEC modes and user
settings, see section 13 “FLEX AEC PRINCIPLES AND
USER SETTINGS” on page 46.
2. Select the focal spot you require. The appropriate
indicator light will come on. Remember that when you
change the focal spot, the key must be pressed and
held down for 4 seconds.
3. If you are using the conventional AEC mode select
the kV value required for the patient to be examined.
NOTE
You can set the X-ray unit so that it will automatically
display a recommended kV value after the breast has
been compressed. See section 13.2.3 “Activating
automatic kV Selection in AEC mode” on page 48.
4. Make sure that filtration you are using is appropriate

for the kV value that you have selected. If necessary,
change the filtration.
10.2 Selecting the view

View selection keys are divided according to the breast
that is being examined, that is, left breast CC, OBL, and
LAT views are selected with the keys on the left (SIN) side
of the panel. Accordingly, the right breast views are
selected with the keys on the right (DEX) side of the
panel.
Each view selection key includes a normal view selection
(see section 10.3 “Normal view selection” on page 33)
and a three-second view selection function (10.4 “Three-
second view selection” on page 33).
The default factory settings for the view selection keys are
listed in figure 1 The key functions can be configured
according to the user preferences. Please contact your
local sales representative.

The breast that is being examined is indicated with an

arrow in the lower left or right corner of the angle display.
Note that this is not available in C-arm angles above 99°.
NOTE
Always select the correct view from the control panel
before the exposure, even if the C-arm is already in the
correct position.
NOTE
If no view selection key is pressed before the exposure,
the X-ray unit will use the previously selected view. Use of
film markers is recommended to ensure the correct view
CL_Nuance_Marker.eps
identification.
To select the desired view:

1. Select the exposure view you are going to use from
the film markers (optional) and slide the other
markers away from the cassette level.
2. Select the exposure view you require by pressing one
of the view keys. The C-arm will move to the view
selected if it is not already in that position.
3. If you wish to stop the C-arm moving, press the key
again.
4. If you chose a wrong view, press the correct view key
and the C-arm will move to the new view. The
different views are explained in the following pages.
Left breast Right breast
selected selected The READY lights on the control panel and the exposure
control holder will come on when the cassette is correctly
loaded, the viewing angle has been selected, and the C-
arm is in the correct position.
NOTE
will not automatically move to the view selected when the
view key is pressed. To move the C-arm to the view
selected press and hold down the “paddle up” or “paddle
down” switch on the foot control. To stop the C-arm
moving remove your foot from the foot control.
Table 1: Default factory settings for the view selection

keys
Breast View selection key Normal selection Three-second selection
Left Left cranio-caudal (SIN CC) LCC PA
Left Left oblique (SIN OBL) LMLO LLMO
Left Left lateral view key (SIN LAT) LML LLM
Right Right cranio-caudal (DEX CC) RCC PA
Right Right oblique (DEX OBL) RMLO RLMO
Right Right lateral (DEX LAT) RML RLM

10.3 Normal view selection
10.3.1 Cranio-caudal view

Press the left CC key to select the left cranio-caudal view
or the right CC key to select the right cranio-caudal view.
The C-arm will remain in the vertical position or move to
the vertical position from one of the other views.
Left CC key
Left breast
10.3.2 Medio-lateral oblique view

Press the left OBL key to select the medio-lateral oblique
Left OBL key view of the left breast, or press the right OBL key to select
the medio-lateral view of the right breast.
The C-arm will rotate to the angle previously selected,
either to the left or the right, depending on which key you
have pressed. The angle will appear on the angle display.
Setting the preset angle is described in section 14.2
Left breast “Setting the oblique view angle” on page 55.
view-obl1.eps
10.3.3 Medio-lateral view

Press the left LAT key to select the medio-lateral view of
the left breast, or press the right LAT key to select the
Left LAT key medio-lateral view of the right breast.
The C-arm will rotate to the horizontal position, either to
the left or right depending on which key you have
pressed. The angle will appear on the angle display.
Left breast
view-lat2.eps
10.4 Three-second view selection
10.4.1 Posterior-anterior view

Press and hold the CC key for three seconds and the C-
CC key arm will rotate to the PA position.
Note that the physical limits of the X-ray unit will not allow
you to adjust the angle of the PA position in the clockwise
direction.

10.4.2 Latero-medial oblique view

Press and hold the left OBL key for three seconds to
select the latero-medial oblique view of the left breast, or
Left OBL key press the right OBL key for three seconds to select the
latero-medial view of the right breast.
The C-arm will rotate to the angle previously selected,
either to the left or the right, depending on which key you
have pressed. The angle will appear on the angle display.
Left breast Setting the preset angle is described in section 14.2
i bl2 “Setting the oblique view angle” on page 55.
10.4.3 Latero-medial view

Press and hold the left LAT key for three seconds to
select the latero-medial view of the left breast, or press
Left LAT key
the right LAT key for three seconds to select the latero-
medial view of the right breast.
The C-arm will rotate to the horizontal position, either to
the left or right depending on which key you have
pressed. The angle will appear on the angle display.
Left breast view-lat1.eps
10.5 Fine-tuning the viewing angle

The viewing angle can be adjusted by pressing the C-arm
rotation switches (see illustration below).
In cranio-caudal view the C-arm can be moved up to
approximately 15° in both clockwise and counterclockwise
directions.
In medio-lateral oblique view and latero-medial oblique
view the viewing angle can be set between 15° and 75°. If
the new angle is between 30° and 75° it will be
automatically stored in the memory and will be recalled by
pressing the oblique key.
In medio-lateral view and latero-medial view the
C-arm can be rotated in both clockwise and
counterclockwise directions.
The new angle will appear on the angle display.
10.6 Adjusting the X-ray unit height

:
Tube head away from the user
Press the upper height adjustment switch to move the C-
arm up, or press the lower height adjustment switch to
move the C-arm down.
C-arm
30
rotation Height
switches adjustm.
NOTE
The height of the X-ray unit can also be adjusted by using
the foot control switches. Refer to section 6.10.3 “Foot
Tube head towards the user
Side ctrl keyb right eps
controls” on page 16.

10.7 Side Access Patient Positioning (optional)

The Side Access Patient Positioning (optional) function
improves positioning ergonomics by providing more
space for the technologist.
30 To activate Side Access Patient Positioning press the
Side Access switch (30°).
The tube head rotates sideways ±30° around the
isocentric centre of the X-ray unit, while the compression
paddle system remains stationary.
30° Side Access The Side Access function turns the tube head according
to the following sequence:
1. The tube head turns away from the 0 position
(dependent on the side of the switch).
2. The tube head stops at ±30°.
3. When the switch is activated, the tube head returns to
the 0 position.
When the tube head has reached the 30° limit, patient
positioning can be optimized with the improved access.
Thereafter, the tube head is rotated back to the original
position and the breast imaging can be continued
normally.
NOTE
The Side Access movement depends on the configuration
of the system. Please contact your local Planmed sales
representative.
side_access30.eps
Side Access position

NOTE
The field light is intended to be used as a general work light
only when the X-ray unit is in the Side Access position.

11 SCREENING MAMMOGRAPHY WITH NUANCE CLASSIC
11 SCREENING MAMMOGRAPHY WITH NUANCE

CLASSIC
This section describes how to use the Planmed Nuance
Classic X-ray unit for screening mammography
examinations.
NOTE
If you are not using the optional MaxView Breast
Positioning System, start the procedure from section 11.2
“Breast positioning and compression without MaxView” on
page 38.
11.0.1 Implant-included views
NOTE
The degree of compression is limited by the
compressibility of the implant. Deliver just enough
compression to immobilize the breast.
NOTE
The manufacturer does not recommend using the
MaxView Breast Positioning System on patients with
implants.
11.1 Breast positioning and compression with MaxView (optional)
NOTE
The MaxView sheets can be pulled either during the
compression procedure or after the breast has been
compressed.
1. Position the breast on the MaxView Bucky. The chest

below the breast should be pressed against the front
edge of the Bucky.
2. Manipulate and spread the breast forwards and
outwards as much as possible on the lower sheet.
3. Start compression by pressing the rightmost switch
(paddle down) on either foot control. The field light
will automatically come on for 25 seconds. The
compression paddle will start to descend while
remaining parallel to the MaxView Bucky. During this
phase of the breast compression the maximum limit
(in decanewtons) at which the compression force is
set will appear on the time/force display and start to
flash.
Paddle down 4. When the compression force reaches max. 6 kg, stop
compression by releasing the foot control switch and
then pull the MaxView sheets.
CAUTION
Be careful not to leave your hands between the Max-
View modules or compression paddles during com-
pression.

