MAMMOMAT B.brilliant 2D & 3D System Overview Turnover Workbook

MAMMOMAT B.brilliant 2D & 3D Turnover Workbook Women’s Health Mammography Iciandia mendaec toribus, omnihit isquis doloria incit mi, sincilita commolo rercium et qui velectatem sit odi blatur. SIEMENS Restricted Healthineers Table of contents Contact Information Summary 3 Introduction 4 System hardware overview 5 Key hardware features 6 Force Conversion Chart 10 Acquisition workstation 11 Icons 16 Tomosynthesis (option) Terms 17 Exercises 18 Exercise: tomosynthesis (option) examination 19 Exercise: Re-enter an Exam 20 Detector calibrations 21 Patient Procedures – Additional Functions 23 Insight BD (option) 25 TiCEM (option) 27 Exercise: TiCEM (option) examination 31 Restricted Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Page 2 of 32 Contact Information Summary Welcome to Siemens Healthineers Siemens Healthineers is dedicated to helping you get the most out of your investment throughout the entire product life cycle and beyond. Our goal is to enable you to take technology further, profitability higher, and patient care to the next level. Find the information, resources, and tools you need to get the most out of your recent investment and stay up-to-date. Visit https://www.siemens-healthineers.com/. Clinical Training and Continuing Education Customer Care Center - Clinical Application Support: Call 1-800-888-7436 Troubleshooting assistance Immediate assistance for software applications and workflow issues Please provide the Functional Location Number when calling for assistance. Siemens Healthineers Training Centers Siemens Healthineers Clinical Education Training Center – TDC2110 Mac Alyson Court Cary, NC 27511 Customer Information Function Location Number Username Password (case sensitive) Serial Number Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 3 of 32 Introduction You may have already gained an overview of the MAMMOMAT B.brilliant hardware components and user interface while working through the provided online training courses on PEPconnect. To help you prepare for the initial training, you can use this workbook to deepen your knowledge about system operation and to be able to perform basic examination workflows (2D, 3D, TiCEM) with a phantom. Please write your open questions down in the notes sections provided after each chapter so that a certified education specialist can answer and clarify them during the handover training. Note: Tomosynthesis, TiCEM, and Insight BD are optional features that require dedicated licenses. The corresponding operator manuals provide detailed information about the features and their workflows. Training overview Upon completion of this workbook, you will be able to: • Identify the key hardware features of the MAMMOMAT B.brilliant • Identify the key features of the acquisition workstation (AWS) • Correctly perform start-up and shutdown as well as calibration procedures • Describe the key features of the syngo® interface and how to operate the application program • Correctly perform a patient registration • Perform basic examinations on screening, tomosynthesis, and TiCEM • Transfer and archive patient data Training materials Please note that the learning material is for training purposes only! The following instructional material is an excerpt from the Operator Manual. It is to be used as training material only and is by no means intended as a substitute for the Operator Manual. For proper use of the software or hardware of the MAMMOMAT B.brilliant, for detailed operating instructions and relevant safety instructions such as warnings and cautions, always use the Operator Manuals issued by Siemens Healthineers. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. Note: Some functions shown in this material are optional and might not be part of your system. For quick assistance, please refer to the online help on the Acquisition Workstation (AWS) which can be found in the menu bar at the top of the screen under Help. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 4 of 32 System hardware overview (2) (1) (3) ( 4 ) ( 5 ) ( 6 ) (7) ( 8 ) (9) (10) (11) (1) Safety cover (2) Swivel arm with X-ray tube unit and collimator (integrated) (3) Emergency STOP buttons on both sides of the X-ray stand (4) Control panels on both sides of the tube housing (5) Stationary headrest and face shield (6) Stand display (7) Compression/decompression control knobs on both sides of the swivel arm (8) Control panels on both sides of the swivel arm (9) Compression unit (10) Object table (11) Two foot switches Foot Switch IT M (1) (2) (3) (4) (1) Lower compression plate (compression) (2) Raise Compression plate (decompression) (3) Lower swivel arm (height adjustment) (4) Raise swivel arm (height adjustment) Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 5 of 32 Key hardware features Overview This section will discuss key hardware features of the MAMMOMAT B.brilliant. Swivel Arm Control panel on the side Control panel on the tube housing of the system Left side Right side Left side Right side (1) Ready A Positioning Button (4) A A (2) Rotate the swivel A (3) Adjust the height + -Switches worklight ON/OFF (5) (1) Ready button: Triggers movement to a predefined position. Press briefly: Automatically moves to the preset position angle position for the next projection view. Press briefly again (during movement): Movement stops. Press a little longer: Move to the angle position of the opposite side. (2) Turn swivel arm (angle adjustment) (3) Lower and raise the swivel arm (height adjustment) (4) Positioning button: with an “out of the way” license, you can press the positioning button to move the tube unit to the center position. You can check collimation with the collimator light. (5) Worklight On/Off: Object lighting consists of lighting of the collimation field and a laserline light for indication of the center of the collimation field. ComfortGuide Display The stand display shows the registered patient and procedure, messages, and system position data. (1)- Samantha Smith 01.01.1960 CC-LEFT-(2) Ready for positioning -(3) OPCOMP PRIME * MIN O TUBE -(4) 200 O O Compression (N) Height (mm) TABLE Rotation (9) (6) (5) (1) Patient name and date of birth (2) Procedure name (3) Message area (4) Rotation angles (5) Height in mm Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 6 of 32 (6) Compression force expressed in Newton (N) Emergency stop buttons Emergency stop buttons are located on both sides of the system and on the Control Box. STOP STO Activation by depressing: All system movements and the release of radiation are stopped. Deactivation by turning clockwise: All system movements and the release of radiation are enabled. Compression paddle Mounting the compression paddle: 1. Insert the guide of the compression paddle into the receiver on the compression unit. 2. The compression paddle automatically locks in position. Removing the compression paddle: 1. Press the release button on the compression paddle receiver. 2. Pull the compression paddle out. Various compression paddles are available for this system. The paddles vary in function, flexibility, and size. Their availability depends on the clinical procedures and your order. Notes Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 7 of 32 Compression/Decompression OPCOMP® The “optimized compression” (OPCOMP) function determines the correct compression force to be exerted on the breast based on its individual features. This provides optimal comfort for the patient and optimal image quality. Please note the following regarding OPCOMP: • Functions with all compression paddles. • Should not be used with spot magnification, implant views, or on patients who have had recent breast surgery. • Is not activated by manual compression. • It is regarded as a recommendation, but not all patients can tolerate it. o If the breast is not taut, additional compression may be given. Operating steps: 1. Set the object table to the correct height. 2. Position the breast and lower the compression plate onto the tissue. 3. Pre-compress the breast to 20-40 N (2-4 kg). Press on the foot switch until the plate rests on the breast. 4. Perform optimized compression by pressing the foot switch again and keeping it steadily pressed, until the stand display signals and compression automatically stops. OPCOMP indication OPCOMP compression/decompression is indicated as follows: OPCOMP OPCOMP OPCOMP OPCOMP OPCOMP OPCOMP OPCOMP MIN MIN MIN MIN MIN MIN MIN 30 95 100 80 80 25 Compression (N) O Compression (N) Compression (N) Compression (N) Compression (N) Compression (N) Compression (N) Initial display Compression Compression Compression is Compression is OPCOMP value Decompres- reached 30 N reached higher than the lower than the reached after sion dropped OPCOMP value OPCOMP value OPCOMP value compressing below 30 N. or decompress- ing OPCOMP calcu- lation started again. Control knobs Compression/decompression is driven by a motor. With the control knobs, it is possible to adjust compression/decompression manually. • 10, Turning knob downward: manually compress • Turning knob upward: manually decompress Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 8 of 32 Emergency compression release In the event of a power failure or if motor-driven decompression is not possible (not working), release the patient as follows: (3) ( 2) 1. Forcefully press the emergency release button (1) with one hand and keep it pressed. 2. Place the other hand under the compression paddle (2) and press it upward. 3. BEFORE letting go of the compression plate, remove your hand from the emergency release button (3) and then from the compression plate. 4. The patient may be removed from the mammography system. .............. The system is automatically reset upon pressing the emergency unlocking device. Confirm the error message on the AWS monitor. Magnification table (option) Using the magnification table obtains a 1.5 or 1.8 magnification of the object (just one table can be set up). Notes Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 9 of 32 Force Conversion Chart Force in Kilograms (kg) Pounds (lbs.) Newtons (N) 1 2.2 9.81 2 4.4 19.61 3 6.6 29.42 4 8.8 39.23 5 11 49.03 6 13.2 58.84 7 15.4 68.65 17.6 78.45 9 19.8 88.26 10 22 98.07 11 24.2 107.87 12 26.4 117.68 13 28.6 127.49 14 30.8 137.29 15 33 147.1 16 35.2 156.91 17 37.4 166.71 18 39.6 176.52 19 +1.8 186.33 20 44.1 196.13 Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 10 of 32 Acquisition workstation Overview This section will discuss the design and function of the acquisition workstation and application program. (2) (1) Radiation shield (option) (2) Monitors (3) Control Box (4) Operating Console (5) Keyboard ( 5) (6) Mouse ( 6 ) Examinations using the MAMMOMAT B.brilliant system are controlled at the Acquisition Workstation. Control Box thineers (1) STOP (4) (2) (3) (5) (1) System ON When the system is ready for operation, the button lights up green (2) System OFF (3) Raise compression paddle (decompression) (4) Emergency stop All system movements and X-ray radiation are stopped. (5) Start radiation (Exposure button) The button lights up yellow during irradiation (radiation display). The button flashes green if action is required, e.g., compression. The button lights up solid green if the system is ready for exposure. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 11 of 32 Switching the system on (startup) The MAMMOMAT B. brilliant system is started from the switched-off mode. • Press the System ON button (5) on the Control Box. • This process takes approximately 4 minutes to complete. Wait until the red X is gone in the lower right corner between the pie and the computer. This means your system has completed the start-up process. Switching the system off (shutdown) • Go to the top menu bar and select on Options, then select End Session and choose Shutdown System. • Confirm by selecting YES. • The system will automatically shut down to standby mode. • Once the system has begun the countdown, press the System OFF button on the Control Box and the system will shut down completely. The MAMMOMAT B.brilliant must be switched off after each working day. Before you switch it off, pending examinations must be closed, and the workstation shut down properly to avoid data loss. Logging In and Logging Off (If HIPAA is activated) To log in, type your username and password on the login user screen. To log off: 1. Options (top toolbar not patient browser). 2. End Session. 3. Log Off (select on 2nd icon). Username: _____________________ Password: _____________________ Notes Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 12 of 32 Application program (1) Examination Viewing (2) Open patient Operator: (3) (1) Menu bar Procedure: (2) Task cards PV sequence: (3) Control area with subtask cards Filming (4) Image aera Auto Filming (5) Image tab card d Auto Expose Acquisition (6) Generator control field Post processing Close patient (4) (7) Status bar Procedure (5) ..... Decomp] Ady Of - (6) Generator control field (6) OPDOSE 60-69 mm 27 kV - + +W/AI1.0162 mm Adv. (1) (2) (3) (4) (5) (6) (7) (8) (9) (1) Display and selection of exposure mode depending on acquisition mode: manual, AEC, OPDOSE, manual OPDOSE (2) Display of compression thickness range (OPDOSE and manual OPDOSE only) (3) Display and selection o f+/- kV (4) Display and selection of +/- mAs (only manual) (5) Display and selection of anode/filter combined (6) Overview of current detail parameter settings in Advanced dialog box (7) Display of currently set focus (small focus, large focus) (8) Display of current compression thickness (value is displayed if compression is over 30N) (9) Button to open the Advanced dialog box to change detail parameters Exposure parameters 26 kV 83.6 mAS W/AI1.0 1.0 mGy 0 deg 41 mm 51 N (1) (2) (3) After irradiation is completed, the exposure parameters used are displayed for your information. As soon as the completed image appears in the image area, this data is hidden again. (1) Radiating parameters (kV, mAs, anode/filter combined, dose value) (2) Angle of rotation of the swivel arm (3) Compression parameters (thickness, compression force) Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 13 of 32 Advanced Dialog Box After selecting the Adv. button on the screen, the Advanced dialog box is displayed. The Options fields here allow you to change the detail parameters preset for the currently set exposure technique. The technique's standby mode determines which options are available. (2) 3) (4) 5 (6) Advanced Grid Position ALto Decompression OPCOMP AEC Segmentation Dose Level o In o un o un o On Normal Out c Off Off - Off LOW Medium low @ AUTO Normal Medium high High (1 ..... OK Cancel (1) Overview of current settings of the detail parameters (same as generator control field) (2) Grid Position: within/outside the beam (3) Automatic Decompression (4) OPCOMP: Optimized compression (5) AEC-Segmentation: measurement range for automatic exposure control (6) Dose Level: Notes Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 14 of 32 Patient browser Patient Transfer Edit View Worklist Filter Sort Private Applications Options Help XI Update Worklist Re-enter exam [4] T_PR_raw R-CC, Screening /com///// / /com/// / / / test 2D+3D SCREENING [5] T_PR R-CC, Screening 1111/1 1 /com///// / /com/// / / / Local Database COMBINED, MODE 2D+3D SCREENING [6] BTO_TOMO R-CC, Premia1, Scre 11/11/ / /com///// / /com/// // / Scheduler TiCEM, MOCK 2D+3D SCREENING [7] INSIGHT 2D R-CC, Screening WORKLIST 111111 / /com///// / /com/// / / / DVDRW 4:1 test [8] T_PR_raw L-CC, Screening 111111 / /com/ 1 111 1 /com//// / / Scheduler TOMO, MOCK [9] T_PR L-CC, Screening 111/11 / /com/// / / / PRIME [10] BTO_TOMO L-CC, Premia1, Scre 111111 1 /com/// / / / 2D standard [11] INSIGHT 2D L-CC, Screening 11/11/ 1 /com/// / / / Detector, Calibration [12] T_PR_raw R-MLO, Screening The patient browser supports you with tasks including the administration of the patient and examination data (raw and processed image data) stored in the databases of your system. Keep in mind that the AWS has limited storage and is not a PACS system. With the patient browser, you can easily access the scheduler, check your transfers, search for patients, use filters and reprocess data, etc. quickly and efficiently. To access the patient browser, go to the menu bar  Patient  Browser. Registering a patient using the scheduler 1. Select Scheduler. 