How to perform a Deep Inspiration Breath Hold scan using the Anzai Medical® respiratory gating system SOMATOM go.Sim or go.Open Pro, VA40; Anzai Medical ® AZ-733VI, version 1.0* NOTE: Before using the laptop - Users of this document should be familiar with the ANZAI AZ-733VI hardware setup and patient preparation for respiratory gating.** The patient should be secured to the belt and sensor, and a waveform should be present on the sensor port screen. 1. On the back of the sensor port, ensure that the switch on the lower left is selected to the USB setting (left side) before opening the laptop as shown below. HOOT COM 2. Laptop: Open and power up the laptop, then select the icon on the home screen as shown below. Click AZ-733VI Application Icon on the desktop of Windows, then the application starts up and the main screen appears. << Main >> Screen Respiratory Gating System AZ-733VI nn Version for Windows 7/8 ANZAI MEDICAL CO ., LTD. ning : This computer program protected by copyright law AZ733VI and international treaties. ------ Wait for a second Double-Click *Screenshots and directions are taken from Anzai Medical® AZ – 733Vi User’s Manual Ver. 1.0 Mar. **Anzai Medical is a third-party company and not affiliated with Siemens Healthineers. The use of their equipment and manual is not managed by Siemens Healthineers and may change. The Anzai Medical User’s Manual shall be used as your main reference, in partic- ular for relevant safety information like warnings and cautions. Unrestricted | Published by Siemens Healthineers AG © Siemens Healthineers AG, 2024 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 01/12/2024 | QR700004357 Healthineers 3. Patient Registration: Follow the steps below to create a new patient, enter patient information, and save. ( 1) << Patient File Management >> Window Display <> Window opens when clicks "Patient File Management" icon. WWW m (2) << Patient Information >> Display << Patient Information >> is selected when clicks "Patient Entry"icon. 3) Registration of New Patient Information Enter each item of << Patient Information >>. [ID No.J and ['Name] is necessary. Registration is completed when "Save"button is clicked. When cancelling registration, click "Cancel"button. Patient Information ID No.: Rudy No.: 000000 Name: Anzal Tor Entry : 2013/11/19 Gender : Imported : Age: 45 Commenti: Test Comment2: Comment3: Save Cancel Unrestricted | Published by Siemens Healthineers AG © Siemens Healthineers AG, 2024 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 01/12/2024 | QR700004357 Healthineers Page 2 of 11 4. Load the Patient Information using the steps below. Select the patient from the list of << Patient File Management >> window. When clicks "Load Patient Information" icon, it returns <
> screen where ID No.J , [Name] is confirmed. ID No : 0123 Name : Anzai TarD Urload Loaded Data : VVV 5. Adjust Waveform Setup: Before setting a breath hold threshold, optimize the waveform as shown below. Adjustment should be performed so the level of patient's respiratory waveform is displayed between the level O~100 by adjusting POSITION value and MAGNIFICATION value. [Optimal Display] WWWWWW Respiratory Waveform is displayed between the level O~~100. [At Higher or Lower Position] Adjust the position of waveform by POSITION value change. [At Narrower or Wider Amplitude] Adjust the amplitude of waveform by MAGNIFICATION change. Unrestricted | Published by Siemens Healthineers AG © Siemens Healthineers AG, 2024 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 01/12/2024 | QR700004357 Healthineers Page 3 of 11 6. The following pictures and steps illustrate how to adjust the position and magnification to achieve an optimal waveform. (1) When the exhaled status is unstable ( Manual Adjustment) 3. Reckon the optimal MAGNIFICATION value. Since the amplitude is 50, you get the level "0~100 by multiplying by 2. 100 4. Adjust MAGNIFICATION value by rotating MAGNIFICATION dial. 50 Waveform Setup CHI :Lazer Senso X120mm) Position -93.8 Magnification 1. Adjust the exhaled peak to the level "O" by rotating POSITION dial x 11.49 . . Naveform Setup HI : Laser Senso<120mm) 100 Position 50 -93.8 Magnification x 11.49 *Offsetting is activated by MAGNIFICATION value change. 100 5. Adjust the level to "O" by rotating POSITION dial. 50 Waveform Setup CHI : LAE MAN ser Senso X120mm) O Position -93.8 Magnification x 11.49 2. Confirm the Amplitude. 100 50 2 +5 MW MAN Amplitude : 50 Unrestricted | Published by Siemens Healthineers AG © Siemens Healthineers AG, 2024 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 01/12/2024 | QR700004357 Healthineers Page 4 of 11 (2) When the exhaled peak is constant. (Semi-Automatic + Manual Adjustment) 100 50 1. Click the waveform needed to be adjusted. 1 100 2. Operate Manual Adjustment > Proceed (1)-2. 