5. Pull as much breast tissue into the imaging field as

possible by pressing the middle switch on the foot
control.
The sheets can also be pulled simultaneously by pressing
both outer sheet control switches on one of the panels. If
needed, you can pull only one sheet by pressing the
Both sheets in corresponding sheet control switch on the panel.
The sheets can be pushed out (when the breast is not

Upper sheet in Upper sheet out
being compressed) by using both inner sheet control
switches on one of the panels. If needed, you can push
only one sheet out by pressing the corresponding sheet
control switch on the panel.
1. Stop the sheet movement by releasing the
switch(es).
2. To continue pulling/pushing press it again.
Lower sheet in Lower sheet out
NOTE
If you try to pull the sheets when the compression paddle
is up, the sheets will be automatically moved back into the
start-up position when you release the switch(es). Lower
the paddle first before you start pulling the sheets.
NOTE
Do not allow any skin folds during the breast positioning.
Any folded breast tissue must be straightened and
flattened as much as possible.
NOTE
The sheets must remain straight and free of wrinkles
during the pulling.
CAUTION
Be careful not to pull the sheets too much. Always
observe the patient closely for signs of discomfort.
Never allow breast tissue to be pulled into the Max-
View modules.
As you start to pull the sheets the angle degree will clear
15 from the angle display and it will be replaced with the
traction distance.
Traction distance
The traction distance is measured in millimeters and it
shows how much the upper or lower sheet has been
pulled in according to the following rules:
• When you pull the sheets in using the foot control, the
traction distance displays how much both sheets
have been pulled in.
• When you press one of the panel switches controlling
the upper sheet, the traction distance display shows
how much the upper sheet has been pulled in.
• When you press one of the panel switches controlling
the lower sheet, the display shows how much the
lower sheet has been pulled in.
If you then use the foot control switch again, the display
shows the traction distance for the sheet that has been
pulled in most.

The maximum traction distance is 50 mm.

1. To continue compression press the foot control
switch again.
2. As you start to compress the patient’s breast, the
compression force stop limit will clear from the
16 kg
daN
6.5 display and it will be replaced with the actual
compression force (in decanewtons). The distance
Compression force Breast thickness
(in centimeters) between the compression paddles,
that is, breast thickness, will appear on the breast
thickness display.
3. When the compression force reaches the preset limit
you will hear a tone and compression will stop.
4. To continue compression stop and then start
pressing the compression control again. The paddle
will start to descend again, but this time at a slower
speed.
To adjust the speed of compression refer to section 14.5
“Setting the speed of the compression paddle movement”
on page 56.
11.2 Breast positioning and compression without MaxView

1. Position the breast on the Bucky or on the
magnification platform. The chest below the breast
should be pressed against the front edge of the
Bucky.
2. Manipulate and spread the breast forwards and
outwards as much as possible on the Bucky.
3. Position the foot control out to a suitable position and
then start the compression by pressing the paddle
Paddle down down switch of either foot control.
The field light will automatically come on for 25 seconds
and the compression paddle will start to descend. During
this phase of the compression the maximum limit (in
decanewtons) at which the compression force is set will
appear on the time/force display and start to flash.
The compression can be stopped by releasing the foot
control switch.
To continue compression press the foot control again.
1. Press either of the field/light keys to switch the
CL_Nuance_field.eps
radiation field light on.

Field light 1. Adjust the size of the radiation field if necessary by
pressing either of the filed/light keys.

The compression paddle can be moved upwards by

pressing the paddle up switch on the foot control.
Paddle up
As you start to compress the patient’s breast the

16 kg 4.5 compression force stop limit will clear from the display
and it will be replaced with the actual compression force
Compression force Breast thickness (in decanewtons). The distance (in centimeters) between
the two paddles, the breast thickness, will appear on the
breast thickness display.
When the compression force reaches the preset limit you
will hear a tone and compression will stop.
30
To continue compression, stop and then start pressing the

Manual compression foot control again. The paddle will start to
compression descend again, but this time at a slower speed.
knob The compression can be fine-adjusted manually by
turning the manual compression knob.
To adjust the speed of compression refer to section 14.5
Cl_Nuance_pad_press.eps
“Setting the speed of the compression paddle movement”

on page 56.
30
NOTE
Be careful not to leave your hands between the
compression paddle and the Bucky during compression.
11.3 Emergency compression release

To release the compression in an emergency:
1. Press compression release key or the paddle up
switch on the foot control.
Do not press the emergency stop button in this situation as this
will stop the X-ray unit working.
If there is a power failure while you are examining a
patient the quickest and easiest way to release the
30
MaxView compression paddle is to pull the handle
towards the patient (see figure). This will release the
compression paddle if the compression force has become
too great.
To return the paddle to its normal position simply push the
Pull here paddle back to its position again.
Cl_Nuance_pad_safe_rel.eps
NOTE
With the magnification platform the handle is not available
(see section 12.1 “Magnification procedures (optional)” on
page 42).
30

11.4 Taking an exposure
1. Before taking an exposure make sure that the

patient’s head or shoulder does not get in the way of
the radiation beam.
2. Protect yourself from radiation.
NOTE
The minimum required protective shielding is 60 cm wide,
.2 m
minimum 185 cm high, and less than 15 cm above the

47 1.2
"
floor. The material used must have a minimum attenuation

in
m
equivalent of 0,08 mm of lead and it must provide visibility

to the patient and equipment. Note that local regulations
must be obeyed in case they differ from the above.
3. Take the exposure by pressing the remote control

button. Note that the button must be held down for
the duration of the exposure. If you remove your
finger from the exposure button before the exposure
OR
is complete, an error code appears on the display.
For more information refer to section 17 “ERRORS
AND ERROR MESSAGES” on page 64.
4. The exposure indicator lights on the control panel
and the exposure control holder will come on and you
will hear two tones during the exposure period. The
CAUTION:X-RAYS first tone is the start up tone and the second, a higher
ATTENTION:RAYONS-X
tone, is the exposure tone. When the exposure is
complete, the tone will stop.
11.5 After the exposure

If the Automatic Paddle Release & Cassette Ejection
function is switched on, the compression paddle will
automatically release and the cassette will be
automatically ejected after the exposure is completed.
1. If the Automatic Paddle Release & Cassette Ejection
function is not activated, press the compression
release key to release the compression paddle. The
paddle will automatically move to the ready position.
You can also release the compression paddle by
pressing and holding down the paddle up switch on
the foot control. Note, however, that the paddle will
only move as long as you hold the switch down, and
the paddle will not automatically rise to the ready
position.
NOTE
When the paddle has risen to the ready position, the
Paddle up MaxView sheets will be automatically moved into the start-
up position for another exposure. Press the sheets onto
the suction cups as described in section 9.8.2 “Attaching
the MaxView sheets” on page 28.

Press here to eject the cassette 2. Press the cassette ejection key to eject the cassette.
The cassette will be ejected on the side where you
press the key.
3. Guide the patient away from the X-ray unit.
The next exposure can be taken as soon as the
current time reappears on the display. The delay time
shown on-line on the time/force display depends on
the exposure parameters used.

12 DIAGNOSTIC MAMMOGRAPHY WITH NUANCE CLASSIC
12 DIAGNOSTIC MAMMOGRAPHY WITH NUANCE

CLASSIC
The following section describes how to use the Nuance
Classic X-ray unit for different diagnostic mammography
examinations: magnification and biopsy procedures. For
instructions on the stereotactic biopsy and spot
procedures, refer to Planmed Nuance Classic DigiGuide
User’s Manual and Planmed Nuance Classic Cytoguide
User’s Manual.
12.1 Magnification procedures (optional)
NOTE
On X-ray units equipped with the MaxView Positioning
System, magnification views can be taken without
removing the MaxView traction modules.
However, the MaxView radiolucent sheets must not be
used when taking magnification views
NOTE
You can adjust the magnification by turning the handles on
both sides inwards and consequently upwards or
downwards. The magnification alternatives are 1.6, 1.8
and 2.0. The magnification value is shown on the MAG
2.0
1.8
factor display.
1.6
1. To place the magnification platform in position, slide

the magnification platform along the shelf surface
until it is in the bottom.
simultaneously.
3. Install the appropriate spot paddle in the paddle
holder.
NOTE
When using the spot paddle, set the AEC sensor key to
sector 1.
4. Select the spot collimator by pressing and holding the

filtration/spot key for 2 seconds. In this mode only the
area of the spot cone will be exposed. The filtration/
spot indicator light will come on.
NOTE
When using the spot collimator the breast thickness read-
out is adjusted for the spot paddle.

NOTE
The X-ray unit can be set up so that the standard
rectangular collimator is selected in the spot mode instead
of the spot collimator, but the breast thickness read-out is
adjusted for the spot paddle. Contact your sales
representative.
5. Load the cassette.

6. You can now set the exposure parameters, compress
Spot paddle the breast, and take an exposure in the same way as
described in section 10 “SETTING THE EXPOSURE
Cl_Nuance_mag.eps
Magnification
VALUES AND SELECTING THE VIEW” on page 31
platform
and section 11 “SCREENING MAMMOGRAPHY
WITH NUANCE CLASSIC” on page 36.
7. Remove the magnification platform.
2.0
1.8
1.6
12.1.1 Emergency compression release in magnification mode

In case of emergency, turn the release knob to remove
the spot paddle (see figure).
E
EAS
REL
ETY
SAF
Release
Digi spot1.6_release.eps
CK
LO
UN
knob
CK
LO
E
EAS
REL
ETY
SAF
Digi spot2.0_release.eps
CK
LO
UN
CK
LO

12.2 Biopsy procedures
12.2.1 Biopsy procedure with the perforated biopsy paddle
1. Install the perforated biopsy paddle in the paddle

holder.
NOTE
Make sure that the Automatic Paddle Release and
Cassette Ejection function is NOT switched on. The
indicator light must be off.
2. Place the Bucky in position and load the cassette.