2. Select Worklist, then select Update Worklist a. (if the worklist is not scheduled to update automatically) 3. Select the folder with the patient’s name. 4. Select Patient Register. 5. Verify the patient information and insert your initials in the operator box. 6. Select on Exam. Registering a patient manually 1. Select on the Register Patient icon or on the menu bar Patient  Register. 2. Enter the required data. 3. Select the Exam button. Re-enter exam The examinations are stored in your local database and listed in the patient browser. You can resume an examination here at any time, e.g. if you want to: • continue an interrupted examination • re-process a project view • add a new project view Select the Re-enter button in the toolbar at the top of the patient browser. The selected study is loaded into the Examination task card. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 15 of 32 Icons mlo 2D exposure Acquired Image Projection view with additional positioning indication (e.g. MLO 0 mlo* rolled medial), exposure scheduled Exposure interrupted Skipped Auto Decompression cc activated Repeat/reject image 8 mlo Magnification view Image Rejected Magnification with additional positioning (e.g. magnification mlo* MLO rolled medial) Repeated image after acquisition Projection view selected, waiting Rejected image after reject or V mlo for system to be ready for exposure repeat and repeat Imo Implant exposure Image transfer ongoing 2D Projection view with Prime mlo Mode mio System is ready for exposure Projection view acquired, images Im Tomo implant transferring T IP TiCEM exposure Image processing ongoing Radiation is released V spec Specimen image CAUTION: X-ray radiation! Projection view selected for cc Spot exposure mlo exposure, system is not read Problem with the MAMMOMAT Cc* Spot magnification exposure mlo system, exposure not possible CC Tomo Spot exposure InSpect InSpect view exposure Z cc Combined - Prime and tomo exposure scheduled. If the red or yellow icons light up, your intervention or appropriate safety measures are required. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 16 of 32 Tomosynthesis (option) Terms Bounding Box Region of Interest, describing the area that will be reconstructed. Using the handles you can adjust the bounding box to the breast tissue area to be reconstructed for slices. First view The processed single middle projection view of a tomo scan. This image is used to adjust the bounding box for a new reconstruction Insight 2D 2D image generated from a corresponding tomosynthesis data set. Specific image processing may have modified the appearance of anatomical structures compared to reconstructed slices and projection images. Processed projections This series contains only the processed first view, which is a middle projection (close to 0° tube angulation). Raw projections This series contains the 25 raw projections from the 50⁰ sweep. They are taken every 2 degrees and saved as DICOM MG objects. Reconstruction The calculation of the stack of slices (3D volume) from the projections using a reconstruction algorithm. Reprocessing Processing of the projections and 2D image with new image processing or reconstruction parameter set. Slices Stacked images parallel to the detector surface reconstructed from projections to display at the workstation monitor. Tomo scan Generated data set of a definite view, consisting of raw projections and/or processed projections and/or the slices or combinations of these. Notes Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 17 of 32 Exercises Exercise: Combined Exam (2D and 3D exposures) Perform the following procedures by using a mammography phantom or similar ones. 1. Register a patient. Open patient 2. Enter Operator initials. 3. Select the required Procedure, e.g. Bilateral Mammo. 4. Double-select on the first projection view (PV). Operator: Note: Skip Auto Decompression is activated. Images a. 5. View the Acquisition sub-task card and verify the parameters. Procedure: CC 6. Position the phantom. Bilateral Mammoc 7. Compress the phantom to OpComp. PV sequence: R-CC, L-CC, R-Mv CC mlo 8. Press the Ready Button to initiate exposure. Display Markers: 9. Perform the first exposure. Except mag/spot mio mlo 10. Check the details shown in the displayed image. Auto Filming Auto Expose a. NOTE: The next exposure is automatically activated. Acquisition Post processing 11. Perform the remaining exposures. Close patient 12. NOTE: Utilize the Ready Button to move to the next view. 13. Verify images are marked correctly. 14. Close patient and end examination. Exercise: Tomosynthesis Exam Perform the following procedures by using a mammography phantom or similar ones. 1. Register a patient. 2. Enter Operator initials. 3. Select the required Procedure, e.g. TOMO Bilateral Mammo. Images 4. Change the PV sequence to RCC, RMLO, LMLO, LCC or depending on your workflow. cc CC mlo 5. Double-select on the first projection view (PV). 6. View the Acquisition sub-task card and verify the parameters. mlo 7. Position the phantom. 8. Compress the phantom to OpComp. 9. Press the Ready button to initiate exposure. 10. Perform the first exposure. 11. Check the details shown in the displayed image. a. NOTE: The next exposure is automatically activated. 12. Perform the remaining exposures. a. NOTE: utilize the Ready button to move to the next view. 13. Verify that images are marked correctly. 14. Close the patient and end the examination. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 18 of 32 Exercise: Combined Examination 1. Register a patient. Images 2. Enter Operator initials. 3. Select the required Procedure, e.g. Bilateral Mammo. 4. Confirm that the procedure is set for 2D and 3D exposures in combined mode. CC CC CC 5. Change the PV sequence to RCC, RMLO, LMLO, LCC 6. Double-select on the first projection view (PV). CC mlo a. Note: Skip auto decompression is activated. 7. View the Acquisition sub-task card and verify the parameters. mlo mlo 8. Position the phantom and compress to OpComp. 9. Press the Ready button to initiate exposure. 10. Perform the first exposure. 11. Check the details shown in the displayed image. 12. Insert a 2D exaggerated RCC after the RCC. 13. Perform the next exposure. 14. Repeat the XCC taken. 15. Perform the remaining exposures. a. NOTE: utilize the Ready button to move to the next view. 16. The image LCC label is marked incorrectly. Use the correct function to change it to LXCC. 17. Verify that images are marked correctly. 18. Close the patient and end the examination. 19. You are now back in the patient browser and can review the patient data. Exercise: Tomosynthesis (option) examination 1. Register a patient. 2. Enter Operator initials. Acquisition Tomo 3. Select a tomosynthesis procedure. Acquisition mode: 1 Reconstr. available 4. Enable Insight 2D and Skip InExam Transfer. Tomo TOMO L-CC, Emj 5. Check the parameters for tomo: Acquisition mode and RPG (Premia). 6. Double-click on the first PV. 7. Position the phantom and compress to OpComp. RPG: Premia0 8. Press the Ready button to initiate exposure. INBD d 8 DO 9. Perform the first exposure. Skip InExam 10. Image processing starts immediately after exposure. Transfer 20 11. The Tomo sub-task card pops up. Insight 2D auto 12. Familiarize yourself with the details. Insight 3D Reconstruct .. Move the mouse over each button to get information on each function. 13. Select the Slices button and scroll through using the slider or dog-ear. Delete Reconstruction 14. Check the details shown in the displayed slices. 15. Select the Insight 2D button and check the image details. 16. Perform the remaining exposures. a. NOTE: utilize the Ready button to move to the next view. 17. Add an additional 2D image. 18. Position and perform the exposure. 19. Verify whether the images are marked correctly. 20. Close the patient and end the examination. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 19 of 32 Exercise: Re-enter an Exam 1. Open the patient browser. 2. Select a patient from the local database and Re-enter the study. 3. Correct one of the images previously acquired, e.g. from an LCC to an RCC. Qi 4. Check the new laterality. 5. Add an RML image and activate the projection. 6. Position the phantom and compress. 7. Perform the exposure. 8. Close patient and examination. Notes Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 20 of 32 Detector calibrations The detector settings can be changed by external influences (e.g. temperature fluctuations, humidity, vibrations). For this reason, regular calibration of the detector is required. Calibrations should be performed every 6 months or when there is a difference between the detector and calibration temperatures of +/- 7°C. The MAMMOMAT B.brilliant offers three types of calibrations to ensure optimal detector settings. • CONTACT • MAGNIFICATION • TOMOSYNTHESIS System preparation: • Rotate swivel arm to 0°. • Remove face shield, compression paddle, magnification table, and all objects in the X-ray beam. • No phantom needed. • Make sure that the surface of the object table is clean. After a 10-minute system warm-up and system preparation, you can start the calibration procedure. 1. Go to the menu bar and select Patient > Detector Calibration. 2. The Examination task card with the Calibration subtask card is displayed: Open patient Open patient Calibration Calibration (1) -Please select which Please select which type of calibration type of calibration shall be performed (1) shall be performed CONTACT 2019-08-02 (3) CONTACT 1970-01-01 31.4'C 0.0'C (3) (2)- MAGNIFICATION 2019-08-02 (2) MAGNIFICATION 1970-01-01 31.4'C 0.0'C TOMOSYNTHESIS 2019-08-02 31.5'C Start Calibration Start Calibration Help Help Post processing Post processing Close patient Close patient (1) Guidance for the next required step (2) Area with the different types of calibration (3) Date of the last calibration for the respective type of calibration (if the calibration type is yellow with a red “!”, the calibration is overdue and must be performed) Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 21 of 32 • Select the type of calibration you want to perform. • Read upcoming messages carefully and confirm or react. • When you select Start Calibration, the Calibration subtask pops up, and the projection view is automatically activated. Open patient • The text on the subtask card guides you step by step through the procedure. Calibration CONTACT • Acquire an image and continue if the image is suitable for calibration. Acquire an image, or evaluate the quality • Select Repeat if the exposure is not suitable. and select accept/reject • The calibration image will be rejected, and a new exposure will be added. • The number of accepted and rejected exposures is counted Continue Repeat in the Calibration subtask card. • Once you have acquired all the calibration images, you get a message Number of: telling you the calibration was performed successfully Acquired images: 0 