100 50 Unrestricted | Published by Siemens Healthineers AG © Siemens Healthineers AG, 2024 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 01/12/2024 | QR700004357 Healthineers Page 5 of 11 (3) When the amplitude is constant. (Automatic Adjustment) 100 50 1. Operate Automatic Adjustment. Waveform Setup CHI :Laser Senso (1 20mm) POSITION MAMMACATION Position -@3.8 Magnification Bespkrufory Garing System AI-7334 :11.49 100 50 2. When the amplitude became adjusted to "O~100", click "MANUAL" icon. Waveform Setup CH1 : Laser Sensor(1 20mm) Position AUTO -93.8 Magnification x 11.49 Unrestricted | Published by Siemens Healthineers AG © Siemens Healthineers AG, 2024 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 01/12/2024 | QR700004357 Healthineers Page 6 of 11 7. Define Breath Hold Threshold: Have the patient practice holding their breath. Watch the waveform to see where the breath hold lies on the graph. Then use one of the following methods, point-to-point mode, or level-to-level mode, to define a gating threshold, as shown below. Point to Point Mode At Point to Point Gate Signal is provided between any starting point and ending point of respiratory waveform, Wineform Loved 100 EX HT ON OFF 1. 1. Soloct Point to Point). 2 Determine rospratory phase N of Gate Simal output to start. In : Inhalation Phase Ex : Exhalation Phase 3. Press /4 to set the level 4. Determine the respiratory phase of Gate Signal output to end. In : Inhalation Phase 3 5 Ex : Exhalation Phase 5. Press VM] to set the level 6. When select « Level Bind », Start Level and End Level is connectedly set. 7. Set (> and confirm Gate Signal output setting. Dotted ine (Gate Threshold Bar color) appears on the level set at Start Point and End Point Colored ine (Gate Waveform colori appears between Start Point and End Point level set Unrestricted | Published by Siemens Healthineers AG © Siemens Healthineers AG, 2024 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 01/12/2024 | QR700004357 Healthineers Page 7 of 11 Level to Level Mode At Level to Level Mode Gate Signal is provided between any level of respiratory waveform. Waveform Level 100 20 O EX ON OFF Time 1. Select [Level to Levell. 2. Press /4 to set the lower 2 level of Gate Signal. Oale Satun 3. Press . to set the upper Level to Level level of Gate Signal Lower Level and Upper Level cannot be set to the same value. 4. Set « Preview >> and confirm Gate Signal output setting. 4 Dotted line (Gate Threshold Bar color) appears on the level set at Lower Level and Upper Level Colored line (Gate Waveform color) appears between the range of Lower Level and Upper Level Level les Level Mode" hin a saliry function for full gite output n ther cine of the respiratory wivelorn a For example. If Lower Level: -10, Upper Level: 110 and smspratery level is 0-100, the gate signaal turns of Unrestricted | Published by Siemens Healthineers AG © Siemens Healthineers AG, 2024 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 01/12/2024 | QR700004357 Healthineers Page 8 of 11 8. Preparing the CT scan: After defining the breath hold threshold, load the CT protocol for deep inspiration breath hold, scan the topogram, and define the scan range. 9. Practice having the patient hold their breath a few times to ensure they can maintain the threshold. Load the exam, and select Go, but do not start the exam yet. SIEMENS ealthineers : 1/2/1959 (65) DIBH RTP Thorax [factory] ( .... DIBH DIBH Recon Ranges *1/2/1959. 65Y $71go CT VANDA Topogram 1/2/2024 5:01:51.25 PM Preconditions 1 IMA 1 TOP 101 Thorax DIBH TP-750 0 CTDivol (32 cm) 4.33 mGy SIEMENS prax DIBH SSDE (6.4 cm) 15.7 mGy DLP 160 may cm ES. mas 65 120 opopure Time 4.47 % Check image quality Reconstruction Patient Marking Close A Start Thorax DIBH scan Contem GO Cancel Press START L 10. On the Anzai laptop, lock in the parameters, then start data acquisition as outlined in the steps below. Setting Lock Clicking "Setting Lock" icon, it locks the setting of Patient Registration, Respiratory Waveform Adjustment, Gate Signal output setting. Parameter Setup (Ch. 3.3~Ch.3.7). Unrestricted | Published by Siemens Healthineers AG © Siemens Healthineers AG, 2024 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 01/12/2024 | QR700004357 Healthineers Page 9 of 11 11.Next, instruct the patient to take a breath in and hold it. 12. Press Start on the CT control box and scan the patient. 13. After the scan is finished, end data acquisition on the Anzai laptop as shown below. End of Data Acquisition Confirm the exterior device terminated examination or treatment. Then the data acquisition is to be end. Clicking "Stop" icon", the data acquisition is to be end and <> appears. Clicking "Yes" button, it is to store the data and to return <> closes and the application ends. 0.0 sec 0.DI min X Unrestricted | Published by Siemens Healthineers AG © Siemens Healthineers AG, 2024 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 01/12/2024 | QR700004357 Healthineers Page 10 of 11 Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated regularly and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product-related claims, or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission, or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters, and configuration-dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthineers AG 2024 Unrestricted | Published by Siemens Healthineers AG © Siemens Healthineers AG, 2024 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 01/12/2024 | QR700004357 Healthineers Page 11 of 11 