Refer to sections 9.1 “Attaching and removing the
Bucky” on page 23 and 9.5 “Loading the cassette” on
page 26.
the breast, and take an exposure. Refer to section 10
“SETTING THE EXPOSURE VALUES AND
SELECTING THE VIEW” on page 31 and section 11
“SCREENING MAMMOGRAPHY WITH NUANCE
CLASSIC” on page 36.
4. After the exposure do not release the compression.
Remove the cassette, and process the film. The
pattern of holes in the perforated paddle will be seen
on the film.
5. Localize the position of the lesion and insert the
needle into the lesion through an appropriate hole in
the biopsy paddle.
6. Take a second exposure.
7. Process the film.
8. If the needle is in the right place take the biopsy.
9. If the needle is not in the right place reposition the
needle and take another exposure.
10. Repeat the procedure until the biopsy can be taken.

12.2.2 Biopsy procedure with the rectangular biopsy paddle
1. Install the rectangular biopsy paddle in the paddle

holder.
A
89
B
67
C
D
45
E
3
12
A
B
C
D
E NOTE
Make sure that the Automatic Paddle Release and
Cassette Ejection function is NOT switched on, the
indicator light must be off.
2. Place the Bucky in position and load the cassette.

Refer to sections 9.1 “Attaching and removing the
Bucky” on page 23 and 9.5 “Loading the cassette” on
page 26.
the breast, and take an exposure in the same way as
described in section 10 “SETTING THE EXPOSURE
VALUES AND SELECTING THE VIEW” on page 31
and section 11 “SCREENING MAMMOGRAPHY
WITH NUANCE CLASSIC” on page 36.
4. After the exposure do not release the compression.
Remove the cassette, and process the film. The
scale of the rectangular paddle will be seen on the
film.
5. Install the hair cursor attachment to the collimator slot
and switch the field light on.
6. Localize the position of the lesion by moving the hair
cursor wire to the lesion position. When the field light
illuminates the hair cursor, the shadow will be cast on
the breast tissue thus helping you to insert the needle
into the lesion.
7. Take a second exposure.
8. Process the film.
9. If the needle is in the right place, take the biopsy.
10. If the needle is not in the right place reposition the
needle and take another exposure.
11. Repeat the procedure until the biopsy can be taken.

13 FLEX AEC PRINCIPLES AND USER SETTINGS
13.1 Principles of the Flex AEC operation

The Flex AEC operation is based on a patented principle
where the imaging chain components are all modelled
into the system software. Once the kV, the mA, the
filtration, the tube radiation output / mAs, the
magnification ratio, the screen type, and the object
thickness are all known, it enables the system to define
the tissue composition imaged and utilize optimal
exposure parameters exactly. Based on the detected
object composition together with the other imaging
parameters the amount of light produced by the
intensifying screen is calculated exactly and, as a result,
the desired OD of the film is reached accurately.
Flex AEC consists of 48 individual detectors that cover an
area of 100 cm2. Therefore, it is able to measure a well
representative sample of the tissue to be exposed and to
adjust the exposure parameters optimal for the tissue
composition. Detectors that measure a non-human tissue
composition during an exposure do not take part in the
operation of Flex AEC. Thus, detectors that receive direct
radiation or are lying underneath a breast implant do not
even partially deteriorate the image quality.
The tissue compositions in this description are indicated
as 0% to 100% glandular. 0% represents a totally fatty,
radio translucent tissue type, and 100% represents a
totally glandular, the most radio-opaque tissue type.
The operation of Flex AEC is strongly dependent on the
correct compression thickness indication. Some spot
paddle models are of different height compared to normal
compression paddles. When these spot paddles are
used, the spot filter must be selected so that the
corresponding thickness parameters are used. If in doubt,
compress an object of known thickness and verify that the
thickness indication shows the same value.
13.2 Flex AEC user settings

A set of unique tuning parameters has been provided for
the operator to tailor the operation of Flex AEC to meet all
user requirements. The Flex Setting and the Glandular
Boost setting offer the operator a possibility to tune the
AEC response to various object compositions and their
mixtures in a way that has never been possible before.
13.2.1 Selecting the AEC sensor

In AEC modes you must select the position of the
radiation sensor according to the size of the patient’s
breast. Select the sensor you require by pressing the
sensor key. The indicator lights refer to the markings and
numbers on the compression paddles.

You can select all 48 sensors into use, or one out of the
three subgroups 1, 2 or 3. The selection is done by the
sensor key that toggles between 1-2-3-all-1 etc. Even with
a selected subgroup of detectors the ones measuring a
non-human tissue composition are disregarded to avoid
accidental image quality deterioration. The best result in
all the imaging modalities is achieved by always selecting
all the sensors into use and letting the system to choose
as many sensors as possible to participate the operation
of the AEC.
NOTE
Choose subgroup 1 in magnification mode with a spot
paddle.
NOTE
Subgroup 3 cannot be selected with the spot collimator.
Even when you have selected all the sensors, subgroup 3
is ignored.
NOTE
In the stereotactic mode, only subgroup 1 can be selected.
13.2.2 Selecting the AEC mode

There are two AEC modes: conventional AEC and
advanced AEC (AAEC), and a manual (MAN) mode.
Press the automatic/manual exposure key so that the

appropriate indicator light will come on. The exposure
mode will change from the original setting to the new
setting.
In manual mode, the kV and mAs are selected by the

operator.
In conventional AEC mode, the mAs is defined by the

desired film OD while the kV is either selected by the user
or, when the Automatic kV Selection is on (see section
13.2.3 “Activating automatic kV Selection in AEC mode”
on page 48), suggested by the AEC system as a function
of the compressed object thickness.
In advanced AEC (AAEC) mode, the Automatic kV
Selection function is active, but it can be overridden by the
operator. The kV value is selected after the patient’s
breast has been compressed and then this value is
automatically corrected during the exposure. The kV
adjustment is based on the tissue density of the patient’s
breast.
At the beginning of the exposure, the Flex AEC system
defines and alters the kV optimal for the tissue
composition detected. If the tissue composition seen by
the Flex AEC system is of the average in composition, the
kV will be kept unchanged.

For a fatty tissue, the kV is lowered by up to 3 kV and for a

glandular tissue it is raised by up to 3 kV. The Flex AEC
system selects an optimal kV value depending on the
mixture of tissue compositions in the object aiming to
keep the exposure time constant for all tissue
compositions.
NOTE
The minimum kV value that can be used in the AAEC
mode is set at the factory to a value 20 kV. If it needs to be
adjusted, contact your sales representative.
NOTE
If the rhodium filter is selected, the advanced AEC cannot
select kV values below 27 kV. Value 27 kV is used instead.
NOTE
If the aluminum filter is selected, the advanced AEC
cannot select kV values below 30 kV. Value 30 kV is used
instead.
NOTE
The AEC accuracy is not guaranteed in 2.0 magnification.
13.2.3 Activating automatic kV Selection in AEC mode

This function automatically selects a recommended kV
value after the breast has been compressed. The kV
value is based on the thickness of the compressed breast.
1. Press the CTL key to select the secondary function
2. Press the kV up key and one of two messages will
appear on the time/force display and start to flash.
The message will depend on whether the Automatic kV
Selection function was previously switched on or off.
0FFA This message indicates that the Automatic kV Selection
mode is switched off.
NOTE
If the advanced AEC mode is selected, the Automatic kV
Selection is on regardless of this setting.
3. Press the right field/light key.

4. Press the CTL key to accept the new setting.
To switch the Automatic kV Selection off:

1. Perform steps 1 and 2 as above.
0n A d
This message indicates that the Automatic kV Selection
function is switched on.
2. Press the left field/light key.
3. Press the CTL key to accept the new setting.

13.2.4 Selecting the density

In order to reach the desired film OD in varying film
1 processing conditions, the system target density can be
varied by 15 steps from –7 to +7. This is the maximum
system dynamic range that includes all offsets and
individual exposure mode offsets.
13.2.5 Adjusting the density offset

If a density setting that is different from zero must be used
to achieve desired film OD, the density display can be
zeroed with the density offset parameter.
To perform this adjustment the AEC mode must first be
selected.
1. Press the CTL key to select the secondary functions.
The indicator light will come on.
2. Press and hold down the density up key for 3
seconds.
3. Press the density up and density down keys to set
1 the display to the same value you had to use in the
normal user density compensation to achieve your
own zero density.
4. Press the CTL key to accept the new density offset.
The indicator light will go out.
13.2.6 Setting the contrast/dose (C/D)
NOTE
This parameter functions in the AAEC mode and in the
AEC mode when the Automatic kV Selection function is
ON.
With the contrast/dose (C/D) parameter the user can set

the desired mode of imaging, from lower patient dose at
lower image contrast to higher dose and contrast.
The kV value is automatically adjusted to give the
optimum exposure time. If the kV value is increased, the
mAs value will decrease resulting in a lower radiation
dosage and lower film contrast. If the kV is decreased, the
mAs will increase resulting in a higher radiation dosage
and a higher film contrast.
1. Press the CTL key to enter the secondary function
2. Press and hold down the automatic/manual exposure
0cd key until the current contrast/dose setting appears on
the time/force display and starts to flash.
3. Press either of the field/light keys to change the
setting of the contrast/dose. The right key will
increase the film contrast and the radiation dose (the
mAs will decrease and the kV will increase) and the
left key will decrease the film contrast and the
radiation dose (the mAs will increase and the kV will
decrease). The highest setting is +4 and the lowest
setting is -4.