in the appropriate calibration type. Accepted images: 0 Rejected images: 0 Wait 10 minutes after calibration is completed Help before embarking on the patient examination. Post processing Exercises Close patient Please perform the following calibrations based on this description and note your observations: 1. Contact calibration a. (3 exposures if TiCEM was purchased) 2. Magnification calibration a. (1 exposure) 3. Tomosynthesis calibration (keep the button pressed until the 25 projections (one scan) are acquired – tube will not move during exposure) Notes Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 22 of 32 Patient Procedures – Additional Functions Test your knowledge and familiarize yourself with the following topics: Activate a projection view 1. Double-clicking on a projection view icon. Deactivate a projection view 1. When a projection view is activated, you cannot modify it. 2. Right-click on the projection view to Disable exposure. Images C CC mlo Disable exposure mlo Image Attributes To locate technical, clinical, and patient factors: 1. Right-click on the image. 2. Select Image Attributes to display the details. Repeat To repeat a selected view: 1. Right-click on the image icon and select Repeat. 2. Select a reason for the repetition. 3. An additional image is provided as the last projection view and can be acquired. 4. Both images will be sent to the reading workstation and the archive. Reject and Repeat To reject and repeat an image: 1. Right-click and select Reject and Repeat. 2. The selected image will be rejected. 3. An additional image is provided as the last projection view and can be acquired. Image Attributes .. Repeat ... Reject + Repeat .. Correct ... Reprocess ... Reject InBD Values Transfer Select/deselect Insight 2D or Insight 3D (tomosynthesis license active) 1. Navigate to the Acquisition subtask card. 2. Check or uncheck the boxes accordingly. Acquisition mode: omo RPG: Premia0 NBD n.a Insight 2D Insight 3D Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 23 of 32 Reprocessing a 2D image Reprocess a 2D image with another IPPG to get a different image impression. 1. Right-click the affected image in the Images subtask card. Select Reprocess. 2. Confirm that the IP Set name is correct. Select the new IPPG. 3. Uncheck the box for Check Display Markers. 4. Select OK. 5. Select Yes to confirm the changes. Modify / Add / Insert / Delete Projection views can be added or inserted on the Images subtask card. 1. Right-click the projection view you want to modify or delete. 2. Select Modify or Delete in the displayed popup menu. 3. Right-click on an arbitrary projection view and select Add in the displayed popup menu. The selected projection view will be added as the last projection. 4. Right-click the projection view in front of which you want to insert an additional projection view and select Insert in the popup menu that appears. 5. Right-click the projection view and select Delete to delete this projection view. Images Modify 18 Add Insert mlo Delete Implant Exam • Navigate to the Open Patient subtask card. • Change the procedure to an Implant Procedure. • Compare the projection views. Images Cc CC mlo mlo mlo* CC* CC mlo* Diagnostic Views • Open a Diagnostic Exam. • Add different diagnostic view (Spot, Mag, Mag Spot) Reconstructing a tomosynthesis scan (tomosynthesis license active) To select a different reconstruction parameter group (RPG): 1. Right-click the affected image in the Images subtask card. 2. Choose the new RPG desired. (Example: PREMIA) 3. Select OK. 4. Delete any unwanted reconstructions before closing. Transferring an image (manually) • Right-click the image you wish to transfer. Note the white arrow as the image is transferring. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 24 of 32 Insight BD (option) Definition Mammography breast density (BD) refers to the amount of glandular tissue in the breast. A higher breast density decreases the sensitivity of mammography because masses might be hidden in dense tissue areas. It is also considered an independent risk factor for breast cancer. Insight BD is a software application (licensed) for volumetric density assessment from digital X-ray images of the breast to aid healthcare professionals in the assessment of breast tissue composition. Insight BD is not a diagnostic aid and should be used only as adjunctive information when the final assessment of the breast density category is made visually by medical professionals. The calculation of the breast density can be performed per breast, side, or woman. Your education specialist will perform this setup in the service configuration. In this example, you can see how the information is shown in the image (detailed information can be found in the Insight BD manual). Insight BD is calculated on CC & MLO projection views in standard 2D, PRIME, and tomosynthesis acquisition modes. Insight BD X Values displayed in the dialog window Patient Name: Sita_065529 Sita_GWCVVC Patient ID: 237876 Density grade for Study date: n.a Patient Right Left Volume of fibroglandular (cm3) 21.8 18.5 b Volume of Breast (cm3) 470.9 512.9 Volumetric Breast Density (%) 4.7 3.6 Density grade b a RMLO RCC LMLO LCC ... ... Result per view 5.2 % 4.2 % 3.3 % 3.9 % b a a a ----------------- --------------------- Result per side 4.7 % Right Left 3.6 % Average (or highest*) of all views of that b breas breas a --------------- Result per patient / b or a client Highest density Average of volumenteric grade index of both breast density per side sides (a-d)cc (%) Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 25 of 32 Insight Breast Density – limitations • Insight BD may not work reliably in the following cases: non-female breast, breast-feeding women, female breast after mastectomy, mastectomy samples. In this case, consider visual evaluation instead. • Insight BD may not be properly calculated for the 2D Biopsy Multihole paddle as well as for the Spot Plus paddle. In this case, reject the Insight BD calculation manually. • Insufficient image data due to unsuitable exposure parameters. Therefore, it is recommended  to use OPDOSE mode (automatic exposure values) for acquisitions used for breast density calculation if possible.  