4. Press the CTL key to store the new contrast/dose

setting into the memory. The indicator light will stop
flashing and go out.
This selection defines the kV at which the imaging is done
based on the compressed object thickness. The
illustration below shows the dependence of the used kV
on the object thickness and on the C/D setting.
35 +4
34
32
0
30
28
kV -4
26
24
22
20
0 1 2 3 4 5 6 7 8 9 10
cm
Figure 1: kV dependence on object thickness and on the

C/D setting
The kV value is altered depending on the C/D parameter
value as illustrated in the figure. The AAEC kV change
depends on the detected average tissue composition as
described in the table below to keep the exposure time
more or less constant independent of the tissue
composition.
Glandularity% kV change
0–8 -3
9 – 22 -2
23 – 36 -1
36 – 64 0
65 – 78 +1
79 – 92 +2
93 – 100 +3

13.2.7 Changing the Flex setting

2. Press the left OBL key and hold it down for 3
seconds.
3. Press either of the field/light keys to change the Flex
Setting.
4. Press the CTL key to store the new setting in the
memory.
13.2.8 The effect of the Flex Setting

The Flex Setting parameter fine-tunes the AEC system
response to various tissue compositions. Assuming that
the object is made of homogenous material, with the Flex
Setting 0 all tissue types from fatty to glandular aim to the
same film OD.
With the Flex Setting 15 a fatty tissue type aims to about
double the film OD and a glandular type to half the film
OD compared to an average tissue type. This keeps the
exposure time approximately constant independent of the
tissue composition.
With the Flex Setting parameter the operator can set the
system response to various mixtures of compositions in
the object. The horizontal lines on the illustration below
(refer to figure 2below) show the AEC behaviour for
homogenous phantoms.
The effect of the Flex Setting to non-homogenous
material, such as the human breast, can be illustrated by
the vertical sets of lines. The lines represent the film ODs
for various tissue composition in one exposure, the upper
end being fatty and the lower end being glandular. The
lines are in groups of three, from left to right, representing
measured average glandularities 30%, 50% and 70%.
As can be seen, with the Flex Setting value 8, the
exposures are quite consistently independent of the
average glandularity. At smaller values the measured
average tends to keep itself at 1.6 OD resulting in a shift.
A more glandular average (the line most on the right)
tends to lift up the OD, making fatty areas very dark. A
more fatty average (the line most on the left) tends to
lower the OD, making the dense areas vanish in the
background fog.
A similar shift appears at high Flex Setting values, but the
other way round. A more glandular average (right-most
line) tends to lower the OD, making glandular areas very
light. A more fatty average (left-most line) tends to lift up
the OD, making the fatty areas very dark.
The optimal result can be achieved with Flex Setting
values close to the middle.

3.5
0%
3 50%
ave 0%
30 % 70%
ave ave
2.5
30 %
2
OD
50 %
1.5
70 %
100%
1
100 %
0.5
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Flex Setting
Figure 2: The Flex Setting of non-homogenous material
13.2.9 Glandular Boost setting

With the Glandular Boost parameter, glandular parts of
the object can be given more weight, letting the system to
slightly over-expose the fattier parts in order to reach a
minimum desired film OD for the glandular areas.
At setting 0 there is no boost and at setting 10 the
glandular tissue is weighed the most.

2. Press the left OBL key and hold it down for about 3
seconds.
3. Press the left OBL key again.
4. Press either of the field/light keys to select the
desired Glandular Boost setting.
5. Press the CTL key to store the new setting in the
memory.

13.2.10 The effect of the glandular boost setting

The Glandular Boost setting will only have effect if more
than 60% glandular tissue is detected by one of the
detectors. The operation principle is illustrated below
(figure 3). With the setting 0, assuming that the system
has been set up to produce 1.6 OD film darkness for 50%
tissue, the bottom line shows the film OD for more
glandular parts. Without Glandular Boost, 80% tissue
appears as 0.8 OD and the more glandular areas become
too light for proper diagnosis. With Glandular Boost, the
image is exposed more, depending on the most glandular
part detected by the system.
As an example, with setting 4 the image is made darker
as shown in the illustration below by the arrows,
depending on the maximum glandularity. If it is up to
100% dense, the overall image darkness is increased by
0.5 OD as shown by the right most arrow. If it was only
80% dense, the image darkness is increased by 0.3 OD
as shown by the arrow in the middle.
It must be noted that the film is exposed in a single
exposure that is the same for all parts of the object. Once
the dense parts are made darker by the Glandular Boost
setting, the fattier parts will also be exposed more, making
them harder to diagnose.
Therefore, if the breast contains both very fatty and very
glandular areas, the Glandular Boost setting should not
be set too high.
Optimal results can be achieved by setting 4 where the
100% glandular areas will be exposed to 0.8 OD that will
make the 50% areas to become a little above 2.0 OD and
the fatty areas will appear slightly over 3.0 OD.
1.80
1.60 10
1.40
8
1.20
1.00
OD
0.80 4
0.60
2
0.40
0.20
0.00
50 60 70 80 90 100
Glandularity %
Figure 3: The dependence of glandularity of OD

14 SPECIAL FUNCTIONS
This section describes the X-ray unit’s special functions.
14.1 Automatic rhodium/molybdenum filter selection
NOTE
This section only applies to X-ray units equipped with the
rhodium filter.
This function automatically selects the rhodium (Rh) or

the molybdenum (Mo) filter after the breast has been
compressed. The selection is based on the thickness of
the compressed breast.
Above the preset breast thickness the rhodium filter is
selected. Otherwise the molybdenum filter is used.

2. Press and hold the filtration/spot key for 3 seconds.
The time/force display will start to flash.
breast thickness above which the rhodium filter is
selected. The minimum value is 5.0 cm and the
maximum is 9.9cm.
7.5 = kg The selected breast thickness limit is shown in the time/
force display.
4. Press the CTL key to accept the new value and exit
the secondary function mode.
To switch the function off:

2. Press and hold the filtration/spot key for 3 seconds.
The time/force display will start to flash.
3. Press the field up key after the maximum breast
thickness (9.9cm) has been reached.
==== kg This message indicates that the automatic rhodium filter

selection is switched off.
4. Press the CTL key to accept the new value and to
exit the secondary function mode.
NOTE
After the patient’s breast has been compressed the filter
can still be changed manually. If the Automatic kV
Selection is on, the filtration/spot key must be pressed
before the filter can be changed.

14.2 Setting the oblique view angle

The angle to which the C-arm will rotate when an oblique
view is chosen can be changed to any angle between 15
degrees and 75 degrees.
1. Make sure that the C-arm is in the vertical (CC)
position.
3. Press the right OBL key to select the oblique view.
45 The angle to which the C-arm will rotate will appear
on the angle display and start to flash.
60 4. Press either of the field/light keys to change the

oblique angle. The new angle will appear on the
display.
5. Press the CTL key to store the new oblique angle in
the memory.
14.3 Taking exposures manually

1. Press the automatic/manual exposure key. The
appropriate indicator light will come on and the
density display will clear.
2. Load the cassette. Refer to section 9.5 “Loading the

cassette” on page 26.
3. Select the required focal spot by pressing and
holding the automatic/manual exposure key for 4
seconds. The appropriate indicator light will come on.
4. Select the required kV value according to the build of
25 the patient with the kV up and kV down keys.
5. Select the mAs value with the mAs up and mAs down
65 keys.
6. You can now compress the breast, and take an
exposure in the same way as described in section 11
“SCREENING MAMMOGRAPHY WITH NUANCE
CLASSIC” on page 36.
14.4 Setting the time and date
The clock is set at the factory to the local time and should
be set to show correct the time and date before using the
X-ray unit.
2. Press and hold the sensor key until the current time
12:33 appears on the time/force display. The minutes start
to flash.
3. Press the sensor key to step to the parameter(s) to
be adjusted, the sequence is: minutes - hours - day -
month - years - century - minutes -.
4. Press the field/light keys to change the setting of the
selected parameter.
5. Press the CTL key to accept the new time. The (non
visible) seconds counter is zeroed.

14.5 Setting the speed of the compression paddle movement

During compression, the compression paddle moves
downwards at two different speeds:
• the speed of initial descent, no compression
• the rate at which the speed decreases during the
compression stage.
These speeds can be adjusted.
14.5.1 Setting initial descent speed

2. Press and hold the mAs down key to select the initial
1H= kg speed of descent range. The current speed number
will appear on the time/force display and start to
flash.
3. Select the speed you require for the initial descent
using the field/light keys. Number 1 is the slowest
speed and number 6 is the fastest speed.
NOTE
The setting 0 (zero) should and can be used only if the
compression force measurement is inoperative. When the
speed 0 is selected the force measurement is totally
ignored. Compression starts at a moderate speed and
continues only at crawling speed, after the compression
movement is shortly interrupted by releasing the control
switch.
4. Press the CTL key again to accept the new initial

descent speed. The indicator light will go out.
14.5.2 Setting compression speed decrease rate
1. Press the CTL key to re-enter the secondary function

2. Press and hold the mAs up key to select the rate at
2L= kgkg which the speed will decrease during the actual
compression stage. The current speed decrease
number will appear on the display and start to flash.
3. Press either of the field/light keys to select the speed
decrease number you require. The number 1 is the
slowest speed decrease and the number 6 is the
fastest speed decrease.
4. Press the CTL key again to accept the new speed
decrease number and exit the secondary function
mode. The indicator light will go out.

14.6 Setting the stop limit of the compression force

2. Press and hold the left LAT key to select the
10F= kg compression force setting mode. The current force (in
decanewtons) will appear on the display and start to
flash.
3. Press either of the field/light keys to select the stop
limit of compression force. The minimum limit is 1 kg
(2.2 lb.) and the maximum limit is 20 kg (44 lb.).
When you reach the preset limit during compression you
will hear a signal tone and the compression will stop. The
compression can be continued after this but only at a very
slow speed.
4. Press the CTL key again to accept the new stop limit
for the compression force and exit the secondary
function mode. The indicator light will go out.
14.7 Adjusting the volume of the exposure indicator signal

2. Press and hold down the density down key until you
hear the exposure warning signal.
volume of the indicator signal. The plus sign (right)
will increase the volume and the minus sign (left) will
decrease the volume.
4. Press the CTL key to accept the new or existing
volume. The indicator light will go out.
14.8 Enabling and disabling the Bucky grid movement
NOTE
Note that the grid movement is forced ON every time the
X-ray unit is turned on.

2. Press and hold down the right field/light key for 2
seconds.
3. Press the field/light keys to change the setting. The
time/force display shows the current setting.
This message indicates that the grid movement is
0FF G kg disabled.
This message indicates that the grid movement is turned
0n G kg on.
4. Press the CTL key to accept the new setting. The

indicator light will go out.

14.9 mA limit (on/off)

2. Press and hold down the kV down key for 2 seconds.
3. Use the field/light keys to change the setting. The

time/force display shows the current setting.
This message indicates that the mA limit is off. The mA

0FF c kg value is chosen to be the maximum allowed mA for the
selected kV value.
0n c kg This message indicates that the mA limit is on. The

maximum mA value that can be used is 80 mA.
4. Press the CTL key to accept the new setting. The

indicator light will go out.

15 TRANSPORTING NUANCE CLASSIC (ONLY UNITS WITH A FREE STANDING BASE)
15 TRANSPORTING NUANCE CLASSIC

(ONLY UNITS WITH A FREE STANDING BASE)
CAUTION
The X-ray unit must only be transported by a qualified
service personnel.
CAUTION
Never move the X-ray unit without first driving it to the
transport position.
15.1 Preparing the X-ray unit for transportation

1. Remove the film cassette, the compression paddle
and the Bucky (or the cassette holder).
2. Slide the foot controls in and disconnect the remote
exposure switch.
NOTE
Detach the cover plate from the X-ray unit’s base and
insert the C-arm locking knob in place before you drive the
X-ray unit to the transport position.
CAUTION
Note that the C-arm locking knob must be rotated as
far down as it goes so that the locking stud just
touches the knob when you drive the C-arm down.

4. Press and hold the left CC key (about four seconds)
until the C-arm starts to rotate. The C-arm will
automatically rotate in a clockwise direction from the
operating position to the transportation position. At
30
the same time the telescopic column will

automatically lower and then rise slightly. When the
Cl_Nuance_side1.eps
C-arm reaches the transportation position it will stop

moving.
30
5. Press the C-arm down switch to drive the C-arm to

Paddle the lowest position.
up Paddle
down NOTE
To stop the C-arm moving, press and hold down the
“paddle up” or “paddle down” switch on the foot control.
6. To start the C-arm moving again repeat the keying

sequence described above.

7. Switch the X-ray unit off with the on/off switch which
is located on the base behind the fixed column and
disconnect the X-ray unit from the power supply.
8. Disconnect the foot controls.
9. Remove the two cover plugs from the hood, insert the
transportation handle into the two holes and tighten
the holding screws.
The X-ray unit is now ready for transportation.

10. Support the cast base (not the metal cover) with your
foot and pull the X-ray unit back, using the
30
transportation handle, until it is on the transportation

wheels. NEVER TRY TO MOVE THE X_RAY UNIT
USING THE HANDRAILS OR CONSOLE ARMS.
11. The X-ray unit can now be moved. Transport it with
30
care. Do not bump the X-ray unit down steps or allow

the tube head assembly to hit anything. Never try to
move the X-ray unit with the C-arm in any other
position than the transport position.
30
30

15.2 Setting up the X-ray unit after transportation

When you have reached the place where the X-ray unit is
to be used, follow this procedure to set up the X-ray unit.
1. Support the base of the X-ray unit with your foot and
lower the front of the X-ray unit gently on to the floor.
NOTE
Do not allow the X-ray unit to drop heavily on to the floor
or you may damage the tube head assembly.
NOTE
It is recommended to bolt the X-ray unit to the floor.
1. Adjust the support feet, which are under the base

plate, until the X-ray unit is stable.
2. Make sure that the C-arm has enough room to rotate
without hindrance.
3. Observe any local or national radiation shielding
requirements.
4. Remove the transportation handle by unscrewing the
two holding screws.
5. Replace the two cover plugs.
6. Connect the foot controls.
7. Connect the X-ray unit to the power supply and
switch the X-ray unit on with the on/off switch which is
located on the base behind the fixed column.
09:00 kg The X-ray unit will carry out a self-test. When the X-
ray unit is ready for use the time will appear on the
display.
9. Press and hold down the CC key (about four
seconds) until the C-arm starts to move. The C-arm
will rotate in a counterclockwise direction from the
Paddle Paddle
up transportation to the operating position. At the same
down
time the column will rise to a preset height, about
three quarters of the maximum height. When the C-
arm gets to the correct position it will stop moving.
NOTE
You can stop the C-arm moving by pressing and holding
down the “paddle up” or “paddle down” switch on the foot
control.
10. To start the C-arm moving again repeat the keying

C-arm locking knob sequence described above.
11. Remove the C-arm locking knob by turning it
counterclockwise. Place the knob as shown on the
cm
kg
image beside. Attach then the cover plate in its

position.
12. Connect the remote exposure switch to the X-ray unit
13. Make sure that the position from which exposures are
to be taken is correctly shielded.
The X-ray unit is now ready for use.

16 HELP MESSAGES
16 HELP MESSAGES
Help message appears on the time/force display if a key
that has no function is pressed, or if the function is not
allowed for some reason. The help message disappears
automatically when the key is released.}
CODE HELP MESSAGE EXPLANATIONS
HE 4 The cassette is not properly positioned into the holder.
HE 5 The cassette has not been removed since the previous exposure.
HE 9 No view selected.
The Up/Down movement of the X-ray unit is not allowed during the compression of the
HE11
breast.
HE13 The aluminum filter (filter no 2) is not allowed with kV settings lower than 30 kV.
HE14 The kV setting cannot be changed before you reduce the mAs setting.
HE18 A higher mAs value is not allowed with the current kV setting.
HE19 AEC subgroup 3 cannot be selected in the spot mode.
HE20 This key functions only during AEC mode.
HE21 This key functions only in the manual exposure mode.
HE23 This key has no function together with the CTL key.
The C-arm cannot be rotated with the C-arm rotation switches, the compression force is
HE24
more than 5 kg.
HE25 The error must be cleared first from the display (CTL key).
HE26 This key has no function in the stereotactic mode.
HE27 The exposure switch is still activated.
HE28 The C-arm is not allowed to continue to rotate without pressing any of the foot controls.
You cannot move the C-arm or the compression paddles before the ST drive has been
HE29
finished. Use the middle switch of the foot control to finish the ST drive.
The Up/Down movement or change of projection is not allowed in the stereotactic mode
HE30
when the needle is inserted or when the compression force is more than 2 kg.
HE31 In stereo mode, use the ST key to drive the C-arm between ST1 and ST2.
HE32 In stereo mode, drive the C-arm to the correct position before selecting the view.
The C-arm is not allowed to continue to rotate without pressing any of the foot controls
HE34
in the stereotactic mode.
HE35 You cannot select the Automatic Paddle Release & Cassette Ejection function.
HE36 You have to release the upper compression paddle before selecting the exposure view.
HE37 No Bucky.
The AAEC mode is not allowed with current kV setting,

HE39 OR:
A lower kV setting is not allowed with the AAEC.

16 HELP MESSAGES
CODE HELP MESSAGE EXPLANATIONS
HE40 The advanced AEC mode cannot be used with the aluminum filter.
HE41 kV cannot be higher than the max. value (AAEC).
HE44 Side Access drive not ready.
HE45 The Side Access function is not available.