to acquire at least two different projection views per breast for reliable breast density calculation. • Implants: If possible, push the implant out of the image area. Otherwise, manually reject the images from the calculation. • Insight BD values are not reliable when a foreign object (e.g. implant, guidance wire, pacemaker, clip) appears inside the breast. In these cases, the images from the calculation are rejected manually. • Very dense breasts: Insight BD requires a reference region of fatty tissue in the breast. If the breast is very dense, the algorithm may not find a suitable reference region. The reported breast density may be lower than expected. In this case, consider visual evaluation instead. • Very small/thin breasts: If the breast is small (compressed thickness < 20 mm or a very small projected area), the volumetric breast density may be less reliable in predicting the breast density category. Insight BD may report a higher categorical breast density than the visual breast density rating. In this case, consider visual evaluation instead. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 26 of 32 TiCEM (option) TiCEM (Titanium Contrast Enhanced Mammography) technology is used to perform a contrast-enhanced mammography examination. It involves the acquisition of two images using two different acquisitions, described as low energy (LE) and high energy (HE), after the patient has been given an intravenous injection of iodine contrast agent. Acquisition of the low and high energy images takes place within a limited time period within the same breast compression phase. The images are combined to produce an image in which the grayscale signal is in proportion to every point in the surface concentration of the contrast agent. The aim of this application is to identify and localize lesions. Terms and definitions LE Low Energy The low-energy technique uses kVp values within the conventional mammography range (“normal” 2D mammography image). HE High Energy The high energy technique uses kVp values at which the average energy in the spectrum is above the k-edge of iodine (49kV, anode/filter  W/Ti). IPPG Image Processing Parameter Groups are used to process low energy views. Using the same parameter as for standard 2D image processing is recommended to secure the same image impression. DPPG Dual Processing Parameter Groups are used to process the recombined image. Insight CEM This is the combined image of the low and high-energy images. Depending on the weighting factor, the image impression can change. Twin View Display mode for TiCEM to display the low and the recombined images next to each other simultaneously. Image DICOM information – what you see >>TiCEM image Patient Transfer Examination Edit View Image Tools Scrol Options Heb Examination Viewing Filming test 17.06.13-13:32:45- 6/13/1984 Open patient BDD Twin View Acquisition TICEM Post processing Close patient R.CC LE R-CC Insight CEM Skip Auto-Transfer Rules Low energy Insight CEM Contrast: N.A. Contrast: N.A. Vol n.a. Vot: n.a. Conc. n.a. Conc: n.a. Flow: n.a. Delay time Flow: n.a. Low F opy Contrat NA Time inj: 00:25 min:sec Time inj: 00:25 min:sec Vol Cor KV: 30 since injection mAs: 115.0 mAs le rt 00:25 minBe Angle: 0.0 Focus: large Angle: 0.0 2 30 AS 115 0 MAS Magn. factor: 1.000 Focus: large Focus: lange Magn. facfor: 1.000 Comp Force: 74 N Comp. Force: 74 N Magn. factor: 1.000 Comp. Force: 74 N Thicknett 62 mm Thickness: 62 mm Thickness: 62 mm Anode Filter WFp Entrance Dose: 5.4 Anode Filter WIRh Anode Filter WIRh - WIT Glandular Dose: Operator ruttution Opor Mo Station Street Cly District R2ation NS192 OPDOSE 41-50 mm 49 kV - + + 50 mm Adv. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 27 of 32 Compression plates For a TiCEM examination, the following paddles (in cm) can be used: • SoftComp compression paddle (12x24, 18x24, 20x26) • Flexible compression paddles (18x24, 24x30) • Compression paddles with high/low edge (18x24, 24x30) Before starting the examination, the following has to be considered concerning: Patient preparation • Inform the patient about the details of the examination. • Ask if any allergic reactions are known. • Check the blood-creatinine value of the patient. • Ask for the patient's weight. • Prepare everything that is needed for the cannulation and perform it (person responsible for cannulation and for patient observation). • Ensure that everything needed is available in case of allergic reactions or other emergencies (emergency cart). Power injector and cannulation preparation • Power injector  training to be given beforehand by the injector vendor. • Pre-heating cabinet – customer dependent (to warm up the contrast agent before injection). • Iodine contrast medium (300-400 