17 ERRORS AND ERROR MESSAGES

If the X-ray unit malfunctions or you make a mistake when
using the equipment, an error message appears on the
display.
Before any corrective action can be taken, press the CTL
key to clear the error message from the display.
CODE REASON CORRECTIVE ACTION
You removed your finger from the Clear the error message. Remove the partially
remote exposure button before the exposed film from the cassette and process the
exposure was complete. film to see if it has been correctly exposed. If not,
Er00 place a fresh film in the cassette and take
another exposure. Remember to hold the
exposure button down for the duration of the
exposure.
Underexposure of the Flex AEC Clear the error message and check that nothing
sensor. foreign is obstructing the radiation beam. If not,
Er03 either increase the kV value or select a different
AEC sensor, or use the X-ray unit in the manual
mode.
The cassette is not properly Clear the error message and make sure that the
positioned inside the Bucky, or a cassette is properly attached. If the X-ray unit still
problem with the cassette sensors does not work correctly, switch the X-ray unit off
Er04 or cabling. from the main power supply, wait a few seconds
and then switch the X-ray unit on again. If the X-
ray unit still does not work correctly, contact your
local sales representative.
The cassette was not removed from Clear the error message and change the
the X-ray unit after the last cassette.
exposure (double exposure If the X-ray unit still does not work correctly,
prevention). switch the X-ray unit off from the main power
Er05
supply, wait a few seconds and then switch the
X-ray unit on again. If the X-ray unit still does not
work correctly, contact your local sales
representative.
No view selected. Clear the error message and select the correct
Er09
view.
X-ray tube anode voltage (kV) Clear the error message and then see if the X-
overshoot. ray unit works correctly. If it does not, switch the
X-ray unit off from the main power supply, wait a
Er10
few seconds and then switch the X-ray unit on
again. If the X-ray unit still does not work
correctly, contact your local sales representative.
dropped suddenly. ray unit works correctly. If it does not, switch the
Er11

X-ray tube cathode filament pre- Clear the error message and then see if the X-
heating voltages are not calibrated. ray unit works correctly. If it does not, switch the
Er12
X-ray tube anode current (mA) Clear the error message and then see if the X-
sudden peak. ray unit works correctly. If it does not, switch the
Er13
Flex AEC sensor(s) are not Clear the error message and continue to use the
Er14 calibrated. X-ray unit in the manual mode. Contact your
sales representative for help.
Overexposure of the Flex AEC Clear the error message and continue to use the
Er15 sensor or too radio translucent X-ray unit in the manual mode. Contact your
object. sales representative for help.
Flex AEC detector failure. Clear the error message and continue to use the
Er16 X-ray unit in the manual mode. Contact your
sales representative for help.
Bias values were not set during Clear the error message and then see if the X-
calibration of the tube head filament ray unit works correctly. If it does not, switch the
voltage (tube type E or F). X-ray unit off from the main power supply, wait a
Er17
kV fine-adjustment parameter Clear the error message and then see if the X-
values in TUBE CPU differ from the ray unit works correctly. If it does not, switch the
values in REAR CPU. X-ray unit off from the main power supply, wait a
Er18
Mirror motor time-out. The mirror Clear the error message and then see if the X-
mechanism does not reach the limit ray unit works correctly. If it does not, switch the
sensor within the specified time. X-ray unit off from the main power supply, wait a
Er20
Filter motor time-out. The filter Clear the error message and then see if the X-
Er21

Collimator motor time-out. The Clear the error message and then see if the X-
collimator mechanism doesn’t ray unit works correctly. If it does not, switch the
reach the limit sensor within the X-ray unit off from the main power supply, wait a
Er22 specified time. few seconds and then switch the X-ray unit on
OR: Cutter motor time-out. The again. If the X-ray unit still does not work
cutter mechanism does not reach correctly, contact your local sales representative.
the sensor within the specified time.
No pulses from the stereo motor Clear the error message and then see if the X-
sensor or from the Side Access ray unit works correctly. If it does not, switch the
motor sensor. X-ray unit off from the main power supply, wait a
Er23
Bucky grid motor time-out. The grid Clear the error message and then see if the X-
does not move or there is no signal ray unit works correctly. If it does not, switch the
from sensor within the specified X-ray unit off from the main power supply, wait a
Er24
time. few seconds and then switch the X-ray unit on
X-ray tube anode does not rotate Clear the error message and then see if the X-
properly, or a problem in the anode ray unit works correctly. If it does not, switch the
motor rotation sensing. X-ray unit off from the main power supply, wait a
Er26
Compression motor time-out. The Clear the error message and then see if the X-
Er27
Compression force measurement Clear the error message and then see if the X-
calibration failure, force signal out ray unit works correctly. If it does not, switch the
of range. X-ray unit off from the main power supply, wait a
Er28
One of the main control panel keys Remove the obstruction. Clear the error code
was being held down as the X-ray and the X-ray unit can be used. If the error code
Er29
unit was carrying out its self test reappears contact your sales representative for
during start up. help.
missing, dropping during exposure ray unit works correctly. If it does not, switch the
or lower than the setting. X-ray unit off from the main power supply, wait a
Er30

missing, dropping during exposure ray unit works correctly. If it does not, switch the
or lower than the setting. X-ray unit off from the main power supply, wait a
Er31
higher than the setting. ray unit works correctly. If it does not, switch the
Er32
X-ray tube filament voltage (V) out Clear the error message and then see if the X-
of range. ray unit works correctly. If it does not, switch the
Er33
X-ray tube bias voltage (V) out of Clear the error message and then see if the X-
range. ray unit works correctly. If it does not, switch the
Er34
The Mains-sync signal from the Clear the error message and then see if the X-
SYNC PCB is not reaching the ray unit works correctly. If it does not, switch the
TUBE CPU. X-ray unit off from the main power supply, wait a
Er35
The REAR CPU detected a too long Clear the error message and then see if the X-
exposure (>10 sec) and terminated ray unit works correctly. If it does not, switch the
it. X-ray unit off from the main power supply, wait a
Er36
kV feedback signal open circuit. Clear the error message and then see if the X-
ray unit works correctly. If it does not, switch the
Er37
mA feedback signal open circuit. Clear the error message and then see if the X-
ray unit works correctly. If it does not, switch the
Er38

One of the C-arm control keys was Remove the obstruction. Clear the error code
being held down as the X-ray unit and the X-ray unit can be used. If the error code
Er39
was carrying out its self test during reappears contact your sales representative.
start up.
C-arm angle, lift mechanism height, Clear the error message and then see if the X-
or compression paddle positional ray unit works correctly. If it does not, switch the
information was wrong. X-ray unit off from the main power supply, wait a
Er41
Spurious pulses from C-arm motor Clear the error message and then see if the X-
rotation sensor, or the motor rotates ray unit works correctly. If it does not, switch the
even if not commanded. X-ray unit off from the main power supply, wait a
Er42
No pulses from C-arm rotation Clear the error message and then see if the X-
motor rotation sensor, or motor ray unit works correctly. If it does not, switch the
does not rotate even if X-ray unit off from the main power supply, wait a
Er43
commanded. few seconds and then switch the X-ray unit on
Lift motor is rotating even if not Clear the error message and then see if the X-
commanded, or spurious pulses ray unit works correctly. If it does not, switch the
from lift motor rotation sensor. X-ray unit off from the main power supply, wait a
Er45
No pulses from lift motor rotation Clear the error message and then see if the X-
detector, or motor does not rotate ray unit works correctly. If it does not, switch the
even if commanded. X-ray unit off from the main power supply, wait a
Er46
Mains frequency out of range Clear the error message and then see if the X-
(45...75 Hz) or failure in frequency ray unit works correctly. If it does not, switch the
measurement circuitry. X-ray unit off from the main power supply, wait a
Er47
Failure in the stereotactic device Clear the error message and then see if the X-
stepper motor or its control circuitry ray unit works correctly. If it does not, switch the
or in the rotation sensors. X-ray unit off from the main power supply, wait a
Er48

The stereotactic device is not at the Clear the error message and then see if the X-
end position sensor, or a failure in ray unit works correctly. If it does not, switch the
the sensor. X-ray unit off from the main power supply, wait a
Er49
Tube head assembly temperature Clear the error message and then see if the X-
sensor short circuit. ray unit works correctly. If it does not, switch the
Er50
Tube head assembly temperature Clear the error message and then see if the X-
sensor open circuit. ray unit works correctly. If it does not, switch the
Er51
Filament voltage feedback open Clear the error message and then see if the X-
circuit. ray unit works correctly. If it does not, switch the
Er52
Power supply heatsink temperature Clear the error message and then see if the X-
sensor short circuit. ray unit works correctly. If it does not, switch the
Er53
Power supply heatsink temperature Clear the error message and then see if the X-
sensor open circuit. ray unit works correctly. If it does not, switch the
Er54
C-arm rotation reference sensor Clear the error message and then see if the X-
failure. ray unit works correctly. If it does not, switch the
Er55
Error in the release limit sensor of Clear the error message and then see if the X-
the compression motor during ray unit works correctly. If it does not, switch the
calibration. X-ray unit off from the main power supply, wait a
Er56

The remote exposure switch was Remove the obstruction. Clear the error code
being held down as the X-ray unit and the X-ray unit can be used. If the error code
Er57
was carrying out its self test during reappears contact your sales representative for
start up. help.
One of the foot controls was being Remove the obstruction. Clear the error code
held down as the X-ray unit was and the X-ray unit can be used. If the error code
Er58
carrying out its self test during start reappears contact your sales representative for
up. help.
Failure in internal emergency STOP Clear the error message and then see if the X-
system. ray unit works correctly. If it does not, switch the
Er59
TUBE CPU internal ± 15 VDC Clear the error message and then see if the X-
voltage is out of limits. ray unit works correctly. If it does not, switch the
Er60
Failure or sporadic disturbance in Clear the error message and then see if the X-
serial communication between ray unit works correctly. If it does not, switch the
TUBE and REAR CPU or non X-ray unit off from the main power supply, wait a
Er61
compatible software versions. few seconds and then switch the X-ray unit on
Failure or sporadic disturbance in Clear the error message and then see if the X-
serial communication between ray unit works correctly. If it does not, switch the
REAR CPU and external test X-ray unit off from the main power supply, wait a
Er62
device. few seconds and then switch the X-ray unit on
Error in STOP communication line Clear the error message and then see if the X-
between TUBE and REAR CPU. ray unit works correctly. If it does not, switch the
Er63
Error in exposure communication Clear the error message and then see if the X-
line between TUBE and REAR ray unit works correctly. If it does not, switch the
CPU. X-ray unit off from the main power supply, wait a
Er64
Both switches (paddle down and Clear the error message and then see if the X-
paddle up) of one foot control are ray unit works correctly. If it does not, switch the
pressed down. X-ray unit off from the main power supply, wait a
Er68

Software chip (Flash EEPROM) Clear the error message and then see if the X-
failure on TUBE CPU. ray unit works correctly. If it does not, switch the
Er71
Software chip (Flash EEPROM) Clear the error message and then see if the X-
failure on REAR CPU. ray unit works correctly. If it does not, switch the
Er72
REAR CPU attempted to execute Clear the error message and then see if the X-
an illegal program instruction. ray unit works correctly. If it does not, switch the
Er73
REAR CPU watchdog reset Clear the error message and then see if the X-
occurred (please contact Planmed). ray unit works correctly. If it does not, switch the
Er74
REAR CPU illegal interrupt Clear the error message and then see if the X-
detected (please contact Planmed) ray unit works correctly. If it does not, switch the
Er75
REAR CPU timer interrupt error Clear the error message and then see if the X-
(please contact Planmed). ray unit works correctly. If it does not, switch the
Er76
REAR CPU stack overflow (please Clear the error message and then see if the X-
contact Planmed). ray unit works correctly. If it does not, switch the
Er77
Time-of-day clock oscillator (32768 Clear the error message and then see if the X-
Hz) not oscillating or out of ray unit works correctly. If it does not, switch the
tolerance. X-ray unit off from the main power supply, wait a
Er78

TUBE CPU stack overflow (please Clear the error message and then see if the X-
contact Planmed). ray unit works correctly. If it does not, switch the
Er79
REAR CPU parameter memory Clear the error message and then see if the X-
(Flash EEPROM) failure. ray unit works correctly. If it does not, switch the
Er80
TUBE CPU parameter memory Clear the error message and then see if the X-
(Flash EEPROM) failure. ray unit works correctly. If it does not, switch the
Er81
REAR CPU CONFIG register Clear the error message and then see if the X-
contains wrong data. ray unit works correctly. If it does not, switch the
Er82
TUBE CPU CONFIG register Clear the error message and then see if the X-
contains wrong data. ray unit works correctly. If it does not, switch the
Er83
REAR CPU parameter memory Clear the error message and then see if the X-
(Flash EEPROM) is empty or ray unit works correctly. If it does not, switch the
erased. X-ray unit off from the main power supply, wait a
Er84
Flat battery on REAR CPU (RAM Clear the error message and then see if the X-
stand-by Ni-MH battery is drained ray unit works correctly. If it does not, switch the
or has failed). X-ray unit off from the main power supply, wait a
Er85
Short mains voltage abruption or Clear the error message. You can now continue
Er86 drop was detected, or error in to use the X-ray unit.
detection circuitry.
Illegal country code or country code Clear the error message and then see if the X-
not set. ray unit works correctly. If it does not, switch the
Er87

Battery back-up memory (RAM) is Clear the error message and then see if the X-
erased. ray unit works correctly. If it does not, switch the
Er88
Wrong type C-arm rotation motor Clear the error message and then see if the X-
sensor in the Flash EEPROM ray unit works correctly. If it does not, switch the
memory. X-ray unit off from the main power supply, wait a
Er89
Error in stereotactic system sensor Clear the error message and then see if the X-
signals. ray unit works correctly. If it does not, switch the
Er91
Error in the compression system Clear the error message and then see if the X-
end limit sensors (simultaneous ray unit works correctly. If it does not, switch the
signals from both end limit X-ray unit off from the main power supply, wait a
Er93
sensors). few seconds and then switch the X-ray unit on
Error in the C-arm rotation sensor Clear the error message and then see if the X-
system (simultaneous signals from ray unit works correctly. If it does not, switch the
the reference and/or limit sensors). X-ray unit off from the main power supply, wait a
Er94
Error in the lift mechanism sensor Clear the error message and then see if the X-
system (simultaneous signals from ray unit works correctly. If it does not, switch the
both end limit sensors). X-ray unit off from the main power supply, wait a
Er95
Error in the Bucky mechanism or in Clear the error message and then see if the X-
the sensor or in the movement of ray unit works correctly. If it does not, switch the
the mechanism. (This error is NOT X-ray unit off from the main power supply, wait a
Er96
displayed, but is stored in the error few seconds and then switch the X-ray unit on
list). again. If the X-ray unit still does not work

18 MAINTENANCE
18 MAINTENANCE
The following maintenance work should be carried out.
18.1 Daily check

A test exposure, using a tissue equivalent test phantom
should be taken at least once a day to ensure that the
mAs and AEC exposure and density values remain
consistent.
Check the condition of the film processing unit. Make sure
that the chemicals used are fresh and that the processing
times and temperatures are constant.
Carry out a sensitometry test and keep a track on the
measurements.
Check the condition of the compression paddles, Buckys,
cassette holder and magnification platform. These parts
can become brittle (light parts and cracks) after prolonged
cleaning with wrong type cleaning solutions.
18.2 Cleaning
18.2.1 Compression paddles, MaxView suction cups, Buckies, cassette holder

and magnification platform
Clean the compression paddles, MaxView suction cups,
Bucky and the magnification platform after each
examination.
Clean the surfaces first using a damp cloth soaked with
mild soap solution and water.
Disinfect the surfaces with non-alcoholic disinfection
solution. Planmed recommends Pharmaceutical
Innovations Inc. M SPRAY 2000 disinfectant and TriGene
-disinfectant wipes. For painted surfaces use a damp
cloth and a neutral disinfectant.
NOTE
Do not use abrasive cleaning agents, mechanical cleaning
methods or cleaning equipment. Do not immerse the parts
in the cleaning agent.
18.2.2 Other X-ray unit surfaces

The X-ray unit surfaces should be periodically wiped with
a soft cloth damped in cleaning solution.

18 MAINTENANCE
18.3 Servicing
To keep the X-ray unit in compliance with § 1020.30 - 31
the following things must be checked once a year:
• Leakage radiation
• HVL measurement
• Linearity and reproducibility (also AEC)
• kV
• mAs
• Exposure time
• Automatic exposure control limits
• Illuminance of light localizers
• Alignment of visually defined X-ray field and contrast
of the light field
• X-ray field size
• Transmission limit
18.4 MaxView maintenance
18.4.1 Removing sheet fragments from the MaxView modules

The MaxView sheets can break if they are misused. This
will happen, for example, if you try to pull the MaxView
sheet out without pressing the eject sheets switch. In this
case the sheet is forced out when the module’s four
locking claws are holding it firmly in position.
NOTE
Always use new sheets for every patient. The sheets can
break if they are not changed between patients.
If sheet fragments get into the MaxView module(s), you

will have to open the module(s) and remove each sheet
fragment separately. Otherwise the module(s) will not
work properly.
18.4.2 Removing sheet fragments from the upper MaxView module

Follow the procedure described below to first move the
module’s locking claws into a position where the sheet
fragments can be easily removed.
To remove sheet fragments from the upper MaxView
module:
1. Press the paddle down switch on the foot control to
lower the compression paddle.
2. Press the middle switch (both sheets in switch) until
Both sheets in the value shown on the angle display (traction
Paddle down distance) is about 15 mm.
3. You can now switch off the power and remove the
15 upper MaxView module from the X-ray unit as
described in section 9.8.1 “Attaching the upper
Traction distance MaxView module” on page 28.

18 MAINTENANCE
4. To open the upper MaxView module, lift the cover at

the top of the module. The sheet roller inside the
module will now be positioned so that the locking
Cover claws and sheet fragments are easily accessible.
Kansi_auki.eps
Locking claw
Sheet fragment 5. To remove a sheet fragment, first gently press the

Sheet strip locking claw down.
6. Slide the trapped sheet fragment forwards using, for
example, a strip cut from a MaxView sheet.
7. You can now easily remove the sheet fragment by
using a pair of tweezers, or by simply shaking it out.
NOTE
istus.eps
Check all four locking claws and remove any sheet

fragments that are trapped in the module.
8. Attach the upper module to the X-ray unit and then

switch on the power as described in section 8
“SWITCHING THE X-RAY UNIT ON” on page 22.
18.4.3 Removing sheet fragments from the lower MaxView module

The lower MaxView module is integrated to the X-ray unit
and it cannot be removed. The sheet fragments can be
removed from the module by removing the lid and the
front metal cover of the module.
1. Remove the lid of the lower MaxView module.
NC_MV_mod-cover.eps

18 MAINTENANCE
2. Loosen the two finger screws on the metal cover of

Finger screws the module.
3. Pull out the front cover. You can now see the sheet
roller and the four locking claws.
Front cover
4. Press the eject sheets button in the middle of the

MaxView sheet control panel.
5. Switch off the power immediately after the movement
of the sheet roller has stopped from the On/Off switch
of the X-ray unit.
The locking claws are now opened and the sheet roller
positioned so that the sheet fragments are visible and
easily accessible.
Eject sheets
6. If a sheet fragment is trapped under one of the

locking claws, slide it away by using, for example, a
MV_lower module.eps
strip cut from a MaxView sheet.