mgI/ml) • Saline  for rinsing • Needles for cannulation (large diameter) and all necessary accessories (gloves, disinfection, etc.) Contrast Agent Configuration System preparation iodine (Default Contrast Agent |Test Concentration • Prepare the AWS Register a patient, 350.00 ng/ml adapt the PV sequence (start with the pathology side Volume 120.00 or according to your defined procedure sequence). Flow rate 3.00 ml/s New Delete Set default • Check the IPPG/DPPG and configure the contrast agent to define which content will be displayed in the OK Cancel Apply Contrast Condition dialog box. Prepare the MAMMOMAT: face shield, Contrast Conditions • compression plate, Contrast Agent Configuration Timer settings • projection view (e.g. MLO 45°). Contrast Agent lodine Time since injection 00:00 min:sec • Activate the first projection view. Concentration 100.00 mg/ml Volume 100.00 ml Delay time 59:00 min:sec Flow rate 3.00 m's Notes Reset time OK Cancel Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 28 of 32 Software overview • Icon for TiCEM  Dual Energy with laterality and a syringe symbol Images Note: Only CC, MLO, and ML projection views are selectable. - - CC mlo 8 8 mlo Acquisition tab card Open patient Acquisition Acquisition mode: TiCEM IPPG: FO_Gen1 Selection of IPPG for the Low energy image DPPG CEM_A Selection of DPPG for the insight CEM image Push button to open „Contrast Conditions” dialogue box Contrast Conditions Contrast Agent Configuration Timer settings 03:10 Display of timer Contrast Agent |lodine Time since injection 00:00 min:sec Concentration 100.00 mg/ml TiCEM Volume 100.00 ml Delay time 59 00 min:sec Post processing Close patient Flow rate 3.00 mi/s Reset time OK Cancel TiCEM tab card 04:19 The Delay time will be displayed e.g. 04:19 means 04:19 min after injection. Open patient Acquisition Opens the window to recombine the InsightCEM image: TiCEM Recombine Background factor, IPPG and DPPG 04:19 X Sand glass: Exposure start Recombine Please keep the exposure button pressed to acquire the dual energy images: 0% Sand glass: in work Please keep the exposure button pressed to acquire the dual energy images: 50% Sand glass: Exposure finish Please release the X-ray button after finished exposure. Please keep the exposure button pressed to acquire the dual energy images: 100% Select the TiCEM Low button:  The 2D LE image is displayed (normal 2D MG image). Post processing Select the Insight CEM button: Close patient  The 2D combined image is displayed (HE-lE) BDD Select the TiCEM Twin View button on the TiCEM subtask card.  The display format is 2:1  the 2D LE image and the Insight CEM image are displayed Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 29 of 32 TiCEM workflow steps Once all preparations have been made, you can start the examination by following these steps: 1. Patient has a venous access. 2. Attach the power injector and inject the contrast medium (and saline). 3. Start the timer when the contrast medium is completely injected. 4. Detach the power injector from the patient. 5. The first image should be acquired after approx. 2 mins. (LE image): Start positioning of the first PV accordingly! 6. The timer will show the time since the injection was finalized. 7. Release the exposure. Keep the exposure button on the Control Box pressed until both exposures are 8. finished. 9. The first and second images are acquired. 10. Make sure the breast is automatically or manually decompressed immediately after exposure. 11. Directly position the next PV. 12. Acquire the next TiCEM exposures (do not waste time). 13. Display and process the TiCEM examination images. 14. End the examination (image transfer starts). Notes Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 30 of 32 Exercise: TiCEM (option) examination Perform the following procedures using a suitable phantom (e.g. eggplant) 1. Activate the single-touch functionality. Register a patient. Open patient 2. 3. Select a TiCEM procedure. 4. Check the PV sequence. Operator: 5. Complete the Contrast Conditions box. 6. At this point, you normally start the power injector. 7. When the contrast medium is completely injected, Procedure: TiCEM select OK, and the timer will start immediately. PV sequence: 8. Detach the power injector from the patient (leave the needle in!). L-MLO CEM, L-CC Cv 9. Position the patient for the first projection view. Display Markers: 10. After approx. 2 mins. acquire the first images Except mag/spot Auto Filming (LE / HE images  keep the button pressed!). Auto Expose 11. Check the information displayed in the image. Acquisition Post processing 12. Continue directly with the positioning of the next PV. Close patient 13. Acquire the next projections (do not waste time). 14. Open the Acquisition subtask card. Use the appropriate icons to display LE/ CEM and TwinView images. 15. Select the RMLO image and check the time since injection. 16. Close the patient and skip auto transfer. 17. Open the patient in the patient browser and check the image details there. Notes Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 31 of 32 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 on a regular basis 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, 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 Healthcare GmbH 2021 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84-0 siemens-healthineers.com Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 10/08/2024 I QR700013750 Healthineers Restricted Page 32 of 32