7. Remove the sheet fragment using, for example, a
pair of tweezers, a strip of a MaxView sheet, or
simply by blowing it out.
8. If you managed to move the fragment(s) away from
the locking claw, you can remove the fragments also
by switching on the power and by rolling the sheet
Locking claw roller upside down. Use the middle switch of the foot
control to drive the sheet roller about 25-30 mm
Sheet roller forwards and back. The sheet fragments will drop out
of the module.
NOTE
Check that all sheet fragments have been removed from
the module.
1. Attach the front cover of the module.

2. Tighten the finger screws on the metal cover.
3. Attach the lid, and switch on the power.

19 DISPOSAL OF THE X-RAY UNIT
19 DISPOSAL OF THE X-RAY UNIT

In order to reduce the environmental load over the
product’s entire life cycle, Planmed’s products are
designed to be as safe as possible to manufacture, use
and dispose of.
Parts which can be recycled should always be taken to
the appropriate processing centres, after hazardous
waste has been removed. Disposal of obsolete X-ray
units is the responsibility of the waste possessor.
All parts and components containing hazardous materials
must be disposed of in accordance with waste legislation
and instructions issued by the environmental authorities.
The risks involved and the necessary precautions must be
taken into account when handling waste products.
Table 2: Disposal of the Nuance Classic mammography
X-ray unit
X = action
(X) = action in cases where processing is available)
Hazardous
Main materials for Recyclable Waste disposal waste
Part
disposal material site (separate
collection)
Frame and covers

- metal Aluminum,
galvanized steel X
lead X
- plastic PVC, X
PUR, UP X
other plastics X X
- rubber X
- glass X
Motors (X)
Component boards (X)
Cables, Copper, X
transformers steel, X
transformer oil X
X-ray tube X
Packing Wood, X
cardboard, X
paper X
MaxView
radiolucent sheets plastic (PET) X
Other parts X

20 TECHNICAL SPECIFICATIONS
MANUFACTURED BY:
Planmed Oy
Sorvaajankatu 7
00880 Helsinki
Finland
MODEL
Nuance Classic
IEC safety class: I
IEC degree of protection: B
IEC enclosure class: IP20
X-RAY TUBE ASSEMBLY
X-ray tube Toshiba E7290 or Varian M113 (Refer to the tube head label)
Anode type rotating anode
Anode thermal capacity 300 000 HU
Target material molybdenum
Tube port material beryllium
Focal spot size 0.1/0.3 mm
Filtration 30 µm Mo/0.5 mm Al or 30 µm Mo/25 µm Rh

GENERATOR ASSEMBLY
Generator constant potential, microprocessor controlled, high

frequency
Anode voltage 20 - 35 kV ±2 kV
Anode current - 0.3mm E7290: 80 - 110 mA ±5 mA

M113: 91 - 120 mA ±5 mA
Anode current - 0.1mm E7290: 21 - 35 mA ±1 mA

M113: 31 - 42 mA ±3 mA
mAs range E7290: 5 - 660 mAs

M113:5 - 720 mAs
Exposure time - 0.3mm 0.1 - 5 seconds (optional 6 seconds) ±5%
Exposure time - 0.1mm 0.1 - 9.9 seconds ±5%
Cooling automatically controlled
Line voltage 208 - 240 VAC, 50 or 60 Hz - single phase
Line voltage automatic ±10%

compensation
Line voltage regulation 10%
Fuses 2 x 15 AT / 250 V
Power consumption 100 VA, 4000 VA max. 5 seconds
Mode of operation intermittent
Maximum apparent 1 ohm

resistance of supply
mains
Maximum continuous 250 W

heat dissipation
Complies with IEC 60601-1 safety and IEC 60601-2-7

radiation performance regulations.

C-ARM
Rotation motorized, range -135°... +180°
Vertical movement motorized range 800 mm... 1400 mm

(31.5 in... 55.1 in)
SID 650 mm
Compression motorized with manual fine-tuning
Cassette 18 x 24 cm and 24 x 30 cm
Magnification manual, 1.6 or 1.8 or 2.0
The Lift and C-arm rotation Intermittent operation. The effective duty cycle is
motors’ operation 8%, 25 sec “ON”, 300 sec “OFF”
AUTOMATIC EXPOSURE CONTROL
Sensors 48 automatically sensors

(can be manually selected in three subgroups)
Density adjustment 15 density steps

(13% change in OD per step, plus fine adjustment ±
5 steps, 0.05 OD per step)
MECHANICAL DATA
Dimensions (H x D x W) 1026 x 994 x 755 mm minimum

(40.4 x 39.1 x 29.7 in)
Weight 191 kg (421 lbs)
Colour RAL 9016
NOTE
The technical specifications are subject to change without
notice.
NOTE
Refer to the Planmed Nuance Classic Technical Manual
for the
User’s Statement.

21 LIST OF ABBREVIATIONS
ABBREVIATION DEFINITION
AAEC Advanced Automatic Exposure Control
AEC Automatic Exposure Control
Al Aluminum
C/D Contrast/Dose
CC Cranio-Caudal
CR Computed Radiography
EC European Community
EEC European Economic Community
EMC Electromagnetic Compatibility
Er Error
EXP Exposure
HE Help
HVL Half Value Layer
IEC International Electrotechnical Commission
LAT Lateral
LCC Left Cranio-Caudal
LLM Left Latero-Medial
LLMO Left Latero-Medial Oblique
LM Latero-Medial
LMLO Left Medio-Lateral Oblique
MAG Magnification
MAN Manual
ML Medio-Lateral
Mo Molybdenum
OBL Oblique
OD Optical Density
PA Posterior-Anterior
RCC Right Cranio-Caudal
RF Radio Frequency
Rh Rhodium
RLM Right Latero-Medial
RLMO Right Latero-Medial Oblique

RMLO Right Medio-Lateral Oblique
ST Stereotactic
WEEE Waste Electrical and Electronic Equipment

Planmed Oy | Sorvaajankatu 7 | 00880 Helsinki | Finland
tel. +358 20 7795 300 | fax +358 20 7795 664 | sales@planmed.com | www.planmed.com

Planmed Nuance Classic: User's Manual

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Planmed Nuance Classic: User's Manual

Uploaded by

Copyright:

Available Formats

Planmed Nuance Classic

User’s manual Planmed Nuance Classic 1

12 DIAGNOSTIC MAMMOGRAPHY WITH NUANCE CLASSIC ............................................... 42

Planmeca pursues a policy of continual product development. Although every effort is

2 Planmed Nuance Classic User’s manual

The Planmed Nuance Classic mammography X-ray unit

All key illustrations indicate that the key should be

1.1 Potential adverse events

User’s manual Planmed Nuance Classic 1

Alternating current (Standard IEC-60417).

Attention, consult accompanying documents (Standard

Electrostatic sensitive device (Standard IEC 60417).

Separate collection for electrical and electronic equipment

2.1 Notes, cautions, and warnings

2 Planmed Nuance Classic User’s manual

3 WARNINGS AND PRECAUTIONS

User’s manual Planmed Nuance Classic 3

4 CHECKLIST BEFORE OPERATION

• Make sure that you are fully acquainted with the

4 Planmed Nuance Classic User’s manual

6 NUANCE CLASSIC - MAIN PARTS

6.1 General view of the X-ray unit (standard configuration)

Main control panel

Telescopic column Column

User’s manual Planmed Nuance Classic 5

6.2 Compression paddles

Perforated biopsy paddle Perforated multi-hole

biopsy opening 50x90 mm

for contact view

6 Planmed Nuance Classic User’s manual

6.4 Multifunction magnification platform (for magnification views only)

6.5 Chin guard

User’s manual Planmed Nuance Classic 7

6.6 Film markers

6.7 Exposure button

6.8 CR interface adapter (optional)

8 Planmed Nuance Classic User’s manual

6.9 Main control panel

Left cranio-caudal key Right cranio-caudal

Left lateral key

Stereotactic operation key

kV down key kV up key

mAs down key mAs up

Density down Density up

Time/force display Breast thickness

Sensor indicator lights Automatic/manual

Exposure/ready indicator Focal spot indicator lights

User’s manual Planmed Nuance Classic 9

6.9.1 Cranio-caudal (CC) key (left and right)

6.9.2 Oblique (OBL) key (left and right)

6.9.3 Lateral (LAT) key (left and right)

6.9.4 Angle display

10 Planmed Nuance Classic User’s manual

6.9.5 kV keys and display

6.9.6 mAs keys and display

6.9.7 Density keys and display

6.9.8 CTL (secondary function) key

6.9.9 Compression release key

User’s manual Planmed Nuance Classic 11

6.9.10 Field/light keys

6.9.11 Time/force display

6.9.12 Breast thickness display

12 Planmed Nuance Classic User’s manual